Kaiser Daily Global Health Policy Report

In The News

Practice Of FGM On Decline Globally, But 30M Girls At Risk Over Next Decade, UNICEF Reports

“More than 125 million girls and women alive today have undergone female genital mutilation [FGM], and 30 million more girls are at risk in the next decade, UNICEF said” in a report (.pdf) released Monday, Agence France-Presse reports (Sheridan, 7/22). “The tradition remains ‘remarkably persistent, despite nearly a century of attempts to eliminate it,’ said the report, which compiled 20 years of data across 29 countries in Africa, Asia and the Middle East in which the practice is still conducted,” Deutsche Welle writes (7/22). “While [FGM] has been virtually abandoned by certain groups and countries, it remains entrenched in many others, even where there is legislation against it and efforts by governments and non-governmental organizations to convince communities to stop” the U.N. News Centre notes (7/22). “According to the comprehensive report, female genital mutilation is mainly practiced in 29 countries in Africa and the Middle East,” Huffington Post’s “World” blog states, adding, “Around one in five of those women and girls live in Egypt,” and “[a]lmost all girls are cut before the age of 15” (7/22). “Surveys in the 29 countries in Africa and the Middle East where [the practice] persists show that girls are less likely to be cut than they were some 30 years ago, and that support for the practice is in decline, even in countries where it remains almost universal, such as Egypt and Sudan,” according to a UNICEF press release (7/22).

“But FGM remains almost universal in Somalia, Guinea, Djibouti and Egypt and there was little discernible decline in Chad, Gambia, Mali, Senegal, Sudan or Yemen, the study found,” BBC News notes (7/22). “Somalia had the highest rate (98 percent of women aged 15-49), followed by Guinea (93 percent), Djibouti (93 percent), and Egypt (91 percent),” GlobalPost adds (Deasy, 7/22). “The report … shows that many men and women want to stop FGM but they feel obliged to continue the tradition because of social pressure,” Thomas Reuters Foundation writes (Batha, 7/22). “The report points to a gap between people’s personal views on [FGM] and the entrenched sense of social obligation that fuels its continuation, exacerbated by a lack of open communication on this sensitive issue,” the U.N. News Centre reports (7/22). “The report’s authors stress that the tradition still has a tenacious hold in many places, but they say the fledgling declines may foreshadow more generational change,” according to the New York Times (Dugger, 7/22). “Laws are not enough to stop the practice entirely, and more people must speak out in order to eliminate it among certain ethnic groups and communities, the researchers said,” Australia’s ABC News notes (Vincent, 7/23). The news service provides an interview with report author Claudia Cappa of UNICEF (Hall, 7/23). Thomas Reuters Foundation provides a factbox on the prevalence of the practice in various countries (Batha, 7/22). The Guardian provides an interactive graphic depicting some of the report data (7/22).

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Contaminated School Lunch That Killed 23 In India Contained Pesticide Banned In Many Countries

“The pesticide that killed 23 Indian schoolchildren last week is a nerve poison banned by many countries because of what the [WHO] describes as its ‘high acute toxicity,'” Reuters reports. “As early as 2009, the United Nations health agency urged India to consider a ban on the pesticide monocrotophos — the substance said by a magistrate investigating the deaths to be the cause of the poisoning,” the news service writes. Reuters highlights “a detailed 2009 WHO report [.pdf] on the health risks of monocrotophos in India,” which notes “the countries and regions that have banned its use include Australia, Cambodia, China, the European Union, Indonesia, Laos, Philippines, Sri Lanka, Thailand, Vietnam and the United States.” The news service continues, “Yet in India, monocrotophos ‘is widely used and easily available,’ and is frequently linked to fatal poisoning, both accidental and intentional.” According to David Coggon, a professor of occupational and environmental medicine at Britain’s University of Southampton, “while a ban on monocrotophos would doubtless help reduce its risks in India, using it more safely could also help to reduce the threat,” Reuters adds (Winterbottom/Kelland, 7/22).

