Health Breaking News 299

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

Health Breaking News 299

 

United Nations Solutions Summit September 2018: call for submissions 

World Humanitarian Day 2018: Remembering Why They Gave Their Lives 

UNHCR: come riusciamo a portare gli aiuti ai rifugiati durante le crisi umanitarie? 

Children in humanitarian crises: How the EU can help them 

Five things I’ve learned being a humanitarian aid worker 

In New York City, Addressing The Mental Health Of Migrant Children Separated From Their Parents 

WEMOS: FINANCING FOR HEALTH (SDG3). SHARED GLOBAL RESPONSIBILITY: AN ANALYSIS OF FIVE AFRICAN COUNTRIES 

WHY INVESTING IN HEALTH IS A CHALLENGE UNDER THE CURRENT GLOBAL ECONOMIC SYSTEM 

What Accountability Really Means 

68th session of the WHO Regional Committee for Europe Rome, Italy, 17–20 September 2018

Alma Ata at 40: Midlife crisis or Graceful Maturity? 

Regional cholera outbreak threat in west Africa as cases increase eight-fold in Lake Chad basin 

We must celebrate the end of polio – but the end of polio funding puts other programmes at risk 

The Latest Ebola Outbreaks: What Has Changed in the International and U.S. Response Since 2014? 

Ebola situation reports: Democratic Republic of the Congo 

Measles cases hit record high in the European Region  

Sudden spike in number of measles cases in Europe, highest death toll in Serbia 

Samoa rolls out triple drug therapy to accelerate elimination of lymphatic filariasis 

Negotiators On UN TB Resolution May Have A Deal 

The Long-Term Financial Toll of Breast Cancer 

‘Accessibility to Medicines in Uganda’ by Denis Bukenya and Michael Ssemakula 

Civil Society And TRIPS Flexibilities Series – Translations Now Available 

Can A Surge In Activism Defeat American Big Pharma? 

Il conflitto d’interessi dei medici con Big Pharma 

White House opens new front in war on US aid budget 

Why strengthening land rights strengthens development 

OFID signs loan agreements to help strengthen food security in Cote d’Ivoire, Malawi 

Cruise ships still using ‘dirtiest of all fuels’ must be banned in European ports, says environmental group 

New way to save endangered sharks – and our seafood 

Rights for people forced out by climate change 

Accessibility to Medicines in Uganda

This paper examines the vast gap in access to essential drugs in Uganda and highlights the many circumstances of the drug stock-outs culminating into the high premiums on medicines hence frustrating access to medicines and many a time sprouting drug resistance illnesses

By Denis Bukenya

and Michael Ssemakula

Human Rights Research Documentation Center (HURIC), Kampala, Uganda

Accessibility to Medicines in Uganda

The Polygonal Lateral Disease Resistance

 

The five fundamental questions of What, How, Who, Where and When to improve medicine accessibility, is still a heavy quarry assemblage of unreciprocated answers to improve medicine availability and accessibility in Uganda. Due to the shifts introduced by the new health system management embraced by the government of Uganda, there has been the introduction of a neoliberal Public Private Partnerships in the drug procurement and management process. This process has caused untold pain due to drug-stock outs. The scourge of stock-outs inherits terrible dynamics of worsened plights of disease from critical to chronic levels especially among the susceptible HIV/AIDs and Non Communicable Disease (NCDs) patients.

Over the years, the vacuity in access to medicines especially those for NCDs has been worsened by the commercialization of the health sector which has become an integral center of worry to the citizenry and turning health into a private good as opposed to a social good provided by the state as a prerogative service. In a report on access to medicines by Hazel Bradley and Richard Laing (2015), 33% of the expenditures on NCDs drugs are out-of-pocket expenditures, implying that those who cannot afford will either opt for cheaper medication which is counterfeit and ineffective causing disease resistance, continue to struggle with the illnesses and hope for a spiritual miracle or befall the preventive death sentences due to the medicine stock-outs and the state ineptness in the protection of the right to health.

This paper examines the vast gap in access to essential drugs in Uganda and highlights the many circumstances of the drug stock-outs culminating into the high premiums on medicines hence frustrating access to medicines and many a time sprouting drug resistance illnesses.

