Lancet – Offline: The ethical darkness of global health

R Horton; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31667-8/fulltext With respect to the likes of Saudi Arabia (see Khashoggi, Yemen, …), the Philippines (Duterte), Myanmar, … (and the list goes on, endlessly, unfortunately), Richard Horton wonders about global health’s stance: “…what about the voice of global health, its institutions, agencies, and leaders? Silence. Instead, the global health community seems comfortable associating itself with regimes that commit appalling human rights violations—regimes that are welcomed and embraced at the World Health Assembly, academic conferences, and even within the pages of scientific journals (including The Lancet). Do those who virtue signal their moral credentials in global health not consider their responsibilities to judge nations more broadly than merely their stated commitments to, for example, universal health coverage? It seems not….” “The ethical cowardice that afflicts global health today is unacceptable…” Horton goes on to list the five lessons David Miliband draws from the current ‘Age of Impunity’. And concludes: “…And finally, there is a new dividing line in politics, between those who understand that power needs to be checked by strengthening the rule of law, and those who do not. Global health leaders must engage with all nations. But those same leaders have also turned their backs on some of the world's gravest atrocities. Smiling and shaking hands with representatives from murderous regimes is one way of doing global health. But it is a way that will end with the normalisation of indecency, inhumanity, and slaughter.”

Ebola DRC – At last a PHEIC

WHO - Ebola outbreak in the Democratic Republic of the Congo declared a Public Health Emergency of International Concern

https://www.who.int/news-room/detail/17-07-2019-ebola-outbreak-in-the-democratic-republic-of-the-congo-declared-a-public-health-emergency-of-international-concern The WHO statement on Wednesday evening:  “… “It is time for the world to take notice and redouble our efforts. We need to work together in solidarity with the DRC to end this outbreak and build a better health system,” said Dr. Tedros….”   See also Tedros’ speech.

HPW - Ebola Emergency Shadowed By Cross-Border Risks, Funding Gaps & Vaccine Challenges

https://www.healthpolicy-watch.org/ebola-outbreak-in-drc-declared-a-public-health-emergency-of-international-concern/ (must-read coverage & analysis) “Against the background of increased cross-border infection risks, the World Health Organization on Wednesday declared the Ebola virus outbreak in the Democratic Republic of the Congo to be a Public Health Emergency of International Concern (PHEIC) – a decision that may help increase aid flows to the disease epicentre but also threaten free-wheeling patterns of regional trade and travel, which are the norm today for local communities, oiling their economies.” “The WHO decision, announced by Director General Dr Tedros Adhanom Ghebreyesus at an evening press conference broadcast live on Twitter, came against the backdrop of a visibly looming Ebola funding crisis, as well as more subtle disagreements over deployment of a second back-up vaccine, which some proponents say would strengthen preparedness. WHO officials said money was not the motive for the PHEIC declaration by a special Emergencies Committee on Ebola. But Mike Ryan, WHO’s head of Health Emergencies, stressed that the Organization and its other health partners would require some US$ 230 million or more to effectively fight the deadly outbreak in the coming months….” The piece also contains the views (and framing) on the rationale by dr. Tedros & R Steffen (chair of the Emergency Committee that had gathered for the 4^th time). As for the rationale, “Steffen said that the Committee had decided to declare an emergency because of the fear of the spread of Ebola from the DRC “gateway” city of Goma along the border with Rwanda, where a pastor from Beni had travelled and fallen ill last week; recurring transmission in Beni, one of the DRC cities at the epicentre of the outbreak in the province of North Kivu; ongoing security risks to responders, and the duration of the outbreak, approaching one year.” Steffen still considers it a regional emergency (and not a global threat). PS: the article hints that WHO is in favour of using a second vaccine (which had been controversial, earlier this week). For the latter, see Stat News - Debate over whether to test a second Ebola vaccine turns acrimonious  (must-read,  with also views from Peter Piot & the Wellcome Trust on this issue, vs the African Minister of Health (  then – who wanted to stick to one vaccine ) then)). For some other great coverage (and first reactions from global health experts, mostly positive as for many (and especially Global Health Law scholars), ‘PHEIC conditions had long been met’)), see also: Guardian (Sarah Boseley) - DRC Ebola epidemic is international emergency, says WHO  (incl view of L Gostin) Devex (J L Ravelo) - WHO declares global public health emergency in DRC Ebola outbreak Stat News (H Branswell) - WHO declares Ebola outbreak an international health emergency  (incl view of Rebecca Katz, among others)

Cidrap News – Ebola cases climb in Beni, international groups applaud emergency decision

http://www.cidrap.umn.edu/news-perspective/2019/07/ebola-cases-climb-beni-international-groups-applaud-emergency-decision Latest update, among others on the DRC government’s mixed feelings on the declaration of a PHEIC.  “One day after the World Health Organization (WHO) called the ongoing Ebola crisis in the eastern reaches of the Democratic Republic of the Congo (DRC) a public health emergency of international concern (PHEIC), DRC officials said they accept the designation — with some reservations. "The ministry hopes that this decision is not the result of the many pressures from different stakeholder groups who wanted to use this statement as an opportunity to raise funds for humanitarian actors despite the potentially harmful and unforeseen consequences for the affected communities that depend on them," the DRC ministry of health said yesterday in their daily update on the outbreak. Officials also said the DRC government had been and remained to be transparent about how funding was being used in the outbreak, and that they hope any aid group that receives an increase in funding because of the PHEIC would also be transparent about spending. The comments seem to reflect the hesitancy the some in the DRC have had surrounding a PHEIC, which they argue would do little to actually increase the outbreak response and instead further economic distress in that country….”

Guardian - More of the same won't solve Congo's Ebola crisis – let locals lead

Susannah Mayhew et al; https://www.theguardian.com/global-development/2019/jul/18/congo-ebola-crisis-let-locals-lead-world-health-organization-public-health-emergency Hard-hitting piece, referring to lessons learnt in the previous Ebola outbreak in Western Africa. “As the World Health Organization declares a public health emergency in DRC, frontline responders must be allowed a greater role in response efforts.” “…On Wednesday, the World Health Organization (WHO) declared the crisis a public health emergency of international concern. This raises the stakes and must lead to fundamental changes in the response. The WHO wants more funding to extend and reinforce outbreak control measures, but simply expanding the current approach is unlikely to result in a more effective response. We believe it is time for the WHO to step back and allow local leaders and frontline responders to lead the response. … … The majority of deaths in DRC are occurring in homes, or at health centres not equipped to deal with the outbreak. The Ebola response must go to where the cases are, which means embedding it into local communities…. … Above all, there is a need to trust in local common sense, once the nature of the epidemic and the infection risks it poses have been made clear…”

WHO - High-level meeting on the Ebola outbreak in the Democratic Republic of the Congo affirms support for Government-led response and UN system-wide approach

WHO; On a High-Level (donor) meeting earlier this week, in Geneva.   (PS: Our national newspaper also said this morning that a secret WB audit report (from June) also might play a role in some of the reluctance of countries to fund the Ebola response (better), in addition to Western indifference.) See HPW -  WHO & UN Emergencies Leadership Call For Major Funding Infusion To End Ebola Outbreak “In the wake of a new Ebola case in the border city of Goma, WHO and its UN partners are calling on donors to make major new funding commitments to halt the outbreak in the Democratic Republic of Congo (DRC) – while WHO will reconvene an expert Emergency Committee to consider if the outbreak should be considered a “public health emergency of international concern.” WHO Director General Dr Tedros Adhanom Ghebreyesus made the twin announcements at a high-level meeting in Geneva today on the emergency response, hosted by the UN Office for the Coordination of Humanitarian Affairs (OCHA). The meeting followed confirmation of the first Ebola case in Goma, a major city along the Rwandan border, as well as the weekend murder of two Ebola responders in their homes in Beni, in North Kivu, where the outbreak has raged since last August. “…Dr Tedros’ call for donors to “step up to the bat” was echoed by the British Secretary of State for International Development Rory Stewart and the UN’s Under-Secretary-General for Humanitarian Affairs Mark Lowcock, among others….” See also UN News - ‘We won’t get to zero cases of Ebola without a big scale-up in funding,’ UN relief chief warns And see the Lancet (Editorial)’s take on this donor meeting (and general mood there): A wake up call for the Ebola outbreak response “The tone of the meeting was defiant and conveyed a definite change in narrative, at odds with those who claim the Ebola virus outbreak is under control. WHO Director-General, Tedros Adhanom Ghebreyesus, announced that he will reconvene the International Health Regulations Emergency Committee. Amidst an immense funding shortfall, the message was clear: the world must now wake up to the fragility of the response.” “…Pleas were made to some G7 and francophone nations who have yet to commit funding. But repeated calls for operational and financial transparency and accountability might partly explain why donors have not fully invested in the response to date.” “…The approach proposed seems to be a scale-up of the existing strategies led by DR Congo, which calls on donors to increase their funding. …“

Devex - Q&A: How the Ebola declaration could threaten food security in DRC

https://www.devex.com/news/q-a-how-the-ebola-declaration-could-threaten-food-security-in-drc-95320 One of the concerns now that it’s been declared a PHEIC. “…there are also concerns that the declaration could negatively impact the response if neighboring countries react by imposing restrictions on trade and travel — fears that contributed to WHO’s hesitancy to make the declaration.  … According to the Famine Early Warning Network, Ebola in DRC continues to “disrupt agricultural activity,” with impacted areas already at “crisis” levels of food insecurity….”

Some tweets

  John Nkengasong (African CDC) “As the Ebola outbreak in DRC is now a PHEIC @AfricaCDC is activating the African Health Voluntary Corp (AHVC), which is decision 570 issued in 2015 by the African heads of state and government. AHVC was critical in controlling the West Africa Ebola outbreak.” Richard Horton – “A question now is what will be different about the response to the Ebola outbreak in DRC with a PHEIC compared to without a PHEIC.” Dr Tedros: “Today the @WHO Emergency Committee recommended that I declare the #Ebola outbreak in #DRC a public health emergency of international concern. I have accepted that advice. Now it's time for the international community to show solidarity with the people of DRC, not to isolate them.” Helen Branswell: “So call me slow (please don't) but none of the reasons Prof. Steffen listed for why the #Ebola outbreak is now being declared a #PHEIC are new, other than the worry about Goma (which is also not new)” Pam Das (commenting on Laurie Garret’s despair on the WB’s Pandemic Fund): “Yes, @WHO averted commenting on whether any pandemic fund money had been given to date. What is it for, if not an emergency like this! @Laurie_Garrett:  “What does this actually mean? So far the @WorldBank has delivered only $6.5M to @WHO for the #Ebola fight. You have a pandemic fund -- release the money! What are you waiting for -- another 1,000 dead? Dead Ugandans? Dead Rwandans? https://twitter.com/WBG_Health/status/1151570924644327424 …”

Some other Ebola DRC related links & reads from this week

UN News - UNICEF warns of higher risk to very youngest children

https://news.un.org/en/story/2019/07/1042531 “…the UN Children’s Fund UNICEF warned that the epidemic “is infecting more children” than earlier outbreaks.  …”

BMJ Editorial - Holding back Ebola

F L Jephcott; https://www.bmj.com/content/366/bmj.l4566 “Domestic public health infrastructure is the best defence.” And concluding, “…"It is no coincidence that the countries where the largest Ebola outbreaks have proliferated are among those most in want of soap and local public health officials."” Devex - UK steps up funding for Ebola response, tells other donors situation is 'on a knife-edge'   (I quite like Rory Stewarts’ attitude & commitment in this).   “…While announcing $63 million in new funding for the response, U.K. Secretary of State for International Development Rory Stewart admonished other donors for their lack of foresight and generosity….” Devex - Q&A: Ebola has reached Goma — what does it mean for the response? The first case in Goma was considered by Tedros himself as a ‘potential game-changer’, early this week. The Conversation - How the DRC’s Ebola crisis has led to children dying from measles Reuters - WHO flags Ebola risk in Rwanda, but then withdraws its report

iHEA in Basel & ‘health taxes’/sin taxes debate

https://www.healtheconomics.org/page/2019Basel Unfortunately, none of us was at the iHeA (International Health Economics Association) conference in Basel.  But then again, with our fondness for “global health gossip & somewhat fake news”, we wouldn’t have fitted in (with all these data-obsessed health economists) 😊.  From a distance (i.e. far away Antwerp), it looked like a nice conference, though. You might want to check out some of the tweets, via the hashtag iHEA2019    (or tweets from Joe  Kutzin, Agnes Soucat, Gavin Yamey, … and many others ). A few random tweets below perhaps, from Agnès Soucat: “Strong collaboration of @IMF @WorldBank and @WHO in developing fiscal analysis and strengthening the Finance-Heath Dialogue Early results show 1. Most countries have some fiscal space 2. Public spending on health mostly driven by taxation capacity.”  “Health taxes” belong to a new generation of fiscal instruments which have shown their effectiveness in market shaping & behavior change. They also often bring additional revenue. They should be part of the #UHC & #SDG3 Financing toolbox together with other instruments GH2035 “This is not the old kind of tax: it is a positive one as the primary objective is NOT to generate funding but to foster healthier behavior. It is a financing instrument first, and not necessarily a funding instrument ..” So it appears WHO increasingly prefers the term ‘health taxes’  (over ‘sin taxes’, for example). Both Richard Horton (“As George Alleyne always argues, please let’s not use the phrase “sin tax.” This implies a moral judgement on the part of the health community, and we should not be in the business of judging fellow citizens.”) and Gavin Yamey (“I agree, let’s call them “health taxes.” Emerging evidence suggests that some are win-win-win-win, eg tobacco taxes improve health AND raise revenue AND are pro-poor (additional life years benefit poor the most) AND reduce out of pocket medical expenses”) seem to agree.

