Showing posts from category global health.
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World AIDS Day 2010: Not Yet in a Position to Say “Mission Accomplished”
›December 1, 2010 // By Schuyler NullToday is World AIDS day. More than 33 million people are currently living with HIV around the world, according to the UN, and the vast majority of them (22 million) are located in sub-Saharan Africa.
“We have halted and begun to reverse the epidemic. Fewer people are becoming infected with HIV and fewer people are dying from AIDS,” said Executive Director Michel Sidibé in the 2010 edition of UNAIDS’ annual report.“However we are not yet in a position to say ‘mission accomplished.’ Growth in investment for the AIDS response has flattened for the first time in 2009. Demand is outstripping supply. Stigma, discrimination, and bad laws continue to place roadblocks for people living with HIV and people on the margins.”
Particularly in sub-Saharan Africa, “people on the margins” often means women and children. As a result, there has been more and more integration of HIV/AIDS programs with gender and maternal health. The environmental community has also worked closely with HIV/AIDS interventions in places where the destruction of natural resources makes certain populations more vulnerable than others and valuable conservation efforts are threatened.
As development efforts become more cross-sectoral, it’s important to keep in mind and maximize these connections between community, economic, and environmental health.
Check out The New Security Beat’s coverage of HIV/AIDS integration with other health and environment programs including coverage from the Global Health Initiative’s “Integrating HIV/AIDS and Maternal Health Services” event last year, a sit-down interview on the challenges facing HIV-positive adolescents with Harriet Birungi of the Population Council in Kenya, and an examination of how gender-based violence contributes to women’s vulnerability to HIV.
Sources: Population Reference Bureau, UN, World Wildlife Federation.
Map Credit: World AIDS Campaign. -
Developing a Blueprint for Addressing Glacier Melt in the Region
Changing Glaciers and Hydrology in Asia
›“Glacier melt is part of larger hydrologic and climate systems, so effective programs will be cross-sectoral and yield co-benefits,” said Elizabeth L. Malone, senior research scientist at the Joint Global Change Research Institute and Pacific Northwest National Laboratory, speaking at the Wilson Center on November 16. “Looking more closely at glacier melt, we come to understand that upstream actions and choices have a potentially huge effect on downstream communities,” added Kristina Yarrow, health advisor at the U.S. Agency for International Development’s Asia and Middle East Bureaus.
Malone and Yarrow were joined by Mary Melnyk, senior advisor for natural resource management at USAID’s Asia and Middle East Bureaus, to discuss the agency’s new report, “Changing Glaciers and Hydrology in Asia: Addressing Vulnerabilities to Glacier Melt Impacts,” prepared by Malone in collaboration with CDM International and TRG. “This report is a move towards mainstreaming climate change across the development portfolio to ensure enduring success of our investments,” Melnyk said.
Mainstreaming Climate Change
Providing information about the science, vulnerabilities, and current efforts to respond to environmental change and glacier melt in Asia, the new report also features a number of practical, cross-sectoral approaches to addressing glacial retreat in Asia that, if implemented well, could produce multiple benefits. The report highlights the complexity of the issues surrounding glacier melt in the region, and the critical need to prepare today for future environmental changes.“Climate change in general, and glacier melt specifically, can potentially impact all sectors: economic growth, governance, and health,” Melnyk said. Because there is a lack of scientific knowledge on glacial retreat in Asia and limited financial and human resources to address these issues, it is critical to maximize results through programs that will provide environmental, health, and development co-benefits.
“The challenge is that, in practice, addressing issues of climate change and other environmental security issues still are not a part of the day-to-day business across sectors,” Melnyk said. This report is a first step in the right direction to raise awareness and action on these issues and “although there is uncertainty, we need to move forward – the time to act is now,” she concluded.
