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

Dusky grouper (Epinephelus marginatus)

News Flash 661

Weekly Snapshot of Public Health Challenges

 

Register today: In conversation with Tom Fletcher, UN Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator, about the most pressing humanitarian and conflict issues facing the United Nations today, and what role the UK can play. 20 April 2026 Event location: Hybrid — Chatham House and Online

Webinar registration: Youth Co-creation Guide Launch Apr 21, 2026

Webinar registration: Integrated Long-term Care in Europe: Learning from the BUILD, LeTsCare and Laurel Projects: Results and Reflections on Policy and Practice Apr 30, 2026

Interview: Francisco Mendina PhD Candidate Western University, Canada  by Daniele Dionisio 

Governing Biological Risk in an Era of Climate Instability: Integrating One Health into Macroprudential Policy Architecture  by Kalolo Chitembo

From supply to strategy: leveraging central medical stores experiences and information for health system strengthening

Safeguarding Health For People With Intellectual And Developmental Disabilities: Absent Federal Leadership, Others Must Step Up

When the medicine runs out: AMR, antibiotic shortage, and the children being left behind

One Million More People to Get HIV ‘Miracle’ Drug Lenacapavir as US, Global Fund Expand Access

Effect of donor exclusion criteria on blood safety and volume of donations: a systematic review of modelling studies

HRR813. THERE IS NO TYRANNY MORE CRUEL THAN THAT WHICH IS EXERCISED UNDER THE SHADOW OF THE LAW AND IN THE NAME OF JUSTICE. (Montesquieu)

Shifting Global Health R&D Funding: Opportunities in a Changing Landscape

Health Taxes and the IMF: Are Support and Reform Aligned?

Rich countries slash development aid in a short-sighted move with long-term global consequences

Global CSOs welcome launch of Borrowers’ Platform at IMF-World Bank Spring Meetings

Online University Throws a Lifeline to Afghan Women Shut Out of Education

Civil Society Launch a Campaign Against Extractive Industry Exploitation and Land Grabs

Did badly designed aid rules lead to a rise in child marriage?

Restitution of findings in humanitarian research: Guidance note

UNPO Collaborates with Munk School of Global Affairs and Public Policy on Determining the Narrative: The Use of Narratives, (Mis)Information, and Media for Unrepresented Nations and Peoples in the 21st Century

Iran war could plunge 32 million into poverty, says United Nations

Beyond the battlefield: The global ripple effects of the Iran war

Sudan’s Catastrophic Civil War Enters Fourth Year

Millions of people in Sudan surviving on one meal a day as food crisis deepens, NGOs say

From genocide to countless acts of solidarity: Documenting three years of war in Sudan

Donors pledge 1.5 bn euros as Sudan marks three years of war

‘Water Nobel’ winner Madani calls for focus on water crisis at COP31

Indian wastewater rife with drug resistance genes

Delhi Has a New Plan to Fight Its Toxic Air, But Will it Deliver?

Human rights and the rights of Nature are linchpins for truly sustainable development

Why Peatlands Matter: Britain’s Overlooked Carbon Store

 

 

 

 

 

IN A NUTSHELL
Editor's note
PEAH had the pleasure to interview Mr Francisco Mendina as a doctoral candidate at Western University in London, Ontario, Canada, who is conducting, under the supervision of Dr. Elysee Nouvet, a research study exploring how humanitarian healthcare professionals conceptualize and practice solidarity in contexts of crisis, conflict, and care. The study has received ethics approval from Western University, and in this capacity Mendina also serves as a staff member of the Global Health Solidarity Project Network as a Wellcome Trust funded research alliance implemented by the University of Ghana and led by Prof. Caesar Atuire at the University of Ghana and the University of Oxford, with six Co-Investigators in Australia, South Africa, Canada, Costa Rica, USA and Austria 

By Daniele Dionisio

PEAH – Policies for Equitable Access to Health

  INTERVIEW

Francisco Mendina

PhD Candidate Western University

Ontario, Canada 

 

–PEAH: Very pleased to meet you Mr Mendina. Just to introduce yourself, share, please, concise information on your professional background

–Mendina: Hi Daniele, thank you for the warm invitation. I am pleased to meet you as well. I am currently a third-year PhD student in Health Information Science at Western University, where I also serve as a teaching assistant and graduate student fellow with the Global Health Solidarity Network. My research, supervised by Dr. Elysee Nouvet, aims to understand how humanitarian healthcare professionals who have worked in prolonged conflict settings understand and enact the concept of solidarity.

My path to this work has been shaped by a longstanding interest in community health and humanitarian contexts. During my undergraduate studies at McMaster University — where I completed a Bachelor’s degree in Life Sciences with a minor in Community Engagement — I began volunteering with global health and community health organizations, which sparked my interest in how health systems serve vulnerable and underserved populations. This interest deepened during my Master’s degree in Management of Applied Sciences in Global Health Systems at the University of Western Ontario, where an internship gave me firsthand exposure to the humanitarian healthcare space and affirmed my commitment to working at the intersection of health equity and community engagement.

Prior to beginning my doctoral studies, I worked as a Program Coordinator for HIV/AIDS Support Services at an AIDS Services Organization in York Region, Ontario. In this role, I oversaw project planning, individual case management, and health promotion initiatives, including organizing and leading community education workshops. Across these experiences — from undergraduate volunteering to professional coordination — I developed a deep appreciation for community-centred approaches to health, which continues to inform my doctoral research today.

–PEAH: As maintained in the Global Health Solidarity Project brief ‘…The Challenge Efforts to promote greater health equity for all have been accompanied by an increase in calls for solidarity, especially during crises such as the Covid-19 pandemic. However, at the global level, these appeals to solidarity have produced meagre results. Common conceptions of solidarity in global health are ambitious but ambiguous and under-theorised, making them inadequate and insufficient in providing the clear goals and tools needed to operationalise solidarity…’  In this connection, what are your thoughts in more detail?

–Mendina: The challenge resonates with what motivated my own research. In reviewing the humanitarian healthcare literature, I consistently found solidarity being called to have a more central role — particularly in calls for more horizontal, inclusive, and politically engaged humanitarian responses — yet rarely defined. Authors across disciplines conceptualize the term differently. Humanitarian organizations themselves use the term in varied and sometimes contradictory ways. The result is a concept that is rhetorically powerful but operationally vague.