The heavyweight burden of disease in Uganda has continued its vicious existence due to the vacuum in access to medicines especially the essential drugs. The deficiencies of essential medicines in public health facilities is a major issue. Despite the increasing attention to this predicament (plentiful reform attempts and creativities in the last ten-years have been used in assessment and evaluation of health facilities, State medicine provision and health human resources), the general population still experiences scarcities of medicines. When patients are unable to get the affordable care needed from the public sector (government hospitals, clinics and government drug authorities in charge), they turn to the atrocious private sector which includes the pharmacies, clinics and nonconformist state of the art private hospitals for profit owned by the politicians in the third world countries which charge them exorbitant prices in accessing medical care. This in effect increases the out of pocket expenditure on access to health putting the citizens at risk of deteriorating into poverty as an after effect to ill-health. This has aligned many defects in the health systems in Africa including counterfeited drugs, the sale of expired drugs and turning to herbal unregulated medications which may harm the general populations.

Considering the inner-city populations in the foregoing, one would literary argue that paying surcharge premiums for essential medicines that should be available at no cost from the public health sector creates  poverty in the economy, robs the citizenry of their fundamental right to attainable standards of health and breaks the SDGs slogan of leave no one behind.  The rural poor populations due to the scarcity of functional public and private health facilities, suffer the consequences of long distance treks to access health care which many a time conclude in avoidable deaths and reduce the percentages of lives for the people living in the rural poor areas.

Looking at essential drugs like trastuzumab whose 440mg of the original drug’s brand version costs Shs 9m whereas its generic costs Shs 4.1m as evidenced by the Uganda Cancer Institute, makes the case that the influence of unaffordable premiums charged on the patented cosmopolitan medicines puts health in a dire state especially for Non-Communicable Diseases (NCDs).

This in Uganda is worsened by the scourge of counterfeit products, medicines in this regard. These are plentiful on the market hence the reason why people in the country are dying from manageable ailments where presumably the medication is readily available in circulation. The management of these counterfeits in Uganda is said to be failing at an unimaginably high rate due to the crippling corruption in the country which makes the cost of curbing, enforcement and regulation of counterfeit medication impossibly high.

There is also a gap on the stock-outs in Uganda due to the institutional inefficiency in the Ministry of health and a link-gap in the information flow between the procurement pharmacy departments and National Medical Stores (NMS) in documenting the status on the drug stocks. Crossing over to the HIV/AIDS drugs, malaria and other preventable and treatable diseases including the Sexual Reproductive Health Commodities, people survive by a two-faced chance. Since May 2018 reports show how the medicine stores in Uganda started going empty.

Further, the recent research survey carried out on 6th and 7th August 2018 by the Uganda Coalition on Access to Essential Medicines (UCAEM) a Civil Society Coalition in which Human Rights Research Documentation Center (HURIC) and PHM-UGANDA bear membership, revealed gory stories of gaps in the availability of essential medicines, family planning and Sexual reproductive health commodities across the eight-health centers in Lira and Pallisa districts. This survey reflected the absence of the following drugs, septrin (Cotrimoxazole), emergency contraceptive pills, Combined Oral Contraceptive pills (like microgynon), Progestin, HCG kits, Combined injectable Contraceptives, Sino Implants, Implanon Classic, ibrogfen tabs, Depo-provera, IUCD, Moon beads, Norigynon, Microrute, Jade  NXT, IUD and a national-wide stock-out crisis in Anti-TB drugs, ARVs, Vaccines and malaria diagnosis equipment. The drug prices and medicine stock-outs have significantly widened the medicine availability and acquirability in Uganda. Upon realizing that there are no drugs in public health centres, patients have resorted to private health facilities and pharmacies which sell the medicines at a cost way above the affordability line of the patients, with some drugs being counterfeits especially the cancer drugs and cardiovascular disease drugs.

In the recent past, reports from World Health Organization warned Uganda’s authorities (the Uganda National Medical Stores) on the procurement of fake copies of the Roche’s Avastin and Pfizer’s Sutent used to treat cancer (WHO, 2017). These had hit the medicine market through pharmacies and scamming patients through the fake generic drugs thus becoming one of the interlopes to end disease in Uganda as a result of the institutions’ inefficiencies and a gap in the ethical values.

