2023: A Year in Review Through PEAH Contributors’ Takes

Contributors’ takes all over the 2023 meant a lot to PEAH scope and aims. Find out here the relevant links whereby health access gaps and challenges worldwide are tackled from an equity based multidisciplinary perspective

 By Daniele Dionisio*

PEAH – Policies for Equitable Access to Health

 2023: A Year in Review Through PEAH Contributors’ Takes

 

Just at the beginning of a new year, I wish to pay homage to the many top thinkers, either stakeholders or academics, who contributed articles all over the 2023. My deepest gratitude goes to each of them. As invaluable food for thought, their insightful reflections meant a lot to PEAH scope and aims, while adding to debate worldwide how to equitably address health priority challenges (including, though not limited to, climate safeguarding, fair access to care, medicines and food, protection of disadvantaged/discriminated people and cultural diversity) from a view encompassing the policies, strategies and practices of all involved actors.

Find out below the relevant links:

Towards a WISE – Wellbeing in Sustainable Equity – New Paradigm for Humanity  by Juan Garay 

Scared New World  by Brian Johnston 

Scientific Perspectives on Climate Change and its Influence on the Spread of Infectious Diseases  by Nicolas Castillo

Frustrations of a Lifelong Global Issues Activist  by Claudio Schuftan 

Who Suffers Most: The Visibility of Children and Older People in Prison  by Philip J Gover 

The Effects of the Onslaught of COVID-19 and its Impact on the Environmental Laws  by Tanushree Mondal 

Snapshot of Food Fortification History in the United States  by Sharman Apt Russell 

Rapid Diagnosis of Dengue: a Crucial Tool in Global Healthcare  by Nicolas Castillo 

WHO, the Right to Health and the Climate Crisis – What Advice for the ICJ?  by David Patterson 

The Gray Houses Polio Eradication Initiative: A Case Study on Identifying and Vaccinating Hidden Children by Muhammad Noman 

Preparing for the Future: The Vitality of an Effective Testing Strategy in Future Pandemics  by Nicolas Castillo 

Karnataka Multisectoral Nutrition Pilot Project (2014-2018): Some Significant New Evidence Based Findings and Need for Further Research by Veena S Rao 

The “One Size Does Not Fit All” Podcast Series  by Biljana Grbevska 

Reflections About Public Private Partnerships (PPPs) in the Health Sector  by Raymond Saner

The Positive Impact of Artificial Intelligence in Future Pandemics  by Nicolas Castillo 

Making Billions for Billions: Unleashing the Power of Social Entrepreneurship  by Sumedha Kushwaha 

Earth Future: Time for a Global ‘Reset’!  by George Lueddeke 

Strategic Litigation and Social Mobilisation: Part of Public Health’s Advocacy Toolbox to Address the Climate Crisis  by David Patterson 

Lessons Learned from the COVID-19 Pandemic: Prioritizing the Health and Well-being of Refugees and Migrants in Libya  by Meftah Lahwel 

The Value of Communication in a Pandemic  by Nicolas Castillo 

Refugees and Migrants Access to Healthcare in Libya: Challenges and the Way Forward  by Meftah Lawhel 

Workshop: Engaging Women in Nature-Based Solutions to Improve Livelihood, Ecosystem Conservation; Resilience to Climate Change and Peace Building in Bugesera; Rwanda  by Innocent Musore 

Forgone Health Care Among Patients With Cardiovascular Disease  by Kirubel Workiye Gebretsadik 

The Covid-19 Pandemic as Tipping Point (Part 2) by Ted Schrecker 

Epidemiological Surveillance in Pandemics  by Nicolas Castillo 

The Level of Awareness and Impact of Ebola Outbreak on Access, Use and Adherence to HIV Treatment and Preventive Care, Psychological and Socioeconomic Well-Being of Female Sex Workers in the Ebola High Risk Districts in Uganda by AWAC Uganda 

The Covid-19 Pandemic as Tipping Point (Part 1)  by Ted Schrecker 

SEE WHAT MATTERS: Combating Stigma to End HIV/AIDS in Eastern Europe and Central Asia (EECA)  by Olga Shelevakho 

Balochistan Primary Healthcare: What Has Been Done and What Needs to Improve?  by Muhammad Noman 

Decision Makers’ Perception of the Performance and Salary of UC Polio Officers in Pakistan  by Muhammad Noman 

A Renewed International Cooperation/Partnership Framework in the XXIst Century  by Juan Garay 

Polio Eradication Programme in Pakistan: Critical Analysis from 1999 to 2023 by Muhammad Noman 

UNMET HEALTHCARE by Kirubel Workiye Gebretsadik

Effective Communication in Pandemics: Lessons Learned from Covid 19  by Nighat Khan 

START: Stop Tobacco with Assistance and Recover Today  by Sumedha Kushwaha 

Shifting Sands – Health in a Changing World  by Brian Johnston 

Risk Factors or Determinants: The NCDs Debate by Claudio Schuftan 

Oregon’s Health Equity and Additional Equity Focuses  by Susan M. Severance

 

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

2022: A Year in Review Through PEAH Contributors’ Takes  by Daniele Dionisio

Not Utopia: Healthy Lives for All in Post-Pandemic World  by Daniele Dionisio

Right to a Healthy Environment Global Coalition -which PEAH is a member- Wins UN Human Rights Prize  by Daniele Dionisio

 

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

 

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*Daniele Dionisio is a member of the European Parliament Working Group on Innovation, Access to Medicines and Poverty-Related Diseases. Former director of the Infectious Disease Division at the Pistoia City Hospital (Italy), Dionisio is Head of the research project  PEAH – Policies for Equitable Access to Health. He may be reached at: danieledionisio1@gmail.com  

 

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

G2H2Geneva Global Health Hub

CEHURD – Center for Human Rights and Development

Center for the History of Global Development

Viva Salud

Asia Catalyst

MEZIS

ATTAC

Wemos

Social Medicine Portal

Health as if Everibody Counted

COHRED’s Research Fairness Initiative (RFI)

AFEW International

TranspariMED

Medicines and Ethics, Institute of Tropical Medicine, Antwerp

Alliance of Women Advocating for Change (AWAC) 


Want to Contribute an Article to PEAH?

PEAH-Policies for Equitable Access to Health aims to tackle ALL health priority challenges relevant to -though not limited to- climate safeguarding, fair access to care, medicines and food, disadvantaged/discriminated people and cultural diversity protection from a view encompassing the policies, strategies and practices of all involved actors.

Inherently, PEAH focus encompasses the best options for use of trade and government rules, the effects of current international agreements and intellectual property standards, the opportunities offered by new financing mechanisms and innovation models, and the ways for better coherence, coordination and collaboration among stakeholders supposed to streamline access to health priorities

By Daniele Dionisio

PEAH – Policies for Equitable Access to Health

Want to Contribute an Article to PEAH?

 

A platform maintained by Daniele Dionisio*PEAH – Policies for Equitable Access to Health serves as an internationally oriented blog backed by academics and stakeholders from a number of organisations worldwide.

Not an indexed journal, PEAH runs without any monetary grant/funding/support. Nonetheless, it benefits from world scale audience actively coming to the website, while relying to date on around eight thousand regular followers whose numbers are on the rise on daily basis.

People from leading centres and institutions continue writing articles for PEAH, as shown by our Featuring section (see also links to 2022  2021 and 2020  external contributions).

WILLING TO CONTRIBUTE AN ARTICLE?

Spontaneous submissions in the form of articles, editorials and blogs are welcome. Pieces dealing with the priorities and challenges first and foremost in the resource-limited countries, including for fair access to high-quality health treatments and care, food, and for climate safeguarding would be to the point.

PEAH aims to face, indeed, ALL health priority challenges relevant to -though not limited to- climate safeguarding, fair access to care, medicines and food, disadvantaged/discriminated people and cultural diversity protection from a view encompassing the policies, strategies and practices of all involved actors.

Inherently, PEAH focus encompasses the best options for use of trade and government rules, the effects of current international agreements and intellectual property standards, the opportunities offered by new financing mechanisms and innovation models, and the ways for better coherence, coordination and collaboration among stakeholders supposed to streamline access to health priorities.

No editorial requirements nor limits as regards the length and structure of your contribution, and you are invited to incorporate references as hyperlinks directly in the text.

Upon editor’s acceptance, your manuscript will enjoy free of charge, immediate online publication for circulation throughout PEAH network** and sharing on social media platforms.

You are free to re-publish your piece from PEAH, provided that PEAH quotation as the original source is included together with proper web-link.

