Tuesday, October 9, 2007

[EQ] Meeting Basic Survival Needs of the World's Least Healthy People - Toward a Framework Convention on Global Health

Meeting Basic Survival Needs of the World's Least Healthy People - Toward a Framework Convention on Global Health

Lawrence O. Gostin
, Associate Dean - Research and Academic Programs & the Linda D. and Timothy J. O’Neill

Professor of Global Health Law - Georgetown University Law Center

Research Paper No. 1, 2007 - Forthcoming Jan. 2008 - Georgetown Law Journal, Vol. 96, 2008

Available
online PDF [52p.] at http://ssrn.com/abstract=1014082

   
“…..This article searches for solutions to the most perplexing problems in global health - problems so important that they affect the fate of millions of people, with economic, political, and security ramifications for the world's population. There are a variety of solutions scholars propose to improve global health and close the yawning health gap between rich and poor: global health is in the national interests of the major State powers; States owe an ethical duty to act; or international legal norms require effective action. However, arguments based on national interest, ethics, or international law, have logical weaknesses. The coincidence of national and global interests is much narrower than scholars claim. Ethical arguments unravel when searching questions are asked about who exactly has the duty to act and at what level of commitment. And international law has serious structural problems of application, definition, and enforcement.

What is truly needed, and which richer countries instinctively do for their own citizens, is to meet what I call “basic survival needs.” By focusing on the major determinants of health, the international community could dramatically improve prospects for good health. Basic survival needs include sanitation and sewage, pest control, clean air and water, tobacco reduction, diet and nutrition, essential medicines and vaccines, and functioning health systems. Meeting everyday survival needs may lack the glamour of high-technology medicine or dramatic rescue, but what they lack in excitement they gain in their potential impact on health, precisely because they deal with the major causes of common disease and disabilities across the globe.

If meeting basic survival needs can truly make a difference for the world's population then how can international law play a constructive role? What is required is an innovative way of structuring international obligations. A vehicle such as a Framework Convention on Global Health (FCGH) could powerfully improve global health governance. Such a Framework Convention would commit States to a set of targets, both economic and logistic, and dismantle barriers to constructive engagement by the private and charitable sectors. It would stimulate creative public/private partnerships and actively engage civil society stakeholders. A FCGH could set achievable goals for global health spending as a proportion of GNP; define areas of cost effective investment to meet basic survival needs; build sustainable health systems; and create incentives for scientific innovation for affordable vaccines and essential medicines.
….”

This article
:

- F
irst examines the compelling issue of global health equity, and inquires whether it is fair that people in poor countries suffer
 
such a disproportionate burden of disease and premature death.

- Second, the article explains a basic problem in global health: why health hazards seem to change form and migrate everywhere on the earth.

- Third, the article inquires why governments should care about serious health threats outside their borders, and explores
  
the alternative rationales: direct health benefits, economic benefits, and improved national security.

- Fourth, the article describes how the international community focuses on a few high profile, heart-rending, issues while largely
 
 ignoring deeper, systemic problems in global health. By focusing on basic survival needs, the international community could
 
dramatically improve prospects for the world's population.

- Finally, the article explores the value of international law itself, and proposes an innovative mechanism for global health reform
  
a Framework Convention on Global Health….”

 

 

 

Lawrence O. Gostin, Associate Dean (Research and Academic Programs) - Linda D. and Timothy J. O’Neill Professor of Global Health Law
Faculty Director, O’Neill Institute for National and Global Health Law - Georgetown  University  Law  Center                             
600 New Jersey  Avenue, NW Washington,  DC  20001
V 202-662-9038 F 202-662-9055 http://www.law.georgetown.edu/faculty/gostin.html and http://www.law.georgetown.edu/oneillinstitute/about.html

 

PDF file [52p.] at: http://papers.ssrn.com/sol3/Delivery.cfm?delivery_id=1014082&frd=yes

 

 

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[EQ] WHO Bulletin - Special Issue on Poverty and Human Development

Poverty and human development

 

Volume 85, Number 10, October 2007

Bulletin of the WHO - World Health Organization (BLT)

 

Available online at: http://www.who.int/bulletin/volumes/85/10/en/index.html

 

 

This month the Bulletin joins over 230 other journals around the world in publishing papers on poverty and human development, as part of an initiative by the Council of Science Editors.

 

The first article on poverty and human development, an editorial, by Augustin Kwasi Fosu, examines the different measures of development and poverty, and how these indicators are linked to health. The second, a research paper by Alexander Warren Hertel-Fernandez et al., reports that infants born to the socioeconomically disadvantaged in Chile had a significantly higher risk for mortality by infectious diseases and trauma during the first month of life.

 

In the third, a review paper, Lale Say & Rosalind Raine find that inequalities in the use of maternal care in developing countries vary widely, highlighting the need to investigate and assess context-specific causes of use of maternal health care. The final paper in this set, by Tanja A J Houweling et al, found that poor–rich inequalities in maternity care in general, and professional delivery care in particular, are much larger than those in immunization coverage or treatment for childhood illnesses.

