2019: a Year in Review through PEAH Contributors’ Takes

Authoritative insights by 2019 PEAH contributors added steam to debate on how to settle the conflicting issues that still impair equitable access to health by discriminated population settings worldwide

by  Daniele Dionisio*

PEAH – Policies for Equitable Access to Health

2019: a Year in Review through PEAH Contributors’ Takes


Now that 2019 is at its end, I wish to thank the top thinkers and academics who enthusiastically contributed articles over the year. Their authoritative insights meant a lot to PEAH scope while adding steam to debate on how to settle the conflicting issues that still impair equitable access to health by discriminated population settings worldwide.

Find out below the relevant links:

Two Goals with One Action: HIV/AIDS and Hunger (Health and Community Development) by Kiyini Jimedine

Developing Countries Urged to Take Charge of Their Digital Future by Juliet Nabyonga-Orem

Have Countries Forgotten about the Sustainable Development Goals? The Case of the Americas by Francisco Becerra-Posada

Why No Talk of an Inequality Emergency? by Ted Schrecker

Patents in Pharmaceuticals: The Emerging Sharp Sword to the Fragile Health Systems in the 21st Century by Michael Ssemakula

Why Some Global Health Experts Didn’t Sign the Call on the United Nations for Human Rights Guidelines on Healthy Diets and Sustainable Food Systems by David Patterson

Insights on Access to Health in Sudan by Hanan Abdel Aziz Marhoum 

The Oxford Statement and The MedsWeCanTrust Campaign: a call for equity in global health by Raffaella Ravinetto (republished by the Institute of Tropical Medicines, Antwerp)

Financialization of Health and the Impact on Peoples’ Lives by Nicoletta Dentico

Reaching out and Engaging with SE Asian Communities: Health, Shared Value and Business by Phil J Gover

Italy’s Way Forward in Clinical Trials Transparency by AIFA Director General Dr. Luca Li Bassi (republished by TranspariMED)

Revelation! The International Monetary Fund Discovers Tax Avoidance and Capital Flight by Ted Schrecker 

The Disease Bringing People Together by Olga Shelevakho

Debates of Reproductive Health in Turkey by Feride Aksu Tanik 

Stigma Affects the Motivation for HIV Testing by Marina Maximova, Olga Shelevakho 

The Role of Familism in Latinx Communities and Impact on Health Care Decision-Making by Karen Mancera-Cuevas

Expanding Access to Rights Documentation: Tools for Marginalized Groups in Myanmar by Julia K. Klein

Why Don’t Venture Capital Firms and Government Funders Co-Invest in Healthcare Technology More Often? by Dhevi Kumar 

Pick the Odd One Out: Sugar, Salt, Animal Fat, Climate Change: What Are We Teaching? by David Patterson

DRC Ebola: Still a Horrifically High Level of Nosocomial Infections by Garance Upham

Stats , Data and the Popular Media: a Closer Look at The Toronto Star’s Stats on Vaccine Coverage in Ontario by Lawrence C. Loh

Ethical Challenges In Big Data In The Developing World by Nighat Khan

Why Public Health Care is Better by Julie Steendam

AFEW Creates Space for Public Health Within EU-Russia Civil Society Forum by Valeria Fulga

The Italian Investor Proposed USD 379.7 Million Lubowa Hospital Construction Project in Uganda: Disconnections and Disruptions in the Health Sector Expenditure Priorities by Michael Seemakula and Denis Bukenya

The Inability of the Patent System to Reward Innovation by Public Actors: the Bedaquiline Example by Barbara Milani

It’s Time to End TB in EECA Countries by Helena Arntz and Olesya Kravchuk

Turbulences in Uganda’s Global Aid Construct: Is the Contemporary Aid Effective Enough to Transform Uganda’s Health System to Achieve UHC? by Michael Ssemakula

How Political Correctness Can Change Society’s Views On Mental Health by Tiffany Osibanjo

Is Wealth Good for Your Health? Some Thoughts on the Fateful Triangle of Health by Iris Borowy

WHO Places Emphasis on IPC, AMR and UHC by Garance F Upham

iBreastExam for Breast Cancer Detection in Low Resource Settings by Sumedha Kushwaha and Garima Kumar

From Ebola to Antimicrobial Resistance: Coming Into a Health Center Could Kill You! by Garance F Upham

The Original ‘7-Year Itch’ – Coming to an Infestation Near You! by Michael Head

Action Alliance “Training 2020” – An Alliance for Independent Continuing Medical Education by Christiane Fischer

Galvanizing the Action to Protect and Promote the Rights of Mentally-Disabled Individuals in the Key Populations: a Pathway to Achieve Health for All by Denis Bukenya and Michael Ssemakula

European Parliament Calls for Regular Evaluation of SPC System, Including its Effect on Access to Medicines in Europe by Dimitri Eynikel

The Rhetoric In Achieving The Universal Health Coverage Under Public-Private Partnerships In Uganda by Denis Bukenya and Michael Ssemakula

Yes, Resilience and Sustainability Are Too Narrowly Defined by Claudio Schuftan

The contributions highlighted above add to PEAH internal posts published throughout the year. Find the links below:

Dementia in Elderly People: an European Priority Non Ruled by a Communitarian Strategy by Pietro Dionisio

Letter of support for Dr Luca Li Bassi sent to Roberto Speranza, Italy’s Minister of Health – 7 November 2019

INTERVIEW to George Lueddeke  – ‘Survival: One Health, One Planet, One Future’ – Routledge, 1st edition, 2019 by Daniele Dionisio (republished by the South Eastern European Journal of Public Health)

INTERVIEW to Mario Raviglione as the Global Health Centre Director, University of Milan by Daniele Dionisio

INTERVIEW to ATTAC – Aim to Terminate Tobacco and Cancer – Society by Daniele Dionisio

The Evil of Unregistered Clinical Trials in Europe by Daniele Dionisio

IMF Conditionalities Still Under the Fire of Criticism by Daniele Dionisio

Haiti Healthcare Sector: Hard Recovery From Disastrous Years by Pietro Dionisio

Moreover, as part of PEAH scope and aims, the column titled ‘Focus on: Uganda’s Health Issues‘ continued to serve as an observatory of challenging health issues in Uganda from a comprehensive view encompassing the policies, strategies and practices of all involved actors. 

In the meantime, our weekly page PEAH News Flash has been serving as a one year-long point of reference for PEAH contents, while turning the spotlight on the latest challenges by trade and governments rules to the equitable access to health in resource-limited settings.


