PMAC 2019 (Bangkok, 29 Jan- 3 Feb)
On the website, you can already find the synthesis, Conclusions & Recommendations presentation by Katie Dain, Viroj … et al. Warmly recommended, of course.
You also find the PMAC statement here.
But we definitely also want to recommend two absolute must-reads on IHP:
Rachel Thompson – The Political Economy of Global Health: Reflections from the Prince Mahidol Award Conference, Bangkok
The read of the week.
In this blog Rachel Thompson shares her personal reflections from the recent Prince Mahidol Award Conference (PMAC) on the political economy of non-communicable diseases (NCDs), considering the wider implications for our understanding of Global Health.
Excerpt, in the paragraph “Global Health is part of the neoliberal global political economy”:
“Once we understand Global Health as inseparable from Neoliberalism, we can begin to get to the root causes of why so much of the world are being “left behind” from global goals. To ignore its influence is to deceive ourselves and the people we are trying to serve. Once we understand Global Health as part of a system that has increased global inequalities and inequities, it seems strange to expect it to do the opposite – to “reduce inequities” e.g. as part of Agenda 2030’s leave no one behind pledge. This is the paradox at the heart of my frustrations with Global Health….”
There’s a lot more in this blog, so make sure you read it (even if you don’t fully agree).
Renzo Guinto – Political Economy of PMAC: Who Gets Invited, Who Doesn’t, and So What
In Renzo’s own words, “My part-ethnography, part-Twitter review of #PoliticalEconomy of #PMAC2019 w/ tweets frm @giannagayle @mariamparwaiz @JesseBump @rheasaksena @johanna_ralston @johnspaula”
Insightful & entertaining blog. Added bonus: some great pictures!
Lancet special issue on advancing women in science, medicine and global health
Fyi – the launch of this special theme issue in London takes place later today, and will be livestreamed.
From the press release:
“This week, The Lancet dedicates an entire issue to advancing gender equity in science, medicine and global health. The collection of papers highlights that gender equity in science is not only a matter of justice and rights but is crucial to producing the best research. By publishing new evidence, commentary and analysis, the journal calls on researchers, clinicians, funders, institutional leaders and medical journals to examine and address the systemic barriers to advancing women in science, medicine and global health.
An editorial in The Lancet states: “It is well-established that women are underrepresented in positions of power and leadership, undervalued, and experience discrimination and gender-based violence in scientific and health disciplines across the world… Despite decades of recognition, these problems have proved stubbornly persistent… Gender equity is not only a matter of justice and rights, it is crucial for producing the best research and providing the best care to patients. If the fields of science, medicine, and global health are to hope to work towards improving human lives, then they must be representative of the societies they serve. The fight for gender equity is everyone’s responsibility, and this means that feminism, too, is for everybody—for men and women, researchers, clinicians, funders, institutional leaders and, yes, even for medical journals.”
So as you might have guessed, do start your reading with this Editorial – Feminism is for everybody.
“ The overwhelming conclusion from this collection of work is that, to achieve meaningful change, actions must be directed at transforming the systems that women work within—making approaches informed by feminist analyses essential.”
The Editorial also quickly runs you through most of the other articles in the Collection.
Being a man, I will refrain from recommending this or that article, so go through the collection, and read as much as you can 😊.
For the purposes of this newsletter, though, I want to flag among others:
“WHO has identified “Ten threats to global health in 2019”. Surprisingly—one should say shockingly—gender inequity is not one of them. It is not only WHO that is failing by excluding women and girls from its priority list of dangers. The entire global health community has abdicated its responsibility for achieving gender justice in health….”
Horton also points specifically to the responsibility of men (in global health for this failure.
“…Something has gone wrong in global health. Gender was a more prominent issue during the era of the MDGs, if too narrowly defined through the lens of women’s, children’s, and adolescent health. It’s time to hold men especially accountable for this regression. Given their political prominence and power, they (we) have a special responsibility to speak out for gender equity. Too often we do not…” “The whole of health is shaped by our approaches to gender. Men must do more to amplify the importance of gender in global health, to listen, to engage, to advocate, and to create the conditions for women to flourish. The fact that, collectively, we are not doing so is a particularly ugly disfigurement of our community.”
- What is The Lancet doing about gender and diversity? (by J Clark & R Horton)
- Gender equality in science, medicine, and global health: where are we at and why does it matter? (by G Shannon et al)
“The purpose of this Review is to provide evidence for why gender equality in science, medicine, and global health matters for health and health-related outcomes. We present a high-level synthesis of global gender data, summarise progress towards gender equality in science, medicine, and global health, review the evidence for why gender equality in these fields matters in terms of health and social outcomes, and reflect on strategies to promote change. Notwithstanding the evolving landscape of global gender data, the overall pattern of gender equality for women in science, medicine, and global health is one of mixed gains and persistent challenges. Gender equality in science, medicine, and global health has the potential to lead to substantial health, social, and economic gains. Positioned within an evolving landscape of gender activism and evidence, our Review highlights missed and future opportunities, as well as the need to draw upon contemporary social movements to advance the field.”