 

Seven papers in this issue of the Bulletin focus on maternal health. In an editorial introducing these papers, Monir Islam describes the enormous challenges to reduce child and maternal mortality in the develop­ing world faced by the Safe Mother­hood Initiative in the 20 years since it was formed.

 

Guo Sufang examines the increase in Caesarean section in China. Nils Chaillet et al. examine the attitude of obstetricians in Quebec to clinical practice guidelines targeting the management of labour and vaginal birth after a previous Caesarean birth.

 

Community-based distribution of injectable contraceptives is common­place in some countries in Asia and Latin America, but is practically unknown in Africa. A community trial in Uganda, by John Stanback et al., shows that well trained community health workers can safely provide contraceptive injections.

 

Steven A Harvey et al. found that skilled birth attendants in Nicaragua lack the knowledge and skills to manage common life-threatening obstetric complications.

 

Use of magnesium sulfate for pre-eclampsia and eclampsia is below desired levels in Mexico and Thai­land, according to a study by Pisake Lumbiganon et al. Laurel Hatt et al. conclude that the poorest women still find it hard to access emergency obstetric care.

 

In an editorial, Sara Wood discusses how policy-makers and scientists often lack access to data they need to assess priorities for public health. She explains how information that can prevent disease outbreaks moves slowly from wealthy to developing countries.  In the news, José Orozco reports on the spread of dengue fever in Venezuela. Claire Keeton reports from South Africa on the challenges of doing clinical trials involving children. Cininta Analen reports from Indonesia on a novel ap­proach to improving maternal health care in rural areas. In this month’s interview, Michael Kazatchkine, Executive Director of the Global Fund to fight AIDS, Tuberculosis and Malaria, talks about plans to start financing health systems in developing countries.

 

Ryuichi Komatsu et al. assess the contribution of Global Fund-supported programmes towards achieving international targets and Millennium Development Goals in terms of fighting HIV/AIDS, tubercu­losis and malaria. They conclude that considerably greater financial support will be needed to meet 2009 targets.

 

Volume 85, Number 10, October 2007, 733-820

Poverty and human development; Maternal health; Why numbers count; In the news; Global Fund targets
Full article text [HTML] | Full article text [pdf 71kb]

EDITORIALS

Poverty and development
- Augustin Kwasi Fosu doi: 10.2471/BLT.07.045955
Full article text [HTML] | Full article text [pdf 84kb]

The Safe Motherhood Initiative and beyond
- Monir Islam doi: 10.2471/BLT.07.045963 Full article text [HTML] | Full article text [pdf 74kb]

Opening data to the world: why health numbers matter
- Sara Wood doi: 10.2471/BLT.07.046649 Full article text [HTML] | Full article text [pdf 71kb]

WHO News
The Global Fund expands its role
Full article text [HTML] | Full article text [pdf 2.06Mb]
 

RESEARCH

Huge poor–rich inequalities in maternity care: an international comparative study of maternity and child care in developing countries
- Tanja AJ Houweling et al. doi: 10.2471/BLT.06.038588
Abstract [HTML] | Full article text [HTML] | Full article text [pdf 1.01Mb]

Delivery settings and caesarean section rates in China
- Guo Sufang et al. doi: 10.2471/BLT.06.035808
Abstract [HTML] | Full article text [HTML] | Full article text [pdf 455kb]

Magnesium sulfate is not used for pre-eclampsia and eclampsia in Mexico and Thailand as much as it should be
- Pisake Lumbiganon et al. doi: 10.2471/BLT.06.037911
Abstract [HTML] | Full article text [HTML] | Full article text [pdf 331kb]

Contraceptive injections by community health workers in Uganda: a nonrandomized community trial
- John Stanback et al. doi: 10.2471/BLT.07.040162
Abstract [HTML] | Full article text [HTML] | Full article text [pdf 1.17Mb]

Did the strategy of skilled attendance at birth reach the poor in Indonesia?
- Laurel Hatt et al. doi: 10.2471/BLT.06.033472
Abstract [HTML] | Full article text [HTML] | Full article text [pdf]

Are skilled birth attendants really skilled? A measurement method, some disturbing results and a potential way forward
- Steven A Harvey et al. doi: 10.2471/BLT.06.038455
Abstract [HTML] | Full article text [HTML] | Full article text [pdf 623kb]

Identifying barriers and facilitators towards implementing guidelines to reduce caesarean section rates in Quebec
- Nils Chaillet et al.  doi: 10.2471/BLT.06.039289
Abstract [HTML] | Full article text [HTML] | Full article text [pdf 380kb]

The Chilean infant mortality decline: improvement for whom? Socioeconomic and geographic inequalities in infant mortality, 1990–2005
- Alexander Warren Hertel-Fernandez et al. doi: 10.2471/BLT.06.041848
Abstract [HTML] | Full article text [HTML] | Full article text [pdf 494kb]