*Daniele Dionisio is a member of the European Parliament Working Group on Innovation, Access to Medicines and Poverty-Related Diseases. Former director of the Infectious Disease Division at the Pistoia City Hospital (Italy), Dionisio is Head of the research project  PEAH – Policies for Equitable Access to HealthHe may be reached at: 

d.dionisio@tiscali.it  https://twitter.com/DanieleDionisio https://www.linkedin.com/in/daniele-dionisio-67032053  https://www.facebook.com/PEAH51/?modal=admin_todo_tour

PEAH collaborates with a number of non-profit entities. These include, among others:


G2H2Geneva Global Health Hub

CEHURD – Center for Human Rights and Development

Center for the History of Global Development

Viva Salud

Asia Catalyst



The 53rd Week Ltd


Social Medicine Portal

Health as if Everibody Counted

COHRED’s Research Fairness Initiative (RFI)

AFEW International


Medicines and Ethics, Institute of Tropical Medicine, Antwerp 





PEAH News Flash 362

News Flash 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

News Flash 362


A Sustainable Europe 2030 Strategy is needed to achieve the SDGs 

Mapping public health policies for healthy living environments – A quick guide to a new EPHA initiative 

Social determinants of health in relation to firearm-related homicides in the United States: A nationwide multilevel cross-sectional study 

How McKinsey infiltrated the world of global public health 

Lessons from Ghana on Universal Health Coverage: Martha Gyansa-Lutterodt on the CGD Podcast 

Move to hide medical evidence threatens patients and public health across Europe 

Le cure per i ricchi e la politica dei farmaci 

Il diritto e il rovescio


Biosimilar Breast Cancer Drug Gets WHO Seal Of Approval – Agency Aims To Increase Worldwide Access To Life-Saving Treatment 

Better together: Caribbean unites to tackle poor-quality medicines 

Two Goals with One Action: HIV/AIDS and Hunger (Health and Community Development) by Kiyini Jimedine

Is the world ready for an HIV vaccine? 

Experts breathe sigh of relief as WHO say Ebola patient was not reinfected with the deadly disease 

DRC Ebola update 

It’s Time to End Drug-Resistant TB in Children 

Final Analysis of a Trial of M72/AS01E Vaccine to Prevent Tuberculosis 

Salmonella Is Leading Cause of Foodborne Illness in EU 

WHO hits out at junk food companies as ‘twin-pronged’ nutrition crisis hits global growth and development goals 

Address Malnutrition, Not Just Food Security 

Low-income countries hit by ‘double burden’ of malnutrition extremes 

Tobacco Use Projected To Decline Among Men Worldwide In 2020; But Shift To E-Cigarettes Unknown Factor 

Social inequalities in multimorbidity, frailty, disability, and transitions to mortality: a 24-year follow-up of the Whitehall II cohort study 

Adequate funding needed to support migrants’ mental health, new report finds 

Total in court for human rights violations in Uganda: Historic hearing in France under the duty of vigilance law 

People Power in Romania Stopped a Mining Project. Now the Corporation is Suing for Billions of Dollars 

Untreated and Unsafe: solving the urban sanitation crisis in the global south 

European Commission: A European Green Deal. Striving to be the first climate-neutral continent 

The right finance crucial to success of the EU’s Green New Deal 

Leading Health Foundation Goes Local to Take on Climate Change 

The False Promise of Natural Gas 

Carbon Markets Can Provide a Crucial Part of the Solution to the Climate Crisis 

Two Goals with One Action: HIV/AIDS and Hunger (Health and Community Development)

Zidan Benevolence International is a local community based organization that works to fight against pediatric HIV and AIDS, and operates in Buikwe district-Uganda Africa to provide HIV prevention, care and treatment services for women, children, and families. Zidan is trying to achieve two goals with one Action that is HIV/AIDS Virus and Hunger by connecting the link between Nutrition and HIV/Aids through Health and Community Development as our focus area.

Find out here an all-round, first-hand report of their much constructive, balanced and passionate field engagement

By Kiyini Jimedine
HIV Rural Community Based Activist

(Achieve Two Goals with One Action)

HIV/AIDS Virus and Hunger (Health and Community Development)


 Mission: Creating self-sustainable and independent communities that rely on tested and aboriginal solutions to local challenges.
 Vision: To create empowered communities free from ignorance, HIV/AIDS and extreme poverty


Zidan Benevolence International is a local community based organization that works to fight against pediatric HIV and AIDS, and operates in Buikwe district-Uganda Africa to provide HIV prevention, care and treatment services for women, children, and families. In order to achieve our mission, Zidan Benevolence International collaborates with and empowers communities to play a strong role in planning, delivering, and monitoring HIV prevention, care and treatment services. The organization is committed to identifying, documenting, and replicating sustainable models of community involvement and service delivery that enhance coordination and partnership between the health sector and communities in order to further the highest attainable standards of health and well-being for all. We’re trying to achieve two goals with one Action that is
HIV/AIDS Virus and Hunger by connecting the link between Nutrition and HIV/Aids through Health and Community Development as our focus area. As such, the organization collaborates with a variety of stakeholders, including government agencies, civil society organizations, community leaders, faith-based institutions, networks of people living with and affected by HIV/AIDS, non-governmental organizations, and other entities.

We work within a variety of communities throughout Buikwe district to ensure access to EMTCT, and HIV care and treatment services. We based our evolving approach toward community involvement on the understanding that access to services which prevent mother to-child HIV transmission should be offered in a supportive environment, as women are more likely to utilize health services that their communities and families have deemed important and necessary.

There are belief structures in certain cultures within the settings we work that can undermine HIV treatment and access to care – beliefs such as choosing local traditional healers over health facility services and home-based delivery of infants over delivering at health facilities, which have the capacity to address obstetric emergencies and intervene with antiretroviral medications to reduce risk of HIV infections. We go door to door to save them wherever there to save them.

