Kaiser Daily Global Health Policy Report
Tuesday, May 10, 2011
GlobalPost has published two articles on President Barack Obama's Global Health Initiative (GHI). "In a series of reports over the coming months from Washington and in capitals around the world, GlobalPost will examine the behind-the-scenes decisions in the Obama administration as well as what diplomats and health experts are doing now in several countries to try to bring to life this new, but what some say is a stumbling approach in global health," the publication writes.
According to the first article, which is reported from Ethiopia, the GHI aims "to expand U.S. government focus much more aggressively into other critical global health challenges, such as saving mothers when they give birth or protecting communities from river blindness, instead of the United States continuing to attack one disease at a time, such as AIDS, tuberculosis and malaria, without any coordination."
But the implementation so far, has not yet reflected that vision, according to the story. "The administration can point only to a few small programs started under GHI in countries around the world, and those are too new or too small to yield any tangible results. While many health experts argue that it takes time to overhaul assistance to a network of programs, and that ensuring quality is more important than rushing into something, the considerable delays in turning words into action have put the initiative in some fiscal peril. And as a result, supporters fear the GHI's lofty goals may now be threatened," GlobalPost reports.
Ezekiel Emanuel, who helped create the GHI, is among several experts quoted in the article. "I'm an impatient guy. Of course, I'm frustrated. But I'm also realistic," Emanuel said of the program. "Have we made as much progress as we would like? No. Have we made no progress in the field? That's absolutely wrong."
Stephen Morrison, director of the Global Health Policy Center at the Center for Strategic and International Studies, said, "The goals and principles of GHI are absolutely correct. ... But GHI is off to a very poor start" (Donnelly, 5/9).
A second article, reported from Washington, indicates that "from the start, the GHI was difficult to define. What was it? What wasn't it? The architects of the GHI acknowledged that the process took time and several said that they needed to think through the consequences of redrawing a whole new global health approach. The old way of doing things, they argued, may have led to quick results against a disease, but it was an inefficient and piecemeal approach to health care," GlobalPost writes.
The story reports that there were "three major hurdles from the start in trying to build a new architecture for U.S. global health programs. One was that the money tilts heavily toward the AIDS fight – roughly 70 percent of all global health funding."
Another issue "was that the GHI had three chiefs – as opposed to ... [President George W.] Bush's PEPFAR AIDS plan that had one office, one ambassador, and a president's marching orders to plow through red tape. ... The third issue was that during the long buildup for the GHI, few administration officials reached out to Congress to keep it informed and build support. The result, according to many observers, was that the bipartisan goodwill built toward the AIDS program began to wither and the support for the GHI has yet to take hold," according to the article.
In addition, GlobalPost reports that funding for the GHI "has run into one of the most difficult budgetary climates in Washington in decades," and the initiative has been dogged by "issues that touch the political third rail of 'reproductive rights' for women" (Donnelly, 5/9).
The article series also features an interview with Lois Quam, the executive director of the GHI (Donnelly, 5/9).
There are also snap-shots available of the eight GHI Plus countries.
Funding for the project is provided by the Kaiser Family Foundation as part of its U.S. Global Health Policy program.
The risk of dying in a natural disaster is decreasing worldwide, but the economic toll weather-related catastrophes inflict is rising "often due to a lack of investment," according to a new U.N. report released in Geneva on Tuesday, Reuters reports. According to the Global Assessment Report on Disaster Risk Reduction, "[d]amage to infrastructure – schools, health centers, roads, bridges – is soaring in many low- and middle-income countries despite improvements in many early warning systems," the news agency writes (Nebehay, 5/10).
The report, released in conjunction with a four-day biennial U.N. conference on disaster risk, "estimated that the amount of global GDP exposed to harm by disasters had nearly tripled from $525.7 billion 40 years ago to $1.58 trillion," according to Agence France-Presse. "The report also reiterated warnings about growing pattern of extreme weather events that has been linked to climate change," AFP adds.
Though nations have made improvements in early warning systems and disaster response, many governments said in the survey they were having difficulties implementing disaster reduction measures, including land planning, safe building codes, or slope stabilization, the news agency reports (5/10).
"One of the reasons why countries aren't investing enough in disaster risk management is probably, to put it in simple terms, human nature. All of us as individuals and governments in particular do tend to heavily discount very low probability future events," Andrew Maskrey, coordinator of the report, said, adding, "It is very clear from the economic evidence that prevention is better than cure," according to Reuters (5/10).
"This Global Assessment Report shows us, without a doubt, that risks are accumulating in all economies. We ignore it, literally, at our peril. This report only confirms what we already suspected and I think we're beginning to realize that it is time to band together and take the action necessary to stem the widespread economic and developmental losses we are witnessing," Maskrey said in a press release from the U.N. International Strategy for Disaster Reduction Secretariat (5/10).
In an article looking at Baghdad Hospital, the Washington Post reports that "[i]t is difficult to overstate how far [the hospital] has come since the worst days of the war, when supplies were so scarce that doctors sometimes performed open heart surgery without gloves. ... Arriving at work was a small miracle: The hospital has lost at least 40 doctors to assassins since 2004 – they are still occasionally targeted – and their photos stare down from walls."
