Preparations UN High-Level Meeting on UHC in full swing
HPW – Major UN Effort To Achieve Universal Health Coverage Taking Shape
“United Nations members and stakeholders are mobilising to bring about universal health coverage across the world with all eyes on the UN High Level Meeting on Universal Health Coverage planned for 23 September. An informal meeting of representatives from countries and leading international health organizations at UN headquarters in New York yesterday provided an update on progress and highlighted emerging priorities for the planned High Level Meeting. …”
“…The 23 September High Level Meeting at the United Nations is supposed to conclude with a political declaration to drive action on the issue. The meeting, under the theme, “Universal Health Coverage: Moving Together to Build a Healthier World,” will take place in the midst of the annual UN General Assembly week. It is considered the last chance to mobilise highest level political support for health issues before the world reaches the 2023 midpoint of the 2030 Sustainable Development Goals. … “
“…A main focus of yesterday’s meeting was a set of “Key Asks” developed by the International Health Partnership for UHC 2030 (UHC2030), a multi-stakeholder platform including countries, international organizations and civil society…”
Key Asks from the UHC Movement – Moving together to build a healthier world https://www.uhc2030.org/fileadmin/uploads/uhc2030/Documents/UN_HLM/The_UHC_Key_Asks_final.pdf
Short document (4 p.) with the 6 key asks. Really nice document (and a big improvement as compared to a previous version). The 6 asks are: (1) Ensure Political Leadership beyond Health. (2) Leave no one behind; (3) Regulate and Legislate; (4) uphold Quality of care; (5) Invest more, invest better; (6) Move together.
For the references of these 6 key asks, see this document.
UN Security Council meeting re attacks on health facilities (1 April)
Telegraph – UN urged to act as research shows nearly 1,000 attacks on health workers in 2018
“New figures presented to the United Nations Security Council show there were nearly 1,000 attacks on health care last year. The annual figures, produced by the Safeguarding Health in Conflict Coalition and presented to members of the Security Council on April 1, show that hospitals have been subjected to airstrikes, clinics have been torched and patients assaulted. In total there were 951 attacks on health facilities in 23 countries. The figures show that 156 health workers were killed and more than 700 were injured. And more than 100 health facilities were forced to suspend operations or close. The data is collected from various sources including news reports, humanitarian organisations and for the first time, the World Health Organization, which began collecting data on attacks last year….”
See also a viewpoint, published ahead of the meeting in Global Health Now, by Leonard S Rubenstein (director of the Program on Human Rights, Health and Conflict at the Center for Public Health and Human Rights at the Johns Hopkins Bloomberg School of Public Health) – Overdue Action Needed to Stop Attacks on Health Care He reckons it’s time the Security Council lives up to its own resolution from 2016, and hopes “[Today’s] French and German initiative at the Security Council discussion [will] be a start.”
This was part of a special meeting of the Security Council to examine ways to promote and strengthen the rule of law, especially in the humanitarian field. For more on this SC meeting, see UN News – Wars have rules: 5 things the UN humanitarian chief wants countries to tackle so human suffering in conflict can be minimized
WASH in health care facilities
WHO – 1 in 4 health care facilities lacks basic water services – UNICEF, WHO
“One in four health care facilities around the world lacks basic water services, impacting over 2 billion people, according to a new report by WHO and UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene (JMP). The WHO/UNICEF JMP report, WASH in Health Care Facilities, is the first comprehensive global assessment of water, sanitation and hygiene (WASH) in health care facilities. It also finds that one in five health care facilities has no sanitation service*, impacting 1.5 billion people. The report further reveals that many health centres lack basic facilities for hand hygiene and safe segregation and disposal of health care waste…..”
“…In an accompanying report, Water, sanitation, and hygiene in health care facilities: Practical steps to achieve universal access for quality care, WHO and UNICEF researchers note that more than 1 million deaths each year are associated with unclean births. Infections account for 26% of neonatal deaths and 11% of maternal mortality. … … At the 2019 World Health Assembly to be held in May, governments will debate a resolution on Water, Sanitation and Hygiene in Health Care Facilities which was unanimously approved by the WHO Executive Board earlier this year. … … The WHO and UNICEF Practical Steps report provides details on eight actions governments can take to improve the WASH services in health care facilities …”
Coverage for example in the Telegraph – Superbugs flourish as a quarter of health facilities lack basic water services worldwide
Lancet (GBD) study on our “suboptimal diet”
For some key messages of this new study, see the press release:
“The Lancet: Globally, one in five deaths are associated with poor diet
Globally, one in five deaths (11 million deaths) in 2017 were associated with poor diet, with cardiovascular disease being the biggest contributor, followed by cancers and type 2 diabetes.
Largest shortfalls in global consumption were seen for foods such as nuts and seeds, milk, and whole grains, while sugary drinks, processed meat and sodium were overeaten.
The largest number of diet-related deaths were associated with eating too much sodium, not enough whole grains and not enough fruits. Across all 15 dietary factors, more deaths were associated with not eating enough healthy foods compared with eating too many unhealthy foods.
Out of all 195 countries, the proportion of diet-related deaths was highest in Uzbekistan, and lowest in Israel. The UK ranked 23rd, the United States 43rd, China 140th, and India 118th.
