The Global Health Centre - GHC, a founding component of the new MACH (MultidisciplinAry ResearCh in Health Science) of the University of Milan established with the support of the Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, is the first of its kind in Italy as it merges didactics and research towards “ensuring healthy lives and promoting well-being for all at all ages” (the United Nations’ Sustainable Development Goal 3 target). It aims at becoming a comprehensive and impactful contributor to the global health discussion internationally.


The GHC is directed by Professor Mario Raviglione. Find here a PEAH interview to him.

 Professor Mario Raviglione*

It is through the education of future decision-makers and leaders that health and access to it will be prioritized in every sector when choices are made. To put it in simple words, we aim at building ‘health-sensitive’ young generations of professionals

Interview

 

Professor Raviglione, the Global Health Centre – GHC is a founding component of the new Centre for MultidisciplinAry ResearCh in Health Science (MACH) and inspires its visionary aims. In this connection, can you tell us more about the MACH?

The new Centre for MultidisciplinAry ResearCh in Health Science (MACH), devoted to the sciences related to the health of populations, established in 2019 at the University of Milan, aims at becoming an international landmark and leading centre for health research. The special interest in infectious diseases, given the background of most of his founders, is complemented by that towards emerging global health threats, including non-communicable diseases, all seen through a global, equitable and multi-disciplinary perspective.

The Institute researchers tackle global health challenges, such as those determining illness and suffering among the poorest and marginalised populations, as well as those that can be faced through innovative biomedical solutions from research in immunology and microbiology. The MACH is truly a brand-new model of collaborative research in our country created with the support of the Fondazione IRCSS Ca’ Granda Ospedale Maggiore Policlinico that will offer its premises to host it.

Back now to GHC and its broad vision

GHC is engaged in addressing the principles and scope of global health, facing inequities and aiming at improving access to “health for all” through didactic and research activities conducted in partnership with experts from other national and international centres and institutes, nationally and internationally, sharing similar.

As for GHC’s ultimate goal?

GHC’s ultimate goal is to contribute to the development and implementation across disciplines, in full alignment with the United Nations Sustainable Development Goals (SDGs) 2016-2030, of sound health policies and practices that ensure universal access to care and prevention for the most vulnerable people in Italy and the world. To achieve this, multidisciplinary research and education engaging young generations of students that will become future leaders and decision-makers are essential. The GHC has therefore some basic functions.

Which are these functions?

The GHC has two clear-cut and well-defined functions. The first is Training and Education in global health: to create a cadre of future passionate leaders capable of being “global health-sensitive” among committed students from different backgrounds, including biomedical sciences, economics, law, international relations, sociology, ecology,  agronomy and all other related fields. As part of this programme, at University of Milan teaching on the essentials of global health is now integrated as a module into the regular medical student curriculum, a unique situation in Europe. In 2019-20, we will also begin teaching the principles of global health to students of other non-medical faculties.  The other real innovation is a new 1-year post-graduate Master Specialty Course in Global Health tht will start in late 2019 in collaboration with experts from prestigious academic institutions nationally and abroad. This is the very first in Italy and one of the few available in Europe. The second is Research to contribute to identification of innovative ways of handling complex public health problems looking at research as a continuum from the laboratory and fundamental research to operational and policy-related investigations.

In addition, two other functions derived from the main two include (i) contribution to making health policies focusing on that evidence generation that influences policy making by health authorities; and (ii) health promotion and advocacy to pursue public awareness and understanding of global health values and healthy behaviours through students towards civil society.

Kindly, add details relevant to the under-graduate module in Global Health and the coming post-graduate Master Course in Global Health

As mentioned above, the GHC staff has introduced teaching in global health for under-graduate students at University of Milan by integrating it into the regular medical student curriculum; second, the new Master Course in Global Health has been established for those who want to pursue a career in global health. Both are coordinated by myself in close collaboration with the team of Professor Andrea Gori. The under-graduate teaching – the first of its kind in Italy and an innovation in Europe – consists of a module, that is adapted to the level of students, focused on the essential knowledge of the big themes of global health as part of the mandatory courses of Public Health and of Introduction to Medicine in the Medical School curriculum. In essence, we teach to first-year medical school students as well as to those in their 2^nd, 4^th and 5^th year enrolled in the course of Public Health (and Hygiene, as it is often still called in Italy). As of  2019-20, we will also start teaching the principles of global health to economics and management students, as I do already at the health management course at Bocconi University. This is an attempt to make other future professionals more “health-sensitive”, so that one can count on their understanding of the concepts of universal access, vulnerability, social and economic determinants, etc when making general policies in the future. It intends to address the fact that health is the result of choices made in many other sectors beside the biomedical one.

As for the Master Course in Global Health (MGH), organised by us at GHC through a joint initiative with colleagues at MACH led by Prof. Gori and with the precious collaboration of Giulia Rolla, and financially supported also by Intesa SanPaolo, it is a professional, specialty master of 1-year duration offered by the University of Milan in close collaboration with experts from major institutions world-wide, including University of Geneva, Karolinska Instituten, Columbia University, Graduate Institute Geneva, Swiss Tropical Medicine Institute, World Health Organization and others such as San Raffaele Hospital, Niguarda Hospital, University of Brescia, University of Sassari, Bocconi University, CUAMM etc. The first year will begin in early November 2019 and end a year later. In a few words, the new master course aims to deepen knowledge and study contemporary global health issues from an interdisciplinary and inter-sectorial perspective. The MGH, conducted in English language, is open to post-graduate students from Italy and abroad coming from a variety of different backgrounds: from health and biomedical sciences to economics, sociology, anthropology, international relations, law, ecology, agronomy, diplomacy, political sciences, management etc. The MGH mission is to provide students the toolbox to understand and analyse health issues with a focus on both their broader determinants and direct causes, while looking for innovative solutions that transcend sectors. The Master aims to prepare students and future leaders to work in different settings that include the public sector at national (e.g. ministries of health, foreign affairs, development cooperation, etc.) or local level (e.g. regional or district public health authorities), international organizations, nongovernmental and faith-based organizations active in health and development, public private partnerships, and the private sector engaged in health.

