The Persisting Toll of Global Health Inequity

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Treatment Action Campaign right to health march

Treatment Action Campaign right to health march

Inequity kills -- by one measure, more than one in three of us. And this unconscionable toll hasn't been getting much better.

That was the finding from calculations by Juan Garay of the European Commission several years back, explained in his new book available for free viewing, Health Equity: The Key for Transformational Change (p. 33-35).  Essentially, if low- and middle-income countries were to have the same under-five and adult (ages 15-60) mortality rates as the average for high-income countries, they would have had some 20 million fewer deaths every year. That is, every year 20 million people are dying because of where they were born, in a low- or middle-income country rather than a wealthy country. And on top of this, not part of the calculations, would be residents of low- or middle-income countries who live past 60 but still might have lived longer in wealthier countries, and the many who die in wealthy countries because of their own inequities.

This level of excess, inequality-related mortality has been quite stable despite overall global health improvements, with 18.2 million in 1970, a peak of 20.9 million in 2000, and still near the peak in 2010, with 20.3 million such deaths (p. 35).

One might argue that at least in present conditions, the standard of high-income countries is, at least as a practical matter, too high. As Professor Garay asks, if the higher life expectancy is linked to above average wealth, but there are not enough resources at present to enable all countries to achieve this level of wealth, how can we expect these standards to be replicated in every country? And the economic development in the world’s wealthy countries has had environmental effects, above all on our climate, that are unsustainable for these countries, much less a model of growth that the world can follow.

Because of these questions of sustainability and universal feasibility, should we ask instead, or as well, how many inequity-related deaths could be avoided consistent with global resources and environmentally sustainable practices? This Professor Garay proceeds to do – and discovers that the answer is not all that different.

The book’s analysis turns to “healthy countries” – ones with life expectancies above the global average – that could serve as global models today. These are countries with gross domestic products below average, avoiding the possibility that the world’s economic resources are simply too few for their levels of health to be achieved by all. And they all have a low carbon footprint (an average of 2.5 metric tons per person in 2000-2010, compared to the present global average of 6 tons per person), indicative of environmental sustainability.

Professor Garay identifies 14 such countries: Albania, Armenia, Belize, Colombia, Costa Rica, Cuba, Georgia, Grenada, Paraguay, St. Lucia, St. Vincent and the Grenadines, Sri Lanka, Tonga, and Vietnam. In 2012, their average life expectancy was 75, compared to a global average of 71 years (p. 40).

Using these countries (concedely, mostly low population nations, raising issues of replicability) as the benchmark, the number of deaths stemming from global health inequities remains huge and persistent – and not distant from when high-income countries serve as the standard. Professor Garay's methodology differs slightly from the previous estimate. Here, the calculation (p. 45-49) compares average mortality rates disaggregated by age and sex of these 14 countries to those of every country in the world. The excess deaths – based on the difference between the mortality rates in the 14 countries and each country with worse mortality rates – are then added up, with the total being the total number of deaths attributed to global health inequity.

Again, the number has varied little over the years. From 1965-1970 to 1990-1995, the number of these deaths ranged from just below 16 million to about 17.6 million, before peaking at 18.6 million in 1995-2000, and then falling to 16.8 million (2005-2010).

The persistence of these health inequalities – and the recognition that the vast majority of these deaths could be prevented – behooves us to find a new way of responding to them. For all the progress the world has made on health over the past decades, current approaches are not enough.

This need for a new way of doing things is one reason to support a Framework Convention on Global Health  (FCGH), the proposed global health treaty based in the right to health and aimed at national and global health equity. Mobilization towards the FCGH is accelerating, with an effort to secure, as part of a resolution at this year’s World Health Assembly, a request to the WHO Director-General to establish a working group that includes strong civil society participation to examine and report on the potential benefits, principles, and parameters of the FCGH – launching a formal process towards the FCGH. I encourage you to sign this petition to the WHO Executive Board, meeting in late January, to support this call. And for those of you representing organizations in Africa, we have this sign-on letter, with the same message.

