PEAH News Flash 367

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 367


Davos wrap-up: Forum runs out of steam as climate becomes ‘king’ 

Wake-up call: 10 years remaining to address inequalities on right to health for all 

Sub-Saharan Africa and International Taxation: Time for Unilateral Action? 

Multilateralism Versus Regionalism: Which Path Should African Countries Pursue to Expand Trade and Investment Opportunities? 

Development Cooperation: Concerns and Emerging Challenges by Michael Ssemakula

WHO, China leaders discuss next steps in battle against coronavirus outbreak 

2019-nCoV outbreak — a timeline 

Coronavirus More Infectious Than Suspected; China Expands Quarantine 

China’s response to a novel coronavirus stands in stark contrast to the 2002 SARS outbreak response 

Another Decade, Another Coronavirus 

A Novel Coronavirus from Patients with Pneumonia in China, 2019 

A Novel Coronavirus Emerging in China — Key Questions for Impact Assessment 

Coronavirus – Early Responses by Rosemary Barber-Madden 

Why tracing the animal source of coronavirus matters 

DRC Ebola update 

Research for the Zika response 

HIV Is Not a Verdict: I Love Every Minute of My Life by Olga Shelevakho

One Step Closer To Ending Leprosy 

As J&J release earnings, MSF protests price of lifesaving TB drug 

Prevalence and genetic profiles of isoniazid resistance in tuberculosis patients: A multicountry analysis of cross-sectional data 

Isoniazid-resistant tuberculosis: A problem we can no longer ignore 

A One Health Approach to Tackle Cryptosporidiosis 

Systematic review of the effectiveness of selected drugs for preventive chemotherapy for Taenia solium taeniasis 

Why is uploading clinical trial results onto trial registries so important? 

Q&A: ‘Transformation takes time,’ Richard Horton on the EAT-Lancet Commission diet 

From Hospital To Home: Why Nutrition Counts 

Human Rights Reader 513 

Family Caregivers Are Rarely Asked About Needing Assistance With Caring for Older Adults 

Australia bushfires contribute to big rise in global CO2 levels – UK’s Met Office 

Farmers face up to climate risks in south Asia 

Coronavirus – Early Responses

Coronavirus (2019-nCoV) epidemic, an emergency in progress.... and a short article here trying to follow the progress and knowledge on potential global effect, diagnostic testing, and what appears to be early intervention strategies on the part of globally

By Rosemary Barber-Madden

Professor Emerita

Mailman School of Public Health, Columbia University, NY, NY, USA

Received 28 January 2020

Coronavirus – Early Responses


Twenty-nine (29) days ago, the Ministry of Health (MOH) of the People’s Republic of China reported cases of pneumonia, of unknown etiology (unknown cause) detected in Wuhan City, Hubei Province to the World Health Organization (WHO) WHO China Country Office (31December 2019) (1). By January 3 2020, a total of 44 case-patients with pneumonia of unknown etiology were reported to WHO. During this reporting period, the causal agent was not identified (2).

Reports of this pneumonia of unknown cause, now classified as novel coronavirus outbreak, in Wuhan, indicated that early cases emanated from an open market selling live poultry, seafood and wild animals. Health authorities in China announced a temporary ban on the trade of wild animals, in response to demands from group of prominent researchers from the Chinese Academy of Sciences, the Wuhan Institute of Virology and the nation’s top universities calling for the government in China to crack down on wildlife markets such as the one at the center of the Wuhan outbreak (3).

By Jan 2, 2020, 41 were admitted to hospital were identified as having laboratory-confirmed 2019-nCoV infection. Most of the infected patients were men (73%); with 32% having underlying diseases that included diabetes, hypertension, and cardiovascular disease. Twenty-seven (27) of 41 patients had been exposed to human seafood market. And, by 7 January 2020, Chinese scientists had isolated a novel coronavirus (CoV) from patients in Wuhan (3).

While Novel Coronavirus (2019-nCoV) has likely spread from animal to person, Chinese officials report that the spread of disease is predominantly in person-to-person. Since the cause was unknown at the onset of these emerging infections, the diagnosis of pneumonia of unknown cause in Wuhan was based on clinical characteristics, chest imaging, and the ruling out of common bacterial and viral pathogens that cause pneumonia. Suspected patients were isolated using airborne precautions in the designated hospital, Jin Yin-tan Hospital (Wuhan, China), and fit-tested N95 masks and airborne precautions for aerosol-generating procedures were taken. This study was approved by the National Health Commission of China and Ethics Commission of Jin Yin-tan Hospital (KY-2020-01.01). Written informed consent was waived by the Ethics Commission of the designated hospital for emerging infectious diseases (4).

By 20 January, the Chinese Ministry of Health had reported 258 cases in Wuhan, 14 in Guangdong Province, 5 in Beijing Municipality and 1 in Shanghai Municipality. Thus far, 37 cases have been identified in 11 other countries, including Japan, Republic of Korea, Viet Nam, Singapore, Australia, Malaysia, Thailand, Nepal, United States of America, Canada, and France. In other countries, possible cases are under evaluation (5).

WHO issued  interim guidance for laboratory diagnosis, clinical management, infection prevention and control in health care settings, home care for mild patients, risk communication and community engagement; provided recommendations to reduce risk of transmission from animals to humans; updated the travel advice for international travel in health in relation to the outbreak of pneumonia caused by a new coronavirus in China; and is working with global expert networks and partners for laboratory, infection prevention and control, clinical management and mathematical modelling (6).

On 23 January 2020, the People’s Daily, China tweeted that “No people in #Wuhan, C China’s Hubei will be allowed to leave the city starting 10 a.m. of Jan. 23. Train stations and airport will shut down; the city bus, subway, ferry and long-distance shuttle bus will also be temporarily closed: local authority (7).”

The WHO Emergency Committee was convened by the WHO Director-General on 23 January 2020 under the International Health Regulations (IHR) (2005) regarding the outbreak of novel coronavirus 2019 in China. After deliberation with the Emergency Committee, WHO declined to classify the outbreak as a global health emergency. WHO plans to reassess that question in ten days, if not sooner (8).

The virus requires close contact to spread between humans and that the majority of those who have perished from the illness suffered from other immune-system deficiencies. As of Sunday, 26 January 2020, the coronavirus was responsible for 80 deaths in China, up from 56 the day before, and more than 2,761 infections, with 5794 suspected cases, according to WHO.  All indications are that the number of cases will increase substantially (9).

Researchers from the German Center for Infection Research (DZIF) at Charité – Universitätsmedizin Berlin have developed a new laboratory assay to detect the novel Chinese coronavirus. The work is based on the establishment and validation of a diagnostic workflow for 2019-nCoV screening and specific confirmation, designed in the absence of available virus isolates or original patient specimens. The design relies on close genetic relatedness of 2019-nCoV with the SARS coronavirus making use of synthetic nucleic acid technology. The assay protocol was published by WHO as a guideline for diagnosis detection. The new assay enables suspected cases to be tested quickly (10).