Traditional healers keep on throwing dust into their eyes where they tell those suffering from AIDS related illness that they were bewitched right from the grave of a person who died of HIV and that’s why they face the same problems he/she faced(the AIDS related illness).They tell them that the person who bewitched went on a grave of a person who died of HIV/AIDS related illness and planted juju (African chemistry from witch doctors) so that you also die since they’re aware that it’s not a curable disease. They keep on asking for a lot of money from them and they pay in installments till they die and the witch doctor benefits yet the person he/she has been treating dies and no one will blame him that he failed because the only excuse he has that they couldn’t pay the money in time. So, since some of these witch doctors do have licenses to carry out their work, we concentrate on door to door mobile voluntary counseling and testing and we give them relevant information about the HIV/AIDS virus. We open their eyes by asking them to give us one person who was treated by witch doctors about the HIV/AIDS related illness within their communities and he/she is feeling good on their juju (African chemistry) but they can’t tell you only to say that those we know all died of witchcraft. Here we use some of the volunteers we use who are positive living that for them they’re on HIV treatment and they’re doing well. We do this kind of work using our local language not like some Organizations who’re found of sending counselors from urban areas and they use English yet these communities the majority never completed even a primary school level of education.

Ngogwe sub-county has one Health center and yet its population is 35,524 people covering up an area of about 158.5 square kilometers. It’s a remote area with poor roads full of feeder roads heading to trading centers, schools and homes. We have no vehicles sometimes we hire but we find when those who transport us charge a lot of money due to poor roads and to the extent that the owner of the vehicle stop in the trading center and the remaining distance we have to walk. It’s a big challenge though we try to challenge it and continue with our work since I grew up in this community where I used to walk 6 kms to attend my primary level of education. So, people face problems of getting access to the health center within Buikwe sub-counties whereby when we mobilize people to go for HIV testing, those who go say that they’re not cared for properly in terms of HIV counseling sessions and services given. They can spend a full day due to lack of health service providers. That’s why in these health facilities, there is no pre-test counseling and the post-test counseling is done briefly where if you prove positive you will be given the ARVs without checking the CD4 count or how strong is your immune system before starting the treatment. When you go they expect you to come back when the tabs are almost done without checking on them. This is the worst action done on health centers. HIV treatment is not like a malaria treatment where not much attention is needed by the health service providers after when you’re given the treatment by the doctors. It needs to at least check on the person who is on treatment.

We introduced what we call Door to Door Mobile HIV/AIDS Voluntary Counseling and Testing (D2DHVCT). Yes the distances are long but not even phone calls even though in my community few can afford to get a simple phone. Relatives of these positive living or family members keep on calling us to visit and help, and the fact is that we move with information relating to Health and community development. We don’t treat but we do voluntary counseling and testing including home base care services. So, we respond to their phone calls and when we reach their homes sometimes we find when the person who was given the HIV treatment (ARVs) is really down and can’t even afford to walk properly and for them they think when they call us we can help and treat the ill person (positive living). It becomes hard for us when we visit them and find such a situation which is beyond our work and we have to forward the person to the health center whereby we have no van/vehicle. We have to organize and look for the motor cycle and to get it we have to first use a bicycle so that we can be in position to find the motor cycle on our way.

We tried to get some contacts of motorcycle riders but they hike the charges due to the poor roads. Now problems come when we were the people who encouraged such people to go for HIV testing, we’re ever blamed and find them sometimes encouraging others not to allow us test them due to what happen to their family members when we forward them to the health centers to confirm (some think that since we’re doing D2DVCT, sometimes they doubt the results) and get treatment. As I said, we face a lot of challenges but we keep on challenging them as you know that a bend in the road doesn’t mean it’s the end of the road unless when you fail to make a turn. We fight tooth and nails to help them and we go at the health center and find out whether those we referred to them were given the treatment and if not we find out why, if yes we follow up and visit them in their respective homes and take their details after getting consent from them. You know every cloud has a silver lining, meaning that there are always positive results out of a tough situation. When we go, they welcome us positively because we do have volunteers within Buikwe communities who do a great job and, where needed, they call us and meet those in need of our help. We found out that the health service providers at the health center do not tell them how to balance their diet when taking the treatment, so, that’s why we came up to fight such by training them the link between Nutrition and HIV/AIDS and since they have land, they should forego processed food because raw food is cheap, better and easy to grow within Buikwe district areas, rural or remote as they’re but with fertile soils. That is why we’re focusing on Health and Community development were we give them developmental ideas so that they don’t die of hunger together with HIV/AIDS.

Education and HIV/AIDS in Buikwe District Communities

Uganda’s education system follows a four tier system. The first tier comprises of seven (7) years of primary education, followed by four (4) years of Ordinary Level secondary education, two (2) years of Advanced Level secondary education and the final tier is three (3) to five (5) years of Tertiary education. Each level is nationally examined and certificates awarded.
The Government introduced Universal Primary Education (UPE) in 1997 to offer free education at the primary level and later in 2007, Universal Secondary Education (USE) was introduced.
University and Tertiary education are offered by both public and private institutions. There also exists informal education in Uganda that aims to serve those persons who did not receive or only partially received formal education. Under the informal system, a range of practical/hands-on skills are imparted. The informal system includes Functional Adult Literacy. As all the education level mentioned above, in my village, no one finished the four (4) years of Ordinary Level secondary education, and a few completed the seven years of primary education. It’s only me who tried and how I managed to complete my Advanced Level secondary education, it’s a long story. My mother said I must always be intolerant of ignorance but understanding of illiteracy. That some people, who were unable to go to school, were more educated and more intelligent than college professors. We ever have that in mind simply because of the journey and life we go through.

Why people fail to go for studies: long distances from home to schools. In my community, there are no nursery schools and a kid of 3 year to 6 years cannot afford to walk 6 kms to and from in the morning and afternoon. Village schools have no vans like town or urban schools. Even though the government introduced the Universal Primary Education to offer free education but still the distance remains the same. So, you will find kids at home when the parents neglected them and they can’t afford transport and even though the schools are free the school management force them to pay lunch fees which isn’t food but porridge only without sugar and they’re supposed to pay $8 pa term. You find that parents can’t afford both transport and lunch fees making them to lose hope from their kids yet it’s their hope in future. The fact is that you can’t build a house without a hammer and saw, and you can’t expect an adult to build a successful life if the tools of learning and health weren’t instilled in childhood. The major problem here is that the parents and children find problems in statements altered/aired out by health service providers when they’re working on them or talking about health issues at the health center especially when some terms are biological and when they’re prescribed the drugs to be used. He/she will leave when he failed to get the information well and health workers since they work on a big number of people, they have no time to concentrate on one person. The government when employing and deploying doesn’t mind about the tribe and location. Uganda has a lot of tribes and they may deploy a health worker not in his/her tribe region. Health centers have no translated charts with relevant information about HIV/AIDS. Most health workers have no counseling skills and have no more details or updates about HIV/AIDS treatment. No connection of any community member at the health facility within the community who would’ve at least is in position to help his community and we find out ourselves coming in, in all areas to help those in need of our help. So, whenever we have health trainings, we encourage parents and the youth to participate and we train/counsel them in our local language and after they deliver the information to their families and neighbors.