Additionally, to my knowledge, there are no studies that have sought to understand how those actually working on the front lines of humanitarian healthcare — the people navigating these principles in real time, under real constraints — understand or enact solidarity. That gap is significant and urgent.

This urgency is compounded by the tensions solidarity introduces in practice. Some scholars have argued that solidarity implies political alignment or a challenge to structural injustice, thereby placing it in direct tension with the principle of neutrality — a foundational humanitarian commitment understood as essential to ensuring access to affected populations and the safety of frontline workers. If solidarity is being called upon to have a more central role in humanitarian healthcare, we need to understand what it actually means to those navigating these realities on the ground, and what the practical implications of different understandings might be for access, safety, and operational effectiveness. That is precisely the gap my research seeks to address.

–PEAH: Some in-depth information now concerning the Project objectives

–Mendina: This study aims to generate empirical knowledge about how humanitarian healthcare workers who have worked in prolonged conflict settings understand and enact solidarity.

The study is organized around two interconnected objectives. The first is to understand how frontline humanitarian healthcare workers construct and make sense of solidarity in relation to neutrality — a foundational humanitarian principle, and an increasingly contested one, that commits organizations to refrain from taking sides in conflict. This relationship matters because some scholars have positioned solidarity as in direct tension with neutrality.

The second objective is to examine how understandings of solidarity are enacted in practice: how they intersect with workers’ experiences of accessing populations, navigating questions of personnel safety, and managing the ethical demands of frontline work in complex emergencies.

Together, these objectives are designed to produce the kind of grounded, experience-near knowledge that is currently missing from the literature.

–PEAH: Relevantly, what about the Project approach?

–Mendina: The study takes an interpretive, qualitative approach. Data is collected through semi-structured interviews with humanitarian healthcare workers who have experience in prolonged conflict settings. These interviews are designed as open-ended conversations, allowing participants to speak to their experiences in their own terms rather than being guided toward predetermined definitions of solidarity or neutrality.

Methodologically, the study is grounded in an abductive logic of inquiry, which is well-suited to concepts like solidarity that are vague, contested, and differently understood across contexts. Rather than testing a fixed theory, the approach remains responsive to the tensions, contradictions, and surprises that emerge from participants’ accounts, allowing meaning to develop iteratively through engagement with the data. Analysis is conducted through reflexive thematic analysis, with attention to moral reasoning, ethical complexity, and the situated nature of participants’ experiences.

–PEAH: And as for the expected outcomes?

–Mendina: This study will contribute to a nuanced account of how solidarity in the eyes of Humanitarian Healthcare workers interacts with competing demands such as neutrality, safety, and access, and how it is enacted or contested in practice. Rather than assuming solidarity is inherently transformative, the study asks what it means, produces, and complicates. Findings will inform ethical frameworks, training, and organizational policy while contributing to broader academic conversations on humanitarian reform.

–PEAH: So compounded, your work contributes to ongoing debates around the role of neutrality and solidarity in humanitarian healthcare. Do you have anything to say about this?

–Mendina: Yes, exactly. It is a timely project, and it has been energizing to receive positive comments about the topic and project as a whole. The interviews have been incredibly engaging and I am excited for the next steps of the project and the ongoing conversations about solidarity in the humanitarian healthcare space.

–PEAH: How much progress has made your research so far?

–Mendina: At the time of this interview, we have conducted 14 semi-structured interviews.

–PEAH: And what would you need to better support the Project?

–Mendina: The opportunity this interview provides is itself a meaningful form of support, and I am grateful for it. At this stage, one of the most valuable things for the project is visibility, reaching humanitarian healthcare professionals who may be willing to share their experiences, and broader audiences who care about the future of humanitarian action. If readers of PEAH are working in or connected to the humanitarian healthcare space, I would warmly welcome the conversation.

–PEAH: In the interest of a wider audience, would you be happy to share information on the project research in French or Spanish language as well upon request?

–Mendina: I am happy to share more information and speak about this project with folks who are interested. For those who may want to connect with me on linked in, it is:  www.linkedin.com/in/francisco-mendina

–PEAH: Thank you Mr Mendina for your exhaustive answers and very deserving humanitarian commitment 

Readers are invited to comment on the content and suggestions of this interview

 

IN A NUTSHELL
Author's Note 
Climate change, biodiversity loss, and health system fragility are increasingly converging into a unified domain of systemic risk. However, global governance frameworks remain structurally fragmented, treating environmental, epidemiological, and economic risks as discrete phenomena. This misalignment limits the capacity of states to anticipate and absorb compound shocks.

This paper argues that biological risk—defined as the interaction between ecological disruption, pathogen dynamics, and human vulnerability—should be incorporated into macroprudential governance frameworks. Drawing on recent evidence linking climate change to increased mortality, disease transmission, and economic loss, we propose a shift from sectoral policy responses to integrated resilience modelling.

We introduce the Integrated Sovereign Resilience Index (ISRI), a composite indicator designed to quantify national capacity to withstand biologically mediated shocks. The ISRI integrates five domains: climate exposure, epidemiological risk, health system surge capacity, biodiversity integrity, and food system stability. We situate this index within a broader One Health Nexus Governance framework, which embeds biological variables into fiscal policy, sovereign risk assessment, and development financing.

We further outline policy mechanisms for operationalization, including climate–health stress testing, prevention-aligned financing, and the integration of One Health principles into treasury-level decision-making.

We conclude that resilience must be reframed as a core economic variable rather than a sectoral outcome. States that internalize biological risk into governance systems will be better positioned to maintain stability under accelerating climate pressures.

This work contributes to ongoing research on climate change, zoonotic disease dynamics, and One Health governance in sub-Saharan Africa, with a focus on policy integration and economic resilience

By Kalolo Chitembo

Crisis Expert/ Emergency Medicine Specialist/ Health Economist/ Global Health Advocate/ Climate and ONE HEALTH Researcher

Zambia

  Governing Biological Risk in an Era of Climate Instability

Integrating One Health into Macroprudential Policy Architecture

 

 

Introduction

The accelerating convergence of climate change, ecological degradation, and population health risks represents a fundamental challenge to contemporary governance systems. While each domain has been extensively studied, their interactions remain insufficiently integrated into policy and economic decision-making frameworks.