These global health inequities are not inevitable. There is no single solution. But the FCGH stands to be a particular powerful tool to establish pathways and accountability towards ending this most lethal of injustices. With so many millions dying every year due to health inequities, there is no time to lose in doing everything in our power to end this wrong – including negotiating, adopting, ratifying, and implementing the FCGH.

Posted in Global Health, Human Rights, WHO; Tagged: , , , , .


HIV and Medical Bills: The Importance of the Affordable Care Act and the Ryan White HIV/AIDS Program

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WP-health_costsYesterday, Margot Sanger-Katz of The New York Times reported on a recent survey of the problems Americans face with medical bills. The survey, conducted by The New York Times and the Kaiser Family Foundation, shows a cascade of financial troubles due to many individuals and households paying substantial medical bills. In the survey, 20 percent of people under age 65 with health insurance reported having problems paying their medical bills in the last year, compared with 53 percent of people without health insurance reporting such problems.

I would like to reflect on this survey from my perspective working on national HIV policy. Medical costs have always been a challenge for people living with HIV. The cost of HIV treatment generally ranges from $2000 to $5000 per month, but health conditions that are commonly comorbid with HIV, such as cancer or problems with the heart, bones, or kidney, can result in greater overall treatment cost. Antiretroviral drugs are the most expensive part of HIV treatment. Even with insurance, many people find it difficult to buy the HIla-fi-mh-over-44-million-americans-20151208-002V drugs they need due to co-payments, deductibles, and/or co-insurance.

The Affordable Care Act (ACA) has expanded insurance access for people living with HIV. Although this law is not perfect, the ACA is making HIV treatment more affordable for people living with HIV. Health plans can no longer deny insurance coverage to people living with HIV or impose annual limits on coverage. Moreover, as Sanger-Katz mentions, the ACA has led to a decline in the number of Americans suffering financial stress from health problems.

It is unfortunate that Sanger-Katz fails to mention that the ACA also established an annual cap on out-of-pocket spending. Prior to the ACA, it was possible to incur hundreds of thousands of dollars in medical expenses in a single year. In 2016, once an individual or household pays enough in co-payments, deductibles, and co-insurance to reach the out-of-pocket maximum of $6,850 or $13,700 respectively, the health plans pay for all the remaining healthcare costs for the year. This is a major achievement toward addressing financial troubles.

Despite the strengths of the ACA, paying medical bills is hard for many people living with HIV, including those with insurance. One common problem is that people living with HIV often have to pay thousands of dollars upfront in deductibles rather than have the cost of their medication spread throughout the year. For those living on tight budgets, this upfront cost means that some people delay treatment until they can pay, use up all or most of their savings, or borrow money. It also affects people’s daily lives, including their ability to pay for housing, food, and childcare.

People living with HIV also have financial troubles when insurance premiums and co-payments add up to make HIV care unaffordable or when big medical bills are not covered by insurance. The ACA’s annual cap on out-of-pocket spending does not count premiums, balance billing amounts for non-network providers and other out-of-network cost-sharing, or spending for non-essential health benefits. As a result, insured patients can struggle to pay their bills.

This is all the more true for people living with HIV in “narrow network” plans, i.e., health insurance plans that place limits on the doctors and hospitals available, and in “adverse tiering” plans, i.e., health insurance plans placing classes of drugs on tiers with high co-payment and co-insurance levels. When plan networks have too few specialty HIV care providers, they have the effect of denying lifesaving care. An alternative consequence is financial hardship for those who can only get appointments with non-network providers. Likewise, when health plans engage in adverse tiering by putting HIV drugs on the top tier of formularies, people living with HIV are forced to pay higher medical costs.

Concerns about out-of-pocket medical costs for HIV and other chronic conditions have prompted a move to cap out-of-pocket drug costs. In October 2015, California passed legislation to cap a single 30-day outpatient prescription at $250, except for consumers with high-deductible plans, who pay $500. Such legislation maintains access to needed specialty drugs without placing an unreasonable burden on health plans since insured patients still pay their share of the costs on a monthly basis rather than all upfront.

