Authors's note
This article discusses about the Stop Cannabis Challenge app developed by The Centre for Addiction and Mental Health (CAMH) to support tolerance breaks and cannabis abstinence. This app promotes cannabis addiction awareness and provides cessation support through health education and intervention

Splash screen of the Stop Cannabis Challenge App


Nejat Hassen(1), Dr. Mohita Chadha(2), Dr. Michael Chaiton(3), Dr. Sumedha Kushwaha(4)

1-Student, Healthcare Management Program, Longo Faculty of Business, Humber College

2-Chief Operating Officer, Global Initiative for Public Health and Innovation

3-Independent Scientist, Center for Addiction and Mental Health

4-Research Assistant, Center for Addiction and Mental Health

 Toronto, Ontario, Canada



Canada is facing a serious mental health crisis alongside rising substance abuse and dangerous drug use. Substance abuse is influenced by many complex factors often beyond individual control (P. H. A. of Canada, 2021). The Cannabis Act, effective October 17, 2018, regulates access, production, distribution, and sale of cannabis. The 2023 Canadian Cannabis Survey reported an increase in cannabis use from 22% in 2018 to 26% in 2023 (H. Canada, 2021).

Cannabis contains two main components: THC and CBD (Zehra et al., 2018). While not everyone who uses cannabis becomes addicted, frequent and long-term use, especially starting in early adolescence, can lead to addiction. Cannabis Use Disorder (CUD) is defined as the inability to stop using cannabis despite it causing harm. About 10% of the 193 million global cannabis users are affected by CUD (Connor et al., 2021).

In 2016, about 22.1 million people worldwide met the criteria for CUD (The Global Burden of Disease Attributable to Alcohol and Drug Use, 2018). Problematic cannabis use includes behaviors like neglecting major duties, giving up important activities, using more cannabis than intended, and being unable to cut down on use. Withdrawal symptoms, both mental and physical, can occur when frequent users stop, increasing the risk of relapse (H. Canada, 2018b).

Treating CUD is complicated by other mental health and substance use disorders. Cognitive behavioral therapy, motivational enhancement therapy, and contingency management can reduce cannabis use, but long-term abstinence is rare (Connor et al., 2021). Legalizing non-medical cannabis could increase CUD by making potent cannabis more accessible and cheaper. Education on the risks and help-seeking is crucial.

Engaging young people with CUD is challenging, but digital interventions show promise. Technology can effectively reach many people, helping to prevent, screen, and treat CUD (Brezing & Levin, 2022). Mobile technology offers new ways to address substance use disorders, including cannabis cessation.

We developed the “Stop Cannabis Challenge” app with The Centre for Addiction and Mental Health (CAMH) to support tolerance breaks and cannabis abstinence. This app promotes cannabis addiction awareness and provides cessation support through health education and intervention.

App Description
  • Abstinence Tracker: allows users to track the time since they last used cannabis. The time is displayed in days, hours and minutes. This serves as a motivational tool by visually representing their progress and encouraging longer periods of abstinence.
  • Chatbot Enabled FAQ Section: a 24/7 chatbot offers users instant access to information on various topics related to cannabis use and cessation. This ensures users receive timely support and answers to their questions at any hour.
  • Mood and Craving Tracker: records daily moods and cravings with graphical representations of their emotional and physical states. Analyzing this data on a weekly and monthly basis helps users identify patterns and triggers that may affect their cessation journey.
  • Invite Friends: The app enables users to send invitations to both registered and non-registered users, fostering a supportive community. Users can view friend requests received and send out invitations, building a network of support crucial for successful cessation.
  • Leaderboard: To offer positive reinforcement, the app includes a leaderboard that ranks users and their friends based on a complex algorithm. It motivates users to remain committed to their goals by seeing their progress with others.
  • Challenge History and Badges: Users earn badges as they progress, categorized by hours, days, and weeks of abstinence. This provides reward milestones and summaries of current and previous challenges.
  • Motivational Messages: Automated daily motivational messages are sent as in-app notifications to inspire users, offering encouragement and positive reinforcement throughout their cessation journey.
  • Baseline Stop Cannabis Survey: The Cannabis Use Disorder Identification Test-Revised (CUDIT-R) has a set of 16 questions which are present to the newly registered user to assess cannabis dependence and its problematic use.
  • Ecological Momentary Assessment (EMA): is presented each time the user stops the abstinence tracker. It aims to collect multiple responses around cannabis withdrawal, peer cannabis use, reasons for use, craving, location during cannabis use, and feedback of the user.
Can technology be used?

Research shows digital interventions can effectively reduce substance use. Several studies have found significant reductions in substance use behaviours through digital tools. For instance, a systematic review of digital interventions aimed at reducing substance misuse among students found significant reductions in substance use behaviours, emphasizing the positive impact on health, social, and economic problems (Dick et al., 2019). A specific randomized controlled trial focusing on an Internet-based intervention to reduce cannabis use (ICan) showed that participants in the intervention group experienced significant reductions in cannabis use compared to the control group, highlighting the potential of digital tools to aid in substance use reduction (Olthof et al., 2021).

Qualitative feedback from users of digital interventions often underscores their acceptability and usefulness. Users find these tools easy to use and appreciate the anonymity and accessibility they provide. Participants have reported positive experiences, including improved self-efficacy and overall quality of life (Jormand et al., 2022).


The Stop Cannabis Challenge app represents a valuable tool in the fight against cannabis addiction. By evaluating its feasibility and efficacy through studies and user feedback, we can improve the app and enhance public health outcomes in Canada. Engaging users through co-creation and integrated knowledge translation ensures the app meets their needs and maximizes its effectiveness. This app is a significant step forward in digital health interventions for cannabis cessation, offering a reliable, user-friendly tool to support individuals in their efforts to quit cannabis. A feasibility study will help refine the app and contribute to the broader field of substance use disorder treatment, ultimately improving public health.


