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IHP news #411 (March 24, 2017)

Highlights of the week

Laurie Garrett – Global Health in a Populist and Nationalist Age


From late last week, but an absolute must-read (if you haven’t done so yet). Laurie Garrett explores the new ( and rather difficult) ‘environment’ for global health.

She ends like this: “…. Global health should not be a matter of endless charity, political whim, profiteering, or philanthropic trendiness. Health is a right, which must be demanded from the bottom up, and achieved through the largesse, skills, and commitment of all, sharing and hoping for the future of humanity. Period.

Do read also Anne Slaughter’s – in the words of Kent Buse – “Perceptive if pessimistic analysis of prospects for rules-based multilateralism & UN” – The return of anarchy?   (recommended)  “…The next four to eight years may well see the end of the United Nations as a serious forum for global decisionmaking about peace and security….

We also think the near future will be one of regional blocks (or worse) rather than multilateralism – especially if Trump & the GOP get a second term.

Meanwhile, make sure you also read (Oxfam’s) Duncan Green’s On Populism, Nationalism, Babies and Bathwater  – Duncan reports on a recent conversation with Oxfamers who were over from the US.  “How should ‘we’ – the aid community broadly defined – respond to the rising tide of nationalism, populism, and attacks on aid?”  Must-read.

Duncan concludes: “…Concerned that the development community could jump into current northern battles on populism, Brexit etc not primarily because doing so is vital to helping the world end poverty in the long term, or because the issues that matter have suddenly become universal, but because the values of northern activists push them to get involved for personal reasons. If that happens, we risk forfeiting our legitimacy, which in the eyes of northern publics and policy makers is rooted in our links with and understanding of events in the South. And what do we gain if ‘Going Northern’ doesn’t add much to the existing progressive forces in the North? And although many issues like equal rights, inequality etc are universal, some things (like famine) are not….”

At least a question worth pondering indeed, also for the global health community.

Humanosphere –  Gates Foundation’s rose-colored world view not supported by evidence

Martin Kirk & Jason Hickel;  http://www.humanosphere.org/opinion/2017/03/gates-foundations-rose-colored-world-view-not-supported-by-evidence/

(must-read) “The annual public letter from Bill and Melinda Gates has become a much-celebrated event in the global development calendar. But lost in the excitement around this year’s letter is the fact that it uses 6,000 words to paint a picture that is so selective in its use of facts that it amounts to little more than propaganda for a failing aid and development industry, and indeed a failing ideology. And the 2017 letter is especially striking for just how out-of-sync it feels with the zeitgeist.”  Kirk & Hickel rip the annual letter from the Gates Foundation apart, while acknowledging the good the Foundation has done and is still be doing.

But read also Charles Kenny’s reply (CGD) – Really, Global Poverty *Is* Falling. Honest. You won’t regret it.

Bill Gates meets with Donald Trump (part two) – 20 March

After Trump’s election victory, Gates already met with him ( in Trump Tower). On Monday, Bill went to the White House.

We recommend the following two pieces (published ahead of the meeting):

VoxBill Gates takes his campaign against “America First” directly to Donald Trump today

Two American billionaires with extremely divergent worldviews are engaging in a quiet war of rhetoric about global health and development. One is Bill Gates; the other is Donald Trump. [On Monday], Gates is scheduled to meet with the president. And ahead of that meeting, Gates has been putting out articles and letters that seem like thinly veiled arguments against Trump’s “America First” approach to foreign aid.”  (for example in Time magazine)

QuartzWe’re wondering what exactly Bill Gates and Donald Trump will have to talk about tomorrow  The tone has changed (as compared to December, when Gates was sort of dreaming that Trump would turn out a new JF Kennedy), but “Gates is, however, among the few tech industry leaders still trying to talk to the president. “

As for the meeting itself, rather little information was released afterwards (by both parties). See Bloomberg :

President Donald Trump met with Microsoft Corp. co-founder Bill Gates at the White House on Monday, just days after releasing a budget proposal that would impose deep cuts on funding for many of the causes championed by the billionaire philanthropist. White House spokesman Sean Spicer said the two spoke about their “shared commitment to finding and stopping disease outbreaks around the world.” Gates, who wrote an article saying cuts to foreign aid Trump proposed would make America “less safe,” didn’t speak to reporters afterward.  … … Sarah Logan, a spokeswoman for the foundation, said in a statement after the meeting that the organization “has a long history of working with officials on both sides of the aisle to pursue shared priorities like global health and development and domestic education.””

As so little information is available on what the two (gentle)men (?) discussed, I jotted down an imaginary conversation between the two (on IHP) – Bill Gates teaches Donald Trump on the many merits of foreign aid for America – Lesson 1.   If anybody feels like writing down other lessons (or even a whole tutorial for The Donald), be our guest!

Gates also  met with several congressional leaders on Tuesday to discuss foreign aid and global health issues (The Hill).

World TB Day – Friday 24 March


2017 is the second year of a two-year “Unite to End TB” campaign for World TB Day. This year, WHO will place a special focus on uniting efforts to “Leave No One Behind”, including actions to address stigma, discrimination, marginalization and overcome barriers to access care.”  “…Last year, WHO reported that 10.4 million people fell ill with TB and there were 1.8 million TB deaths in 2015, making it the top infectious killer worldwide.

WHO – WHO issues ethics guidance to protect rights of TB patients


“New tuberculosis (TB) ethics guidance, launched today by the World Health Organization (WHO), aims to help ensure that countries implementing the End TB Strategy adhere to sound ethical standards to protect the rights of all those affected….”

Guardian – Decades of TB progress threatened by drug-resistant bacteria, warn experts

Sarah Boseley; Decades of TB progress threatened by drug-resistant bacteria, warn experts.

The rise of multi-drug resistant bacteria threatens to overturn decades of progress on tuberculosis (TB), experts are warning. Multi-drug resistant (MDR) and extensively drug-resistant (XDR) strains of TB are causing increasing concern, says a new report in the Lancet Respiratory Medicine journal. Migration and travel mean that drug-resistant cases of tuberculosis that are difficult to treat have appeared in almost every part of the world.”

In a comment piece in the journal Dr David W Dowdy, from the Johns Hopkins Bloomberg School of Public Health in the US, said the report described an epidemic that is at a crossroads….” “…Over the next decade, it is quite possible that we will see a drug-resistant tuberculosis epidemic of unprecedented global scale. But it is also possible that the next decade could witness an unprecedented reversal of the global drug-resistant tuberculosis burden. The difference between these two outcomes lies less with the pathogen and more with us as a global tuberculosis control community and whether we have the political will to prioritise a specific response to the disease. Drug-resistant tuberculosis is not standing still; neither can we.”

For the new Lancet Respiratory Medicine report – see  here.  The Lancet Respiratory Medicine Commission “focuses on multidrug-resistant, extensively drug-resistant, and incurable tuberculosis, and highlights the growing burden of disease, the implications for patient management, as well as social and legal aspects”.

Read also a Lancet (Comment)Reducing global tuberculosis deaths—time for India to step up  “As another World Tuberculosis Day passes by the outlook for tuberculosis control is far from optimistic, especially for India, the ground zero for the global epidemic.”

And finally, a Lancet World ReportNew plan to end tuberculosis in south and southeast Asia  “Health ministers from south and southeast Asia agreed to fast-track strategies to eliminate tuberculosis by 2030 at a WHO regional meeting in Delhi last week. Dinesh C Sharma reports.”

Trump & US health care

It’s clearly not a walk in the park – repealing Obamacare.  It turns out a very difficult balancing act for the GOP leadership & Trump to keep enough GOP conservatives ànd moderates on board in order to get the required number of votes.

Ahead of an important vote in the House (on Thursday), (NYT) House Republicans rolled out amendments to their plan to replace the ACA.   (see also Reuters  or FT – Party makes last-ditch effort to bridge divisions and keep Trump’s promise on track : “Republicans seeking to keep Donald Trump’s healthcare overhaul on track have made a series of last-ditch changes to their plans as they struggle to unite the party behind them. Party leaders on Monday night announced revisions to their healthcare bill in an effort to bridge the divide between conservatives and moderates ahead of a planned vote in the House of Representatives on Thursday. Divisions within the party are threatening Mr Trump’s progress not just on healthcare but also in other areas, including tax reform….”

On Wednesday, Trump himself also made a last-ditch pitch to Republicans to back the healthcare bill (Guardian). See also NYT  or FT – Trump warns Republicans to support health law (or lose their seats in 2018).

Guardian – House plans Friday healthcare vote as Trump gives ultimatum to Republicans


(must-read) And this is the latest state of affairs. Friday looks set to be D-Day now (for the House).  “Emissaries for Donald Trump have told Republicans that the president was done negotiating over healthcare legislation and that the House of Representatives must vote on the current bill Friday or he would leave the Affordable Care Act in place. White House budget director Mick Mulvaney reportedly told a conference of House Republicans: either vote or lose your chance to replace Obamacare. For their part, the Republican leadership announced a series of votes for Friday, including one on an amendment to repeal essential health benefits in Barack Obama’s signature law. A vote on the full bill was planned for later on Friday, , after a vote initially planned for Thursday was delayed. “ Still not clear whether the bill has the votes to pass. And then it still has to go to the Senate (where the GOP’s majority is smaller).

