IHP News 543 : “We Need a Greta As Well !”

IHP news 543 : “We need a Greta as well !”

( 18 October 2019)

The weekly International Health Policies (IHP) newsletter is an initiative of the Health Policy unit at the Institute of Tropical Medicine in Antwerp, Belgium.

Dear Colleagues,

This week, with many of you probably already looking forward to the World Health Summit in Berlin, we come back on the Global Fund replenishment from last week (among others, with a Featured article from Stéphanie Tchiombiano, Coordinator of the French think tank Santé mondiale 2030 ) ; cover the start of the IMF/WB annual meetings ( The Bretton Woods conference took place 75 years ago, so this is sort of an ‘anniversary’, albeit a gloomy one); World Food Day (16 Oct) and of course provide you with the usual digest of the main other global health policy news & publications (including a new Global TB report ).

With multilateralism in crisis (the UN’s current cash- flow crisis is a rather wry symbol of our times - the 75th anniversary of the UN in 2020 looks grim, for now ) and people all over the world protesting in the streets (at least if they’re allowed to, and police & government don’t crack down on them ), many in the development & aid sector are wondering what we can learn from the impact of Greta Thunberg and the global climate strikes. Check out for example this analysis on Open Democracy, What INGOs can learn from Greta Thunberg and the global climate strikes. A quote: “ While Greta Thunberg has mostly targeted governments and multilateral bodies for their failure to tackle the climate crisis, the global Climate Strike Movement her Friday protests have inspired may also have inadvertently exposed the shortcomings of international non-governmental organisations (INGOs). With the kind of global reach and popular mobilisation of which most INGOs can only dream, the climate strikes have succeeded in catapulting the climate crisis to the top of the political and media agendas. In the process, this movement has exposed the lack of critical interrogation by INGOs of government and corporate inaction to reduce global warming, and shed light on the growing inertia of an INGO sector that trades in incremental change rather than systemic political and economic transformation. …”

In global health circles, you often hear nowadays “We need a Greta as well” – for this or that lofty cause, whether it’s AMR, NCDs, …. Presumably, to raise awareness and start a global movement on ‘their’ cause as well. But as the abovementioned quote makes clear, ‘being a Greta’ has rather “disruptive” implications in terms of the transformative change one should advocate for, the ‘partners’ one should (perhaps better not?) seek, and the likelihood of ‘win-wins’ while fighting for global health. Perhaps a good question to dedicate an abstract or even session to, in Dubai? What does being a Greta for global health, HPSR, the SDGs … really imply? What would a global health Greta think of the Global Fund replenishment, by the way (PS: the GF PR team seems to take a sardonic pleasure in widely advertising its collaboration with Coca Cola )? And more importantly, how can we all become more like her, uncompromising when evidence asks us to, in order to really get to Health for All on a now rapidly warming planet ?

Or, as Billie Eilish would probably sing, “All the Gates girls (& Bono boys) go to hell ... ‘Cause even God herself has enemies. “ 

Enjoy your reading.

Kristof Decoster

Featured Article

What can we learn from the 6th Global Fund Replenishment Conference in Lyon?

Stéphanie Tchiombiano, Associate Lecturer, Paris 1 Pantheon Sorbonne and Coordinator of the French think tank Santé mondiale 2030

Funding for the Global Fund to Fight AIDS, Tuberculosis and Malaria is based on the organization of conferences during which various donors (States and private actors) make financial commitments for the next three years. After Canada (in 2016), France just hosted the latest edition, on October 9 and 10, 2019, at the Centre de Congrès in Lyon, under the slogan "Step Up the Fight".

A financial mobilization unprecedented in the history of health

Never before has an international organization dedicated to health succeeded in mobilizing such a large amount of money. This mobilization is all the more important as it takes place in a context where the United Nations system, including WHO, has difficulty in securing funding. The target was to mobilize at least USD $14 billion (€12.7 billion), which the Global Fund estimates will save an additional 16 million lives. This financial target (considered insufficient by some) has almost been reached, with USD 13.928 billion in commitments at the conference and an additional USD 100 million to be sought by December. The slogan of a 15% increase in contributions over the previous conference in Canada was generally heard (USD $12,9 billions were pledged in Montreal).

A real happening

Delegates from all over the world will have been on the alert throughout the conference. In the morning, Emmanuel Macron announced in his speech that the situation was critical, that the full amount wasn’t there yet, but that "no one would leave Lyon until we reach 14 billion", calling on delegates to "put pressure", announcing that he was going to make relentless phone calls and even citing by name certain States that "could do better": "Call in your capitals. Harass the countries I mentioned. Go help me get the money within three hours.” With the finish line in sight, several countries made an additional gesture (including France, which finally increased its contribution by 20%, under strong pressure from the NGO sector, which demanded a 25% increase), following the momentum of "Peter, Bono and Bill", as all three of them went on stage calling for increased funding: Peter Sands, the director of the Global Fund, Bono (the singer of U2, co-founder of the initiative (Red) and Bill Gates, the American billionaire who added $60 million in the final sprint. This symbolic staging

and last-minute donation obviously helped to reinforce Bill Gates' (problematic) weight in the global health ecosystem.

Strong engagement of civil society and the scientific community

One of the particularities of this replenishment conference was the mobilization of many actors, beyond the official delegations (several African heads of state were present): the organization of about fifteen side events, a "Die In" by the French association “Aides” in front of the Congress Centre, various stands, etc. The official ceremony was marked by a strong tribute to Kofi Annan (considered one of the founding fathers of the Global Fund) and by the intervention of several Nobel Prize winners, including Françoise Barré-Sinoussi (Nobel Prize in Medicine in 2008 for discovery of the HIV virus), who made a strong appeal to strengthen links between researchers, political decision-makers and field actors: "We need science".

Several African countries decide to finance the Global Fund

One of the highlights of this replenishment conference was the decision of many African countries to help finance the Global Fund. While some countries such as Côte d'Ivoire and Senegal were already donors, others such as Niger, Chad and the Central African Republic now also committed to financing the Global Fund (USD 1 million for the first two and USD 500,000 for the third), becoming both donors and recipients of the Global Fund. Several international NGOs, such as Catholic Relief Services, Cordaid or Plan International, are now also members of the Global Fund's donor club (from which they in turn receive many funds in the countries of intervention). The financial flows of international aid sometimes make surprising detours.

Inability to mobilize beyond the G7 countries & failure to get a substantial financial contribution from the private sector (minus the Gates Foundation)

The Global Fund remains very dependent on the US government, which is responsible for exactly one third of its budget (USD 4.680 billion) for the next three years (the US Congress having set itself the firm rule of not financing more than one third of the global budget). Next, come the United Kingdom (USD 1.716 billion), France (USD 1.429 billion) and Germany (USD 1.102 billion). The general dynamic of the event and the personal investment of Emmanuel Macron (who was said in the corridors of the congress centre to have "done the job", together with Peter Sands’ team) did not succeed in mobilising new countries, beyond the G7 countries, and in particular the BRICS, which remain absent (Brazil, Russia) or very cautious (China, India, South Africa). Similarly, private sector actors remain very marginal funders, accounting for only 5% of the overall budget ( and they are almost non-existent if the Gates Foundation is removed) even though the Global Fund systematically emphasizes its "public- private" nature and the word "innovation" was certainly the word most often mentioned at the conference (together with the word "Bill"?).

In any case, the bet has paid off for France, which, by hosting this conference, seems to have regained its place among the "countries that count" within the Global Fund. It will have to move into action and support this financial effort with a mobilization at the highest level for global health issues in the coming months. The dynamic created by the replenishment conference should not only launch a new French dynamic in global health but also lead to a more in-depth reflection on the future of the Global Fund.

Highlights of the week

Annual meetings IMF/WB week (14-20 October) & 75 years “Bretton Woods”

Analysis ahead of the IMF/WB meetings

Devex - 5 questions for the World Bank and IMF Annual Meetings Devex;

“David Malpass and Kristalina Georgieva [will] preside over their first World Bank and International Monetary Fund Annual Meetings as the heads of their respective institutions this week. World Bank President Malpass, who has been in his role for six months, previewed his priorities last week with a call for better development coordination at country-level, something he sees as a key role for the World Bank. IMF Managing Director Georgieva, in her own curtain-raiser speech, raised alarms about the cost of trade disputes for the global economy, and brought some of her focus on fragile states from her recent experience as World Bank CEO to the Bretton Woods sibling institution across the street….”

The 5 questions raised in this analysis pertain to the WB’s IDA (International Development Association) replenishment (& debt anxiety in many LMICs), the Bank & climate change, & transparency/accountability; whether the ‘human capital’ agenda (from Jim Kim) still means something under Malpass; and finally, PEF 2.0 (given that PEF 1.0 hasn’t exactly been a success in the Ebola DRC outbreak).

Bretton Woods Project - 2019 Annual Meetings Preamble https://www.brettonwoodsproject.org/2019/10/2019-annual-meetings-preamble/

“As the Bretton Woods Institutions reach 75, much-needed critical reflection is still missing.”

“…The BWIs’ leadership contests and the expected announcement of failure of the IMF’s 15th quota reform at this Annual Meetings should not be viewed in isolation, but through the lens of what the GRR asserts are deepening fissures in the international system” that threaten the stability of the global system. As the BWIs wrestle to stay relevant within a broader ‘crisis of multilateralism’, more attention must be paid to their own role in helping to create it.” This analysis also provides some key attention points in this week’s annual meetings (from a more critical perspective).

And for an analysis of Georgieva’s likely priorities at IMF, see the Guardian - Georgieva’s brave new agenda at IMF threatened by economic storm clouds

“… the world’s finance ministers and central bankers [will] be in Washington this week for the annual meetings of the International Monetary Fund and World Bank amid growing concerns that the global economy is heading towards stagnation. Predictions of a sharp downturn fill policymakers

with anxiety, knowing that job losses and lower tax revenues can only lead to social unrest. Last week the IMF’s new leader, Kristalina Georgieva, asked nations involved in tit-for-tat trade wars if they dare ignore warnings of the most serious threat to the global economy since the financial crisis. However, her agenda goes beyond the short-term difficulties posed by a downturn. Beginning her five-year tenure as managing director and chairwoman of the IMF’s executive board, she said the organisation’s long-term objectives included “dealing with issues like inequalities, climate risks and rapid technological change.” Georgieva, previously number two at the World Bank and a Bulgarian national, is known for her commitment to tackling the climate crisis…”

Gender equality will also be a key priority of her (and IMF’s role in boosting it). See for example a new IMF blog (by Georgieva et al) - The Economic Cost of Devaluing “Women’s Work” on issues such as promoting women’s leadership, redistributing the burden of unpaid care work, and equitable labor access. See also Reuters - 'Buckle up:' New IMF chief vows 'relentless' focus on gender equality

Some news & reports (+ analysis) from the annual meetings Guardian - The IMF thinks carbon taxes will stop the climate crisis. That's a terrible idea

“On Thursday, the IMF suggested a $75-per-ton global carbon tax is the most efficient way to fight greenhouse gas emissions and keep warming below 2C.” K Aronoff argues: “The IMF’s proposed $75-per-ton tax would exacerbate rampant inequality. There are better ways to fund decarbonization.” My take: all her ideas on where to get the money are great, but we should combine them with a high carbon tax (and make sure it’s done in a socially fair way).

Bloomberg - Africa May Have 90% of the World’s Poor in Next 10 Years, World Bank Says

“Africa could be home to 90% of the world’s poor by 2030 as governments across the continent have little fiscal space to invest in poverty-reduction programs and economic growth remains sluggish, the World Bank said. That’s up from 55% in 2015 and it will happen unless drastic action is taken, the lender said in its biannual Africa Pulse report released Wednesday, in which it also cut growth forecasts for the region’s key economies….”

Devex - Is the World Bank aligned with the Paris Agreement? They're not sure yet.

“The World Bank and other multilateral development banks are trying to come up with a shared definition of what it means to “align” with the Paris climate agreement.”

