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UNHCR Alarmed at Impact of U.S. Refugee Program Suspension 

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Gates, Mastercard launch new platform for smallholder farmers 

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UNPO Nesletter December/January edition 

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UN High-Level Panel, Medicines Access Find Foothold At World Health Assembly In May 

Gates Foundation, KEI Enter Into Official Relations With WHO 

Resolution On Compulsory Licences For Patented Medicines Passes In Chile 

Feb 24, 2017 – U.S. History, Experiences, and Prospects of Compulsory Licensing of Medical Patents 

Merck reveals seven years of its U.S. drug price increase history 

Médecins Sans Frontières Partners with TB Alliance in Three-Country Study 

The Medicines Patent Pool Announces First Licence for Tuberculosis Treatment 

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Pneumonia: “What haunts me is knowing how different it can be for each child, depending on where he or she lives” 

British Scientists: Drug-resistant Malaria Cases ‘A Warning For Africa’ 

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Michael Marmot: Do something. Do more. Do better (interview) 

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European Commission: EU “On Track” for 2020 Renewables Goal 

CDC’s canceled climate change conference is back on – thanks to Al Gore 

Do the Credit Policies of the WB, IMF & EC Damage Health?

Despite recent positive rhetoric by the IMF, WB and the EC to reform conditionality policies, a gap persists between the declared intentions and the general practice. It is time for the three institutions to turn the rhetoric into reality

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by  Daniele Dionisio*

PEAH – Policies for Equitable Access to Health

Do the Credit Policies of the WB, IMF & EC Damage Health?

 

The mandates of the International Monetary Fund (IMF) and the World Bank (WB) include the obligation to facilitate financial stability, international trade, and economic growth, while securing assistance in the form of loans to countries suffering from balance-of-payments constraints. The European Commission (EC) provides both Budget Support – accounting for approximately 25% of EU development aid – and Macro Financial Assistance (EUMFA) in the form of loans and grants for non EU countries facing a balance-of-payments crisis, provided the country has an IMF programme.

This context gives these three institutions great power to shape domestic policies in other countries, through quite identical prescriptions.

Conditionalities: a threat to health?

As creditors, the three institutions seek to ensure that they recover their loans from borrowers by setting strict ‘conditionalities’ on lending. Loan disbursements have been linked to economic and trade liberalization with regressive consequences for poor people.

In most cases, conditionalities encompass cutting public spending, including  government subsidies and ceilings on government wage bills (common in Africa), as well as privatization of public services such as health and education and removal of barriers to international trade.

Critics have charged macroeconomic reform programmes with a narrow vision on economic stability and for not protecting social spending on health and education. For example, ceilings on governments’ wage bills disrupt the much needed expansion of the health workforce, thus impairing the ability of the health sector to recruit and retain health workers.

The impact of the reform recipes has been highlighted especially in Africa in terms of cuts in public spending and adopting user fees policies which are known to act against poor people, especially women. However, recently the same recipes have been implemented in high income countries such as Greece where cuts in public spending and dismissal of health workers have led to deterioration in the health of the population.

Moreover, cuts in the health spending affect the supply of medicines, which can have tremendous negative consequences on the health of a population, including fueling transmission of infections like HIV/AIDS, tuberculosis (TB), hepatitis and sexually transmitted diseases. For example, a study of the link between the IMF loans and TB in the former Soviet Union and Eastern European countries documented a 16.6% rise in annual TB mortality from early to mid-1990s.

The WB, IMF and EC defend themselves by denying fixing targets for specified expenditures or wages and stating that governments are accountable for expenditure priority allocations. They thus deny any responsibility for their actions.

However, regular reviews by the WB, IMF and EC determine whether a loan is released depending on economic performance, not on protection of social spending. As contended, ‘this is an example of how the power dynamics between WB, IMF, EC and the recipient of their programmes make it very difficult for the latter to ignore policy prescriptions, even when they are not legally binding.’

Basic requirements to reform

Given the influence of these institutions on domestic policies, they should focus on helping countries explore a wide range of options for dealing with fiscal deficits. These options should ensure the protection and increase in social spending, especially on health and education, and the removal of the budget ceiling on the recruitment and retention of health workers.

A key problem underlying the damage of the macroeconomic reform recipe is that negotiation is usually limited to a narrow circle of finance ministries in the absence of public participation or scrutiny. Transparency of negotiation and participation of other relevant ministries and civil societies are essential to ensure pro- human development policies.