Organization Justification

Human Immunodeficiency Virus (HIV); Acquired Immunodeficiency Syndrome (AIDS) remains a major public health problem in Uganda, with about 1.5million people living with HIV/AIDS in 2015 (Uganda Demographic Health UDHS 2016). Significant progress has been registered in addressing HIV/AIDS in Uganda; however a lot is still required especially to address specific regional and local disparities, challenges and needs.
In Uganda today, over 2.2 million people are living with HIV. The AIDS epidemic in Uganda is still severe and the most recent findings indicate that the number of infections by far increase daily in the rural areas of Uganda. Females between the ages of 20-24 show the highest rates of infection with HIV/AIDS. Adolescent females are more vulnerable than their male counterparts in the same age group.
Today, over half of the new cases occur in the between 12-24 years. Uganda is one of the worst hit by the AIDS epidemic in the world with 1.7 million children orphaned at the loss of either one or both their parents. These orphans are stigmatized, denied inheriting property left behind by their parents. They are at risk of malnutrition, illness, sexual abuse and exploitation compared to children orphaned otherwise. This goes hand in hand with causing psychosocial suffering to these children resulting into other social problems as influx of street children, retarded growth, drug abuse and addiction among others.

The HIV/AIDS problem is so complex that to overcome it, one must take into consideration a series of closely inter-related issues. Through working with women, youth and communities, Zidan Benevolence International has learnt that:
The rapid spread of HIV/AIDS among adolescents and young adults (10-24 years) is simply a symptom of deep underlying chronic causes. These include poverty, unemployment, gender bias, breakdown of family and community structures, insufficient parenting, moral degeneration, rape, defilement, lack of life skills, harmful traditional cultural practices and beliefs, peer and social pressure, lack of role models, lack of adequate information and alternative services to them.

For most young people, change of behavior is viewed as being hard and unattainable. Our experience demonstrates that a gap exists between knowledge and information on one hand and change of behavior on the other. Helping individuals develop and internalize life skills can bridge this gap. Life skills, in this case, act as a link between mitigating factors, that is knowledge of positive behavior and their benefit and behavior change, which is action. Life skills therefore create the capacity and will to choose from alternatives and implement the desired choices. In both the short and long run life skills translate knowledge of what to do, into how to do it, and provide the enabling factors for doing it.

Behavior change is a gradual process that requires continuous support from ones immediate and distant environment. The support young people get from their immediate communities, guardians and givers is invaluable in this process.

Peer and social pressure: inadequate access to services due to numerous reasons (such as a distance, poor quality services and unfriendly attitudes of health service providers to young people, economic submission of young girls, limited responsibilities culturally assigned to men in regard to reproductive health) are among the factors impending behavioral change.

Using the “fear strategy” to effect behavior change is counterproductive. With the advent of HIV/AIDS, some of the presentation strategies that were designed relied on generating fear in the minds of people so as to bring about change in their sexual behavior. This led to some young people resorting to bestiality, incest and defilement as a safe means of venturing their sexual energy.
While implementing our activities, Zidan Benevolence International has learnt that from positive change to be effected, individuals need to be facilitated to understand how to apply the twin motivating force of “fear and pleasure” to achieve good results. This in our experience helps individuals to examine their perceptions and how perceptions lead to their attitudes and behavior.

Community sensitization and mobilization, which is the provision of Information, Education and Communication (IEC) to communities to ensure their participation, contribution and involvement in solving a common problem, through change of knowledge, attitudes and practices (KAP) is very crucial for the success of any program/project. We have learnt that equipping young people with life skills should be accompanied with programs seeking to sensitize their parents/guardians, teachers and community members. Sustainability of this Project/Program will only be achieved if the community and the beneficiaries themselves recognize it as a goal and if they contribute adequately to the process, rather than as an aspiration of the implementing agency.

The problem to be addressed therefore is the negative modes of behavior that expose people to risks of the life such as HIV/AIDS infection and its shattering effects on human development. There are two causes to this problem:
First, the youth lack adequate knowledge of the cause-effect inter-relationship of life situations.
Secondly, people especially youth lack adequate life skills to translate the knowledge and information of what to do into how to do it and how to access and utilize the enabling factors of doing it.

In many societies/communities, children orphaned to HIV/AIDS suffer problems such as social distress, isolation, shame, fear and rejection that often surround people infected with HIV.
There is therefore need for confidentiality and privacy in regard to their HIV status that should be recognized.

Young people experience orphanhood at the age when parental guidance and support is most needed; they suffer loss of loves, and innocent taking care of their infected parents before they die. Often they are denied education and health services especially because their extended families cannot afford them.

In this regard therefore, Zidan Benevolence International wishes to address these community needs through strengthening HIV/AIDS prevention strategies and interventions and promote economic strengthening among PLWHIV.

This project is relevant to the strategic objectives of Zidan Benevolence International, and therefore it’s an opportunity for the organization to deliver its objectives, while at the same time making contribution to the national and global goal in the context of HIV prevention in Uganda and the world at large.

Organization Survey

Buikwe District has a total area of about 1209 Square Kilometers of which land area is 1209 square km. The total population 146,641.The District has got 30 Health Centers of different level where almost 75% have to walk 5 to 6kms to access the treatment.

The number/ratio of doctors or healthy workers to the patients is alarming where very few doctors work on many patients. This brings in delays at the dispensaries on the appointment days. Some even end up not getting the services as needed in time and HIV/AIDS tend to be common in all the places in question basing on the statistics from their different hospitals. This is because the greatest numbers of patients they get are mainly inquiring about this deadly disease for example in Kasanda Health Center IV where 1422 clients are on ART and not all attend because some could not afford public transport fares.

The common problem all the dispensaries here face little supply of ARVs and are few to accommodate all. This is due to the increasing number of patients due to the change of the system where instantly after testing, doctors encourage those who test positive to start on ARVs straight away without checking whether his/her immune system is strong enough to for him to start the treatment. Due to poor feeding were ever called upon and at the end it’s because of the treatment which leads to weakness. People take ART at the same time starving. So, they need help on the link between nutrition and HIV.