BMJ (blog) - Syntax and the “sin tax”: the power of narratives for health

https://blogs.bmj.com/bmj/2019/07/17/syntax-and-the-sin-tax-the-power-of-narratives-for-health/ One of the blogs of the week. By Anna Purdie & Kent Buse who emphasize we need to reclaim the narrative on regulation (on the likes of Boris Johnson etc). “Why does right to consume appear more important than the right to health? In  @bmj_latest,  we argue hierarchy produced & reproduced by powerful narratives which health community must tackle and contradict, instead highlighting expansive possibility of health…” “#Nannystate narratives paint health regulation as restrictive - but the expansive possibility of promoting the #RightToHealth to prevent #NCDs is possible. It's up to #publichealth to get this right.” “How, then, do we work to bring about a change, where health is seen as an expansive possibility while the primacy of (over)consumption, which is threatening the sustainability of both people and planet, is both questioned and curtailed? How should we, the public health community, rebalance and perhaps even begin to prioritise the right to health, over the right to consume, in the public mindset?  Three areas stand out:…”

Annual UNAIDS report: call for greater urgency

UNAIDS - UNAIDS calls for greater urgency as global gains slow and countries show mixed results towards 2020 HIV targets

https://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2019/july/20190716_PR_UNAIDS_global_report_2019 “Impressive advances in some countries, troubling failures in others as available resources for HIV fall by nearly US$ 1 billion.” “The pace of progress in reducing new HIV infections, increasing access to treatment and ending AIDS-related deaths is slowing down according to a new report released today by UNAIDS. UNAIDS’ Global AIDS Update, Communities at the centre, shows a mixed picture, with some countries making impressive gains while others are experiencing rises in new HIV infections and AIDS-related deaths….” As for financing: “…Disconcertingly, the report shows that the gap between resource needs and resource availability is widening. For the first time, the global resources available for the AIDS response declined significantly, by nearly US$ 1 billion, as donors disbursed less and domestic investments did not grow fast enough to compensate for inflation. In 2018, US$ 19 billion (in constant 2016 dollars) was available for the AIDS response, US$ 7.2 billion short of the estimated US$ 26.2 billion needed by 2020. To continue progress towards ending AIDS, UNAIDS urges all partners to step up action and invest in the response, including by fully funding the Global Fund to Fight AIDS, Tuberculosis and Malaria with at least US$ 14 billion at its replenishment in October and through increasing bilateral and domestic funding for HIV….”

UNAIDS press release - Kaiser/UNAIDS analysis finds donor governments spent US$8 billion for HIV in 2018, similar to a decade ago

https://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2019/july/20190716_donor-government-disbursements “Donor government disbursements to combat HIV in low- and middle-income countries totaled US$8 billion in 2018, little changed from the US$8.1 billion total in 2017 and from the levels of a decade ago, finds a new report from the Kaiser Family Foundation (KFF) and UNAIDS. Half of the 14 donor governments analyzed in the study increased their spending on global HIV efforts from 2017 to 2018; five decreased their spending; and two held steady. Donor government funding supports HIV care and treatment, prevention and other services in low- and middle-income countries. The United States remains the world’s largest donor for HIV by far, disbursing US$5.8 billion last year, and also ranks first in disbursements relative to the size of each donor’s economy. The next largest donors are the United Kingdom (US$605 million), France (US$302 million), the Netherlands (US$232 million) and Germany (US$162 million)….” Great coverage among others in: The Guardian - UNAids target to end epidemic by 2030 at risk as funding falls for first time HPW - New HIV Infections Declining, But So Is Funding To Combat The Disease “A new UNAIDS report found that while new HIV infections have declined globally since 2010, the rate of progress has slowed, with some regions showing increases in new infections. … … The overall decline in new cases – 16 percent since 2010 – signifies an impressive improvement, which is driven largely by steady progress across eastern and southern Africa, the regions most affected by HIV. However, there have been increases in new HIV infections in eastern Europe and central Asia (29%), in the Middle East and North Africa (10%) and in Latin America (7%), according to a UNAIDS press release…”

UHC & disability

Lancet Editorial - Prioritising disability in universal health coverage

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31638-1/fulltext “Current health systems are failing the 1 billion people worldwide living with disabilities. Unless access to health care is dramatically improved for this marginalised group, the goal of universal health coverage will not be achieved. These are the stark conclusions of The Missing Billion, a report from the London School of Hygiene & Tropical Medicine and other partners, published on July 9, which shines a light on the barriers to health care and disparities in outcomes faced by people living with disabilities….” “…Although implicit in the pursuit of universal health coverage, disability does not feature on the agenda of the upcoming UN High-Level Meeting on Universal Health Coverage, nor is it mentioned specifically in Sustainable Development Goal 3. Access to good-quality health care for people with disabilities is a litmus test for whether universal health coverage is achieved. Designing health-care systems that meet the needs of people with disabilities and other marginalised groups will undoubtedly improve health care for all.”

Mosquito control

Nature news - World’s most invasive mosquito nearly eradicated from two islands in China

https://www.nature.com/articles/d41586-019-02160-z?utm_source=twt_nnc&utm_medium=social&utm_campaign=naturenews&sf215898036=1 “Researchers have all but obliterated populations of the world’s most invasive mosquito species — the Asian tiger mosquito (Aedes albopictus) — on two islands in the Chinese city of Guangzhou. They reduced A. albopictus populations by up to 94% using a combination of two promising control techniques in a field trial for the first time. The two-pronged approach, published in Nature on 17 July, integrates the sterilization of female Asian tiger mosquitoes with the infection of males using Wolbachia pipientis, a bacterium that hinders the insects’ ability to reproduce and transmit disease-causing viruses such as dengue and Zika. …”

Lancet Series on Oral Health: “a Tipping point for global oral health?”

https://www.thelancet.com/series/oral-health Do start perhaps with this week’s Lancet Editorial - Oral health at a tipping point. “…A new Lancet Series lays out why oral health has been neglected and argues that radical public health action is needed. The Series presents a considerable critique of current oral health-care systems and comes at a time when shifts within the global health agenda present an opportunity to bring much needed visibility to oral health….”  “…Because oral diseases share the main risk factors of other non-communicable diseases (NCDs)—sugar consumption, tobacco use, and harmful alcohol use—oral health should have a stronger place on the global NCDs agenda….” Some key messages via the Lancet press release: “The Lancet: Big Sugar and neglect by global health community fuel oral health crisis  “Oral diseases present a major global public health burden, affecting 3.5 billion people worldwide, yet oral health has been largely ignored by the global health community, according to a new Lancet Series on Oral Health. With a treat-over-prevent model, modern dentistry has failed to combat the global challenge of oral diseases, giving rise to calls for the radical reform of dental care. The burden of oral diseases is on course to rise as more people are exposed to the underlying risk factors of oral diseases, including sugar, tobacco and alcohol. Emerging evidence of the food, beverage, and sugar industry’s influence on dental research and professional bodies raises fresh concern.” “Oral health has been isolated from traditional healthcare and health policy for too long, despite the major global public health burden of oral diseases, according to a Lancet Series on Oral Health, published today in The Lancet. Failure of the global health community to prioritise the global burden of oral health has led to calls from Lancet Series authors for the radical reform of dental care, tightened regulation of the sugar industry, and greater transparency around conflict of interests in dental research. … “…The Lancet Series on Oral Health led by University College London (UCL) researchers brought together 13 academic and clinical experts from 10 countries, including the  US, to better understand why oral diseases have persisted globally over the last three decades, despite scientific advancements in the field, and why prevalence has increased in low- and middle- income countries (LMIC), and among socially disadvantaged and vulnerable people, no matter where they live.  … …    “Dentistry is in a state of crisis,” said Professor Richard Watt, Chair and Honorary Consultant in Dental Public Health at UCL and lead author of the Series. “Current dental care and public health responses have been largely inadequate, inequitable, and costly, leaving billions of people without access to even basic oral health care. … … In high-income countries (HIC), dentistry is increasingly technology-focused and trapped in a treatment-over-prevention cycle, failing to tackle the underlying causes of oral diseases. Oral health conditions share many of the same underlying risk factors as non-communicable diseases, such as sugar consumption, tobacco use and harmful alcohol consumption. … …  Lancet Series authors have called for wholesale reform of the dental care model in five key areas: 1. Close the divide between dental and general healthcare 2. Educate and train the future dental workforce with an emphasis on prevention 3. Tackle oral health inequalities through a focus on inclusivity and accessibility 4. Take a stronger policy approach to address the underlying causes of oral diseases 5. Redefine the oral health research agenda to address gaps in LMIC knowledge  “ And a quote by Dr Jocalyn Clark, an Executive Editor at The Lancet: “Dentistry is rarely thought of as a mainstream part of healthcare practice and policy, despite the centrality of the mouth and oral cavity to people’s well-being and identity. A clear need exists for broader accessibility and integration of dental services into healthcare systems, especially primary care, and for oral health to have more prominence within universal health coverage commitments. Everyone who cares about global health should advocate to end the neglect of oral health.”

The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness

https://www.thelancet.com/commissions/physical-health-in-mental-illness “People with mental illness have an increased risk of physical disease, as well as reduced access to adequate health care. Physical-health disparities are observed across all mental illnesses in all countries. The high rate of physical comorbidity, which often has poor clinical management, reduces life expectancy for people with mental illness, and increases the personal, social, and economic cost of mental illness across the lifespan. This Commission summarises advances in understanding on the topic of physical health in people with mental illness, and presents clear directions for health promotion, clinical care, and future research. It aims to: (1) establish highly pertinent aspects of physical health-related morbidity and mortality that have transdiagnostic applications; (2) highlight the common modifiable factors that drive disparities in physical health; (3) present actions and initiatives for health policy and clinical services to address these issues; and (4) identify promising areas for future research that could identify novel solutions.”

HLPF in New York (9-18 July) (second part)

Some news snippets from the last few days of the HL meeting:

UN News - Inclusion, empowerment and equality, must be ‘at the heart of our efforts’ to ensure sustainable development, says UN chief

https://news.un.org/en/story/2019/07/1042581 “The world’s people are demanding “transformative change that is fair and sustainable,” Secretary-General António Guterres said on Tuesday, calling on government leaders to use the upcoming slate of key United Nations meetings in September to “kickstart a decade of delivery and action for people and planet.” “

UN News - 25 years after population conference, women still face challenges to ‘well-being and human rights’, says UN chief

https://news.un.org/en/story/2019/07/1042611 “Many women and girls “still face enormous challenges to their health, well-being and human rights”, Secretary-General António Guterres told a High-level General Assembly meeting on Tuesday convened to mark the 25th anniversary of the International Conference on Population and Development (ICPD), a milestone in reproductive health and rights….”