Chinese scientists were able to quickly identify the genetic sequence of the new coronavirus and officials posted it publicly within a few days, allowing scientific research teams to get to work right away. With the genetic code in hand, scientists can start vaccine development work without needing a sample of the virus. According to a JAMA Viewpoint article posted online on 23 January 2020, biomedical researchers are initiating ‘countermeasure development for 2019-nCoV using SARS-CoV and MERS-CoV as prototypes.’ For 2019-nCoV, they hope to proceed more rapidly, using messenger RNA (mRNA) vaccine technology. With these prototypes, it is likely that other researchers will be able to ‘construct viral vectors and subunit vaccines.’ (11)

The European Union issued a request to Member States to share travel advice and report on measures or plans regarding entry screening, or other measures at entry points to inform in writing on clinical management capacities available (stocks of antivirals, shortages), and dedicated hospitals (isolation facilities, respiratory treatment, PPE). The Directorate-General for Health and Food Safety (DG SANTE) is working  with European Union Aviation Safety Agency (EASA) on information exchange related to air traffic/contact tracing as well as with air flight operators to share incoming airlines passenger data timely, provide guidelines for entry screening, mapping laboratory and other capacities since 23 January; and circulate a survey on preparedness on capacities, including capacities to manage novel coronavirus, based on survey developed by the European Centre for Disease Prevention and Control (ECDC) (12)

US Centers for Disease Control issued guidance for public health entry professionals, in particular those where known cases have entered the country (San Francisco, New York, Los Angeles, Atlanta and Chicago. An alert was issued to clinicians for careful review of patients with respiratory symptoms, especially for those who had traveled to Wuhan, and guidance for testing and management of home care patients with 2019-nCoV. CDC also reports that it is developing a diagnostic test to detect this virus in clinical specimens, accelerating the time it takes to detect infection, and activated its Emergency Operations Center to better provide ongoing support to the response (13)



  1. World Health Organization (WHO). Coronavirus. Geneva: WHO; 2020 Available from:
  1. Pneumonia of unknown cause-China, Disease outbreak news, Geneva: WHO; Available from:
  1. Huang C, Wang Y, Li X et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. 2020; (published online Jan 24)
  1. Hornby PW, Hayden FG, Gao GF. A novel coronavirus outbreak of global health concern. Lancet.2020; (published online Jan 24).
  1. World Health Organization. (WHO). Novel Coronavirus (2019-nCoV). Situation report – 1. Geneva: WHO; 21 Jan 2020. Available from:
  1. Coronavirus: China bars 11m residents from leaving city at center of outbreak, The Guardian. 22 January 2020.
  1. Novel coronavirus (2019-nCoV) situation report – 2 (22 January 2020). Geneva: World Health Organization.
  1. Statement on the meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV), 23 January 2020, Statement, Geneva, Switzerland. Available from:
  1. World Health Organization. (WHO). Novel Coronavirus (2019-nCoV) SITUATION REPORT – 6 26 JANUARY 2020.–ncov.pdf?sfvrsn=beaeee0c_4
  1. CormanVM, OlfertL, KaiserM, et al. Detection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCR. Euro Surveill.2020;25(3): pii=2000045. 21 Jan 2020; Accepted: 22 Jan 2020
  1. Paules CI, Marston HD, Fauci AS. Coronavirus Infections—More Than Just the Common Cold. Published online January 23, 2020.
  1. Novel coronavirus 2019-nCoV.
  1. First travel-related case of 2019 novel coronavirus detected in United States. Atlanta, GA: US Centers for Disease Control and Prevention.









Dev Cooperation Concerns and Emerging Challenges

Challenging the ideological deficiency in the existing Aid narrative is essentially dependent on how we accord attention to the existing shifts in the interests of global economic power centers, and power imbalances rooted in imperialism- that is perpetuating the misdiagnosed fundamental dynamics of capitalism in the multilateral trading system that has quite often acted as a tandem to direct the route of trade

By Michael Ssemakula

        Human Rights Research Documentation Center (HURIC) &  People’s Health Movement

Development Cooperation: Concerns and Emerging Challenges


The challenges surrounding Aid and overall support towards the health, humanitarian and development programs of the south, sets in another significant conversation on the notion of aid especially its flow- through the far-old outdated narrative of aid coming from the bloc [1] of “first world capitalist” states to the poor-est and low-est wage countries.[2] The question remains, who has access to these resources? Why Aid flows predominantly from one side of “philanthropic stream”, mainly from ex-colonial monopoly and north partnership financing initiatives? [3] Who has access to this stream? How is the Aid system in the multilateral trust funds and groups structured to reduce systems of aid that are “parallel” to local systems [4] which is one of the Paris Declaration [5] priorities. What is the role of proximity to these Aid resources between the south and north divides? How effective is aid in impacting the livelihoods of the recipients besides being used largely for influencing the macro-economic policies of developing countries? [6]

Challenging the ideological deficiency in the existing Aid narrative is essentially dependent on how we accord attention to the existing shifts in the interests of global economic power centers, and power imbalances rooted in imperialism- that is perpetuating the misdiagnosed fundamental dynamics of capitalism in the multilateral trading system that has quite often acted as a tandem to direct the route of trade.

Thousands of policy analysts and advice-givers commend for aid as a catalyst to harness the global development agenda, health and development transformation in the economic growth stages of nations- from traditional economy to the age of high-mass-consumption- but is aid the ultimate solution? Who demystifies the misleading purported “persuasive thought of fair trade that is acting as a blindfold in promoting neoliberalism syndrome in the world economy ruining fragile economies and fueling dependency through aid.

Echoing back on the historical reality, and the contemporary reality that suggests a required model shift in aid drawn for its coverage and effectiveness; that is aid flowing from north to south- to universal coverage through global public investment, where all countries should contribute to Global Public Investment according to their ability, and all can benefit from it according to need. [7]  Circumstances have changed over time and this is a manifestation of the fact that developing nations are no longer a homogeneous boat of “poor” countries but instead are extremely differentiated in their capacities and needs [8]. Historically Aid was coiled in the dominant narrative of rich countries helping poor countries to develop [9]. This traditional model of development and health assistance has been superseded by a more complex reality of aid in response to new prevailing conditions, new global players, and new mechanisms for aid delivery.

In the recent Kampala initiative workshop (November 2019) “cooperation and solidarity within and beyond aid” civil society activists from diverse professional and experience backgrounds met in Kampala to examine the notion of Aid, dominant narratives about aid and charity emanating from the global North (the rich states helping the “poor” states- and in particular from many NGOs), establish a democratic civil society space and structure of independent, critical-thinking activists and organizations across Southern and Northern boundaries and address the failures and shortcomings of “health aid” and its actors and practices.[10] But how can we change this narrative with the existence of funding mechanisms and systems of these new players operating differently from and parallel to the country policies and structures?

In the current global development evolution both in north and south, the progressive development and health cooperation among the partnering agencies and states through bilateral, multilateral and aid trust funds like the Global Financing Facility of the World Bank Group have become more and more essential joints in financing for health. All these are multiple mechanisms that have been designed to channel aid to the high priority areas, but how can we strengthen coordination to prevent distortion of national policies and structures through these funding modalities? Most significantly how governments in low- and lower-middle income countries can transform how they prioritize and finance their health [11] without necessarily drifting away from their country health strategies, plans and programs because of the enthralling “big monies” promised by big agencies to support new areas that are far-divergent from the country original strategic plans?

Aid can be a propulsion to strengthening health systems, but also its intended purpose and achievements can remain “imaginary” if power imbalances remain unchecked, one-sided and firmly ingrained in decisions made by aid agencies. The current narrative on aid reinforces power imbalances, and through Kampala initiative, civil society recognized that the framing of the language in aid is still problematic and inadequately represents the reality. This is detrimental to strengthening policy coherence and the normative values of aid and solidarity among the aid actors especially the intergovernmental agencies.