- More talk than action: gender and ethnic diversity in leading public health universities (by M S Khan et al)
“Improving the career progression of women and ethnic minorities in public health universities has been a longstanding challenge, which we believe might be addressed by including staff diversity data in university rankings. We present findings from a mixed methods investigation of gender-related and ethnicity-related differences in career progression at the 15 highest ranked social sciences and public health universities in the world, including an analysis of the intersection between sex and ethnicity. Our study revealed that clear gender and ethnic disparities remain at the most senior academic positions, despite numerous diversity policies and action plans reported. In all universities, representation of women declined between middle and senior academic levels, despite women outnumbering men at the junior level. Ethnic-minority women might have a magnified disadvantage because ethnic-minority academics constitute a small proportion of junior-level positions and the proportion of ethnic-minority women declines along the seniority pathway.”
- Why it must be a feminist global health agenda (by Sara Davies et al)
Some of the key messages:
“Feminist research is vital to advance the women in global health agenda, and feminist methodologies are crucial for global health research. • Feminist leadership requires more than gender quotas; it requires formal and informal cultural change within institutions across global health governance. Quotas are important, but so too is reform towards feminist institutions and conditions. • Inequalities exist across sex but also class, education, geography, income, race, and physical and mental ability. Gender advocacy must promote inclusive participation and data collection to identify where discrimination and barriers to inclusion exist. • Global health is dependent on gender bias. Women predominantly occupy unpaid roles as caregivers and health workers, and this disparity needs to be recognised and the labour paid. • Gender inequality is often informal and private; we need diverse methods of research and research collaboration to expose, recognise, and address the informal and hidden ways in which inequality exists. • Critical dialogue must be matched by gendered allocation of resources, support for women’s champions, and institutional reform to facilitate research and programmes that secure progressive gender rights in global health governance, leadership, and everyday practices.”
And last but not least, Engaging men to support women in science, medicine, and global health
Trump’s State of the Union & health
Trump didn’t say much about global health during his State of the Union. With respect to health, however, Trump focused on two issues, drug pricing and his announcement of ‘the end of HIV in the US in a decade’ (or so he hopes).
See the following reads:
“President Donald Trump gave the US Congress a rosy, nationalistic presentation of the condition of the US economy and security last night and amid the range of issues raised, mentioned intellectual property twice in the context of trade, and extensively discussed lowering drug prices.” On drug pricing, see also the NYT – How Trump’s Latest Plan to Cut Drug Prices Will Affect You “The proposal seeks to lower out-of-pocket spending in Medicare by taking aim at the secret deals that drug makers strike with industry go-betweens.”
With some background on how this announcement came into being.
See also Vox – Trump called for an end to HIV in the US by 2030. That’s totally realistic. (with the view of 7 experts) and NYT – Trump Plan to Stop Spread of H.I.V. Will Target ‘Hot Spot’ Areas.
See also Nature News – Scientists kick the tires on Trump’s plan to tackle HIV
“Eliminating the disease in the US is a worthy goal, researchers say, but many worry that administration policies will make it impossible to achieve.”
Some more reads related to WHO’s 144th EB meeting
Some analyses (related to the last few days of the EB meeting) you might have missed, but that are well worth a read (in steno-style), mostly from IP-Watch/ HPW:
- Priti Patnaik in the Wire: WHO Report Flags Distortion of Investment and Innovation in Cancer Research
“A new cancer report by World Health Organisation (WHO) has both countries and the pharma industry debating on just how much profit cancer drugs generate for pharmaceutical companies. At stake is not only how much money the drug industry makes from high priced cancer drugs, but also, as the report suggests – is this investment really efficient? Is too much money chasing too few cancer drug candidates with only marginal benefits, diverting funds away from other therapeutic areas? The technical report that minced no words, said that “pharmaceutical companies set prices according to their commercial goals, with a focus on extracting the maximum amount that a buyer is willing to pay for a medicine”. The industry denounced the report as flawed….”
“… This story tries to understand and explain some of the issues raised by the industry, including on returns on investment, pricing transparency and efficiency of investments – and compares it to what the WHO’S report has said. It also places the report in the context of the discussions at the executive board meet last week. The Wire exclusively spoke to the author of the report….”
“World Health Organization Board members agreed last week on a draft resolution for the preparation of a United Nations General Assembly high-level meeting on universal health coverage in the fall, following intensive closed consultations in which intellectual property rights played a significant role.”
“With a united voice that World Health Organization Board members agreed last week on a draft resolution for the preparation of a United Nations General Assembly high-level meeting on universal health coverage in the fall, following intensive closed consultations. The United States, however, dissociated itself from language it thought gave a permissive view of abortion….”
PS: you find the draft resolutions all here (scroll to the bottom).
“Over the past year, the World Health Organization (WHO) has rolled out the latest version of its benchmarking tool for evaluating progress of national regulatory authorities towards meeting WHO quality assurance targets. This benchmarking tool applies a more transparent and systematic approach than previous versions, and was developed through “extensive” consultation with member states and the public. National regulatory authorities are responsible for “providing regulatory oversight of all medical products such as medicines, vaccines, blood products, traditional or herbal medicines and medical devices,” a WHO regulatory system overview states. The Global Benchmarking Tool (GBT) “represents the primary means by which the WHO objectively evaluates regulatory systems, as mandated by WHA Resolution 67.20 [pdf] on Regulatory System Strengthening for medical products,” the WHO website explains….”