The incompetent drug tracking system and inconsistences in the procurement plans in the pharmacy department and the National Medical Stores as the national entrusted bodies mandated to procure medicines and store them, is another key prime cause of medicine inaccessibility in Uganda that increase fluctuations. The gist here is that the dilemma of medicine inaccessibility in Uganda is not only about the tight resource constraints and technical gaps, but also a sequence of poor political rationalities that permit and reinforce temporary makeshift policy-implementation that results in weak oversight and a gap in meaningful accountability. The ramifications for this inadequacies are translated into preventable deaths due drug resistance and reduced DALY years of the general population.

With such paucities in our health system, commercialization drive has been inevitable through importation of expensive medicines by private pharmaceutical companies. Which makes the poor strata to suffer severely.

It is therefore recommended that appropriate drug tracking systems are put in place together with training of properly qualified health professionals in the health procurement departments to improve their stock taking capacities and narrow the gap in the information flow between the health workers at grass roots like the store managers, procurement and finance departments. Such skills training is needed for the health professionals in health centers’ inventory management systems to learn the new technologies involved in drug implementation tracking processes as a tool to better the practice of reconciling the medicines stock-gaps to minimize shortages, human errors and streamline ardently the inventory management procedures.

Also a need for right supportive political rationalities is necessary. This will permit and strengthen policy-implementation on strategic plans for medicine provision with strong oversight and meaningful accountability.

Finally the need to negotiate for parallel importation from the medicine patent holders and originators of the medicines is essential. This is because parallel importation allows the country to procure medicines from a cheaper source where the originator or patent holder sells his drugs at a lower premium than the actual price cost from the patent holder of the medicines. This reduces the cost incurred in purchasing the medicines thereby increasing their affordability and accessibility to all patients regardless of social status.

 

 

 

Health Breaking News: Link 298

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

Health Breaking News: Link 298

 

5 experimental treatments introduced in latest DRC Ebola outbreak 

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

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

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

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

Inside Namibia’s HIV success story 

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

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

A post-conflict vaccination campaign, Central African Republic 

Mutant mosquitoes: Can gene editing kill off malaria? 

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

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

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

Integrating Care for Children, Young People and Their Families 

Alternative malnutrition treatments hold promise for millions of children 

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

Human Rights Reader 457 

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

Take Charge of Your Food: Your Health is Your Business 

African countries fare poorly in innovation ranking 

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

‘Public Finance and Public Health’ by Ted Schrecker 

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

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

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

Watermelon rind a cheap filter for arsenic in groundwater 

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

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

How coal-burning countries are making their neighbours sick 

Working with China on Pacific climate change 

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

Public Finance and Public Health

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

By Ted Schrecker

Professor of Global Health Policy, Newcastle University

Public Finance and Public Health

 

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

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

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

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

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

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

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

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

By Yves Charpak

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

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

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

 

Health Breaking News: Link 297

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

Health Breaking News: Link 297

 

WHO: Public Health round-up 

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

Europe and the Sustainable Development Goals: 3 years on  

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

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

Opinion: Reaching universal health coverage means tackling malnutrition 

Child malnutrition fears as US opposes WHO breastfeeding resolution 

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

Treatment of people diagnosed with chronic hepatitis C virus infection 

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

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

Ebola vaccination begins in North Kivu 

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

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

Choices in vaccine trial design in epidemics of emerging infections 

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

Bacteria becoming resistant to hospital disinfectants, warn scientists 

Indicators for the surveillance of AMR and antimicrobial consumption 

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

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

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

Global susceptibility and response to noncommunicable diseases 

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

A human rights approach to mental health and people with disabilities 

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

World risks entering irreversible ‘hothouse’ state  

Climate change and health: Moving from theory to practice 

Prioritizing the needs of children in a changing climate 

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

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

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

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

Course announcement: The Struggle for Health – Savar November 2018 

Health Breaking News: Link 296

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

Health Breaking News: Link 296

 