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WHO Working Group On Substandard Medicine To Meet This Week

Members of the WHO “are meeting this week to advance the international mechanism against substandard and counterfeit medicines,” Intellectual Property Watch reports. Meeting documents, for the “Open-ended Working Group to Identify the Actions, Activities and Behaviours that result in substandard/spurious/falsely-labeled/falsified/counterfeit (SSFFC) medical products,” including the draft agenda and a report by the secretariat, are available on the WHO website, the news service notes. “The SSFFC issue has historically been sensitive among member states, making agreement difficult,” Intellectual Property Watch writes, noting, “All countries seek to prevent these types of medicines in their markets, but some have been concerned that measures taken not interfere with the flow of legitimate and affordable generic versions of the more expensive brand-name drugs.” According to the news service, the working group this year “is expected to move forward on: establishing the working group on the actions, activities, and behaviors that result in SSFFC medical products; convening a technical consultation on the work plan; and a steering committee meeting” (New, 7/22).

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Wall Street Journal, Forbes Examine Global Implications Of Measles Outbreak In Wales

The Wall Street Journal examines a recent outbreak of measles in Wales, discussing the backlash in the U.S. and U.K. against immunizations following allegations that vaccines were linked to autism — a theory which has since been disproved — as well as the implications for global health. The outbreak, which has sickened more than 1,200 people in Wales, “presents a cautionary tale about the limits of disease control,” the newspaper writes, and notes, “Most measles occurs in developing countries. But it is resurging in some of the very countries that have led global campaigns against it.” The newspaper continues, “The outbreak matters to the rest of the world because measles can quickly cross oceans, setting back progress elsewhere in stopping it” (Whalen/McKay, 7/19).

In a Forbes opinion piece responding to the Wall Street Journal article, Forbes contributor Emily Willingham writes, “One of the most common refrains people repeat in arguing against vaccinating their children is that diseases like measles simply aren’t their problem. That virus, they say, is a ‘third world’ or ‘developing world’ problem, something to worry about in places where water isn’t clean and nutrition is poor.” However, she continues, “the Wall Street Journal story makes an important point — one that yes, has been made ad nauseam but bears repeating: In this global society, there are no ‘first’ and ‘third’ worlds.” She adds, “People who forego measles vaccination likely forego other vaccinations as well, including immunization against slower-moving but even deadlier diseases like diphtheria and pertussis. In other words, measles outbreaks might simply be the beginning of something even more serious” (Willingham, 7/21).

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Editorials and Opinions

Lack Of Focus On Sanitation In Africa A 'Shortcoming' Of Global Health Policy

“With all the attention given to AIDS, malaria and TB in Africa, are we losing sight of other basic services?” Azad Essa, an online producer at Al Jazeera, asks in the news service’s “Africa” blog. He highlights a meeting between journalists and “the Chief Macha of Choma, leader of the Tonga speaking people in southern Zambia,” noting, “The Choma district, made up of 260,000 people, heaves heavily under the burden of HIV, malaria and TB. But like every other region in the country, the district has made significant gains against the triad of disease in recent years.” Essa writes, “Here we were, intent on bringing out the usual set of questions related to HIV, malaria and TB: peoples’ behavior, the role of culture and tradition and empowerment of women. Instead, he challenged our basic assumptions of what mattered most to him, or his people” — sanitation.

“More than 600 million or 70 percent of people on the continent still do not have access to a clean toilet. Poor sanitation is the cause of hundreds of thousands of deaths in Africa each year,” Essa continues, adding, “Poor sanitation lays hidden behind the big names of malaria, HIV and TB, as the primary killers on the continent.” He writes, “But under conditions of poor or no sanitation, millions live in constant risk of a myriad of diseases: The soiled hands feeding children medication and the contaminated water that carries typhoid and causes diarrhea, contribute to economic dysfunction, and even fatalities.” He states, “There remains a fixation on HIV and to a lesser extent TB as illnesses that impose a particular violence on human beings, requiring dramatic intervention,” adding, “The Gods of global health policy appear merely intent ‘on keeping people alive,’ but not necessarily transforming their lives.” He writes, “And while toilets and clean water won’t solve the challenges related to AIDS, or TB, it certainly does illustrate a severe shortcoming of global health policy” (7/22).

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Focus On Vulnerable Mothers Needed To Reduce Preventable Child Deaths

Writing in the Huffington Post’s “Global Motherhood” blog, Leith Greenslade, co-chair of the Child Health Pillar for the MDG Health Alliance, examines the circumstances of mothers who experience multiple child deaths. “It is no coincidence that child deaths are concentrated in the places with the greatest numbers of disempowered mothers — India, Nigeria, Democratic Republic of Congo, Pakistan and Ethiopia. Half of all child deaths occur to mothers in these five countries,” she writes. Greenslade highlights a study about child deaths in three states in Northern Nigeria, and continues, “The mothers who had nobody to turn to for support, who rarely or never had anyone to help look after their children, and who felt that they were not respected by their peers were much more likely to have children die before they turned five.” She adds, “This is why it is so important that when we talk about child survival we talk about mothers” (7/22).

