Showing posts from category global health.
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Weekly Reading
›A report from the Center for Strategic and International Studies argues that the global food crisis poses a moral and humanitarian threat; a developmental threat; and a strategic threat. The authors recommend that the United States: modernize emergency assistance; make rural development and agriculture top U.S. foreign policy priorities; alter the U.S. approach to biofuels; ensure U.S. trade policy promotes developing-country agriculture; and strengthen relevant U.S. organizational capacities.
In an article in Scientific American, Jeffrey Sachs argues that the global food shortages Thomas Malthus predicted in 1798 may still come to pass if we do not slow population growth and begin using natural resources more sustainably.
A report by the Government Accountability Office finds that food insecurity in sub-Saharan African persists, despite U.S. and global efforts to halve it by 2015, due to “low agricultural productivity, limited rural development, government policy disincentives, and the impact of poor health on the agricultural workforce. Additional factors, including rising global commodity prices and climate change, will likely further exacerbate food insecurity in the region.”
In an article in the Belgian journal Les Cahiers du Réseau Multidisciplinaire en Etudes Stratégiques, Thomas Renard argues that climate change is likely to increase the risk of environmental terrorism (attacks that use the environment as a tool or target), eco-terrorism (attacks perpetrated on behalf of the environment), nuclear terrorism, and humanitarian terrorism (attacks targeting humanitarian workers).
A Community Guide to Environmental Health, available for free online in PDF, is a field-tested, hands-on guide to community-based environmental health. Topics include waterborne diseases; sustainable agriculture; mining and health; and using the legal system to fight for environmental rights. -
World Water Week Draws Attention to Taboo Topics Like Sanitation
›August 22, 2008 // By Geoffrey D. DabelkoA recent post on Andy Revkin’s Dot Earth blog—entitled “Poop is Funny, But It’s Fatal”—highlights a UNICEF World Water Day video about the necessity of destigmatizing human waste. Bacterial infections caused by contact with human waste kill 1.5 million people every year—most of them children. The stakes are high. The film uses kids and humor—two good ingredients for education through entertainment—to explain the importance of sanitation. The film emphasizes that although we may not like talking about feces, urine, toilets, and the like, we need to because the fact that 2.6 billion of us lack adequate sanitation is a fundamental threat to human health, productivity, and dignity. It’s a short film—YouTube friendly—and these are complex links, but they are key to understanding the need to invest in available technologies.
The UNICEF video rightly emphasizes the additional costs of lack of sanitation, noting that girls often won’t attend school if there isn’t adequate sanitation. The benefits of attending school longer include higher educational attainment, of course, but also the less-obvious knock-on effects: These young women are more likely to know and assert their rights in the household; they are more likely to earn more income; they often choose to have smaller families and better-spaced births, and are consequently able to concentrate their resources on the well-being of those children; their children are more likely to be better-educated—the list goes on.
The video leaves unspoken another sensitive topic: When adolescent girls begin to menstruate, they often either choose not to come to school or their parents (usually the father) pull them out of school if there aren’t “adequate” and separate facilities. This timing often correlates with young women’s assumption of greater responsibilities in the household, but it is also about the stigma associated with menstruation.
I’ve seen the connections between sanitation, education, and women’s equality have tremendous resonance with what is presumably a primary target audience of the UNICEF film—leaders in donor, government, and civil society communities who can mobilize resources. This example illustrates the urgency of overcoming the stovepiping that plagues so many development efforts, which often tackle education, economic growth, sanitation, and human health in isolation from one another, rather than in an integrated fashion. This year, the International Year of Sanitation, we should all make an effort to step out of our comfort zones and speak out about these “taboo” topics. -
Population Reference Bureau Releases 2008 World Population Data Sheet
›August 20, 2008 // By Sonia SchmanskiThe Population Reference Bureau (PRB) officially launched its 2008 World Population Data Sheet yesterday at the National Press Club. The 2008 Data Sheet features key population, health, environmental, and economic indicators for more than 200 countries. New in this year’s edition, co-authored by Carl Haub and Mary Mederios Kent, are data on percent of population in urban areas, number of vehicles per 100,000 people, and percent of population with access to improved drinking water.
Several findings highlight the significant health inequalities between wealthy and poor countries. For example, while around 1 in 6,000 women in developed countries dies from pregnancy-related causes, in the 50 least-developed countries, the risk is an astonishing 1 in 22. Because maternal mortality is generally seen as a proxy for the general state of a country’s health care system, these statistics point to alarming systemic health care failings in many of the world’s least-developed countries.
