News Flash Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

News Flash 365

 

Policy Cures: Launch of the 2019 G-FINDER report 

Consultation process for the Handbook on Social Participation for universal health coverage (UHC) 

Handbook on Social Participation for universal health coverage (UHC): general introduction 

How We Can Score Development Agencies on Evaluation and Learning Systems 

Five Health Care Trends For 2020 

Urgent health challenges for the next decade 

Axes of a revolution: challenges and promises of big data in healthcare 

Emergencies, Cervical Cancer, IP & Innovation Among Highlights Of Member State Consultations Ahead Of WHO Executive Board 

Medicines and Intellectual Property: 10 Years of the WHO Global Strategy 

Patient Influencers Paid By Pharmaceutical Companies Should Be Required To Disclose Industry Ties 

WHO statement on novel coronavirus in Thailand 

After Thailand, Japan confirms imported case of new coronavirus 

First death reported in China as mystery new virus spreads to Thailand 

Surge in polio cases has reversed progress to eradicate virus – and now risks global spread 

DRC Ebola update 

Mental Health – Among The ‘Most Neglected’ Of Neglected Tropical Disease Issues, Says DNDi Scientist 

‘Vaginal tobacco’, a risky cocktail for West African women 

Q&A: Why most nutrition programming is not scalable 

Making Nutrition and Health More Equitable within Inequitable Societies by Claudio Schuftan

UN sounds alarm over unprecedented levels of hunger in southern Africa 

“A LA CARTE” JUSTICE FOR TRANSNATIONAL CORPORATIONS? 

Human Rights Reader 511 

Haiti 10 years after the earthquake: the fight for social and economic justice continues 

The female face of Southern Africa’s climate crisis 

Despite plans to ban glyphosate, its sales in France increase by 10%

Raising Money for a Clean Water Future 

Anomalously warm temperatures are associated with increased injury deaths 

Climate change and conflict could fuel hunger in 2020 

In Dealing With Climate Change: Foresight is Key 

Mitigating and Adapting to the Effects of Climate Change on Health in the Suburbs Through Adaptations in the Built Environment by Debbie Brace, Vanessa Kishimoto, Michelle A. Quaye, Mike Benusic, Louise Aubin, Lawrence C. Loh

This literature review aims to identify evidence-based built environment interventions that may be deployed in North American contexts to mitigate and adapt to the health effects of climate change. Identified mitigation and adaptation strategies are then analyzed for potential application within a suburban context

image credit: WHO

Debbie Brace¹, Vanessa Kishimoto², Michelle A. Quaye³, Mike Benusic⁴, Louise Aubin⁵, Lawrence C. Loh, MD, MPH, FCFP, FRCPC, FACPM^4,5

 1 – Degroote School of Medicine, McMaster University

2 – Faculty of Arts & Science, University of Toronto

3 – Schulich School of Medicine and Dentistry, Western University

4 – Dalla Lana School of Public Health, University of Toronto

5 – Region of Peel—Public Health

Mitigating and Adapting to the Effects of Climate Change on Health in the Suburbs Through Adaptations in the Built Environment

A Literature Review

 

Background

Climate change has been heralded as the “biggest global health threat of the 21^st century” (Watts 2018). The World Health Organization (WHO) has estimated that between 2030 and 2050, climate change will cause 250 000 deaths per year: 38 000 due to heat exposure in elderly people, 48 000 due to diarrheal diseases, 60 000 due to malaria, and 95 000 due to childhood under-nutrition (World Health Organization 2018).

One way of categorizing the health impacts of climate change is classifying those impacts as direct or indirect. Examples of direct health impacts include worsening air pollution that can contribute to cardiovascular diseases or heat stress and injuries due to more extreme weather, while indirect effects include food insecurity due to extreme weather and droughts, or changes in vector patterns that contribute to higher rates of vector-borne diseases (Watts 2018).

Another categorization from the Centers for Disease Control (CDC) categorizes health effects as they relate to environmental changes such as rising temperature, extreme weather, rising sea levels, and increasing carbon dioxide levels (Centers for Disease Control and Prevention 2014).

There is also a recognition that different communities and populations will be impacted by these health effects. Well known are the anticipated impacts on vulnerable populations of concern including the elderly, young children, individuals living with chronic diseases, and individuals of lower socioeconomic status or social marginalization. (Buse 2012, Intergovernmental Panel of Climate Change 2018) However, there will also be differential impacts anticipated by community context and form, with suburban settings being of particular importance given that they are home to a large proportion of the Canadian population.

Suburbs face the highest growth in the coming years (Ibbitson 2018) while simultaneously presenting challenges to climate change intervention owing to their automobile centric design and lower population density (Williams et al. 2010, 2012). Given this, our literature review aims to identify evidence-based built environment interventions that may be deployed to mitigate and adapt to the health effects of climate change. Identified mitigation and adaptation strategies are then analyzed for potential application within a suburban context.

Context

Suburbs represented the predominant planning paradigm following World War II, driving increasing sprawl and automobile-dependence in metropolitan areas across Canada. (David and Janzen 2013). Suburbs have become the predominant neighbourhood type for metropolitan dwellers, with the Canadian suburban population surpassing the city centre population in the 1970s (Bourne 1996). By 2006, 80% of Canadians in metropolitan areas lived in suburbs (David and Janzen 2013). It has been estimated that two thirds of the total Canadian population live in suburbs. Gordon and Shirokoff (2014) found that the overwhelming majority of population growth in a study of census metropolitan areas was found to be in automobile-dependent suburbs and “exurbs”, defined as rural areas with commuting access to metropolitan centres. Suburbs are currently growing 160% faster than city centres in Canada (Thompson 2013).

The typical North American suburban community has a built form that encompasses low density housing, dispersed amenities and services, and reliance on personal vehicles (Leichenko and Solecki 2013).  Despite these common elements, various suburbs exhibit demographic differences with regards to age, income, and visible minorities, with consequent impacts on health status. As an example, while suburbs have traditionally resulted in housing that is more affordable compared to the city, low socioeconomic status individuals living in suburbs often find themselves isolated from easy geographic access to work and important services because of unaffordability of automobiles and poor public transit infrastructure (Bourne 1996).

Community reliance on automobile transport also affects environmental health and drives climate change through air pollution and greenhouse gas emissions (Gordon and Shirokoff 2014). Greenhouse gas emissions come largely from road-based vehicles, and these emissions increased 33% from 1990 to 2010. Motor vehicles are also sources of air contaminants that lead to smog, with smog estimated to be responsible for 9500 deaths in Ontario per year.

Finally, other climate change effects experienced differently by suburban settings are extreme weather events, which can cause community and economic disruption (Thompson 2013), and also extreme temperature events, particularly extreme heat, which amplify the urban heat island effect. The latter is the result of infrastructure supporting suburban reliance on motorized vehicles (i.e. wide roadways and highways, industrial surfaces, a lack of vegetation, and parking lots) which results in surface temperatures that magnify the urban heat island effect in suburban areas (Taylor et al. 2018).

An example of a suburban community is the Region of Peel, a diverse and large upper-tier municipality in the Greater Toronto Area that is home to nearly 1.3 million people (Region of Peel 2016). Peel encompasses three municipalities, the Town of Caledon, and the cities of Mississauga and Brampton, and has a predominantly suburban form that envelopes dense urban, urbanizing, and rural forms. Approximately 14.7% of the population of Mississauga, 11.3% of Brampton and 5.7% of Caledon are considered low income (Region of Peel 2017a). According to the 2016 census, 62.3% of the Peel population are a visible minority, of whom 50.8% are South Asian, 15.3% are African American and 7.5% are Chinese (Region of Peel 2017b).

Concerning the urban heat island effect, meteorological data has demonstrated that Peel has seen an average increase in daily temperature of 1.2°C between 1938 and 2017 (Region of Peel 2019), though the range of surface temperatures varies, particularly with distance from the lake. Data on vegetation shows that 11% of Brampton, 15% of Mississauga, and 29% of Caledon East has tree cover (Buse 2012), with no recorded data for tree cover in Caledon West.

This context and community example shows the importance of intervening to address the impacts of climate change for all who live in suburban settings, while also prioritizing vulnerable populations that already experience disadvantage and are at increased risk of adverse health outcomes.

Methods

A literature review was performed to identify current built environment interventions being used to mitigate and adapt the health effects of climate change that may apply to a suburban context. The following databases were searched: Environment Complete, Web of Science, PsychINFO, Emcare, PubMed, MEDLINE, MEDLINE In-Process, Global Health, Health Star, and Cochrane Database of Systematic Reviews. Search terms used were: climate change, global warming, environmental pollution and/or greenhouse effect, and health, and measuring, mitigating, strategies, interventions, policy or prevention, and/or city planning or environmental design or built environment. The search was limited to papers published in English, between 2009-2019, and available online.