People in almost every region of the world could benefit from rebalancing their diets to eat optimal amounts of various foods and nutrients, according to the Global Burden of Disease study tracking trends in consumption of 15 dietary factors from 1990 to 2017 in 195 countries, published in The Lancet. …”
Lancet Comment – Global diet and health: old questions, fresh evidence, and new horizons
The related Comment.
« … the current GBD findings provide evidence to shift the focus, as the authors argue, from an emphasis on dietary restriction to promoting healthy food components in a global context. This evidence largely endorses a case for moving from nutrient-based to food-based guidelines. Their findings also reinforce those of the EAT–Lancet Commission on optimising diets for sustainable food systems, achievable through predominantly plant-based diets…”
Some excellent coverage also in the Guardian – Bad diets killing more people globally than tobacco, study finds
“Unhealthy diets are responsible for 11m preventable deaths globally per year, more even than smoking tobacco, according to a major study. But the biggest problem is not the junk we eat but the nutritious food we don’t eat, say researchers, calling for a global shift in policy to promote vegetables, fruit, nuts and legumes. While sugar and trans-fats are harmful, more deaths are caused by the absence of healthy foods in our diet, the study found. … … The research is part of the Global Burden of Disease study by the Institute of Health Metrics and Evaluation (IHME) in Seattle, published in the Lancet medical journal. … …. The paper is the most comprehensive analysis on the health effects of diet ever conducted, says the IHME.”
PS: Anthony Costello was slightly less impressed by this (in his view) “suboptimal” paper, mostly from a methodological point of view. Cfr a series of tweets introduced by “ Er…I have just read the paper from the Lancet on effects of dietary risks in 195 countries, 1990–2017. There are three reasons why this paper grossly misleads and does not warrant the media it has received”…” One of them being something with ‘complex statistical manipulation of crap data’ 😊.
World Health Day (7 April) & World Health Statistics 2019
Uneven access to health services drives life expectancy gaps: WHO
“…Women outlive men everywhere in the world – particularly in wealthy countries. The World Health Statistics 2019 – disaggregated by sex for the first time – explains why….”
“The gap between men’s and women’s life expectancy is narrowest where women lack access to health services …”
“Published to coincide with World Health Day on 7 April, which this year focuses on primary health care as the foundation of universal health coverage, the new WHO statistics highlight the need to improve access to primary health care worldwide and to increase uptake. … … Between 2000 and 2016, global life-expectancy at birth increased by 5.5 years, from 66.5 to 72.0 years. …”
For a great summary of this year’s World Health Statistics, see HPW – Global Life Expectancy Improved, Women Outlive Men, But Gaps Persist Based On Income
“Global life expectancy at birth has increased from 65.5 years in 2000 to 72 years in 2016, a new World Health Organization report has found. But despite this overall improvement, significant disparities persist: life expectancy in low-income countries was 18.1 years lower than in high-income countries in 2016. This year’s World Health Statistics Overview, which compiles health statistics for WHO’s 194 Member States, also found that overall, women outlive men everywhere in the world, particularly in high-income countries; but for low-income countries, this gap between men and women is much smaller. This is primarily due to the lower access women have to maternal health services in low-income countries, where one in 41 women die in childbirth, as compared to one in 3,300 women in high-income countries….”
2nd WHO Africa Health Forum (Cabo Verde, end of March)
See also last week’s IHP newsletter.
“The second World Health Organization’s (WHO) Africa Health Forum culminated [today] with a road map that governments in the region as well as partners should urgently implement to manage and mitigate Africa’s health needs. Hosted by the Government of the Republic of Cabo Verde and WHO and seeking new ideas and challenging questions under the theme “Achieving Universal Health Coverage and Health Security: The Africa We Want To See”, the Forum underscored the central role of good health in the sustainable development of the continent. … … To take universal health coverage to the next level, the recommendations call for faster action in building stronger, more resilient national health systems, the prioritizing of primary health care, ensuring that vulnerable groups are reached, the strengthening of public-private partnerships and greater, more efficient, investment. Greater preparedness and prevention of disease outbreaks and other public health emergencies as well as preparedness for detecting and responding when they do occur and preparedness for the impact of natural disasters formed the core of recommendations for health security. The full implementation of the International Health Regulations, which cover the capacity standards for all countries in preventing and responding to acute public health risks, needs to be accelerated, with cross-border collaborations strengthened. Crucial for improving both universal health coverage and health security are public-private partnerships…. “
GAVI Board retreat (27-29 March, Ottawa)
The GAVI Board got together in Ottawa last week, to discuss GAVI 5.0 (you might want to re-read CGD notes on this). GAVI 5.0 stands for the Alliance’s strategy for 2021-2025. Not much available yet on this meeting, except for:
“Japan will host a launch meeting for Gavi’s third replenishment at August’s TICAD 7 in Yokohama that will set out how Gavi, the Vaccine Alliance, on the eve of its 20th anniversary, will continue its work vaccinating millions of children in the world’s poorest countries.” TICAD refers to “Tokyo International Conference on African Development””.
As you might recall, the UK will host GAVI’s 3rd replenishment, in 2020 (for the period 2020-25).
In other vaccine related news, you might want to read Heidi Larsson’s Op-ed (Devex) It’s time to rebuild public confidence in vaccines in which she argues that much more will be necessary than just addressing technical fixes (Facebook, Amazon, …) even if these are very needed too. But “we need new modes of engagement rooted in a deeper understanding of the key constituencies and their concerns.”