See also Vox The Republican health care plan is totally nuts  (also with an eye on the Senate already)

Trump & global health

To start this section, by now a sorry fixture in this newsletter, we remind you of Trump’s “brand new image”:  during a joint press conference with German Chancellor Angela Merkel last week on Friday, Trump denied he was “an isolationist”, rather he’s “a free trader, but also a fair trader“. Ahum.

Some reads:

Foreign PolicyTrump’s America First budget puts Africa last  “Slash-and-burn cuts to the State Department and USAID would deepen the worst humanitarian crisis since World War II.”

Perhaps providing a little bit of comfort, Senate Majority Leader (GOP) Mitch McConnell rejected in an AP interview Trump’s foreign aid cuts.  For what it’s worth.  As for the rising resistance to Trump’s budget blueprint, see also Humanosphere Congressional resistance leaves Trump’s foreign aid cuts ‘dead on arrival’. (good overview from late last week)

Also the US military emerge as a key voice in the budget debate (Devex).  (info on two defense-related congressional hearings this week) See also Military Leaders on Capitol Hill Today Push to Protect State Department, USAID Budget.

Laurie Garrett  (CFR) – Trump 2018 Budget Proposal: What We Know (And Don’t Know)   Breakdown based on the info available.  (Must-read)     See also KFF for this tentative (global health & development, soft power, …. ) breakdownWe already covered the (likely) key global health (programme) implications of Trump’s budget blueprint in last week’ IHP newsletter.

Foreign Policy – Trump administration eyes $1 billion in cuts to UN peacekeeping; The White House also targets hundreds of millions in funding for U.N. programs for children and the poor.


“…The White House budget office informed State Department officials this week that the administration plans to eliminate all U.S. funding to the $326 million International Organizations and Programs account, which provides more than $130 million to the U.N. Children’s Fund, a sizeable chunk of the more than $500 million the U.S. contributed to UNICEF in 2016,  and around $70 million to the U.N. Development Program. They were also told to brace for a 40 percent cut to the State Department’s U.N. peacekeeping budget. The U.S. contributed over $2 billion to the U.N.’s $8 billion-plus peacekeeping budget last year. The proposed cuts, which were drafted by the White House Office of Budget and Management, show that the Trump Administration is seeking far deeper cuts to the U.N. in the international affairs budget than to the State Department or USAID.”

Some of the news perhaps less covered last week:

Buried in the cuts to science and public health in President Trump’s newly released budget blueprint is a longtime conservative proposal to award lump sums of money to states – block grants – to let them decide how to respond to public health issues such as the Zika virus. That proposal is “a really bad idea,” according to Dr. Tom Frieden, who until this past January was director of the U.S. Centers for Disease Control and Prevention….”

You might also want to listen to a CGD podcast (with Amanda Glassman & Scott Morris) – What Do the Trump Administration’s Budget Cuts Mean—and What Do They Mask? – Podcast with Scott Morris and Amanda Glassman  “…Major global health programs, such as PEPFAR (on HIV/AIDS) and US contributions to the vaccination alliance GAVI, appear to be safe. Yet CGD senior fellow Amanda Glassman worries about other areas, including family planning, which she wrote about after the administration issued an executive order cutting funding for foreign family planning services, and the US role in ensuring global health security. “The budget did have a callout for an emergency response fund in case of outbreaks, but I understand that to be just for domestic use,” she tells me. “Really we have to think about fighting disease over there so it doesn’t come here. This is a global undertaking.”

JAMA – Presidential Immigration Policies- Endangering Health and Well-being?

L Gostin et al ; http://jamanetwork.com/journals/jama/fullarticle/2613724

This Viewpoint discusses President Trump’s executive orders on US immigration policy and how they could affect health care, health systems, and public and global health.”

As for Trump’s “slash & burn” impact on planetary health, see the ‘planetary health’ section.

Lancet Public Health – Implementation of key demand-reduction measures of the WHO Framework Convention on Tobacco Control and change in smoking prevalence in 126 countries: an association study

S Gravely et al; http://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(17)30045-2/fulltext

A new study assesses the association between the implementation of key tobacco control measures and change in smoking prevalence in 126 countries.” It turns out the global tobacco control treaty (WHO FCTC) has indeed reduced smoking rates in its first decade, but (a lot) more work is needed.

“…The global tobacco control treaty has increased the adoption of tobacco reduction measures around the world, which has led to a 2.5% reduction in global smoking rates” (a significant change).

Read also the accompanying Lancet Public Health Comment –    Understanding the association between the WHO Framework Convention on Tobacco Control, adoption of tobacco control policies, and reduction in smoking prevalence

Plus the Lancet Public Health EditorialThe power of a treaty :

“… in their study published in The Lancet Public Health, [the authors] looked at the association between the change in countries’ implementation of five key measures (increased taxes on tobacco products; protection of people from tobacco smoke; health warnings; enforcement of bans on tobacco advertising, promotion, and sponsorship; and cessation aid) and the change in smoking prevalence in those countries from 2005 to 2015. Their results are clear: countries’ implementation of these key measures is associated with a decrease in smoking. Importantly, the more interventions, the larger the effect: overall, each additional measure implemented at the highest level was associated with a reduction in smoking prevalence of 1·57%. On average, smoking rates across all 126 countries went down from 24·7% in 2005 to 22·2% in 2015. These results are important because they show the potential of tobacco control measures to reduce tobacco use, they do validate the importance of such treaty and the public health impact it can have in countries.”

“…From April, the FCTC 2030 project will support WHO FCTC Parties that are eligible to receive official development assistance to achieve the SDGs by advancing implementation of the FCTC. The project will provide extra technical support to aid governments in developing countries to advance tobacco control. It aims to address the drastic disparities between countries with many low-income and middle-income countries struggling under the weight of the tobacco epidemic. Control of the tobacco epidemic is essential for countries worldwide. Not only can it have devastating health consequences but also the tobacco epidemic costs countries’ economies enormously through increased health-care costs and decreased productivity. “Tobacco—a threat to development” will be the theme of this year’s World No Tobacco Day on May 31. The campaign aims to “demonstrate the threats that the tobacco industry poses to the sustainable development of all countries, including the health and economic well-being of their citizens””

Sustainable Development Solutions Network (SDSN)- World Happiness Report 2017


Launched on the International Day of Happiness, 20 March.  You find the exec summary here.  (2 pages only) Some key messages: Norway tops the ranking, happiness is both personal and social; much of Africa is struggling, China’s people are no happier than 25 years ago, and happiness has fallen in the US.

See also UAE takes happiness global with new council  “The Ruler of Dubai has announced the formation of the World Happiness Council, headed by a Columbia professor.  Headed by Columbia University Professor Jeffrey Sachs, the 12-member council will focus on six key areas: health, education, environment, personal happiness, happy cities and community standards for happiness, each with its own sub-council chaired by a different member of the team.  “The council aims to support international goals to standardise happiness as a measure of development, as we are doing in the UAE,” Sheikh Mohammed noted on his Twitter account. The council will be tasked with compiling an annual Global Happiness Report, highlighting international practices and achievements with regards to happiness and happiness research. … ”

As “the Smurfs” are now officially also enrolled for the SDGs – see “Ahead of International Day, UN and Smurfs team up to promote happiness and sustainable development” (UN News), it’s fair to say that Jeffrey Sachs is from now on ‘Big Smurf’. Jeffrey has to lead the world towards ‘Smurfdom’.  Gargamel can be found in the White House (among others).

PS: The Economist reported (in a nice blog on this new World Happiness Report) – Mental illness is a better predictor of misery than poverty is (in the rich countries at least. And they thus conclude: “In rich countries at least, investing in care for mental illness provided the best return (as measured by happiness gains) on public expenditure.”)  Not much attention for the link between mental illness & poverty though…

UNDP- Human Development report 2016: Human Development for everybody


A quarter-century of impressive human development progress continues to leave many people behind, with systemic, often unmeasured, barriers to catching up. A stronger focus on those excluded and on actions to dismantle these barriers is urgently needed to ensure sustainable human development for all. …. … The report finds that although average human development improved significantly across all regions from 1990 to 2015, one in three people worldwide continue to live in low levels of human development, as measured by the Human Development Index.”

See UN News for a quick overview of key messages- Despite progress, world’s most marginalized still left behind – UN development report.

Coverage and analysis in the GuardianIdentity politics and intolerance a barrier to development, says UN report.

“… The annual human development index said that at a time when global action and collaboration were imperative in achieving the sustainable development goals by 2030, exclusion and intolerance could prevent progress reaching everyone. “Brexit is one of the most recent examples of a retreat to nationalism … ” the report said. “Intolerance of others in all its forms – legal, social or coercive – is antithetical to human development.” Overall, the report said, millions of women, indigenous peoples and ethnic minorities continue to be excluded from a quarter-century of impressive global progress on human development. There have been significant achievements worldwide between 1990 and 2015, including the halving of the under-five mortality rate and ending extreme poverty for a billion people. But systemic discrimination – in both developed and developing countries – has left the world’s most marginalised groups behind, with the gap set to widen unless “deep-rooted barriers” to development are removed, the United Nations Development Programme (UNDP) 2016 human development report found.”

See also HumanosphereGlobal progress hides crippling inequality and suffering, U.N. report says. and IP – WatchUN Development Programme Calls For Reform Of IP And Investor Protection Regimes.