Brezing, C. A., & Levin, F. R. (2022). Applications of technology in the assessment and treatment of cannabis use disorder. Frontiers in Psychiatry, 13, 1035345.

Canada, H. (2018a, March 2). Addiction to cannabis [Education and awareness]. html

Canada, H. (2018b, October 17). Is cannabis addictive? [Research;education and awareness]. ve.html

Canada, H. (2021, December 16). Key findings: Cannabis use in Canada (2023) [Datasets;statistics;education and awareness;interactive resource;].

Canada, P. H. A. of. (2021, December 15). Statement from the Minister of Mental Health and Addictions on the Overdose Crisis [Statements].

Connor, J. P., Stjepanović, D., Le Foll, B., Hoch, E., Budney, A. J., & Hall, W. D. (2021). Cannabis use and cannabis use Disorder. Nature Reviews. Disease Primers, 7(1), 16.

Dick, S., Whelan, E., Davoren, M. P., Dockray, S., Heavin, C., Linehan, C., & Byrne, M. (2019). A systematic review of the effectiveness of digital interventions for illicit substance misuse harm reduction in third-level students – BMC public health. BioMed Central.

Elsbernd, A., Hjerming, M., Visler, C., Hjalgrim, L. L., Niemann, C. U., Boisen, K. A., Jakobsen, J., & Pappot, (2018). Using Cocreation in the Process of Designing a Smartphone App for Adolescents and Young Adults With Cancer: Prototype Development Study. JMIR Formative Research, 2(2), e23.

Government of Canada, C. I. of H. R. (2012, December 6). Guide to Knowledge Translation Planning at CIHR: Integrated and End-of-Grant Approaches – CIHR.

ICD-11 for Mortality and Morbidity Statistics. (n.d.). Retrieved February 28, 2024, from

Jormand, H., Bashirian, S., Barati, M., Rezapur-Shahkolai, F., & Babamiri, M. (2022). Evaluation of a web-based randomized controlled trial educational intervention based on media literacy on preventing substance abuse among college students, applying the Integrated Social Marketing Approach: A study protocol – trials. BioMed Central.

Olthof, M. I. A., Blankers, M., Laar, M. W. van, & Goudriaan, A. E. (2021). ICAN, an internet-based intervention to reduce cannabis use: Study protocol for a randomized controlled trial – trials. BioMed Central.

Kroon, E., Kuhns, L., Hoch, E., & Cousijn, J. (2020). Heavy cannabis use, dependence and the brain: A clinical perspective. Addiction (Abingdon, England), 115(3), 559–572.

The global burden of disease attributable to alcohol and drug use in 195 countries and territories, 1990–2016: A systematic analysis for the Global Burden of Disease Study 2016. (2018). The Lancet. Psychiatry, 5(12), 987–1012.

Zehra, A., Burns, J., Liu, C. K., Manza, P., Wiers, C. E., Volkow, N. D., & Wang, G.-J. (2018). Cannabis Addiction and the Brain: A Review. Journal of Neuroimmune Pharmacology, 13(4), 438–452.




Homepage displaying Manage Challenge which allows users to track the time since they last used cannabis, My Progress which records daily moods and cravings with graphical representations of their emotional and physical states, Chat & FAQs, a 24/7 chatbot offers users information on various topics related to cannabis use and cessation

Chatbot Enabled FAQ Section: a 24/7 chatbot offers users instant access to information on various topics related to cannabis use and cessation. This ensures users receive timely support and answers to their questions at any hour

Mood and Craving Tracker records daily moods and cravings with graphical representations of their emotional and physical states. Analyzing this data on a weekly and monthly basis helps users identify patterns and triggers that may affect their cessation journey

Abstinence Tracker: allows users to track the time since they last used cannabis. The time is displayed in days, hours and minutes. This serves as a motivational tool by visually representing their progress and encouraging longer periods of abstinence

Challenge History and Badges: Users earn badges as they progress, categorized by hours, days, and weeks of abstinence. This provides reward milestones and summaries of current and previous challenges

Inadequate Access to Essential Medicines in Poor Countries

Author's note
Essential medicines are medicines that meet the health needs of the country's population and should always be available in sufficient quantities, in the appropriate dosage form and at an affordable price.

 The World Health Organization WHO has been compiling the model list[i] since 1977 and updating it every two years. Each country should adapt it to its needs. 

Access to essential medicines in Africa, Latin America and Asia is inadequate. Economic, political, infrastructural and social aspects mean that many people in these countries have no or only insufficient access to essential medicines

By Dr. med. Christiane Fischer

Chairwoman, PHM Deuteschland

Inadequate Access to Essential Medicines in Poor Countries


Challenges in accessing essential medicines


Patents are a major driver of high drug prices and a major obstacle to access in the global south. The minimum requirements for a product to qualify for a patent are: it must be new, manufacturable by industry and innovative. This is regulated by an agreement of the World Trade Organization (WTO), the Agreement on the Protection of Intellectual Property Rights (TRIPS). However, the agreement does not regulate when a product is considered innovative.

The World Trade Organization WTO has existed since 1994. Since then, there has been 20 years of patent protection on all products, including medicines. During this time, the company has a temporary monopoly. As with any monopoly, this leads to price increases and a shortage of supply. Patent protection applies in all WTO member states, although there are exceptions for the least developed countries (LDCs). Since January 1, 2005, developing countries that are not LDCs have had to implement the provisions of the TRIPS agreement and grant full product patent protection for medicines. This also includes India, the country with the largest pharmaceutical production in the world. Without India, almost all African countries would not be able to be supplied. In the case of vaccines or antiretroviral drugs (ARVs) that are effective against HIV, this means that many people in poor countries, especially in most African countries, do not have access to these drugs or do not have access to them in sufficient quantities. The problem also affects other drugs.