If you wish to contribute, please submit to PEAH editor at danieledionisio1@gmail.com

 

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

** PEAH network includes, among others, the EU Parliament Group on “Innovation, Access to Medicines and Poverty-Related Diseases”, representatives at the Italian Ministry of Foreign Affairs' Directorate General for Development Cooperation in Rome, leaders from academia worldwide, managers from emerging economies' drug industries and executives from UN agencies, Medecins Sans Frontieres and international NGOs, the Global Fund, Knowledge Ecology International, Indian Council of Medical Research, Quamed, Oxfam, SciDev.net, Devex, Health Property Watch, I-MAK, AFEW, Wemos, DNDi, the Italian National Institutes of Health,...

News Flash 553: Weekly Snapshot of Public Health Challenges

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

Cleaver wrasse (Xyrichtys novacula)

News Flash 553

Weekly Snapshot of Public Health Challenges

 

Wrapping up 2023 with some noteworthy medicines, law and policy developments

Climate Change, Conflict and Disease Outbreaks All Loom as Global Health Threats at Close of 2023

2023: The Year of Missed Opportunities

WHO officially recognizes noma as a neglected tropical disease

Going Public: The Unmaking and Remaking of Universal Healthcare By Ramya Kumar and Anne-Emanuelle Birn  Online by Cambridge University Press:  12 December 2023. Free online from 13th December 2023 – 27th December 2023

Where the Low Countries spend their development aid

DNDi 2023 Year in Review

Artificial intelligence workplan to guide use of AI in medicines regulation

WHO prequalifies a second malaria vaccine, a significant milestone in prevention of the disease

COVID-19 vaccinations shift to regular immunization as COVAX draws to a close

Tuberculosis and Inequality: How Race, Caste, and Class Impact Access to Medicines

Joint statement by the European Commission and the High Representative on International Migrants Day

EU reaches a major breakthrough towards a common system for managing migration

People’s Health Dispatch Bulletin #65 The siege on health in Palestine continues

Rethinking the role of humanitarian principles in armed conflict

Bridging the Gap between the Dual Burden of Homelessness and Cancer across Europe

How public health should bridge justice gaps, break silos and promote health co-benefits

Millions in Opioid Settlement Funds Sit Untouched as Overdose Deaths Rise

Uganda activists, lecturers and others fight harsh anti-LGBT law in court

HRR 709 THE CONCEPT OF SOCIALLY DETERMINED HEALTH OPPOSES THE DOMINANT EUROCENTRIC THEORIES OF INTERNATIONAL DEVELOPMENT

World Bank warns record debt levels could put developing countries in crisis

New South-South health cooperation initiative launched linking Africa and the Caribbean

How our health systems are doing: a work in progress and better prepared for future health crises

1 in 3 children in Afghanistan face crisis-level hunger after UK slashes aid

Vogliamo gabbie vuote: difendiamo gli animali e la democrazia

COP 28 adaptation accord blasted as ‘devoid of actionable commitments’

Africa: Historic Win or Climate Injustice? Experts Divided On What COP28 Means for Africa

COP28: The Beginning of the End on Fossil Fuels, and the End of the Beginning on Climate Finance

Watching the Arctic Melt, Meteorologist’s Experience on Icebreaker Oden

COP28 puts climate AI on global agenda

EU significantly off-track from 2030 climate goal, Commission warns

The intersections between climate change and noise pollution

Millets: The crop that could solve hunger and climate change

Peru’s Andean Peoples ‘Revive’ Water that the Climate Crisis Is Taking From Them

 

 

 

 

 

 

News Flash 552: Weekly Snapshot of Public Health Challenges

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

Mauve stinger (Pelagia noctiluca)

News Flash 552

Weekly Snapshot of Public Health Challenges

 

Towards a WISE – Wellbeing in Sustainable Equity – New Paradigm for Humanity  by Juan Garay

Plant Based Treaty’s Safe and Just report

Scared New World  by Brian Johnston 

Commission welcomes political agreement on Artificial Intelligence Act

COP28: Landmark Fossil Fuel Deal Falls Short of Phase-Out

COP28: Deal to ‘Transition Away’ From Fossil Fuels Agreed

Midnight Marathon at COP28 as Island Nations Confront a ‘Death Sentence’

COP 28 special edition: The summit crawls its way toward a hotly contested finish line

Scientific Perspectives on Climate Change and its Influence on the Spread of Infectious Diseases  by Nicolas Castillo

Deadly Super-Pollutant Black Carbon Has Evaded Global Attention So Far

Finance at COP28: After the Euphoria, Come Questions Galore

It’s Time To Align Climate Finance and Social Justice, Says Youth Climate Activist

Human trafficking, sexual abuse and exploitation: the ‘loss and damage’ from climate change a fund will not compensate

Good COP/Bad COP: It’s Not Easy Being Green

Restore Our Planet Podcast #37 Fighting Climate Change, fighting poverty. The Margaret Pyke Trust

Snapshots: How the climate crisis is hurting people in Central America

WHO calls for protection of humanitarian space in Gaza following serious incidents in high-risk mission to transfer patients, deliver health supplies

Censorship of grassroots voices at global health conference raises concerns

A new beginning: escaping the chains of domestic violence

Discovering Life Without Violence

How an Indian farmer uses sports to save girls from early marriage

Health effects associated with exposure to intimate partner violence against women and childhood sexual abuse: a burden of proof study

UN says Africa faces unprecedented food crisis, with 3 in 4 people unable to afford a healthy diet

The biggest philanthropy pledges at COP 28

HRR 708: WHEN MISFORTUNE BECOMES INJUSTICE, HUMAN RIGHTS AND SOCIAL EQUALITY STRUGGLES CANNOT BUT BE THE COROLLARY

First version of the Union list of critical medicines agreed to help avoid potential shortages in the EU

WHO Statement on the antigen composition of COVID-19 vaccines

Gavi pledges US$1bn for African vaccine manufacturing

Verification of the active pharmaceutical ingredient in tablets using a low-cost near-infrared spectrometer

Anthrax is Spreading in Zambia and Neighbouring Countries

 

 

Towards a WISE – Wellbeing in Sustainable Equity – New Paradigm for Humanity

What is the alternative to current world disarray? The ethics, concept, and metrics of the new world order economy based on Wellbeing in Sustainable Equity -WiSE- prove that a new political and socio-economic order is urgently needed and is feasible, which can preserve and advance human knowledge, avert the tragic constant death toll of global health inequity, and avert the climate disaster and ecological destruction threatening the very future of coming generations

By Juan Garay

 Professor of ethics and metrics of health equity in Spain (ENS), Mexico (UNAChiapas), and Cuba (ELAM, UCLV, and UNAH)

Co-founder of the Sustainable Health Equity movement

Towards a WISE – Wellbeing in Sustainable Equity 

New Paradigm for Humanity

 

"As the present now will later be past, the order is rapidly fadin'"

 

The post-World Wars era, referred to as the European wars by the Chinese, is drawing to a close. It commenced with the Universal Declaration of Human Rights and the establishment of the United Nations (biased by the war-winning side) 75 years ago. It is slowly concluding with a major ideological confrontation between the global north (with the “western” epicentre between the USA and Western Europe) and the global south (with its “eastern” epicentre between Russia, China, and India). These groups are neither geographically clear (the West is linked to Japan and Korea, while the East includes Brazil, for instance) nor ideologically compact (the West champions “free-market economies,” but there is a wide scope in market regulation within, while the East has a stricter centrally planned economy yet communist systems are gradually embracing free markets – notably and most efficiently, China). What may differentiate the two epicentres most is the focus on the main value of anthropocentric and individual life and freedom in the West (linked to capitalism), probably rooted in hierarchical monotheisms, versus the principle of human-nature interconnectedness and collective good in the East (linked to communism).

The first half of the post-war era polarized the world between the USA and the USSR’s extreme economic systems, defended with massive military and nuclear power during the Cold War, with each counting on historical allies (USA with Western Europe and related countries while USSR with China). They reached out to other regions (USA to Latin America, the USSR to South Asia) and competed for influence and links to natural resources in Africa and the Middle East, where such tension led to greater instability and conflict.

The second half of this era, fading as argued below, was preceded by the Washington consensus, and triggered by the fall of the Berlin Wall. This gradually shifted, at least for three decades, the bipolar dynamics to a multipolar system with still one centre around Washington and the G7, and the other with Moscow and Beijing, with a growing role of other economies of large countries clustered around BRICS and later the G20. The USA and Russia kept their military power and tension between them, mainly around the shifting eastern border of Europe. Both, while endowed with oil reserves, focused on influencing the main oil sources in the Middle East, with the USA influencing Saudi Arabia and neighbouring emirates while Russia got closer to Iran. Meanwhile, China gradually dominated the rare earth metals, critical to renewable energy sources and storage. The European Union gradually became dependent on USA security through NATO, on Russian oil and gas energy, and on the trade dynamics with and versus China.

