Parental Leave: Time for a new norm in the U.S.

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Many people don’t consider the impact of parental leave options until they are in the position of needing to take time off to have a baby. This is not an area where the United States has excelled as one of only two countries in the world that do not guarantee paid time off according to the International Labor Organization. However, it appears that we may be on the brink of a new social norm. For the first time in an American presidential race, candidates are debating the possibility of implementing national paid parental leave policies. The arguments for and against paid parental leave fall squarely along partisan lines with Democrats putting forward a plan that supports 12-weeks paid leave following the birth of a child but Republicans largely arguing that mandating parental leave payments would place undue hardship on small businesses.

Currently, Federal parental leave requirements are outlined by the Family and Medical Leave Act (FMLA) of 1993. Under FMLA, companies with 50 or more employees must provide 12-weeks of family leave when a new baby arrives. This leave, however, does not have to be paid and companies are only required to hold the new mom’s job for the 12-week period. The inadequacy of coverage provided under FMLA becomes even more apparent when you consider statistics by the U.S. Census Bureau, which state that 97.9% of all American businesses have 20 or fewer employees. This means that the vast majority of American businesses have no requirement to ensure that their employees even get time off when they have a child, let alone provide paid time off. This would cover a significant number of low-income families who can scant afford to lose income for any period of time.

Objectively, there is a body of evidence outlining the benefits of paid parental leave. There are clear health benefits to the baby, with studies demonstrating that parents with paid leave are more likely to vaccinate their infants and to breast-feed longer, which reduces infant rates of asthma, obesity and some infections. Infants with parents who have paid-leave also have lower rates of mortality and generally better health than infants whose parents do not. Longer-term, studies have found that infants whose parents had paid leave, ended up achieving higher IQs, and higher levels of education than infants whose parents did not have access to paid leave. There are also mental and physical health benefits of paid leave to parents. Moms who are able to breast-feed longer have lower levels of breast and ovarian cancer, heart disease and lower rates of both short-term and long-term depression. Fathers who are given paid leave have better father-child relationships and increased involvement in parenting long-term.

Economically, the U.S. Department of Labor estimates that a significant portion of mothers who do not receive at least partial pay when they have a child, have to turn to public assistance to make ends meet and companies with more generous leave policies have significantly higher rates of new-mother retention than companies that do not. Extending parental leave to fathers, further improves family economic outcomes by increasing the mother’s overall income.

Parental leave has clear benefits, and has been very successful in States where policies have been implemented. For those who choose to have children, paid leave should not be considered a benefit that is only available to those who already have well-paid positions in ‘generous’ companies, but should be seen as a social good and an entitlement that could help in closing the health and education gaps between the rich and the poor.

Posted in National Healthcare; Tagged: , , .


Faster, higher, sicker? Ending sugary drink and junk food sponsorship of the Olympic Games

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In the midst of a global epidemic of adult and childhood obesity, it is time for the International Olympic Committee (IOC) to reject sponsorship from manufacturers of junk food and sugary beverages and harness the power of the Olympic brand in support of health and longevity.

Faster Higher Sicker

Big food, big soda, big sponsorships

At the 2016 Rio Olympics the world’s most recognized junk food and sugary beverage manufacturers take top billing as two of twelve “Worldwide Olympic Partners.” According to the International Olympic Committee, “the Olympic Games are one of the most effective international marketing platforms in the world, reaching billions of people in over 200 countries and territories.” Depending on sponsorship level, companies are entitled to marketing rights in various regions, including category exclusivity and the use of coveted trademarks and images. The financial details of sponsorship deals are “confidential commercial information,” but there is no doubt that big food and big soda are investing millions in Olympic sponsorships and associated advertising campaigns.

Why we should end junk food and sugary beverage sponsorship of the Olympics

While there are some great things about the Olympics (I was particularly impressed by the inclusion of the Refugee Olympic Team), the Olympics provides a unique and effective platform for companies to market junk food and sugary beverages. This contributes to the global obesity epidemic and conflicts with the values of Olympism.

Calorie-dense nutrient-poor options, including junk food and sugary beverages are key contributors to worldwide obesity, which has more than doubled since 1980. Sophisticated and pervasive marketing techniques, including advertising, sponsorship, brand mascots, and point-of-purchase displays influence our food preferences and our consumption patterns. Children are particularly vulnerable to marketing, with research revealing strong associations between increases in junk food advertising and childhood obesity rates.

Providing a platform for marketing harmful products does not fit with the values of the Olympic Movement. The fundamental principles of Olympism refer to “exalting and combining in a balanced whole the qualities of body, will and mind,” “social responsibility and respect for universal fundamental ethical principles,” and “promoting a peaceful society concerned with the preservation of human dignity.”

Could we really have an Olympics without big food and big soda?