Will students have the opportunity to go outside of the school class and see the realities of the world today when it comes to the way of managing global health issues?

Certainly! The Master Course will include a week of simulations of monitoring and support visits to high-disease burden countries, led by the team of Prof. G.B Migliori of the WHO Collaborating Centre based at Fondazione Maugeri, Tradate, Italy, and conducted in the peaceful Valtellina mountains, in a sort of retreat format. Further, the master course will allow students to rotate through major institutions in Milan, such as Niguarda and San Raffaele Hospitals, and learn the significance and applications of modern “omics”, so that they are ready to face ethical and technological issues. And, very importantly, the master course includes a rotation of one month for all students to low-income settings of Africa such as Cameroun, thanks to a collaboration with the national government through the University of Geneva, and Pemba, in the U.R. of Tanzania, also thanks to the collaboration with the local government through the Fondazione Ivo De Carneri, Milan, Italy.

Eventually, what about global health research at the GHC?

Global health research is an ongoing programme that explores innovative ways of handling complex public health problems, embracing innovations in technology and epidemiological understanding, and exploring implementation challenges. The programme works with experts from partner institutions in Italy and world-wide and focuses on priority conditions in infectious diseases and beyond, determinants of health, and innovations in delivery of care and prevention. GHC priorities in global health research include:

• Innovations and new technologies in the response to major killers like tuberculosis and HIV
• Poverty, migration and vulnerability as socio-economic determinants of access to health
• Translation of technological advances into policy and practice

In concrete terms, I am working now on projects related to migrant health issues, the definition of “precision global health “, which is a new concept under development by important global health experts in Europe, policies for new drug development for which we have a grant from the European Union, and some specific challenges in the global fight against tuberculosis, that is my old passion and area of expertise.

Thank you Professor Raviglione for your enlightening answers and highly commendable engagement

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* About Professor Mario Raviglione

Mario Raviglione graduated from the University of Turin and specialised in the USA (Cabrini Medical Centre, NY, and Beth Israel Hospital at Harvard Medical School, Boston) in internal medicine, infectious diseases and AIDS. He was director of the Global Tuberculosis Programme at the World Health Organization, Geneva, between 2003 and 2017. He is Full Professor in Global Health and Director, Global Health Centre, at the University of Milan and holds the appointment of Professeur Titulaire at the Global Studies Institute of the University of Geneva, Switzerland.

Contact: mario.raviglione@unimi.it

 

Health Breaking News 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

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This article explores how nonprofit Asia Catalyst implemented a rights-training program for community-based organizations (CBOs) in Myanmar and the positive outcomes of these collaborations. The three CBO partners discussed represent heavily marginalized groups in Myanmar: people who use drugs, people living with HIV, and sex workers.  Through this program, Asia Catalyst taught rights-driven approaches to gathering data in interviews, which has helped the groups sharpen and enhance their advocacy skills, which in turn has enabled them to effectuate positive change

 By Julia K. Klein, J.D.

Duke University School of Law, J.D.

Vanderbilt University, B.A., cum laude

julia.k.klein@duke.edu

Duke Law International Human Rights Clinic

Expanding Access to Rights Documentation: Tools for Marginalized Groups in Myanmar

 

Asia Catalyst is a nonprofit organization empowering community-based organizations (CBOs) with tools and resources to help them become more effective in human rights documentation and advocacy, which strengthens organizations’ ability to function democratically, sustainably, and more effectively cater to the needs of their communities. We have worked domestically, nationally, and internationally to empower hundreds of civil society groups across Asia, primarily in China and Southeast Asia, since 2006.  We began working concertedly in Myanmar in 2015 with our Regional Rights Training (RRT) program, which also included Viet Nam, Cambodia, and China.  The RRT program focused on strengthening CBOs through workshops on topics such as a rights-driven approach to data collection and documentation, regional coalition-building of like-minded organizations, publications of comprehensive reports highlighting findings and policy recommendations, and customized advocacy support to assist in implementation of rights-based advocacy projects for each of the participating groups.   In 2017, Asia Catalyst established a country program in Myanmar to focus on continued rights training demand from local CBOs following our successful RRT engagement. Through this new Human Rights Documentation and Advocacy Project in Myanmar, CBOs are guided through the rights framework and identify priority issues to document and create an evidence base for policy advocacy and coalition building.

Myanmar has undergone widespread changes in government and expansion of civil liberties since November 2010, when the long-ruling military junta was replaced by a military-backed civilian government.[1]  Accompanying changes such as the revival of democracy, the installation of a human rights commission, and the advent of legalized demonstrations in Myanmar are the collective efforts of government, nongovernmental organizations (NGOs), intergovernmental organizations (IGOs), and international nongovernmental organizations (INGOs) to improve access to healthcare for marginalized groups, such as people who use drugs and people living with HIV.  Focus in Myanmar on these areas is crucial.  Myanmar has the second highest HIV prevalence in Southeast Asia after Thailand,[2] with an estimated prevalence of 0.7% of adults living with HIV.[3] Myanmar is one of 35 countries accounting for 90% of new cases of HIV.  Illicit drug use is pervasive, with an estimated 83,000 people using opium or heroin in Myanmar.  HIV prevalence among people who inject drugs is 34.9%.  Among sex workers, another stigmatized group, 5.4% have acquired HIV.[4]  Given these alarming statistics, and in line with global health and development goals, in 2017, Myanmar pledged to end HIV as a public health threat by 2030 through a robust educational program and universal access to prevention, treatment, and care.[5]  The Myanmar government also plans to achieve ambitious 90-90-90 targets.[6] The 90-90-90 target means 90% of people living with HIV know their status, 90% of people who know they are living with HIV have access to treatment, and 90% of people in treatment have successfully suppressed viral loads.[7] Myanmar aims to complete the 90-90-90 plan by 2020.[8]

Accurate data on people living with or at high risk of HIV is essential for governments in order to address epidemics, yet criminalized groups are frequently denied, ignored, or invisible in national statistics and data collection efforts. Understanding HIV among key populations,[9] such as people who use drugs and sex workers, is essential for the appropriate design of and access to effective prevention and treatment programs.