Multiple Sectors, Multiple Benefits
“Cross-sector collaboration and programs, when done correctly, can have a much greater impact than when doing a vertical program within a specific sector,” Yarrow said, stressing the importance of multidisciplinary approaches to address environment, health, and development issues. Understanding the health impacts of climate-related environmental change now can help prepare us to address these specific impacts in the future.“On a global scale, there is indeed a relationship between population growth, environmental change, and development,” Yarrow said. In Asia, stress on water resources due to climate change and rapid population growth will likely exacerbate health problems caused by lack of clean water. Proactively expanding and improving programs that address the causes and effects of diarrheal disease and under-nutrition can help address these vulnerabilities and make communities more resilient.
“Finding innovative ways to improve access to and integrate family planning messages and services into climate adaptation programs will also yield some important co-benefits,” Yarrow said. Family planning can slow population growth, which could help reduce projected demand for water supplies, as well as potentially reduce the amount of water pollution.
Yarrow also added that “population growth affects glacier melt indirectly through the consumption of resources that exacerbate black carbon.” Black carbon, which is produced by cooking and heating with biomass fuels, contributes to regional climate change and severe health problems, including respiratory illness and pneumonia. Accompanied by efforts to promote alternative fuels, family planning could reduce black-carbon emissions, significantly improve health, and strengthen community resilience to climate change.
“Though challenging, integrating across sectors is absolutely essential – we’re not experts yet, but we’re definitely getting better,” Yarrow said. “Understanding and addressing the multiple issues like climate change, poor health, poverty, dependence on natural resources, and governance challenges that these communities are dealing with in a comprehensive and holistic fashion will improve results.”
Responding to Glacier Melt
“We simply do not have the kind of broad-scale knowledge that we would like to have,” Malone said. Current data on glacier melt is scarce and very few direct measurements of glacier volume exist, making calculations of glacier retreat difficult. Moving forward, it is critical to respond to this lack of information by improving regional scientific cooperation on glaciers, snowpack, and water resources in High Asia, and strengthening climate and water monitoring capacity.“Even the smallest amounts of glacier-melt contribution correspond to the regions of the highest population, so any change in water supply has large implications,” Malone said. Glaciers may not be disappearing as fast as had been previously thought, but “climate change is happening in the Himalayas and is having an effect.”
“If systems – both human and ecological – are already stressed, they are less able to be resilient in the face of changes. But the good news is that we can take actions now that will be crucially important to how societies can respond in the future,” Malone said.
Implementing cross-sector projects can help to target places where environmental, economic, health, and even security issues overlap. Focusing on water resource management, ecosystems, and the needs of high-mountain communities, as well as mitigating climate change by reducing emissions of black carbon, can help reduce both direct and indirect vulnerabilities and improve resilience to future changes.
“The results of this report allow USAID and others to grasp the complexity of these issues, understand the critical gaps, and to respond to the changes in the glaciers to come,” Melnyk said. The next step is applying the knowledge gathered in the report to practitioners in the field and in policy discussions.
“A crucial role USAID can play is to link partners in the government and private sectors to build capacity and spark synergies among new initiatives to really integrate new initiatives with concerns about glacier melt,” Malone concluded.
Photo Credit: “Nepal Sagamartha Trek,” courtesy of flickr user mckaysavage. -
IGWG’s K4Health Gender and Health Toolkit Is a One-Stop Shop for Integration
›November 30, 2010 // By Ramona Godbole
Addressing and analyzing gender norms, roles, and relations is increasingly viewed as critical in the development of equitable, effective, and sustainable health care. However, there has been relatively little integration of gender into health policies, programs, and systems.
The Interagency Gender Working Group (IGWG) – founded in 1997 as a way to bring together NGOs and parts of USAID to share best practices – has partnered with K4Health to create a Gender and Health Toolkit specifically designed to bridge this gap.IGWG’s Gender and Health Toolkit provides access to hundreds of tools, databases, training modules, websites, and publications in one place. Broadly divided into sections including program design, implementation approaches, capacity building, monitoring and evaluation, health systems, best practices examples, and even country-specific case studies, the toolkit provides nearly everything needed to begin integrating gender into new or existing public health programs.
