FROM a Great Canadian and World Statesman

"A great gulf... has... opened between man's material advance and his social and moral progress, a gulf in which he may one day be lost if it is not closed or narrowed..." Lester B Pearson http://nobelprize.org/nobel_prizes/peace/laureates/1957/pearson-lecture.html

Monday 8 December 2008

PacificSci ~~~~~~~~~~~~~~~~~~~~~~~~~ FIFTH ANNIVERSARY OF A BUSINESS VENTURE WITH A SOCIAL PURPOSE


PREAMBLE: Fourth Sector Enterprises
Pacific Health & Development Sciences Inc. (PacificSci), a health systems consulting firm based in Canada, falls within a new class of organization known as “fourth sector” or “for benefit” enterprises. Such entities represent a new paradigm in organizational design, aiming to link two concepts which are held as a false dichotomy in other models: private interest and public benefit.[1]

Before telling the short story of PacificSci, we muse in this preamble on the emergence of “fourth sector” organizations. To place this in the contemporary context, consider the following observations regarding the conflicts confronting traditional organizations[2]:

• Private companies have always had to balance between achieving the largest possible profits for their shareholders and retaining trust and contact with their other stakeholders: the local community, consumers, sub-contractors, pressure groups, etc.

• The public sector for years now has faced enormous political pressure in favour of privatization of a wide range of functions - and then being forced to 'repurchase' the very same functions and institutions when private companies no longer find them profitable.

• Voluntary organizations: Due to fierce competition from other voluntary organizations and tight state financing, voluntary organizations are having to experiment with their independent income - the sale of services and new products. All of which - activities and financial priorities - can be at odds with the organization's main goals and mission.

As far as the private sector is concerned, one only has to look at the world financial crisis to recognize that some firms are simply too big to be allowed to fail, despite incompetent leadership e.g, even now the US is bailing out its once mighty banking industry. Clearly, western industrialized nations are capitalist when going up, and socialist going down!

Equally, it has become increasingly clear that neither public nor voluntary sector organizations really operate in the “pure” manner traditionally implied. Increasingly public enterprises compete with the private sector, while the voluntary sector has become more commercially oriented.

For example, the success of many voluntary not-for-profit organizations today is due to a fully funded core staff, supplemented by contract income, thus able to build handsome “working capital funds”, while remaining eligible for government grants, which conveys a competitive advantage over other types of organization. In effect, such non-governmental organizations or NGOs (once mostly charitable organizations) have actually become a good “business model”!

In the meantime, many public sector (government) entities have become so hollowed out that they simply must hire private contractors to deliver the expertise that actually belongs with their public mandate. In addition to consulting firms, much of that expertise (sometimes hidden) is obtained from universities, themselves having become “hybrid” organizations[3]. Even publicly funded universities now engage in industry partnerships while receiving government financing, and simultaneously contracting out services to government! For those wishing a more academic analysis, we refer to Claude Menard.[4]

In this increasingly complex scenario, for which the neat rules separating the traditional organizational forms seem increasingly less applicable if not actually quite murky, the emergence of fourth sector organizations is perhaps virtually inevitable: breaking with earlier conceptions of the relationship between the state, the private sector and the voluntary sector. Operating outside the world of grants, and inside the basic economic realities of surviving as a business, the bottom line is nonetheless one of social purpose: in many ways a modern renaissance of motivation to improve the human condition.

With this backdrop we now offer the short story of PacificSci as a fourth sector organization.

References:
1. FourthSector.net http://www.fourthsector.net/for-benefit-organizations.php Accessed Dec 5, 2008.
2. KaosPilot International - International School of New Business Design and Social Innovation. http://users.homebase.dk/~awi/Publications/fourth_sector.pdf Accessed Dec 5, 2008.
3. Lamb R. Hybrid Organization. University of Hawaii, Manoa. June 17, 2004. http://www.vfh.fh-brandenburg.de/vfh/gastvorlesungen/gastvortrag_05.pdf Accessed Dec 5, 2008.
4. Menard C. The Economics of Hybrid Organizations. Presidential address to the annual conference of the International Society for New Institutional Economics, MIT, September
27–29, 2002. Journal of Institutional and Theoretical Economics. JITE 160 (2004), 345–376 2004 Mohr Siebeck – ISSN 0932-4569
http://atom.univ-paris1.fr/documents/Menard_JITE_2004.pdf Accessed Dec 5, 2008.

Feature Story - FIFTH ANNIVERSARY OF PacificSci
Pacific Health & Development Sciences Inc. (PacificSci), was incorporated precisely five years ago, on December 8th, 2003, as a health systems consulting firm. Our mission is “seeking solutions to health and social impacts of economic development”.