Climate change is projected to contribute to millions of additional deaths and substantial economic losses over the coming decades, driven by heat exposure, food insecurity, and the expansion of infectious diseases. Concurrently, biodiversity loss is increasing the probability of zoonotic spillover, while health systems—particularly in low- and middle-income countries—remain under-resourced to manage large-scale shocks.

Despite these trends, institutional responses remain fragmented. Ministries of finance, health, and environment operate within distinct analytical frameworks, limiting the capacity to model and manage compound risks. This fragmentation constitutes a structural vulnerability.

The One Health approach, which recognizes the interconnectedness of human, animal, and environmental health, offers a conceptual foundation for integration. However, its implementation has largely been confined to technical coordination rather than systemic governance reform.

This paper advances the argument that biological risk must be incorporated into macroprudential policy architecture. We propose a measurable framework—the Integrated Sovereign Resilience Index (ISRI)—and outline institutional pathways for embedding One Health principles into economic governance.

The Convergence of Biological and Economic Risk

The relationship between environmental change and health outcomes is increasingly well established. Rising temperatures are associated with increased mortality, reduced labour productivity, and heightened strain on health systems. Climate variability is altering the geographic distribution of vector-borne diseases such as malaria and dengue, exposing new populations to infection.

At the same time, land-use change and biodiversity loss are intensifying human–animal interactions, increasing the likelihood of zoonotic spillover events. These processes are not independent; they interact to produce cascading risks that affect both population health and economic stability.

Economic analyses suggest that climate-related disruptions could significantly reduce global output over the coming decades. Importantly, these impacts are not limited to physical infrastructure or agricultural productivity. Health-related effects—including increased disease burden and reduced workforce participation—constitute a major component of economic loss.

However, these risks are not systematically incorporated into sovereign risk assessments or macroeconomic models. Financial systems typically evaluate exposure to climate risk through physical and transition pathways but rarely account for epidemiological dynamics or health system capacity. This omission limits the accuracy of risk pricing and investment decision-making.

From One Health to Macroprudential Governance

The One Health framework provides a critical conceptual basis for integration but requires expansion into governance and financial systems. We define macroprudential biological governance as the incorporation of ecological and health variables into national economic policy and risk management structures.

This shift entails three key transformations:

Analytical integration: linking climate, health, and ecological data within unified modelling frameworks

Institutional alignment: embedding One Health principles across ministries, particularly finance and planning

Financial internalization: incorporating biological risk into budgeting, debt management, and investment decisions

Such integration would enable governments to anticipate compound risks and allocate resources more effectively.

The Integrated Sovereign Resilience Index (ISRI)

Conceptual Framework

The ISRI is designed to quantify a country’s resilience to biologically mediated shocks by integrating exposure and capacity variables across five domains:

1. Climate Exposure (CE)

Indicators include temperature extremes, precipitation variability, and frequency of extreme weather events.

2. Epidemiological Risk (ER)

Captures disease burden, vector distribution shifts, zoonotic spillover potential, and surveillance system coverage.

3. Health System Surge Capacity (HSSC)

Includes healthcare workforce density, infrastructure availability (e.g., ICU beds), and emergency response capability.

4. Biodiversity Integrity (BI)

Measures ecosystem stability, habitat loss, and human–wildlife interface intensity.

5. Food System Stability (FSS)

Assesses agricultural resilience, supply chain robustness, and nutritional security.

Functional Form

The ISRI can be expressed as:

ISRI = (CE × ER) / (HSSC + BI + FSS)

Where:

Higher values indicate greater systemic vulnerability

Lower values reflect stronger resilience capacity

Operational Utility

The ISRI enables:

Cross-country comparison of resilience capacity

Integration into sovereign credit risk analysis

Targeting of development financing

Monitoring of policy effectiveness over time

Policy Integration Pathways

1. Climate–Health Stress Testing

Governments should incorporate epidemiological and health system variables into macroeconomic stress-testing frameworks. This includes modelling scenarios involving simultaneous climate shocks and disease outbreaks.

2. Prevention-Oriented Financing

Public finance systems should shift from reactive expenditure to preventive investment. This includes funding for surveillance systems, primary healthcare, and ecosystem protection.

3. Risk Transfer Mechanisms

Parametric insurance and other risk financing tools can provide rapid liquidity in response to climate-related shocks. Expanding these mechanisms to include health triggers would enhance systemic resilience.

4. Institutional Reform

Embedding One Health units within finance ministries would facilitate cross-sectoral coordination and ensure that biological risks are considered in fiscal decision-making.

5. Multilateral Alignment

International financial institutions and development partners should incorporate resilience metrics such as ISRI into lending frameworks and policy conditionalities.

Implications for Low- and Middle-Income Countries

Low- and middle-income countries face disproportionate exposure to climate and biological risks while having limited adaptive capacity. Integrating resilience into economic governance offers an opportunity to align development pathways with long-term stability.

In regions such as sub-Saharan Africa, investments in health systems, climate adaptation, and biodiversity conservation can generate co-benefits across multiple sectors. However, achieving this integration requires access to financing, technical capacity, and institutional reform.

Conclusion

Biological risk is no longer a peripheral concern; it is central to economic stability and governance. The convergence of climate change, ecological disruption, and health system vulnerability necessitates a shift from fragmented policy responses to integrated resilience frameworks.

The Integrated Sovereign Resilience Index provides a practical tool for operationalizing this shift, enabling governments and financial institutions to quantify and manage systemic risk more effectively.

Embedding One Health principles into macroprudential governance represents not only a scientific and policy imperative but also a strategic necessity in an era of accelerating climate instability.

IN A NUTSHELL
Author's Note 
The increasing integration of algorithmic infrastructures in defense and financial systems is transforming global power dynamics. Platforms such as Palantir Technologies and BlackRock’s Aladdin concentrate data analysis, predictive modeling, and decision-making capabilities at a planetary scale. This process generates asymmetrical advantages that amplify structural inequalities. The Sustainable Health Equity Movement (SHEM) estimates that over 16 million deaths annually are attributable to unjust inequities.