To promote vital data collection by and for communities and to promote effective government advocacy from findings, we implemented workshops designed to expand the ability of CBOs to document rights abuses, contribute to the local evidence base, and advocate for their rights more effectively. This article highlights two recent examples from our program. The first describes documentation and advocacy by women living with HIV and sex workers, on access to healthcare including sexual and reproductive services. The second describes community-led data collection by people who use drugs on the impact of recent closures of harm reduction[10] drop-in centers (DICs) in Yangon, Myanmar’s largest city.

Rights-Based Data Collection on Accessing Reproductive Healthcare for Women Living with HIV and Sex Workers and Subsequent Advocacy

A core component of our rights training program includes building documentation skills to generate local evidence for advocacy. We worked with Myanmar Positive Women’s Network (MPWN) and Right to Health Action Myanmar (RHAM) to design and implement research on their communities’ priority concerns. For RHAM, this was access to sexual and reproductive health services for sex workers. For MPWN, this was collecting rights-focused data about sex workers’ experiences accessing health services at government healthcare facilities in Yangon. MPWN is a country-wide organization dedicated to empowering women living with HIV through training them to advocate for themselves to meet health, economic, and social needs.  RHAM is a Yangon-based CBO focused on improving access to sexual and reproductive health services for sex workers as well as fighting for improvement of policies that lead to discrimination and violence against sex workers.  It is imperative to address the issues facing these groups because 5.4% of sex workers[11] and 0.7% of women aged 15 and over are currently living with HIV.[12]

Overall, women living with HIV reported negative experiences in accessing treatment because of harassment from medical professionals and staff, public exposure of their HIV status, and addition of unnecessary treatment costs. In general, the interviewees reported feeling comfortable accessing healthcare at National Aids Program treatment centers. Interviewees reported easy access to condoms, but some sex workers stated access was harder due to discrimination from doctors and fear that their occupation would be disclosed to their families and neighbors. However, interviewees reported having very little information about preventing HIV transmission during pregnancy and childbirth.  Some women reported being shamed by healthcare workers for getting pregnant, and they were not provided meaningful education on how to have a healthy pregnancy with HIV. One interviewee reported forced sterilization.  Some reported further stigmatization because they were also sex workers. Stigmatization sometimes took the form of having to pay additional fees, such as cleaning costs and additional bedsheets, when non-sex workers did not have to.  Many respondents reported emotional distress when medical providers or staff disclosed their HIV status publicly. One interviewee stated that she “was traumatized mentally. Because of them, my family knows that I am HIV-positive and I faced a lot of family problems. The lab technician told my result to my mother-in-law.  My mother-in-law shouted at me in front of others, ‘you are a prostitute. That’s why you got HIV. You deserve this.’”

The data gleaned from these interviews helped the CBOs construct recommendations to township-level National AIDS Program team leaders about the needs and requests of sex workers in Myanmar. It also enabled the development of recommendations, such as nondiscrimination training of medical staff and doctors, by women living with HIV to the National Aids Program, INGOs, IGOs, NGOs, and the Ministry of Health and Sports.

Community-Oriented Data Collection on the Impact of Drop-in Centers for and Their Closures for People Who Use Drugs

We worked with five CBOs of people who use drugs in Myanmar to understand their human rights and document barriers to evidence-based harm reduction services.  It is crucial to work with this population because the Myanmar government chooses to address the epidemic, an estimated 83,000 people who inject drugs, through prison sentences and other punitive approaches by which numerous rights are violated.[13]

The example below provides results from documentation by Youth Empowerment Team (YET),  a Yangon-based organization run by young people who have drug use experience.  YET focuses on harm reduction programs and is dispelling the notion that harm reduction is equivalent to encouraging drug use.  Below, we report on community research methodology and findings as reported by YET.

YET trained four peer educators who interviewed 27 people who use drugs about access to harm reduction drop-in centers, where participants receive services such as methadone therapy, condoms, harm reduction techniques, clean injecting equipment, and referrals to methadone treatment centers and places where they could receive naloxone, which is administered to reverse opioid overdose. Interviewees reported feeling comfortable and welcomed at DICs, perhaps because they are partially run by peer drug users and did not experience as much shaming. They emphasized how crucial methadone is to their recovery and well-being.  One interviewee stated “because of methadone therapy I can concentrate more on my work.”

By October 2017, many of these DICs were forced to close due to a lack of funding. This was devasting for people who use drugs in the Yangon area. They reported difficulties in accessing methadone therapy and overdose treatments.  DICs were also important social settings for drug users.  One interviewee described how the DICs provided him with psychological benefits he can no longer access, stating “it was difficult to get counseling, which I really needed.” They felt comfortable meeting friends and counselors with similar struggles.  One interviewee shared that he “lost a place to rest.” Based on these findings, closure of DICs has been devastating for people who use drugs in Myanmar.  One interviewee stated “I don’t get needles anymore, so I share with others. I don’t know where to [get] blood testing. I am worried that I could be infected by blood-borne diseases. I can’t control my desire to use drugs.”