Despite recent positive rhetoric by the IMF, WB and the EC to reform conditionality policies, a gap persists between the declared intentions and the general practice. As maintained in a recent Eurodad analysis, ‘…The IMF continues to attach problematic conditions to its loans, notably by suggesting reforms in sensitive economic areas. The World Bank continues to make loan decisions on the basis of the assessments made by its rich country-dominated board on the economic agenda of recipient countries. Finally, the EC’s Budget Support was originally created to support the local ownership of its recipients and its guidelines reflect that. In practice, though, it sometimes incentivizes economic reforms that are not part of partner countries’ development strategies…’

It is time for the three institutions to turn their new rhetoric into reality.  But, will they be up to this at this time of  Trump, Brexit, and the rising success of so-called populist/nationalist movements – which perhaps mirror the mounting unpopularity of the idea of globalization as the driver for economic prosperity?

———————————–

*article originally published in International Health Policies 

http://www.internationalhealthpolicies.org/do-the-credit-policies-of-the-wb-imf-ec-damage-health/

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 http://www.peah.it/ https://twitter.com/DanieleDionisio

 

Oltre il PIL per la Misura del Benessere Globale

‘GDP is an abstraction that has little personal meaning for individuals’ - Richard Easterlin, professor of economics , University of Southern California

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by Daniele Dionisio

Membro, European Parliament Working Group on Innovation, Access to Medicines and Poverty-Related Diseases

Responsabile del Progetto Policies for Equitable Access to Health – PEAH

Oltre il PIL per la Misura del Benessere Globale

 

Il successo del PIL (Prodotto Interno Lordo, GDP in lingua inglese), quale abusato indice di misura del benessere nazionale, non accenna a diminuire. Una fissazione che persiste sebbene evidenze e fonti autorevoli ne denuncino l’insufficienza come indicatore di progresso. Il Nobel economista Joseph Stiglitz ha affermato che il PIL non è una buona misura di performance economica né di benessere. E secondo un altro economista, Jennifer Blanke, ‘…it merely provides a measure of the final goods and services produced in an economy over a given period, without any attention to what is produced, how it’s produced or who is producing it.’ Blanke pone una domanda chiave trascurata dal PIL: è la crescita equa, rispettosa dell’ambiente, e migliorativa delle nostre vite?

In effetti, qual è la giusta direzione per un’economia moderna e inclusiva? Senza dubbio che essa dovrebbe impegnarsi a soddisfare le necessità di base di ognuno, principalmente in termini di salute e serenità di vita. E che dovrebbe anche evitare di immagazzinare ogni potenziale fonte di danno di lungo termine, estrema diseguaglianza e collasso ambientale inclusi.

Nel contempo, l’economista Richard Easterlin, ha definito il PIL ‘an abstraction that has little personal meaning for individuals’. E Joseph Stiglitz incalza ‘Ciò che misuriamo informa ciò che facciamo. E se misuriamo la cosa sbagliata, noi faremo la cosa sbagliata’.

In tal senso, secondo Jennifer Blanke, il PIL è solo una misura parziale di breve termine, mentre il mondo ha bisogno di strumenti di fiducia e di più larghe vedute per informare il modo in cui costruire le economie del futuro.

Al riguardo, dati presentati al World Economic Forum (WEF) del gennaio 2017 mostrano che sebbene il PIL di buona parte delle economie avanzate indichi una crescita annuale di circa il 2% nel 2016, in realtà il reddito medio pro-capite in 26 nazioni ricche è caduto del 2,4%. Il dato non stupisce se è vero che oggi masse di poveri vivono in aree dove maggiore benessere coesiste con sacche di maggiore diseguaglianza per l’incapacità dei governi a trasferire la crescita economica entro un ampio ed equo progresso sociale.

Per l’occasione il WEF ha lanciato l’Inclusive Development Index – IDI, un indicatore più completo e inclusivo del PIL, per la misurazione del benessere globale.  L’IDI associa ai consueti indicatori economici, criteri più ampi tra i quali la disparità nei redditi e nelle ricchezze, la mobilità sociale, la qualità della vita e dell’ambiente, la sicurezza.  In base all’IDI la Norvegia si conferma ancora la più virtuosa fra i Paesi avanzati: con una crescita economica solo dello 0,5% tra 2008 e 2013, lo standard di vita è in realtà cresciuto del 10,6%.  Lussemburgo, Svizzera, Islanda e Danimarca seguono a ruota (Figura).

most inclusive advanced economies

Gli Stati Uniti, invece, si collocano al 23mo posto, peggio di Estonia, Repubblica Ceca e Corea del Sud.

L’Italia, ventunesima su trenta economie avanzate per PIL pro-capite, scende al ventisettesimo posto (su 29) nella classifica IDI. Secondo il rapporto WEF l’Italia paga il ritardo sulla crescita, sul lavoro e sui giovani mentre il sistema di protezione sociale non affronta questi problemi con la dovuta efficienza.