Guardian - Conditions improve for world's poorest but children bear greatest burden – UN

https://www.theguardian.com/global-development/2019/jul/12/conditions-improve-for-worlds-poorest-but-children-bear-greatest-burden-un See also last week’s IHP News.  “The UN’s key global poverty index has identified that conditions for the world’s poorest 40% are improving more quickly than for those just above them. The positive trend has been identified in the latest assessment of world poverty collected by the UN Development Programme, which quantifies relative impoverishment across the globe by multiple factors. “We looked at data for a group of 10 middle- and low-income countries and we found encouraging news that the bottom 40% were moving faster than the rest,” said Sabina Alkire, director at the Oxford Poverty and Human Development Initiative, which drew up the report with UNDP.  “Within these 10 countries, data show that 270 million people moved out of multidimensional poverty from one survey to the next.” According to the report, the progress was largely driven by south Asia. In India there were 271 million fewer people in poverty in 2016 than in 2006, while in Bangladesh the number dropped by 19 million between 2004 and 2014. …” And some quick links: Project Syndicate (M Laberge (UNDP))- How Africa Measures Up on Governance  “Data on governance, like any other official statistics, are a public good and should be accessible to all. Otherwise, the true scale of violence, exclusion, and discrimination will remain hidden, and the potential of carefully collected information to improve life for ordinary citizens will not be fully realized.”  Re SDG 16. “…according to a new study by the South African Institute of International Affairs (SAIIA) and the United Nations Development Programme (UNDP), African countries are among the most innovative and committed in measuring and reporting on the governance goal….” IISD - HLPF Participants Reflect on Four Years of VNRs IISD - Panels Discuss 2030 Agenda under G20 Japanese Presidency, Reveal Priorities for Saudi Arabia’s Presidency in 2020 Excerpt: “Princess Haifa Al Mogrin, Saudi Arabia, announced the priorities for her country’s G20 Presidency in 2020, underscoring women’s empowerment and youth, infrastructure, food security, energy, human capital, climate change, inclusive business, water, and small and medium-sized enterprises (SMEs). … …  During another panel titled, ‘Analysis on G20 Contribution to the Implementation of the 2030 Agenda,’ Kerri Elgar, Organisation for Economic Co-operation and Development (OECD), presented the report titled, ‘G20 Contribution to the 2030 Agenda: Progress and Way Forward,’ which explores the ways in which the G20 could collectively contribute to the SDGs. She highlighted opportunities for: lowering costs of remittances to generate at least USD 25 billion a year by 2030; increasing female participation in the workforce and reducing the gender gap by 25% by 2025; and cooperating on tax transparency, which has already resulted in USD 95 billion in additional revenue since 2009….”

Global Health Security

Devex - 3 global health leaders outline their health security visions

https://www.devex.com/news/3-global-health-leaders-outline-their-health-security-visions-95249 Mainly for this quote from John Nkengasong (director Africa CDC), on “Global health, public health, and health security — the distinctions”: “…But being clear on what exactly is being requested is also important. This is something Dr. John Nkengasong, director of the Africa Centers for Disease Control and Prevention, says the health security sector has yet to properly define. “I still am struggling with a basic definition of what we are talking about — and that is important,” he told Devex. “If we are going to mobilize resources, we are mobilizing resources from people who are meant to be stakeholders but are not part of our daily conversation. The clarity with which we present this to other stakeholders is important. Otherwise, we continue to talk among ourselves.” The fine distinction between global health, public health, and health security, he said, has to be developed and defined in short, succinct, and crystalized ways. “If we define global health security in terms of the impact of diseases or a disease outbreak on mobility or mortality, that is one way of defining health security. In that case, you have to say HIV/AIDS is the greatest health security threat for all of Africa. If instead, we say we’re looking at a disease that has the possibility of impacting mobility and mortality as well as destabilize and disrupt social services globally, we can distinguish from HIV.” But this “tight” definition has yet to be cemented, something Nkengasong said needs to happen in order to see progress….” And a quick link (in BMC Public Health ) -   Establishing a theoretical foundation for measuring global health security: a scoping review  (by S Ravi et al)  “…We sought to aggregate evidence-based principles that capture a country’s baseline public health and healthcare capabilities, its health security system performance before and during infectious disease crises, and its broader social, political, security, and ecological risk environments….”

Global Hunger report

WHO - World hunger is still not going down after three years and obesity is still growing – UN report

https://www.who.int/news-room/detail/15-07-2019-world-hunger-is-still-not-going-down-after-three-years-and-obesity-is-still-growing-un-report “An estimated 820 million people did not have enough to eat in 2018, up from 811 million in the previous year, which is the third year of increase in a row. This underscores the immense challenge of achieving the Sustainable Development Goal of Zero Hunger by 2030, says a new edition of the annual The State of Food Security and Nutrition in the World report released today. The pace of progress in halving the number of children who are stunted and in reducing the number of babies born with low birth weight is too slow, which also puts the SDG 2 nutrition targets further out of reach, according to the report. At the same time, adding to these challenges, overweight and obesity continue to increase in all regions, particularly among school-age children and adults….” See also a tweet: “Today’s launch of the #SOFI2019 report at the #HLPF is a major wake up call: - for 3rd year in a row global #hunger has ↑, with #climatechange a key driver - 2 billion people are food insecure - we are off track at meeting all global #nutrition targets, including for #obesity” Coverage & analysis:

• UN News - Over 820 million people suffering from hunger; new UN report reveals stubborn realities of ‘immense’ global challenge

 

• HPW - Hunger & Obesity Both Rising Worldwide Says UN Report

   

• Devex - Why is global hunger on the rise? UN economists explain a new answer

Excerpts: “… Global hunger trends, measured by a prevalence of undernourishment, showed progress from 2005 until 2015, but then reverted and have since risen over the last three years, according to the new "2019 State of Food Security and Nutrition in the World” report. … … Devex spoke with Holleman and Arif Husain, chief economist at WFP, in advance of the high-level meeting. They explain the creeping hunger phenomenon and how the new findings challenge pre-existing notions of global hunger. … … In 2015, there were 785.4 million people suffering from hunger. Since then, food insecurity has been on the rise globally but has increased the most in Africa and Latin America. And most of the world’s hungry now live in middle-income countries. … More than 75% of the world’s hungry, 78% of stunted children, and 64% of the extreme poor live in middle-income countries, Husain said. “The level of severe food insecurity is almost three times higher in countries with high-income inequality compared with countries with low-income inequality,” Husain said. …And hunger is not just limited to people who regularly go without enough food, the agencies show for the first time in this annual report. An increasing number of people experience moderate levels of food insecurity — meaning they face uncertainty about their ability to obtain food or may need to choose between the quality or quantity of food. This reclassification significantly expands the scope of the problem. Over 2 billion people do not have regular access to safe, nutritious, and sufficient food, according to the report. … … … … Conflict and climate change are clear drivers of hunger, but poor economic performance for many countries following the 2008-2009 financial crisis is another major factor. “We cannot just talk about climate and conflict. That is too simple. It is economic,” Holleman said. “We need to change our concept of hunger: It is not just in the very poor countries. It is middle-income countries. And this is the most shocking to me, because these are the countries that are performing well, in terms of overall development,” Holleman said, noting that this requires governments to put in place policies and reforms with the priority of addressing hunger and malnutrition….”

Global vaccination

HPW - 20 million children miss out on lifesaving measles, diphtheria and tetanus vaccines in 2018

https://www.healthpolicy-watch.org/20-million-children-miss-out-on-lifesaving-measles-diphtheria-and-tetanus-vaccines-in-2018/ “20 million children worldwide – more than 1 in 10 – missed out on lifesaving vaccines such as measles, diphtheria and tetanus in 2018, according to new data from WHO and UNICEF. Globally, since 2010, vaccination coverage with three doses of diphtheria, tetanus and pertussis (DTP3) and one dose of the measles vaccine has stalled at around 86 percent. While high, this is not sufficient. 95 percent coverage is needed – globally, across countries, and communities – to protect against outbreaks of vaccine-preventable diseases….” “…In a report on global immunization coverage, the U.N. agencies found that vaccination levels are stagnating, notably in poor countries or areas of conflict. “Vaccines are one of our most important tools for preventing outbreaks and keeping the world safe,” the WHO’s director general, Tedros Adhanom Ghebreyesus, said in a statement. “It’s often those who are most at risk – the poorest, the most marginalized, those touched by conflict or forced from their homes - who are persistently missed,” he said. “Far too many are left behind.”…” See also UN News - ‘Complacency’ a factor in stagnating global vaccination rates, warn UN health chiefs The UN cited obstacles including conflict, cost and complacency. And dr. Tedros in the FT - Anti-vaxxers distract from a more serious threat. "... Myths and misinformation about vaccines are a serious threat that the World Health Organization is committed to countering. But that's only part of the challenge. The global vaccine crisis is not that rates are falling everywhere, it's that they have stubbornly stalled. …Close to 20m children worldwide -- more than one in 10 -- are not getting the vaccines they need. For the most part, that's not because their parents are being spooked by social media trolls. It's because they simply can't access vaccines. ... … That's why WHO's top priority is to support countries to achieve universal health coverage, so that everyone has access to essential health services" ….”

Planetary Health

Lancet Planetary Health (July issue)

https://www.thelancet.com/journals/lanplh/issue/vol3no7/PIIS2542-5196(19)X0008-X Do start with the (more than timely) editorial, Record breakers. You probably have a hunch which “records” they’re referring too…

• Do read also: Climate change and health: more research on adaptation is needed (by T Liu et al)

“… However, [so far ] few studies have considered the effects of adaptation, which might lead to uncertainty in risk assessments of climate change. In The Lancet Planetary Health, Hicham Achebak and colleagues did a country-wide time-series analysis in mainland Spain and the Balearic Islands to assess trends in temperature-related cardiovascular disease mortality between 1980 and 2016. This is the first study to systematically investigate the health impact of the 1°C increase in annual temperature that has been observed in Spain since 1980….” “…The study by Achebak and colleagues provides valuable information for policy makers and researchers for the development of strategies that enable adaption to the adverse health impacts of climate change.”

• Biodiversity loss—more than an environmental emergency (by D Roe)

“…[the] lack of familiarity accounts for the scarcity of engagement of the development community in debates about biodiversity and how to protect it. It is not that those concerned with development have a blind spot for environmental issues—climate change is a priority on high on the agenda of many development organisations. But they don't seem to fully understand biodiversity. In this comment, I argue that they need to, and quickly….” “.. So, what is biodiversity and why does it really matter to development?  The formal definition of biodiversity comes from the UN Convention on Biological Diversity which describes it as “the variability among living organisms from all sources including, inter alia, terrestrial, marine and other aquatic ecosystems and the ecological complexes of which they are part; this includes diversity within species, between species and of ecosystems.” The key word is variability. Biodiversity is more than an elephant, a herd of elephants, or the entire world population of elephants. It is the diversity of life and the ecological interactions between diverse lifeforms that matters most. … Diversity matters because it has a big effect on the productivity and stability of natural ecosystems, and on the services they provide, many of which are important for key development sectors.   … Development professionals need to engage, because the current rate of loss poses a severe threat to key development priorities (eg, health and hunger) “In 2020, the international community will agree on a new 10-year framework for biodiversity management. Developing this new framework into one that works for both biodiversity and for people requires active engagement by the development community, and there are some actions that could be taken to enable this. … In 2020, biodiversity is as much a development priority as is the climate change emergency and therefore needs much more proactive engagement and response from the development community.”