However, inspired by needs articulated in interviews, YET has developed a plan to create its own harm reduction program with wide-ranging services such as clean needle distribution, risk-reduction education, and testing for sexually transmitted infections (STIs) including HIV.  YET encourages donors and the government to make efforts to reopen centers like DICs for the crucial medical, psychological, educational and social benefits they provided to vulnerable people who use drugs in need.  Notably however, CBOs such as YET engaging in outreach programs face the possibility of arrest and harassment by police.  For the most meaningful change to occur in reduction of drug-use-related harms including HIV and overdose, draconian laws against drug use must be reformed and people who use drugs should be decriminalized.

Looking Ahead

Myanmar has made significant strides in the post-military junta era in addressing healthcare, such as establishing Universal Health Care, which includes a Basic Essential Access to Health Services Package.[14]  It has also committed to addressing the HIV crisis through programs such as comprehensive sex education for Myanmar’s youth population[15] and a five-year strategic plan aimed to end HIV as a public health threat by 2030.[16]  However, data from interviewees confirm that key populations still face significant barriers to universal access to HIV services and other rights.  On April 29^th, 2019, President Win Myint’s spokesperson, U Zaw Htay, stated that Myanmar’s drug policy would be to rehabilitate and reintegrate people who use drugs into society.  Reflecting a rehabilitative approach, Htay noted that people who use drugs need assistance instead of punishment.[17]  Gains are being made regarding HIV law and policy as well.  A bill designed to help people living with HIV, prevent new cases of HIV, eliminate discrimination on the basis of HIV status, and increase access to healthcare for people living with HIV, which has been in the drafting process since 2014, is about to be finalized.[18]  The political transition, the passage of progressive and transformative bills, and the introduction of new bills can help create more robust civil society, improved public health, and expand access to rights for all in Myanmar.

The grassroots groups we supported through our Human Rights Documentation and Advocacy Project continue to reap benefits from the training provided.  Based on recent feedback from interviewees, RHAM is distributing condoms to sex workers in Yangon. It is also engaging in an outreach program to interview more sex workers about their experiences accessing healthcare for the prevention and treatment of HIV and STIs.  MPWN has worked closely with local service providers from the Myanmar Ministry of Health and Sports.  MPWN representatives presented their interview findings, developed a regional strategy plan for improved access to healthcare, and discussed how the Ministry and CBOs can coordinate further in the future to meet the needs of women living with HIV. MPWN also advocated to medical service providers to end mistreatment of people living with HIV by medical personnel and establish mechanisms to ensure appropriate interactions. YET has been providing clean needles to people who use drugs and advocating to local team leaders in the Ministry of Health and Sports for the need to reopen spaces where people who use drugs are treated with dignity and can avail themselves of evidence-based harm reduction interventions without discrimination. In addition to advocacy at the local level, YET also presented its interview findings at a National Harm Reduction forum in December 2018.

Despite these critical lifesaving advancements, without investment in groups like MPWN, RHAM, and YET, Myanmar’s traction and gains for its civil society will wither, goals will not be met, and its people will unnecessarily and unjustly suffer. Given the success of our rights training programs, more groups than ever are requesting to take part. We plan to expand our capacity to respond to increasing demands for our training programs through staffing up and investing more in local leadership and coalition-building to improve sustainable civil society advocacy.   For more information on how to help these groups continue to perform their crucial work, please visit www.asiacatalyst.org or contact info@asiacatalyst.org.

 

References and Quotations

[1] “Timeline: Reforms in Myanmar.” BBC News. July 08, 2015. Accessed June 19, 2019. https://www.bbc.com/news/world-asia-16546688

[2] “HIV and AIDS in Myanmar.” AVERT. January 18, 2019. Accessed June 19, 2019. https://www.avert.org/professionals/hiv-around-world/asia-pacific/myanmar.

[3] Ibid.

[4] “Myanmar.” UNAIDS. June 14, 2019. Accessed June 19, 2019. https://www.unaids.org/en/regionscountries/countries/myanmar.

[5] Unaids.org. “Myanmar Launches New HIV Strategic Plan.” UNAIDS. May 19, 2017. Accessed June 19, 2019. https://www.unaids.org/en/resources/presscentre/featurestories/2017/may/20170519_myanmar.

[6] Ibid.

[7] Ibid.

[8] Ibid.

[9] UNAIDS defines key populations as “gay men and other men who have sex with men, sex workers and their clients, transgender people, people who inject drugs and prisoners and other incarcerated people as the main key population groups. These populations often suffer from punitive laws or stigmatizing policies, and they are among the most likely to be exposed to HIV. Their engagement is critical to a successful HIV response everywhere—they are key to the epidemic and key to the response. Countries should define the specific populations that are key to their epidemic and response based on the epidemiological and social context. The term key populations at higher risk also may be used more broadly, referring to additional populations that are most at risk of acquiring or transmitting HIV, regardless of the legal and policy environment.”  UNAIDS Terminology Guidelines.” UNAIDS. 2015. Accessed June 19, 2019. https://www.unaids.org/sites/default/files/media_asset/2015_terminology_guidelines_en.pdf.

[10] UNAIDS describes harm reduction as “a comprehensive package of policies, programmes and approaches that seeks to reduce the harmful health, social and economic consequences associated with the use of psychoactive substances. The elements in the package are as follows: needle and syringe programmes; opioid substitution therapy; HIV testing and counselling; HIV care and antiretroviral therapy for people who inject drugs; prevention of sexual transmission; outreach (information, education and communication for people who inject drugs and their sexual partners); viral hepatitis diagnosis, treatment and vaccination (where applicable); and tuberculosis prevention, diagnosis and treatment. For example, people who inject drugs are vulnerable to bloodborne infections (such as HIV) if they use non-sterile injecting equipment. Therefore, ensuring adequate supplies of sterile needles and syringes is a harm reduction measure that helps to reduce the risk of blood-borne infections.”  Ibid.

