Showing posts from category global health.
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Colin Kahl on Demography, Scarcity, and the “Intervening Variables” of Conflict
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“One of the major lessons of 9/11 is that even superpowers can be vulnerable to the grievances emanating from failed and failing states,” said Colin Kahl, now deputy assistant secretary of defense for the Middle East, at an ECSP event at the Wilson Center in October 2007. However, “if poverty and inequality were enough to lead to widespread civil strife, the entire world would be on fire.”
“I think any in-depth examination of particular cases shows that there’s a complex interaction between demographic pressures, environmental degradation and scarcity, and structural and economic scarcities – that they tend to interact and reinforce one another in a kind of vicious circle,” Kahl said.
“It’s really important to keep in mind that any attempt to address…environmental and demographic factors should focus not just on preventing environmental degradation, or slowing population growth, or increasing public health. They must also focus on those intervening variables in the middle that make certain societies and countries more resilient in the face of crisis.”
The “Pop Audio” series is also available as podcasts on iTunes. -
Former Botswana President Champions Health, Governance Issues
›November 16, 2010 // By Wilson Center StaffOriginally featured in the Scholar Spotlight, Centerpoint, November 2010.
His Excellency Festus Mogae, who served as president of Botswana from 1998–2008, recently spent several months at the Wilson Center as a public policy scholar. During his stay, he conducted research, networked with senior policy officials in the U.S. government, the United Nations, and with NGO representatives in Washington and New York, and attended Wilson Center seminars related to health and governance.
Since leaving office, Mogae has advocated for governance reform in Africa, notably presidential term limits, and efforts to mitigate the effects of climate change. Another critical initiative he is pursuing actively is HIV/AIDS prevention across Africa.
Mogae is the founder and chairman of Champions for an HIV-Free Generation, a group that assists current African presidents in dealing with the AIDS pandemic. This year, the delegation visited South Africa, Namibia, Mozambique, and Swaziland and, most recently, Zambia in October. The group seeks policy and attitude changes among the leaders of these nations and also advocates for increased financing for AIDS prevention in their health budgets. “If [these countries] allocate their own resources, the donor agencies will see they are serious about this problem” and match funds, said Mogae.
“We take the view that a more outspoken leadership must come from the continent regarding the AIDS epidemic,” he said. “African leaders must not only care but also be seen by donor countries and agencies as leading from the front on these matters.”
The group includes Mozambique’s Joaquim Chissano, Tanzania’s Benjamin Mkapa, Zambia’s first president Kenneth Kaunda, former Vice President of Uganda Speciosa Wandira, and former Chairperson of Kenya’s National AIDS Control Council, Miriam Were. Also in the coalition are two notables from South Africa, Nobel Laureate Archbishop Desmond Tutu and Constitutional Court judge, Justice Edwin Cameron.
The Champions coordinate with local health representatives based in Africa, from UNAIDS, the World Health Organization, PEPFAR, and the Gates Foundation, which prepare country reports on the status of AIDS. Then, armed with this research, the group meets with African leaders, including the presidents, finance and health ministers, local government and parliamentary officials, private sector, union, and civil society representatives, and church groups to lobby for policy changes.
“We highlight success stories on the continent so others can emulate them,” Mogae said. “We are calling for social behavioral change, but that can only happen if advocated and led by the top religious and traditional leadership.”
One particular challenge has been mother-to-child transmissions. He said in sub-Saharan Africa, in 2000, 40 percent of children born to HIV-positive mothers got infected but by 2008, the figure was down to three percent. The target is zero, he said.
Another major initiative chaired by Mogae is the Coalition for Dialogue on Africa, or, CoDA, a joint venture among the African Development Bank, the African Union Commission, and the UN Economic Commission for Africa. This global effort focuses on education, agriculture and conservation, energy and natural resources, and helping women. CoDA currently is organizing a symposium on women’s empowerment, he said, that will focus on education, and reforming land ownership and marriage laws.
These and other organizations with which he is affiliated aim to help shape policies and set priorities for Africa. He said, “We can’t ask the international community for help unless we first help ourselves.”