• Feature - The march of climate policy (by M Hope). Starting from the gilets jaunes protests in France, Hope lives up to his name:  “What the gilets jaunes protests made clear to all policymakers was that whatever option they choose, it must be fair to all in society. Without it, there will remain staunch opposition and the risk of conflating climate policy with blue collar job losses…. There are promising signs that global policymakers are engaging with the notion that any transition away from fossil fuels must be equitable, however. At the same meeting, the concept of a “just transition”—the idea that climate policies must be coupled with measures to provide those hit by the policies with new jobs and a new future—got top billing. Thanks to the gilets jaunes, the message that the climate crisis must be addressed, but in an equitable way, is now loud and clear.”

Guardian - US philanthropists vow to raise millions for climate activists

https://www.theguardian.com/environment/2019/jul/12/us-philanthropists-vow-to-raise-millions-for-climate-activists I’m probably not the only one who had mixed feelings about this news from late last week. “A group of wealthy US philanthropists and investors have donated almost half a million pounds to support the grassroots movement Extinction Rebellion and school strike groups – with the promise of tens of millions more in the months ahead. Trevor Neilson, an investor and philanthropist who has worked with some of the world’s richest families, has teamed up with Rory Kennedy – daughter of Robert Kennedy – and Aileen Getty, whose family wealth comes from the oil industry, to launch the Climate Emergency Fund. Neilson, who has worked with figures such as Bill Gates and Richard Branson, said the fund was inspired by Swedish teenager Greta Thunberg and the Extinction Rebellion protesters in the UK in April. Neilson said the three founders were using their contacts among the global mega-rich to get “a hundred times” more in the weeks and months ahead. “This might be the single best chance we have to stop the greatest emergency we have ever faced,” he told the Guardian. The new fund has the author and environmentalist Bill McKibben, who set up 350.org, and David Wallace Wells, who wrote international best seller Uninhabitable Earth, on its advisory board….”

Jacobin - The Rich Are Committing Crimes Against Nature

https://jacobinmag.com/2019/07/environment-rich-people-tesla-powerwall-super-yacht-private-jet “Mansions, superyachts, luxury cars, and private jets produce more carbon emissions than whole countries. Researchers are calling it “green crime.”” “A new paper called “Measuring the Ecological Impact of the Wealthy: Excessive Consumption, Ecological Disorganization, Green Crime, and Justice,” published by researchers Michael J. Lynch, Michael A. Long, Paul B. Stretesky, and Kimberly L. Barrett, takes a long hard look at the role of the rich’s consumption habits in destabilizing the climate. …”

Devex - IFRC issues new guidelines to help cities combat deadly heat waves

https://www.devex.com/news/ifrc-issues-new-guidelines-to-help-cities-combat-deadly-heat-waves-95305 “The International Federation of Red Cross and Red Crescent Societies released the first set of international guidelines on heat waves for cities on Tuesday, issuing an urgent call for cities to prepare for the increasingly common “silent killers.”…”

Wired – A Global pollution observatory hunts for hidden killers

https://www.wired.com/story/a-global-pollution-observatory-hunts-for-hidden-killers/ “…A new global coalition of pollution experts, the Global Observatory on Pollution and Health, is monitoring pollution data in real time and developing country-specific policies to address its sources….” And some Planetary health related quick links:

• Guardian - July on course to be hottest month ever, say climate scientists

 

• Women's Connected Leadership declaration on climate justice

“The climate movement cannot succeed without an urgent upsurge in women’s leadership across the Global South and the Global North. Women and girls are already boldly leading on climate justice, addressing the climate crisis in ways that heal, rather than deepen, systemic injustices. Yet, these voices are often under-represented and efforts inadequately supported.  Now is the moment to recognize the wisdom and leadership of women and girls. Now is the moment to grow in number and build power. We invite all of our sisters to rise and to lead on climate justice, and for those with relative power and privilege to make space for and support others. …”

Menstrual cups

Cfr the Lancet press release of a new study in the Lancet Public Health - Menstrual cup use, leakage, acceptability, safety, and availability: a systematic review and meta-analysis “The Lancet Public Health: First scientific review of menstrual cups suggests they are safe and may be as effective as other sanitary products. Review indicates that menstrual cups are a safe option for menstruation management. Around 70% of women wanted to continue using menstrual cups once they were familiar with how use them, but practice, peer support and training are key to initiation. Although there are 199 brands of menstrual cup, and cups are available in 99 countries, awareness is low – cups were only mentioned in 21 of 69 websites containing educational materials on puberty from 27 countries. Preliminary evidence on the cost and waste savings associated with using menstrual cups suggests that they could be beneficial. The first systematic review and meta-analysis of the international use of menstrual cups, including 43 studies and data from 3,300 women and girls – published in The Lancet Public Health journal, suggests they are safe and result in similar, or lower, leakage than disposable pads or tampons. …” “… “Despite the fact that 1.9 billion women globally are of menstruating age - spending on average 65 days a year dealing with menstrual blood flow, few good quality studies exist that compare sanitary products,” says senior author Professor Penelope Phillips-Howard from the Liverpool School of Tropical Medicine, UK. “We aimed to address this by summarising current knowledge about leakage, safety, and acceptability of menstrual cups, comparing them to other products where possible.”  …” Coverage for example in the Telegraph - Menstrual cups are as safe and effective as other sanitary products, report finds  and the NYT -  A better way to manage your period? Try the Menstrual Cup, scientists say.

Legacy Lagarde at IMF

Via Devex: “International Monetary Fund Managing Director Christine Lagarde formally resigned on Tuesday after eight years leading the institution. … … While the IMF had previously been the target of criticism from development advocates who warned against its promotion of austerity measures and reduced social spending, Lagarde took steps to change that image and approach. She “brought the Fund into the 21st Century, using her leadership role to promote the relevance of the IMF’s mandate to addressing women’s economic empowerment and inclusion, climate action, governance issues, and crucially, inequality,” wrote Nadia Daar, head of Oxfam’s Washington Office, in a statement. … the latest shortlist of candidates to succeed Lagarde includes four eurozone officials, according to the Wall St. Journal. They are: Jeroen Dijsselbloem, the former finance minister of the Netherlands; Mário Centeno, current head of the Eurogroup and Portugal’s finance minister; Olli Rehn, governor of the Finnish central bank; and Nadia Calviño, the Spanish economy minister.”

Trump & global health

CNN – US aid cuts to UN agency will hurt vulnerable women and children, critics say

CNN; “The Trump administration will withhold funds from the United Nations agency focused on reproductive and maternal health care for a third consecutive year, though critics and lawmakers say the decision will hurt vulnerable women and children, undermine US interests and is not based on evidence. Secretary of State Michael Pompeo authorized the move to cut $32.5 million in funding to the agency for its core operations addressing maternal death, female genital mutilation, child marriage and gender-based violence and meeting family planning needs. Pompeo's decision also denies the UN Population Fund, known as UNFPA, any US funding for emergency humanitarian operations in places such as Venezuela and Syria -- support that has amounted to as much as $36 million in previous administrations. …” For more extensive analysis of the current UNFPA (funding) situation & general backdrop, see IPS - US Defunds UNFPA for Third Consecutive Year– on Misconceived Assumptions (recommended) Meanwhile, Joe Biden (not our preferred candidate, but hey, at this stage, anything is better than ‘’four more years for the Donald”) outlined plans to reset US foreign policy after Trump. Among others, Joe pledged to end the global gag rule, which blocks federal funding for nongovernmental organizations that provide services related to abortion.

Devex – New USAID procurement strategy targets increased work with religious groups

https://www.devex.com/news/new-usaid-procurement-strategy-targets-increased-work-with-religious-groups-95317 “The U.S. Agency for International Development’s new procurement strategy will help facilitate work with faith-based organizations in conflict and fragile settings, the agency’s Deputy Administrator Bonnie Glick said Wednesday. In its latest procurement reform effort, the U.S. Agency for International Development is foregoing top-line targets and highlighting the links between international organizations and local capacity. USAID’s New Partnerships Initiative “is designed to lower the barriers to be eligible to receive our funding,” she said. “I don’t mean only faith-based organizations, of course, as a federal agency, our job is to find whoever is best qualified to get the job done. But it’s no secret that very often faith-based groups best fit that description.” Glick, speaking at the second annual Ministerial to Advance Religious Freedom in Washington, D.C., outlined the agency’s strategy for working with faith-based groups in development and humanitarian contexts. The ministerial brought together religious leaders and civil society members from more than 100 countries for a three-day conference at the Department of State, aimed at expanding freedom of religion around the world….”

HIV studies in NEJM on ‘Test & Treat’

NEJM (Editorial) - HIV-1 Epidemic Control — Insights from Test-and-Treat Trials

S A Karim et al; https://www.nejm.org/doi/full/10.1056/NEJMe1907279?query=featured_secondary “Debate ensued when mathematical models predicted that universal testing and treatment could achieve epidemic control within a few years in a high-burden setting. However, the idea rapidly gained new credence when antiretroviral therapy (ART)–induced viral suppression was shown to be highly effective in preventing transmission of human immunodeficiency virus type 1 (HIV-1) in a clinical trial. Four large, cluster-randomized, controlled trials, each with a different approach to maximizing viral suppression, set out to assess the effect of universal testing and treatment on community HIV incidence. … In this issue of the Journal, three trials of universal testing and treatment show varying outcomes, from modest to no reductions in HIV incidence…   (resp. in Kenya/Uganda; Botswana; and Zambia/South-Africa). … … Although three and a half of the four trials of universal testing and treatment did not show significant reductions in HIV incidence, they provide valuable insights on four key challenges in achieving effective HIV prevention with ART in high-burden settings….” “The three trials collectively signal a way forward. They indicate that increasing viral suppression is achievable, even by routinely available care, but also that reaching universal coverage is very difficult, even with substantial effort. Viral suppression approximating or exceeding 73% (Joint United Nations Program on HIV/AIDS [UNAIDS] 90-90-90 target) in the three current trials had some evidence of clinical and survival benefit but was not enough to reduce HIV incidence or to meet the 2030 UNAIDS goal of epidemic control. In these settings, programs need to consider going beyond universal testing and treatment to universal testing, treatment, and prophylaxis to achieve HIV epidemic control.” Links to the new NEJM articles: HIV Testing and Treatment with the Use of a Community Health Approach in Rural Africa Effect of Universal Testing and Treatment on HIV Incidence — HPTN 071 (PopART) And some coverage & key messages in the NYT - Intensive HIV efforts meet with mixed success in Africa “…Results from three of the studies suggest that the strategy comes nowhere near bringing the rate of new infections with HIV, or incidence, down to zero. But all of the studies showed that incidence dropped by about 30 percent, and one found a decrease in HIV-related deaths…”

Aid (& health)

Guardian - Alarming’ shortfall in foreign aid for world's biggest crises

https://www.theguardian.com/global-development/2019/jul/16/alarming-shortfall-foreign-aid-worlds-biggest-crises “The head of one of the world’s leading aid agencies has issued a stark warning over the “alarming lack of funding” for global humanitarian crises. Jan Egeland, secretary general of the Norwegian Refugee Council, noted that halfway through the current funding year, humanitarian organisations had received less than a third of money – 27% – needed to provide relief to people affected by crises worldwide. “The current lack of funding is alarming. Despite increasing needs, substantially less money is available for humanitarian assistance compared with the same period last year,” he said….”

BMJ Global Health - Responding to epidemics in large-scale humanitarian crises: a case study of the cholera response in Yemen, 2016–2018

https://gh.bmj.com/content/4/4/e001709 by Paul Spiegel et al.

Lancet Global Health – August issue

https://www.thelancet.com/journals/langlo/issue/vol7no8/PIIS2214-109X(19)X0009-1 Do start with the Editorial - SRHR: unmet needs and unfinished agendas ….  Front and centre are sexual and reproductive health and rights (SRHR), and this year, World Population Day celebrates the 25th anniversary of the International Conference on Population and Development (ICPD), which cemented the central role of SRHR in sustainable development….” … The research presented in this issue is reassurance that the family planning side of SRHR is firmly on the agenda, in concrete ways. Yet there are still understudied areas to bring to light—infertility, for instance. As a panel at the recent Women Deliver conference discussed, infertility is a data-sparse, cross-cutting issue spanning health, rights, and justice spaces. A taboo subject in many cultures, it can all too often lead to familial disharmony and even domestic violence, as people lack information on the causes and are ill-equipped to support affected individuals. … … 25 years after the ICPD, the agenda is clearly unfinished, but the work continues.” But do check out the whole issue.    Of the articles that were not published online yet, we suggest, among others:

• The viability of social accountability measures

“…Fabrri and colleagues have clearly shown that in settings like Uttar Pradesh, where the patient–provider relationship is often marked by strict hierarchy and adversity, an approach that relies on citizens' voices alone is insufficient, even when patients know that the care they are receiving is substandard. Their results therefore force us to expand our thinking of how and when information can work, opening the agenda for deeper reflection of the social environment, the choice architecture, and the role of information.”