Moving forward, the complex mix of approaches interweaved with new global instruments for delivery designed to reshape rules and policies and strengthen coordination and corroborative efforts (such as the Global Action Plan-GAP on healthy lives and wellbeing) in health financing and development among the existing and new institutions and funding models, have served as an imperative tandem of shifting development paradigms in health, thriving on the assumption of what is purported to work best for the aid agencies’ systems. But little grip of attention on what works best for the in-country systems. With the increasing diversity of approaches and aid streams, the development cooperation space now faces a blend of multiple exciting opportunities to expand funding, however this raises difficult questions about how to forge meaningful and effective partnerships,[12]shared ownership, mutual accountability, deliverable results, and harmonization of processes as guiding principles of the Paris declaration.[13]



[1] First, Second and Third World

[2] Ecological modernization: World Bank’s ‘impeccable’ logic of pollution trade, Lawrence H. Summers

[3] 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;


[5] The Paris Declaration on Aid Effectiveness

[6] The Effectiveness of Foreign Aid on Economic Development in Developing Countries: A Case of Zimbabwe (1980-2000)

[7] GLOBAL PUBLIC INVESTMENT Five paradigm shifts for the future of aid: Jonathan Glennie, Principal Associate, Joep Lange Institute; September 2019

[8] Building a Foundation for Better Development Cooperation: CGD Development Leaders Conference 2019




[12] Building a Foundation for Better Development Cooperation: CGD Development Leaders Conference 2019

[13] The Paris Declaration on Aid Effectiveness

[14]  “Beyond aid” – the Kampala Initiative,




PEAH is pleased to cross-post an article by AFEW partner organization. AFEW is dedicated to improving the health of key populations in society. With a focus on Eastern Europe and Central Asia, AFEW strives to promote health and increase access to prevention, treatment and care for major public health concerns such as HIV, TB, viral hepatitis, and sexual and reproductive health

First published January 22, 2020 

By Olga Shelevakho

Communications officer, AFEW International


I Love Every Minute of My Life


HIV is not a verdict. It is a reason to look at your life from a different angle and get to love every moment of it

That is exactly what Amina, the protagonist of this story who lives with HIV, did. She went through the dark side of self-tortures, reflections, and suicidal attempts to realize that every minute is precious and HIV is what helped her to become strong, independent and happy.

Amina works in the Tajikistan Network of Women Living with HIV. She found herself in this field and nowadays she is actively involved in the Antistigma project implemented within the Bridging the Gaps programme.

How I learned about my status

“In 2012, I got pregnant for the fourth time. Seven months into my pregnancy, I got tested for HIV within the routine health monitoring. Four weeks after, I was asked to come to the clinic and was told that they detected haemolysis in my blood. I got tested again. My doctor told me the result of this second test after my baby was already born.

HIV. The diagnosis sounded like a verdict. What should I do? How should I live? Where can I get accurate information? My conversations with health workers were not very informative. Nobody told me that one can live an absolutely normal life with the virus. I felt that I was alone, left somewhere in the middle of an ocean. I had my baby in my arms, my husband who injected drugs was in prison. Back then, I hoped that I could tell at least my mother about the diagnosis to make it easier for me. However, the virus drove us apart. My mother, who took care of me for all my life, turned her back on me. At the same time, my three-month-old daughter, who also had HIV, died of pneumocystis pneumonia. I hated myself so much that I even had suicidal thoughts. I took some gas oil, matches… If not for my brother, who saw me, I would have burned myself. Then I remember a handful of pills, an ambulance and another failed attempt to kill myself. I felt that I was completely alone on this dark road of life. I started losing weight and falling into depression”.

Through suicidal attempts to the new life

“Two years passed, and my suicidal thoughts started to gradually go away. I had to go on living. Throughout all this time, I kept ignoring my status, but I was searching for the information on HIV in the internet. I was not even thinking about ARVs, I was not ready for the therapy. Sometimes I did not believe that I had HIV as doctors kept telling me that HIV was a disease of sex workers.

After a while, I came to the AIDS centre with a clear intention to start ART. I passed all the required examinations and told the infectious disease doctor that I wanted to start the treatment. Six months after, I already had an undetectable viral load! I believed in myself, in my results, so I wanted to share this knowledge with all the people who found themselves in similar situations. That’s how I started working at the AIDS centre as a volunteer and later as a peer consultant”.

I am happy!

“HIV helped me to start a new life. I am happy – I help people, I am doing something good for the society working at the Tajikistan Network of Women Living with HIV. Recently, I was the coordinator of the Photo Voice project.

I want to keep people who find themselves in similar situations from repeating my mistakes. I want to protect them from unfair attitude, stigma and discrimination against PLWH as well as different conflicts, in particular based on gender.

In 2019, I gave birth to a baby. My boy is healthy. Just recently, with the help of the Photovoices project I disclosed my HIV status to my older sons.  Before that, I wanted to keep that as a secret, but after training and meetings with women within the framework of this project, I decided that I need to open my status. For me it was the scariest thing to do as I thought that they might not accept me as my mother did. However, I did not have to worry. My children hugged me and said that I am the best mother in the world. Now I’m a happy wife of my husband, whom I convinced to start opioid substitution treatment.

HIV helped me to be happy and independent! I am not afraid to say that I have HIV and I love every minute of my life!”


PEAH News Flash 366

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 366



The World On Fire: Five Global Health Stories To Watch In 2020 

The World On Fire: Five Global Health Stories To Watch In 2020 – Part II 

The University in the early Decades of the Third Millennium: Saving the World from itself? by George Lueddeke 

Davos 2020 diary – day #1 

Davos 2020 diary – day #2 

Davos 2020 diary – day #3 

Key Global Health Positions and Officials in the U.S. Government 

New impact fund could put smallholder finance on path to asset class 

Increase Healthcare Spending By 1% GDP, Save 60 Million Lives 

As Gavi turns 20, MSF urges the vaccine alliance to protect more kids from pneumonia 

Wuhan placed under lockdown as coronavirus outbreak kills 17 in China 

WHO Director-General’s statement on IHR Emergency Committee on Novel Coronavirus 

2019-nCoV outbreak — a timeline 

Why the Coronavirus Should Worry Us All 

Low Antibiotic Prices Dampen Industry Investment In Vital New Tools To Combat Superbugs – Says AMR Industry Alliance 

Fight against antibiotic crisis stymied by lack of R&D spend 

WHO warns that pipeline for new antibiotics is running dry 

Novartis scandal : the product of a system encouraged by the lack of public policy 

E-cigarettes: how risky are they? 

La dipendenza da interessi commerciali 

A Foundation Set Out to Bolster African Health Systems. What Has it Achieved? 

UN report: half a billion people struggle to find adequate paid work 

EU sets up $998 million budget for humanitarian aid 

A Long Way to Go: What Kind of Change is Needed Within Foundations to Advance Racial Equity? 

Human Rights Reader 512 

4 Years Seeking Justice: Daughter of Slain Indigenous Environmental Leader Berta Cáceres Speaks Out 

One Health: Africa’s diseased aquaculture 

Sounding the Alarm on Climate Change, 1989 and 2019 

Nature losses threaten emerging economies 

Invasion of desert locusts in Kenya: A climate change crisis or a curse? 

Processo al Futuro: come le multinazionali bloccano la transizione ecologica e perché dobbiamo fermarle 

The University in the early Decades of the Third Millennium: Saving the World from itself?

Recognising the need to change our worldview (belief systems) from human-centrism to eco-centrism – and re-building of trust in our institutions, in this chapter, the Author argues  for the re-conceptualization of  the university / higher education  purpose  and scope   focusing   on achieving the UN-2030 Transformative Vision –  “ending poverty, hunger, inequality and protecting the Earth’s  natural  resources.” 

Announcing a Forthcoming Chapter

The University in the early Decades of  the Third  Millennium

Saving the World from  itself?


By George Lueddeke, PhD, MEd, Dipl. AVES (Hon.)