L’IDI è solo l’ultimo, in ordine cronologico, di una serie di indicatori inclusivi proposti per il superamento del PIL in termini sociali, economici e ambientali. Tra essi, l’ Human Development Index (HDI), lanciato dalle Nazioni Unite e focalizzato, fra l’altro, al monitoraggio di qualità e attese di vita, educazione e redditualità pro-capite; il Social Progress Index con enfasi sul benessere sociale e ambientale; e il World Happiness Index inclusivo di ‘measures of generosity, freedom and corruption’.

Nel frattempo, la New Economics Foundation (NEF) proponeva 5 indicatori in un report dell’ ottobre 2015: buona occupazione lavorativa, benessere, ambiente, equità, e salute. Giusto ad esempio il report sottolineava, fra l’altro, come a fronte di un 94% di cittadini inglesi ufficialmente al lavoro nel 2014, solo il 61% godeva di posti sicuri e remunerativamente soddisfacenti.  E, con riguardo alla salute, proponeva la misura delle ‘morti evitabili’ quale indice della qualità degli interventi e dei livelli di prevenzione.

Senza dimenticare, una volta ‘rodato’ e implementato, il potenziale impatto nella realtà italiana del BES, l’indice di Benessere Equo e Sostenibile sviluppato da ISTAT e CNEL per valutare il progresso di una società non solo dal punto di vista economico ma pure sociale e ambientale, e corredato da misure di disuguaglianza e sostenibilità.  I 12 indicatori del BES includono, fra gli altri, la salute, l’istruzione e la formazione, il lavoro e il benessere economico, il benessere soggettivo, l’ambiente, la qualità dei servizi.

Il 28 luglio 2016 il BES è entrato nel Bilancio dello Stato al fine di rendere misurabile la qualità della vita e valutare l’effetto delle politiche pubbliche su alcune dimensioni sociali fondamentali.

 

PER APPROFONDIRE

This might be the best alternative yet to GDP as a way to measure a country’s growth https://qz.com/885723/this-might-be-the-best-alternative-yet-to-gdp-as-a-way-to-measure-a-countrys-growth/

Beyond GDP – is it time to rethink the way we measure growth?https://www.weforum.org/agenda/2016/04/beyond-gdp-is-it-time-to-rethink-the-way-we-measure-growth/

Five measures of growth that are better than GDP  https://www.weforum.org/agenda/2016/04/five-measures-of-growth-that-are-better-than-gdp/

The Inclusive Growth and Development Report 2017 WEF http://www3.weforum.org/docs/WEF_Forum_IncGrwth_2017.pdf

Inclusive Development Index: Measuring What Matters  http://impactalpha.com/inclusive-development-index-measuring-what-matters/

Human Development Index  http://hdr.undp.org/en/content/human-development-index-hdi

Social Progress Index http://www.socialprogressimperative.org/global-index/

World Happiness Index http://worldhappiness.report/

Rapporto Bes 2016: il benessere equo e sostenibile in Italia https://www.istat.it/it/archivio/194029

 

 

 

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New Book Highlights IP Trade Law Flexibilities For Public Health 

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Barack Obama transfers $500m to Green Climate Fund in attempt to protect Paris deal 

Brexit can be Hazardous to our Health

...health researchers and professionals are (or should be) asking how Brexit will, and could, affect public health.  Among the questions, informed by a political economy perspective on health and its social determinants, five stand out.
One needs to remind oneself that the last word in Albert Camus’ famous essay about suicide is ‘hope’.  But it is hard to sustain in these times.

TSchrecker

By Ted Schrecker *

Professor of Global Health Policy, Durham University, UK

Brexit can be Hazardous to our Health

 

Some public policies should carry health warning labels like cigarettes or uncooked meat.  Certainly that is true for a reckless and ill-thought-out policy like the UK government’s current approach to leaving the European Union, after a close advisory referendum in which at least one of the campaigns would quickly have run afoul of trading standards law if had involved a consumer product.  As controversy rages on about exit paths – ‘strategies’ would be too kind a word – health researchers and professionals are (or should be) asking how Brexit will, and could, affect public health.  Among the questions, informed by a political economy perspective on health and its social determinants, five stand out.

  1. Whose living standards will be hit first, and worst, as sterling dives towards parity with the US dollar, or even lower? Make no mistake, it is headed that way.  What will be the direct and indirect effects on housing costs, on transport costs, on the cost of a healthy diet?
  2. What kind of job losses are likely to be associated with the shift of corporate operations to locations where they are ensured of continued access to the single European market? It is certainly plausible that the most severe losses will be concentrated among the so-called ‘unskilled’, whose mobility and options are limited by lack of formal credentials.  If you doubt that the locational shift will be substantial, ask yourself:  how much of your pension pot would you want to invest in a country with no access to any markets other than the 64 million within its borders beyond that ensured by time-consuming WTO disciplines that its government has no experience of negotiating?