Practitioners can also post questions and comments about the toolkit through an integrated discussion board. The toolkit even has a database to share gender-related photos.
While designed primarily for gender and health specialists and practitioners, the scope of the toolkit extends beyond typical public health issues like maternal health, family planning, HIV/AIDS, and reproductive health. The toolkit links to resources and training modules covering a wide range of cross-cutting topics including gender-based violence; nutrition and food security; integrated population, health and environment; and conflict/post-conflict humanitarian assistance.
The accumulated wealth of knowledge presented in the IGWG Gender and Health Toolkit is an impressively comprehensive resource, and it should be bookmarked by environment, health, and gender specialists and interested policymakers alike.
Image Credit: K4Health. -
Climate-Proofing Development: An Interview With Karen Hardee
›November 29, 2010 // By Hannah MarquseeWhile expectations are deflated for broad international consensus at the UN Climate Change Convention in Cancun, the need to “climate-proof” development efforts has been gaining ground in recent years as a necessary preventative measure to help developing countries adapt to the adverse effects of climate change.
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PRB’s Jay Gribble at Kenya’s National Leaders Conference on Population and Development
›November 29, 2010 // By Wilson Center StaffJay Gribble, vice president of International Programs at the Population Reference Bureau (PRB), recently attended the Kenya National Leaders Conference on Population and Development, November 15-17, at the Kenyatta International Conference Center in Nairobi. During the conference, he produced a series of posts for PRB’s Behind the Numbers on some of his impressions. Gribble focuses on Kenya’s resurgent interest in integrating population issues into the development agenda, the country’s ongoing HIV/AIDS epidemic, and the importance of family planning.
Below are the introductory excerpts from his posts; to read the full posts, please visit Behind the Numbers.
“Anticipating Change in Kenya”
Sitting in the hall where Kenya’s National Leaders Conference will be starting in a few minutes, I can’t help but feel that there is an opportunity to refocus national attention to development…to the goal that I have heard repeatedly of becoming a Middle Income country. And to achieve this goal, they must first recognize that population is an underpinning development issue that cannot be ignored.
In the 1980s and 1990s, Kenya was a leader in reproductive health and maternal health, really setting a pace for the continent. But during the 2000s, Kenya turned its attention to other pressing issues – namely HIV/AIDS – and began to give less attention to population issues. Though HIV continues to be a plague, it is now time to return to the importance of slowing population growth, for until this fundamental issues is addressed, there will be less opportunity for education, jobs, and better health. At the same time, as a predominantly rural country with agriculture representing a major part of the economy, smaller families will be critical to maintaining farms that are large enough to feed families and the country.
Continue on PRB.
“As the Rich Get Richer, the Poor Get Children”
The Kenya National Leaders Conference has begun, representing the first time since 1989 that Kenya’s national population policy has been discussed in a large, open forum. With a new national constitution, Kenya is poised to redress many of the social and economic inequalities that have stood in the way of its development. In fact, the current population policy expires in December, 2010, and one of the purposes of this conference is to gather the input from leaders throughout the country on how a new policy should be framed. I find it impressive that such a large conference is convened to ensure that a new policy reflects the needs of the nation. The conference is also a forum for reaching leaders with important information about the need to address population growth through family planning if Kenya is to achieve its Vision 2030 development plan.
Continue on PRB.
“In Kenya, Prioritizing Population…and Family Planning”
As Kenya’s National Leaders Conference on Population and Development winds down today, it offers leaders an opportunity not only to think and talk about how population growth is an issue that underlies the country’s development, but to act on it too. Whether thinking about business, agriculture, or the environment, it is impossible to be strategic about Kenya’s future without also considering how rapid population growth will affect it.