While capping out-of-pocket costs helps to protect against some of the high cost of HIV care, it is insufficient to address the myriad of issues that people living with HIV confront. The Ryan White HIV/AIDS Program, the largest federal program focused exclusively on HIV/AIDS, remains a critical part of making HIV care affordable. At times, some have questioned whether the Ryan White program will be necessary after the ACA is implemented. Yet, some people cannot pay medical bills despite having insurance. Seventy percent of Ryan White clients have insurance coverage and rely on the program to supplement limits in their coverage or help with co-payments, deductibles, and/or co-insurance. The Ryan White program also provides a range of services needed to keep people living with HIV engaged in care and on treatment that neither the ACA or state legislation currently provides.

Much work still needs to be done to make access to affordable care a reality. Change never comes fast enough, but we must continue efforts to build upon the successes of the ACA. I believe that the Ryan White program is likely to act as the fulcrum of such efforts related to HIV and may serve as a model for making medical and support services affordable, accessible, and effective for all.

Posted in National Healthcare; Tagged: , , , , , .


Public Health: A Missing Link in the Executive Action to Reduce Gun Violence

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This post was written by O’Neill Institute Faculty Director, Lawrence O. Gostin and O'Neill Institute Associate, Aliza Glasner. Questions about this post can be directed to gostin@law.georgetown.edu or ayg8@law.georgetown.edu.


Courtesy of Time

Courtesy of Time

Yesterday, President Obama took a modest, but critical first step to strengthen America’s existing regulatory framework aimed at preventing firearm-related injuries and deaths. Speaking from the White House to a crowd of gun violence survivors and advocates, the President explained that some restraints on freedom are the well-accepted consequences of living in a civilized society. We respect our right to free speech along with the limitation that we cannot yell fire in a movie theater. We cherish our right to privacy, while accepting inspections through metal detectors before boarding a plane. And, we do public health research to inform laws to better protect our society. We regulate childproof-caps on aspirin. We regulate our roads to reduce traffic fatalities.

And yet, the President explained, “when it comes to an inherently deadly weapon… Congress actually voted to make it harder for public health experts to conduct research into gun violence. Made it harder to collect data and facts, to create strategies to reduce gun violence...That’s not right.”

America’s greatest limitation in addressing our culture of gun violence is our willful refusal to understand it as an epidemic. Imagine another public health problem that killed tens of thousands each year, and Congress refused to act. Or, worse yet, affirmatively blocked public health authorities. Firearm injuries are, first and foremost, a public health problem. We can and should use the law as a tool to prevent and control firearm injuries. Vaccine laws, driver’s licenses, the height of fencing around a pool, are just a few of hundreds of examples of how public health law and regulations foster a civilized society where one’s right to certain freedoms does not infringe on another’s most basic right to life, liberty and the pursuit of happiness.

Keep firearms out of the hands of potentially dangerous individuals

The President’s executive action is modest compared to what Congress could and should do, but his goal is compelling—to keep guns out of the wrong hands through background checks. The President’s action clarifies a crucial regulation from the Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF) defining who is a seller of firearms and who is required to conduct background checks. Accordingly, “[i]f you’re in the business of selling firearms, you must get a license and conduct background checks.”[1] The President’s action will strengthen this crucial layer of accountability and liability on gun sellers. ATF clarified that there are criminal penalties, including jail time and fines, for failing to comply with these principles. Additionally, ATF clarified that a licensee who ships a gun is responsible for notifying law enforcement if they learn that it was lost or stolen in transit. In support, the US Attorney General Loretta Lynch issued a statement to the United States’ Attorneys to go after gun crimes, this could include everything from falsifying firearm applications to straw-man purchases.

Still, the President’s action will not close the loopholes in the system, namely preventing gun sales from unlicensed sellers. This country is plagued by an enormous person-to-person, and Internet market for firearm sales. While the President’s clarification of the existing law is significant, much work remains to be done in Congress to pass legislation aimed at gun sales from non-licensed sellers.