PacificSci is a joint venture of principals Franklin White (FW) and Debra Nanan (DN), President and Vice-President respectively. It was conceived primarily as a vehicle for our continued involvement in the field of public health, within which we had accumulated some 50 years professional experience. FW having worked outside Canada for the previous 15 years, and DN also experienced in both developed and developing countries and now a new resident of Canada, it was clear that –having been out of sight and out of mind for so long – one way to sustain our involvement in mid-career at appropriate levels of philosophy and responsibility would be to set up a private entity with its own mission.

The act of incorporation was carried out without professional legal assistance, using a simple “how to” guide. Within the first year, we became listed on various public sector registries in Canada, and launched our first website using freeware. In 2006, "PacificSci" was approved as our registered trademark. We upgraded our website in 2007 using the basic package from SiteCube.com, again without assistance[1]. See http://www.pacificsci.org/

Since incorporation, PacificSci has engaged in a blend of contractual and pro bono activities, mostly with an international focus, and with an expanding domestic portfolio. Without attempting to be comprehensive, the following is a selection from our portfolio.

Revenue Generating Activities
As a fourth sector organization, contractual work has been our primary source of corporate income. In this we have had reasonable success in attracting both international and domestic assignments, all of which reflect our social mission. In carrying out this mission, we commit to the same level of rigour and professionalism as we previously applied to our former careers in both academia and government service.

International Contracts
Foremost in this category has been Health Project Monitoring in Pakistan: In 2004 PacificSci participated with Universalia Management Group to bid for this Canadian International Development Agency (CIDA) role. A 5-year contract was awarded in 2005. Since then we have conducted M&E tasks in relation to four CIDA-supported initiatives:

- Family Planning Association of Pakistan (FPAP)
- HIV/AIDS Surveillance Project (HASP)
- Systems-Oriented Health Investment Programme (SOHIP)
- Lady Health Workers Programme (LHWP)

We are currently engaged in continued monitoring of both SOHIP and the LHWP. In addition, at CIDA’s request in 2006, FW carried out a review of a World Bank evaluation on a primary health care initiative in Pakistan, duly acknowledged by the bank.

We were also contracted by Sweden’s International Development Cooperation Agency (SIDA) to represent them in a joint donor evaluation of the African Medical & Research Foundation (AMREF). From October 2005 this entailed site visits to headquarters and field operations in Kenya, Uganda and Tanzania; the assignment was completed in March 2006.
NOTE: Links to each of these projects are supplied on our website: http://www.pacificsci.org/

Domestic Contracts
Domestic contract have also been a significant source of revenue, compatible with our mission. Over our first 5 years, PacificSci has engaged in several contracts, the most significant of which have been:

. Royal Roads University, Centre for Health Leadership & Research (CHLR): In April 2008 DN, PacificSci, contracted to support CHLR research; concluded Sept 2008. In July 2007, both principals delivered a review of process evaluation for population health initiatives. In Sept 2006, White co-developed with Dickson of CHLR a concept paper to support the ActNow-BC initiative, Ministry of Tourism, Sports & the Arts.

. EDS Canada: From December 2005 to February 2006, PacificSci was retained for our technical expertise to assist EDS in developing disease surveillance and management solutions, in response to an RFP to develop a Pan Canadian system. While EDS did not win this competition, out of 10 bidders it ranked second in a final run-off with IBM Canada, and ruled eligible if IBM did not complete the initial contracting requirements.

. British Columbia Ministry of Health: in 2004 PacificSci developed (complete draft) the Provincial Health Officer's (PHO) 2003 report. "Every Breath You Take..." This cites ~200 references and presents original analyses of air quality and morbidity data, including the first analysis of health services impact of 2003 forest fires. It was presented by PHO Dr Perry Kendall to the BC Legislature.

NOTE: Links to each of these initiatives are supplied on our website: http://www.pacificsci.org/

Pro Bono and Academically-Associated Activities
PacificSci’s voluntary activities have included many hundreds of hours in mentoring individuals and groups abroad and in Canada, participating in e-communities and in health policy groups, and reviewing for scientific journals.

We have also engaged in communications work. In 2006 the firm launched this monthly blog (PacificSci Global Perspectives) to present an independent view on current affairs, emphasizing the social determinants of health and social well-being. We were also a Communications Partner for the World Urban Forum (WUF) 2006, Vancouver.

On January 10, 2006, we launched PacificSci GLOBAL HEALTH DATA LINKS [2], a free subsidiary website developed primarily for students of international and global health providing annotated links to the following sources:

. UNDP Human Development Statistical Reports
. WHO Statistical Information Systems
. US Census Bureau International Database
. Population Reference Bureau Data-Finder
. WHO's Global Health Atlas.