In talking with Kenyans who grew up in the 1970s and 1980s – back when family planning and population growth were a priority – they remember the messages that were at the tips of people’s tongues – smaller families live better. Before the HIV/AIDS epidemic, family planning and slowing population growth was a priority and a source of national pride because it put Kenya on track for prosperity and development.
Continue on PRB.
Photo Credit: Adapted from “King Kenyatta?” courtesy of flickr user rogiro. -
Robert Walker on Family Planning Promotion and Global Population Growth
›“Expanding voluntary family planning access and ensuring that all women have access to reproductive health services is, to me at least, a no brainer,” said the Population Institute’s Robert Walker in this interview with ECSP. “I think it’s a win for women, for their health, for their welfare, the welfare of their families, for their communities, for the environment, and for the planet at large.”
While China and India dominate much of the global headlines about population growth, other parts of South Asia – namely Afghanistan and Pakistan – and sub-Saharan Africa receive comparatively little attention. For Walker, a renewed global effort to boost the quality and quantity of reproductive healthcare tools and services in these areas of the developing world is essential.
“This is very, very doable. We face a lot of really incredible challenges in the world today, particularly with respect to food, energy, water, and poverty. But if we can increase what we spend on international family planning assistance by three or four billion dollars a year, we can literally change the world,” Walker said. “And I think we desperately need to.”
The “Pop Audio” series is also available as podcasts on iTunes. -
What’s Good for Women Is Good for the Planet
›Ammi, my mother-in-law, was 16 years old when her marriage was arranged. Before she was 18, she had borne her first child, who died within the year, and by 30, she had given birth to six more. She had a fourth-grade education, and like other women in the new state of Pakistan, she knew little about contraceptive choices.
More than 50 years later, contraception still remains inaccessible for millions of women in Pakistan, such as Rani, the young woman who cleans Ammi’s Karachi home. Illiterate and married off to a cousin at age 15, Rani already has three children, and, like the majority of married Pakistani women who have never used modern contraception, will most likely have at least one more.Giving women the ability to determine whether and when to become pregnant is fundamental to the realization of their basic human rights. It is also a proven health and development strategy, substantially reducing maternal and infant mortality by allowing women to space their pregnancies. And now, for the first time, two studies offer compelling evidence that it has another benefit: What is good for women is also good for our planet.
These groundbreaking studies have rigorously quantified the effect on the environment of helping women and girls control their reproductive destinies. The studies – “The World Population Prospects and Unmet Need for Family Planning,” by the Futures Group, and, “Global Demographic Trends and Future Carbon Emissions,” by the National Center for Atmospheric Research and the International Institute for Applied Systems Analysis – demonstrate that giving women and girls access to contraception offers a precious co-benefit: a substantial reduction in carbon emissions.
The logic is simple: When women have the power to plan their families, populations grow more slowly, as do greenhouse gas emissions. The cost of providing these needed family planning services worldwide is minimal compared with other development and emissions reductions strategies – roughly $3.7 billion per year.
More than 200 million women in the United States and developing countries are sexually active and do not want to become pregnant, yet are not using modern contraception. The results are staggering: One in four births worldwide is unplanned, leading to 42 million abortions each year (half of them clandestine) and 68,000 women’s deaths.
Moreover, the large number of women who become pregnant when they do not want to is a significant source of population growth. Read in tandem, the studies show that a reduction of 8-15 percent of essential carbon emissions can be obtained simply by providing modern contraception to all women who want it. This reduction would be equivalent to stopping all deforestation or increasing the world’s use of wind power 40-fold. Although this is just one piece of the emissions reduction puzzle, it is a substantial piece.
The world is now facing multi-layered challenges of economic distress, rising inequality, and environmental devastation caused by climate change. International climate negotiations have repeatedly stalled as powerful nations play the blame game and block progress. Meanwhile, a series of severe weather events has buffeted the earth from Moscow to Iowa to Pakistan, each one hitting women and children hardest. This is the reality that rich nations must reckon with – and commit to changing – today.