IISD – UN Establishes Inter-Agency Coordination Group on AMR


All you need to know about the (end of last week established) UN Inter-agency coordination group on AMR.  “UN Secretary-General António Guterres announced the establishment and membership of an ad hoc inter-agency coordination group on antimicrobial resistance. The group, chaired by Amina Mohammed, UN Deputy Secretary-General, and Margaret Chan, WHO Director-General, will convene its first meeting shortly and report to the UN Secretary-General during the UNGA’s 73rd session.“

“…Amina Mohammed, UN Deputy Secretary-General and co-chair of the group, said AMR poses a “formidable threat” in the attainment of the SDGs, particularly in developing countries, noting that if “superbugs” are not stopped, SDG targets will likely not be met by 2030.

Health Systems & Reform –Taking Results Based Financing from Scheme to System

Z C Shroff, Nhan Tran, B Meessen, M Bigdeli & A Ghaffar; http://www.tandfonline.com/doi/full/10.1080/23288604.2017.1302903

Introduction to a special issue.

“Over the last 15 years, a growing number of low- and middle-income countries (LMICs) have adopted Results-Based Financing (RBF) approaches for their health sectors. This special issue presents key findings from the research program “Taking Results-Based Financing from Scheme to System.” The issue includes four case studies on RBF in LMICs, and three cross-cutting articles—one on reframing RBF and two on scaling RBF up from projects and schemes to its integration into national health systems….”.

Make sure you also read the rest, starting with part two  From Scheme to System (Part 2): Findings from Ten Countries on the Policy Evolution of Results-Based Financing in Health Systems.

WHO Bulletin – Understanding and measuring quality of care: dealing with complexity

J Hanefeld et al; http://www.who.int/bulletin/online_first/BLT.16.179309.pdf?ua=1

Existing definitions and measurement approaches of quality of health care often fail to address the complexities involved in understanding the quality of care. It is perceptions of quality, rather than clinical indicators of quality, that drive service utilization and are essential to increasing demand. Here we reflect on the nature of quality, how perceptions of quality influence health systems and what such perceptions indicate about measurement of quality within health systems. We discuss six specific challenges related to the conceptualization and measurement of the quality of care: perceived quality as a driver of service utilization; quality as a concept shaped over time through experience; responsiveness as a key attribute of quality; the role of management and other so-called upstream factors; quality as a social construct coproduced by families, individuals, networks and providers; and the implications of our observations for measurement….”

World Water Day – March 22

Guardian – World Water Day: one in four children will live with water scarcity by 2040


One in four of the world’s children will be living in areas with extremely limited water resources by 2040 as a result of climate change, the UN has warned. Within two decades, 600 million children will be in regions enduring extreme water stress, with a great deal of competition for the available supply. The poorest and most disadvantaged will suffer most, according to research published by the children’s agency, Unicef, to mark World Water Day on Wednesday….”. For the UNICEF report, see here.

Some other links & tweets related to World Water Day:

In low- and middle-income countries, 35% of health care facilities lack water and soap for hand washing. Source: @WHO #WorldWaterDay

ReutersGovernments must recognise wastewater as resource – U.N.  “Wastewater from households, industries and agriculture should not be seen as a problem but a valuable resource which could help meet the demands for water, energy and nutrients from a growing global population, a U.N. water expert said. Globally, more than 80 percent of wastewater is released into rivers and lakes without treatment with a negative impact on health and the environment, according to the 2017 U.N. World Water Development Report published on Wednesday.… … But wastewater contains nutrients such as phosphorus and nitrates which can be turned into fertiliser, said Richard Connor, editor-in-chief of the report.”

WHO DG election campaign

All three candidates are campaigning hard. Still, it was a bit Sania Nishtar’s week, we felt.

  • First she got to answer some questions in the weekly FT health newsletter  (the other two candidates will follow soon)  (among others, she stressed being a change maker throughout her career & that she wants to scale up the health emergencies programme).

I will definitely scale up the health emergencies programme. Exercising stewardship to protect the world against infectious threats is WHO’s exclusive mandate. … …My New Vision for WHO hinges on leveraging its comparative advantages and normative role, which will involve stepping back from noncore roles, in any case.”

  • And then she got a big forum on Global Health Now in a series of Q&A (must-reads!!)

Check out also her new vision for WHO.

Global Health NowThe Changemaker: WHO DG Candidate Sania Nishtar’s Q&A, Part I  “The next WHO Director-General needs be a changemaker, a campaigner who can meet with heads of state on critical health issues and persuade them to “get it done,” says Sania Nishtar, one of 3 finalists in the running to lead the organization.”

Global Health NowCulture Change: WHO DG Candidate Sania Nishtar’s Q&A, Part II  “A focus on core priorities, a culture based on accountability and cost effectiveness, and a revamped funding process for WHO are some of the key changes Sania Nishtar says she would undertake if elected as Director-General of the WHO.

Global Health NowThe Politics of Global Health: WHO DG Candidate Sania Nishtar’s Q&A, Part III

““WHO is entering a new era of responsibilities, where a political role assumes great importance—and it must realign and reconfigure,” says Sania Nishtar, one of three finalists in the race for DG. The future, Nishtar says, demands that WHO deal more directly with heads of government whose decisions in finance, trade, IP [intellectual property], investment treaties, food, migration, etc. have major impacts on global health.”

As for the other two (who will surely also get their spot in the limelight in the coming weeks), David Nabarro seems to be on a world tour (he met with Theresa May, among others, and was happy with Boris Johnson’s backing as well ), and do read Tedros’ view in DevexPutting people first at the WHO — from ill health to public health emergencies.

New WHO Leader Will Need Human Rights to Counter Nationalistic Populism

Eric Friedman & Larry Gostin; https://www.hhrjournal.org/2017/03/new-who-leader-will-need-human-rights-to-counter-populism/?platform=hootsuite

Must-read. “The need for WHO leadership on human rights—and for global leadership on health and human rights beyond WHO—has always been present, yet has become ever more pressing. A reactionary, nationalist populism has been gaining momentum, particularly in the United States and parts of Europe, and some of its most disturbing features, such as xenophobia and disregard for international law and institutions, are surfacing elsewhere. Persisting health challenges—such as immense national and global health inequities, with universal health coverage and the Sustainable Development Goals offering some hope of lessening them—and growing threats such as outbreaks of infectious disease, worsening antimicrobial resistance, and climate change demand the type of leadership that the right to health entails. In this immensely challenging environment, WHO needs to become a 21st century institution that has the gravitas and credibility to carve a path through these obstacles towards global health justice. The next WHO Director-General, to be elected in May, must lead the organization there.”  Enter the Framework Convention on Global Health which should get the firm support from the next WHO DG, they say.

WHO – 3rd Global Disease Resource Tracking meeting  (20-24 March)


WHO is hosting the 3rd Global Disease Resource Tracking meeting in Geneva between 20–24 March 2017. This year, we are combining data work sessions with country teams (March 20-23), with the establishment of a Consortium on Tracking Disease-Specific Expenditures (March 24-25).”

Stat News – Facing significant yellow fever outbreak, Brazil appeals for more vaccine


Brazil, in the grips of an unusually large yellow fever outbreak, has asked for millions of doses of vaccine from an international emergency stockpile. The body that maintains and manages the stockpile, the International Coordinating Group on Vaccine Provision, has approved the release of more than 3.5 million doses of the vaccine, according to the Brazilian office of the Pan American Health Organization. The office said the vaccine should arrive in Brazil over the next few days. The request signals public health officials’ increasing concern over the scale of Brazil’s outbreak. The country is already home to one of four yellow fever vaccine manufacturers in the world, and it normally produces enough to meet its own needs. But since last December, Brazil has recorded a larger-than-normal number of cases of yellow fever. And as cases have crept ever closer to two of the country’s largest cities — Rio de Janeiro and São Paulo — there have been fears that the disease could start to spread in these cities and, from them, to other parts of the Americas….”

Another excerpt perhaps: “…The virus normally spreads in what is known as a jungle or sylvatic cycle, with transmission between Haemagogus mosquitoes and monkeys. Occasionally a person becomes infected, but human cases are generally rare in the jungle cycle. But if the virus finds its way into cities, it can infect Aedes mosquitoes, which live in close proximity to people, and that can trigger a cycle of hard-to-contain urban yellow fever. Given the severity of the disease, the specter of urban yellow fever alarms public health officials. Still, the World Health Organization said last week that to date there is no evidence that Aedes mosquitoes are spreading the virus.”

Meanwhile, in other yellow fever vaccination news, CDC is  evaluating the use of fractional dose vaccinations (in the DRC).

Science March – Science march on Washington, billed as historic, plagued by organizational turmoil


“…At the heart of the disagreements are conflicting philosophies over the march’s purpose. In one corner are those who assert that the event should solely promote science itself: funding, evidence-based policies, and international partnerships. In another are those who argue that the march should also bring attention to broader challenges scientists face, including issues of racial diversity in science, women’s equality, and immigration policy.”

Social Science & Medicine – Health inequities in the age of austerity: The need for social protection policies

Arne Ruckert & Ronald Labonté; http://www.sciencedirect.com/science/article/pii/S0277953617301752

This commentary assesses the impacts of the global austerity drive on health inequities in the aftermath of the global financial crisis of 2008. In doing so, it first locates the origins of austerity within the 40 year history of neoliberal economic orthodoxy. It then describes the global diffusion of austerity since 2008, and some of its key policy tenets. It next describes the already visible impacts of austerity-driven welfare reform on trends in health equity, and documents how austerity has exacerbated health inequities in countries with weak social protection policies. We finally identify the components of an alternative policy response to the financial crisis than that of austerity, with specific reference to the need for shifts in national and global taxation policies and public social protection policies and spending. We conclude with a call for a reorientation of public policy towards making human health an overarching global policy goal, and how this aligns with the multilaterally agreed upon Sustainable Development Goals.”

