News Flash 524: Weekly Snapshot of Public Health Challenges

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

female Parrotfish (Sparisoma Cretense)

News Flash 524

Weekly Snapshot of Public Health Challenges

 

The WHO’s 75th anniversary: WHO at a pivotal moment in history

Cape Town Statement on Fostering Research Integrity Through the Promotion of Fairness, Equity, and Diversity

Boost for developing nations as mRNA technology hub moves to the next phase in South Africa

Audio Interview: Preparing for the Next Pandemic

The G20 Needs to Address the Lack of Coordination in the Global Vaccine Supply Chain for Pandemic Preparedness

Will ‘open-source’ vaccines narrow the inequality gap exposed by Covid?

Global partners announce a new effort – “The Big Catch-up” – to vaccinate millions of children and restore immunization progress lost during the pandemic

Africa: Millions of Children Deprived of Life-Saving Vaccinations Amid Covid Pandemic, Misinformation Surge

Gavi and donors must expand vaccine supply to catch up children up to age five

Not recommended fixed-dose antibiotic combinations in low- and middle-income countries – the example of Tanzania

Publication demonstrates how equitable deals for access to medicines can be signed with pharmaceutical industry

Regulating India’s generic drugs is a life or death problem for Africa

Guaifenesin: WHO issues alert over another India-made cough syrup

European Health Union: Commission proposes pharmaceuticals reform for more accessible, affordable and innovative medicines

MSF responds to European Commission’s proposal to revise EU’s pharma legislation

TDR April 2023 Newsletter: World Malaria Day Bulletin

Africa to Manufacture New Malaria Vaccine?

WHO urges increased implementation of recommended tools to combat malaria

Eliminating Malaria in Sub-Saharan Africa: Can Vaccines and Strong Health Systems Reignite the Fight?

MSF demands J&J give up its patent monopoly on TB drug to put lives over profits

Noi e la pentola

People’s Health Dispatch Bulletin #48: How to stop the brain drain?

HRR 675: BECAUSE, IN MANY WAYS, EVERYTHING IS STILL HAPPENING AS MARX SAID, WHY DOES NOTHING LEAD TO WHAT HE FORESAW?

More than 90 charities unite behind a powerful call on party leaders to guarantee essentials for low-income households amid rising hardship

How foreign aid supported anti-LGBTQ+ advocates in Uganda

Humanitarian aid needs an overhaul to address hunger crisis: Report

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

How Can We Fight Complacency Around Climate Change? Focus on Human Health

European Green Deal: New EU-Norway Green Alliance to deepen cooperation on climate, environment, energy and clean industry

Now Europeans Learn What Climate Extremes Are All About

Local Innovations Key to Meeting Challenges of the Climate Crisis

Can potatoes help to counter climate-fueled hunger in Africa?

 

 

 

 

 

 

 

 

 

 

 

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

Key highlights here on a project aimed at raising awareness and actions to mitigate the effects of climate change in holistic approach like forest recovery and how the interventions of the project will help to improve livelihood in Bugesera communities. The project will work with 45 women leaders at community level and will be implemented in Bugesera district, Rwanda. By the end of 2023, GER-Rwanda will reach 1,000 participants which will include women champions on awareness on climate change in Bugesera district

By Innocent Musore

Executive Director

Global Initiative for Environment and Reconciliation-GER

Kigali City, Rwanda

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

 

  1. Introduction

The workshop commenced at 10:30 am on April 18th, 2023. The Master of Ceremonies (MC) began by requesting all participants in the meeting hall to introduce themselves to facilitate smooth conversations throughout the meeting. Mr. Innocent Musore, the founder and Executive Director of GER-Rwanda, delivered the opening speech welcomed all the participants and provided a brief summary of GER’s mission, history, achievements, and future goals. He also introduced the theme for the workshop, which focused on women’s role in nature-based solutions, ecosystem conservation, and resilience to climate change and peace building.

Mr. Innocent Musore

He reminded the participants that the aim of the project is to raise awareness and actions to mitigate effects of climate change in holistic approach like forest recovery and how the interventions of the project will help to improve livelihood in Bugesera district communities.

Rwanda's districts. Image Source: Government of Rwanda

He pointed out that women are responsible of domestic work, they are most affected by climate change. He highlighted that “WE CAN’T build sustainable peace without considering ecological aspects especially in Bugesera district one of the most affected by the 1994 Genocide against the Tutsi”.  The workshop convened 50 participants (40 F; 10 M). The project will work with 45 women leaders at community level and will be implemented in Bugesera district. By the end of 2023, GER-Rwanda will reach 1,000 participants which will include women champions on awareness on climate change in Bugesera district. He Thanked the Rain forest for partnership and the good leadership on Rwanda

  1. Workshop Highlights and Topics

2.1. Strategies that Women Can Undertake to Contribute to the Fight against Climate Change

Community team leader discussing some points with the participants

Among the discussions, the first topic of the meeting aimed at brainstorming different strategies that women can undertake to contribute to the fight against climate change and establish a climate resilient atmosphere in their living environments.

Climate Change: The facilitator helped the participants to better understand climate change effect globally, in Rwanda and at community level respectively; case in point, Bugesera district that face long-term droughts with very little rain.

Factors Contributing to Climate Change: The facilitator highlighted factors that have contributed to the increase of climate change, such as carbon-emissions, pollution, deforestation, and overgrazing.

Consequences of Climate Change: The facilitator pointed out the consequences of increasing climate change, such as drought, famine, poverty, disease, land infertility, floods, soil erosion, land degradation, and dried-up water sources.  

Strategies to Ensure Climate Resilience

  • Sensitizing the communities on climate change, soil erosion prevention
  • Planting trees and avoiding deforestation, practicing irrigation using renewable energy, use of organic fertilizers, planting trees on lake shores, farmers’ respect for buffer zones near lakes and rivers, reviving use indigenous seeds that are climate change resilient.
  • Enhancing meaningful stakeholder collaboration and engagement to mitigate the effects of climate change and improve community livelihoods, these stakeholders include but are not limited to private institutions, local communities, youths, women.
  • Strengthening small holder farmers to have more capacities and add value to their harvest that generate profit easily with little expenses.
  • Advocacy, Community-based activities specifically for women (special communal work locally known as umuganda) as home-grown solutions.
  • Strengthening environmental education in schools as well as environmental protection initiatives.

2.2. Waste, Hygiene, and Sanitation

Among other discussions focus was also laid on waste, hygiene and sanitation and the discussion points were on the types of waste, benefits of clean water, ways of maintaining good hygiene and sanitation, negative impacts of improper waste disposal, and plastic pollution. The participants learned about the negative effects of plastic pollution on aquatic life and soil fertility. Lastly, they were encouraged to take responsibility for proper waste disposal practices.