[11] “Myanmar.” UNAIDS. June 14, 2019. Accessed June 19, 2019. https://www.unaids.org/en/regionscountries/countries/myanmar.

[12] Ibid.

[13] More information about drug laws in Myanmar can be found at: Frontier. “Myanmar’s Zero-tolerance Drug Policy Is Doomed to Fail.” Frontier Myanmar. January 28, 2019. Accessed June 19, 2019. https://frontiermyanmar.net/en/myanmars-zero-tolerance-drug-policy-is-doomed-to-fail.

[14] Tea Circle Oxford, Elliot Brennan. “Myanmar’s Public Health System and Policy: Improving but Inequality Still Looms Large.” Tea Circle. August 30, 2017. Accessed June 19, 2019. https://teacircleoxford.com/2017/08/30/myanmars-public-health-system-and-policy-improving-but-inequality-still-looms-large-2/.

[15] Unaids.org. “Positive Health, Education and Gender Equality Outcomes for Myanmar Youth.” UNAIDS. June 14, 2019. Accessed June 19, 2019. https://www.unaids.org/en/resources/presscentre/featurestories/2019/june/20190614_myanmar-youth.

[16] Unaids.org. “Myanmar Launches New HIV Strategic Plan.” UNAIDS. May 19, 2017. Accessed June 19, 2019. https://www.unaids.org/en/resources/presscentre/featurestories/2017/may/20170519_myanmar.

[17] Htut, Pars Yi. The Myanmar Times. April 26, 2019. Accessed June 19, 2019. https://myanmar.mmtimes.com/news/122549.html.

[18] This update has not been publicized yet.  It was provided to us by our partner, Community Network Consortium (CNC).  CNC is a Myanmar national consortium of nine community-based networks representing people living with HIV and key populations. Its members have been involved in consultations with government officials for current law reform processes.  CNC members have been co-authors of the new HIV bill titled Law related to People living with HIV and Affected Populations.

 

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About the author

Julia K. Klein, J.D. is a research fellow at Asia Catalyst.  Klein is interested in international human rights law and public interest law.  Klein has worked on matters such as health justice for low-income populations in the United States, legal strategies for implementation of sex workers’ rights in Cambodia, and legal strategies for fighting human trafficking in the Mediterranean.  Klein received her Juris Doctor from Duke University School of Law in 2018 and is currently awaiting admission to the New York Bar.

Health Breaking News 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

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Salute globale. Nasce Mach, il polo di eccellenza che unisce la Statale di Milano e il Ca Granda. In autunno il primo master 

MACH – Centre for Multidisciplinary Research in Health Science 

Draft UHC Declaration Strong On R&D Transparency, Weak On R&D Incentives Reform 

Four Recommendations to Accelerate Global Access to Quality, Affordable Health Products 

Poor countries pay up to 30 times more for medicines 

Zolgensma: A Remarkable New Treatment, An ICER Analysis, And A Poorly Justified Price 

Charity and NIH funding related to Zolgensma 

New Resource Gateway Launched On Innovation & Access To Medicines 

KNOWLEDGE PORTAL on innovation and access to medicines 

New Drug Transparency Observatory Launched In France 

Call for sanctions as data shows hundreds of UK clinical trials (and over 39,000 medical studies worldwide) still fail to register 

Tackling the Triple Transition in Global Health Procurement 

In the face of slow progress, WHO offers a new tool and sets a target to accelerate action against antimicrobial resistance 

WHO: Statement on the meeting of the International Health Regulations (2005) Emergency Committee for Ebola virus disease in the Democratic Republic of the Congo 

Merck to make more Ebola vaccine, WHO declines to declare global emergency 

WHO under pressure over Ebola response 

DRC Ebola: latest numbers as of 17 June 2019 

Becoming malaria free by 2020 

UK announces $215 million food, water and medical help for Afghanistan 

Rising Population Trends Threaten UN’s Development Goals in Asia & Africa 

Italy adopts decree that could fine migrant rescuers up to €50,000 

Human Rights Reader 485 

Women Deliver: time and place 

Reflections on Women Deliver 2019: It’s time to move beyond individualistic gender empowerment 

Eurodad Annual Report 2018 

WFP accused of negligence over Uganda food aid deaths 

Drones deployed to monitor Brazil forest growth 

National energy and climate plans will not meet targets, EU warns 

Desertification ‘More Dangerous and More Insidious than Wars’ 

Health Breaking News 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

Health Breaking News 338

 

Universal Health Coverage: Moving Together, Stronger Together

Universal health coverage and primary care, Thailand 

Myth Buster: why European economic governance is a key policy for health? 

CONCORD Annual Report 2018 – Fifteen years of collective actions 

Watered-down Tobin tax could enter into force in 2021 

Realigning Incentives To Optimize Generic And Biosimilar Prescribing 

Government policy interventions to reduce human antimicrobial use: A systematic review and evidence map 

Tech solutions to fight fake medicines 

Beyond Band-Aids: For a Funder Collaborative Taking on Global Poverty, It’s All About Changing Systems 

Measles kills 1,500 in Congo: Epidemic declared as health workers struggle to contain Ebola and cholera 

Second Ebola victim dies in Uganda as disease spreads 

Confirmation of case of ebola virus disease in Uganda 

DRC Ebola: latest numbers as of 12 June 2019 

Estimating undetected Ebola spillovers 

OPINION: Ebola patients are human beings not biosecurity threats 

Seasonal Influenza Vaccination: A Tool To Advance Epidemic And Pandemic Preparedness In Low- and Middle-Income Countries 

New Gavi Partnership: Deploying Biometric Technology To Expand Child Vaccine Coverage 

Interview With Seth Berkley, CEO Of Gavi, The Vaccine Alliance 

HIV project in Eshowe, South Africa reaches 90-90-90 target one year ahead of 2020 deadline 

