Health Breaking News 327

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 327


Access To Essential Medicines – Charles Gore Speaks About MPP’s Expanding Role 

After Shutdown, Prompt Implementation Of FDA Plan To Combat Antibiotic Resistance Is Critical 

44 African countries plan for effective implementation of new WHO TB guidelines  

UNAIDS Reports Mixed Progress Towards Reaching The 2020 Target Of Reducing TB Deaths Among People Living With HIV By 75% 

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

Building tuberculosis awareness in low-risk countries 

TDR collaborations build regional networks and research capacity to fight TB 

Breaking the cycle: Paediatric DR-TB detection, care and treatment in Tajikistan 

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

The U.S. Government and Global Tuberculosis Efforts 

WHO Calls For International Support After Ebola Infections Rise In DRC 

DRC Ebola: latest numbers as of 25 March 2019 


Diarrhoea kills more children in war zones than war itself – Unicef 

Measles vaccination: A matter of confidence and commitment 

At A Post-Gottlieb FDA, What Does The Future Hold For Public Health? 

New report: 25 major U.S. medical universities violate key transparency law 

Poor lose out as rich countries link aid with trade: think-tank 

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

Is CDC doing enough to ‘make tackling poverty its top priority’? 

Human Rights Reader 477 

Who Is Funding Solutions to the Root Causes of Mexican and Central American Migration? 

US expands abortion ‘gag rule,’ cuts funding to the Organization of American States 

ACADEMICS FOR PEACE: A BRIEF HISTORY Human Rights Foundation of Turkey (HRFT) Academy, March 2019 

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

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

Stiglitz urges joint EU-China trade sanctions against the US on climate change 

EU on track for 50% emission cuts by 2030, study says 

Q&A: Guyana’s Roadmap to Become a Green State 

L’impronta ecologica delle strutture e dei servizi sanitari 

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

An impressive number of public actors are sponsoring and collaborate on Phase II/III trials and observational studies for the development of shorter, more effective regimens for Drug Resistant Tuberculosis (DR-TB), including the new chemical entity bedaquiline. The evidence accrued from these studies is being used by WHO to develop treatment guidelines. It will likely be used by stringent regulatory agencies to grant full registration status to bedaquiline. Despite important public investments, the accessibility of bedaquiline is a major concern for the implementation of the new WHO guidelines for DR-TB treatment and for public health strategies to tackle tuberculosis. Can public actors claim rights over their investments in and contribution to innovation?

By Barbara Milani

Independent Consultant, Pharmaceuticals and Public Health – Programme & Policy Specialist

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


With WHO recommending bedaquiline as a priority medicine for the treatment of Drug Resistant Tuberculosis (DR-TB) in August 2018, a renovated call for access has mobilized patients, the global health community and civil society to gain access to this life-saving medicine. (1,2)

The bedaquiline story adds a new dimension to the debate of the past 20 years on the patent system and its inability to foster innovation to meet public health needs. Several commissions, working groups and processes have been established within the United Nations umbrella, yet with no tangible reform of the governance system for Research and Development. The last attempts are represented by the WHO Consultative Expert Working Group on Research and Development (CEWG) and by the UN Secretary-General’s High-Level Panel on Access to Medicines.

Bedaquiline was developed by Janssen Pharmaceuticals for the treatment of DR-TB in a stand-alone mode only up to Phase II trial level. The development of the innovator company has allowed for its ‘conditional registration’ in the USA and Europe as an add-on medicine to the toxic cocktail of old medicines in a 24-months DR-TB regimen with an efficacy of around 50%. The ‘conditional registrations’ were provided by the US FDA and the EMA based on Janssen’s Phase IIb results. Subsequently, the US FDA requested Janssen to proceed to a Phase III trial of bedaquiline as part of a new shorter less toxic regimen for DR-TB in order to proceed to a full registration of the medicine. (3) At this point in the story, an impressive amount of public actors and hence public investments come into play to trial bedaquiline as part of new shorter and more effective DR-TB regimens.

Bedaquiline is being studied in at least 8 Phase II and III trials by over 10 public actors as main sponsors (scientific organizations, state research institutions, NGOs, not-for-profit organizations, academic institutions) in over 25 countries. An uncountable number of public institutions are collaborators of the main sponsors of these trials. South Africa presents more than 12 clinical trial sites in public hospitals and TB clinics studying bedaquiline in different regimens. (4) Public actors are also conducting several observational studies in different countries, which contribute to produce evidence on the use and safety of the medicine as part of new regimens for DR-TB. The WHO recommendations on the use of bedaquiline as a priority medicine for new DR-TB regimens are based on evidence produced through the impressive mobilisation and investment by public actors. (5,6)

Janssen Pharmaceuticals holds on to its patents to maintain exclusive price control on bedaquiline as in the usual schemes of private product development and market control. (5, 7) Bedaquiline is widely patented in several middle and low income countries. The filed and granted patents include process patents, patents on the compound family, on the salt of the medicine, on the use of the medicines to treat DR TB and latent TB. Patent expiry for bedaquiline is due some time between 2023 and 2028, thereby providing Janssen with exclusive price control until patent expiry in countries. (8) The company has applied tiered pricing to bedaquiline for public health programmes since the medicine’s conditional registration. The lowest tiered price now applied by Janssen is 400 USD for six months of treatment. This is still a significantly high price for the new WHO-recommended DR-TB regimens. The medicine is available at much higher prices in the Russian Federation and in other middle income countries, making it virtually impossible for countries to implement the new WHO recommendations. (5,6) Civil society organizations and TB activists have filed a patent opposition in India to facilitate generic competition and reduced prices. (9)

There is an additional element that the global health community should consider beyond playing by the patent system. The current governance system for new health technologies largely based on the patent system fails to reward the investments made by public actors as well as to balance public financial incentives for product development. (5)

The US FDA has requested Phase II and III trials in order to proceed to the full registration of bedaquiline.  The public entities involved in these trials, including the hosting countries, should request for a reward on their invested resources to the company.  Hence, legal actions should not only target the shortfalls of the patent system to provide access to this life-saving medicine, but should also address in other venues a recognition of the public investments to reach full registration for an improved indication of bedaquiline.