Global Fund-supported programmes’ contribution to international targets and the Millennium Development Goals: an initial analysis
- Ryuichi Komatsu et al. doi: 10.2471/BLT.06.038315
Abstract [HTML] | Full article text [HTML] | Full article text [pdf 348kb]

PUBLIC HEALTH REVIEWS

A systematic review of inequalities in the use of maternal health care in developing countries: examining the scale of the problem and the importance of context
- Lale Say & Rosalind Raine doi: 10.2471/BLT.06.035659
Abstract [HTML] | Full article text [HTML] | Full article text [pdf 763kb]

LETTER

Addressing smoking cessation in tuberculosis control
- Nick K Schneider & Thomas E Novotny Full article text [HTML] | Full article text [pdf 93kb]

 

 

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This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
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[EQ] Evidence-based health care for all is the topic of the Cochrane Colloquium

Evidence-based health care for all is the topic of the Cochrane Colloquium

 

Português: http://espacio.bvsalud.org/boletim.php?articleId=10170556200749

 

Español: http://espacio.bvsalud.org/boletim.php?articleId=10110807200738

 

English: http://espacio.bvsalud.org/boletim.php?articleId=10110826200727

 

 


On October 23-27, 2007, the XV Cochrane Colloquiuminternational forum of scientific evidence in health will be held in Sao Paulo, Brazil.

Evidence based health care for all
1. To introduce the Cochrane Collaboration and its achievements to those interested in using the best available evidence to inform healthcare decision making;
2. To provide members of the collaboration with opportunities to hold meetings and to advance their knowledge and skills;
3. To encourage partnerships among clinicians, researchers, consumers, policy makers and funders committed to advancing evidence-based practice;
4. To provide opportunities for members of the collaboration to get together at social cultural and recreational events;
5. To provide a forum where members of the Collaboration can contribute to the future directions of the organizations;
6. To provide a forum for discussion of health technology assessment, evidence-based health care and the role of the Cochrane Collaboration in supporting these activities
 


The scientific program include challenges that systematization and use of scientific evidence represent to the development and strengthening of national health policies, health promotion and enhancing quality of healthcare.

There will be 60 workshops, four plenary sessions, 180 original articles, eight special sessions on evidence in key areas, such as mental health, surgery, obstetrics and AIDS.


Website: http://www.colloquiumbrasil.info/php/index.php

 

 

Elenice de Castro - BIREME/OPS/OMS, Coordinadora (EVE/GA)

 

 

 

 

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This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
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[EQ] Mapping Health Services Access: National and Cross-Border Issues

Mapping Health Services Access: National and Cross-Border Issues

 

(HealthACCESS)

Final Report, November 2006
EU Commission - Directorate General for Health and Consumer Protection

 

Reinhard Busse*, Markus Wörz*, Thomas Foubister**, Elias Mossialos** and Philip Berman***

*Dept. Health Care Management, Berlin University of Technology, Berlin/ Germany

**LSE Health and Social Care, London School of Economics and Political Science, London, UK

***European Health Management Association (EHMA), Dublin/ Brussels

 

Available online as PDF file [53p.] at: http://ec.europa.eu/health/ph_projects/2003/action1/docs/2003_1_22_frep_en.pdf

 

“…..According to the EU Charter of Fundamental Rights, ‘Everyone has the right of access to preventive health care and
the right to benefit from medical treatment under the conditions established by national laws and practices’.
The Health ACCESS project has examined whether any of six hurdles:
- population covered for health insurance,
- benefits covered,
- cost-sharing arrangements,
- geographical barriers,

- organisational barriers and
- utilization of accessible services make it harder or even impossible to access health care within 10 EU countries, and whether cross-border arrangements between actors of different countries can effectively alleviate such problems. European integration has the potential to alleviate some but not all access barriers. However, it can also make access more problematic….”

 

Content

 

Summary and Policy Recommendations

Introduction

Access to health care within countries

The use of cross-border arrangements to enhance access

I. Access to health care within countries

Six hurdles to access health care services

Hurdle 1: The proportion of the population covered for health care

Hurdle 2: Benefits covered by health care systems

Hurdle 3: Cost-sharing arrangements

Hurdle 4: Geographical barriers to access

Hurdle 5: Organisational barriers to access

Hurdle 6: Utilization of accessible services

II. Cross-border arrangements and European patient mobility

Background

Cross border arrangements promoting access to health care

Types of arrangement and actors involved

Patient flows in cross-border arrangements

Access hurdles and other reasons for cross-border arrangements

Individual patient mobility

“European Centres of Reference”

III. Analysis of cross border arrangements and cross border movement

Types of cross-border arrangements

Localism/ local agency

Why are cross-border numbers so different? The relative importance of factors

Other features of cross-border arrangements

Conclusion
References

 

 

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This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
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