Science tikkun: A framework embracing the right of access to innovation and translational medicine on a global scale 

In Peru, Baby Formula Reps Target Doctors In Low-Income Community Despite Decades-Old Ban 

Britain’s NIHR launches new clinical trial policies – but some other research funders still drag their feet 

PEAH Interviews ATTAC – Aim to Terminate Tobacco and Cancer – Society 

To Bolster Access to Water and Sanitation, These Funders Are Betting on a Systems Approach 

Snakebite testimonials – in Agok, South Sudan 

Food safety is everyone’s business 

Drought in Africa leaves 45 million in need across 14 countries 

Poor nations could be future ‘guardians’ of agrobiodiversity 

Scotland and Wales place hopes in battery power 

Climate change: UK government to commit to 2050 target 

EU fossil gas investments undermine bloc’s climate goals, campaigners say 

PEAH is pleased to interview Dr. Sumedha Kushwaha and Dr. Dikha De, as the Founder and, respectively, the Head - Strategy and Operations, of India based not for profit ATTAC - Aim to Terminate Tobacco and Cancer - Society. 

Dr Sumedha also serves as Head - Public Health, UE LifeSciences India Pvt. Ltd

 

 Dr. Sumedha Kushwaha  Founder

 

 Dr. Dikha De Head – Strategy and Operation

 ATTAC – Aim to Terminate Tobacco and Cancer – Society

 

 What will save the most lives in the next 50 years is the daily service of people—people like you, imaginatively deployed to prevent human suffering. Volunteer health workers who travel across muddy roads to deliver health care to their communities. Nurses and doctors effectively delivering the right level of care, not the type of care that pays them the most money. The volunteer on the end of the phone, talking to someone who feels desperate. It will be human kindness, brilliantly channelled, that will continue to improve the health of millions over the next 50 years.

Rebecca Hope, Director of Programs and Co-Founder, YLabs

Interview

 

Dr. Sumedha, when and why did you start ATTAC?

It all started with a young 13-year old boy unaware of a pre-cancerous lesion in his oral cavity. Asked about his habit, he told us that he has been chewing tobacco in the form of Gutka sold in loose flashy packet easily available just outside his school gates in the nearby village. After he was informed about the lesion and its consequences, he replied

“I knew it was a bad thing but I didn’t know it would take away my life.”

This was it. As if a switch clicked inside me, fuelled by the apathy, I started on my social work journey and volunteered for more than 6 organizations learning about the ways of social work and altruism.

And in mid-August 2014 I as a 2^nd year postgraduate student in Public Health Dentistry with my college batchmates opened a not for profit society called ATTAC – Aim To Terminate Tobacco And Cancer in 2014

What have been your major accomplishments?

Since 2014, ATTAC’s team ably helped by 100+ dedicated volunteers over the globe, has made more than 30,000 patients aware of such an unregulated, low priced, conveniently attainable cancer-causing substance. Apart from providing 11,000+ patients with a basic health check-up we have screened 7,000+ patients for oral cancer and the females with breast cancer screening too.

Those with positive habit history of tobacco usage are provided short one-on-one counselling on methods to quit, steps to quit and remain tobacco-free. Those with pre-cancerous lesions are counselled with emphasis on cessation and referred for further tests.

We’ve collaborated with similar not-for-profits to cover wider areas and provided training sessions for law enforcement officers, primary health-care workers, educational institutions and the Uttar Pradesh State Tobacco Control Cell.
We have also opened a facility for low cost diagnostic tests and tied up with various health care facilities for subsidized treatment along with running 3 cessation centres with no fees.

Our focus is majorly prevention and early diagnosis of diseases because we understand that if diseases are detected at their initial stages, the per capita expenditure is reduced grossly. Therefore, unburdening the Indian health care system.

What are the challenges you faced?

Tobacco use in India has deep cultural and historical roots; people take a puff of Hookah to get relief from stomach problems or they might fill tobacco in their teeth cavities to get pain relief. Along with this attractive packaging, little information on contents, various and newer methods of intake, advertisements and media portrayal have made it harder to break through. But they don’t realize that even a one-time contact with this poison is addictive enough to create a vicious cycle.

Although pan chewing and associated tobacco use began among the nobility, it soon spread to the common folk, and its importance as an obligatory social custom was established at all levels of society. By 1617, Smokeless tobacco use had become so popular among all classes that Jahangir, who came to the throne after Akbar, issued a decree identifying tobacco’s potential harms and forbidding its use.
 Smokeless Tobacco and Public Health in India, MoHFW, Govt. Of India

To change the mindset and break some centuries-old myths, ATTAC has travelled to several rural, semi-urban and urban areas to create awareness, prevent, screen, provisionally diagnose and provide referral for treatment. These little steps to create a tobacco and cancer free society matter a great deal when a patient understands and relates to our mission, through either the public health talks or the individualised screening sessions. But sometimes one session is not enough. Its human nature to follow the path of least resistance and resisting change is easy because people tend to focus on what they have to give up. We make them realize what all they could gain, but bringing along change is a gradual, time-consuming and laborious process. Many patients are lost in follow ups and further assistance cannot be provided due to logistics or finances.

Since 2014, we’ve only been able to open up three cessation centres. Our major logistical limitation is acquiring adequate manpower and budgeting to expand our reach pan India and open up at least a 100 more tobacco cessation centres by next year. But that can only happen if we collaborate with local doctors/dentists and similar not-for-profits.

How do you plan to solve them?

Like I said, to reach more areas, we need to lessen the distance between interested public and specialists who can provide help and for that to be feasible, technology might be an enabler.
Nowadays technology is what brings us closer, be it accessing healthcare information, finding a suitable doctor, getting online consultations to even finding online support groups.