Just after the fall of the Berlin Wall, the equator of this post-war era, the AIDS pandemic ravaged the world, mainly Africa, and exposed the deep gap in the basic right to life between high-income countries, clustered around the Western axis, and low-income countries, mainly in Sub-Saharan Africa. AIDS shamefully revealed, by the turn of the century, how the massive profits of wealthy economies overruled the life of some 30 million people[1], mostly in Africa, who died lacking access to high-priced lifesaving drugs. In parallel, the collapse of the Soviet Union meant some 7 million excess deaths[2], mostly young men, while the economic rise of China reduced a similar figure from the mortality trend well before its economic growth in the 90s[3].

During this second half of the post-world-war era, Humanity saw the rise of the internet, boosting the speed of human communication, enabling exponential growth and the power of financial operations and speculation deeply linked to media influence and global production, trade, and consumption. In parallel, combining the Washington consensus blessing (or state-hands-off) of the speculative economy and the link to the progressive concentration of financial-media powers, economic and health/wellbeing equity stalled, and the burden of global health inequity remained since then at a level of 16-18 million deaths-by-global-injustice mainly in low-income countries, one third of all deaths, every year (when disaggregated by subnational analysis, the figure may double). Meanwhile, the growing evidence of man-made climate impending disaster which, at present trend, would mean over 200 million excess deaths in non-polluting countries[4], called for global collaboration to roll back global warming, yet with commitments lagged in time and far below the necessary speed of the transition to the post-oil era.

In the last five years, the world saw the impact of the Covid pandemic, where still the rich countries hoarded vaccines[5], and the blast of wars in the cold war battlefields of Eastern Europe (Ukraine) and the Middle East (Gaza). While in the former, the world’s majority did not side with Russia, in the latter the USA and its European allies were the minority in being complacent with Israel genocide and voting or even vetoing against a ceasefire.

In the midst of the growing political and economic gap between rich and poor, west and east, north and south, three vital decisions for the future of humanity corner the wealthy north, questioning its real commitment to the Universal Declaration of Human Rights 75 years ago: the negotiations of the pandemic Treaty to better respond globally to likely future pandemics, where the rich north restricts the use of knowledge and patents to save life above profits, again, the discussions at the Dubai COP 28 where emissions will remain in rich countries far above the ethical threshold bounding Humanity to the 1.5 degrees increase of no return, and the recent vote to start negotiations towards a UN tax treaty aimed at preventing financial flows to tax havens benefiting the very rich. Such is today the “world disorder” of growing economic injustice translated into excess mortality in low-income countries and communities, fake global democracy hijacked still by security council veto powers, and ecological impending disaster given the complacent low and lagged commitments in reducing carbon emissions.

What are the root causes of this world disarray? Individual and collective greed seem to have taken grip of humanity, north and south, east, and west. The expansion of capitalism and the alliance of virtual realities and communication means dominated by financial powers have swamped human consciences globally with biased data and competitive dynamics, paradoxically championed as freedom beacons. With biased information and knowledge and shrinking empathy, the human inner nature of making free and conscious choices towards common good seems, though difficult to measure, to be in rapid decline in favour of individual (competition and consumption) and collective (nationalism and corporate interests) selfishness.

What is the alternative? The ethics, concept, and metrics of the new world order economy based on Wellbeing in Sustainable Equity -WiSE- prove that a new political and socio-economic order is urgently needed and is feasible, which can preserve and advance human knowledge, avert the tragic constant death toll of global health inequity, and avert the climate disaster and ecological destruction threatening the very future of coming generations. The following ten steps of analysis and action are proposed towards that urgent and ethical change:

  1. The most cherished human aspiration across cultures and times is to have, and so their descendants, long and healthy lives.
  2. Such aspiration is captured in Article 25 of the Universal Declaration of Human Rights – a standard of living adequate for health and well-being – and further defined in the constitutional objective of the World Health Organization: the best feasible level of health for all people, the only common global health objective shared by all UN member states[6].
  3. The best feasible (also for coming generations: sustainable) level of health-wellbeing has not been defined. Such a level can be defined as the best levels of wellbeing – measured by life expectancy at birth – which are feasible according to the two main limited resources – interrelated: economic (lower than the world average GDP pc) and ecological (below planetary boundaries)[7].
  4. The identification of human group references of wellbeing in sustainable equity (WiSE) enables the identification of social, economic, and cultural-philosophic dynamics that may orient global collaboration towards a fair and sustainable order.
  5. The comparison of mortality rates by country, age group, sex, and time period[8] of the WiSE models with the rest of the world allows the estimation of the gap from the common global health objective, through the burden of health inequity, now standing at some 16 million excess deaths per year, some 30% of all[9].
  6. Such models can also identify the income level (correlated with wealth and assets) below which no country has, in the last 60 years of comparable records, been able to enjoy those best feasible levels of health. We name such an income minimum level as the dignity threshold enabling the universal right to health, that is, to the best feasible level of health for all, and which stands today at some $10 per person and day (constant value, variable in purchasing power parity), which should be considered in the discussions around the universal basic income[10].
  7. The present dignity gap to enable countries with GDP pc below the dignity threshold (deficit countries) to have sufficient economic resources to aim at the best feasible level of health is of some $7 trillion, calling for fair redistribution of some 7% of the world´s GDP, similar to the level of annual oil subsidies[11].
  8. The above figure is 4 times less than the average internal GDP redistribution in high-income countries[12] through fiscal and public financing policies yet 20 times lower than the very low levels of development cooperation, which is progressively linked to northern private sector investments often disconnected to country needs[13].
  9. There is an excess threshold income-GDP pc above which there is no country that has ever respected planetary boundaries (including the CO2 emissions ethical threshold of annual 1.6mTn pc), and wellbeing measured by life expectancy at birth does not increase any further. The excess threshold stands today at some $50 per person and day. The GDP above such a level, called in other comparative analysis “waste GDP”[14], is in the region of 60% of the total world GDP, which is also responsible for the 90% of carbon emissions. Even after fair redistribution potentially preventing 16 million annual deaths, simpler lives in terms of production, trade, and consumption could reduce carbon emissions below the ethical threshold and free resources for collaborative research into global public goods.
  10. The negative effects of excess income-wealth accumulation (preventing fair redistribution and much of the burden of health inequity) and excess carbon emissions (leading to the above-mentioned levels of excess mortality due to global warming) can be estimated and deducted from the levels of wellbeing-birth expectancy at birth, hence combining the individual wellbeing with the negative collective effects in the wellbeing in sustainable equity index which challenges the UN human development index (where none of the top 10 ranked countries in the last 20 years has been economically replicable nor ecologically sustainable[15].

Towards that necessary transformation, the following actions are proposed at global, national, and community level governance and dynamics:

 

Endnotes

[1] Fact sheet – Latest global and regional statistics on the status of the AIDS epidemic. (unaids.org)

[2] Mortality in Russia Since the Fall of the Soviet Union (researchgate.net)

[3] An exploration of China’s mortality decline under Mao: A provincial analysis, 1950–80 – PMC (nih.gov)

[4] Health and Climate Change: a Third World War with No Guns – PEAH – Policies for Equitable Access to Health

[5] The Lancet, 30 May 2020, Volume 395, Issue 10238, Pages 1669-1738, e98-e100

[6] Global health: evolution of the definition, use and misuse of the term (openedition.org)

[7] Health Equity Metrics | Oxford Research Encyclopedia of Global Public Health

[8] The Global Health Equity Atlas unveiled (interacademies.org)

[9] Global Health Inequity 1960-2020 – PEAH – Policies for Equitable Access to Health

[10] IMF Fossil Fuel Subsidies Data: 2023 Update

[11] IMF Fossil Fuel Subsidies Data: 2023 Update

[12] Fiscal redistribution in the European union (worldbank.org)

[13] A Renewed International Cooperation/Partnership Framework in the XXIst Century – PEAH – Policies for Equitable Access to Health

[14] Wasted GDP in the USA | Humanities and Social Sciences Communications (nature.com)

[15] Global Health Inequity 1960-2020 – PEAH – Policies for Equitable Access to Health

 

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By the same Author on PEAH

A Renewed International Cooperation/Partnership Framework in the XXIst Century

COVID-19 IN THE CONTEXT OF GLOBAL HEALTH EQUITY

Global Health Inequity 1960-2020

Health and Climate Change: a Third World War with No Guns

Understanding, Measuring and Acting on Health Equity

Scared New World

Insightful reflections here on how the emergence of artificial intelligence and related technologies could impact the already serious problem of digital poverty and in turn negatively affect the health and wellbeing of millions of people

By Dr. Brian Johnston

Senior Public Health Intelligence Manager

London, United Kingdom

Scared New World

 

Despite what people say about death and taxes, the only truly inevitable part of life is change.  Artificial intelligence (AI), machine learning and cloud computing  are all important drivers for change in our modern world and seem destined to radically transform our existence for years to come.