The late involvement of public actors in the development of bedaquiline has not been framed within appropriate Public Private Partnerships (PPPs)/Product Development partnerships (PDPs), where ideally the entities taking part in product development obtain an upfront agreement on the future availability and accessibility of the medicine. Several examples show that PPPs/PDPs can be established on very weak terms in relation to pricing and access to the resulting product, hence with little reward to public investment. This approach would have additional limitations in the case of multiple public actors involved in different trials with the purpose of defining a shorter and more effective regimen, as for bedaquiline. Only one agreement is reported between Janssen and one of the trial sponsors. (3,7) The pull incentives granted by the US government for development of bedaquiline as an orphan and neglected tropical disease medicine and eventual agreements with trial sponsors did not have any impact beyond the tiered pricing applied by the company. (5) A recent systematic review intended to assess the functioning and impact of PPPs/PDPs for new health technologies for neglected tropical medicines revealed a clear lack of empirical assessment of PPPs/PDPs (10). Public funded incentives and late stage public investments for the development of shorter more effective regimens for DR-TB are failing to ensure availability and accessibility of this life-saving medicine.

The bedaquiline story once again raises the question: who rewards public investments on product development? Do public actors have the means to legally claim rights over their investment and contribution to innovation? Under which existing governance system and jurisdiction?



  1. Rapid Communication: Key changes to treatment of multidrug- and rifampicin-resistant tuberculosis (MDR/RR-TB), World Health Organization, Geneva, August 2018.
  2. WHO treatment guidelines for multidrug- and rifampicin-resistant tuberculosis, 2018 update, World Health Organization, Geneva, December 2018.
  3. Milani B, A pipeline analysis of new products for malaria, tuberculosis and neglected tropical diseases: A Working Paper, United Nations Development Programme, August 2016.
  4. Clinical trials data on bedaquiline Phase II and III trials were collected through:
  5. The price of bedaquiline, Treatment Action Group, October 2018.
  6. Open Letter to J&J: Calling for affordable access to critical TB drug bedaquiline, MSF Access Campaign, September 2018.
  7. A review of the bedaquiline patent landscape, Unitaid, 2014.
  8. Updated patent landscape for bedaquiline available MedsPaL:
  9. TB activists for first time challenge TB drug patent in India, in bid to prevent J&J from extending monopoly, Press release, MSF, February 2019
  10. Aerts C, Sunyoto T, Tediosi F, Sicuri E. Are public-private partnerships the solution to tackle neglected tropical diseases? A systematic review of the literature. Health Policy. 2017 Jul;121(7):745-754. doi: 10.1016/j.healthpol.2017.05.005. Epub 2017 May 19.




It’s Time to End TB in EECA

Within the European region, most new TB cases and deaths are found in the Eastern European and Central Asian (EECA) countries. In this region we face an increasing number of drug resistant TB cases which becomes a real concern for patients and public health. AFEW Network is helping to eliminate tuberculosis in EECA

By Helena Arntz and Olesya Kravchuk

AFEW International

It’s Time to End Tuberculosis in Eastern Europe and Central Asia


24th of March marks World Tuberculosis day. The mortality rate of tuberculosis (TB) continues to decrease, but it is still one of the top 10 causes of death worldwide. According to the World Health Organization (WHO), TB caused 1.7 million deaths in 2017. Within the European region, most new TB cases and deaths are found in the Eastern European and Central Asian (EECA) countries. In this region we face an increasing number of drug resistant TB cases which becomes a real concern for patients and public health.

Countries in the Eastern part of the WHO European Region are most affected by the TB epidemic: 18 high-priority countries for TB control bear 85% of the TB burden, and 99% of the multidrug-resistant TB (MDR-TB) burden. These countries are Armenia, Azerbaijan, Belarus, Bulgaria, Estonia, Georgia, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, the Republic of Moldova, Romania, the Russian Federation, Tajikistan, Turkey, Turkmenistan, Ukraine and Uzbekistan. Despite much progress in Eastern Europe, critical challenges remain as regards access to appropriate treatment regimens, patient hospitalisation, scale-up of laboratory capacity, including the use of rapid diagnostics and second-line Drug Susceptibility Testing (DST), vulnerable populations human resources, and financing.

AFEW Network is helping to eliminate tuberculosis in EECA. AFEW Kazakhstan together with KNCV in the Improved TB/HIV prevention & care – building models for the future project is increasing access to TB treatment. A model for effective partnership between government and public sectors of health care and organisations of civil society that provide TB-HIV services in Almaty, Kazakhstan is being developed. Within the Fast-Track TB/HIV Responses for Key Populations in EECA Cities project, AFEW Kazakhstan is piloting the innovative model of increasing the participation of the city administration in programs for the prevention and treatment of HIV infection and tuberculosis in the city of Almaty with particular emphasis on key populations. Within this program, models of sustainable city responses to HIV and TB in key population in EECA that significantly contribute to achieving 90-90-90 HIV/TB targets for key populations are being developed. The program is working in Bulgaria (Sofia), Georgia (Tbilisi), Kazakhstan (Almaty), Moldova (Balti), Ukraine (Odesa).

This year’s International TB Day’s theme is “IT’S TIME”. This slogan is indicating that it is time to end tuberculosis. There is a number of events that will draw attention to this day in Eastern Europe and Central Asia. The youth community center “Compass” in Kharkiv, Ukraine will hold a training session on the prevention of TB in one of the schools they work. Local NGOs in Kazakhstan have been providing tuberculosis screening in the shopping malls and markets before the World TB Day and were raising awareness of the disease within the students and migrants.



Turbulences in Uganda’s Global Aid Construct

At a time when to care about Uganda’s health system a model shift is required to be drawn for the coverage and effectiveness of aid to yield more productive results, this paper scrutinizes the changes, the form, and the applicability of external financing for health to Uganda and evaluates the level of influence of new alternatives available for health sector development

By Michael Ssemakula

Health Rights Advocate

Human Rights Research Documentation Center (HURIC), and PHM-Network, Uganda

Turbulences in Uganda’s Global Aid Construct

Is the Contemporary Aid Effective Enough to Transform Uganda’s Health System to Achieve UHC?