Make our communities safer from gun violence

America’s problems with gun violence are multifactorial, requiring authority and action at the local, state, and federal level. Accordingly, the President’s actions foster coordination at varying levels of government by improving the reporting systems, dedicating more resources to tracking illegal gun sales and stolen guns, increasing federal personnel dedicated to background checks and other ballistic reporting systems, and encouraging states to provide records to the background check system and to improve reporting. Clarifications on reporting, including in the case of mental illness, will foster a more robust federal database aimed at keeping firearms out of the hands of dangerous people.

The president singled out a pledge to victims of domestic violence, urging local law enforcement to work with the office of United States Attorneys to prevent prohibited persons from obtaining firearms. In families experiencing issues of domestic violence, access to a firearm leaves vulnerable family members 12 times more likely to die in an assault.[2] Ironically, a great majority of the statistics on domestic violence related-injuries comes directly from the Centers for Disease Control (CDC), the same agency that is hamstringed when it comes to researching ways to prevent gun violence.

Increase mental health treatment and reporting to the background check system

Mental health is a buzzword thrown around both sides of the gun control debate. Time and again, especially after a mass shooting, Republicans and Democrats alike call for stronger mental health regulations. Mental health services and equitable laws are crucial. More than half of all gun-deaths in America are firearm-inflicted suicides. Extending mental health services to this vulnerable group is a key strategy to reducing the staggering number of suicides in America each year. Still, society should not have the knee-jerk reaction that persons with mental illness are, as a class, more dangerous. In fact, mental illness is only an indicator of future violence when coupled with a history of violence or substance abuse. (That is true also of individuals not diagnosed with a mental illness). All the research demonstrates that simple fact.

Of course, there should be more mental health treatment, much more. But society and lawmakers in particular should not stereotype and stigmatize persons with mental illness suggesting they are dangerous.

While the attention given to the issue of mental health is significant, President Obama’s proposal lacks funding for critical research necessary to guide mental health policies and to better understand the root cause of so much of America’s problem with gun violence.

Shape the future of gun safety technology: safety through design

Politicians, and the public generally, tend to think public health professionals have competence mainly or solely to stem infectious diseases. To be sure, firearm injuries are an epidemic, but not the way we commonly think of that term. The truth is that public health agencies can prevent injuries far more effectively than they can prevent infectious disease outbreaks. We have learned that if the means with which harm is caused (e.g., a car, a hazardous mine, a rapid fire gun) can be designed with safety in mind, we can prevent many injuries and deaths. For example, airbags, passive restraints, and crash avoidance systems have resulted in a precipitous drop in traffic deaths. The one factor that did not change was the driver.

The lifeblood of public health is the ability to study a problem and examine which measures work best. President Obama’s executive order recognizes the power of research. As, he explained in his address “With more research we could further improve gun safety just as with more research we've reduced traffic fatalities enormously over the last 30 years… research, science, those are good things. They work.” Yet he vests the responsibility for research with the Department of Defense and Department of Homeland Security. The CDC is the most competent and experienced agency to conduct injury prevention research. This move is acknowledgment of the reality of our current Congress’ reticence towards the CDC. Why? The CDC has a strong track record with every other public health problem, and the agency should be amply funded and encouraged to conduct firearm research to inform policymakers of the best solutions.

And so, an Executive Order…

 Left with no other choice, the President is using the vehicle of an executive order rather than waiting for Congress to act. It is virtually certain that firearm advocates will sue, challenging the President’s authority in order to deflect attention from the real issue. Firearm injuries are one of the most preventable threats to the public. We can prevent a great deal of gun violence and unintentional injuries such as by suicide, and accidental shootings in the home. But unlike the President’s Executive Order on immigration, the courts will have no difficulty upholding these Executive Orders. The President has acted squarely within his powers. The Executive Branch has the power, and duty, to interpret laws and to implement them effectively. That is what the President’s order has done—nothing more. Far from being an executive over-reach, it is a modest effort to use the powers of the presidency within the law and for the public good.

Firearm injury prevention emphatically does not diminish the right to bear arms through the lawful and reasonable use of guns and rifles. And, President Obama’s executive order will begin the long overdue process of addressing America’s gun violence epidemic.