Chapter Overview

Environmental degradation, economic and political threats along with ideological extremism necessitate a global redirection towards well-being and sustainability. Since the survival of all species (humans, animals, plants) is wholly dependent on a healthy planet, urgent action at the highest levels to address large-scale interconnected problems is  needed to counter the thinking that perpetuates the “folly of a limitless world.”1

Paralleling critical societal roles played by universities – ancient, medieval and modern – throughout the  millennia, and  prompted by  my current book, Survival: One Health, One Planet, One Future , 1  and  contributing chapter to a forthcoming publication,2  I call  for all universities and  higher education institutions generally – estimated  at over 28,000 with close to 300 million students – to take a lead  together  with the United Nations  Youth Forum and other major partners – to tackle  the pressing complex and intractable challenges that face  us.

Recognising the need to change our worldview (belief systems) from human-centrism to eco-centrism – and re-building of trust in our institutions, in this chapter, 2,1  I argue   for the re-conceptualization of  the university / higher education  purpose  and scope   focusing   on achieving the UN-2030 Transformative Vision –  “ending poverty, hunger, inequality and protecting the Earth’s  natural  resources.” 4

Time is not on our side. While much of the groundwork has been done by the UN and civil society, concerns remain over the variable support given to the UN-2030 Sustainable Development Goals (SDGs), especially in light of the negative impact of global biodiversity loss3 on achieving the UN-2030 Sustainable Development Goals (SDGs).4

Ten Propositions for Global Sustainability,1  ranging from adopting the SDGs4 at national and local levels to ensuring peaceful uses of technology  and UN reforms in line with global socioeconomic shifts,  are  highlighted.1  As one example, Proposition #7 calls for the unifying One Health and  Well-Being (OHWB) concept to become the cornerstone of our educational systems as well as societal institutions and  to underpin the UN-2030 SDGs.

A step in this direction is the evolving international One Health for One Planet Education  initiative (1 HOPE),  led by the One Health Commission and  the  One Health Initiative.5  With working groups from education and societal sectors presently being established across six global regions,  its main aim  is  to ‘Build global capacity for promoting and valuing the OHWB concept and approach as the foundation for achieving the UN-2030 Sustainable Development Goals (SDGs).’

In a post-chapter reflection the evidence that our planet’s biosphere  continues to be at  risk (e.g., Australian bushfires) is increasing. As a consequence, it appears that some who see their role as having to satisfy different  interest groups  (e.g., electorate, shareholders)  are having  second  thoughts. The  efforts of Sir David Attenborough,6, Greta Thunberg,7 Xiuhtezcatl Martinez,8 and   pro-environment Youth campaigners  around the globe are  having  at least some  impact on reversing irresponsible decisions. A few   government and corporate leaders are even re-setting their priorities – not because of external pressures but because they personally realise what is at stake for their families and future generations.

Indeed, global support for those who continue to ‘subscribe  to the follies that Earth  resources are limitless, that climate change is a hoax, that autocracy is preferable to democracy,  that compassion is a sign of weakness, that profit  comes before  principle, that division is preferable to unity,’ 2  is gradually  weakening at least in a few corners of the world.

Martin Wolfe, chief economics commentator at the Financial Times, London, concludes that tackling climate change ‘policy has to be global, with all the bigger economies involved’ and  with solutions  ‘found in generous assistance from high-income countries to emerging and developing countries.’ 9 He doubts the probability of success  ‘in an era of populism and nationalism’ cautioning  his readers, ‘But the young are surely right to expect better.’

It is noteworthy that for the first time since 2006 the World Economic Forum ‘Global Risks Report 2020 is dominated by the environment’.10  In the light of projected global impacts (e.g., extreme weather, biodiversity loss),  it seems unimaginable and totally unacceptable “that in the face of  this development, when the challenges before us demand immediate collective action, fractures within the global community appear to only be widening.”



1Lueddeke, G. (2019). Survival: One Health, One Planet, One Future. London: Routledge.

2Lueddeke, G.R. (2020, summer). The University in the early Decades of  the Third  Millennium    (Saving the World from  itself?).  In  E. Sengupta, P. Blessinger, & C. Mahoney (Eds.), Civil society and social responsibility in higher education  (vol.21, Innovations in Higher  Education Teaching and Learning).

3IPBES (2019, May 6). Global assessment report on biodiversity and ecosystem services. Retrieved from

4 United Nations. (2015). Transforming our world: The 2030 agenda for sustainable development. Division for Sustainable Development Goals. (Department of Economic and Social Affairs). Retrieved from

5One Health Commission & One Health Initiative. (2020, December 12). The One Health education task force: Preparing society for the world we need. Retrieved from

6Davies, H.J. (2020, January 15 ). David Attenborough warns that humans have ‘overrun the world.’ The Guardian. Retrieved from

7Berghof, E. (2019,  August 23). Economics can  no longer ignore the earth’s natural boundaries. World Economic Forum. Retrieved from

8Tang, M.C. (2019, August 28). Xiuhtezcatl Martinez: “This crisis is one of the most unifying moments of human history.” Landscape News. Retrieved from

9Wolf, M. (2019, |November 5). There is one way forward on climate change. Financial Times. Retrieved from

10World Economic Forum. (2020, January 17). Retrieved from




On the same topic recently on PEAH

INTERVIEW – ‘Survival: One Health, One Planet, One Future’ – Routledge, 1st edition, 2019

Also of interest

USA Senate (bi-partisan) declares January 2020  National One Health Awareness Month!


 (1) January 30, 20209:30 AM – 10:30 AM Eastern Standard Time (EST)


Hosted by the CORE Group. Presentation by Dr. George Lueddeke

(2) 9 February, 20201PM-2:30 PM EST


Hosted by the  International Student One Health Alliance (ISOHA)

Presentations by Dr Deborah Thomson and Dr George Lueddeke











PEAH News Flash 365

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 365


Policy Cures: Launch of the 2019 G-FINDER report 

Consultation process for the Handbook on Social Participation for universal health coverage (UHC) 

Handbook on Social Participation for universal health coverage (UHC): general introduction 

How We Can Score Development Agencies on Evaluation and Learning Systems 

Five Health Care Trends For 2020 

Urgent health challenges for the next decade 

Axes of a revolution: challenges and promises of big data in healthcare 

Emergencies, Cervical Cancer, IP & Innovation Among Highlights Of Member State Consultations Ahead Of WHO Executive Board 

Medicines and Intellectual Property: 10 Years of the WHO Global Strategy 

Patient Influencers Paid By Pharmaceutical Companies Should Be Required To Disclose Industry Ties 

WHO statement on novel coronavirus in Thailand 

After Thailand, Japan confirms imported case of new coronavirus 

First death reported in China as mystery new virus spreads to Thailand 

Surge in polio cases has reversed progress to eradicate virus – and now risks global spread 

DRC Ebola update 

Mental Health – Among The ‘Most Neglected’ Of Neglected Tropical Disease Issues, Says DNDi Scientist 

‘Vaginal tobacco’, a risky cocktail for West African women 

Q&A: Why most nutrition programming is not scalable 

Making Nutrition and Health More Equitable within Inequitable Societies by Claudio Schuftan

UN sounds alarm over unprecedented levels of hunger in southern Africa 


Human Rights Reader 511 

Haiti 10 years after the earthquake: the fight for social and economic justice continues 

The female face of Southern Africa’s climate crisis 

Despite plans to ban glyphosate, its sales in France increase by 10%

Raising Money for a Clean Water Future 

Anomalously warm temperatures are associated with increased injury deaths 

Climate change and conflict could fuel hunger in 2020 

In Dealing With Climate Change: Foresight is Key 

Mitigating and Adapting to the Effects of Climate Change on Health in the Suburbs Through Adaptations in the Built Environment by Debbie Brace, Vanessa Kishimoto, Michelle A. Quaye, Mike Benusic, Louise Aubin, Lawrence C. Loh