· WHO & the Foundation for Smoke Free World
“Last week, the innocuously named Foundation for a Smoke Free World (FSFW), was once again embarrassed by the World Health Organisation (WHO). The WHO’s director general Dr Tedros publicly condemned the efforts of this foundation to influence anti-smoking and public health policy globally. This is the foundation’s third denouncement from the WHO….”
The Foundation was more popular in Davos, apparently, see Bloomberg – Philip Morris Rebuffed by WHO as It Tries to Rewrite Narrative.
“Philip Morris International Inc. is trying to burnish its image, most recently among the international, socially conscientious elite at Davos. … But Chief Executive Officer Andre Calantzopoulos says it’s hard to make headway in a shift away from cigarettes with the WHO still characterizing it as a bad actor. “The WHO continues to refuse to even have a conversation with us,” Calantzopoulos said in an email after the company returned from the World Economic Forum in Davos, where it called for a truce between “anti-tobacco lobbies” and the industry. If the WHO and tobacco companies are able to work together, Philip Morris says they can better encourage adult smokers who would otherwise keep buying cigarettes to switch to vaping or other alternatives it calls lower risk. It projects that by 2025, at least 40 million Philip Morris cigarette smokers will have switched to smoke-free products….”
Well, let’s just say – we’re being kind for once – the Davos crowd is more gullible.
“The fair pricing of medicines and the transparency of costs were underlined as key by many nongovernmental organisations last week during a discussion at the World Health Organization Executive Board on access to medicines. The Board heard about staggering numbers of people deprived of access to medication and health products, with examples from patients with epilepsy, kidney diseases and other illnesses preventing them from getting better or surviving their condition. A number of reasons can be attributed to the lack of availability and affordability to safe medications, but many NGOs pointed to high prices, and underlined the need for transparency to achieve fair pricing, and brought attention to issues they thought were not considered enough in the larger debate on access to medicines at the WHO….”
(gated) “Intellectual property is often pointed at as hindering access to medicines by resulting in their long-lasting unaffordability, a view which is strongly opposed by IP proponents. The discussions on access to medicines last week during the World Health Organization Executive Board meeting yielded a record number of interventions by member states and nongovernmental organisations, reflecting the importance of the issue.”
World Cancer Day (4 Feb) (with focus on cervical cancer)
UN News – World Cancer Day: Early cervical cancer diagnosis could save lives of over 300,000 women
“Cervical cancer kills more than 300,000 women every year, with one woman diagnosed every minute, despite the fact that it is one of the most preventable and curable forms of the disease. In a statement released on Monday to coincide with World Cancer Day, the United Nations World Health Organization (WHO) said that nine out of ten women who die from cervical cancer are from poor countries, and that if no action is taken, deaths from the disease will rise by almost 50 per cent by 2040. The WHO points out that new diagnoses can be reduced by ensuring that all 9-14 year old girls globally are vaccinated against Human papillomavirus (HPV), a group of viruses that are extremely common worldwide, two types of which cause 70 per cent of cervical cancers….”
“…New diagnoses can be reduced in two ways, HPV vaccination and screening of the cervix with follow on treatment of early changes before cancer appears….”
For coverage, see also VOA – WHO: Cervical Cancer Preventable, Can Be Eliminated
“Ahead of World Cancer Day (February 4), the World Health Organization (WHO) is calling for accelerated action to eliminate cervical cancer, a preventable disease that kills more than 300,000 women every year…”
Lancet Global Health (Editorial) – Lifting the veil on cancer treatment
The Lancet Global Health’s new Editorial (for World Cancer Day 2019) highlights the inequalities in access to treatment for cancer and the economic case for investing in cancer control. (the editorial comes back, among others, on WHO EB discussions)
Lancet Global Health Comment – Cervical cancer: lessons learned from neglected tropical diseases
Slightly ominous analysis. « …The global outlook on cervical cancer is at risk of becoming similar to that on neglected tropical diseases (NTDs), for which investment in treatment discovery is stalling and clinical know-how is dwindling. NTDs afflict approximately 1 billion people worldwide. Yet this heavy but preventable burden is neither felt nor perceived in wealthy parts of the world, as NTDs are almost entirely concentrated in low-income settings, where people do not have sufficient ability to affect political decisions in any meaningful way. … … Cervical cancer and NTDs share many common features…. … The NTD trajectory shows that when diseases almost exclusively affect the poor, they are at risk of becoming progressively deprioritised on national and international health agendas… … … In the case of cervical cancer, there is no reason to wait until its status as an NTD is confirmed, but instead to plan ahead for the not-too-distant future when it is largely eliminated in high-income populations. Cervical cancer can either become a neglected disease with a devastating and inequitable burden on the poorest women of the world, or the global health community can work collectively towards its elimination and treatment based on an equity maxim….”