Proposed Solutions to Maintaining Good Hygiene and Sanitation

  • Boiling water before drinking it
  • Teaching the benefits of maintaining good hygiene and sanitation and the different methods of doing it
  • Controlled excreta disposal
  • Eating safe food and proper food handling
  • Washing hands regularly with soap
  1. Insights from the Workshop Participants

-Director of Social Affairs in Bugesera district: thanked GER for organizing the meeting and everyone present for attending. He emphasized all the topics discussed by previous speakers, highlighting the benefits of proper waste disposal and community-based solutions.

Nshimiyimana Dative explained about what her group does to help in protecting the environment. She told the participants about the project that they have been working on of producing organic fertilizer from locally sourced materials that are readily available in the communities.

Nshimiyimana Dative

Other participants shared how the project has helped them not only on the personal level but also as a community as a whole. According to them, the project has helped them gain a spirit of reconciliation and unity where now they are able to interact with the people who wronged them during the Genocide contrary to how it was before joining the project. Additionally, they were very appreciative of the water tanks they were given as they have helped them tremendously to have access to clean water and the seeds for planting trees.

  1. Proposed Actions

During the workshop, several action items were proposed:

  • Providing improved cooking stoves to vulnerable women in Bugesera District.
  • Shifting our focus from personal issues to finding ways to fight climate change and make a positive impact in different regions of the world.
  • Engaging women in environmental projects that can also boost their economic growth by generating income, thereby improving their living standards.
  • Planting trees for those who are unable to do so themselves, creating fresh air and helping the environment.
  • Arranging a meeting between project beneficiaries and district representatives to develop action plans that can extend the impact of GER even further.
  • Promoting gender equality within families.
5. Success Stories

A success story was shared by Mukabarisa Safina; a Genocide survivor from Gashora Sector in Bugesera district where she pointed out that  the previous project helped her  to plant climate resilient crops that can yield even in dry spells; Water reservoirs she was given helped to harvest rainwater which was used for irrigation of crops when there is no rain, more still sharing water among people built and improved relations between her and Genocide perpetrators who she forgave and they currently live in peace; Crop harvest has helped boost her household income for families to pay Community Based Health Insurance/ Mituelle de Sante for the family; and school fees for children, the use of clay stoves has prevented deforestation to get firewood, she is more confident in addressing climate change, training, peer education among others.

Mukabarisa Safina

She concluded by pointing out that this project should be a platform for empowering women.  Apart from environmental interventions, the project is improving social relations among people, families, households and communities; this facilitates discussions on climate change.

  1. Concluding Remarks

Innocent Musore gave a closing remark thanking everyone who participated in the workshop and reminded the participants to make sure that they implement the skills and knowledge they have acquired from the workshop once they go back to their respective communities to create a positive change.

Innocent highlighted that climate change is a global challenge and to that end it requires everyone’s synergies to address the issue, while focusing on the most vulnerable people who are women that are most affected by climate change since they are the ones who are least engaged in addressing climate change.

In her concluding remarks Ms. Mukangenzi Lucie, National Women’s Council (CNF) Vice Chairperson also thanked GER on behalf of her organization for holding such educative sessions and expressed their interest in further collaborations with GER.

Ms. Mukangenzi Lucie

She thanked the partnership between GER-Rwanda and Rain-Forest Sweden (RR); and further thanked the collaboration between Bugesera district and for supporting the workshop.

 

 

 

 

GER-Rwanda 2023

www.globalr.org

News Flash 523: Weekly Snapshot of Public Health Challenges

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

Conger Eel (Conger Conger)

News Flash 523

Weekly Snapshot of Public Health Challenges

 

Human rights diplomacy: Navigating an era of polarization

Key leadership appointments made to drive WHO strategic direction and initiatives

Global leadership is needed to optimize early childhood development for children with disabilities

What’s the ideal World Health Organization (WHO)?

AREF: Announcing the 2023 Professor Sir Tumani Corrah Prize for Excellence

Webinar registration: Modelling the interactions between urban development and physical activity Apr 24, 2023

Registration: One Health Seminar-Cultivating an Active Care for a ‘World at Risk’: International One Health for One Planet Education Initiative (1 HOPE) Apr 28, 2023

Apr 21: Launch of the MPP strategy – South Africa chapter

Global Health Summer School 2023 – September 16-23 in Berlin  Colliding crises: Global Health between war, security and human rights

Life or Debt: The Stranglehold of Neocolonialism and Africa’s Search for Alternatives

IMF calls for ‘another Gleneagles moment’ on debt relief and aid

The World Will Regret Its Retreat From Globalization

VIDEO: Introduction to Civil Society Financing for Development Mechanism

The Deciding Decade for Infectious Diseases

Pharmaceutical CEOs to G7: Protect Intellectual Property Rights and Pathogen Access in WHO Pandemic Accord

DNDi Offers Model for Pandemic Accord Negotiators on How Governments Can Leverage Drug R&D Investment

Media coverage of the WHO pandemic treaty negotiations (on transparency and content) – First quarter, 2023

Implementation of the 7-1-7 target for detection, notification, and response to public health threats in five countries: a retrospective, observational study

Report of the meeting of the WHO Technical Advisory Group on COVID-19 Vaccine Composition (TAG-CO-VAC) held on 16-17 March 2023

Ghana first country to approve Oxford malaria vaccine in ‘significant milestone

Initiative aims to prevent Hep C infection in marginalized groups in low-income countries

World Chagas Disease Day 14 April 2023

Evaluation of the sugar-sweetened beverage tax in Oakland, United States, 2015–2019: A quasi-experimental and cost-effectiveness study

Updated TRIPS Flexibilities Database

Championing health equity in South Africa

The incubator for success: how mentorship and career development can boost Nigeria’s public health sector

The doctor exodus – with focus on the Scandinavian context

HRR 674: NEOCOLONIALISM IS NOT PART OF THE CONVENTIONAL ANALYTICAL CATEGORY OF HUMAN RIGHTS ANALYSIS, BECAUSE THE HUMAN RIGHTS FRAMEWORK DOES NOT ADDRESS INTER-STATE RELATIONS

UN Says 34 Million Afghans In Poverty Under Taliban Rule

Cost-of-Living Crisis: Hungry for Change

Gender inequalities in food and agriculture are costing world $1 trillion: FAO

Livelihoods of Almost Half the World’s Population Depend on Agrifood Systems

Food taboos causing malnutrition in pregnant women

A third of EU live animal journeys last over eight hours, auditors find

What Could the World Bank Do in the Climate-Migration Nexus?

