Showing posts from category global health.
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PRB’s Jay Gribble at Kenya’s National Leaders Conference on Population and Development
›November 29, 2010 // By Wilson Center StaffJay Gribble, vice president of International Programs at the Population Reference Bureau (PRB), recently attended the Kenya National Leaders Conference on Population and Development, November 15-17, at the Kenyatta International Conference Center in Nairobi. During the conference, he produced a series of posts for PRB’s Behind the Numbers on some of his impressions. Gribble focuses on Kenya’s resurgent interest in integrating population issues into the development agenda, the country’s ongoing HIV/AIDS epidemic, and the importance of family planning.
Below are the introductory excerpts from his posts; to read the full posts, please visit Behind the Numbers.
“Anticipating Change in Kenya”
Sitting in the hall where Kenya’s National Leaders Conference will be starting in a few minutes, I can’t help but feel that there is an opportunity to refocus national attention to development…to the goal that I have heard repeatedly of becoming a Middle Income country. And to achieve this goal, they must first recognize that population is an underpinning development issue that cannot be ignored.
In the 1980s and 1990s, Kenya was a leader in reproductive health and maternal health, really setting a pace for the continent. But during the 2000s, Kenya turned its attention to other pressing issues – namely HIV/AIDS – and began to give less attention to population issues. Though HIV continues to be a plague, it is now time to return to the importance of slowing population growth, for until this fundamental issues is addressed, there will be less opportunity for education, jobs, and better health. At the same time, as a predominantly rural country with agriculture representing a major part of the economy, smaller families will be critical to maintaining farms that are large enough to feed families and the country.
Continue on PRB.
“As the Rich Get Richer, the Poor Get Children”
The Kenya National Leaders Conference has begun, representing the first time since 1989 that Kenya’s national population policy has been discussed in a large, open forum. With a new national constitution, Kenya is poised to redress many of the social and economic inequalities that have stood in the way of its development. In fact, the current population policy expires in December, 2010, and one of the purposes of this conference is to gather the input from leaders throughout the country on how a new policy should be framed. I find it impressive that such a large conference is convened to ensure that a new policy reflects the needs of the nation. The conference is also a forum for reaching leaders with important information about the need to address population growth through family planning if Kenya is to achieve its Vision 2030 development plan.
Continue on PRB.
“In Kenya, Prioritizing Population…and Family Planning”
As Kenya’s National Leaders Conference on Population and Development winds down today, it offers leaders an opportunity not only to think and talk about how population growth is an issue that underlies the country’s development, but to act on it too. Whether thinking about business, agriculture, or the environment, it is impossible to be strategic about Kenya’s future without also considering how rapid population growth will affect it.
In talking with Kenyans who grew up in the 1970s and 1980s – back when family planning and population growth were a priority – they remember the messages that were at the tips of people’s tongues – smaller families live better. Before the HIV/AIDS epidemic, family planning and slowing population growth was a priority and a source of national pride because it put Kenya on track for prosperity and development.
Continue on PRB.
Photo Credit: Adapted from “King Kenyatta?” courtesy of flickr user rogiro. -
Robert Walker on Family Planning Promotion and Global Population Growth
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“Expanding voluntary family planning access and ensuring that all women have access to reproductive health services is, to me at least, a no brainer,” said the Population Institute’s Robert Walker in this interview with ECSP. “I think it’s a win for women, for their health, for their welfare, the welfare of their families, for their communities, for the environment, and for the planet at large.”
While China and India dominate much of the global headlines about population growth, other parts of South Asia – namely Afghanistan and Pakistan – and sub-Saharan Africa receive comparatively little attention. For Walker, a renewed global effort to boost the quality and quantity of reproductive healthcare tools and services in these areas of the developing world is essential.
“This is very, very doable. We face a lot of really incredible challenges in the world today, particularly with respect to food, energy, water, and poverty. But if we can increase what we spend on international family planning assistance by three or four billion dollars a year, we can literally change the world,” Walker said. “And I think we desperately need to.”
The “Pop Audio” series is also available as podcasts on iTunes. -
What’s Good for Women Is Good for the Planet
›Ammi, my mother-in-law, was 16 years old when her marriage was arranged. Before she was 18, she had borne her first child, who died within the year, and by 30, she had given birth to six more. She had a fourth-grade education, and like other women in the new state of Pakistan, she knew little about contraceptive choices.
