Challenges in UHC in Pakistan

Some of the major challenges faced by Pakistan include high maternal and child mortality rates, increasing double burden of communicable and non communicable diseases, poorly funded and poorly governed health systems, lack of accountability and corruption and low health literacy rates, along with ongoing challenges like terrorism and susceptibility to natural disasters like floods and earthquakes. Pakistan spends less than 2% of her GDP on healthcare services. This results in majority of population spending out of their own scant resources

By Nighat Khan

Affiliate at Global eHealth Academy University of Edinburgh

Challenges in Universal Health Coverage in Developing Countries like Pakistan

 

Article 25 of United Nations’ Universal Declaration of Human Rights 1948, states that “Everyone has the right to a standard of living adequate for the healthand well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services.” (1).

More recently out of the 17 Sustainable Development Goals (SDGs) adopted by the UN General Assembly in September 2015, SDG 3 focuses on health with target 3.8 of SDG 3 referring to achieving universal health coverage (UHC). The latter includes financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all, as the foundation stone for achieving all health related targets (2).

After seven decades of the Declaration, the dream of universal coverage (UHC) and health as a basic human right remains a distant reality for majority of inhabitants of the globe in countries like Pakistan. Poor access to promotive, preventive, curative and rehabilitative services of minimal acceptable quality is evident from country profilereports by the WHO, World Bank and UNESCO (3,4 &5).

According to one study, out-of-pocket payment for healthcare leads to an estimated 44 million households to suffer financial burden and 25 million are pushed into poverty each year (6).

More recently WHO reported that nearly 100 million people are pushed into extreme poverty due to health care expenses and over 800 million spent at least 10% of their household budget on health (7).

Protection from high cost of healthcare facilitates better access to healthcare as well as reducing depletion of their poor financial reserves (8).

Countries where public health service delivery is functioning well, with access to acute and chronic care for adults and children and better availability of medicines, show encouraging outcomes, with less out-of-pocket spending.

In a recent series of Lancet, Hogan and coworkers (9), identified four focus areas, i.e. reproductive, maternal, neonatal and child health (RMNCH), communicable diseases, non- communicable diseases (NCDs), service capacity and access and to reach UHC service coverage index, and used geometric means across these four areas. Major inequalities were reported in the baseline estimates across the countries.

The case of Pakistan

Some of the major challenges faced by Pakistan include high maternal and child mortality rates, increasing double burden of communicable and non communicable diseases, poorly funded and poorly governed health systems, lack of accountability and corruption and low health literacy rates, along with ongoing challenges like terrorism and susceptibility to natural disasters like floods and earthquakes. Pakistan spends less than 2% of her GDP on healthcare services. This results in majority of population spending out of their own scant resources (10).

In Pakistan, like any other developing country, health care provision is by public and private sectors. Studies suggest that it is the poor access to public health services, lack of availability of essential medicines and supplies as well as most importantly the perceptions about substandard quality services by public institutions which account for resorting to expensive private medical services. Expensive non-generic essential medicines are purchased for fear of generic being less potent or counterfeit.

Pakistan is one of the six countries with highest maternal and child mortality rates, in contrast to some improvements globally. Pasha et al (11), reported major discrepancies within the country with some regions like Thatta, a southern coastal town, had maternal mortality almost three times higher than other regions (313/100,000 versus 116/100,000). Stillbirth (56.5 versus 22.9/1000 births), neonatal mortality (50.0 versus 20.7/1000 live births) and perinatal mortality rates (95.2 versus 39/1000 births) were twice as high in the region as compared to national rates. Despite the official claims Pakistan is the only country in Global Network where maternal mortality has increased from 231/100,000 to 353/100,000 over their period of study. Despite the tall official claims, urban-rural health inequities are glaring and require urgent official attention.

In another recent study Zakar et al (12), reported only 36.6% women made four or more antenatal visits, 59% were attended by skilled birth attendant and 55.3% gave birth in a health care facility. The authors reported positive correlation between education and socio-economic status of the woman and negative correlation with birth order and her own autonomy. Their findings reemphasize the inequities between rich and poor women

Deforestation in many areas of Pakistan has led to massive monsoon floods since 2010, which pushed the goals to improve the health indicators further down by diverting the existing resources to rehabilitation and disaster management. Geographically the country lies on earthquake fault lines (13). In 2005, Pakistan suffered from one of the deadliest earthquakes in the northern regions killing 80,000 to 100,000 people with extensive damage to already fragile infrastructure like roads and bridges. The rehabilitation is still incomplete after over a decade (14).

Poor health literacy and ancient taboos and practices bar an individual from seeking existing services. LMICs are fraught with such socio-cultural beliefs. It becomes State’s responsibility to provide basic accurate health information through mass campaigns using various resources like information technology, including mobile messages and social and electronic media.

Pakistan is one of the few countries which failed to eradicate polio despite the availability of polio vaccine. Various misconceptions regarding polio vaccination in Pakistan led to a number of children not being vaccinated by parents. If concerted efforts were made by the state to ensure that accurate information regarding the safety of vaccine is imparted to her citizens, we may never had see polio-stricken children in Pakistan (15,16).

Climate changes and water shortages in a traditional agricultural state is leading to rapid urbanization. As a result the infrastructure is under stress in major cities likes Karachi and Lahore due to huge internal migration of the population. Job competition and unemployment has led to drastic increase in urban crime rates.

Rapid urbanization and a growing middle class is accompanied by adoption of urban lifestyle. Rise in Non Communicable Diseases (NCDs) like hypertension, diabetes, cardiovascular, mental illnesses (for e.g. depression) and cancer, while the country is still struggling to fully eradicate infectious diseases and vector borne outbreaks is double jeopardy for countries like Pakistan (17).  It is predicted that by 2020, NCDs will cause seven out of ten deaths in LMICs (18). Chronic infections like TB and malaria, dengue and chikungunya outbreaks continue to exact a heavy toll on fragile health systems in many LMICs.

Counterfeit medicines have swamped the country’s market with dangerous trends of self- medication.There is no official pharmacovigilance system in the country. Pharmaceutical regulation is carried out by Drug Regulatory Authority of Pakistan (DRAP). National essential medicine list (NEML), which is based on the WHO standards to encourage generic prescribing, is followed only in public sector hospitals, while private sector prescribers are heavily influenced by pharmaceutical marketing. Pharmaceutical companies have promoted a culture of corruption amongst physicians with the result that the prescribing of generics is very poor. Concerns have been raised about over prescribing and self-medication by the patients, as they can buy almost all medicines with or without prescriptions (19).