“The World Bank and other multilateral development banks have sought to position themselves at the forefront of financing climate action, supporting a wide range of activities in low- and middle- income countries. They are now under pressure to show that the big picture of their investments is helping put countries on low-carbon pathways that can make the Paris Agreement targets a reality. The first challenge is to arrive at a shared understanding of what “Paris alignment” means for the multilateral development banks….”

Quick links on the annual meetings

• Devex - Q&A: What donors and clients want from IDA19

• IMF World Outlook 2019 - World Economic Outlook, October 2019: Global Manufacturing Downturn, Rising Trade Barriers “ Global growth is forecast at 3.0 percent for 2019, its lowest level since 2008–09 and a 0.3 percentage point downgrade from the April 2019 World Economic Outlook….” • Bretton Woods Project - Bretton Woods at 75: series of (5) critical essays related to the anniversary.

World Food Day (16 October), Global hunger report & malnutrition & obesity

Guardian - Higher temperatures driving 'alarming' levels of hunger – report https://www.theguardian.com/global-development/2019/oct/15/higher-temperatures-driving- alarming-levels-hunger-report-climate-crisis

“The climate crisis is driving alarming levels of hunger in the world, undermining food security in the world’s most vulnerable regions, according to this year’s global hunger index. The annual report, a ranking of 117 countries measuring hunger rates and trends, shows progress since 2000, but warns that the world still has a long way to go to reach the zero hunger target agreed by world leaders by 2030. The report is published as a series of committee on world food security meetings take place in Rome in the run-up to World Food Day on 16 October. The findings show levels of hunger are “serious” or “alarming” in 47 countries, and “extremely alarming” in one: the Central African Republic. Rates are categorised as “alarming” in Chad, Madagascar, Yemen and Zambia. Nine countries have worse scores today than in 2010 – the Central African Republic, Madagascar, Venezuela, Yemen, Jordan, Malaysia, Mauritania, Lebanon and Oman….”

See also HPW - Climate Change Exacerbating Global Hunger

“Some 822 million people worldwide suffer from hunger, and climate change is driving rising food insecurity in countries struck by worsening patterns of drought, flooding and other extreme weather that reduces crop yields and livestock production among for the rural poor, as well as causing food price spikes for urban populations, according to the 2018 Global Hunger Index (GHI), released on Tuesday….”

And via, of all people, Bob Geldof - “…The German government aims to catalyse the global response. Next June it will host an international event to push for action to boost agriculture and tackle hunger in low-income countries, while staying within the environmental boundaries of what our planet can cope with….”

UN News - 'Alarmingly high' number of children malnourished worldwide: UNICEF report https://news.un.org/en/story/2019/10/1049261

“Across the globe, at least one-in-three children under-five are malnourished and not developing properly, UNICEF revealed on Tuesday, in its most comprehensive report on children, food and nutrition in 20 years. “An alarmingly high number of children are suffering the consequences of poor diets and a food system that is failing them,” the UN children’s agency (UNICEF) warned. Around 200 million children under-five are either undernourished or overweight, while one-in-three globally - and almost two-thirds of children between the fragile ages of six months to two years - are not fed food that nurtures proper development, The State of the World’s Children 2019: Children, food and nutrition, found. “

Lancet Editorial – Child nutrition: the need for courageous action https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32323-2/fulltext

Among others, in response to the abovementioned UNICEF report.

“The report clearly quantifies the huge burden, but its suggestions to address malnutrition are largely a combination of the old (improve education on nutrition, provide food vouchers), the vague (“understand and leverage family and community dynamics”), and the weak (“…food producers should be discouraged from marketing nutrient-poor, sugar-rich, and highly processed food…”). UNICEF's leaders have defended the organisation's record on health in a letter published online in The Lancet [see below], identifying inadequate domestic spending on health and lack of donor support for multilateral agencies as barriers to “achieving much more” for children. If UNICEF had put these criticisms of governments at the heart of its work on malnutrition, its call to action would have been more forceful. As it stands, the report is unlikely to gain traction….”

The Editorial concludes: “Childhood malnutrition is a burgeoning public health disaster. It is only with courageous new ideas, and clear lines of independent accountability, that there is any chance of meaningful progress.”

UN agencies' consensus on healthy diet principles V Chadwick & J L Ravelo; https://www.devex.com/news/un-agencies-consensus-on-healthy-diet- principles-95828

“With some form of malnutrition affecting 1 in 3 people and costing an estimated $3.5 trillion each year, the United Nations’ agriculture and health agencies have released guidance to countries on what constitutes a sustainable, healthy diet. Their guiding principles, out this week following an expert consultation in July, offer a roadmap for policymakers, Nancy Aburto, deputy director in the nutrition and food systems division of the U.N. Food and Agriculture Organization, told Devex on Tuesday in Brussels. …. …. The principles include: favoring breastfeeding; a variety of unprocessed or minimally processed foods; limiting greenhouse gas emissions; minimizing use of packaging, and food waste; and avoiding time-intensive buying and preparation of food, which can adversely affect women. Aburto said the document does not stipulate steps as specific as a sugar tax, because that “may not be the solution in a particular country.”…”

UN News - Obesity rates soar due to dramatic global diet shift, says UN food agency https://news.un.org/en/story/2019/10/1049361

“Eating food high in starch, sugar, fats and salt; combined with a sedentary lifestyle, is a recipe for soaring global obesity rates, even in countries where many still suffer from hunger. On World Food Day, which falls on Wednesday, the UN’s food agency, FAO, is calling for action to make healthy, sustainable diets affordable and accessible for all.”

We now face a “… situation whereby almost 800 million people are considered obese, and over 40 million children under-five are overweight. The health costs of unhealthy eating habits – blamed as the leading cause of diabetes, heart disease and certain cancers – are estimated at around $2 trillion per year. At the same time, some 821 million people are still suffering from hunger across the world, with numbers increasing over the past three years, and around one in three children are malnourished and not developing properly: in some parts of Africa, hunger has risen by almost 20 per cent….”

Global Fund replenishment Lyon – Overview pledges & more analysis

Global Fund Sixth Replenishment pledging conference sees historic private sector contribution plus pledges from 23 implementing countries http://www.aidspan.org/gfo_article/global-fund-sixth-replenishment-pledging-conference-sees- historic-private-sector

Here you get a detailed overview of all public & private & Non-government pledges/commitments. Recommended.

For the List of all pledges, see also the Global Fund. 75 in total.

Lancet World Report – Global Fund secures US$14 billion from donors https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32333-5/fulltext

“The Global Fund achieved its replenishment target, but it has called for substantial increases in domestic financing by developing countries. Ann Danaiya Usher reports.”

“…The fund's investment case assumes that $101 billion will be required during 2021–23 to enable a trajectory towards ending all three epidemics by 2030. This amount represents 82% of the total resources required. “An additional $18 billion would be required to entirely close this gap”, the fund's investment case states. The Global Fund estimates that $23 billion of the $101 billion will be provided by multilateral and bilateral donors whose support is projected to remain unchanged over the coming 3 years. The other crucial element of funding is domestic financing from the

governments of developing countries which, according to the Global Fund, must grow by 48% to $46 billion. In other words, governments must increase their own budgets for combating the three diseases by 14% each year for the next 3 years. Sands says that this goal is realistic given that countries' co-financing commitments for 2018–20 were 41% greater than those for the 2015–17 cycle.

Both MSF (Mit Philips) & Amanda Glassman have huge doubts on whether this is indeed feasible…

Some other GF related news:

• Aidspan - Global Fund resumes funding to the Democratic People’s Republic of Korea • Aidspan - ( Analysis by C Boulanger) Civil Society engagement in the Sixth Replenishment campaign: A unique example in the world of global health • HPW - Bringing Health Innovations To Market Is Key In The Global Fight Against HIV/AIDS, Malaria And Tuberculosis

Report on a side event at the GF replenishment: “The global health community needs to scale-up collaborations with product development partnerships (PDPs) that could bring life-saving innovations for prevention, diagnosis, and treatment of HIV/AIDS, Malaria and Tuberculosis to market faster, said health experts at a side event ahead of the Global Fund’s Sixth Replenishment Conference….”

PS: Fans of Voltaire’s language, might also want to read Valéry Ridde’s Les paradoxes français de la santé mondiale - Analysis of 4 paradoxes – a reflection written in the aftermath of the GF replenishment.

ITM colloquium – Connecting the dots (9-10 Oct)

IHP - Perception shifts at the 60th ITM Colloquium, Antwerp

Helen Anyasi; https://www.internationalhealthpolicies.org/blogs/perception-shifts-at-the-60th-itm- colloquium-antwerp/

A first blog on the colloquium of last week, and well worth a read. Helen Anyasi, while giving a quick overview of the colloquium, including keynotes & key quotes, emphasizes that the main purpose of events like this is: “…. Aside from being a forum where questions like the ones above can be earnestly

discussed (eg. Decoloniality), I see that what it does is create space for new categories in our thinking in very subtle, almost imperceptible ways. “ Shift minds, so to speak.

While waiting for a next blog (scheduled for early next week), do check out also the very nice 2- minute Youtube video on the colloquium. Even featuring our Belgian queen!

Global TB report

WHO – 7 million people receive record levels of lifesaving TB treatment but 3 million still miss out https://www.who.int/news-room/detail/17-10-2019-7-million-people-receive-record-levels-of- lifesaving-tb-treatment-but-3-million-still-miss-out

“More people received life-saving treatment for tuberculosis (TB) in 2018 than ever before, largely due to improved detection and diagnosis. Globally, 7 million people were diagnosed and treated for TB - up from 6.4 million in 2017 – enabling the world to meet one of the milestones towards the United Nations political declaration targets on TB. WHO’s latest Global TB Report says that 2018 also saw a reduction in the number of TB deaths: 1.5 million people died from TB in 2018, down from 1.6 million in 2017. The number of new cases of TB has been declining steadily in recent years. However, the burden remains high among low-income and marginalized populations: around 10 million people developed TB in 2018….”

• For the report, see here.

• Coverage HPW - World Falling Short Of 2020 Targets For ‘End TB’ Strategy

• Read also Madhukar Pai’s take on the report (Forbes) - Fighting TB: Slow Progress Should Ignite Action Among others, on the persistent access track, the fact that the world is not on track to reach the 2020 targets, the TB funding gap…

He concludes: “For too long, the TB response has been top-down, medicalized and run with a public health (not human rights) perspective. It is time for the TB community to put patients and

communities at the center of the global response, and adequately support them, to harness their power…”

Randomistas win economics Nobel

Nature - Randomistas' who used controlled trials to fight poverty win economics Nobel https://www.nature.com/articles/d41586-019-03125-y

Just in case you missed this. “Abhijit Banerjee, Esther Duflo and Michael Kremer have been awarded the prize for their experimental approach to alleviating poverty.”

“Three economists who used randomized controlled trials to determine how best to lift people out of poverty and improve their health have been awarded this year’s Nobel prize in economic sciences.

“….Kremer, Banerjee and Duflo are at the vanguard of the ‘randomista’ movement, which applies the methods of rigorous medical trials — in which large numbers of participants are randomized to receive either a particular intervention or a standard treatment, and followed over time — to social interventions such as improving education.”

In the case of Duflo, there were also many positive comments on her being the second woman only so far to receive a Nobel prize economics (after E Ostrom).

Read some more analysis to put this prize in perspective:

• CGD (blog) (by P Jakiela) - A Nobel Prize for the Randomistas • Quartz India - Why did Banerjee, Duflo, and Kremer win the Nobel prize this year?

“Through the award, the Nobel committee recognised both the significance of development economics in the world today and the innovative approaches developed by these three economists….”

And from a somewhat more critical angle:

Oxfam’s F2P blog - The Randomistas just won the Nobel Economics prize. Here’s why RCTs aren’t a magic bullet.

Duncan Green offers an overview of some FP2P links to various sceptical views of RCTs going back several years.

Vaping

Stat News - Vaping-related illness has a new name: EVALI https://www.statnews.com/2019/10/11/vaping-related-illness-has-a-new-name-evali/

“The vaping-related condition that has sickened hundreds of people has a new name: EVALI, or e- cigarette or vaping product use-associated lung injury. The new name, noted Friday in newly issued guidance for clinicians from the Centers for Disease Control and Prevention, is a sign of the rapidly evolving investigation into the illness, which has sickened 1,299 people across 49 states, Washington, D.C., and the U.S. Virgin Islands….”