The 2008 World Population Data Sheet also highlights disparities between developed and developing countries in population growth rate trends; as wealthier countries’ populations stagnate or even begin to decline, the populations of the world’s poorest countries continue to grow at a rapid clip. PRB president Bill Butz noted that “[n]early all of the world population growth is now concentrated in the world’s poorer countries,” and that “[e]ven the small amount of overall growth in the wealthier nations will largely result from immigration.” As Kent pointed out at yesterday’s press conference, the United States is the major exception to this trend, because most of its population growth over the next several decades will come from natural increase.Unfortunately, the countries with the least access to improved water sources—and therefore some of the highest rates of diarrheal disease and child malnutrition—have among the world’s fastest-growing populations. For instance, in Ethiopia, which has a total fertility rate of 5.3 births per woman, only 42 percent of the population has access to an improved water source, and in Afghanistan, which has a total fertility rate of 6.8, the figure is a mere 22 percent.
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Access to Contraception Could Reduce Maternal Mortality by One Third, World Bank Reports
›August 14, 2008 // By Sonia SchmanskiFertility rates worldwide have been on the decline for many years, the result of a steady decrease in desired family size. But more often than not, fertility rates have not fallen as quickly as desired family size, as access to contraceptives has not kept pace with increasing demand. Consequently, more than 75 million pregnancies each year are unintended, finds “Fertility Regulation Behaviors and Their Costs: Contraception and Unintended Pregnancies in Africa and Eastern Europe & Central Asia,” a World Bank discussion paper surveying decades of research from Africa, Eastern Europe, and Central Asia. One fifth of these pregnancies end in induced abortion, fully half of which are classified as unsafe, meaning they are not attended by a properly trained health care worker or in an environment that conforms to minimum medical standards.
The costs of unsafe abortion are tremendous, financially and in terms of human lives. Approximately 67,000 women die annually from complications resulting from unsafe abortion, leaving more than 200,000 children motherless. Sexual and reproductive health issues constitute 20 percent of the global disease burden, and produce additional “direct and indirect costs to the individual woman, the woman’s household, the country’s health system and society as a whole.”
In Africa, post-abortion care can consume up to half of obstetrics and gynecology department budgets. The cost of this care is often much higher than the patient’s monthly salary. The authors report that “comprehensive family planning services to prevent unwanted pregnancy and reduce unsafe abortion in Nigeria would cost only a quarter of what is being spent in direct costs to treat post-abortion complications.” This point is taken up by author Margaret E. Greene is the latest issue of FOCUS, ECSP’s series of occasional papers featuring Wilson Center speakers. She writes that “[r]obust, compelling evidence linking good reproductive health to poverty reduction,” as is offered in the World Bank report, will “support efforts to include it in country-level poverty reduction strategies and in the allocation of international poverty reduction funding.”
This situation repeats itself across the globe. In Central Asia and Eastern Europe, induced abortion is “the principal method of birth control,” due to the expense of importing Western contraceptives, the medical community’s stigma against oral contraceptives, and the availability of abortion result. In Russia, government concerns about low fertility led the government to dismantle its sex-education curriculum and to carry out widespread layoffs in the government-controlled offices of contraceptive manufacturers.
Without exception, the case studies in this discussion paper find significant financial benefit to increasing modern contraceptive availability. Inadequate access is “an important barrier,” the authors write, discounting the argument that the contraceptives are there and people simply don’t use them. DHS surveys worldwide find that cost has prohibited contraceptive use for fewer than 2 percent of the estimated 137 million women with an unmet need. Women have decided, it seems, that the costs of childbearing far outweigh those of contraceptives.
“It is imperative,” the authors write, “that policies and programs address the need for contraception globally – for all population groups but with special emphasis on those who are most disadvantaged.” Community insurance schemes to reduce out-of-pocket payments can help accomplish this. Other ideas include increased subsidies for basic health services and adjusted user fee policies. The report also urges expanded and improved provision of contraceptive information and services, as well as improved training for health care providers. The problem is not a lack of good ideas and policies, but a lack of political will.
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“There’s only one health”: AVMA Initiative Emphasizes Links Between Human, Animal, Environmental Health
›August 4, 2008 // By Sonia Schmanski“[O]ver the last three decades, approximately 75% of new emerging human infectious diseases have been zoonotic”—transmitted between humans and animals. So states the final report of the One Health Initiative Task Force, warning that “[o]ur increasing interdependence with animals and their products may well be the single most critical risk factor to our health and well-being with regard to infectious diseases.” The One Health Initiative was established by the American Veterinary Medical Association (AVMA) in 2006, and the task force was assembled in early 2007 to articulate its goals and vision. Released last month, the report stresses that “[b]y working together, more can be accomplished to improve health worldwide, and the veterinary medical profession has the responsibility to assume a major leadership role in that effort.”
In our interconnected world, human, animal, and environmental health are linked in numerous and complex ways. One organization tackling these connections is the Ugandan NGO Conservation Through Public Health (CTPH). Founded and directed by Gladys Kalema-Zikusoka, CTPH works to bolster human and animal health in Uganda’s Bwindi Impenetrable National Park (BINP), home to half of the world’s remaining mountain gorilla population. Zoonotic disease transmission is especially prevalent in remote areas like BINP, where people frequently live in close proximity to animals, and is exacerbated by the fact that these remote areas are often woefully underserved by government services like health care. “They’re the last people the government thinks about,” said Kalema-Zikusoka in a presentation at the Wilson Center on May 8, 2008.