Visiting the village communities with relevant information about HIV virus without any developmental idea or food, it’s like applying horse manure into your garden. These people they know it that to start the HIV treatment you have to be having to eat 24/7 and the side effect of taking the ARVs is experiencing the internal weakness poor desperate people who are starving to death, they’re too weak to go for the HIV treatment because no one to deliver the treatment to them. Healthy centers are far away from them.

Some families in Kiyindi and Bukunja do not even allow you to step into their court yard simply because they know you will be wasting their time since they can go for medication when they have no or enough food. Few do accept but again you find when they don’t know how to read and write and not aware of what the treatment is for. This is what we call illiteracy. This is defined as lack of the ability to read and write with understanding in any language. Persons aged 10 years and above who could not read and write. For those who have never been to school, we consider the age group 15 years and above on the assumption that by age 15 there are minimal chances for one joining school for the first time. This is where our organization will deploy HIV/AIDS counselors within the health centers to help them understand well the prescriptions of the HIV treatment during a Post-Test counseling before they see the doctors. The objective of using this indicator is to shed light on the areas that need improvements in the delivery of the services.

That’s the reason why our organization have come up with the idea to fight against ignorance extreme poverty, hunger, stigma and dangerous diseases affecting and infecting the younger generation and the general Public throughout the operation area and end HIV and AIDS focusing on strengthening health and community systems and improving the quality of services including
Prevention: Voluntary male medical circumcision, prevention of mother-to-child transmission
Diagnosis: HIV testing and counseling
Treatment: Antiretroviral therapy, pediatric HIV care and treatment, tuberculosis and TB/HIV co-infection.

The Organization has introduced organic farming within village communities to fight against hunger and malnutrition to help those who’re starving to death. The health benefits of this farming method is it’s free of artificial colors, preservatives, flavors, trans fats, enhancers, stabilizers, fillers, sweeteners or other additives.
Rural communities have little say in their own future and in directing support to create the innovations to get there. Those with greatest need and the least voice, poor and smallholder farmers, women, youth are precisely those most strategic to involve in order to reach the Sustainable Development Goals. These farmers and social groups are experimenters, producers of knowledge and researchers in their own right; hence they need to be empowered to drive the innovation processes. As key partners in co-research initiatives, development programs and organizations that place their aspirations and capacities at the center, they can become dynamic, pro-active players in the pro-poor governance transformation of agricultural innovation systems. Approaches to improve governance include participatory research and foresight, institutionalizing the rights of rural women and recognizing farmers’ rights to genetic resources.

Personal Hygiene, Water and Sanitation in Buikwe

Poor drinking water access causes waterborne illnesses such as diarrhea, cholera, dysentery, typhoid and polio that kill young children and it’s very difficult to pass by two families when they have no a sick person or kid. They keep on using local medicine or herbs to treat themselves. So, self-medication is the order of the day within my community though we try our level best to out the ignorance from them by visiting their homes and contribute in drenching their wells though we lack funds to drill for them boreholes.

Diarrhea remains a leading cause of death globally among children under five years of age. Diarrhea contributes to nutritional deficiencies, reduced resistance to infections and impaired growth and development. Severe diarrhea leads to fluid loss, and may be life-threatening, particularly in young children and people who are already malnourished or have impaired immunity. As we know that diarrhea mostly results from lack of safe drinking-water, adequate sanitation and hygiene. A number of interventions are effective in preventing diarrheal diseases, thereby positively impacting the nutritional status of those most vulnerable. These are: Access to safe drinking water (e.g. water safety planning – the management of water from the source to tap; household water treatment and safe storage), Access to improved sanitation facilities, Hand washing with soap at critical times (e.g. after toilet use and before the preparation of food) and Hygiene promotion, along with access to safe drinking water and adequate sanitation should be accessible by all. The figure shows the community well contaminated water.

Unimproved sanitation, and poor hygiene practices brings in or attracts parasites that consume nutrients, aggravate malnutrition, retard children’s physical development and result in poor school attendance and performance. Poor sanitation reduces my community’s well-being, social and economic development due to impacts such as anxiety, risk of sexual assault, and lost educational opportunities. To our knowledge, we can improve poor sanitation by introducing the idea of Pit latrine with slab, Ventilated improved pit latrine (abbreviated as VIP latrine) and Composting toilet. Also maintaining wouldn’t be a problem to them but they need to be told how to go about it. They have to know that proper personal hygiene includes frequent hand and arm washing and covering cuts, proper cleaning and sanitizing of all food contact surfaces and utensils, proper cleaning and sanitizing of food equipment, good basic housekeeping and maintenance; and food storage for the proper time and at safe temperatures.

Poor hygiene in my community often accompanies certain mental or emotional disorders, including severe depression and psychotic disorders. Other community members develop poor hygiene habits due to social factors such as poverty or inadequacy of social support.


Zidan Benevolence International members have been very instrumental in the provision of Home Based Care services; they trained 136 home family members who could come in to access the HIV treatment of a positive living who could be not in the condition to reach the health center and later they became our community volunteers. Additionally, Support group leaders have benefitted from trainings by ZICO and today this has been able to allow them to pass this knowledge on to others as well as ensure being able to take care of their peers at home.

We are certain from what we have witnessed from our simple interaction with Buikwe village community members and hopeful optimistic faces that we are betting on the right people who need our attention and the right generation for the future of Uganda. We do face challenges especially when we’re giving them our views during voluntary counseling and testing basing on the rumors they hear. But we convince them basing on the facts about HIV/AIDS. Sometime if your point of view is positive, you will see the challenges in the future as opportunities. Though stigma is still within these communities, the best way to curb it, we need to know the root cause first, and those are the modes of transmission. They still have it in mind that when you shake hands with a positive living, you can be infected. That’s where stigma starts from. Our key members are optimist; they’re always enthusiastic and believe in the project. Small setbacks will not deter them, but will actually motivate them to work even harder-things that can only get them better after all. With their never ending enthusiasm, they motivate and encourage other community members and sometimes all what they need is to complete a project successfully believing that you can achieve it. They always believe in the worst case scenario and expect that things that can go wrong will go wrong that is why they’re very risk-averse. However with their tendency to be more careful, they keep the team grounded and keep them from making ill-advised decisions. In addition to that, they hold the middle of the ground position between the optimist and pessimist. They’re neither overly optimistic nor do they expect doom and gloom around every corner. They base their decisions on careful assessments and calculations. They weigh the pros and cons with each other and consider the benefits with the losses. Since they know that they’re going to face different people with different attitudes, young, youth and old, they don’t take time to think and to be creative, they just follow someone to win with no struggle and after they try to take credit for everyone else’s work.