In my 14 years at the Global Fund for Women, I have observed the wave of change that comes from empowering women – what some call the “girl effect.” Making information, education, and contraception easily available offers us an affordable, no-regrets strategy that can be implemented now.
Meeting the need for family planning services is not a complex challenge. We know how to provide the commodities, services, and education that women and their families want. There are thousands of programs around the world with successful track records in every conceivable religious, cultural, and political setting.
Investing in family planning has already been proven as an essential strategy to ensure the health, safety, and development of societies. Now we know that it is also an effective way to safely steward Mother Earth through one of her most challenging crises.
Kavita N. Ramdas is chair of the Expert Working Group of the Aspen Institute’s Global Leaders Council for Reproductive Health and senior adviser and former president and CEO of the Global Fund for Women.
Sources: Futures Group, National Center for Atmospheric Research and the International Institute for Applied Systems, Science, UNFPA, WHO.
Photo Credit: “Chaco: Madre pilagá,” courtesy of flickr user Ostrosky Photos, and Kavita Ramdas, courtesy of Global Fund for Women. -
Nigeria’s Future Clouded by Oil, Climate Change, and Scarcity [Part Two, The Sahel]
›November 19, 2010 // By Schuyler NullIf southern Nigeria’s demographic and environmental problems have helped fuel today’s conflicts, it’s the north’s issues that may feed the conflicts of tomorrow.
Nigeria’s lack of development and poor governance is not exclusive to the delta region, only more well-known because its oil reserves. The north of the country, which is predominately Muslim and accounts for more than half of Nigeria’s population, faces many of the same problems of environmental degradation, lack of jobs, and inadequate infrastructure. Northern Nigeria is also growing much faster than the south, with a total fertility rate of 6.6 children per woman, compared to 4.6 in the southern states. The median age of first-time mothers in northern Nigeria is only 18 years old.Nigeria holds nearly a fifth of the entire population of sub-Saharan Africa. By 2050, it’s expected to pass Indonesia, Brazil, and Bangladesh and take its place among the top five most populous countries in the world, according to UN estimates. But a litany of outstanding and new development, security, and environmental issues – both in the long-troubled Niger delta in the south and the newly inflamed north – present a real threat to one West Africa’s most critical countries.
If southern Nigeria’s demographic and environmental problems have helped fuel today’s conflicts, it’s the north’s issues that may feed the conflicts of tomorrow.
Nigeria’s lack of development and poor governance is not exclusive to the delta region, only more well-known because its oil reserves. The north of the country, which is predominately Muslim and accounts for more than half of Nigeria’s population, faces many of the same problems of environmental degradation, lack of jobs, and inadequate infrastructure. Northern Nigeria is also growing much faster than the south, with a total fertility rate of 6.6 children per woman, compared to 4.6 in the southern states. The median age of first-time mothers in northern Nigeria is only 18 years old.
Climate, Culture, and Discontent in the North
Last summer, in an offensive that stretched across four northern states, a hardline Islamist group called Boko Haram emerged suddenly to challenge the government, attacking police stations, barracks, and churches in escalating violence that claimed more than 700 lives, according to The Guardian. The government responded with a brutal crackdown, but recent targeted killings and a prison break seem to indicate the group is back.
Perhaps most distressingly, Boko Haram appears to have won some local support. Said one local cloth trader to The New York Times in an interview this October, “It’s the government’s fault. Our representatives and our government, they are not sincere. What one person acquires is enough to care for a massive amount of people.”
As in the south, mismanagement of natural resources has also played a role in creating a dangerous atmosphere of distrust in the government. After gold was discovered this spring in northwestern Nigeria, many under- and unemployed flocked to the region to try their luck, but they also unwittingly contaminated local water with high levels of lead. Although the state health officials say they have now identified more than 180 villages thought to be affected, the epidemic was only discovered after a French NGO stumbled upon it while testing for meningitis in June. More than 400 infant deaths have been connected to the mining, according to Reuters.