• A sustainable approach to universal health coverage – Authors' reply

(by J Mukherjee, Paul Farmer et al) “In response to our Comment, Maarten Jansen and colleagues suggest that the use of their framework for evidence-informed processes is a better way for health authorities to set “fair and sustainable priorities in what services to provide first in the progressive realisation of universal health coverage”. To base health priorities on evidence, as Jansen and colleagues suggest, is indeed an improvement over using cost-effectiveness alone. Yet, prioritisation exercises based solely on choosing interventions that are considered sustainable on the meagre health budgets of impoverished countries will ultimately preserve the unacceptable and inequitable status quo. A status quo that is a direct outcome of historical and ongoing oppression of people in the global South…”

Some papers of the week

Regulation & Governance - Bad governance: How privatization increases corruption in the developing world

B Reinsberg, T Stubbs et al; http://www.tstubbs.net/uploads/4/0/5/3/40534697/reinsbergbetal2019.pdf “International organizations have become key actors in the fight against corruption. Among these organizations, the International Monetary Fund (IMF) maintains a powerful position over borrowing countries in its ability to mandate far-ranging policy reforms – so-called “conditionalities” – in exchange for access to financial assistance. While IMF pressure can force the implementation of anti-corruption policies, potentially reducing corruption, other IMF policy measures, such as the privatization of state-owned enterprises, can create rent-extraction opportunities and limit the capacity of state institutions to limit corrupt behavior. To test these mechanisms, we conduct instrumental-variable regression analysis using an original dataset on IMF conditionality for up to 141 developing countries from 1982 to 2014. We find that conditions to privatize state-owned enterprises exert significant detrimental effects on corruption control. Conversely, other areas of IMF intervention are not consistently related to corruption abatement. These findings offer policy lessons regarding the design of conditionality, which should avoid large-scale privatization, especially under conditions of weak accountability.”

Human Resources for Health - Medical diaspora: an underused entity in low- and middle-income countries’ health system development

S Frehywot et al; https://human-resources-health.biomedcentral.com/articles/10.1186/s12960-019-0393-1 “At present, over 215 million people live outside their countries of birth, many of which are referred to as diaspora—those that live in host countries but maintain strong sentimental and material links with their countries of origin, their homelands. The critical shortage of Human Resources for Health (HRH) in many developing countries remains a barrier to attaining their health system goals. Usage of medical diaspora can be one way to meet this need. A growing number of policy-makers have come to acknowledge that medical diaspora can play a vital role in the development of their homeland’s health workforce capacity. To date, no inventory of low- and middle-income countries (LMIC) medical diaspora organizations has been done. This paper intends to develop an inventory that is as complete as possible, of the names of the LMIC medical diaspora organizations in the United States of America, the United Kingdom, Canada, and Australia and addresses their interests and roles in building the health system of their country of origin….”

IJHPM - What Happens When Donors Pull Out? Examining Differences in Motivation Between Health Workers Who Recently Had Performance-Based Financing (PBF) Withdrawn With Workers Who Never Received PBF in the Democratic Republic of Congo

R Maini, J Borghi et al ; http://www.ijhpm.com/article_3647.html « A motivated workforce is necessary to ensure the delivery of high quality health services. In developing countries, performance-based financing (PBF) is often employed to increase motivation by providing financial incentives linked to performance. However, given PBF schemes are usually funded by donors, their long-term financing is not always assured, and the effects of withdrawing PBF on motivation are largely unknown. This cross-sectional study aimed to identify differences in motivation between workers who recently had donor-funded PBF withdrawn, with workers who had not received PBF….” Some results & conclusion: “The results indicated that workers in facilities where PBF had been removed scored significantly lower on most dimensions of motivation compared to workers who had never received PBF. The removal of the PBF scheme was blamed for an exodus of staff due to the dramatic reduction in income, and negatively impacted on relationships between staff and the local community. Donors and governments unable to sustain PBF or other donor-payments should have clear exit strategies and institute measures to mitigate any adverse effects on motivation following withdrawal.”

Global Health Research & Policy - The political economy of results-based financing: the experience of the health system in Zimbabwe

Sophie Witter et al; Global Health Research & Policy; “Since 2000, results based financing (RBF) has proliferated in health sectors in Africa in particular, including in fragile and conflict affected settings (FCAS) and there is a growing but still contested literature about its relevance and effectiveness. Less examined are the political economy factors behind the adoption of the RBF policy, as well as the shifts in influence and resources which RBF may bring about. In this article, we examine these two topics, focusing on Zimbabwe, which has rolled out RBF nationwide in the health system since 2011, with external support…” Results: “Our findings highlight the role of donors in initiating the RBF policy, but also how the Zimbabwe health system was able to adapt the model to suit its particular circumstances – seeking to maintain a systemic approach, and avoiding fragmentation. Although Zimbabwe was highly resource dependent after the political-economic crisis of the 2000s, it retained managerial and professional capacity, which distinguishes it from many other FCAS settings. This active adaptation has engendered national ownership over time, despite initial resistance to the RBF model and despite the complexity of RBF, which creates dependence on external technical support. Adoption was also aided by ideological retro-fitting into an earlier government performance management policy. The main beneficiaries of RBF were frontline providers, who gained small but critical additional resources, but subject to high degrees of control and sanctions….” Conclusion: “This study highlights resource-seeking motivations for adopting RBF in some low and middle income settings, especially fragile ones, but also the potential for local health system actors to shape and adapt RBF to suit their needs in some circumstances. This means less structural disruption in the health system and it increases the likelihood of an integrated approach and sustainability. We highlight the mix of autonomy and control which RBF can bring for frontline providers and argue for clearer understanding of the role that RBF commonly plays in these settings.”

Global Health Action – Is there a social justice variant of South–South health cooperation?: a scoping and critical literature review

A E Birn et al ; https://www.tandfonline.com/doi/full/10.1080/16549716.2019.1621007 “In recent decades, global health scholars and policymakers have highlighted the burgeoning role of South–South cooperation (SSC) in health, claiming it constitutes a more just and even-handed approach to health cooperation. But the assertion that SSC inherently challenges power asymmetries and pursues egalitarian agendas and forms of interaction merits interrogation. Here we explore a transformative, counter-hegemonic, solidarity-oriented form of SSC – social justice-oriented South–South cooperation (SJSSC) – as differentiated from other types of health aid….” “… Through an iterative process, we developed two overarching categories: values and strategies. Each comprises four themes that allowed us to map the ideas and practices of SJSSC depicted in the literature. The values mapped are: an anti-hegemonic world view; equity-oriented and redistributive political values; egalitarian terms of cooperation; and reciprocity. The strategies encompass: solidarity-building; health justice approaches; mutual exchange and collective justice; and challenging interests of dominant classes in the health arena. This review rectifies ungrounded claims about SSC by identifying and mapping the research literature on SJSSC and has relevance for the conceptualization, policy development, and practice of equitable health cooperation.”

Lancet Comment – Understanding masculinities to improve men's health

C Ragonese et al; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31609-5/fulltext By authors of the recent Promundo Global 209report.  “…Promundo Global's 2019 report, Masculine Norms and Men's Health: Making the Connections, shows that seven key health behaviours—poor diet, tobacco use, alcohol use, occupational hazards, unsafe sex, drug use, and limited health-seeking behaviour—account for more than half of all premature male deaths and about 70% of men's illnesses….” “All seven behaviours are partly related to masculine social norms that reinforce the notion that manhood is associated with self-sufficiency, stoicism, risk-taking, and hypersexuality. These norms, individually and collectively, encourage a specific set of health behaviours that are among the drivers of men's poor health outcomes and have implications for men and women….”

Some blogs and mainstream articles of the week

F2P blog - Is Africa facing its second debt crisis? What are the solutions?

J Atienza (Oxfam Intermon); https://oxfamblogs.org/fp2p/is-africa-facing-its-second-debt-crisis-what-are-the-solutions/ Very much recommended, this blog.  “Though different to their “first debt crisis”, which was incubated in the 80s, hit in the 90s and was resolved (partly) in the 2000s, the situation is again profoundly uphill for a growing number of African countries: in 2019 their debt repayments as a percentage of revenues will be higher than in 2001 – before the last round of debt relief….”

Holes, plugs and rubber ducks: the SDG health financing gap and transparent procurement

Tom Wright; https://voices.transparency.org/holes-plugs-and-rubber-ducks-the-sdg-health-financing-gap-and-transparent-procurement-eec6c2b02deb Wright talks through how transparency in health procurement can increase available health financing and reduce corruption simultaneously.

Madhukar Pai - How can we become better mentors & mentees?

https://naturemicrobiologycommunity.nature.com/users/20892-madhukar-pai/posts/51088-how-can-we-become-better-mentors-mentees “The Mentoring Guide is an outstanding little book, full of great advice and practical suggestions, for both mentors and mentees.”  Are you like ‘The Vampire’, ‘the Backstabber’ or instead ‘The Overcommitter’? 😊.

Guardian - MPs say 'embarrassing and insulting' UK visa system damages Africa relations

Guardian; “British MPs have warned that the UK visitor visa system is “broken” and doing “severe damage” to UK-Africa relations. The problems faced by experts trying to visit the UK are so widespread that many Africans believe the Home Office to be prejudiced against them and deliberately trying to reduce visitor numbers. After six months taking evidence from people working across a range of sectors, cross-party parliamentary groups for Africa, Malawi and diaspora, development and migration report that UK visitor visas are “inaccessible to many Africans, under-resourced, unaccountable and widely perceived as biased or even discriminating against Africans”….”

Speaking of Medicine - PLOS Medicine Special Issue: Refugee and Migrant Health

https://blogs.plos.org/speakingofmedicine/2019/07/15/plos-medicine-special-issue-refugee-and-migrant-health/ Call for papers. “The editors of PLOS Medicine together with Guest Editors Paul Spiegel, Kolitha Wickramage, and Terry McGovern, announce a forthcoming special issue devoted to refugee and migrant health. Research submissions are now being invited….”

Left foot forward - Why Boris Johnson could spell the end of international development

Nick Dearden; https://leftfootforward.org/2019/07/why-boris-johnson-could-spell-the-end-of-international-development/ “Johnson wants to make 'aid' about serving UK corporate interests.” In other DFID related news, read also Devex - DFID headed toward centralization despite its leader's concerns “The amount of money the U.K. Department for International Development spent through its country and regional programs has fallen for the second year in a row, sparking concerns that the department is becoming too centralized despite the new international development secretary of state calling for it to move in the opposite direction. DFID’s latest annual report, released last week, shows that while the amount DFID spent on programs and departments increased by more than £325 million ($430 million) to £10.7 billion in 2018-19, the amount that flowed through DFID’s regional and country programs decreased in both absolute and relative terms….”

Guardian - France will not back down on digital tax despite US legal threats

https://www.theguardian.com/world/2019/jul/16/france-will-not-back-down-on-digital-tax-despite-us-legal-threats “France will not back down in the face of US threats of legal action over its plans for a digital tax on tech giants, the French finance minister has said.  “We will never give up,” Bruno Le Maire told the Guardian in an interview. “We are implementing a digital tax on digital giants because we think it is a fair and efficient way of taxing them.” Le Maire said Paris would only change course if a better deal for taxing the firms could be agreed internationally. He said he hoped the G7 finance ministers’ meeting hosted by France on Wednesday in Chantilly would be able to find a compromise that could pave the way for a wider subsequent agreement at the level of the Organisation for Economic Co-operation and Development. The 184-nation OECD oversees international tax structures. … … He said he hoped the G7 would agree in principle to a corporation tax “corridor” – minimum and maximum tax rates – but it was unlikely such rates would be set at Wednesday’s meeting. … … In his Guardian interview, Le Maire insisted he would not back down on the principle of ensuring the digital giants were taxed equally, one of the themes of the current French G7 presidency….” Will be interesting to see what comes out of this G7 meeting (17-18 July), and what happens further, next year, in this respect. See also this analysis (/hopes) on global tax reform in 2020 (in Dutch) by an Oxfam fiscal expert. Johan Langerock sounded optimistic.