Guardian – Rotavirus vaccine could save lives of almost 500,000 children a year


A vaccine capable of enduring scorching temperatures for months at a time could strike a decisive blow in the fight against rotavirus, preventing nearly half a million children around the world from dying of diarrhoea each year. Médecins Sans Frontières (MSF) has hailed successful trials of the BRV-PV vaccine in Niger as a “game changer” in tackling rotavirus infection, which is the leading cause of severe diarrhoea globally and claims the lives of an estimated 1,300 children daily, most of them in sub-Saharan Africa.”   “It must be approved by the World Health Organization before it can be widely distributed, a process that is underway…” (see also NYT ).

See the study in NEJM –  Efficacy of a Low-Cost, Heat-Stable Oral Rotavirus Vaccine in Niger.

For the broader picture (including on GAVI’s role, prequalification, … ), we also recommend reading the NEJM EditorialA new hope  .

WHO/UNICEF – From coast to coast: Africa unites to tackle threat of polio


More than 190 000 polio vaccinators in 13 countries across west and central Africa will immunize more than 116 million children over the next week, to tackle the last remaining stronghold of polio on the continent. The synchronized vaccination campaign, one of the largest of its kind ever implemented in Africa, is part of urgent measures to permanently stop polio on the continent. All children under five years of age in the 13 countries – Benin, Cameroon, Central African Republic, Chad, Côte d’Ivoire, Democratic Republic of Congo, Guinea, Liberia, Mali, Mauritania, Niger, Nigeria and Sierra Leone – will be simultaneously immunized in a coordinated effort to raise childhood immunity to polio across the continent.”

Europe’s treatment of child refugees ‘risks increasing radicalisation threat’


It’s sad that increasingly, we have to frame it like this to get the attention of right wing top politicians in Europe.  “Europe’s “abysmal” treatment of refugee children, who have made up about a third of those seeking asylum on the continent over the last two years, will increase the danger of their later radicalisation and drift into criminality, a damning report from the Council of Europe has said. A system that allows the sexual and physical abuse of children in overcrowded detention centres, where they are often separated from their families, will only condemn Europe to trouble in the future the report warns.”

G20 & health

Science 20 Dialogue –  Improving global health strategies and tools to combat communicable & noncommunicable diseases


Some concise recommendations on global health for Angela Merkel, from Science 20 Academies. Both short-term & long-term evidence based strategies are needed, they say.

See also Science academies of the G20 states have joined forces to highlight the global challenge of diseases that endanger global health and threaten the global economy.  “In a joint statement – delivered today to Chancellor Angela Merkel – the academies offer strategies and tools to tackle communicable and non-communicable diseases and to strengthen public health systems. The joint document provides a basis for the G20 Summit consultations.”

Global Policy (Working paper) – Corporate influence on the G20: The case of the B20 and transnational business networks


Over the past eight years, the G20 has emerged as one of the most prominent political fora for international cooperation. For transnational corporations and their national and international associations and lobby groups, the G20 process provides important opportunities to engage with the world’s most powerful governments, shape their discourse, and influence their decisions. For this purpose, business actors have created a broad network of alliances and fora around the G20, with the Business20 (B20) as the most visible symbol of corporate engagement. A new working paper published by GPF and Heinrich-Böll-Stiftung maps out the key business players and associations from the different sectors and branches involved in the work of the G20, and analyzes their core messages and policy recommendations.”

Save the Children position paper for G 20 leaders


Includes a global health section.

BMJ (Editorial )- Health workers are vital to sustainable development goals and universal health coverage

L Fairall et al; http://www.bmj.com/content/356/bmj.j1357

« … The interagency and expert group on sustainable development goal indicators recognised the pivotal role of health workers in the quest for universal coverage, calling for their “recruitment, development and training in developing countries.” In many of these countries, where doctors are in short supply, this means depending on non-physicians, whether nurses, clinical officers, or healthcare extension workers. We question whether this vital aspect of healthcare delivery is receiving the attention it deserves. »

The authors have their doubts about the game changing potential of mHealth, CHWs – “Task shifting to community health workers, without adequate support from trained professionals, can easily become task dumping” – and data driven quality improvement of health systems.

They conclude: “It is time to refocus attention on the recruitment, empowerment,and retention of healthcare providers, who in many countries are non-physician clinicians…”.

Lancet Editorial – What has Europe ever done for health?


The Lancet’s take on what Europe has done for health so far (and future prospects). As you might know, “March 25, 2017, marks the 60th anniversary of the signing of the Treaties of Rome—two treaties that gave birth to the European Economic Community (EEC) and to the European Atomic Energy Community (EURATOM).”

Lancet Editorial – Preparing for future global health emergencies


(must-read) “On March 13–14, Chatham House and the Graduate Institute Geneva-Global Health Centre hosted a roundtable meeting on preparedness for global health crises. Representatives from WHO and the UN, including member states, global health and development agencies, foundations, academia, and non-profit initiatives shared their work and experiences on monitoring preparedness for outbreaks and other public health emergencies. Several themes emerged…” “   …  Chatham House and the Graduate Institute will contribute to this ecosystem through a new Monitoring and Accountability for Preparedness initiative (MAP-Global Health Crises). Harvard University and the US National Academy of Sciences have convened a meeting to advance these discussions on April 18, and meetings are planned by others. The Geneva meeting is a good first step towards identifying the stakeholder ecosystem required to ensure that countries and the global community continue to strengthen their collective preparedness for the health crises that will inevitably arise.”

Lancet (Correspondence) – Getting pandemic prevention right

B Dahn et al ; http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)30775-4/fulltext

The voices of the countries most affected by Ebola have not been at the forefront of the numerous global commissions convened to review the crisis. The history of the HIV pandemic suggests that nuances of managing such a response need to come from those who managed the response and were most affected by it. One review suggests that the global response to Ebola remains inadequate. This Correspondence is a regional perspective from west Africa, the community most affected by the Ebola epidemic and by infectious-disease outbreaks in general. Systematic inclusion of the perspective of the most affected people in these epidemics will contribute to the overall success of health-related security efforts worldwide….” An analysis of all these HL reports from their perspective. They point out quite some gaps.

WHO – Aligning public financial management and health financing: Health financing working paper No. 4

C Cashin, J Kutzin et al ; http://www.who.int/health_financing/documents/aligning-pfm-health-financing/en/

In recent years, many countries have committed to UHC as a national policy priority. Since public funds are the cornerstone of sustainable financing for UHC in most countries, the public financial management (PFM) system – the institutions, policies and processes that govern the use of public funds – plays a key role. …” … “Aligning public financial management and health financing: sustaining progress toward universal health coverageoutlines areas where the PFM system and PFM rules are crucial for the effective implementation of health financing policy in support of UHC and offers guidance for improving alignment. Many of the steps toward improving alignment between the PFM system and health financing policy are considered good PFM practices in general. But specific measures may be called for to address the particular needs of health budgeting. The main objective is to support productive dialogue between health and finance authorities of finance to better harmonize the PFM system with health financing policy and thereby achieve UHC goals according to principles of good public-sector management. The paper was commissioned by World Health Organization (WHO) and jointly prepared by Results for Development Institute (R4D) and WHO under the auspices of WHO’s Department of Health Systems Governance and Financing, Health Financing Unit. It is part of the Collaborative Agenda on Fiscal Space, Public Financial Management and Health Financing Policy.”

Vox – Scientists made a detailed “roadmap” for meeting the Paris climate goals. It’s eye-opening.


“…In a new paper for Science, a group of European researchers lay out a vivid way to frame the climate challenge — with details on what would have to happen in each of the next three decades if we want to stay well below 2°C.”  At least if you don’t consider geo-engineering.  It’s jaw-dropping.



Nature (News) – Zika mosquito genome mapped – at last


As the Zika virus raced across the Western Hemisphere in 2015 and 2016, geneticists eager to battle the outbreak felt crippled. The genome sequence of the Aedes aegypti mosquito that spreads Zika was incomplete and consisted of thousands of short DNA fragments, hampering research efforts. With help from a new technique for stitching together genome sequences, scientists have finally ‘assembled’ the genome of A. aegypti as well as that of Culex quinquefasciatus, a mosquito that transmits West Nile virus….”  After 10 years of hard work.


Global Health Events

Launch meeting of HQQS Commission (Boston) – short report  March 13)


On the launch of the Lancet Global Commission on High Quality Health Systems in the SDG era.  “Chaired by Margaret Kruk, associate professor of global health at Harvard T.H. Chan School of Public Health, and Muhammad Pate, former Minister of State for Health, Nigeria, the Commission was launched at a daylong conference held March 13, 2017 at Harvard Medical School’s Joseph B. Martin Center.”  Read about the day here.

Check out also what Commissioners said on the first meeting (series of blogs here ).

GH lab in London – Where does global health fit in a post-truth world?  (21 March)


Must have been a great debate there in London. “With the rise of public figures and public campaigns that appeal on an emotional level and disregard the evidence, the ‘truth’ is just one of many competing narratives. Global health has always had to navigate the tension between health beliefs and scientific evidence, but does the broader challenge to the notion of ‘expertise’ create an additional threat to global health practice?  Should global health embrace the trend and play the emotional game to achieve its higher aims? Or should it always stick with the evidence however ‘unpopular’? Join us to discuss these and other issues as we explore where global health fits in a ‘post-truth’ world.