Contributing to natural resource-related misery in the north are climatic changes. Declining rainfall in the West African Sahel over the last century has pushed rain belts successively south, driving pastoralists into areas often already occupied. According to Anthony Nyong’s work, presented in ECSP Report 12, these changes have elevated competition over natural resources to the single most common cause of conflict in northern Nigeria in recent years.In addition to the long-term trend of declining rainfall, an acute drought in 2009 and another this year in neighboring Niger and Chad have created the worst food security crisis in 30 years. The droughts have also driven a great deal of cross-border migration into Nigeria, which itself saw lower than usual rainfall in the north, especially the northeast, around the ever-disappearing Lake Chad (see map above for resulting migration patterns).
What rain did fall in the border areas fell suddenly and torrentially, causing rampant flooding that affected two million people. The floods not only caused physical damage but also came just before harvest season, destroying many crops and further reducing food security. Made more vulnerable by the number of displaced people and flooding, the area was then hit with its worst cholera outbreak in years, which has killed 1,500 people so far and spread south.
Cholera is not the only preventable disease to flourish in northern Nigeria in recent years. In 2003, cleric-driven fear of a U.S. plot to reduce fertility in Muslim women caused the widespread boycott of a UN-led polio vaccination drive. The fast-spreading disease then emerged in six of Nigeria’s neighbors where the disease had previously been eradicated. The northern states today remain the only consistently polio-endemic area in Africa, according to the Global Polio Eradication Initiative.
“A Stable Nigeria Is a Stable Africa”
Nigeria’s size and its wealth of natural resources make it a strategically important country for the future of the region. “A stable Nigeria is a stable Africa,” said Wilson Center scholar and former NEITI officer Uche Igwe in an interview. “Nigeria is 150 million people and the minute Nigeria becomes unstable, the West Africa sub-region will be engulfed.”
While there have been some strides in recent years in reducing corruption and addressing infrastructure needs (for example, NEITI’s work to promote revenue transparency), the development, health, environmental security, and human security situations remain dire in many parts of the country. With one of the fastest growing populations in the world and severe environmental problems in both the north and the south, scarcity will almost certainly be a challenge that Nigeria will have to face in the coming years. How the government responds to these challenges moving forward is therefore critical.
In 2008, in response to high oil prices, British Prime Minister Gordon Brown announced his intentions to send military aid to help combat Niger Delta militants. The statement was met with dismay from humanitarian organizations and caused the collapse of a ceasefire (which was then resumed for a time and now seems to be falling apart again). Brown was forced to backtrack into simply offering training support to Nigerian security forces.
In terms of U.S. assistance, USAID requested $560 million for Nigeria in FY 2010 – 75 percent of which is allocated towards HIV/AIDS – and the U.S. military has engaged in joint exercises with Nigerian forces. But so far, little has been done to integrate U.S. aid in a cohesive manner. Given the breadth of these issues, such integration is crucial.
“We need partners, like the United States and Europe, who have a stake in stability – in Nigeria, the Niger Delta, the Gulf of Guinea, and the world,” Igwe said. It remains to be seen what the Nigerian reaction would be to an offer of aid from the West that addresses not only the country’s security issues but also its myriad other problems, in a substantial and integrated fashion.
Part one on Nigeria’s future – The Delta – addresses oil, insurgency, and the environment in the south.
Sources: AFP, AFRICOM, AP, BBC, Global Polio Eradication Initiative, The Guardian, Independent, The New York Times, ReliefWeb, Reuters, SaharaReporters, USAID.
Photo Credit: “The Ranch,” courtesy of flickr user Gareth-Davies, and “Niger and Nigeria: Food security drives population movement,” courtesy of the U.S. State Department.
