IHSJ Reader, August 8, 2011
Posted on Aug 8, 2011
IHSJ Reader August 2011 Issue 6
Note:Triple asterisk (***) indicates subscription-only sources.
NON-COMMUNICABLE DISEASES
***A World of Chronic Disease (Sara Reardon, Science, July 29, 2011)
Non-communicable diseases (NCDs) like cardiovascular disease, cancer, diabetes, and asthma now kill more people worldwide than all other causes combined, with 80% of these deaths occurring in low- and middle-income countries. The United Nations will convene a high level meeting in September to address this global NCD epidemic with a focus on four major risk factors that affect large populations (tobacco, alcohol abuse, lack of physical activity and poor diets). However, cardiologist Gene Bukhman warns that by lumping NCDs together, the poorest billion who struggle with poverty-related risk factors are further marginalized from the global response to prevent and treat non-communicable diseases.
HEALTH SYSTEMS STRENGTHENING
Partners In Help: Assisting the Poor Over the Long Term (Paul Farmer, Foreign Affairs, July 29, 2011)
Adapted from his May 2011 commencement speech at the Harvard Kennedy School of Government, in this article Paul Farmer further defines the practice of “accompaniment”. True accompaniment, Farmer argues, “does not privilege technical expertise above solidarity or compassion or a willingness to tackle what may seem to be insuperable challenges.” Instead, accompaniment “requires cooperation, openness and teamwork… sticking with a task until it is deemed completed by the person being accompanied.” In a time of renewed focus on aid effectiveness, PIH’s longstanding approach which is human rights-based and which prioritizes the accompaniment of government and local partners, serves as an important guide for international actors committed to an equitable future in Haiti and beyond. The article is adapted from his May 2011 commencement speech at the Harvard Kennedy School of Government
Improving Sanitation, Still a Long Way to Go (Aimable Twahirwa, Inter Press Service News Agency, July 22, 2011)
Nearly half of the world’s population lacks access to basic sanitation, and 1.9 million people die every year from diarrhea. In Africa, Rwanda is one of only four countries that are on track to achieve Millennium Development Goal 7, which includes halving the population that doesn’t have access to safe drinking water and basic sanitation. By addressing the issue of sanitation through local initiatives, 61% of Rwanda’s rural population has improved access to potable water and 20% has improved access to sanitation. The Rwandan government’s strong vision and leadership has helped galvanize sustainable solutions for hygiene and sanitation.
WOMEN’S HEALTH
Maternal Deaths Focus Harsh Light on Uganda (Celia Dugger, The New York Times, July 29, 2011)
The recent deaths of two Ugandan women while seeking delivery care at public hospitals have received widespread criticism within Uganda and have led to a lawsuit against the government for violating these women’s right to life. This tragedy reflects the larger crisis of maternal mortality within Uganda: approximately 5,200 maternal deaths occurred in the country in 2008 alone, making Uganda one of the twenty-one countries in the world in which 80% of maternal mortalities occur. With aid narrowly focused on disease-specific programs, broader health systems remain weak and underfunded. The result is drastic shortages of health workers such as midwives and obstetricians, equipment and supplies.
FOREIGN AID REFORM
The United States Development Assistance Committee: 2011 Peer Review (Organization for Economic Co-operation and Development, July 2011)
In addition to increasing the total amount of foreign assistance available to fight hunger, disease and poverty, the U.S. could maximize contributions by implementing reforms laid out by the OECD. Key recommendations include improving coordination amongst the 25 U.S. agencies involved in development to avoid duplication and strengthening the role of USAID. Though the U.S. has made progress in increasing resources for development assistance, from 0.1% of gross national income (GNI) in 2001 to 0.21% in 2010, the U.S. is far from meeting the U.N. target of allocating 0.7% of its GNI to aid.
Modernizing the Foreign Assistance Act of 1961 (Rep. Howard Berman, Modernizing Foreign Assistance Network, July 2011)
In this post, Congressman Berman, former Chairman and now Ranking Member of the House Foreign Affairs Committee (D-CA), calls upon the U.S. Congress to overhaul the Cold War-era Foreign Assistance Act of 1961. Foreign aid is a critical tool in the fight against global hunger, poverty and disease, but in the 21st century we need to evaluate how well aid projects are implemented and ensure that they are coordinated with national plans and other donors. Partners In Health has provided feedback on Rep. Berman’s previous draft legislation and continues advocating for a rights-based approach to development that prioritizes local public sector capacity-building and results-based, pro-poor development assistance.