The initial search provided 577 results. A single reviewer scanned titles and abstracts to determine inclusion or exclusion based on their relevance to climate change and health, and interventions specifically relating to the built environment. Papers were included if they cited climate change as the exposure of interest, analyzed the effect of an intervention in the built environment, reported human health-related outcomes, and were published in English. Papers were excluded if they could not be applied to North American contexts (i.e., if the papers were based in a low-income or developing nation), if they were published before 2009, and if they were not related to suburban environments. A total of 23 articles were identified as possible for inclusion. One was excluded as it was not available in online archives. A further 9 were excluded as they did not report health outcomes related to climate change, or were related exclusively to urban contexts. Two reviewers then retrieved these articles and appraised these full texts for final inclusion. In total, 13 articles met the criteria.

From these included articles, promising built environment interventions were then extracted and summarized in key themes, which underwent critical analysis. These themes were then critically analyzed against suburban context and considerations to identify interventions that might support adaptation and mitigation efforts in such settings.

For the purposes of this review, we defined mitigation interventions as those designed to abate contributing factors to climate change, with related health co-benefits, and defined adaptation measures as adjusting and resourcing a community to manage health-related climate change impacts (Prior et al. 2018).

Results

Thirteen papers were identified in our review. Six articles were literature reviews and five articles reported simulation or predictive modeling. The final two papers were primary research articles, one of which was an online survey of Australian’s heat stress resilience, while the other reported on water quality monitoring and interventions.

Identified common themes for suburban interventions included urban vegetation and green infrastructure to cool temperatures, reducing heat stress, improving infrastructure resiliency, retrofitting buildings, and reducing greenhouse gases by promoting healthy and active living.

Mitigation

Two articles found that active transport was linked with better health outcomes and decreased greenhouse gas emissions (Ulmer et al. 2014, Frank et al. 2010).

Ulmer et al. (2014) used predictive modeling to characterize the health impacts of policies and laws regarding urban planning, land use and transportation. They found that walkability, sidewalks, bike facilities, and recreational activities was correlated with more physical activity and better health, as well as decreased greenhouse gas emissions.

Frank et al. (2010) used simulations to investigate how active transport can improve health and reduce greenhouse gas emissions. They found that increasing transit and density improves health indicators and decreases emissions from motorized transport and concluded that funding for transit should be increased to improve health and climate sustainability.

Adaptation

Five of the papers investigated the impact of green infrastructure, such as urban vegetation, green roofs, and suspended pavements to protect vegetation. Taken together, these papers found that green infrastructure reduces the risks of climate-related exposures. Stone et al. (2013) demonstrated that increased vegetation in urban centres and the surrounding areas was linked with mitigation of the “urban heat island effect” through decreased land surface temperature. Several other papers also linked vegetation to improved air quality and reduced pollutant concentrations, which was predicted to help mitigate anticipated poorer air quality owing to hotter ambient community temperatures (Abhijith et al. 2017, Page et al. 2015, Demuzere et al. 2014, Houghton and Castillo-Salgado 2017).

Four articles demonstrated that various building retrofits could reduce heat related mortality; three of these were specific to residential buildings (Taylor et al. 2018, Hatvani-Kovacs et al. 2016, Williams et al 2013) while one was a general review of cooling technologies (Pisello 2017). Of note, Taylor et al. (2018) found that shutters on windows were linked with lower summer time heat-related mortality, while complete energy-efficient retrofitting was associated with an increase in heat-related mortality.  This finding was at odds with the other three papers that linked energy efficient retrofitting and cool coatings with decreased risk of heat-related illness and better health outcomes (Hatvani-Kovacs et al. 2016, Williams et al. 2013, Pisello 2017).

Two of the papers were literature reviews investigating the various strategies and characteristics being used to mitigate urban heat islands (Santamouris et al. 2017, Hintz et al. 2017). Both of these papers identified benefits from a multifactorial approach including the use of urban vegetation and green infrastructure, the use of cooling techniques like increased albedo on surfaces, and individual behaviors, such as remaining in air conditioned spaces and avoiding strenuous exercise during extreme heat events (Santamouris et al. 2017, Hintz et al. 2017).

Discussion

Our review found evidence-based interventions that, if implemented, could have promise in addressing climate change contributions and impacts in suburban settings. Both mitigation and health-protective adaptation efforts would be supported by suburban investments in green infrastructure, the former through improved carbon capture by increased foliage and shade, and the latter through increased soil and root systems that increase resilience to seasonal flooding and improved air and water quality. Other interventions that could be deployed in suburbs to protect health relate more to adaptation, specifically building retrofits that might reduce heat-related mortality and morbidity, and health promotion messaging that encourages remaining indoors and avoiding strenuous physical activity during extreme heat events.

Broadly applying these interventions to the suburban context, one notes that active transportation (e.g., walking, cycling, taking public transit) would not only contribute to climate change mitigation efforts but also provide important health co-benefits through increased physical activity and improved air quality. In the absence of built environments that encourage physical activity, it has been shown that there is risk of obesity (Papas et al. 2007). In addition, increased driving time has been associated with higher prevalence of self-reported smoking, physical activity, insufficient sleep and psychological distress (Ding et al 2014). In other parts of the world, childhood asthma has emerged, likely as a consequence of industrial and car-related pollution (Loh and Brieger 2014)

People who live in suburbs spend more time in cars, owing to long distances, low density, and limited public transport. (Sugiyama et al. 2012). Active transportation use in adults is further associated with subjective density, mixed land use, walkability, and safety for cycling (Van Dyck et al. 2013). However, our findings are clear that a suburban transformation toward active transportation is not optional; in addition to mitigating climate change, greater intensification to promote active transportation will provide health benefits to a growing population and reduce congestion and air pollution. Compared to traditional urban settings, suburban contexts will require significant investment and effort in determining how to transform automobile-focused transportation infrastructure towards making active transportation safer, more desirable, and more feasible in thinking of where and how people move around.

This review also found that green infrastructure and urban vegetation has important mitigation and adaptation benefits. In the Region of Peel, substantial natural cover is present largely in the northern rural areas, with more built up areas in the south left vulnerable to urban heat island effect. Research suggests that areas vulnerable to urban heat island effect would benefit from increased urban vegetation and green infrastructure, which is linked to lower land surface temperatures, better air quality, and flood mitigation. This poses considerable challenges given the spread and scale of various developments that rely on wide arterial roads and low-density buildings with extensive parking lot facilities.

The final theme that emerged from the literature is that of building retrofitting, though evidence in this review is mixed. Increasing the energy efficiency of buildings through retrofitting would help reduce energy use and mitigate greenhouse gas emissions, while helping residents adapt to extreme shifts in temperature. Specific data from Natural Resources Canada indicate that residential and commercial activities account for about 14% of total Canadian energy use and greenhouse gas emissions; in residential settings, data suggests that 81% of the energy consumption is used for space and water heating (Natural Resources Canada 2019). As most retrofits are cost-effective when borne out in more dense settings, suburban settings will need to consider how best to encourage changes, particularly in residential settings.

Limitations

A direct comparison of results and conclusions from the included papers was not possible given their variability in topics, contexts, and research methods. While some of the papers identified potential interventions, none of them presented specific data that would permit a quantification of the impact of their interventions on health outcomes. Specific to context, the evidence reviewed largely focused on urban environments, with only one of the included papers specifically focused on a suburban context. Finally, none of the papers examined the effects of interventions on specific sub-populations or comparatively across different areas.

Conclusion

The results of this literature review point to some promising practices around climate change mitigation and adaptation through the built environment that might be health-supportive and may be of some application to suburban settings. Key themes identified include opportunities presented by green infrastructure, building retrofit, and active transportation interventions. Cross-referencing these to the built form found in a traditional suburban context identifies certain barriers to implementation.

Further research and evaluation will help to determine, in suburban settings, how feasible such interventions might be, how they might be deployed, and how they might impact efforts to mitigate climate change and also adapt to protect general and vulnerable community populations from the direct and indirect health impacts of this phenomenon.

 