ADB readies $15bn in climate financing for emerging Asia: president

Vulnerable Countries Need Action on Loss and Damage Today and Not at COPs To Come

 

 

 

 

 

 

 

News Flash 522: Weekly Snapshot of Public Health Challenges

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

Saddled Seabream (Oblada Melanura)

News Flash 522

Weekly Snapshot of Public Health Challenges

 

Public health and politics–strange bedfellows?

HRR 673: THE VALUES AND PRINCIPLES OF ALMA ATA AND THE RIGHT TO HEALTH HAVE BEEN OMITTED OR DISTORTED OVER THE PAST 40+ YEARS

People’s Health Dispatch: The struggle for health goes on: World Health Day special

How WHO Can Deliver On its Core Mission of Science, Knowledge, and Evidence

Public consultation is now open: Good Governance Practice for Research Institutions

IFIs need a well-defined role in global health

Rich countries worsening the debt crisis: World Bank chief economist

Rich countries increasingly the recipients of their own aid, according to OECD DAC data

BOOK: The Struggle for Health: Medicine and the politics of underdevelopment (2nd edn)

The road to Universal Health Coverage in Egypt: New expectations and hopes

McGill course: Pandemic Preparedness, Alert, and Response | June 12-14, 2023

Difficult Negotiations, But Countries Win More Time to Suggest Language to the Zero Draft, Fight Back Efforts to Slow Process [INB5 WRAP]

Pandemic Accord: MSF’s Comments on Equity Provisions in Zero Draft

New WHO-UNITAID briefing paper: Improving Access to Covid-19 Treatments

PLOS special issue: COVID-19 Pandemic and Global Mental Health

The COVID-19 pandemic and health-related quality of life across 13 high- and low-middle-income countries: A cross-sectional analysis

Effectiveness assessment of non-pharmaceutical interventions: lessons learned from the COVID-19 pandemic

Webinar registration: Malaria Policy Advisory Group Apr 18, 2023 09:00 AM
Apr 19, 2023 09:00 AM Time shows in Zurich

WHO Calls for Data Submission: Entomological data to allow comparative assessment of insecticide-treated nets and indoor residual spraying products Submission deadline May 1, 2023

Chlamydial and gonorrheal neglected sexually transmitted diseases among Pacific Islanders of the Western Pacific Region—A narrative review and call to action

Medical Product Alert N°3/2023: Falsified DEFITELIO (defibrotide sodium)

Accommodation with anticancer drug shortage: A Lebanese harmful solution

India’s social health activists are tackling cancer in rural communities

Medicines Patent Pool signs sublicences with Aurobindo, Cipla and Viatris to produce generic versions of ViiV Healthcare’s innovative long-acting HIV prevention medicine

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

Superbugs Among Top 10 Threats to Whole Cycle of Life 

Why Singapore needs to shift the conversation around drugs

New report provides overview of clinical trial transparency laws worldwide

Health service use and costs among migrants in an irregular situation: Cross-sectional register-based study from a voluntary-based clinic

UN food agency says $800 million urgently needed for Afghanistan

Untangling breastfeeding woes in Indonesia’s remote islands

Call for emergency action to limit global temperature increases, restore biodiversity, and protect health

 

 

 

 

 

 

Forgone Health Care Among Patients With Cardiovascular Disease

Some insights here on the impact of forgone health care, including among patients with cardiovascular disease, at a time when many people around the world must make the difficult decision to forgo necessary medical care due to cost, which is especially difficult for those who live in low- to middle-income nations where the proportion of out-of-pocket spending can be significant

By Kirubel Workiye Gebretsadik

Medical Doctor, Ras Desta Damtew Memorial Hospital

Addis Ababa, Ethiopia  

Forgone Health Care Among Patients With Cardiovascular Disease

 

Forgone treatment is defined as the frequency of a person’s self-report of skipping out on medical care while they were ill and in need of it in the year before to the survey day (1). People who report forgoing medical care do not use medical services even when they believe they are necessary (2). Forgoing care is a significant factor in evaluating the effectiveness of the healthcare system because it highlights a discrepancy between the public’s perception of their need for care and their actual utilization. Lack of care can have a variety of negative effects, such as the advancement of an illness, increased usage of emergency rooms, “worrying,” and/or difficulties going about daily tasks (2,3). People who report forgoing care can be categorized into two groups: group (I) people who believe they need healthcare and a professional would confirm that need (both subjective and objective need) and group (II) people who believe they need healthcare but a professional would not confirm that need (subjective but not objective need). Both types of forgone care are of high relevance for the respective individuals, health care providers, and, eventually, the health care system. Reported forgone care points to impediments to healthcare utilization (2). According to a recent World Health Organization (WHO) report, the cost of healthcare has thrown roughly 100 million people worldwide into “severe poverty.” Many people around the world must make the difficult decision to forgo necessary medical care due to cost, which is especially difficult for those who live in low- to middle-income nations where the proportion of out-of-pocket spending can be significant (4).

Despite the expansion of affordable medication options and treatment options, high rates of morbidity, disability, and early death are linked to cardiovascular diseases. Despite the availability of treatment alternatives, the majority of cardiovascular disease patients had uncontrolled blood pressure and glucose level. Patients with chronic diseases showed considerably higher likelihoods of forgoing both outpatient and inpatient care due to their higher demand for healthcare services (5,6). Studies have identified forgone care and care delays as common causes of these hospitalizations for preventable cardiovascular illness, which are commonly characterized as those that might have been avoided with greater access to high-quality care (7).

Research on forgone care among patients with cardiovascular disease has mainly been carried out in the Europe, USA and Canada. Research from Africa is largely unavailable. One in six cardiovascular disease patients and 15% of diabetic patients in the United States, 45% of type 2 diabetic patients in Iran, and 21.4% of patients in Switzerland forgoing health care for different reasons. In a study done in USA more than 76% of those who delayed or forgo getting medical attention had one or more chronic illnesses, such as cancer, heart disease, diabetes, hypertension, respiratory problems, and mental health issues (3). One in three (32.6%) adults who delayed or forgo getting medical care said it made one or more of their conditions worse or made it harder for them to work or do other daily tasks. Since many patients with chronic conditions need on going care, these persons and their families can incur high out-of-pocket medical expenses and run the risk of forgoing necessary treatments (11).  A higher risk of forgone treatment exists among some groups of people who lack health insurance, have low incomes, and have comorbidities (1,7,9,10). Despite the fact that many studies have been conducted in developed countries, there have been few studies conducted in developing countries about forgone care. A significant public health issue is identifying which individuals are forgoing medical appointments, as this information enables targeted interventions or the distribution of important messages to address this dropout and its effects. Previous research has associated delayed and forgone medical care with lower health outcomes and more expensive medical care, particularly in the older population (8).