HPW – Cancer Patients Need Greater Access To Pain Relief, Including Opioids, Says WHO
““Nobody, cancer patients or not cancer patients, should live or die in pain in the 21st century,” Dr Etienne Krug, director of WHO’s Department for Management of Noncommunicable Diseases, said at the launch of new WHO Guidelines for management of cancer pain just ahead of World Cancer Day, which is observed today….”
Spread of child welfare in Africa
Reuters – U.N. sees poverty hope in African uptake of child welfare payments
“The spread of state welfare for children around Africa has the potential to make a major dent in global poverty, the United Nations said on Wednesday.”
“Children account for the majority of those around the world in extreme poverty, living on less than $1.90 per day, with half of them in Africa, where social security systems are weak. Globally, about a third of children are covered by social protection programs, but it ranges from 88 percent in Europe and Central Asia to 16 percent in Africa, said a new study by two U.N. bodies. “The evidence shows clearly that social protection benefits, and cash transfers in particular, have a positive impact on poverty, food security, health and access to education – thus helping to ensure that children can realize their full potential, breaking the vicious cycle of poverty,” it said….”
According to the new study by the International Labour Organization (ILO) and children’s agency UNICEF, “In sub-Saharan Africa, expected to have 90 percent of children in extreme poverty by 2030, 40 out of 48 countries have some form of cash transfer program, but most pay too little and overall only 13.1 percent of children receive them. “They aren’t all huge programs but it’s been a real growth in the region and it’s moving very, very quickly,” David Stewart, UNICEF’s head of child poverty, told reporters….” “Several African countries were to discuss expanding their coverage at a conference in Geneva this week, Stewart said….”
Guardian – Billions of UK aid failing to reduce poverty, report finds
“Too much of Britain’s aid budget is being spent poorly by Whitehall departments on projects that fail the test of reducing poverty in the world’s poorest countries, a campaign group has said. The One Campaign … … said the huge gulf in standards across government was undermining the battle to build public trust that taxpayers’ money was being well spent. … Romilly Greenhill, the One Campaign’s UK director, said that money spent by DfID scored highly for poverty focus, effectiveness and transparency, but the same could not always be said of the 30% of the budget spent by other Whitehall departments….” “The campaign group’s new Real Aid Index said that only 5% of the £765m spent by the business, energy and industrial strategy department (BEIS) and 16% of the £1.05bn spent by the Foreign Office (FCO) went to the countries that needed it most.”
See also Devex.
In other UK related news, the Guardian reported Brexit could put 1.7 million people around globe into extreme poverty – study
“Britain leaving the EU could hit least-developed countries hard, with Cambodia most affected, report finds.”
Greta Thunberg and the #climatestrike are shaping the climate debate
“With the 16-year-old climate activist Greta Thunberg as their figurehead, thousands of young people have taken to the streets and social media in the past couple of months to demand an end to politicians’ climate inaction. These youngsters have been successful, both through their online and offline activities, in sparking debate and mainstreaming the extending of the limits of the ‘sayable’ in the climate change discussion…. … What started as the lone action of a Stockholm teenager against politicians’ inaction towards climate change has since become an international phenomenon. There have been strikes in for instance Germany, Belgium, Australia, Switzerland, the US, Canada, Finland, Denmark, Japan, and the UK. …”
“…What is also remarkable about Thunberg and the #climatestrike is that it has been steering the discussion around climate change away from mere individualised solutions towards questions of systemic injustice, and the way in which the most vulnerable are the first ones to pay the price when financial gain is prioritised over the future of young people….”
PS: It’s & pity that some countries (like China) are firmly authoritarian, and will no doubt not allow the young generation to strike, as if this were to become a truly global movement of youngsters, they would even be more effective. But in China, the CP has some bad memories of youngsters taking to the streets…
Guardian – A third of Himalayan ice cap doomed, finds report
Your weekly dose of horror news. “At least a third of the huge ice fields in Asia’s towering mountain chain are doomed to melt due to climate change, according to a landmark report, with serious consequences for almost 2 billion people. Even if carbon emissions are dramatically and rapidly cut and succeed in limiting global warming to 1.5C, 36% of the glaciers along in the Hindu Kush and Himalaya range will have gone by 2100. If emissions are not cut, the loss soars to two-thirds, the report found….”
For more horror news, see the ‘Planetary Health’ section.
BMJ (Editorial) – Challenges for health in the Anthropocene epoch
A Haines et al; https://www.bmj.com/content/364/bmj.l460
“A new series and a call for papers.”
“… The BMJ is planning a special series on planetary health and the practical transformations needed to improve human health and protect our essential natural systems. Our knowledge of the challenges and opportunities in the Anthropocene epoch is still evolving and we aim to stimulate debate, advance understanding, and share experience. We call for manuscripts that assess threats to planetary health and present evidence for relevant policies and interventions —including ideas for feature articles or multimedia—illustrating what can be achieved at local level….”
Lancet Letter – Global public health challenges, fiscal policies, and yellow vest
“…The case for using fiscal and pricing policies designed to improve health is strong, and the evidence base is growing. Many governments have been able to overcome strong opposition to these measures from industry, but they will need to sharpen their fiscal policy tools to avoid disenfranchising taxpayers, whose support they need the most.”