Mitigating and Adapting to the Effects of Climate Change on Health in the Suburbs

This literature review aims to identify evidence-based built environment interventions that may be deployed in North American contexts to mitigate and adapt to the health effects of climate change. Identified mitigation and adaptation strategies are then analyzed for potential application within a suburban context

image credit: WHO

Debbie Brace1, Vanessa Kishimoto2, Michelle A. Quaye3, Mike Benusic4, Louise Aubin5, Lawrence C. Loh, MD, MPH, FCFP, FRCPC, FACPM4,5

 1 – Degroote School of Medicine, McMaster University

2 – Faculty of Arts & Science, University of Toronto

3 – Schulich School of Medicine and Dentistry, Western University

4 – Dalla Lana School of Public Health, University of Toronto

5 – Region of Peel—Public Health

Mitigating and Adapting to the Effects of Climate Change on Health in the Suburbs Through Adaptations in the Built Environment

A Literature Review



Climate change has been heralded as the “biggest global health threat of the 21st century” (Watts 2018). The World Health Organization (WHO) has estimated that between 2030 and 2050, climate change will cause 250 000 deaths per year: 38 000 due to heat exposure in elderly people, 48 000 due to diarrheal diseases, 60 000 due to malaria, and 95 000 due to childhood under-nutrition (World Health Organization 2018).

One way of categorizing the health impacts of climate change is classifying those impacts as direct or indirect. Examples of direct health impacts include worsening air pollution that can contribute to cardiovascular diseases or heat stress and injuries due to more extreme weather, while indirect effects include food insecurity due to extreme weather and droughts, or changes in vector patterns that contribute to higher rates of vector-borne diseases (Watts 2018).

Another categorization from the Centers for Disease Control (CDC) categorizes health effects as they relate to environmental changes such as rising temperature, extreme weather, rising sea levels, and increasing carbon dioxide levels (Centers for Disease Control and Prevention 2014).

There is also a recognition that different communities and populations will be impacted by these health effects. Well known are the anticipated impacts on vulnerable populations of concern including the elderly, young children, individuals living with chronic diseases, and individuals of lower socioeconomic status or social marginalization. (Buse 2012, Intergovernmental Panel of Climate Change 2018) However, there will also be differential impacts anticipated by community context and form, with suburban settings being of particular importance given that they are home to a large proportion of the Canadian population.

Suburbs face the highest growth in the coming years (Ibbitson 2018) while simultaneously presenting challenges to climate change intervention owing to their automobile centric design and lower population density (Williams et al. 2010, 2012). Given this, our literature review aims to identify evidence-based built environment interventions that may be deployed to mitigate and adapt to the health effects of climate change. Identified mitigation and adaptation strategies are then analyzed for potential application within a suburban context.


Suburbs represented the predominant planning paradigm following World War II, driving increasing sprawl and automobile-dependence in metropolitan areas across Canada. (David and Janzen 2013). Suburbs have become the predominant neighbourhood type for metropolitan dwellers, with the Canadian suburban population surpassing the city centre population in the 1970s (Bourne 1996). By 2006, 80% of Canadians in metropolitan areas lived in suburbs (David and Janzen 2013). It has been estimated that two thirds of the total Canadian population live in suburbs. Gordon and Shirokoff (2014) found that the overwhelming majority of population growth in a study of census metropolitan areas was found to be in automobile-dependent suburbs and “exurbs”, defined as rural areas with commuting access to metropolitan centres. Suburbs are currently growing 160% faster than city centres in Canada (Thompson 2013).

The typical North American suburban community has a built form that encompasses low density housing, dispersed amenities and services, and reliance on personal vehicles (Leichenko and Solecki 2013).  Despite these common elements, various suburbs exhibit demographic differences with regards to age, income, and visible minorities, with consequent impacts on health status. As an example, while suburbs have traditionally resulted in housing that is more affordable compared to the city, low socioeconomic status individuals living in suburbs often find themselves isolated from easy geographic access to work and important services because of unaffordability of automobiles and poor public transit infrastructure (Bourne 1996).

Community reliance on automobile transport also affects environmental health and drives climate change through air pollution and greenhouse gas emissions (Gordon and Shirokoff 2014). Greenhouse gas emissions come largely from road-based vehicles, and these emissions increased 33% from 1990 to 2010. Motor vehicles are also sources of air contaminants that lead to smog, with smog estimated to be responsible for 9500 deaths in Ontario per year.

Finally, other climate change effects experienced differently by suburban settings are extreme weather events, which can cause community and economic disruption (Thompson 2013), and also extreme temperature events, particularly extreme heat, which amplify the urban heat island effect. The latter is the result of infrastructure supporting suburban reliance on motorized vehicles (i.e. wide roadways and highways, industrial surfaces, a lack of vegetation, and parking lots) which results in surface temperatures that magnify the urban heat island effect in suburban areas (Taylor et al. 2018).

An example of a suburban community is the Region of Peel, a diverse and large upper-tier municipality in the Greater Toronto Area that is home to nearly 1.3 million people (Region of Peel 2016). Peel encompasses three municipalities, the Town of Caledon, and the cities of Mississauga and Brampton, and has a predominantly suburban form that envelopes dense urban, urbanizing, and rural forms. Approximately 14.7% of the population of Mississauga, 11.3% of Brampton and 5.7% of Caledon are considered low income (Region of Peel 2017a). According to the 2016 census, 62.3% of the Peel population are a visible minority, of whom 50.8% are South Asian, 15.3% are African American and 7.5% are Chinese (Region of Peel 2017b).

Concerning the urban heat island effect, meteorological data has demonstrated that Peel has seen an average increase in daily temperature of 1.2°C between 1938 and 2017 (Region of Peel 2019), though the range of surface temperatures varies, particularly with distance from the lake. Data on vegetation shows that 11% of Brampton, 15% of Mississauga, and 29% of Caledon East has tree cover (Buse 2012), with no recorded data for tree cover in Caledon West.

This context and community example shows the importance of intervening to address the impacts of climate change for all who live in suburban settings, while also prioritizing vulnerable populations that already experience disadvantage and are at increased risk of adverse health outcomes.


A literature review was performed to identify current built environment interventions being used to mitigate and adapt the health effects of climate change that may apply to a suburban context. The following databases were searched: Environment Complete, Web of Science, PsychINFO, Emcare, PubMed, MEDLINE, MEDLINE In-Process, Global Health, Health Star, and Cochrane Database of Systematic Reviews. Search terms used were: climate change, global warming, environmental pollution and/or greenhouse effect, and health, and measuring, mitigating, strategies, interventions, policy or prevention, and/or city planning or environmental design or built environment. The search was limited to papers published in English, between 2009-2019, and available online.

The initial search provided 577 results. A single reviewer scanned titles and abstracts to determine inclusion or exclusion based on their relevance to climate change and health, and interventions specifically relating to the built environment. Papers were included if they cited climate change as the exposure of interest, analyzed the effect of an intervention in the built environment, reported human health-related outcomes, and were published in English. Papers were excluded if they could not be applied to North American contexts (i.e., if the papers were based in a low-income or developing nation), if they were published before 2009, and if they were not related to suburban environments. A total of 23 articles were identified as possible for inclusion. One was excluded as it was not available in online archives. A further 9 were excluded as they did not report health outcomes related to climate change, or were related exclusively to urban contexts. Two reviewers then retrieved these articles and appraised these full texts for final inclusion. In total, 13 articles met the criteria.

From these included articles, promising built environment interventions were then extracted and summarized in key themes, which underwent critical analysis. These themes were then critically analyzed against suburban context and considerations to identify interventions that might support adaptation and mitigation efforts in such settings.

