The Global Syndemic of Obesity, Undernutrition, and Climate Change: The Lancet Commission report
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32822-8/fulltext
“
Malnutrition in all its forms, including obesity, undernutrition, and other dietary risks, is the leading cause of poor health globally. In the near future, the health effects of climate change will considerably compound these health challenges. Climate change can be considered a pandemic because of its sweeping effects on the health of humans and the natural systems we depend on (ie, planetary health). These three pandemics—obesity, undernutrition, and climate change—represent The Global Syndemic that affects most people in every country and region worldwide. They constitute a syndemic, or synergy of epidemics, because they co-occur in time and place, interact with each other to produce complex sequelae, and share common underlying societal drivers. This Commission recommends comprehensive actions to address obesity within the context of The Global Syndemic, which represents the paramount health challenge for humans, the environment, and our planet in the 21st century.”
Cfr the
press release:
“The Lancet: Powerful vested interests, misplaced economic incentives are major drivers of the joint pandemics of obesity, undernutrition and climate change
*The global interplay of obesity, undernutrition and climate change represents ‘The Global Syndemic’ and is the greatest threat to human and planetary health, affecting most people in every country and region.
*Powerful opposition by commercial vested interests, lack of political leadership, and insufficient societal demand for change are preventing action on The Global Syndemic, with rising rates of obesity and greenhouse gas emissions, and stagnating rates of undernutrition.
*New social movement for change and radical rethink of the relationship between policymakers, business, governance and civil society is urgently needed.
*The Commission calls for a global treaty to limit the political influence of Big Food (a proposed Framework Convention on Food Systems – modelled on global conventions on tobacco and climate change); redirection of US$5 trillion in government subsidies away from harmful products and towards sustainable alternatives; and advocacy from civil society to break decades of policy inertia.”
Read also some of the
related Comments in the Lancet:
Rethinking systems to reverse the global syndemic (by
Rachel Nugent)
Obesity needs to be put into a much wider context (by
S Kleinert & S Horton)
And great coverage in
the Guardian -
Take on food industry to beat malnutrition and obesity, says report “
The influence of “big food” must be curbed around the world if obesity, malnutrition and climate change are to be effectively tackled, according to a report….”
Or
Vox -
Want to fix obesity and climate change at the same time? Make Big Food companies pay.
Devex zooms in on the
role of development actors -
What role for development actors in global food system overhaul?
Global Fund update & preparations for GF replenishment
Lancet Viewpoint - On results reporting and evidentiary standards: spotlight on the Global Fund
R Friedel, R Silverman, A Glassman, K Chalkidou;
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)33055-1/fulltext
This was a bit of a (CGD) bombshell, late last week, ahead of the GF replenishment.
Cfr a tweet: “
a new analysis calls for @GlobalFund to publish more robust data and be more transparent in its official impact reports.”
Excerpt:
“
Examining publicly available documents for 2018, it is our judgment that the Global Fund's results reporting is insufficiently rigorous to inform the allocation of scarce resources (results reports from previous years are no longer available through the Global Fund website, making it difficult to compare this document to previous iterations). Most obvious is the question of attribution. In its results reporting and communication materials, the Global Fund conflates two ideas about its own nature. First, the Global Fund is presented as a partnership, encompassing every funder, government, non-governmental organisation, implementer, and private actor involved in treating or preventing the three diseases in eligible countries. And second, the Global Fund operates as a standalone funding instrument with an annual budget of roughly $4 billion. The results reporting explicitly takes credit for the accomplishments of the partnership, including bilateral mechanisms like the President's Emergency Plan for AIDS Relief and the President's Malaria Initiative, plus domestic government investments. However, the replenishment will advocate for investment in the Global Fund as a funding instrument, attracting resources that could otherwise be channelled elsewhere in the partnership through alternative bilateral or multilateral mechanisms. How can results reporting without direct attribution to the Global Fund as a standalone institution support continued institutional investment? With domestic resources growing faster than development assistance for some priority conditions, such as HIV/AIDS, attribution across all payers—national, international, public, and private—becomes even more difficult to justify.”
Coverage for example in
the Telegraph -
Global Fund must copper-bottom claims it has saved 27 million lives, say experts.
The
Global Fund’s reply was swift:
Measuring and Reporting Results (25 Jan)
Lancet Infectious Diseases (Editorial) - Fuelling the Global Fund
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(19)30006-4/fulltext
This Editorial sets the scene nicely for the preparatory meeting in Delhi, next week. “
On Jan 11, 2019, the Global Fund to Fight AIDS, Tuberculosis and Malaria announced the fundraising target for its next 3 year replenishment cycle—“The single most important public health measure of 2019”, according to a blog by Jeffrey Sachs and colleagues published at the time of the announcement. The investment case was launched in Paris by French President Emmanuel Macron and calls for US$14 billion of donations—largely from national governments in wealthy countries—to cover the Global Fund's sixth investment period of 2020–22. The $14 billion is just part of an estimated $83 billion that needs to be spent to fight the diseases over the 3 year period, most of which will come from domestic government budgets in affected countries. The full investment case will be presented at a meeting in New Delhi, India, on Feb 8, 2019, and France will host the Global Fund's Sixth Replenishment Conference in Lyon on Oct 10, 2019….”
The Editorial goes on then to point out the (scientific) risks of backsliding, and the political challenges currently in the US, UK and even France.
“
Perhaps it's time for the governments of rapidly growing economies to take up some of the slack from traditional donors. Sachs and colleagues suggest that China, a former recipient of Global Fund support but now the world's second largest economy, should become a donor. These authors also suggest that to achieve its targets the Global Fund should be asking for at least twice the $14 billion it has requested, and that this gap in funding should be filled by donations from the pockets of the world's billionaires….” The latter is not very likely, according to this Editorial.
Peter Sands - The private sector is working to fight climate change. Why isn’t it doing the same to improve global health?
https://www.statnews.com/2019/01/25/private-sector-global-health-investment/
Among others, Peter Sands aims to raise 1 billion among the private sector. Of which, most is expected to come from the Gates Foundation, duh 😊.
Kristof Decoster - The Global Fund: no longer a frontrunner in the SDG era (and what to do about it)
https://kdecoster.blogspot.com/2019/01/the-global-fund-frontrunner-no-more-in.html
My own view on how the Global Fund could become ‘innovative’ again in the SDG era. Along the same lines, I have a suggestion for the Replenishment of the Big Four Health Funds (in the coming 18 months). And WHO, while we’re at it.
Global Fund Observer – new issue
http://www.aidspan.org/gfo_article/step-or-slip-back-case-investing-14-billion-global-fund%E2%80%99s-sixth-replenishment
Make sure you read at least
Step up or slip back? The case for investing $14 billion for the Global Fund’s Sixth Replenishment (by David Garmaise)
““
Step Up the Fight” is the title of the Investment Case document published by the Global Fund for the Sixth Replenishment. That phrase accurately reflects the central message of the Investment Case which is that the Fund and its many partners need to “build on the gains we have made, or we [will] see those achievements eroded, infections and deaths resurge, and the prospect of ending the epidemics disappear.” … . This article covers three topics: (1) the Investment Case; (2) the $14 billion target; and (3) comments from civil society on the target. Please see the separate article in this issue on the preparatory meeting….”
Read also
Are African countries ready for the Global Fund’s Sixth Replenishment’s push toward greater domestic financing to end HIV, TB and malaria?.
WHO 144th EB meeting (Geneva, 24 Jan-1 Feb)
https://www.who.int/news-room/events/executive-board-144th-session
Last week we already covered the first two days of the EB meeting, and see also this week’s editorial by Deepika.