UNAIDS action plan
UNAIDS presents a new plan to create a healthy, equitable and enabling environment for UNAIDS staff
“UNAIDS presented a new Action Plan to its Board members during a special session of the UNAIDS Programme Coordinating Board (PCB), held on 28 March 2019. The Action Plan sets out a series of priority areas that UNAIDS will be working on to create a positive organizational culture and increase the awareness of managers and staff of their accountability, rights and duties. “We are transforming a difficult moment into a moment of opportunity,” said Michel Sidibé, Executive Director of UNAIDS….”
World Bank & Human Capital Index
Devex – Q&A: World Bank human capital index gathers momentum
“The number of countries working with the World Bank to improve their health, education, and social protection outcomes as part of the flagship human capital index has nearly doubled in the last six months, according to Annette Dixon, vice president for human development at the development finance institution. Twenty-seven countries were listed as “early adopters” when the index was launched to much fanfare during the institution’s annual meetings in Indonesia last October. But now, 57 countries have signed up to be “human capital countries,” Dixon told Devex during the Global Education & Skills Forum in Dubai, United Arab Emirates, last weekend….”
FT – David Malpass sails past doubts to secure World Bank presidency
“David Malpass is poised to secure approval from the World Bank’s board as the next president of the Washington-based multilateral lender on Friday, after a low-profile campaign with no competition. The comfortable run experienced by the 63-year-old former chief economist of Bear Stearns on the path to the World Bank presidency marks a victory for the Trump administration, which will now have an avenue to bring its America-first worldview to one of the top international economic institutions. Mr Malpass has prevailed despite concerns among officials in many countries about his well-documented scepticism of multilateralism, and doubts about his commitment to some of the World Bank’s main goals, particularly combating climate change….”
“… One of the biggest concerns with Mr Malpass’s arrival at the helm of the World Bank is that he will be less committed to the institution’s growing role in financing “global public goods”, from tackling climate change and healthcare to programmes that help refugees. Mr Malpass has laid out a narrower vision for the World Bank, saying it should be more exclusively focused on providing assistance to the poorest countries. He consistently warned that multilateralism had gone “too far” and international economic co-operation had become sprawling and ineffective….”
“… Mr Malpass is expected to take office as early as next week, in time for the spring meetings of the International Monetary Fund and the World Bank, giving him the opportunity to make a high-profile debut. His early actions will be closely scrutinised for any signs of tensions with China. In congressional testimony as recently as November, Mr Malpass had warned that the multilateral development banks risked being captured by Beijing’s “geopolitical” influence. This is likely to translate into less support for the institution’s direct lending to China, and a more critical look at the value of infrastructure projects under the Beijing-financed Belt and Road Initiative….”
Global Fund replenishment
This letter, by representatives from the US private sector, concerned about Trump’s latest budget cut plans for the GF, is directed at key Congress members from the Appropriations Subcommittee for State and Foreign Operations and Foreign Operations. They write “…to encourage you to provide increased funding to the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) in your Fiscal Year 2020 (FY20) appropriations bills.”
Alternatively, as many of these companies don’t pay much taxes, they might just want to suggest a “voluntary” Global Fund tax on multinationals around the globe.
Guardian – Toxic air will shorten children’s lives by 20 months, study reveals
“The life expectancy of children born today will be shortened by 20 months on average by breathing the toxic air that is widespread across the globe, with the greatest toll in south Asia, according to a major study. Air pollution contributed to nearly one in every 10 deaths in 2017, making it a bigger killer than malaria and road accidents and comparable to smoking, according to the State of Global Air (SOGA) 2019 study published on Wednesday….”
See also HPW – Air Pollution Lops Nearly 2 Years Off Global Life Expectancy.
Guardian – A natural solution to the climate disaster
See this week’s intro. “Climate and ecological crises can be tackled by restoring forests and other valuable ecosystems, say scientists and activists.” Featuring Greta Thunberg, Naomi Klein, G Monbiot, and many others.
“… We call on governments to support natural climate solutions with an urgent programme of research, funding and political commitment. It is essential that they work with the guidance and free, prior and informed consent of indigenous people and other local communities. This approach should not be used as a substitute for the rapid and comprehensive decarbonisation of industrial economies. …” (but as a vital complement)
Or cfr a tweet: “Momentum for massive ecosystem restoration is building ahead of @UN Secretary-General’s #Climate Summit, and UN Decade on Ecosystem Restoration 2021-2030”
Nature (News) – Global political climate of ‘fear’ threatens ecologists’ work
“Government policies are increasingly bringing ecologists into conflict with officials.”
The Conversation – Emissions inequality: there is a gulf between global rich and poor
One of the must-reads of the week on the enormous emissions inequality between rich & poor. He concludes: “…Given the problem is overwhelmingly, dare I say it, rich white men, we don’t do ourselves any favours by assigning blame to whole populations – be it humanity, Americans, or even the whole global north. Thinking this way makes it harder to identify the actual source of the problem and formulate solutions to it. That is to say, rather than signing on for yet another call for meat free Mondays and giving up meat, we’d be better off “eating the rich”.”