[1] White House, Office of the Secretary, FACT SHEET: New Executive Actions to Reduce Gun Violence and Make Our Communities Safer, January 4, 2015

[2] Id.

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


An Obligation to Meet the Health Needs of Sexual Violence Survivors in Colombia

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Image courtesy of Blu Radio

Image courtesy of Blu Radio

On December 17, Colombia's Constitutional Court ruled that health care providers must provide survivors of sexual violence with immediate, comprehensive, confidential and free medical services. The decision is particularly important for sexual violence survivors who have been displaced by the armed conflict in Colombia, as they are more likely to face a daunting array of obstacles when accessing medical services.

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Posted in Human Rights; Tagged: , , , , , , , .


Two things we should STOP doing in the name of public health in 2016

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In 2013, my colleague Brian Honermann wrote a popular blog post on four things we should probably stop doing in the name of public health: 1) Vitamin supplementation amongst otherwise healthy individuals; 2) PSA-Based Prostate Cancer Screenings, 3) Asymptomatic Mammography-Based Breast Cancer Screening; and 4) Obsessive Concern with Obesity based on BMI.


Unfortunately, all of Brian’s recommendations are still in need of change with the exception of PSA-based prostate cancer screenings. As reported last week by the NYT, the Public Health Service Task Force has changed its recommendations to reflect the science on PSA-based Prostate Cancer Screenings. In the last two years however, there has been no notable change on the other three. And so, I encourage you to read Brian’s blog post here.

In 2016, I propose adding two more things that we should STOP doing in the name of public health: (1) Stop using antibacterial soaps and hand-sanitizers, and (2) Stop throwing out food past the date label on the package.

Stop using antibacterial soaps and hand-sanitizers

According to a 2010 lawsuit filed by the Natural Resources Defense Council (NRDC), the Food and Drug Administration (FDA) first considered regulating topical antiseptic products, including triclosan in 1972, but never finished its review. In 1978, FDA proposed banning triclosan directly as an active ingredient in soaps, but that proposal never amounted to anything more. Again in 1994, the agency initiated similar steps towards banning triclosan, but again failed to actually authorize a rule.

And so, in 2010, NRDC sued FDA to finish what it started in evaluating the safety of triclosan in consumer products. In 2013, FDA issued a proposed rule to ban the use of antibacterial chemicals in soaps for consumer purchase unless companies can offer scientific data to prove they are safe and effective for long term use. As a condition of settlement, FDA promised to issue a final action on triclosan by 2016. What will happen in 2016 remains a mystery, in the meantime, consumers should stop using products with antibacterial ingredients.

What’s the issue?

Antibacterial soaps (sometimes called antimicrobial or antiseptic soaps) contain drug-chemicals, typically triclosan, intended to reduce or prevent bacterial contamination. According to the US Centers for Disease Control (CDC), “studies have shown that there is no added health benefit for consumers (this does not include professionals in the healthcare setting) using soaps containing antibacterial ingredients compared with using plain soap.” And, according to FDA "[n]ew data suggest that the risks associated with long-term, daily use of antibacterial soaps may outweigh the benefits. There are indications that certain ingredients in these soaps may contribute to bacterial resistance to antibiotics, and may have unanticipated hormonal effects that are of concern to FDA.”

In short, antibacterial soaps do not kill bacteria any better than plain old soap and water. They do however, introduce a number of other serious concerns including health problems, antibiotic resistance, environmental issues and specific hazards for children.

A recent CDC study detected triclosan in the blood stream of nearly 75% of people in the US, making the following concerns very real for the overwhelming majority of the population.

Health Concerns

In animal studies, scientists found that triclosan acts as an endocrine disruptor, altering the way hormones work in the body and raising concerns over infertility, artificially-advanced puberty, obesity and cancer (for more detail see here). A 2014 study published by the National Academy of Sciences found “[t]riclosan causes liver fibrosis and cancer in laboratory mice through molecular mechanisms that are also relevant in humans.”

