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Kaiser Daily Global Health Policy Report

In The News

U.N. Calls For International Collaboration To Improve Sanitation For Billions

“The U.N. [on Monday] called for collaboration between governments, the private sector and scientists to improve [the] sanitation needs of billions of people around the world and to focus on the issue of open defecation,” Thomson Reuters Foundation reports. “More than 2.5 billion people around the world — more than one-third of the population — still lack access to adequate sanitation such as toilets or latrines, and of those, one billion practice open defecation, which translates to one of every four people in developing countries defecating in the open,” the news service notes (Mis, 9/3). “In a keynote address to the World Water Week plenary session in Stockholm, Deputy-Secretary-General Jan Eliasson said: ‘Dealing effectively with the water and sanitation crisis is fundamental to fighting disease and poverty,'” the U.N. News Centre writes, adding, “He urged the hundreds of delegates gathered for the session entitled ‘Building partnerships for Sanitation and Water for All’ to work towards sustainable solutions and measures among actors, including national governments, local administrations, development partners, international organizations, the private sector, the research and science community and civil society.” The news service notes, “Inadequate water supply and sanitation around the world lead to an economic loss of $260 billion in health costs and diminished work productivity, WHO reported” (9/2).

Eliasson “has urged states to step up their efforts on sanitation, which is the subject of the seventh Millennium Development Goals (MDGs),” according to The Guardian, which notes, “Meeting the target would involve reducing the proportion of people without access to sanitation from 51 percent to 25 percent by 2015.” The newspaper adds the WHO “says the objective is off track but, even if it were met, about 1.7 billion people will be without access to sanitation” (Tran, 9/2). In related news, Devex examines efforts to improve sanitation in Zimbabwe, highlighting “the innovative work of Peter Morgan, who back in the 1970s, invented the Blair Ventilated Improved Pit Latrine” and who, on Sept. 5, “will receive the 2013 Stockholm Water Prize from King Carl XVI Gustaf of Sweden” (Villarino, 9/2). In similar news, Agence France-Presse reports USAID and the Swedish government “announced a $25 million grant program Monday to increase access to clean water for farming,” adding, “The Securing Water for Food program is intended to fund innovators and help their businesses take root in countries where the technology is desperately needed” (9/2).

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U.N.'s Ban Urges Countries To Commit to Sustainable Development Agenda

In a letter to members of the G20, U.N. Secretary-General Ban Ki-moon last week “called on countries to show leadership and commitment to achieve a sustainable future,” the U.N. News Centre reports. Meeting in St. Petersburg, Russia, this week, the “G20 comprises Argentina, Australia, Brazil, Canada, China, France, Germany, India, Indonesia, Italy, Japan, the Republic of Korea, Mexico, Russia, Saudi Arabia, South Africa, Turkey, the United Kingdom, and the United States, as well as the European Union,” the news service notes. “Implementing a sustainable development agenda calls for renewed progress in trade, finance, technology and knowledge-sharing. I count on you to bring stability to the global economy and lead the way to sustainable development for all,” Ban wrote, according to the news service (8/30).

On Sunday, Ban “urged participants at the European Forum Alpbach to boost action towards achieving the anti-poverty targets known as the Millennium Development Goals (MDGs) and to shape a shared vision for a universal sustainable development agenda,” the U.N. News Centre reports in a separate article. “‘Our shared challenge is to conquer the persistent problems of old — poverty, hunger, disease and hatred — while building a new landscape of peace, prosperity and dignity for all,’ Mr. Ban said in a message delivered by Valerie Amos, under-secretary-general for humanitarian affairs to the closing session of the forum,” the news service writes, noting the annual “forum brings together academics, students, and decision makers from all areas to discuss and brainstorm new ideas and solutions to European and global problems, according to the event website” (8/31).

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U.N. Agencies To Continue Assistance To Syrian Refugees Despite Escalating Tension

“The United Nations children’s agency is scaling up its assistance to thousands of Syrian refugee children and their families in the Kurdistan region of Iraq where tens of thousands of families arrived in recent weeks,” the U.N. News Centre reports. “A plane carrying 100 tons of supplies — including water tanks, latrine equipment, school materials and temporary schools — landed yesterday evening in Erbil, the U.N. Children’s Fund said in a news release,” the news service writes (9/2). “These items come in addition to 12 trucks of supplies, carrying primarily hygiene kits for over 50,000 people, that arrived earlier this week from UNICEF’s warehouse hub in Mersin, Turkey, as well as an additional four trucks of emergency materials that arrived from Baghdad, Iraq,” according to the UNICEF news release (9/1).