Dana Steinberg is the editor of the Wilson Center’s Centerpoint.
Photo Credit: AIDS sign in Gaborone, Botswana, courtesy of flickr user cordelia_persen. -
Disease in the Developing World
Poverty, Politics, and Pollution
›November 15, 2010 // By Ramona GodboleA look at the most common illnesses that kill people in the developing world reveals, for the most part, easily preventable and/or treatable diseases and conditions, highlighting the deep disparities between health systems in rich and poor countries. But many of the causes and solutions to these common diseases are also linked to political and environmental factors as well as economic.
Cholera: “A disease of poverty”
Ten months after the earthquake that killed more than 230,000 people, Haiti is facing yet another disaster – a cholera outbreak. The current health crisis highlights broader structural and political issues that have plagued Haiti for years.
Cholera, an intestinal infection caused by bacteria-contaminated food or water, causes severe diarrhea and dehydration, but with quick and effective treatment, less than one percent of symptomatic people die according to the World Health Organization. According to BBC, as of November 15, more than 14,000 people have been hospitalized and over 900 deaths have been attributed to cholera in Haiti thus far.
Even before the earthquake, conditions in Haiti, the poorest country in the Western hemisphere, were bleak. The country has very high maternal and child mortality rates (again, highest in the Western hemisphere), and is in the midst of an ongoing environmental crisis, due to deforestation, soil loss, and flooding.
Less than 40 percent of the Haitian population has access to appropriate sanitation facilities and clean water is scarce, according to UNICEF. Displacement, rapid population growth, and destroyed infrastructure in the wake of the earthquake exacerbated already poor conditions and public health officials warned of the increased risk of cholera and other diarrheal diseases after the disaster.
Today these fears have become reality. While public health messages urging Haitians to wash their hands, boil drinking water, and use oral rehydration salts are working to control the current outbreak, long-term solutions to prevent future outbreaks will require much more systematic changes.
As Partners in Health Chief Medical Officer Joia Mukherjee puts it, cholera is “a disease of poverty.” Citing a joint report from Partners in Health and the Robert Kennedy Center for Human Rights, Mukherjee notes that in 2000, loans from the Inter-American Development Bank to improve water, sanitation, and health (including the public water supply in the Artibonite Valley, where the cholera outbreak originated) were blocked for political reasons by the U.S. government, in an effort to destabilize former President Aristide.
The failure of the international community to assist Haiti in developing a safe water supply, writes Mukherjee, has been a violation of the basic human right to water. To halt the current cholera epidemic and prevent future outbreaks, providing water security must become a priority in the reconstruction efforts of the international community.
Politics and Polio
Recent reports have indicated that the global incidence of polio, a highly infectious, crippling, and potentially fatal virus, is significantly declining and a new vaccine is renewing hopes of eradication. Nigeria, one of the few countries where polio continues to be endemic, has also made major progress over the last few years.
But the situation was very different just a few years ago. In 2003 religious and political leaders in Northern Nigeria banned federally sponsored polio immunization campaigns, citing “evidence” that the polio vaccine was contaminated with anti-fertility drugs intended to sterilize Nigerian women. The boycott led to an outbreak of the disease that spread to 20 countries and caused 80 percent of the world’s cases of polio during the length of the ban, according to a study in Health Affairs.
While the boycott was eventually stopped through the combined efforts of local, national, and pressure, the boycott serves as a useful reminder that global health problems can have political, rather than biological or behavioral, origins.
Combating Climate Change and Pneumonia
Studies from the World Health Organization indicate that exposure to unprocessed solid fuels increases pneumonia risk in children by a factor of 1.8, but today more than three billion people globally continue to depend on coal and biomass fuels for their cooking and heating needs.
Cooking and heating with these fuels creates levels of indoor air pollution that are up to 20 times higher than accepted WHO guidelines, putting people at considerable risk for lower respiratory infections. Women, who are often responsible for collecting fuel and performing household tasks like cooking, and their children, are particularly at risk. Today, exposure to indoor air pollution is responsible for 1.6 million deaths globally including more than 900,000 of the two million annual deaths from pneumonia in children under five years old, representing the most important cause of death in this age group.