After a constitutional amendment in 2011, health and education services were decentralized to the five provincial governments rather than a federal ministry (20). While this was supposed to serve as a source of healthy competition amongst these provinces, leading to improvement in services, it has led to five more potential settings for corruption.

No service delivery is successful without strong and committed leadership. Rwanda has been able to bring positive changes in its health indicators after long drawn conflict, due to committed leadership (21).

For past decade and a half the province of Khyber-Pakhtoonkhwa (KPK) in north-west region of Pakistan had one of the highest rates of terrorist attacks in the country. Girl education and women empowerment suffered the most in hands of terrorists. Effective provincial leadership since 2013, led not only to improvement in law and order situation but a concerted focus on state schools and healthcare facilities led to drastic improvements in child enrolment in state schools and health services, within the same budgetary constraints.

Some positive steps have been taken in provinces like Khyber-Pakhtoonkhwa province where a health insurance scheme has been initiated along with financial incentive for expectant mothers for antenatal visits and child vaccination (22).The province successfully carried out a tree plantation drive and planted nearly one billion trees in the flood prone regions of the province (23).

It cannot be stressed enough here that strong leadership and commitment, proper accountability and political will underpin the foundation of states’ attempts to provide UHC. The natural disasters are inevitable but better preparedness and anticipation of these dangers cause fewer loss of lives of citizens.

 

References

  1. http://www.un.org/en/universal-declaration-human-rights ( Accessed December 10th, 2017)
  2. http://www.un.org/sustainabledevelopment/sustainable-development-goals (Accessed December 10th, 2017)
  3. http://www.who.int/gho/publications/world_health_statistics/2017/en/ (Accessed December 12th ,2017)
  4. https://data.worldbank.org/topic/health (Accessed December 12th ,2017)
  5. https://data.unicef.org/resources/resource-type/country-profiles/ (Accessed December 12th ,2017)
  6. Jacobs, B., Bigdeli, M., Pelt, M.V., Ir, P., Salze, C. and Criel, B., 2008. Bridging community‐based health insurance and social protection for health care–a step in the direction of universal coverage? Tropical Medicine & International Health13(2), pp.140-143.
  7. http://www.who.int/mediacentre/factsheets/fs395/en/ (Accessed December 12th ,2017)
  8. Xu, K., Evans, D.B., Carrin, G., Aguilar-Rivera, A.M., Musgrove, P. and Evans, T., 2007. Protecting households from catastrophic health spending. Health affairs26(4), pp.972-983.
  9. Hogan, D.R., Stevens, G.A., Hosseinpoor, A.R. and Boerma, T., 2017. Monitoring universal health coverage within the Sustainable Development Goals: development and baseline data for an index of essential health services. The Lancet Global Health.
  10. http://www.worldbank.org/en/country/pakistan/overview (Accessed December 12th ,2017)
  11. Pasha, O., Goldenberg, R.L., McClure, E.M., Saleem, S., Goudar, S.S., Althabe, F., Patel, A., Esamai, F., Garces, A., Chomba, E. and Mazariegos, M., 2010. Communities, birth attendants and health facilities: a continuum of emergency maternal and newborn care (the Global Network’s EmONC trial). BMC pregnancy and childbirth10(1), p.82.
  12. Zakar, R., Zakar, M.Z., Aqil, N., Chaudhry, A. and Nasrullah, M., 2017. Determinants of maternal health care services utilization in Pakistan: evidence from Pakistan demographic and health survey, 2012–13. Journal of Obstetrics and Gynaecology37(3), pp.330-337.
  13. Khan, S.R. and Khan, S.R., 2009. Assessing poverty–deforestation links: Evidence from Swat, Pakistan. Ecological Economics68(10), pp.2607-2618.
  14. Rathore, F.A., Farooq, F., Muzammil, S., New, P.W., Ahmad, N. and Haig, A.J., 2008. Spinal cord injury management and rehabilitation: highlights and shortcomings from the 2005 earthquake in Pakistan. Archives of physical medicine and rehabilitation89(3), pp.579-585.
  15. Khan, M.U., Ahmad, A., Aqeel, T., Salman, S., Ibrahim, Q., Idrees, J. and Khan, M.U., 2015. Knowledge, attitudes and perceptions towards polio immunization among residents of two highly affected regions of Pakistan. BMC Public Health15(1), p.1100.
  16. Murakami, H., Kobayashi, M., Hachiya, M., Khan, Z.S., Hassan, S.Q. and Sakurada, S., 2014. Refusal of oral polio vaccine in northwestern Pakistan: a qualitative and quantitative study. Vaccine32(12), pp.1382-1387.
  17. Gowani, A., Ahmed, H.I., Khalid, W., Muqeet, A., Abdullah, S., Khoja, S. and Kamal, A.K., 2016. Facilitators and barriers to NCD prevention in Pakistanis–invincibility or inevitability: a qualitative research study. BMC research notes9(1), p.282.
  18. World Health Organization, 2013. Global action plan for the prevention and control of noncommunicable diseases 2013-2020.
  19. Atif, M., Ahmad, M., Saleem, Q., Curley, L. and Qamar-uz-Zaman, M., 2017. Pharmaceutical Policy in Pakistan. In Pharmaceutical Policy in Countries with Developing Healthcare Systems(pp. 25-44). Springer International Publishing.
  20. Nishtar, S., Boerma, T., Amjad, S., Alam, A.Y., Khalid, F., ulHaq, I. and Mirza, Y.A., 2013. Pakistan’s health system: performance and prospects after the 18th Constitutional Amendment. The Lancet381(9884), pp.2193-2206.
  21. Sekabaraga, C., Diop, F. and Soucat, A., 2011. Can innovative health financing policies increase access to MDG-related services? Evidence from Rwanda. Health policy and planning26(suppl_2), pp.ii52-ii62.
  22. Ramsay, S., 2015. Implementing the WHO Safe Childbirth Checklist in Pakistan. A new approach to reducing maternal and newborn mortality in Khyber Pakhtunkhwa.
  23. Kharl, S. and Xie, X., Green Growth Initiative will lead toward sustainable development of natural resources in Pakistan: an investigation of “Billion Tree Tsunami Afforestation Project”.

