Health Breaking News: Link 298

Health Breaking News Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

Health Breaking News: Link 298

 

5 experimental treatments introduced in latest DRC Ebola outbreak 

WHO Director-General updates on Ebola outbreak in DR Congo – Aug 2018  

‘This is a very dangerous outbreak’: WHO chief ‘worried’ over Ebola in DRC, as experimental treatment begins 

WHO calls for free and secure access in responding to Ebola outbreak in the Democratic Republic of the Congo 

Opinion | Ebola responders must learn language lessons from the 2014 epidemic 

Inside Namibia’s HIV success story 

African governments are far from powerless in global health initiatives like those against AIDS 

Malawi study boosts calls to roll out rotavirus vaccine in more countries 

A post-conflict vaccination campaign, Central African Republic 

Mutant mosquitoes: Can gene editing kill off malaria? 

MSF applauds the World Health Organization’s move to recommend improved tuberculosis treatment options  

What would a feminist approach to localisation of humanitarian action look like? 

Akeredolu reverses self, adopts Mimiko’s free health services for pregnant women, children 

Integrating Care for Children, Young People and Their Families 

Alternative malnutrition treatments hold promise for millions of children 

Strategic orientations for the future of child health in a new online collection at BMJ 

Human Rights Reader 457 

Civil society calls on G20 leaders to urgently take joint action in tackling global challenges 

Take Charge of Your Food: Your Health is Your Business 

African countries fare poorly in innovation ranking 

‘Promoting Some Literacy on the Health Systems of Countries of Origin of Migrants in Europe’ by Yves Charpak 

‘Public Finance and Public Health’ by Ted Schrecker 

Gilead loses key patent claims for Sovaldi in China, opening door to earlier generic entry 

KEI and UACT comments on the prospective grant of an exclusive license to Midissia Therapeutics 

Health as if Everybody Counted (second edition) by Ted Schrecker, Professor of Global Health Policy 

Watermelon rind a cheap filter for arsenic in groundwater 

Truth Squad: Bloomberg’s Latest Move to Fight Big Tobacco in the Global South 

It Takes an Oncologist: A New and Promising Tobacco Control Initiative

How coal-burning countries are making their neighbours sick 

Working with China on Pacific climate change 

IPHU Course announcement: The Struggle for Health – Savar 6 to 13 November 2018, Bangladesh 

Public Finance and Public Health

Finance ministries are the most important ministries for improving population health – first, because they determine the budgets available to health ministries; second, because their policies determine the capacity of governments to meet health-related economic and social policy objectives (through taxation) and the distribution of the benefits of those policies (through their expenditure priorities)

By Ted Schrecker

Professor of Global Health Policy, Newcastle University

Public Finance and Public Health

 

I have argued for many years that public finance is a public health issue.  Against the odds, this view appears to be gaining credence.  The Disease Control Priorities Project is a massive effort to identify the most ‘cost-effective’ options for improving health, funded by the Bill and Melinda Gates Foundation and organised by the World Bank.  The authors of a summary of its nine volumes of recommendations argued that ‘[i]n all likelihood, the finance ministry is the most important ministry (after health) for improving population health’.  Their argument related mainly to the options for taxing such health-destructive commodities as sugary drinks, while reducing subsidies on fossil fuels.  These are all laudable and important objectives, but we must go further.  Finance ministries are the most important ministries for improving population health – first, because they determine the budgets available to health ministries; second, because their policies determine the capacity of governments to meet health-related economic and social policy objectives (through taxation) and the distribution of the benefits of those policies (through their expenditure priorities).

In the United Kingdom, since 2010 we have witnessed an especially striking illustration of this point.  Tax and benefit policy changes have substantially reduced the incomes of those households near the bottom of the economic distribution, with minimal impact on those near the top.  Food bank use has increased sharply, and this is almost certainly only the tip of the health impact iceberg; the most deprived local authorities, which derive much of their income from central government, have been hit hardest by budget cuts and are closing libraries and preventive services like smoking cessation, even as the National Health Service simultaneously cuts back on stop-smoking prescriptions.  Indeed, the NHS as a whole is in a state of continued crisis because of government’s unwillingness to provide adequate funding from general tax revenues.  Meanwhile, corporate tax policy allows firms like Amazon to pay minimal taxes in the UK, even as their low operating costs – thanks to a perverse structure of business rates (taxes) – contributes to the destruction of high street retail.  This is likely to have at least indirect health consequences, for example as town centre dwellers whose age, abilities or finances mean they cannot hop in the car and drive to a suburban shopping park lose ‘control over destiny’.