More than 50 years later, contraception still remains inaccessible for millions of women in Pakistan, such as Rani, the young woman who cleans Ammi’s Karachi home. Illiterate and married off to a cousin at age 15, Rani already has three children, and, like the majority of married Pakistani women who have never used modern contraception, will most likely have at least one more.Giving women the ability to determine whether and when to become pregnant is fundamental to the realization of their basic human rights. It is also a proven health and development strategy, substantially reducing maternal and infant mortality by allowing women to space their pregnancies. And now, for the first time, two studies offer compelling evidence that it has another benefit: What is good for women is also good for our planet.
These groundbreaking studies have rigorously quantified the effect on the environment of helping women and girls control their reproductive destinies. The studies – “The World Population Prospects and Unmet Need for Family Planning,” by the Futures Group, and, “Global Demographic Trends and Future Carbon Emissions,” by the National Center for Atmospheric Research and the International Institute for Applied Systems Analysis – demonstrate that giving women and girls access to contraception offers a precious co-benefit: a substantial reduction in carbon emissions.
The logic is simple: When women have the power to plan their families, populations grow more slowly, as do greenhouse gas emissions. The cost of providing these needed family planning services worldwide is minimal compared with other development and emissions reductions strategies – roughly $3.7 billion per year.
More than 200 million women in the United States and developing countries are sexually active and do not want to become pregnant, yet are not using modern contraception. The results are staggering: One in four births worldwide is unplanned, leading to 42 million abortions each year (half of them clandestine) and 68,000 women’s deaths.
Moreover, the large number of women who become pregnant when they do not want to is a significant source of population growth. Read in tandem, the studies show that a reduction of 8-15 percent of essential carbon emissions can be obtained simply by providing modern contraception to all women who want it. This reduction would be equivalent to stopping all deforestation or increasing the world’s use of wind power 40-fold. Although this is just one piece of the emissions reduction puzzle, it is a substantial piece.
The world is now facing multi-layered challenges of economic distress, rising inequality, and environmental devastation caused by climate change. International climate negotiations have repeatedly stalled as powerful nations play the blame game and block progress. Meanwhile, a series of severe weather events has buffeted the earth from Moscow to Iowa to Pakistan, each one hitting women and children hardest. This is the reality that rich nations must reckon with – and commit to changing – today.
In my 14 years at the Global Fund for Women, I have observed the wave of change that comes from empowering women – what some call the “girl effect.” Making information, education, and contraception easily available offers us an affordable, no-regrets strategy that can be implemented now.
Meeting the need for family planning services is not a complex challenge. We know how to provide the commodities, services, and education that women and their families want. There are thousands of programs around the world with successful track records in every conceivable religious, cultural, and political setting.
Investing in family planning has already been proven as an essential strategy to ensure the health, safety, and development of societies. Now we know that it is also an effective way to safely steward Mother Earth through one of her most challenging crises.
Kavita N. Ramdas is chair of the Expert Working Group of the Aspen Institute’s Global Leaders Council for Reproductive Health and senior adviser and former president and CEO of the Global Fund for Women.
Sources: Futures Group, National Center for Atmospheric Research and the International Institute for Applied Systems, Science, UNFPA, WHO.
Photo Credit: “Chaco: Madre pilagá,” courtesy of flickr user Ostrosky Photos, and Kavita Ramdas, courtesy of Global Fund for Women. -
Nigeria’s Future Clouded by Oil, Climate Change, and Scarcity [Part Two, The Sahel]
›November 19, 2010 // By Schuyler NullIf southern Nigeria’s demographic and environmental problems have helped fuel today’s conflicts, it’s the north’s issues that may feed the conflicts of tomorrow.
