Today is Human Rights Day, the anniversary – this year, the 65th – of the United Nations’ adoption of the Universal Declaration of Human Rights on December 10, 1948. It is a date well known in human rights circles, but with little recognition from the broader public, at least in the United States.
This should change. Human Rights Day should become a national holiday. Not a holiday of department store sales and three-day weekends, but a day of deep civic significance and action, somewhat akin to the trend to make January’s Martin Luther King, Jr. Day a day of service.
It would be a day where human rights organizations and institutions, schools, dedicated civil servants and public officials, civic groups, and “ordinary” individuals committed to giving effect to an extraordinary yet very far from realized commitment of humanity to humanity, to human rights, organize events and actions dedicated to human rights education and action around human rights, on how to achieve these rights here in the United States, and around the world. Read More
I was in the middle of listening to the folk anthem If I Had a Hammer when I learned that Nelson Mandela died last Thursday. Afterwards, I watched this video of the folk trio Peter Paul and Mary singing in 1986, at the global height of the anti-apartheid movement, No Easy Walk to Freedom: “Nelson Mandela now we’re walking with you / No easy walk to freedom / No easy walk to freedom / Keep on walking and you shall be free / That’s how we’re gonna make history…/ Keep on walking and apartheid will fall.” And so Nelson Mandela and the masses in South Africa, supported by people around the world, kept on walking, and apartheid did fall.
William Steward said of Abraham Lincoln, as President Obama echoed in his tribute, “Now he belongs to the ages.” If President Lincoln passed into the ages upon his death, upon having successfully concluded his evolved imperative to use his office to turn a war for union into a mission to end slavery and give democracy its second American birth, Nelson Mandela belonged to the ages even in his life, for years now. Read More
Last month in an effort to stem its soaring obesity rates, Mexico took bold public health action and passed a new soda and junk food tax. Beginning on January 1, 2014, Mexico will impose a national tax of one peso per liter (about 10 percent) on sugar-sweetened beverages and 8 percent on junk food. The junk food tax applies to foods that contain more than 275 calories per 100 grams, excluding meat, dairy and other “real foods”. Although Mexico’s Constitution does not allow for “earmarks” or tax revenues for specific purposes, there is preliminary agreement that much of the money will be allocated for public health, including a pending $270 million initiative to install drinking fountains that dispense purified water in all schools. This new law is a considerable feat in a country that consumes more soda per capita than any in the world and where the former president had been the top executive for the Latin-American arm of Coca-Cola. Indeed, 30% of people in Mexico are obese and the country recently surpassed the United States as the most obese nation in the world.
Posted in Global Health;
This week Washington, DC hosted the Fourth Global Fund Replenishment, which was followed by a half-day conference: “The Global Fund 2014-2016: Sustaining the Fight Against AIDS, Tuberculosis, and Malaria,” held at Georgetown University. While the Global Fund fell short of its $15 billion goal, the $12 billion pledged represents a 30% increase over its last funding round —and the Georgetown conference struck an optimistic tone. This post offers a summary of what was discussed during the keynote address and during each of the three panels.
The conference began with a keynote address by Ambassador Mark Dybul, Executive Director of the Global Fund. He offered an optimistic and inspiring vision of an “historic moment”—one in which the world could realistically imagine the end to two plagues that have haunted humanity for millennia (tuberculosis and malaria) and a modern plague that has caused tremendous devastation (AIDS). His optimism was tempered with a warning, however. Progress made toward eradication is fragile and could easily be undone if the global community fails to devote the necessary resources and attention to controlling, and ultimately eliminating, these diseases.
He concluded by outlining how international financial assistance must be reconceptualized in order to ensure that progress in fighting these three diseases continues. For instance, those most affected by the three Global Fund diseases are the most vulnerable members of a population (e.g. sex workers, injection drug users or those living in extreme poverty). Simply adding more clinics or sending more drugs cannot solve the issue of stigma. Moreover, an intervention that works for Rwanda may not be effective in the Central African Republic. Global health must therefore eschew its paternalistic roots and adopt a development strategy that is person-to-person, country-owned, and based on the concept of an “inclusive human family.”
Panel 1: Perspectives from the Global Fund Board
The first panel consisted of three Global Fund board members: Lucy Chesire, David Stevenson and Todd Summers, and was moderated by Georgetown professor Steven Radelet. Discussion focused heavily on a new funding model the Global Fund has developed, which focuses on health impact and country ownership. Moreover, the new model is meant to be more cooperative, with the Global Fund and its partner countries working together in “getting to yes.” Relatedly, the panel discussed the Global Fund’s rollout of “strategic investments,” designed to ensure the greatest possible impact per dollar.