References

1. Abhijith, K. V., Kumar, P., Gallagher, J., McNabola, A., Baldauf, R., Pilla, F., et al. (2017). Air pollution abatement performances of green infrastructure in open road and built-up street canyon environments–A review. Atmospheric Environment, 162, 71-86.
2. Bourne, L. S. (1996). Reinventing the suburbs: Old myths and new realities. Progress in Planning, 46(3), 163-184.
3. Buse, C. (2012). Report on Health Vulnerability to Climate Change: Assessing Exposure, Sensitivity, and Adaptive Capacity in the Region of Peel. Peel Public Health.
4. Centers for Disease Control and Prevention (2014). Climate Change and Public Health – Climate Effects on Health. CDC. https://www.cdc.gov/climateandhealth/effects/default.htm
5. Demuzere, M., Orru, K., Heidrich, O., Olazabal, E., Geneletti, D., Orru, H., et al. (2014). Mitigating and adapting to climate change: Multi-functional and multi-scale assessment of green urban infrastructure. Journal of environmental management, 146, 107-115.
6. Ding, D., Gebel, K., Phongsavan, P., Bauman, A. E., & Merom, D. (2014). Driving: a road to unhealthy lifestyles and poor health outcomes. PloS one, 9(6), e94602.
7. Frank, L. D., Greenwald, M. J., Winkelman, S., Chapman, J., & Kavage, S. (2010). Carbonless footprints: promoting health and climate stabilization through active transportation. Preventive medicine, 50, S99-S105.
8. Gordon, D., & Janzen, M. (2013). Suburban nation? Estimating the size of Canada’s suburban population. Journal of Architectural and Planning Research, 30(3), 197-220.
9. Gordon, D., & Shirokoff, I. (2014). Population Growth in Canadian Suburbs, 2006–2011. Kingston: School of Urban and Regional Planning, Queen’s Univ.
10. Hatvani-Kovacs, G., Belusko, M., Skinner, N., Pockett, J., & Boland, J. (2016). Drivers and barriers to heat stress resilience. Science of the Total Environment, 571, 603-614.
11. Hintz, M. J., Luederitz, C., Lang, D. J., & von Wehrden, H. (2018). Facing the heat: A systematic literature review exploring the transferability of solutions to cope with urban heat waves. Urban climate, 24, 714-727.
12. Houghton, A., & Castillo-Salgado, C. (2017). Health co-benefits of green building design strategies and community resilience to urban flooding: A systematic review of the evidence. International journal of environmental research and public health, 14(12), 1519.
13. Ibbitson, J. (2018) City growth dominated by car-driving suburbs, whose votes decide elections. The Globe and Mail. https://www.theglobeandmail.com/canada/article-city-growth-dominated-by-car-driving-suburbs-whose-votes-decide/
14. Intergovernmental Panel on Climate Change (2018). Global warming of 1.5°C. Intergovernmental Panel on Climate Change. http://www.ipcc.ch/report/sr15/
15. Leichenko, R. M., & Solecki, W. D. (2013). Climate change in suburbs: An exploration of key impacts and vulnerabilities. Urban Climate, 6, 82-97.
16. Loh, L. C., & Brieger, W. B. (2014). Suburban sprawl in the developing world: Duplicating past mistakes? The case of Kuala Lumpur, Malaysia. International Quarterly of Community Health Education, 34(2), 199-211.
17. Natural Resources Canada (2019). Energy and Greenhouse Gas Emissions (GHGs). Natural Resources Canada. https://www.nrcan.gc.ca/science-and-data/data-and-analysis/energy-data-and-analysis/energy-facts/energy-and-greenhouse-gas-emissions-ghgs/20063
18. Page, J. L., Winston, R. J., & Hunt III, W. F. (2015). Soils beneath suspended pavements: An opportunity for stormwater control and treatment. Ecological Engineering, 82, 40-48.
19. Pisello, A. L. (2017). State of the art on the development of cool coatings for buildings and cities. Solar Energy, 144, 660-680.
20. Prior, J. H., Connon, I., McIntyre, E., Adams, J., Capon, T., Kent, J., et al. (2018). Built environment interventions for human and planetary health: integrating health in climate change adaption and mitigation. Public Health Research and Practice.
21. Region of Peel (2016). Peel Data Centre – Population and Housing Estimates. Region of Peel. https://www.peelregion.ca/planning/pdc/data/population-est/population-housing-est.htm
22. Region of Peel (2017). 2016 Census Bulletin Labour, Education & Mobility. Region of Peel. https://www.peelregion.ca/planning-maps/censusbulletins/2016-labour_education_mobility-bulletin.pdf
23. Region of Peel (2017). 2016 Census Bulletin Immigration & Ethnic Diversity. Region of Peel. https://www.peelregion.ca/planning-maps/CensusBulletins/2016-immigration-ethnic -diversity.pdf
24. Santamouris, M., Ding, L., Fiorito, F., Oldfield, P., Osmond, P., Paolini, R., et al. (2017). Passive and active cooling for the outdoor built environment–Analysis and assessment of the cooling potential of mitigation technologies using performance data from 220 large scale projects. Solar Energy, 154, 14-33.
25. Stone Jr, B., Vargo, J., Liu, P., Hu, Y., & Russell, A. (2013). Climate change adaptation through urban heat management in Atlanta, Georgia. Environmental science & technology, 47(14), 7780-7786.
26. Sugiyama, T., Neuhaus, M., Cole, R., Giles-Corti, B., & Owen, N. (2012). Destination and route attributes associated with adults’ walking: a review. Medicine and science in sports and exercise, 44(7), 1275-1286.
27. Thompson, D. (2013). Suburban sprawl: Exposing hidden costs, identifying innovations.
28. Taylor, J., Wilkinson, P., Picetti, R., Symonds, P., Heaviside, C., Macintyre, H. L., et al. (2018). Comparison of built environment adaptations to heat exposure and mortality during hot weather, West Midlands region, UK. Environment international, 111, 287-294.
29. Ulmer, J. M., Chapman, J. E., & MSA, S. E. K. (2015). Application of an evidence-based tool to evaluate health impacts of changes to the built environment. Canadian Journal of Public Health, 106(1), ES26.
30. Van Dyck, D., De Meester, F., Cardon, G., Deforche, B., & De Bourdeaudhuij, I. (2013). Physical environmental attributes and active transportation in Belgium: what about adults and adolescents living in the same neighborhoods?. American journal of health promotion, 27(5), 330-338.
31. Watts, N., Amann, M., Arnell, N., Ayeb-Karlsson, S., Belesova, K., Berry, H., et al. (2018). The 2018 report of the Lancet Countdown on health and climate change: shaping the health of nations for centuries to come. The Lancet, 392(10163):2479–514.
32. World Health Organization (2018). Climate change and health. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/climate-change-and-health
33. Williams, K., Joynt, J. L., & Hopkins, D. (2010). Adapting to climate change in the compact city: the suburban challenge. Built Environment, 36(1), 105-115.
34. Williams, K., Joynt, J. L., Payne, C., Hopkins, D., & Smith, I. (2012). The conditions for, and challenges of, adapting England’s suburbs for climate change. Building and Environment, 55, 131-140.
35. Williams, K., Gupta, R., Hopkins, D., Gregg, M., Payne, C., Joynt, J. L., et al. & Bates-Brkljac, N. (2013). Retrofitting England’s suburbs to adapt to climate change. Building Research & Information, 41(5), 517-531.

 

 

You can -as individuals- come to the will and intent to change underlying structural inequalities in society either from a primarily ethical or political process. In terms of equity, the bottom-up political process (in which commitments are needed beyond ethics)  looks preferable in that it better accommodates and represents the perceptions of needed development actions as seen from the perspective of development’s beneficiaries. In this approach, beneficiaries are clearly the protagonists of the process; the process is mostly politically motivated and assigns a key role to ‘social activists and political advocates’ who are to advance the cascading process 

By Claudio Schuftan*

Ho Chi Minh City, schuftan@gmail.com

Making Nutrition and Health More Equitable within Inequitable Societies 

 

I would like to think that you -as me- often ask yourself what we could all do better to achieve greater equity in what we do given that we most often work in countries with appalling social inequities. Allow me to share with you some of my thoughts on this.

I see our role in helping put in place the needed social processes and mechanisms that will drive sustainable policies in health and nutrition as being inseparable from us helping to re-establish a will and intent to change underlying structural inequalities in society. To achieve the latter, you can -as individuals- come to this will from either of 2 backgrounds: you can either come to it from a primarily ethical or from a political motivation.

These two motivational approaches that can drive us to become more involved in lessening social inequities represent, not packages of universal solutions, but rather paths to follow to get things that need to be done done, and the latter by whom and with whom (and against whom).

Living as we do in a mean, unfair and selfish world, I see the challenge we face as being one to graduate from the first into the second approach. Let me explain why.

THE PRIMARILY ETHICS-LED PROCESS TO SUSTAINABLE DEVELOPMENT IN HEALTH AND NUTRITION

As is true for slavery, there are ethical limits to tolerating extreme poverty

The growing new development ethics that calls for working with the poor as protagonists and not merely as recipients has, so far, itself unfortunately remained mostly a top-down approach. It represents mostly the view of academicians, of intellectuals, of church leaders, of international bureaucrats and of a few politicians (mostly in the opposition). Beneficiaries have remained mostly passive in this approach, merely being counted as the ‘object’ of the process. This ethics-led process is mostly ethically motivated and assigns a key role to ‘moral advocates’ who are to advance the following cascading process:

– NEEDS (Entails assessing needs requiring fulfillment using
 “objective”(?) field research techniques)
 |
 – ENTITLEMENTS (Entails granting selected identified needs the status of
 entitlements to be honored by society)
 |
 – RIGHTS (Entails translating accepted entitlements into actual rights)*
 |
 – LAWS (Entails delegating to members of Parliament the
 legitimization of selected rights by promulgating them
 into laws)
 |
 – LAW ENFORCEMENT (Entails assuring/securing that the laws get
 enforced by government institutions)**
 _________________________________________________________
 * : Promoting these rights is not, by itself, a progressive political
 act.
 **: Often very weak or non-existent and without the people getting involved
 directly in it.

The inherent weakness of this process is that to have rights ultimately respected, someone other than the poor takes the responsibility at each step to steer the process from entitlement to enforcement.