The Ecologist – An open letter to David Wallace-Wells
“The best-selling book ‘The Uninhabitable Eart’h focusses attention on unprecedented climate breakdown – but places false hope in geoengineering”, according to these 3 British scientists (& adepts of the ‘Deep Adaptation Agenda’).
“…Instead of fantasies of one-world command-and-control salvation, we believe that The Uninhabitable Earth should wake us all up to the need for what one of us has recently and influentially named a ‘Deep Adaptation agenda’. This involves building resilience, both physical and psychological, learning to relinquish long-held beliefs and aspirations (such as that of uninterrupted ‘progress’), and the attempted restoration of attitudes and practices which our carbon-fuelled way of life has so dangerously eroded. Such an approach, while recognising the certainty that the civilisation which has brought us to this pass is finished, accepts also that we cannot know in advance what fine human and societal possibilities may emerge from the crucible of this very recognition….”
“…The sooner we realise that humanity won’t have a Hollywood ending to climate change, the more chance we have to avoid ours becoming a true horror story….”
SDGs in reverse?
Scidev.net – Most SDGs ‘going into reverse’ – UN expert group member
“Progress on most Sustainable Development Goals (SDGs) has gone into reverse, according to Jean-Paul Moatti, the director-general of the French National Research Institute for Development (IRD) and a member of the expert group charged by the UN with evaluating progress so far on the objectives. … … The 15-member expert group is working on the first instalment of a four-yearly Global Sustainable Development Report which will give the UN a scorecard on how well countries are doing against the objectives, to be published in September this year. In an interview with SciDev.Net on 29 March, Moatti said that it was now time to sound the alarm over the SDGs, and explained that the emerging field of sustainability science could offer a way forward. …”
“…The three goals which are now clearly identified in the scientific literature as being the ones which – not meaning that the other ones are not important – if we don’t solve these we are going to have problems for the whole agenda, these three goals are the ones that are not going well….” “Reduction of inequalities (SDG10), limitation and adaptation to climate change (SDG13) and reduction of the environmental and ecological footprint of our modes of production and consumption (SDG 12) – these are the key goals, the things that we need to tackle everywhere if we want to not only achieve these goals but the whole agenda. In these three areas, the situation is one of the worst. So, yes, we need to sound the alarm….”
IATF – Financing for Development 2019 Report
Cfr the press release: Major new UN report calls for overhaul of global financial system
“Sixty-plus international organizations, led by the United Nations and including the International Monetary Fund, the World Bank Group and World Trade Organization, jointly sounded the alarm Thursday in a new report, warning that unless national and international financial systems are revamped, the world’s governments will fail to keep their promises on such critical issues as combatting climate change and eradicating poverty by 2030….” Check out their recommendations.
For some coverage of this report, see also IISD – UN Report: Repurpose Global Architecture to Finance Sustainable Development
“The UN’s Inter-agency Task Force on Financing for Development launched the 2019 Financing for Sustainable Development Report, which is the substantive basis for discussion at the UN Economic and Social Council’s annual Forum on Financing for Development Follow-up. The report contains policy recommendations to build supportive financial systems to change the current trajectory, going beyond raising additional investment. It also includes a “data-rich monitoring of progress,” and puts special emphasis on five SDGs that will be reviewed during the July 2019 session of the UN High-level Political Forum on Sustainable Development (HLPF).”
“The report introduces “integrated national financing frameworks” to help countries align their financing policies with their strategies and priorities. The authors also call for “repurposing” the global institutional architecture to create a more sustainable global economy….”
See also an ODI Analysis – New pan-agency development financing report suggests major economic crisis brewing (by J Griffiths)
Growing debt crisis in many low-income countries
Guardian – Debt crisis warning as poorest countries’ repayment bills soar
“Debt repayments by the world’s poorest countries have doubled since 2010 to reach their highest level since just before the internationally organised write-off in 2005, campaigners have warned. The Jubilee Debt Campaign (JDC) said a borrowing spree when global interest rates were low had left many developing nations facing repayments bills that were forcing them into public spending cuts. Plunging commodity prices, a stronger dollar and rising US interest rates had combined to increase debt repayments by 85% between 2010 and 2018, the JDC said. … … Repayments account for more than 12% of government revenue on average, the highest level since 2004, the year before the G8 summit held at Gleneagles agreed a comprehensive package of financial assistance involving aid and debt relief. The International Monetary Fund has become increasingly concerned at the financial vulnerability of poor countries and will discuss the issue at its spring meeting in Washington DC next week. Two-fifths of low-income countries are assessed by the IMF to be at “elevated risk of debt distress”, a doubling since 2013….”
Not so “resilient” ?
“The Rockefeller Foundation is ending its 100 Resilient Cities initiative, a high-profile climate change adaptation effort that included funding chief resilience officers in more than 80 metropolitan areas around the world, including Addis Ababa, Bangkok, and Cape Town. The initiative was launched on the Rockefeller Foundation’s centennial in 2013 by former president Judith Rodin, who made resilience a central theme of her tenure and authored a book about it in 2014. Rajiv Shah, who took the reigns at Rockefeller two years ago, previously pledged to continue supporting 100RC. On Monday, 86 of the initiative’s staffers were told their jobs would end on July 31….”