Many unnecessary patents are also granted in many African countries. Indian patent law, on the other hand, prohibits such patents on so-called marginal innovations. Therefore, many drugs can be exported from India but not imported into African countries.

In India there are also many local production capacities for drugs. They mostly produce generic drugs. India is also known as the pharmacy of the poor. In Africa, local production facilities exist almost exclusively in South Africa. Many countries in these regions have only limited capacity to produce drugs locally, which leads to a strong dependence on imported drugs. A transfer of technology and knowledge to develop local production is urgently needed.

Other reasons for high drug costs

Many countries in Africa, Latin America and Asia have limited financial resources and cannot purchase expensive essential medicines. This particularly affects patented medicines. But high prices on medicines also arise when there is only one manufacturer, creating a quasi-monopoly. These are then referred to as neglected medicines. High poverty rates in these regions are an additional factor and mean that many people cannot afford the medicines they need. Health insurance hardly exists and people have to finance most expenses out of their own pockets.

Some diseases, such as multiple sclerosis, are less common or less diagnosed in these countries. The prices of medicines that are supposed to work against these diseases are unrealistically high. Most people cannot afford the medicines. The World Health Organization (WHO) has included three MS drugs in its model list of essential medicines for the first time in 2023. But their effectiveness is limited. The critical organization LinienWatch, which checks guidelines for conflicts of interest, gives the guidelines published by the Society of Neurology only a mediocre rating, awarding them ten out of a possible 18 points.[ii]

The overpriced drugs also have very problematic side effects. Cladribine (a single 10 mg tablet costs €2,663) carries the risk of serious liver damage, as Merck Healthcare Germany admits in a Red Hand Letter.[iii] Glatiramer acetate (30 pre-filled syringes cost €1,426.96) can also lead to acute liver failure. And rituximab (in Germany you pay €1,085.70 for an infusion bottle) can lead to serious immune deficiencies, warns the Drug Commission of the German Medical Association.[iv]

Infrastructure problems

Infrastructure problems also exist in many poor countries. Unreliable supply chains can lead to bottlenecks and delays in the delivery of medicines. Lack of infrastructure for the safe storage and transport of medicines exists particularly in remote or rural areas. In villages there are often no refrigerators, so many medicines cannot be cooled and therefore cannot be used. This affects HIV medicines and vaccines, among others.[v]

Overly strict or inefficient regulatory processes and corruption also hinder access to new and important medicines. However, there is a risk that the argument will be misused by the pharmaceutical industry to justify why essential medicines do not reach those affected.

Lack of education, insufficient knowledge and problematic awareness about the correct use of medicines exist. They are often just an excuse to keep people away from essential medicines.

Strategies to improve access

There are many strategies in poor countries to improve access to essential medicines. These include strengthening health systems, improving the infrastructure for storing and transporting medicines, and developing efficient and transparent supply chains.

Providing financial assistance to poor population groups is essential to enable them to access essential medicines. A successful example is that in the Indian state of Tamil Nadu, essential medicines are made available to everyone free of charge in the public health sector.[vi]

A ban on patents on medicines would make medicines more affordable. On October 2, 2020, India and South Africa submitted a request to the World Trade Organization (WTO) to at least temporarily suspend patent protection for all products that are necessary for the prevention, containment and treatment of Covid-19. In WTO language, such an exception is called a “waiver”. This request failed mainly due to resistance from wealthy countries, including the USA, Great Britain and Germany.[vii]

Success stories and initiatives

International cooperation, local initiatives and innovative approaches are crucial to tackling the health challenges in these regions. Successful examples include:

Global Fund to Fight AIDS, Tuberculosis and Malaria: A financing instrument against major infections. The global fund provides the financial means to fight these diseases and has thus improved access to medicines in many affected countries. [viii]

Gavi, the Vaccine Alliance: Gavi has successfully improved access to life-saving vaccines in developing countries. Since its founding in 2000, Gavi has promoted the vaccination of 760 million children against life-threatening diseases such as diphtheria, tetanus and whooping cough, thus preventing around 13 million deaths. [ix]

The Medicines Patent Pool (MPP) is committed to improving the health of people in low- and middle-income countries. It is part of the United Nations. It improves access to high-quality, safe, effective, appropriate and affordable medicines, especially for the treatment of HIV/AIDS and tuberculosis. To do this, MPP negotiates with patent holders to put their intellectual property into the pool. MPP then grants licenses to facilitate the production of affordable generics.[x]


[i] WHO, WHO Model Lists of Essential Medicines, 2023 (10.6.2024)

[ii] (10.6.2024)

[iii] Merck Healthcare Germany , Mavenclad ® (Cladribin-Tabletten): Risiko von schwerwiegendenn Leberschäden und neue Empfehlungen zur Überwachung der Leberfunktion, 16.02.2022 (10.6.2024)

[iv] WHO endorses landmark public health decisions on Essential Medicines for Multiple Sclerosis, 2023 (10.6.2024)

DMSG, WHO nahm drei MS-Medikamente in Liste der unentbehrlichen Arzneimittel auf, 2023 (10.6.2024)

U Rosien, Akutes Leberversagen unter Glatirameracetat, Arzneiverordnung in der Praxis 1/2016  (10.6.2024)

AKDÄ, Schwere Immundefekte nach Behandlung mit Rituximab
Deutsches Ärzteblatt, Jg. 115, Heft 49, 07.12.20 2015nach-behandlung-mit-rituximab-aus-der-uaw-datenbank (10.6.2024)
The prices refer to the German Red List 2023

[v] MSF, Empty Shelves Come Back Tomorrow, (10.6.2024)

[vi] NHM. Free Drugs Service Initiative (10.6.2024)

[vii] Paritätischer Wohlfahrtsverband ,Paritätisches Positionspapier Patente für Covid-19 relevante medizinische Produkte und Technologien aussetzen, Menschen weltweit schützen” 2020 (10.6.2024)