BRICS and mortar 

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

AIDS 2018 told the story of a global health crisis 

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

HIV research missing focus on young women 

Time to Fix Bad Laws on HIV 

Negotiations On UN Tuberculosis Declaration Still Open, Reports Say 

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

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

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

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

WHO: World Heapatitis Day 28 July 2018 

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

The MPP welcomes the new WHO hepatitis C treatment guidelines  

Cheap drugs not enough to fight hepatitis C in Asia 

Eradicating Leprosy in Mozambique, a Complicated Task 

Sequencing A Malaria Mosquito’s Motherline 

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

How the private sector can take WHO recommendations on NCDs forward 

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

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

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

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

Human Rights Reader 456 

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

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

Human rights in Thailand: No improvement, no trade deal 

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

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

Climate change is here, and the world is burning 

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

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

Health Breaking News: Link 295

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

 Health Breaking News: Link 295

 

A look at the Global Financing Facility’s goals, strategies, and learnings 

NHIS as a source of health financing towards UHC in Nigeria 

Argentina: 20 years on, has the IMF really changed its ways? 

Advancing A Health System Transformation Agenda Focused On Achieving Health Equity  

How to ensure access to essential medicines for all? New WHO report reviews medicines reimbursement policies in Europe 

Addressing Out-Of-Pocket Specialty Drug Costs In Medicare Part D: The Good, The Bad, The Ugly, And The Ignored 

The 22nd International AIDS Conference (AIDS 2018) 

Live: AIDS Conference 2018 

Join DNDi at 22nd International AIDS Conference

Pfizer and GSK’s HIV/AIDS division, ViiV, prevents children with HIV from getting needed medicine 

African Countries Leading the Way in Fight Against HIV/Aids 

Balancing Health Care’s Checkbook: New Strategies For Providers And States 

UN Political Declaration On TB Finalised: No Commitment To TRIPS Flexibilities 

NGOs: Countries Pressured To Drop Reference To Affordable Medicines In UN TB Negotiations 

As Pandemic Preparedness bill clears House committee, effort to include antibiotics transferable exclusivity extension fails 

Oppositions Filed Against Gilead Hepatitis C Patent Applications In India 

AbbVie Hepatitis C Treatment Patents Challenged In India For Evergreening 

Follow California’s Lead: Treat Inmates With Hepatitis C 

Towards a science of global health delivery: A socio-anthropological framework to improve the effectiveness of neglected tropical disease interventions 

New drug for recurring malaria 

Guinea worm outbreak dashes hopes of elimination in South Sudan 

Ebola: How a killer disease was stopped in its tracks 

The state of the antivaccine movement in the United States: A focused examination of nonmedical exemptions in states and counties 

Two-thirds of Africa’s population still don’t have access to electricity – and it’s threatening the security of the continent 

Achieving Sustainable Development Goal 2: Which Policies for Trade and Markets?  

How can we measure coherence? HLPF and progress trackers – from Rilli Lappalainen 

Infected ticks and Lyme disease expand because of climate change 

Building the Caribbean’s Climate Resilience to Ensure Basic Survival 

Can Cities Reach the Zero Waste Goal? 

High levels of sewage contamination released from urban areas after storm events: A quantitative survey with sewage specific bacterial indicators 

Photo-based crop insurance could debut in Kenya in 2019 

Health Breaking News: Link 294

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

Health Breaking News: Link 294

 

Eurodad Annual Report 2017 

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

The complexity of -interrelated- planet and human health and the lack of international consensus on the sustainability threshold of carbon footprint deserves some analysis and reflection. The Authors hereby relate some concepts and pieces of evidence which alarm on this challenge, most probably Humanity´s greatest this century

 

By Juan E Garay*, David E Chiriboga, Nefer Kelley, Adam Garay, Estefania Garcia-Carmino

Equity Movement

*Corresponding  Author and ad-honorem Professor of bioethics, University of Chiapas, Mexico

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

First published 19th July 2018. Updated 22nd October 2018

 