I thought so.  Prime Minister May herself conceded the point during the referendum campaign.

  1. Beyond these impacts on social determinants of health are those on the NHS – where those of us without deep pockets or private insurance go when things go wrong. The most recent figures and projections from the International Monetary Fund show projected UK government spending as a percentage of GDP trending downward towards US levels – or, in historical terms, to the levels characteristic of the pre-war period, before the establishment of the NHS and the Beveridge approach to social policy.

Diapositiva1

A public sector budget of that constrained size is simply incompatible with a comprehensive health service that is free at the point of use.  The insurance industry, as shown by a tube advertisement from 2011, understood this point years ago.  Crucially, these expenditure projects do not take into account the need (at least, so we will solemnly be told) for further austerity measures as government revenues drop with slower growth in anticipation of Brexit.

Diapositiva2

  1. In a similar vein, how will economic policy respond to the challenges of Brexit? Chancellor Hammond has recently warned (or threatened) that the post-Brexit UK might need to become a tax haven to an even greater degree than is already the case in pursuit of corporate investment, abandoning ‘a recognisably European-style economy’ in favour of ‘something different’ – travelling still further down the neoliberal road that my colleague Clare Bambra and I described in 2015.  (Some of us think that was the objective of ruling class Brexiteers all along.) What is this likely to mean for public sector revenues, and for whatever solidaristic social policies have survived the post-2010 upward redistribution of income, wealth and opportunity?
  2. Finally, what will post-Brexit trade negotiations mean for the future of the NHS? A detailed legal analysis by the UK Faculty of Public Health pointed out the possible dangers of investor protections proposed as part of the Transatlantic Trade and Investment Partnership: ‘the worst case scenario for the NHS would then be that commercialisation becomes “locked in”, sealed by the threat of huge compensation claims by investors’.  TTIP is now almost certainly dead, but the UK would face post-Brexit trade negotiations with both the EU and the United States from a far weaker position that it occupied as part of the EU negotiating bloc.  It is hard to imagine that UK negotiators informed by the health system wisdom of Jeremy Hunt would resist opening up investor access to health services, in particular when dealing with a United States in which the health care industry accounts for one-sixth of the entire economy, with associated domestic political clout.  Indeed, the profit potential of a privatised NHS might be one of the most important offers available to those negotiators.

One needs to remind oneself that the last word in Albert Camus’ famous essay about suicide is ‘hope’.  But it is hard to sustain in these times.

———————

*article originally published in OurNHS openDemocracy

https://www.opendemocracy.net/ournhs/ted-schrecker/5-reasons-brexit-is-very-bad-for-our-health

 

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Proteggere i Diritti Terrieri delle Comunità Indigene per Salvare il Pianeta

‘Riconoscere i diritti terrieri delle comunità locali e indigene significa rispettare i diritti umani di circa due miliardi e mezzo di persone, e inoltre ridurre i conflitti, combattere il cambiamento climatico e proteggere ed espandere gli importanti,fragili ecosistemi di Madre Terra’

Victoria Tauli-Corpuz,UN Special Rapporteur on the Rights of Indigenous Peoples

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by Daniele Dionisio

Membro, European Parliament Working Group on Innovation, Access to Medicines and Poverty-Related Diseases

Responsabile del Progetto Policies for Equitable Access to Health – PEAH 

Proteggere i Diritti Terrieri delle Comunità Indigene per Salvare il Pianeta

 

Nel marzo 2016 Oxfam, International Land Coalition e Rights and Resources Initiative lanciarono il report  ‘Common Ground: Securing Land Rights and Safeguarding the Earth’ quale richiamo all’azione per la tutela dei diritti terrieri delle comunità locali e indigene. Esigenza quanto mai impellente in un mondo in cui, a dispetto dell’uso proprietario e abituale di oltre il 50% delle terre emerse del pianeta, due miliardi e mezzo di uomini e donne hanno diritti riconosciuti su solo un quinto di esse. I cinque miliardi di ettari rimanenti restano vulnerabili all’accaparramento/sequestro da parte di governi e potenti corporazioni.

Questa enorme disparità è tra le concause della violazione e privazione dei diritti civili e umani, della povertà, e dei focolai di conflitto nelle aree geografiche coinvolte.

Queste realtà stridono di fronte all’ evidenza del ruolo del riconoscimento dei diritti terrieri delle comunità nel preservare le diversità culturali e contrastare la povertà e la fame, l’instabilità politica e i mutamenti climatici, in linea con lo spirito dei Sustainable Development Goals delle Nazioni Unite e dell’Accordo di Parigi sul clima.