 

Health Breaking News: Link 270

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: Link 270

 

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Health Breaking News: Link 269

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: Link 269

 

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Clean Energy Sources Manage to Cut Electricity Bill in Chile 

Africa’s planned dams could disrupt electricity supply 

 

 

 

 

 

 

 

 

 

Uncertain Status of UHC and the Latent Balance of Social-Justice Approach to Health

Universal Health Coverage (UHC) is a human right deeply rooted in the social-justice approach to health. Unfortunately, in several Low and Middle Income Countries (LMICs) it is still a mirage at a time when its achievement is not obvious in the High Income Countries (HICs) either. As such, UHC rests on everyday fight with uncertain results

By Pietro Dionisio

EU health project manager at Medea SRL, Florence, Italy

Degree in Political Science, International Relations Cesare Alfieri School, University of Florence, Italy

The Uncertain Status of UHC and the Latent Balance of the Social-Justice Approach to Health

 

Since the Alma-Ata Declaration, in 1978, the health and human right movement entered the international stage and rooted in the early 1990s in response to the HIV/AIDS epidemic.

According to the movement, the link between health and human rights means that everyone should have the right to the highest attainable standard of physical and mental health. As such, the definition of a healthcare system should be driven by standards including adequate infrastructure availability, high quality services provision, transparent health information, as well as the active participation by individuals and communities in decisions affecting health, non-discrimination, and other relevant mainstays.

The human right to health is protected in several declarations and covenants. Among these, the “Universal Declaration of Human Rights” and the “International Covenant on Economic, Social and Cultural Rights” maintain that healthcare system must be accessible to everyone (child, mothers and disadvantaged people first), while being equipped to prevent catastrophic health conditions.

A social-justice approach to health could actually safeguard the right to access health services and goods.

This approach requires a full understanding of the socio-economic, cultural and political contexts and their implications for healthcare services and resource allocation according to the collective needs. It also requires a commitment to share and learn from the communities and local experts. As such, the role of the central governments in putting aside the industry interests for the benefit of the collectivity should be emphasized.

In the face of this equity-based ideal approach, a grim reality shows how Universal Health Coverage (UHC) and a social-justice approach to health still lag behind as hardly achievable conquests for million people worldwide.

Concerning this, few examples from Asia, Africa and North America are enlightening.

In India the cost of rolling out UHC would actually be only 0.28% of Country’s GDP (the current GDP is estimated at $ 2,26 trillion), and well within the Country’s health expenditure. However, a mix of misplaced priorities, adding to a lack of evidence-based decision-making, are thwarting the achievement of a UHC system. For instance, while more new health insurance packages came-up in the last year, their utility is frustrated by distant health facilities and no trained healthcare workers providing services. The situation is so critic that despite India has become the global pharmacy for myriad inexpensive drugs, 63 million of its people sink into poverty each year because of unaffordable healthcare costs.

Among other issues, resources misallocation is an usual practice in African countries. As such, a huge number of African people look at UHC as a mirage, though for some critical health services and interventions an impressive progress in coverage has been registered. The most rapid improvement has been the change in supply of insecticide treated bed nets for children, which increased on average by about 15% per year between 2006 and 2014. All of the maternal health indicators have also improved over the last 20 years. Antenatal care visits and skilled birth attendance have also both increased from about 40% in 1990, to around 60% in 2014. In spite of this, wide disparities remain within countries including relevant to skilled birth attendants, treatment regimens for severe illnesses, and to access to more complex interventions. Even for schedulable routine services such as immunizations, very few countries are achieving universal coverage since the Regional immunization coverage, irrespective of its rise from 57% in 2000 to 76% in 2015, has remained below the expected target.

Furthermore, the UHC achievement in several African countries is undermined by the poor quality of care meaning, among other things, significant deficits in essential drugs and medical equipment availability, as well as in the knowledge and practices of frontline health workers.

However, if India and African countries cases are emblematic for LMIC, the most striking case is the U.S one. The former President, Barack Obama, implemented the Affordable Care Act, nicknamed Obamacare, as the first concrete American step towards the launching of a UHC system in the Country.

The Trump’s administration is endangering the Act and the President has begun a personal fight against the Law. In 2017, He and Republicans failed in their effort to cut Medicaid but they are going to try again in 2018. In fact, the strategy is to dismantle it on his own by scrapping subsidies to health insurance companies that help pay Out-of-Pocket Payments (OOPs) of low-income people, thus letting insurance premiums soar and fleeing insurance companies from the health law’s online marketplaces.

This inexplicable attitude towards the Act is grounded on conviction that healthcare entitlements are the big drivers of the U.S. debt. However, this approach is baffled by the propensity of many States, such as Maine and Virginia, for vowing to expand Medicaid.

UHC cannot be considered an once and for all achievement. The contexts mentioned above are just few and superficially analyzed examples on how the UHC issue is both relevant and critical as an often forgotten people right. As such, no wonder that even in those countries professing democratic attitude and having the needed cultural and economic resources UHC is a hardly achievable goal.

Accomplishing UHC requires properly equipped policies in place. In this regard, a focus on providing good coverage for a well-defined basket of benefits would be preferable to shallow coverage for any service with high patient cost sharing.

Financial sustainability needs to be built into the system from the start, including by exploring options to broaden revenue sources and prioritize the appropriate use of resources. Reforms in delivery systems should prioritize investment in non-hospital services, high-quality primary and community care services, and in public health programs. Nonetheless, these requirements often crash against the political will of decision makers thus making impossible stemming the tide of health inequities.

Tough progress results on a world scale are clear, the blatant examples here show how much has yet to be done and how, even in HICs, results not followed by a strong political will risk to be aleatory in the long run.

 

 

 

 

Health Breaking News: Link 268

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: Link 268

 

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2017: a Year in Review through PEAH Contributors’ Takes

Authoritative insights by 2017 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 

2017: a Year in Review through PEAH Contributors’ Takes

 

Now that 2017 just came to its end, I wish to thank the top thinkers and academics who enthusiastically contributed articles over the year. Their authoritative insights meant a lot to PEAH scope while adding steam to debate on how to settle the conflicting issues that still impair equitable access to health by discriminated population settings worldwide.

Find out below a list of links and relevant summaries:

Brexit can be Hazardous to our Health

By Ted Schrecker  Professor of Global Health Policy, Durham University, UK

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

Substantive Work of WHO, particularly in  Relation to Health Systems Development, Should Counter the Privatization Agenda, but Does It?