Below you find
reads on the issues & debates since then. We won’t try to reinvent the wheel here, but will just refer to the excellent
coverage by IP-Watch/Health Policy Watch & Devex. More or less chronologically.
- But first, on the civil society meeting (23 Jan):
http://g2h2.org/posts/january2019/ Documentation is available now (with presentations on UHC/PHC, climate change, access to medicines, WHO governance, and more).
Make sure you also check out the following
letter by Thomas Schwarz to EB members:
Good Governance starts at home
Overview of sessions, debates, issues, … via coverage of Devex & HPW
Devex -
Tedros addresses alleged misconduct at WHO
“
The World Health Organization’s director-general has addressed allegations of misconduct within the organization, which were sent to WHO directors in anonymous emails. Tedros Adhanom Ghebreyesus said Thursday that the organization’s Office of Internal Oversight Services’ preliminary review of the allegations made against several members of staff is due by end of the week and that any substantiated allegations will be reported to member states….”
HPW -
Board Debates WHO Plans For Efficiencies At Headquarters & Funding Shifts To Countries
“A massive restructuring of WHO’s 2020-2021 budget should see a shift away from siloed disease control programmes to a more integrated approach, focused on building health systems and strengthening country operations. These were the key strategic features of the proposed budget of US$ 4.785 billion, reviewed by WHO’s Executive Board in a lengthy session today….”
HPW
- Next On Stage: WHO Academy & Foundation
“A
WHO Academy where millions around the world can be trained in the health policy guidelines, methods and practical tools that WHO develops and promotes,
is one of the big new dreams of WHO Director General Dr. Tedros Adhanom Gheyebresus – wrapped into WHO’s strategic planning for coming years. A WHO Academy,
along with proposals to create a WHO Foundation; and
a position for a WHO chief scientist, may have raised eyebrows amongst some member states, but Dr. Tedros says that these are
all logical outcomes of the WHO Transformation plan, which aims to make the country more nimble, more efficient and more relevant and responsive to countries most in need….”
HPW -
WHO Director Tedros: World Must Redouble Efforts On Health-Related SDGs
“
Health-related Sustainable Development Goals won’t be met unless global, regional and country efforts are intensified, WHO Director General Dr Tedros Adhanom Gheyebresus declared yesterday. “Progress is slow, we are not on schedule – we are behind schedule,” said Dr Tedros, speaking before the WHO Executive Board (EB) in a 27 January session on progress in health-related SDGs. But he expressed hopes that a WHO-led Global Action Plan for Healthy Lives and Well Being For All, could help get progress back on track. The action plan, involving 11 other UN and donor agencies, is being drafted in response to a request by Norway, Germany and Ghana, to be presented at the United Nations SDG Summit in September….”
IP Watch -
WHO Draft Resolution On Universal Health Coverage Shows Efforts At Consensus
“With half the world’s population still lacking access to essential health services, World Health Organization Executive Board members this week are working to agree on a resolution indicating ways through which this situation can be alleviated. Discussions are going on outside plenary room as delegates seek agreement on a draft resolution.”
For this draft resolution (proposed by Japan & Thailand – 26 Jan) on the HL Meeting, see
here.
HPW -
WHO Board Looks Into Means To Reach Polio-Free World
“
Poliomyelitis, a highly infectious and sometimes debilitating viral disease, is about to be eradicated from the world. However, the last mile is the hardest, World Health Organization Director General Tedros Adhanom Ghebreyesus said last week at a member state discussion on polio eradication. Beyond the direct eradication of wild polioviruses in the three last endemic countries, and the steady supply of affordable inactivated poliovirus vaccines, the WHO is called on to help countries keep the virus at bay, and implement a strategy to use polio-related structures to strengthen their national health systems, as polio funding is dwindling….”
IP Watch -
Measuring Outputs Seen As Key To WHO Transformation (gated)
“
Measurable outputs are a key element of the World Health Organization transformation and its “triple billion” target. Last week, WHO Executive Board discussed the Impact Framework, a key measurement system. Board members asked clarifications on indicators and underlined the challenge of data collection in many countries. A consultation with country experts is expected to be held before the May World Health Assembly.”
HPW -
DNDi, MMV Make 400 Compounds Available To Boost Pandemic Disease Research
“
The Drugs for Neglected Diseases initiative (DNDi) and Medicines for Malaria Venture (MMV) today announced the launch of the “Pandemic Response Box”, which offers researchers open access to 400 compounds that could lead to development of new treatments for pandemic diseases. In return, researchers “will be expected to share data resulting from research on the molecules from the box in the public domain within 2 years of its generation.” … …
The Pandemic Response Box is a collection of antibacterial, antiviral and antifungal compounds for screening against infective and neglected diseases, the Geneva-based organisations said in a
press release….”
IP-Watch -
WHO Holds Discussions On Roadmap For Improving Access To Medicines
“
Unaffordable prices, unavailable medicines, a rising need for accessible noncommunicable diseases treatments – these set the stage as the World Health Organization Executive Board started discussion today on one of the more contentious issues of the week. For the Board’s approval is in particular a roadmap and action plan including a dual strategy based on safety and efficacy of health products, and their affordability.”
IP-Watch -
WHO’s Access Roadmap And The Art Of Accommodation Of Pharma Interest
Analysis by
K M Gopakumar, ahead of this discussion: “
The Roadmap to access to medicines, vaccines and other health products (Roadmap) to be discussed at this week’s 144th session of WHO’s Executive Board accommodates vital interest of pharmaceutical TNCs on critical issues such as the approach to access, technical assistance on the use of TRIPS flexibilities and access to biosimilars….”
IP-Watch -
WHO Member States Call For Transparency, Access To Innovation On Cancer Drug Pricing
(gated) “
A substantive discussion took place at the World Health Organization Executive Board meeting yesterday in response to a recently released WHO report on cancer drug pricing. Among the variety of perspectives expressed, many formed consensus in calling for increased transparency of research and development (R&D) costs and equitable access to innovative cancer drugs.”
Devex -
WHO's controversial next steps to improve access to medicines
“
A majority of countries cheered the World Health Organization's draft roadmap on access to medicines presented this week, applauding its relevance in the struggle to achieve universal health coverage. But several stakeholders think the draft requires continued consultations on key — and controversial — issues. …”
IP Watch -
Board Debates Medicines Access; WHO Asserts Mandate On IP, Trade Issues
(gated) “
Shortages, faulty supply chains, unbearable prices, weak health systems – the issue of access to medicines is multifaceted and gave way to a long list of interventions yesterday at the World Health Organization. Challenged on its mandate to address intellectual property and trade issues, WHO Director General Tedros Adhanom Gheyebresus (Dr Tedros) confirmed that WHO’s mandate includes work with partners on those issues. Discussions also included fair pricing and transparency, for which Italy called for a resolution at the next World Health Assembly.”
HPW -
Italy & United States: Remove Reference To Sugary Drink Tax From WHO NCDs Report
“
Representatives of Italy and the United States today asked the World Health Organization to remove a summary of evidence on how taxes on sugar-sweetened drinks may help reduce unhealthy sugar consumption from its latest progress report on tackling non-communicable disease (NCDs). The WHO Prevention and Control of Noncommunicable Diseases, update and companion Workplan, following on from the United Nations General Assembly’s High Level Meeting on NCDs in September 2018 were under review by WHO’s 34-member Executive Board, in advance of the World Health Assembly meeting of all WHO member states, scheduled for May….”