Check Twitter: #GHLab

UHC Partnership meeting in Brussels  (21-23 March)


This year marks the 5th Year Anniversary of the EU-Luxembourg-WHO UHC Partnership, an unique programme with a global ambition promoting policy dialogue on national health policies, strategies and plans with 28 target countries, with the goal of supporting the achievement of UHC  by 2030, as part of the SDGss. On this occasion, from 21-23 March, Ministers of Health representatives, development organizations, decision-makers, European institutions representatives, Luxembourg’s Ministry of Foreign Affairs, WHO officials from the three levels of the Organization, academia and donors [are meeting] to celebrate achievements, collectively share experiences on challenges and ruminate on innovative solutions at country level with the aim of jointly moving the UHC agenda forward. The three-day meeting will address critical health systems issues in the context of UHC and the SDGs: the close connection between resilient health systems and security in particular in fragile states; the implementation and monitoring of the SDGs at country level and how this can positively impact different health areas i.e investment in health workforce; the importance of genuine and strong partnerships at global and at country level to improve aid-effectiveness; and the relevance of a Health-in-All-policies approach involving all sectors to respond to shifting health needs.”

For some more information on this Partnership, see WHO.   The Department of Health System Governance and Financing (HGF) of the World Health Organization is hosting the UHC Partnership since 2011. The UHC Partnership is currently supporting a great number of countries to strengthen health policy dialogue, health systems financing, and effective development cooperation.

And some tweets perhaps  (many by Agnes Soucat):

@WHO #UHCpartnership supports #UHC policy & financing dialogue & peer-learning in 75 countries: 150+ policymakers meeting today @EU

#UHCPartnership Brussels meeting: @WHO‘s @asoucat & #UHC2030‘s @MarjolaineNicod concludes important session on transformation of #IHPplus

How to strength #HealthSystems? FIT strategy: foundations, institutions and transformation. Cartoon @ 5th meeting of #uhcpartnership

FIT for context, FIT for purpose health systems @WHO supports investments in Foundations, Institutions and Transformation to reach #UHC

At #UHCPartnership meeting @MarjolaineNicod presents #UHC2030 as a movement to reach #UHC

how to build the strategic purchasing function among most common questions of countries on the road to #UHC: support by @who #UHCpartnership

Finally, make sure, if you haven’t done so yet, to read  A system-wide approach to analysing efficiency across health programmes  (WHO) (by S Sparked, J Kutzin et al).

Coming up –21st Expert Committee on the Selection and Use of Essential Medicines  (Geneva, 27-31 March)


The meeting of the 21st WHO Expert Committee on the Selection and Use of Essential Medicines will be held at WHO Headquarters, Geneva, from 27 to 31 March 2017 to revise and update the WHO Model List of Essential Medicines (EML) including Essential Medicines for Children (EMLc)….”

Coming up – 10th meeting of the Strategic and Technical Advisory Group for Neglected Tropical Diseases (29-30 March)


The tenth meeting of the Strategic and Technical Advisory Group for Neglected Tropical Diseases (STAG) will take place on 29–30 March 2017 in WHO/Headquarters, Salle C, Geneva, Switzerland. Among the main issues to be discussed are: the Global Vector Control Response; examination of dossiers requesting the potential inclusion of diseases as NTDs; gaps in disease elimination; eradication of dracunculiasis; integrated data management; the 2nd WHO NTD Global Partners’ Meeting.”

Coming up – Coming up – NTD Summit 2017, 19 to 22 April (Geneva)


2017 marks the 5th anniversary of the World Health Organization’s roadmap on NTDs and the London Declaration. To celebrate this milestone, Uniting to Combat NTDs, the World Health Organization and the NTD community are hosting the NTD Summit in Geneva, Switzerland in April 2017.”

Coming up – World Immunization week  (24-30 April)


“…2017 marks the halfway point in the Global Vaccine Action Plan (GVAP) – endorsed by 194 Member States of the World Health Assembly in May 2012 – which aims to prevent millions of deaths from vaccine-preventable diseases by 2020 through universal access to immunization.”


Global governance of health

Global taxation

Estimating tax avoidance: New findings, new questions

Alex Cobham; http://ictd.ac/blogs/entry/estimating-tax-avoidance-new-findings-new-questions

Based on a  new paper. Recommended. Tweet: “New estimate of the scale of global #tax avoidance: $500 billion in losses (annually), with greater relative intensity in #LICs.”

International corporate tax is an important source of government revenue, especially in lower-income countries. An important recent study of the scale of this problem was carried out by International Monetary Fund researchers Ernesto Crivelli, Ruud De Mooij, and Michael Keen. We first re-estimate their innovative model, and then explore the effects of introducing higher-quality revenue data from the ICTD–WIDER Government Revenue Database. Whereas Crivelli et al. report results for two country groups only, we present country-level results to make the most detailed estimates available. Our findings support a somewhat lower estimate of global revenue losses of around US$500 billion annually and indicate that the greatest intensity of losses occurs in low- and lower middle-income countries, and across sub-Saharan Africa, Latin America and the Caribbean, and South Asia.”

Euractiv – Belgium told to get off the fence, stop blocking FTT


Blame our neoliberal minister of Finance. Gets along very well with Dijsselbloem and Schäuble, which tells you all you need to know.

Devex –  DfID minister announces a challenge fund for small charities and calls UK a ‘global leader’ in development


The head of the U.K.’s aid agency announced the first ever challenge fund exclusively for small charities, as well as a new capacity building initiative to help boost public trust in the third sector during a wide-ranging speech to civil society groups. Speaking at the annual Bond conference in London on Monday, international development secretary Priti Patel also emphasized Britain’s role as a global leader in development and said the country should exert its influence to encourage other governments not to “turn your back on the world.”  “

Ahead of the speech, the Guardian reported  Patel to defend aid budget as famine crisis spreads.

So at least for the time being, the UK is not following the US “lead”. At least not in terms of rhetoric.

Euractiv – Brexit ‘may mean huge loss for EU as global donor’, Parliament report warns


Britain’s departure from the EU will challenge the bloc’s role as the world leading aid donor, and could see EU aid shrink by up to 3%, according to an authoritative new study by the European Parliament”


IISD – The 2030 Agenda’s “Missing Piece”: Update on SDG Indicators


(must-read) –  Excellent SDG indicator update. Highlights: “Creating the indicators for the SDGs is a historic challenge on par with creating statistics to measure post-war recovery in the 1950s and environmental indicators in the 1990s, according to UNStats. The draft resolution agreed by UNSC 48 seeks to link agreement on the framework of global indicators to two issues of key importance to NSOs: support for capacity building at the national level, and national ownership of country data. The work plan for the IAEG-SDGs points to the long road ahead for the indicator framework, in particular with regard to data disaggregation, capacity building, and the refinements and review mechanisms.”  Read also about the steps ahead.

IISD – ECOSOC President Provides Updates on HLPF Preparations


ECOSOC President Frederick Musiiwa Makamure Shava said the HLPF’s first week will address the theme of the session, ‘Eradicating poverty and promoting prosperity in a changing world’ and the sub-set of SDGs to be reviewed in depth this year (which include health SDG 3). The second week, which includes the Ministerial Segment, will consider the voluntary national reviews of SDG implementation by 44 volunteering countries.”

Imaxi –Towards SDG Target 16.7


Speaking of the SDGs, the author of this nice article is “suffering from severe repetitive jargon syndrome provoked by an overdose of hearing the SDGs’ mantra “Leave no one behind”. It constantly reverberates down from those at the top of the UN and its Agencies such as the WHO, UNICEF, UNDP and a dozen other organizations.”  He/she is not the only one.  Here the focus is on what is really needed to reach SDG Target 16.7: “Ensure responsive, inclusive, participatory and representative decision-making at all levels” by 2030. Sooner is also ok.

ODI (report) – Starting Strong: The first 1000 days of the SDGs Informing a set of regional dialogues on SDG early implementation

P Lucci et al; https://www.odi.org/sites/odi.org.uk/files/resource-documents/10636.pdf

“… the Overseas Development Institute (ODI) and Southern Voice on Post-MDG International Development Goals, along with the Kenya Institute for Public Policy Research and Analysis (KIPPRA), The Centre for Poverty Analysis (CEPA) and Centro de Pensamiento Estratégico Internacional (CEPEI), have organised a series of regional dialogues focused on identifying priority actions on SDGs during the next few years, with the aim to set out a 1000-day agenda…”

IISD – UNFCCC, ILO Partner for Decent Work, Just Transition


The world’s central fora for addressing climate change and for protecting labor have come together to promote decent work and a “just transition” of the workforce towards sustainable economies and societies for all. The UNFCCC and the International Labour Organization (ILO) signed a Memorandum of Understanding (MoU) to bolster efforts to create jobs and protect workers in the transition to a low-carbon, climate-safe world. This partnership is an example of working across the Sustainable Development Goals (SDGs), including SDG 8 (decent work and economic growth) and SDG 13 (climate action) as envisioned by SDG 17 (partnerships)….”