This article examines how the expansion of algorithmic power, combined with everyday citizen participation in data generation and financial flows, contributes to power concentration and the loss of human life. Community autonomy strategies are proposed as mitigation mechanisms, and potential futures are considered, including scenarios with bionic “humanks” capable of emitting and receiving information oriented toward power and control dynamics

By Juan Garay

Co-Chair of the Sustainable Health Equity Movement (SHEM)

Professor/Researcher of Health Equity, Ethics and Metrics (Spain, Mexico, Cuba, Brazil)

Founder of Valyter Ecovillage (valyter.es)

By the same Author on PEAH:see HERE

The Progressive Power of Data and Algorithms, and Their Effect on Human Life Loss Due to Geopolitical Tensions, Military Spending, and Global Injustice

From Passive Consumers Contributing to Lethal Inequity Dynamics to Sovereign, Resilient Communities Gradually Detached from the Global Toxic Nexus

 

Introduction

Global power no longer relies solely on physical resources or military capacities, but increasingly on the ability to collect, process, and anticipate information through algorithmic systems. The transition from industrial economies to data-driven economies has created a new form of power concentration: predictive power.

This change is evident in specific platforms. In defense and security, Palantir Technologies integrates massive datasets to produce real-time operational analyses. Its evolution into systems such as Palantir AIP (Artificial Intelligence Platform) demonstrates the gradual replacement of human judgment with algorithmic decision-making in critical contexts, where computational speed diminishes the role of the “human-in-the-loop.”

In finance, platforms like BlackRock’s Aladdin —along with Vanguard and State Street— analyze and model between 20 and 25 trillion dollars in assets. These infrastructures not only manage investments but also influence global capital flows and economic and social priorities.

PwC’s Sizing the Prize report estimates that artificial intelligence could generate up to $15.7 trillion in global economic value, highlighting the growing gap between those who control data and analytical capabilities and the rest of society.

Conceptual Framework

A systemic perspective integrates three dimensions:

Algorithmic infrastructures in defense and finance as sources of predictive power.

Global health inequities, based on SHEM, WHO, and Global Burden of Disease estimates.

Indirect citizen participation, through data generation and economic flows.

AI is analyzed not as an isolated tool but as a component of complex power accumulation systems capable of shaping decisions, perceptions, and human lives.

Results and Analysis

Concentration of Analytical Power

Current platforms operate at unprecedented scales. In defense, they integrate satellite, drone, and sensor data. In finance, they model global scenarios and guide multi-trillion-dollar investments, generating asymmetrical predictive advantages.

Geopolitical and Military Implications

AI has become a strategic element in global competition, driving a technology race that increases military spending (SIPRI, 2024) and diverts resources from social sectors to control and defense infrastructures.

Impact on Inequities and Human Life Loss

Over 16 million deaths annually are attributable to structural inequalities (SHEM, WHO 2023, World Bank 2023). AI amplifies these inequities if its orientation is not aligned with the common good (PEAH, 2025).

Citizen Participation in the System

The use of mobile devices, social networks, digital payments, and global consumption generates data flows that feed algorithmic systems. Individual savings, channeled through banks and investment funds, also indirectly contribute to concentrated power.

Feedback Cycle of Power

Data and capital concentration

Development of advanced algorithmic capabilities

Increased geopolitical and financial control

Reinforcement of structural inequities

This cycle directly impacts global health by influencing resource allocation and social determinants of life.

Discussion

AI has the potential to improve knowledge and efficiency in health, but when it operates within concentrated power systems, it amplifies inequalities.

Historically, the relationship between people and power has evolved:

Empires and feudal systems: coercive contributions (slavery, tribute, conscription).

Progressive democracy: formal political relations from the Renaissance to universal suffrage.

Industrial Revolution and the 20th century: economic contribution through labor, goods consumption, and services.

21st century: massive and often unconscious digital contribution feeding global algorithmic systems.

Power has transitioned from religious, military, and political to industrial and commercial, and finally to algorithmic and data-based, increasingly shaping human freedom and conditioning the common good. Traditional educational and political structures lose influence relative to these systems, and future generations may interact with even more sophisticated control systems, including bionic “humanks” capable of emitting and receiving information oriented toward power dynamics.

Conclusion

Algorithmic infrastructures in defense and finance redefine global power and the relationship between society and data. Citizens contribute directly and indirectly—often unconsciously—to power concentration and human life loss.

History shows that public contribution has evolved from coercive to political, then economic, and now digital, consolidating power capable of shaping perceptions, behaviors, and global priorities. The result is a reduction in human freedom and the potential to generate the common good.

Community-based alternatives grounded in autonomy, resilience, and the local provision of basic needs—such as low-consumption, high-harmony eco-villages—can serve as counterbalances. The challenge lies in redirecting technological systems toward equity, freedom, and collective well-being.

References

World Health Organization. Global Report on Health Equity and Research & Development. 2023.

World Bank. Tracking Universal Health Coverage: 2023 Global Monitoring Report. 2023.

PEAH – Policies for Equitable Access to Health. Artificial Intelligence and Global Health Inequities. 2025. https://www.peah.it/2025/09/15065/

PwC. Sizing the Prize: What’s the real value of AI for your business and how can you capitalise?

BlackRock. Annual reports and Aladdin platform documentation.

Fichtner, J., Heemskerk, E., & Garcia-Bernardo, J. (2017). Hidden Power of the Big Three?

Karp, A., & Zamiska, N. (2023). The Technological Republic.

Marmot, M. et al. (2020). Health Equity in England.

Piketty, T. (2014). Capital in the Twenty-First Century.

SIPRI (2024). Global Military Expenditure Database.

WHO (2008, 2025). Social Determinants of Health.

Global Burden of Disease Study (IHME).

Sustainable Health Equity Movement (SHEM), internal analyses.