HPW - Draft Global Strategy On Health: Environment, Climate Change Hailed At WHO
https://www.healthpolicy-watch.org/draft-global-strategy-on-health-environment-climate-change-hailed-at-who/
“Preventable environmental risks lead to at least a yearly toll of 13 million people, 7 million of which are caused by air pollution, according to a World Health Organization report presented yesterday to its members attending the organisation’s Executive Board. Time is of the essence and
the WHO draft global strategy on health, environment, and climate change received broad support, as well as a draft action plan for small island developing states, particularly vulnerable to climate change….”
HPW - WHO Aims To Broaden Dialogue With Civil Society
https://www.healthpolicy-watch.org/who-aims-to-broaden-dialogue-with-civil-society/
“The World Health Organization is exploring ways to expand relationships with non-governmental organizations, including broader collaborations on key global health priorities and a possible informal consultation with civil society every year, Director General Dr Tedros Adhanom Gheyebresus told WHO’s Executive Board today….”
Well worth a read this one, as you can imagine.
Some other relevant news from the EB meeting
“
Achieving progress on universal health coverage and the Sustainable Development Goal health targets requires a strong primary health care sector as the cornerstone of health systems. The World Health Organization Executive Board, convening in Geneva from 24 January to 1 February, has taken an important step in supporting and recognizing the importance of community health workers (CHWs), as part of a diverse and sustainable health workforce skills mix. The Executive Board adopted a resolution introduced by the Governments of Ethiopia and Ecuador, entitled “Community health workers delivering primary health care: opportunities and challenges”. The document, which builds on both countries’ experience and the Declaration of Astana, underscores the value of community health workers as a vital health system component in providing primary health care services. The resolution, which will be considered at the World Health Assembly in May 2019, takes note of the newly-launched WHO Guideline on health policy and system support to optimize community health worker programmes (CHW Guideline), which consolidates evidence on the effectiveness and cost-effectiveness of CHWs….”
“Philip Morris International's Foundation for a Smokefree World (FSFW), a thinly disguised part of the company's efforts to market its IQOS heated tobacco product and rehabilitate PMI's image, is seeking to partner with WHO. Today a letter signed by 89 health organizations and 170 public health leaders (including me) was sent to the WHO DIrector General urging WHO to reject FSWS's offer. The letter is accompanied by two short briefing papers, one analyzing FSFW's strategy of framing its efforts under the Sustainable Development Goals, and another summarizing some of the actions by a wide range of organizations to block FSFW's efforts on behalf of the PMI and the tobacco industry generally. WHO should promptly reject FSFW's latest efforts as a violation of FCTC Artcle 5.3.”
“
A number of non-state actors seeking renewal of their official relation status with the WHO receive funding from pharmaceutical, food and alcohol industries.”
2019 PMAC Bangkok (29 Jan-3 Feb)
https://pmac2019.com/site
The theme of the Prince Mahidol Award Conference in Bangkok this year is ‘
The Political Economy of NCDs – a Whole of Society approach’. Very interesting and more than timely too.
Which is why, the
tweet from ‘Health in Myanmar’ was rather apt:
“
Aagh. Seems #PMAC2019 is a closed conference. Only summary statement & some slides may be later put online. Leaves many people behind. If a partly publicly-funded conference in Bangkok is to meet international standards then live webcasts must be made available.”
You find an overview of the
objectives of the conference, the three sub-themes and the various
sessions here.
For a flavour of the discussions so far, check out the
hashtag #pmac2019.
Presentations will be made available to all soon, according to the organizers.
WHO Bulletin – Theme issue on the prevention and control of NCDs
https://www.who.int/bulletin/volumes/97/2/en/
For the (PMAC) occasion.
“
Despite global commitments, progress on noncommunicable disease prevention and control has been slow and uneven, particularly in low- and middle-income countries. This theme issue on noncommunicable diseases presents a selection of papers that analyse how the burden of noncommunicable diseases could be addressed more efficiently…”
The Editorial gives a
quick overview of the papers in the series. Many of these were already published online before.
“…
The 2018 Political Declaration of the Third High-level Meeting on Noncommunicable Diseases notes that progress and investment on noncommunicable diseases have been insufficient to meet the health-related targets of the sustainable development goals. Countries face many challenges in responding to the rapid rise in noncommunicable diseases and improving mental health as part of the 2030 agenda for sustainable development … ….. The United Nations (UN) InterAgency Task Force on the Prevention and Control of Non-communicable Diseases has undertaken joint missions to over 25 countries to support government responses to these challenges…. … While the responsibility for addressing these priorities lies with countries, the UN system has a key role in catalysing these responses…. … The WHO Independent High-level Commission also recommended that the international community consider a multidonor fund to catalyse financing for the development of national noncommunicable disease and mental health responses and stronger policy coherence at country level….”
The future of UNAIDS
Devex – The Future of UNAIDS
A Green;
https://www.devex.com/news/the-future-of-unaids-94165
“
The United Nations AIDS agency ended 2018 in crisis. It is unclear how it will recover….”
Warmly recommended (balanced) piece. With among quotes from
A Nordström,
J S Morrison &
Gorik Ooms.
See also a
Lancet Infectious Diseases Newsdesk report.
“…
Many, including the Swedish Government, have expressed concern for the organisation’s ability to regain its credibility without an immediate change of leadership. Furthermore, amid funding declines and fresh challenges in tackling HIV and AIDS, Christine Stegling, executive director of the International HIV/AIDS Alliance, fears that HIV could slip further down the global health agenda unless structural abuses of power within the agency are addressed promptly….”
World Bank update
Lancet World Report - Jim Yong Kim steps down from World Bank
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30155-2/fulltext
“
Jim Yong Kim's decision to leave World Bank post early ushers in uncertainty about its future direction. John Zarocostas reports.”
This World report from last week was well worth reading,
providing a rather in-depth and balanced overview of the pros & cons of Jim Kim’s track record at the helm of WB. I was a bit surprised not to see the Human Capital agenda being mentioned, though.
Speaking of the
Human Capital Project, by now 46 countries have signed up for it as early adopters, see
WB.
Meanwhile,
the search for a successor isn’t going too well. Check out these links:
WSJ -
U.S. Contemplates Appointing First Female President of World Bank
“Strong woman candidate could clear away competitors.”
Bloomberg -
Trump Met Heidi Cruz for World Bank Job But Passed on Her, Sources Say
With some info on the possible (US favoured) candidates for the moment.
See also
Devex: “…
World Bank President Jim Kim will make his official exit Friday, as current CEO Kristalina Georgieva takes the reigns until Kim’s successor is chosen. The Trump administration is expected to announce its nominee soon, and while a few other names continue to circulate around Washington, D.C., Under Secretary of the Treasury David Malpass has emerged as the clearest frontrunner….”
In the backdrop, Ngozi Okonjo-Iweala is also considering a run, it’s said, if conditions were to be favourable.
The more radical readers of this newsletter might want to read (in the Guardian)
The World Bank and IMF are in crisis. It's time to push a radical new vision (by
D Adler & Y Varoufakis). They want a revamped WB-IMF to function towards an
international Green New Deal, and thus work in the service of the many, not the few.
Final analysis & “take home messages” Davos
Last week we already covered in detail Davos, from a global health (and broader inequality) perspective.
With hindsight, it’s clear that
two messages got worldwide attention, and went viral.
Would be good if the global health community (and especially the big (philanthropy-loving) shots present in Davos) paid a lot more attention to these.
Guardian - Historian berates billionaires at Davos over tax avoidance
https://www.theguardian.com/business/2019/jan/30/historian-berates-billionaires-at-davos-over-tax-avoidance
On global inequality: “
A discussion panel at the Davos World Economic Forum has become a sensation after a Dutch historian took billionaires to task for not paying taxes. In a video shared tens of thousands of times, Rutger Bregman, author of the book Utopia for Realists, bemoans the failure of attendees at the recent gathering in Switzerland to address the key issue in the battle for greater equality: the failure of rich people to pay their fair share of taxes….”