Antibiotic Resistance*

Studies have linked the use of tricolosan in consumer products with antibiotic resistance in the humans. The American Medical Association recommends avoiding the use of any product with triclosan in the home, because of the threat of antibiotic resistance

*What is antibiotic resistance? Antibiotic resistance is a naturally occurring process. Bacteria adapt to resist susceptibility to antibiotics. Each time bacteria are exposed to antibiotics, some of the organisms are likely to develop resistance and some will be killed off. Resistant strains multiply and find a new host. As bacteria become more resilient, treating the infections they cause becomes more difficult and in some cases, impossible. When people expose themselves to antibiotics on a routine basis, their bodies have more opportunities to develop mutations and resistance to bacteria.

Environmental Concerns

Wastewater treatment does not adequately remove triclosan from our water. Triclosan is very toxic to aquatic life. Consequently, this chemical pollutes waterways, exposing nature and humans to unnecessary levels of antibiotics.

Special considerations for children

Babies build their immune systems by adapting to their environment. Developing immunity requires exposure to environmental pathogens. A baby’s memory T cells, or white blood cells learn to “remember” pathogens the body encounters to fight infection. Consequently, if you limit exposure to environmental pathogens, you also limit the body’s opportunity to develop those memory T-cells necessary to fight infections. Routine antibiotic use limits exposure to certain pathogens necessary for building a healthy immune system. Of course, exposure to certain pathogens and viruses is dangerous for a baby, but in non-healthcare settings proper handwashing with regular soap and water is proven to be equally effective at eliminating dangerous pathogens.

Another consideration for parents of young children, is a CDC finding linking the overuse of antibacterial products to allergic reactions. Shielding children from certain bacteria that tax the immune system may cause the body to have misguided reactions to otherwise harmless substances. Studies have found that limiting a baby’s exposure to certain pathogens increases the risk of developing allergies to common things like hay and peanuts.

A Note about Hand Sanitizers

“Washing” your hands with hand sanitizer is a misnomer. Waterless cleaners are designed to kill bacteria, but they do not remove dust or dirt from your hands. Additionally, the chemicals in the hand sanitizers are left to absorb into your skin, including antibiotics.

If soap and water are not available, CDC recommends using an alcohol-based hand sanitizer that contains at least 60% alcohol. Alcohol based sanitizers are not linked to antibiotic resistance.

How SHOULD you wash your hands? The U.S. Centers for Disease Control (CDC) dubs handwashing a five-step “do-it-yourself” vaccine (Wet, Lather, Scrub, Rinse, Dry).

Stop Throwing out Food Past the Date Label on the Package. It’s not (necessarily) spoiled.

sell by, use by, best before – In the US, almost none of those dates indicate the safety of food, nor does the law require them to (*with one exception for infant formula. FDA strictly regulates the nutritional content of infant formula. If infant formula is not consumed before its expiration date it should be thrown away). By and large, “dates” printed on food are set by the manufacturer based on the expected peak quality of the product, not the microbial safety of the food.

According to the Food Marketing Institute, nine out of ten consumers throw away food based on a listed date. But most of the time, the food is still perfectly edible. Generally, the average family of four wastes more than two million calories, worth nearly $1500, of uneaten food each year. Somewhere around 40% of food in America is wasted annually.

Food waste is a public health issue because decomposing organic matter in landfills emits an unbelievable amount of methane into our atmosphere, contributing to global warming. If global food waste were a country, it would rank behind only the United States and China in terms of harmful emissions. Still, decomposing food is only part of the equation. Throwing out food also wastes the energy that went into the original production, transportation and storage of the food, adding to its total carbon footprint. Food waste also amounts to throwing out 25 percent of all freshwater used in the US. Reducing your personal food waste, starting with healthy, viable “expired” food is a great place to start.


And, we can’t consider food waste without considering the one in seven Americans who go hungry each day. Experts at USDA project reducing food waste in the US by just 15% would feed roughly 25 million hungry Americans every year. Regulating date labels would be one place to start.