The panel also contemplated the dwindling number of “low-income” countries (as defined by the World Bank)—many of which have graduated to middle-income status. The panel emphasized that these World Bank indicators could not be used as a reliable proxy for poverty and health needs (in fact, the majority of the world’s poor live in middle-income countries). However, in places where a country’s wealth is sufficiently high, there could be an opportunity for the Global Fund to transfer some responsibilities to the state, with the Global Fund and states sharing “mutual accountability” for controlling its disease burden—although states would remain in control of their response.
Panel 2: U.S. Programmatic and Scientific Perspectives
The second panel included four U.S.-based global health leaders: Anthony Fauci, Director of the NIH’s National Institute of Allergy and Infectious Diseases; Thomas Frieden, Director of the CDC; Ambassador Eric Goosby, Former U.S. Global AIDS Coordinator; and, Rear Admiral Timothy Ziemer, U.S. Global Malaria Coordinator. The panel was moderated by Larry Gostin, the Faculty Director of the O’Neill Institute and Georgetown professor.
The panel began with a discussion of how U.S. national interests dovetail with the interests of recipients of U.S. foreign assistance. The conversation later turned to what were likely to be the greatest achievements of the 21st century, with panelists discussing such developments as: a safe and effective vaccine for HIV/AIDS, the elimination of violence against women and girls, vaginal microbicides, better and more widespread use of information systems to inform programming, and closing the gap between scientific evidence and implementation.
The issue of fake drugs spurred a discussion of the overarching importance of good consumer education, combined with more aggressive attempts to identify and remove such products from the market. Finally, the conversation turned to the question of promoting global health programs in the current U.S. political climate, and particularly to how advocates could convince voters and politicians of the need for global health interventions. Panelists pointed out that it was imperative that Americans understand that foreign aid for global health was not discretionary, and in particular that such aid prevents international instability (and thus threats to U.S. national security); and, echoing Mark Dybul’s discussion of promoting an “inclusive human family,” that improving global health is the morally right thing to do.
Panel 3: Partnerships and the Future of the Global Fund
The panelists for the final discussion included: Jesse Bump, a Georgetown professor; Lisa Carty, Director of the U.S. Liaison Office, UNAIDS; Cheryl Healton, Director of the Global Institute of Public Health at New York University; and, John Monahan, Advisor for Global Health to the U.S. State Department and Senior Fellow and Special Advisor at Georgetown University. The moderator was Berhard Liese, Chair of the Department International Health at Georgetown.
The panel’s wide-ranging conversation began with a discussion of the future of global health, and whether a treaty on counterfeit drugs would be effective. Panelists expressed concern over the time, cost, and need for careful planning for such a treaty—along with a more general concern that the efforts could potentially distract from efforts to use the formidable tools already available to fight disease and prevent counterfeiting.
In a discussion of new mechanisms needed for the Global Fund, Prof. Bump argued for a WTO-like dispute settlement mechanism to deal with global health issues. Others argued for the need for mechanisms to facilitate greater engagement with regulators—particularly regional bodies—and for the vital importance of including civil society at all levels of decision-making.
Finally, panelists argued that the private sector was an important partner in the fight against the three diseases of the Global Fund. For instance, they suggested thatthe private sector injects much-needed funding and other resources into institutions and brings innovative ways of thinking about health problems. The panelists also raised concerns that not enough is being done to reach out to the private sector in developing countries.
After not being able to get his son to the doctor for a strep throat test, Rick Krieger established the first retail clinic at a local grocery chain in 2000. The idea was to address issues of access to health care and allow patients to obtain care and treatment for minor conditions “in a quick, convenient way.” Since then, retail clinics have grown considerably in number in the United States—from about 1200 in 2008 to an estimated 2400 in 2013. However, they have also become a point of controversy. Their growth is threatening the traditional way that patients have sought health care—through hospitals and physician groups—and the “patient-centered medical home” approach to primary care, where the primary care physician coordinates treatment for the patient in order to ensure that the patient “receive[s] the necessary care when and where [the patient] need[s] it, in a manner [s/he] can understand.”
Retail clinics are characterized by their convenient hours and location, limited scope of services (although this is being expanded), comparatively low costs, quick service, and services being provided by nurse practitioners (NPs) and physician assistants. As suggested by their name, they are located in retail stores, such as Walmart and Target, and many offer extended hours on workdays and weekends. They also tend to be located in more affluent areas. The services provided and their cost are “prominently displayed” for patients, so that patients are aware of the cost prior to obtaining the service. For the most part, retail clinics accept both private and public insurance, and those with no insurance are charged somewhere between $15 to approximately $100. Read More
Posted in National Healthcare; Tagged: access to health care, Affordable Care Act, Cancer, cardiovascular diseases, chronic disease, chronic disease management, chronic respiratory diseases, Diabetes, health care provider, health care services, heart disease, medical home, NCDs, obesity, patient, preventative care, primary care, retail clinics, Rick Krieger, Target, Walmart.