For a related op-ed, see Stiglitz (on Project Syndicate) – From Yellow Vests to the Green New Deal
World Bank (leadership) update
Devex – As Jim Kim steps down, a tumultuous World Bank presidency comes to an end
Final analysis of Kim’s legacy. Well worth a read.
“As the dust settles on Jim Kim’s abrupt resignation from the World Bank, former colleagues, staff, and experts weigh in on what he accomplished during more than six years as president.”
“…But while his presidency was tumultuous, Kim is not without his supporters. They argue that while he may have failed to win over those inside the bank, he was successful in selling the institution to those outside it. Kim increased shareholder confidence in the bank, put it on a more secure financial footing, and increased its relevance by pivoting to work on “public goods” and human development. He also pushed the institution to invest in fragile and conflict-affected states, they say….”
NYT – Trump Nominates David Malpass to Head World Bank
“Mr. Malpass, currently the under secretary for international affairs at the Treasury Department, has been a point person in the Trump administration’s trade negotiations with China and has overseen the government’s relationship with the World Bank. He is also a longtime critic of the World Bank’s lending practices and its business model and has expressed concern about the power that multilateral institutions exert….”
Profile of David Malpass, Trump’s likely pick for WB president (if nobody stops him). See also Politico – Trump picks World Bank critic Malpass to lead institution and Bloomberg.
Some other reads, providing additional angles, or arguing for different candidates:
- Nancy Birdsall (CGD) – May the Best Woman Win at the World Bank
- Owen Barder – Time, Gentlemen, Please
“It is time for an open, fair, merit-based process to appoint the next President of the World Bank. And I’ll explain below why I think the Europeans may, at last, break the cartel that has prevented this.”
I’m afraid Owen overestimates European cohesion – these days, EU leaders only show strong cohesion when it comes to Brexit 😊.
“In the wake of U.S. President Donald Trump’s announcement on Wednesday that he will nominate David Malpass to be the next president of the World Bank, Malpass’ record as a critic of the bank — and particularly of its relationship with China — has some staffers and development experts worried.”
CGD – How Will Donors Spend $170 Billion This Year and Next?
Owen Barder et al; https://www.cgdev.org/blog/how-will-donors-spend-170-billion-year-and-next
“In 2019–20, donors will commit roughly $170 billion of public funding to an alphabet soup of international aid organisations, many of which their citizens may never have heard of. The UK, the US, Japan, and Germany (the four biggest funders in declining order), as well as key participants in multilateral governance and performance assessments will commit this money with no shared vision of the international system they want to build, little useful information about the respective strengths and weaknesses of the organisations, or any strategic overview of each other’s intentions, we argue in a new CGD paper. Each replenishment will be considered as a separate exercise, ignoring the reality that they are competing for limited donor resources….”
The paper considers how the donors should approach these replenishments instead.
Global Fund 6th Replenishment Preparatory Meeting (Delhi, 7-8 February)
India is hosting the kick-off meeting of the Global Fund’s Sixth Replenishment fundraising drive in Delhi. The Global Fund is seeking to raise at least US$14 billion for the next three years to help save 16 million lives, cut the mortality rate from HIV, TB and malaria in half, and build stronger health systems by 2023.
- Among others, an India Showcase Event already took place – “India stands committed to increase its overall health allocations to 2.5% of its GDP”; the India Working Group for Health Advocacy also sent an Open Letter to the PM of India ahead of the GF Sixth Replenishment Preparatory Meeting calling for a doubling of India’s pledge to the Global Fund and a doubling of national health expenditure.
- The full investment case will be published later today. Check Global Fund for updates later today, & Aidspan in the coming days.
Published ahead of the kick-off meeting: “Deadly, drug-resistant tuberculosis — as lethal as Ebola and tough to treat in even the best hospitals — is a “blinking red” worldwide threat, the head of a global health fund warned in an interview with AFP. …. … “We should all be more worried about multidrug-resistant TB than we are. It gets nothing like the level of attention it should do,” Peter Sands, Global Fund’s head, told AFP during a visit to New Delhi….”
Coincidentally, the GF also reported Significant Progress Achieved Against TB in High-Burden Asian Countries
“Preliminary results from a joint initiative to find and treat additional 1.5 million “missing” tuberculosis patients by the end of 2019 show solid progress, with Asia driving the success. Six countries in Asia with the highest burdens of TB in the world have found an additional 450,000 cases of TB in the past year alone, and more than 840,000 additional patients compared with 2015. Half of the additional TB cases found last year through the initiative, which is supported by the Global Fund, World Health Organization and the Stop TB Partnership, were in India alone….”
CGD (blog) – Gavi Going Forward: Immunization for Every Child Everywhere?
Must-read. “In December 2018, the Gavi Alliance, the organization that helps low-income countries vaccinate its children, hosted a mid-term review to assess progress towards its core purpose: “reach every child everywhere with vaccines against preventable diseases.” The good news is that there’s been advances on new vaccine introductions, and an estimated 65 million children were immunized with Gavi-supported new and underutilized vaccines in 2017. The bad news? There is still huge variability on the measure that counts most for building herd immunity and reducing vaccine-preventable disease: full vaccination for age among children under 2 years old. And this problem is worse where Gavi is phasing out, raising issues for the organization as it looks critically at its mission ahead of its 2019/2020 replenishment, and is relevant all over the world as recent measles outbreaks in the Philippines and in Washington State starkly illustrate….”