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

female Parrotfish (Sparisoma cretense)

News Flash 660

Weekly Snapshot of Public Health Challenges

 

WHO and France shift One Health vision to action with new high-impact initiatives

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The Inside Track: the pope, the Force and the hope

MMI Webinar Series | Community Health Workers: Building Blocks of Primary Healthcare REGISTER HERE

Interview with Danielle Jones on the development of tools to help family physicians address social determinants of health and advance health equity

The Lancet Regional Health Africa

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The benefits of investments to combat HIV, tuberculosis, and malaria for primary healthcare from 2000 to 2023: An economic modeling analysis

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Sudan’s collapsed health system: why community-led structures are now the backbone of survival

Aid groups warn Iran war is hindering food and medicine from reaching millions

Gaza: Israeli entry restrictions cause critical shortage of medical supplies

How Middle East Conflicts Influence Health System Implementation in Sub-Saharan Africa  by Kirubel Workiye Gebretsadik

HRR812. THE RECOGNITION THAT THERE IS CERTAIN HUMAN RIGHTS LANGUAGE THAT NEEDS TO SHIFT IS IMPORTANT. (Ben Phillips, Patreick Gathara)

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When Seeds Carry Memory: On Indigenous Spirituality, Biodiversity Conservation, and Sustainable Food Systems in Wayanad

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From Dialogue to Delivery: The Pacific’s Climate Mobility Moment

GCF Board agrees on roadmap to updated strategic plan for 2028-2031

 

 

 

 

 

 

IN A NUTSHELL
Author's note
 

This article examines how current Middle East conflicts reshape health system implementation across Sub-Saharan Africa and explores adaptive strategies for building resilience and sustainability

 

By Kirubel Workiye Gebretsadik

Medical Doctor, Ras Desta Damtew Memorial Hospital

Addis Ababa, Ethiopia

By the same Author on PEAH:see HERE

Geopolitical Tensions and Public Health

How Middle East Conflicts Influence Health System Implementation in Sub-Saharan Africa

 

Introduction

The persistent geopolitical frictions involving the United States, Israel, and Iran—now degenerated into outright war—all the more continue to reverberate across global systems. Beyond energy and security implications, these dynamics subtly but profoundly affect international cooperation, financial flows, and ultimately, the advancement of equitable public health in Sub-Saharan Africa (SSA).

This article examines how Middle Eastern instability reshapes health system implementation across SSA and explores adaptive strategies for building resilience and sustainability.

Global Ripples of Regional Conflict

The interplay between Middle Eastern instability and global development manifests through several interconnected channels:

• Energy Market Volatility: Fluctuating oil prices drive inflation and erode healthcare budgets in import-dependent African economies.
• Aid Redistribution: Security imperatives can reorient donor priorities, diverting funds from long-term health initiatives to humanitarian or defense-related spending.
• Migration Pressures: Instability-induced displacement affects not only the Middle East but also transit and destination regions in Africa, straining public health infrastructure.
• Supply Chain Disruptions: Pharmaceutical and medical supply shortages—exacerbated by trade bottlenecks—disproportionately affect countries with limited domestic manufacturing capacity.

Impact on Sub-Saharan Africa’s Health Systems

Economic and Financial Strains

Global uncertainty can reduce international health funding and increase operational costs within domestic systems. Rising fuel prices inflate healthcare delivery expenses, while volatile logistics costs impede the reliable distribution of essential medicines. Reduced predictability in donor support further complicates long-term health sector planning.

Systemic Pressures

The cascading economic effects limit fiscal space for public health investment, constrain workforce retention, and disrupt ongoing reforms toward Universal Health Coverage (UHC). In some cases, global competition for medical commodities heightens inequities between wealthier and lower-income regions.

Strategic Adaptations for Resilience

Sub-Saharan governments and stakeholders are responding with a mix of pragmatic and innovative strategies to mitigate dependence and enhance autonomy:

Diversification of Partnerships

South–South Cooperation: Broadening collaboration with Latin America, Asia, and other developing regions to reduce reliance on Western donors. Regional Integration: Strengthening collective action through African Union and regional economic communities. Private Sector Engagement: Expanding investment opportunities for domestic and international partners in health infrastructure and innovation.

Strengthening Local Production

Pharmaceutical Manufacturing: Encouraging regional drug production hubs and scaling up generic manufacturing. Medical Equipment Assembly: Supporting technology transfer and local assembly of basic devices. Skills Development: Establishing training programs for technicians, engineers, and health professionals to sustain growth in local industries.

Advancing Digital Health and Innovation

Telemedicine Expansion: Leveraging mobile health applications to reach isolated populations and optimize scarce resources. Data and AI Utilization: Applying predictive analytics for outbreak forecasting, resource allocation, and system monitoring. Health Information Systems: Promoting interoperability and digital health record frameworks to enhance service continuity.

Toward Resilient and Sustainable Health Systems

A multi-layered approach—short-, medium-, and long-term—is essential to counter the ripple effects of geopolitical turbulence.

Short-term:

• Strengthen emergency preparedness through strategic stockpiles and crisis-response protocols.
• Optimize existing resources by prioritizing high-impact, low-cost interventions.

Medium-term:

• Expand primary care networks and community health worker programs.
• Invest in leadership, research capacity, and health workforce development.

Long-term:

• Institutionalize UHC-oriented financing models, such as community-based health insurance.
• Foster integration between traditional and modern healthcare systems to enhance accessibility.

Policy Recommendations

For African Governments

1. Deepen Regional Cooperation: Build collective resilience under African Union and regional community frameworks.
2. Invest in Domestic Capacity: Prioritize local pharmaceutical and equipment manufacturing.
3. Engage Diverse Partners: Expand diplomatic and financial partnerships beyond traditional donors.
4. Accelerate Digital Transition: Integrate technology in service delivery, surveillance, and management.

For International Partners

1. Sustain Development Commitments: Avoid reallocation of funds from fragile health systems.
2. Support Knowledge Exchange: Promote technology transfer and capacity building.
3. Adopt Flexible Funding Modalities: Enable programs to adapt amid geopolitical or economic shocks.
4. Design Crisis-Resilient Programs: Embed contingency planning within global health initiatives.

Future Outlook

Despite global uncertainty, opportunities for transformation abound:

• Innovation Acceleration: Disruptions can catalyze cost-efficient technologies and new delivery models.
• Regional Self-Reliance: Strengthened regional production capacities build long-term sustainability.
• Digital Transformation: The leap toward digital health can enhance access and efficiency across SSA.

However, challenges persist—most notably, funding shortfalls, human resource migration, and continuing supply chain vulnerabilities. Addressing these requires sustained global solidarity grounded in the principle of health equity.

Conclusion

Geopolitical instability, while distant, reverberates sharply in Sub-Saharan Africa’s health systems. The region’s resilience will hinge on strategic diversification, technological innovation, and inclusive governance—anchored by a shared global responsibility to preserve health equity amid an evolving world order.