Planetary Health

Lancet Planetary Health (October issue) https://www.thelancet.com/journals/lanplh/issue/vol3no10/PIIS2542-5196(19)X0012-1

In addition to the Editorial - Looking for leaders (with the Lancet PH’s implicit agreement with Extinction Rebellion and all other climate activists taking to the streets now, rebelling) we recommend in particular: Planetary health: from concept to decisive action (by M Pongsiri, A Haines et al)

Excerpt:

“For planetary health to realise its potential in advancing systems thinking and acting for the SDGs, the growing planetary health community should propose an integrated approach to implement planetary health in a coherent manner while continually strengthening and updating the evidence base on the broad landscape of natural systems and human health interactions. Any proposed approach should link strategically to existing policy processes for sustainable development (ie, the SDGs), health (ie, the WHO Global Strategy on Health, Environment and Climate Change and WHO Health Emergency and Disaster Risk Management Framework), environment (the United Nations [UN] Environmental Assembly resolutions on environment, health, and pollution issues), climate change (ie, The Paris Agreement), disasters (ie, The Sendai Framework for Disaster Risk Reduction), biodiversity (ie, the post-2020 global biodiversity framework), and others under relevant multilateral environmental agreements….”

NYT - Extinction Rebellion and the Birth of a New Climate Politics

D Wallace-Wells; http://nymag.com/intelligencer/2019/10/extinction-rebellion-and-the-birth-of-a- new-climate-politics.html

Sharp analysis of the “new climate politics”.

Excerpts: “One striking feature of these movements is that, unlike even recent bursts of environmental activism, their rhetoric is, with few exceptions, not out of line with the chorus of scientific consensus, which grows increasingly panicked by the day…. “

And it’s not just the scientists getting panicked: “… When alarmist rhetoric and Establishment wisdom [ read, the increasingly worriedly sounding UN (Guterres), IMF reports, …) have collapsed into each other, what role is there for protest? It may be less about shifting the Overton window and more about simply insisting that those in power operate as though they believe what they say, rather than retreat into an already-familiar climate hypocrisy (declaring a climate emergency and then immediately approving a new oil pipeline, as Justin Trudeau, for instance, has done)….”

Reuters - Scientists endorse mass civil disobedience to force climate action

Reuters;

“Almost 400 scientists have endorsed a civil disobedience campaign aimed at forcing governments to take rapid action to tackle climate change, warning that failure could inflict "incalculable human suffering." In a joint declaration, climate scientists, physicists, biologists, engineers and others from at least 20 countries broke with the caution traditionally associated with academia to side with peaceful protesters courting arrest from Amsterdam to Melbourne….”

It's clear, however, that increasingly, the ‘powers that be’, crack down on mass civil disobedience. Whether on Extinction Rebellion (as in London), youth climate protests (see Belgium’s new Minister of Education’s take on that), or others.

International Health - Air pollution: the emergence of a major global health risk factor

H Boogaard et al; https://academic.oup.com/inthealth/advance-article- abstract/doi/10.1093/inthealth/ihz078/5587652?redirectedFrom=fulltext

“Air pollution is now recognized by governments, international institutions and civil society as a major global public health risk factor. This is the result of the remarkable growth of scientific knowledge enabled by advances in epidemiology and exposure assessment. There is now a broad scientific consensus that exposure to air pollution increases mortality and morbidity from cardiovascular and respiratory disease and lung cancer and shortens life expectancy. Although air pollution has markedly declined in high-income countries, it was still responsible for some 4.9 million deaths in 2017, largely in low- and middle-income countries, where air pollution has increased over the past 25 y. As governments act to reduce air pollution there is a continuing need for research to strengthen the evidence on disease risk at very low and very high levels of air pollution, identify the air pollution sources most responsible for disease burden and assess the public health effectiveness of actions taken to improve air quality.”

Vox – Capitalism is turning us into addicts https://www.vox.com/science-and-health/2019/10/17/18647521/capitalism-age-of-addiction- phone-david-courtwright

Interview with the author of a new book on ‘limbic capitalism’.

“…A recent book by University of North Florida historian and addiction expert David T. Courtwright, called The Age of Addiction: How Bad Habits Became Big Business, tries to answer these questions in a fascinating history of corporate America’s efforts to shape our habits and desires. What we have today is something Courtwright calls “limbic capitalism,” a reference to the part of the brain that deals with pleasure and motivation. As our understanding of psychology and neurochemistry has advanced, companies have gotten better at exploiting our instincts for profit. Think, for example, of all the apps and platforms specifically designed to hijack our attention with pings and dopamine hits while harvesting our data. We’ve always had some form of limbic capitalism, Courtwright says, but the methods are much more sophisticated now and the range of addictive behaviors are much wider than they used to be. …” As we also live in the digital era.

Biannual meeting SAGE

HPW - Measles Resurgence, Polio Persistence & HPV Vaccine Shortages Concern Health Experts https://www.healthpolicy-watch.org/measles-resurgence-polio-persistence-hpv-vaccine-shortages- concern-health-experts/

News from end of last week. “ Measles is undergoing a worrisome worldwide resurgence, and it has killed more people in the Democratic Republic of Congo than the current Ebola outbreak – which is finally showing signs of decline, said a panel of vaccine experts in a WHO press briefing on Thursday. Meanwhile, a worldwide shortage of human papillomavirus (HPV) vaccine, which protects girls and women from cervical cancer, is confounding efforts to expand coverage, warranting a temporary change in vaccine strategy to focus more exclusively on pre-adolescent girls, said the experts who spoke just after the close of a biannual meeting of the Strategic Advisory Group of Experts on Immunization (SAGE), the principal expert advisory group to WHO for vaccines and immunization. And Pakistan and Afghanistan are seeing a worrisome resurgence of the wild polio virus, serotype 1. Vaccine-derived polio cases seen in some countries also continue to thwart global eradication efforts – although experts are hopeful that a novel oral polio vaccine (nOPV2) under expedited development and production will demonstrate far greater efficacy in preventing vaccine-derived cases. The new polio vaccine could be ready for deployment as early as June 2020….”

See also Reuters - 'Alarming upsurge' in measles has devastating impact, WHO warns.

AMR

WHO - Establishment of a One Health Global Leaders Group on Antimicrobial Resistance as recommended by the United Nations ad hoc Interagency Coordination Group (IACG) on Antimicrobial Resistance https://www.who.int/antimicrobial-resistance/interagency-coordination-group/public-discussion- leaders-group/en/

Call for public discussion on the draft terms of reference (on the One Health Global Leaders group on AMR). Deadline: 8 November.

WB (Working paper) – Pulling Together to Beat Superbugs: Knowledge and Implementation Gaps in Addressing Antimicrobial Resistance http://documents.worldbank.org/curated/en/430051570735014540/Pulling-Together-to-Beat- Superbugs-Knowledge-and-Implementation-Gaps-in-Addressing-Antimicrobial-Resistance

95 p. “…This report sets out a fresh way to look at the AMR crisis. It uses a new narrative to identify areas where knowledge gaps exist and further investigation is needed. It suggests that too much effort is spent searching for the right solutions in the wrong places, and proposes ways of “pulling together” across traditional institutional and disciplinary boundaries to contain and reduce AMR. …. “

“… we build a cross-disciplinary evidence-based narrative on AMR, emphasizing that, in many instances, the use of antimicrobials is a substitute for failing systems and infrastructures. We propose to reframe AMR as a global development challenge; a challenge that requires both a technical and adaptive approach, as well as an approach that acknowledges how and why the use of antimicrobials has become ingrained in many societies. Appreciating the tensions around antimicrobials—the way we think about them as socio-technical objects, the way we use them, and external factors—can be the starting point to expand the horizon of what can be done to address AMR.”

…. The vast majority of published knowledge and evidence covers AMR from the perspective of high-income countries (HIC) across a narrow range of subjects. While progress on abating AMR has been achieved in some HIC situations, there remains a significant gap between proposed technical solutions and the reality of implementing them in practice. This implementation gap is even more acute in low- and middle-income countries (LMICs), which will bear the greatest burden of AMR’s rising social and economic impacts…”

“Through several country-based case studies, this report illustrates factors that either enable or block interventions for controlling AMR in specific LMIC contexts. The report identifies knowledge and implementation gaps that merit research attention, together with actionable interventions that can be applied now. It particularly focuses attention on the importance of local context in carrying out implementation actions by proposing a typology of countries in terms of the interventions likely to provide the greatest benefits.”

“Two intertwined findings of this report are that (1) AMR needs to be reframed as a global development issue that cannot be solved with technical solutions alone; and (2) AMR-sensitive interventions are often the most cost-effective way, especially in LMICs, to overcome the underlying weaknesses in establishing an enabling environment for successful application of AMR-specific interventions aimed at reducing the unnecessary use of and overreliance on antimicrobials.”

PS: stay tuned for the @WHO toolkit for implementing #antimicrobialstewardship in LMIC – should come out this week.

Ebola DRC - Still a PHEIC?

Cidrap News - WHO: Insecure Ebola hot spots pose resurgence risk elsewhere http://www.cidrap.umn.edu/news-perspective/2019/10/who-insecure-ebola-hot-spots-pose- resurgence-risk-elsewhere

“In its weekly detailed analysis of the Democratic Republic of the Congo (DRC) Ebola outbreak, the World Health Organization (WHO) said another week of low case numbers is promising, but it worries that the remaining hot spots are in insecure areas that could seed new infections to other health zones where transmission has ended. … … The guarded optimism paired with worries about conditions in current hot spots comes just days before the fifth meeting of the WHO's Ebola emergency committee. On Oct 18 the group will meet to discuss the latest developments and whether the situation still warrants a public health emergency of international concern under the International Health Regulations….”

Cidrap News - Butembo treatment center cleared of Ebola patients in DRC Cidrap;

“For the first time since September 2018, the Butembo Ebola treatment center is clear of the deadly virus, as the last two patients still being treated were just released, according to the Twitter feed of Ibrahima Soce Fall, MD, the World Health Organization (WHO) assistant director-general for emergency response. Butembo had been a hot spot of Ebola virus activity throughout the 14- month-long outbreak in the Democratic Republic of the Congo (DRC)….”

Reuters - Congo to start using Johnson & Johnson Ebola vaccine in November

Reuters;

“Health authorities in Democratic Republic of Congo will introduce a Johnson & Johnson Ebola vaccine in November in the country’s eastern provinces, to counter the current outbreak, they said….”

Nature - Why Japan imported Ebola ahead of the 2020 Olympics https://www.nature.com/articles/d41586-019-03103-4

“The deadly virus is one of five that have been brought to a secure laboratory.” “Japan is preparing for tens of thousands of international tourists to descend on Tokyo for the Olympic Games next year — and that includes being ready for unwanted biological visitors….”

Telegraph - Climate change could push Ebola into untouched regions, report warns https://www.telegraph.co.uk/global-health/science-and-disease/climate-change-could-push-ebola- untouched-regions-report-warns/

“A perfect storm” of climate change, population growth and poverty could push Ebola into previously untouched regions, experts have warned. In a study published in Nature Communications journal, researchers used a statistical model to predict how increases in temperature and socio-economic development will affect the spread of Ebola over the next five decades. They found that in a worst-case scenario, the area at risk of disease outbreaks could increase by 14.7 per cent, stretching beyond the current endemic zone of central Africa. The study also found that human factors such as population growth, rising poverty levels and poor health infrastructure could cause a 50 per cent rise in the number of outbreaks….”

Some other Ebola related news snippets:

Cidrap News - FDA OKs rapid test

“…the US Food and Drug Administration (FDA) approved its first Ebola rapid diagnostic test.”

NYT – You’re Swabbing a Dead Gorilla for Ebola. Then It Gets Worse.