Purtroppo, nonostante alcuni progressi, gli impegni al rispetto dei diritti terrieri delle popolazioni si sono rivelati in genere vuote promesse.  E la realtà corrente insegna che le risorse forestali, idriche, di pascolo e minerarie continuano ad essere oggetto di progetti di investimento e sviluppo implicanti lo spostamento altrove delle comunità locali.

Il numero crescente di persone uccise perché difendevano la loro terra testimonia l’indicibile violenza su quanti si vedono negata ogni partecipazione in decisioni coinvolgenti le loro terre e le loro vite.

In particolare le donne risentono della violazione di questi diritti in termini di ostacolo al conseguimento di un ruolo socialmente paritario con l’uomo. Non è un caso che in Tanzania le donne con diritti sicuri sulla propria terra vantano introiti economici tre volte superiori rispetto a quelle senza; e che in India la certezza del diritto sulla terra ha mostrato una positiva correlazione con la forte riduzione dei casi di violenza domestica.

Fatti certi:

  • In Africa mancano documenti sicuri di proprietà per il 90% dei terreni rurali; di conseguenza le comunità locali sono estremamente vulnerabili alla sottrazione/accaparramento di terre.
  • Sicuri diritti terrieri sono un diritto umano, specialmente per le popolazioni indigene alle quali la legislazione internazionale riconosce il diritto di accesso e controllo sulla propria terra abituale.
  • Sicuri diritti terrieri sono un ‘sine qua non’ per lo sviluppo. Essi consentono l’aumento del reddito e un ventaglio di benefici sociali estesi oltre i confini delle singole comunità. I Paesi tesi all’implementazione dei diritti terrieri hanno positivi ritorni in termini di riduzione della fame e maggiore e più equa crescita economica.
  • L’eguaglianza di genere nella proprietà terriera darebbe maggior potere e influenza alle donne circa i modi, gli esiti e le pratiche di coltivazione. Secondo la FAO una maggiore gestione della terra da parte delle donne si tradurrebbe in maggiori raccolti (circa il 20-30% in più) con riduzione potenziale del 10-20% delle persone denutrite su scala mondiale.
  • Le foreste gestite dalle comunità indigene e locali immagazzinano 37.7 miliardi di tonnellate di carbone – più delle emissioni mondiali 2013 di CO2 da combustione di carburanti fossili e processi industriali.
  • Secondo il Programma per l’Ambiente delle Nazioni Unite (UNEP) la pastorizia è ‘one of the most sustainable food systems on the planet […] between two and 10 times more productive per unit of land than the capital-intensive alternatives that have been put forward’.
  • Sicuri diritti terrieri delle comunità locali e indigene sono in grado di prevenire l’estinzione di più di quattromila idiomi.

Raccomandazioni per l’azione

Il report in oggetto conclude con una serie di raccomandazioni, fra le quali:

  • La richiesta ai governi di implementare la UN Declaration on the Rights of Indigenous Peoples, la ILO Convention No. 169, la UN Declaration on Human Rights Defenders, e le UN Voluntary Guidelines on the Responsible Governance of Tenure of Land, Fisheries and Forests. Inoltre, di dichiarare tolleranza zero su ogni accaparramento/sequestro di terre e di includere la protezione dei diritti (soprattutto per popolazioni dipendenti dalle foreste, produttori agricoli di piccola-media scala, pescatori e pastori) quale pilastro per le strategie di sviluppo nazionale comprese quelle correlate al clima, all’agricoltura, alla tutela ambientale, alle fonti energetiche, al turismo, alla crescita economica e al commercio.
  • La richiesta ai Parlamenti di migliorare o introdurre specifiche legislazioni e di allocare adeguati budgets per garantire il diritto alla terra delle comunità indigene e locali.
  • La richiesta alle corporazioni e istituzioni finanziarie internazionali di sviluppare e implementare politiche (e meccanismi di reclamo)per evitare, ridurre, mitigare e sanare ogni impatto diretto e indiretto sulle terre e risorse naturali delle comunità locali e indigene.
  • La richiesta all’UN High Level Political Forum di adottare almeno un indicatore per la misura dei progressi di settore nel contesto dell’Agenda 2030, e di impegnarsi a sostenere i diritti delle comunità locali e indigene nell’ambito dei Sustainable Development Goals.
  • L’invito alle comunità locali e indigene a rafforzare le loro istituzioni e capacità, a sostenere la partecipazione egualitaria delle donne nella difesa della terra e delle risorse, e ad attivare alleanze per contrastare efficacemente le minacce.