For the purposes of this review, we defined mitigation interventions as those designed to abate contributing factors to climate change, with related health co-benefits, and defined adaptation measures as adjusting and resourcing a community to manage health-related climate change impacts (Prior et al. 2018).


Thirteen papers were identified in our review. Six articles were literature reviews and five articles reported simulation or predictive modeling. The final two papers were primary research articles, one of which was an online survey of Australian’s heat stress resilience, while the other reported on water quality monitoring and interventions.

Identified common themes for suburban interventions included urban vegetation and green infrastructure to cool temperatures, reducing heat stress, improving infrastructure resiliency, retrofitting buildings, and reducing greenhouse gases by promoting healthy and active living.


Two articles found that active transport was linked with better health outcomes and decreased greenhouse gas emissions (Ulmer et al. 2014, Frank et al. 2010).

Ulmer et al. (2014) used predictive modeling to characterize the health impacts of policies and laws regarding urban planning, land use and transportation. They found that walkability, sidewalks, bike facilities, and recreational activities was correlated with more physical activity and better health, as well as decreased greenhouse gas emissions.

Frank et al. (2010) used simulations to investigate how active transport can improve health and reduce greenhouse gas emissions. They found that increasing transit and density improves health indicators and decreases emissions from motorized transport and concluded that funding for transit should be increased to improve health and climate sustainability.


Five of the papers investigated the impact of green infrastructure, such as urban vegetation, green roofs, and suspended pavements to protect vegetation. Taken together, these papers found that green infrastructure reduces the risks of climate-related exposures. Stone et al. (2013) demonstrated that increased vegetation in urban centres and the surrounding areas was linked with mitigation of the “urban heat island effect” through decreased land surface temperature. Several other papers also linked vegetation to improved air quality and reduced pollutant concentrations, which was predicted to help mitigate anticipated poorer air quality owing to hotter ambient community temperatures (Abhijith et al. 2017, Page et al. 2015, Demuzere et al. 2014, Houghton and Castillo-Salgado 2017).

Four articles demonstrated that various building retrofits could reduce heat related mortality; three of these were specific to residential buildings (Taylor et al. 2018, Hatvani-Kovacs et al. 2016, Williams et al 2013) while one was a general review of cooling technologies (Pisello 2017). Of note, Taylor et al. (2018) found that shutters on windows were linked with lower summer time heat-related mortality, while complete energy-efficient retrofitting was associated with an increase in heat-related mortality.  This finding was at odds with the other three papers that linked energy efficient retrofitting and cool coatings with decreased risk of heat-related illness and better health outcomes (Hatvani-Kovacs et al. 2016, Williams et al. 2013, Pisello 2017).

Two of the papers were literature reviews investigating the various strategies and characteristics being used to mitigate urban heat islands (Santamouris et al. 2017, Hintz et al. 2017). Both of these papers identified benefits from a multifactorial approach including the use of urban vegetation and green infrastructure, the use of cooling techniques like increased albedo on surfaces, and individual behaviors, such as remaining in air conditioned spaces and avoiding strenuous exercise during extreme heat events (Santamouris et al. 2017, Hintz et al. 2017).


Our review found evidence-based interventions that, if implemented, could have promise in addressing climate change contributions and impacts in suburban settings. Both mitigation and health-protective adaptation efforts would be supported by suburban investments in green infrastructure, the former through improved carbon capture by increased foliage and shade, and the latter through increased soil and root systems that increase resilience to seasonal flooding and improved air and water quality. Other interventions that could be deployed in suburbs to protect health relate more to adaptation, specifically building retrofits that might reduce heat-related mortality and morbidity, and health promotion messaging that encourages remaining indoors and avoiding strenuous physical activity during extreme heat events.

Broadly applying these interventions to the suburban context, one notes that active transportation (e.g., walking, cycling, taking public transit) would not only contribute to climate change mitigation efforts but also provide important health co-benefits through increased physical activity and improved air quality. In the absence of built environments that encourage physical activity, it has been shown that there is risk of obesity (Papas et al. 2007). In addition, increased driving time has been associated with higher prevalence of self-reported smoking, physical activity, insufficient sleep and psychological distress (Ding et al 2014). In other parts of the world, childhood asthma has emerged, likely as a consequence of industrial and car-related pollution (Loh and Brieger 2014)

People who live in suburbs spend more time in cars, owing to long distances, low density, and limited public transport. (Sugiyama et al. 2012). Active transportation use in adults is further associated with subjective density, mixed land use, walkability, and safety for cycling (Van Dyck et al. 2013). However, our findings are clear that a suburban transformation toward active transportation is not optional; in addition to mitigating climate change, greater intensification to promote active transportation will provide health benefits to a growing population and reduce congestion and air pollution. Compared to traditional urban settings, suburban contexts will require significant investment and effort in determining how to transform automobile-focused transportation infrastructure towards making active transportation safer, more desirable, and more feasible in thinking of where and how people move around.

This review also found that green infrastructure and urban vegetation has important mitigation and adaptation benefits. In the Region of Peel, substantial natural cover is present largely in the northern rural areas, with more built up areas in the south left vulnerable to urban heat island effect. Research suggests that areas vulnerable to urban heat island effect would benefit from increased urban vegetation and green infrastructure, which is linked to lower land surface temperatures, better air quality, and flood mitigation. This poses considerable challenges given the spread and scale of various developments that rely on wide arterial roads and low-density buildings with extensive parking lot facilities.

The final theme that emerged from the literature is that of building retrofitting, though evidence in this review is mixed. Increasing the energy efficiency of buildings through retrofitting would help reduce energy use and mitigate greenhouse gas emissions, while helping residents adapt to extreme shifts in temperature. Specific data from Natural Resources Canada indicate that residential and commercial activities account for about 14% of total Canadian energy use and greenhouse gas emissions; in residential settings, data suggests that 81% of the energy consumption is used for space and water heating (Natural Resources Canada 2019). As most retrofits are cost-effective when borne out in more dense settings, suburban settings will need to consider how best to encourage changes, particularly in residential settings.


A direct comparison of results and conclusions from the included papers was not possible given their variability in topics, contexts, and research methods. While some of the papers identified potential interventions, none of them presented specific data that would permit a quantification of the impact of their interventions on health outcomes. Specific to context, the evidence reviewed largely focused on urban environments, with only one of the included papers specifically focused on a suburban context. Finally, none of the papers examined the effects of interventions on specific sub-populations or comparatively across different areas.


The results of this literature review point to some promising practices around climate change mitigation and adaptation through the built environment that might be health-supportive and may be of some application to suburban settings. Key themes identified include opportunities presented by green infrastructure, building retrofit, and active transportation interventions. Cross-referencing these to the built form found in a traditional suburban context identifies certain barriers to implementation.

Further research and evaluation will help to determine, in suburban settings, how feasible such interventions might be, how they might be deployed, and how they might impact efforts to mitigate climate change and also adapt to protect general and vulnerable community populations from the direct and indirect health impacts of this phenomenon.