“Industry had to “stop talking about philanthropy and start talking about taxes…. “That’s it,” he says. “Taxes, taxes, taxes. All the rest is bullshit in my opinion.””
Guardian - 'Our house is on fire': Greta Thunberg, 16, urges leaders to act on climate
https://www.theguardian.com/environment/2019/jan/25/our-house-is-on-fire-greta-thunberg16-urges-leaders-to-act-on-climate
On the climate change threat: Cfr a tweet
: “Swedish teen #GretaThunberg slams #Davos elite over #climatechange hypocrisy.”
If you compare with these two key messages the more typical sounds & noises coming from Davos, the contrast is striking. But do judge for yourself:
“
The statement said the international financing organisation the Global Fund needs at least $14bn to $16bn to fund its next three years of work, including $1bn from the private sector. “
Bill Gates certainly doesn’t get the new times yet, he’s still stuck in the MDG mode (not making the link with global inequality):
“
Bill Gates, of the Bill & Melinda Gates Foundation, a charitable organisation, explained at the session on health at Davos that public funding could shrink if taxpayers were not made aware of the “successes” in fighting infectious diseases to date….”
“Private investment for humanitarian issues was a hot topic at this year's World Economic Forum Annual Meeting — but some cautioned of its limits. “
On new therapies, new questions & a digital future.
“
The World Economic Forum annual meetings drew more than 3,000 stakeholders from across sectors, and while development was not always top of an agenda that focused on “making globalization 4.0 work for all,” some significant commitments were made, including on aid issues such as mental health, disability, and refugees. … … As leaders from around the world underlined the importance of multilateralism and called for cooperation on global challenges, the Wellcome Trust committed $260 million to mental health, the Rockefeller Foundation and the Mastercard Center for Inclusive Growth announced a new $50 million collaborative philanthropy effort, and the IKEA Foundation backed a development impact bond for refugees. …
“…Here are some of the major deals that are likely to emerge from this year’s forum. … On Wednesday, Bill Gates and Gates Foundation CEO Sue Desmond-Hellmann laid out the investment case and discussed their concerns that domestic politics will hurt these organizations’ ability to raise the funds they need. … … While key government funders, including the U.S., the U.K. and France, are facing pressures at home, the replenishment efforts need existing donors to commit, Desmond-Hellmann said. The Gates Foundation is working to strengthen ties with African philanthropists and donors in Asia and the Middle East as it works with the Global Fund and Gavi to raise funds, she said. While Bill Gates is in Davos, Melinda Gates is holding meetings elsewhere in Europe, to talk about the return on investment in global health…”
(must-read analysis !!!!) Broad helicopter view by Raj Kumar, in line with the currently ‘hegemonic thinking’ in these circles:
“…
The kind of profound change that is needed requires a new development model, one that Sustainable Development Goal 17 describes as including country ownership, domestic resource mobilization, private sector partnerships, and innovative financing mechanisms. In conversations with business and global development leaders attending WEF’s annual meetings, it is clear there are areas of significant progress when it comes to the new era envisioned by the SDGs, and others where stories similar to Ibrahim’s are not yet breaking through….” Check out Kumar’s
overview of what’s working, what’s showing promise, what’s not moving fast enough what’s stuck.
The section ‘what’s working’ zooms in specifically on the replenishment of the 4 Big Global Health Funds in the coming months.
NYT – The hidden Automation agenda of the Davos elite
K Roose;
https://www.nytimes.com/2019/01/25/technology/automation-davos-world-economic-forum.html
As a farewell to this year’s Davos, read this very worrying piece. PS: next year it’ll be the 50
th Davos anniversary.
“
They’ll never admit it in public, but many of your bosses want machines to replace you as soon as possible. I know this because, for the past week, I’ve been mingling with corporate executives at the World Economic Forum’s annual meeting in Davos. And I’ve noticed that their answers to questions about automation depend very much on who is listening. In public, many executives wring their hands over the negative consequences that artificial intelligence and automation could have for workers. They take part in panel discussions about building “human-centered A.I.” for the “Fourth Industrial Revolution” — Davos-speak for the corporate adoption of machine learning and other advanced technology — and talk about the need to provide a safety net for people who lose their jobs as a result of automation. But in private settings, including meetings with the leaders of the many consulting and technology firms whose pop-up storefronts line the Davos Promenade, these executives tell a different story: They are racing to automate their own work forces to stay ahead of the competition, with little regard for the impact on workers….”
Migration & health
HPW - WHO Walking The Line Of Caution On Refugees And Migrants’ Health In Europe
N Denticco;
https://www.healthpolicy-watch.org/who-walking-the-line-of-caution-on-refugees-and-migrants-health-in-europe/
“…
for WHO Europe, the report on the health of refugees and migrant people in the 53 countries of the region is the first one of its kind, which may explain the hesitance of the beginner. But it is difficult to deny a bitter aftertaste, especially after the press conference….”
“…Obviously, the WHO walks the line of extreme caution. ZsuZsanna Jakab, WHO Euro Regional Director, acknowledges governments’ lack of preparation in tackling the inflow of people in the last few years, but does not formulate any criticism with regard to the national migration policies that are increasingly bound to harm refugees and migrants’ health. Nor does she recall the fact that inflows of migrants have sensibly diminished. She only makes reference to the “reluctance ” of some countries to understand the stakes, but she fails to address the health irrelevance of the persisting semantic disquisition on distinguishing between “economic migrants”, “refugees”, “clandestine migrants”, “illegal refugees”, or “vacational refugees”, according to the geopolitical sub-culture of the Italian interior minister. Not a word is said for example about the Dublin Convention regulating the management of asylum seekers in Europe: today, one of the most ferocious policy tools used to paralyze people’s migration projects and a key political determinant of refugee and migrants’ ill health status across their lifetime in Europe. Indeed, also, a major political determinant of the xenophobic disease spreading among residents in the European continent. One epidemic trend that WHO Euro should definitely consider addressing for a next report….”
Plos Med (Editorial) - Human trafficking and labor exploitation: Toward identifying, implementing, and evaluating effective responses
https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002740
“
In an Editorial, Ligia Kiss & Cathy Zimmerman discuss the need for research on the prevention of human trafficking and mitigation of its effects.”
UN News - Human trafficking cases hit a 13-year record high, new UN report shows
https://news.un.org/en/story/2019/01/1031552
“
The latest Global Report On Trafficking In Persons, released on Tuesday … shows a record-high number of cases detected during 2016, but also the largest recorded conviction rate of traffickers.”… “While in 2003 fewer than 20,000 cases had been recorded, the number of cases recorded in 2016 had jumped to over 25,000. ..Over the last decade, the capacity of national authorities to track and assess patterns and flows of human trafficking has improved in many parts of the world. In 2009, only 26 countries had an institution which systematically collected and disseminated data on trafficking cases, while by 2018, the number had risen to 65. “
“The study shows that in all the conflicts examined for the report, forcibly displaced populations (refugees and internally displaced families) have been specifically targeted: from settlements of Syrian and Iraqi refugees, to Afghans and Rohingya fleeing conflict and persecution.”
“While we are far from ending impunity, we have made headway in the 15 years since the Protocol against Trafficking in Persons entered into force,” said UNODC’s chief Mr. Fedotov, as he noted that “nearly every country now has legislation in place criminalizing human trafficking.” The international community needs to accelerate progress to build capacities and cooperation, to stop human trafficking in conflict situations and in all our societies where this terrible crime continues to operate in the shadows,” he stated in the report’s preface.”