Don’t wait to realize the use of water when the source is dry. If you have a chance to help, help those who are in need of your help. I can be reached on kiyini.jim.jimdean@gmail.com, whatsapp: +256702737256/+971525122704. We need help to save our community.

PEAH News Flash 361

News Flash 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

News Flash 361


WHO: Survey on pathogen sharing and access and benefit sharing arrangements 

12 December: Universal Health Coverage (UHC) Day 

Watch the GAP! A critical civil society perspective on the “Global Action Plan for Healthy Lives and Well-Being for All” 

Have Countries Forgotten about the Sustainable Development Goals? The Case of the Americas by Francisco Becerra-Posada 

Developing Countries Urged to Take Charge of Their Digital Future by Juliet Nabyonga-Orem 

With ‘digital transformation,’ UNDP seeks to stay relevant and add value 

The right to health: supporting marginalised people living and working in urban informal spaces

EU Commission: Social protection expenditure and its financing in Europe: A study of national policies 

Neoliberal Health Restructuring, Neoconservatism and the Limits of Law: Erosion of Reproductive Rights in Turkey 

AIM proposal for fair and transparent prices for pharmaceuticals 

Drug Makers Cry Wolf Yet Again 

Do large pharma companies provide drug development innovation? Our analysis says no 

Sanofi, Maker of World’s Top-Selling Insulin, to Exit Diabetes Research 

Сommunities make an invaluable contribution to the AIDS response 

Congo Authorities Say Ebola Survivor Falls Ill Second Time 

Ebola Surges After Attacks On Healthcare Workers 

DRC Ebola update 

WHO Recommends Worldwide Adoption Of All Oral-Regimen For MDR/RR-TB 

OneHealth Initiative: Rabies Webinar – 14th of January 2020 

AUDIO: If We Are to Achieve Zero-leprosy by 2030, This Is the Best Time and Opportunity 

Leveraging Urban Leaders To Battle NCDs – Healthy Cities Partnership Expands To 70 

Are INGOs ready to give up power? 

UNDP: Human Development Report 2019 

Human Rights Reader 507 

“I Could Double That.” A Tech Philanthropist Takes on India’s Daunting Challenges 

Turkey: ICJ and IBAHRI call for release of Osman Kavala following European Court of Human Rights decision 

Indigenous groups call for voice at COP25 climate talks 

EU leaves Poland out of 2050 climate deal after standoff 

European Green Deal will change economy to solve climate crisis, says EU 

IFRC makes climate action its top priority 

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9th December 2019: Open letter on the Energy Charter Treaty (ECT)


Developing Countries Urged to Take Charge of Their Digital Future

Digital advances would ideally offer opportunities for improved and efficient service delivery, population participation in decision making and accountability, but pose a risk of exclusion of the poor and marginalized. These are population segments who will be left behind in consultations, service delivery and economic opportunities through use of digital innovations. Such gaps are recipe for abuse and exploitation of the poor by the powerful.

Relevantly, a conducive environment for successful deployment and use of technology is important. This involves appreciation of the scope of technology revolution as a transition involving optimizing social, political and economic conditions for inclusive growth in the digital age as opposed to isolated digital policies

By Juliet Nabyonga-Orem

World Health Organization, Inter-Country Support Team for Eastern & Southern Africa; Health systems and services cluster; P.O Box CY 348; Causeway, Harare, Zimbabwe

Developing Countries Urged to Take Charge of Their Digital Future


We are in an era of digital technology which is advancing at a very fast pace in developing countries. In as much as this creates opportunities for growth and better service delivery, challenges and risks are real. It is against this backdrop that the Pathways for prosperity Commission (here in referred to as the Commission) set out to investigate how developing countries can embrace advances in technology effectively. Through a research and consultative process that started as far back as January 2018, the Commission proposes rational solutions developing countries can implement in embracing digital solutions for the benefit of everyone.

Embracing opportunities accorded by advances in technology whilst guarding against risks lies the interface for wide spread adoption.  Indeed, opportunities do exist in developing countries that can be leveraged. For example, 43 countries in sub Saharan Africa are implementing a Health Information System Strategy based largely on the use of ICT (Information and Communications Technology). Eight percent of people in developing countries live under a cellular internet signal although only 30% have ever used the internet. The Commission further cautions that “do not connect people to the internet just for the sake of it, people must be able to make use of it to improve livelihoods”.

There are concerns to be addressed. The use of digital solutions in developing countries today is described as suboptimal at best or chaotic at the worst. Several countries in Sub Saharan Africa have witnessed an epidemic of pilots of digital solutions to improve service delivery and monitoring that are never scaled up, and in influx of APPs with varied relevance to developing countries’ health systems. In majority of African countries, capacity for health technology assessment to guide decision making is at infancy. The Pathways for prosperity Commission further highlights the low human capital, lack of digital readiness, ineffective institutions and a difficult business environment as major challenges.

Digital advances would ideally offer opportunities for improved and efficient service delivery, population participation in decision making and accountability, but pose a risk of exclusion of the poor and marginalized. Whether developing countries can ensure reach of digital solutions to the poor and vulnerable cannot be ascertained and the Commission likens “trickle-down digitalization” to failed attempts of “trickle-down growth” to deliver inclusive development. How can developing countries purposively plan for inclusiveness?  A significant proportion of the population live below the poverty line as high as 28% in Colombia; 65% in Burundi. These are populations who will be left behind in consultations, service delivery and economic opportunities through use of digital innovations. Such gaps are recipe for abuse and exploitation of the poor by the powerful.

Loss of jobs due to advances in technology is a real fear that must be handled carefully to mobilize popular support for technology development. Taking an example of Africa, mobile money banking by mobile telephone providers impacted on use of banking services which concern was real to commercial banks. In some countries this happened in a regulatory vacuum and subsequent efforts to introduce a tax on such transactions resulted in tensions between the government and the population. On a positive note however, linkages with mobile money banking and commercial banks have been forged paving a way for a fruitful coexistence.

The Commission draws our attention to the importance of a conducive environment for successful deployment and use of technology and refers to this as “getting the analogues matters right in a digital age”.  This involves appreciation of the scope of technology revolution as a transition involving optimizing social, political and economic conditions for inclusive growth in the digital age as opposed to isolated digital policies. In this regard, availability of essential physical infrastructure, foundational digital systems and investment capital are among the prerequisites for wide spread adoption.