THE PRIMARILY POLITICALLY-LED PROCESS TO SUSTAINABLE DEVELOPMENT IN HEALTH AND NUTRITION

This more bottom-up political approach (in which commitments are needed beyond ethics) better accommodates and represents the perceptions of needed development actions as seen from the perspective of development’s beneficiaries. In this approach, beneficiaries are clearly the protagonists of the process; the process is mostly politically motivated and assigns a key role to ‘social activists and political advocates’ who are to advance the following cascading process:

– FELT NEEDS (As freely and spontaneously expressed by organized
 communities)
 |
 [Consciousness raising]
 |
 – CONCRETE DEMANDS (Felt needs are articulated into concrete
 demands each tackling perceived causes)
 |
 [Social learning]
 |
 – CLAIMS/EFFECTIVE DEMANDS (Based on concrete demands, people
 make claims* and exert an effective
 demand**)
 |
 [Social Mobilization/Empowerment]
 |
 [Acquisition of Social Power]
 |
 – ORGANIZED PEOPLE’S ACTIONS (Initial mobilization of own and
 other available resources)
 |
 [Gains in self-confidence]
 |
DE-FACTO EXERCISE OF POWER (Within or challenging the law;

bringing in, using and progressively
 controlling needed external resources)
 |
 [Networking]
 |
 [Acquisition of Political Power]
 |
 – CONSOLIDATION OF NEW POWER (Coalition building)
 |
 [Leads to new felt needs and the cycle restarts]
 ________________________________________________________
 * : Claims correspond to entitlements in the previous diagram.
 **: When people are willing to invest their own resources to fulfill
 their felt needs.

Although the ethically and politically led approaches, as simplified in these two diagrams, represent different paths, both can contribute -through their own merits- to sustainable changes in the health and nutrition of the poor. The two approaches complement each other, but would be even more synergistic if the ethically led process gets more proactive civil society inputs and gets more politically savvy.

It is in the realm of the second diagram that I see us ever getting a chance to influence the choice of needed investments in health and nutrition, as well as influencing the redistributive and social protection measures/priorities that will concomitantly address the poverty underlying the ill-health and malnutrition we (as professionals) are left to deal with.

It is in the realm of the second diagram as well -with the added strength coming from an organized community- that I see us ever  effectively influencing how the public sector allocates its resources and chooses geographic/socioeconomic/ethnic targets, and how, in the process, the government favors programs that are under strong community control.

Finally, it is also in the realm of the second diagram that I see us succeeding in re-establishing a will and an intent to change structural inequalities underlying ill-health and malnutrition; our strength will come from building the new constituencies that do have a vested interest in pushing for the
unpostponable changes in the system that basically reproduces the existing structural inequalities and determines the parameters within which we (as professionals) are “allowed” to intervene.

———————————-

*Short Bio

Claudio Schuftan has worked extensively at global level (especially in Africa and Asia) in fields such as Public Health including, Strengthening Management of Health Systems and Health Policy Formulation, Public Health Nutrition, Primary Health Care; Maternal and Child Health Care, Health Management Information Systems, Human Resources for Health, Health Project Design, Health in SWAPs, District Health Management, Health and Human Rights Capacity Building, Community Health, Health Promotion, Health governance, Health Sector Reform and Gender Issues. Dr Schuftan has significant monitoring and evaluation experience in these fields. Apart from sector and joint evaluations for various donors,he has monitored EU projects mainly in the fields of health and nutrition especially since the establishment of the ROM initiative in 2001. 

Dr. Schuftan has worked on the drafting of national plans of action in Cameroon, Kenya and Vietnam and has carried out in-depth situation analyses including access to health and right to health issues. He has prepared health investment plans and facilitated numerous training workshops. He has also written numerous training manuals. As senior adviser in the MOHs in Nairobi and in Hanoi he was in charge of operational planning at both central and local levels and contributed to SWAP-related work in one province in Vietnam. The same was done in Bangladesh. He has closely worked with concerned government agencies including public finance institutions and human rights committees.

By training, Dr Schuftan is a Medical Doctor and Pediatrician with a degree of the Universidad de Chile in Santiago and holds a post-graduate diploma in Food and Nutrition Planning from the Massachusetts Institute of Technology (MIT) in the US. He is a US, Chilean and German national and resides in Vietnam since 1995 (first Hanoi and then in Ho Chi Min City since 2003). He is the author of over 85 scholarly papers published in refereed journals.

 

 

News Flash Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

News Flash 364

 

2020: a Year Full of Danger 

Mystery Virus In Wuhan Strikes 59 People; Chinese Rule Out SARS, MERS & Seasonal Flu 

Deaths from Democratic Republic of the Congo measles outbreak top 6000 

DRC Ebola update 

DRC Struggles With Twin Outbreaks Of Measles & Ebola; WHO Appeals For US$40 Million For Measles Vaccine Drive 

Statement of the Twenty-Third IHR Emergency Committee Regarding the International Spread of Poliovirus 

Impacts of intellectual property provisions in trade treaties on access to medicine in low and middle income countries: a systematic review 

New opportunities to increase access to medicines for universal health coverage in Africa 

WHO needs to go beyond mass drug administration in addressing neglected tropical diseases. New report calls for integrated control programs, multisectoral action, and health system strengthening (but omits reference to political and economic reform) 

Prescription Drug Policy: The Year in Review, And the Year Ahead 

What can the United States learn from the French system for controlling cost of meds? 

Get the global tuberculosis report data in your pocket: TB Report App 

Artificial intelligence has come to medicine. Are patients being put at risk? 

Review of the Decade: Ten Trends in Global Education 

Analysis of FDA Documents Reveals Inadequate Monitoring of Key Program to Promote Safe Opioid Use 

Human Rights Reader 510 

Searching for the nexus: Why we’re looking in the wrong place 

Non-clinical interventions to reduce unnecessary caesarean sections: WHO recommendations 

WHO mulls UN high level declaration on non-communicable diseases. Focus on mental health, air pollution, alcohol harm and early diagnosis 

National, regional, and global burdens of disease from 2000 to 2016 attributable to alcohol use: a comparative risk assessment study 

An end to coercion: rights and decision-making in mental health care 

Social disconnectedness, perceived isolation, and symptoms of depression and anxiety among older Americans (NSHAP): a longitudinal mediation analysis 

Upwards harmonisation of food standards a risk to community nutrition and food sovereignty. Trade facilitation and food safety confused in new item on EB agenda 

Addressing Food Insecurity In Clinical Care: Lessons From The Mid-Ohio Farmacy Experience 

South Sudan government strategizes to stave off potential famine 

How to scale up biofortified crops 

‘Like sending bees to war’: the deadly truth behind your almond-milk obsession 

Not all Trade is Good – the Case of Plastics Waste 

EU plans ‘big increase’ in green gas to meet climate goals 

Australian bushfire smoke drifts to South America 

News Flash Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

News Flash 363

 

MSF: our wishlist for 2020 

2020 Is the Decade of Action & It Has to Be a Sprint 

Aid policy trends to watch in 2020 

WHO: Year of the Nurse and the Midwife 2020 

Looking back at 2019: Key moments 

Wrapping up 2019 – Noteworthy Medicines Law and Policy Events 

2019: a Year in Review through PEAH Contributors’ Takes by Daniele Dionisio 

WHO: public health round-up 

Applying Implementation Science to Improve Antimicrobial Stewardship: Why is it Important? 

Why Harnessing Tech For Universal Health Coverage is Essential 

Why We Need Whistleblower Protections 

Population-based projections of blood supply and demand, China, 2017–2036 

Improving quality of care in fragile, conflict-affected and vulnerable settings 

Charging for the use of survey instruments on population health: the case of quality-adjusted life years 

German universities: 445 clinical trials missing results 

Can We Talk? Rethinking FDA Communications With Drug Developers 

The Case For Letting Biosimilars Compete 

New pneumococcal vaccine from Serum Institute of India achieves WHO prequalification 

Three tropical diseases targeted in push for new drugs 

Availability, prices and affordability of essential medicines for treatment of diabetes and hypertension in private pharmacies in Zambia 

DRC Ebola update 

Syndromic Surveillance for E-Cigarette, or Vaping, Product Use–Associated Lung Injury 

Vitamin E Acetate in Bronchoalveolar-Lavage Fluid Associated with EVALI 

Convenience store visitors recall cigarette advertisements even if they do not purchase cigarettes 

Human Rights Reader 509 

How to put farmers in control of food systems transformation 

Industry and farmers expect ‘science-based’ solutions to deliver New Green Deal 

Making the Business Case for Nutrition Workshop 28 January 2020 – 9:30am to 5:00pm Chatham House | 10 St James’s Square | London | SW1Y 4LE 

Climate takes centre stage in global development – 2019 in review 

Authoritative insights by 2019 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

2019: a Year in Review through PEAH Contributors’ Takes

 

Now that 2019 is at 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 the relevant links:

Two Goals with One Action: HIV/AIDS and Hunger (Health and Community Development) by Kiyini Jimedine

Developing Countries Urged to Take Charge of Their Digital Future by Juliet Nabyonga-Orem

Have Countries Forgotten about the Sustainable Development Goals? The Case of the Americas by Francisco Becerra-Posada

Why No Talk of an Inequality Emergency? by Ted Schrecker

Patents in Pharmaceuticals: The Emerging Sharp Sword to the Fragile Health Systems in the 21st Century by Michael Ssemakula