Want to learn more, read this terrific report:dating game




And a note on vitamin supplementation

Since Brian reported in 2013, the science hasn’t changed. It is still true that “[s]ystematic reviews of vitamin supplementation have produced a fairly clear picture that taking vitamin supplements has little to no effect on overall health outcomes and has produced some conflict as to whether vitamin supplementation is actively harmful or only marginally beneficial.”

Still, if you need a different reason to avoid supplements, or at least think twice before taking them, here are a few things you ought to know.

This past October, the New England Journal of Medicine published a study led by CDC doctor Dr. Andrew Geller. The study analyzed why tens of thousands of Americans ended up in the ER between 2004-2013 complaining of an adverse reaction to a dietary supplement. Complaints included everything from irregular heart beat and chest pain, to children’s accidental ingestion and chocking. Weight-loss and energy boosting supplements were responsible for almost three-quarters of the problems (71.8%). Of the 23,005 analyzed ER visits, 2,154 patients were admitted to the hospital. And note, the study did not include anyone who died enroute to the hospital or in the ER.

As I reported earlier this year, the dietary supplement industry has repeatedly been found guilty of selling fraudulent and mislabeled products leading to serious illness and death.

One of the biggest issues with dietary supplements is simply a lack regulatory authority and oversight. While FDA is responsible for regulating the dietary supplement industry, its actual authority is enormously limited. By law, the dietary supplement industry is essentially responsible for regulating itself. The companies are required to conduct their own safety and efficacy studies and are not required to prove anything to FDA before they actually begin selling their products. FDA only has the authority to stop a company from selling its product after an injury has occurred.

For most people, you are much better off eating a well-balanced diet to get the nutrients you need from food. If you are committed to supplements, talk to your doctor. And, make sure to only buy brands that carry the seal of a reputable third-party accreditor like the US Pharmacopeia.


You know the old adage, a little goes along way? Nothing could be truer about the actions I propose for 2016. Antimicrobial resistance is too real and incredibly frightening. So is climate change. Remediating each of these public health threats depends upon individuals changing behaviors. On an individual level using plain soap and water to clean our hands and making sure to eat the food we buy are not huge tasks, but if done collectively, the pay off could be.


Posted in Uncategorized;


Why We Need the Framework Convention on Global Health Following the SDGs

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FCGH logoNext month, the WHO Executive Board will meet with a lengthy agenda, representing the range of serious health burdens and threats that persist. One challenge stands above the rest: immense global and national health inequities, linked to some 20 million deaths every year (about which more in an upcoming blog). The Executive Board could take a historic step towards health equality by beginning a formal WHO process towards a Framework Convention on Global Health (FCGH), the proposed global treaty to be based in the right to health and aimed at national and global health equality. (For more on the FCGH, see the FCGH platform statement and this briefing paper.) And there is reason to believe it could happen.

The Sustainable Development Goals, on the WHO Executive Board meeting agenda, provide an important entrée for the FCGH. While the SDGs and FCGH would cover some similar ground – such as assurances of universal access to health care, clean water, adequate sanitation, nutritious food, and decent housing – the FCGH could fill in critical SDG governance gaps: Read More

Posted in Global Health, Human Rights, Non-communicable diseases, Trade, WHO; Tagged: , , , , , , , , , , , .


Food marketing to children in Latin America in need of an urgent makeover

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Written by Gianella Severini and Fernanda Alonso 

Today, worldwide rates of nutrition-related NCDs such as diabetes and obesity in children are alarming. This situation has been particularly critical in Latin American and Caribbean countries in the last couple of years. Because of this, the implementation of different programs to monitor and prevent unhealthy weight gain in children and adolescents is urgently needed.

Policymakers and researchers internationally are increasingly emphasizing how marketing is contributing to unhealthy diets, mainly among children. The wide range of marketing techniques such as television advertising, in-school marketing, sponsorship, product placement, internet and text promotions creates and reinforces the demand for HFSS foods (High Fat, Salt and Sugar).