O’Neill Institute - Health Equity Programs of Action (HEPA)
http://oneill.law.georgetown.edu/projects/tuberculosis-law-and-human-rights-project/health-equity-programs-of-action/
“…
We offer a new approach to reducing [these] health inequities, an approach that would be comprehensive, aim to empower the people who experience these inequities, and that could help establish a sustained national focus on health equity. This approach is embodied in the concept of health equity programs of action (HEPA), which is what we propose here. These programs of action would be based on seven principles:…”
Cfr a tweet: “
MDG era lesson: No health equity without deliberate plans. Missing: Systematic, systemic & inclusive plans to address vast health inequities. Found: Just such an approach: health equity programs of action, launched today”.
You also find here material on HEPA, with more in-depth descriptions and the complete implementation framework, as well as on the concept from which it emerged:
national health equity strategies.
Lassa Fever vaccine ?
Guardian - First-ever safe, effective vaccine against Lassa fever
https://guardian.ng/features/health/first-ever-safe-effective-vaccine-against-lassa-fever/
“…scientists have developed the first-ever live ML29 vaccine that is safe and effective against Lassa fever in Nigeria and has advantages for containing outbreaks and large-scale epidemics of the virus. The breakthrough study was presented last week at the first-ever Lassa Fever International Conference to celebrate the 50th anniversary of the discovery of the first case of the virus in Lassa, Borno State, tagged: “Rising To The Challenge.”The Nigeria Centre for Disease Control (NCDC) Abuja organized the conference. … … The study is titled “Development of safe and effective Vaccine against Lassa Fever in Africa.” …”
“
NCDC, Innovative Biotech, Medigen others plan human clinical trials in Nigeria, says licensed product will be available by 2022. *Company sets 24 months timeline to manufacture as promising immunisations for diseases in poor countries are going to waste. ”
Hepatitis C interventions modelling
Cfr a press release on a
new study in the Lancet:
“The Lancet: Major progress against hepatitis C by 2030 is possible, but will need vast improvements in screening, prevention and treatment”
“First global estimates to determine the impact of improved prevention, diagnosis and treatment, and examine how achievable the WHO elimination targets are.
A comprehensive package of prevention, screening, and treatment interventions could avert 15.1 million new hepatitis C infections and 1.5 million cirrhosis and liver cancer deaths globally by 2030 – equal to an 80% reduction in incidence and a 60% reduction in deaths compared with 2015, according to the first study to model hepatitis C interventions globally published in The Lancet.
The estimates suggest that the interventions modelled in the study would reach the elimination targets set by the World Health Organization (WHO) to reduce the number of new hepatitis C infections by 80%, but narrowly miss the target to reduce mortality by 65% – which would instead be reached by 2032….”
Check out also the
related Lancet Comment -
How feasible is the global elimination of HCV infection?
Ebola outbreak DRC – a new hotspot & still spreading
Some links from this week:
Reuters (25 Jan) -
Ebola spreads to high-risk area of Congo: WHO
“
Democratic Republic of Congo’s Ebola outbreak has spread southwards into an area with high security risks, the World Health Organization said…. Most of the cases since the start of the year have been in Katwa health zone, where the WHO said Ebola workers had faced “pockets of community mistrust” and most people falling ill were not on lists of people suspected of coming into contact with Ebola. “The outbreak has also extended southwards to Kayina health zone, a high security risk area,” the WHO said in its statement late on Thursday. There have been five cases in Kayina, which lies between the main outbreak zone and the major city of Goma, which is close to the Rwandan border….” See also
Cidrap.
MSF crisis update (as of 30 Jan) -
https://www.msf.org/drc-2018-ebola-outbreak-crisis-update
“The current #Ebola outbreak in #DRCongo is also its largest - As of 29th January @MinSanteRDC confirms there were : ➡️ 689 confirmed cases; ➡️ 258 cured persons; ➡️ 461 deaths . …”
See also
Cidrap News for an
update. Or
BMJ News -
Congo’s Ebola epidemic is now its worst ever and still spreading (
perhaps even to a third province (MoH DRC) ).
Meanwhile,
South-Sudan has also started vaccinations of front line health staff.
And (Cidrap) -
More than 70,000 people in the Democratic Republic of the Congo (DRC) have now been vaccinated with VSV-EBOV, Merck's unlicensed Ebola vaccine, according to today's update from DRC health officials. Plus there are cross-border concerns near Uganda.
Devex - DRC Ebola crisis serves as test for WHO health reform
J L Ravelo;
https://www.devex.com/news/drc-ebola-crisis-serves-as-test-for-who-health-reform-94216
Analysis from the EB meeting: “
The World Health Organization was quick in its response to the Ebola outbreak in the Democratic Republic of the Congo, but still needs to work on staffing, security, and coordination, according to the latest evaluation of its health emergencies work — with strong criticism coming from some member states….”
Global health security
IDS - Pandemic preparedness: who is being prepared for what, and by whom?
M Leach et al;
https://www.ids.ac.uk/opinions/pandemic-preparedness-who-is-being-prepared-for-what-and-by-whom/
“…We have launched a new project funded by the Wellcome Trust: Pandemic Preparedness: local and global concepts and practices in tackling disease threats in Africa. .. The project aims to track the meanings and concepts of pandemic preparedness at global, regional and local levels, and the ways these interconnect – or fail to.”
“At this crucial juncture, there is an urgent need to reflect on differences between preparedness as a global health concept, and what we term ‘preparedness from below’ – the understandings and practices of communities through which they anticipate and manage disease and other adversity on an everyday basis. Put slightly differently: who is being prepared, for what, and by whom? These are critical questions – for the ethics of humanitarian engagement, for considerations of global justice, and indeed for the effectiveness of disease control and response.”
Focus will be on three themes.
BMJ Global Health Commentary - Improving emergency preparedness and response in the Asia-Pacific
Ben J Marais et al ;
https://gh.bmj.com/content/4/1/e001271
“Given that the Asia-Pacific region is a recognized hotspot for disease emergence and spread, every effort should be made to improve regional health security by strengthening and advancing adequate disease surveillance and response capacity. In general, efforts within and collaboration between the Western Pacific and South-East Asia regions have been exemplary, but many challenges remain. Potential solutions include new regional funding mechanisms to support infrastructure and capacity-building programmes, together with increased domestic investment in health systems and laboratory infrastructure, as well as ongoing monitoring and evaluation to identify and reduce vulnerability at the Subnational, National and Regional levels.”
BMJ Global Health - Assessing global preparedness for the next pandemic: development and application of an Epidemic Preparedness Index
B Oppenheim et al;
https://gh.bmj.com/content/4/1/e001157
“
Robust metrics for national-level preparedness are critical for assessing global resilience to epidemic and pandemic outbreaks. However, existing preparedness assessments focus primarily on public health systems or specific legislative frameworks, and do not measure other essential capacities that enable and support public health preparedness and response. We developed an Epidemic Preparedness Index (EPI) to assess national-level preparedness. The EPI is global, covering 188 countries. It consists of five subindices measuring each country’s economic resources, public health communications, infrastructure, public health systems and institutional capacity….”