Challenges notwithstanding, the Commission asserts that developing countries should not resign to being passive observers but should take charge of their digital future. In rising to the challenge, the following are proposals to embrace:

  • Creation of a digital compact involving all stakeholders to guide coordination, deployment and use of technology and improve inclusiveness and adoption of consensual options. The effective use of such a compact will be premised on strong institutions and regulatory frameworks that are enforced. An important component of such effective partnership efforts that has not received much recognition in the past is institutionalization of mechanisms to manage conflict of interest. This is crucial given the important role of the private sector in technology development who have been labeled as “for profit”.
  • Technology advances must put people at the center, be it to spur economic growth, improve service delivery, participatory processes the focus must be the people as major beneficiaries. In ensuring this, training in digital use should be mainstreamed in training curriculum for all learners. Relatedly, Governments must make information relating to their programs, including budgets, publicly available.
  • The private sector and government must put in place foundational digital systems which are interoperable.
  • Public and private actors must make deliberate efforts to leave no one behind through embracing business models that enable the poorest to access and use digital solutions; provide incentives or regulation to encourage pro-poor innovation. Private sector needs to work towards a balance between profitability, affordability and user experience.
  • The role of governments in ensuring meaningful contribution of digital solution to economic development and efficient service delivery is paramount. Particularly is addressing technical disruptions and advancing digital transformation which the commission contends that should not be left technical agencies with a narrow mandate.
  • Governments need to actively purpose to embrace digital solutions. While the private sector and donors need to explore regulatory solutions designed to meet the unique needs of developing countries, governments need to explore ways to ensure effective regulation.



Have Countries Forgotten about the Sustainable Development Goals? The Americas Case

Of the reviews presented or committed to be presented by countries of the Region of the Americas towards achieving the Sustainable Development Goals, there are some that have presented once, others twice or with a commitment to present a second time, while many that have not done so

By Francisco Becerra-Posada MD, MPH, DrPH

Public Health Policy

Have Countries Forgotten about the Sustainable Development Goals?

The Case of the Americas


The world is seeing a series of political changes, such as the ones in Mexico, Argentina, countries in Europe; unrest due to economic or policy changes as has happened in Hong Kong, France, Bolivia, Ecuador, Peru to mention a few. Economic trade war between the USA and China, and a constant threat to world peace by unilateral actions from a few countries. Also, we have seen and continue seeing the longstanding discussions and push back from establishment around climate change and its implications towards humanity as a whole.

These chaotic times we are facing make one wonder what has happened to the work countries were supposed to be doing towards achieving the Sustainable Development Goals (SDGs). There is evidence that countries have reported advances of the proposed objectives they signed up for and the reviews they have or will be presenting are stored by the UN in the Voluntary National Reviews Database.

Of the reviews presented or committed to be presented by countries of the Region of the Americas, there are some that have presented once, others twice or with a commitment to present a second time, while many that have not done so.

Of the 35 countries in the Region (not counting territories), Table 1 presents those countries that have reported or will report on the advances on the SDGs.

Table 1. Countries of the Region of the Americas that have presented or committed reviews on advances on the SDGs

  Source: Voluntary National Reviews Database,  https://sustainabledevelopment.un.org/vnrs/

Of the 35 countries in the region, 11 countries have or will present one review only by 2020. Of these seven are from the Caribbean and four of the continental region [*]: Bolivia, Canada, El Salvador and Paraguay. Of those presenting or committed to present twice, 13 countries have done so, amongst them, five countries of Central America. Only Nicaragua has not signed up for the review of their advances. Some countries of the continental Americas have yet to present or commit to: Guyana, Nicaragua, Suriname, United States and Venezuela.

The Caribbean has still to move forward and start committing to present their reviews. Of the 13 countries (including Cuba, Dominican Republic and Haiti), only six have done or committed to present the reviews.

Hopefully all SDGs are being covered and fully reviewed. Advancing towards the implementation of the planned interventions in each country is key as to diminish social determinants that hinder the advancement of a better life of millions of people that live in poverty and see their needs not fulfilled.

Hopefully the reviews speak of real advances and policy -social and economic- changes towards bringing these populations in need forward and their governments don’t leave them behind.


[*] Countries are being considered geographically, not by geo-political organizations.

PEAH News Flash 360

News Flash 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

News Flash 360


The economy of well-being: between European objectives and national realities 

The Bretton Woods Institutions, 75 years on: reform or risk irrelevance 

25 November 2019, WHO reform EB 146/33: Involvement of non-State actors in WHO’s governing bodies. Report by the Director-General

Web consultation with non-State actors on their participation in WHO governance 

Information session to non-State actors: WHO Headquarters, Geneva Salle D on Monday 16 December 10:00-12:00 Geneva time. If you wish to participate, please register for the session 

WHO response to WTO member state challenges on tobacco, food and beverage policies 

Labelling changes in response to a tax on sugar-sweetened beverages, United Kingdom of Great Britain and Northern Ireland 

WHO: public health round-up 

$262 million subsidy should not go to pharma giants Pfizer and GSK for pneumococcal vaccine 

Opinion: Step up the fight against HIV 

HIV treatment access isn’t rising fast enough to reach 2020 targets, UNAIDS report shows 

HIV treatment for children to be produced for under one dollar a day 

Samoa shuts down government as measles death toll rises to 53 

DRC Ebola update 

Swine fever raises fears of bird flu pandemic 

ONE HEALTH: Awareness to Action – Antimicrobial and Anthelmintic Resistance Conference, Dublin, 27 November 2019 – Proceedings 

Health workers’ education and training to prevent antimicrobial resistance 

Time for $5: GeneXpert diagnostic tests 

More pregnant women and children protected from malaria, but accelerated efforts and funding needed to reinvigorate global response, WHO report shows 

Meeting the needs of people with physical disabilities in crisis settings 

Human Rights Reader 506 

Thirty years of children’s rights – what has Europe achieved? 

Why No Talk of an Inequality Emergency? By Ted Schrecker 

Biofortified Food, a Business Boost for Smallholder Farmers 

Care for Economic Development, Then Care for Food Nutrition, Food Researcher Tells Africa’s Politicians 

Fixing the Business of Food 

Africa’s Civil Society Calls for Action as COP25 Kicks off in Madrid 

Why COP25 matters to the emergency aid sector 

Countries are ‘exposed and vulnerable’ to health impacts of climate change 

Agricultural emissions: Not enough cash for solutions 

Why No Talk of an Inequality Emergency?