“On the outcomes of research to predict Ebola outbreaks, published recently in a study in Philosophical Transactions of the Royal Society B. Supported by USAID’s Predict program, among others. “

Global health security

Imperial college London - Rapid response research centre to predict and prevent global health crises Imperial

“The world’s most advanced institute for disease and emergency analytics is opening in London this week. J-IDEA, the Abdul Latif Jameel Institute for Disease and Emergency Analytics, headquartered at Imperial College London, will rapidly respond to emergencies such as epidemics, extreme climate events, and natural and humanitarian disasters….”

“J-IDEA is co-founded by Community Jameel, the global philanthropy established by Mohammed Abdul Latif Jameel KBE….”

War: a man-made public health problem

Lancet (Letter) - Is war a man-made public health problem?

O Razum et al; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31900- 2/fulltext

You know the answer to this question, but more than worth a read, in our times once again. Sadly.

“Wars and armed conflicts have devastating consequences for the physical and mental health of all people involved, for the social life within and surrounding the war-affected regions, and for the health of the environment. Wars destroy health infrastructure, undoing years of health advancement, and severely compromise health systems' capacity to respond to the direct and indirect health consequences of fighting. Millions of people have been internally displaced or forced to flee their countries because of armed conflict. Forced migration creates further physical and mental health problems during transit, in enforced encampment, and because of restricted entitlement to health care in countries hosting refugees. The disastrous effects might last for generations to come. In short, war is a man-made public health problem.”

International Day of the Girl Child (11 October)

UN News - Day of the Girl Child spotlights 25 years of progress, with more on the horizon https://news.un.org/en/story/2019/10/1049061

“The world’s one billion young girls, are being celebrated on Friday as an “unscripted and unstoppable” force for change, with 11 October designated each year the International Day of the Girl Child. Every day, girls under-18 are challenging stereotypes, breaking barriers, and leading movements to tackle the issues that affect them, and beyond, Secretary-General António Guterres said in his message for the Day. “As the theme of this year’s observance underscores, they are proving to be unscripted and unstoppable” in their undertakings, from eliminating child marriage, to closing the education gap, addressing violence and standing strong against the climate crisis.”

Meanwhile, the UK international Development Secretary (Alok Sharma) wrote she will put women & girls at the heart of UK aid.

NPR Goats & Soda – 6 Young Women Went To The U.N. With A Bill Of Rights For Girls NPR Goats & soda;

“Six young women went to the U.N. …. to present a document that has no precedent: a Global Girls' Bill of Rights....” “… The bill of rights begins with the preface, "All girls have the right to....." followed

by ten points, each backed up by statistics from such sources as the U.N., UNICEF and the World Bank….”

LGBT

Thomson Reuters – Uganda denies plans to impose death penalty for gay sex amid global concern

Reuters;

“Uganda will not impose the death penalty for gay sex, a presidential spokesman said on Monday, after major aid donors said they were monitoring a plan by the African nation to reintroduce a bill colloquially known as “Kill the Gays”. Uganda’s Ethics and Integrity Minister Simon Lokodo last Thursday said the government planned to re-introduce an anti-homosexuality bill in parliament within weeks to curb the spread of homosexuality in the east African nation. Lokodo’s statement was widely reported across the world and international donors such as the European Union, World Bank, the United States and the Global Fund said they were monitoring the situation closely and stood by the rights of LGBT+ people. A spokesperson for President Yoweri Museveni on Monday said the government has no plans to introduce the legislation that would impose the death penalty for gay sex….”

See last week’s news: (Reuters) Uganda plans bill imposing death penalty for gay sex

Access to Medicines

CBS - Doctors Without Borders presses Johnson & Johnson to slash price of tuberculosis drug CBS;

“ Doctors Without Borders is calling on Johnson & Johnson to halve the price of a lifesaving tuberculosis drug, called bedaquiline, to make it more accessible to patients around the world.

Currently, a six-month supply of the drug for a single person costs $400 in countries around the world that participate in the Global Drug Facility, a United Nations-linked organization that is the world's largest provider of tuberculosis medication. A 20-month supply is slightly cheaper at $1,200, or $2 a day, though the drug is pricier in more developed countries. MSF is demanding that bedaquiline cost no more than $1 per day — or half its current lowest price, making a 20-month supply available for $600. The group argues that because taxpayer, non-profit and philanthropic contributions helped fund the development of the drug, J&J should not have sole discretion over how it is priced….”

See also TWN – “The medical humanitarian organisation Medecins Sans Frontieres (MSF) has launched a global campaign on 10 October that calls on pharmaceutical giant Johnson & Johnson

(J&J) to lower the price of its life-saving anti-tuberculosis (TB) drug bedaquiline to no more than US$1 per day for everyone who needs it. …”

FT Op-ed - There are solutions to the global drug price problem Suerie Moon; https://www.ft.com/content/0221d14a-ef68-11e9-a55a-30afa498db1b

“We should override patent protection on some medicines and change how R&D is funded”. Recommended read – with a number of good proposals.

BMJ Letter - Universal health coverage: drug quality and affordability can go together

R Ravinetto & C Dujardin; https://www.bmj.com/content/367/bmj.l6004

The authors of this letter complement the recent BMJ essay by Elizabeth Pisani in which she warned against some possible unwanted consequences of the efforts to achieve universal health coverage. “…In particular, an unconditional push for the lowest possible prices of essential drugs may lead some manufacturers to apply cuts to quality assurance costs, thus increasing the risk of poor quality drugs or of manufacturers’ withdrawal from the market.” Ravinetto & Dujardin believe, however, “…that quality and affordability can go together—as shown by the World Health Organization’s prequalification programme (WHO PQP)6 and the Medicines Patent Pool—and that incentives to invest in pharmaceutical quality assurance may even descend from the market, as prices are not only linked to manufacturing costs but also to manufacturing volumes and market opportunities…” “To complement the important measures listed by Pisani, we call on all major purchasers, including major funding agencies and their implementers, to create the demand for quality assured essential drugs by setting stringent criteria as a prerequisite for purchase.”

HPW – Drug Pricing Transparency To Be Discussed At World Trade Organization https://www.healthpolicy-watch.org/drug-pricing-transparency-to-be-discussed-at-world-trade- organization/

“A request by South Africa to the World Trade Organization (WTO) TRIPS Council to “address the transparency of R&D costs and pricing of medicines and health technologies” is expected to be reviewed Friday, 18 October 2019 as the TRIPS Council meets this week for its third session this year. The TRIPS Council, the administrative body for the 1995 TRIPS Agreement, will thus become the third international body to take up the issue of drug pricing, following a landmark resolution by the World Health Assembly (WHA) in May urging countries to adopt transparency policies, followed by a Human Rights Council Resolution in July….”

Global Public Investment

Devex - Opinion: Embracing global public investment can get financing for development back on track J Glennie et al; Devex;

“As the international community seeks to build momentum behind the ambitious Sustainable Development Goals, the question of how to fund them is a priority for everyone. With the current funding gap estimated to be anywhere from $2-4 trillion per year until 2030, it is easy to see why. A new approach is needed to help us meet our ambitions: an approach that is inspiring, yet grounded in pragmatism, an approach reflecting the universality of the SDG agenda, where everyone has a part to play and is motivated to act. This brings us to “global public investment”: a new, simple and much-needed big idea that has the potential to revolutionize concessional international public finance intended for sustainable development. This new funding mechanism is universal — any country can contribute to it and any country can benefit from it. GPI is an investment in our global common good, reflecting the ideals of the SDGs. This idea originates from work by the Joep Lange Institute, supported by the Global Fund Advocates Network and International Civil Society Support — who have organized many consultations over the past two years. It is backed by senior figures, including Helen Clark, former prime minister of New Zealand and administrator of the U.N. Development Programme.”

Five shifts are needed. From reducing poverty to reducing inequality; From overall quantity to the unique characteristics of financing; From ‘north-south’ to universal; From closed to accountable governance; From a foreign to global positioning

And the authors’ conclusion: “The international community needs to break out of its comfort zone and transform financing. Current aid models, including those that leverage the private sector, will not live up to the needs and promise of the SDGs. The job of the international development community is not, as is sometimes said, to do itself out of a job. This is not the beginning of the end for concessional international public finance; rather it is the end of the beginning.”

Coincidentally, we happen to agree.

Digital health, cryptocurrencies & aid, …

Devex - Nonprofits explore the newest fundraising frontier: Cryptocurrency https://www.devex.com/news/nonprofits-explore-the-newest-fundraising-frontier-cryptocurrency- 95789

“UNICEF can now receive, hold, and disburse digital currency built on blockchain technology with the launch of the UNICEF Cryptocurrency Fund. Building on its past work with blockchain, UNICEF will use cryptocurrencies — beginning with Bitcoin and Ether — to fund open source technology that benefits children and young people, including startups in the blockchain space. A growing number of nonprofit organizations accept donations in cryptocurrency, but UNICEF is the first U.N. agency to

accept “crypto as crypto without converting it,” said Chris Fabian, who co-founded UNICEF's Innovation Unit and leads UNICEF Ventures….”

Digital dystopia – rise of the “digital welfare state”

Guardian - ‘Digital welfare state’: big tech allowed to target and surveil the poor, UN warns https://www.theguardian.com/technology/2019/oct/16/digital-welfare-state-big-tech-allowed-to- target-and-surveil-the-poor-un-warns?CMP=Share_iOSApp_Other

“Nations around the world are “stumbling zombie-like into a digital welfare dystopia” in which artificial intelligence and other technologies are used to target, surveil and punish the poorest people, the United Nations’ monitor on poverty has warned. Philip Alston, UN rapporteur on extreme poverty, has produced a devastating account of how new digital technologies are revolutionizing the interaction between governments and the most vulnerable in society. In what he calls the rise of the “digital welfare state”, billions of dollars of public money is now being invested in automated systems that are radically changing the nature of social protection. Alston’s report on the human rights implications of the shift will be presented to the UN general assembly on Friday. It says that AI has the potential to improve dramatically the lives of disadvantaged communities, but warns that such hope is being lost amid the constant drive for cost cutting and “efficiency”….”

For an overview of this exclusive Guardian series, see Digital dystopia: how algorithms punish the poor

Mental Health

Healthy policy watch - New WHO Special Initiative Aims To Expand Mental Health Coverage To 100 Million More People By 2023 https://www.healthpolicy-watch.org/new-who-special-initiative-aims-to-expand-mental-health- coverage-to-100-million-more-people-by-2023/

News from last week. “The World Health Organization aims to expand mental health coverage to 100 million more people in 12 priority countries by 2023 as part of a new Special Initiative for Mental Health launched Monday at start of the 11th World Mental Health Forum.”

“Over 20 health ministers from around the world gathered in Geneva along with NGO representatives and WHO officials for the two-day forum, whose theme this year is “Enhancing Country Action on Mental Health.” The Special Initiative is just the latest global action WHO has taken to integrate mental health into its non-communicable disease platform. Just last year, the WHO Director-General called for the agency to accelerate implementation of mental health initiatives in its work….”

Global eye care

Lancet Editorial - A vision for universal eye health https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32325-6/fulltext

“World Sight Day, Oct 10, 2019, opened the final stages of Vision2020 and the Global Action Plan, two global advocacy initiatives that strived to tackle the global burden of avoidable blindness and vision impairment. 80% of vision impairment is preventable or treatable, yet it affects millions of people, and many have no access to affordable, good-quality eye care. WHO's first World Report on Vision, released on Oct 8, 2019, suggests how to meet the world's growing eye care needs…. “ “…In this light, WHO calls for eye care to become an integral part of universal health coverage.”

“…Taking on the next phase of global advocacy, the Lancet Global Health Commission on Global Eye Health will seek solutions to provide equity in access, quality, and effective implementation of eye health services. …”

Alcohol control

Lancet Comment – Will alcohol harm get the global response it deserves? S Casswell; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31883-5/fulltext

Hard-hitting Comment, and spot on. “For the first time since the endorsement in 2010 of the WHO global strategy to reduce harmful use of alcohol, alcohol had a place on the World Health Assembly (WHA) agenda. At the 2019 WHA, it was agreed that the WHO Director-General will report on “the implementation of WHO's global strategy to reduce the harmful use of alcohol during the first decade since its endorsement, and the way forward” to the WHA in 2020. This move comes after several years of civil society and some member states working cooperatively to raise the profile of alcohol at the WHA. In non-communicable disease (NCD) debates, middle-income countries, the main targets for market expansion by transnational alcohol corporations, have called for a stronger global response to alcohol….”