UNAIDS – Global social work responds to HIV


The International Association of Schools of Social Work (IASSW) and UNAIDS have published a new joint report, Getting to zero: global social work responds to HIV, a collection of stories and articles showing how social workers are central to the AIDS response around the world. Launched at an event in Geneva, Switzerland, on World Social Work Day 2017 attended by UNAIDS and the President of IASSW, Annamaria Campanini, the report highlights how social workers connect people living with HIV with essential services and make services work for people living with HIV.”

IP-Watch – World Bank Now Relying On Capital Markets, Focuses On Fragile Countries


(gated) “After the announcement in December of a record US$75 billion commitment to its International Development Association (IDA), the World Bank Group said today that this commitment was both historic in terms of value, and also a sign of a paradigm change, including the raising of funds from capital markets.”

Lancet Global Health (blog)  -Making the Coalition for Epidemic Preparedness Innovations (CEPI) more effective

R Seifman; http://globalhealth.thelancet.com/2017/03/17/making-coalition-epidemic-preparedness-innovations-cepi-more-effective

The emergence and spread of Ebola virus disease (EVD), Middle East respiratory syndrome (MERS), and Zika virus have focused global attention on epidemic and pandemic threats. Despite this, preventing the emergence of disease outbreaks has remained relatively underexplored, and the central role of zoonotic transmission in such diseases remains a neglected dimension of global health security. “  CEPI should take heed, is the message.

NPR Goats & Soda – Win $1 Million For Your Bright Idea To Fix The World

NPR Goats & Soda;

Update on the competition “A new shape: remodeling global cooperation”.  Proposals are due by September 30, but you have to register by the end of the month.

Check out also what Banerjee thinks of this competition (and of an ideal world). And: “…For Banerjee, an ideal world government would have lots of money and the ability to hand it out for different purposes — similar to how the U.S. federal government funds state projects. “Having influence without resources is very difficult,” he says. “This is a pie in the sky but, 10 percent of [global] GDP should go into a pot which will be used for dealing with climate change and world poverty and things like that. Right now, not even one percent of global GDP is available. If it was 10, we’d see change.”

BMJ (blog) – Revisiting health as a human right—does everyone have the right to be healthy?

A Karan (Harvard); http://blogs.bmj.com/bmj/2017/03/21/abraar-karan-revisiting-health-as-a-human-right/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+bmj%2Fblogs+%28Latest+BMJ+blogs%29&g=w_blogs_bmj-com

Not just human rights lawyers will enjoy this article.   He concludes: “…I still think that “health as a human right” is too simplistic a notion, which doesn’t account for the fact that health is both a process and an outcome; that health is both a part of the systematic conditions that we are part of, as well as a component of how we choose to live our lives. I think that health is easier to argue as a negative right—that we have a right to live without our health being harmed—and that high quality healthcare access is a positive right. Every person deserves to have the opportunity to improve his or her own health with the guidance, care, and compassion of a physician, and to live in environments that do not inherently cause harms.”

CGD (blog) – Results Measurement and the Case for Aid

C Lee; https://www.cgdev.org/blog/results-measurement-and-case-aid

At a moment when the case for maintaining aid budgets is being fundamentally questioned, we might do well to ponder once again how we measure and communicate results. As illustrated during the recent CGD panel discussion with Mark Suzman of the Gates Foundation, many in the development community lament that we have failed on two counts: broad audiences don’t know about unprecedented progress in poverty reduction and human development indicators in recent decades, and, if they do know, they don’t see the connection between aid programs and such progress.”     (no comment)



India’s new National Health Policy sets a very low bar for better public health


By Amit Sengupta (PHM), so you know this is a must-read.

Interestingly, Dr Tedros also weighed in (Hindustan Times) – The new health policy can help India achieve universal coverage.

Meanwhile, after hospital violence in Mumbai reported in the Guardian Rob Yates tweeted “Hospital violence in Mumbai shows that the Indian people are becoming angry about their lack of health coverage” and wondered whether this could spark similar action from the government in India as in China over the past decade  ( after Chinese discontent with their health care).

USAID (HFG) – Financing of Universal Health Coverage and Family Planning: A Multi-Regional Landscape Study and Analysis of Select West African Countries


From January 2017.  “This report presents observed trends and lessons learned from a health financing landscape study of fifteen countries….”

BMJ (Editorial) – Cost effective but unaffordable: an emerging challenge for health systems

V Charlton et al; http://www.bmj.com/content/356/bmj.j1402

The new (NICE) “budget impact test” is an unpopular and flawed attempt to solve a fundamentally political problem, these authors argue.  Focusing on the UK (and hepatitis C medicines), but obviously a concern now in many health systems.

Financing health in Africa – PBF and quality of care: ready for an upgrade?

Bruno Meessen ; http://www.healthfinancingafrica.org/home/performance-based-financing-and-quality-of-care-ready-for-an-upgrade

Performance Based Financing (PBF) is now being implemented in a large number of countries. Ensuring that the PBF strategy is continuously improved must get our full attention. In this blog post, I focus on the challenge of quality care. I also present what the Community of Practice intends to do on this key issue. We are currently looking for experts willing to help us organize a first international meeting. Why not you ? »

CGD (blog) – Benefits and Universal Health Coverage: What Public Money Can Buy Given Budget Realities

Amanda Glassman; https://www.cgdev.org/blog/benefits-and-universal-health-coverage-what-public-money-can-buy-given-budget-realities

Earlier this month, Amanda Glassman “hosted a workshop on defining and updating health benefits packages for UHC with participants from seven sub-Saharan African countries, Indonesia, Thailand and China, as a final input into [her] forthcoming book on defining and adjusting health benefits with Ursula Giedion and Peter C. Smith, What’s In, What’s Out: Designing Benefits for Universal Health Coverage. In every country, the budget constraint is different. But in every country, the decisions are hard and—in too many cases, as in the USA— the process in place to decide what’s in and what’s out comes down to political wrangling, and not what generates the most benefits, distributed as fairly as possible, given the budget available. That’s what the new book is about—how to structure the governance, process and methods needed to determine benefits in an on-going, politically feasible, ethical and sustainable way, subject to the budget constraint…”  Key messages from participants in this blog.

HP&P – Understanding public perception of the need for major change in Latin American healthcare systems

R Perez-Cuevas et al ; https://academic.oup.com/heapol/article/doi/10.1093/heapol/czx020/3074006/Understanding-public-perception-of-the-need-for

The opinions and experiences of the public regarding health services are valuable insights into identifying opportunities to improve healthcare systems. The authors analyzed the 2012–2013 Public Opinion Health Policy Survey carried out in Brazil, Colombia, El Salvador, Jamaica, México and Panama.

Global health research and policy – What does the development of medical tourism in Barbados hold for health equity? An exploratory qualitative case study

R Labonté et al; https://ghrp.biomedcentral.com/articles/10.1186/s41256-017-0025-z

« Although the global growth of privatized health care services in the form of medical tourism appears to generate economic benefits, there is debate about medical tourism’s impacts on health equity in countries that receive medical tourists. Studies of the processes of economic globalization in relation to social determinants of health suggest that medical tourism’s impacts on health equity can be both direct and indirect. Barbados, a small Caribbean nation which has universal public health care, private sector health care and a strong tourism industry, is interested in developing an enhanced medical tourism sector. In order to appreciate Barbadians’ understanding of how a medical tourism industry might impact health equity.  …»

Labonté et al conclude: “…In clarifying the direct and indirect pathways by which medical tourism can impact health equity, these findings have implications for health system stakeholders and decision-makers in Barbados and other countries attempting both to build a medical tourism industry and to protect health equity.”

CGD (blog ) – Technology won’t save health care

Bill Savedoff; https://www.cgdev.org/blog/technology-wont-save-healthcare

“…Health technologies can reduce healthcare spending. On average, they don’t. Prominent examples—like the way polio vaccines eliminated the need for iron lungs—seem to drive a common faith in healthcare technology as a tool to “cure” costly health systems. But it actually works the other way around—health systems (policies, institutions, and markets) and human responses to them determine whether these tools will (or won’t) increase spending….”

BMJ Global Health – Financing for universal health coverage in small island states: evidence from the Fiji Islands

A D Asante et al; http://gh.bmj.com/content/2/2/e000200

Universal health coverage (UHC) is critical to global poverty alleviation and equity of health systems. Many low-income and middle-income countries, including small island states in the Pacific, have committed to UHC and reforming their health financing systems to better align with UHC goals. This study provides the first comprehensive evidence on equity of the health financing system in Fiji, a small Pacific island state. The health systems of such states are poorly covered in the international literature….”


Planetary health

Some quick links from this week:

State of the planet

GuardianRecord-breaking climate change pushes world into ‘uncharted territory’.   “The record-breaking heat that made 2016 the hottest year ever recorded has continued into 2017, pushing the world into “truly uncharted territory”, according to the World Meteorological Organisation. The WMO’s assessment of the climate in 2016, published on Tuesday, reports unprecedented heat across the globe, exceptionally low ice at both poles and surging sea-level rise.”

Humanity is entering Star Trek territory, clearly keen “to boldly go where no man has gone before”.

GuardianCO2 emissions stay same for third year in row – despite global economy growing.

Still, not all is lost.  “Last week, the International Energy Agency (IEA) said that carbon dioxide emissions from energy have not increased for three years in a row even as the global economy grew.  “…The pause in emissions growth was welcomed by the IEA, but it warned it was not enough to meet globally-agreed targets to limit temperature rises to below 2C above pre-industrial levels – considered to be the threshold for dangerous climate change.”