Preparations for the UN High-Level Meeting on UHC: civil society consultation
UHC 2030 - Contribute to UN HLM Preparation
https://www.uhc2030.org/un-hlm-2019/contribute-to-un-hlm-preparation/
“
The President of the United Nations General Assembly (PGA) will organise a multi-stakeholder hearing, before the end of July 2019, to allow non-state actors to formally contribute to the preparation of UN HLM. … … UHC2030 has been asked to support the preparatory process for the UN HLM, particularly regarding “sharing evidence and good practices, challenges and lessons learned”. Based on the experience with recent high-level events, UHC2030, as a multi-stakeholder platform for UHC, is expected to co-convene the multi-stakeholder hearing of UN HLM with PGA. This will take place before the formal inter-governmental negotiations of the political declaration….”
Check out the (10 p.)
Draft UHC2030 Asks for multi-stakeholder engagements
The aim is, among others, to develop a set of ‘asks’ to feed into the political declaration.
See also a
PMAC event – “
UHC2030 [is] holding a side event at the Prince Mahidol Award Conference, Bangkok, 30 January 2019 to discuss inputs into the High-level Meeting on UHC in September 2019
Lancet - Offline: India's health crisis: will democracy deliver?
R Horton;
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30192-8/fulltext
Horton reflects on the upcoming elections in India and notes health is not yet a key issue in the election debates. “…
The battle for the votes of 850 million people is between the current Prime Minister, Narendra Modi, who leads the Bharatiya Janata Party (BJP), and Rahul Gandhi, who leads the India National Congress. … …Until recently, Modi was expected to win again in 2019. But his popularity seems to be waning, while political momentum is now behind Gandhi….”
“…Disappointingly, health does not yet seem to be an important factor in India's election. The best that Rahul Gandhi could do in Dubai was cite health care as a future industrial opportunity—“We have the most complex DNA structures on the planet”, he said (rather inexplicably). Meanwhile, Modi might point to his Ayushman Bharat health reforms, launched last year. …”
Concluding
: “…India faces a challenge: not to squander this opportunity to make the health of its most deprived people the country's supreme political priority….”
Slightly along the same lines, read:
Lancet World Report - Health agenda close to absent in Nigeria's election campaign
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30199-0/fulltext
“
The so-called Giant of Africa is holding presidential elections shortly. Despite the many challenges the country faces, health is far down the candidates' policy priorities. Paul Adepoju reports.”
Time to fly in Rob Yates, I say, in both countries.
PHC
Leadership - Routine Immunisation: Nigeria To Receive $75m Incentive From Gates Foundation
Leadership;
“
The federal government, represented jointly by the ministers of Budget and National Planning, Finance, and Health, yesterday, announced a new innovative financing agreement with the Bill & Melinda Gates Foundation. This, the ministers said was aimed at strengthening both routine immunisation (RI) and broader primary healthcare (PHC) services in the country. In a statement, the Ministry of Heath said under the agreement, Nigeria will receive incentive financing of up to $75 million over five years from the Gates Foundation as the government meets existing commitments to increase domestic funding of its RI programme. According to the statement, the incentive financing will be directly invested in country’s Basic Healthcare Provision Fund (BHCPF), strengthening other PHC services for the poorest….”
Ayushman Bharat: 1.53 lakh health and wellness centres by 2022, only 6,000 so far
https://indianexpress.com/article/india/narendra-modi-ayushman-bharat-scheme-health-and-wellness-centres-5556574/
“Since the launch of the first health and wellness centre (HWC) in Chhattisgarh by PM Narendra Modi in April last year, 6,193 HWCs are functional in the country till January 23, and of these, more than 2,500 are in just Andhra Pradesh and Tamil Nadu. Progress on HWCs will be reviewed in the PMO on January 30, the third time that the programme will be reviewed …”
“A senior health ministry official said, “We are hopeful that by the end of this month, 9,000 will be completed. By the end of the financial year, we will meet the target of 15,000 HWCs. Even as we speak, the first batch of close to 4,000 mid-level workers will be graduating from IGNOU and that would help in manning some more centres. The target for next year is 25,000. We will have all 1,53,000 in place by December 2022.” … … However, if the progress in the first year is any indication though, 1,53,000 HWCs could take upward of 10 years.”
CGD – Will 2019 Be the Year of Making Primary Health Care Happen?
C Kenney et al ;
https://www.cgdev.org/blog/will-2019-be-the-year-making-primary-health-care-happen
“…
While the Astana declaration spotlighted the importance of PHC, its ambitious rhetoric is not yet backed by meaningful actions and clear accountability mechanisms. The High-Level Meeting on UHC planned for September 2019 presents the perfect moment for governments and global health funders to move beyond buzzworthy yet hollow declarations and instead make concrete financial and strategic commitments. Thoughtful and systematic consideration of the policy and implementation pitfalls that often go overlooked will be critical.
“Below, we highlight four policy ideas for making PHC a reality on the path to UHC, drawing on a recent event CGD convened in partnership with John Snow, Inc. (JSI) and the Primary Health Care Performance Initiative (PHCPI).
- Rationalize spending to drive efficiency and appropriate resource allocation within countries
- Incentivize donors to invest in PHC in a way that mutually reinforces shared priorities
- Identify missing links and foster connections across sectors and healthcare system levels
- Data and measurement should lead the way towards accountability”
World Leprosy day (27 January)
Devex - Leprosy community asks if their magic bullet really is magic
https://www.devex.com/news/leprosy-community-asks-if-their-magic-bullet-really-is-magic-94186
“
Leprosy post-exposure prophylaxis is the first major innovation in treatment since multidrug therapy — which stops the transmission and prevents further disabilities — was introduced in the 1980s. But organizations fighting the neglected tropical disease disagree on whether it’s really the magic bullet it’s been touted to be. LPEP, as the innovation is otherwise known, was launched by the Novartis Foundation in 2014 and is a drug therapy consisting of a single dose of the antibiotic rifampicin. If administered to those who come into close contact with a person with leprosy — regardless of whether or not they present with leprosy symptoms: nerve damage, numbness, and loss of vision — it is 50-60 percent effective in preventing the development of the disease over the next 2 years. Some academics, including Diana Lockwood, the U.K.’s chief leprologist and trustee of Lepra, believe it’s not an effective method, does not protect against leprosy, and presents serious ethical problems….”
“…
LPEP is included in the World Health Organization’s guidelines for the diagnosis, treatment and prevention of leprosy and has so far been rolled out in eight countries….”
“…
While the process of LPEP delivery may “out” a person with leprosy, Dr. Bart Vander Plaetse, deputy director of FairMed, said there’s no better solution currently out there: “[LPEP] is not the golden bullet in leprosy control, but it's a bullet and in the absence of any other new additional tools in our toolbox, it’s something that most practitioners in the field — not practitioners in the laboratory — are eager to start implementing.”…”
And then, probably thinking of me (i.e. my way of ‘causal thinking’ 😊 ), ““…
The fact that it's on the Novartis Foundation’s agenda makes many people suspicious because Novartis Foundation sounds very much like Novartis and Novartis sounds very much like big pharma, and the assumption is that nothing can be true from that side,” said Vander Plaetse, who previously worked for Novartis Foundation and believes that assumption is wrong….”
Lancet Comment - Picturing health: a new face for leprosy
A Kumar et al;
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30158-8/fulltext
“
It is true that leprosy impairs and society disables. Leprosy is a neglected tropical disease and one of the most stigmatising of diseases. Images of severely disabled patients with leprosy have helped to raise awareness, attract attention, and drive donations. But these pictures are not representative of the disease. Leprosy patients deserve a better image—leprosy needs a new face. Many people with leprosy will not develop severe disease if they access treatment early. Leprosy infection is curable with 6 or 12 month courses of two or three antibiotics depending on the type of leprosy that they develop, provided free to national leprosy programmes by WHO through the Novartis Foundation…. ”
See also a
Lancet Editorial this week -
Abandoning the stigma of leprosy
“…
To coincide with World Leprosy Day on Jan 27, we publish images from the New Face of Leprosy Project….”