[viii]  (10.6.2024)

[ix]  (10.6.2024)

[x] (10.6.2024)


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How COVID-19 Exacerbated Existing Disparities

Author's note

This article explores the profound effects of the COVID-19 pandemic on existing health inequalities, highlighting how it has intensified disparities in access to healthcare, socio-economic factors, and health outcomes among different demographic groups

By Nicolás Castillo

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Impact of the Pandemic on Health Inequalities: How COVID-19 Exacerbated Existing Disparities



The COVID-19 pandemic has acted as a magnifier of pre-existing health inequalities, exposing and exacerbating deep-seated gaps in global healthcare systems and disproportionately affecting marginalized communities. This article explores how the health crisis has intensified pre-existing health disparities worldwide, highlighting socioeconomic, geographical, and structural factors that have influenced the spread of the virus, healthcare system responses, and consequences for vulnerable groups.

Pre-existing Health Inequalities Before the Pandemic

Prior to the COVID-19 outbreak, many regions of the world faced significant disparities in access to healthcare and health outcomes. Factors such as geographical location, socioeconomic status, race, and gender exerted significant influence over the quality and availability of healthcare services, exacerbating disparities in life expectancy, rates of chronic diseases, and infant mortality.

  • Geographical Location: Limited access to healthcare services in rural and remote areas due to inadequate infrastructure and medical resources.
  • Socioeconomic Status: Financial barriers hindering access to medical services and essential medications, especially for those in poverty.
  • Race and Gender: Disparities in medical treatment and care based on racial and gender identity, reflecting inequalities in early diagnosis and quality of care received.

Impact of COVID-19 on Vulnerable Communities

The COVID-19 pandemic has disproportionately impacted marginalized and vulnerable communities, exacerbating existing health disparities and widening gaps in access to healthcare, resources, and resilience capacity.

  • Essential Workers: High exposure to the virus among essential workers in sectors such as healthcare, transportation, and services, due to precarious working conditions and lack of adequate personal protective equipment (PPE).
  • Overcrowded Housing: Difficulty in practicing social distancing in overcrowded housing, leading to increased virus spread and case incidence.
  • Limited Access to Healthcare: Barriers to COVID-19 testing, adequate treatment, and medical follow-up due to lack of accessible healthcare facilities and medical resources.

Uneven Healthcare System Responses

Healthcare systems worldwide have faced significant challenges in their capacity to effectively respond to the COVID-19 pandemic, revealing disparities in preparedness, response capability, and access to adequate healthcare services.

  • Hospital Capacity: Overload of hospitals in densely populated urban areas, with limited resources and exhausted medical staff.
  • Medical Resources and PPE: Initial shortages and uneven distribution of critical supplies such as PPE, ventilators, and medications, affecting proper patient care.
  • Inequalities in Vaccine Distribution: Unequal access to vaccines between high-income and low-income countries, exacerbating disparities in global immunization efforts and pandemic response.

Socioeconomic Impact and Economic Inequalities

The COVID-19 pandemic has had devastating economic consequences, exacerbating economic inequalities and disproportionately affecting informal workers, small businesses, and people living in poverty.

  • Job Losses and Livelihoods: Severe economic impact on vulnerable sectors such as tourism, hospitality, and the informal economy, resulting in increased poverty and food insecurity.
  • Limited Access to Social Safety Nets: Gaps in coverage and access to social benefits, exacerbating economic and social vulnerability.
  • Digital Inequalities: Limitations in access to online education, remote work, and telemedicine due to lack of technological infrastructure and digital skills in marginalized communities.

Challenges and Opportunities for Recovery and Resilience

Despite unprecedented challenges, the COVID-19 pandemic has also presented opportunities to more effectively address health inequalities and build more equitable and resilient global healthcare systems.

  • Healthcare System Reform: Implementation of policies and strategies to strengthen public health infrastructure, improve access to essential medical services, and reduce disparities in healthcare delivery.
  • Innovation and Technology: Use of digital technologies and telemedicine platforms to enhance access to healthcare, especially in remote and underserved areas.
  • International Collaboration: Global cooperation to ensure equitable distribution of vaccines and medical resources, promoting global solidarity and coordinated response to future health emergencies.


In conclusion, the COVID-19 pandemic has underscored the urgent need to address existing health inequalities and strengthen global healthcare systems to ensure a more equitable and effective response to future crises. Post-pandemic recovery efforts must focus on inclusive policies that address socioeconomic and structural gaps that have exacerbated vulnerability among marginalized populations. It is crucial to learn from lessons learned during the pandemic and redouble efforts to build a healthier and more equitable future for all.


  1. World Health Organization. (2020). Addressing inequity: The root of the problem. Retrieved from
  2. Centers for Disease Control and Prevention. (2021). COVID-19 and health equity. Retrieved from
  3. Marmot, M., Allen, J., Goldblatt, P., Herd, E., & Morrison, J. (2020). Build back fairer: The COVID-19 Marmot Review. Retrieved from
  4. Berkowitz, S. A., Cené, C. W., Chatterjee, A., & Covid-19, Health Equity, and the Promise of Community-Driven Reform. (2021). New England Journal of Medicine, 384(5), 455-457. doi:10.1056/NEJMp2024056
  5. Farmer, P., & Maskalyk, J. (2021). Pandemics and social inequalities. The Lancet, 397(10218), 1684-1685. doi:10.1016/S0140-6736(21)00894-4



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Holistic Systemic Change to Care for All Life on Earth

Editor's note PEAH is pleased to turn the spotlight on a just received note by our acknowledged partner* Dr. George Lueddeke, Global Lead International One Health for One Planet Education & Trandisciplinarity Initiative (1 HOPE-TDI)

George Lueddeke

By George LueddekePhD

Consultant in Higher, Medical, and One Health Education

Global Lead – International One Health for One Planet Education initiative (1 HOPE)

Originally from Canada, now residing in the United Kingdom, George Lueddeke PhD MEd Dipl.AVES (Hon.) is an education advisor in Higher, Medical and One Health education and global lead of the international One Health for One Planet Education initiative (1 HOPE) in association with national, regional, and global organisations

Holistic Systemic Change to Care for All Life on Earth


Here is a link to the recently – launched All Life Institute website and brochure that might be of interest to PEAH affiliates / colleagues.

