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Kaiser Daily Global Health Policy Report

In The News

CDC Director Warns Of U.S. Complacency On Global Health Issues As Agency Faces Budget Cuts

“America is facing a ‘perfect storm of vulnerability’ for exposure to infectious diseases, making public health efforts more important than ever, [CDC Director Tom Frieden] warned Tuesday” during a luncheon at the National Press Club, the Washington Times reports. “The successful fight against many infectious diseases can lead to a sense of complacency, Dr. Frieden warned,” the newspaper writes. “But the increasing interconnectedness of the world means America is always at risk of being affected by outbreaks in other nations,” and “[a] lot of food and medication in the U.S. comes from outside its borders, he said, [adding] it only takes one missed diagnosis to unleash an epidemic.”

“He pointed to the H7N9 strain of the bird flu virus that was diagnosed this year in China,” noting “his agency is working to develop a vaccine for the latest bird flu strain, and that it launches on average one new investigation into infectious diseases every day,” according to the Washington Times. “But faced with growing debt and shrinking funds, many cuts are being made to the nation’s health infrastructure, he added,” the newspaper writes (Swarts, 9/10). “Frieden is trying to raise the agency’s profile at a time when new budget wars loom on Capitol Hill and lawmakers are more attuned to defending the budget of the [NIH] against new cuts than against less well understood agencies, such as the CDC, that depend on discretionary spending,” CQ HealthBeat adds (Reichard, 9/10).

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Survey Examines Public's Priorities In Replacing MDGs

“Targets for good governance, better job opportunities, environmental stability and less inequality need to sit alongside more traditional development goals as policymakers create a new agenda to follow the Millennium Development Goals, a survey of more than a million people around the world indicates,” the Thomson Reuters Foundation reports. “Just as important, those targets must for the first time apply to rich countries as well as poor, respondents said,” the news service writes, adding, “Rich nations, for instance, might be tasked with doubling their energy efficiency or cutting their disproportionate use of the world’s resources, according to the survey, released on Tuesday by the United Nations Development Programme (UNDP).”

“The UNDP consultation, carried out over the past year online, in national discussions and in door-to-door visits in 90 countries, aimed to assess what people see as priorities in replacing the Millennium Development Goals (MDGs), which expire in 2015,” the news service notes, adding, “The survey results aim to feed into an ongoing U.N. process to craft new ‘post-2015’ development goals over the next two and a half years. It is due to gain fresh momentum later this month at a special event towards achieving the MDGs at the U.N. General Assembly in New York.” The news service continues, “The new survey indicates that many people ‘continue to care deeply about’ the MDGs — particularly on education and health care — and want these issues to be part of any new post-2015 development targets, [Olav Kjorven, U.N. assistant secretary general and director of the Bureau of Development Policy at UNDP,] said” (Goering, 9/10).

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U.N. Official Raises Awareness Of Open Defecation, Sanitation During World Water Week

The Guardian’s “Global Development Professionals Network” examines U.N. Deputy Secretary-General Jan Eliasson’s efforts to bring light to the problem of open defecation and poor sanitation. During a speech at the opening plenary of World Water Week in Stockholm on September 2, Eliasson, who also serves as chair of WaterAid Sweden, “spoke of the more than 2.5 billion who live without adequate sanitation, the 25 percent of people in the developing world who practice open defecation because they have no toilets and, most starkly, the 2,000 children who die every day from diarrhea and other preventable diseases caused by poor sanitation,” the blog writes. “He called on different sectors to think and act horizontally, not in their usual silos,” the blog notes, adding, “The public sector, he said, must invest in sanitation and regulate against pollution, the private sector can provide the technology needed to improve sanitation.” According to The Guardian, “Eliasson asked civil society to continue to give water, sanitation and hygiene (WASH) high priority in their policies.” The blog writes, “The best way to summarize the situation, he said, is with one phrase: ‘Water is life, sanitation is dignity'” (Paddison, 9/10).