OECD – Governance as an SDG accelerator: Country experiences and tools

http://www.oecd.org/gov/pcsd/governance-as-an-sdg-accelerator-0666b085-en.htm “Delivering on the SDGs is a formidable governance challenge for countries at all levels of development. It requires governments to co-ordinate, consult and work across policy areas – as well as with the businesses sector and civil society – in an unprecedented way. This report provides evidence from OECD countries and partner economies on how public governance practices can be strengthened to help implement the SDGs. It looks at whole-of-government co-ordination, policy coherence and integrity, stakeholder engagement and open government, and the strategic use of budgeting, procurement and regulatory tools. It discusses robust monitoring and evaluation systems for ensuring that public policies and resource allocations for SDG implementation result in meaningful outcomes. It also explores how governance frameworks to support equal access to justice and gender equality can help catalyse implementation across the entire 2030 Agenda.”

Lancet - Taiwan's health-care system and administration are independent of China

Shih-Chung Chen; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31630-7/fulltext Now this was an “interesting” set of letters in the Lancet 😊.  This one for example by the Taiwan MoH. “As the Taiwan Minister of Health and Welfare, I am writing to make a formal protest against the erroneous designation of Taiwan as a province of China in the systematic analysis of mortality, morbidity, and risk factors in China and its provinces, 1990–2017 for the Global Burden of Disease Study 2017.” Check out also the authors’ reply (by C Murray & team) - Taiwan's health-care system and administration are independent of China – Authors' reply   Not very convincing, if you ask me, as they prefer to focus on the scientific questions raised in the Letters (which they do well), while more or less dodging the political stuff. On the latter: “…First, the issue on the appropriate name for Taiwan generates considerable political debate. It would be inappropriate for the GBD collaboration to try and forge its own political view on the naming of political entities. Rather, we seek to follow international standards laid down by WHO on naming. This commitment to following international norms present since GBD 2013 has been reinforced through our Memorandum of Understanding with WHO, signed in May, 2018. The memorandum is leading to closer coordination of the GBD scientific enterprise with WHO technical work on disease and risk factor estimation. We recognise that there has been inconsistent naming in some online tools, which was not meant to imply any political stand on naming. Going forward, we will make sure that both printed and online naming is consistent with WHO guidance.”

Devex –Donors issue safeguarding guidelines as focus moves to implementation

https://www.devex.com/news/donors-issue-safeguarding-guidelines-as-focus-moves-to-implementation-95291? “Thirty of the world’s major aid donors agreed on a new standard on preventing sexual exploitation,  abuse, and harassment Friday, vowing to hold each other to account for improving their procedures. The recommendation from the Organisation for Economic Co-operation and Development’s Development Assistance Committee — the group that sets the rules for the world’s biggest donors — is not legally binding, but DAC chair Susanna Moorehead told Devex it would feed into the committee’s peer review process.  …”

Spotlight report on sustainability in Europe - Who is paying the bill? (Negative) impacts of EU policies and practices in the world

https://eurodad.org/Entries/view/1547078/2019/07/11/Spotlight-report-on-sustainability-in-Europe-Who-is-paying-the-bill-Negative-impacts-of-EU-policies-and-practices-in-the-world “ Studying EU policies thoroughly means studying policies of externalization. The thirteen chapters assembled in this publication by SDG Watch Europe constitutes an impressive – impressively gloomy though – evidence for this assertion. Wherever you turn your eyes, whatever policy domain you may be concerned with: what at first glance may seem to be part of the European Union’s internal policies immediately turns out to be a story of externalities, a matter of spill-over effects transcending the borders of the European polity. And more often than not it is negative externalities that come into sight. Negative externalities that we should be talking about instead of obsessively trying to ignore them. This publication contributes to unsettle the double standard of EU policies, consisting in protecting our own industries, corporations, workers, and consumers by confining the opportunities and threatening the well-being of economies and populations in other parts of the world. Every single of the following thirteen chapters is a strong and profound case for ending this double standard of European policy-making. … .”

Foreign Affairs - Demystifying Belt and Road The Struggle to Define China’s “Project of the Century”

Yuen Yuen Ang; https://sites.lsa.umich.edu/yy-ang/wp-content/uploads/sites/427/2019/06/BRI-essay-posted-on-website.pdf Now Open Access. “…Facing a global outcry over BRI, Beijing is now shifting gears from a hazily defined BRI 1.0 to a more fine-tuned BRI 2.0. … … If China is serious about improving BRI, however, it will need to go beyond a change in rhetoric and take at least three concrete steps… … “ And Y U Ang concludes: “…Chinese leaders who invoke history as a guide need not go as far back as the age of the Silk Road. They should instead look to the more recent past. China rose from an impoverished communist country to a capitalist superpower on the strength of its pragmatism and adaptability—the two qualities that should guide BRI 2.0.”

Devex - Here's how to strengthen development cooperation — and meet the SDGs

https://www.devex.com/news/opinion-here-s-how-to-strengthen-development-cooperation-and-meet-the-sdgs-95277 “… The international community must think differently about our efforts to get back on track — and that means advancing the effectiveness of development cooperation. For long-lasting results, this will require a focus on country ownership, development results, inclusive partnerships, transparency, and mutual accountability. These four principles of effectiveness provide a basis for more empowered, more equal, partnerships. And that matters because ultimately, it will be how we work together that defines our success….” “… The Global Partnership for Effective Development Co-operation — a multistakeholder partnership supported jointly by OECD and the United Nations Development Programme — looks closely at the “how.” The partnership aims to advance the effectiveness of joint development efforts — by governments, civil society, the private sector, and many others — to deliver results that are long-lasting and contribute to the achievement of the SDGs….” Check out the GPEDC’s latest Progress report (Part I) -  Making development co-operation more effective: How partner countries are promoting effective partnerships “This work is a joint publication of the Organisation for Economic Co-operation and Development (OECD) and the United Nations Development Programme (UNDP). It is part of a report that presents the results of the 2018 Monitoring Round of the Global Partnership for Effective Development Co-operation, and focuses on how development partners support partner country-led efforts. …”

Reuters - Trump administration plans to divert $40 million in aid to Venezuela's opposition

https://uk.reuters.com/article/uk-venezuela-politics-usa-aid/trump-administration-plans-to-divert-40-million-in-aid-to-venezuelas-opposition-la-times-idUKKCN1UB2X2 “U.S. President Donald Trump’s administration plans to divert more than $40 million (£32 million) in humanitarian aid for Central America to support the U.S.-backed opposition in Venezuela, according to an internal document obtained by Reuters on Tuesday. The $41.9 million had been destined for Guatemala and Honduras, two of the three Central American countries at the centre of a migration crisis in which thousands of people have fled poverty, violence and corruption and attempted to cross the southern U.S. border….”

CGD - Should Developing Countries Borrow Internationally to Finance Social Sector Development?

Masood Ahmed; https://www.cgdev.org/blog/should-developing-countries-borrow-internationally-finance-social-sector-development “From time to time I come across development practitioners who believe that it’s a bad idea for poor countries to borrow money, particularly non-concessional loans, to finance health or education projects. Moreover, recent research by the Human Development Practice at the World Bank shows that as countries graduate from softer IDA financing to the somewhat more expensive terms of IBRD loans, there is a disproportionate decline in the share of social sectors in the programs the World Bank supports in those countries. So, it seems that not only do some analysts believe that borrowing for social sectors (especially on less concessional terms) is a bad idea, country policymakers also appear to reflect this in their actual borrowing behavior.  What is the rationale for this belief? Does it make economic sense? In this blog, I set out why I think decisions to borrow for the social sectors should be made in the same way as decisions to borrow for so called ‘hard sectors’ like infrastructure or industry….”

WHO Bulletin - Towards optimal collaboration: reforming the WHO country cooperation strategy in Thailand

S Tiantong, Suwit W et al; https://www.who.int/bulletin/online_first/BLT.18.219287.pdf?ua=1 “As the leading coordinating agency for global public health, the World Health Organization (WHO) is challenged to improve its country-level work. In May 2016, the World Health Assembly requested WHO’s senior management to use country budgets and the organization’s social and intellectual capital to leverage additional resources to implement and sustain national programmes. A 2017 meeting of WHO country representatives highlighted the need to transform WHO into a flexible, nimble, responsive and proactive organization at the country level. Here we describe how WHO and Thai health authorities (the ministry, autonomous health agencies outside the ministry, civil society and academia), have created an innovative country cooperation strategy that responds to these recommendations….””

Some UHC 2030 updates

See also the latest UHC 2030 newsletter. UHC 2030 welcomes new members “UHC2030 warmly welcomes six new signatories to the UHC2030 Global Compact for progress towards UHC. Ukraine, Switzerland, World Medical Association, World Heart Organization, Humanity and Inclusion (formerly Handicap International) and the International Council of Nurses are now members of UHC2030….” Private sector engagement with UHC - an update   “News from the private sector constituency with a new deadline for application on 15 August 2019.” For the Full list of private sector members so far: https://www.uhc2030.org/what-we-do/private-sector-engagement/

FT Times - India plan to merge ID with health records raises privacy worries

https://www.ft.com/content/4fbb2334-a864-11e9-984c-fac8325aaa04 (gated) “Move would unify disparate patient information systems into central database.”

Nature News - New EU chief makes bold climate pledges

https://www.nature.com/articles/d41586-019-02204-4?utm_source=twt_nnc&utm_medium=social&utm_campaign=naturenews&sf215887192=1 “Ursula von der Leyen’s ambitions to strengthen carbon-cutting goals will need support from European Union member states.” The new EC president has put climate change at the top of her agenda.  “… In a speech in parliament a few hours before her election, von der Leyen said that she intends to make climate and the environment top priorities in all EU policy areas. She pledged to strengthen the EU’s short-term goal on greenhouse-gas emissions from a 40% reduction to a 50% cut, at least, by 2030, relative to 1990 levels. The EU will also take a lead role in forthcoming international climate negotiations and will encourage other major economies to increase their level of ambition by 2021, she said.”

Global Policy Journal - Jair Bolsonaro wants to Deforest the Amazon – What Powers does the UN have to Stop Him?

A White; https://www.globalpolicyjournal.com/blog/16/07/2019/jair-bolsonaro-wants-deforest-amazon-what-powers-does-un-have-stop-him The picture from Brazil is a lot less encouraging. “Deforestation of the Amazon rainforest in Brazil is at its highest rate in a decade, according to new satellite data. This comes after president Jair Bolsonaro has loosened environmental regulations, cut enforcement budgets, and supported further development in the region.” “… The primary purpose of the United Nations is to maintain international peace and security. With climate breakdown already causing conflict and undermining human security, it’s hard to argue the UN should not get involved.  So what could it do about Brazil’s deforestation? My PhD research examines the intersection between environmental governance and the UN Security Council. The council is a legislative body designed to safeguard international peace and security – it’s made up of five permanent members and ten non-permanent (elected) members. I want to consider three options available to it: the support of international law; intervention through force; and sanctions.” None look very promising, for now. Sanctions probably are the best option.

Nature (news) - China plans CFC-monitoring network to investigate rogue emissions

https://www.nature.com/articles/d41586-019-02109-2?utm_source=twt_nnc&utm_medium=social&utm_campaign=naturenews&sf215667533=1 “The move follows a recent study that attributed a spike in an ozone-depleting chemical to two Chinese provinces.”