 

PER APPROFONDIRE 

Common Ground: Securing Land Rights and Safeguarding the Earth https://www.oxfam.org/sites/www.oxfam.org/files/file_attachments/bp-common-ground-land-rights-020316-en_0.pdf 

The International Land Coalition (ILC) www.landcoalition.org

Oxfam www.oxfam.org

The Rights and Resources Initiative (RRI) www.rightsandresources.org

United Nations: Sustainable Development Goals http://www.un.org/sustainabledevelopment/sustainable-development-goals/

Paris Climate Agreement http://unfccc.int/paris_agreement/items/9485.php

Land grabbing https://www.oxfamamerica.org/take-action/campaign/food-farming-and-hunger/land-grabs/

2016: a Year in Review through PEAH Contributors’ Stands

Authoritative insights by 2016 PEAH external contributors added steam to debate on how to settle the conflicting issues that still impair equitable access to health by discriminated population settings worldwide

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by  Daniele Dionisio*

PEAH – Policies for Equitable Access to Health 

2016: a Year in Review through PEAH Contributors’ Stands

 

Now that 2016 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:

Denis Joseph Bukenya, Human Rights Research Documentation Centre (HURIC) Kampala, Uganda, pointed out that….As a matter of life and death, governments in the LDC sector need to strive to ensure that they develop effective health policies including development of essential medicines lists in a bid to improve access to health care.  Also they need to live up their individual and collective commitments and adopt a human rights based approach to access to all medicines, not only essential medicines

As regards this, a couple of articles [here and here] by Taye Tolera Balcha, Director General Armauer Hansen Institute (AHRI), Ethiopia, reminded us that… Although Ethiopia’s health care is grounded in equity principles and health outcomes have shown considerable improvements during the past 20 years, substantial challenges persist. Indeed, though equal access to essential health services for those in equal need has been largely ensured, equal utilization of health care for them and equal health outcomes have not been attained yet. Systematic disparities in the burden of diseases, service uptake and health outcomes prevail between communities, particularly arising from differences in places of residence. In the face of this, a range of diverse initiatives have been taken by the Ministry of Health to mend the chasm in health service uptake and health outcomes between the regions…and thatExcellent partnership between the government, key stakeholders, and the community has helped Ethiopia rise to the tectonic challenge of HIV. Since 1990, more than 90% reduction in new HIV infection has been recorded. Survival of HIV-positive individuals has substantially improved. At present, about 70% of HIV-positive people in the country know their status and 65% are on treatment…

As underlined by Alex Henriquez, Msc. Health Systems and Public Policy at the University of Edinburgh,In LMICs where access to medicines is essential to guarantee the health systems’ capacity to address people’s health needs, the inefficient fragmentation of supply chains is one of the main factors that increase the costs of medicines. Introducing a pre-wholesaler could help improve this inefficiency and reduce costs…

As regards these issues, the article by Junior Bazile, Moderator of the HIV Treatment and Prevention Community on Global Health Delivery Online; Global Health Delivery Project at Harvard University, dealt with the fact that…HIV-infected women in serodiscordant partnerships in African countries experience relationship stress due to low socioeconomic status, gender-related power dynamics and pressure to have children with their current partner to ‘bind’ the relationship. These stressors may influence ART adherence. As biomedical interventions (ART, PrEP, VMMC) are scaled up, couple-focused interventions including shared decision making, risk-reduction counseling, mutual adherence support, safer conception and economic empowerment could improve relationship and treatment outcomes in serodiscordant partnerships…

What’s more, the analysis co-authored by Eloan Pinheiro, Consultant in Public Health Policy, Lucia Brum, Renata Reis and Juan-Carlos Cubides, Médecins Sans Frontières-Brazil contended that…The response to Chagas disease still needs inclusive protocols, sustainable and adequate financing and does not have a robust portfolio of investigation of new treatments and diagnosis. Beyond that, production capacity and supply of Benznidazole (BZN) medication is far from being minimally sufficient. The price factor also strongly impacts access to medication. A point deserving attention in the analysis of BZN’s prices is the need, as in the response to other diseases in general, to maintain competition as a factor of market regulation…

The article by Plaxcedes Chiwire, Deputy Director, Strategic Planning Unit at Western Cape Department of Health, South Africa, turned the spotlight on evidence that …South Africa has a lot of improvements to make in terms of population’s physical accessibility, financial protection and acceptability of the current public health care system. The National Health Insurance offers hope to the disadvantaged but it will not be ready anytime soon leaving the current health care arrangements with their own vulnerability needing continued revamping. The government may need to stop being reactive but proactive in addressing the inequality that is fuelling the lack of access for a majority of the population…