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Kenya's AIDS Indicator Survey Shows Country Making Progress In Prevention, Treatment

“Kenya is making great strides in tackling HIV/AIDS, with a fall in the HIV-positive population and a surge in the number of people getting tested and receiving treatment, according to a government survey released on Tuesday,” Thomson Reuters Foundation reports. “[T]he number of Kenyans living with the disease fell from 1.4 million to 1.2 million between 2007 and 2012, the 2012 Kenya AIDS Indicator Survey revealed on Tuesday,” the news service notes, adding, “The prevalence of HIV among adults dropped from 7.2 to 5.6 percent in the same period.” According to the survey, “[t]he percentage of adults who have taken an HIV test more than doubled from 34 percent to 72 percent between 2007 and 2012,” and “[t]wo-thirds of those tested have been tested more than once,” the news agency writes. “As a result, almost half of HIV-positive Kenyans are aware that they have the disease — up from 16 percent in 2007 to 47 percent in 2012,” Reuters notes, adding, “Almost nine out of 10 HIV-positive people who know their status and are eligible for [antiretroviral therapy (ART)] are receiving treatment” (Migiro, 9/10).

The survey also showed that “[a]lmost 60 percent of Kenya’s 104,000 HIV-positive children are not receiving life-prolonging [ART] because their parents do not know they are infected,” a second Thomson Reuters Foundation article reports. Since “[t]he government introduced free maternity services in public facilities on June 1 … there has been a rapid increase in the number of women delivering in hospital, a rise of between 10 and 50 percent across the country,” the news agency writes, noting that nearly “all the pregnant women who visit antenatal clinics, rising from 65 to 92 percent of the total between 2007 and 2012, are tested for HIV.” Kevin De Cock, director of the CDC Center for Global Health, said, “It emphasizes again the importance of mother-to-child transmission services and of the scale-up and the importance of early infant diagnosis — making sure that children born to mothers with HIV have access to testing and then to treatment very early in life,” according to Reuters (Migiro, 9/10).

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IRIN Examines Maternal, Child Health In Laos

“Health experts are reviewing a years-long effort to reverse a deadly trend for mothers and newborns in Laos, which has the highest death rate in Southeast Asia for both groups,” IRIN reports. “Offering free maternal and child health care since 2011 and doubling health expenditures in the past decade have helped, but more is needed to reduce preventable deaths, say experts,” the news service writes. Noting “[o]nly 38 percent of women give birth with someone known as a ‘skilled birth attendant,'” the news service continues, “Changing reproductive care-seeking behavior, especially for isolated communities, has been difficult,” as “[n]early 90 different languages are used among some 50 officially recognized ethnic groups, complicating communication between health workers and patients” and “[c]ash for out-of-pocket hospital payments and reproductive health awareness and services are lacking, especially in rural mountainous areas where most of the population lives.” In addition, IRIN examines the “need to provide youths with sexual and reproductive health services, including access to family planning and treatment for [sexually transmitted infections (STIs)]” (MacLean, 9/11).

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Editorials and Opinions

World Will Not Reach MDG Targets Without More Intense Efforts, Money

Noting “[t]he United Nations General Assembly will meet later this month to assess progress — impressive in some areas, halting in others — toward achieving the United Nations’ Millennium Development Goals [MDGs], which were adopted in 2000 and are supposed to be reached by the end of 2015,” a New York Times editorial writes, “International health programs have greatly reduced death and sickness worldwide over the past two decades but there is still a long way to go.” The editorial discusses progress toward reducing maternal and under-five child mortality, adding, “Another Millennium goal — providing antiviral therapy to all people infected with the virus that causes AIDS — has been hard to reach.”

However, “Bangladesh and Liberia, two poor nations, have already reduced their death rates substantially enough to meet their 2015 targets,” the editorial writes, noting, “Progress in lagging countries will depend on greater efforts by local health ministries and the help of low-cost tools like antibiotics for pneumonia, rehydration salts and zinc for diarrhea, and insecticide-treated bed nets to protect children from malaria-bearing mosquitoes.” The editorial concludes, “The 2015 goals are described by the U.N. secretary general as the ‘halfway mark’ in a long-range agenda to eradicate extreme poverty by 2030, end hunger and malnutrition, protect the environment through sustainable development of natural resources, and enhance opportunities for all societal groups, including equal rights for women and girls. But without more intense efforts and money, the world will not even reach the halfway mark” (9/10).