A recent study from The Lancet shows improved cooking stoves could simultaneously reduce greenhouse gas emissions and the global burden of disease caused by indoor air pollution in developing countries. Such an intervention, the authors argue, could have substantial benefits for acute lower respiratory infection in children, chronic obstructive pulmonary disease, and ischemic heart disease. The potential health benefits don’t stop there: fuel-efficient stoves can also improve the security of women and children in conflict zones and decrease the risk of burns while improving local air quality.
There would be significant environmental benefits as well. A World Wildlife Fund project in Nepal, which provided loans to purchase biogas units and build improved cookstoves, curbed deforestation for firewood and grazing as well as reduced the incidence of severe cases of acute respiratory infection among under-five children.
Overall, greater access to modern cooking fuels and improved cooking stoves in the developing world could both mitigate climate change and make significant contributions to MDGs 4 & 5, which focus on the reduction of child and maternal mortality.
Prescription for Change
The international community’s experience with cholera in Haiti, polio in Nigeria, and pneumonia around the world shows that health issues in developing countries rarely occur in a vacuum. As these three cases demonstrate, politics, environmental, and structural issues, for better or worse, play an important role in health affairs in the developing world. Yet efforts to combat these conditions often focus only on prevention and treatment.
Antibiotics and vaccines alone cannot provide solutions to these problems. Employing economic, diplomatic and policy tools to address health and development challenges can save lives. More specifically, public health efforts should not only focus on poverty reduction, but also target environmental, political, and structural issues that contribute to disease globally.
Sources: BBC, Bill and Melinda Gates Foundation, CIA World Factbook, Health Affairs, The Lancet, Scientific American, UNICEF, United Nations, USAID, World Health Organization, and World Wildlife Fund.
Photo Credit: “Lining up for vaccination,” courtesy of flickr user hdptcar. -
John Bongaarts on the Impacts of Demographic Change in the Developing World
›“The UN projects about 9.1 billion people by 2050, and then population growth will likely level off around 9.5 billion later in the century. Can the planet handle 9 billion? The answer is probably yes. Is it a desirable trajectory? The answer is no,” said John Bongaarts, vice president of the Policy Research Division at the Population Council, in this interview with ECSP.
Although family planning was largely brushed aside by international policymakers following the 1994 UN International Conference on Population and Development in Cairo, Bongaarts said he is hopeful because it is now enjoying a higher profile globally – and receiving greater funding.
“I am optimistic about the understanding now, both in developing and developed world, and in the donor community, that [family planning] is an important issue that should be getting more attention,” Bongaarts said. “And therefore I think the chances of ending up with a positive demographic outlook are now larger than they were a few years ago.”
The “Pop Audio” series is also available as podcasts on iTunes. -
Blue Ventures’ Integrated PHE Initiative in Madagascar
›In the small coastal village of Andavadoaka, Madagascar, the village elders offer a bottle of rum and two cigarettes to their ancestors before the men and their sons launch their wooden dugout canoes into the sea. Leaning over the side, their masked faces scour the water for their prey.
Meanwhile, the women – with babies on back and spears in hand – set out on foot into the shallow waters. One probes a small hole with her spear, and a tentacle reaches out to grapple with it. After careful coaxing, she pulls out an octopus, kills it, and adds it to her collection, which she tows on a string behind her.
In total, more than 1,850 pounds of octopus are collected on the opening day of the octopus harvest, a seasonal occurrence in Velondriake, the Indian Ocean’s first locally managed marine area.
Velondriake, which means “to live with the sea,” stretches along more than 40 km of southwestern Madagascar’s coast. The region encompasses 25 villages and is home to more than 8,000 people of the Vezo ethnic group, who are almost entirely dependent on marine resources, such as octopus, fish, and mangrove forests, for subsistence and income. But these resources are quickly disappearing due in large part to over-harvesting.
Blue Ventures Conservation – the London-based NGO I work for – has been working in the area since 2003 to protect the region’s coral reefs and mangroves, as well as their biological diversity, sustainability, and productivity, while also improving the quality of life of the local community.