Increasingly, data and how it is processed and analysed, shapes our lives in ways that we could not have predicted even a few years ago. Our world is in a constant state of flux and shows a rate of change that would have been labelled as ”science fiction” even a decade ago.

Like most engines of change, AI and its associated technological advances have received a mixed reception and this state of affairs is likely to persist for the foreseeable future. Tangible benefits from AI within the health sector are emerging, from enhanced logistics, improved digital patient record handling and image scanning for cancers, to name but a few. However, these benefits must be judged against a complex constellation of challenges within data governance, privacy and the potential threats posed by systems which automate and improve processes previously controlled by human beings alone.

Against this background, digital poverty, where people lack digital skills, access to suitable devices, connection to the internet, or the ability to get online regularly, remains a major barrier to personal and economic growth, both at an individual and societal level.

A recent report on Digital Poverty in the UK  described it as a “pervasive issue,” and estimated that between 13 and 19 million people in the United Kingdom aged 16+ are in digital poverty.

Digital poverty exerts its greatest impact on the most deprived people in society, who struggle to feed their families and heat their homes in the current worldwide economic downturn. Where digital poverty exists, it permeates most aspects of a person’s existence, in this world so heavily dependent on technology. Communication, education, health, entertainment, work, and many other facets of modern life, are often navigated on-line through devices which require access to data collected, processed, and distributed via digital media.

Even in affluent countries, with well-developed digital infrastructures, digital poverty remains an important, persistent, and ongoing problem, blighting the lives and aspirations of millions of people.

Limiting or reducing access to computing and its associated benefits, can impact a person’s ability to fully realise their life potential in a variety of ways –  by influencing the type and quality of work that they do, their lifestyle choices, how and where they live, the decisions they make in life, the quality of their relationships and ultimately their physical and mental health and wellbeing. So digital poverty can be regarded as a cancer eating away at the fabric of society;  largely unseen and seldom discussed, but nonetheless causing serious damage under the surface.

In developing countries, where access to computing and its benefits is denied to large portions of the population, the negative impacts of digital poverty are keenly felt. Similarly, in a competitive world, where data and computing skills are becoming increasing prized, digital poverty seems set to create and perpetuate existing inequalities, at both an individual and national level. Older adults, women and poor people are already more likely to experience the negative impacts of digital poverty and these inequalities are highly likely to worsen in the years to come.

The digital revolution currently blossoming as a result of AI and related technologies, whilst it will create wealth, opportunities, and advances in various fields of human endeavour, will also exact heavy costs. The pace of change catalysed by AI, will create an environment where access to digital devices and skilled knowledge in their use, may become a prerequisite to achieving a decent standard of living in many sectors of employment. Those experiencing digital poverty will find it difficult to ride the waves of change created by AI – to use a surfing analogy; they lack the surf board as well as the skills and experience to use it, so will be condemned to stand on the side lines, watching others joyfully riding the waves of success. From this perspective, AI can be seen as a catalyst for change, which exacerbates the already serious problem of digital poverty and deepens the divide between the digital “haves” and “have-nots.”

Like the first industrial revolution of the 18th century, this digital revolution energised by AI, may also encourage people to migrate from the countryside into cities. Especially in developing countries, where Wi-fi connectivity in remote rural areas can be lacking and the digital infrastructure required to effectively use AI is patchy or unavailable, there may be a greater impetus to travel and settle in cities.

The perception that access to job opportunities linked to AI related industries, may lift people out of poverty in rural areas, may act as a strong magnet drawing them away from agricultural production towards urban environments. In countries, where climate change is already making the land more difficult to cultivate, through droughts, erosion of top soil and encroaching desertification, the exodus of people from the land for economic reasons, may worsen an already dire situation and place intolerable pressures on local food production and distribution.

Furthermore, the migration of people from rural to urban environments is likely to negatively impact the resources and infrastructure of many cities and place increasing stress on their health and social care systems. The creation of economically excluded populations, forced to live in poor quality, overcrowded housing, could overwhelm the existing services provided by many cities, through the spread of infectious diseases. This scenario would have serious implications for the health and wellbeing of millions of people across the globe.

However, targeted investment in programmes to increase digital access and literacy, could promote a culture of levelling up, where the effects of digital poverty are reduced and the negative changes created by the AI digital revolution mitigated. The changes brought about by AI are likely to be many and far reaching, so if we are to lessen the impact on our physical and mental health and wellbeing, we should be prepared to act swiftly and decisively, in ways that yield tangible benefits for everyone, including the digitally dispossessed.

 

By the same Author on PEAH

Shifting Sands – Health in a Changing World

How to Combat Future Pandemics
 
The New Abnormal
 
Living with COVID in a Transformed World

  Death in the Time of COVID

  Unleashing the True Potential of Data – COVID-19 and Beyond

 

 

Scientific Perspectives on Climate Change and its Influence on the Spread of Infectious Diseases

This article addresses the intricate interactions between climate change and the spread of infectious diseases, highlighting key scientific perspectives. The mechanisms through which climate change influences the epidemiology of these diseases are examined, considering climatic variables, changes in vector patterns, and pathogen adaptation. Additionally, the relationship between extreme weather events and the occurrence of epidemic outbreaks is explored. Findings reveal the necessity of integrated approaches and public health policies to mitigate emerging impacts on global health

By Nicolás Castillo

 Biochemical. Private Laboratory Santa Clara de Saguier Sanatorium, Santa Fe, Argentina 

Scientific Perspectives on Climate Change and its Influence on the Spread of Infectious Diseases

 

Introduction

The phenomenon of climate change has emerged as one of the most pressing challenges of the 21st century, generating profound and widespread effects on natural and social systems. Amidst the complexities of its ramifications, an increasingly evident connection manifests in the realm of global health: the intricate relationship between climate change and the spread of infectious diseases. This article delves into the depths of this intertwining, exploring fundamental scientific perspectives that illuminate the magnitude and complexity of these interactions.

The epidemiology of infectious diseases has become a constantly changing puzzle, and climate change stands as a determining factor shaping this dynamic landscape. Examining climatic variables as driving forces for disease spread, from equatorial regions to the poles, becomes a crucial task. This article meticulously breaks down the mechanisms through which climate change affects temperature, precipitation, and humidity patterns, and how these variables, in turn, impact the expansion of infectious diseases.

Vectors, essential vehicles for disease transmission, are directly affected by climate disruptions. Changes in the migration and distribution patterns of vectors such as mosquitoes and ticks can create new areas conducive to the spread of diseases that were previously confined to specific regions. Similarly, pathogen adaptation to changing climatic conditions presents an additional challenge, altering the virulence and survival capacity of infectious agents.

The article also ventures into the realm of extreme weather events, exploring their role as catalysts for sudden epidemic outbreaks. Floods, droughts, and intense storms not only directly alter environmental conditions but also trigger population displacements and disruptions in health infrastructures, facilitating the rapid spread of infectious diseases.

Climate Change and the Epidemiology of Infectious Diseases

Climate change directly impacts the epidemiology of infectious diseases by altering environmental conditions conducive to the proliferation of pathogens. Variations in climatic variables, such as temperature increases, changes in precipitation patterns, and modifications in humidity, exert a significant influence on the geographical distribution and frequency of infectious disease outbreaks. This phenomenon not only expands geographical areas conducive to the transmission of existing diseases but also creates environments conducive to the emergence of new pathogenic strains.

Impact on Vectors and Pathogen Adaptation

Vectors, organisms transmitting diseases, respond directly to climate changes. Modifications in the migration and distribution patterns of vectors such as mosquitoes, ticks, and other insects generate the expansion of diseases previously limited to specific areas. Additionally, climate change drives the adaptation of pathogens to new environmental conditions, altering their biological characteristics and, in some cases, increasing their virulence. These adaptations represent an additional challenge for the prevention and control of infectious diseases.

Extreme Weather Events as Catalysts for Epidemic Outbreaks

Extreme weather events, such as floods, droughts, and intense storms, not only have direct impacts on affected communities but also trigger sudden epidemic outbreaks. The destruction of health infrastructures, population displacement, and conditions conducive to vector proliferation contribute to the rapid spread of infectious diseases. These extreme events not only generate short-term health crises but also establish conditions for the persistence and sustained spread of diseases in the future.

Need for Integrated Approaches and Public Health Policies

Findings here emphasize the urgency of adopting integrated approaches and public health policies to address emerging challenges resulting from the interaction between climate change and infectious diseases. Collaboration between scientific communities, health institutions, and governments is essential to develop preventive and mitigation strategies. Additionally, the importance of public education on the relationship between climate change and health is highlighted, aiming to encourage the adoption of behaviors that reduce disease spread. 