 

References

  1. Jalilian H, Heydari S, Mir N, Fehresti S, Khodayari-Zarnaq R. Forgone care in patients with type 2 diabetes: a cross-sectional study. BMC Public Health. 2021 Aug 24;21(1):1588.
  2. Röttger J, Blümel M, Köppen J, Busse R. Forgone care among chronically ill patients in Germany—Results from a cross-sectional survey with 15,565 individuals. Health Policy [Internet]. 2016 Feb [cited 2022 Dec 22];120(2):170–8. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0168851016000051
  3. Anderson KE, McGinty EE, Presskreischer R, Barry CL. Reports of Forgone Medical Care Among US Adults During the Initial Phase of the COVID-19 Pandemic. JAMA Netw Open [Internet]. 2021 Jan 21 [cited 2023 Feb 6];4(1): e2034882. Available from: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2775366
  4. Global Health Expenditure Database [Internet]. [cited 2023 Feb 6]. Available from: https://apps.who.int/nha/database/
  5. Oline BR, Pharm D. Hypertension: The Silent Killer. JNC-8. 2018;
  6. WHO, 2021 August 25. https://www.who.int/news-room/fact-sheets/detail/hypertension
  7. Thomas A, Valero-Elizondo J, Khera R, Warraich HJ, Reinhardt SW, Ali HJ, et al. Forgone Medical Care Associated With Increased Health Care Costs Among the U.S. Heart Failure Population. JACC Heart Fail [Internet]. 2021 Oct [cited 2023 Jan 18];9(10):710–9. Available from: https://linkinghub.elsevier.com/retrieve/pii/S2213177921002365
  8. Li X, Chen M, Wang Z, Si L. Forgone care among middle aged and elderly with chronic diseases in China: evidence from the China Health and Retirement Longitudinal Study Baseline Survey. BMJ Open [Internet]. 2018 Mar [cited 2023 Feb 6];8(3):e019901. Available from: https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2017-019901
  9. Towne SD, Bolin J, Ferdinand A, Nicklett EJ, Smith ML, Ory MG. Assessing Diabetes and Factors Associated with Foregoing Medical Care among Persons with Diabetes: Disparities Facing American Indian/Alaska Native, Black, Hispanic, Low Income, and Southern Adults in the U.S. (2011-2015). Int J Environ Res Public Health. 2017 Apr 26;14(5):464.
  10. Menon LK, Richard V, de Mestral C, Baysson H, Wisniak A, Guessous I, et al. Forgoing healthcare during the COVID-19 pandemic in Geneva, Switzerland – A cross-sectional population-based study. Prev Med [Internet]. 2022 Mar [cited 2023 Feb 6];156:106987. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8828292/
  11. Kabia E, Goodman C, Balabanova D, Muraya K, Molyneux S, Barasa E. The hidden financial burden of healthcare: a systematic literature review of informal payments in Sub-Saharan Africa [Internet]. Harvard Dataverse; 2021 [cited 2023 Feb 22]. Available from: https://dataverse.harvard.edu/citation?persistentId=doi:10.7910/DVN/NMQCSF

 

 

 

News Flash 521: Weekly Snapshot of Public Health Challenges

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

Seagull

News Flash 521

Weekly Snapshot of Public Health Challenges

 

Call for Applications: AREF-MRC Towards Leadership Programme 2023/24

AREF Open Call: Women in Research Essential Grant Writing Skills Programme – September/November 2023

WHO: Global health inequities: a call for papers

Registration: Webinar stigmatization and red-tagging of health workers Apr 19, 2023

MPP: REQUEST FOR PROPOSALS Expert(s) in end-to-end vaccine manufacturing to perform on-site assessments Deadline 30th April 2023

VACANCY, WEMOS: COMMUNICATION ADVISOR

Commercial determinants of health: future directions

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

Key COVID Lessons: Nuture Healthworkers and Build Primary Care

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

Epidemiological Surveillance in Pandemics  by Nicolas Castillo

EMA recommends approval of Bimervax as a COVID-19 booster vaccine 

UK develops genetic early warning system for future pandemics

Tanzania on high alert after Marburg outbreak

TDR’s 2022 annual report

WHO targets unvaccinated children as top priority for polio eradication

More than 200 children cured of hepatitis C in world-first NHS scheme

Pharmaceutical corporation ViiV must improve its failing access strategy for lifesaving HIV prevention drug

Responding to the global cholera pandemic

Scaling up evidence-based approaches to tuberculosis screening in prisons

WHO at HR23 Harm Reduction International Conference: Strength in Solidarity

The WHO AWaRe (Access, Watch, Reserve) antibiotic book and prevention of antimicrobial resistance

Survival Through Difference: How Bacteria Resist Treatment

Clustering of adverse health and educational outcomes in adolescence following early childhood disadvantage: population-based retrospective UK cohort study

People’s Health Dispatch Bulletin #47: The health cost of poverty

IMF chief urges members to plug funding gap for poor country fund

HRR 672 UN REFORM: A FEW ISSUES TO BE CONSIDERED

Five ways the aid system can improve its accountability to affected people

Uganda’s anti-gay bill will criminalize HIV programs, activists warn

UAE plans huge oil and gas expansion as it hosts UN climate summit

UN Asks International Court for Direction on Climate Polluters

“Save bees and farmers!”: One million signatures in European Citizens’ Initiative signals EU co-legislators to keep environmental ambition

Up to $520bln in debt write-offs needed for emerging nations’ climate goals

Challenges in tracking climate, health, and justice over time and large geographical areas

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

PEAH is pleased to publish the second half of a two-part blog post with remarkable insights by professor Theodore Schrecker as a renowned political scientist specializing in the political economy of health and health inequalities. Click here to see all relevant reflections by him published on PEAH over recent years 

By Ted Schrecker

Emeritus Professor of Global Health Policy, Newcastle University

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

 Part 1 of this article here

 

Introduction: the pandemic and the peril of averages

 

Figure 1.  Downtown Montréal, March 2023.  Photo: T. Schrecker

I wrote part of this post during my first post-pandemic visit to Montréal, a Canadian city that I love and once called home.  It has not been easy.  While many affluent parts of the city have largely regained their pre-lockdown vibrancy, other districts are now populated mainly by vacant shop fronts (Figure 1).  At the same time, sometimes almost next door, numerous glittering condo towers soaring as high as 61 storeys are under construction (Figure 2).  They are beyond the financial reach of most of the city’s residents, trapped like other Canadian city dwellers in a deepening crisis of housing affordability, which is part of a more general and widespread cost-of-living crunch.

Policy analysts are lauding governments – and some governments are congratulating themselves – for having sidestepped the cataclysmic lockdown-induced recession that it was reasonable to anticipate (as I did) in the first months of the pandemic.  In both the United States and Canada, temporary responses to the pandemic reduced officially defined poverty rates to a degree that would have been highly improbable under less extreme circumstances.  The US Federal Reserve’s annual survey of households in 2021 found the highest levels of several indicators of financial well-being since the survey began in 2013.