But it’s called ‘transitioning’ to a new phase, and 3 different pathways, if I understand this correctly. See An Update from 100 Resilient Cities
2019 Global Report on Food crises
Devex – Acute hunger hits 113 million people, but data gaps remain
“More than 113 million people across 53 countries experienced acute hunger last year, according to new figures released Tuesday. And the main factors — conflict and insecurity; climate change; and economic shocks — are not expected to abate in 2019. The “Global Report on Food Crises,” prepared with 15 development and humanitarian agencies, found that 58 percent of those experiencing acute hunger were in Africa, 24 percent in the Middle East, and 13 percent in South and Southeast Asia….”
Global Health Security
CSIS Brief – Harnessing Multilateral Financing for Health Security Preparedness
“The economic consequences of large-scale disease outbreaks can be enormous: pandemics could cause $570 billion per year in average economic losses over the coming decades. Health security threats have an especially destructive impact on development investments and GDP in low-income and lower-middle-income countries (LICs and LMICs….) … By contrast, upgrading countries’ preparedness is relatively inexpensive and affordable; recent data demonstrates most countries would need to spend approximately $0.50-$1.50 per person per year to get an acceptable level of epidemic preparedness. The financing gap for preparedness is one of the starkest problems in health security, especially among LICs and LMICs. That gap is estimated at $4.5 billion per year. Investments in preparedness are cost-effective and affordable, but low-income and lower-middle-income country governments continue to underinvest at dangerously low levels. … … The World Bank Group’s International Development Association (IDA) replenishment takes place every three years and presents a choice opportunity to make adjustments that reflect important emerging priorities. In the current IDA19 replenishment, stakeholders can take a major step towards closing the preparedness financing gap by incentivizing $1 billion or more per year in preparedness investments in LICs and LMICs.”
Lancet Public Health – Public health priorities for China–Africa cooperation
G F Gao & John Nkengasong; https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(19)30037-4/fulltext
Worth a read. Focus on the cooperation between the African CDC(s) & China.
Global Health Security Index expert panel in London (2 days)
For more info on this Index, see JH Center for Health Security
“In partnership with the Nuclear Threat Initiative and the Economist Intelligence Unit, the Center is developing the Global Health Security Index to assess a country’s technical, financial, socioeconomic, and political capabilities to prevent, detect, and rapidly respond to epidemic threats with international implications, whether naturally occurring, deliberate, or accidental. The index will draw from internationally-accepted technical assessments including the World Health Organization’s International Health Regulations Joint External Evaluation and the World Organization for Animal Health’s Performance of Veterinary Services Pathway. It will also incorporate other important factors, such as countries’ overall health system strength, commitment to global norms, and the risk environment. The index framework will be piloted in four countries to determine what adjustments, if any, need to be made before it can be scaled up significantly…”
A few tweets by Larry Gostin on the 2-day meeting in London:
“In London @TheEconomist @NTI_WMD @JHSPH_CHS host Global Health Security Index, innovative eval of 196 @WHO #IHR States’ capacity to detect & respond to novel pathogens. Index adds > value to #JEE. If every nation objectively evaluates capacities, major advance in global security.”
“GH Security Index aims: assess & track advances in preparedness (cycle of quality improvement), transparency, accountability, pol leadership, int’t funding. Benefits incl indep external spur to action, supporting @WHO @DrTedros. Evaluates pol instability, key to #DRC #Ebola”
“2nd day of Global Health Security Index expert panel in London. Goes beyond JEE: rigorous, indep eval of core #IHR capacities. Next week in Cape Town legal experts will interpret IHR, Arts 43, 44 re int’l duties to build core health system capacities. Universal preparedness vital”
“Global health security index, @WALETOM final words: Instead of JEE think FEE. To keep the world safe: Funding Evaluation Expectation. I would add good governance & accountability. FEE”
HPW – GARDP Set Up As Independent Legal Entity
“The Global Antibiotic Research and Development Partnership (GARDP) is now an independent legal entity following a successful three-year incubation, hosted by the Drugs for Neglected Diseases initiative (DNDi). During this time, GARDP has already begun working with partners to develop antibiotics to tackle drug-resistant infections which pose a threat to global health and development, including the achievement of the Sustainable Development Goals….”
Ebola DRC outbreak – Expanding faster than ever
Reuters – Congo Ebola outbreak spreading faster than ever: WHO
“Democratic Republic of Congo’s Ebola outbreak is spreading at its fastest rate yet, eight months after it was first detected, the World Health Organization (WHO) said on Monday. Each of the past two weeks has registered a record number of new cases, marking a sharp setback for efforts to respond to the second biggest outbreak ever, as militia violence and community resistance have impeded access to affected areas….”
“An Ebola treatment centre located at the epicentre of the current outbreak in eastern Democratic Republic of Congo has resumed operations after it was attacked last month, the country’s health ministry said on Saturday.” “For now the centre (formerly run by MSF) is managed by the ministry in collaboration with the World Health Organisation (WHO) and UNICEF.”
Artificial Intelligence & global health
Lancet (Comment) – WHO and ITU establish benchmarking process for artificial intelligence in health
“… Two UN agencies, WHO and the International Telecommunication Union (ITU), established a Focus Group on Artificial Intelligence for Health (FG-AI4H) in July, 2018. FG-AI4H is developing a benchmarking process for health AI models that can act as an international, independent, standard evaluation framework….”
With the findings of the new report, AI in Global Health: Defining a Collective Path Forward, as background and context, the panel will discuss some of the most promising use cases of AI in healthcare, the opportunities and challenges to scaling AI in global health, and how the global health community can best accelerate the development and scale of AI in global health.