The Institute is “a global think tank based in Washington D.C. that is uniquely dedicated to protecting and enhancing all life on this planet including humans, nonhumans and the Earth.”

Three fundamental truths (imperatives?) appear on the introductory page:

  • “All that we do depends upon abundant plant and animal life as well as clean air and water.”
  • “Our collective future depends upon the decisions that we are making now.”
  • “What is good for nonhumans and the Earth is virtually always in the best interests of humans, given the profound interdependence of all life.”

Embedding  these  themes across  22-23 September 2024 UN Summit of the Future  ‘Pact for the Future’ and ‘Declaration on Future Generations’  implementation  strategies, including enabling actions, seems especially timely and highly relevant  in developing  “a collective understanding that we need a new way of thinking that safeguards our futures” and  building “the anticipatory governance this century demands” (Wales Protocol For Future Generations – from Declaration to Implementation). 

In addition, promoting holistic “systemic change” (e.g., 1 HOPE-TDR) by cultivating “an active care for the world and with those with whom we share it” (UNESCO) could help strengthen engagement of Member States and other stakeholders in pre and post – Summit of the Future discussions.

Image credit: All Life Institute


PEAH readers are invited to comment on the content and suggestions of this post   



*By George Lueddeke on PEAH 

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Reflections on Transforming Higher Education for the 21st Century: PART 3 The international One Health for One Planet Education Initiative (1 HOPE) and the ‘Ecological University’ 

Reflections on Transforming Higher Education for the 21st Century: PART 2 Development of a Global ‘All Life’ Narrative 

Reflections on Transforming Higher Education for the 21st Century: PART 1 The One Health & Wellbeing Concept 

Planet Earth: Averting ‘A Point Of No Return’? 

Tackling the Root Causes of Climate Change. If Not Now, WHEN?

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Postscript – The World at Risk: Covid-19, Global Sustainability and 1 HOPE

 On this theme, see also

INTERVIEW – ‘Survival: One Health, One Planet, One Future’ – Routledge, 1st edition, 2019

News Flash 574: 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

Egg jellyfish (Cotylorhiza tuberculata)

News Flash 574

Weekly Snapshot of Public Health Challenges


Seventy-seventh World Health Assembly – Daily update: 29 May 2024

WHO Member States agree way forward to conclude Pandemic Agreement

Africa CDC holds out hope for a pandemic treaty

Seventy-seventh World Health Assembly – Daily update: 28 May 2024

Building Institutions for Priority Setting in Health: Six Lessons from 10 Years of iDSI

MSF at the 77th World Health Assembly

WHA 77 – Constituency statement of Knowledge Ecology International, Health Action International, Oxfam, World Blind, Union and World Council of Churches – WHO Pandemic Accord

Global Health Law for a Safer and Fairer World

How Big Pharma kept COVID-19 vaccine negotiations in South Africa secret

Experts call for greater emphasis of therapeutics in pandemic response


A Forgotten, Yet Life-Threatening Infection

EMA: Annual report highlights progress in science, medicines and health in 2023

The Power of Partnerships in Advancing Global Health

Voluntary Licensing: Right for Health, Smart for Business – Report

Lessons from rural Bolivia: the United States must rethink community-based medicine

The Role Of Payers In Achieving Environmentally Sustainable And Climate Resilient Health Care

INTERVIEW: Liele Netsanet, Gainhopes organization, Ethiopia  by Daniele Dionisio

Melinda French Gates to donate $1 billion to support women’s rights

Championing Change: How Political Action Can Transform Menstrual Health in India

Results-based funds aim to boost preschool access in Rwanda, Sierra Leone

South Suffering Due to Powerful Nations’ Policies

Migrants in Central America and Mexico face violence and abuse

Can Technology Help Address Global Migrant Crisis? Experts Weigh In


Opinion: Why the potato deserves to finally have its day

Collaboration for sustainable Amazon food production

Climate change caused 26 extra days of extreme heat in last year: Report

UN Chief Says ‘Obscene’ That Small Islands Pay Climate Consequences

To Tackle Climate Crisis, the World Bank Must Stop Financing Industrial Livestock

Europe’s climate movement continues to evolve and grow








INTERVIEW: Liele Netsanet, Gainhopes organization, Ethiopia

Gainhopes is a visionary non-profit organization founded in 2021 by Dr. Liele Netsanet Desta with the mission to empower women and provide them with the resources and opportunities they need to overcome obstacles and reach their full potential.  Based at Bahir Dar, Ethiopia, Gainhopes believes that when women are empowered, they can transform not only their own lives, but also those of their families and communities as a ripple effect of progress that uplifts families, societies, and beyond. 

In this connection, PEAH had the pleasure to interview Dr. Liele Netsanet as Founder and CEO at Gainhopes.

 By Daniele Dionisio

PEAH – Policies for Equitable Access to Health


 Liele Netsanet

 Founder and CEO at GainhopesEthiopia

Vision of a world where leadership knows no bounds and women are empowered to rise and shine


PEAH: Dr. Netsanet, what kinds of challenges do women face in Ethiopia?

  Netsanet: In Ethiopia, traditional and cultural negative beliefs of society  discourage and overlook the rights and abilities of women. In a country where women’s rights and potential are not regarded as privileges, they frequently face various challenging situations. These include sexual abuse, early marriage, female genital mutilation, and diminished educational and healthcare access. Additionally, the lack of job opportunities and limited access to economic resources pose further obstacles for women in Ethiopia.