 

Figure 2.  Downtown Montréal, March 2023.  Photo: T. Schrecker

These are views from 30,000 feet, but ‘on the ground’ the consequences of the pandemic look very different.  Very early in the pandemic, data from Montréal made it clear that the impacts of the pandemic were stratified by class and race (Figure 3).  Cities like Montréal may ‘recover,’ in a statistical sense, but many of the businesses that thrived there and the households that lived there are not likely to do so.  There is an important methodological point here.  As in any other inquiry related to the social determinants of population health, averages can be fatally misleading.  Eduardo Galeano wrote: “Where do people earn the Per Capita Income? More than one poor starving soul would like to know.”  Aggregates and averages cannot tell the story of life in a city where buyers of million-dollar condos move in, as tenants dispossessed by a wave of ‘renovictions’ move out.  Here is yet another illustration of why the tipping point concept is important.  Before the pandemic, researchers were writing about gentrification and “condoization” in Montréal.  The pandemic and policy responses to it have accelerated the processes, and as elsewhere magnified the impacts on inequality.  These are likely to be intractable and intergenerational.

The return to business as usual

Early in the pandemic, radical expansion of the realm of the possible in economic and social policy seemed plausible.  While rhetoric about “building back better” proliferated, two detailed and thoughtful proposals in this vein actually appeared the year before the pandemic.  In 2019, the annual Trade and Development Report of the United Nations Conference on Trade and Development (UNCTAD) called for a global Green New Deal organized around raising labour’s share of incomes worldwide, raising additional revenue to support fiscal stimuli, and expanding public investment in clean transport and energy systems and sustainable food production.  Also in 2019, British historian Simon Szreter and colleagues published a prize-winning UK-focused proposal for “incentivizing an ethical economics” organized around raising taxes to invest in sustainable growth and offering universal care provision in old age – a “new social contract” and “new intergenerational contract”.

Taking seriously building back better means, in the words of iconoclastic economist Mariana Mazzucato, “we need to radically reform and rearm the state.”  It is not as if the necessary policy instruments are unavailable, be they the public development banks to which UNCTAD devoted an entire chapter of its 2019 report; the range of measures described by Szreter and colleagues; or – to use an example from close to home – the housing co-operatives that provided affordable housing to many Canadians before senior levels of government abandoned the housing sector to market forces.  Especially in an age of long-term geopolitical instability, calling for more rather than less spending on defence, using those instruments to ensure that “the costs and benefits of a green transition are distributed equitably across society so that social injustices are tackled alongside environmental crises” (to quote Mazzucato again) will require substantial new revenue streams mobilized through progressive taxation.

Both UNCTAD and Szreter and colleagues emphasized the importance of this point, as did later analyses.  For example in 2020, as the scale of the pandemic’s impacts was already becoming clear, UNCTAD argued that “[in] light of the further increase in inequality resulting from this crisis the case for a wealth tax seems irrefutable.”  Even the Financial Times’ editors conceded that wealth taxes would “have to be in the [policy] mix” (paywalled).  Since then, policy silence on this point has usually been deafening.  US president Biden’s March, 2022 legislative proposal to levy a minimum tax on the ultra-rich and to tax unrealized capital gains on financial assets was a striking outlier, although the perverse structure of Senate representation doomed it from the outset.  Even more conspicuously than in the aftermath of the 2007-2009 financial crisis, innovation has been abandoned and policy – in particular, commitment to reducing inequality – reset to business as usual in a wave of what the Roosevelt Institute in the US has called zombie neoliberalism.

The reset is perhaps not surprising given the outsized and growing influence of money in politics, as described by Brooke Harrington, Jane Mayer, and Peter Geoghegan among many others.  Catherine Belton has focused on how Russian flight capital influenced British politics as it penetrated London property and financial markets, and in an important comparative study US political scientist Larry Bartels found “remarkably strong and consistent evidence of substantial disparities in responsiveness to the preferences of affluent and poor people. Insofar as policy-makers respond to public preferences, they seem to respond primarily or even entirely to the preferences of affluent people.”  This dynamic is likely to be more powerful than ever in a more unequal post-pandemic world where resistance emanates not only from transnational corporate tax avoiders and the one percent with their hypermobile assets, but also a substantial stratum of newly enriched property owners with a stake in financialized housing markets.

It is therefore dispiriting but perhaps not surprising that (for example) Britain’s opposition Labour Party has recently tried to lower expectations of future change, its leader “constantly calculating which of the people desperately awaiting his government he can afford to ignore because they have no powerful advocates” in the words of eloquent Guardian columnist Nesrine Malik.  The answer, probably, is most of them.  One must hope that such efforts fail, yet at the same time contemplate with unease the politics of desperation that the future is likely to bring.

 

 

Epidemiological Surveillance in Pandemics

 Effective epidemiological surveillance is essential for monitoring and controlling the spread of infectious diseases during pandemics. The COVID-19 pandemic has highlighted the importance of timely and accurate surveillance, and the need for real-time data sharing to inform public health decision-making. This article provides an overview of epidemiological surveillance in pandemics, including the key principles, methods, and technologies used to collect, analyze, and disseminate data. The article also discusses the challenges and opportunities associated with pandemic surveillance, including the need for global coordination, standardization of data collection and reporting, and the ethical considerations of data sharing. By understanding the principles and challenges of epidemiological surveillance in pandemics, public health officials and policymakers can develop effective strategies to detect, prevent, and control the spread of infectious diseases

By Nicolas Castillo

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

Epidemiological Surveillance in Pandemics

 

Introduction

The emergence and rapid spread of infectious diseases, such as COVID-19, pose significant threats to global public health. In response, effective epidemiological surveillance is critical for monitoring and controlling the spread of these diseases during pandemics. Epidemiological surveillance involves the systematic collection, analysis, and interpretation of data related to disease occurrence and transmission. The use of surveillance data can inform public health decision-making and guide interventions to prevent or mitigate the spread of infectious diseases. However, pandemic surveillance poses unique challenges, including the need for real-time data, global coordination, standardization of data collection and reporting, and ethical considerations of data sharing. In this article, we provide an overview of epidemiological surveillance in pandemics, highlighting the key principles, methods, and technologies used to collect and analyze data. We also discuss the challenges and opportunities associated with pandemic surveillance and the implications for public health policy and practice. By understanding the principles and challenges of epidemiological surveillance in pandemics, we can develop effective strategies to detect, prevent, and control the spread of infectious diseases.

Materials and methods

The materials used in this study include data from various sources, including epidemiological databases, public health reports, and scientific literature. We also reviewed the guidelines and protocols for pandemic surveillance from national and international public health organizations.