Why Some Global Health Experts Didn’t Sign the Call on the United Nations for Human Rights Guidelines on Healthy Diets and Sustainable Food Systems by David Patterson

Insights on Access to Health in Sudan by Hanan Abdel Aziz Marhoum 

The Oxford Statement and The MedsWeCanTrust Campaign: a call for equity in global health by Raffaella Ravinetto (republished by the Institute of Tropical Medicines, Antwerp)

Financialization of Health and the Impact on Peoples’ Lives by Nicoletta Dentico

Reaching out and Engaging with SE Asian Communities: Health, Shared Value and Business by Phil J Gover

Italy’s Way Forward in Clinical Trials Transparency by AIFA Director General Dr. Luca Li Bassi (republished by TranspariMED)

Revelation! The International Monetary Fund Discovers Tax Avoidance and Capital Flight by Ted Schrecker 

The Disease Bringing People Together by Olga Shelevakho

Debates of Reproductive Health in Turkey by Feride Aksu Tanik 

Stigma Affects the Motivation for HIV Testing by Marina Maximova, Olga Shelevakho 

The Role of Familism in Latinx Communities and Impact on Health Care Decision-Making by Karen Mancera-Cuevas

Expanding Access to Rights Documentation: Tools for Marginalized Groups in Myanmar by Julia K. Klein

Why Don’t Venture Capital Firms and Government Funders Co-Invest in Healthcare Technology More Often? by Dhevi Kumar 

Pick the Odd One Out: Sugar, Salt, Animal Fat, Climate Change: What Are We Teaching? by David Patterson

DRC Ebola: Still a Horrifically High Level of Nosocomial Infections by Garance Upham

Stats , Data and the Popular Media: a Closer Look at The Toronto Star’s Stats on Vaccine Coverage in Ontario by Lawrence C. Loh

Ethical Challenges In Big Data In The Developing World by Nighat Khan

Why Public Health Care is Better by Julie Steendam

AFEW Creates Space for Public Health Within EU-Russia Civil Society Forum by Valeria Fulga

The Italian Investor Proposed USD 379.7 Million Lubowa Hospital Construction Project in Uganda: Disconnections and Disruptions in the Health Sector Expenditure Priorities by Michael Seemakula and Denis Bukenya

The Inability of the Patent System to Reward Innovation by Public Actors: the Bedaquiline Example by Barbara Milani

It’s Time to End TB in EECA Countries by Helena Arntz and Olesya Kravchuk

Turbulences in Uganda’s Global Aid Construct: Is the Contemporary Aid Effective Enough to Transform Uganda’s Health System to Achieve UHC? by Michael Ssemakula

How Political Correctness Can Change Society’s Views On Mental Health by Tiffany Osibanjo

Is Wealth Good for Your Health? Some Thoughts on the Fateful Triangle of Health by Iris Borowy

WHO Places Emphasis on IPC, AMR and UHC by Garance F Upham

iBreastExam for Breast Cancer Detection in Low Resource Settings by Sumedha Kushwaha and Garima Kumar

From Ebola to Antimicrobial Resistance: Coming Into a Health Center Could Kill You! by Garance F Upham

The Original ‘7-Year Itch’ – Coming to an Infestation Near You! by Michael Head

Action Alliance “Training 2020” – An Alliance for Independent Continuing Medical Education by Christiane Fischer

Galvanizing the Action to Protect and Promote the Rights of Mentally-Disabled Individuals in the Key Populations: a Pathway to Achieve Health for All by Denis Bukenya and Michael Ssemakula

European Parliament Calls for Regular Evaluation of SPC System, Including its Effect on Access to Medicines in Europe by Dimitri Eynikel

The Rhetoric In Achieving The Universal Health Coverage Under Public-Private Partnerships In Uganda by Denis Bukenya and Michael Ssemakula

Yes, Resilience and Sustainability Are Too Narrowly Defined by Claudio Schuftan

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

Dementia in Elderly People: an European Priority Non Ruled by a Communitarian Strategy by Pietro Dionisio

Letter of support for Dr Luca Li Bassi sent to Roberto Speranza, Italy’s Minister of Health – 7 November 2019

INTERVIEW to George Lueddeke  – ‘Survival: One Health, One Planet, One Future’ – Routledge, 1st edition, 2019 by Daniele Dionisio (republished by the South Eastern European Journal of Public Health)

INTERVIEW to Mario Raviglione as the Global Health Centre Director, University of Milan by Daniele Dionisio

INTERVIEW to ATTAC – Aim to Terminate Tobacco and Cancer – Society by Daniele Dionisio

The Evil of Unregistered Clinical Trials in Europe by Daniele Dionisio

IMF Conditionalities Still Under the Fire of Criticism by Daniele Dionisio

Haiti Healthcare Sector: Hard Recovery From Disastrous Years by Pietro Dionisio

Moreover, as part of PEAH scope and aims, the column titled ‘Focus on: Uganda’s Health Issues‘ continued to serve as an observatory of challenging health issues in Uganda from a comprehensive view encompassing the policies, strategies and practices of all involved actors. 

In the meantime, our weekly page PEAH News Flash has been serving as a one year-long point of reference for PEAH contents, while turning the spotlight on the latest challenges by trade and governments rules to the equitable access to health in resource-limited settings.

——————————————————

*Daniele Dionisio is a member of the European Parliament Working Group on Innovation, Access to Medicines and Poverty-Related Diseases. 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 https://www.linkedin.com/in/daniele-dionisio-67032053  https://www.facebook.com/PEAH51/?modal=admin_todo_tour

PEAH collaborates with a number of non-profit entities. These include, among others:

#MedsWeCanTrust

G2H2Geneva Global Health Hub

CEHURD – Center for Human Rights and Development

Center for the History of Global Development

Viva Salud

Asia Catalyst

MEZIS

ATTAC

The 53rd Week Ltd

Wemos

Social Medicine Portal

Health as if Everibody Counted

COHRED’s Research Fairness Initiative (RFI)

AFEW International

TranspariMED

Medicines and Ethics, Institute of Tropical Medicine, Antwerp 

 

 

 

 

News Flash Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

News Flash 362

 

A Sustainable Europe 2030 Strategy is needed to achieve the SDGs 

Mapping public health policies for healthy living environments – A quick guide to a new EPHA initiative 

Social determinants of health in relation to firearm-related homicides in the United States: A nationwide multilevel cross-sectional study 

How McKinsey infiltrated the world of global public health 

Lessons from Ghana on Universal Health Coverage: Martha Gyansa-Lutterodt on the CGD Podcast 

Move to hide medical evidence threatens patients and public health across Europe 

Le cure per i ricchi e la politica dei farmaci 

Il diritto e il rovescio

NOVARTIS WITHDRAWS AN ABUSIVE PATENT FOR AN OVER-PRICED CANCER MEDICATION 

Biosimilar Breast Cancer Drug Gets WHO Seal Of Approval – Agency Aims To Increase Worldwide Access To Life-Saving Treatment 

Better together: Caribbean unites to tackle poor-quality medicines 

Two Goals with One Action: HIV/AIDS and Hunger (Health and Community Development) by Kiyini Jimedine

Is the world ready for an HIV vaccine? 

Experts breathe sigh of relief as WHO say Ebola patient was not reinfected with the deadly disease 

DRC Ebola update 

It’s Time to End Drug-Resistant TB in Children 

Final Analysis of a Trial of M72/AS01E Vaccine to Prevent Tuberculosis 

Salmonella Is Leading Cause of Foodborne Illness in EU 

WHO hits out at junk food companies as ‘twin-pronged’ nutrition crisis hits global growth and development goals 

Address Malnutrition, Not Just Food Security 

Low-income countries hit by ‘double burden’ of malnutrition extremes 

Tobacco Use Projected To Decline Among Men Worldwide In 2020; But Shift To E-Cigarettes Unknown Factor 

Social inequalities in multimorbidity, frailty, disability, and transitions to mortality: a 24-year follow-up of the Whitehall II cohort study 

Adequate funding needed to support migrants’ mental health, new report finds 

Total in court for human rights violations in Uganda: Historic hearing in France under the duty of vigilance law 

People Power in Romania Stopped a Mining Project. Now the Corporation is Suing for Billions of Dollars 

Untreated and Unsafe: solving the urban sanitation crisis in the global south 

European Commission: A European Green Deal. Striving to be the first climate-neutral continent 

The right finance crucial to success of the EU’s Green New Deal 

Leading Health Foundation Goes Local to Take on Climate Change 

The False Promise of Natural Gas 

Carbon Markets Can Provide a Crucial Part of the Solution to the Climate Crisis 

Zidan Benevolence International is a local community based organization that works to fight against pediatric HIV and AIDS, and operates in Buikwe district-Uganda Africa to provide HIV prevention, care and treatment services for women, children, and families. Zidan is trying to achieve two goals with one Action that is HIV/AIDS Virus and Hunger by connecting the link between Nutrition and HIV/Aids through Health and Community Development as our focus area.