The One Health Initiative demonstrates that people are starting to think seriously about the intersections between human, animal, and environmental health. “We are standing at the precipice of a health care transformation,” said Task Force Chair Lonnie King. “[D]isease prevention and health promotion in people, animals and our environment have become a critical strategic need.”
Speaking at the Wilson Center in November 2005, King expressed a desire for a program like the One Health Initiative. “We have to build infrastructures in health systems in developing countries,” he said, “not just human health, but animal health, too.” At the same event, William Karesh, director of the Wildlife Conservation Society’s Field Veterinary Program, said, “[t]he concept we have is ‘one world, one health.’ There is the division of human health and wildlife health. But really, there’s only one health.” The idea of integrated health finally seems to be catching on.
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Former HHS Secretary Tommy Thompson Links Global Health, U.S. Security
›July 18, 2008 // By Daniel Gleick“They say good fences make good neighbors, and maybe they do. But what I’ve learned is that good medicine makes good neighbors, and it makes good foreign policy too,” said Tommy Thompson, former secretary of the U.S. Department of Health and Human Services, in a press release received by the New Security Beat. In an appearance at the National Press Club on Wednesday, Thompson announced his new position as global ambassador for the Global Network for Neglected Tropical Diseases (NTDs). “It is a tragedy,” he said, “that the world’s poorest citizens are suffering from diseases that have been neglected for too long, particularly when we can treat many of them for less than 50 cents a year.”
Thompson’s announcement came amid news of a $3.8 million grant from the Bill & Melinda Gates Foundation to raise awareness about the diseases and advocate for increased funding for NTDs, which include leprosy, river blindness, hookworm, and elephantiasis and affect one billion of the world’s poor. Thompson, who will travel to Rwanda next months as part of his new position, was quick to articulate the broader impacts of global humanitarian aid for health. “Through medical diplomacy, we can win the hearts and minds of people in less fortunate areas of the world by exporting medical care, expertise, and personnel to those who need it most,” he said. “America has the best chance to beat the war on terror and defeat the terrorists by enhancing our medical and humanitarian assistance to vulnerable countries.”
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PEPFAR Boon to U.S. National Security, Says Senator Richard Lugar
›July 17, 2008 // By Jackson DroneyIn a rare display of bipartisan unity, the U.S. Senate voted 80-16 Wednesday to reauthorize the President’s Emergency Plan for AIDS Relief (PEPFAR). Originally passed in 2003 and set to expire this September, the White House credits PEPFAR with delivering antiretroviral drug treatment to 1.7 million people worldwide.
Reflecting the bipartisan support of the program, the top two members of the Senate Foreign Relations Committee heaped praise on the program and the president. Senator Joseph Biden (D-DE), chairman of the committee, said the program is “the single most significant thing the president has done.” Senator Richard Lugar (R-IN), the committee’s ranking member, argued eloquently that PEPFAR benefits U.S. national security and foreign policy. During the floor debate, he made the following statement:We should understand that our investments in disease prevention programs have yielded enormous foreign policy benefits during the last five years. PEPFAR has helped to prevent instability and societal collapse in a number of at-risk countries; it has stimulated contributions from other wealthy nations to fight AIDS; it has facilitated deep partnerships with a new generation of African leaders; and it has improved attitudes toward the United States in Africa and other regions.
The Senate legislation extends the program five years and triples its funding to $48 billion. The bill met with initial opposition from several conservatives, and the Democratic-controlled Senate defeated several Republican amendments earlier this week. The House passed a slightly different version of the legislation in April; differences between the two bills will be resolved in a conference committee.
In my judgment, the dollars spent on this program can be justified purely on the basis of the humanitarian results that we have achieved. But the value of this investment clearly extends to our national security and to our national reputation. -
African Development, Security at Forefront of G8 Summit
›July 11, 2008 // By Kai CarterWednesday marked the close of the G8 Summit, where critical topics like climate change, global food security, and development were on the table. Much of the discussion of the latter centered on
It seems, however, that the G8 may have renewed its commitment to global health, including maternal and child health and nutrition. The declaration stated:In some developing countries, achieving the MDGs on child mortality and maternal health is seriously off-track, and therefore, in country-led plans, the continuum of prevention and care, including nutrition should include a greater focus on maternal, new born and child health. Reproductive health should be made widely accessible.
The United Nations has urged the G8 to demonstrate its commitment to these areas by increasing funding. Secretary-General Ban Ki-moon has stated that $10 billion dollars would ensure basic coverage of maternal and child health worldwide. The G8 has finally caught on to these critical needs; it is now time to make real financial commitments to global health.