By Claudio Schuftan People’s Health Movement – PHM

Donor countries (the US in particular) continue to push WHO towards working with industry through ‘multistakeholder partnerships, rather than giving WHO the chance to implement regulatory and fiscal strategies that could make a real difference. Moreover, bilateral donors (and big philanthropies) demand WHO provides data according to their particular interests. Therefore, the types of data produced by WHO (and other UN agencies) are greatly influenced by a donor mandate that goes beyond the simple compilation of country-reported statistics

AFEW–Tajikistan Has Unique HIV Rapid Testing Point in the Country

By Olesya Kravchuk Communications Officer at AFEW (AIDS Foundation East-West) International

 Tajikistan is among the countries where HIV prevalence has increased by more than 25% over the last 10 years. In Tajikistan the number of sterile needles and other commodities for people who inject drugs per year is still very low. AFEW-Tajikistan is the only NGO in the country that has HIV voluntary counselling and rapid testing

Public-private Partnership Paradox: the Case of Gavi and Health System Strengthening

By Renée de Jong  Junior Global Health Advocate at Wemos Foundation  

The WHO model for Health System Strengthening (HSS) includes improving its six health system building blocks and managing their interactions in ways that achieve more equitable and sustained improvements across health services and health outcomes.... It appears that Gavi maintains a very different interpretation of HSS....vhere the interconnectedness between the building blocks is hardly taken into account

Inclusive Communication as a Mechanism to Improve Equity of Access in Health Systems

By Alex Henriquez   Research Analyst at Healthcare Improvement Scotland / Scottish Health Council

 A really equitable health system is that that ensures that people with special needs also have fair access to healthcare. This is especially relevant for people with communication needs, who may experience more barriers of access to healthcare services. Inclusive communication is an approach to communication in which information and its understanding are made accessible to everyone

Creating and Maintaining Fair, Trustworthy and Sustainable Research Collaborations

By Lauranne Botti, Manager, and Carel Ijsselmuiden, Executive Director, COHRED’s Research Fairness Initiative (RFI) 

The Research Fairness Initiative (RFI) responds to the increasing understanding of the importance of partnerships and SDG 17 by ensuring that institutions around the world can have access to an evidence-base on how to create and maintain fair, trustworthy and equitable partnerships in research and innovation

From Animosity to Murder: the Spectrum of Workplace Violence against Physicians

By Lawrence C. Loh  Dalla Lana School of Public Health, University of Toronto, and Director of Programs at The 53rd Week Ltd 

The observed increase in violence against physicians is a clear trend, supplemented by no end of anecdotal stories of physician disrespect; spitting, verbal, and physical assault, online harassment. Many of these would be criminal if done against a transit operator, but such behaviour seems to be increasingly tacitly accepted as part of a doctor’s craft

AMR as a Key Issue for BRICS and Low-Middle Income Countries

By Garance Fannie Upham Chief Editor AMR-Times Geneva, Switzerland 

Antimicrobial resistance (AMR) poses a serious threat to public health, growth and global economic stability. We affirm the need to explore in an inclusive manner to fight antimicrobial resistance by developing evidence-based ways to prevent and mitigate resistance, and unlock research and development into new and existing antimicrobials from a G20 value-added perspective, and call on the WHO, FAO, OIE and OECD to collectively report back in 2017 on options to address this including the economic aspects. In this context, we will promote prudent use of antibiotics and take into consideration huge challenges of affordability and access of antimicrobials and their impact on public health 
G20 Leaders Communique, Hangzhou Summit 4-5 September 2016, point 46

Treatment Affordability and the Entry of Biosimilars

By Fifa Rahman Postgraduate Researcher, University of Leeds, UK

 Uptake of biosimilars, i.e. cost saving highly similar versions of the stiff price reference biologic products, has been slow throughout most of Europe and the rest of the world. Without express and official government policy purchasing and recommending biosimilars, doctors will not use biosimilars and the resulting cost savings cannot be made

Is There a Fair and Equitable Access to Safe Blood Transfusion Products in the World?

By Yves Charpak MD, Public Health Specialist, PhD in Epidemiology 

Blood transfusions are today safer than any other treatment procedures today in the richest part of the world. But it is less true elsewhere, where the role of unsafe blood transfusions on major dramatic epidemic situations is certainly high although not so well documented: hepatitis B and C and E... and even HIV...it is estimated by WHO (The World Health Organization) that up to 80% of the world population who need safe blood products don’t get them

The Promise of PrEP for HIV Prevention

By Marieke Bak Research Intern at AFEW International 

A large international study among gay men and transgender women,the so-called iPrEx trial, suggested that pre-exposure prophylaxys (PrEP) by a tenofovir/emtricitabine combination can reduce the risk of HIV infection by at least 92% when the pills are taken consistently. Other trials subsequently confirmed PrEP effectiveness. PrEP is not intended as a stand-alone intervention, but rather as part of a multi-faceted strategy involving the use of condoms as well as regular follow-ups including for HIV and other sexually transmitted diseases testing

SOS a la Situation Humanitaire dans les Provinces du Tanganyika, du Kasai-Kananga, du Nord-Kivu et du Sud-Kivu en Republique Democratique du Congo/DRC

By Alphonse Kitoga Secretary General, Grands-Lacs en Action pour la Paix et le Développement Durable -The Great-Lakes in Action for Peace and the sustainable Development GLAPD_ Africa, asbl 

La République démocratique du Congo continue à être confrontée à une crise humanitaire de très grande ampleur, et cela depuis plus de deux décennies, bien que la grande majorité du territoire nationale demeure stable, mais les provinces du Sud-Kivu, du Nord-Kivu, du Tanganyika et du Kasaï central sont les théâtres des tueries, massacres et violations répétitives des droits de l’homme à l’heure actuelle

The Uganda’s “Narcotic Drugs and Psychotropic Substances (Control) Act” and how it impacts on Public Health and Human Rights

By Muhwezi Edward Harm Reduction Counselor, Uganda Harm Reduction Network 

The essence of the Uganda's Narcotic Drugs and Psychotropic Substances (Control) Act (NDPSA) is to treat people who use and inject drugs (PWUIDs) as criminals who need to be locked up instead of viewing them as human being in need of assistance. The criminalisation of drug use has had the effect of limiting the range of medical  intervention available and accessible to PWUIDs in both private and public facilities. There is no comprehensive facility for the provision of public health services to PWUIDs. There is also no treatment available within Uganda for people who are on drugs and need critical and urgent medical attention like opioid substitution therapy. And there is a direct link between the criminalisation of drug use and HIV/AIDS as well as mental health challenges

U.S.  Philanthrocapitalism and the Global Health Agenda: The Rockefeller and Gates Foundations, Past and Present

