WHEC Update - June 2008
|A Newsletter of worldwide activity of Women's Health and Education Center (WHEC)|
June 2008; Vol. 3, No. 6
We all follow a path, don't we? We have a life to lead, and we have a choice to follow. Every mistake is an opportunity to increase competence. Once people have the information to understand the current situation, boundaries don't seem like constraints but rather guidelines for action. Since the launch of WHEC Practice Bulletins in 2006, hundreds of millions of readers around the world have used WomensHealthSection.com in many ways. The web-site's popularity has expanded in ways that few could have anticipated, and its community of users continues to grow and develop new genres. Hopefully, within the pages of our e-learning publication, you will find something to improve your experience of this ever-evolving project / program. And even learn a few things about Program Development in general. The greatest gap in life is the one between knowing and doing. The journey begins with the first step. Less than a decade ago, the biggest problem in global health seemed to be the lack of resources available to combat the multiple scourges ravaging the world's poor and sick. Today, thanks to extraordinary and unprecedented rise in public and private giving, more money is being directed toward pressing health challenges than ever before, and thousands of Non-Governmental Organizations (NGOs) are vying to spend it. What kind of initiatives could improve the accountability of all institutions to people whose lives they shape? What initiatives could serve merely to undermine NGO's useful and largely accepted role in holding business and government accountable for their actions? Stay tuned.
May be it was the bold dream. May be it was the determination. May be it was crazy hours. No matter how we created WomensHealthSection.com, with a unique understanding of the things that matter most to you. We offer a personal approach to structuring and managing knowledge in reproductive health. It is designed to maximize opportunity for you and your institutions, supported by a depth of personal commitment and intellectual capital - that is rooted in over 200 years of experience. None of us forget where we came from or the values that got us to we are today. Public health education that is irrelevant to national health priorities and divorced from public health practice is useless and constitutes a lost opportunity. Our e-Health Network can serve as a platform for public health education reform. There is a clear understanding among the WHEC Working Group that new information and communicating technologies hold out the promise of changing how people access information, and a determination to use these technologies, in particular the Internet, to improve the condition of millions of disadvantaged people throughout the world. How to get there was and is a continuing challenge. Today, NGOs are involved in all stages of political processes with the UN, influencing decision-making and policy implementation from the inside. These relations have, however, only been partially understood in the social sciences and reproductive health sciences. Health for all needs the participation of each and every one of us. Live your dreams.
Reviving A Promise
Rita Luthra, MD
Your Questions, Our Reply:
Can we expect full compliance and transparency from scientific, medical, clinical trial community involved in trials when so many interests are involved? What can fix the system?
Standards of Clinical Trials & Research: The Universal Declaration of Human Rights [adopted by the UN General Assembly in 1948] was a declaration of principles to which governments were invited to sign up. It is important that the declaration was issued because it provided benchmarks against which we think the behavior of human beings to each other should be judged. Governments are responsible for trying to ensure those principles are observed. But there will always be backsliding because the stakes are often very high, particularly the financial stakes for some players in this business. But something else is at stake too, and that is human health. It really does come down to a question on how you balance the interests of human beings who wish to improve and maintain their health, and what we can do about that, against other interest, such as financial, political and academic kudos.
Governments can do various things to encourage transparency in clinical trials so that science and the discovery process can be more efficient. Too much secrecy exists in science, which makes it inefficient. There are forces operating against pushing for proper scientific behavior. This is not a problem limited to people with vested commercial interests. It also exists throughout academia, where people do not systematically access what is known already before embarking on new research. It is important to repeatedly remind oneself that the clinical trials business should be about trying to improve health care and the health of people. But as long as distortions exist in the research design and reporting processes, we won't have done as well as we could for the public interest. World Health Organization (WHO), as the leading health organization in the world, has a leadership role to set the standards. Quite rightly, WHO points out that greater transparency in clinical trials is a moral issue; and that it is a matter of moral concern that the trial process is not more transparent.
WomensHealthSection.com is an educational resource helping people understand why trials are necessary. Our main responsibility is to introduce people to these principles.
About NGO Association with the UN:
The Millennium Declaration, signed by world's leaders of 189 countries in 2000, established 2015 as the deadline for achieving most of the Millennium Development Goals (MDGs). The majority of MDG targets has a baseline of 1990, and is set to monitor achievements over the period 1990-2015.
Millennium Development Goals (MDGs) 6: Combat HIV/AIDS, Malaria & Other Diseases
TARGET: Have halted by 2015 and begun to reverse the spread of HIV/AIDS. HIV prevalence has leveled off in the developing world, but deaths from AIDS continue to rise in sub-Saharan Africa. By the end of 2006, an estimated 39.5 million people worldwide were living with HIV (up from 32.9 million in 2001), mostly in sub-Saharan Africa.