Find out here an all-round, first-hand report of their much constructive, balanced and passionate field engagement

By Kiyini Jimedine
HIV Rural Community Based Activist

KILL TWO BIRDS WITH ONE STONE
(Achieve Two Goals with One Action)

HIV/AIDS Virus and Hunger (Health and Community Development)

 ZIDAN BENEVOLENCE INTERNATIONAL

 Mission: Creating self-sustainable and independent communities that rely on tested and aboriginal solutions to local challenges.
 Vision: To create empowered communities free from ignorance, HIV/AIDS and extreme poverty

 

Zidan Benevolence International is a local community based organization that works to fight against pediatric HIV and AIDS, and operates in Buikwe district-Uganda Africa to provide HIV prevention, care and treatment services for women, children, and families. In order to achieve our mission, Zidan Benevolence International collaborates with and empowers communities to play a strong role in planning, delivering, and monitoring HIV prevention, care and treatment services. The organization is committed to identifying, documenting, and replicating sustainable models of community involvement and service delivery that enhance coordination and partnership between the health sector and communities in order to further the highest attainable standards of health and well-being for all. We’re trying to achieve two goals with one Action that is
HIV/AIDS Virus and Hunger by connecting the link between Nutrition and HIV/Aids through Health and Community Development as our focus area. As such, the organization collaborates with a variety of stakeholders, including government agencies, civil society organizations, community leaders, faith-based institutions, networks of people living with and affected by HIV/AIDS, non-governmental organizations, and other entities.

We work within a variety of communities throughout Buikwe district to ensure access to EMTCT, and HIV care and treatment services. We based our evolving approach toward community involvement on the understanding that access to services which prevent mother to-child HIV transmission should be offered in a supportive environment, as women are more likely to utilize health services that their communities and families have deemed important and necessary.

There are belief structures in certain cultures within the settings we work that can undermine HIV treatment and access to care – beliefs such as choosing local traditional healers over health facility services and home-based delivery of infants over delivering at health facilities, which have the capacity to address obstetric emergencies and intervene with antiretroviral medications to reduce risk of HIV infections. We go door to door to save them wherever there to save them.

Traditional healers keep on throwing dust into their eyes where they tell those suffering from AIDS related illness that they were bewitched right from the grave of a person who died of HIV and that’s why they face the same problems he/she faced(the AIDS related illness).They tell them that the person who bewitched went on a grave of a person who died of HIV/AIDS related illness and planted juju (African chemistry from witch doctors) so that you also die since they’re aware that it’s not a curable disease. They keep on asking for a lot of money from them and they pay in installments till they die and the witch doctor benefits yet the person he/she has been treating dies and no one will blame him that he failed because the only excuse he has that they couldn’t pay the money in time. So, since some of these witch doctors do have licenses to carry out their work, we concentrate on door to door mobile voluntary counseling and testing and we give them relevant information about the HIV/AIDS virus. We open their eyes by asking them to give us one person who was treated by witch doctors about the HIV/AIDS related illness within their communities and he/she is feeling good on their juju (African chemistry) but they can’t tell you only to say that those we know all died of witchcraft. Here we use some of the volunteers we use who are positive living that for them they’re on HIV treatment and they’re doing well. We do this kind of work using our local language not like some Organizations who’re found of sending counselors from urban areas and they use English yet these communities the majority never completed even a primary school level of education.

Ngogwe sub-county has one Health center and yet its population is 35,524 people covering up an area of about 158.5 square kilometers. It’s a remote area with poor roads full of feeder roads heading to trading centers, schools and homes. We have no vehicles sometimes we hire but we find when those who transport us charge a lot of money due to poor roads and to the extent that the owner of the vehicle stop in the trading center and the remaining distance we have to walk. It’s a big challenge though we try to challenge it and continue with our work since I grew up in this community where I used to walk 6 kms to attend my primary level of education. So, people face problems of getting access to the health center within Buikwe sub-counties whereby when we mobilize people to go for HIV testing, those who go say that they’re not cared for properly in terms of HIV counseling sessions and services given. They can spend a full day due to lack of health service providers. That’s why in these health facilities, there is no pre-test counseling and the post-test counseling is done briefly where if you prove positive you will be given the ARVs without checking the CD4 count or how strong is your immune system before starting the treatment. When you go they expect you to come back when the tabs are almost done without checking on them. This is the worst action done on health centers. HIV treatment is not like a malaria treatment where not much attention is needed by the health service providers after when you’re given the treatment by the doctors. It needs to at least check on the person who is on treatment.

We introduced what we call Door to Door Mobile HIV/AIDS Voluntary Counseling and Testing (D2DHVCT). Yes the distances are long but not even phone calls even though in my community few can afford to get a simple phone. Relatives of these positive living or family members keep on calling us to visit and help, and the fact is that we move with information relating to Health and community development. We don’t treat but we do voluntary counseling and testing including home base care services. So, we respond to their phone calls and when we reach their homes sometimes we find when the person who was given the HIV treatment (ARVs) is really down and can’t even afford to walk properly and for them they think when they call us we can help and treat the ill person (positive living). It becomes hard for us when we visit them and find such a situation which is beyond our work and we have to forward the person to the health center whereby we have no van/vehicle. We have to organize and look for the motor cycle and to get it we have to first use a bicycle so that we can be in position to find the motor cycle on our way.

We tried to get some contacts of motorcycle riders but they hike the charges due to the poor roads. Now problems come when we were the people who encouraged such people to go for HIV testing, we’re ever blamed and find them sometimes encouraging others not to allow us test them due to what happen to their family members when we forward them to the health centers to confirm (some think that since we’re doing D2DVCT, sometimes they doubt the results) and get treatment. As I said, we face a lot of challenges but we keep on challenging them as you know that a bend in the road doesn’t mean it’s the end of the road unless when you fail to make a turn. We fight tooth and nails to help them and we go at the health center and find out whether those we referred to them were given the treatment and if not we find out why, if yes we follow up and visit them in their respective homes and take their details after getting consent from them. You know every cloud has a silver lining, meaning that there are always positive results out of a tough situation. When we go, they welcome us positively because we do have volunteers within Buikwe communities who do a great job and, where needed, they call us and meet those in need of our help. We found out that the health service providers at the health center do not tell them how to balance their diet when taking the treatment, so, that’s why we came up to fight such by training them the link between Nutrition and HIV/AIDS and since they have land, they should forego processed food because raw food is cheap, better and easy to grow within Buikwe district areas, rural or remote as they’re but with fertile soils. That is why we’re focusing on Health and Community development were we give them developmental ideas so that they don’t die of hunger together with HIV/AIDS.

Education and HIV/AIDS in Buikwe District Communities

Uganda’s education system follows a four tier system. The first tier comprises of seven (7) years of primary education, followed by four (4) years of Ordinary Level secondary education, two (2) years of Advanced Level secondary education and the final tier is three (3) to five (5) years of Tertiary education. Each level is nationally examined and certificates awarded.
The Government introduced Universal Primary Education (UPE) in 1997 to offer free education at the primary level and later in 2007, Universal Secondary Education (USE) was introduced.
University and Tertiary education are offered by both public and private institutions. There also exists informal education in Uganda that aims to serve those persons who did not receive or only partially received formal education. Under the informal system, a range of practical/hands-on skills are imparted. The informal system includes Functional Adult Literacy. As all the education level mentioned above, in my village, no one finished the four (4) years of Ordinary Level secondary education, and a few completed the seven years of primary education. It’s only me who tried and how I managed to complete my Advanced Level secondary education, it’s a long story. My mother said I must always be intolerant of ignorance but understanding of illiteracy. That some people, who were unable to go to school, were more educated and more intelligent than college professors. We ever have that in mind simply because of the journey and life we go through.

Why people fail to go for studies: long distances from home to schools. In my community, there are no nursery schools and a kid of 3 year to 6 years cannot afford to walk 6 kms to and from in the morning and afternoon. Village schools have no vans like town or urban schools. Even though the government introduced the Universal Primary Education to offer free education but still the distance remains the same. So, you will find kids at home when the parents neglected them and they can’t afford transport and even though the schools are free the school management force them to pay lunch fees which isn’t food but porridge only without sugar and they’re supposed to pay $8 pa term. You find that parents can’t afford both transport and lunch fees making them to lose hope from their kids yet it’s their hope in future. The fact is that you can’t build a house without a hammer and saw, and you can’t expect an adult to build a successful life if the tools of learning and health weren’t instilled in childhood. The major problem here is that the parents and children find problems in statements altered/aired out by health service providers when they’re working on them or talking about health issues at the health center especially when some terms are biological and when they’re prescribed the drugs to be used. He/she will leave when he failed to get the information well and health workers since they work on a big number of people, they have no time to concentrate on one person. The government when employing and deploying doesn’t mind about the tribe and location. Uganda has a lot of tribes and they may deploy a health worker not in his/her tribe region. Health centers have no translated charts with relevant information about HIV/AIDS. Most health workers have no counseling skills and have no more details or updates about HIV/AIDS treatment. No connection of any community member at the health facility within the community who would’ve at least is in position to help his community and we find out ourselves coming in, in all areas to help those in need of our help. So, whenever we have health trainings, we encourage parents and the youth to participate and we train/counsel them in our local language and after they deliver the information to their families and neighbors.