 

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

Bearded fireworm (Hermodice carunculata)

 News Flash 659

Weekly Snapshot of Public Health Challenges

 

Gaza and the End of a Moral Order: Energy, Power, and the Emergence of a Post-Hegemonic World—and the Prospect of a New Global Life Expectancy Decline  by Juan Garay 

The United Nations Needs a Secretary-General of Courage, Not Convenience 

As Iran war drags on, food and medicine for millions is stuck in limbo

Iran war complicates WHO’s emergency medical supply routes

HRR811. TRADE-OFFS AND CHALLENGES IN IMPLEMENTING A RIGHTS-BASED APPROACH TO DEVELOPMENT

The New Compact in Action: What Would It Take to Align Aid and Domestic Health Financing?

More Countries Refer to Refugees in Health Policies, but Access and Data Gaps Persist

UNPO on Baloch and Sindhi Peoples: Accountability, Self-Determination, and the Structural Roots of Exclusion

MSF report finds there are no safe places for women and girls in Darfur

People’s Health Dispatch Bulletin #116: The health fallout of US imperialism

Filling Africa’s early-stage funding gap, one angel investor at a time

How Germany Is Externalizing Its Shortage of Health Care Workers

Inside Rwanda’s Push to Bring Surgery Within Reach

Antimicrobial Resistance in Conflict-Affected Settings: Field Realities, Operational Challenges & Policy Insights

From WHO Endorsement to Implementation: TB REACH grantees evidence on Scaling Near Point-of-Care TB Testing

Manufacturing medicines for NTDs, with Dr Stephen Robinson

Eliminating Cervical Cancer is a Global Health Equity Challenge

Liberia stalls on lead rules, with children at risk

Challenges Confronting State Regulation Of Health Care Prices: Ten Questions

Gilead refuses to sell groundbreaking HIV prevention drug to MSF

What Doctors Want You to Know About Cicada, the Latest COVID-19 Variant

Seeing Everything from Nowhere: A Human Rights Assessment of the United Nations Food and Agriculture Organization’s Data Governance

Estimated effects of food taxes and subsidies on health, economics, and equity in Australia: a modelling study

Why Health Taxes Alone Won’t Fix Malnutrition in Poor Countries

Hundreds of thousands of Rohingya refugees in Bangladesh face food aid cuts

When Seeds Carry Memory: On Indigenous Spirituality, Biodiversity Conservation, and Sustainable Food Systems in Wayanad

EMA consults on virtual control groups to help reduce animal use in medicines development

Modernising our approach to tackling the rising wildfire threat

US has caused $10tn worth of climate damage since 1990, research finds

Climate change is altering Saharan dust – and Europe is downwind

 

 

 

 

 

IN A NUTSHELL
Author's Note 
...Gaza may be remembered not only for its destruction, but for what it revealed: the exhaustion of a global order that can no longer reconcile its claims with its actions.

The United States and its allies may retain power, but legitimacy has been profoundly eroded. Emerging powers critique but do not transform.

What lies ahead may be uncertain and unstable—but also transformative: a transition toward a post-oil, post-hegemonic world grounded in interdependence, ethical coherence, and grassroots action...

By Juan Garay

Co-Chair of the Sustainable Health Equity Movement (SHEM)

Professor/Researcher of Health Equity, Ethics and Metrics (Spain, Mexico, Cuba, Brazil)

Founder of Valyter Ecovillage (valyter.es)

By the same Author on PEAH: see HERE

Gaza and the End of a Moral Order

Energy, Power, and the Emergence of a Post-Hegemonic World – and the Prospect of a New Global Life Expectancy Decline

 

The destruction of Gaza is no longer only a humanitarian catastrophe; it is a historical rupture. What is unfolding has been increasingly described, in legal and academic arenas, as genocide, and it is reshaping the global order with a clarity that decades of diplomacy failed to produce.

According to the United Nations Office for the Coordination of Humanitarian Affairs and data referenced across the United Nations system, reported deaths have exceeded 30,000. However, this figure is widely considered an underestimate due to missing persons under rubble and indirect deaths from starvation, disease, and collapse of health systems. Analyses published in The Lancet and other academic sources suggest that the true death toll could plausibly exceed 100,000 when indirect mortality is included. The International Court of Justice has already determined that claims under the Genocide Convention are “plausible,” ordering provisional measures to prevent further destruction. The legal process continues; the moral collapse is already evident.

War, Oil, and the Machinery of Control

To understand Gaza is to move beyond Gaza. The strategic alignment between the United States and Israel reflects a broader architecture of military and economic control over the Middle East—still central to global oil reserves and maritime trade routes. These routes remain essential not only to Western economies but also to energy flows toward China.

The United States maintains a vast global military infrastructure—over 750 overseas bases—ensuring its capacity to project power across these corridors. This system has long underpinned both the dominance of the U.S. dollar and the stability of fossil-fuel-dependent global trade.

Yet this architecture is now under strain. Regional escalation, including tensions involving Iran and disruptions across key maritime chokepoints, has contributed to volatility in oil markets (International Energy Agency) and growing uncertainty in global supply chains. The result is not simply higher prices, but the exposure of a fragile, overextended system.

A Decadent Convergence: West and East in Fossil Dependence

Paradoxically, the emerging global divide does not represent a clean ideological rupture. Instead, it reveals a shared dependency. On one side, the U.S.–European Union axis remains deeply tied to fossil-fuel consumption and military enforcement of supply lines. On the other, the Russia–China alignment rests on its own fossil-fuel interdependence.

This is not a clash between systems, but a convergence within a declining paradigm. Both poles are structurally embedded in a fossil-fuel order that is ecologically unsustainable and geopolitically destabilizing.

This diagnosis echoes classical philosophical warnings. Plato cautioned that societies collapse when excess—of wealth, power, or desire—surpasses ethical limits. Modern industrial civilization appears to have crossed such thresholds.

Institutional Failure and the End of Credibility

The paralysis of the United Nations Security Council has rendered it ineffective in preventing or halting mass atrocities. International legal mechanisms lack enforcement capacity when confronted with geopolitical power.

Human rights organizations such as Amnesty International and Human Rights Watch continue to document violations, yet accountability remains absent. The gap between normative frameworks and political action has rarely been so stark.

For many across the Global South, this moment confirms that the post-war order is not universal, but selectively applied.

Fracture, Realignment, and the Limits of Power

Countries such as Brazil have emerged as vocal critics, yet lack sufficient leverage to reshape the system. Meanwhile, Russia remains absorbed in Ukraine, and China prioritizes economic continuity.