  1. Abhijith, K. V., Kumar, P., Gallagher, J., McNabola, A., Baldauf, R., Pilla, F., et al. (2017). Air pollution abatement performances of green infrastructure in open road and built-up street canyon environments–A review. Atmospheric Environment162, 71-86.
  2. Bourne, L. S. (1996). Reinventing the suburbs: Old myths and new realities. Progress in Planning, 46(3), 163-184.
  3. Buse, C. (2012). Report on Health Vulnerability to Climate Change: Assessing Exposure, Sensitivity, and Adaptive Capacity in the Region of Peel. Peel Public Health.
  4. Centers for Disease Control and Prevention (2014). Climate Change and Public Health – Climate Effects on Health. CDC.
  5. Demuzere, M., Orru, K., Heidrich, O., Olazabal, E., Geneletti, D., Orru, H., et al. (2014). Mitigating and adapting to climate change: Multi-functional and multi-scale assessment of green urban infrastructure. Journal of environmental management146, 107-115.
  6. Ding, D., Gebel, K., Phongsavan, P., Bauman, A. E., & Merom, D. (2014). Driving: a road to unhealthy lifestyles and poor health outcomes. PloS one, 9(6), e94602.
  7. Frank, L. D., Greenwald, M. J., Winkelman, S., Chapman, J., & Kavage, S. (2010). Carbonless footprints: promoting health and climate stabilization through active transportation. Preventive medicine50, S99-S105.
  8. Gordon, D., & Janzen, M. (2013). Suburban nation? Estimating the size of Canada’s suburban population. Journal of Architectural and Planning Research, 30(3), 197-220.
  9. Gordon, D., & Shirokoff, I. (2014). Population Growth in Canadian Suburbs, 2006–2011. Kingston: School of Urban and Regional Planning, Queen’s Univ.
  10. Hatvani-Kovacs, G., Belusko, M., Skinner, N., Pockett, J., & Boland, J. (2016). Drivers and barriers to heat stress resilience. Science of the Total Environment571, 603-614.
  11. Hintz, M. J., Luederitz, C., Lang, D. J., & von Wehrden, H. (2018). Facing the heat: A systematic literature review exploring the transferability of solutions to cope with urban heat waves. Urban climate, 24, 714-727.
  12. Houghton, A., & Castillo-Salgado, C. (2017). Health co-benefits of green building design strategies and community resilience to urban flooding: A systematic review of the evidence. International journal of environmental research and public health14(12), 1519.
  13. Ibbitson, J. (2018) City growth dominated by car-driving suburbs, whose votes decide elections. The Globe and Mail.
  14. Intergovernmental Panel on Climate Change (2018). Global warming of 1.5°C. Intergovernmental Panel on Climate Change.
  15. Leichenko, R. M., & Solecki, W. D. (2013). Climate change in suburbs: An exploration of key impacts and vulnerabilities. Urban Climate6, 82-97.
  16. Loh, L. C., & Brieger, W. B. (2014). Suburban sprawl in the developing world: Duplicating past mistakes? The case of Kuala Lumpur, Malaysia. International Quarterly of Community Health Education, 34(2), 199-211.
  17. Natural Resources Canada (2019). Energy and Greenhouse Gas Emissions (GHGs). Natural Resources Canada.
  18. Page, J. L., Winston, R. J., & Hunt III, W. F. (2015). Soils beneath suspended pavements: An opportunity for stormwater control and treatment. Ecological Engineering82, 40-48.
  19. Pisello, A. L. (2017). State of the art on the development of cool coatings for buildings and cities. Solar Energy144, 660-680.
  20. Prior, J. H., Connon, I., McIntyre, E., Adams, J., Capon, T., Kent, J., et al. (2018). Built environment interventions for human and planetary health: integrating health in climate change adaption and mitigation. Public Health Research and Practice.
  21. Region of Peel (2016). Peel Data Centre – Population and Housing Estimates. Region of Peel.
  22. Region of Peel (2017). 2016 Census Bulletin Labour, Education & Mobility. Region of Peel.
  23. Region of Peel (2017). 2016 Census Bulletin Immigration & Ethnic Diversity. Region of Peel. -diversity.pdf
  24. Santamouris, M., Ding, L., Fiorito, F., Oldfield, P., Osmond, P., Paolini, R., et al. (2017). Passive and active cooling for the outdoor built environment–Analysis and assessment of the cooling potential of mitigation technologies using performance data from 220 large scale projects. Solar Energy154, 14-33.
  25. Stone Jr, B., Vargo, J., Liu, P., Hu, Y., & Russell, A. (2013). Climate change adaptation through urban heat management in Atlanta, Georgia. Environmental science & technology47(14), 7780-7786.
  26. Sugiyama, T., Neuhaus, M., Cole, R., Giles-Corti, B., & Owen, N. (2012). Destination and route attributes associated with adults’ walking: a review. Medicine and science in sports and exercise44(7), 1275-1286.
  27. Thompson, D. (2013). Suburban sprawl: Exposing hidden costs, identifying innovations.
  28. Taylor, J., Wilkinson, P., Picetti, R., Symonds, P., Heaviside, C., Macintyre, H. L., et al. (2018). Comparison of built environment adaptations to heat exposure and mortality during hot weather, West Midlands region, UK. Environment international111, 287-294.
  29. Ulmer, J. M., Chapman, J. E., & MSA, S. E. K. (2015). Application of an evidence-based tool to evaluate health impacts of changes to the built environment. Canadian Journal of Public Health106(1), ES26.
  30. Van Dyck, D., De Meester, F., Cardon, G., Deforche, B., & De Bourdeaudhuij, I. (2013). Physical environmental attributes and active transportation in Belgium: what about adults and adolescents living in the same neighborhoods?. American journal of health promotion27(5), 330-338.
  31. Watts, N., Amann, M., Arnell, N., Ayeb-Karlsson, S., Belesova, K., Berry, H., et al. (2018). The 2018 report of the Lancet Countdown on health and climate change: shaping the health of nations for centuries to come. The Lancet, 392(10163):2479–514.
  32. World Health Organization (2018). Climate change and health. World Health Organization.
  33. Williams, K., Joynt, J. L., & Hopkins, D. (2010). Adapting to climate change in the compact city: the suburban challenge. Built Environment36(1), 105-115.
  34. Williams, K., Joynt, J. L., Payne, C., Hopkins, D., & Smith, I. (2012). The conditions for, and challenges of, adapting England’s suburbs for climate change. Building and Environment55, 131-140.
  35. Williams, K., Gupta, R., Hopkins, D., Gregg, M., Payne, C., Joynt, J. L., et al. & Bates-Brkljac, N. (2013). Retrofitting England’s suburbs to adapt to climate change. Building Research & Information41(5), 517-531.



More Equitable Nutrition and Health within Inequitable Societies

You can -as individuals- come to the will and intent to change underlying structural inequalities in society either from a primarily ethical or political process. In terms of equity, the bottom-up political process (in which commitments are needed beyond ethics)  looks preferable in that it better accommodates and represents the perceptions of needed development actions as seen from the perspective of development’s beneficiaries. In this approach, beneficiaries are clearly the protagonists of the process; the process is mostly politically motivated and assigns a key role to ‘social activists and political advocates’ who are to advance the cascading process 

By Claudio Schuftan*

Ho Chi Minh City,

Making Nutrition and Health More Equitable within Inequitable Societies 


I would like to think that you -as me- often ask yourself what we could all do better to achieve greater equity in what we do given that we most often work in countries with appalling social inequities. Allow me to share with you some of my thoughts on this.

I see our role in helping put in place the needed social processes and mechanisms that will drive sustainable policies in health and nutrition as being inseparable from us helping to re-establish a will and intent to change underlying structural inequalities in society. To achieve the latter, you can -as individuals- come to this will from either of 2 backgrounds: you can either come to it from a primarily ethical or from a political motivation.

These two motivational approaches that can drive us to become more involved in lessening social inequities represent, not packages of universal solutions, but rather paths to follow to get things that need to be done done, and the latter by whom and with whom (and against whom).

Living as we do in a mean, unfair and selfish world, I see the challenge we face as being one to graduate from the first into the second approach. Let me explain why.