Various national and international initiatives have recommended that limits should be placed on the types of foods promoted to children. Just last June, UNICEF asked governments and civil society in Latin America to work together to improve advertising practices. They issued this call after a study in 2013 revealed that “Marketing and advertising of unhealthy food and beverages directed to children is attributed to the high incidence of childhood obesity that leads to the development of non-communicable diseases during adulthood.” Read More

Posted in Uncategorized;


We have a deal! The Paris Agreement: An innovative legal agreement to save the planet?

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Unknown-1Unless you have been living under a rock, or about to head out on a long holiday, you may have heard the news this past weekend that 195 states and the EU (196 Parties) adopted a new international agreement on climate change in Paris. The Paris Agreement aims to limit the increase in global temperature to an aspirational, but likely necessary, 1.5 degrees Celsius. The Agreement is the result of years of negotiation and was concluded during an intense two-week period of negotiations.

The Agreement includes substantive provisions regarding a) mitigation; b) adaptation; c) loss and damage; d) financial support; e) technology development and transfer; f) capacity-building; g) transparency measures; h) stocktaking events; and i) implementation and compliance. The Agreement also includes provisions for the pre-2020 period before the proposed $100 billion USD per year fund to assist developing countries begins in 2020. As a public health lawyer, I am interested in the potential implementation and results of the Paris Agreement and am hopeful it is a success. However, I do not profess to have much knowledge about the substantive environmental elements of the Agreement.

Procedurally, however, the resulting Agreement is pretty fascinating. The following are three procedural points I found interesting about the Paris Agreement: Read More

Posted in Global Health, Human Rights, Uncategorized;


Tianjin Blasts: A Regulatory Catastrophe

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This post was co-authored by Ana Ayala and Chun Wu.


From: Wall Street Journal | China

The Chinese city of Tianjin, a port city of close to 14 million people and an important transport and manufacturing center, shook with a series of explosions in August of this year. The explosions at Ruihai International Logistics’s warehouse, which stored highly hazardous and flammable chemicals, led to more than 170 deaths and hundreds injured. Eight people remain missing. This week, a report published by Allianz Global Corporate & Specialty, a global insurance company, declared the Tianjin explosions as the “largest man-made loss suffered by Asia.” According to the report, the US$3.25 billion in losses amount to “almost half the year's total losses globally.”

The continued human, environmental, and economic toll should come to no one’s surprise, and concerns over corruption within the Chinese government are rampant. It did not take long to realize that the explosions resulted from a failure of regulatory enforcement on the part of the government.

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


A public health approach to gun violence (or move to Australia)

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Courtesy of Time

Courtesy of Time

As an Australian living in the US, it’s often hard for me to engage with debates on gun violence that sound exactly the same after every awful mass shooting that now seems to take place before we’ve even had time to grieve the last one. Even though I understand the history behind the 2nd Amendment, it feels very foreign to think of gun violence as a civil rights issue. To hear the word “rights” invoked by one of the richest and most powerful associations of white men who spend over $28 million dollars a year lobbying federal candidates.

Lobbying that clearly works, blocking any legislative initiatives to regulate guns, leaving the US with nearly twice as many guns per capita than any other nation in the world, while an average of 297 people are shot every day, 48 of those children. I’m especially puzzled that those “rights” are tied to some concept of safety, when the unfortunate but common sense reality is that possessing a gun makes both individuals and families more vulnerable, not less. In fact, having access to a gun actually makes you three times more likely to commit suicide and twice as likely to be a victim of homicide.

It’s offensive to keep hearing about mental illness being blamed for gun violence, when we know that the mentally ill are far more likely to be victims of violent crime rather than perpetrators. Never mind the “lone wolf” narrative, which is used to shift the responsibility to a single anomaly, the outcast. If loneliness and isolation are indicators, then those of us living in large urban cities should be worried. Of course, they’re not, because we know that 85% of shootings occur in social networks and people are far more likely to be shot by relatives, friends, enemies or acquaintances than by lone violent psychopaths.

But until the US realizes that aside from cute furry animals, Australia also has the most rational gun control laws, the public health approach offers a sensible way forward. And for anyone who hasn’t seen John Oliver’s brilliant and hilarious six minute insight into why the Australian approach could work here, I strongly urge you to do so. Read More

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