For the last 200,000 years (less than 0.02% of time of life on Earth- equivalent to half an hour in one year) we have seen ourselves as “homo sapiens”. Due to our unique sophisticated-crafting activity (as hands are not used for walking) and our abstract thinking (as our frontal lobe grew) we have evolved to believe in our superiority to other forms of life and hence justify understanding nature as the means to satisfy our needs and ever-growing ambitions (driven by the abstract projections). Some 5 generations ago (one thousandth of our time on Earth) we discovered nature’s resources under the surface, the life (carbon) sediments of over 3 billion years. We learnt how to burn them and boost our ambition and “needs” (consumption). In the last two centuries, we have based most of the way we work, we move, we eat, we warm or cool, we relate, we think, in burning our planet’s inner life sediments to “fuel” (and so we call it) our lives. This activity has had such a (destructive) impact in our planet that some call this the planet’s Anthropocene era, after the very stable (weather-wise) 10,000 years of the Holocene. Our generation, around the 5000th, is the most privileged in life expectancy and sophistication in the capacity of transformation of nature to meet our needs, well rather, our abstract-driven ambitions. But the way we have been using Nature has surpassed its capacity to recover in balance to the speed of our damage. We damaged the basis of life as we exhausted soils, dried water sources and cut down the forests. We hence reduced life’s main wealth, its diversity of adapting through the last 3 billion years. We have also upset the balances of hydrogen, phosphorus and nitrogen in the soils and oceans. We have filled the air with the carbon extracted and burnt and upset its balance with oxygen. We have even broken-down elements so they will generate radiations distorting life cycles for thousands of years.

Nature suffers our unbalanced damage but we will suffer it gradually advancing towards our extinction which -if our destructive mode persists- would be a relief for our planet and life in it which would soon (in the Planet’s time dimension) recover from our damage which is, overall, an unconscious and self-centered (narcissistic) suicide.

One of the ways we damage the Planet and progress towards our extinction is by burning underground carbon and releasing it above the surface. All that carbon (more than the natural carbon cycle of the Planet’s surface) is accumulated in the atmosphere. Since the time we started burning coal in the XVIIIth century and later boosted with the burning of liquid oil mainly in the XXth century and gas by this XXIst century, we have released some 700,000 million tons of carbon in the atmosphere surrounding and protecting life in the planet.

The carbon accumulated in the atmosphere is measured by particles per million. Their greenhouse effect traps the solar radiation overheating the Planet’s surface temperature. There is a strong linear relation between the million if carbon tons accumulated in the atmosphere, and Planet`s surface average temperature increase.

As all inter-connected living creatures, including ourselves, the Planet needs a fine equilibrium if its temperature to maintain the complex interaction of molecules we call life. As our life is compromised with fever, so is the Planet`s. And in a very similar range:  temperature increases above 2 degrees our average baseline (fever above 38.5 Celsius degrees) compromise our individual health, and so it also happens with life (inclusing ours) in our Planet. The most recent IPCC report brings that threshold lower, to 1.5°.

In the last 200 years, we have caused the Planet (as infections – uncontrolled growth of microorganisms- behave in our body) to suffer progressively of mild fever episodes causing draughts, and consequences of sweating (floods) and possibly even shivering (earthquakes). Those are the fever-related symptoms, while we also cause dehydration (water shortage), alopecia (deforestation), dysbacteriosis – imbalance with our bacteria in the gut mainly, the cause and consequence of most ill health- (loss of biodiversity), tumors (uncontrolled growth of cities), metabolic disorders as diabetes (imbalances of carbon, nitrogen and phosphorus, the players of life, resulting in the acidification of soils and oceans) or intoxications (as heavy metals in lands and plastics in oceans, soon more than fish).

The Planet will survive to this annoying self-centered human infection and recover to a harmony among its living dwellers but we – at this rate- will not only extinct but leave the worst form of life`s legacy proving probably an evolutionary mistake, in the history of our Planet.

Within our homo sapiens time of 30 minute-period-in-year, our generation, a 5-minute glimpse of time in one year, is the most privileged yet the most destructive and will leave the worst legacy ever to our children and grandchildren.

The analysis

We lack knowledge on the depth and width of the consequences of global warming above 2 degrees over the year 1850 baseline. In human health, the estimates based on the impact of vector-borne infections, water restricted-related diarrheal diseases, crops` impact-related malnutrition and heat waves. The analysis by WHO renders an estimate of 250,000 excess annual mortality with 2 degrees increase[1]. While that may sound tragic enough, it only represents a 0,3% increase in mortality and ill health, highly likely a gross underestimate of the impact we`ll suffer from the dramatic and unprecedented climate and environmental change we`re responsible for.