Over the last sixty-two years, Africa land mass has received an enormous share of foreign aid of over one-trillion US-Dollars (USD). This has intently been given to fight absolute poverty, hunger, and disease, humanitarian causes such as addressing internal conflicts, child labor and human trafficking to lessen the contemporary cross-Atlantic slave trade, and debt reliefs through the multi-lateral debt relief initiatives to expand the fiscal spaces of the resource poor countries especially in the sub-Saharan Africa, the world’s poorest region. Uganda in a particular has been in position to improve its health through Development Assistance for Health (DAH) for activities within health sector such as population programmes and Health Development Aid (HDA) from external resources in form of financial or in-kind aid that is directed to fund health-allied activities such as water and sanitation programmes (F, 2016). But, the disease burden continues to thrive in Uganda despite of all the multi-million dollar donations from external assistance for health.

The paper scrutinizes the changes, the form, and the applicability of external financing for health to Uganda and evaluates the level of influence of new alternatives available for health sector development. Aid has been contracted significantly for health sector projects’ support and enhancing national budget expenditures towards health to expand our fiscal space and attain the Sustainable Development Goals’ agenda…. which are supposed to guide countries to improve their health and development at large, to leave no one behind. But grants and loans given to accelerate health accessibility and poverty reduction programs have shown low propensity in health sector improvement. Case in line, Mulago Specialized Women and Neonatal Health Hospital in Uganda was renovated partly through the support of the donor’s aid to improve reproductive and maternal health services, but it has continued to set exorbitant fees for patients to access health thus expanding the inequality gap in accessing health in impoverished communities, and worsening the public decry, according to a report by (Atwine, 2018).  Over eras-of-time, health has been renowned to be a significant component for Gross Domestic Product (GDP) growth and economic development as a populace in good health can raise the productivity and efficiency of the State’s labor force while plummeting poverty. Therefore it is imperative to view access to good adequate health as a fundamental basic human right enshrined in the international covenant on social economic and cultural rights, a fulfillment and global commitment for both developed and countries in low-levels of economic transition.

Uganda needs approximately USD 15 billion to achieve affordable, acceptable and accessible health for all Ugandans through well planned holistic pre-payment mechanisms such as the National Health Insurance Scheme and Uganda National Minimum Health Care Package in our health system that can cover all citizens in their diverse income stratas. This comes at the time when donor environment over time has reformed the mechanisms through which they fund programmes. In Uganda, Structural Adjustment Programmes and State Wide Approaches were widely applied in many sectors like health and education (which were centralized systems of funding that circled macroeconomic policies in their operations such as retrenchment policies, liberalization and privatization drives to make state governments more efficient), to now project based form of funding which has been incorporated in projects like Global Financing Facility of the World Bank group and European Union Emergency Trust Fund for Africa (EUTF). All these models have been designed by the donor communities and the recipient state governments to improve health systems and infrastructure developments in the resource limited settings like Uganda, but the inequality gap in health accessibility does not correlate with the amount of aid pumped into the countries’ health sectors and other health-related activities to achieve Universal Health Coverage (UHC). The state is nevertheless the chief actor in the strengthening of the development assistance for health processes to maximize the health outcomes. Therefore the link between donors and state’s health sector should be purely interpreted as a cordial relationship formed to increase free-of-cost health service provision, through establishment of a strong health infrastructural system and well streamlined strategy for the proper utilization of development aid assistance.

Uganda has applied a queue of health development strategies and policies such as the Health Sector Development Plans and so many others to improve health with more than 45% dependence on aid from donors, foundations, philanthropists, and non-government organizations (Health, 2014/15 & 2015/16). The state of poor health system in Uganda and other countries in the East African bloc amidst the increasing donor funding is attributed to a multiplicity of factors. Research shows the contemporary aid given in most of times is largely shrouded with donor interests. Further, it is being taken as a conduit for expansion of influence and conglomerates of the multinational private companies especially the pharmaceutical corporations; this is because many of these leverage on the partnerships they have with the global financing trust funds through contract provision of certain services such as, infrastructure development, medicines and technologies. They eventually price their services or health products so highly thereby enlarging the health accessibility disparity in the vulnerable communities, which is contrary to the principles of public health. Unendurable conditionalities are part of the mix in the aid construct which in most cases are hard to meet to yield the desired results. For instance, the Global Financing Facility (GFF´s) Results-Based Financing (RBF) model in its monitoring framework which focuses on specific indicators to determine fund disbursement at health facility and district level has been encircled with many inadequacies in Uganda.  The approach is meant to increase the motivation of healthcare workers and the financial autonomy of healthcare facilities, in order to improve performance of health systems and ultimately improve the health outcomes. However, emerging evidence of this financing approach reveals an irregular performance record. In adding, the broad implementation of RBF across a feeble or unprepared health care system raises many concerns. Experience shows that health facilities with existing poor performance levels will simply not succeed in creating a sufficient inflow of funds through RBF mechanism. Struggling health centres failing to reach RBF targets risk penalization through aid-cuts for failure to meet the set targets as part of the conditionalities in this funding modality, thereby demoralizing health workers and creating greater inequity as these health centres and the populations they serve are left behind, (Paul E, 2018).

Apparently, NGOs and the third-sector which are essentially the second engine of the health sector functioning in Uganda have a remarkable role to play as their sovereignty and self-sufficiency raises above the state’s; this is reflected through the variance in support towards the health sector by the government and the donor community. Uganda has experienced so many periods of incapacity to meet the required global financing commitments to health to provide its primary health care services to the society, which has prompted the donors (internally and externally) and lenders of all sorts to intervene through credits, grants, aid and others. Aid given to economies in transition such as those in the great-lakes region of Africa, is majorly destined to assist these states to undertake and complete their health and development projects. These aids usually come from the ex-colonial monopole and partnership financing initiatives to fortify bilateral-ties and advance donor interests. In sub-Saharan Africa, foreign aid now comes in numerous forms but the most common one is through partnership trust funds like Global fund, Global Alliance for Vaccines and Immunizations (GAVI); International Monetary Fund (IMF) through World Bank Group, European Union Emergency Trust Fund for Africa, and Global Financing Facility of the World Bank Group. These support projects that involve investment in health (such as advancing Primary Health Care, health infrastructure development and health system upgrade: case in line Uganda upgraded health centres in 2018 in different levels to revive its referral system), technical assistance of the various projects, budget support, debt reliefs through multilateral debt relief initiatives; not to mention investing in people to harness better social welfare provision and improve our Human Development Index, bio-diversity protection and climate change, support to non-state institutions involved in the human development and humanitarian causes, food security, migration problems, and so on. However, due to the dynamics in the contemporary aid, a lot of inadequacies surround aid given. There is always a lacuna in its effectiveness, delays and postponements in execution of projects due to aid’s volatility and unpredictability.