This post was written by Jeffrey S. Crowley, Distinguished Scholar and Program Director of the O’Neill Institute’s National HIV/AIDS Initiative. Any questions or comments can be directed to email@example.com.
Belynda Dunn has been on my mind all week. Like too many people with HIV, she is someone we lost too soon. She was an amazing person. She was caring, passionate, and fun. I got to know her when she served on the Board of Directors of the National Association of People with AIDS (NAPWA) where I was the organization’s Deputy Executive Director. Her national work, however, was just a small part of her story. To many people she was a hero working in her own community from her perch at the AIDS Action Committee of Massachusetts. There, she founded the “Who Touched Me” ministry that had a big impact on creating a pathway for black churches to become engaged in the fight against AIDS.
Posted in Uncategorized;
This post was written by Jacqueline Fox, JD, LLM, Associate Professor, School of Law, University of South Carolina. Any questions or comments can be directed to firstname.lastname@example.org.
The Affordable Care Act is huge, and covers many, many things. The focus of public debate in recent months has been on the parts related to personal insurance, especially for individuals who don’t get care from their employers. People seem puzzled, frightened, and angered by many of the changes. I thought it might help to clarify what the public health thinking is that has gone into this new structure.
Posted in Uncategorized;
After I wrapped up last month’s blog post on the ownership of amputated limbs in China, I read an astonishing news story online: a 47-year-old Chinese peasant, Mr. Zheng Yanliang, cut off his diseased right leg to save both his life and healthcare costs.
Mr. Zheng lives in Qingyuan County in the Hebei Province, just 100 miles south from Beijing. He started to feel pain in his legs in 2011, and was diagnosed with massive arterial thrombosis after multiple visits to hospitals in the Hebei Province and Beijing. Doctors there told Mr. Zheng that he had three months to live at most, and recommended amputation of his right leg. The estimated costs, according to Zheng, would be 300,000 to 1 million RMB (approximately 50,000 to 170,000 US Dollars.) Fearing the unaffordable hospital costs, Mr. Zheng decided not to receive treatment and went back home. In April, he reportedly used a fruit knife and a saw to amputate his right leg while biting into a back scratcher to tolerate the pain. His story was published by the media in October and received immediate attention from the public and government agencies.
Further investigation found that Mr. Zheng participates in the New Cooperative Health Insurance Plan for Rural Residents, and the inpatient costs for the surgery could have been partially covered by his insurance. (The annual reimbursement celling was 70,000 RMB, or 12,000 USD for insured Hebei rural residents in 2012.) Journalists also pointed out that the self-amputation story was recounted by Mr. Zheng and his wife and had not been verified by a third party. Read More
This post was written by Tanya Baytor, the O’Neill Institute LL.M. Program Director. Any questions or comments can be directed to email@example.com.
A recent study examined the availability of and the marketing techniques used for child-oriented snack foods sold in school kiosks and convenience stores near public schools in Guatemala. The study classified the majority of child-oriented snack foods as unhealthy and found that the most commonly used marketing technique was promotional characters such as cartoon characters, athletes or celebrities. Premium offers were found in 34% of the packages and were mostly collectible toys. These findings are consistent with those of child-oriented snack food packages found in supermarkets in the United States and Australia, where most have promotional characters and are classified as unhealthy. The study notes that promotional characters have been found to influence children’s eating habits as they are more likely to choose a snack with a character on the packaging compared to one without a character.
Posted in Uncategorized;
The large and growing burden of non-communicable diseases in lower-income countries is now a common storyline in global health. So too is the global movement towards universal health coverage. Might the former help in measuring progress towards the latter? Might progress on addressing non-communicable diseases (NCDs) – in particular, treatment for breast cancer, or perhaps another cancer that wholly or primarily affects women and responds well to treatment – be an important indicator of universal health coverage?
The question of how to measure universal health coverage is not easily resolved. For present purposes, I consider only coverage of health services. Measurements of financial protection, including ending the impoverishing effect of health spending – presently pushing 100 million people into poverty every year (World Health Report 2010, p. 5) – will also be needed, such as the proportion of health spending by the lowest wealth quintile or lowest several wealth quintiles that is out-of-pocket. Read More
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The views reflected in this blog are those of the individual authors and do not necessarily represent those of the O’Neill Institute for National and Global Health Law or Georgetown University. This blog is solely informational in nature, and not intended as a substitute for competent legal advice from a licensed and retained attorney in your state or country.