Now as "a semblance of calm has settled over Iraq, doctors say the biggest menace to patients these days is not so much a lack of money, basic training or even supplies. Rather, they say, it is the skewed priorities of a corrupt, often indifferent Health Ministry that has gone on spending sprees in certain realms while leaving basic health care to flounder." The article says the "problems are emblematic of the wider dysfunction of the U.S.-backed Iraqi government as a whole."
While "such issues are common to developing nations, which is what Iraq essentially is," the Washington Post reports that "to a large extent, the dysfunction has been enabled and well modeled by the United States, whose $61 billion reconstruction effort included nearly $1 billion poured into the Iraqi health sector, spending followed by audits that documented huge cost overruns, delays, poor planning and waste."
According to Stuart Bowen, U.S. special inspector general for Iraq reconstruction, "The health sector was the worst. ... It's the sector that fell the farthest short of expectations" (McCrummen, 5/9).
The U.N.'s response to severe flooding in Pakistan was "patchy," according to a report from the U.K.'s International Development Committee, which also said leadership and humanitarian coordination since the flooding started has been poor, AlertNet reports (Nguyen, 5/10). As of February, about $1.2 billion of the U.N.'s $1.9 billion appeal had been received, according to the report, Reuters writes. Of the money received, only $720 million in aid has been delivered, the report said (5/9).
The committee "said the reaction of the Pakistan government was 'commendable,' but that its resources and capacity were dwarfed by the scale of the damage," AlertNet writes, adding that it "noted that the disaster overwhelmed the international humanitarian community already stretched by the January 2010 earthquake in Haiti."
"Many of the report's concerns regarding the involvement of the army in delivering aid, which aid workers say blurred the lines between military and humanitarian action, as well as U.N. coordination of clusters – groups responsible for delivering relief in sectors such as health and sanitation – echoed the criticism levelled at the Haiti response," the news service adds (5/10).
"While the flood waters have receded, the disaster continues for many," said Andrew Mitchell, Britain's secretary of state for international development, Reuters reports. "The international community must step up to the mark to ensure that help continues to get through to those who remain in need," he said (5/9).
"The report also calls on the Department for International Development and the wider international community to pay greater attention to disaster preparedness and risk reduction as climate change is likely to increase the frequency and severity of natural disasters," a release from the committee states (5/10).
Congress Should Continue To Support Global Child Survival Programs
"Over my 22 years in Congress, programs that support child survival around the world have enjoyed bipartisan support and have saved millions of young lives worldwide. Unfortunately, funding for these lifesaving programs is at risk now. ... We should not give up now on a great American achievement: helping more of the world's mothers and children survive," Rep. Donald Payne (D-N.J.) writes in Star-Ledger opinion piece that highlights the successes of U.S. global health programs.
"Taking care of children is a fundamental American value. And we know what works. ... Meanwhile, current economic pressures threaten our progress. But the reality is that foreign aid spending is less than six-tenths of 1 percent of the U.S. budget. We should spend more, not less, to save children's lives. Hard economic decisions are necessary, but they must not endanger child survival," Payne concludes (5/10).
Time To Galvanize Political Will To Support Global Family Planning
"Rapid population growth is bad news for" Africa, "as it will likely outstrip gains in economic development. It's also a wake-up call: If the world doesn't begin investing far more seriously in family planning, much of our progress fighting poverty in sub-Saharan Africa over the last half-century could be lost," Malcolm Potts, a professor at the School of Public Health at the University of California, Berkeley, and Martha Campbell, president of Venture Strategies for Health and Development, write in a Foreign Policy opinion piece.
Potts and Campbell examine the recent U.N. population predictions and look at the implications for Africa, where "access to contraceptives – and information about family planning – is extremely hard to come by." The "lack of attention" to international family planning "may well prove to be one of the worst foreign-policy mistakes of recent decades. Budgets for family planning have collapsed – despite the fact that they were yielding real results."
"If we want to live in an ecologically sustainable world, we'll have to meet the needs of the present without compromising the natural resources and services our children and grandchildren will need. ... We have to ensure that the population can be slowed by purely voluntary means and within a human rights framework. We need to galvanize the political will to make it happen and invest now so that family planning options are universally available. Fail to do so, and we may give birth to a new, difficult era of poverty instead," they conclude (5/9).
Nuclear Fallout Should Continue To Be Researched
"It has been 25 years since the worst nuclear power accident in history at the Chernobyl plant in Ukraine, and we still aren't certain what health damage it may ultimately cause. That gap needs to be filled by a vigorous research program – both to improve readiness to cope with another bad nuclear accident and to enhance understanding of the long-term effects of low doses of radiation," a New York Times editorial states.