In unison, Enrique Restoy, Senior Technical Advisor: Human Rights at the International HIV/AIDS Alliance, highlighted that…The history of the Equitable Access Initiative (EAI) is so far short, but complex. It was a seemingly straight forward proposition initiated by the Global Fund to fight AIDS, Tuberculosis and Malaria to find fairer alternatives to decisions on country eligibility for external financing for health solely based on economic income. However, since its launch in 2014, the initiative has lived five draft reports, the front opposition of over 200 global civil society organisations, and a mysterious descent into near secrecy. In the meantime, the main providers of Official Development Assistance (ODA) have increased their sole reliance on economic income to justify their pulling out from an ever greater number of countries. As the numbers of poorer and marginalised people living in so called middle-income countries being abandoned by ODA skyrocket, never before were the premises behind the EAI more relevant. Yet, as the EAI has just produced what should be its final report, this op-ed enquiries the validity of the EAI proposition from the point of view of the key principle of equality in the access to health. The paper concludes that despite its stated intentions, the EAI is so far failing to deliver on proposing alternatives that guarantee equality in access to health. This added to criticism as to the lack of transparency and inclusiveness of the initiative and the limited leverage it has had to change the status quo, invite to a profound reflection as to its current validity and relevance…

As regards antimicrobial resistance, Shila Kaur, Coordinator Health Action International Asia Pacific (HAIAP), affirmed  that…The review of the Global Action Plan for Antimicrobial Resistance at the upcoming (23-28 May 2016) WHA must consider the following: 1) More attention has to be focussed on public health measures that promote conservation and restoring of existing AB effectiveness. The principles espoused at Alma Ata in the Declaration on Health For All chart the path and apply to tackling ABR. Improvements in water and sanitation cannot be overlooked as important components of the primary health care (PHC) approach; 2) Other approaches to infection control and treatment are necessary to retain the effectiveness of current and emerging AB. These include vaccines (human and animal), diagnostic technologies and complementary and alternative technologies such as bacteriophages. Sub-therapeutic use of antibiotics in animal farming and agriculture must be phased out; 3) New AB while important must be affordable and accessible in LMICs. They must be available to the poorest of the poor. Their availability only in high income countries will not help the global response…

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 While European citizens have been asked to trust on Commission and Member States to negotiate agreements which will not compromise health systems and social security, the reality so far falls short of this aim. In this paper the focus is on general textual parts where responsibility is mostly with Commission. Unfortunately what is promised has not been delivered and there remains substantial room for improvement. European Commission has also some explanation to do in terms of why European Unions’ own proposals have compromised so much in the sensitive areas of health services and social security… 

From a complementary perspective, Ted Schrecker, professor of Global Health Policy, and Clare Bambra, professor of Public Health Geography, Durham University, England maintained that Conditionalities attached to loans from the World Bank and IMF were among the key negative influences  on health and its social determinants between 1980 and 2000 in many of the more than 75 low- and middle-income countries in which they were applied. Best available evidence suggests that this ‘neoliberal epidemics’ era is not over. In the future, neoliberalism is likely to reflect the erosion of territorial divisions between core and periphery, or the global North and the global South, in the world economy…

To the point, Claudio Schuftan, People’s Health Movement-PHM, provided a lot of forward-looking reflections stressing that…Globalization creates wealth for the few and depresses local wages and conditions of employment for the many. Globalization has brought about a shift in power: the nation state has weakened and there is a reduction in social accountability. This makes sovereign states row rather than steer in the process of development, i.e. if countries do not intensely participate in this paradigm set by the North, they are “out”. As a consequence, the poor countries’ very right to development is threatened by this unrelenting liberalization/globalization process. Globalization has put the fate of those many in the hands of large corporations. Although the corporocracy (or corporarchy of Robin Sharp) very well knows the negative effects of Globalization, few of them are committed to change. They tend to ignore the root causes of the social problems they see as patently as everyone else, but seldom address the negative social impacts of their activities. Since they lack the openness and transparency required, they pay only lip service to change and seldom change their practices (or change them in very marginal ways)…

On a complementary wavelength, the article by Laura LeMoon, Disease Research & Intervention Specialist at King Co. Public Health Seattle USA, emphasized that …human trafficking activists want nothing to do with a sex worker’s rights based approach as they believe the existence of prostitution is to blame for the plight of forced labor, and sex worker’s want nothing to do with trafficking activists out of a need to distance themselves from anti-trafficking activists (at times) very punitive movement….these two realities are often dealt with by policy makers and activists alike as being mutually exclusive, when they are in fact, not…

On her part, Raffaella Ravinetto, Antwerp Institute of Tropical Medicine, pointed out that…The WHO and ICH (International Conference for Harmonization) GCP codes have not been updated since 1995 and 1996 respectively. Currently, a partial revision of the ICH GCP code is ongoing, but the update process does not seem sufficiently inclusive. If GCP codes are meant to set standards pertinent and applicable at global level, then a more comprehensive revision is needed, characterized by more transparency and more inclusiveness together with adequate representation of researchers, sponsors, regulators and ethical reviewers from LMICs…