By Anne-Emanuelle Birn  Professor of Critical Development Studies, University of Toronto, Canada. and Judith Richter Affiliated Senior Researcher, Institute of Biomedical Ethics and History of Medicine, University of Zurich, Switzerland 

Collective activism to overturn philanthrocapitalism’s hold on global health is an urgent necessity. This effort should draw from, and build upon, the resistance to the UN’s promotion of “multi-stakeholder partnerships” and neoliberal global restructuring since the 1990s. Those actors who have contributed either unwittingly, or through silent assent, or even with active collaboration, to the global health plutocracy also share responsibility in re-democratizing it

Novo Nordisk’s ‘Changing Diabetes’ Aid Programme Exacerbates Issues of Insulin Access, and Must End for Compulsory Licensing to be Effective

By Rebecca Barlow-Noone Student, University of Leeds, UK 

To establish sustainable access to insulin in Cameroon, it is an imperative that reliance on pharmaceutical aid is revoked in favour of prioritising compulsory licensing and biosimilar usage. Until Novo Nordisk’s monopoly is challenged, patients will remain in uncertainty over access to insulin and essential equipment

The Injurious TRIPS Relationship between Human Rights and Access to Medicine in Uganda

By Bukenya Denis Joseph Human Rights Research Documentation Centre (HURIC) Kampala, Uganda 

The issue to ponder about is who is this TRIPS meant to protect? Is it protecting the LDCs or the Developed Countries? The views I am trapping out there imply that the Agreement intends to protect creativity and the manufacturers so that they can expand their potential and motivate them in research. The least developed countries, Uganda inclusive need time to overcome the constraints preventing them from creating viable technological bases and Intellectual Property (IP) Laws. The IP Laws in Uganda are so muddled that they curtail the availability of affordable generic drugs in the country. Uganda as a nation would use a good training to the officers of the law in the IP section and also there is a need for increased materials on IP to be circulated amongst the health rights activists and advocates

Resistance to Isoniazid, Pyrazinamide and Fluoroquinolones in Patients with Tuberculosis

By Matteo Zignol and Mario Raviglione Global Tuberculosis Programme, World Health Organization 

Testing of resistance to isoniazid, pyrazinamide and fluoroquinolones is of paramount importance to guide treatment decisions and ensure that patients receive the best standard of care and have the highest chances to be cured. In this report the authors present an overview of the prevalence of resistance to isoniazid, pyrazinamide and fluoroquinolones and discuss the need of rapid diagnostics to detect resistance to these drugs

The Unacceptable Inequity of Orphan Drugs Access in Europe:a Call for Urgent Policy Change

By Katherine Eve Young MD, MSc, MPH Manager Pricing & Market Access Creativ-Ceutical  and Mondher Toumi Professor of Public Health University of Aix-Marseille, and CEO at Creativ-Ceutical 

The current EU policy has a low ability to align access to orphan drugs across different Member States, leaving high inequity, especially between richer and poorer countries...The variation stems from the fact that although the marketing authorisation of drugs is at the European level, pricing and reimbursement decisions, and therefore patient access, are on a national level...Perhaps, to assure equal access to orphan drugs for all rare diseases, an EU-wide procurement should be considered...The EU can procure orphan drugs centrally and charge the MS based on their affordability while setting a fixed pan-European list price. Ultimately this will result in a differential pricing scheme

Wide Area Malaria Vector Suppression

By Richard Howe  Application Dynamics School of hard knocks, aviation trades, pilot and aircraft mechanic Punta Gorda, Florida USA 

Richard Howe writes: Only one aircraft equipped with a pair of high pressure aerosol generators would be capable of treating over one million acres per night, using only 1/10 of the recommended amount of insecticide

Environment and Health in the Anthropocene: Towards Holistic Understandings and Policy Responses

By Ted Schrecker  Professor of Global Health Policy, Newcastle University, UK  Co-editor, Journal of Public Health 

The idea of the 'Anthropocene' as an epoch with unprecedented scale, scope and interactions of multiple human impacts on the biosphere, can serve as a 'window' into crucial issues related to the connections among climate change, environment and health. In such contexts, integration of the fields of environmental ethics, public health ethics and bio(medical) ethics is needed

Teenage Pregnancy in Nicaragua Towards Achieving the Sustainable Development Goals (SDGs)

By Clara Affun-Adegbulu  Intern and Research Assistant at Institute of Tropical Medicine in Antwerp (ITM) 

Nicaragua currently lags behind other countries in the LAC region as for the decline of teenage pregnancies, and although the adolescent fertility rate fell sharply between 1990 and 2000, the decline has slowed considerably

 Zero Tolerance for Female Genital Mutilation

By Jitendra Panda Country Director at Health Poverty Action Universitat Oberta de Catalunya, Somalia 

Over 200 million girls and women living across 30 countries mainly in Africa as well as Middle-East and Asia share a common misery called genital mutilation / excision also known as female circumcision or Female Genital Mutilation (FGM). An additional 30 million girls are on the verge of submitting themselves into this practice in the coming decade.....The true extent of the abuse against children beginning as young as 7 and 9 years is much more than what we see in the numbers

Ready to Use Therapeutic Food from Locally Available Food Ingredients for Children with Severe Acute Malnutrition in India

By Kishore Shintre Food Fortification Consultant, ‘Hamara Prayatan’ (‘Our Efforts’) NGO, New Delhi, India 

Tackling Severe Acute Malnutrition (SAM) among children has been a big challenge faced by several developing nations including India for decades now. Many Indian states have tried to use the packaged Ready to Use Therapeutic Food (RUTF) supplied by a few manufacturers (Indian and overseas) with limited success. Owing to the strong resistance put up by the Government Departments as well as the ‘Anganwadi ‘(Children Community) workers together with other associated people in implementing this effort due to variety of reasons it becomes imperative that we think of alternatives. One of them is producing freshly made RUTF at community level using the locally available food ingredients thereby making the food more palatable, easy to administer without changing the food habits of the children. This article deals with our experiment of creating this RUTF locally at community level tried out by our NGO Hamara Prayatan through research and development carried out at our laboratory

How Can EU Trade Policy Ensure Equitable Access to Medicines?