Failure to understand and declare an inequality emergency reflects the success of neoliberalism or ‘market fundamentalism’ as a global class project of restoring inequality and the privileges of the rich to the levels that prevailed before what has been called the ‘great compression’ that reduced inequality after World War II in much of the high-income world, and inspired egalitarian visions far outside it

By Ted Schrecker 

Professor of Global Health Policy, Newcastle University

Why No Talk of an Inequality Emergency?


We hear much talk now of a climate emergency.  As I was revising a talk I give frequently on ‘global health in an unequal world’, I realised that there is no talk of an inequality emergency, either globally or close to home, although the same macroeconomic trends and political choices driving increased inequality within national borders and on a variety of smaller scales are often involved wherever on the map one happens to look.  (On these inequalities at metropolitan scale, I cannot recommend too highly photographer Johnny Miller’s compelling aerial images.)

Why is there no talk of such an emergency?  Many manifestations of climate change occur on a scale that makes them fodder for our spectacle-hungry visual media: think Californian and Australian wildfires; collapsing glaciers; and catastrophic damage from hurricanes and floods.  The casualties of inequality tend to be smaller in scale and less visible: the lives ended sooner and more painfully than they should have been because of the accumulated damage done by relying on food banks and fearing the ‘brown envelope’ that initiates the vicious privatised process of fitness-for-work assessments here in the UK, or the estimated 300,000 women per year who die in pregnancy or childbirth from causes that are routinely avoided in the high-income world.   Academically, it may be effective to compare the annual toll from death in pregnancy and childbirth to the crash of two or three airliners every day of the year, as a colleague and I have done, but such comparisons have little salience in the broader, media-corrupted world of political priorities.

Relatively vast resources have been devoted to climate science – the Intergovernmental Panel on Climate Change is the world’s largest-ever scientific collaboration – and climate researchers  long ago realised that just generating more evidence was never going to be enough to generate the change needed.   So many became advocates, for example tracing 63 percent of cumulative worldwide emissions of carbon dioxide and methane between 1751 and 2010 to just 90 massive state- and investor-owned corporations (and their customers, of course).  More recently, another group of authors (supported by more than 11,000 signatories) argued that ‘Scientists have a moral obligation to clearly warn humanity of any catastrophic threat’.  Researchers on health inequalities, in particular, have generally been more circumspect.  In the UK, advocacy that looks far enough ‘upstream’ at the economic and political substrates of health inequalities – more on that point later – is unlikely to be acceptable to agencies of the capitalist state and the trustees of billionaires’ fortunes whose funding priorities shape the direction of academic research and the career paths of academics.  And the health inequalities of greatest concern, by definition, do not affect ‘all of us’.  Whether the consequences of climate change will genuinely do so is too complex a question to be investigated here, but the question is well worth asking.  Certainly, its effects will be felt first and worst by those least implicated in its origins.

Another issue is the decades-long rhetorical and ideological Thatcherite drumbeat that ‘there is no alternative’ to rising inequality and the policies that drive it.  This problem is particularly acute with regard to the austerity that has been thoroughly discredited in terms of the macroeconomic objectives of sustaining growth that it was supposed to achieve, whether in the era of World Bank and IMF-mandated structural adjustment or, more recently, in post-2010 responses to the financial crisis.  As Nobel prize-winning economist Paul Krugman commented in the run-up to the 2015 UK election: ‘All of the economic research that allegedly supported the austerity push has been discredited. On the other side of the ledger, the benefits of improved confidence failed to make their promised appearance. Since the global turn to austerity in 2010, every country that introduced significant austerity has seen its economy suffer, with the depth of the suffering closely related to the harshness of the austerity’.  Post-2015, of course, austerity in the UK became harsher still, demonstrably redistributing income and resources upward within British society, through both tax and benefit ‘reforms’ and savagely destructive cuts to local authority budgets.

Now, austerity has become normalised; it is part of the quotidian policy landscape to the extent that we are almost no longer capable of rage when the strutting, glossy Home Secretary straightfacedly claims that poverty is not the government’s problem, when the evidence is overwhelming that post-2010 public policy has systematically and premeditatedly made the problem worse.  Despite the best efforts of the fossil fuel industry, we can imagine a decarbonised economy, even though we may not be able to specify its details.  Too many of us now have difficulty imagining economic systems that do not operate as what Serge Halimi, the editor of Le Monde Diplomatiquehas called an ‘inequality machine’.  A powerful antidote to this well-funded intellectual cauterisation is the United Nations Conference on Trade and Development’s 2017 blueprint for a global new deal.  How many global health researchers have read it, I wonder?  How many medical or MPH students have been asked to do so?

Back to the view looking upstream.  Failure to understand and declare an inequality emergency reflects the success of neoliberalism or ‘market fundamentalism’ as a global class project of restoring inequality and the privileges of the rich to the levels that prevailed before what has been called the ‘great compression’ that reduced inequality after World War II in much of the high-income world, and inspired egalitarian visions far outside it.  The evidence on this point can’t even be summarised here – I am glad to provide key sources – but in the context of the work that academics do, two decades of marketisation in British universities must be understood as part of the project.  Centrally funded institutions that served a public educational and scholarly purpose were dismantled, replaced by corporate-style enterprises organised around generating income from deep-pocketed funders and indebted students, with careers often ended by failure to put out salable products.

Isn’t this a form of conspiracy theory, you ask?  Empirically, the best rejoinders come from the work of journalists like Jane Mayer and historians like Stefan Collini and Nancy MacLean.  Conceptually, an especially apposite riposte comes from the brilliant legal historian Douglas Hay, who established himself in the field with the research that underpinned the following conclusion: ‘The private manipulation of the law by the wealthy and powerful’ in eighteenth-century England ‘was in truth a ruling-class conspiracy, in the most exact meaning of the word. …. The legal definition of conspiracy does not require explicit agreement; those party to it need not even all know one another, provided they are working together for the same ends.  In this case, the common assumptions of the conspirators lay so deep that they were never questioned, and rarely made explicit’ (1).  Enough said.

(1)  Hay, D.  Property, Authority, and the Criminal Law. In D. Hay et al., Albion’s Fatal Tree: Crime and Society in Eighteenth-Century England (pp. 17-64). New York: Pantheon, 1975

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