Against this background, central government continues to commit tens of billions of pounds to megaprojects like high speed intercity rail lines and foreign-built atomic power stations.  If the World Health Organization’s important message of health in all policies had been taken seriously, at the very least we would have independent, peer-reviewed health impact assessments of these expenditures, including alternative uses of the funds committed and of the ‘do nothing’ option.  Based on decades of experience with environmental impact assessments, these are essential.  Such assessments are nowhere to be found; health economists’ ritual incantation that resources are limited so priorities must be set clearly does not apply here.

Unfortunately all this will be familiar even to casual observers of UK politics, and has parallels elsewhere, although the public health community has too often remained silent about them.  At the same time, once-radical perspectives on the revenue side of the fiscal policy equation are moving into the mainstream of policy analysis, if not yet of politics.  In 2013, the former head of Canada’s national public service and his son published a powerful edited volume called Tax is Not a Four-letter Word, and decried Canada’s ‘dangerously distorted tax conversation’ – sadly, to little effect.  In February 2018, The Economist warned that ‘[I]f Britons want good public services’ as an alternative to the current collapse, then ‘they will need to pay more’ and hinted at the need for some form of wealth taxation.  In August, it was more explicit.  A leader noted that ‘Amazon’s British subsidiary paid £1.7m ($2.2m) in tax last year, on profits of £72 m’ – an effective tax rate of less than three percent.  The leader also foregrounded the need to tax windfall gains from rising property values ‘in big, global cities’ – which without an effective inheritance tax regime will magnify economic inequalities across generations –  and to reform corporate tax regimes to address the ability of firms like Amazon to shift their revenues to low-tax jurisdictions.  Further, it noted that ‘[a]s the labour market continues to polarize between high earners and everyone else’, with labour’s share of national income in much of the world in a decades-long decline, ‘income taxes should be low or negative for the lowest earners’.  A briefing in the same issue explores one intriguing option – a land value tax, which would capture windfall gains in prosperous areas – in considerable detail.  (Today, taxes on residential property in England and Scotland are assessed on real or hypothetical value in 1991, with a capped ‘top band’ that corresponds to just a small fraction of today’s seven- and eight-figure prices.)

Unfortunately, The Economist did not extend its analysis to such policy options as comprehensive wealth taxation or higher marginal tax rates and alternative minimum taxes on high-income individuals.  Nevertheless, its critical attention to public finance offers the possibility that ‘distorted tax conversations’ may become less so – offering prospects for reducing health inequalities by way of their essential economic substrate.  In these grim and disturbing times, we must seek faint hope where we can.

This posting also appears on Prof. Schrecker’s blog ‘Health as if Everybody Counted

Promoting Some Literacy on the Health Systems of Countries of Origin of Migrants in Europe

This article turns the spotlight on daily dilemma faced by EU host countries whether or not to allow a migrant to stay for benefiting health services. A core question should be answered: could the individual health condition of the migrating person motivating a request to stay for health reason be properly managed in the country of origin?

By Yves Charpak

MD, PhD, Consultant, Vice-president of the French Public-Health Association

Promoting Some Literacy on the Health Systems of Countries of Origin of Migrants in Europe

 

More and more citizens of the world have reasons for migrating, whatever the “urgency” of it. Among the reasons for migrating, health was not often up to now the primary reason among economic migrants, often young and in good health, or among “asylum seekers” flying away from conflicts, catastrophic events, and other life-threatening situations.

At the same time the world population is aging at a global level, increasing everywhere the need for essential health services, both preventive and curative. And although better health systems are being promoted and developed everywhere, their capacities and resources in many countries remain far from the expectation of their citizens’ needs and request.

Therefore, in a global world with widespread global knowledge on what is available elsewhere, including health services, it is not a surprise that seeking health services abroad starts to be more and more “in the picture”.

Tourists, short term expatriates, health travelers, as long as they can pay for health services are not creating major concerns for the financing of national health systems and create even expectation for new resources: the services are then paid through direct payments or international insurance coverage or bilateral agreements for coverage with the countries of origin.

Some national health systems can even develop specific “excellency” services targeted for foreigners, irrespective of the overall “comprehensive” capacity of their health system.

It may also be facilitated at regional level, through specific regulation like in the European Union, through the Cross-border care directive and/or the development of centers of excellences in some European countries but accessible to all EU citizens (rare diseases centers for example).