The editorial supports an expert panel's recommendation that "a research foundation be established to conduct long-term studies much as a foundation in Japan has been studying the long-term effects of the bombings of Hiroshima and Nagasaki." The New York Times writes that "continuing uncertainties should be a warning to Japanese authorities to begin studies of the health effects of the Fukushima nuclear accident while the evidence trail is still fresh" (5/9).
International Development, Health Organizations Should Stop Crying Wolf And Recognize Successes
Charles Kenny, who holds fellowships at the Center for Global Development and the New America Foundation, asserts in a Foreign Policy opinion piece that "Apocalypse buffs and international development types have one thing in common: They're both wrong." Kenny highlights examples of progress in global health and development, but also acknowledges that there is still "plenty of tragedy and suffering." Kenny writes that a "statistical analysis of news stories on developing countries in particular suggests a focus on the apocalyptic rather than the positive. Peaceful elections or declining mortality rates in Africa are apparently of little interest to the U.S. or European news consumer. ... And, of course, it also works for well-meaning nonprofits and aid agencies trying to raise attention and funding to respond to development challenges."
Despite the improvements, "nearly every agency continually cries crisis – and that reduces the incentive to give assistance to any of them. ... The tragedy of continually crying wolf is that NGOs, aid agencies, and governments have in fact been part of the immense progress in quality of life we've seen worldwide over those 40 years. And that's why it makes sense to provide continuing assistance," he writes. Kenny concludes: "The apocalypse now is further off in the future than ever before, so it is long past time to change the marketing strategy for development. It might work for Glenn Beck, but Raj Shah can do better" (5/9).
Taiwan To Lodge Protest With WHO Over Classification As Chinese Territory
Taiwanese President Ma Ying-jeou on Tuesday "accused China of pressuring the World Health Organization into recognizing Taiwan as a Chinese territory and says Beijing's move is 'very negative' for bilateral ties," the Associated Press/Washington Post reports. Taiwan gained observer status in the World Health Assembly in 2009 following reconciliation efforts with China, which still considers it as its territory despite the two splitting in 1949 (5/10). Ma's remarks came after a Taiwan legislator on Monday made public a letter issued by the office of WHO Secretary-General Margaret Chan "dated Sept. 14, 2010 that the lawmaker said denigrated Taiwan" by calling it "the Taiwan Province of China," Focus Taiwan reports. According to the news service, "Deputy Foreign Minister Shen Lyu-shun confirmed that the Ministry of Foreign Affairs (MOFA) has directed the country's representative office in Geneva to protest the WHO's denigrating definition of Taiwan" (Cheng/Wu, 5/9).
Simple Midwife Training Helps Reduce Newborn Death Rate, Study Shows
Simple training for midwives can help lower first-week death rates among newborn infants, according to a study published online in the journal Pediatrics, the New York Times reports. The study, funded by NIH and the Bill & Melinda Gates Foundation and carried out at 18 Zambian clinics by American and Zambian researchers, involved training midwives in "simple interventions like cleaning and warming a newborn, resuscitation, breast-feeding and diagnosing common illnesses," according to the newspaper. The first-week death rate among infants prior to the training was 11.5 per 1,000 live births and dropped to 6.8 deaths following training. "Even a small pilot project costing only $20,244 saved the lives of 97 infants, the authors estimated, meaning that it cost just $208 per life saved," the New York Times writes (McNeil, 5/9).
Forbes India Examines Global Market And Competition For Indian Vaccine Manufacturers
Forbes India examines the global market for Indian vaccine manufacturers, who "find themselves at a crucial crossroads." In addition to being eyed for takeovers by multinational corporations (MNCs), Indian vaccine makers "[f]or the first time … will compete with Chinese companies in the export market, even as they continue to navigate the muddy waters of Indian public health policies and poor delivery systems," the magazine writes. "Most Indian companies get the bulk of their revenue from exports to U.N. agencies, charitable organisations including the Bill & Melinda Gates Foundation and the Global Alliance for Vaccine and Immunisation, and several country-specific immunisation programmes," but the Chinese national regulatory agency in March received "pre-qualification" from WHO, which "allows it to approve locally manufactured vaccines to compete for U.N. tenders," Forbes India states. The story also looks at the implications of India manufacturers being bought by MNCs, including the potential for reduced supplies of low-cost vaccines (Singh, 5/9).
WHO Plan Aims To Lower Deaths, Injuries From Traffic Accidents
A WHO-coordinated plan to reduce morbidity and mortality from traffic accidents aims "to save five million lives and prevent 50 million serious injuries over the next 10 years," BMJ News reports. According to the story, WHO estimates "that without action traffic crashes are projected to kill 1.9 million people a year by 2020." Currently, "road traffic injuries have become the leading cause of death among young people aged 15 to 29 years and ... nearly 1.3 million people die each year on the world's roads, making it the ninth leading cause of death. In addition, road crashes injure 20 to 50 million people a year, leaving many disabled for life," the WHO says. The plan consists of five focal areas, which are outlined in the article (Zaracostas, 5/9).
The Kaiser Daily Global Health Policy Report is published by the Kaiser Family Foundation. © 2011 Henry J. Kaiser Family Foundation. All rights reserved.