PEAH: As a non-profit organization, Gainhopes is dedicated to women’s empowerment, fostering an inclusive world where women thrive. Its initiatives support women from diverse backgrounds, providing resources and mentorship to overcome challenges and achieve their goals. Practically, how do you do it?

Netsanet: At Gainhopes, we believe that empowering women is directly creating positive change in the world.  Supporting women is strengthening a family and the community at large. Gainhopes is committed to transform the lives of women through different initiatives in the areas of economic empowerment, educational and improved healthcare access.

Due to the current political instability and ongoing conflict in Ethiopia, Gainhopes is mainly focused on empowering women in conflict-affected areas, internally displaced, and those living with HIV/AIDS. To address this, we are running multiple projects to provide economic security through skill training and capacity building to enable disabled women to achieve long-term financial stability. Additionally, we are engaging in projects to promote healthcare provision and initiatives.

In addition to these economic empowerment efforts, Gainhopes also advocates and protects for rights of women with disabilities. We believe that all women, regardless of their circumstances, deserve the opportunity to have and reach their full potential. 

PEAHHow many women is Gainhopes currently looking after? 

Netsanet: Currently, Gainhopes provides regular support to 101 women. Additionally, the organization is piloting various projects aimed at enhancing its support and empowering up to 350 women.

PEAHSomething more about Gainhopes mission and vision?

Netsanet: As a visionary nonprofit organization that aims at women empowerment, we have multiple goals and missions to broaden through our projects. In the coming two years, we will expand our vision to promote reproductive and adolescent health. Additionally, we aim to prevent the rate of unsafe abortion by collaborating with the Ethiopian Family Planning Center and respective organizations.

– PEAHAt Gainhopes you emphasize that integrity, insight, and inclusiveness are the cornerstone values for empowering women. Can you detail?

Netsanet: Gainhopes takes integrity, insight, and inclusiveness as pillars of sustainable growth and development of society. Community problems are addressed with careful analysis of challenges through a comprehensive insight into societal issues. The second step should be integrity and inclusiveness to reach common interests and solve existing problems. The implementation of integrity provides transparency and accountability which fosters better decision-making activity. In the approach of inclusivity, multiple stakeholders will get the opportunity to participate in addressing societal challenges.

PEAHAs for the results achieved by Gainhopes so far?

Netsanet: Gainhopes has been tirelessly supporting and empowering women through multiple initiatives. The organization regularly provides basic needs for low-income women with HIV/AIDS.

Moreover, it fosters long-standing financial security by offering skill training to displaced women, which is a means for their economic independence. Additionally, it has systems of advocacy for disabled women who experienced sexual abuse.

PEAHDoes Gainhopes cooperate with national and/or international partners?

Netsanet: Yes, Gainhopes networks with both domestic and international NGOs. Additionally, it cooperates with civic societies

 PEAHWhat are your own duties, tasks and challenges inside Gainhopes organization? 

Netsanet: As CEO of nonprofit organization that aims at empowering women, I do have multiple tasks to address and manage in a daily basis. In the organization, I have the following key responsibilities:

  1. Formulating strategic plans to guide the organization’s vision and goals.
  2. Drafting and managing annual budget.
  3. Handling internal and external communications.
  4. Overseeing the implementation of new projects and initiatives.

The major challenges I have encountered are:

  1. Insufficient funding to support our initiatives
  2. Lack of volunteers who will devote in project implementation and other organizational activities.
  3. The ongoing conflict and political instability in Ethiopia has posed significant challenges in my organization.

PEAHThanks for having taken the time to share on Gainhopes strong humanitarian commitment


News Flash 573: 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

Island of Stromboli, Italy

News Flash 573

Weekly Snapshot of Public Health Challenges


“All for Health, Health for All” sets the stage for the Seventy-seventh World Health Assembly

Largest number of regulatory agencies for medical products approved as WHO Listed Authorities

WHO donors in 2023– Setting the agenda for Global Health?

The Pandemic Agreement: A Bridge to Nowhere or North Star to Access and Global Health Security?

New report flags major increase in sexually transmitted infections, amidst challenges in HIV and hepatitis

Malawi and Mozambique combat wild poliovirus

Proactive surveillance for avian influenza H5N1 and other priority pathogens at mass gathering events

WHO updates list of drug-resistant bacteria most threatening to human health

MSF statement and position paper on UNHLM for AMR

Webinar: Part 1 – Lowering the price of insulin everywhere: let’s make it a reality

Webinar: Part 2 – Access to GLP-1s (medicines like Ozempic) and SGLT-2s for people living with type 2 diabetes

Continuing to ignore the problem of the know-how gap won’t make it go away

Center For Medicare And Medicaid Innovation Should Test An Alternative Payment Model For Hospital Nursing

Promoting Indigenous Midwifery: First Nations Mothers’ Resilience surrounding Canada’s Evacuation Policy

How Slovenia Managed to Ban Flavours in E-Cigarettes

People’s Health Dispatch Bulletin #76: More hospitals raided in Gaza; floods cause public health concerns in Brazil

Sudan’s Millions Suffer as Humanitarian Help Falls Short

Urgent need of medical supplies in Haiti as extreme violence isolates people in need

Rethinking Development Cooperation: Aid 2.0

Unmasking Gender Inequities in Health: Research Findings & A Roadmap to Gender-Equitable UHC  by Philip J Gover

Human rights group Asylum Aid files legal challenge to UK’s Rwanda policy 

Billions will Vote this Year – LGBTIQ+ People Must not be Excluded

IMF reaches staff-level agreement with Tanzania on $790 mln climate financing

African leaders pledge to triple fertilizer use to improve soil quality

Tailoring messages about healthy and sustainable eating to reach the most vulnerable

How tech and tradition are cyclone-proofing Vanuatu’s food systems

The Open Food Conference under the Belgian Presidency

Court requires German government to improve climate plans as law reform gets green light

Economic damage from climate change six times worse than thought – report

Brazil’s Amazon fires off to record 2024 start as green union blames firefighting budget cut




Unmasking Gender Inequities in Health: Research Findings & A Roadmap to Gender-Equitable UHC

Editor's note In this article, the Author takes into account the results from a new study, published in The Lancet, funded by the Bill & Melinda Gates Foundation, which emphasizes the importance of considering sex and gender differences in health outcomes, while facing Health Inequity that weakens the value of Public Health.