For tourists and expatriates, information on where to seek care may be given by their own foreign affairs services, their insurance companies and even some good “travel books”. Health travelers may benefit from the growing number of business companies proposing to find the relevant health services and organizing everything for them.

On the contrary, access to proper health care for migrants, whatever the reasons for it, is at stake everywhere for the host countries. Decisions regarding migrants access to health services are mostly “political” and “societal”, linked to humanitarian, generosity and solidarity values in host countries: when the reasons for migrating are not health, access to health services may be granted to migrants as part of an integrated package of rights. They don’t call for a specific knowledge of what is available in the countries of origin of migrants.

But there are more and more situations where health becomes the core reason for migrating.

The global epidemiological and demographic transition, illustrated by more aging populations and increased chronic conditions (cancer, cardiovascular diseases, renal terminal insufficiencies, diabetes, etc.), create an increase need for health care services (not to mention the needs for primary prevention policies on risk factors for those diseases), including in poor and emerging countries.

Situations of shortage of services, of bad quality services, of unaffordability of existing services are more and more visible all over the world.

It is reasonable that more citizens of the world being in danger of losing life because of no access to an effective care in their own country start also to look for opportunities elsewhere.

They cannot pay for it, but it is clearly a societal, humanitarian and ethical question: if a citizen of the world is in danger of losing life or a major biological function because of a disease for which proper care can avoid the tragic consequences, can any country refuse to provide it if the country of origin cannot… especially if the person has already moved to the potential host country?

In the EU, it is already a daily situation, for which some administrations have to decide whether or not somebody is allowed to stay for benefiting health services. Rules and regulation for it are very different from one host country to another. And the decisions are very sensitive politically and financially, in particular in times of economic “shortages” for national health services.

One essential question is raised by those specific requests linked to individual health situations: what is the state of the health system in the country of origin? What is the probability that the health condition of the person requesting to be welcome could be properly managed in the country of origin or not? Where to put the barriers in terms of immediate danger, and is there really a lack of any relevant health services in the country of origin which could provide such lifesaving care? What would be considered acceptable care even if not the highest quality and “high-tech” care? Where is the knowledge needed to answer this?

A joint action program called MedCOI (Medical Country of Origin Information program), financed by the EU and piloted by Netherland and Belgian has been developing a set of knowledge. It is now being absorbed by the EASO (European Asylum Seeker Office). The exercise of providing relevant information on the countries of origin is more complex than it seems: the administrations and professionals in charge of answering those questions on individual situations are not experts in health systems analysis worldwide, and sometimes not even knowledgeable on medical and health issues.

Then, what kind of information could provide them a relevant answer to this specific question?: Could the individual health condition of the migrating person motivating a request to stay for health reason be properly managed in the country of origin?

The truth is that nobody can answer this precisely. Health system specialists would answer that the individual situation analysis is not at reach through overall reports and indicators on a country: for example, even in the richest countries, you can find citizens who would not get a proper access, a proper financial coverage to some health services even for life threatening situations. Answering individual requests would need proper investigation on site, to be replicated for each demand.

When the demand is increasing (in France, there are around 60 000 demands per year of asylum seekers for health reasons), the decision making cannot for sure be based on individual investigations.

Then the only way forward is through describing at best the availability and access to health services by citizens at collective level, focusing on specific diseases (the most frequent health situations motivating the requests) and generic indicators of the capacity of the considered health system (financing, overall solidarity mechanisms, health infrastructures availability and distribution, human health resources availability…).

Specialized organizations and academic institutions working on health systems analysis provide very comprehensive set of data and structured analysis for contributing to the knowledge on health systems: European Observatory on Health Systems and Policies,  OECD, World Bank, Institute for Health Metrics and Evaluation, WHO Global Health Observatory…. Some may also provide global analysis on the management of specific health problems (UNAIDS, International Agency for Research on Cancer, International Diabetes Foundation…).

This very comprehensive knowledge is used for research purposes but also for guiding decision making and international AID on overall governance of the health systems, regarding organization, financing, improving the quality and the efficacy of the health services.

But informing administrations and health practitioners in charge of managing records of individual migrants in Europe about the capacity of their countries of origin cannot rely only on this higher-level knowledge. They have to react quickly, they cannot spend hours or days understanding in depth the situation in each country of origin.

In other words, far from academic and comprehensive documents describing health systems in the world, how to give those non-specialists in health systems analysis sufficient literacy and very practical tools allowing fair decision making?