“…what of the way forward? Since the endorsement of the global strategy, certain developments have made it even less likely a global strategy, if endorsed today, would gain traction….”

“…Alcohol harm goes beyond NCDs and alcohol needs to be lifted out of the NCD agenda. If WHO can't accommodate this, the UN's commitment to SDGs provides another potential home, but this will require stronger recognition of the importance of commercial determinants of health than was seen in the 2018 Political Declaration of the UN High-Level Meeting on NCDs. In a global environment dominated by powerful corporations and economic agreements that privilege their interests, global legally binding responses to support health and wellbeing are required. There is a precedent in the Framework Convention on Tobacco Control for a legally binding international treaty that has assisted the efforts of nation states to reduce harm from tobacco. Many academics and professional organisations, including the World Medical Association, have long called for a similar legally binding framework for alcohol. The commercial drivers and industry practices of transnational alcohol

corporations require a Framework Convention for Alcohol Control to replace the global strategy…..”

Global Network for Health in all policies – First Global Status report on Health in all policies https://actionsdg.ctb.ku.edu/wp-content/uploads/2019/10/HiAP-Global-Status-Report-final-single- pages.pdf

“This is the first Global Status Report on Health in All Policies (HiAP), an important development in the advancement of HiAP. It presents a picture of HiAP approaches and the diversity of HiAP practice based on the responses of 41 jurisdictions across the world. … … This report was prepared on behalf of, and in collaboration with, the Global Network for Health in All Policies (GNHiAP). The GNHiAP is a network of government entities (national, regional, local) and other institutions (UN, inter-government and non-government organisations, academia) committed to working collaboratively to strengthen HiAP practice internationally. The report documents the status of HiAP practice across the world in order to establish an account of HiAP models, to examine current progress, identify key challenges and share lessons in HiAP action. It presents an analysis of how HiAP operates in different jurisdictions, including by different levels of government and by stages of maturation…”

FT Special report on Universal health care – more articles https://www.ft.com/reports/universal-healthcare

Check out some of the new articles in this nice series.

Among others now one on India’s ‘Modicare’ and Kenya’s ‘Afya Care’ . We also recommend The ‘Elder’ pushing for universal health coverage (on Gro Harlem Brundtland’s HL- advocacy for UHC).

Some key papers & reports of the week

BMJ Global Health Supplement – Resilient health systems for the attainment of Universal Health Coverage https://gh.bmj.com/content/4/Suppl_9

WHO Afro-led supplement. Do start with the Editorial - Resilient health systems for attaining universal health coverage for an overview of the supplement (and some key messages).

Among others, make sure you also read Towards universal health coverage: reforming the neglected district health system in Africa (by P Tumusiime et al)

“In most African countries, the district sphere of governance is a colonial creation for harnessing resources from the communities that are located far away from the centre with the assistance of minimally skilled personnel who are subordinate to the central authority with respect to decision- making and initiative. Unfortunately, postcolonial reforms of district governance have retained the hierarchical structure of the local government. Anchored to such a district arrangement, the (district) health system (DHS) is too weak and impoverished to function in spite of enormous knowledge and natural resources for a seamless implementation of universal health coverage (UHC). Sadly, the quick-fix projects of the 1990s with the laudable intention to reduce the burden of disease within a specified time-point dealt the fatal blow on the DHS administration by diminishing it to a stop-post and a warehouse for commodities (such as bednets and vaccines) destined for the communities. We reviewed the situation of the district in sub-Saharan African countries and identified five attributes that are critical for developing a UHC-friendly DHS. In this analytical paper, we discuss decision-making authority, coordination, resource control, development initiative and management skills as critical factors.”

Health Systems & Reform (Commentary) - Why Do Societies Ever Produce Common Goods for Health? W Savedoff; https://www.tandfonline.com/doi/full/10.1080/23288604.2019.1655982

“… In this commentary, I argue that we need to be clear-eyed about the history and motivations that led societies to invest in the Common Goods for Health (CGH) that we take for granted today. Studying the past may help us identify the political strategies that could create, expand and sustain CGH in the future. So why do societies ever produce CGH? The answer is essentially historical and political, not conceptual and technical….” Spot on, this short Comment.

Report from first Working Group of WHO Independent High-level Commission on NCDs https://www.who.int/ncds/governance/high-level-commission/HLC2-WG1-report.pdf?ua=1

Via Twitter: “They looked at #Presidential Leadership, national multisectoral, multi-stakeholder, & accountability mechanisms, #HealthLiteracy, and made recommendations. “

Health Research Policy & Systems- Embedding implementation research to enhance health policy and systems: a multi-country analysis from ten settings in Latin America and the Caribbean

E Langlois et al; https://health-policy-systems.biomedcentral.com/articles/10.1186/s12961-019- 0484-4

“… we developed an innovative model of implementation research embedded in real-world policy and programme cycles and led directly by policy-makers and health systems decision-makers. The approach was tested in ten settings in Latin America and the Caribbean, supported under a common funding and capacity strengthening initiative. The present study aims to analyse ten embedded implementation research projects in order to identify barriers and facilitators to embedding research into policy and practice as well as to assess the programme, policy and systems

improvements and the cross-cutting lessons in conducting research embedded in real-world policy and systems decision-making…..”

Medicine Anthropology Theory - Global health futures? Reckoning with a pandemic bond Susan Erikson; http://www.medanthrotheory.org/read/11401/global-health-futures

One of the recommended reads of the week. “Since 2010, there has been a discernable expansion of global health financing forms using private equity, bonds, and ‘facilities’ to finance international development and humanitarian endeavors. I present the logics of the Pandemic Emergency Facility (PEF), a World Bank device that lashes together a bond, cash, and swaps to lie in reserve for an infectious disease outbreak. I explain how the PEF is emblematic of financial devices that have the potential to fund global health aid while offering investors a chance to make money. Reckoning with the pandemic bond means that we take account not only of the PEF (what does it organize and by what logics?) but also of the relationships it cultivates (what does it bind together?) and reproduces (what does it aim to multiply and what does it forsake?). I use ‘reckoning with’ as an analytic concept to help us think about measures and futures of global health in both economic and ethical registers, as well as to take account of how death data is used. Reckoning with something lets us pause to take account of where we are and where we are going, and helps us think about what we want. Is it necessary to translate the ethical obligation to help those who are suffering into financial devices that make people money, a trend we are clearly in the initial stages of? Are there conditions when the suffering of others as the source of financial speculation becomes desirable?”

IJHPM - Our Blind Spots in the Fight Against Health Systems Corruption; Comment on “We Need to Talk About Corruption in Health Systems” R Huss; http://www.ijhpm.com/article_3674.html

“The health sector often appears prominent in surveys of perceived corruption, because citizens experience the symptoms of systemic corruption most distressingly during their interaction with frontline health workers. However, the underlying drivers of systemic corruption in society may be located in other social systems with the health system demonstrating the symptoms but not the path how to exit the situation. We need to understand the mechanisms of systemic corruption including the role of corrupt national and international leaders, the role of transnational corporations and international financial flows. We require a corruption definition which goes beyond an exclusive focus on the corrupt individual and considers social systems and organisations facilitating corruption. Finally there is an urgent need to address the serious lack of funding and research in the area of systemic corruption, because it undermines the achievement of the SDGs in many low income countries with the most deprived populations.”

CGD (blog) - Money Can’t Buy You “Country Ownership” W Savedoff; https://www.cgdev.org/blog/money-cant-buy-you-country-ownership

Linked to a new paper - What Is “Country Ownership”? A Formal Exploration of the Aid Relationship.

“Efforts to make aid more effective in the last two decades have given prominence to "country ownership." With true country ownership, aid is supposed to follow the priorities of recipient countries, rather than those of the funders. Yet funders have their priorities too. So recipients and funders have sought to resolve this potential conflict through policy dialogue and alignment of priorities. My new paper, "What is 'Country Ownership'?" explores this basic problem using a formal model to unravel three interrelated factors affecting country ownership.”

WHO – Health taxes: a primer https://www.who.int/publications-detail/health-taxes-a-primer

16 p. “This document summarizes the evidence on the health and economic impact of health taxes (those imposed on products with a negative public health impact like tobacco, alcohol, sugar- sweetened beverages and fossil fuels). These taxes result in healthier populations and generate revenues for the budget even in the presence of illicit trade/evasion. Furthermore, these are progressive measures which benefit low-income populations relatively more once health care costs and health burden are taken into account.”

Happy to see fossil fuel taxes are also in there.

Lancet Letter – A perpendicular framing for global health R Dhillon et al; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32464- X/fulltext

In response to an Offline from Horton (on the reducing attention for child & maternal mortality, in the SDG era), the authors argue: “… Rather than pitting these frames against one another, and losing emphasis on important perspectives, global health should be reconceptualised as perpendicular, whereby vertical priorities are maintained but considered in terms of how they pragmatically insert into and are operationalised through horizontal systems and policies. Similarly, horizontal priorities, such as community health workers, should be pursued with particular attention and thought given to how they can advance vertical priorities like maternal and child health. This reconceptualisation allows UHC and maternal and child health to simultaneously and synergistically be the fashion du jour rather than competing agendas.”

Lancet Letter – A child's right to health Stefan Peterson et al; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32463- 8/fulltext

Also a response to the Horton piece. “…Horton also asserted that “health is no longer prioritised by UNICEF's leadership”. This is incorrect. UNICEF continues to prioritise inequities and to reach the most vulnerable children with the health services they need to survive and thrive, but it is clear that multilateral agencies, including UNICEF, national governments, and the donor community, must do more to deliver better health outcomes for children….” Peterson et al then go on, explaining the diversified approach UNICEF uses nowadays (with a few remaining ‘MDG-effort style needed’ countries, and others where a multisectoral SDG-effort is more appropriate). In any case, maternal & child health remain a key priority for UNICEF, also budget wise.

Lancet – Offline: The necessity of the engaged scientist https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32462-6/fulltext

Horton has convinced us long ago on this one : )

Here, he refers to Blaise Pascal, to make his case: “…Pascal shows that science and social engagement can be mutually reinforcing. There can be no science, he seems to be saying, without a concern for the human predicament, our fragility, our contingency. He seeks to restore the idea of human dignity as a means to rediscover one's legitimate place in the world. “It is not in space that I must look for my dignity”, Pascal writes, “but in the organisation of my thoughts”. “All our dignity consists therefore of thought…This is the principle of morality.” The life of Pascal is a challenge to those who see science and politics as separate activities….”

Some blogs and mainstream articles of the week

Devex - Data gaps threaten achievement of development goals in Africa https://www.devex.com/news/data-gaps-threaten-achievement-of-development-goals-in-africa- 95825

“Data gaps across the African continent threaten to hinder the achievement of the Sustainable Development Goals and the African Union’s Agenda 2063, according to the Mo Ibrahim Foundation’s first governance report released on Tuesday. The report, “Agendas 2063 & 2030: Is Africa On Track?“ based on an analysis of the foundation’s Ibrahim index of African governance, found that since the adoption of both of these agendas, the availability of public data in Africa has declined. With data focused on social outcomes, there has been a notable decline in education, population and vital statistics, such as birth and death records, which allow citizens to access public services….”