By Zoltán Massay-Kosubek  Policy Manager for Health Policy Coherence at the European Public Health Alliance (EPHA) 

High medicine prices is a key public health challenge in Europe and Trade policy – an exclusive EU competence can improve or exacerbate the situation. Free Trade and Investment agreements can make easier or harder for European governments to change existing policies to curb the costs of pharmaceuticals. Following a civil society dialogue meeting with EU Trade Commissioner Cecilia Malmström, the author is calling for policy between public health and trade goals on medicines, giving a priority to population health

Global Health Initiatives: What Do We Know About Their Impact On Health Systems?

By Angela Owiti Trainee at Wemos foundation

Global Health Initiatives such as GAVI, GFATM and PEPFAR have incurred criticism of being selective and narrowly defined while placing poor emphasis on - and falling short of - health systems strengthening

The Global Rise of Antibiotic Resistance

By Taye T. Balcha, MD, PhD, MPH Director of Armauer Hansen Research Institute in Addis Ababa, Ethiopia, and Donna A. Patterson, PhD Director of Africana Studies and Associate Professor of History at Delaware State University, USA

The authors turn the spotlight on the root causes of the rise of antibiotic resistance worldwide at a time when a global shortage of antibiotics has been reported by the WHO. Relevantly, the article emphasizes some solutions and calls on philanthropies, non-government organizations, regional institutions, states, and the private sector to work together and defeat the global threat posed by superbugs

Medical Ethics and Social Media in Pakistan

By Muhammad Usman Khan WFP’s Technical Consultant to Planning and Development Department

...Still, the fact that doctors hold power over their patients is indisputable. One of the fundamental duty/responsibility of governments, medical boards and hospital administrations in this regard is/should be to ensure that rules are put into place in order to diminish the probability of any abuse of this power...
 ...there are serious institutional questions that need to be addressed here and patient-doctor interaction is more complicated than we would like to believe...
 ...We need to develop a policy framework within which the various facets of patient-doctor relationship are analysed and which forms the basis for nationwide guidelines that help doctors to understand their roles and responsibility better in their social media interactions...

Latinx Who Reside in the U.S. and Availability of Accessible Health Care Resources

By Karen Mancera-Cuevas MS, MPH, CHES Senior Project Manager at Northwestern University, Feinberg School of Medicine, Chicago USA 

Resolving disparities in access to health care suffered from Latinx who reside in the U.S. includes the ability to understand the barriers created as a consequence of limited acculturation which is further compounded by social determinant of health indicators such as living situation, education, and access to social capital

Examining Public Health Positive Preventative Messaging within the Cambodian Press

By Philip J. Gover Director of Health Squared, Phnom Penh and G.J. Daan Aalders Media Intelligence advisor / entrepreneur, Amsterdam

How we think about and view health problems, and what we do about them as a result, is largely determined by how they are reported by television, radio, newspapers and social media. This article refers to a recent study whereby reports by two Cambodian newspapers across a range of key public health issues were analysed in terms of inclusion or absence of Positive Preventative Messages-PPMs (meaning any additional information enabling the reader to understand how the outcome of a story may have differed). As the authors maintain, PPMs shouldn’t be given up since using only naked facts denies the reader of critical information that could help improve health and health literacy

 

The contributions highlighted above add to PEAH internal articles published throughout the year in English or Italian language. Find the links below to English language collection:

Taking a Pill: Not So Counted On in South Africa

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

Review: Textbook of Global Health  

The Venezuelan Powder Keg Floods in the Neighboring Countries

Brazil Crippled by Corruption

EU to Get Rid of Big Pharma-friendly SPCs

Repealing Non-Violation Provisions under TRIPS

See also the following links to Italian language articles:

 Oltre il PIL per la Misura del Benessere Globale

 Proteggere i Diritti Terrieri delle Comunità Indigene per Salvare il Pianeta

 Diritto alla Salute: il Ruolo Vitale della Legge

Antibiotico-resistenza: la risposta OMS

 ‘Orphan Drugs’ Business negli USA: un Monopolio Legalizzato

70ma Assemblea Mondiale OMS Risoluzioni Principali

Sesta Conferenza OMS Ambiente e Salute

Operativi in Italia gli Indicatori BES

 

In the meantime, our weekly page Health Breaking News Links 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.

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*Daniele Dionisio is a member of the European Parliament Working Group on Innovation, Access to Medicines and Poverty-Related Diseases. He is an advisor for “Medicines for the Developing Countries” for the Italian Society for Infectious and Tropical Diseases (SIMIT), and former director of the Infectious Disease Division at the Pistoia City Hospital (Italy). Dionisio is Head of the research project  PEAH – Policies for Equitable Access to Health. He may be reached at d.dionisio@tiscali.it  https://twitter.com/DanieleDionisio 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Health Breaking News: Link 267

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: Link 267

 

Ten Silver Linings in 2017 

Looking Forward: Development in 2018 – CGD Podcast 

Heading for a not so Grand Convergence 

Universal Health Coverage (UHC) Forum 12 – 15 December 2017 

UHC Forum: Dreams of health for all or slogans detached from reality?  

Global trade conference ends without progress 

WTO Ministerial: In Landmark Move, Country Coalitions Set Plans to Advance on New Issues 

Ministerial Conference Eleventh Session Buenos Aires, 10-13 December 2017 Original: English TRIPS NON-VIOLATION AND SITUATION COMPLAINTS DRAFT MINISTERIAL DECISION OF 13 DECEMBER 2017 

Financing for Development: What can be achieved at the 2018 FfD Forum? 

Multiannual Financial Framework : Making the case for a strong EU development cooperation budget 

After the bitcoin gold rush: Could blockchain change the way we give money to charity? 

Tracking the career development of scientists in low- and middle-income countries trained through TDR’s research capacity strengthening programmes: Learning from monitoring and impact evaluation 

‘Drugs are too expensive for the NHS – and people are paying with their lives’ 

Nigeria fake drugs: ‘My patient woke up mid-surgery 

DNDi: 2017 in Review 

MSF challenges Gilead’s patent application for hepatitis C combination treatment in China, to bring down prices 

Drug resistance and treatment failure in leishmaniasis: A 21st century challenge 

Pinprick test designed for Ebola heads for field trial 

UNITAID Call for Proposals: Catalyzing the market introduction of next-generation, long-lasting insecticidal nets (LLINs) 

Call: MRC/DFID African Research Leader scheme 2018 

Surrogate endpoints in global health research: searching for silver bullets? 

Are actions out-of-step to control the ‘tsunami’ of NCDs? 