Currently, most of the aid financing modalities intends to leverage on lending. For instance, the Global Financing Facility project on Reproductive Maternal Newborn Child and Adolescent Health and Nutrition (RMNCAH+N), being implemented in Uganda and other sub-Saharan Africa states, links its grant money to World Bank lending. At the onset, an average of USD $1 of a GFF grant was matched with USD $4 of a World Bank loan. Three-years ahead, this fraction has almost doubled, ascending to USD $1: USD $7. With several GFF eligible and qualified countries already worryingly and severely indebted, additional increases in nation’s indebtedness are troubling. In the long-term, such heavy dependence on credit risks forming untenable loan repayment burdens. If the countries prioritize the servicing of these debts, this may force governments into resolutions to cut their spending in other areas, such as indispensable essential social services. Ultimately, this undermines or weakens health systems.

Conclusion and Recommendation

To care about our health system, a model shift is required to be drawn for the coverage and effectiveness of aid in Uganda to yield more productive results. Therefore close monitoring of aid especially in form of credit both short- and long-term effects is crucial. In countries such as Uganda where the risks of debt increases are deemed high, aid structures need to be revised and implement measures to protect the delivery of essential health services for the long-term. Establishment of strong robust evaluation mechanisms, and adaptation of design and implementation modalities is required. This can be backed by continuing a thorough and transparent review of health and equity outcome data under performance-centric schemes on aid effectiveness.



Atwine, A. (2018). Public anger as Govt sets exorbitant charges for new Mulago women hospital. Kampala: daily post Uganda.

F, N. (2016). Failure of Foreign Aid in Developing Countries: A Quest for Alternatives. Accra: Business and Economics Journal.

Health, M. o. (2014/15 & 2015/16). National Health Expenditure. Kampala: Ministry of Health.

Paul E, A. L. (2018). Performance-based financing in low-income and middle-income countries: isn’t it time for a rethink? BMJ global health, pg e000664.



Health Breaking News 326

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 326


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

Democracy Matters in Global Health 

Establishing Credibility and Legitimacy: Seven Challenges for David Malpass 

EU’s ‘Tobin tax’ now expected to collect only €3.5 billon 

International Clinical Engineering and Health Technology Management Congress October 21st -22nd 2019 Rome, Italy 

Almost 7% of EU imports are counterfeit and pirate goods 

NICE refuses to release survival data for breast cancer drug 

DRC Ebola: latest numbers as of 19 March 2019 

Ebola Epidemic in Congo Could Last Another Year, C.D.C. Director Warns 

Ebola is Still Stalking Africa. Who’s Supporting Front-line Work to Stop More Outbreaks? 

Doubling down on Ebola 

Gavi@20: What’s Next for Global Immunization Efforts 

In Madagascar, 1,100 measles deaths are more about money than ‘vaccine hesitancy’ 

Africa: ‘Exciting’ News in Fight Against Drug-Resistant TB 

New WHO recommendations to accelerate progress on TB 

Study shows dramatically shorter treatment for Chagas disease could be just as effective, and significantly safer 

Strategy for a globally coordinated response to a priority neglected tropical disease: Snakebite envenoming 

The 2018 Nigeria HIV/AIDS Indicator and Impact Survey (NAISS): Results and Implications for Nigeria’s HIV Program 

Yemen’s health system fragmentation during the conflict: The impact on the health and nutrition status of a vulnerable population 

Severe mental illness and substance use disorders in prisoners in low-income and middle-income countries: a systematic review and meta-analysis of prevalence studies 

Re-imagining global health through social medicine 

WHO guideline on health policy and system support to optimize community health worker programmes 


Human Rights Reader 476 

Sex Workers’ Untold Stories 

Fighting the World’s Largest Criminal Industry: Modern Slavery 

Cost-effectiveness of financial incentives for improving diet and health through Medicare and Medicaid: A microsimulation study 

World Bank Doubles Pledge to Climate Efforts in Africa 

Young climate activists around the world: why I’m striking today 

The climate strikers should inspire us all to act at the next UN summit 

As children strike around the world, Oxfam calls for climate action 

Climate Change Also Affects Mental Health in Mexico 

Environmental degradation threat to health, says UN 

EU Parliament votes for 55% emissions cuts by 2030 

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

At a time when youth mobilisation worldwide is urging governments to take on their duties at last and tackle global health threats with no delay, PEAH is pleased to publish an appeal by a fifteen-year-old health advocate aimed at curbing mental health stigma

By Tiffany Osibanjo

Youth Councillor (St Albans and Harpenden), Young Commissioner and Health Ambassador, St George’s School

Hertfordshire, England

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


Depression and anxiety rates have increased by 70% among the adolescent in the past 25 years. 1 in 4 people experience mental health problems in the UK every year, and some figures suggest that 70% of children and young people don’t receive the help they need at a sufficiently early age. These statistics prove that urgent attention and prioritization for mental health is required. Too many teenagers are afraid to talk about mental health for fear of being judged or treated differently.

The problem at hand could partly be rectified by encouraging society to join the discussion on mental health, where talking about our issues and anxieties becomes the norm. This is where political correctness should be one of the solutions we are looking for.

Political correctness is usually a term that’s referred to as avoiding language and demonstrations of insult to those, suffering discrimination or are, at a disadvantage in society. An example of ‘politically correct behaviour’ may be: Asking a person about their ‘partner’, instead of using gendered terms that may be of insult. Unfortunately, many believe political correctness is a term that many hide behind to escape the harsh truths of reality that there is inequity in society.