Nigeria’s lack of development and poor governance is not exclusive to the delta region, only more well-known because its oil reserves. The north of the country, which is predominately Muslim and accounts for more than half of Nigeria’s population, faces many of the same problems of environmental degradation, lack of jobs, and inadequate infrastructure. Northern Nigeria is also growing much faster than the south, with a total fertility rate of 6.6 children per woman, compared to 4.6 in the southern states. The median age of first-time mothers in northern Nigeria is only 18 years old.Nigeria holds nearly a fifth of the entire population of sub-Saharan Africa. By 2050, it’s expected to pass Indonesia, Brazil, and Bangladesh and take its place among the top five most populous countries in the world, according to UN estimates. But a litany of outstanding and new development, security, and environmental issues – both in the long-troubled Niger delta in the south and the newly inflamed north – present a real threat to one West Africa’s most critical countries.
If southern Nigeria’s demographic and environmental problems have helped fuel today’s conflicts, it’s the north’s issues that may feed the conflicts of tomorrow.
Nigeria’s lack of development and poor governance is not exclusive to the delta region, only more well-known because its oil reserves. The north of the country, which is predominately Muslim and accounts for more than half of Nigeria’s population, faces many of the same problems of environmental degradation, lack of jobs, and inadequate infrastructure. Northern Nigeria is also growing much faster than the south, with a total fertility rate of 6.6 children per woman, compared to 4.6 in the southern states. The median age of first-time mothers in northern Nigeria is only 18 years old.
Climate, Culture, and Discontent in the North
Last summer, in an offensive that stretched across four northern states, a hardline Islamist group called Boko Haram emerged suddenly to challenge the government, attacking police stations, barracks, and churches in escalating violence that claimed more than 700 lives, according to The Guardian. The government responded with a brutal crackdown, but recent targeted killings and a prison break seem to indicate the group is back.
Perhaps most distressingly, Boko Haram appears to have won some local support. Said one local cloth trader to The New York Times in an interview this October, “It’s the government’s fault. Our representatives and our government, they are not sincere. What one person acquires is enough to care for a massive amount of people.”
As in the south, mismanagement of natural resources has also played a role in creating a dangerous atmosphere of distrust in the government. After gold was discovered this spring in northwestern Nigeria, many under- and unemployed flocked to the region to try their luck, but they also unwittingly contaminated local water with high levels of lead. Although the state health officials say they have now identified more than 180 villages thought to be affected, the epidemic was only discovered after a French NGO stumbled upon it while testing for meningitis in June. More than 400 infant deaths have been connected to the mining, according to Reuters.
Contributing to natural resource-related misery in the north are climatic changes. Declining rainfall in the West African Sahel over the last century has pushed rain belts successively south, driving pastoralists into areas often already occupied. According to Anthony Nyong’s work, presented in ECSP Report 12, these changes have elevated competition over natural resources to the single most common cause of conflict in northern Nigeria in recent years.
In addition to the long-term trend of declining rainfall, an acute drought in 2009 and another this year in neighboring Niger and Chad have created the worst food security crisis in 30 years. The droughts have also driven a great deal of cross-border migration into Nigeria, which itself saw lower than usual rainfall in the north, especially the northeast, around the ever-disappearing Lake Chad (see map above for resulting migration patterns).
What rain did fall in the border areas fell suddenly and torrentially, causing rampant flooding that affected two million people. The floods not only caused physical damage but also came just before harvest season, destroying many crops and further reducing food security. Made more vulnerable by the number of displaced people and flooding, the area was then hit with its worst cholera outbreak in years, which has killed 1,500 people so far and spread south.
Cholera is not the only preventable disease to flourish in northern Nigeria in recent years. In 2003, cleric-driven fear of a U.S. plot to reduce fertility in Muslim women caused the widespread boycott of a UN-led polio vaccination drive. The fast-spreading disease then emerged in six of Nigeria’s neighbors where the disease had previously been eradicated. The northern states today remain the only consistently polio-endemic area in Africa, according to the Global Polio Eradication Initiative.
“A Stable Nigeria Is a Stable Africa”
Nigeria’s size and its wealth of natural resources make it a strategically important country for the future of the region. “A stable Nigeria is a stable Africa,” said Wilson Center scholar and former NEITI officer Uche Igwe in an interview. “Nigeria is 150 million people and the minute Nigeria becomes unstable, the West Africa sub-region will be engulfed.”