Yes, I think it’s possible, and here are some reasons why:

  • The Olympic Games have not been sponsored by a tobacco manufacturer since 1984. This shows that it is possible to stop taking funds from generous, long-time funding sources.
  • Most of the 12 Worldwide Olympic Partners are not food and beverages companies. They include an IT company, a well-known tire and rubber manufacturer, a major credit card company, and multiple electronics brands. This suggests that there are lots of companies interested in and willing to contribute to the large amount of funding required to stage the Olympics.

Should we go even further?

In addition to rejecting sponsorship from manufacturers of junk food and sugary beverages, I’m looking forward to the day when these products are replaced with healthier alternatives at all Olympic events. For many of the same reasons, the Olympics should no longer designate an “official beer” and national sports teams should end sponsorship arrangements with manufacturers of alcohol, junk food, and sugary beverages.

Disassociating the Olympics with unhealthy products such as tobacco, alcohol, and unhealthy foods and beverages will not solve epidemics of obesity and chronic diseases, but it would harness the power of the Olympic brand in support of health and longevity.

Posted in Non-communicable diseases; Tagged: , , .


Global Implementation of PrEP: The Importance of Addressing Social and Structural Barriers – Part 2

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Human rigths HIV

I have previously written about the global implementation of pre-exposure prophylaxis (PrEP) and how important it is to remove social and structural barriers to PrEP. On Tuesday, I drew attention to France and its challenges in viewing itself as a color-blind society and addressing the needs of migrants and communities of color. Today I am turning my attention to South Africa and the barriers that stop cisgender and transgender women and men, especially those engaged in sex work, from accessing PrEP, including violence, stigma, discrimination, and criminalization of sex work.

In November 2015, South Africa became only the third country and the first high HIV prevalence middle- or low-income country to approve tenofovir-emtricitabine (marketed in the United States as Truvada) for PrEP. On March 8, 2016, the Southern African HIV Clinicians Society released revised and expanded guidelines advising that PrEP is a highly effective and safe prevention option for HIV prevention that can be incorporated with combination prevention strategies. On March 11, 2016, the National Health Department and the South African National AIDS Council announced the National Sex Worker HIV Plan. The Plan is a comprehensive response to the needs of sex workers and includes the provision of PrEP and early treatment for sex workers. The targets of the Plan are:

  1. To reach 70000 sex workers with a core package of services;
  2. To recruit 1000 peer educators;
  3. To ensure that 95% of sex workers use condoms with their clients;
  4. To provide PrEP for 3000 sex workers (this target will be reviewed once the uptake is assessed in the first year);
  5. To ensure that 90% of sex workers reached are tested for HIV and know their status;
  6. To ensure that 90% of sex workers who test positive are on ART;
  7. To ensure that 90% of sex workers on ART are virally suppressed;
  8. To reduce instances of violence against sex workers by 50%.

The decision was made to start PrEP implementation with the most vulnerable groups. The National Health Department and SANAC’s Technical Working Group first developed implementation guidelines for PrEP rollout through existing service delivery platforms to sex workers, to be followed by guidelines for rollout to men who have sex with men (MSM) and to adolescents and young people. PrEP rollout to sex workers in South Africa commenced at 11 sites on June 1, 2016.

South Africa has set ambitious goals to reduce HIV infections and mortality among sex workers and to reduce human rights violations among sex workers. But any efforts to achieve these goals will fail unless the country can address structural drivers of HIV.

Sex workers face high levels of violence, stigma, discrimination, and criminalization. Perpetrators of violence against sex workers are not limited to their clients, intimate partners, or controllers. Sex workers also experience systemic harassment and abuse from law enforcement and members of the public. Police violence and harassment, including unlawful arrest, blackmail, and rape, is pervasive in the lives of sex workers. A study conducted among 300 sex workers in Cape town found that 70 percent has been subjected to police abuse, such as beatings, pepper spraying, and sexual assault. Fear of arrest and police violence also prevents sex workers from reporting such incidents.

Sex workers face violence because of discrimination based on gender, race, and other factors as well as because of stigma associated with sex work, which is criminalized in South Africa and many other countries. Criminalization itself has a direct impact on access to health care because it disrupts the ability of sex workers to remain in care and adhere to medication, including antiretroviral treatment or PrEP. Disruption is especially common with short stays in jails, with one study from the United States showing that 76% of jail detainees with HIV and multiple incarcerations had interruptions in their medications. Many individuals often cease to seek care for their medical conditions upon leaving jail or prison.

A recent study in the Lancet showed that decriminalization of sex work has the strongest effect on reducing HIV among sex workers. Decriminalizing sex work could prevent up to 46 percent of new HIV infections among sex workers – and their clients – in the next decade. Whereas criminalization of sex work has been shown to increase violence against sex workers and elevate their risk for HIV infection, decriminalizing sex work allows sex workers to speak up against violence and promotes access to health care.