Discussion and Alert on Possible Epidemic Outbreaks

The discussion of these findings leads to an unavoidable conclusion: the need to be vigilant against possible epidemic outbreaks in a context of climate change. Climate variability and the intensification of extreme phenomena increase the probability of events that could trigger the rapid spread of infectious diseases. Enhanced epidemiological surveillance, early warning systems, and rapid response become crucial to prevent and mitigate the impacts of potential epidemic outbreaks.

Importance for Public Health

Addressing the intersection between climate change and infectious diseases is not only essential for short-term public health but also positions itself as a crucial strategy for long-term resilience and sustainability. Preventive action and planned adaptation can reduce the burden of diseases, protect vulnerable communities, and strengthen the response capacity of health systems. Ultimately, recognizing and acting on these scientific perspectives is fundamental to preserving global health in a world of constant climate change.

Reflections here seek to shed light on the multidimensional interactions between climate change and global health, focusing on infectious diseases as sensitive indicators of this phenomenon. By understanding key scientific perspectives, the door will be opened to informed integrated approaches and evidence-based public health policies, aimed at mitigating emerging impacts on the health of populations worldwide.

Conclusions

In conclusion, this article has explored the complex interactions between climate change and the spread of infectious diseases, providing a detailed insight into the underlying mechanisms and key scientific perspectives. The impacts of climate change on the epidemiology of these diseases are undeniable, ranging from the alteration of climatic variables to changes in vector patterns and pathogen adaptation. The intrinsic connection between extreme weather events and epidemic outbreaks adds an additional layer of complexity and urgency.

The influence of climate change on the spread of infectious diseases not only affects local communities but also presents challenges to global health. The need for integrated approaches and public health policies stands out as an imperative to mitigate emerging impacts and protect the health of populations worldwide.

The discussion of possible epidemic outbreaks under the influence of climate change highlights the importance of enhanced epidemiological surveillance, early warning systems, and efficient rapid response. Climate variability and the intensification of extreme phenomena increase the probability of events that could trigger the rapid spread of infectious diseases, emphasizing the need for preparation and planning.

Ultimately, this article advocates for a deep understanding of the intersection between climate change and public health, recognizing the importance of preventive action, planned adaptation, and global collaboration. In a constantly evolving world, the ability to preserve global health depends on our capacity to address these multidimensional interactions with informed approaches and effective strategies.

 

References

  1. Patz, J.A., Campbell-Lendrum, D., Holloway, T., & Foley, J.A. (2005). Impact of regional climate change on human health. Nature, 438(7066), 310-317.
  2. Haines, A., Kovats, R.S., Campbell-Lendrum, D., & Corvalán, C. (2006). Climate change and human health: Impacts, vulnerability, and mitigation. The Lancet, 367(9528), 2101-2109.
  3. McMichael, A.J., Woodruff, R.E., & Hales, S. (2006). Climate change and human health: Present and future risks. The Lancet, 367(9513), 859-869.
  4. Semenza, J.C., & Menne, B. (2009). Climate change and infectious diseases in Europe. The Lancet Infectious Diseases, 9(6), 365-375.
  5. Epstein, P.R. (2001). Climate change and emerging infectious diseases. Microbes and Infection, 3(9), 747-754.
  6. Altizer, S., Ostfeld, R.S., Johnson, P.T., Kutz, S., & Harvell, C.D. (2013). Climate change and infectious diseases: From evidence to a predictive framework. Science, 341(6145), 514-519.
  7. Harvell, C.D., Mitchell, C.E., Ward, J.R., Altizer, S., Dobson, A.P., Ostfeld, R.S., & Samuel, M.D. (2002). Climate warming and disease risks for terrestrial and marine biota. Science, 296(5576), 2158-2162.
  8. Rohr, J.R., Dobson, A.P., Johnson, P.T., Kilpatrick, A.M., Paull, S.H., Raffel, T.R., … & Thomas, M.B. (2011). Frontiers in climate change–disease research. Trends in Ecology & Evolution, 26(6), 270-277.
  9. Morse, S.S. (1995). Factors and determinants of disease emergence. Revue scientifique et technique, 14(1), 177-182.
  10. Jones, K.E., Patel, N.G., Levy, M.A., Storeygard, A., Balk, D., Gittleman, J.L., & Daszak, P. (2008). Global trends in emerging infectious diseases. Nature, 451(7181), 990-993.

 

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BY THE SAME AUTHOR ON PEAH 

Rapid Diagnosis of Dengue: a Crucial Tool in Global Healthcare 

Preparing for the Future: The Vitality of an Effective Testing Strategy in Future Pandemics 

 The Positive Impact of Artificial Intelligence in Future Pandemics 

The Value of Communication in a Pandemic 

Epidemiological Surveillance in Pandemics

Population Aging, a Challenge for Public Health in Latin America and the World

News Flash 551: Weekly Snapshot of Public Health Challenges

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

White seabream (Diplodus sargus sargus)

News Flash 551

Weekly Snapshot of Public Health Challenges

 

75 years after Universal Declaration of Human Rights: Time to recognize rights of future generations

Frustrations of a Lifelong Global Issues Activist  by Claudio Schuftan

Webinar registration: Improving Drug Regulation for Greater Access to Biologics and Vaccines Dec 8, 2023

Sexual health and well-being across the life course: Bulletin of the World Health Organization call for papers

People’s Health Dispatch Bulletin #64: Health crises unfold in Palestine, Sudan, Bangladesh

The ‘Climate Migration’ Narrative Is Inaccurate, Harmful, and Pervasive. We Need an Alternative

Who Suffers Most: The Visibility of Children and Older People in Prison  by Philip J Gover 

Opinion: This World AIDS Day, we need to stop criminalizing people with HIV

WORLD AIDS DAY 2023 – “LET COMMUNITIES LEAD”

Halting discrimination: International day of persons with disabilities

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Deciding the Fate of Billions: What’s Next for Gavi’s Unspent COVAX Funds?

Gavi Board must make catch-up vaccination a priority when allocating leftover COVAX money

NEW REPORT BY TAG AND STOP TB: TB R&D FUNDING PERILOUSLY OFF TRACK OF UN COMMITMENTS TO END TB BY 2030

Agriculture in Africa 2023 – Empowering Africa’s Youth and Women to Shape Sustainable Agri-Food Systems

Snapshot of Food Fortification History in the United States  by Sharman Apt Russell

WHO air quality database: relevance, history and future developments

The Effects of the Onslaught of COVID-19 and its Impact on the Environmental Laws  by Tanushree Mondal

Work Begins to Revive Britain’s Lost Rainforests

New report shows 10 lifesaving health products contribute 3.5 megatons of carbon emissions per year – while also being at risk from climate change

Cop28 president says there is ‘no science’ behind demands for phase-out of fossil fuels

COP 28 becomes first to focus on cycle of conflict and climate change

COP28 climate summit just approved a ‘loss and damage’ fund. What does this mean?

What should COP28 urge from multilateral development banks and their shareholders?

Beware Carbon Myopia at COP28: Why Climate and Nature Action Must Now Come Together in the Race for a Liveable Planet

Emerging Climate Finance Infrastructure to Match Africa’s Green Bankable Solutions

The debate over meat at COP 28, explained

Transition to Clean Cooking Is a ‘Low-Hanging Fruit’ in Climate Action

 

 

 

 

 

 

 

 

Frustrations of a Lifelong Global Issues Activist

 Back come to my memory, among other, the so many defeats I have lived through with so many others where and when things went sour for us tireless activists struggling for a fairer world. To name just a few: The Voluntary Guidelines on the Right to Food and those on Food Systems, the Food Systems Summit, reforming the CFS in FAO, the introduction of COVID at the Committee on Food Security in FAO, the Binding Treaty on TNCs and human rights being painfully negotiated for six years at the Human Rights Council, the UN’s Global Compact, WHO’s FENSA, the SUN Initiative, One Nutrition, COVAX, ETOs, the COVID waiver at WTO, 26 COPs since the Rio Earth Summit in 1992… on-and-on

By Claudio Schuftan

Freelance Public Health Consultant and Human Rights Activist  

Co-founding member of the People’s Health Movement

Ho Chi Minh Cityschuftan@gmail.com

Frustrations of a Lifelong Global Issues Activist

 

Frustrations brood, but they also make us rethink. Here I want to zero-in on the challenges we in social movements (have) chronically face(d) in relation to so unsuccessfully having tackled and continue to tackle global governance issues. The story of our lives has so often become a string of disappointments making us sometimes wonder: Are we made a laughing stock? Are we fooling ourselves that ‘things are going to be alright’? or Do we need to work in a totally different way given that the private sector has pushed our backs totally against the wall in rooms where governance issues are decided? Are smart young people going to pick up the challenges as we, old people, are going to phase out pretty soon?