To this end, Blue Ventures helped the community create a series of coastal marine reserves. Several permanent reserves protect the biodiversity of the coral reefs and mangroves, and help fish populations recover; while nearly 50 temporary reserves have increased the productivity of the octopus and crab fisheries. Octopuses reproduce quickly and juveniles grow at a nearly exponential rate, so a brief harvesting hiatus can lead to significant increases in yield. Increased yields translate to increased profits – something greatly welcomed by the people of this impoverished region.
The people of the region are also reproducing quickly: the average total fertility rate in Velondriake is 6.7 children per woman, according to our data. On average women are only 15 years old when they first conceive. To compound this problem, a majority of the population is under the age of 15 – at or approaching reproductive age. At the current growth rate, the local population will double in only 10 to 15 years. The local food sources, already heavily depleted, barely feed the current population, let alone twice that amount. Without enabling these coastal communities to stabilize their population growth, efforts to improve the state of marine resources and the community’s food security are considerably hindered.
In August 2007, Blue Ventures launched its Population, Health, & Environment (PHE) program as a weekly family planning clinic in Andavadoaka, which provided access to ingestible and injectable birth control options, as well as condoms. The clinic increased the village’s contraceptive prevalence rate (CPR) from 9.4 percent to 36.3 percent, and the Velondriake region’s CPR from 11.0 percent to 15.1 percent, in its first two years. (CPR data for the third year is not yet available, but should be notably higher, especially at the regional level.)
In 2009, Blue Ventures opened two more clinics and began holding quarterly outreach clinics in all Velondriake villages. We started offering long-acting, reversible contraceptive options, including Implanon and IUDs. Most recently, we have implemented a community-based distributor (CBD) program to provide wider access to contraceptives around the region, particularly for villagers that could not easily reach one of the clinic sites. These expansions paid dividends: the number of patients increased almost four-fold between the second and third years, with a cumulative total for all three years of just under 1,700 patients.
Recently, the PHE program began a partnership with the UN Population Fund (UNFPA), becoming the first PHE project to receive support from the UNFPA within Madagascar. The UNFPA funds will allow us to add new regional clinics; launch a behavior change campaign, including a regional theater tour and educational events; and further develop the CBD program.
UNFPA’s support of this initiative represents an important endorsement of Blue Ventures’ integrated approach to the challenges of marine sustainability, food security, reproductive health, and population growth. Funding applications to focus on improving maternal and infant health and to conduct a full health-needs assessment of the Velondriake region are pending.
In taking a population, health, and environment approach, Blue Ventures creates synergies that allow for the more effective achievement of health and conservation outcomes. Through providing family planning and health options – services the community really wants – Blue Ventures generates more support for all of its other initiatives, such as conservation and aquaculture programs.
This integrated multi-pronged approach also helps speed up the move towards a more sustainable future. By empowering and enabling couples to take control of their fertility, couples are able to have the size family they want. The use of family planning helps lower the population growth rate, and lower growth rates decrease pressures on natural resources. Decreased pressures on natural resources lead to healthier ecosystems; healthier ecosystems mean more natural resources available; and more resources lead to healthier families.
Through recognizing this inextricable link between communities, their health, and the environment they live in, Blue Ventures hopes to preserve not just the local coral reefs and mangroves, but the Vezo seafaring lifestyle. This way, the sons on the boats and the babies on the women’s backs may still have enough octopus and fish to harvest when they take their own children out to sea.
Matthew Erdman is the PHE coordinator for Blue Ventures. For more information about Blue Ventures’ PHE activities, please contact phe@blueventures.org, or visit their website at www.blueventures.org.
Photo Credit: Adapted from “07,” courtesy of Blue Ventures. -
Mapping World Bank-Funded Projects
›The World Bank recently released their interactive “Mapping for Results Platform” that allows users to see where and how World Bank funding is being spent. Users can view project costs and expenditures by sector at sub-national levels and overlay this with human development data such as poverty, population, and health indicators. In the current beta version, interactive maps and downloadable data are available for Kenya, Bolivia, and the Philippines.