Globally, 4.3 million people were newly infected with the virus in 2006, with Eastern Asia and the Commonwealth of Independent State (CIS) showing the fastest rates of infection. The number of people dying from AIDS has also increased - from 2.2 million in 2001 to 2.9 million in 2006. The use of non-sterile injecting drug equipment remains the main mode of HIV transmission in Commonwealth of Independent States (CIS) countries. Recently, injecting drug use has emerged as a new factor for HIV infection in sub-Saharan Africa, especially in Mauritius, but also in Kenya, Nigeria, South Africa and the United Republic of Tanzania. In Southern and South-Eastern Asia, people are most often infected through unprotected sex with sex workers. Over the past two years, HIV outbreaks among men who have sex with men have also become evident in Asia - in Cambodia, China, India, Nepal, Pakistan, Thailand and Viet Nam. In hardest hit areas, more than half of those living with HIV are women. Though access to AIDS treatment has expanded, the need continues to grow. Efforts to provide treatment for those living with HIV and AIDS continue to expand. As of December 2006, an estimated 2 million people were receiving antiretroviral therapy in developing regions. This represents 28 per cent of the estimated 7.1 million people in need. Though sub-Saharan Africa is home to the vast majority of people worldwide living with HIV (63 percent), only about one in four of the estimated 4.8 million people there who could benefit from antiretroviral therapy are receiving it. The magnitude of the problem is growing: Though 700,000 people received treatment for the first time in 2006, an estimated 4.3 million people were newly infected that year, highlighting the urgent need to intensify prevention efforts. If current trends continue, the number of people with advanced HIV infection in need of therapy will rise faster than treatment services can be scaled up. Care of orphans is an enormous social problem, which will only get worse as more parents die of AIDS. In 2005, an estimated 15.2 million children had lost one or both parents to AIDS, 80 per cent of them in sub-Saharan Africa. By 2010, the figure is likely to rise to more than 20 million. Several countries are making progress in providing a minimum package of services for orphans and vulnerable children, including education, health care, and social welfare and protection. But far more work is needed to provide a humane and comprehensive response to this unprecedented social problem.
TARGET: Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases. Malaria-control efforts are paying off, but additional effort is needed. Key interventions to control malaria have been expanded in recent years, thanks to increased attention and funding. A number of African countries, for example, have widened coverage of insecticide-treated bed nets (ITNs), which are among the most effective tools available for preventing the mosquito bites that cause malaria. Preliminary results from household surveys conducted in 2005-2006 show that many other countries are advancing on the bed net front as well, though final results will only be available later this year. Still, only a few countries came close to the 2005 target of 60 per cent coverage set at the African Summit on Roll Back Malaria in 2000. A strengthened commitment from all concerned is needed if countries are to reach the revised target of 80 per cent ITN use by 2010. Countries will also need to ensure that coverage is more equitable. In sub-Saharan Africa, only 5 per cent of children under five sleep under insecticide-treated bed nets. And in rural areas of countries where malaria is endemic, the burden of malaria is often highest and ITN coverage lowest. According to the most recent surveys of 30 African countries (conducted from 2000 to 2006), children under five living in urban areas were nearly 2.5 times as likely to be sleeping under an insecticide-treated net as their rural counterparts. To meet the MDG target, the most effective treatment for malaria must also be made available to those in need. A significant proportion of the nearly 40 per cent of children with fever in sub-Saharan Africa who received anti-malarial drugs were treated with chloroquine, which has lost some of its effectiveness due to widespread resistance. A number of African countries have shifted their national drug policies to encourage the use of artemisinin-based combination therapy (ACT). But to get these medicines to people who could benefit from them will require better forecasting of needs and improved management of procurement and supply-chain processes. Around $3 billion are needed worldwide - $2 billion for Africa alone - to fight malaria in countries hardest hit by the disease. International funding for malaria control has risen more than tenfold over the past decade, but the amount available in 2004 was still only around $600 million. The incidence of tuberculosis is leveling off globally, but the number of new cases is still rising.