Bringing relevant issues to mind (needed elements for a cool-headed analysis)

As public interest civil society organizations (PICSOs)(i) and social movements, we forever seek meaningful participation in global fora –beyond voice– in an effort to influence and strengthen the decisions that can lead to lasting legally binding changes. How many times, at what is left of true multilateral venues, do we find ourselves defending already earlier agreed language when we are ultimately most often ignored, for instance, at open-ended working group (OEWG) discussions at UN agencies? But, we keep trying, and..?:  …“I participate. You participate. He/she participates. We participate. but… They decide”. (chalkboard in Bolivia)

(i): I do recognize that some PICSOs are also part of the problem and act, not in the interest of their constituencies, and take the side of international NGOs and of rich member states, i.e., many PICSOs have bought-in into public private partnerships (PPPs) and multistakeholder platforms –take the UN’s Scaling Up Nutrition (SUN) initiative as an example that has attracted PICSOs. [PICSOs are to be distinguished from PINGOS and BINGOs (Private and Business Interest NGOs and front groups). BINGOs are, among other, backed by big powerful often Gates-funded international NGOs like Save the Children, Helen Keller, ILSI … ) who are brought in to implement and monitor UN resolutions].

So, we have to ask ourselves: When is PICSOs participation in these venues an instrument to manipulate us? I believe some opportunities-still-open are given us simply to give the illusion of genuine consultation/inclusivity –or to use the SUN Initiative’s depicting this as a true ‘dialogue’. They forget to tell us that the same opportunities are given to BINGOs(ii) who, from a position of much greater power, have learned how to word and position their interventions to serve their and their stockholders’ narrow interests. The language they use is now so deceptive that too few are able to tell that it is all a smokescreen. (Keep in mind here: New opportunities to better participate is not what we are ultimately striving for; we are striving for on-the-ground results). For that, therefore, are we truly challenging the dominant narratives by truly bringing people’s experiences, evidence and apprehensions into the global negotiation space? I would say no; we are rather banging our heads against multiple walls –one after the other… Are we thus wasting our time? How many more boils and bruises can we take? The sad truth is that, if we are not there yet, the omnipresent global controlling forces can shamelessly go right ahead with no worries.(ii)  …There is much here to dispassionately rethink so as to profoundly review the way we operate.(iii)

(ii): Final decisions that, as PICSOs we try to influence, too often clash with the call for consensus resolutions by UN member states. Appallingly, what comes out are mostly non-binding resolutions (that may be norm-setting making them sometimes of some relevance). Consensus resolutions are not a written rule in the UN system though. In some decision-making processes in UN agencies, rulings are arrived-at by voting. In reality, the rules for processes of negotiation of UN resolutions are only in theory ‘democratic’ though, i.e., when resolutions are voted, each member state has voice and can abstain or oppose the adoption of a given instrument or resolution. On the other hand, when important resolutions are adopted by consensus, it is because the member states ‘convey that they have the political will to work by consensus’ (it remains to be proven that this is by genuine choice or by pressure reflecting an international system captured by those countries rendered rich). Only in counted processes is consensus approval less controversially chosen, because the negotiating parties have no real big differences with regards to what is being negotiated.

(iii): Progressive movements work best when the ground is laid by, across-the-board– raising their political consciousness …and this takes a long time and much effort, as well as funding, lots of it, and fast. A question we can no longer ignore thus is: Where can progressives get the funding needed for this?  And no less important: Are any groups in place ready to do this consciousness raising? Certainly a huge job.

Because we have historically failed on the politicization front, corporations and allied governments are, again and again, going to easily outmaneuver us. We are literally decades behind. It is our well-founded disappointment that has to lead us into possible new approaches. My point of departure is the fact that money talks. The drivers of global governance have access to enormous and growing resources –and wealth concentration continues to accelerate upwards dramatically– so that those rendered rich will find more and more ways to reduce regulations that hamper their booming businesses. Do I see any promising way forward to make up for this? Being a pessimist-optimist, yes, I do.

More often than not, the above reasons have historically relegated PICSOs’ and social movements’ positions and demands to the dust bin, i.e., member states’ consensus resolutions ignore PICSOs’ well-reasoned inputs so that, at the end, these inputs end up making little or no difference: a pre-desired consensus with softened language is hammered out at the we-hours of the night only to see that, then, the resolutions are not applied at national level where political powers keep things under (their) control. As a response, we may as well demand voting so that minority positions be accepted and tabled! We probably could count on a small number of member states going along with us on this. Make no mistake: what we are talking about here is about the need to demand the overruling of anachronic procedures and rules so as to genuinely democratize UN agencies.

But it is not just about the procedures and rules in UN fora. Probably, an entire new UN reshape is needed. Discussions do exist about this. But they are so far dominated by academics, think tanks, international NGOs and former UN officials. Grassroots social movements have hardly taken up this question; no good reason for it. Basically, it is not about coming up with brilliant new ideas. It is about building up political forces from the ground pushing for the democratization of this absolutely key international body. At this moment, we do not have the right governments, parties, UN officials to bring about and materialize such a vision; much work is ahead here. Moreover, democratizing the UN has to go hand-in-hand with addressing power imbalances among countries and with reclaiming democracy from below. Otherwise it will lead to just more tinkering with pat solutions.

It is pertinent and very important here to remember that, since its creation, the UN has been based on two fundamental principles, namely member states’ sovereignty and polycentrism.(iv)

(iv): Polycentrism in the UN development system gives member states the global voice promised in the organization’s founding Charter. (https://www.google.com/search?client=firefox-b-e&q=polycentrism+in+the+UN) Polycentrism is key for building a more egalitarian international order. It is thus a must for member states, particularly in the South, to resurrect this concept and use it as a central revindication banner to build an international order based on true cooperation and respect of their sovereignty, i.e., to defend the UN obligation for states to negotiate as equals. The UN simply must serve as a platform in which all states sit around the table and negotiate the different aspects of, for example (but not only), the SDGs as equals. As can be easily seen, polycentrism is the antithesis of the way the current (and past) international system works based on the law of the most powerful, on a frantic competition between nations and on the primacy of national as opposed global collective interests. Terms are imposed rather than negotiated, therefore protecting/advancing the interests of the great powers and of the international financial institutions –all against the solemn UN principles.

Additionally, at the base of our frustrations is the fact that time has allowed corporations to creep-in to advance their positions through public-private partnerships, within and outside the UN, allowing them to act with impunity so that the power of special interests ends up being far greater than that of the member states and of public interest civil society.

Yes, multilateralism is under attack by corporate capture. Despite our significant and well-reasoned contestations and our resistance to these developments over the past decades, these accumulated trends have culminated in a privatized multistakeholder space we need to forcefully denounce and dispute, simply because financial and transnational  corporations are dominating the agenda laying out a joint UN-corporate roadmap (not only cherry-picking areas of involvement, i.e., those most profitable to them, but also involving ‘socializing’ risks and privatizing profits. They have learned to use hypocrisy…).  What, of course, comes to mind here are developments at the World Economic Forum (take their ‘Great Reset’ Initiative https://en.wikipedia.org/wiki/Great_Reset ) and the travesty we observed in the 2021 UN Food System’s Summit with its disregard for the fundamental changes needed for the right to food, to food sovereignty and to agroecology to be respected, among other. Also, Codex Alimentarius boasts about its care for malnourished children and the importance of a fair global trade yet the PICSOs involved in it have a real struggle to get effective safeguards into the texts under discussion –industry dominates the field.

When discussing human rights issues in so many relevant UN and other international fora, country delegations from the Global South are poorly informed and poorly staffed so that they often ‘flow with the Joneses’ as if they do not realize or care when things, the way they are going, clearly go against their national interest. PICSOs are much better informed and prepared than, I would say, 2/3 of the member states’ delegations. But we cannot forget that most PICSOs and individual activists:

a) have pitifully scarce financial and human resources and, unless sufficiently coordinated, achieve only limited synergy –in reality, many are still fragmented and siloed (and thus weak)(v), on top of being vulnerable to problematic offers of funding for technical interventions (some of them good and important, admittedly). But this is at the root of why they fail to see the bigger picture and realize how they are being used to usher-in PPPs that make them loose their independence.

b) are facing shrinking operational spaces and perhaps a reduced ambition to stand up for human rights in a commensurate way.

(v): To make sense of current world problems, we too often fall back on a ‘shish-kebab mentality’. This much easier and convenient approach looks at the various problems affecting the world as if they were all separate events skewed together by tragedy or destiny. So, we set out to tackle each individual morsel …when the problem is in the skewer, i.e., in the structural determinants or, if you wish, the common systemic drivers of the problems behind each morsel. These are linked to the prevailing neoliberal system that is at the very core of each of the morsels. But the point is: We have to focus on changing the skewer to radically change the morsels. So, the morsels have to first come together as a collective rather than letting themselves be pinched up individually on the skewer. (Important note: Also applies to vegetarian kebabs…).