USAID/Rockefeller Foundation (report) – Artificial intelligence in global health
“The Rockefeller Foundation and United States Agency for International Development’s (USAID) Center for Innovation and Impact (CII) have partnered, in close coordination with the Bill and Melinda Gates Foundation, to develop AI in Global Health: Defining a Collective Path Forward. This report identifies opportunities for donors, governments, investors, the private sector, and other stakeholders to explore and accelerate the appropriate development and cost-effective use of AI at scale in global health. AI in Global Health: Explores the current state of the art of AI in healthcare to determine use cases with the highest potential in the global health context; Assesses the most critical challenges to scaling AI in low- and middle-income countries to understand which barriers may require more strategic and deliberate intervention; Explores potential investments as part of a coordinated approach to funding this space effectively….”
Access to Medicines
WHO Essential Medicines Review : Cancer Drugs, Insulin Analogues Draw Controversy
“Expanding access to costly cancer treatments and the high price of new generation insulin formulas were among the controversial topics of debate today as the WHO Expert Committee on the Selection and Use of Essential Medicines convened for its biennial update of the list of over 400 drugs deemed most essential for treating public health needs globally.
Scientific American (Editorial) – The World Health Organization Gives the Nod to Traditional Chinese Medicine. Bad Idea
“The World Health Organization is now promoting unproved traditional Chinese medicine.”
“…Over the past decade proponents of TCM have worked hard to move it into the mainstream of global health care—and it appears those efforts are coming to fruition. The latest (11th) version of the World Health Organization’s list known as the International Statistical Classification of Diseases and Related Health Problems (ICD) will include these remedies for the first time. … To include TCM in the ICD is an egregious lapse in evidence-based thinking and practice. Data supporting the effectiveness of most traditional remedies are scant, at best. … … China has been pushing for wider global acceptance of traditional medicines, which brings in some $50 billion in annual revenue for the nation’s economy. And in 2016 Margaret Chan, then the WHO director, praised China’s plans to do so. But while it’s a good idea to catalogue TCM and make health workers aware of treatments used by millions, their inclusion in the ICD recklessly equates them with medicines that have undergone clinical trials. … … Until they undergo rigorous testing for purity, efficacy, dosage and safety, the WHO should remove traditional medicines from its list. These remedies should be given the same scrutiny as other treatments before being included in standard care practices.”
Trump cuts aid to 3 “Mexican countries”
“The United States has cut its aid to three Central American countries that President Donald Trump has accused of sending migrants north. The State Department confirmed that Washington is ending foreign assistance to El Salvador, Guatemala and Honduras – the so-called ‘Northern Triangle’ of states blamed by Trump.” On Fox, they were labelled “three Mexican countries”.
“…Aid experts warn that the proposed cuts would most immediately effect US efforts to strengthen the rule of law and contain gang violence, which is one of the main drivers of the migrant exodus….” So cutting aid will be counterproductive, even from Trump’s point of view.
See also CGD’s Michael Clemens – What Will the White House’s Halt to Aid Mean for the Northern Triangle? Here’s What We Know.
World Autism Awareness Day
UN News – Strengthen inclusion, participation of people with autism to ‘achieve their full potential’ says UN chief
“On World Autism Awareness Day, United Nations Secretary-General António Guterres underscored in his message on Tuesday, the importance of technology which helps people living with autism “achieve their full potential”.”
UHC & detention over unpaid bills
WEF (blog) – How Africa and Asia are joining forces on universal healthcare
“In Africa and Asia, there has been a recognition of the importance of partnership among governments, civil society and the private sector in advancing UHC. The two regions have begun to cooperate in making use of a global south perspective on how to achieve UHC. Here are examples of how this has worked so far: (1) Kenya bids for free basic healthcare through partnership with Thailand … (2) Egypt looks to Japan for UHC guidance …”
KNH releases 300 patients detained over unpaid bills
Cfr a tweet by Rob Yates: “Great to see Kenya tackling the human rights abuse of hospital detentions, Nigeria, DRC and Cameroon take note!”
Let’ s hope indeed that these detentions over unpaid bills will soon be a thing of the past, now that UHC tops the agenda in SSA and elsewhere.
China Tobacco looks to take on global cigarette makers
“A monopoly in the world’s largest cigarette market is no longer enough for China National Tobacco. The combination of a slowing domestic economy and efforts by health officials to curb smoking in a country where over a quarter of the adult population are regular users, means the company is now taking aim at western rivals in global markets. China exported cigarettes worth $722m last year, according to customs data, up from $248m a decade ago, with the majority heading to developing countries in Asia. The global push has Beijing’s backing, with the government calling for China Tobacco’s international competitiveness to be “comprehensively” enhanced. “China Tobacco’s overall goal [is] to eventually become a transnational tobacco company with its own leading brands, in order to compete with the likes of Philip Morris International and British American Tobacco,” said Jennifer Fang of Simon Fraser University in Canada, who studies the company. …”
Lancet (Comment) – Unite for a Framework Convention for Alcohol Control
“…Since the WHO FCTC has been successful, we advocate for a Framework Convention for Alcohol Control (FCAC) and urge WHO to start the process as soon as possible. We also propose a stage of alcohol epidemic model (SAEM) with reference to the stage of tobacco epidemic model and the stage of obesity epidemic model….”