However, instead of using the term to draw controversy and debates, it can be one of the solutions for the stigma surrounding mental health. As a united society, the world leaders could encourage the discussion of mental health and its urgent prioritization through the use of ‘politically correct ‘language. Instead of political correctness being a term used for avoiding insulting language, it could be a term for promoting positive demonstrations of support, through words, actions and possibly social media to ensure a socially sustainable society.

Political correctness when used effectively, can make one’s transition into modern society easier and help reduce social isolation. In mental health terms, this may help reduce the stigma significantly, and make the other interventions and solutions more effective such as youth focus groups.

Youth focus groups have started emerging including youth councils, which could be used as a platform to drive this initiative. I also turn to global leaders to initiate other local and community programmes involving the youth; to discuss the challenges and solutions to mental health and possibly use testimonies of those previously suffering mental health issues to create hope and change for the future.

Change may happen soon through the prioritization of mental health for a better future and a better world.


References  – – The Independent – mental health foundation








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

By conflating literature data, this article adds food for thought to the awareness that '...the connections between climate change and wealthy lives are real, the connections between wealthy lives and health benefits are real as well, as are the connections between wealthy lives and environmental degradation... The problem is that these connections are easy to understand but also easy to ignore and difficult to act on in everyday life'. 

A really tough, much conflicting issue for which a leap of political will to find non-destructive ways of increasing incomes and material well-being is required at a time when '...the Sustainable Development Goals provide direction for where a healthful development could be going, though they leave unexplained how the world is supposed to generate sufficient economic growth to eliminate extreme poverty by 2030 (Goal 1) while at the same ensuring universal access to affordable, reliable and modern energy services (Goal 7.1.) and mobilizing $100 billion annually by 2020 from all sources to address the needs of developing countries regarding climate change mitigation and adaptation (Goal 13A).'

By Iris Borowy *

Distinguished Professor, Center for the History of Global Development

Shanghai University

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


It is easy to forget to what degree good health is of recent origin. Gapminder provides an interactive timeline for life expectancy for many countries beginning with the nineteenth century. Though exact data are difficult to find or non-existent for large parts of the world for long periods and it is misleading to assume that lives were the same in all places at all times, there is good evidence that, until about 300 years ago, frequent hunger, chronic malnutrition, impaired immune systems and stunted growth were facts of life for the majority of people. But, of course, within their own times, general people’s height was not considered stunted, parents losing several of their children in infancy was not considered abnormal and short lives were not considered short. It is only in hindsight that we gain this perspective, knowing how long people can live, how tall they can grow and how many children can survive, given the circumstances.  In what Robert Fogel and Dora Costa have called the a technophysio evolution, a drastic change in human environments have enabled people in industrialized countries to double their lifetime and increase their body weight by 50 percent. But what exactly, has brought about these immense health improvements? Fogel and Costa argue that it was a combination of more food, better living conditions, more leisure time and better medical care. In simple terms, they argue that increased incomes have provided people with the opportunity to improve their living conditions to such an extent as to live vastly longer and healthier lives.

But is it really increased wealth that has brought about these changes? In part, the answer seems a no-brainer: rich people can afford to live in healthier environments, eat healthier food and live in healthier housing than poor people. High-income societies can provide better quality preventive and therapeutic health care, offer better and more extensive education for men and women, invest more in health-related research and afford more extensive social servicess such as unemployment benefits and old-age pensions than low-income societies. In short, people in rich Japan (84.2 years) can expect to live more than thirty years longer than in poor Lesotho (52.9 years), today. People in wealthy countries also tend to lead safe lives, at comparatively little risk of being killed either by others or by themselves, as the list of world death rate rankings for violence/homicide and suicide reveals. As use of the interactive statistical tools provided by gapminder shows, virtually all health-related indicators are in some way positively correlated to incomes. If we had a choice where we would like to be born, there is little doubt that most of us would opt to be born as well-off people in high-income countries, where our lives would in all likelihood be long, safe, and healthy, unthreatened by famine, malnutrition, economic insecurity, and a host of preventable diseases. This view has perhaps been most poignantly expressed in a paper entitled “Wealthier is Healthier”, published in 1993 by leading World Bank economists Lant Prichett and Lawrence Summers in preparation of a World Bank World Development Report dedicated to health. In illustration, they stated that if “income were one percent higher in the developing countries, up to 33,000 infant and 53,000 child deaths would be averted annually.” So, the easy answer is: of course, wealth is good for health. Nevertheless, there is a more complicated side to this.

The question of whether higher income improved health became the object of targeted research the context of a debate among historians about the reasons for population growth in industrialized countries. It focused on Britain, initiated by a series of publications between 1955 and 1980 by medical historian Thomas McKeown, who aimed to show that the main reason was a decline in mortality rates brought about by improving living standards, notably better nutrition, resulting from better economic conditions. His main point at the time was that medical interventions, widely believed to be key at the time, had had little impact, if any, but his argument was subsequently picked up by neo-liberal proponents of market-driven economic growth and invoked against state programs.  This “McKeown Thesis” stimulated further studies into the reasons for historical mortality decline and into the determinants of past and present life expectancy. One of the outcomes of this field of study was the Preston Curve, a graph which combines income, measured as per capita GDP, on the x-axis, with life expectancy at birth, on the y-axis. This graph, repeated for different points in time, consistently results in a positive correlation between income and life expectancy, though the vertical movement of the curve in time indicates that there are also other factors at work, unrelated to income, so that similar levels of income allowed longer lives in 1960 than in 1930, and longer in 1990 than in 1960.

(Preston Curve. Source:

While compelling (and frequently cited), the graph is also a drastic simplification of the relation between economic level and health. The curve does not explain causality (is health better because of high incomes, or are incomes higher because of better health?), nor show to what extent both income and health may be the impacted by another independent variable. The Prichett-Summers article,  cited above, readily acknowledged but then discarded those points. Most importantly, the curve connected only one manifestation of health (life expectancy) with only one possible variable (national income), reducing a highly complex condition to a seemingly simple unilateral relation.