HPW - New & Updated Food Code Standards Adopted For Pesticide Residues, Food Additives & Vegetable Oils

https://www.healthpolicy-watch.org/new-standards-set-for-pesticides-food-additives-and-vegetable-oils/ “New maximum residue limits for more than 30 different types of pesticides in animal feed and foodstuffs, updated standards for food additives, and a new standard for high value vegetable oils, and well as for hybrid varieties of palm oil, were approved today at the 42nd meeting of the Codex Alimentarius Commission (CAC42), the UN member state body that sets international food safety standards guiding the world food trade as well as significant national legislation. Closing a week-long session in Geneva, delegates from some 100 countries also agreed to a code of practice for reducing chemical contaminants common to palm oil production, as well as to launch new work on allergen labeling, e-commerce, aflatoxins in cereals and cereal-based products, and bio-pesticides, among other topics….”

Plos One - Why environmentalists eat meat

Evon Scott et al; https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0219607 Some even eat a lot of meat. “Why do people who care about the environment adopt behaviours that are not consistent with their beliefs? Previous studies approach this as a case of cognitive dissonance, researchers looking into the strategies through which people reduce gaps between their attitudes and their behaviours. Here we start from the premise that there is no dissonance, and that people have consistent reasons of why they are doing what they are doing. The research task is then to shed light on these reasons. Using Q-methodology, a mixed quantitative-qualitative approach, we interviewed 42 environmentally-minded researchers asking them why they eat meat. Our interviewees were aware of and cared about the environmental and ethical impacts of meat eating, but reasoned that they eat meat because either technological, or political changes are more important than what they personally do, because of doubts about the impact of personal action in a complex world, or simply because they lack the determination to stop eating meat. Our analysis suggests that policies and messages that try to educate or guilt meat-eaters are unlikely to work with those well aware of the impacts of their actions.” Quick links: FT - Munich Re boss wants higher carbon emission costs Cfr a tweet: “The world's largest reinsurance company, MunichRe, suggests a €115/tonne price on carbon is what's needed to meet the Paris targets—and that to prevent climate catastrophe, we must expect that "carbon-heavy companies would probably go out of business."”

Global Public Health - HIV/AIDS and intersectional stigmas: Examining stigma related behaviours among medical students during service delivery

N Varaz-Dias et al ; https://www.tandfonline.com/doi/abs/10.1080/17441692.2019.1633378?journalCode=rgph20 « HIV/AIDS stigma remains a major global health issue with detrimental consequences for people with HIV/AIDS (PWHA), especially when manifested by health professionals. Research on HIV/AIDS stigma has documented negative attitudes towards PWHA among health professionals. However, fewer studies have examined how HIV/AIDS stigma is manifested behaviourally during clinical interactions and how it interacts with other stigmas (i.e. drug use, sexism, homophobia). This study aimed to: (1) examine behavioural manifestations of HIV/AIDS stigma among medical students during clinical interactions, and (2) explore HIV/AIDS stigma intersectionality with other stigmas….”

Stat News - HIV’s genetic code, extracted from a nub of tissue, adds to evidence of virus’ emergence in humans a century ago

Stat News; “For more than 50 years, the RNA remained hidden in a lymph node that had been snipped out of a 38-year-old man in what is now the Democratic Republic of the Congo. That nub of tissue, the size of a nail on a pinky finger, had been sealed up in a protective block of paraffin. Once freed from its wax casing, scientists at the University of Arizona were able to extract from the tissue a nearly complete genetic sequence of an HIV virus — the oldest nearly full-length genetic code for an HIV-1 virus recovered thus far, and one that supports the theory that the virus that causes AIDS began to transmit among people within the first decade or two of the 20th century….”

Reuters – Fake polio markers highlight risks to Pakistan vaccination drive

https://www.reuters.com/article/us-pakistan-polio/fake-polio-markers-highlight-risks-to-pakistan-vaccination-drive-idUSKCN1UA0HN?feedType=RSS&feedName=healthNews “Pakistan’s polio eradication campaign has hit serious problems with an alarming spike in reported cases that has raised doubts over the quality of vaccination reporting and prompted officials to review their approach to stopping the crippling disease….” “…Local officials say parents suspicious of mass immunization campaigns have been getting hold of special markers, used by health workers to put a colored spot on the little fingers of children who have been vaccinated. “They themselves would mark the fingers of their children, in case of any official visit to countercheck the vaccinated children,” one official associated with an international organization told Reuters in the northwestern city of Peshawar….”

Cidrap News - WHO notes clusters in recent MERS cases, unveils environmental sampling guide

http://www.cidrap.umn.edu/news-perspective/2019/07/who-notes-clusters-recent-mers-cases-unveils-environmental-sampling-guide “In a profile of MERS-CoV cases in Saudi Arabia for May, the World Health Organization (WHO) today provided more details about 14 cases and noted that 4 were part of two clusters. In other developments, the WHO released a new protocol for investigating Middle East respiratory syndrome coronavirus (MERS-CoV) surface contamination in health settings, and Saudi Arabia's ministry of health (MOH) announced one new case detected in Riyadh….”

AMR

NYT – Urinary Tract Infections affect Millions. The Cures are faltering

https://www.nytimes.com/2019/07/13/health/urinary-infections-drug-resistant.html “As the infections become increasingly resistant to antibiotics, some standard treatments no longer work against an ailment that was once easily cured.”

Guardian -  Babies in Nepal get quarter of calories from junk food, study finds

https://www.theguardian.com/science/2019/jul/17/babies-nepal-get-quarter-calories-junk-food-study?CMP=Share_iOSApp_Other “Children under the age of two in Nepal are getting a quarter of their calories from junk food, according to groundbreaking research that warns their diet is linked to stunting and undernutrition. Biscuits, crisps, instant noodles and sugary drinks appear to be displacing foods with the vitamins, minerals and other vital nutrients babies need to grow well, say the researchers. The work, published in the Journal of Nutrition, illustrates that the 21st-century junk food diet spreading around the globe is linked not just to obesity but also to poor growth in children….”

Guardian - WHO urges ban on high levels of sugar from fruit puree in baby food

https://www.theguardian.com/society/2019/jul/15/who-urges-ban-on-high-levels-of-sugar-from-fruit-puree-in-baby-food “Commercial baby foods contain too much sugar – even when they are labelled as savoury meals, says the World Health Organization, which is seeking a ban on added sugars in foods for children under 36 months old. WHO Europe is calling for a crackdown on the high levels of sugar in the diet of babies fed on commercially available foods, warning that their first teeth may suffer and they are at risk of developing a preference for sweet foods, which may lead to overweight and obesity-related disease in adulthood….”

Tobacco Control - ‘Pro-tobacco propaganda’: a case study of tobacco industry-sponsored elementary schools in China

J Fang et al; https://tobaccocontrol.bmj.com/content/early/2019/07/13/tobaccocontrol-2018-054646 Not exactly in line with FCTC... “China is the largest producer and consumer of tobacco products worldwide. While direct marketing and advertisement of tobacco products is restricted, indirect marketing still exists under the guise of sponsorship and corporate social responsibility (CSR). This case study is focused on tobacco industry-sponsored elementary schools in Chinese rural areas….”

Marlboro owner invests $12.8 billion in e-cigarette maker Juul

engaget; “Tobacco giant Altria (which owns Marlboro and Virginia Slims) has bought a 35 percent stake in Juul for $12.8 billion.  …. ; Altria owns 35 percent of the company, which is now valued at $38 billion….” So Big Tobacco really gets into vaping.

Foreign Policy - Document of the Week: Is the U.N. Revisiting the Ban on Big Tobacco?

https://foreignpolicy.com/2019/07/12/document-of-the-week-is-the-u-n-revisiting-the-ban-on-big-tobacco/ “Outgoing U.N. official pleads a case for the tobacco industry, saying health expertise and cigarette jobs can contribute to global prosperity and improved understanding of health risks.” “…On his final day on the job, Michael Moller, who stepped down last month as the head of the U.N. office in Geneva, wrote an appeal to U.N. Secretary-General António Guterres suggesting that it may be time to end a moratorium on U.N. cooperation with the tobacco industry. We are sharing his note as our Document of the Week. … The memo has fueled suspicions among some U.N. staff that the influence of tobacco giants … .. is being felt behind the scenes at the U.N. and the World Health Organization… “

WB resource: WBG Global Tobacco Control program

https://www.worldbank.org/en/topic/tobacco Via P Marquez: “Tobacco taxation: a win win win policy measure for public health, domestic resource mobilization, and equity. For WBG global and country reports, videos, and blogs, visit: WBG Global Tobacco Control Program”…

IOGT - New resource on Big Alcohol: World Map of Big Alcohol Interference

https://iogt.org/news/2019/05/19/new-resource-world-map-of-big-alcohol-interference/ “IOGT International has released a brand new resource to map the global alcohol industry, reveal Big Alcohol’s lobbying front group and to illustrate concrete case stories of alcohol industry interference from around the world.” And a quick link: BMJ News -  Ketamine could be first of new generation of rapid acting antidepressants, say experts

Thomas Reuters Foundation - More breastfeeding could save the world $1 billion every day

https://www.reuters.com/article/us-global-health-breastfeed-idUSKCN1U70ZV “Not enough breastfeeding costs the global economy almost $1 billion each day due to lost productivity and healthcare costs, researchers said on Friday, as health experts urged more support for nursing mothers. A new website developed by researchers in Canada and Asia showed that the world could have saved $341 billion each year if mothers breastfeed their children for longer, helping prevent early deaths and various diseases. Known as the “Cost of Not Breastfeeding”, the online tool used data from a six-year study supported by the U.S.-based maternal and child nutrition initiative, Alive & Thrive….” “…the website was the first of its kind and aimed to help policymakers to measure economic losses in individual countries when they do not support breastfeeding….”

UN News – UNICEF urges ‘transformative shift’ in family-friendly work policies to reap ‘huge’ benefits

https://news.un.org/en/story/2019/07/1042821 “Because the “earliest years” of life are the most crucial, the United Nations Children’s Fund (UNICEF) published a list of new family-friendly policy recommendations on Friday it says will likely reap “huge” benefits….”

CFR (brief) - Abortion Law: Global Comparisons

R Vogelstein et al; CFR; “A recent spate of state laws to restrict abortion services in the United States has reignited debate over the procedure. How does the United States’ regulation of abortion compare to the rest of the world?”

The Blueprint for Sexual and Reproductive Health, Rights, and Justice

https://reproblueprint.org/?utm_source=STAT+Newsletters&utm_campaign=962b25b2d1-MR_COPY_01&utm_medium=email&utm_term=0_8cab1d7961-962b25b2d1-149865409 “The Blueprint for Sexual and Reproductive Health, Rights, and Justice is a proactive policy agenda to advance sexual and reproductive health in the United States and around the world. The endorsing organizations are committed to a future where those in power will support, not restrict, our individual sexual and reproductive health and rights, a time when a fully supportive Congress and Administration will work together to enact policies the Blueprint lays out. This Blueprint is our agenda for that future.”  “…A coalition of nearly 80 [US] organizations came together to develop a visionary policy agenda that boldly proclaims that for people to be free and equal, they must be able to exercise complete autonomy over their bodies. The Blueprint lays out a broad vision for the future that includes forward thinking ideas to transform sexual and reproductive health, rights, and justice policy domestically and globally, as well as basic and fundamental measures to correct the backtracking that has taken place in recent years….” The Blueprint has 5 key principles.  For the executive summary, see here.

BMJ Global Health - Is female genital mutilation/cutting associated with adverse mental health consequences? A systematic review of the evidence

Salma Abdalla (EV 2018) et al ; https://gh.bmj.com/content/4/4/e001553 “The adverse physical consequences of female genital mutilation/cutting (FGM/C) have been thoroughly investigated and documented. Yet, we know little about the adverse mental health consequences of the practice. To fill this research gap, we systematically reviewed studies that assessed any adverse mental health consequences related to FGM/C….”