“Gavi’s recent 2021–2025 strategy document highlights some of the reasons behind low coverage and inequalities in both Gavi-eligible and transition countries. They include weak health systems, clustering of vulnerable populations in non-eligible MICs, vaccine pricing in non-eligible MICs, conflict, back-sliding coverage in MICs, changing demographics, prevention of and response to outbreaks, and climate change, among others. And a 2017 study found that inequalities in vaccination coverage across 45 Gavi-eligible countries is most strongly associated with low levels of maternal education and poverty (with child sex, child malnutrition, and urban/rural residence also playing a role in some countries)….”
International Day of Zero Tolerance for Female Genital Mutilation (6 Feb)
UN News – With millions of girls ‘at risk’ today of genital mutilation, UN chief calls for zero tolerance
“Female genital mutilation, is “an abhorrent human rights violation” still affecting women and girls around the globe, UN Secretary-General Antonio Guterres stated in his message for the International Day of Zero Tolerance for FGM, marked on Wednesday.”
…“An estimated 200 million women and girls alive today have been subject to this harmful practice” the UN chief said, “and every year, almost four million girls are at risk”….
““On this Day of Zero Tolerance, I call for increased, concerted and global action to end female genital mutilation and fully uphold the human rights of all women and girls,” concluded the Secretary-General. …”
NPR Goats & Soda – The 2019 Report Card For The Fight To End Female Genital Mutilation
Good helicopter view of the worldwide FGM situation. “ …Despite the recent headlines, researchers believe that very real strides have been made to reduce FGM’s prevalence….”
And an excerpt: “This February the African Union is launching a campaign to eliminate FGM at its conference in Addis Ababa, The goal is to set up a mechanism for African countries to report regularly on their progress, making them accountable to the public and the international community, says Nafissatou Diop, coordinator of the UNFPA-UNICEF joint program on the elimination of FGM. Diop points to more promising news: Over the past several months two announcements of major funding show “clear and important … momentum to eliminate” practice by 2030, as called for by the U.N.’s Sustainable Development Goals, she says. One is the United Kingdom’s recent pledge of 50 million pounds to help end FGM across the most affected areas in Africa. The other is the European Union’s commitment of 250 million euros for the U.N.’s Spotlight Initiative to eliminate violence against women and girls in Africa….”
Ebola DRC – Guarded optimism as Ebola outbreak hits its 6 month mark
For the latest snapshot, see CIDRAP.
Stat News – Top WHO official sees progress in grueling fight against Ebola outbreak
From late last week. “…six months after the ongoing Ebola outbreak in the Democratic Republic of the Congo began, efforts to stop spread of the disease are producing signs of progress, a senior World Health Organization official told STAT on Thursday. Transmission has either been halted or significantly reduced in a number of the areas where the disease has spread, said Dr. Mike Ryan, assistant director of the WHO’s emergency preparedness and response program. But there is still intense transmission in a large city, Katwa, and stopping the disease there is not going to be an easy task, said Ryan. He described the outbreak as more of a series of linked epidemics than one large outbreak….” (see also CIDRAP – Guarded optimism as DRC Ebola outbreak hits 6-month mark )
Lancet – Ebola in the Democratic Republic of the Congo: time to sound a global alert?
WHO’s message of ‘guarded optimism’ contrasted with this Lancet viewpoint by a number of public health experts, which came out on Monday.
“…Faced with an evolving complex humanitarian crisis, and recent elections complete, WHO Director-General Tedros Adhanom Ghebreyesus should reconvene the Emergency Committee (EC) and consider declaring a Public Health Emergency of International Concern (PHEIC)….”
Criteria for a PHEIC have been met (already for some time, actually), they say, and although they commend WHO’s leadership & operational endurance in this outbreak, they feel it’s time to declare a PHEIC. They, however, admit, that announcing a PHEIC might also have potential adverse impacts.
Devex – Why can’t pregnant women be vaccinated during epidemics?
“As an Ebola outbreak worsens in Congo, one key group is being denied a life-saving vaccination.” An update on where things stand for pregnant women in terms of vaccination during epidemics. Linked to a new Wellcome Trust supported report. “It’s time to shift the paradigm”.
Telegraph – Ebola’s lost blood: row over samples flown out of Africa as ‘big pharma’ set to cash in
Other Ebola related news: “A row is simmering over the ownership of thousands of Ebola blood samples taken from patients during the 2014-16 epidemic in West Africa and now held in secretive laboratories around the world. The samples have enormous value to researchers involved in creating new vaccines and medicines but also to defence facilities such as Porton Down in the UK where research on bio-chemical agents and their antidotes is conducted. Now several African scientists and Ebola survivors accuse the laboratories of biological asset stripping. Despite the samples having been taken from thousands of Africans, scientists from these patients’ home countries – Sierra Leone, Guinea and Liberia – are unable to access them for their own research….”
Moreover, “…. none of the people whose blood was taken gave their consent for research and the samples are still linked to the clinical and personal data of the patients….”