Read together with Vox5 ways to think about the remarkable slowdown in global CO2 emissions. (Recommended background & analysis)

And also, encouraging, in VoxThe global coal boom finally seems to be winding down.  “Researchers from Coalswarm, the Sierra Club, and Greenpeace — drawing on the Global Coal Plant Tracker — have just released their latest annual “Boom and Bust” report on the global coal pipeline. Brad Plumer wrote about the same report last year, and it was mostly bad news. But a great deal changed in 2016. Though the big picture remains daunting, the shift from last year to this year is fairly astonishing. It offers a ray of hope….”

The politics of climate change

Devex – Trump’s international climate budget: ‘We’re not spending money on that anymore’

No surprises there.

Also can’t wait to find out about Trump’s Plans to Reverse Obama’s Climate Change Legacy (NYT).  “President Trump is poised in the coming days to announce his plans to dismantle the centerpiece of President Barack Obama’s climate change legacy, while also gutting several smaller but significant policies aimed at curbing global warming.”  “…In an announcement that could come as soon as Thursday or as late as next month, according to people familiar with the White House’s planning, Mr. Trump will order Mr. Pruitt to withdraw and rewrite a set of Obama-era regulations known as the Clean Power Plan, according to a draft document obtained by The New York Times.”

Lancet (World Report) – US health and science advocates gear up for battle over EPA


“The Trump administration’s proposed budget makes large cuts to the US Environmental Protection Agency. Susan Jaffe, The Lancet’s Washington correspondent, reports.”


IndependentUS ‘forces G20 to drop any mention of climate change’ in joint statement.

Even more worrying perhaps….  And prompting a tweet from Richard Horton: “So the G20 fails to include a pledge on climate change, contrary to past practice. America’s undermining of multilateralism gains pace.

See also Reuters –  Climate change financing dropped from G20 draft statement.     Looks like we’re going to have to believe in the “power of the market” to tackle climate change (sigh).

But Antonio Guterres gets the last word – “Climate change is undeniable. Climate action is unstoppable”. See the Secretary-General’s remarks at the High-Level Meeting on Climate Change and the Sustainable Development Agenda  “”The trend is clear, the world is moving towards a green economy. Governments and business increasingly understand that there is no trade-off between a healthy environment and a healthy economy.””   He probably has it right.


infectious diseases & NTDs


WHO – Global health sector strategy on viral hepatitis, 2016-2021


“Worldwide, approximately 240 million people have chronic hepatitis B infection and 80 million people have chronic hepatitis C infection – two liver infections that together result in an estimated 1.4 million deaths worldwide. A stepped-up global response can no longer be delayed. The Global Health Sector Strategy on Viral Hepatitis is the first of its kind and, when implemented, will contribute to the achievement of the 2030 Agenda for Sustainable Development. The Strategy outlines a Vision, Goals and Targets, Frameworks for Action, and 5 critical Strategic Directions to eliminate viral hepatitis as a public health threat by 2030.”


NYT (Editorial) – UN Accepts Blame but dodges the bill in Haiti


António Guterres (who “inherited” this very sorry UN disaster from his predecessor) so far only raised $ 2 million for the so called “New Approach” to help Haiti’s cholera victims and eradicate cholera in Haiti, whereas  $400 million is needed.  The UN owes it to the citizens in Haiti.

Another  NYT article says, “…A trust fund created to help finance the strategy has only about $2 million, according to the latest data on its website. Just six of the 193 member states — Britain, Chile, France, India, Liechtenstein, and South Korea — have donated. Other countries have provided additional sources of anti-cholera funding for Haiti outside the trust fund, most notably Canada, at about $4.6 million, and Japan, at $2.6 million, according to the United Nations….”  That doesn’t come anywhere near what’s needed. “

See also AFP.

International business times – Cholera threatens millions in drought-hit east Africa as famine looms


Fears of a cholera outbreak in drought-ravaged east Africa are increasing. The Disasters Emergency Committee (DEC) in the UK warned of an “alarming surge” of waterborne diseases in the area, where millions have gone hungry due to lack of rain and prolonged insecurity.”


Lancet Global Health – Population coverage of artemisinin-based combination treatment in children younger than 5 years with fever and Plasmodium falciparum infection in Africa, 2003–2015: a modelling study using data from national surveys

This study from the April issue of the Lancet Global Health (already covered in the last IHP newsletter) probably deserves a special mention. “…Despite progress during the 2003–15 malaria programme, ACT treatment for children with malaria in Africa remains unacceptably low. More work is needed at country level to understand how health-care access, service delivery, and ACT supply might be improved to ensure appropriate treatment for all children with malaria.”

Stat News – Can science rob snakes of their deadliest weapon?


On the new breed of snake bite entrepreneurs. Still, “While they’re excited about the new research, veterans of the field warn it could be decades before new synthetic treatments are available for snakebite. Some fear the growing hype over barely tested research amounts to a not-so-subtle bashing of current antivenom therapy — which is commonly dismissed as “from the 19th century.” The old treatments may be flawed, but they do save lives in the here and now.”



Politico – Bad news for the bad-news agency


As President Donald Trump raises the axe on U.S. medical research funding, scientists across the Atlantic are trembling, too. The World Health Organization’s cancer agency, the France-based International Agency for Research on Cancer (IARC), has long been a prime purveyor of bad news. Now, with big business blasting it as fake news and Republicans in total control, U.S. funding crucial for IARC’s work is under threat. “  “… … (Last week) On Thursday, Trump unveiled a FY2018 budget that would chop $6 billion, or nearly 20 percent, from the National Institutes of Health (NIH). IARC’s work classifying things like bacon, plutonium and wood dust as carcinogens relies most heavily on NIH funding….”

Global Policy – Generating Sustained Political Priority for Non-communicable Diseases: Towards a Suitable Governance Model

C H Schneider et al; http://onlinelibrary.wiley.com/wol1/doi/10.1111/1758-5899.12416/full

The 2011 high-level meeting of the United Nations General Assembly on non-communicable diseases (NCDs), and subsequent developments in global public policy on NCDs can be seen as a contemporary case study in global health governance. As the debate on what constitutes appropriate and desirable governance continues, highly contrasting models are being compared as starting points. We define these as the global health initiative model and the convention/strategy model. Each has a different strategy at its core and represents a different response to key normative challenges that are said to plague global health governance – participation, scope of action, balancing power, legitimacy and effectiveness. As the current structure of the Global Coordinating Mechanism for NCDs within the WHO emerges as a possible new model, we argue that these normative challenges need to be addressed to safeguard against potential policy ineffectiveness.”

Social Science & Medicine – Food and beverage product reformulation as a corporate political strategy

C Scott et al; http://www.sciencedirect.com/science/article/pii/S0277953616306293

Product reformulation– the process of altering a food or beverage product’s recipe or composition to improve the product’s health profile – is a prominent response to the obesity and noncommunicable disease epidemics in the U.S. To date, reformulation in the U.S. has been largely voluntary and initiated by actors within the food and beverage industry. Similar voluntary efforts by the tobacco and alcohol industry have been considered to be a mechanism of corporate political strategy to shape public health policies and decisions to suit commercial needs. We propose a taxonomy of food and beverage industry corporate political strategies that builds on the existing literature. We then analyzed the industry’s responses to a 2014 U.S. government consultation on product reformulation, run as part of the process to define the 2015 Dietary Guidelines for Americans. … … The food and beverage industry in the United States used a highly similar narrative around voluntary product reformulation in their consultation responses: that reformulation is “part of the solution” to obesity and NCDs, even though their products or industry are not large contributors to the problem, and that progress has been made despite reformulation posing significant technical challenges. This narrative and the frames used in the submissions illustrate the four categories of the taxonomy: participation in the policy process, influencing the framing of the nutrition policy debate, creating partnerships, and influencing the interpretation of evidence. These strategic uses of reformulation align with previous research on food and beverage corporate political strategy.”

Bloomberg – Italy’s Struggling Economy Has World’s Healthiest People


Based on the Bloomberg Global Health Index, Italy is ranked the healthiest nation in the world. The diet is a key factor, but they also have plenty of doctors.

And a quick link:

WB (blog) – Recent Gains on Global Tobacco Taxation  (by Patricio Marquez)


SR/Mat/neonatal & child health

(Blog) – Improving child survival

Stefan Peterson (UNICEF); http://www.sustainablegoals.org.uk/improving-child-survival/

For some reason, Stefan’s name always makes me think of a Scandinavian striker playing for Ajax Amsterdam. But no, he’s UNICEF’s Chief of Health section. Here is his latest blog. Well worth a read. “The global commitment to slash child mortality by 2030 promises to save millions of lives. But achieving it requires a step change in how we facilitate healthy living for society’s most vulnerable”  Somewhat in line with this year’s Human Development Report.

Humanosphere – New report calls for ‘big data’ to help world’s most vulnerable women and girls


A lack of information on the experiences of women and girls is one of the greatest barriers to addressing their needs, particularly in the developing world. A new report seeks to fill that gap by demonstrating how “big data” can provide critical information on health, social status and other experiences of women in countries where data is most lacking. The report was released today by Data2X, a United Nations Foundation initiative aiming to advance gender equality through improved data collection. Deputy Director Rebecca Furst-Nichols said the report calls for ways to supplement traditional forms of data collection that often unintentionally silence women and girls….”