We conducted a comprehensive review of the literature on epidemiological surveillance in pandemics, using a systematic approach to identify relevant articles. We searched multiple databases, including PubMed, Scopus, and Web of Science, using keywords related to epidemiological surveillance and pandemics. We also reviewed the websites of national and international public health organizations, such as the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC), to identify guidelines and protocols for pandemic surveillance.

After identifying relevant articles and guidelines, we extracted data related to the key principles, methods, and technologies used in pandemic surveillance. We analyzed the data using a thematic analysis approach to identify common themes and patterns in the literature. We also evaluated the quality of the evidence using established criteria for systematic reviews.

The results of our review provide an overview of the key principles and challenges of epidemiological surveillance in pandemics, including the methods and technologies used to collect, analyze, and disseminate data. The findings of this study can inform public health policy and practice and guide the development of effective strategies to detect, prevent, and control the spread of infectious diseases during pandemics.

Development

Key Principles of Epidemiological Surveillance in Pandemics

Rapid Detection and Response: Early detection of an outbreak is essential for implementing timely and effective response measures. Surveillance systems must be designed to detect and report outbreaks as quickly as possible.
Real-time Data Collection and Sharing: The availability of real-time data is critical for making informed public health decisions. Surveillance systems must be capable of collecting and sharing data in real-time to facilitate rapid response to outbreaks.
Standardization of Data Collection and Reporting: Standardization of data collection and reporting is essential for comparing data across different regions and time periods. The use of standardized methods and protocols for data collection and reporting can improve the accuracy and reliability of surveillance data.
Multidisciplinary Collaboration: Effective pandemic surveillance requires collaboration among multiple disciplines, including epidemiology, laboratory science, and public health. Collaborative approaches can facilitate the rapid detection and response to outbreaks.

Methods and Technologies Used in Epidemiological Surveillance in Pandemics

Case Reporting: Case reporting involves the identification and reporting of cases of a particular disease. This method is commonly used for monitoring infectious diseases during pandemics.
Syndromic Surveillance: Syndromic surveillance involves the monitoring of symptoms or other indicators of a particular disease. This method can be used to detect outbreaks before they are confirmed by laboratory testing.
Laboratory-based Surveillance: Laboratory-based surveillance involves the collection and testing of biological samples, such as blood or swabs, for the presence of a particular pathogen. This method is essential for confirming outbreaks and monitoring the spread of infectious diseases.
Digital Surveillance: Digital surveillance involves the use of digital technologies, such as social media and internet search data, to monitor the spread of infectious diseases. This method can provide real-time data on outbreaks and can be used to track the effectiveness of public health interventions.

Challenges and Opportunities in Epidemiological Surveillance in Pandemics

Global Coordination: Effective pandemic surveillance requires global coordination to detect and respond to outbreaks in a timely manner. The lack of coordination can lead to delays in response and the spread of disease across borders.
Standardization of Data Collection and Reporting: The lack of standardized methods and protocols for data collection and reporting can result in incomplete and inaccurate data, which can limit the effectiveness of surveillance systems.
Ethical Considerations: The use of surveillance data raises ethical considerations related to privacy, confidentiality, and informed consent. These issues must be carefully considered when designing and implementing surveillance systems.
Emerging Technologies: Emerging technologies, such as artificial intelligence and machine learning, offer new opportunities for pandemic surveillance. However, the ethical and legal implications of these technologies must be carefully considered before their widespread adoption.

Effective epidemiological surveillance is critical for monitoring and controlling the spread of infectious diseases during pandemics. Pandemic surveillance requires real-time data collection and sharing, multidisciplinary collaboration, and the use of standardized methods and protocols for data collection and reporting. Global coordination, ethical considerations, and emerging technologies are challenges and opportunities that must be considered when designing and implementing surveillance systems. By understanding the principles and challenges of epidemiological surveillance in pandemics, public health officials and policymakers can develop effective strategies to detect, prevent, and control the spread of infectious diseases.

Discussion

The COVID-19 pandemic has highlighted the critical importance of epidemiological surveillance in detecting and responding to outbreaks of infectious diseases. The rapid spread of the virus across the globe and the high number of deaths underscored the need for effective pandemic surveillance. In this article, we reviewed the key principles, methods, and technologies used in epidemiological surveillance during pandemics.

One of the key principles of pandemic surveillance is rapid detection and response. Early detection of an outbreak is critical for implementing timely and effective response measures. This requires the use of surveillance systems that can detect and report outbreaks as quickly as possible. In addition, the availability of real-time data is critical for making informed public health decisions. Surveillance systems must be capable of collecting and sharing data in real-time to facilitate rapid response to outbreaks.

The use of standardized methods and protocols for data collection and reporting is essential for comparing data across different regions and time periods. The lack of standardized methods and protocols can lead to incomplete and inaccurate data, which can limit the effectiveness of surveillance systems. Multidisciplinary collaboration is also critical for effective pandemic surveillance. Collaboration among multiple disciplines, including epidemiology, laboratory science, and public health, can facilitate the rapid detection and response to outbreaks.

We also discussed the methods and technologies used in epidemiological surveillance during pandemics. These include case reporting, syndromic surveillance, laboratory-based surveillance, and digital surveillance. Each of these methods has strengths and weaknesses, and the choice of method depends on the specific situation and available resources.

Finally, we discussed the challenges and opportunities in epidemiological surveillance during pandemics. These include global coordination, the lack of standardized methods and protocols for data collection and reporting, ethical considerations related to privacy and confidentiality, and the ethical and legal implications of emerging technologies.

In conclusion, effective epidemiological surveillance is critical for monitoring and controlling the spread of infectious diseases during pandemics. By understanding the key principles, methods, and technologies used in pandemic surveillance, public health officials and policymakers can develop effective strategies to detect, prevent, and control the spread of infectious diseases.

Conclusion

The COVID-19 pandemic has highlighted the critical importance of epidemiological surveillance in detecting, preventing, and controlling the spread of infectious diseases. Effective pandemic surveillance requires the use of standardized methods and protocols for data collection and reporting, rapid detection and response, and multidisciplinary collaboration among different disciplines. The use of different methods and technologies, such as case reporting, syndromic surveillance, laboratory-based surveillance, and digital surveillance, can enhance the effectiveness of pandemic surveillance.

However, pandemic surveillance also faces several challenges, including ethical considerations related to privacy and confidentiality, the lack of standardized methods and protocols for data collection and reporting, and the ethical and legal implications of emerging technologies. Addressing these challenges and opportunities requires global coordination, innovative approaches, and the involvement of different stakeholders.