FOOD SECURITY
Escaping from Somalia's Famine into a Perilous Refuge (Samuel Loewenberg, TIME, August 03, 2011)
Journalist Sam Loewenberg reports on the heart-wrenching humanitarian situation at a refugee camp in Kenya where hundreds of thousands of Somalis have relocated and are arriving daily to escape the drought and famine in their own strife-torn country. Over 29,000 children under 5 years old have perished in just the past few months. The current situation, with extremely high levels of acute malnutrition and mortality, represents the worst nutrition crisis in Africa since the 1991--1992 famine in Somalia.
GHI targets chronic malnutrition in Guatemala (Lomi Kriel, Global Post, July 18, 2011)
Though Guatemala has the highest GDP in Central America, it simultaneously suffers from the greatest prevalence of chronic malnutrition in the western hemisphere, and the third highest rate of chronically malnourished children in the world. In the short term, U.S. foreign assistance is critical to fighting some of the highest rates of stunting in the world. Aid channeled through the Global Health Initiative and Feed the Future have begun targeting food insecure regions such as El Quiche, where seventy percent of children under five are chronically malnourished. Long-term measures including land reform and improved conditions for the historically subjugated Mayan population will be critical to overcoming centuries of mistreatment.
International Food Assistance: Funding Development Projects through the Purchase, Shipment, and Sale of U.S. Commodities Is Inefficient and Can Cause Adverse Market Impacts (GAO, June 23, 2011)
This GAO report finds that monetization—or the process of using foreign aid to purchase U.S. agricultural commodities for NGOs to sell on local markets to fund their development work—diverted $219 million from the U.S. food aid budget over a three year period. Not only is monetization inherently inefficient, but it often forces NGOs to undermine local livelihoods by driving down prices and/or underselling local farmers with highly subsidized U.S. commodities. Legal requirements that 75 percent of food aid be shipped on U.S. maritime vessels were also found to divert critical resources necessary to address food security. GAO findings only reinforce PIH’s position that food aid must be untied from U.S. procurement and shipping, as other donor countries have done. For more concrete recommendations from PIH and our colleagues, please see “Sak Vid Pa Kanpe: The Impact of U.S. Food Aid on Human Rights in Haiti.”
Agriculture Accountability: Holding Donors to their L’Aquila Promises (ONE International, July 11, 2011)
In the wake of the 2007-08 global food crisis, the G8 and five other donors responded by committing to deliver $22 billion in financing for agriculture and food security within three years. This report investigates the promises made by the G8 and the European Commission, and finds that donors remain severely below their promised donations. Two years into the pledge, only 22% of funds have been disbursed. In addition to calling for donors to fulfill their pledges, the G20 and developing countries themselves need to play a central role in strengthening development and food security.
Empty Promises, Empty Stomachs (Roger Thurow, Global Food for Thought, July 15, 2011)
In response to the release of ONE’s report on the failing commitment of L’Aquila pledges, Roger Thurow ties these unfulfilled pledges to the food crisis devastating the horn of Africa. In the two years since the G8 promised $22 billion in financing for agriculture and food security, the number of people in Somalia, Kenya, Ethiopia, Djibouti and Uganda in dire need of emergency food aid has nearly doubled from 6.3 million to 10 million. This dramatic increase cannot be ignored and should be an impetus for wealthy countries to disburse their pledges without further delay.
***Estimated Deaths Attributable to Social Factors in the United States (Sandro Galea, Melissa Tracy, Katherine Hoggatt, Charles DiMaggio, Adam Karpati, American Journal of Public Health, June 16, 2011)
A recent study on the underlying social determinants of health in the U.S. calculated the number of adult deaths attributable to “big social factors” such as poverty and inequality. The analysis quantified the relative risk of mortality for six social factors with astounding results: “245,000 deaths… attributable to low education, 176,000 to racial segregation, 162,000 to low social support, 133,000 to individual-level poverty, 119,000 to income inequality, and 39,000 to neighborhood poverty.” The results are comparable to those for the leading pathophysiological causes—such as 193,000 deaths a year due to heart attack—and behavioral causes—such as 400,000 deaths a year due to smoking. Though public health campaigns and biomedical interventions are critical to the prevention and treatment of disease, they must be accompanied with political and economic interventions to curb the gross disparities in national health outcomes.
A Worker with No ID and Great Medical Need (Sanjay Basu, New York Times, August 1, 2011)
Access to health care is a basic right for all people. It is also one of the rights most frequently stripped from the marginalized poor, particularly within immigrant populations. In this telling New York Times post, Dr. Sanjay Basu, co-founder of Nyaya Health, recounts the story of one of his patients, Carlos. Carlos was an undocumented, uninsured migrant laborer from Mexico whom Dr. Basu treated regularly in his mobile clinic. When Carlos developed a growth in his neck, Dr. Basu struggled but was ultimately unable to connect him with a timely biopsy and proper medical care. This narrative illustrates the injustices in healthcare that persist in the United States.