PrEP has the potential to dramatically reduce HIV infections among sex workers, but implementation of PrEP will have limited impact if countries like South Africa criminalize sex work and do nothing to address the stigma, discrimination, and violence that sex workers experience. Effective HIV prevention for sex workers is not possible while sex workers operate illegally and remain vulnerable in the shadows.

Posted in Global Health; Tagged: , , , , .


Global health, civil society, and a growing threat

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IMAXI civil society and SDGs July 26 2016

Image courtesy of IMAXI Cooperative.

In how many ways is civil society integral to achieving the health-related Sustainable Development Goals (SDGs)? In a recent article in Globalization and Health, Julia Smith, Kent Buse, and Case Gordon identify eight ways. I will offer thoughts on several of them, and suggest that given the importance of civil society to the SDGs and to the right to health, health advocates must include among our top priorities pushing back against restrictions on civil society organizations in increasing numbers of countries.


First, the eight ways, detailed more in the article:

1. Transforming data into moral arguments
2. Building coalitions that reach beyond the traditional health sector
3. Democratizing policy debates and offering innovative options

The authors include the Framework Convention on Global Health, the proposed treaty based in the right to health and aimed at health equity, among these innovative possibilities. We see in the FCGH the dynamic between civil society and governments and other members of officialdom. Civil society advocates pressed for this proposed treaty for some six years before UN Secretary-General Ban Ki-moon stated in his report to this past June’s High-Level Meeting on Ending AIDS: “I further encourage the international community to consider and recognize the value of a comprehensive framework convention on global health” (para. 74). The Secretary-General’s call to action creates a powerful new argument for civil society to call upon states to take a close look at the FCGH, and for the next WHO Director-General to assume leadership on the FCGH. Read More

Posted in Global Health, Uncategorized; Tagged: , , , , , , , , , , , , .


Global Implementation of PrEP: The Importance of Addressing Social and Structural Barriers

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Global implementation of pre-exposure prophylaxis (PrEP), a pill taken to prevent HIV infection, has made major strides in the last year. The U.S. Food and Drug Administration first approved Truvada for daily oral PrEP in July 2012, but no other country approved PrEP in the subsequent three years. In November 2015, France became the second country and the first with a centrally organized, national health system to approve PrEP. The French National Agency for Medicines and Health Products Safety authorized both a daily regimen for all people at risk for HIV infection and an intermittent or “on demand” regimen, as used in the IPERGAY study, for men who have sex with men.  This authorization was made possible under a Recommendation for Temporary Use, but recent approval by the European Medicines Agency in July 2016 means that France can now apply PrEP as a permanent part of its health system.

Shortly after France’s approval of PrEP, PrEP was approved in South Africa and Kenya in December 2015. Canada, Israel, Peru, and Australia took the same step in 2016. Just last week, the High Court of Justice ruled that the National Health Service (NHS) in England can legally fund PrEP. Although the High Court ruling does not make funding PrEP automatic and the NHS is set to appeal, the decision further underscores that PrEP is a core component of HIV prevention.

Even as global implementation of PrEP gains momentum, it is not happening quickly enough for millions of men and women at risk for HIV. More countries must approve PrEP and develop effective ways to delivery PrEP to those in need. This includes mobilizing funding, raising medical provider and community awareness, and establishing policies and systems.

To ensure on-the-ground access and impact, it is also critical that all countries remove social and structural barriers to PrEP. Such barriers contribute to HIV disparities among racial, gender, and sexual minorities and could keep these and other vulnerable populations from benefiting from PrEP.

France, for instance, has made a significant investment in PrEP rollout. Up to July 2016, 1077 people, 96.4% of whom identify as gay men, started PrEP through the public health system in France; 90 clinics offer PrEP assessment and prescription and 273 doctors have been accredited as PrEP physicians. But like the United States, France must do a better job ensuring that people of African descent have access to PrEP. Data presented at the 21st International AIDS Conference (AIDS 2016) showed that 87% of PrEP users in France are French, i.e. non-migrants. This suggests a serious need to support greater PrEP uptake among migrants, especially sub-Saharan migrants, who account for nearly one-third of new diagnoses in France. Migrants in France face frequent hardship that increases HIV risk, with one study finding that more than 40% have lived a year or more without a residence permit and more than 20% lack stable housing. PrEP rollout in France will have limited effectiveness if these social problems are not addressed.

Beyond the issue of migration, France faces challenges in thinking of itself as a color-blind society and refusing to measure race in its census and health system. Despite its significant problems of racial segmentation and discrimination, France has limited tools to measure or correct them. As a result, it is difficult to assess the HIV prevention needs of French Blacks and promote PrEP through targeted policy and programmatic activity.

Social and structural barriers need to be addressed for PrEP to have large-scale impact in France and other countries. It is important that we do not ignore or reinforce racial, gender, and sexual inequalities in global HIV prevention.


Posted in Global Health; Tagged: , , , , .


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