Collaboration with World Health Organization (WHO):
WHO: 61st Session of the World Health Assembly
The World Health Organization (WHO) held its 61st World Health Assembly (WHA) in Geneva from 19-24 May 2008, bringing together 2,704 participants from 190 nations to tackle longstanding, new and looming threats to global public health. The 61st session discussed a number of issues, adopted several resolutions and established a key strategy for removing intellectual property barriers to essential research and development for public health, entitled a Global strategy on public health, innovation and intellectual property. The strategy will use innovative methods to encourage research, development and access to medicines for the common diseases of the developing world. The Health Assembly also:
- Endorsed a six-year action plan to tackle non-communicable diseases, now the leading threats to human health;
- Called upon WHO to present at the World Health Assembly in 2010 a draft global strategy to reduce harmful use of alcohol;
- Adopted a resolution urging Member States to take decisive action to address health impacts from climate change;
- Committed Member States to accelerating action towards the elimination of the practice of female genital mutilation through laws and educational and community efforts.
- Directed WHO to help countries in reaching higher coverage of immunization and to encourage development of new vaccines; and
- Requested WHO to assess the health aspects in migrant environments and to explore options to improve the health of migrants.
Bulletin of the World Health Organization; Volume 86, Number 6, June 2008, 417-496 Table of contents
Collaboration with UN University (UNU):
UNU-WIDER (World Institute for Development Economics Research) Expert Series on Health Economics:
The World Distribution of Household Wealth
There has been much recent research on the world distribution of income, but also growing recognition of the importance of other contributions to well-being, including those of household wealth. Wealth is important in providing security and opportunity, particularly in poorer countries that lack full social safety nets and adequate facilities for borrowing and lending. We find, however, that it is precisely in the latter countries where household wealth is the lowest, both in absolute and relative terms. Globally, wealth is more concentrated than income both on an individual and national basis. Roughly 30 per cent of world wealth is found in each of North America, Europe, and the rich Asian-Pacific countries. These areas account for virtually all of the world's top 1 per cent of wealth holders. On an official exchange rate basis India accounts for about a quarter of the adults in the bottom three global wealth deciles while China provides about a third of those in the fourth to eighth deciles. If current growth trends continue, India, China and the transition countries will move up in the global distribution, and the lower deciles will be increasingly dominated by countries in Africa, Latin American and poor parts of the Asian-Pacific region. Thus wealth may continue to be lowest in areas where it is needed the most.
Research on economic inequality--both within countries and between countries--is usually framed in terms of differences in income or consumption. In recent years a number of studies have extended this line of work to the global stage, by attempting to estimate the world distribution of income: see, for example Bourguignon and Morrison (2002), and Milanovic (2002, 2005). The findings document the very high disparity of living standards amongst the world's citizens, but indicate that the rising inequality seen within many countries in recent decades has not led to a clear upward trend in global income inequality. The lack of trend is due to the rapid increase of incomes in certain developing countries, of which China is by far the most important. Household wealth is important for a number of reasons. First, it provides a means of raising long term consumption, either directly by dissaving, or indirectly via the income stream of investment returns to assets. Second, by enabling consumption smoothing, ownership of wealth helps to insulate households against adverse events, especially those that lead to a reduction in income, such as ill health, unemployment, or simply growing old. Thirdly, household wealth provides a source of finance for informal sector and entrepreneurial activities, either directly or by use as collateral for business loans. These motives are less compelling in countries that have good state pension arrangements, adequate social safety nets and well developed source of business finance. By the same token, private wealth has more significance in countries which lack these facilities, which is the case in much of the developing world. Thus, as our results will make evident, household wealth tends to be lower in precisely those countries where it is needed most.
Discussion Paper No. 2008/03; By James B. Davies, Susanna Sandström, Anthony Shorrocks, and Edward N. Wolff
(Details of the paper can be accessed from the link of UNU-WIDER on CME Page of WomensHealthSection.com)
United Nations Charter:
We the Peoples of the United Nations .... United for a Better World
- Nothing in the present Charter precludes the existence of regional arrangements or agencies for dealing with such matters relating to the maintenance of international peace and security as are appropriate for regional action provided that such arrangements or agencies and their activities are consistent with the Purposes and Principles of the United Nations.
- The Members of the United Nations entering into such arrangements or constituting such agencies shall make every effort to achieve pacific settlement of local disputes through such regional arrangements or by such regional agencies before referring them to the Security Council.
- The Security Council shall encourage the development of pacific settlement of local disputes through such regional arrangements or by such regional agencies either on the initiative of the states concerned or by reference from the Security Council.
- This Article in no way impairs the application of Articles 34 and 35.
- The Security Council shall, where appropriate, utilize such regional arrangements or agencies for enforcement action under its authority. But no enforcement action shall be taken under regional arrangements or by regional agencies without the authorization of the Security Council, with the exception of measures against any enemy state, as defined in paragraph 2 of this Article, provided for pursuant to Article 107 or in regional arrangements directed against renewal of aggressive policy on the part of any such state, until such time as the Organization may, on request of the Governments concerned, be charged with the responsibility for preventing further aggression by such a state.