NYT – Bill Gates met with Jeffrey Epstein many times, despite his past https://www.nytimes.com/2019/10/12/business/jeffrey-epstein-bill-gates.html

Their relation cooled in 2014, though. A few excerpts:

“…Mr. Gates met with Mr. Epstein on numerous occasions — including at least three times at Mr. Epstein’s palatial Manhattan townhouse, and at least once staying late into the night, according to interviews with more than a dozen people familiar with the relationship, as well as documents reviewed by The New York Times. Employees of Mr. Gates’s foundation also paid multiple visits to Mr. Epstein’s mansion. And Mr. Epstein spoke with the Bill and Melinda Gates Foundation and JPMorgan Chase about a proposed multibillion-dollar charitable fund — an arrangement that had the potential to generate enormous fees for Mr. Epstein. … … “Bill Gates regrets ever meeting with Epstein and recognizes it was an error in judgment to do so,” Ms. Arnold said. “Gates recognizes that entertaining Epstein’s ideas related to philanthropy gave Epstein an undeserved platform that was at odds with Gates’s personal values and the values of his foundation.”…”

In other Gates related news, see the Guardian - Striking sanitation workers decry low pay as company makes millions for Bill Gates

“Sanitation workers for Republic Services, the second-largest sanitation company in the US, are going on strike amid new union contract negotiations with workers in 10 cities around the country. The company’s largest single shareholder is the billionaire tech mogul and global philanthropist Bill Gates, whose private investment firm Cascade Holdings owns nearly 34% of the company’s stocks, earning over $100m annually in dividends from the shares. Gates’ investment has become a focus for strikers’ complaints. In 2018, Republic Services made a profit of $2.81bn and estimated a savings of $190m from Trump’s tax cut bill passed in December 2017. In 2018, Republic Services reported returning $1.2bn to shareholders through stock buybacks and dividends….”

NYT – Anand Giridharadas: Stop Spreading the Plutocrats’ Phony Religion https://www.nytimes.com/2019/10/16/opinion/anand-giridharadas-global-elites.html

Excerpts: “The theory of the book is that we are in a moment of extreme inequality, of political stasis, of democratic erosion, because our common culture has been infected by a phony religion. And that phony religion tells us that the best society is achieved by unleashing people to make money, as much as possible, in every way possible, cutting every corner they can, exploiting people, underpaying taxes, degrading the environment, evading regulation, manipulating government, and then donating some of the spoils of that, or repurposing some side part of their businesses, and claiming to save the world.”

“… My theory of change is simple: I believe if you can begin to dethrone the phony religion, you can clear away the brush obscuring the path to ﬁxing these problems the real way, which is democratically.”

PS: side remark – while generally a fan of ‘phony religions’, like Giridharadas, I do think this particular phony religion has affected Americans more than others (at least Europeans).

FP - The Presidential Candidates Are Ignoring One of the World’s Biggest Looming Threats

M Kavanagh; https://foreignpolicy.com/2019/10/15/presidential-candidates-ignoring-pandemics- worlds-biggest-threat/

On the lack of attention for global health (and pandemics in general) in the US presidential race.

“…Even in a presidential campaign that has so far largely avoided foreign policy, the lack of attention to pandemics is notable. None of the leading campaigns (of either party) has come out with a foreign-policy approach that addresses global health….”

IHP - Potential Health Impact of the African Continental Free Trade Area Agreement Abiodun Awosusi; https://www.internationalhealthpolicies.org/blogs/potential-health-impact-of- the-african-continental-free-trade-area-agreement/

“Nearly all African countries have endorsed the African continental free trade agreement (AfCTA). Trading is scheduled to commence in 2020 after key negotiations are concluded. Implementation of the agreement is likely to impact health in at least five areas: human capital investments, health innovations, trade for social impact, health security and universal health coverage. Health and development stakeholders should take proactive measures to ensure health is protected in policies, programs and negotiations.”

Guardian - Did a ‘white saviour’’s evangelical zeal take a deadly turn in Uganda? https://www.theguardian.com/global-development/2019/oct/17/did-a-white-saviours-evangelical- zeal-turn-deadly-uganda-renee-bach-serving-his-children

“Unqualified American missionary denies she sought to portray herself as a doctor at centre where at least 105 children died.”

“Amid growing unease about the behaviour of so-called “white saviours” in Africa – often unqualified evangelicals working for small missionary outfits – the long-running allegations against Bach and SHC have taken the issue to a whole new level of seriousness….”

LSE (blog) – The role of health in confronting toxic masculinity https://blogs.lse.ac.uk/africaatlse/2019/10/17/health-toxic-masculinity-uganda/

“The link between masculinity and health is often framed as strictly negative, where normative notions of gender are said to proliferate sexual transmitted diseases and intimate partner violence. But, in Uganda, historically health crises have decreased with few changes in masculinity, and masculine sexual privilege remaining largely intact. Robert Wyrod draws on research to argue that health can, in fact, be a potent catalyst for addressing complex gender power dynamics.”

Stat - Doctors argue for term limits to diversify medical school leadership Stat;

“In a new paper, a group of doctors argues that medical schools should impose term limits on department chairs and deans to bring in more diverse perspectives.” Based on a new NEJM perspective.

A few tweets of the week

• Dr. Tedros:

“@WHO is proposing that every country bring one nurse and one midwife to the World Health Assembly #WHA73 next year. The world must hear their voices and their stories. #EMRC66.”

• I Kickbusch:

“The contradiction of multilateralism - 14 billion for @GlobalFund - lacking 1.3 billion for @UN. - some prefer voluntary payments to paying their dues,some just don’t care. What if citizens did the same with their taxes? “ re: The U.N. is warning that it's facing a "cash crisis" if member states don't pay the annual dues they owe — as $1.3 billion in payments are outstanding (NPR news article)

• Stefan Peterson:

“Academia is stuck in 20th century form and incentives. Unreadable papers 2 years post hoc! We need credible knowledge (near) real-time. Accessible by policy makers and people themselves. Innovate for the 21st century!”

Global health events

WHO – Universal Health Coverage Passes Key Global Milestone https://www.who.int/news-room/detail/17-10-2019-universal-health-coverage-passes-key-global- milestone

“The World Health Organization today welcomed a new Inter-Parliamentary Union (IPU) Resolution on achieving Universal Health Coverage (UHC) by 2030. The resolution, adopted at the IPU Assembly in Belgrade, Serbia, comes one month after heads of state agreed a high-level United Nations Political Declaration on UHC in New York….”

“…Today’s Resolution calls on parliaments and parliamentarians to “take all possible measures to achieve UHC”, stressing the need for robust legal frameworks and the need to allocate adequate resources….”

And a tweet:

“The #NCDs investment case forum gathers together ministries of #health and #finance from 18 countries across the globe to agree new ways of using economic data and arguments in developing #BeatNCDs fiscal, regulatory and taxation policies. Moscow, Russia 14-15 Oct 2019.”

Global governance of health

Heinrich Böll Stiftung - From the Washington Consensus to the Wall Street Consensus

R Rowden; https://us.boell.org/2019/10/11/washington-consensus-wall-street-consensus

“This paper reviews the recent initiative being led by the G20 countries and their respective development finance institutions (DFIs), including the major multilateral development banks (MDBs), for the financialization of development lending that is based on the stepped-up use of securitization markets. It describes the key elements of the new initiative – specifically how securitization markets work and how the effort is designed to greatly increase the amount financing available for projects in developing countries by attracting new streams of private investment from private capital markets. The paper introduces the basic logic underpinning the initiative: to leverage the MDBs’ current USD 150 billion in annual public development lending into literally USD trillions for new development finance. In fact, the World Bank had initially called the initiative “From Billions to Trillions,” before finally calling it, “Maximizing Finance for Development” (MFD) (World Bank 2015; MFD 2019). While securitization can be useful for individual investors and borrowers under certain circumstances, the proposal to use securitization markets to finance international development projects in developing countries raises a set of major concerns. The paper lists 7 important ways in which the G20-DFI initiative introduces a wide range of new risks to the financial systems in developing countries while undermining autonomous efforts at national economic development. “ Check out the 7 risks of securitization.

FT - Global business chiefs pledge to boost sustainable development https://www.ft.com/content/15ae565a-efc4-11e9-ad1e-4367d8281195

“Chief executives from 30 of the world’s biggest companies have promised to do more in support of investment to tackle a shortfall measuring trillions of dollars a year in funding the UN’s sustainable development goals. The business leaders represent a range of industries from banks such as UBS and China’s ICBC, to pension groups such as Aviva and Japan’s Government Pension Investment Fund, and industrial companies including Enel of Italy and Kenya’s Safaricom. They were brought together by UN secretary-general António Guterres. Members of the new Global Investors for Sustainable Development alliance committed to “scale up and speed up” their efforts to align their businesses with the 17 wide-ranging goals covering everything from ending hunger to peace, economic growth and climate action that the UN has set for 2030. They also promised to remove barriers in the way of others committing more to development finance. …”

See also UN News - Business leaders join UN to rev up sustainable development investments

“In a bid to scale up investment efforts to reach sustainable development targets, the Secretary- General on Wednesday convened the first meeting of a new UN-backed corporate alliance to discuss plans for spending on sustainability, likely to be in the trillions of dollars. The Global

Investors for Sustainable Development Alliance (GISD), a UN-supported coalition of 30 business leaders, works to provide decisive leadership in mobilizing resources for sustainable development, with the core objective being to identify incentives for long-term sustainable investments.”

CGD - ABCs of the IFIs: The African Development Bank, the Asian Development Bank, and the International Fund for Agricultural Development

S Morris et al; https://www.cgdev.org/publication/abcs-ifis-african-development-bank-asian- development-bank-and-international-fund

2019/2020 are really ‘replenishment years’…

“The African Development Bank (AfDB), the Asian Development Bank (ADB), and the International Fund for Agricultural Development (IFAD) are among the international financial institutions seeking pledges from donor countries as part of upcoming replenishment cycles in 2019 and 2020…..”

You might also want to check (CGD) - ABCs of the IFIs: The World Bank.

NYT – Facing cash-flow crisis, the UN cuts hiring, heating, escalators and the A.C. https://www.nytimes.com/2019/10/11/world/americas/UN-cash-shortage.html

A tweet: “…seven nations — the United States, Brazil, Argentina, Mexico, Iran, Israel and Venezuela — are responsible for 97 percent of the unpaid budget.”

Guardian – Venezuela wins UN human rights council seat despite record of abuses https://www.theguardian.com/world/2019/oct/17/venezuela-un-human-rights-council-activists- outraged

“Other seat for Latin America went to Brazil, whose far-right leader has expressed contempt for the concept of human rights.”

CGD (blog) - Is the Ayrton Fund A High Impact Way to Spend UK ODA?

E Ritchie et al; https://www.cgdev.org/blog/ayrton-fund-high-impact-way-spend-uk-oda

“The UK Prime Minister announced during his visit to the UN General Assembly that one billion pounds worth of overseas development assistance (ODA) will be used to set up the ‘Ayrton Fund’ to support British scientists “and other scientists from around the world” to “work in partnership with developing countries” on climate and energy. Topics would include off-grid energy solutions, battery technology, clean stoves, reducing carbon output from major polluting industries, improving the efficiency of cooling systems, and research into electric vehicles. The fund would be run jointly by DFID and the UK Department of Business, Environment and Industrial Strategy (BEIS). There is a lot to like in this proposal: it backs research in an area where the world needs urgent progress, it looks like the funding isn’t formally tied to British researchers, and it emphasizes partnership with developing countries. That said, redirecting ODA to the Ayrton Fund raises some big concerns….”

“…More climate research finance is welcome–the world needs innovation to find new climate solutions. But by using the UK aid budget, the Ayrton Fund diverts financing for poverty reduction, and–to the extent it focuses on poor-country mitigation challenges–it diverts responsibility and focus from where the greatest challenges exist.”

Global Policy - Ideas, Institutions and the World Bank: The Social Protection and Fragile States Agendas

S Mackinder; https://onlinelibrary.wiley.com/doi/10.1111/1758-5899.12746

“Ideas and institutions are frequently used as explanatory concepts regarding policy development and change. There is an ongoing debate as to the explanatory weight that each should be afforded; Weiss and Carayannis (2001) identify a spectrum of opinions, with ‘institutionalist' approaches that embed ideas within institutionalist frameworks at one end, and ‘constructivist' approaches which argue that ideational concepts should be dis‐embedded from institutional considerations at the other. Drawing on 43 interviews with senior World Bank staff and a documentary analysis, this paper traces two policy agendas – social protection and fragile states – to identify the institutional and ideational features of the World Bank that a developmental agenda must navigate to achieve prominence in the Bank's work. It finds that the success of a policy agenda is determined by whether the ideas fit with a macro‐ideational dominant paradigm, and identifies several institutional features such as the incentive structure and lending mechanisms that influence an agenda's success.”