“In a briefing to reporters in Geneva [on Friday], officials from the World Food Programme (WFP), the Office of the U.N. High Commissioner for Refugees (UNHCR), [WHO], and [UNICEF] all said they would continue to carry out their operations and deliver basic supplies and services to those affected by the conflict,” the U.N. News Centre notes in a separate article. “UNICEF spokesperson Patrick McCormick said that despite the rise in tension the agency and its partners were on the ground delivering essential services for children and their families, and would continue their efforts to meet existing and new needs,” the news service adds (8/30). “The head of the U.N. refugee agency in Syria says seven million Syrians, or almost one-third of the population, have been displaced by the country’s civil war,” the Associated Press/Politico writes, adding, “Tarik Kurdi told [the AP] on Monday that five million of the displaced are still in Syria while about two million have fled to neighboring countries. He says two million children are among those directly affected by the war” (9/2).

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Life Expectancy Improves For Older Women But Disparities Between Rich, Poor Countries Grows, WHO Study Says

“Life expectancy for women at 50 has improved, but the gap between poor and rich countries is growing and could worsen without better detection and treatment of cardiovascular disease and cancers, the [WHO] said on Monday,” Reuters reports. “A WHO study, one of the first to analyze the causes of death of older women, found that in wealthier countries deaths from non-communicable diseases has fallen dramatically in recent decades, especially from cancers of the stomach, colon, breast and cervix,” the news agency writes (Nebehay, 9/2). “The head of the WHO Mortality and Burden of Disease Unit, Colin Mathers, says developed countries have the health systems and means to reduce and control cardiovascular problems,” VOA News states, adding, “He tells VOA screening and treatment programs also are successfully reducing the incidence of breast and cervix cancers.” According to the news service, the WHO “says the epidemic of chronic diseases can be reversed with available cost-effective ways to address common non-communicable diseases,” including “prevention, early diagnosis and management of high blood pressure, obesity and high cholesterol.” In addition, “[t]he study says inexpensive and simple tests for the screening and early detection of cervical cancer can save many lives,” VOA notes (Schlein, 9/1).

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Health Experts Call For Greater Focus On Mental Health In Africa

“As African countries strive to meet the U.N. Millennium Development Goals (MDGs) by 2015 and plot a new development agenda thereafter, health experts are gathering evidence across the continent to make a case for a greater focus on its millions of mentally ill,” IRIN reports. “Experts say investing in mental health treatment for African countries would bolster development across the continent, but national health priorities have been overtaken by the existing MDG structure, which has specific targets for diseases like malaria and HIV, placing them higher on countries’ agendas than other health issues,” the news service writes. “Global experts celebrated the passing of a World Health Assembly action plan on World Mental Health Day in May, calling it a landmark step in addressing a staggering global disparity,” but, “[i]n order for the plan to be implemented, both governments and donors will need to increase their focus on mental health issues,” according to IRIN.

“As it stands, [USAID], the world’s biggest bilateral donor, will only support mental health if it is under another MDG health priority such as HIV/AIDS,” the news service notes, adding, “Meanwhile, mental health receives on average one percent of health budgets in sub-Saharan Africa despite the WHO estimate that it carries 13 percent of the global burden of disease.” The news service examines the link between poverty and mental illness; highlights pending mental health legislation in Uganda, a country “ahead of most on the continent with its comprehensive National Policy on Mental, Neurological and Substance Use Services, drafted in 2010”; and writes, “Although a number of projects have shown success in working with existing government structures to ultimately integrate mental health into primary health care, the scaling up of such initiatives is being hindered by a lack of investment, as the funding of African health systems is still largely seen through donor priorities, which have been focused elsewhere” (9/2).

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India's Upper House Of Parliament Approves National Food Security Bill

India’s upper house of Parliament, the Rajya Sabha, “late on Monday night passed the National Food Security Bill by voice vote after an almost 10-hour-long debate,” the Hindustan Times reports. “The Lok Sabha has already passed the bill and so it now needs the president’s assent to become a law,” the newspaper notes, adding, “The bill aims to provide cheap food grain to two-thirds of India’s 1.2 billion population” (9/2). “The bill aims to reduce hunger in India where two decades of economic growth has failed to dent malnutrition,” Bloomberg reports. “More than two-thirds of the population eats less than the minimum target set by the government,” the news agency writes, noting, “The country has the highest percentage of malnourished children in the world after East Timor, according to the 2012 annual Global Hunger Index” (MacAskill, 9/2). “Each person qualifying for the aid will be entitled to five kilograms of rice, wheat and coarse cereals at a nominal price every month,” Al Jazeera reports, adding, “The program has been estimated to bring food subsidy costs up to $19.6 billion this financial year, almost $5 billion dollars more than current spending” (Dutt, 9/2).