Tobacco cessation counselling is a metaphorical handheld guidance to direct the patient into changing their toxic habit to a healthy one. It’s not imposition of your values or writing prescriptions but a soft skill to help the patient detoxify years of physiological and psychological effects of nicotine, a combined persistent effort tailored to their dependence and usage to achieve a quit phase.

We at ATTAC, along with a multidisciplinary advisory board from both healthcare and technological divisions, aim to innovate a novel mHealth idea to help the healthcare professionals provide a standardised, evidence-based, session-wise therapy easily delivered in a healthcare setup. This will not only help to reduce the burden on the overall healthcare system but also in treating non communicable disease load of the society by simply increasing the information flow from practitioner to client i.e. making him aware.

We aim to objectify the entire cessation protocol but the same time acknowledge the fact that quitting is a personalized journey. The basics of counselling coupled with the knowledge of the practitioner in a user-friendly tool with access to newer material regularly is what we envision. Currently in its development phase, we are taking inputs on user-interface designing and content by various leaders in their specialities.

Dr. Dikha, do you believe technology can solve the problems of the developing world?

We have many visionaries of different sectors working relentlessly to solve public health problems, especially in war zones of Palestine and Iraq, and technology is the supreme carrier. If not solve them completely, technology can definitely help aid us in bridging the doctor-patient gap.

“To improve health and reduce health inequalities, rigorous evaluation of eHealth is necessary to generate evidence and promote the appropriate integration and use of technologies.” WHO

Yes, there are issues of data encryption and multiple bug fixes, but sustainable change takes time to grow roots and while technology might be fast, but it is slow to achieve a steady level and gain trust with its users. Apart from using technology as an adjunct, our main focus will remain on soft skills focus because the we might have robots in the future, but the world will still need people to pick up the phone and talk on the Quit line.

Dr. Dikha, what’s the plan for the future?

ATTAC’s goal is to increase the number of people we can reach out to, be it – wider area of reach by arranging health camps and public health talks or setting up of Tobacco Cessation Centres in each district easily accessible by the patient.

Our first and foremost plan is to expand our network. Rope in healthcare leaders, advisors and similar minded people to tackle the problem in a multi-disciplinary fashion and launch our mHealth cessation app for validation tests.

We will also be working closely with the Uttar Pradesh State Government on ensuring awareness in the younger age groups with their school programmes and helping the ASHA (Accredited Social Health Activists) and ANM’s (Auxiliary Nurse Midwife) get trained in tobacco cessation counselling, since they are India’s doorstep health workers.

Thank you Dr. Sumedha and Dr. Dikha for your enlightening answers and highly commendable engagement

Health Breaking News 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

Health Breaking News 337

 

WHO: public health round up 

Artificial Intelligence: Wild Card To Address Global Health Issues 

Almost 2,000 Ebola cases confirmed in DR Congo as crisis worsens 

DRC Ebola: latest numbers as of 5 June 2019 

Large Ebola outbreaks new normal, says WHO 

Genetically modified fungus hailed as malaria breakthrough 

The case for robust tobacco control: strengthening tobacco tax and trade policy 

Heated tobacco products – No smoke without fire? 

Tobacco as an ‘offensive interest’ in trade talks? The role of rules of origin 

European Union Review of Pharmaceutical Incentives: Suggestions for Change 

Comparison of essential medicines lists in 137 countries 

Dept. of Fine Print: Who Benefits Most When Pharmaceutical Companies Donate Product? 

The Nagoya protocol and research on emerging infectious diseases 

Otto Cars: reacting to antimicrobial resistance 

More than 1 million new curable sexually transmitted infections every day 

Water, sanitation and hygiene: measuring gender equality and empowerment 

Delivering human rights and the SDGs: Does IMF Conditionality pass muster? 

Human Rights Reader 484 

‘Socialism for the rich’: the evils of bad economics 

To Address Disparities, Health Services Research Students Must Understand Inequity, Not Just Inequality 

Not one single country set to achieve gender equality by 2030 

Women Deliver Conference On Gender Equality Grabs Global Attention 

‘Catastrophic’ healthcare costs put mothers and newborns at risk 

Crisis In Care: Year Two Impact of Trump’s Global Gag Rule 

Celebration of World Food Safety Day 

Climate becomes top priority in EU’s 2020 budget 

Mobilisation Needed for Climate-Related Disasters 

Climate Change Could Cost Business Almost $1 Trillion 

We Must do More to Speed up Ending Fossil Fuel Subsidies 

Behind a Search for Breakthrough Ideas to Capture River Plastic Before It Reaches the Ocean 

Health Breaking News 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

Health Breaking News 336

 

World Health Assembly Approves Milestone Resolution On Price Transparency 

WHO Resolution 28 May 2019: Improving the transparency of markets for medicines, vaccines, and other health products 

Negotiators Agree On Game-Changing WHA Resolution For Medicine Price Disclosure 

The growing gap between what the public had been told R&D costs are, and the actual costs 

Does the political will exist to bring quality assured and affordable drugs to low- and middle income countries? 

‘You disappointed us’: Why is Canada opposing more transparency in drug prices? 

