Authoritative insights by 2015 PEAH contributors added steam to debate on how to settle the conflicting issues that still impair equitable access to health by discriminated population settings worldwide
by Daniele Dionisio*
PEAH – Policies for Equitable Access to Health
2015: A Year in Review through PEAH Contributors’ Stands
Now that 2015 just came to its end, I wish to thank the top thinkers and academics who enthusiastically contributed articles over the year. Their authoritative insights meant a lot to PEAH scope while adding steam to debate on how to settle the conflicting issues that still impair equitable access to health by discriminated population settings worldwide.
Find out below a list of summaries and relevant links:
Beatriz Becerra Basterrechea, Member European Parliament, pointed out that …there is a total lack of transparency on the prices paid by governments for medicines. There is no public access or transparency regarding the clinical trials which test the efficacy and security of our medicines. We do not know how much has been invested in research nor do we have mechanisms to trace costs of production. A legislative effort should be undertaken to achieve transparency in industry’s investments in R&D as a process which would benefit both corporate public image and patients’ access to medicines….
As regards challenging antimicrobial resistance, Shila Kaur, Coordinator Health Action International Asia Pacific (HAIAP), reminded us that at the 67th World Health Assembly in May 2014, WHO Member States agreed to a Global Action Plan (GAP) to tackle the escalating antimicrobial resistance, including antibiotic resistance, global public health emergency. She regretted that … Despite having undergone two rounds of consultation with the global health community prior to its tabling at the WHO Executive Board meeting in January 2015, the draft GAP gives no indication on how developing and less developed countries, with limited or even non-existent technical resources and capacities, will design and implement their own national plans…
Inherently, Garance Fannie Upham, Deputy General Secretary, AC2BMR/WAAAR World Alliance Against Antibiotic Resistance, extensively reported on the book “AMR Control 2015”. As per her words…This book gathers more than 30 outstanding authors on a broad range of topics and concepts, from proposals for new Intellectual Property Rights approaches to R&D for antibiotics, to the latest data showing that the 44 billion dollars spent on antibiotic for animal husbandry may only be wasteful, to the need for urgent investments in water and waste management by banks and investors, or, last but not least, as it is top in the just adopted United Nations Global Plan of Action on AMR: infection prevention and control (IPC) as a must against AMR, Ebola and MERS.
As regards these issues, Matteo Zignol and Mario Raviglione, Global Tuberculosis Programme World Health Organization, underlined that …Surveillance of resistance to anti-TB drugs remains a cornerstone of any effective TB control programme worldwide. With the availability of new technologies and new drugs, and the prospect of new regimens for the treatment of TB and MDR-TB, surveillance of drug resistance is evolving and adapting to continue being a critical tool to inform public health actions to fight TB.
In unison, Kaspars Lunte, Team Leader Sourcing and Special Projects, Global TB Drug Facility, Stop TB Partnership/UN Office for Project Services added that …Stop TB Partnership’s Global Drug Facility (GDF) was established in 2001, with the aim of using donor funding to consolidate demand from different countries and negotiate affordable prices for quality-assured anti-tuberculosis drugs. Today, as one of the main players in the complex global market for TB drugs, the GDF plays a crucial role in not only shaping drug supply, but also in reducing the price of medicines.
From a complementary perspective, Giorgia Sulis, Lucia Urbinati, and Alberto Matteelli, Division of Infectious and Tropical Diseases – WHO Collaborating Centre for “TB/HIV co-infection and for TB elimination”, University of Brescia, Brescia, Italy, remarked that …Persons with LTBI (latent tuberculosis infection) have no signs or symptoms and are not contagious; however, they are at risk of progression from latency to active disease. On average, this happens in 5-10% of those affected during their lifetime, but some (“at-risk”) populations have a substantially higher risk of progression than the average. Hence, diagnosis and treatment of LTBI may represent an attractive strategy for TB prevention.
Linda Mans and Diana Hoeflake, Wemos Foundation, highlighted that …The world is 7.2 million health workers short. Low-income countries are particularly affected by the shortage of health personnel. Too few health workers are being trained and retained due to insufficient public investments in health care and medical staff. Migration of health workers increases the inequalities and presents a challenge for all countries. Vacancies in high-income countries have a pull effect on qualified health workers from low- and middle-income countries. One of the reasons is that health personnel are leaving for greener pastures – countries where salaries are higher and facilities are better…
In his article, Matthew Rimmer, Associate Professor, Australian National University College of Law, Canberra, reported that …At an international level, there has been a growing impetus for climate action in order to address public health risks associated with global warming…. As he maintained,…At the international level, there is a need to encourage fossil fuel divestment by governments, companies, and institutions in order to promote a healthy climate and a safe planet.
The article by Lawrence C. Loh, University of Toronto and The 53rd Week, emphasized that…Modern transport planning has rapidly moved away from an expensive, outdated system of car-dependent suburban sprawl. Understanding that health is different from and more than healthcare, wider societal discourse needs to apply planning’s lessons learned to move away from a singular focus on healthcare that is similarly expensive and outdated.
To the point, Claudio Schuftan, People’s Health Movement –PHM, provided a lot of forward-looking reflections on inequality and poverty reduction, as a reliable voice amidst the efforts to address today’s challenges involving policies, strategies and practices, and push for inclusive and sustainable development grounded on equity.
From a different point of view, Tomas Mainil and Olaf Timmermans, HZ University of Applied Sciences, Vlissingen, the Netherlands, maintained in their contribution that …Globally, countries need to overcome demographic tensions in their populations. The challenge for the Dutch province of Zeeland is to develop social innovation in response to key societal challenges in tourism and health: Coastal regions are confronted with demographic changes, especially ageing of inhabitants as well as visitors (tourists) and their changing needs health-related issues. A cross-border cooperation, wherein a common approach is developed to explore problems and enhance opportunities, benefits the possibility to address this challenge…Relevantly, the article outlines a professorship aimed at establishing a crossover between the tourism and health economies, developing innovative services that fit the changed needs of both inhabitants and visitors on healthy living related services/products and have an economic and social value.