Heat-not-burn tobacco product use in Japan: its prevalence, predictors and perceived symptoms from exposure to secondhand heat-not-burn tobacco aerosol 

To Address the Opioid Crisis, Build A Comprehensive National Framework 

Sizing Up Health Commodity Markets in Low- and Middle-Income Countries: Take One 

Almost 100 million people a year ‘forced to choose between food and healthcare’  

New data gateway helps developing countries collect crucial information 

Production Diversity, Diet Diversity and Nutrition in Sub -Saharan Africa 

Changing Men: How a Nonprofit and Its Funders Are Looking Upstream to Fight Sexual Abuse 

A Woman’s Voice for Women at the U.N. Agency for Reproductive Rights 

At The Prospect Of Delivering A Child With A Genetic Disorder, Poorer Women May Have Less Information and Fewer Choices 

Rise of Teenage Pregnancy Deters Development Goals 

Canada G7 Presidency to Focus on Women, Gender Equality: Trudeau 

THE MEDICINES PATENT POOL GOVERNANCE BOARD ANNOUNCES CHANGE IN LEADERSHIP AT THE FOUNDATION: EXECUTIVE DIRECTOR GREG PERRY RESIGNS TO PURSUE OTHER OPPORTUNITIES 

Former Medicines Patent Pool Head Greg Perry Joins Pharmaceutical Industry 

Health Breaking News: Link 266

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: Link 266

 

2017’s Word Of The Year In Health Law And Bioethics: Uncertainty 

40 NGOs call on the EU to take action to curb corruption  

In Italy’s refugee centers, NGOs struggle to speak up about corruption 

Life in the camps: the Rohingya crisis 

MSF estimates more than 6,700 Rohingya killed in Myanmar 

Diphtheria in Bangladesh Rohingya camps expected to double every few days 

Scholars at Risk Network 2018 Global Congress April 23 – 26, 2018 Freie Universität Berlin, Germany 

Questioning the Role of Bitcoin for Financial Inclusion 

Can blockchain bridge the economic divide for the developing world? 

Emmanuel Macron says the world is losing the fight against climate change: ‘We’re not moving quick enough’ 

What you need to know about the One Planet climate summit 

How the United States Can Remain Engaged in International Climate Finance 

How Did This Grantmaker Help Reduce Homelessness by 98 Percent? 

Human Rights Reader 430 

Policy Cures G Finder Report 2017: Neglected Disease Research and Development 

Welcome to the G-Finder Public Search Tool 

What is universal health coverage? 

Opinion: 5 ways to make progress towards universal health coverage 

Better Decisions, Better Health: Practical Experiences Supporting UHC from around the World 

Association between infrastructure and observed quality of care in 4 healthcare services: A cross-sectional study of 4,300 facilities in 8 countries 

Sizing Up Health Commodity Markets in Low- and Middle-Income Countries: Take One 

SCP27: KEI statement on pressures faced by Brazil and Colombia in using TRIPS flexibilities 

WHO, World Bank Say Half The World Population Cannot Access Essential Health Services 

Medicines Patent Pool Expands Its Patent Database To Cancer Treatments 

Will New FDA Regulation On IRB Review Speed Patient Access To Experimental Drugs? 

Three-quarters of antibiotics are used on animals. Here’s why that’s a major problem 

Malaria: News from Consortium for Health Action 

The end of HIV: Still a very long way to go, but progress continues 

Brazil Fights H.I.V. Spike in Youths With Free Preventive Drug 

UN health agency launches first global monitoring system for dementia 

EU and Gates Foundation pledge €500 million for innovations in agriculture 

Deaths from window blinds show need for cord ban, study says 

Examining PPMs within the Cambodian Press

 How we think about and view health problems, and what we do about them as a result, is largely determined by how they are reported by television, radio, newspapers and social media. This article refers to a recent study whereby reports by two Cambodian newspapers across a range of key public health issues were analysed in terms of inclusion or absence of Positive Preventative Messages-PPMs (meaning any additional information enabling the reader to understand how the outcome of a story may have differed). As the authors maintain, PPMs shouldn’t be given up since using only naked facts denies the reader of critical information that could help improve health and health literacy

 

By Philip J. Gover

Director of Health Squared, Phnom Penh

G.J. Daan Aalders

Media Intelligence advisor / entrepreneur, Amsterdam

Examining Public Health Positive Preventative Messaging within the Cambodian Press

 

 Background

In recent years, the notion of public health, has been able to draw together and focus the attention of an increased global audience.  Amongst many factors, this shift in awareness can be credited to mainstream media agencies, who have systematically delivered informed, cross border accounts of new, spontaneous and aggressive health conditions.  The outbreak, impact and contemporary control of Ebola, as well as the more recent identification and spread of Zika virus, are good examples of how the media industry in action, can proactively help and impact upon human health.  As such, and combined with improvements in the collection of scientific data, the value and importance of both public health, and public health development, is perhaps now more clearly understood than it has ever been, amongst the global community.

Yet common awareness surrounding the concept of public health remains tied to, and associated with, advances in medicine and pharmaceutical development.  Whilst this view is not necessarily bad, or incorrect, it does detract from an underlying base of knowledge, which explains the recurring and systematic nature of poor population health.  Whilst individual lifestyles, behaviour and patterns of consumption remain important, the evidence to date, routinely identifies that poor health thrives upon poverty, poor social conditions and inequality.

In this sense, the overarching responsibility for improving public health is not stationed within the realm of the medical profession.  Nor should it be.  Public health is, by definition, a shared concept, with obligations that span a variety of social, political and economic agencies.  As such, the future development and optimisation of public health continues rests with an increased awareness of, and commitment to, this shared and interdependent relationship.

Within this collaborative relationship in mind, the media industry can also be understood to play an important and critical role in the development of human health and health related systems.  This is largely because the media is associated with presenting and describing the problems, developments and achievements that exist within both the public spaces, and communities in which we live.  Indeed, how we think about and view health problems, and what we do about them as a result, is largely determined by how they are reported by television, radio, newspapers and social media. This can mean that the ways in which health related behaviours are portrayed and sold in the media, can also be understood as an extremely powerful tool for change.

Yet in this sense, and in relation to more traditional methods of media communication such as newspapers, how can we be sure that enough is being done when the stories that are being published are of critical importance to human health?  Given its inherent value, can we be satisfied with the manner in which  public health incidents that newspapers report on, are communicated in the most meaningful way?  Do newspapers fully understand and embrace the critical role that they play, in the ‘health information supply chain’?  Aside from new pandemic threats, how are those common but often under acknowledged risks, like road traffic accidents and drowning presented to the wider consumer?  How can newspapers ensure that the composition of their stories are sufficiently challenging, engaging and contain enough preventative flavour, so as to eclipse that appetite of simple reader curiosity?