While there have been some strides in recent years in reducing corruption and addressing infrastructure needs (for example, NEITI’s work to promote revenue transparency), the development, health, environmental security, and human security situations remain dire in many parts of the country. With one of the fastest growing populations in the world and severe environmental problems in both the north and the south, scarcity will almost certainly be a challenge that Nigeria will have to face in the coming years. How the government responds to these challenges moving forward is therefore critical.
In 2008, in response to high oil prices, British Prime Minister Gordon Brown announced his intentions to send military aid to help combat Niger Delta militants. The statement was met with dismay from humanitarian organizations and caused the collapse of a ceasefire (which was then resumed for a time and now seems to be falling apart again). Brown was forced to backtrack into simply offering training support to Nigerian security forces.
In terms of U.S. assistance, USAID requested $560 million for Nigeria in FY 2010 – 75 percent of which is allocated towards HIV/AIDS – and the U.S. military has engaged in joint exercises with Nigerian forces. But so far, little has been done to integrate U.S. aid in a cohesive manner. Given the breadth of these issues, such integration is crucial.
“We need partners, like the United States and Europe, who have a stake in stability – in Nigeria, the Niger Delta, the Gulf of Guinea, and the world,” Igwe said. It remains to be seen what the Nigerian reaction would be to an offer of aid from the West that addresses not only the country’s security issues but also its myriad other problems, in a substantial and integrated fashion.
Part one on Nigeria’s future – The Delta – addresses oil, insurgency, and the environment in the south.
Sources: AFP, AFRICOM, AP, BBC, Global Polio Eradication Initiative, The Guardian, Independent, The New York Times, ReliefWeb, Reuters, SaharaReporters, USAID.
Photo Credit: “The Ranch,” courtesy of flickr user Gareth-Davies, and “Niger and Nigeria: Food security drives population movement,” courtesy of the U.S. State Department. -
Colin Kahl on Demography, Scarcity, and the “Intervening Variables” of Conflict
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“One of the major lessons of 9/11 is that even superpowers can be vulnerable to the grievances emanating from failed and failing states,” said Colin Kahl, now deputy assistant secretary of defense for the Middle East, at an ECSP event at the Wilson Center in October 2007. However, “if poverty and inequality were enough to lead to widespread civil strife, the entire world would be on fire.”
“I think any in-depth examination of particular cases shows that there’s a complex interaction between demographic pressures, environmental degradation and scarcity, and structural and economic scarcities – that they tend to interact and reinforce one another in a kind of vicious circle,” Kahl said.
“It’s really important to keep in mind that any attempt to address…environmental and demographic factors should focus not just on preventing environmental degradation, or slowing population growth, or increasing public health. They must also focus on those intervening variables in the middle that make certain societies and countries more resilient in the face of crisis.”
The “Pop Audio” series is also available as podcasts on iTunes. -
Former Botswana President Champions Health, Governance Issues
›November 16, 2010 // By Wilson Center StaffOriginally featured in the Scholar Spotlight, Centerpoint, November 2010.
His Excellency Festus Mogae, who served as president of Botswana from 1998–2008, recently spent several months at the Wilson Center as a public policy scholar. During his stay, he conducted research, networked with senior policy officials in the U.S. government, the United Nations, and with NGO representatives in Washington and New York, and attended Wilson Center seminars related to health and governance.
Since leaving office, Mogae has advocated for governance reform in Africa, notably presidential term limits, and efforts to mitigate the effects of climate change. Another critical initiative he is pursuing actively is HIV/AIDS prevention across Africa.
Mogae is the founder and chairman of Champions for an HIV-Free Generation, a group that assists current African presidents in dealing with the AIDS pandemic. This year, the delegation visited South Africa, Namibia, Mozambique, and Swaziland and, most recently, Zambia in October. The group seeks policy and attitude changes among the leaders of these nations and also advocates for increased financing for AIDS prevention in their health budgets. “If [these countries] allocate their own resources, the donor agencies will see they are serious about this problem” and match funds, said Mogae.
“We take the view that a more outspoken leadership must come from the continent regarding the AIDS epidemic,” he said. “African leaders must not only care but also be seen by donor countries and agencies as leading from the front on these matters.”