Among experts of public health, the complexity of factors affecting health had been well established since the nineteenth century. But it took fifteen years before there was a visualization that could rival the Preston curve. In 1991, Göran Dahlgren and Margaret Whitehead published a background paper for WHO Europe on Policies and strategiesto promote social equity in health, which focused on equity levels as important predictors of health, citing, among others, the demonstrable impact of housing, education, food and labor. While the paper is no longer broadly known, its legacy lives on in the drawing it included and which has become the frequently cited standard view of the social determinants of health.

Source (for instance):

Subsequently, these factors have received further recognition. In 2001, the Commission on Macroeconomics and Health, instituted by Gro Harlem Brundtland as Director-General of the World Health Organizations, issued a report on Macroeconomics and Health: Investing in Health for Economic Development, which highlighted the importance of population health as a crucial driver of the economic development especially of low-income countries, effective reversing the perspective on the relation between income and health. Seven years later, another high-level WHO commission, the Commission on Social Determinants of Health, issued its final report, which spelled out a series of factors related to socio-economic conditions and governmental policies and their impact on health, pointing out, among other aspects, the importance of early life conditions and societal power structures.

Thus, the lively McKeown debate of past decades has been put to rest in the sense that it is beyond doubt that the declining mortality and expanding life expectancy in Britain (and, by implication, elsewhere) cannot be explained by one cause alone but that they have been affected by numerous factors, including (but not limited to) state programs such as vaccinations, changing agricultural practices, sanitation and water safety measures, urbanization, migration, marriage patterns, and changing incomes due to industrialization. The debate is not over in the sense that within this field, many questions remain open. Often, as different dynamics have been at work at different times, the relative significance of individual factors for specific cases is still quite unclear. Sometimes the same factor can have contradictory effects, such as the significance of declining grain prices, which made both bread and gin more affordable to working class Britons, thus simultaneously improving nutrition and fostering alcoholism. As a result, revisiting old debates mainly leads to new, still more complicated debates.

Regarding the effect of wealth and income on health, one particularly perplexing finding of the analysis of past demographic data has been that the robust positive cross-country correlation with national income and life expectancy cannot be confirmed in longitudinal studies. On the contrary, gaining incomes and wealth seem to have a downright negative influence on people’s health. In a phenomenon called “ante-bellum-puzzle” in the United States and “early-industrial-growth-puzzle” in Europe, it was found that in numerous countries, periods of economic growth and rising incomes coincided with shrinking body heights, indicating that young people at an age of growth suffered from impaired nutrition, higher diseases burdens and generally impaired health status. Similarly, mortality rates increased during times of economic expansion in OECD countries after 1960. Paradoxically, while being wealthy seems good for health, getting wealthy is not. In fact, it is getting poorer that may be good for your health. With the notable exception of suicides, important health indicators have repeatedly been found to improve during periods of economic crisis, leading two researchers to conclude that, counterintuitively “population health tends to evolve better during recessions than in expansions.” This discrepancy has been explained by the social disruptions, the increased workload, and the growing stress, which frequently go hand-in-hand with economic expansions, which have serious but temporary negative effects on health,  while declines in working hours, road traffic and high-fat diets can reduce health burdens.

This seeming paradox points to time as an important, and sometimes neglected, aspect of the relation between wealth and health. In simplistic terms, one could say that the parents, who are working hard to earn the money necessary for good food, a nice home and a good school for the children while paying taxes to a welfare state, are sacrificing some of their own health for the health benefits their children will be able to enjoy. There is enough truth in this stereotype to make this part of the larger picture, but it is by no means all of it. To begin with, people’s lives also influence the health not only of their own children but also of strangers separated from them both in time and place. And secondly, such influence can be – and is! – negative as well.

The Relation over Time

As I have argued elsewhere, the industrialization, which formed the basis for the historically unprecedented rise in material wealth, was built in parts on the death of millions of indigenous people in North America (resulting mainly from Old World epidemics and making possible large-scale emigration from Britain and investment in labor-saving technology) and on slavery (producing the cotton which fed the British textile industry). In ways that are impossible to quantify, these deaths form part of a development that tangibly prolonged and improved the lives of future generations like our own today – and therefore, arguably, part of the relation between wealth and health.

The relation becomes even more complicated when including environmental factors in the consideration. The environment plays multiple roles in this connection as a supplier of resources for the economy which underpins societal wealth, as a provider of food and other crucial necessities for healthy lives, and as a recipient of the wastes generated by populations and their wealth. Here, I argue that the relation between health and the states of the economy, on the one hand, and of the environment, on the other, are caught in a fateful triangle.

As the research on the social determinants of health, cited above, has amply shown, people’s health depends crucially on their economic status, including employment, working conditions, private incomes that allow comfortable living standards and national incomes that allow effective social services. In a quasi confirmation of the Preston Curve, this point is born out by recent ranking of countries according to their health based on a series of indicators including life expectancy, tobacco use, obesity, access to clean water and sanitation. All but two of the 37 highest-ranking countries were categorized as high-income countries by the World Bank. The exceptions are Cuba and Costa Rica, two countries that prioritize public health. The list also confirms that money is not everything, or these two cases would not exist and the rich United States would not end up on place 35. But clearly money matters. With the same two exceptions, all these countries also rank among the highest third in a ranking of countries according to their ecological footprint. Ecological footprint is a controversial measurement of human (over-)use of Earthly resources. It has been criticized as overly simplistic, misleading or insufficiently transparent. But another indicator has a yet been found that would translate the complexity of environmental degradation into a single measurement, however imperfectly. Besides, for the question of the environmentally destructive effect of present economic practices, the weakness of the ecological footprint is hardly reassuring since, if anything, it seems to undercount the real extent of damage being done.  Overall, it is difficult to avoid the impression that wealth comes with some degree of long-term environmental destruction.

With regard to health, this finding is serious since health also depends on crucial environmental determinants including clean air, clean water and a reasonably stable climate. Again, the differences within this group are substantial and worth studying. (For instance, Spain, which topped the list of healthy countries, takes a remarkably low 66th place in the ranking of the countries according to ecological footprint.) Nevertheless, the correlations strongly suggest that population health is best in those countries that also go furthest in sacrificing environmental integrity  for economic well-being. This leads to a paradoxical finding: in a fateful health triangle, economic wealth is both good and bad for health, and probably both at the same time.