Suicide rates falling globally
BMJ Editorial – Suicide falls by a third globally
“In a linked article, Naghavi and colleagues analysed findings from the 2016 iteration of the Global Burden of Disease Study and identified remarkable changes in suicide rates worldwide. They describe patterns of suicide mortality and years of life lost globally, regionally, and for 195 countries and territories by age, sex, and Socio-demographic index from 1990 to 2016. Their results indicate substantial reductions in suicide globally—a 33% decline in the age standardised suicide rate between 1990 and 2016—but underscore that suicide remains a leading cause of years of life lost in many parts of the world. …
… Further, their findings draw attention to the remarkable heterogeneity in suicide trends across countries and demographic subgroups that warrant further investigation. … … Exceptionally high (Lesotho, Lithuania), rising (Zimbabwe, Jamaica), low (Lebanon, Syria), or falling (China, Denmark) suicide rates prompt the question of whether estimated patterns are real. The lack of complete and high-quality vital registration data in most countries leads to heavy reliance on modelling; results could reflect modelling assumptions rather than underlying data….”
- See also the linked Opinion in BMJ – Global suicide mortality: Using data to inform action and monitor progress (by M Naghavi et al)
- For some coverage, see The Guardian – Suicide rates falling around the world, study says
“Researchers say the overall trend is down thanks to poverty reduction and better healthcare.”
“Suicides have fallen globally by more than a third since 1990, according to a far-reaching analysis that highlights profound differences in the number of men and women taking their own lives….”
Guardian – The tech giants won’t like it, but a digital tax must become a reality
“The OECD’s bid to tax digital services across the world’s 34 richest nations is a step towards fairness.”
“…Last week, the Organisation for Economic Co-operation and Development (OECD), which is attempting to standardise tax rules across the world’s 34 richest nations, said that its members had agreed to consider benchmarks for taxing digital services….”
“The Harvard Kennedy School published a preview of its research into “systems leadership,” an approach to solving complex problems. The authors suggest that systems leadership is suited to harnessing broad-based efforts towards achieving the SDGs….”
“The research preview is issued in the form of the executive summary to a forthcoming report. The summary identifies key features of systems leadership: engaging with stakeholders to define shared goals; conducting a mapping of the system in question; finding ways to energize stakeholders, for example through inspiration, incentives and deadlines; acting with accountability; and reviewing progress….”
By Lisa Dreier, David Nabarro and Jane Nelson.
Key papers of the week
Global Health Research and Policy – (How) does RBF strengthen strategic purchasing of health care? Comparing the experience of Uganda, Zimbabwe and the Democratic Republic of the Congo
S Witter et al; Global Health Research and Policy;
“Results-Based Financing (RBF) has proliferated in health sectors of low and middle income countries, especially fragile and conflict-affected ones, and has been presented as a way of reforming and strengthening strategic purchasing. However, few studies have empirically examined how RBF impacts on health care purchasing in these settings. This article examines the effects of several RBF programmes on health care purchasing functions in three fragile and post-conflict settings: Uganda, Zimbabwe and the Democratic Republic of Congo (DRC) over the past decade. …”
Results & conclusion: “Across the cases, at the government level, we find little change to the accountability of purchasers, but RBF does mobilise additional resources to support entitlements. In relation to the population, RBF appears to bring in improvements in specifying and informing about entitlements for some services. However, the engagement and consultation with the population on their needs was found to be limited. In relation to providers, RBF did not impact in any major way on provider accreditation and selection, or on treatment guidelines. However, it did introduce a more contractual relationship for some providers and bring about (at least partial) improvements in provider payment systems, data quality, increased financial autonomy for primary providers and enforcing equitable strategies. More generally, RBF has been a source of much-needed revenue at primary care level in under-funded health systems. The context–particularly the degree of stability and authority of government–, the design of the RBF programme and the potential for effective integration of RBF in existing systems and its stage of development were key factors behind differences observed. … Our evidence suggests that expectations of RBF as an instrument of systemic reform should be nuanced, while focusing instead on expanding the key areas of potential gain and ensuring better integration and institutionalisation, towards which two of the three case study countries are working. “
BMJ Global Health (Commentary) – Using rapid reviews to strengthen health policy and systems and progress towards universal health coverage
Etienne Langlois et al ; https://gh.bmj.com/content/4/1/e001178
Summary : « Progress towards universal health coverage should be informed by timely evidence on the effectiveness of health systems interventions, how and in what settings these interventions work, their cost-effectiveness, and the legal, ethical and societal implications of implementing these interventions. Rapid reviews have emerged as an efficient approach to producing relevant and contextualised evidence often arising from requests by decision-makers, thus enhancing their applicability for health policy and systems decision-making. Various mechanisms exist to enhance the timeliness of reviews, including using review shortcuts, narrowing the scope, intensifying the work on review processes and automating review steps. Stakeholders involved in rapid reviews should be transparent about their methodological choices, and strong collaboration between knowledge producers and users is encouraged to make sure the resulting evidence fits its intended purpose. Challenges in fast-tracking reviews include their application to complex health policy and systems interventions, striking a balance between accelerating review methods and maintaining robustness and transparency, as well as strengthening capacity for the conduct and use of rapid reviews.”