This creates a vacuum: a declining hegemonic order without a coherent successor.

Economic Contradictions of Late Capitalism

The current crisis reflects structural tensions within global capitalism. Amartya Sen emphasized that development must be measured in human capabilities and freedoms. Thomas Piketty demonstrated the systemic concentration of wealth and power.

The devastation in Gaza reflects a system where strategic and economic priorities override human well-being.

The Energy Shock and the Beginning of the End

The weakening of stable oil flows from the Middle East reinforces price volatility, disrupts trade, and accelerates fragmentation of globalization. At the same time, it exposes a deeper contradiction: both Western and Eastern blocs remain locked into fossil-fuel dependency.

This shared reliance signals not strength, but systemic decadence.

A New Global Health Signal: Toward Another Decline in Life Expectancy?

This geopolitical crisis unfolds after an unprecedented global health setback. Data from the World Health Organization indicate that global life expectancy fell by approximately 1.8 years between 2019 and 2021 due to the COVID-19 pandemic, disproportionately affecting vulnerable populations.

Although a partial recovery has occurred after 2022, analyses aligned with the Sustainable Health Equity Movement show that global health inequities have widened, and overall burden of disease remains elevated.

The next release of the United Nations Department of Economic and Social Affairs World Population Prospects—reportedly postponed to 2027—will be critical. It may reveal whether the combined effects of pandemic aftermath, war-driven economic disruption, rising energy prices, and reduced global trade are triggering a second, structurally driven decline in global life expectancy which will probably link to the progressive impact of global warming into the second half of the XXI century, marked by human life decline parallel to its ecocidal impact on other life in the planet.

Ethics of Peace and the Failure of Power

The present moment stands in stark contrast to ethical traditions of nonviolence and justice. Mahatma Gandhi, Martin Luther King Jr., and Nelson Mandela articulated visions of peace grounded in justice, dignity, and reconciliation—principles largely absent in current geopolitical strategies.

Beyond Hegemony: The WISE Paradigm and Grassroots Futures

Emerging alternatives are being articulated outside traditional power structures. The WISE paradigm—Wellbeing, Inclusion, Sustainability, and Equity—outlined in WISE paradigm article and expanded in We Have a Dream proposes a systemic shift away from extractive and hierarchical models.

This aligns with the work of the Sustainable Health Equity Movement, whose webinars emphasize ethical coherence, sustainability, and equity.

Across the world, grassroots networks—low-consumption communities, localized economies, and cooperative systems—are beginning to embody these principles.

A World After Legitimacy

Gaza may be remembered not only for its destruction, but for what it revealed: the exhaustion of a global order that can no longer reconcile its claims with its actions.

The United States and its allies may retain power, but legitimacy has been profoundly eroded. Emerging powers critique but do not transform.

What lies ahead may be uncertain and unstable—but also transformative: a transition toward a post-oil, post-hegemonic world grounded in interdependence, ethical coherence, and grassroots action.

 

References 

United Nations OCHA. Occupied Palestinian Territory – Gaza emergency reports. https://www.ochaopt.org

United Nations. Gaza crisis updates. https://www.un.org

The Lancet. Counting the dead in Gaza: difficult but essential. 2024. https://www.thelancet.com

International Court of Justice. Application of the Genocide Convention (South Africa v. Israel). https://www.icj-cij.org

World Health Organization. Global life expectancy losses due to COVID-19. https://www.who.int/news/item/24-05-2024-covid-19-eliminated-a-decade-of-progress-in-global-level-of-life-expectancy

Institute for Health Metrics and Evaluation. Global Burden of Disease Results. https://www.healthdata.org

United Nations DESA. World Population Prospects. https://population.un.org/wpp

International Energy Agency. World Energy Outlook. https://www.iea.org

Stockholm International Peace Research Institute. Military Expenditure Database. https://www.sipri.org

Garay J. The WISE Paradigm. PEAH. 2023. https://www.peah.it/2023/12/12800/

Garay J. We Have a Dream. PEAH. 2026. https://www.peah.it/2026/01/we-have-a-dream/

 

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

Vulcano island, Italy

News Flash 658

Weekly Snapshot of Public Health Challenges

 

The Decade Dividend  by Philip J. Gover 

Neoliberal Epidemics, part 1 “The Inequality Machine”  by Ted Schrecker

UN Classes Slave Trade as ‘Gravest Crime Against Humanity’

Pandemic Talks: Europe is Blocking Health Equity – And It Knows It

World TB Day 2026

Dr Jeremiah Chakaya Muhwa: Championing care for disabilities resulting from tuberculosis

Dr Obioma Chijioke-Akaniro: Eliminating TB through research and capacity building

Tackling zoonotic tuberculosis through the One Health approac

WHO recommends new diagnostic tools to help end TB

A R60 test could help SA test millions more TB patients — but will it miss the most dangerous cases?

MSF demands sustained investments and political will to end neglect of children with tuberculosis

How TB Treatment Decision Algorithms Help Diagnose Children: A Paediatrician’s Experience

Tuberculosis Cases and Deaths Averted by PEPFAR

Social protection for tuberculosis—how can we make it universal?

How a boy born on World TB Day helped turn the tide on SA’s deadliest form of TB

Global Vaccine Security Still Needs International Cooperation: Are Middle Powers the Key?

Documenting global Insulin Shortages and Stockouts 2023–2025: Comprehensive overview using various data sources

MPP presents its new visual identity reflecting the evolution of its mission and mandate

HRR810. CHARACTERIZATION OF MANY A POLITICIAN YOU KNOW. (Mauricio Vargas)

Encouraging progress in inclusive health policies for refugees and migrants

When Conflict Enters the Womb: Maternal Health-Seeking in Manipur’s Fragile Setting

From pain to policy: Improving endometriosis awareness, diagnosis, and treatment

Funding Down, Temperatures Up: The Struggle to Protect Women in a Warming World

UN to Help Nations Value Critical Minerals for Taxes (1)

As East Africa’s Migratory Fish Vanish, a Food Security Crisis Surfaces

New Dietary Guidelines Neglect The Health Risks Of Food Processing And Packaging

The myth of meritocracy: why universal water access is a prerequisite for a fair society