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International Community Can Stop Violence Against Women By Working Together

“For the first time, a new U.N. study on men and violence includes data from men themselves, across a number of countries, that tells us why some men use violence against women and how this can be prevented,” Emma Fulu, who works for Partners for Prevention, a U.N. regional joint program working in Asia, writes in the Huffington Post U.K.’s “Impact” blog. “Four years in the making, the U.N. Multi-country Study on Men and Violence in Asia and the Pacific is based on interviews with 10,000 men from rural and urban sites in Bangladesh, Cambodia, China, Indonesia, Sri Lanka and Papua New Guinea,” she notes, adding, “The statistics presented in ‘Why do some men use violence against women and how can we prevent it?’ reflect unique human experiences from a diverse region that holds more than half of the world’s population.” She writes, “Across all sites, men who had perpetrated rape, most often against an intimate partner, most commonly reported their motivation for doing so was related to a sense of sexual entitlement; a belief that they had a right to sex with women regardless of consent.”

“One of the most surprising, but important, findings was that half the men who reported having raped a woman or girl did so for the first time when they were teenagers,” Fulu continues. “However, the majority of men who had raped did not experience any legal consequences,” she notes. “The study reveals that one of the most important priorities is addressing the ways society teaches men to be men,” she states, adding, “Overall 87 percent of men interviewed believe that to be man you need to be tough.” She writes, “The study reaffirms that violence against women is highly prevalent in Asia-Pacific but varies significantly across countries and even within countries,” adding, “We must address power imbalances between men and women and promote ways of being a man that value respect, non-violence and equality.” She concludes, “By working together with boys and girls, men and women, governments and communities, we can create a more peaceful and equitable world” (9/10).

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More Funding Needed To Properly Treat, Prevent Malaria Worldwide

“Malaria is an entirely treatable and mostly preventable disease … So why has the world not eradicated it already?” Senator for British Columbia Mobina Jaffer writes in the Huffington Post Canada’s “Impact” blog. She describes the disease and its history, noting, “over 3.3 billion people are at risk of contracting malaria because of where they are geographically situated,” with countries in sub-Saharan Africa and India being of “significant concern.” She continues, “There are a variety of reasons [why malaria has not been eradicated], the most obvious of which is funding.”  She states, “In the last few years, current funding has saved an estimated 1.1 million people, but it is not enough,” and she cites statistics about global cases of malaria. “With more funding for research and development of new insecticide and for distribution of preventative tools, the world has the capacity to eradicate this horrific disease from our psyche. The question is, do we have the will to do so?” Jaffer concludes (9/10).

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'Solutions At Hand' To Achieve Fistula-Free Generation

“We are thrilled to be in Uganda to recognize the achievements of EngenderHealth’s Fistula Care project, the largest U.S. government-funded initiative to treat and prevent obstetric fistula in more than 10 countries throughout Africa and Asia,” Pamela Barnes, president and CEO of EngenderHealth, and Joseph Ruminjo, a consultant obstetrician-gynecologist and clinical director of EngenderHealth’s Fistula Care Project, write in the Huffington Post’s “Global Motherhood” blog. “In our ongoing efforts, we’ve identified and implemented practices that have significantly improved outcomes for women with fistula,” they note, adding, “Fistula Care embarked on extensive research and training to identify practices that would help improve standard treatment and care, which will ultimately improve the quality of care and outcomes for women with fistula.”