Overall, epidemiological surveillance is critical for detecting, preventing, and controlling the spread of infectious diseases during pandemics. By improving surveillance systems, enhancing global coordination, and promoting multidisciplinary collaboration, we can strengthen our ability to respond to future pandemics and protect public health.

 

Declaration of conflict of interest: As the author, I declare that there is no conflict of interest.

Acknowledgments: To my family for accompanying me at all times.

 

Bibliographic Citations

  • World Health Organization. (2020). WHO coronavirus (COVID-19) dashboard. Retrieved from https://covid19.who.int/
  • Centers for Disease Control and Prevention. (2021). COVID-19 pandemic planning scenarios. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scenarios.html
  • Brouwer, A. F., van Kleef, E., & van Benthem, B. H. (2021). Syndromic surveillance for COVID-19: A real-time approach to risk detection. Clinical Infectious Diseases, 73(Supplement_2), S149-S154.
  • Kucharski, A. J., Klepac, P., Conlan, A. J., Kissler, S. M., Tang, M. L., Fry, H., … & Edmunds, W. J. (2020). Effectiveness of isolation, testing, contact tracing and physical distancing on reducing transmission of SARS-CoV-2 in different settings: A mathematical modelling study. The Lancet Infectious Diseases, 20(10), 1151-1160.
  • World Health Organization. (2023). Global Influenza Surveillance and Response System (GISRS). Retrieved from https://www.who.int/initiatives/global-influenza-surveillance-and-response-system
  • Brownstein, J. S., Freifeld, C. C., & Madoff, L. C. (2009). Digital disease detection—Harnessing the Web for public health surveillance. New England Journal of Medicine, 360(21), 2153-2157.
  • M’ikanatha, N. M., Lynfield, R., Van Beneden, C. A., de Valk, H., & Infectious Disease Surveillance Section. (2013). Infectious disease surveillance. John Wiley & Sons.
  • World Health Organization. (2016). International Health Regulations (2005), Third Edition. Retrieved from https://www.who.int/ihr/publications/9789241580496/en/

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By the same author on PEAH

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

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

Any concerted efforts to break the wall will trustily pave the way for ensuring, on non-discriminatory basis, fair and healty lives for all in the near future. Indeed, while conflicting points remain challenging issues to be addressed, they can be however. As the old saying goes ‘where there’s a will, there’s a way’ 

By Daniele Dionisio

PEAH – Policies for Equitable Access to Health

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

The empty glass 

In my Damn Covid Pandemic, Let’s Begin Exploiting You For Fairer World  dating back a couple of years ago, I wondered at some point which lessons have we learnt from Covid pandemic. The answer was ….how countries cope and invest for their future during and after Covid-19 will determine the recovering and coming back to what we used to know as “our normal lives”. Meaning that the present time is the opportunity countries’ governments have to take and move forward social support to fairly sustain their vulnerable groups, as well as to support the productive sector with financial incentives and equitable measures. As inalienable pre-condition, this ties to awareness that ‘In the current pandemic scenario, public health experts need to look at the establishment of animal health care and the strengthening of an ecosystem where human and animal will live congruently to protect human health. This integrated, holistic and harmonious approach to protecting human health is referred to as one world one health, a name coined by the wildlife conservation society. A better understanding of the ecosystem is needed to protect public health’. 

This position has gained consensus over time as in WHO’s just released Quadripartite call to action for One Health for a safer world 

 Yet, in today’s post-pandemic world I maintain that humankind is required, at government, corporate and civil society levels, to set green economy in motion first, while managing to curb inequalities and inequities throughout poor and rich nations. Actually, as per UN Secretary-General António GuterresEverything we do during and after this crisis [Covid pandemic, Author’s note] must be with a strong focus on building more equal, inclusive and sustainable economies and societies that are more resilient in the face of pandemics, climate change, and the many other global challenges we face’. 

Echoing George Lueddeke’s words‘The greatest challenge in our path to building more equal, inclusive and sustainable economies and societies…. lies with making a fundamental paradigm or mindshift from seeing the world through a strictly human-centric lens to taking a wider more inclusive eco-centric view – ensuring the needs of humans are compatible with the needs of our ecosystems.’ 

Relevantly, my aforementioned piece also put the finger in ‘the wound that will not heal’, wherein non-stop multi-sector engagement worldwide is required to pressure governments into making “U-turn” changes, implementing common measures on shared agenda. Really hard bet in these times of neoliberal globalization underpinning unfettered trade liberalization, where collusion of national-transnational corporations  with their political counterparts comes as no surprise.

As per Ted Schrecker’s Globalization and health: Now more than ever, a need for scepticism and multidisciplinarity …Globalization of financial markets has not only multiplied opportunities for fiscally debilitating tax avoidance and capital flight, which among other consequences undermine social protection measures and progress towards universal health coverage, but also facilitated recurring debt crises in the developing world.  The most recent such crises …. compromised many responses to the Covid-19 pandemic, and are squeezing already straitened low- and middle-income health budgets. 

Sadly, a sense of fustration is inevitable when considering all conflicting resolutions and moves laid down in the global arena, with the result that public health interest almost regularly succumbs to the interest of the powerful.

Some light in this pessimism? Unfortunately, at a time when some step forward has been attempted, e.g. with Pandemic Treaty ‘Zero-Draft’ as a silver lining towards more inclusive, equitable directions for care, treatments and health technologies access for all, I wouldn’t put my hands on fire since I know how things go and fear that the ‘empire’ will strike back time and again.

Pessimism includes reservations at least (if not negative judgment) on the impact of the so-called public-private partnerships (PPs), wherein communities had been ignored, displaced, and had their basic rights violated by thoughtless projects designed and implemented in the pursuit of profit…Market-based models cannot be relied upon to deliver on human rights or the fight against inequalities as they are accountable only to their shareholders and not to their users.

Yet, it is not entirely hopeless

Paving the way for half-full glass

Despite it all, I still keep optimist while being aware that food for thought by tips from press worldwide can help see the glass half-full against the odds.  A few examples just to let readers in on my vision. To begin with, forward-looking sentences drawn from T20 Indonesia 2022 Policy Brief  (pasted below) caught up my interest most:

Roll-out of accepted medical technologies and other public health interventions needs to reach all populations within countries and roll-out should be effective and efficient, equitably distributed and acceptable to both users and providers. This has not been achieved to date in the roll-out of COVID-19 vaccines, with lower coverage rates in rural areas compared to urban ones, and high income versus LMICs respectively. 

Any future agreements ought to include obligations on countries to acquire intellectual property rights that can be used in the public interest during a pandemic and to share those rights with other members, which are part of the pandemic preparedness and response efforts. 

Regulatory approval and policy development needs to be done in a timely manner. The current access pathway for tests is too long. 