- The term enemy state as used in paragraph 1 of this Article applies to any state which during the Second World War has been an enemy of any signatory of the present Charter.
The Security Council shall at all times be kept fully informed of activities undertaken or in contemplation under regional arrangements or by regional agencies for the maintenance of international peace and security.
INTERNATIONAL ECONOMIC AND SOCIAL CO-OPERATION
With a view to the creation of conditions of stability and well-being which are necessary for peaceful and friendly relations among nations based on respect for the principle of equal rights and self-determination of peoples, the United Nations shall promote:
- higher standards of living, full employment, and conditions of economic and social progress and development;
- solutions of international economic, social, health, and related problems; and international cultural and educational cooperation; and
- universal respect for, and observance of, human rights and fundamental freedoms for all without distinction as to race, sex, language, or religion.
All Members pledge themselves to take joint and separate action in co-operation with the Organization for the achievement of the purposes set forth in Article 55.
- The various specialized agencies, established by intergovernmental agreement and having wide international responsibilities, as defined in their basic instruments, in economic, social, cultural, educational, health, and related fields, shall be brought into relationship with the United Nations in accordance with the provisions of Article 63.
- Such agencies thus brought into relationship with the United Nations are hereinafter referred to as specialized agencies.
The Organization shall make recommendations for the co-ordination of the policies and activities of the specialized agencies.
The Organization shall, where appropriate, initiate negotiations among the states concerned for the creation of any new specialized agencies required for the accomplishment of the purposes set forth in Article 55.
Responsibility for the discharge of the functions of the Organization set forth in this Chapter shall be vested in the General Assembly and, under the authority of the General Assembly, in the Economic and Social Council, which shall have for this purpose the powers set forth in Chapter X.
To be continued...
Top Two Articles Accessed in May 2008:
- Neural Tube Defects Screening;
WHEC Publications. Special thanks to World Health Organization for the contributions
- Vesico-Vaginal Fistula: The Need for Safe Motherhood Practices in India;
Author: Dr. S. Kataria, Director General Health Services (Union Territories), India
News, Invitations and Letters:
THEMATIC DEBATE OF THE GENERAL ASSEMBLY ON THE MILLENNIUM DEVELOPMENT GOALS
The Debate took place from the 1st to the 4th of April 2008. This summary is brought to you by the President of the General Assembly. The United Nations General Assembly held a thematic debate on the Millennium Development Goals at United Nations headquarters, New York on 1-4 April, 2008 on the theme " Recognizing the achievements, addressing the challenges and getting back on track to achieve the MDGs by 2015". The meeting consisted of an opening session, three panel discussions and a wrap-up session on 1 April, 2008, followed by a debate in the General Assembly from 2-4 April, 2008. The panel focused on the poverty and huger, education and health MDGs where progress is urgently required and experience has shown that positive result can have a catalytic effect on the other goals.
Link to the summary: www.un-ngls.org/docs/ga/summary_MDG_thematic_debate.pdf (pdf)
Making Pregnancy Safer in Least Developed Countries - The Challenge of Delivering Available Services
By Quazi Monirul Islam
Although an increasing number of developing countries have succeeded in improving the health and well-being of mothers and their newborns in recent years, the countries that started off with the highest burdens of maternal and neonatal mortality and ill-health made least progress during the 1990s. In some countries, the situation has actually worsened. Worrying reversals in maternal and newborn mortality have taken place. Progress has slowed down and is increasingly uneven, leaving large disparities between regions and countries. Moreover, within individual countries, there are often striking inequities and differences between population groups. National figures often mask substantial internal variations--geographical, economic and social. Rural populations have less access to skilled care than urban dwellers; mortality is higher among slum populations within urban dwellers; rates can vary widely by ethnicity or wealth status; and remote areas often bear a heavy death burden. Unless efforts are stepped up significantly, there is little hope of eliminating avoidable maternal and newborn mortality. Details: http://www.un.org/Pubs/chronicle/2007/issue4/0407p69.html
WHEC thanks Dr. Phillips M. Sarrel, Emeritus Professor of Obstetrics and Gynecology and Psychiatry, Yale School of Medicine, CT (USA) for his priceless contributions, support and friendship. It is indeed a pleasure to work with you and hope to explore and develop various areas of mutual interest. The entire team at Women's Health and Education Center (WHEC) had pleasant experience with you and we all thank you again.
Beyond the numbers...
Heaven sees as the people see;
Heaven hears what the people hear.
Dedicated to Women's and Children's Well-being and Health Care Worldwide