ODI (blog) – Low-income country debt: three key trends

Jesse Griffiths; https://www.odi.org/blogs/10801-low-income-country-debt-three-key-trends

“Three worrying trends dominate the public debt picture for low-income developing countries: debt is rising; it has become more expensive; and the proportion of countries that are vulnerable to a damaging debt crisis is high and rising….” Great blog.

UHC

JAMA Forum - Is Affording Undocumented Immigrants Health Coverage a Radical Proposal?

L Gostin; https://jamanetwork.com/journals/jama/fullarticle/2752913

Starting from the US debate, but worthwhile reading for all.

Sociedade cultura - Is SMART the new stupid? Health worker perspectives on producing PBF indicators

Y Raikotia ; https://www.researchgate.net/publication/336354839_Is_SMART_the_new_stupid_Health_worker _perspectives_on_producing_PBF_indicators

“PBF program designers have traditionally selected and priced service delivery indicators based on public health value, and whether the indicator is SMART (specific, measurable, achievable, relevant, and timely). This approach ignores the providers perspective on the value of inputs and opportunity costs of service provision. We conducted in-depth interviews, focus group discussions, and rank order exercises with health workers to elucidate factors that drive their motivation to deliver PBF incentivized services. Health workers identified three key considerations that drive service prioritization: effort to acquire a patient, effort to treat a patient, and health worker locus of control. Health workers consider multiple factors when prioritizing PBF services to maximize their total reward. In pricing PBF services, program designers must understand inputs’ value and total opportunity costs, rather than relying on public health value and the SMART indicator framework alone. When pricing services, PBF program designers should collaborate with health workers to account for the range of factors that health workers consider when alone. When pricing services, PBF program designers should collaborate with health workers to account for the range of factors that health workers consider when making service provision decisions.”

Lancet Haematology – The global need and availability of blood products: a modelling study

Lancet Haematology;

“Blood transfusions are an important resource of every health-care system, with often limited supply in low-income and middle-income countries; however, the degree of unmet need for blood transfusions is often unknown. We therefore aimed to estimate the blood transfusion need and supply at national level to determine gaps in transfusion services globally….”

“Our data suggest that the gap between need and supply is large in many low-income and middle- income countries, and reinforce that the WHO target of 10–20 donations per 1000 population is an underestimate for many countries. A continuous expansion and optimisation of national transfusion services and implementation of evidence-based strategies for blood availability is needed globally, as is more government support, financially, structurally, and through establishment of a regulatory oversight to ensure supply, quality, and safety in low-income and middle-income countries.”

Lancet Editorial – Canada needs universal pharmacare https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32324-4/fulltext

“Canada's often-lauded health-care system has an unusual and unfortunate distinction. Physician care and hospital stays are universally publicly funded, but medicines are not. Canada is the only country in the world with public health care and no universal public system for providing prescription drugs (pharmacare). In the run-up to the country's federal election on Oct 21, the harms to Canadians, and the costs to the health-care system, of the absence of national pharmacare are again in the spotlight….”

Planetary health

BMJ Sexual & Reproductive Health (Commentary) - Climate change and contraception

J Bongaarts et al (Population Council); BMJ SRH;

“Global climate change represents a grave threat to the future of human welfare and our natural environment. The contentious ongoing policy debate about potential interventions focuses on switching to renewable energy sources and increasing energy use efficiency. But given the urgency of the problem and the lack of political will, other approaches to limit greenhouse gas emissions should be given higher priority. Improving access to effective contraception is one such policy that has thus far been largely ignored by the international climate community. This recommendation is based on three simple facts: (1) population growth is a key driver of climate change, (2) higher and more effective use of contraception reduces unplanned pregnancies and hence population growth, and (3) many more women and men would freely choose to use contraception if only it were available and acceptable. The authors’ recommended policy is about improving universal access to reproductive technologies, not about coercion.”

For coverage of this, see Reuters - Scientists back wider family-planning access to ease climate threats

“Making affordable contraception available to women who want it would be a cheap, effective way to curb climate change and fast-rising risks in a hotter world, scientists said on Tuesday. … … What is largely missing in expanding that access, Bongaarts said, is backing from top political and community leaders with the standing to promote new ideas - something that has happened in nations from Bangladesh to Rwanda. “Leaders have to say this is important. That’s how social norms change,” he said….”

And for an example of this perhaps, see the Guardian - Niger's president blames explosive birth rate on 'a misreading of Islam'

“Mahamadou Issoufou calls for ‘responsible parenthood’ as he warns population boom will undermine climate adaptation.”

UN News - Climate emergency: City mayors are 'world's first responders', says UN chief https://news.un.org/en/story/2019/10/1049091

“City bosses are “the world’s first responders to the climate emergency” UN chief António Guterres declared on Friday, at an international mayors’ summit in Copenhagen. In his opening remarks to the C40 World Mayors Summit – a forum for member cities to present innovative actions to slow global warming – the Secretary-General noted that cities, which contain more than half the world’s population, and have an “enormous climate footprint”, are “on the frontlines of sustainable and inclusive development”….”

Vice - This Global Map Shows You How Nature Benefits You Directly https://www.vice.com/en_us/article/pa7xdk/this-global-map-shows-you-how-nature-benefits-you- directly

Very nice (global) visualization of ‘natural capital’. The map displays how people all over the world receive benefits from the environment, and who is most likely to lose them due to land use issues and the climate crisis.

“The importance of “natural capital”—resources such as healthy soil, clean water, and resilient ecosystems—is literally mapped out in a study published on Thursday in Science. A team led by Rebecca Chaplin-Kramer, lead scientist for the Natural Capital Project at Stanford University, unveiled an interactive global map that demonstrates nature’s effects on crop pollination, water quality, and coastal hazard risks….”

Infectious diseases & NTDs

UNAIDS - New HIV infections rising in Latin America―key populations particularly affected

UNAIDS;

“Although several countries in Latin America have shown impressive declines in HIV incidence, the number of new HIV infections in the region increased by 7% between 2010 and 2018, with 100 000 people contracting HIV in 2018. Roughly half of the countries in the region saw increases in incidence between 2010 and 2018, with the largest increases occurring in Brazil (21%), Costa Rica (21%), the Plurinational State of Bolivia (22%) and Chile (34%). At the same time, there were impressive declines in El Salvador (–48%), Nicaragua (–29%) and Colombia (–22%). Forty per cent of new HIV infections in Latin America in 2018 occurred among gay men and other men who have sex with men―key populations and their sexual partners account for the majority of new infections in the region….”

JAMA – Complexity in Assessing the Benefit vs Risk of Vaccines: Experience With Rotavirus and Dengue Virus Vaccines https://jamanetwork.com/journals/jama/fullarticle/2753531

“This Viewpoint uses experience with rotavirus vaccine–induced intussusception and dengue virus vaccine–induced shock syndrome to discuss issues of disease prevalence and severity underlying recommendations the vaccines be used widely, and it reviews the systems in place to monitor vaccine safety that broadly favor vaccine benefits over risks to individuals and society.”

And a few quick links:

• UNICEF USA - The Democratic Republic of the Congo Eliminates MNT

“Babies in the DRC are no longer at risk of contracting tetanus, thanks to immunization and education campaigns by UNICEF and partners. “

“The Democratic Republic of the Congo (DRC) has officially become the 47th country since 1999 to eliminate maternal and neonatal tetanus (MNT). This milestone was achieved despite ongoing insecurity and conflict in the DRC, including attacks on health workers battling Ebola and measles outbreaks. The announcement by the World Health Organization leaves just 12 countries around the world still facing the threat of MNT, an excruciating and almost always fatal disease that overwhelmingly affects mothers and newborns, usually through unhygienic childbirth and umbilical cord care practices….”

• BMJ News - WHO drafted in to help control severe dengue outbreak in Pakistan

AMR

SS&M - The state of social science research on antimicrobial resistance

S S Frid-Nielsen et al; https://www.sciencedirect.com/science/article/abs/pii/S027795361930591X

“Despite growing interest in AMR, social science research lags other health crises. Social science is fragmented and peripheral in the scientific discourse on AMR. Most social science research is published in interdisciplinary health outlets. Future contributions should also engage with more general social science audiences.”

NCDs

Bhekisa - Dancing with the devil: UCT stubs out tobacco- funded unit https://bhekisisa.org/article/2019-10-16-dancing-with-the-devil-uct-snubs-out-tobacco-funded- unit/#.Xaa9E1rIkVI.twitter

“The university says it had no idea researchers had signed up to take big tobacco money funnelled through a non-profit. But the decision could have lasting effects. “

“The University of Cape Town’s (UCT) department of psychiatry and mental health agreed to take more than R1-million from a foundation funded by tobacco giant Philip Morris International, 2018 tax returns reveal. The school says it never signed off on the deal that could now decide the fate of the country’s tobacco control Bill. UCT is one of at least two South African universities to have taken Big Tobacco money in the last year….”

UNICEF explores experience from countries that have implemented “soda taxes” to prevent childhood overweight, including France, Mexico, Hungary Norway: https://gallery.mailchimp.com/fb1d9aabd6c823bef179830e9/files/08e73191-c279-4179-b54b- e7f79c217432/190328_UNICEF_Sugar_Tax_Briefing_R09.pdf

Paper of 20 p. Focus on benefits for children.

Quick links:

• War on diabetes: Unhealthy label for high-sugar drinks, total ban on ads to be introduced in Singapore

“The war on diabetes continues with a total ban on advertisements of packaged drinks with very high sugar content - making Singapore the first country in the world to do so….”

• Guardian - Alcohol industry 'puts pregnant women at risk', researchers say

“Firms and bodies are casting doubt on health advice for expecting women to abstain from drinking.” See the article here: Pregnancy, Fertility, Breastfeeding, and Alcohol Consumption: An Analysis of Framing and Completeness of Information Disseminated by Alcohol Industry–Funded Organizations (journal of studies on Alcohol & Drugs)

Sexual & Reproductive / maternal, neonatal & child health

Nature - Mapping 123 million neonatal, infant and child deaths between 2000 and 2017

R Burstein et al; https://www.nature.com/articles/s41586-019-1545-0

Brand new IHME study.

“Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2—to end preventable child deaths by 2030—we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000–2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations.”

• Do check out the visualizations as well. Coverage for example in the Telegraph - Children's lives are 'cut short' as countries urged to tackle [within-country] inequality.

• And a related Comment by Michelle Bachelet in Nature - Data on child deaths are a call for justice

“A study in Nature this week zooms in on the 99 low- and medium-income countries where, in 2017, 93% of deaths of children under 5 happened (R. Burstein et al. Nature 574, 353–358; 2019). The authors estimate mortality for young children in each of 17,554 administrative regions from 2000 to 2017 — a remarkable level of detail. The overall result is encouraging: 60% of the districts show sustained progress. But a closer look reveals continued inequalities….”

“The overarching lesson of these detailed mortality maps is that we must frame health programmes very broadly. Tackling child mortality requires efforts across all government functions — providing access to medical treatment is just one element. If governments are to uphold citizens’ rights to health, they must consider the social determinants of children’s well-being.”

New Statesman - The myth of sex work is distorting the voices of the exploited women

J Bindel; https://www.newstatesman.com/politics/feminism/2017/09/myth-sex-work-distorting- voices-exploited-women

From 2017, but well worth a read. “”Sex workers’ rights” are being used as a cover for neoliberal pro-prostitution politics in the global south.”

BMJ Global Health – What can the global movement to end child marriage learn from the implementation of other multisectoral initiatives?