Organization Justification

Human Immunodeficiency Virus (HIV); Acquired Immunodeficiency Syndrome (AIDS) remains a major public health problem in Uganda, with about 1.5million people living with HIV/AIDS in 2015 (Uganda Demographic Health UDHS 2016). Significant progress has been registered in addressing HIV/AIDS in Uganda; however a lot is still required especially to address specific regional and local disparities, challenges and needs.
In Uganda today, over 2.2 million people are living with HIV. The AIDS epidemic in Uganda is still severe and the most recent findings indicate that the number of infections by far increase daily in the rural areas of Uganda. Females between the ages of 20-24 show the highest rates of infection with HIV/AIDS. Adolescent females are more vulnerable than their male counterparts in the same age group.
Today, over half of the new cases occur in the between 12-24 years. Uganda is one of the worst hit by the AIDS epidemic in the world with 1.7 million children orphaned at the loss of either one or both their parents. These orphans are stigmatized, denied inheriting property left behind by their parents. They are at risk of malnutrition, illness, sexual abuse and exploitation compared to children orphaned otherwise. This goes hand in hand with causing psychosocial suffering to these children resulting into other social problems as influx of street children, retarded growth, drug abuse and addiction among others.

The HIV/AIDS problem is so complex that to overcome it, one must take into consideration a series of closely inter-related issues. Through working with women, youth and communities, Zidan Benevolence International has learnt that:
– The rapid spread of HIV/AIDS among adolescents and young adults (10-24 years) is simply a symptom of deep underlying chronic causes. These include poverty, unemployment, gender bias, breakdown of family and community structures, insufficient parenting, moral degeneration, rape, defilement, lack of life skills, harmful traditional cultural practices and beliefs, peer and social pressure, lack of role models, lack of adequate information and alternative services to them.

– For most young people, change of behavior is viewed as being hard and unattainable. Our experience demonstrates that a gap exists between knowledge and information on one hand and change of behavior on the other. Helping individuals develop and internalize life skills can bridge this gap. Life skills, in this case, act as a link between mitigating factors, that is knowledge of positive behavior and their benefit and behavior change, which is action. Life skills therefore create the capacity and will to choose from alternatives and implement the desired choices. In both the short and long run life skills translate knowledge of what to do, into how to do it, and provide the enabling factors for doing it.

– Behavior change is a gradual process that requires continuous support from ones immediate and distant environment. The support young people get from their immediate communities, guardians and givers is invaluable in this process.

– Peer and social pressure: inadequate access to services due to numerous reasons (such as a distance, poor quality services and unfriendly attitudes of health service providers to young people, economic submission of young girls, limited responsibilities culturally assigned to men in regard to reproductive health) are among the factors impending behavioral change.

– Using the “fear strategy” to effect behavior change is counterproductive. With the advent of HIV/AIDS, some of the presentation strategies that were designed relied on generating fear in the minds of people so as to bring about change in their sexual behavior. This led to some young people resorting to bestiality, incest and defilement as a safe means of venturing their sexual energy.
While implementing our activities, Zidan Benevolence International has learnt that from positive change to be effected, individuals need to be facilitated to understand how to apply the twin motivating force of “fear and pleasure” to achieve good results. This in our experience helps individuals to examine their perceptions and how perceptions lead to their attitudes and behavior.

– Community sensitization and mobilization, which is the provision of Information, Education and Communication (IEC) to communities to ensure their participation, contribution and involvement in solving a common problem, through change of knowledge, attitudes and practices (KAP) is very crucial for the success of any program/project. We have learnt that equipping young people with life skills should be accompanied with programs seeking to sensitize their parents/guardians, teachers and community members. Sustainability of this Project/Program will only be achieved if the community and the beneficiaries themselves recognize it as a goal and if they contribute adequately to the process, rather than as an aspiration of the implementing agency.

The problem to be addressed therefore is the negative modes of behavior that expose people to risks of the life such as HIV/AIDS infection and its shattering effects on human development. There are two causes to this problem:
– First, the youth lack adequate knowledge of the cause-effect inter-relationship of life situations.
– Secondly, people especially youth lack adequate life skills to translate the knowledge and information of what to do into how to do it and how to access and utilize the enabling factors of doing it.

In many societies/communities, children orphaned to HIV/AIDS suffer problems such as social distress, isolation, shame, fear and rejection that often surround people infected with HIV.
There is therefore need for confidentiality and privacy in regard to their HIV status that should be recognized.

Young people experience orphanhood at the age when parental guidance and support is most needed; they suffer loss of loves, and innocent taking care of their infected parents before they die. Often they are denied education and health services especially because their extended families cannot afford them.

In this regard therefore, Zidan Benevolence International wishes to address these community needs through strengthening HIV/AIDS prevention strategies and interventions and promote economic strengthening among PLWHIV.

This project is relevant to the strategic objectives of Zidan Benevolence International, and therefore it’s an opportunity for the organization to deliver its objectives, while at the same time making contribution to the national and global goal in the context of HIV prevention in Uganda and the world at large.

Organization Survey

Buikwe District has a total area of about 1209 Square Kilometers of which land area is 1209 square km. The total population 146,641.The District has got 30 Health Centers of different level where almost 75% have to walk 5 to 6kms to access the treatment.

The number/ratio of doctors or healthy workers to the patients is alarming where very few doctors work on many patients. This brings in delays at the dispensaries on the appointment days. Some even end up not getting the services as needed in time and HIV/AIDS tend to be common in all the places in question basing on the statistics from their different hospitals. This is because the greatest numbers of patients they get are mainly inquiring about this deadly disease for example in Kasanda Health Center IV where 1422 clients are on ART and not all attend because some could not afford public transport fares.

The common problem all the dispensaries here face little supply of ARVs and are few to accommodate all. This is due to the increasing number of patients due to the change of the system where instantly after testing, doctors encourage those who test positive to start on ARVs straight away without checking whether his/her immune system is strong enough to for him to start the treatment. Due to poor feeding were ever called upon and at the end it’s because of the treatment which leads to weakness. People take ART at the same time starving. So, they need help on the link between nutrition and HIV.

Visiting the village communities with relevant information about HIV virus without any developmental idea or food, it’s like applying horse manure into your garden. These people they know it that to start the HIV treatment you have to be having to eat 24/7 and the side effect of taking the ARVs is experiencing the internal weakness poor desperate people who are starving to death, they’re too weak to go for the HIV treatment because no one to deliver the treatment to them. Healthy centers are far away from them.

Some families in Kiyindi and Bukunja do not even allow you to step into their court yard simply because they know you will be wasting their time since they can go for medication when they have no or enough food. Few do accept but again you find when they don’t know how to read and write and not aware of what the treatment is for. This is what we call illiteracy. This is defined as lack of the ability to read and write with understanding in any language. Persons aged 10 years and above who could not read and write. For those who have never been to school, we consider the age group 15 years and above on the assumption that by age 15 there are minimal chances for one joining school for the first time. This is where our organization will deploy HIV/AIDS counselors within the health centers to help them understand well the prescriptions of the HIV treatment during a Post-Test counseling before they see the doctors. The objective of using this indicator is to shed light on the areas that need improvements in the delivery of the services.

That’s the reason why our organization have come up with the idea to fight against ignorance extreme poverty, hunger, stigma and dangerous diseases affecting and infecting the younger generation and the general Public throughout the operation area and end HIV and AIDS focusing on strengthening health and community systems and improving the quality of services including
Prevention: Voluntary male medical circumcision, prevention of mother-to-child transmission
Diagnosis: HIV testing and counseling
Treatment: Antiretroviral therapy, pediatric HIV care and treatment, tuberculosis and TB/HIV co-infection.

The Organization has introduced organic farming within village communities to fight against hunger and malnutrition to help those who’re starving to death. The health benefits of this farming method is it’s free of artificial colors, preservatives, flavors, trans fats, enhancers, stabilizers, fillers, sweeteners or other additives.
Rural communities have little say in their own future and in directing support to create the innovations to get there. Those with greatest need and the least voice, poor and smallholder farmers, women, youth are precisely those most strategic to involve in order to reach the Sustainable Development Goals. These farmers and social groups are experimenters, producers of knowledge and researchers in their own right; hence they need to be empowered to drive the innovation processes. As key partners in co-research initiatives, development programs and organizations that place their aspirations and capacities at the center, they can become dynamic, pro-active players in the pro-poor governance transformation of agricultural innovation systems. Approaches to improve governance include participatory research and foresight, institutionalizing the rights of rural women and recognizing farmers’ rights to genetic resources.

Personal Hygiene, Water and Sanitation in Buikwe

Poor drinking water access causes waterborne illnesses such as diarrhea, cholera, dysentery, typhoid and polio that kill young children and it’s very difficult to pass by two families when they have no a sick person or kid. They keep on using local medicine or herbs to treat themselves. So, self-medication is the order of the day within my community though we try our level best to out the ignorance from them by visiting their homes and contribute in drenching their wells though we lack funds to drill for them boreholes.