The group includes Mozambique’s Joaquim Chissano, Tanzania’s Benjamin Mkapa, Zambia’s first president Kenneth Kaunda, former Vice President of Uganda Speciosa Wandira, and former Chairperson of Kenya’s National AIDS Control Council, Miriam Were. Also in the coalition are two notables from South Africa, Nobel Laureate Archbishop Desmond Tutu and Constitutional Court judge, Justice Edwin Cameron.
The Champions coordinate with local health representatives based in Africa, from UNAIDS, the World Health Organization, PEPFAR, and the Gates Foundation, which prepare country reports on the status of AIDS. Then, armed with this research, the group meets with African leaders, including the presidents, finance and health ministers, local government and parliamentary officials, private sector, union, and civil society representatives, and church groups to lobby for policy changes.
“We highlight success stories on the continent so others can emulate them,” Mogae said. “We are calling for social behavioral change, but that can only happen if advocated and led by the top religious and traditional leadership.”
One particular challenge has been mother-to-child transmissions. He said in sub-Saharan Africa, in 2000, 40 percent of children born to HIV-positive mothers got infected but by 2008, the figure was down to three percent. The target is zero, he said.
Another major initiative chaired by Mogae is the Coalition for Dialogue on Africa, or, CoDA, a joint venture among the African Development Bank, the African Union Commission, and the UN Economic Commission for Africa. This global effort focuses on education, agriculture and conservation, energy and natural resources, and helping women. CoDA currently is organizing a symposium on women’s empowerment, he said, that will focus on education, and reforming land ownership and marriage laws.
These and other organizations with which he is affiliated aim to help shape policies and set priorities for Africa. He said, “We can’t ask the international community for help unless we first help ourselves.”
Dana Steinberg is the editor of the Wilson Center’s Centerpoint.
Photo Credit: AIDS sign in Gaborone, Botswana, courtesy of flickr user cordelia_persen. -
Disease in the Developing World
Poverty, Politics, and Pollution
›November 15, 2010 // By Ramona GodboleA look at the most common illnesses that kill people in the developing world reveals, for the most part, easily preventable and/or treatable diseases and conditions, highlighting the deep disparities between health systems in rich and poor countries. But many of the causes and solutions to these common diseases are also linked to political and environmental factors as well as economic.
Cholera: “A disease of poverty”
Ten months after the earthquake that killed more than 230,000 people, Haiti is facing yet another disaster – a cholera outbreak. The current health crisis highlights broader structural and political issues that have plagued Haiti for years.
Cholera, an intestinal infection caused by bacteria-contaminated food or water, causes severe diarrhea and dehydration, but with quick and effective treatment, less than one percent of symptomatic people die according to the World Health Organization. According to BBC, as of November 15, more than 14,000 people have been hospitalized and over 900 deaths have been attributed to cholera in Haiti thus far.
Even before the earthquake, conditions in Haiti, the poorest country in the Western hemisphere, were bleak. The country has very high maternal and child mortality rates (again, highest in the Western hemisphere), and is in the midst of an ongoing environmental crisis, due to deforestation, soil loss, and flooding.
Less than 40 percent of the Haitian population has access to appropriate sanitation facilities and clean water is scarce, according to UNICEF. Displacement, rapid population growth, and destroyed infrastructure in the wake of the earthquake exacerbated already poor conditions and public health officials warned of the increased risk of cholera and other diarrheal diseases after the disaster.
Today these fears have become reality. While public health messages urging Haitians to wash their hands, boil drinking water, and use oral rehydration salts are working to control the current outbreak, long-term solutions to prevent future outbreaks will require much more systematic changes.
As Partners in Health Chief Medical Officer Joia Mukherjee puts it, cholera is “a disease of poverty.” Citing a joint report from Partners in Health and the Robert Kennedy Center for Human Rights, Mukherjee notes that in 2000, loans from the Inter-American Development Bank to improve water, sanitation, and health (including the public water supply in the Artibonite Valley, where the cholera outbreak originated) were blocked for political reasons by the U.S. government, in an effort to destabilize former President Aristide.
The failure of the international community to assist Haiti in developing a safe water supply, writes Mukherjee, has been a violation of the basic human right to water. To halt the current cholera epidemic and prevent future outbreaks, providing water security must become a priority in the reconstruction efforts of the international community.
