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Kaiser Daily Global Health Policy Report

In The News

Supreme Court Strikes Down Anti-Prostitution Pledge, Saying It Violates First Amendment Free Speech Rights

“In a ruling [.pdf] backing robust free speech rights for recipients of government funds, the Supreme Court on Thursday struck down as unconstitutional the federal government’s requirement that groups accepting U.S. aid declare their opposition to prostitution,” Politico reports. “In a 6-2 decision, the justices found a 2003 law violated the First Amendment by demanding that groups receiving funding to fight HIV, AIDS and certain other diseases affirmatively reject prostitution,” the news service notes (Gerstein, 6/21). Under PEPFAR, “organizations receiving … U.S. funding had to comply with two separate conditions laid out by Congress,” Scientific American’s “Observations” blog writes, adding, “The first was that funds could not be used to promote or advocate the legalization of prostitution. The other, more controversial, provision — and the one struck down by the Supreme Court [Thursday] — forced groups receiving U.S. funds to sign a pledge saying they would not provide ‘assistance to any group or organization that does not have a policy explicitly opposing prostitution and sex trafficking'” (Maron, 6/20). “The Alliance for Open Society International and Pathfinder International … sued in 2005, citing the guarantee of free speech in the U.S. Constitution’s First Amendment,” Reuters states (Hurley, 6/20).

In addition to imposing on their right to free speech, the groups “argued that adopting such a policy would undermine efforts to fight HIV/AIDS: denouncing prostitution would alienate prostitutes in need of contraception and treatment,” The Economist’s “Democracy in America” blog notes (6/20). “More than 200 organizations filed briefs supporting the challenge to the pledge,” the Center for Global Health Policy’s “Science Speaks” adds (Barton, 6/20). “The Obama administration argued in favor of the constitutionality of the law, contending that rules Obama officials set out in 2010 allowing aid recipients to work with affiliates that disagreed with the government policy were sufficient to address any First Amendment problems,” but “[t]he court’s majority explicitly rejected that position,” Politico writes (6/21). In the majority opinion, Chief Justice John Roberts “said these decisions involve the government’s refusal to subsidize certain activities,” according to the Los Angeles Times’ “Politics Now” blog. “The government may not go further, he said, and ‘leverage funding to regulate speech outside the contours of the program itself,'” the newspaper notes. “The law requiring groups to declare their opposition to sex trafficking ‘falls on the unconstitutional side of the line,’ he said,” according to the newspaper (Savage, 6/20). “Justice Elena Kagan recused herself from the case, presumably because she had worked on it when she was President Obama’s solicitor general,” the Washington Post states. “Justices Antonin Scalia and Clarence Thomas dissented,” the newspaper notes, adding, “Scalia said the government was not coercing speech but simply acquiring partners who share its beliefs” (Barnes, 6/20). The case is Agency for International Development v. Alliance for Open Society International, U.S. Supreme Court, No. 12-10.

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One In 3 Women Experience Sexual, Physical Violence, WHO Report Says

“One in three women experience sexual or physical violence — most likely from their intimate partner, according to a report from the [WHO],” CNN reports (Park, 6/20). “The report, ‘Global and regional estimates of violence against women: Prevalence and health effects of intimate partner violence and non-partner sexual violence,’ represents the first systematic study of global data on the prevalence of violence against women — both by partners and non-partners,” the U.N. News Centre writes (6/20). “Put together by the WHO in partnership with the London School of Hygiene & Tropical Medicine and the South African Medical Research Council, the report says 35 percent of women around the world are victims of sexual or physical violence, and that assault at the hands of an intimate partner is by far the most common form of such violence,” the Huffington Post’s “World” blog notes (Mosbergen, 6/20). “Among the findings: 40 percent of women killed worldwide were slain by an intimate partner, and being assaulted by a partner was the most common kind of violence experienced by women,” the Associated Press adds (Cheng, 6/20). “Topping the regional list is WHO’s South-East Asia administrative region, which includes India, Bangladesh, and Thailand, where an estimated 37.7 percent of women [were found to have been] beaten or sexually assaulted by a spouse or intimate partner,” National Geographic’s “News Watch” writes (Morrison, 6/20). “The report says women of all ages, young and old alike, are subject to violence,” according to VOA News (Schlein, 6/20).