MPP Statement at the 72nd session of the World Health Assembly 

Reporting a clinical trial result on the European registry: My nightmare journey 

AMR incentives could be next big EU opportunity, pharma boss says 

Linking Vaccines And Quality: A Public Health Imperative In A Value-Based Era 

Major cholera vaccination campaign begins in North Kivu in the Democratic Republic of the Congo 

Following 110 years of neglect, an official day for Chagas disease is declared 

New Plan For Ebola Outbreak Response To Ensure Safety Of Respondents 

Aid group: Most new Ebola cases were not known contacts 

DRC Ebola: latest numbers as of 27 May 2019 

Big tobacco, global health, and the limits of shared value 

WHO: World No Tobacco Day 31 May 2019 

Poor people struggle to access cancer medicines in India 

India: extreme inequality in numbers 

As the World Health Assembly Convenes, Let’s Elevate Use of Economic Evidence on the UHC Agenda 

Budget Cuts May Undercut the U.N.’s Human Rights Committees 

Human Rights Reader 483 

The Time is Now: End Sexual and Gender-Based Violence 

For Lack of Will: Child Hunger in Africa 

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

Nobel Laureate: UN Reform Needed to Stop Climate Rule Fights 

European cities target net-zero carbon buildings by 2050 

Fossil fuel subsidies are wrecking the world, says U.N. chief 

Four energy storage projects that could transform Europe 

Water Research & Education Needs to Flow Towards Developing World 

We can and must tackle global health and environmental challenges holistically, thus benefiting from double and triple duty actions.

Food and beverage corporations are unlikely to adopt environmentally sustainable approaches without strong government regulation. (In fact, they may vigorously oppose them.)

In democratic societies at least, governments will most likely require broad civil society support to legislate to sustainably transform the food and beverage sector. (In undemocratic countries and in countries transitioning to democracy, there is an even greater risk that corruption will weaken government resolve.)

By David Patterson

Health, Law and Development Consultants

 dpatterson@healthlawdc.com

Disclosure: From 2009 – 2018 David Patterson was senior legal expert, health, for the International Development Law Organization (IDLO). He is now a consultant with IDLO and other health, law and development organizations

 

 Pick the Odd One Out: Sugar, Salt, Animal Fat, Climate Change

 What Are We Teaching?

 

 At a recent dinner party in The Hague, my friends’ 14-year-old son told us how at school the kids mapped how much of the Netherlands will be flooded if there is inadequate action on climate change over the next few years.[1] The adult conversation faltered… and moved on. But the child’s implicit plea haunts me. In fifty years, much of this country may well not be habitable.

This year two reports from The Lancet linked food, health and climate change and offered part of the solution. The reports ‘Food in the Anthropocene: the EAT-Lancet Commission on healthy diets from sustainable food systems’ (‘EAT Commission report’) and ‘The Global Syndemic of Obesity, Undernutrition and Climate Change: The Lancet Commission report’ (‘Global Syndemic report’) between them recommend a fully or largely plant-based diet for most of us to improve global health and also reduce the green-house gas emissions associated with the meat industry. Importantly, the reports address the impact of current, unsustainable food systems and climate change on low- and middle-income countries. Droughts, floods and desertification caused by climate change drive up food prices and increase both under-nutrition and obesity as people shift to less nutritious, often calorie-dense foods.

The reports also identify some culprits and systemic barriers, and hence some opportunities. Crucially, the Global Syndemic report notes that many countries have failed to include environmental sustainability principles within their dietary guidelines due to pressure from strong food industry lobbies, especially the beef, dairy, sugar, and ultra-processed food and beverage industry sectors.

Yet these lobbies are corporations. Corporations are, by definition, created by law. They can be controlled, taxed, and dissolved by law. But governments won’t adequately regulate these industries without strong civil society support for tight legislative control.

Among other suggestions, the Global Syndemic report proposes an approach based on international human rights law. This move reflects the increasingly multi-disciplinary nature of the teams convened to tackle global health challenges. Similarly, a recent WHO Bulletin special issue on noncommunicable diseases (NCDs) included an article on legal capacities required in NCDs prevention and control. In April 2019 The Lancet published the report of the Lancet–O’Neill Institute Commission on Global Health and Law titled ‘The legal determinants of health: harnessing the power of law for global health and sustainable development’ (‘Global health and law report’).  Most importantly, the report is replete with observations about the essential role of civil society in advocating for government action on law reform for global health.

Drawing together the threads of these four reports from these two authoritative journals, it emerges that

• We can and must tackle global health and environmental challenges holistically, thus benefiting from double and triple duty actions.
• Food and beverage corporations are unlikely to adopt environmentally sustainable approaches without strong government regulation. (In fact, they may vigorously oppose them.)
• In democratic societies at least, governments will most likely require broad civil society support to legislate to sustainably transform the food and beverage sector. (In undemocratic countries and in countries transitioning to democracy, there is an even greater risk that corruption will weaken government resolve.)

Hence we need national and global civil society movements that are informed, resourced, courageous and free to advocate for sustainable food policies, including access to accurate, accessible information to inform food choices. (For example, in many countries, industries lobby hard against ‘traffic-light labelling’ that helps people identify healthier processed food.)

The internet provides a powerful platform for social organization and advocacy, but also an almost unregulated medium to market junk food, and trace and censor dissent more effectively.

So what do we say to a 14-year-old who is questioning why he should study Latin if, in 30 years’ time, he may be a climate refugee? In November 1969, the educator Neil Postman delivered a lecture in Washington D.C. at the National Convention for the Teachers of English. He called it ‘Bullshit and the Art of  Crap-Detection.’ Postman reckoned that ‘…the best things schools can do for kids is to help them learn how to distinguish useful talk from bullshit.’

Fair advice. So, let’s stop pretending we can address climate change without transforming our diets. Let’s be straight about the profit motives of corporations, and the need for government capacity and political will to regulate them for the common good. And let’s use the common language of human rights to draw together all the civil society movements implicated in the struggle for global health, including the women’s, children’s, labour, faith, disability, indigenous, people of colour, LGBT and other groups. Above all, let’s share our vision of human and planetary health with young people over the dinner table – keeping in mind Postman’s advice!

 

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[1] For example, Delta Programme 2019, measures to adapt the Netherlands to climate change in time available at https://english.deltacommissaris.nl/news/news/2018/09/18/delta-programme-2019-measures-to-adapt-the-netherlands-to-climate-change-in-time [accessed 27 May 2019]