In a recent research report, these questions were considered across a range of key public health issues, as reported by two Cambodian newspapers.  The articles identified for scrutiny, appeared across two 12-month periods, 2013-14 and 2014-15.  All the articles collected for analysis, related to one of six distinct public health themes, namely:

•      Alcohol Abuse

•      Drowning

•      Health in the Elderly

•      Gender Based Violence (Inc. Rape)

•      Road Traffic Accidents

•      Smoking

Positive Preventative Messages (PPMs)

Positive Preventative Messages (PPMs) can often be found in newspaper articles.  PPMs relate to, and add value to the centrality of the storyline, by providing additional information that helps enable the reader to understand how the outcome of a story may have differed.

This informed style of communication and journalism is different from that which typically seeks to collect, compose and report, using naked facts.  PPMs provide a balance to a story, in ways that they help the reader to understand and learn more about the science and critical elements, which underpin the circumstances, that define and characterise the story being reported.

In the absence of a recognised definition, and for the purposes of expanding the subject matter, the authors have adopted the following working definition of a PPM as:

Any term, phrase or collection of words that seeks to inform and/or warn the reader of either a) distinct circumstances, or b) alternative action, that would, could or may have prevented and/or led to a positive alternative outcome.

This working definition was used consistently for the purposes of concision and utility.

The relationship between PPMs and Public Health issues is of particular importance, especially where the known burden of disease, health and social problems are acute.  Given the latent impact that these problems and pressures have on individuals, families, employers and the wider economy, there is further value and justification in scrutinising this relationship.  As health economists routinely point out, where the concept of prevention is absent, society in its entire guise, almost always pays a high and avoidable price.

The inclusion of PPMs within national newspaper stories can be either subtle or explicit, as the fictional examples below illustrate:

Example A:

Police and ambulances were called to the scene, when two motorcycles collided on Thursday morning, on a road, on the outskirts of Takeo. One man, aged 18, was pronounced dead at the scene, whilst the other, aged 54, sustained minor injuries. Both men were commuting to work when the collision occurred.

Example B:

Police and ambulances were called to the scene, when two motorcycles collided on Thursday morning, on a dangerous potholed road, on the outskirts of Takeo. One man, aged 18, was pronounced dead at the scene, whilst the other, aged 54, who was wearing a motorcycle helmet, sustained minor injuries. Both men were commuting, to work, along an unlit road, when the collision occurred. Records illustrate this is the 99th fatal accident to occur, in three months, on this stretch of road between Takeo and Phnom Penh.

These examples serve only to illustrate the explicit contrast that can occur between two stories, when PPMs are adopted. One story, formed using 51 words, is devoid of PPMs, and another, constructed using 86 words, includes 5 PPMs. 35 words are used to construct the PPMs, which in turn, transforms the story.

Findings

 

 

Discussion

If column inches count in the media environment, then some public health thematic areas appear to capture more newspaper attention than others.  Why this happens, is still unknown.  In this respect, Elderly Health, Smoking and Alcohol appeared to be the least demonstrable out of six.  The Cambodia Daily contributed no column inches to news pertaining to Elderly Health across 2014-15, whilst The Phnom Penh Post contributed 1356 words.  Given the nature, knowledge and impact associated with smoking, both newspapers managed to communicate all of their public facing content in no more than 2500 words each.

There is a view that PPMs provide a balance to a thematic story, especially when the subject matter lends itself to preventable public health outcomes.  Reporting stories that are salient to public health, using only naked facts, invariably denies the reader of critical information that could help improve health and health literacy.  In this regard, an important relationship exists between the volume of stories, the volume of words used to construct a published story, and the volume of words used to construct PPMs that are adopted within it.  As a result, the research found that in all thematic areas, distinct contrasts existed in relation to the inclusion of PPMs.  With the exception of Elderly Health, no thematic subject areas dedicated more than 10% of its article word count to PPMs, with the majority falling short of 5%.

From the published articles that were subject to audit, it was clear that the nature of the journalism employed carried a distinct style.  It was found that significant and compelling opportunities, from which increased intervention and advocacy could have been used and communicated to the reader were absent.  In this sense significant opportunities appear to have been lost.

It is the authors’ observation that the journalism under audit, carried with it a simplistic view of what a theory of change involves.  The idea of pointing out social problems and awaiting external reform, seems a weak approach to a subject matter that exists in an environment whose population, poverty and burden of disease is well documented.

The authors suggest that an improved and positive theory of change be included as and adopted as a key element of quality assurance amongst journalists reporting on public health issues.  This approach could help fully engage the reader with information, evidence and a scope of opportunity, which can help in numerous ways, least of all, in ways that hold the subject matter to account.  This style of journalism can be achieved without necessarily drifting into the territory of campaigning or lobbying.

 

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The full article, containing detailed analysis of each subject area is available here:  https://goo.gl/pMnPGp

 

Authors:

Philip J. GOVER is the Director of Health Squared (UK).   Graduate from Durham University Business School (UK), with an MA (Business Enterprise Management).  Additional academic studies include an MPH (Public Health) from the University of Northumbria (UK), and a BA Hons’ in Community Development from Durham University. He is a Fellow of the Royal Society for Public Health and a Fellow of the Chartered Management Institute. He has worked in developing countries in East Africa, South East Asia and various youth settings across Europe. Following 3 years’ involvement with Northumbria University Sustainable Cities Institute, he spent 12 years working as a Senior Public Health Manager with the UK NHS. Philip is a Founding Member of Health Squared, a UK Social Enterprise and Public Health Consultancy. Philip can be reached via phil.gover@healthsquared.org.

G.J. Daan AALDERS, the former director of Media Matters, graduated from VU University Amsterdam with an MSc (Political Science). He has over 8 years’ experience working in the media sector for a range of large clients across Europe and the US and is the founder of Media Matters International, a Hong Kong based research agency that provides a wide range of media services with a particular focus on Asia. In 2011, he started operations with Media Matters International in Cambodia, providing a range of clients across Europe and Asia with daily press reviews and strategic analytic media insights. Using a unique database developed for advanced analysis, Media Matters analysts have translated and analysed over 25,000 newspaper articles from Khmer and English language newspapers in Cambodia. Daan can be reached via daan@mediamatters.asia

Health Breaking News: Link 265

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: Link 265

 

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