The example map shown above shows all of the World Bank’s 38 active water and sanitation, health, and agricultural projects in Kenya, as well as malnutrition rates by district. Clicking on any of the projects on the map displays the project name, financing amount, and exact location of the program.
Presumably, in the final version, all 2,669 active World Bank projects and 15,246 project locations – accounting for $136.91 billion – will be included.
Image Credit: World Bank Mapping for Results Platform. -
Meeting the Health Challenges of the Urban Poor
›November 2, 2010 // By Joshua NickellFifty percent of the world’s population now lives in cities, a figure that is predicted to rise to 60 percent by 2030, and 70 percent by mid-century, according to UN figures. The majority of this growth will occur in the Global South, where most of the world’s slums are found.
Why the rampant urban migration? Prospects for better health care, education, and employment are drawing the world’s poor out of rural areas into cities. But as the number of impoverished city-dwellers and slums grows, it is becoming increasingly important for society to consider how it will address the problems associated with this unprecedented degree of global urbanization.
At a recent event, “Meeting the Health Challenge of Urban Poverty and Slums,” co-hosted by the Wilson Center on the Hill program and the Comparative Urban Studies Project, Jacob Kumaresan, director of WHO Center for Health Development in Kobe, Japan, and Richard B. Lamporte, director of new program development, Jhpiego, discussed poverty and health challenges in rapidly growing urban slums.
The chances that the world’s rapidly growing number of city-dwellers will live a healthy and prosperous life depend on the services and opportunities cities can offer. As Kumaresan pointed out, there is currently no shortage of problems. Among other ills, he stated that 170 million urban residents currently do not have access to a latrine, while more than 1.2 million people will die from urban air pollution this year alone. As more individuals migrate to cities, these problems will be compounded.
Kumaresan also noted that cities have the “worst and the most unimaginable disparities when it comes to health.” While urban centers have more hospitals and attract many of the best doctors, the hospitals are often not managed or governed well. As a result, many poor urbanites suffer worse health care than their rural neighbors.
For instance, Kumaresan noted that tuberculosis rates in rural parts of India are half those of urban settings. Kumaresan also emphasized that these disparities are certainly not limited to the Global South: developed cities like New York and Los Angeles contend with similar inequities.
To address these issues, Kumaresan encouraged policymakers to examine the unique circumstances and conditions of their cities. “You’ve got to do analytical work to see what the problems are in each city, and to look not at the averages, but to unmask the differentials,” he said.
In Osaka, Japan, tuberculosis rates are 12 times higher than the rest of the country, said Kumaresan, primarily because of high affliction rates among its homeless population. As such, it is important for Osaka’s policymakers to address its tuberculosis problem by considering related socio-economic factors and following through with concrete policy actions.
Lamporte emphasized the importance of giving aid and development organizations flexible funding in order to allow them to better address unique local urban problems and inequities. He advised international donors to devote a certain percentage of their funding to integrated initiatives. “Certainly the goalposts could be set, but having some element of complementary funding … would be extremely useful,” he said.
As both Lamporte and Kumaresan pointed out, the future of the city is increasingly becoming the future of the world. As such, it is crucial to have “an urban optic going into the future,” according to Lamporte. If not, he argued, it will be at our own peril, as disease and unrest find increasingly sturdy footholds in urban slums. As the transformation from a rural to an urban planet continues, it will be essential for emerging and growing cities must use successful urban development techniques from both the Global North and the South.
Joshua Nickell is an intern with the Program on America and the Global Economy.
Sources: IRIN, Osaka University Graduate School of Medicine, UN, World Health Organization.
Photo Credit: “kibera_photoshow08,” courtesy of flickr user newbeatphoto. -
Mobile Phones for Maternal Health in the Developing World
›With rising use in the developing world, cell phones and mobile technologies can create “connected and coordinated health systems that save more lives,” said Josh Nesbit at the GHI event “New Applications for Existing Technologies to Improve Maternal Health,” on October 27. Capitalizing on these new technologies could increase efficiency, cost-effectiveness, and efficacy of public health programs. Nesbit, executive director of FrontlineSMS: Medic, was joined by Alain Labrique, assistant professor at the Johns Hopkins School of Public Health, and David Aylward, executive director of the mHealth Alliance at the United Nations Foundation, to discuss the role of Information and Communication Technologies (ICTs) in the prevention of maternal mortality.