We now have some preliminary evidence of the effects of temperature increase due to human pollution on excess mortality by geo-climatic regions [2]. We have applied the reported excess mortality rates (age, sex and region- specific) under the current trend of growing carbon emissions (despite the Paris agreements- in any case insufficient) to the UN prospects of population and mortality for the rest of the XXIst century by countries according to the Koppen climate classification. The analysis results in 216 million excess deaths due to temperature increase, mainly in the last three decades of the century, in > 65 years of age and in the sub-Saharan and South Eastern Asian regions. A higher disaggregation of sub-national regions would surely render higher sensitivity and a larger death toll due to temperature increase.

This tragic death toll is over three times that of the Second World War.  Man-made climate change is a silent Third World War  with no weapons, just blind (the worst kind, the one which refuses to see) negligence (as if we were driving without seeing, and constantly killing others…), it mainly kills people with no responsibility in carbon emissions, as 80% of deaths will take place in the non-polluting tropics.

In order to develop better mathematical models to predict the real effect of global warming and the distribution of such impact across populations and territories and hence better estimate the burden of inter-generational inequity, and better understand the major consequences of our lifestyles today in the lives of our children and grandchildren, we are developing intergenerational health equity metrics based to estimate such burden by country, age , sex and time period.

The strong correlation between the cumulative carbon emissions, particles per million and temperature increase, has been clearly proven[3]. The following graph shows the correlation between the models of cumulative carbon emissions and global warming, with a clear crossing of 1000000 million tonnes (one trillion), at 2 degrees excess temperature[4].

Given the dramatic rate of Nature and self-destruction, Humanity needs to change in this century its ways of living, producing, consuming, moving, relating, using energy and developing knowledge and global public goods, in order to avoid the 2 degrees Celsius in excess (fever) of baseline levels in 1850, when this destructive dynamic started.

Such profound changes require at least two generations with generation of conscience, knowledge, attitudes, means and practices, that is, the remains of the XXIst century.

The universal ethical threshold of CO2 emissions

In order to avoid the dramatic glass-roof of 2 degrees increase due to the cumulative 1 trillion tonne carbon emissions, we have calculated the ethical threshold of annual per capita carbon emissions so that all persons foreseen to live during the XXIst century would collectively produce less than the approximately 400,000 tonnes remaining to the trillionth one. Humanity has identified sources of oil and gas which if burnt would mean over 1,2 billion tons of carbon emissions, three times the space to hit the 2º threshold, and yet oil companies worldwide continue to search for more reserves.

Figure 1 shows the predictions of cumulative carbon emissions (in bars) given the UN Population forecast for the century and in four scenarios of annual carbon emission annuals per capita: the present level, the present trend (based on time series of the last 20 years) and the maximum levels which in a stable or progressively lowering trend would avoid the trillion tonne cumulative carbon emissions by year 2100. At the present level of carbon emissions, we would hit the trillion tones (and the consequence of 2 degrees warming) by 2044. Given the slight lowering trend in the last ten years, the present trend of emissions would mean reaching the trillion tones 5 years later, in 2049.

Figure 1 : Calculation of the sustainability threshold of carbon emissions 1960-2100

In a stable way, the ethical universal threshold in Humanity’s main challenge this century is of 1.7 tons of CO2 (3.67 conversion factor from carbon to CO2) per person and year.  This is the limit for every human being (in annual CO2 emissions) required to preserve the Planet for our children and grandchildren. We call it the Universal Ethical Threshold (UET). In a progressive lowering rate, it would start from the present world average levels of 5 cross by 2060 the average threshold of 1.7 and thereafter decrease till zero emissions by 2100.

In any scenario, the ethical threshold is calculated as the per capita share given at any time the balance to one trillion tones and the estimated population living in the planet until 2100.

Ethical threshold vs present situation and trend

In contrast with the ethical threshold calculated (to spare the coming generation from a tragic global warming with yet unknown impact on human health-even survival as a species-), Figure 2 represents the relation between the ethical threshold of CO2 emissions and the average and median values of global human emissions. The median is lower than the mean given the accumulation of high values in a lower share of countries. As Humanity, we have trespassed this ethical threshold in 1970 and now stand at emissions 2.5 times higher than the universal ethical threshold (UET).