Furthermore, consider these four arguments

a) To keep calling for convergence, coordination and coherence is but a pipe dream. It is like, as we so often have done before, calling for ‘more multidisciplinarity’.(vi)

(vi): There is nothing terribly wrong with this concept, but it just gratuitously assumes that looking at the problem behind these issues from a ‘wider’ multi-professional perspective is going to automatically lead us to the better, more rational and egalitarian solutions… Just by putting together brains ‘sowed’ differently, without considering where they are coming from ideologically, is not going to, all of a sudden, make a significant difference in the outcome and the options that will be chosen. Most proponents of a convergence fall into the same game. They call for putting a stop to groups acting in silos and…converge. Bottom line, true convergence is not to be just an intellectual process. To be effective, it has to lead to a convergence of motivations and energies directed towards the organization of politically driven movements. (I do recognize that there are some who understand the call for convergence rather in terms of ‘grassroots struggles of the world, unite!’. But are they not a minority?).

b) The core issue we are dealing with is a push and/or a pull question. Nothing much will come from (UN) reforms being pushed from above. Only active organized claim holders unrelenting ‘pulling’ for needed changes will move the process ahead. History is clear about this.(vii)

(vii): Where to ‘pull’? Michael Fakhri (the UN’s Special Rapporteur) reminded us that ‘PICSOs coming to the table to discuss better, global solutions’ is not as simple as it sounds, especially if the table is already set, the seating plan non-negotiable and the menu highly limited. …And what if the real conversation is actually happening at a different table?

c) Looking-at and ensuring the progressive realization of human rights is an activity terribly neglected. (Is it perhaps because human rights are not understandable or too abstract to the average claim holders?). Add to this the poorly functioning accountability mechanisms being applied by PICSOs-acting-as-watchdogs (Again, do claim holders really understand what human rights accountability means?).(viii)

(viii): Watchdogs are a man’s best friend: dogs bite. So, what this calls for is more watchdog civil society organizations that are to watch like ‘white knights fighting the dark forces of development aid, corruption and incompetence’. The watchdog function being of utmost importance, we need to become much better at shedding light into darkness by exposing much more what goes wrong.  As said, PICSOs have a crucial role in monitoring the progress, stagnation or regression made in the progressive realization of long-term plans (10 years) to fulfill the right to health, to nutrition, to education… Annual benchmarks of processes-set-in-motion (or not) have to be set so that these PICSOs can assess, to repeat, progress, stagnation or retrogression on an annual basis with something akin to widely disseminated shadow reports.

d) And then there is all this signing of letters of complaint and this writing of declarations and the reading of statements at UN meetings we all so (too) often engage in. Yes, they may make us feel better, but how much do they help? Do we follow up on them? To make a difference, we need to get where it really hurts –and not all PICSOs are happy to go this far; they may make nice gestures, but then hold back. ‘Well done is better than well said’ Benjamin Franklin told us.(ix)

(ix): The lessons to be learned here can best be found with the trade unions that started organizing themselves over a hundred years ago, locally, nationally, globally, not always with equal success. But, to this day, they remain the only credible organizations that can negotiate, that can enforce something –that can bring about true counter-power. (I note that boycotts also have real potential power). Nothing is going to come from ‘the government or the state or the international community should’. World Bank Reports are full of these ‘shoulds’(!) and look where that has taken us. Assessing claim holders’ capacity to demand is thus part of the broader challenge to rectify their chronic inertia. In short, any call must be coupled with human rights learning at the bases so as to help/contribute to empower claim holders to demand the needed changes themselves. Otherwise, our calls will become yet more wish letters to Santa Claus.  [A relevant aside here: what is this animal ‘the international community’? There is no such a thing as the international community; we must take it out of our vocabulary. There is no global obligation for the international community to root out poverty so that the presence of poverty can be considered as a dereliction of duty towards the SDGs.

So far, the international community has failed to organize a credible system of global re-distribution (disparity reduction) so it can be objectively regarded as a violator of the goal on poverty in the SDGs charade. This ‘international community’ will not move effectively in solidarity against poverty and other human rights violations until the neoliberal global restructuring that Globalization has mounted is modified by an ethics about which the proponents of Globalization continue to be terribly ambivalent or choose to turn a blind eye on. Unacceptable passivity has characterized the attitude of the international community in embarking in decisive human rights work. Worldwide coordination among all social movements that support the human rights-based framework is thus the crucial challenge: forget the international community].

What I think needs, among other, to be done:

[Actions suggested here to address the deplorable current situation are brief to the point of caricatures; they are presented in no particular order of priority and, let it be said, I am not as pretentious to think I have the package of actions to follow –they are rather terribly prescriptive and normative at that].

  • Accept no more promises without concrete measures that can be legally enforced and monitored. Accept no more discrepancy between principles and practice.
  • Not only (more) political analyses are needed, but also (more) political action. Action is actually needed on a scale that is mainly only contemplated and voiced by those not sitting at the various decision-making tables.
  • If we want to achieve something more, redouble our organization, further strengthen our structures and mentor more able spokespersons, especially young activists.
  • Having well hammered-out goals and objectives is not enough. In the end, they are only aspirations. Without commensurate and matching policies that lead to legally enforceable measures, they are of no interest to the fulfilment of human rights; only policies that set plausible pathways point to credible destinations.
  • Increase PICSOs mobilization around the shish kebab concept. Only this will build the needed ground resistance to change things sustainably. For this, claim holders must get inside traditionally closed or uninvited spaces…
  • We say we have to convince more member state delegates at UN venues (often diplomat-bureaucrats). But decisions are taken in capitals –mostly in foreign affairs ministries. So, capitals is where our pressure ought to be exerted.
  • Sympathetic champions within UN and other international agencies are key assets: seek, nurture and encourage them.
  • Actively work with sympathetic governments willing to be vocal in international fora partnering with PICSOs in our demands (these demands ultimately clearly benefiting them).
  • Critically question and, as needed, oppose the processes and governance guidelines and procedures of the UN (other than the General Assembly’s one-country-one vote) proposing new, more democratic ones.
  • A procedural change must be kept as a preferred option to move away from passing resolutions by consensus, i.e., allowing for member states’ voting and eventually for minority reports in the several and fragmented UN governance spaces. (This said, I do not underestimate the need for an overall new direction of where the UN should go).
  • Add to these a) contesting the deceiving language in use: no more stakeholders, no more loosely defined partnerships (among unequals), no more non-state actors, no more international community, no more mutual accountability…, and b) be careful not to compromise when, so often –in a mockery of democratic decision-making– we are asked for comments on ‘zero’ or advanced drafts of UN documents.
  • Many small struggles are to coalesce. Among other, this means engaging with academics, trade unions and with youth and women’s organizations –emulating the climate movement and their effective denunciation, e.g., the Fridays For Future movement and Greta’s Blah! Blah! Blah!, and last but not least
  • Broaden our alliances and engagement with the different UN mandate holders (including rapporteurs) and with the South Center in Geneva.(x)

(x): The South Center was created by Mwalimu Nyerere as a think tank of and for the countries of the South. Its positions have, more often than not, been congruent with those of PICSOs. Over the years, it has become influential in many capitals around the world. Working with and through them has the potential of reaching member states with an authoritative and prestigious voice.

Bottom line

Can we work towards building a people’s governance grounded in multilateralism and human rights? For this, the answer may or may not be a new more radical way of engagement(xi) with, for example, the Committee on Food Security (CFS) at FAO, where PICSOs and social movements still have a nominal presence. If this fails, PICSOs and social and indigenous people’s movements in the Civil Society Mechanism (CSM) of the CFS must ponder the alternative to leave the CFS moving their demands to other stages with a greater potential to influence governance decisions that break away from the neoliberal chokehold). I recognize we are not there yet. Grassroots social movements are not giving priority to this question yet. So, for now, we should stay in places like the CFS to do precisely this: become biting watchdogs and continue demanding conditions we want to see in place. In that sense, it is more about resisting, about ‘throwing sticks to the wheels’.

(xi): The example of the People’s Health Movement’s ‘WHO Watch’ active in the World Health Assembly (and its Executive Board meetings) every year adds an important action point suggestion here. Activists go through the agenda of each of these meetings weeks in advance and prepare a one or two pager briefing document that, on the top half page, objectively summarizes the key issues under discussion. Then, in a paragraph or two, PHM says which points it agrees with. Underneath, the points of disagreement are summarized with clear justification from a PICSO’s perspective. This is followed by calls for changes to be made in the texts under discussion –not necessarily exhaustively in this short briefing document, but clearly addressing ‘pink lines’ that are of great concern to civil society. The document is then distributed to all member state representatives attending and used for the advocacy PHM volunteers do ‘in the corridors’ in-situ. This has proven effective to provide arguments when member state delegates make use of the floor. [Note that in the case of hybrid meetings, the document can be emailed to Geneva or Rome country Delegations].