‘Flashing Red’: Extreme Weather Events Challenge Most of the Globe in 2025

Air Quality Worsens Globally – Share of Cities Meeting WHO Guidelines Declines

Toxic fallout from Gulf war ‘could last decades’

 

 

 

IN A NUTSHELL
Editor's note
PEAH is pleased to publish a manuscript here as the first part of a two-part posting based on the new edition of Ted Schrecker and Clare Bambra's book How Politics Makes Us Sick: https://link.springer.com/book/10.1057/978-1-349-96127-6

By Ted Schrecker

Emeritus Professor of Global Health Policy, Newcastle University

By the same Author previously on PEAH: see HERE 

Neoliberal Epidemics, part 1

“The Inequality Machine”

 

“The inequality machine is reshaping the planet,” wrote the editor of Le Monde Diplomatique in 2013.  The following year Christine Lagarde, then Managing Director of the International Monetary Fund, warned that: “There has been a staggering rise in inequality – 7 out of 10 people in the world today live in countries where inequality has increased over the last three decades. … If we are not careful, the ghosts of the 19^th century will haunt the 21^st century.”  (The irony that the IMF had done so much to create the increase in inequality in low- and middle-income countries through its structural adjustment programs was apparently lost on her.)  Those ghosts now haunt much of the world, with far-reaching implications for health inequalities.

In 2025 colleague Clare Bambra and I published the second, expanded edition of our book How Politics Makes Us Sick: Neoliberal Epidemics.  A decade of accumulated evidence since the first edition appeared in 2015 further supported our core argument that health inequalities driven by interconnected epidemics of inequality, insecurity and austerity can only be explained with reference to neoliberalism, which by the mid-1990s had become “the central ideological force in the Western world”¹ and if anything has since strengthened its hold on political imaginations and political processes alike.  As in the book, most of the examples used here are drawn from the United States and the United Kingdom, the two large rich countries that have travelled farthest down the neoliberal path.  They are not outliers so much as warnings of what is to come – a point to which we in Canada do not pay nearly enough attention.

The reach of the inequality machine is truly global, as documented in the indispensable World Inequality Report 2022.  Gabriel Zucman won the 2023 John Bates Clark medal of the American Economic Association, and is one of the lead researchers at the World Inequality Lab, which produced the Report.  He has shown the scale of the machine’s impact by calculating that the wealth of the world’s US dollar billionaires (about 2,900 households, roughly one in a million worldwide in 2024) grew from a figure comparable to 3 percent of global GDP in 1987 to almost 14 percent in 2024.  In the United States, New York Times journalists recently reported that the number of billionaires increased from 200 in 2004 to more than 900 in 2025, enabled most recently by rising share prices and the personal and corporate income tax cuts passed during the first Trump administration (and now extended).

At the other end of the economic spectrum, a 2020 RAND Corporation study concluded that: “Fundamentally, the majority of workers did not share in the benefits of economic growth to any significant degree” between 1975 and 2018.  Far from trickling down, the benefits of growth in the US were trickling upwards: labour market changes and tax policy redistributed at least US$47 trillion from the bottom 90 percent of the income distribution to the top 10 percent.  A later update found that the trend intensified between 2018 and 2023.  Many workers for 20 large US service sector employers like Wal-Mart are paid so little that they are eligible for food stamps (government vouchers for groceries) and Medicaid (the public health insurance program for the very poor).  In its annual survey of US households, the Federal Reserve Board found in 2023 that “13 percent of all adults said they would be unable to pay” an emergency expense of $400 “by any means,” including borrowing or selling assets.

In the United Kingdom the number of workers on zero-hours contracts, which guarantee no minimum hours of work in a given week, more than quintupled from 168,000 is 2010 to 1,059,000 in 2020.  The number of people living in destitution, the most extreme form of poverty, more than doubled  from 1.55 million in 2017 to 3.8 million in 2022. And in Canada one-quarter of the population “lived in households that reported experiencing some form of food insecurity” in 2023, including almost half the country’s single-parent households.  One in ten residents of Toronto, Canada’s largest city, visited a food bank at least once in 2023 – this in a country where the top one-thousandth (0.1 percent) of the country’s households own more than 11 percent of the country’s overall wealth.

What has all this to do with health?  In  Stockton-on-Tees, a small deindustrialized city described by the BBC in 2018 as “England’s most unequal town,” the pre-pandemic difference in life expectancy between wards (small areas with populations of a few thousand) was comparable to the difference in national average life expectancy between England and Tanzania. The graphs show a strong correlation between lower life expectancy and a more deprived population (triangles, right-hand vertical axis) – a socioeconomic gradient that is almost ubiquitous. In the US, where the effects of material deprivation are compounded by a long history of racial segregation and a health care system that rations most care on the basis of ability to pay, life expectancy differences are as high as 30 years.

Sir Michael Marmot, who chaired the World Health Organization’s Commission on Social Determinants of Health, wrote with colleagues in 2010 that: “It is hard to see how even ideologically driven commentators could think that having sufficient money to live on is irrelevant to health inequalities.”  (Sir Michael is a perennial optimist.)  Beyond obvious impacts of material deprivation such as food and housing insecurity, a variety of pathways connect “low social position” with negative health outcomes by way of what a far-reaching review by Dame Margaret Whitehead and colleagues called “loss of control over destiny.” A central point of our book is that neoliberalism is indispensable to explaining who ends up in low social positions, and how.

The physiological dimensions of chronic high levels of stress are crucial to understanding the pathways identified by Whitehead and colleagues, even as stress remains studiously neglected by most public health researchers – showing that they urgently need to rethink their entire methodological armamentarium.  The World Health Organization’s failure to consider poor socioeconomic circumstances as a risk factor for noncommunicable diseases in an action plan targeting mortality reductions by 2025 is another demonstration.  Above and beyond quotidian stresses associated with (for example) balancing multiple insecure jobs, unaffordable groceries and housing, and inadequate or nonexistent non-automotive transport, a broader loss of control arises from a political world where outcomes are increasingly predetermined by oligarchs and symbiotic semi-permanent political classes.  How these dynamics will play out in the near future is the topic of the second part of this posting.

 

Notes 

[1]  A. Przeworski et al., Sustainable Democracy (Cambridge: Cambridge University Press, 1995), p. 5. The book reported the findings of a multidisciplinary group of social scientists assessing the prospects for democracy after the fall of the Soviet Union.