Figure 2: International average CO2 emissions pc vs sustainability threshold, 1961-2013

The number of countries where the average carbon footprint per capita was under the universal ethical threshold (UET) has been decreasing since 1960 going from 140 in 1960 to some 80 now. The present trend points at a continued decrease down to 60. The Paris agreement in Conference of Parties (COP)-21 would reduce the downfall and lead to a stable number till 2030 of some 100 countries (half the world’s nations) below the UET, that is, with sustainable level of carbon emissions which would avoid the trillionth ton glass roof and the 2ºC increase, enabling a chance to shift towards a post-petroleum XXII nd century. The population living in sustainable countries went from 2 billion in 1960 to over 3 billion in 1990 but then fell abruptly (to some 2.5 billion) due to the increase of carbon emissions (surpassing the UET) in China. Under the current trend scenario, the total population under the UET would slowly grow (due to the population growth rate in low income countries) hitting another abrupt decrease in 2020 due to the increase of per capita emissions above the UET in India, going back to some 2 billion living in countries with ecologically sustainable economies, less than one third of the world´s population. If COP 21 commitments are met, India would not fall out of the sustainability group and in fact China would rejoin by 2028, increasing the overall population living in sustainable countries to close to six thousand million people, half the world`s people and over twice the scenarios without the COP 21 commitments.

If the COP-21 commitments are met in 2030, the population entering the countries` sustainability range due to compliance with COP-21 commitments would belong to 13 countries, with 44% of such population from India, 41% from China, 8.5% from Indonesia and 3% from Vietnam (the four latter add to 95% of the additional 3.8 billion people under the UET). The world`s share of population  under the UET has a step-ladder shape with slow decrease since the 60s till the 90s (60 to 50%), a first abrupt fall to 35% due to China`s surpass, followed by again slow gradual decrease till 2020 when (under the current trend), India would fall out and the overall share would be around 20%. If COP 21 commitments are met, then, as mentioned above, India would not fall out in 2020 and China would rejoin near 2030 so the final share would be some 50%. Some 50% of the world`s population would be producing some 20% of total emissions (40% and 10% respectively without China before 2028).

2030 scenarios

Three different scenarios may be foreseen towards 2030: the present trend, the one under compliance of COP21 commitments and the former one excluding the USA (given their recent withdrawal). There would be a reduction to less than 50% of the current trend if COP 21 commitments were met by 2030, yet it would still be some 50% higher than the required UET. The withdrawal of the USA (if their current slow-lowering trend) would only (given their moderate COP21 commitments) increase some 0.1% the already too-high world`s average carbon footprint per capita.

In summary, the world runs blind and hastily towards the global warming threshold (fever of the planet) of the 2 degrees excess unprecedented for Human kind. At the current rate and trend, we would reach that turning point (possibly of no return) by the half of the century. By COP 21 commitments emissions would be reduced in 2030 by half of what the present current trend would lead to, and the population living in countries below the UET would double (to half the world’s population), largely due to the commitments of India and China.

The forecast after 2030 depends on whether the current trend remains, the COP 21 commitments remain stable after 2030, their lowering trend continues till 0 or it even goes beyond and starts recapturing the carbon in the atmosphere by knowledge and technology developed for that aim.

Inter-generational inequity

The above analysis reveals a very likely damage to the planet and the environmental conditions affecting the next generation. WHO has only estimated some 0,5% increase in the burden of ill health if we hit the trillion ton and the 2ºC of global warming. Given the major implications of such global warming -unprecedented for the last 200,000 years- in all living factors (nutrition, water, air, temperature) and the already major impact it has in many other living species on earth, it seems that 0,5% impact on our health is a gross underestimate.

References

[1] http://www.who.int/news-room/fact-sheets/detail/climate-change-and-health

[2] https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(17)30156-0/fulltext.

[3] http://iopscience.iop.org/article/10.1088/1748-9326/11/6/065003/pdf

[4] Myles R. Allenet al, Warming caused by cumulative carbon emissions towards the trillionth tonne, Nature 458, 1163-1166 (30 April 2009)