C L Forte et al ; https://gh.bmj.com/content/4/5/e001739

“If the Sustainable Development Goal (SDG) target 5.3 to end child marriage by 2030 is to be met, the annual rate of reduction in the prevalence of child marriage must increase from 1.9% to 23%. Over 30 countries have developed, or are developing, national policies/programmes towards this goal. However, many are struggling to operationalise these policies/programmes, particularly at subnational levels. Thus, Girls Not Brides and the WHO commissioned a review of lessons learnt from national and subnational implementation of multi-sectoral policies/programmes targeting other issues that could be applied to the global movement to end child marriage. This review identified a number of pragmatic lessons learnt…. »

The Telegraph - Payment-by-results contracts are the best way to ensure aid reaches girls, says Baroness Sugg https://www.telegraph.co.uk/global-health/women-and-girls/payment-by-results-contracts-best- way-ensure-aid-reaches-girls/

“Payment-by-results contracts help to ensure UK aid is spent on family planning initiatives that prioritise vulnerable women and girls, the international development minister has claimed. Last year the Department for International Development (Dfid) launched a £200 million programme in 27 countries across Africa and Asia, which aimed to provide sexual health services for women who often miss out – teenagers and the poorest in society. The fund, called Wish (women’s integrated sexual health), includes results-based financing – meaning project partners will only be paid if they can demonstrate they have reached certain groups of marginalised women. The project partners, in this case Marie Stopes International and International Planned Parenthood Federation, do not have to deliver certain quantities of contraception services – performance targets are based solely on access. Speaking to The Telegraph from Senegal, Baroness Sugg said that “it’s an absolutely priority” to give marginalised women choice over contraception – and payment-by-results contracts help to “ensure we’re getting to those people who most need it”….”

HP&P - A rapid assessment of the political economy of health at district level, with a focus on maternal, newborn and child health, in Bangladesh, Indonesia, Nepal and the Philippines

D B Hipgrave et al ; https://academic.oup.com/heapol/advance-article- abstract/doi/10.1093/heapol/czz082/5585826?redirectedFrom=fulltext

“Low- and middle-income countries (LMICs) face many challenges and competing demands in the health sector, including maternal and newborn mortality. The allocation of financial and human resources for maximum health impact is important for social and economic development. Governments must prioritize carefully and allocate scarce resources to maximum effect, but also in ways that are politically acceptable, financially and institutionally feasible, and sustainable. Political economy analysis (PEA)—that gets what, when and why—can help explain that prioritization process. We used PEA to investigate how four Asian LMICs (Bangladesh, Indonesia, Nepal and the Philippines) allocate and utilize resources for maternal, newborn and child health (MNCH)….”

International Health - Does involving male partners in antenatal care improve healthcare utilisation? Systematic review and meta-analysis of the published literature from low- and middle-income countries

D Suandi et al; https://academic.oup.com/inthealth/advance-article- abstract/doi/10.1093/inthealth/ihz073/5587654?redirectedFrom=fulltext

“Although in most low- and middle-income countries (LMICs) men are decision makers and control the household budget, their involvement in maternity care is limited. Reports from high-income countries indicate a beneficial effect of involving men in antenatal and delivery care on birth outcomes. … … We conducted a systematic review to assess whether similar effects are observed in LMICs. …”

Results: “We found that involving a male partner in antenatal care was associated with skilled birth attendance utilization (pooled OR 3.19 [95% CI 1.55 to 6.55]), having institutional delivery (OR 2.76 [95% CI 1.70 to 4.50]) and post-partum visit uptake (OR 2.13 [95% CI 1.45 to 3.13]). Mother’s knowledge of danger signs and modern contraception utilization were also positively affected. However, it had no significant impact on the number of antenatal visits….”

The Ken – Exit in Sight, Gates Foundation hopes India will foot the bill

R Kandhari; https://the-ken.com/story/bmgf-vaccines-india-govt/

“After pouring hundreds of millions of dollars into building India’s preventable disease vaccine market, the $48 billion Bill and Melinda Gates Foundation (BMGF) wants to step back. But if the Modi government doesn’t pick up where BMGF left off, the house the Foundation painstakingly built could come crashing down”

PS: you have to register to read this article.

Conflict & Health - A systematic review of monitoring and evaluation indicators for sexual and reproductive health in humanitarian settings

E T Broaddus-Shea et al ; https://conflictandhealth.biomedcentral.com/articles/10.1186/s13031- 019-0221-1

This article aimed to conduct a comprehensive mapping of published indicators for monitoring and evaluation (M&E) of sexual and reproductive health (SRH) services and outcomes in humanitarian settings.

Lancet Comment – HEALTH for heavy menstrual bleeding: real-world implications

S Singh et al; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32086-0/fulltext

“Heavy menstrual bleeding is common and can substantially affect quality of life. Millions of women worldwide defer personal, professional, and family goals because of heavy menstrual bleeding. In

The Lancet, Kevin Cooper and colleagues report a multicentre, parallel-group, open-label randomised trial of 660 women younger than 50 years that compared laparoscopic supracervical hysterectomy with endometrial ablation for the management of heavy menstrual bleeding. To our knowledge, the HEALTH trial is one of the largest randomised controlled trials to date in benign gynaecology….”

Miscellaneous

Stat News - Calling embryo editing ‘premature,’ Russian authorities seek to ease fears of a scientist going rogue

Stat News;

“Russian health officials are playing down international concerns that a Moscow researcher plans to create gene-edited babies any time soon, saying for the first time that the experiment would be “premature.” Denis Rebrikov, the scientist who has said he wants to use the genome-editing technology CRISPR to alter embryos, has sparked widespread alarm among scientists who fear that he could become the second researcher to conduct such work, following the birth of gene-edited twins in China last year. But in a statement issued last week to Russian wire services, the health ministry here said it fully supports the World Health Organization position against making changes to the human germline — the genome of eggs, sperm, and embryos — that would be inherited by future generations “until its implications have been properly considered.” The ministry said it views any clinical use of genome-editing technologies on human embryos “premature.”…”

BMJ blog - Palliative care in humanitarian crises—an idea that’s time has come

BMJ Blog;

“The move to integrate palliative care into humanitarian crisis relief should encompass all that the specialty has to offer, say Elisha Waldman and Marcia Glass.”

OECD report – Health for everyone? Social Inequalities in Health and Health Systems https://www.oecd.org/fr/publications/health-for-everyone-3c8385d0-en.htm

“Good health is a key component of people’s well-being. It is a value in itself but – through its influence on social, education and labour market outcomes – being in good or bad health has also wider implications on people’s chances of leading a fulfilling and productive life. Yet, even in the OECD countries, health inequality persists with severe consequences on the goal of promoting inclusive growth. This report documents a comprehensive range of inequalities in health and

health systems to the detriment of disadvantaged population groups in a large set of OECD and EU countries. It assesses the gaps in health outcomes and risk factors between different socio-economic groups. When it comes to health systems, the report measures inequalities in health care utilisation, unmet needs and the affordability of health care services. For each of these different domains, the report identifies groups of countries that display higher, intermediate, and low levels of inequality. … .”

The Times - Genetics lab told to hand back African tribes’ DNA

The Times;

(gated) “ An African university has demanded that a leading genetics laboratory returns DNA samples taken from indigenous tribes that it sought to commercialise without consent. Documents seen by The Times show that the Wellcome Sanger Institute in Cambridgeshire has been warned by Stellenbosch University in South Africa that its conduct could bring about “serious legal and ethical consequences”. The dispute involves hundreds of samples collected by scientists at African universities and the Lebanese American University. Some came from indigenous communities, such as the Nama people from South Africa, Namibia and Botswana, who were told that they would be used only to study “population history and human evolution”. Other subjects were told on consent forms that their samples “will not be used for any medically related study”. …”

The Institute denies the allegations.

Economist – How to reveal a country’s sense, over the years, of its own well-being https://www.economist.com/science-and-technology/2019/10/19/how-to-reveal-a-countrys-sense- over-the-years-of-its-own-well-being

The authors of this new research “…searched these texts for words that had been assigned a psychological “valence”—a value representing how emotionally positive or negative a word is— while controlling for the changing meanings of words such as “gay” and “awful” (which once most commonly meant “to inspire awe”). The result is the National Valence Index, published this week in Nature Human Behaviour….” Check out how the US, UK, Germany, … have done since 1820 on this valence index.

“…Overall, then, Dr Sgroi and Dr Proto found that happiness does vary with gdp. But the effect of health and life expectancy, which does not have the episodic quality of booms, busts and armed conflict, is larger, even when the tendency of wealth to improve health is taken into account. A one- year increase in longevity, for example, has the same effect on national happiness as a 4.3% increase in gdp. And, as the grand historical sweep suggests, it is warfare that causes the biggest drops in happiness.”

Guardian – Up to 90% of 10-year-olds in world's poorest countries struggle to read https://www.theguardian.com/global-development/2019/oct/18/up-to-90-of-10-year-olds-in- worlds-poorest-countries-struggle-to-read

“World Bank targets ‘learning poverty’ as research shows major shortfall in basic reading skills among least privileged children.”

“Nine out of 10 children in the world’s poorest countries are unable to read a basic book by the age of 10 – a situation mirrored in reverse in rich countries, where only 9% cannot do so by the same age. Data compiled by the World Bank and the UN also shows that when low- and middle-income countries are taken together – a total of 135 states – more than half of all children cannot read a simple text at 10 years old. The World Bank is setting a new target to cut the rate of what it calls “learning poverty” by at least half before 2030, a goal it describes as “ambitious, yet achievable”.

Emerging Voices

Global Health Action - ‘It needs a complete overhaul…’ district manager perspectives on the capacity of the health system to support the delivery of emergency obstetric care in an urban South African district

Siphiwe B Thwala (EV 2013) et al; https://www.tandfonline.com/doi/full/10.1080/16549716.2019.1642644

“A high maternal mortality ratio persists in South Africa despite developments in emergency obstetric care (EmOC), a known effective intervention against direct causes of maternal deaths. Strengthening the health systems is one of the focus areas identified by the National Committee for Confidential Enquiries into Maternal Deaths in South Africa. District managers as immediate overseers of the frontline health system are uniquely positioned to provide insight into the overall health system processes that influence the delivery of EmOC. … We sought to identify health system enablers and barriers to the delivery EmOC from the perspective of district managers…..”

Other EV related news & publications:

• The public’s health and the social meaning of guns By Sandro Galea & Salma Abdalla (EV 2018). (with focus on the US).

• #CoPGS2019 congratulates the winner of the Creative Accountability Contest- The Best Entry Films Category is Brady Leanne from University of Capetown, SA. Her film is titled 'Red Zone Paramedics'. (PS: Leanne Brady is an EV 2018) Congrats!

Research

In line with this week’s Be-Cause Health conference on Urban Health (15-16 October, Brussels), check out a few more urban health/planning related reads:

HP&P - Is evidence-informed urban health planning a myth or reality? Lessons from a qualitative assessment in three Asian cities

T Mirzoev et al; https://academic.oup.com/heapol/advance- article/doi/10.1093/heapol/czz097/5585652?searchresult=1

“City governments are well-positioned to effectively address urban health challenges in the context of rapid urbanization in Asia. They require good quality and timely evidence to inform their planning decisions. In this article, we report our analyses of degree of data-informed urban health planning from three Asian cities: Dhaka, Hanoi and Pokhara. Our theoretical framework stems from conceptualizations of evidence-informed policymaking, health planning and policy analysis, and includes: (1) key actors, (2) approaches to developing and implementing urban health plans, (3) characteristics of the data itself….”

SS&M - Can health and health equity be advanced by urban planning strategies designed to advance global competitiveness? Lessons from two Australian case studies https://www.sciencedirect.com/science/article/abs/pii/S0277953619305891

“The purpose of this article is to investigate whether the neo-liberal goal of global economic competitiveness when included alongside image-inspired social goals such as liveability and environmental goals such as sustainability can lead to policies that impact positively on health and health equity. The paper presents an analysis of the content and intent of strategic planning and transport plans from two Australian state governments….”

“Global competition has raised city image as an important policy consideration. Liveability has become a normative planning goal due to its links with global image. Liveability helps incorporate health objectives into urban planning policy. Overriding emphasis on productivity can undermine health benefits of liveability. Liveability as a goal has the potential to exacerbate health inequity.”