Comment linked to a new study in the Lancet – Conventional and genetic evidence on alcohol and vascular disease aetiology: a prospective study of 500 000 men and women in China.
For some of the key messages of this study, see the press release:
“The Lancet: Moderate alcohol consumption does not protect against stroke, study shows
Blood pressure and stroke risk increase steadily with increasing alcohol intake, and previous claims that 1-2 alcoholic drinks a day might protect against stroke are dismissed by new evidence from a genetic study involving 160,000 adults….”
Global Health has forgotten the Arab world
Lancet – Offline: Global health has forgotten the Arab World
“…The pain felt in the Arab World is pervasive. And the health community, including international health institutions, has utterly failed to prioritise a region facing endemic conflict and conflagration…. … The only health organisation with an exclusive mandate to address health in the Arab World is WHO’s Regional Office for the Eastern Mediterranean (EMRO)…” But, “…EMRO’s regional priorities are also standard fare: universal health coverage, health emergencies, healthier populations, and transformative changes at WHO. Ten “key initiatives” for 2019 include creating an “Alliance for Health for All”, revitalising community-based programmes, and promoting patient safety. But these priorities and initiatives are pedestrian. They do not match the urgency of multiple predicaments facing Arab countries. Something needs to change—in the Arab World, at EMRO, and globally. … … What can be done? Instead of waiting for governments to act, the health and medical research communities could do more to encourage collaborations with Arab nations. The Arab World is home to world-class universities—the American University of Beirut, Birzeit University, the University of Jordan, to name but a few. By forging bilateral educational, clinical, and research partnerships, possibilities for a transformational shift in opportunities for a new Arab generation are palpable….”
“Decolonializing” Duncan Green (‘s) blog
Duncan Green’s (widely read) FP2P blog is being ‘decolonialized’. For what Duncan & team have in mind, see We’re changing up FP2P: here’s the plan (but we haven’t got a name yet – please help!)
Check out already a few of the contributions in this respect. For a nice example, see The ‘Black Market’ of Knowledge Production
“Researchers David Mwambari and Arthur Owor question the effect of money in producing knowledge in post-conflict contexts and argue that it restricts independent local research. These insights were developed at a recent workshop at Ghent University, which brought together Ghent-based researchers and a group of researchers, commonly called “research assistants”, from post-conflict and developing regions.”
Forbes – Highly Profitable Medical Journal Says Open Access Publishing Has Failed. Right.
“Surprise: the New England Journal of Medicine thinks open access is a bad idea. Open access is the model of scientific publishing in which all results are freely available for anyone, anywhere, to read. This week NEJM published an editorial by one of their correspondents, Charlotte Haug, that purports to present an objective look at open access publishing, and finds that the “experiment” has failed, and that free access to scientific publications hasn’t delivered on its promises. What is NEJM worried about? Their expensive, exclusive model of publishing–where everyone has to pay high subscription fees, or else pay exhorbitant fees for each article they read–is threatened by scientists who want all science to be free. Pesky scientists! NEJM is especially worried about “Plan S“, a proposal in Europe to require that all scientists whose work is funded by the public be required to publish their results in open-access venues. Plan S is due to take effect very soon, in 2020 for 11 research funders in Europe….”
Salzberg takes the NEJM Editorial down.
Or cfr. a tweet by John Arne Rottingen –
“Highly Profitable Medical Journal Says Open Access Publishing Has Failed. Right. #PlanS is here to stay and to reform.”
Some key papers, publications and journal articles of the week
BMJ Global Health- Are public–private partnerships the future of healthcare delivery in sub-Saharan Africa? Lessons from Lesotho
Mark Hellowell; https://gh.bmj.com/content/4/2/e001217
Cfr. a tweet by Hellowell himself:
“So many governments in Africa are looking to #PPPs as a way of building and running new health facilities. What can we learn from the most ambitious contract signed so far? My mid-point evaluation of the #Lesotho PPP is published OA in @GlobalHealthBMJ”.
“Many governments in sub-Saharan Africa are seeking to establish public–private partnerships (PPPs) for the financing and operation of new healthcare facilities and services. While there is a large empirical literature on PPPs in high-income countries, we know much less about their operation in low-income and middle-income countries. This paper seeks to inform debates about the use of PPPs in sub-Saharan Africa by describing the planning and operation of a high-profile case in Maseru, Lesotho. The paper highlights several beneficial impacts of the transaction, including the achievement of high clinical standards, alongside a range of key challenges—in particular, the higher-than-anticipated costs to the Ministry of Health. Governments have budget-related incentives to promote the use of PPPs—even in cases in which they may threaten financial sustainability in the long term. To address this, future proposals for PPPs need to be exposed to more effective scrutiny and challenge, taking into account state capacity to proficiently manage and pay for contracted services.”
Health Systems & Reform – Putting Country Ownership into Practice: The Global Fund and Country Coordinating Mechanisms
By an “inspired” Peter Sands. His view on the Global Fund’s CCM model and how it still needs to evolve. Including a few nice camel metaphors.