As the Author maintains, ‘to dismantle the systemic barriers perpetuating gender inequities in health, we must adopt a multifaceted approach that includes sub-national analysis as a critical tool’. 

In such an endeavour, investing in data, empowering communities, building capacity, reforming policies and challenging norms must serve as not to be given up pillars.

By Philip J Gover BA MA MPH

Public Health Consultant, Cooperation Works

Unmasking Gender Inequities in Health: Research Findings & A Roadmap to Gender-Equitable UHC


Universal Health Coverage (UHC), a global health goal introduced by the World Health Organization (WHO), aims to ensure equitable access to essential health services without financial barriers. Its significance lies in its potential to enhance health outcomes, reduce inequalities, and foster economic development. UHC offers several benefits, including access to essential medical services, improved health outcomes, mitigation of health disparities, and promotion of economic growth.

Achieving UHC presents challenges across all economies, particularly in low-income countries. Structural barriers such as high healthcare costs, disparities in insurance coverage, and limited healthcare availability hinder access to care. However, recent research[1] published in The Lancet, funded by the Bill & Melinda Gates Foundation, highlights the importance of considering sex and gender differences in health outcomes, adding further complexity to the planning and delivery of UHC.

Key Insights from Research

The research article provides several key insights regarding health differences between females and males across different age groups and geographies. Key insights and conclusions from the research include:

Global Health Disparities: The study reveals substantial global health differences between females and males, with little progress in bridging these disparities from 1990 to 2021. Conditions such as depressive disorders, anxiety disorders, and road injuries disproportionately affect females or males, with disparities emerging as early as adolescence and continuing to grow over the life course.

Regional Patterns: The research highlights various regional patterns in the distribution of disease burden across age groups for females and males. Variations in the prevalence of different health conditions across regions underscore the complex and context-specific relationships between health and gender norms, economic conditions, and social practices.

Importance of Gender-Sensitive Interventions: The findings underscore the importance of developing gender-sensitive interventions and preventive measures from a young age to address growing health differences between females and males across life stages. Gender norms and attitudes intensify during adolescence, emphasizing the need for early interventions that consider social determinants of health.

In addition to gender, it is crucial to recognize the intersecting influences of race, ethnicity, socioeconomic status, and geographical location on health outcomes. Intersectionality underscores the complex interplay between various social determinants of health, magnifying disparities experienced by marginalized communities. For instance, women of colour may face compounded barriers to accessing healthcare due to systemic racism and economic inequality. Similarly, rural communities may encounter distinct health challenges stemming from limited healthcare infrastructure and resources. By adopting an intersectional lens, policymakers and healthcare providers can develop more targeted interventions that address the unique needs of diverse populations, thereby advancing health equity.

Need for Inclusive Health Data: The study highlights the need for inclusive health data that span the gender spectrum to support more comprehensive and equitable health research. Current data limitations, including the binary framework of female or male in data disaggregation, hinder the analysis of health differences for gender-diverse individuals.

Persistent Health Differences: Despite advancements in understanding sex and gender disparities in health, the research underscores the persistent nature of health differences between females and males. The study calls for continued innovation in analysing health data from a gender perspective to address the roots of health disparities and promote health equity.

Life Course Approach: The research emphasizes the importance of adopting a life course approach in strategic planning for health systems to address the diverse and evolving health needs of females and males across different life stages. Effective health system strategies should consider the interplay between sex, gender, and other social determinants of health.

[Figure 1 – Global rankings of the top 20 causes of DALYs globally for females and males, age-standardised (10 years and older), 2021]

The list of causes of disease burden represents the top 20 causes of age-standardised DALYs observed across females and males for the age group of 10 years and older globally in 2021. This same list of health conditions was ranked according to the DALY rates (per 100 000 population) for both females and males globally in 2021 for the same age group. The colours of the bars and lines denote whether DALY rates are higher for females (red) or males (blue) as established by whether the 95% uncertainty interval of the absolute difference in DALY rates includes zero. The degree of transparency reflects the composition of DALYs for each cause, split between mortality (YLL) and morbidity (YLD). DALY=disability-adjusted life-year. YLL=years of life lost. YLD=years lived with disability.

In conclusion, the research article highlights the ongoing health disparities between females and males globally, the regional variations in disease burden, the importance of gender-sensitive interventions, the need for inclusive health data, and the significance of adopting a life course approach in healthcare planning to promote health equity and address health differences across diverse populations.

Limitations and Considerations

Acknowledging several limitations, including the inability to fully disentangle the influences of sex and gender on health outcomes, the study calls for more inclusive health research that considers intersectionality with other determinants of health.

The research emphasizes the necessity of adopting sex-informed and gender-informed strategies to address the distinct health challenges faced by men and women at different stages of life. This approach is crucial for achieving an equitable and healthy future for all individuals. Additionally, incorporating a sub-national perspective into these strategies can ensure that interventions are tailored to the specific needs of different regions and populations.

The research also hints at the need for sub-national analysis to understand how these disparities manifest at a local level.  By examining data at a sub-national level, researchers can identify localized health challenges, tailor interventions to specific regions, and allocate resources effectively to address disparities within different communities.