The Fateful Health Triangle: Iris Borowy

Sometimes, the connection is relatively straight-forward. One example is ambient air pollution. Ambient air pollution emanating from vehicles, power plants, industry, households and biomass burning is to a large extent a function of an emerging economy. The burden is highest in low and, especially, in middle income countries. The health burden is immense. According to WHO, in 2016, ambient air pollution was responsible for 4.2 million deaths, including about 16% of the lung cancer deaths, 25% of chronic obstructive pulmonary disease (COPD) deaths, about 17% of ischaemic heart disease and stroke, and about 26% of respiratory infection deaths.

It has been argued that these burdens decline with further economic growth, as advanced economies rely more strongly on cleaner energy and more energy-efficient technology. This effect, known as the Environmental Kuznets Curve, has been cited as a refutation that “environmental degradation is an inevitable consequence of economic growth.” If this argument was true, environmental destruction would resemble high work stress as something related to rapid economic growth rather than mature wealth and, therefore, a regrettable but necessary but temporary health burden.

However, the empirical basis is weak and often inconclusive. While such a correlation (an initial rise of the environmental burden with economic growth, followed by a decline with further growth) has been documented for some selected forms of environmental burdens, notably some urban air pollutants. But for others, such as carbon emissions and solid waste, no turning point has been observed so far, it is unclear when – if ever – such a turning point will occur, nor is it clear whether past turning points have reflected a real decline in pollution or a relocation of pollution generation to other – presumably poorer – places. In other words, it is unclear if or to what extent environmental degradation is a function of the overall size of the economy and/or to its form or to the nature of specific forms of pollution.

One useful interpretation of these connections has been Environmental Risk Transition theory, developed in the 1990s by Berkeley professor Kirk Smith. It postulates different types of environmental health risks with different reactions to economic growth: 1. Traditional health risks, acting at the household level (e.g. access to water, sanitation, indoor air pollution), which decline with rising incomes, 2. Transitional health risks acting at the community level (e.g. industrial pollution), which behave according to the Environmental Kuznets Curve, and 3. Modern health risks, acting at the global level (e.g. climate change, ozone layer depletion), which keep rising with growing incomes.

Environmental Risk Transition Theory:

According to this theory, these health risks differ not only in response to economic growth but also in space and temporality: while traditional risks tend to have local and immediate effects, the impact of modern risks is global and delayed. This changed character has muddled the picture and has made it more difficult to grasp the connections or, conversely, has made it possible to select specific connections in line with ideological policy preferences. Thus, the perceived relation between level of income and health has been used as an argument against policies designed to counter climate change, lest they slow economic growth.

On one level, the argument is a foolish, since the health repercussions of climate change are beyond doubt. Climate change is predicted to negatively affect health of millions of people by increasing direct heat related illnesses and deaths, by exacerbating respiratory diseases, by changing conditions for vector- and water-borne diseases, by increasing forced migration and related disruptions and violence and by impairing mental health. WHO expects that between 2030 and 2050, climate change will cause approximately 250 000 additional deaths per year, from malnutrition, malaria, diarrhoea and heat stress and will incur costs of between two and four billion dollars per year.  Among public health experts, the effects are considered so significant that institutions like Harvard University have begun offering classes on the topic. In 2009, the Lancet Commission called climate change “the biggest global health threat of the 21st century”, a verdict that has been adopted by others since.

However, on another level, it is also true that the health damages of climate change will disproportionately affect the poor and that  – expensive –  adaptation measures (such as dams in protection against rising sea levels) and effective health and social services (such as vaccinations and other prevention measures against re-emerging infectious diseases) will go a long way to mitigate the health effects of climate change. So, calling for measures to boost incomes is not senseless. It only shows the size of the predicament. Indeed, modern health risks are most painfully felt by those societies in low-income countries that are still struggling to free themselves from the health effects of the traditional and transitional environmental risks. One study, published in 2008, analyzed the effects of three burdens, unsafe water, sanitation and hygiene, indoor air pollution from solid fuel use and outdoor air pollution (i.e. a mixture of traditional and transitional health risks), and found that it is low income countries that “suffer the most from environmental health factors, losing up to 20 times more healthy years of life per person per year than high income countries.” To this effect of a double burden will increasingly be added the third burden of climate change. If poor countries can increase their national incomes, chances are they will be better able to address all forms of environmental health risk – while at the same time making some of them bigger.

On other words, the connections between climate change and wealthy lives are real, the connections between wealthy lives and health benefits are real as well, as are the connection between wealthy lives and environmental degradation, though not necessarily at the same time and in the same place. The problem is that these connections are easy to understand but also easy to ignore and difficult to act on in everyday life. The wealth-related health benefits I enjoy when I take a taxi to the airport and then a plane to fly to a conference which I need to attend as part of the academic job which gives me material comfort and emotional support (and enables me to write this paper),  are far removed from the health damages experienced by the peasant in Africa, who finds he can no longer feed his children because climate change has dried up his fields, or by the home owner in the Seychelles who will find his house disappearing in floods caused by rising sea levels in fifty years. This connection is so indirect, it might as well not exist. So far, nobody has found a convenient illustration similar to the others included in this paper.  Nevertheless, in billions of faint, indirect connections between here and the other side of the world and between now and the future, the wealth which supports health of people today is tied to the health of people many generations from now. Thus, just like a full consideration of the relation between wealth and health should extend into the past, it must also extend into the future.

The solution, obviously, would be to find non-destructive ways of increasing incomes and material well-being. So far, human history provides little experience in this regard, which could serve as guidelines. The Sustainable Development Goals provide direction for where a healthful development could be going, though they leave unexplained how the world is supposed to generate sufficient economic growth to eliminate extreme poverty by 2030 (Goal 1) while at the same ensuring universal access to affordable, reliable and modern energy services (Goal 7.1.) and mobilizing $100 billion annually by 2020 from all sources to address the needs of developing countries regarding climate change mitigation and adaptation (Goal 13A). Maybe it is possible. But it would require an enormous leap of political will, and it would lead humanity into uncharted ground. The pessimistic view is that humanity has never known a level of material wealth comparable to today without the massive use of fossil fuels. Keeping a similar level without fossil fuels, and without other forms of environmental degradation, would be a revolution. The optimistic view is, humanity has known revolutionary changes in the past.