Meanwhile, Sara Gorman, Department of Health Policy & Management, Columbia University Mailman School of Public Health, pointed out that …although new technology is essential, social change and social progress depend upon people, not on technologies. Social progress relies on understanding complex systems and the people who inhabit them first and foremost.
A couple of articles by Corie Leifer, AIDS Foundation East-West (AFEW), dealt with prison inmates:
Based on evidence that prisons are often a catalyst for the outbreak of contagious disease epidemics, the first article explored …why prisoners are at greater risk for contracting certain infections, why this inequity should not be tolerated, and how this issue is innately connected to the public health of the general population. As a follow-up, the second article highlighted …a few projects that are working to address the underserved population of prisoners and ex-prisoners, particularly those who use drugs.
To the point, Lesley Doyal, Emeritus Professor, School for Policy Studies University of Bristol, UK, stressed that … The major focus in both national and international responses to HIV pandemic is now on ensuring that as many positive people as possible have sustainable access to the specific drugs. But, whatever their medical efficacy they can only ever provide a partial solution to what has become a ‘post- modern plague’ in so many of the poorest parts of the world. The coming decades are likely to be ones of increasing need and declining resources. Hence optimistic suggestions that drugs alone will soon bring an end to the pandemic will need to be treated with the greatest caution.
And this occurs at a time when, as argued by Meri Koivusalo, Senior Researcher on Health Policy at National Institute for Health and Welfare, Helsinki … The new generation trade agreements, such as the TPP (Trans-Pacific Partnership) and TTIP (Transatlantic Trade and Investment Partnership), have changed the ground and context of trade negotiations through extension of negotiations further to national policies and regulation. These new generation trade agreements have gained criticism… Relevantly, …from health policy priorities perspective, the more systemic danger of TTIP is that it could hinder necessary change of corporate profiteering and an already failing model for innovation and R&D towards pharmaceutical policy in the public interest…
On her part, Raffaella Ravinetto, Antwerp Institute of Tropical Medicine, pointed out that… In April 2015, The WHO Expert Committee, tasked with the review and update of the WHO Lists of Essential Medicines for adults (EML) and children (EMLc), recommended the addition of 36 new medicines to the EML, and of 16 to the EMLc. It is hoped that the indications of the WHO Expert Committee will be considered and followed by all the concerned stakeholders, including pharmaceutical companies and policy makers.
In this environment, the article by Iris Borowy, Aachen University, Germany, tackled challenges to global health from a multi-pronged, entwining perspective. She alerted that … Health threats from waste thrive on socio-economic inequalities in two complementary ways: while affluence in parts of the global population produces mass consumption and rapid discarding of products (i.e. waste), poverty in another part invites the concentration and uncontrolled dumping of waste which amplifies its dangers to health…On a global scale, this transfer of waste from rich to poor unfolds when high-income countries export part of their hazardous waste to Africa and Asia…
From a different viewpoint, the article by Juan Garay, Head of Cooperation Section, Delegation of the European Union to Mexico, reminded us that …Measuring health equity challenges many of the present global concepts and policies on Health. The tragic death toll from global Health inequity (injustice) requires a deep transformation of concepts and dynamics towards the universal right to Health…
On a complementary wavelength, Bashir Saiegh Saiegh, Founder and CEO of the Tulaitula Health Consulting Group, featured in-depth the World Network for Medical Diagnosis, as a clinical information system to support and facilitate the medical diagnosis and the medical treatment in resource-limited countries and worldwide.
As an useful addition, the article by Hongzhou Lu, Tangkai Qi, and Jiaying Shen, Division of Infectious Disease Shanghai Public Health Clinical Centre affiliated to Fudan University, reminded us that …Since the first H7N9 influenza case was diagnosed in 2013, the disease has involved more than ten provinces and municipalities of China. There are a number of cases diagnosed in the years 2014 and 2015, most of whom had a history of live poultry contact, although there are already strict limitations on the purchase of live poultry. This reflects the dilemma between the needs of disease prevention and pre-existing social economic factors… The authors discuss this issue starting from a recent case of human H7N9 influenza diagnosed in Shanghai and suggest measures to better manage the production and trading of live poultry.
From another perspective, Amina Aitsi-Selmi, Consultant in International Public Health, Global Disaster Risk Reduction/International Public Health, Public Health England, focused …on the Sendai Framework for Disaster Risk Reduction 2015-2030 and how it addresses health and vulnerability. As such, her article is equipped …to assist communities of research, policy in understanding the aim of the Sendai Framework and identifying synergies and foster collaboration, particularly through research and evidence-translation for policy makers.
Last but not least, Vipin Varma, Principal Advisor (Health Affairs) & Founder , THOT Consultants – Ideas Without Borders, highlighted in his article that …Since health education is the base of the modern healthcare pyramid, eradicating the silent public health epidemic of health illiteracy is the most cost-effective means to reduce the healthcare burden of developing nations, while moving the populations to greater self-reliance.
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*Daniele Dionisio is a member of the European Parliament Working Group on Innovation, Access to Medicines and Poverty-Related Diseases. He is an advisor for “Medicines for the Developing Countries” for the Italian Society for Infectious and Tropical Diseases (SIMIT), and former director of the Infectious Disease Division at the Pistoia City Hospital (Italy). Dionisio is Head of the research project PEAH – Policies for Equitable Access to Health. He may be reached at d.dionisio@tiscali.it https://twitter.com/DanieleDionisio