“Such figures mean that violence should be considered alongside ‘mainstream’ health risks such as smoking and alcohol use, says Kristin Dunkle, a social epidemiologist at Emory University in Atlanta, Georgia, who was not involved in the studies,” Nature writes (Baker, 6/20). “The report found that violence against women is a root cause for a range of acute and chronic health problems, ranging from immediate injury to sexually transmitted infections, to HIV, to depression and stress- and alcohol-related health disorders,” Reuters reports (Kelland, 6/20). “The head of the [WHO], Dr. Margaret Chan, called it ‘a global health problem of epidemic proportions,’ and other experts said screening for domestic violence should be added to all levels of health care,” the AP writes (6/20). “‘The main message is that this problem affects women everywhere,’ [Karen Devries, an epidemiologist from the London School of Hygiene & Tropical Medicine] says,” NPR’s “Shots” blog states. “Because of the stigma associated with rape and abuse, ‘some of our findings may underestimate the prevalence,'” Devries said, the blog notes (Doucleff/Chatterjee, 6/20). “The study highlights the need for all sectors to engage in eliminating tolerance for violence against women and [improving] support for women who experience it,” according to a WHO press release, which adds, “New WHO guidelines, launched with the report, aim to help countries improve their health sector’s capacity to respond to violence against women” (6/20). The Guardian’s “Data Blog” details some of the findings of the report (Chalabi/Holder, 6/20).

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Pope Decries World Hunger As 'Scandalous,' Urges Countries To Work Together

“Decrying starvation in a world of plenty as ‘scandalous,’ Pope Francis was joined today by the head of the United Nations Rome based-agricultural agency in urging countries to work together to eliminate hunger and poverty,” the U.N. News Centre reports. “‘It is a well-known fact that current levels of production are sufficient, yet millions of people are still suffering and dying of starvation. This is truly scandalous,’ Pope Francis said [to] an audience at the Vatican with members of the U.N. Food and Agriculture Organization (FAO) and delegates attending the agency’s 38th Conference,” the news service notes, adding, “Pope Francis underlined that countries must ‘must move beyond indifference’ and change policies that exclude the most vulnerable populations, exacerbating hunger and poverty” (6/20). “The pontiff said that the purpose of the meeting was to ‘share the idea that something more can and must be done’ to help the poor, and that they need more than simply goodwill and promises that often have not been kept,” according to Christian Post (Zaimov, 6/20). “The speech was the latest in a series of criticisms by the Argentinian pontiff, the first Latin American pope, of what he has called ‘the dictatorship of the economy’ and the spread of consumerist values,” Reuters writes, adding, “Francis has made repeated calls to tackle poverty and focus on the needs of the poor since he succeeded Pope Benedict in March” (6/20).

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Global Alliance For Clean Cookstoves Head Speaks About Group's Strategies, Goals In Devex Interview

In an interview with Devex, Global Alliance for Clean Cookstoves Executive Director Radha Muthiah discusses “how the small secretariat manages such a complex alliance [with more than 700 partners] and what other ‘mega partnerships’ can learn from the alliance’s experience.” She highlights the alliance’s flagship report (.pdf), titled “Igniting Change: A Strategy for Universal Adoption of Clean Cookstoves and Fuels,” “which identifies a three-pronged approach to universal adoption of clean cooking solutions by enhancing demand, strengthening supply, and fostering an enabling environment,” as well as the group’s long-term strategies (Useem, 6/20).