Lancet Diabetes and Endocrinology – Community groups or mobile phone messaging to prevent and control type 2 diabetes and intermediate hyperglycaemia in Bangladesh (DMagic): a cluster-randomised controlled trial
Cfr a tweet: “We can prevent diabetes. A new large population trial in Bangladesh, published in the Lancet today, shows community mobilisation through men’s and women’s groups cuts the relative risk of pre-diabetes and diabetes by an astonishing 64% “
Some key blogs & mainstream media articles of the week
Ongoing debate on long-term trends in global poverty in the blogosphere
We recommend the following two blogs:
His view is not uncontroversial (among others, Martin Ravaillon weighed in, on Twitter, and there was also this blog How do we know the history of extreme poverty? (by Joe Hasell & Max Roser) ).
- To put it in the right perspective, also read Branko Milanovic’s (even broader) helicopter view: Global poverty over the long-term: legitimate issues
Meanwhile, Hickel already reacted to Roser’s graph as well – A response to Max Roser: how not to measure global poverty.
Global Health Policy Unit (Edinburgh) – Bringing the IMF in from the cold
Mark Hellowell; https://ghpu.sps.ed.ac.uk/bringing-the-imf-in-from-the-cold/
“The IMF is unpopular among global health scholars. But in the SDG era, should we be bringing this powerful actor in from the cold? “ Well worth a read.
Excerpts: “…Many global health scholars have argued that the IMF has prevented the equitable development of health systems in Africa. Others argue to the contrary that the IMF has enabled higher public health spending in LMICs on average. There is a more nuanced position that, like its neighbour on Washington’s 19th Street, the World Bank, the IMF is not the creature it was in the last 15 years of the 20th century….”
“…The architecture for the poorest countries changed again in 2009, in a series of reforms that further enhanced the IMF’s focus on safeguarding ‘social protection’. By failing to take account of this variation over time, the existing research is less informative than it could be about what the IMF does and what its consequences are for poor countries. As the IMF is left out in the cold, scholars are missing out on opportunities to influence this key global actor. Our work in GHPU has begun to address this. We have examined, for example, how the effects of IMF agreements on public health spending vary by type of agreement (i.e. those that are designed to emphasise social protection, and those that are not), and by the income category of the recipient country (see more here)….” Check out what they found.
Read also Austerity Politics, Global Neoliberalism, and the Official Discourse within the IMF (by K Farnsworth et al, on Global Policy)
“Is austerity a ‘dream come true’ for neoliberals, or did the global financial crisis force policymakers to question neoliberalism’s core principles and change direction? Focusing on speeches by members of the International Monetary Fund, Kevin Farnsworth and Zoë Irving find little to suggest that the fundamental assumptions of neoliberalism have been displaced.”
The Collective Psychology Project
Alex Evans’ latest project, “fit for our polarised age”.
Some background: “The Collective Psychology Project is a collaborative inquiry into how psychology and politics can be brought together in new, creative ways that help us to become a larger us instead of a them-and-us. From now until summer 2019, we’re working on an initial research and scoping phase, including mapping the ground and who’s doing what, convening conversations between the worlds of psychology and politics, and pulling our findings together in an agenda-setting think piece. … … Discussion of anxiety often centres on young people and the personal pressures they face, but anxiety and threat perception can be collective as well as individual. What would it look like, then, to take a more psychologically sound approach to political polarisation, in which polarisation is seen and treated as a symptom of exactly the kind of unresolved threat perception that lies at the heart of trauma and chronic anxiety?… Reimagining polarisation as a public mental health issue implies that the way forward is less about victory than about healing…. “
The Davos set are cosying up to the far right – and scared of the left
“The World Economic Forum event revealed how elites are more afraid of leftwing populists, than rightwing ones like Bolsonaro. ”
NYT – Giant Strides in World Health, but It Could Be So Much Better
With quotes from Devi Sridhar, Peter Piot and others.
Cfr a tweet by Benjamin Mason Meier: “A welcome “#globalhealth is getting better” story, but it feeds into an oversimplified view of #publichealth — #infectiousdisease flows from south to north while #NCDs flow north to south — and neglects the complex interdependence of a globalizing world.”
NYT – Abolish Billionaires
“A radical idea is gaining adherents on the left. “ Hope Global Health will take it up. And no worries, this is not mean to be a 21st century Stalinist-style purge, it would all go via “structural reforms” 😊.
Excerpt: “… it is an illustration of the political precariousness of billionaires that the idea has since become something like mainline thought on the progressive left. Bernie Sanders and Elizabeth Warren are floating new taxes aimed at the superrich, including special rates for billionaires. Representative Alexandria Ocasio-Cortez, who also favors higher taxes on the wealthy, has been making a moral case against the existence of billionaires. Dan Riffle, her policy adviser, recently changed his Twitter name to “Every Billionaire Is A Policy Failure.” Last week, HuffPost asked, “Should Billionaires Even Exist?” I suspect the question is getting so much attention because the answer is obvious: Nope. Billionaires should not exist — at least not in their present numbers, with their current globe-swallowing power, garnering this level of adulation, while the rest of the economy scrapes by….”