 

 

Health Breaking News: Link 297

Health Breaking News Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

Health Breaking News: Link 297

 

WHO: Public Health round-up 

TDR 2017 annual report shows strong achievements, new strategy well underway 

Europe and the Sustainable Development Goals: 3 years on  

This Tool Measures How Far States And The US Are From Meeting Health and Well-Being Goals 

Report – Patent Abuse A Leading Cause Of High Drug Prices In US 

Opinion: Reaching universal health coverage means tackling malnutrition 

Child malnutrition fears as US opposes WHO breastfeeding resolution 

How the Lack of Affordable Vegetables is Creating a Billion-Dollar Obesity Epidemic in South Africa 

Treatment of people diagnosed with chronic hepatitis C virus infection 

Ebola death toll climbs to 34 as health workers struggle to contain latest outbreak in Congo  

Ebola Poses High Risk in Congo, W.H.O. Says 

Ebola vaccination begins in North Kivu 

Experimental Ebola Vaccine Can Be used in Latest Outbreak, W.H.O. Says 

Ebola vaccinations to begin in DR Congo as tests confirm Zaire strain is behind both outbreaks 

Choices in vaccine trial design in epidemics of emerging infections 

Race to contain destructive march of armyworm as pest spreads to India 

Bacteria becoming resistant to hospital disinfectants, warn scientists 

Indicators for the surveillance of AMR and antimicrobial consumption 

Patient-led active tuberculosis case-finding in the Democratic Republic of the Congo 

India aims to eradicate TB by 2025, but access to low-cost drugs a challenge 

South Africa strikes deal on new TB drug as WHO revisits guidance 

Global susceptibility and response to noncommunicable diseases 

As Western donors abandon Africa’s cancer crisis, Muslim nations are filling the gap 

A human rights approach to mental health and people with disabilities 

Support Increases When Opioid ‘Safe Consumption Sites’ Called ‘Overdoes Prevention Sites’

World risks entering irreversible ‘hothouse’ state  

Climate change and health: Moving from theory to practice 

Prioritizing the needs of children in a changing climate 

Climate change, urban health, and the promotion of health equity

Briefing | The Invisible Killer: the health burden from air pollution in Europe

Forty-One Minutes to Save The World: Investing in Nuclear Security 

People’s Health Movement: Let’s Mobilise for PHA4! 

Course announcement: The Struggle for Health – Savar November 2018 

Health Breaking News: Link 296

Health Breaking News Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

Health Breaking News: Link 296

 

BRICS and mortar 

Cluster of presumptive Ebola cases in North Kivu in the Democratic Republic of the Congo 

AIDS 2018 told the story of a global health crisis 

Progress on HIV goes off-track as donor commitments continue to shrink 

HIV research missing focus on young women 

Time to Fix Bad Laws on HIV 

Negotiations On UN Tuberculosis Declaration Still Open, Reports Say 

South Africa breaks the silence procedure: UN Political Declaration on tuberculosis 

The July 26, 2018 draft of the UNGA HLM3 NCDs: draft outcome document 

60 House Democrats introduce bill on Medicare negotiations that includes compulsory licensing provisions to protect patients when price negotiations break down 

Spending On Prescription Drugs In The US: Where Does All The Money Go? 

WHO: World Heapatitis Day 28 July 2018 

New: WHO Guidelines for the care and treatment of persons diagnosed with chronic hepatitis C virus infection  

The MPP welcomes the new WHO hepatitis C treatment guidelines  

Cheap drugs not enough to fight hepatitis C in Asia 

Eradicating Leprosy in Mozambique, a Complicated Task 

Sequencing A Malaria Mosquito’s Motherline 

Schistosomiasis in Africa: Improving strategies for long-term and sustainable morbidity control 

How the private sector can take WHO recommendations on NCDs forward 

3 in 5 babies not breastfed in the first hour of life  

International development lacks diversity – and it’s holding us back 

Improving Access To Medical Devices: The Use And Evolution Of Objective Performance Criteria 

Digital transformation in Africa: three lessons from India’s experience  

Human Rights Reader 456 

States Must Treat Refugees & Migrants as Rights Holders & Prevent Trafficking & Exploitation 

In Rohingya camps, traditional healers fill a gap in helping refugees overcome trauma 

Human rights in Thailand: No improvement, no trade deal 

Should women be considered a sector when it comes to humanitarian and development funding? 

Survey: Nearly Two-Thirds of Americans Oppose Cuts to SNAP Program 

Climate change is here, and the world is burning 

Using Data to Address Climate Challenges: 5 Takeaways from Sierra Leone and Tanzania 

Global “worming”: Climate change and its projected general impact on human helminth infections