While national-level data provides a crucial overview of gender disparities in health, sub-national analysis offers a more granular understanding of these inequities. By examining health outcomes at the district or community level, policymakers and healthcare providers can identify localized challenges and tailor interventions to specific populations. This approach has proven successful in addressing other health disparities, such as maternal mortality and infectious disease outbreaks. For example, in India, sub-national analysis revealed significant variations in maternal mortality rates across states, prompting targeted interventions that led to a substantial decline in overall maternal deaths. Similarly, in Cambodia, sub-national data has been used to identify high-risk areas for malaria transmission, allowing for targeted distribution of bed nets and antimalarial medications. These examples demonstrate the potential of sub-national analysis to inform effective and equitable healthcare strategies, particularly in addressing the complex issue of gender disparities in health.

The Cambodian Context

In Cambodia, the unique burden of disease, that represents its top 20 causes of age-standardised DALYs will be slightly different from that of the global collection.  However, the underlying research illustrates that without assessment, gender-based access can be inhibited.  This is important for economies like Cambodia, as addressing its health inequities requires a nuanced understanding of various demographic factors and gender dynamics that play a crucial and influential role in the provision of healthcare.

The female population outnumbers males by 2-4%.  This demographic skew is further compounded by a pattern of rural to urban migration, whereby men predominantly leave provincial districts for city-based employment opportunities, leaving behind a disproportionately female rural population.  Beyond this, it is asserted that there are still a significant number of rural communities, within localities, still unmapped.[2]

[Figure 2 – Unmapped Villages and Towns in Cambodia, 2019]

Women, in general, also tend to outlive men both locally and globally, resulting in an aging and rural population, predominantly comprised of older women.  Adding further complexity is the consideration associated with the healthcare needs of prisoners, especially those of older incarcerated men and women, living out their lives in settings, where healthcare standards inside the prison gate fall way short of the limited standards that already exist outside the gate.

Sub-National Analysis: A Critical Tool for Action

Policymakers are increasingly recognizing the value of sub-national and sub-regional analysis in healthcare. By collecting and analysing health data within districts or communities, typically organized into cohorts of around 100,000 individuals (100k Analysis), we can identify regional and often sub-regional disparities in health outcomes, healthcare access, and resource allocation. This approach enables policymakers and healthcare providers to gain insights into localized health needs, prioritize interventions, and allocate resources more effectively.

The 100k Analysis approach can help facilitate a focus that examines and unmasks the granular detail of health outcomes, disparities, and healthcare utilization patterns within specific geographic areas.

While sub-national analysis offers a promising avenue for addressing gender inequities in health, it is important to acknowledge the potential challenges and limitations of this approach. Data availability and quality can vary significantly across regions, particularly in resource-limited settings. Additionally, financial and human resource constraints may hinder the implementation of comprehensive sub-national analysis. Strong political will and coordination among various stakeholders are essential for success, but can be challenging to achieve. Furthermore, the complexity of health systems and the interplay of multiple factors beyond gender may not be fully captured by sub-national analysis alone. Finally, equity considerations must be prioritized to ensure that resources and interventions are distributed fairly across all populations.

While challenges exist in capturing the complex nature of health needs within a fixed population size, the benefits of this approach outweigh the drawbacks. By complementing population-based analyses with localized evaluations, we can develop targeted interventions that address the diverse and evolving health needs of rural and urban populations across different age groups.

A Roadmap to Gender-Equitable UHC

To dismantle the systemic barriers perpetuating gender inequities in health, we must adopt a multifaceted approach that includes sub-national analysis as a critical tool:

  1. Invest in Data: We need robust, sex-disaggregated data at both national and sub-national levels. This data must inform targeted interventions and policies addressing the specific health needs of different populations in different regions.
  2. Empower Communities: Engage with communities at all levels, especially marginalized groups, to raise awareness of gender disparities and empower them to advocate for their health rights.
  3. Build Capacity: Provide healthcare professionals with training and resources to deliver gender-sensitive care free from bias and discrimination, ensuring that this capacity is distributed equitably across regions.
  4. Reform Policies: Advocate for policies promoting gender equity in all aspects of health, from access to services to research funding, with consideration for regional variations in health needs.
  5. Challenge Norms: Confront harmful social norms and power dynamics that drive gender disparities in health, recognizing that these norms can vary across different communities and regions.

The time for action is now. By working together, we can create a world where all individuals, regardless of gender or geography, have the opportunity to live healthy, fulfilling lives. This is not just a matter of justice; it is an investment in the future of our societies. When we prioritize gender equity and sub-national analysis in health, we create a ripple effect of positive change that extends to all aspects of life.

Author profile

Philip J Gover BA MA MPH

Public Health Consultant based in Cambodia with Cooperation.Works Mobile and open to program and research management opportunities that address inequalities in Public Health, Social Justice and Sustainable Development. 

I solve complex development challenges, designing innovative programs and securing funding through strategic partnerships.  With a proven track record in Community Development, Public Health, and Business Enterprise, I like to drive projects from concept to implementation. Passionate about the UN SDGs, I aim to support and empower communities to create sustainable solutions. I enjoy coaching teams and mentoring talent and I take calculated risks to achieve transformative change.

Let's connect if you seek a change-maker with vision and execution.



[1]     Patwardhan, V., Gil, G. F., Arrieta, A., Cagney, J., DeGraw, E., Herbert, M. E., … & Flor, L. S. (2024). Differences across the lifespan between females and males in the top 20 causes of disease burden globally: a systematic analysis of the Global Burden of Disease Study 2021. The Lancet Public Health9(5), e282-e294.  Available here

[2]     See here


By the same Author on PEAH

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

Diversionary Measures for Children in Conflict with the Law

Reaching out and Engaging with SE Asian Communities: Health, Shared Value and Business