Devex - African activists seek universal access to sanitary products

https://www.devex.com/news/african-activists-seek-universal-access-to-sanitary-products-95248 “In April, South Africa removed its 15% value-added tax from sanitary products, such as pads and tampons, in a move that was praised by advocates as a win in the fight against “period poverty.” “Experts in menstrual hygiene management emphasize that access to products alone is not enough to end period poverty, and that education and infrastructure are just as important.  But the issue of cost has gained attention in recent years, as campaigners from the United Kingdom to Malaysia have urged their governments to remove the so-called “tampon tax.” Despite the VAT relief, advocates in South Africa say sanitary products remain expensive, and that more is needed to ensure universal access….” “…The debate is following a similar path elsewhere in Africa. Several countries have removed VAT, including Mauritania and Tanzania. Kenya, a global pioneer on the issue, removed the tax in 2004, and budgets about $3 million annually for the distribution of free sanitary pads to girls in low-income communities. … … Yet even there, about 65% of women and girls cannot afford pads. So what else can be done?...”

Guardian - US activists promote anti-birth control app in Nigeria's 'most vulnerable' areas

https://www.theguardian.com/society/2019/jul/15/femm-menstruation-tracking-app-nigeria-anti-pill-campaignersus- “US campaigners who oppose the birth control pill have promoted a menstruation tracking app in “the most vulnerable communities” in rural Nigeria with the backing of the Catholic church, the Guardian has learned. Prominent anti-abortion campaigners in New York developed and funded the Femm app, which collects intimate information about women’s sex lives and sows doubt about hormonal birth control methods. The app has been downloaded more than 400,000 times globally, according to its developers, and appears to be the first ideologically aligned fertility tracking app. But leaders of the organization are also promoting the app and teaching the “Femm methods” of natural family planning in places such as rural Nigeria, where women are at high risk of HIV infection, child marriage and sexual violence….”

BMJ Blog - Bridging the access gap for treatment of diarrhea

Rasa Izadnegahdar (deputy director of the Bill & Melinda Gates Foundation’s Maternal, Newborn and Child Health Discovery & Tools team); https://blogs.bmj.com/bmjgh/2019/07/12/bridging-the-access-gap-for-treatment-of-diarrhea/ “This week, the global public health community welcomed the World Health Organization’s decision to include co-packaged oral rehydration salts (ORS) and zinc on its Model List of Essential Medicines for Children (EMLc). This new global normative guidance is an important and enabling step toward improving access to first line treatments for children with diarrhea. This decision is important because it reinforces the lifesaving benefits of both ORS and zinc in treating childhood diarrhea….”

Science – Starving children often don’t recover, even when fed enough. Restoring their gut bacteria could help

https://www.sciencemag.org/news/2019/07/starving-children-often-don-t-recover-even-when-fed-enough-restoring-their-gut-bacteria?rss=1 Based on two new studies in Science (see here and here ). The right gut microbes might help starving children recover.

HPW - Cancer Cases Growing Alarmingly, Can Alternative Therapies Support Response?

https://www.healthpolicy-watch.org/cancer-cases-growing-alarmingly-alternative-medicines-can-support-response/ “If the fight against cancer has yielded substantial results on survival rates in high-income countries, low- and middle-income countries are lagging behind, while cancer is gaining ground, with a particularly worrying trend in children. A first-ever International Health Congress on Integrative Oncology, held 28-30 June in Geneva, presented traditional and alternative medicines as precious allies for conventional medicine, including for promoting good health and cancer prevention….”

BMJ Global Health - The global scale and implications of delivering multiple interventions through integrated child health events

N Kamatsuchi, D Balabanova et al ; https://gh.bmj.com/content/4/4/e001333 “Delivering child health services through integrated child health events (ICHEs) has been a useful and popular strategy implemented in many in low-income and middle-income countries (LMICs) to accelerate the reduction of child mortality. The study aims to portray the scope of ICHEs and examine the association between the number of child health-nutrition interventions and types of ICHE packages delivered through these campaigns with vitamin A supplementation (VAS) and measles vaccination….”

WB - All Hands on Deck : Reducing Stunting through Multisectoral Efforts in Sub-Saharan Africa

http://documents.worldbank.org/curated/en/904531562219343466/All-Hands-on-Deck-Reducing-Stunting-through-Multisectoral-Efforts-in-Sub-Saharan-Africa Sounds like a Bon Jovi song, but no, it’s a World Bank book. “In Sub-Saharan Africa, the scale of undernutrition is staggering; 58 million children under the age of five are too short for their age (stunted), and 14 million weighs too little for their height (wasted). … …  Recent World Bank estimates suggest that the income penalty a country incurs for not having eliminated stunting when today’s workers were children is about 9-10 percent of gross domestic product per capita in Sub-Saharan Africa. Much of the effort to date has focused on the costing, financing, and impact of nutrition-specific interventions delivered mainly through the health sector to reach the global nutrition targets for stunting, anemia, and breastfeeding, and interventions for treating wasting. However, the determinants of undernutrition are multisectoral, and the solution to undernutrition requires multisectoral approaches. An acceleration of the progress to reduce stunting in Sub-Saharan Africa requires engaging additional sectors, such as agriculture; education; social protection; and water, sanitation, and hygiene (WASH), to improve nutrition. This book lays the groundwork for more effective multisectoral action by analyzing and generating empirical evidence to inform the joint targeting of nutrition-sensitive interventions. Using information from 33 recent Demographic and Health Surveys (DHS), measures are constructed to capture a child’s access to food security, care practices, health care, and WASH, to identify gaps in access among different socioeconomic groups; and to relate access to these nutrition drivers to nutrition outcomes. All Hands on Deck: Reducing Stunting through Multisectoral Efforts in Sub-Saharan Africa addresses three main questions: do children have inadequate access to the underlying determinants of nutrition? What is the association between stunting and inadequate food, care practices, health, and WASH access? Can the sectors that have the greatest impact on stunting be identified? This book provides country authorities with a holistic picture of the gaps in access to the drivers of nutrition within countries to assist them in the formulation of a more informed, evidence-based, and balanced multisectoral strategy against undernutrition.”

HPW - Japan Claims There Is No Evidence That “Delinkage” Improves Medicines Access

https://www.healthpolicy-watch.org/japan-claims-no-evidence-that-delinkage-will-improve-medicines-access/ “Japan said on Friday that it disagrees with aspects of an already-adopted Human Rights Council (HRC) resolution on access to medicines, claiming that there is no evidence that “delinkage” between the cost of research & development (R&D) and the price of medicines improves access to medicines. Japan also disagreed with pursuing alternative frameworks for R&D incentives, which it said disregards existing R&D frameworks….”

Does the Roadmap for Access to Medicines 2019–2023 Neglect TRIPS Flexibilities?

WHO Watch team; https://www.newsclick.in/Roadmap-Access-Medicines-2019%E2%80%932023-Neglect-TRIPS-Flexibilities “The excessive focus of the new WHA Roadmap on voluntary licenses gives an impression that WHO’s preferred route to manage intellectual property is through private ordering.”

Stat News - A bird’s-eye view of clinical trials provides new perspectives on drug research and development

Stat News; “Waste and inefficiency in drug development are big problems. They can be hard to spot, especially when you are in the midst of the process. A new way of visualizing clinical trials might help….” “Here’s a proof-of-concept for the bird’s-eye view that uses ClinicalTrials.gov data and the AERO graphing method to analyze all of the registered clinical trials from 10 large pharmaceutical companies — AbbVie, Bayer, Gilead, GSK, Johnson & Johnson, Merck, Novartis, Pfizer, Roche, and Sanofi — over past 20 years or so. The full result is a giant graph showing 13,749 trials that included more than 6 million patients….”   Quick links: How pharma, under attack from all sides, keeps winning in Washington  (Stat News) With the quote: “… “Big Pharma has replaced Big Tobacco as the most powerful brute in the ranks of Washington power brokers.”…” Guardian - Drug makers flooded US with billions of opioid pills as epidemic surged, data shows

Human Resources for Health - Are the Global Strategic Directions for Strengthening Nursing and Midwifery 2016–2020 being implemented in countries? Findings from a cross-sectional analysis

O Ajuebor, G Cornetto et al ; https://human-resources-health.biomedcentral.com/articles/10.1186/s12960-019-0392-2 “Nurses and midwives are the largest component of the health workforce in many countries. The World Health Organization (WHO) together with its partners facilitates the joint development of strategic policy guidance for countries to support the optimization of their nursing and midwifery workforce. The Global Strategic Directions for Strengthening Nursing and Midwifery 2016–2020 (SDNM) is a global policy guidance tool that provides a framework for Member States, the WHO and its partners to adapt, develop, implement and evaluate nursing and midwifery policy interventions in Member States. As part of the broader monitoring and accountability functions of the WHO, assessing the progress of the SDNM implementation at a country level is key to ensuring that countries stay on track towards achieving UHC and the SDGs.” Some of the results: “… Summing up the implementation frequency of interventions across all thematic areas, 19% of responses were in the category of “completed”; 55% were reportedly “in progress” and 26% indicated a status of “not started”. Findings reveal a stronger level of implementation for areas of nursing and midwifery development related to enhancing regulation and education, creating stronger roles for professional associations and policy strengthening. Leadership and interprofessional collaboration are intervention areas that were less implemented….”

Nature (Editorial) – How to make development funds go further

https://www.nature.com/articles/d41586-019-02172-9 “International grants for low-income countries should be matched by local sources.”

Guardian - $90 for a bottle of melted iceberg? Inside the world of luxury water

https://www.theguardian.com/lifeandstyle/2019/jul/16/luxury-bottled-water-is-absurd-so-why-is-it-so-popular?CMP=Share_iOSApp_Other “People pay top dollar for ‘premium’ brands indistinguishable in blind taste tests from tap water – is it about status, wellness or something more fundamental?” I particularly liked this paragraph: “… In a recent social-psychological study on water consumption choices, researchers Stephanie Cote and Sarah Wolfe claim, “individuals’ unacknowledged death anxiety may be an unrecognized barrier to environmentally sustainable behavior change”. “Death reminders reliably increase humans’ selfish exploitation of natural resources,” writes Wolfe in her related work explaining that when humans consider our impending demise, our instinctive denial and need for distraction leads us to make irrational decisions. Such as, perhaps unconsciously, thinking: “How could the planet be dying when I hold in my hand a bottle of such unfathomably pristine water? How could I be dying when I’m making such healthy decisions?” Cote and Wolfe argue that the way that bottled water is marketed – its associations with wellbeing – happen to make it a particularly appealing antidote for existential despair.” Doesn’t work for Brits on a night out, I’ve been told.

Devex – White House names intended nominee for top job at new US DFI

https://www.devex.com/news/white-house-names-intended-nominee-for-top-job-at-new-us-dfi-95272? “The White House plans to nominate Adam Boehler to be the CEO of the new U.S. Development Finance Corporation, a move that would put an entrepreneur and development outsider at the helm of the country’s new development finance agency. Boehler, who is a relative unknown to the development community, has been serving as the director of the Center for Medicare and Medicaid Innovation and is a senior adviser to the secretary of the Department of Health and Human Services. He is also reportedly close with White House adviser Jared Kushner, who was his roommate for a summer in college….”

FT – G7 pushed to back $255 million financial inclusion fund

https://www.ft.com/content/116f36f0-a8a6-11e9-984c-fac8325aaa04?sharetype=blocked (gated). Cfr a tweet: “Melinda Gates proposes ambitious $255m financial inclusion fund to @G7 finance ministers to accelerate expanding access to financial services to women across Africa @gatesfoundation.”

Twitter Women’s Tips on Academic Writing: A Female Response to Gioia’s Rules of the Game

T Greenhalgh; https://journals.sagepub.com/doi/pdf/10.1177/1056492619861796 By Trisha Greenhalgh. “This article, intended in a spirit of good humor, offers a critique of a paper by Gioia on how to get published. Based on a social media discussion to which 46 women academics from around the world contributed, we ask whether the recommendations in Gioia’s original paper are based on gendered assumptions and stereotypes (the “lone wolf” male academic competing with colleagues for a slot in a prestigious journal). Drawing on feminist scholars such as Mary Wollstonecraft (“Virtue can only flourish among equals”), we offer some additional recommendations which emphasize the importance of reflection, collaboration, acceptance of ambiguity, attention to audience and context, and nurturing self and others.”