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Reports Highlight Economic Impact Of Child Malnutrition In Uganda, Egypt

“Uganda loses about $899 million a year due to effects of malnutrition such as lost productivity, according to a report,” titled “The Cost of Hunger in Africa,” Bloomberg Businessweek reports (Ruitenberg, 6/18). “The study was conducted by the Government of Uganda with the support of the African Union Commission including New Partnership for Africa’s Development (NEPAD), the U.N. Economic Commission for Africa and the U.N. World Food Programme (WFP),” according to a WFP press release. The study “underlines that undernutrition is not just a health issue, but an economic one as well,” the press release states (6/18). According to the report, “poor early years feeding — whether through not enough food or, more often, a monotonous, vitamin-poor diet — has reduced national income by 5.6 percent,” BBC News writes. “Of course, there are many other factors that contribute to the well-being of children — from the quality of parenting to the physical environment,” but the study “looks only at the effects of nutrition from cradle to grave,” the news service notes (Doyle, 6/21).

Another study, “undertaken in Egypt by the Cabinet’s Information and Decision Support Center (IDSC) in collaboration with the United Nations World Food Programme (WFP), the African Union Commission and the United Nations Economic Commission for Africa (UNECA),” found “Egypt lost an estimated 20.3 billion Egyptian pounds (US$3.7 billion) or 1.9 percent of Gross Domestic Product in 2009 as a result of child undernutrition,” a WFP press release reports (6/20). “Higher health care costs, additional burdens on education and lower productivity stemming from stunting or chronic malnutrition were particular drivers for the economic losses,” according to the WFP, Bloomberg Businessweek notes in another article. The study was part of the same report, which covered 12 countries in Africa, according to the news agency (Ruitenberg, 6/20).

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Editorials and Opinions

Opinion Pieces, Editorials Address Supreme Court Ruling On Anti-Prostitution Pledge

“In a ruling [.pdf] backing robust free speech rights for recipients of government funds, the Supreme Court on Thursday struck down as unconstitutional the federal government’s requirement that groups accepting U.S. aid declare their opposition to prostitution,” according to Politico, which notes, “In a 6-2 decision, the justices found a 2003 law violated the First Amendment by demanding that groups receiving funding to fight HIV, AIDS and certain other diseases affirmatively reject prostitution” (Gerstein, 6/21). The following is a summary of opinion pieces and editorials addressing the ruling.

  • Lindsay Coates, Huffington Post’s “Impact” blog: “The Supreme Court’s decision was a resounding affirmation of the freedom of civil society organizations to express their views, even as they work alongside government in addressing the toughest global challenges,” Coates, executive vice president of InterAction, writes. “The fact that the ruling was so broad-based reflects the wide-ranging support we got for our case in general,” she continues, adding, “We are gratified that the Supreme Court upheld the lower courts’ decisions that this U.S. government policy requirement is unconstitutional. We’re also looking forward to continuing our partnership with the U.S. government to save lives and ultimately end up with the AIDS-free world which John Kerry so eloquently spoke about just [Wednesday]” (6/20).
  • Amy Davidson, New Yorker’s “Closed Read” blog: “In a 6-2 opinion written by John Roberts, the Chief Justice, the Court ruled that groups receiving money to fight the spread of AIDS cannot be required to make certain statements about prostitution,” Davidson, a senior editor at the magazine, writes. “Justice Scalia, in his dissent, said that the government had every right to ask for a pledge — that it was no more intrusive than a decision not to turn over tax money to shady characters like Hamas or ‘cigar aficionados,'” she notes, adding, “But such a pledge does much more. It would leave no room for silence — silence that did not affect the job that the groups were meant to do (a key point for the Court).”
  • Gabriel Grand, PolicyMic: Grand, an editorial intern for PolicyMic, recounts the history of the case and writes, “The Court’s ruling creates a potentially dangerous precedent for the government. It places limits on the extent to which the government can advance its own agenda and political views through the appropriation of federal funding.” He adds, “While it seems unlikely that the removal of the Leadership Act’s restrictions on NGOs will actually help to fight HIV/AIDS, we can rest assured that the integrity of the Constitution remains intact” (6/20).
  • Elias Groll, Foreign Policy’s “Passport” blog: Noting the non-governmental organizations (NGOs) that brought the suit argued “that a law requiring them to oppose prostitution would make it more difficult to reach sex workers, a population particularly at risk for HIV/AIDS,” Groll, an editorial assistant at Foreign Policy, “raises a question: How have the restrictions baked into PEPFAR affected the ability of aid groups to reach sex workers and carry out the federal program’s larger mission?” He highlights “the most comprehensive examination of PEPFAR,” in which “a 2013 independent advisory panel found that the program has seen a great deal of success,” and writes, “PEPFAR’s restrictions may hinder its ability to reach out to sex workers, but the program does deserve some credit for distributing funds fairly effectively” (6/20).
  • Los Angeles Times: The editorial gives an overview of the case and writes, “As Roberts conceded, it is sometimes difficult for courts to draw the line between ‘conditions that define the federal program and those that reach outside it.’ But here, Congress went beyond setting rules for how government funds are spent to try to force recipients to renounce their right to free speech. The court was right to rein it in” (6/21).
  • New York Times: “The Supreme Court on Thursday imposed an important limit on how far the government can go in controlling the speech of a group that takes government money,” the newspaper writes. “Chief Justice Roberts, quoting from a 1943 opinion barring the government from requiring public school children to salute the flag, noted: ‘If there is any fixed star in our constitutional constellation, it is that no official, high or petty, can prescribe what shall be orthodox in politics, nationalism, religion, or other matters of opinion,'” the editorial continues, adding, “That principle guided the court to the right result in this case” (6/20).