Based in Addis Ababa, Ethiopia (with plans to expand to other countries), the project has captured images and personal journeys of those living with leprosy. … The positive images portrayed in the New Face of Leprosy Project offer powerful human stories for overcoming stigma. …”
2020 – Year of the nurse ?
It appears rather likely that 2020 will be the ‘year of the nurse’. Cfr a few tweets coming from the WHO’s EB meeting:
“
It was a huge honour this afternoon to deliver this statement to the WHO Exec Board on behalf of @ICNurses and in support of 2020 being a year to celebrate Florence Nightingale, Nurses, Nursing and Midwifery - @DrTedros said it could be a game changer in delivering #UHC & #PHC.”
“Great news! #EB144 has agreed to designate 2020 - the 200th anniversary of the birth of Florence Nightingale - as Year of the Nurse and Midwife. Nurses & midwives play such a vital role in delivering #HealthForAll.”
“Fantastic news that @WHO supports designating 2020 as 'Year of the Nurse’. Nurses are key to health teams across the world and this would be fitting.”
Let’s hope that all the other years of this century will not be the ‘year of the doctors’, then.
Global burden of postoperative death
Lancet (Correspondence) – Global burden of postoperative death
D Nepogodiev et al (on behalf of the National Institute for Health Research Unit on Global Surgery)
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)33139-8/fulltext
“
The Lancet Commission on Global Surgery identified that 313 million surgical procedures are performed worldwide each year. Little is known about the quality of surgery globally because robust reports of postoperative death rates are available for only 29 countries. The rate of postoperative deaths is a measure of the success of surgical care systems, and improving this metric is a global priority. We aimed to estimate, on the basis of surgical volume, case mix, and postoperative death rates adjusted for country-income level, how many people around the world die within 30 days of surgery. … “
“…
Our analysis suggests that at least 4·2 million people worldwide die within 30 days of surgery each year, and half of these deaths occur in LMICs. This number of postoperative deaths accounts for 7·7% of all deaths globally, making it the third greatest contributor to deaths, after ischaemic heart disease and stroke (figure). More people die within 30 days of surgery annually than from all causes related to HIV, malaria, and tuberculosis combined (2·97 million deaths). We project that an expansion of surgical services to address unmet need would increase total global deaths to 6·1 million annually, of which 1·9 million deaths would be in LMICs….”
“…
Although there is a pressing need to expand surgical services to populations that are underserved, this expansion must be done in tandem with initiatives to reduce postoperative deaths….”
Some key papers of the week
Global Policy (Special Issue) – Knowledge and Politics in Setting and Measuring SDGs
https://www.globalpolicyjournal.com/journal-issue/special-issue-knowledge-and-politics-setting-and-measuring-sdgs
“
The papers in this special issue investigate the politics that shaped the SDGs, the setting of the goals, the selection of the measurement methods. The SDGs ushered in a new era of ‘governance by indicators’ in global development. Goal setting and the use of numeric performance indicators have now become the method for negotiating a consensus vision of development and priority objectives. The choice of indicators is seemingly a technical issue, but measurement methods interprets and reinterprets norms, carry value judgements, theoretical assumptions, and implicit political agendas. As social scientists have long pointed out, reliance on indicators can distort social norms, frame hegemonic discourses, and reinforce power hierarchies. The case studies in this collection show the open multi-stakeholder negotiations helped craft a more transformative and ambitious goals. But across many goals, there was slippage in ambition when targets and indicators were selected. The papers also highlight how the increasing role of big data and other non-traditional sources of data is altering data production, dissemination and use, and fundamentally altering the epistemology of information and knowledge. This raises questions about ‘data for whom and for what’ – fundamental issues concerning the power of data to shape knowledge, the democratic governance of SDG indicators and of knowledge for development overall.”
Make sure you check out at least:
RingS - Key Considerations for Accountability and Gender in Health Systems in Low- and Middle-Income Countries
https://ringsgenderresearch.org/resources/accountability-gender-health-systems/
“
This article poses questions, challenges, and dilemmas for health system researchers striving to better understand how gender shapes accountability mechanisms, by critically examining the relationship between accountability and gender in health systems. It raises three key considerations, namely that: (1) power and inequities are centre stage: power relations are critical to both gender and accountability, and accountability mechanisms can transform health systems to be more gender-equitable; (2) intersectionality analyses are necessary: gender is only one dimension of marginalisation and intersects with other social stratifiers to create different experiences of vulnerability; we need to take account of how these stratifiers collectively shape accountability; and (3) empowerment processes that address gender inequities are a prerequisite for bringing about accountability. We suggest that holistic approaches to understanding health systems inequities and accountability mechanisms are needed to transform gendered power inequities, impact on the gendered dimensions of ill health, and enhance health system functioning.”
See
Linda Waldman et al in
IDS Bulletin -
Key Considerations for Accountability and Gender in Health Systems in Low- and Middle-Income Countries*
BMZ - A systems perspective on Universal Social Protection - Towards life-long equitable access to comprehensive social protection for all
M Ulrichs et al;
http://health.bmz.de/ghpc/discussion_papers/Universal_Social_Protection/index.html
Discussion paper.
“…
Jointly initiated by the World Bank and the International Labour Organization (ILO), the Global Partnership for Universal Social Protection (USP2030) was launched in September 2016 together with other development agencies and NGOs, the African Union, the European Union and individual countries including Germany….”
Some of the key points: “
Is the USP2030 goal (SDG 1.3) realistic? How to provide USP in Lower- and Middle-Income Countries (LMICs) including to people in the informal sector? What is the role of targeting in USP? What problems can hamper the development of USP? Has the focus on the official shared goal of USP2030 improved coordination among development partners?”
HP&P - Reconceptualizing the role of emergency care in the context of global healthcare delivery
L C Carlson et al ;
https://academic.oup.com/heapol/advance-article-abstract/doi/10.1093/heapol/czy111/5301490?redirectedFrom=fulltext
«
Since the adoption of the SDGs in 2015, innovation in global healthcare delivery has been recognized as a vital avenue for strengthening health systems and overcoming present implementation bottlenecks. In the recent rapid development of the science of global health-care delivery, emergency care—a critical element of the health system—has been widely overlooked. Emergency care plays a vital role in the health system through providing immediately responsive care and serving as one of the main entry points for those with symptomatic disease. We present a new perspective on emergency care’s role in the health system within the context of global health-care delivery, and argue that, if properly integrated, emergency care has the potential to add significant value across the healthcare continuum….”
BMJ Global Health (supplement) - - Complex health interventions in complex systems: improving the process and methods for evidence-informed health decisions
https://gh.bmj.com/content/4/Suppl_1
Start with the
Editorial by S Norris et al.
“…
In order to address the challenges and realities of public health and health system interventions and to better meet the needs of decision-makers, in 2016 WHO initiated a project to strengthen its processes and methods for developing guidelines on complex health interventions and interventions delivered in complex systems. The work led to this series of papers which contribute to the broader conceptualisation of complexity and the implications for evidence synthesis and guideline development, whether at the global, national or health systems level….”
You also find a nice
figure here on how the 8 papers relate to each other.
Then go for the analysis & research papers.
BMJ Collection - Solutions for non-communicable disease prevention and control
https://www.bmj.com/NCD-solutions
“
Non-communicable diseases (NCDs) constitute a major global health challenge. This collection examines the major obstacles to preventing and controlling these diseases and suggests scalable solutions.”
Already with 6 articles and more to come!