WHO Bulletin – Private sector care provision and universal health coverage
D Clarke, G Schmets, A Soucat et al; https://www.who.int/bulletin/online_first/BLT.18.225540.pdf?ua=1
“…Ignoring the role of the private sector in national efforts towards UHC is not an option, despite its challenges. Here we suggest the following approach to managing, and where appropriate, engaging the private sector as part of efforts to achieve UHC. …”
“.. WHO plays a key role in supporting Member States with this critical area of work. The organization works to strengthen the governments’ capacity to make informed decisions about the role of the private sector. For this purpose, WHO has developed a new conceptual framework and a decision-making model to help guide countries through the approaches recommended above….”
Fyi – Forthcoming – “Harnessing the private sector for UHC, a decision-making model”. Geneva: World Health Organization; 2019.
Public Health Reviews (meeting report) – Critical reflections, challenges and solutions for migrant and refugee health: 2nd M8 Alliance Expert Meeting
N-E Bempong et al ; https://publichealthreviews.biomedcentral.com/articles/10.1186/s40985-019-0113-3
“…In response to the growing health challenges faced by migrants and refugees, members of the M8 Alliance launched an annual Expert Meeting on Migrants’ and Refugees’ Health. This report is shaped by discussions from the second M8 Alliance Expert Meeting (Sapienza University of Rome, Italy, 15–16 June 2018) and is supported by supplementing literature to develop a framework addressing critical reflections, challenges and solutions of and for migrant and refugee health. This report aims to inform decision-making fostering a humanitarian, ethics and rights-based approach. Through a series of country-specific case studies and discussions, this report captures the most prominent themes and recommendations such as mental health, tuberculosis (TB) and best practices for increased access….
Global Health Promotion – Health promotion 4.0
“Throughout the world there is the recognition that we are at a turning point of development—The World Economic Forum has used the terms Globalization 4.0 and Industrial Revolution 4.0 as code words for the radical changes underway (World Economic Forum Annual Meeting 2019, Overview, 2019). In health and medicine we are also on to Health 4.0—which basically means the digital transformation of health and medical care, both in its practice and its governance….” Kickbusch dwells on some of the implications for Health Promotion 4.0.
SRHR – issue in progress: The impact of politics on sexual and reproductive health and rights
Already online (and with more to come):
HP&P – Rebuilding health post-conflict: case studies, reflections and a revised framework
“… the present article aims to evaluate health system development in three post-conflict environments over a 12-year timeline. Applying and adapting a framework from Waters et al (…) health policies and inputs from the post-conflict periods of Afghanistan, Cambodia and Mozambique are assessed against health outputs and other measures. From these findings, we developed a revised framework, which is presented in this article….”
BMJ Global Health – Evaluation of research on interventions aligned to WHO ‘Best Buys’ for NCDs in low-income and lower-middle-income countries: a systematic review from 1990 to 2015
Luke Allen et al; https://gh.bmj.com/content/3/1/e000535
Already from last year, but worth re-flagging.
Cfr a tweet: “Evaluation of #research on interventions aligned to @WHO ‘Best Buys’ for #NCDs in LIC and LMIC countries from 1990 to 2015 reveals that very little research has been done. Needs to be urgently prioritized”
WHO/UNICEF Draft Operational Framework for PHC (for consultation)
From late last year, we assume, but in case you hadn’t seen this yet: “This draft for consultation was produced as part of a technical series on primary health care on the occasion of the Global Conference on Primary Health Care under the overall direction of Naoko Yamamoto…”
WHO Bulletin – April issue
- You might want to start with the Editorial – Substance use services for refugees
“With the forcibly-displaced population growing, and with the increase in the burden of substance use disorder globally, substance use among refugees must be considered a public health priority and addressed through concerted actions. …”
- And the other Editorial – Taking a complexity perspective when developing public health guidelines
Related to the already released supplement ( in BMJ Global Health ) that introduced the new WHO-INTEGRATE evidence-to-decision framework, which incorporates WHO’s norms and values with a complexity perspective.
BMJ (Global Health) Series – Self care interventions for SRHR
This week The BMJ and BMJ Global Health launch a series of articles focused on self care interventions for sexual and reproductive health and rights that aim to add to the evidence base in this important area.
Start with the Editorial – It’s time to recognise self care as an integral component of health systems
Blogs and mainstream articles of the week
Brookings (blog) – Poverty in Africa is now falling—but not fast enough
“… According to projections from the World Data Lab, Africa has now reached a milestone in the fight against poverty. As of March 2019—and for the first time since the start of the SDGs—more Africans are now escaping extreme poverty than are falling (or being born) below the poverty line (Figure 1). The pace of this net poverty reduction is currently very small: only 367 people per day. Nevertheless, by the end of this year, this rate will increase to over 3,000 people per day, resulting in a 1 million-person reduction in total African poverty in 2020. If these broad trends continue, by 2030, Africa will reduce the ranks of its extremely poor by 45 million and relative poverty will decline from 33.5 percent today to 24 percent. However, this still means that the continent will fall short of achieving Sustainable Development Goal (SDG) 1, eradicating extreme poverty by 2030. Approximately 377 million Africans will still be living on less than $1.90 a day and very few African countries will have ended poverty. The most significant challenges for reducing poverty in Africa are found in just two countries: Nigeria and the Democratic Republic of the Congo (DRC)….”
New Scientist – The 10 biggest moral dilemmas in science
Just for the fun of it. But many have links with global and/or planetary health. For example: should we geoengineer the planet?