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Opinion Piece, Editorial Address WHO Report On Violence Against Women

According to a new report from the WHO, published in partnership with the London School of Hygiene & Tropical Medicine and the South African Medical Research Council, 35 percent of women worldwide are victims of sexual or physical violence. The following opinion piece and editorial address the report’s findings.

  • The Lancet: As part of the WHO’s publication, the editorial notes that The Lancet this week “publish[ed] online … a systematic review of the global prevalence of intimate partner homicide.” The editorial continues, “Awareness of violence against women as a health problem (and not just a criminal justice or domestic issue) is still low in many countries and, in some nations, the attitudes of health workers towards women disclosing such violence can be more negative than supportive. These latest reports should help counteract this situation.” In addition, “[g]overnments should also act to end violence against their female citizens,” the editorial states, continuing, “Sadly, nowhere in the world is a woman safe from violence. But global momentum for change is building” (6/20). “The findings and their implications for public health are discussed in a comment, editorial, and podcast,” the journal’s homepage notes (6/21).
  • Claudia Garcia Moreno Esteva, Huffington Post’s “Global Motherhood” blog: “If violence against women were a sudden new disease outbreak, it would make headline news,” Esteva, WHO lead specialist for gender, reproductive rights, sexual health and adolescence, writes, adding, “Nevertheless, today’s report highlights the fact that violence against women represents a major public health issue: ‘a global health problem of epidemic proportions,’ says Dr. Margaret Chan, the Director General of the [WHO].” She continues, “We have gone from having to prove that this is a problem in the first place to countries acknowledging that this is a problem that needs urgent action. … We have gone from not knowing much about the extent of the problem to having global data and looking at what works to prevent it.” She adds, “A life free of violence is a basic human right, one that every woman, man and child deserves” (6/20).

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Forbes Interview Examines Link Between Women's Rights, World Population

Noting the U.N. last week “announced in its ‘World Population Prospects’ report that by 2050, global population will reach 9.6 billion, a 300 million people increase from the 2010 revision,” Forbes contributor Anushay Hossain interviews Suzanne Ehlers, president of Population Action International (PAI), in Forbes’ “World With A View” blog. They discuss how women’s rights factor into the issue and “why Americans should be listening.” According to the interview transcript, Ehlers examines how, “in Washington, attacks on women’s reproductive health, both globally and domestically, persist as foreign aid keeps getting cut”; whether “U.S domestic politics around abortion spilled onto the international arena”; how “investing in women’s rights tie into slowing the world’s population growth”; and what the role of U.S. foreign policy is in promoting women’s rights, among other topics (6/20).