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From the Global Health Policy Community

GHTC Blog Examines FY 2014 State and Foreign Operations Appropriations Bill

Writing in the Global Health Technologies Coalition’s (GHTC) “Breakthroughs” blog, GHTC Policy Officer Ashley Bennett summarizes a bill that was approved on Friday by the House Committee on Appropriations, Subcommittee on State, Foreign Operations, and Related Programs, which includes funding for “key global health research activities.” She writes, “Overall, global health programs fared relatively well under the bill, compared with other [State and Foreign Operations] accounts,” and notes, “Congress should move quickly to protect these programs in upcoming Committee discussions and final budget negotiations later this year” (7/22).

Additional details regarding the subcommittee’s appropriations bill proposal are available on the Kaiser Family Foundation’s Policy Tracker (7/19).

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CSIS Report Examines U.S. Strategic Rebalance In Asia-Pacific Region

In a new report titled “A Greater Mekong Health Security Partnership,” the Center for Strategic & International Studies (CSIS) Task Force on Health and Smart Power in Asia examines the “U.S. strategic rebalance to the Asia-Pacific region,” writing it “reflects a cumulative historic shift in U.S. foreign policy priorities that has evolved steadily over recent decades,” according to the report summary (Morrison/Daniel/Hiebert, 7/22). The report, which “which argues there is a unique, time-sensitive opportunity for a targeted, major U.S. initiative to improve health security in the Greater Mekong subregion,” will be launched on Monday, July 29, according to an event notification on the CSIS website (July 2013).

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'Science Speaks' Blog Profiles 3 Global Health Service Partnership Volunteers

The Center for Global Health Policy’s “Science Speaks” blog profiles three of “the 30 American doctors and nurses sworn into the Peace Corps as the first class of the program’s Global Health Service Partnership volunteers in a White House ceremony Thursday.” The blog states, “The effort is the product of a Peace Corps, [PEPFAR] and Boston-based nonprofit Seed Global Health (previously Global Health Service Corps) collaboration,” and notes, “The volunteers, who left over the weekend  following their swearing in — for Tanzania, Malawi and Uganda — will spend a year or more working with local medical school faculty helping to train doctors and nurses in countries where health systems are hobbled by shortages of medical professionals and people to educate them” (Barton, 7/22).

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U.N. To Establish Task Force On Prevention, Control Of NCDs

“The Economic and Social Council (ECOSOC) adopted a resolution requesting the U.N. Secretary-General to establish a United Nations Interagency Task Force on the Prevention and Control of Noncommunicable Diseases [NCDs]” at the ECOSOC’s 2013 Substantive Session held in Geneva, a WHO media note reports. “The Task Force will be convened and led by the WHO” and “will coordinate the activities of all U.N. organizations to implement the WHO Global Action Plan for the Prevention and Control of NCDs 2013-2020, adopted by the World Health Assembly in May 2013,” the media note states before providing details of the plan. “WHO will convene a formal meeting with Member States on November 13, 2013 to complete the work on a draft terms of reference for the U.N. Task Force on NCDs,” the media note adds (7/22).

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Blog Examines Need For PMTCT In Order To Achieve AIDS-Free Generation

Noting “[r]ecently released guidelines from [the WHO] recommend starting HIV treatment earlier — even pre-emptively — as a measure to preventing and eradicating AIDS,” Foreign Policy Association blog contributor Elyse Lichtenthal writes in the blog, “Reading about the push to approach [antiretroviral (ARV)] treatment in this way makes me very sanguine. … We cannot approach the treatment of this diagnosis, as we would heart disease or cancer, for 50-60 years and hope that measure will result in the reduction of AIDS.” She continues, “Through the prevention of mother-to-child transmission (PMTCT), we can create a future generation of AIDS-free populations,” and highlights a number of organizations across Africa “working toward this method of AIDS prevention.” She states, “Until a vaccination is discovered, patented, and available on the global market, we must prevent future cases of AIDS, in addition to treating existing cases” (7/22).

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