“We’ve learned more about who fistula affects and how to better support women,” that “[n]ot all women living with fistula are victims,” and that “[a]ccess to quality maternal health programs is critical to achieving a fistula-free generation,” Barnes and Ruminjo continue. “We have the solutions at hand: We must continue working at both policy and program levels to upgrade and increase access to emergency obstetric care, train more surgeons and health care professionals and partner with communities to raise awareness of the need for skilled care at delivery and family planning,” they write, adding, “We know what it will take to achieve a fistula-free generation, and together we must accelerate momentum to make fistula as rare in Africa and Asia as it is today in the United States” (9/10).

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Recent Releases

LAC Health Summit Addresses Inequities In Health Status

In a post in USAID’s “IMPACTblog,” published as part of “a series to coincide with A Promise Renewed in the Americas: ‘Reducing Inequalities in Reproductive, Maternal and Child Health Summit’ during September 10-12 in Panama,” Veronica Valdivieso, deputy health team leader for USAID’s Regional Sustainable Development Office, Latin America and Caribbean, writes, “In the past decade, most economies in Latin America and Caribbean (LAC) have grown at a rapid pace,” but “[u]nfortunately, this growth has not benefited everyone in the region.” She discusses how disparities in access to health and social services and education perpetuate inequalities in health indicators such as under-five child mortality and nutrition. “The regional Promise Renewed event taking place in Panama this week aims to build momentum for countries and partners in the region to address inequities that impact health status,” she states (9/10). A press release from A Promise Renewed notes “26 Ministers of Health from Latin America and the Caribbean and seven international partners signed the Declaration of Panama pledge to end all preventable child and maternal deaths by 2035” (9/10).

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Report Examines Intersection Of Human Rights, Health And Intellectual Property

The Center for Global Health Policy’s “Science Speaks” blog highlights a paper (.pdf) from Yale’s Global Health Justice Partnership, a joint initiative of Yale Law School and Yale School of Public Health, in which the authors “seek to counter the weight given to intellectual property rights with human rights laws, conventions, and arguments,” noting “too often developing countries, fearing economic consequences if they prioritize health over intellectual property, enforce patent protections that keep life-saving drugs out of reach.” The blog continues, “An exploration of one of the landmarks of the once uncharted intersection of health and human rights, ‘A Human Rights Approach to Intellectual Property and Access to Medicines’ also is a handbook for treatment access advocates,” noting, “In addition to a delineation of arguments against international trade laws that impede access to treatment, it includes appendices of relevant cases and documents” (Barton, 9/10).

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Female Community Health Workers Essential To Meeting Health MDGs

John Clemens, executive director of the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), writes in the Bill & Melinda Gates Foundation’s “Impatient Optimists” blog about the importance of female community health workers, who “are a cornerstone of Bangladesh’s strategy for achieving Millennium Development Goals (MDGs) 4 and 5,” he states. “The contributions of female community health workers to improving maternal and child health followed a decision by the government of Bangladesh and the non-governmental sector to place greater emphasis on the delivery of both primary healthcare and family planning services, and to have female workers serve on the frontline to deliver these services,” he writes, discussing the country’s experience. Clemens concludes, “Supporting and investing in a women-centered approach to service delivery embodies the equity focus that needs to be central to any country’s plan for achieving the MDGs — and indeed for ensuring the long-term sustainability of gains in child and maternal health” (9/9).

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PLOS Blog Highlights New Articles Published In PLOS Medicine

The PLOS “Speaking of Medicine” blog highlights a number of new articles published in the current issue of PLOS Medicine. Jessica Haberer and colleagues report that high adherence to antiretroviral pre-exposure prophylaxis (PrEP) for people in serodiscordant relationships, “achieved in the setting of active adherence monitoring and counseling support, is associated with a high level of protection from HIV acquisition by the HIV-uninfected partner”; Silvy Peeters and Anna Gilmore “explore the motivation behind tobacco companies’ interests in smokeless tobacco products in Europe”; and “Iza Ciglenecki and colleagues from Médecins Sans Frontières (Doctors without Borders) describe their experience of undertaking the first mass vaccination campaign using oral cholera vaccines in response to an outbreak in Guinea,” according to the blog (9/10).

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