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Efforts To Eradicate Polio Continue In Israel, Pakistan

NPR’s “Shots” blog and “Morning Edition” program report on nationwide efforts in Israel to vaccinate one million children against polio after researchers found the virus in 85 different sewage samples from across the country. “Getting rid of polio flare-ups, like the one in Israel right now, is a crucial part of eradicating polio globally, [Emory University’s Walt Orenstein] says,” the blog writes. The “Morning Edition” segment discusses the country’s use of the oral polio vaccination in its current drive, as it is better at eliminating the disease on a community-level than the killed-virus vaccine (Beaubien, 9/2). The Associated Press/ABC News reports on polio outbreaks in Pakistan, where “militant threats and attacks on vaccination teams … could worsen [the outbreaks] and [cause them to] spread to other parts of Pakistan, especially since the country is entering the high season for virus transmission.” According to the AP, “There have been 27 confirmed polio cases in Pakistan so far this year — the third highest total in the world after Somalia and Nigeria.” “Threats by al-Qaida-linked militants also have hampered vaccination efforts this year in Somalia, which has suffered the worst polio outbreak in the world,” the news agency writes, noting there have been at least 192 confirmed polio cases worldwide so far in 2013 (Dawar/Abbot, 9/2).

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Editorials and Opinions

U.S. Trade Officials Should Side With Public Health In Trade Negotiations

“Give thanks to Malaysia for heading off, at least temporarily, an American effort to weaken the ability of countries to impose stiff rules on the sale of cigarettes and other tobacco products within their own borders,” a New York Times editorial states, noting, “The Malaysian proposal to preserve that ability led to a stalemate at a Trans-Pacific Partnership trade meeting in Brunei last week and forced the deferral of the issue to future meetings.” According to the newspaper, “The American proposal simply refers to other international agreements that allow exceptions for public health and requires health officials from the 12 Trans-Pacific Partnership countries to consult each other before making trade challenges,” but it “leaves the door open for multinational tobacco companies to challenge legitimate tobacco control measures, as they already have in several countries in recent years.”

“Malaysia countered by proposing a complete carve-out of tobacco control measures that would protect a country’s ability to set its own rules for marketing, advertising, banning or taxing various tobacco products, among other control measures,” and “it would remove the danger that some countries might not enact strong tobacco control measures in order to avoid any possibility of challenges,” the New York Times writes. Noting the “Campaign for Tobacco-Free Kids and several other medical and patient advocacy groups, including the American College of Obstetricians and Gynecologists,” support the Malaysian proposal, the editorial concludes, “American trade officials need to toughen their stance when Trans-Pacific Partnership negotiations resume. They should be siding with the public and those concerned about public health, not the makers of products known to be lethal and highly addictive” (8/31).

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International Community Can Learn From Success Of MDGs In Designing SDGs

Noting “[t]he world’s governments [are to] meet at a special session of the U.N. General Assembly on Sept. 25 to discuss how to accelerate progress on the Millennium Development Goals [MDGs], and also to agree on a timetable for a new set of Sustainable Development Goals [SDGs],” Jeffrey Sachs, director of the Earth Institute at Columbia University and special adviser to the U.N. secretary-general on the MDGS, writes in a Korea Herald opinion piece, “Setting international development goals has made a huge difference in people’s lives, particularly in the poorest places on the planet. Sub-Saharan Africa has benefited enormously from the MDGs, and we can learn from that success in designing the SDGs.” He states, “To see the MDGs’ importance for sub-Saharan Africa, one need only compare the decade before their adoption with the decade after,” noting, “In the 10 years before the MDGs, economic growth in the region was slow, the poverty rate was high (and rising), and there was an increasingly heavy disease burden, including HIV/AIDS and malaria.”

“The adoption of the MDGs focused increased attention by African governments, non-governmental organizations, U.N. agencies, international donors, foundations, and activists on the urgency of combating poverty, hunger, and disease,” Sachs continues, noting “[t]here were significant improvements in disease control,” particularly with regard to malaria and HIV. “Of course, much remains to be done to maximize progress on achieving the targets set by the MDGs,” he states, writing, “Most important, significant gains in health could be attained with adequate financial resources. Donor countries should provide ample replenishment funding later this year to the Global Fund to Fight AIDS, Tuberculosis, and Malaria, which would ensure this vital agency’s continued success.” He provides specific recommendations for setting the SDGs and concludes, “The MDGs have helped to play [a] role in the fight against poverty. The SDGs can do the same for the complex challenge of achieving sustainable development” (9/2).