BMJ Editorial – Preventing and managing chronic diseases
R Nugent;
https://www.bmj.com/content/364/bmj.l459
“Would reduce the cost of healthcare and spur economic growth.”
“
This is why non-communicable diseases (NCDs) are the second theme of The BMJ’s series on health, wealth, and profits.”
“…
Options exist for reducing impoverishment and medically related financial stress, and the most attractive is universal health coverage financed by public sources. “Essential” universal health coverage offers an affordable and cost effective path for low income and lower middle income countries to follow in expanding prevention and care for NCDs…”
Plos blog - Introducing the Economic Cases for NCD Prevention and Control Collection
The
International NCD Economics Research Network;
https://blogs.plos.org/collections/introducing-the-economic-cases-for-ncd-prevention-and-control-collection/#.XFB8P7ekIoE.twitter
“…
Aiming to expand the evidence base on the economic burden of NCDs and the importance of NCD prevention and control programs globally, the International NCD Economics Research Network has launched a PLOS Special Collection titled “Economic Cases for NCD Prevention and Control: A Global Perspective”. The Special collection currently features nine articles published in PLOS ONE on economic evaluations of interventions, investment cases for NCD interventions, evaluation of NCD risk reduction policies, socioeconomic distribution of risk behaviors, and the economic impacts of NCDs on households, health systems, and nations….”
BMJ Global Health (Analysis) - Health systems changes after decentralisation: progress, challenges and dynamics in Pakistan
S A Zaidi et al ;
https://gh.bmj.com/content/4/1/e001013
“
Decentralisation is widely practised but its scrutiny tends to focus on structural and authority changes or outcomes. Politics and process of devolution implementation needs to be better understood to evaluate how national governments use the enhanced decision space for bringing improvements in the health system and the underlying challenges faced. We use the example of Pakistan’s radical, politically driven provincial devolution to analyse how national structures use decentralisation opportunities for improved health planning, spending and carrying out transformations to the health system….”
AJPH – Faith and Global Health Practice in Ebola and HIV Emergencies
John Blevins et al ;
https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2018.304870
“
We examined the relationship between religion and health by highlighting the influences of religion on the response to the 2014 to 2016 Ebola outbreak and the global HIV epidemic. We recounted the influences of religion on burial practices developed as an infection control measure during the Ebola outbreak in West Africa. We also explored the influence of religion on community outreach and health education. We examined faith-based responses to the global HIV/AIDS pandemic, noting that religion conflicted with public health responses to HIV (e.g., justification for HIV-related stigma) or aligned with public health as a force for improved HIV responses (e.g., providing HIV services or providing social capital and cohesion to support advocacy efforts). We further discussed the similarities and differences between the influence of religion during the HIV/AIDS pandemic and the 2014 to 2016 Ebola outbreak.”
Lancet Psychiatry - A partnership for transforming mental health globally
D Vigo et al;
https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(18)30434-6/fulltext
“
The large and increasing burden of mental and substance use disorders, its association with social disadvantage and decreased economic output, and the substantial treatment gaps across country-income levels, are propelling mental health into the global spotlight. The inclusion of targets related to mental health and wellbeing in the UN's Sustainable Development Goals, as well as several national and global initiatives that formed during the past 5 years, signal an increasing momentum toward providing appropriate financing for global mental health. Drawing on the organisational and financial architecture of two successful global health scale-up efforts (the fight against HIV/AIDS and the improvement of maternal and child health) and the organisational models that have emerged to finance these and other global health initiatives, we propose a multi-sectoral and multi-organisational Partnership for Global Mental Health to serve two main functions. First is the mobilisation of funds, including raising, pooling, disbursing, and allocating. Second is stewardship, including supporting countries to use funds effectively, evaluate results, and hold stakeholders accountable. Such a partnership would necessarily involve stakeholders from the mental health field, civil society, donors, development agencies, and country-level stakeholders, organised into hubs responsible for financing, scale-up, and accountability.”
Global Policy (briefing) - What you get for your dollar - "Effective Altruism"-What it is, how philanthropic foundations use it and what are its risks and side-effects
K Seitz;
Global Policy;
“
A new approach, labeled “Effective Altruism” (EA) has gained traction in the debate on the impact of development aid. Unlike Aid Effectiveness, which involves donor and recipient governments, the new approach involves philanthropic institutions and their chosen (non-)governmental recipients and explores ways in which funding can be used most efficiently to have the greatest impact. Its proponents claim that their funding decisions are based on evidence-based results. However, such decisions are primarily grounded in cost-benefit considerations, neglecting social and cultural considerations and looking at problems in isolation from the wider context. From a human rights perspective, several concerns arise concerning the underlying assumptions, the methodology and the consequences of the practical application of EA. A new briefing paper, published by Global Policy Forum, Brot für die Welt and MISEREOR provides an overview of the approach underlying EA, how and by whom it is applied and its problems and consequences. It concludes that policy makers, rather than be guided by its assumptions and conclusions, must instead concentrate on understanding the confounding structural causes of interdependent global challenges and aim at their long-term solution, within an overarching human rights framework.”
Some key blogs & mainstream articles of the week
PHM - Modicare: High on rhetoric, low on evidence
https://phmovement.org/modicare-high-on-rhetoric-low-on-evidence/#
4 PHM people take down
Richard Horton’s Offline from a while ago, on Modi Government’s Ayushman Bharat.
Guardian – Bill Gates says poverty is decreasing. He couldn’t be more wrong
Jason Hickel;
https://www.theguardian.com/commentisfree/2019/jan/29/bill-gates-davos-global-poverty-infographic-neoliberal
A bit one-sided perhaps, but not more so than his (intellectual) opponent’s. And thus well worth a read.
“
An infographic endorsed by the Davos set presents the story of coerced global proletarianisation as a neoliberal triumph”.
NYT - If a Government Can’t Deliver Safe Vaccines for Children, Is It Fit to Rule?
Yanzhong Huang (CFR) ;
NYT;
Interesting read. On the link between the Chinese government’s performance legitimacy and vaccine scandals. For political scientists 😊. Huang also provides a way forward for the Chinese government. Admittedly, a rather unlikely one in the current circumstances.
Social Europe - From the ‘yellow vests’ to the social-ecological state
- Laurent; https://www.socialeurope.eu/the-social-ecological-state
“
The concept of the social-ecological state can inspire a new social policy to tackle the twin crises of inequality and environment.” I hope it also inspires the global/planetary health community.
“
The revolt of the gilets jaunes is the first social-ecological crisis of contemporary France and one of the first in Europe. It was triggered by the major issue—too long eluded in the country of pristine republican equality—of fossil fuels trapping millions of workers daily. Many others crises will follow or are already here, some blazing, others nagging. All ecological challenges are social issues and the environment is the new frontier of inequality….”
“In the face of these social-ecological crises, the same question arises: are we ready? Obviously not. What can we do about it? Everything. … … More precisely, we can be doing as we have been doing in Europe for over a century with resounding success—building collective institutions able to mutualise risk to reduce injustice. We can build a social-ecological state calibrated for the 21st century, where the crisis of inequality and the ecological crisis are intertwined and mutually reinforcing….”
WB (blog) – The World Bank’s role in SDG monitoring
http://blogs.worldbank.org/opendata/world-bank-s-role-sdg-monitoring?CID=DEC_TT_data_EN_EXT
“
In 2015, leaders of 193 countries formed an ambitious plan to guide global development action for the next 15 years by agreeing on a set of Sustainable Development Goals (SDGs). Four years after their launch, the World Bank’s expertise in development data and its large repository of development indicators has played an important role in helping track progress made towards the achievement of the SDGs. How does SDG monitoring work and how is the World Bank involved?...”