An important component of a transition towards a health regime beyond the Fateful Health Triangle might be to change common concepts of “development”, “developed” and “developing” countries. Clearly, the model to emulate cannot be those countries that combine high health levels with economic practices that will be detrimental to people’s health, now and in the future. The countries that come closer to serving as examples may be outliers such as Cuba and Costa Rica, mentioned above, and others that are nudging closer to a system of good health and a good material living standard with little environmental destruction.

It would be helpful to have an indicator that actually measures – and thereby provides direction for – such a development. The Happy Planet Index, developed by the new economics foundation, has precisely this aim, combining life expectancy with declared life-satisfaction, inequality and the ecological footprint. The 2016 data give Costa Rica the highest score, followed by Mexico, Colombia, Vanuatu and Vietnam. But even in Costa Rica, the ecological footprint is considered surpassing the country’s biocapacity quite considerably.

There is not much of a conclusion to the paper except that given that non-negotiable relations between health and its economic and environmental determinants we need to look for a system that brings these determinants into harmony. To do this, we probably need to begin by changing our attitude towards economic growth. Economic growth has taken us far. Thanks to growth many people have longer, healthier lives than ever before in history. And if we do not manage to change the nature of growth, it will be thanks to economic growth that these health levels will be compromised again in the future.



* In part, this article makes use of material presented in more detail in: Iris Borowy, “Economic growth and health: evidence, uncertainties and connections over time and place.” In: Iris Borowy and Matthias Schmelzer (eds.), History of the Future of Economic Growth. Historical Roots of Current Debates on Sustainable Degrowth. Milton Park: Routledge 2017, 129 – 153.


Health Breaking News 325

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 325


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WHO Places Emphasis on IPC, AMR and UHC

An effective health service needs to be able to prevent and manage infections” thus starts a very excellent draft WHO discussion paper: “Tackling AMR while making progress towards UHC”

By Garance F Upham

Vice-President, World Alliance Against Antibiotic Resistance (WAAAR

Editor in Chief AMR CONTROL 

Ex-Member Steering Committee, Patients for Patient Safety, WHO Patient Safety Program (2004-2014)

WHO Places Emphasis on IPC, AMR and UHC


This week and last, three news confirmed our hunch: the WHO is beefing up its commitment to infection prevention and control (IPC).

– Dr. Hanan Balkhy, was named Assistant Director-General (ADG) Antimicrobial Resistance, which places greater emphasis on AMR, as well as raising up on the agenda the urgency of IPC, since Dr Balkhy is a world renown cheffe in implementation of IPC, having lead the Saudi Arabia’s struggle against the MERS-CoV  spread.

Previously, AMR had a low profile in the leadership group, since it fell under a very general heading of Strategic Initiative with the Italian ADG, Dr. Ranieri Guerra, now leading WHO’s preparations for the UN high-level meeting on Universal Health Coverage at the UN General Assembly in NYC this fall. Of note, Italy is today leading in an effort to bring drug pricing under control. Will Dr. Guerra follow his own government’s radical turn, or his own sentiment, whatever it may be?

If, as the Interagency Coordination Group-IACG reports tend to indicate as well as the general background rumors, AMR was to acquire dominance in global health to the point of demanding much greater visibility and funding, Hanan will have the awesome task of preventing a replay of what happened with HIV/AIDS: the creation of the GFATM, UNAIDS and UNITAID which all in all contributed to weakening of the WHO since 1996 and of the national ministries of health in their responsibility and funding to face deadly disease problems, even if the three, of course, did contribute to the necessary action. Perhaps the wisest comment came from Peter Sands (just as he was to assume his role as director of the Global Fund) when he said that to combat HIV, TB, Malaria, people should think of first dealing with the millions of cases of ordinary infectious diseases, because to do that would, indeed, affect our global capacities to roll back and treat the “HIV-TB-Malaria”.

In AMR, it seems to us important that WHO claims and retains global leadership, and be the funnel to funding.

The other news from the WHO reorganization pointing in the same direction are:

– Dr Mike Ryan was moved to become the Director the Health Emergency Department; as indicated in my previous blog article, his understanding of IPC as the only way to stop Ebola outbreaks, and his comments on WHO Director-General Dr Tedros having witnessed this in the Democratic Republic of Congo (DRC), indicates a commitment to IPC at the highest level of the WHO.


– Dr Alessandro Cassini (lead author of the report in The Lancet ID on the majority of AMR infections being acquired nosocomially, i.e. in health centers contaminations) is moving from the European Centers for Disease Control-ECDC to the WHO, this week, to beef up an IPC department which has had little staff and power over the past years.

Now, as I wrote earlier : “Dr Ryan could be the harbinger of a massive change in the WHO leadership on the need for IPC, which could come back to the forefront as a specialized department under the Emergency Health Department.

However, for that Member States would have to understand and fund that initiative.”

Or to put it otherwise: Member States could /should fund the WHO core, and the WHO stay on track to prioritize the 3 billion initiative. Dr Tedros and his team are said to hope for “emerging countries” to come forward.

An effective health service needs to be able to prevent and manage infections” thus starts a very excellent draft WHO discussion paper: “Tackling AMR while making progress towards UHC”.

Sources and references

For the WHO listing of the new leadership:

For the new hot discussions on prices and access to medicines in general and cancer in particular:

Entitled: Improving the transparency of markets for drugs, vaccines and other health-related technologies,” the resolution, to be discussed at the 72nd session of the WHA, asks national governments to demand greater price transparency as part of regulatory processes and also gives WHO a clear global mandate to track and compare drug prices nationally and worldwide.

The Italian lead initiative comes on the heels of the very hot discussions in and around the Executive Board meeting at WHO HQ this winter on the Cancer resolution (EB144/18 Cancer medicines,), and analysis of the high profitability of cancer drugs (14 USD profits for each dollar invested,
See pre-EB preparatory discussions on:

Health Breaking News 324

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 324


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