Collaborations for mHealthWhile “cell phones can’t save lives, the lack of information does kill,” said Aylward. Using technology that many people already own and use, mobile technology is an appropriate tool for disseminating health data and information. Existing technologies such as mobile phones and SMS text messaging can revolutionize healthcare by improving data collection and disease tracking, expanding patient diagnostics, and advancing education and awareness among health workers and patients.
With 64 percent of all mobile phone users located in the developing world, the use of mobile devices to improve health services in low-income countries is especially promising.
Aylward hopes that mobile health technology (mHealth) will help combat maternal mortality in the developing world. With approximately 350,000 women dying in childbirth each year, and only marginal progresses towards achieving Millennium Development Goal 5, finding such innovative solutions to improve maternal health is crucial.
Public-private partnerships are particularly important when considering the long-term sustainability of mHealth programs. “This didn’t happen because of the World Bank, it happened because people who are very poor voted with their very limited funds to have access to information,” said Aylward.
Aylward is hopeful that government and donor support will continue to become more supportive of mobile technology and coordinated in their implementation of mHealth programs globally.
Mobile Health Solutions in the Developing World
“Through mobile tools, we can act as quickly as possible to improve access to skilled birth attendants, emergency obstetric care, and access to reproductive health commodities,” said Nesbit.Nesbit’s organization, FrontlineSMS: Medic, is working to eliminate barriers created by the lack of resources and infrastructure in the developing world using mobile health technology. Now working in 20 countries, the organization uses free software “that enables large-scale, two-way text messaging using only a laptop, a GSM modem, and inexpensive cell phones,” explained Nesbit.
“One of the best measures is whether people continue to use your tools, and they will if it impacts their lives positively and they won’t if it doesn’t—sometimes it’s as simple as that,” said Nesbit on why communities in the developing world are eagerly embracing mobile technology.
Moving forward, Nesbit hopes to “scale and replicate, both vertically and horizontally, models that we’ve shown can work, but also to build new tools” and work with the health community “to help identify the needs and the gaps in these systems.”
However, Nesbit stresses that “these are very much tools and not solutions; they become solutions when they are paired with people on the ground who use them.”
Compressing the Time Between Crisis and Care
“The opportunities for mobile phones to act synergistically with existing health systems in low- to middle-income countries are many,” said Labrique. The current challenge is to harness this technology to improve health outcomes in the developing world, where disease burden is disproportionately high.
In the developing world, “decisions influenced by the lack of resources, such as poverty, or lack of information have led to highly convoluted patterns of care-seeking,” said Labrique.“Delayed decision-making compounded by delayed transport can have tragic consequences for maternal mortality,” said Labrique, and the most immediate use of mobile technology is “getting the necessary care, on time, to where these deaths are taking place.” Cell phones can help women, their families, and local health workers to seek timely, appropriate medical help for an obstetric emergency.
“Addressing equity and access to phones when evaluating the impact or success of mHealth interventions is critical,” Labrique said. Although cell phone use is high and steadily increasing, social and cultural norms in some countries might prevent women from using them. Further, Labrique notes, in Bangladesh, cell phone use among the poorest families is noticeably less than those with higher socioeconomic status.
“ICT and mHealth solutions have tremendous promise to improve maternal health in resource limited settings; however, it’s important not to let the technology guide the public health agenda,” said Labrique. More data is needed to determine how these tools might strengthen and enhance health systems and a clearer research agenda can help ensure evidence-based solutions guide programming.
For more from David Aylward and mHealth, be sure to see “Watch: David Aylward on How Wireless Technology is Changing Global Health and Empowering Women.”
Sources: Lancet, United Nations Foundation.
Photo Credit: “‘SMS till you drop’ — mobile phone ad on van in Kampala, Uganda,” courtesy of flickr user futureatlas.com.