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Examining Solutions To Distribution Of Substandard Malaria Drugs

Noting the emergence of drug resistance to the “once highly successful malaria treatments chloroquine and sulphadoxine pyrimethamine (SP)” and the resulting need for artemisinin combination therapies (ACTs), Jasson Urbach, director of the South Africa-based Africa Fighting Malaria, in a post in The Guardian’s “Global Development Professionals Network” blog, examines “what can be done [to] stop the distribution of substandard drugs that make resistance worse.” “Drug resistance can emerge due to porous borders, because they allow peddlers of fake and substandard drugs to move freely between countries,” Urbach notes, arguing that “[g]overnments should improve border control.” In addition, he says “[m]anufacturers can develop anti-tampering packaging and certification systems”; “[c]ompanies can develop drug detection technologies [such as text message services (SMS)] … to check the authenticity of their packs”; “[r]egulation bodies can streamline registration processes … to harmonize more and accept registrations on a regional basis”; and “[t]he international community can unite and commit to the issue … signing an international treaty on counterfeiting medicines” (9/2).

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Closing Funding Gap To Eradicate Polio Now Would Mean Fewer Resources Spent On Disease In Future

Noting the Bill & Melinda Gates Foundation “has been spearheading an effort over the past couple of years to close the last mile on polio eradication,” Matthew Yglesias, business and economics correspondent for Slate, writes in the magazine’s “Moneybox” blog, “The Gates Foundation believes it has a plan to get this done for about $5.5 billion over a six-year period, and they’ve raised about $4 billion in pledges already.” He continues, “Their rather modest ‘ask’ of the United States government is that we increase our annual contribution to this effort to $200 million a year from its current pace of $150 million [in FY12] (a sum we occasionally undermine by using vaccination as a front for intelligence operations),” adding, “My guess is that the relevant members of the Obama administration are highly sympathetic to the idea of coughing up the extra money, but have not been incredibly successful at obtaining the time of the most senior level of officials to discuss political, legal, and communications strategies for getting this done.”

“Fully closing the funding gap would cost approximately what the U.S. spent on the Libya intervention (that’s not considering spending by NATO allies) so winning the war on polio would be an undertaking of roughly the scale that we’re prepared to contemplate for military measures,” Yglesias notes, and concludes, “I would just urge that if you’re thinking about international humanitarian issues this week you spend some time to ponder how close we are to eradicating a major disease and to the idea that maybe it’d be smart for major rich world powers to throw their shoulders into this” as “we can permanently stop spending resources on polio vaccines and redirect that public health money to malaria or clean water or whatever else catches your fancy” (8/30).

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From the Global Health Policy Community

Research Paper Examines Performance-Based Funding At Global Fund

In a paper published in the September 2013 issue of The Lancet Global Health, Victoria Fan, a research fellow with the Center for Global Development, and colleagues examine performance-based funding at the Global Fund to Fight AIDS, Tuberculosis and Malaria. According to the abstract, the researchers “aimed to test the association between grant ratings and disbursements, an indication of the extent to which incentives for performance are transmitted to grant recipients.” They conclude in the abstract, “The Global Fund’s present performance-based funding system does not adequately convey incentives for performance to recipients, and the organization should redesign this system to explicitly link a portion of the funds to a simple performance measure in health coverage or outcomes, measured independently and robustly” (September 2013).

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U.K. To Invest $215M Over 5 Years For Development Of Global Health Technologies

“Close on the heels of the announcement that Australia is newly investing in global health product development, the … U.K.’s Department for International Development (DFID) announced [last week] it is investing £138 million — or approximately $215 million — over the next five years into nine product development partnerships (PDPs) to support the development of new drugs, vaccines, insecticides, diagnostic tools, and microbicides,” Kim Lufkin, communications officer at the Global Health Technologies Coalition (GHTC), writes in the coalition’s “Breakthroughs” blog. She says “this new round of funding is a welcome and much-needed continuation of the department’s recognition that new products are critical components of improving health worldwide.” “It’s incredibly encouraging to see that the United Kingdom is boosting its long-standing support for PDPs and that new donors like Australia are starting to enter the field,” Lufkin states, adding, “The outcome could have significant ramifications for the country’s role in global health and medical research” (8/30).

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WHO/Europe To Organize Regional Consultation On HIV Treatment Guidelines

“WHO/Europe will organize a regional technical consultation on the dissemination of the ‘Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection,’ published by WHO headquarters in July 2013,” the U.N. health agency reports in a post on its webpage. “The technical consultation will take place in Istanbul, Turkey, with the participation of national counterparts, including managers of the national HIV/AIDS programs and national clinical experts in HIV/AIDS treatment and care, as well as civil society organizations involved in provision of services for people living with HIV/AIDS, from 12 Eastern European and central Asian Member States,” the press release notes and highlights the main objectives of the consultation (9/2).

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September 2013 Issue Of WHO Bulletin Available Online

The September issue of the WHO Bulletin features an editorial on transforming health systems to address women’s health, a public health news roundup, several research papers on women’s health across the life course, and a policy paper on addressing breast and cervical cancers in low-resource settings, among other articles (September 2013).

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