[Some concepts were taken from the CSM and Indigenous Peoples’ document ‘Towards a Strategy on Global Food Governance’. Otherwise, I acknowledge the generous inputs of Nora Mckeon, Sofia Monsalve, Raffaele Morgantini, Patti Rundall, Ted Greiner].

On a more facetious note:

En un café de Madrid escuché esta conversación, que mostraba un gran pesimismo, pero ningún dramatismo:

Uno de los contertulios le decía a otro:

-A mi, lo que más me gusta es perder a las barajas.

-¿Pero es que no te gusta ganar?

-¡Coño! ¿se puede?   (you can googletranslate this)

Postscript

It takes courage to stand up for the things we do at this moment of history. We believe in human rights, we pretend to represent the interests of people and countries rendered poor and receiving pittances in ‘development aid’. And we hope that slowly slowly the world will become a better place to live in, if only member states of the Global South were able to acknowledge that they too have a responsibility and much to lose, that there should be no corruption, that democracy is important, that the emission of greenhouse gases has to be reduced… We want to believe it. But we know it is not reality. Are we achieving what we stand for (fighting poverty, injustice, inequality, climate change, human rights violations)? I mean, are we really?  Of course not. What are we saying and what needs to be done? Who are ‘we’ and who stands with us? Who is listening? We can and do dream; is it the only thing left to us? We continue to believe in a different world, for the generations of today and tomorrow. We try to follow what happens in this world, from a human rights and social justice point of view —in spite of all of today’s gloom. We have to continue to fight for a better world, but are there better ways? (adapted from Francine Mestrum)

Some out-of-the-box ideas

We have to make it our mission to gain full access to the table wherever food governance decisions are being made –beyond the CFS. This has some tactical implications to work-on (the how and the who…and the against whom).

Even more out-of-the-box here: Can we start a campaign for a WHO Committee on Health Security and for a UNICEF Committee on Child Security? Not that we are going to win, but just to raise some eyebrows and eventually gain some momentum (no reason why FAO yes and the others no).

Fight for the approval and funding of a global HR Learning campaign organized by PICSOs, both for duty bearers and for claim holders. This is based on acknowledging that we have little clout, because too many DBs do not know the obligations they are bound-under and CHs do not know the powers HR entitles them to use in organizing, mobilizing and demanding their rights. This will put a lot of responsibility on our shoulders to come up with appropriate curricula and capabilities to participate in these trainings the world over. (We do not have to reinvent the wheel; lots already there).

Make it a point that the Sp Rapp for F+N is on the table at the highest food governance bodies with voice and (minority?) vote!

Make sure genuine reps of social movements/PICSOs are nominated to ‘join the table’ and hold periodic trainings for them to unify criteria of what to fight for as priorities (includes setting red lines).

Even more out-of-the-box here: Ask our lawyer comrades if and how we can sue UN bodies (in HR courts: Europe, other?) for failing to discharge their responsibility of forcefully enough reaffirming the duty of states and of international cooperation as per their respective mandates and UN Charter that obliges them to carry out that duty to realize the RTF and other rights.  (Includes these bodies creating an enabling environment through the allocation of sufficient resources –human and other). This may well end up in a dead end, but has PR and visibility value. (This is not about People’s Tribunals which is another alternative)

Who Suffers Most: The Visibility of Children and Older People in Prison

This article precedes a research paper that will be published in 2024.  For further information on Children that accompany a parent Prison, or the health of older people in prison, contact the author using the details at the end of this article 

The prison system, while serving a vital role in society by ensuring public safety and holding individuals accountable for their actions, often comes at a cost to those directly and indirectly affected by it. Two distinct sub-groups within the prison population – children who accompany their parents in prison and older inmates – are routinely denied access to basic human rights, particularly in the areas of early years education and healthcare. This article delves into these injustices, highlighting the need for urgent action and systemic reform

By Philip J Gover BA MA MPH

Public Health Consultant, Cooperation Works

Who Suffers Most:  The Visibility of Children and Older People in Prison

 

Children in Prison: Denied a Fundamental Right

Children who accompany a parent (routinely the mother) in prison are essentially the innocent victims of circumstance, yet they face a multitude of challenges that can have lasting consequences on their personal development. One of the most significant is the lack of access to early years education. These crucial years, from birth to age five, are critical for building a strong foundation in cognitive, social, and emotional development. Yet, children in prison settings are often excluded from early childhood education programs, depriving them of the opportunity to learn, play, and interact with their peers in a stimulating environment.  For those invisible children who live their life on the inside, the formative years of development are being wasted.

The Consequences of Educational Deprivation

The lack of early years education can have severe consequences for children in prison. Studies have shown that children who are deprived of educational opportunities are more likely to experience developmental delays, behavioural problems, and academic difficulties later in life. They may also struggle to build healthy relationships and integrate into society upon release. This can create a cycle of disadvantage, perpetuating the same issues that led to their parents’ incarceration.

Investing in early years education for children in prison is not just a moral obligation; it’s an economic imperative. By providing these children with the support and resources they need to thrive, we can help break some of the elements that contribute to the cycle of poverty and crime, and promote safer and more prosperous futures for more.

Addressing the Healthcare Needs of Older Prisoners

As the global prison population ages, the number of older inmates is also on the rise. This demographic faces unique challenges, including increased vulnerability to poor health, mobility issues, and chronic diseases. In overcrowded prisons, the consequences are multiplied.  Yet, healthcare services within prison settings are often inadequate, lacking the resources and expertise to meet the specific needs of older inmates. In other corners of the world, these services are absent.  This lack of appropriate care can result in needless suffering and long term increases in healthcare costs for society as a whole.  At worst, the consequences can lead to preventable premature death.  Like metrics associated with excess Winter deaths and heat implicated mortality, we need to pay more attention to premature and preventable prison-based mortality.

The Human Rights Dimension

Both the denial of early years education for children in prison and the neglect of healthcare for older inmates raise serious human rights concerns. These individuals are entitled to the same basic rights as everyone else, including access to education and healthcare. Yet, the prison system often fails to uphold these rights, creating a system of inequality and injustice.  

The Need for Systemic Change

To ensure that all individuals within the prison system have access to their fundamental rights, systemic change is needed. This includes:

  • Investing in early years education programs for children in prison. This would involve providing early years learning systems, qualified educators, age-appropriate materials, and safe creative space in which to learn.
  • Improving healthcare services for all prison populations is essential, but for older prisoners, it is critical. This would require increasing funding, recruiting and training specialized healthcare professionals, and implementing age-appropriate care plans.
  • Ratifying and implementing international human rights treaties that guarantee the rights of prisoners. This would provide a legal framework for ensuring that all prisoners are treated with dignity and respect.
  • Promoting public awareness and understanding of the unique challenges faced by children in prison and older inmates. This would help generate support for reform efforts and create a more compassionate and humane prison system.

Conclusion 

The denial of early years education for children in prison and the neglect of healthcare among older inmates are unacceptable injustices that demand immediate attention. By advocating for systemic change, investing in essential programs and upholding human rights principles, we can create a prison system that is more just, equitable, and humane for all. The well-being of these vulnerable populations is not just a moral imperative, but a crucial step towards building a more inclusive and sustainable future for all.

At Cooperation Works, we see transformational opportunities for those that direct prison systems to play a more proactive role.  Prisons can become beacons of education, health, wellbeing and rehabilitation if the political will is present. If we want public health to gain more traction in society and deliver the widespread benefits that we know it can, it is likely to be within a settings approach that can provide the most utility and value.

Public health is a shared responsibility with the determinants of inequality to be found in every corner of society. Prisons are both homes, workplaces and learning environments, but inadequate attention is being given to prison-based education and healthcare.  If equality have any place in the future of our society, we could do no worse than prioritising and focusing our efforts on health and educational improvements in prison settings.

About 

This article precedes a research paper that will be published in 2024.  For further information on Children that accompany a parent Prison, or the health of older people in prison, contact the author using the details below.

Philip J Gover is a Community & Public Health Consultant, based in SE Asia.  A frequent speaker at subject specific conferences, his expertise lies in leveraging creativity, innovation and incentives to build transformational systems that reduce poverty and inequality.  With an approach rooted in community development and underpinned by the lived experience of members, Philip embraces and promotes adult education, lifelong learning and shared knowledge.

For collaborative conversations, contact philip.gover@cooperation.works