Meanwhile, Fifa Rahman Policy Consultant at Malaysian AIDS Council, stressed that…Biologics is the future of medicines, and PhRMA is preparing for the next wave of IP to suit the changing medicines landscape….that it is based on the idea that maximalist IP is needed to drive innovation of new medicines.  Unfortunately, most of the public health exceptions interred in today’s trade agreements are… difficult for governments to employ in protection of their public health policies. This is because these exceptions require that the public health measures in question be ‘not more trade restrictive than necessary’ or that they are not disguised barriers to trade. The assertion that trade as is does not trump public health is disingenuous and the new biologics market exclusivity provisions indicate a new and perilous trend… to delay entry of biosimilars into the market… 

Relevantly, PEAH posted a comment by Chase Perfect, (MA, MsPH) Access to Medicines Policy Officer, HIV/HCV Drug Affordability Project Coalition Plus, and Fifa Rahman on a recent article ‘A Dose of the TPP’s Medicine – Why U.S. Trade Deals Havent Exported U.S. Drug Prices’ authored by Thomas J. Bollyky, Senior Fellow for Global Health, Economics, and Development at the U.S. Council on Foreign Relations.

To the point, Roberto De Vogli, School of Medicine, Department of Public Health Sciences, University of California, Davis, maintained thatThe recognition that the Transatlantic Trade and Investment Partnership, or TTIP, prioritized the “right to profit” of transnational corporations over the “right to health” of citizens deeply affected people’s sense of justice. It is exactly for this reason that it triggered such widespread civic protest that has been decisive in stopping the fast-track approval of the TTIP…

In this context, the article by Mohga Kamal-Yanni, Senior Health and HIV Policy Advisor, Oxfam GB, Editor ‘Global Health Check’, remarked that…The report by the United Nations (UN) High-Level Panel (HLP) on Access to Medicines went public on 14 September. Concerted efforts are now needed for the UN system and member states to adopt and implement the HLP recommendations. Otherwise the report will simply end up gathering dust on some shelves in a UN office…

Under these circumstances, the article by Iris Borowy, professor of History at Shanghai University, College of Liberal Arts, tackled the challenges to global health from a multi-pronged, entwining perspective. She alerted that… A full assessment of the SDGs, let alone of their implementation, will not be possible for some time. What is clear enough is that they differ from the MDGs and from most development efforts of the last decades in two important aspects: 1) They approach development as a global activity, involving all countries, as opposed to an area defined by deficiencies in low-income countries in the Global South; 2) They address numerous aspects where developmental improvements have been promised before but whose ongoing trends are uncertain or downright negative, such as climate change, global arms expenditures, deforestation, desertification, waste production or road traffic deaths…

From a different viewpoint, the article by Jin Hee Kim, Dalla Lana School of Public Health, University of Toronto, Michael Schwandt, College of Medicine, University of Saskatchewan, and Lawrence C. Loh, Dalla Lana School of Public Health, University of Toronto and Director of Programs at The 53rd Week Ltd, analyzed …four key areas of public health and preventive medicine practice portrayed by the film ‘Contagion’: infectious disease transmission dynamics, the role of public health physicians, the interface between clinical practice and public health, and the role of social media in health promotion. The findings presented here promote an understanding of how the film represents these topics and illustrates the potential benefits to public health as a discipline arising from popular media depictions…

Last but not least, the piece by Corie Leifer, Project and Department Assistant at Phillips-Medisize, presented  itself as…an exploration of some possible answers to the confounding question why do some American citizens not support universal health care, including some misconceptions and interesting opinions. As such, it will not explore health care as a right or pros and cons of universal health care. Rather, its scope is limited to expressing reasons given by a few people for not supporting universal health care in the United States of America…

As an useful addition to the articles featured here, PEAH was pleased to post an interview with Dr. Sumedha Kushwaha and Dr. Manasvi Bawa Behl, as the General Secretary/Founder and the President of ATTAC – Aim to Terminate Tobacco and Cancer – Society. 

PEAH also interviewed Christiane Fischer as the founder and medical managing director at MEZIS.

The contributions highlighted above add to PEAH internal articles published throughout the year. Find below the relevant links:

Secondhand Smoke in Lawless Japan

What Ebola has Taught Us to Counter Mismanagement of Epidemic Outbreaks

Female Genital Mutilation in Nigeria: is it over?

Illegal Migrant Status and the Littleness of the European Health System

Gaza Strip: the Press of War on People’s Health

Rio de Janeiro Olympic Games: Mixed Blessing in Badly Running Country

Streamlining R&D Core Areas for Global Health Reporting

International Pressure on India’s Drug Industry: The Hide-and-Seek Game of Modi’s Administration

Access to Medicines Report, Green Light to Action

Kenya in a Bad Shape about Open Defecation Free Goal

WHO Makes Headway in Hepatitis C Treatment Access Campaign

Domestic Policies for Trade to Uphold the Right to Health

 

 

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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