As is true for slavery, there are ethical limits to tolerating extreme poverty

The growing new development ethics that calls for working with the poor as protagonists and not merely as recipients has, so far, itself unfortunately remained mostly a top-down approach. It represents mostly the view of academicians, of intellectuals, of church leaders, of international bureaucrats and of a few politicians (mostly in the opposition). Beneficiaries have remained mostly passive in this approach, merely being counted as the ‘object’ of the process. This ethics-led process is mostly ethically motivated and assigns a key role to ‘moral advocates’ who are to advance the following cascading process:

– NEEDS (Entails assessing needs requiring fulfillment using
 “objective”(?) field research techniques)
 – ENTITLEMENTS (Entails granting selected identified needs the status of
 entitlements to be honored by society)
 – RIGHTS (Entails translating accepted entitlements into actual rights)*
 – LAWS (Entails delegating to members of Parliament the
 legitimization of selected rights by promulgating them
 into laws)
 – LAW ENFORCEMENT (Entails assuring/securing that the laws get
 enforced by government institutions)**
 * : Promoting these rights is not, by itself, a progressive political
 **: Often very weak or non-existent and without the people getting involved
 directly in it.

The inherent weakness of this process is that to have rights ultimately respected, someone other than the poor takes the responsibility at each step to steer the process from entitlement to enforcement.


This more bottom-up political approach (in which commitments are needed beyond ethics) better accommodates and represents the perceptions of needed development actions as seen from the perspective of development’s beneficiaries. In this approach, beneficiaries are clearly the protagonists of the process; the process is mostly politically motivated and assigns a key role to ‘social activists and political advocates’ who are to advance the following cascading process:

– FELT NEEDS (As freely and spontaneously expressed by organized
 [Consciousness raising]
 – CONCRETE DEMANDS (Felt needs are articulated into concrete
 demands each tackling perceived causes)
 [Social learning]
 – CLAIMS/EFFECTIVE DEMANDS (Based on concrete demands, people
 make claims* and exert an effective
 [Social Mobilization/Empowerment]
 [Acquisition of Social Power]
 – ORGANIZED PEOPLE’S ACTIONS (Initial mobilization of own and
 other available resources)
 [Gains in self-confidence]
DE-FACTO EXERCISE OF POWER (Within or challenging the law;

bringing in, using and progressively
 controlling needed external resources)
 [Acquisition of Political Power]
 – CONSOLIDATION OF NEW POWER (Coalition building)
 [Leads to new felt needs and the cycle restarts]
 * : Claims correspond to entitlements in the previous diagram.
 **: When people are willing to invest their own resources to fulfill
 their felt needs.

Although the ethically and politically led approaches, as simplified in these two diagrams, represent different paths, both can contribute -through their own merits- to sustainable changes in the health and nutrition of the poor. The two approaches complement each other, but would be even more synergistic if the ethically led process gets more proactive civil society inputs and gets more politically savvy.

It is in the realm of the second diagram that I see us ever getting a chance to influence the choice of needed investments in health and nutrition, as well as influencing the redistributive and social protection measures/priorities that will concomitantly address the poverty underlying the ill-health and malnutrition we (as professionals) are left to deal with.

It is in the realm of the second diagram as well -with the added strength coming from an organized community- that I see us ever  effectively influencing how the public sector allocates its resources and chooses geographic/socioeconomic/ethnic targets, and how, in the process, the government favors programs that are under strong community control.

Finally, it is also in the realm of the second diagram that I see us succeeding in re-establishing a will and an intent to change structural inequalities underlying ill-health and malnutrition; our strength will come from building the new constituencies that do have a vested interest in pushing for the
unpostponable changes in the system that basically reproduces the existing structural inequalities and determines the parameters within which we (as professionals) are “allowed” to intervene.


*Short Bio

Claudio Schuftan has worked extensively at global level (especially in Africa and Asia) in fields such as Public Health including, Strengthening Management of Health Systems and Health Policy Formulation, Public Health Nutrition, Primary Health Care; Maternal and Child Health Care, Health Management Information Systems, Human Resources for Health, Health Project Design, Health in SWAPs, District Health Management, Health and Human Rights Capacity Building, Community Health, Health Promotion, Health governance, Health Sector Reform and Gender Issues. Dr Schuftan has significant monitoring and evaluation experience in these fields. Apart from sector and joint evaluations for various donors,he has monitored EU projects mainly in the fields of health and nutrition especially since the establishment of the ROM initiative in 2001. 

Dr. Schuftan has worked on the drafting of national plans of action in Cameroon, Kenya and Vietnam and has carried out in-depth situation analyses including access to health and right to health issues. He has prepared health investment plans and facilitated numerous training workshops. He has also written numerous training manuals. As senior adviser in the MOHs in Nairobi and in Hanoi he was in charge of operational planning at both central and local levels and contributed to SWAP-related work in one province in Vietnam. The same was done in Bangladesh. He has closely worked with concerned government agencies including public finance institutions and human rights committees.

By training, Dr Schuftan is a Medical Doctor and Pediatrician with a degree of the Universidad de Chile in Santiago and holds a post-graduate diploma in Food and Nutrition Planning from the Massachusetts Institute of Technology (MIT) in the US. He is a US, Chilean and German national and resides in Vietnam since 1995 (first Hanoi and then in Ho Chi Min City since 2003). He is the author of over 85 scholarly papers published in refereed journals.



PEAH News Flash 364

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 364


2020: a Year Full of Danger 

Mystery Virus In Wuhan Strikes 59 People; Chinese Rule Out SARS, MERS & Seasonal Flu 

Deaths from Democratic Republic of the Congo measles outbreak top 6000 

DRC Ebola update 

DRC Struggles With Twin Outbreaks Of Measles & Ebola; WHO Appeals For US$40 Million For Measles Vaccine Drive 

Statement of the Twenty-Third IHR Emergency Committee Regarding the International Spread of Poliovirus 

Impacts of intellectual property provisions in trade treaties on access to medicine in low and middle income countries: a systematic review 

New opportunities to increase access to medicines for universal health coverage in Africa 

WHO needs to go beyond mass drug administration in addressing neglected tropical diseases. New report calls for integrated control programs, multisectoral action, and health system strengthening (but omits reference to political and economic reform) 

Prescription Drug Policy: The Year in Review, And the Year Ahead 

What can the United States learn from the French system for controlling cost of meds? 

Get the global tuberculosis report data in your pocket: TB Report App 

Artificial intelligence has come to medicine. Are patients being put at risk? 

Review of the Decade: Ten Trends in Global Education 

Analysis of FDA Documents Reveals Inadequate Monitoring of Key Program to Promote Safe Opioid Use 

Human Rights Reader 510 

Searching for the nexus: Why we’re looking in the wrong place 

Non-clinical interventions to reduce unnecessary caesarean sections: WHO recommendations 

WHO mulls UN high level declaration on non-communicable diseases. Focus on mental health, air pollution, alcohol harm and early diagnosis 

National, regional, and global burdens of disease from 2000 to 2016 attributable to alcohol use: a comparative risk assessment study 

An end to coercion: rights and decision-making in mental health care 

Social disconnectedness, perceived isolation, and symptoms of depression and anxiety among older Americans (NSHAP): a longitudinal mediation analysis 

Upwards harmonisation of food standards a risk to community nutrition and food sovereignty. Trade facilitation and food safety confused in new item on EB agenda 

Addressing Food Insecurity In Clinical Care: Lessons From The Mid-Ohio Farmacy Experience 

South Sudan government strategizes to stave off potential famine 

How to scale up biofortified crops 

‘Like sending bees to war’: the deadly truth behind your almond-milk obsession 

Not all Trade is Good – the Case of Plastics Waste 

EU plans ‘big increase’ in green gas to meet climate goals 

Australian bushfire smoke drifts to South America