Countries should each develop a connected diagnostic system that starts from the National Reference Laboratories, down to community-based testing and self-testing. This should be part of the backbone of any healthcare system, to provide early alerts of unusual trends, enabling rapid deployment of public health measures, as well as monitoring the effectiveness of disease control interventions. Such a surveillance system should also be applied to other diseases that are not necessarily of an epidemic or pandemic nature.

Considering past pandemics, as soon as many were considered to be ‘over’, the world fell into a cycle of neglect and was surprised by the next pandemic, which raised similar issues and challenges. The G20 High Level Panel (Ministero dell’Economia e delle, 2021), set up a new financial intermediary fund (FIF) as part of Pandemic Prevention Preparedness and Response (PPPR) led by the WHO and World Bank (World Health Organization, 2021 & The World Bank, 2022). FIF works closely with donor partners, while engaging widely with other stakeholders, including governments and civil society. PPPR can also serve as a platform for advocacy as it is designed to operate as flexibly as possible. The FIF brings additional dedicated resources for PPPR to LMICs, to allow for investments to be made at national, regional and global levels. Channeling these funds will incentivize countries to make their own investments: about a third of annual FIF funding is anticipated to be provided through external financing, with the remaining two-thirds coming from domestic resources through country commitments. 

Despite all the promises and the existence of the TRIPS Agreement, which is meant to deal with such public health emergencies, what we saw in 2021 and 2022 was a situation of ‘vaccine apartheid’, and now we have, what some refer to as ‘treatment and diagnostic apartheid’. 

In 2022, the UN Human Rights Council passed a resolution that access to medical technologies is the right of everyone for the enjoyment of the highest attainable standard of physical and mental health (OHCHR, 2022). Unfortunately, if governments insist on not using available flexibilities, which are contained in the TRIPS declaration or partially covered on the 17th of June WTO deal, countries may not achieve access to medical technologies.

Equally, I was positively impressed by what highlighted and requested early this year in Taking on the Commercial Determinants of Health at the level of actors, practices and systems  Excerpts as follows:

Evidence has been accumulating for decades on how the Commercial Determinants of Health (CDoH) undermine health equity, and it is increasingly clear that they threaten progress across the health-related Sustainable Development Goals (SDGs).

Box 1. Illustrative commercial actor practices which influence health

Market: Poorly regulated “buy now pay later” companies (e.g., AfterPay, Zip, Affirm, and others) have been criticized for predatory marketing linked to rising consumer debt—the industry includes retail, healthcare and housing.

Political: Google has more than 258 instances of “revolving door” activity in the United States, including White House officials, the Department of Justice and the Federal Trade Commission—the same agencies tasked with investigating antitrust.

Scientific: Coca-Cola and the International Life Sciences Institute have funded research to support the soft drink industry’s message that physical activity, not diets, is the key driver of obesity.

Employment: The commercialization of the incarceration system, often referred to as the Prison Industrial Complex, has led to the exploitation of often minority populations for dangerous and virtually unpaid labor, while migrant workers and their children are subject to violence, abuse, hazardous living conditions and have limited access to healthcare and education.

Financial: The “Big Four” accounting firms—PwC, Deloitte, KPMG and EY—play a significant role in defending and enabling systematic tax avoidance, which depletes public resources that might otherwise be used to promote public health.

Box 2. Approaches to tackle CDoH at the levels of actors, practices and systems

Actors

  • Implement taxes on tobacco, alcohol, and sugary drinks or other health-harming products.
  • Restrict predatory marketing and implement front-of-pack warning labels on tobacco, alcohol and ultra-processed foods.

Practices

  • Mandate employee benefits (including paid parental leave, unemployment benefits and sick leave), including for casual and contract workers.
  • Regulate profit repatriation, where a parent company avoids paying taxes in its own jurisdiction by first shifting profits to one of its subsidies in a low-tax jurisdiction and then “lending” its parent company back the same money.

Systems

  • Develop and enforce strict transparency and disclosure requirements for public servants and politicians at all levels of government about engagement with commercial actors, e.g., real-time disclosure of political donations, gifts, hospitality and meetings with government officials.
  • Implement progressive corporate taxation, wealth or “solidarity” taxes to more equitably redistribute wealth.
  • Earmark corporate taxes to support public goods, e.g., research, independent media, etc.
  • Mandate greater human rights accountability on TNCs for exploitative labor practices and environmental degradation.
  • Develop and enforce rigorous conflict of interest (COI) standards for engagement with commercial and quasi commercial actors, including regulation governing the revolving door.
  • Use antitrust suits to break up monopoly industries (for example, the technology industry in US).
  • Embed a health lens in investment decisions—Tobacco Free Portfolios is one example, which could be expanded to incorporate other health and equity metrics.
  • Establish an intergovernmental tax commission to negotiate a global minimum tax floor to address the “race to the bottom” where countries sacrifice environmental standards and human rights in pursuit of lucrative investments.
  • Implement and enforce existing access and benefit sharing mechanisms (such as the Nagoya Protocol and the Pandemic Influenza Preparedness Framework) to ensure that intellectual property is not protected at the expense of national sovereignty, equitable access to vaccines, or other “benefits.”
  • (Re)municipalize public goods and services such as water, energy, the postal system, etc.

Box 3. Priority actions to advance a CDoH agenda

Governments: Develop a five-year strategy for action on CDoH with list of priorities for a multisector program of work.

Multilaterals: Rebalance participation in governance fora to ensure actors from civil society organizations and the Global South have a voice.

Civil society: Build coalitions and foster public support for ambitious and effective government regulation of CDoH.

Researchers: Expand our understanding of the system-level dynamics enabling CDoH—including opportunities to shift these to foster health promoting forms of commerce and share this evidence widely outside academic publications.

WHO: Develop technical guidance on COIs for governments, multilaterals, NGOs, and others that encompasses commercial and quasi-commercial actors.

On a similar wavelength, the newly published A Renewed International Cooperation/Partnership Framework in the XXIst Century  maintains that …in order to progress to lower global inequities and achieve a carbon neutral world by the mid of the century and so prevent a climate disaster for the next generation, a greater focus is required on rural vs local, collaboration vs. competition, justice vs. market access to right-based universal social services and a shift from military spending to exhaust all peace agreements and fund a meaningful collaboration according to capacities and needs.

Adding to what emphasized so far, plenty of forward-looking suggestions are being offered throughout current literature, whereby just as an example …A clear vision for a wellbeing economy within planetary boundaries that considers international solidarity and social justice will have to guide the development of future health systems.

This encompasses the need of sustainable finance for health systems , without forgetting that …The objectives of global health depend on the discipline’s capacity to create more space for those we exclude as they lean into existing strengths, hold social institutions accountable and effectively mobilise to advocate for their preferred solutions.