CSIS (report) – Her health, her lifetime, our world: Unlocking the potential of adolescent girls and young women


CSIS launched the Task Force on Women’s and Family Health in the belief that there is an exceptional opportunity—and pressing need—for U.S. leadership in this critical area. The Task Force has generated a bold vision, detailed in this report, for a major U.S. initiative by the Trump administration to unlock the potential of adolescent girls and young women in select low-income countries. It is a call for a new and different U.S. approach to foreign assistance: one that creatively integrates key health interventions—improving maternal and newborn health, increasing access to voluntary family planning, reducing anemia, and expanding access to the HPV vaccine to prevent cervical cancer—with education and other development efforts. It promises to deliver concrete and enduring returns on investment, firmly establish adolescent girls and young women as a pillar of long-term economic growth and opportunity, as well as bring vital benefits to Americans.”

The chance of Trump et al investing substantial money in this is essentially nil, if you ask me. Just a “bold guess”.

Guardian – Sale of Cambodian breast milk to mothers in US criticised by UN


The UN children’s fund has strongly criticised the sale by a commercial company of breast milk donated by Cambodian mothers to women in the US, warning it could lead to the babies of poor and vulnerable women becoming malnourished. Unicef condemned the trade by Utah-based company Ambrosia Labs as the Cambodian government intervened…”

Lancet Public Health (Comment) –  eSexual health interventions: promising, but more evidence needed

K Wellings et al; http://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(17)30051-8/fulltext

“… In The Lancet Public Health, Claudia Estcourt and colleagues report the findings of a feasibility study of a fully online chlamydia treatment and management system, an eSexual Health Clinic.” This is the accompanying comment.


Access to medicines

IP-Watch – WHO Advisory Group Report On Fair Pricing Forum Released: A ‘Matter Of Global Concern’


The report from a meeting of a World Health Organization informal advisory group on challenges of medicines pricing and organising a Fair Pricing Forum this spring has been made public. The report shows the analysis and assertions of the diverse group, as well as questions and plans to take forward.” “The informal advisory group met in a closed-door session at WHO from 22-24 November. A Fair Pricing Forum, co-organised by the WHO and the Netherlands government has been planned for 10-11 May (second day is the main day) in Amsterdam. The WHO has published a Q&A page on the May forum. It notes among other things that the forum initiative :does not replace WHO’s ongoing work on intellectual property and TRIPS flexibilities….”

Governance Now – The battle to access affordable medicines heats up

S Mithra Jha; http://www.governancenow.com/views/columns/the-battle-access-affordable-medicines-heats-who-health-wto-united-nations-human-rights-council

The UN Human Rights Council discussed access to medicines and the right to health. Big question: Shouldn’t the right to life come before profits from IPRs?


Human Resources for Health

Guardian – Record numbers of EU nurses quit NHS


Staffing crisis worsens as workers fear being unwelcome after Brexit.”

ILO (report) – Improving Employment and working conditions in health services


This report has been prepared by the International Labour Office as a basis for discussions at the Tripartite Meeting on Improving Employment and Working Conditions in Health Services, to be held from 24 to 28 April 2017 in Geneva. It provides an overview on recent developments in the health sector and reviews challenges and opportunities for enhancing decent work in health services.”

Quick link:

Kenya to employ 500 doctors from Tanzania. “International migration of health workers” (Jim Campbell on Twitter).   “Kenya is determined to keep its word on importing doctors after a revelation that some 500 Tanzanian doctors could be on their way to the country. A statement from Tanzanian president John Pombe Magufuli office revealed the plan which the country said follows a plea from Kenya. … … After the strike, it has been revealed that the country (Kenya) has an acute shortage of doctors that cannot be solved by depending on those still in school but by hiring from other countries,” read the statement in Swahili.”



Jonathan Glennie – The poverty trap in an era of inequality


Glennie never disappoints. “Breaking the cycle of poverty requires an understanding of the circumstances that sustain it. What can be done to address poverty that is intentional and not accidental?”  Based on his experience with Colombia (and South-Korea as an opposite example).

“…I lived in Colombia for some years. It has been a middle-income country for decades and has been described to me as a ‘vividero’: a great place to play if you have the cash. Living well in Colombia depends a great deal on income and wealth differentials. If the wages and capital of the majority improved significantly, gone would be the cheap maids, labourers, food and travel. The affluent, often flamboyant, lifestyle enjoyed by wealthy Colombians would be threatened. The privilege to which you have become accustomed and which you hope to hand on to your children begins to look less sustainable. It is perfectly plausible, even logical, to deduce that those currently benefiting from great inequality will do their best to maintain it. As we enter the era of the SDGs we are seeing more countries that resemble Colombia. As inequality between countries continues to reduce (as poorer countries very gradually converge with wealthier ones) inequalities within countries are increasing. This is the poverty trap facing billions of people in the world today. Whether they are extremely poor or living above the $1.90 poverty line, they are miles away from having anything resembling a life of reasonable opportunity and stability. This is not an accident of nature but a consequence of a specific set of instincts and decisions intended to maintain high levels of inequality. This matters because the policies and actions required to respond to the poverty trap depend on one’s analysis….”

Reuters – World has just months to stop starvation in Yemen, Somalia – Red Cross


The world has got three to four months to save millions of people in Yemen and Somalia from starvation, as war and drought wreck crops and block deliveries of food and medical care, the International Committee of the Red Cross said on Wednesday. The aid agency still needs $300 million to bring emergency assistance to a total of 5 million people in Yemen, Somalia and northeast Nigeria as well as areas of South Sudan, where famine has already been declared. “We have probably a window of three to four months to avoid a worst case scenario,” Dominik Stillhart, the ICRC’s director of operations worldwide, told a Geneva news briefing.”  “…The United Nations has appealed for about $5.6 billion, bringing total funding needs to $6 billion, Stillhart said.”

ODI (report) – Supporting Economic Transformation: An Approach Paper

M McMillan et al ; http://set.odi.org/set-approach-paper/

As continuous and sometimes remarkably fast economic growth has become more usual in much of the developing world over recent decades, attention has shifted to the pattern and quality of that growth. Issues of concern include the persistence of extreme poverty in many countries, despite growth in gross domestic product, and the weak capacity of many sectors to produce sustained increases in employment. Much of recent growth in sub-Saharan African economies has been due to factors like buoyant urbanisation, and an expansion in the service economy that serves only the middle- and upper-classes. This pattern of growth is both highly skewed and non-inclusive. Another way to express this is that these economies are achieving growth without depth, or economic growth without economic transformation. This approach paper seeks to define economic transformation, offers an approach to measuring progress towards it, and examines case studies from African and Asian economies where transformative policies have been successful to greater and lesser extents. The paper concludes by presenting a multi-disciplinary approach to identifying opportunities, diagnosing constraints and mapping out realistic policy options for countries to use to turn their economic growth into genuine transformation.”

You might also want to read another recent ODI paper, Putting theory into practice: how DFID is doing development differently.

Branko Milanovic  (blog) – Why 20th century tools cannot be used to address 21st century income inequality?


Brilliant blog.



Health research policy & systems – International consultation on long-term global health research priorities, research capacity and research uptake in developing countries

D McConalogue et al; http://health-policy-systems.biomedcentral.com/articles/10.1186/s12961-017-0181-0

« In recognition of the need for long-term planning for global health research, and to inform future global health research priorities, the United Kingdom Department for International Development (DfID) carried out a public consultation between May and June 2015. The consultation aimed to elicit views on the (1) the long-term future global health research priorities; (2) areas likely to be less important over time; (3) how to improve research uptake in low-income countries; and (4) how to build research capacity in low-income countries. … … The survey responses confirmed the growing importance of non-communicable disease as a global health research priority, being placed above infectious diseases. Participants felt that the key area for reducing funding prioritisation was infectious diseases. The involvement of policymakers and other key stakeholders was seen as critical to drive research uptake, as was collaboration and partnership. Several methods to build research capacity in low-income countries were described, including capacity building educational programmes, mentorship programmes and research institution collaboration and partnership. »

Stanford Social Innovation review – Collective impact


Worth a read, certainly for the many UHC proponents among you. “Large-scale social change requires broad cross-sector coordination, yet the social sector remains focused on the isolated intervention of individual organizations.”

Critical Public Health – Special issue on post-human perspectives – Editorial: Posthuman perspectives: relevance for a global public health

S Cohn et al; http://www.tandfonline.com/doi/full/10.1080/09581596.2017.1302557

In this special issue of Critical Public Health the papers collectively explore how certain theoretical perspectives in the social sciences, often termed ‘posthumanism’, might productively be applied to public health research. In this introduction we want to argue that this is much more than an academic exercise that simply follows intellectual fashion, to show its value for those engaged in a wide range of research and applied work. More than this, we also want to argue how it has the potential to reinvigorate a key argument that some readers may fear is disappearing from view – that talking about health is talking about politics….”

Health Promotion International – Community participation in research from resource-constrained countries: a scoping review

M Brear et al; https://academic.oup.com/heapro/article-abstract/doi/10.1093/heapro/dax010/3074693/Community-participation-in-research-from-resource?redirectedFrom=fulltext

Participatory health research (PHR) involves equitable community participation in all aspects of the research process. It is a potentially beneficial approach to research in resource-constrained countries. Measuring participation in specific activities and aspects is necessary for understanding the community and research-related benefits of PHR. The aims of this scoping review were to: develop a measure of lay-community participation in aspects and activities of PHR in resource-constrained countries; and use the measure to assess the nature and extent of reported participation….”