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From the Global Health Policy Community

Kaiser Family Foundation Report Maps Global Efforts To Address HIV/AIDS In Low-, Middle-Income Countries

A new Kaiser Family Foundation report “maps the complex network of international assistance aimed at addressing the global impact of HIV/AIDS,” a report summary on the foundation’s webpage states, continuing, “The large number of donor organizations working on these efforts creates challenges for effectively negotiating, coordinating and delivering programs, particularly in the current era of economic austerity.” The report tracks donor engagement in 143 recipient countries and is the first in a series of reports aimed at “providing perspective on the geographic presence of global health donors and to enable more effective coordination and delivery of services globally and within individual recipient nations.” According to an email from the foundation, “Future analyses are planned for family planning and reproductive health assistance, tuberculosis, and malaria” (6/21).

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USAID Releases 2012 Report On Global Health Programs To Congress

USAID on Thursday released its 2012 report (.pdf) on global health programs to Congress, according to the agency’s webpage. “The Global Health Programs: Report to Congress describes USAID’s ongoing commitment to advancing global health science, research, innovation and implementation across three inspiring goals: creating an AIDS-free generation, ending preventable child and maternal deaths, and fostering a world safe from major and emerging disease,” according to the report summary (6/20).

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Failed Food Aid Reform Amendment To House Farm Bill 'A Moral Outrage'

Noting the House this week voted down an amendment to the Farm Bill that would have allowed up to 45 percent of funds in the Food for Peace program to be used for aid other than U.S. commodities, development blogger Ansel Herz writes in Humanosphere, “Congress has again preserved American exceptionalism, and in so doing ensured millions more people in poor countries will go hungry.” He includes quotes from several Congress members about the amendment, and says, “This shows how far food aid reform has to go. The amendment did not reflect the far-reaching, meaningful reforms to food aid proposed by the Obama administration and progressive [non-governmental organizations (NGOs)] like Oxfam.” He continues, “That the amendment failed is a terrible sign — a moral outrage, really — that entrenched interests blocked a tiny, productive shift in how we feed the world’s hungry. The upside is, as Oxfam points out, that the vote was close. And Congress has an opportunity to support an even stronger package of reforms in the form of the Food Aid Reform Act. The world is watching” (6/20).

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Blog Examines Absence Of NTDs In G8 Summit Discussions

“[T]he 2013 G8 Summit concluded quietly on Tuesday with the release of the Lough Erne Communiqué [.pdf],” Dano Gunderson, a policy assistant for the Global Network for Neglected Tropical Diseases, writes in the Global Network’s “End The Neglect” blog. “[D]isappointingly, NTDs were unable to penetrate the G8’s discussions this year,” he states, adding, “Instead, David Cameron’s three T’s — tax, trade and transparency — dominated the agenda.” He continues, “While these issues will surely help alleviate global poverty, the G8 missed a prime opportunity to build on previous discussions to tackle these diseases that perpetuate poverty and inequality.” He concludes, “Hopefully the G8 will seriously consider its previous global health commitments over the next year, including its commitments to NTDs. Until then, you can read more about how the G8 can act now to control NTDs in our G8 Call to Action [.pdf]” (6/20).

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Global Fund Board Approves Grants For First Applicants Under New Funding Model

“The Board of the Global Fund to Fight AIDS, Tuberculosis and Malaria has approved grants for the first applicants to participate in a new funding model that is dramatically expanding support for countries fighting these infectious diseases,” a Global Fund press release reports. “The grants, totaling $622 million, are ready to be implemented,” the press release notes, adding, “They embody a new approach to funding, with greater predictability, improved interaction among partners and swifter implementation. The new funding model is designed to make more effective grants, with greater impact, so that more people can benefit from prevention, care and treatment of AIDS, TB and malaria” (6/19).

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