Diarrhea remains a leading cause of death globally among children under five years of age. Diarrhea contributes to nutritional deficiencies, reduced resistance to infections and impaired growth and development. Severe diarrhea leads to fluid loss, and may be life-threatening, particularly in young children and people who are already malnourished or have impaired immunity. As we know that diarrhea mostly results from lack of safe drinking-water, adequate sanitation and hygiene. A number of interventions are effective in preventing diarrheal diseases, thereby positively impacting the nutritional status of those most vulnerable. These are: Access to safe drinking water (e.g. water safety planning – the management of water from the source to tap; household water treatment and safe storage), Access to improved sanitation facilities, Hand washing with soap at critical times (e.g. after toilet use and before the preparation of food) and Hygiene promotion, along with access to safe drinking water and adequate sanitation should be accessible by all. The figure shows the community well contaminated water.

Unimproved sanitation, and poor hygiene practices brings in or attracts parasites that consume nutrients, aggravate malnutrition, retard children’s physical development and result in poor school attendance and performance. Poor sanitation reduces my community’s well-being, social and economic development due to impacts such as anxiety, risk of sexual assault, and lost educational opportunities. To our knowledge, we can improve poor sanitation by introducing the idea of Pit latrine with slab, Ventilated improved pit latrine (abbreviated as VIP latrine) and Composting toilet. Also maintaining wouldn’t be a problem to them but they need to be told how to go about it. They have to know that proper personal hygiene includes frequent hand and arm washing and covering cuts, proper cleaning and sanitizing of all food contact surfaces and utensils, proper cleaning and sanitizing of food equipment, good basic housekeeping and maintenance; and food storage for the proper time and at safe temperatures.

Poor hygiene in my community often accompanies certain mental or emotional disorders, including severe depression and psychotic disorders. Other community members develop poor hygiene habits due to social factors such as poverty or inadequacy of social support.

Achievement

Zidan Benevolence International members have been very instrumental in the provision of Home Based Care services; they trained 136 home family members who could come in to access the HIV treatment of a positive living who could be not in the condition to reach the health center and later they became our community volunteers. Additionally, Support group leaders have benefitted from trainings by ZICO and today this has been able to allow them to pass this knowledge on to others as well as ensure being able to take care of their peers at home.

We are certain from what we have witnessed from our simple interaction with Buikwe village community members and hopeful optimistic faces that we are betting on the right people who need our attention and the right generation for the future of Uganda. We do face challenges especially when we’re giving them our views during voluntary counseling and testing basing on the rumors they hear. But we convince them basing on the facts about HIV/AIDS. Sometime if your point of view is positive, you will see the challenges in the future as opportunities. Though stigma is still within these communities, the best way to curb it, we need to know the root cause first, and those are the modes of transmission. They still have it in mind that when you shake hands with a positive living, you can be infected. That’s where stigma starts from. Our key members are optimist; they’re always enthusiastic and believe in the project. Small setbacks will not deter them, but will actually motivate them to work even harder-things that can only get them better after all. With their never ending enthusiasm, they motivate and encourage other community members and sometimes all what they need is to complete a project successfully believing that you can achieve it. They always believe in the worst case scenario and expect that things that can go wrong will go wrong that is why they’re very risk-averse. However with their tendency to be more careful, they keep the team grounded and keep them from making ill-advised decisions. In addition to that, they hold the middle of the ground position between the optimist and pessimist. They’re neither overly optimistic nor do they expect doom and gloom around every corner. They base their decisions on careful assessments and calculations. They weigh the pros and cons with each other and consider the benefits with the losses. Since they know that they’re going to face different people with different attitudes, young, youth and old, they don’t take time to think and to be creative, they just follow someone to win with no struggle and after they try to take credit for everyone else’s work.

 

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Don’t wait to realize the use of water when the source is dry. If you have a chance to help, help those who are in need of your help. I can be reached on kiyini.jim.jimdean@gmail.com, whatsapp: +256702737256/+971525122704. We need help to save our community.

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Digital advances would ideally offer opportunities for improved and efficient service delivery, population participation in decision making and accountability, but pose a risk of exclusion of the poor and marginalized. These are population segments who will be left behind in consultations, service delivery and economic opportunities through use of digital innovations. Such gaps are recipe for abuse and exploitation of the poor by the powerful.

Relevantly, a conducive environment for successful deployment and use of technology is important. This involves appreciation of the scope of technology revolution as a transition involving optimizing social, political and economic conditions for inclusive growth in the digital age as opposed to isolated digital policies

By Juliet Nabyonga-Orem

World Health Organization, Inter-Country Support Team for Eastern & Southern Africa; Health systems and services cluster; P.O Box CY 348; Causeway, Harare, Zimbabwe

Developing Countries Urged to Take Charge of Their Digital Future

 

We are in an era of digital technology which is advancing at a very fast pace in developing countries. In as much as this creates opportunities for growth and better service delivery, challenges and risks are real. It is against this backdrop that the Pathways for prosperity Commission (here in referred to as the Commission) set out to investigate how developing countries can embrace advances in technology effectively. Through a research and consultative process that started as far back as January 2018, the Commission proposes rational solutions developing countries can implement in embracing digital solutions for the benefit of everyone.

Embracing opportunities accorded by advances in technology whilst guarding against risks lies the interface for wide spread adoption.  Indeed, opportunities do exist in developing countries that can be leveraged. For example, 43 countries in sub Saharan Africa are implementing a Health Information System Strategy based largely on the use of ICT (Information and Communications Technology). Eight percent of people in developing countries live under a cellular internet signal although only 30% have ever used the internet. The Commission further cautions that “do not connect people to the internet just for the sake of it, people must be able to make use of it to improve livelihoods”.

There are concerns to be addressed. The use of digital solutions in developing countries today is described as suboptimal at best or chaotic at the worst. Several countries in Sub Saharan Africa have witnessed an epidemic of pilots of digital solutions to improve service delivery and monitoring that are never scaled up, and in influx of APPs with varied relevance to developing countries’ health systems. In majority of African countries, capacity for health technology assessment to guide decision making is at infancy. The Pathways for prosperity Commission further highlights the low human capital, lack of digital readiness, ineffective institutions and a difficult business environment as major challenges.

Digital advances would ideally offer opportunities for improved and efficient service delivery, population participation in decision making and accountability, but pose a risk of exclusion of the poor and marginalized. Whether developing countries can ensure reach of digital solutions to the poor and vulnerable cannot be ascertained and the Commission likens “trickle-down digitalization” to failed attempts of “trickle-down growth” to deliver inclusive development. How can developing countries purposively plan for inclusiveness?  A significant proportion of the population live below the poverty line as high as 28% in Colombia; 65% in Burundi. These are populations who will be left behind in consultations, service delivery and economic opportunities through use of digital innovations. Such gaps are recipe for abuse and exploitation of the poor by the powerful.

Loss of jobs due to advances in technology is a real fear that must be handled carefully to mobilize popular support for technology development. Taking an example of Africa, mobile money banking by mobile telephone providers impacted on use of banking services which concern was real to commercial banks. In some countries this happened in a regulatory vacuum and subsequent efforts to introduce a tax on such transactions resulted in tensions between the government and the population. On a positive note however, linkages with mobile money banking and commercial banks have been forged paving a way for a fruitful coexistence.

The Commission draws our attention to the importance of a conducive environment for successful deployment and use of technology and refers to this as “getting the analogues matters right in a digital age”.  This involves appreciation of the scope of technology revolution as a transition involving optimizing social, political and economic conditions for inclusive growth in the digital age as opposed to isolated digital policies. In this regard, availability of essential physical infrastructure, foundational digital systems and investment capital are among the prerequisites for wide spread adoption.

Challenges notwithstanding, the Commission asserts that developing countries should not resign to being passive observers but should take charge of their digital future. In rising to the challenge, the following are proposals to embrace:

• Creation of a digital compact involving all stakeholders to guide coordination, deployment and use of technology and improve inclusiveness and adoption of consensual options. The effective use of such a compact will be premised on strong institutions and regulatory frameworks that are enforced. An important component of such effective partnership efforts that has not received much recognition in the past is institutionalization of mechanisms to manage conflict of interest. This is crucial given the important role of the private sector in technology development who have been labeled as “for profit”.
• Technology advances must put people at the center, be it to spur economic growth, improve service delivery, participatory processes the focus must be the people as major beneficiaries. In ensuring this, training in digital use should be mainstreamed in training curriculum for all learners. Relatedly, Governments must make information relating to their programs, including budgets, publicly available.
• The private sector and government must put in place foundational digital systems which are interoperable.
• Public and private actors must make deliberate efforts to leave no one behind through embracing business models that enable the poorest to access and use digital solutions; provide incentives or regulation to encourage pro-poor innovation. Private sector needs to work towards a balance between profitability, affordability and user experience.
• The role of governments in ensuring meaningful contribution of digital solution to economic development and efficient service delivery is paramount. Particularly is addressing technical disruptions and advancing digital transformation which the commission contends that should not be left technical agencies with a narrow mandate.
• Governments need to actively purpose to embrace digital solutions. While the private sector and donors need to explore regulatory solutions designed to meet the unique needs of developing countries, governments need to explore ways to ensure effective regulation.