Politics and Polio
Recent reports have indicated that the global incidence of polio, a highly infectious, crippling, and potentially fatal virus, is significantly declining and a new vaccine is renewing hopes of eradication. Nigeria, one of the few countries where polio continues to be endemic, has also made major progress over the last few years.
But the situation was very different just a few years ago. In 2003 religious and political leaders in Northern Nigeria banned federally sponsored polio immunization campaigns, citing “evidence” that the polio vaccine was contaminated with anti-fertility drugs intended to sterilize Nigerian women. The boycott led to an outbreak of the disease that spread to 20 countries and caused 80 percent of the world’s cases of polio during the length of the ban, according to a study in Health Affairs.
While the boycott was eventually stopped through the combined efforts of local, national, and pressure, the boycott serves as a useful reminder that global health problems can have political, rather than biological or behavioral, origins.
Combating Climate Change and Pneumonia
Studies from the World Health Organization indicate that exposure to unprocessed solid fuels increases pneumonia risk in children by a factor of 1.8, but today more than three billion people globally continue to depend on coal and biomass fuels for their cooking and heating needs.
Cooking and heating with these fuels creates levels of indoor air pollution that are up to 20 times higher than accepted WHO guidelines, putting people at considerable risk for lower respiratory infections. Women, who are often responsible for collecting fuel and performing household tasks like cooking, and their children, are particularly at risk. Today, exposure to indoor air pollution is responsible for 1.6 million deaths globally including more than 900,000 of the two million annual deaths from pneumonia in children under five years old, representing the most important cause of death in this age group.
A recent study from The Lancet shows improved cooking stoves could simultaneously reduce greenhouse gas emissions and the global burden of disease caused by indoor air pollution in developing countries. Such an intervention, the authors argue, could have substantial benefits for acute lower respiratory infection in children, chronic obstructive pulmonary disease, and ischemic heart disease. The potential health benefits don’t stop there: fuel-efficient stoves can also improve the security of women and children in conflict zones and decrease the risk of burns while improving local air quality.
There would be significant environmental benefits as well. A World Wildlife Fund project in Nepal, which provided loans to purchase biogas units and build improved cookstoves, curbed deforestation for firewood and grazing as well as reduced the incidence of severe cases of acute respiratory infection among under-five children.
Overall, greater access to modern cooking fuels and improved cooking stoves in the developing world could both mitigate climate change and make significant contributions to MDGs 4 & 5, which focus on the reduction of child and maternal mortality.
Prescription for Change
The international community’s experience with cholera in Haiti, polio in Nigeria, and pneumonia around the world shows that health issues in developing countries rarely occur in a vacuum. As these three cases demonstrate, politics, environmental, and structural issues, for better or worse, play an important role in health affairs in the developing world. Yet efforts to combat these conditions often focus only on prevention and treatment.
Antibiotics and vaccines alone cannot provide solutions to these problems. Employing economic, diplomatic and policy tools to address health and development challenges can save lives. More specifically, public health efforts should not only focus on poverty reduction, but also target environmental, political, and structural issues that contribute to disease globally.
Sources: BBC, Bill and Melinda Gates Foundation, CIA World Factbook, Health Affairs, The Lancet, Scientific American, UNICEF, United Nations, USAID, World Health Organization, and World Wildlife Fund.
Photo Credit: “Lining up for vaccination,” courtesy of flickr user hdptcar. -
John Bongaarts on the Impacts of Demographic Change in the Developing World
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“The UN projects about 9.1 billion people by 2050, and then population growth will likely level off around 9.5 billion later in the century. Can the planet handle 9 billion? The answer is probably yes. Is it a desirable trajectory? The answer is no,” said John Bongaarts, vice president of the Policy Research Division at the Population Council, in this interview with ECSP.
Although family planning was largely brushed aside by international policymakers following the 1994 UN International Conference on Population and Development in Cairo, Bongaarts said he is hopeful because it is now enjoying a higher profile globally – and receiving greater funding.
“I am optimistic about the understanding now, both in developing and developed world, and in the donor community, that [family planning] is an important issue that should be getting more attention,” Bongaarts said. “And therefore I think the chances of ending up with a positive demographic outlook are now larger than they were a few years ago.”
The “Pop Audio” series is also available as podcasts on iTunes.