Academically, PacificSci has been active in various (mostly honorary and voluntary) roles with: the Aga Khan University (Community Health Sciences), Dalhousie University (Community Health & Epidemiology), Kuwait University (College of Medicine), Royal Roads University (Centre for Health Leadership and Research), and others. The roles have included serving as: thesis supervisor; research advisor; external examiner; visiting speaker; curriculum design advisor; co-grantee; and co-author. In addition, Franklin White serves on an Advisory Board at the University of Victoria, Faculty of Human and Social Development, and Debra Nanan recently held a research post under a PacificSci contract with RRU. In May 2008, Franklin White was an invited by the University of Wisconsin to help launch the Survey of the Health of Wisconsin (SHOW), supported by the Wisconsin Partnership Fund for a Healthy Future.

Since incorporation, PacificSci principals have reviewed various scientific and professional articles for the following leading international journals:

. Anthropology & Medicine
. Archives Medical Sciences
. Canadian Medical Association Journal
. Evidence-based Complementary and Alternative Medicine
. Globalization & Health
. Medical Science Monitor
. International Journal Quality Health Care
. Journal of Public Health
. Qualitative Health Research

Since incorporation, as an expression of ongoing commitment to the population health sciences, PacificSci principals (in addition to numerous contracted technical reports) have themselves authored or co-authored 19 articles in peer-reviewed journals, 2 book contributions, 4 conference abstracts and 1 on-line video. Franklin White served as an Associate Editor and Debra Nanan as a contributor in: Dictionary of Public Health. JM Last (ed) Oxford University Press 2007. [Oxford Reference Online Series.] We also completed a major book chapter: White F, Nanan D. International and Global Health. Chap 76. In: Maxcy-Rosenau-Last, Public Health & Preventive Medicine. 15th Ed. McGraw Hill 2008. Full citations are available on a free website PacificSci NEWS & REPORTS [3], where we maintain a cumulative public record of our work. Unlike the contributions of most of our university and government colleagues, these contributions are of a pro bono nature. We see this as essential in staying in touch with and maintaining leadership in our field, while growing PacificSci as a fourth sector organization.
NOTE: Links to many items noted above are on our website: http://www.pacificsci.org/

Discussion
The most significant discovery in growing our enterprise, is that, despite working outside the formal system, we are able to make a unique and valued contribution to the public good, perhaps even “above our weight”. While less personally remunerative than working in either the public sector or in a university, this is offset by more “intellectual freedom” than most full time academics, and more control over professional time than persons working in a health service. Our third party independence, especially in monitoring and evaluation roles, and in our greater opportunity to “think outside the box”, frees us to speak out and write on issues as we see them, and make pro bono contributions out of choice, according to our best judgment. A significant disadvantage however is that, not being part of collective agreements that provide for professional networking and development, we must either dip into our own pockets or be invited as a resource e.g., conferences. This is the price to be paid for a different way of working: the fourth sector approach – in striving towards our social mission, we must also deliver on our skills, or go out of business. As we enter our sixth year, so far this has not happened.

Envoi: This has been a brief and candid account of the experience of Pacific Health & Development Sciences Inc., during its first 5 years or operation. During this period, PacificSci has managed to deliver reasonably well on its mission while being a “business venture with a social purpose”. Our “fourth sector” model has facilitated flexibility in what we, as principals, choose to do professionally. We can recommend this form of organization for anyone who wishes professional freedom of choice, within a strong social mission, and with the discipline to ride through lean inter-contract periods.

References
1. Pacific Health & Development Sciences Inc. MAIN WEBSITE http://www.pacificsci.org/
2. PacificSci GLOBAL HEALTH DATA LINKS http://www.webspawner.com/users/globalhealthdata/index.html
3. PacificSci NEWS & REPORTS http://www.webspawner.com/users/pacificsci/index.html

Wednesday 12 November 2008

CAN OBAMA RESTORE THE WORLD’S TRUST IN AMERICA'S IDEALS?

PREAMBLE: The past 8 years have been devastating for the world, due to the cavalier attitude of US leadership: an ignorant and arrogant approach to global issues from the environment to the “war on terror”, negligence in economic stewardship, and not least sweeping aside ethical and legal principles as if these are unconnected to core democratic principles.

Equally, due to the skewed priorities of now discredited neo-conservative ideology, the USA failed to make progress on its domestic front, especially in health and education: areas in which it does not compare favourably to other developed countries.

Responsibility for the catastrophic damage to the reputation of the USA can be laid at the feet of the “Bush 2” administration: so much damage done, so much opportunity lost.

Reprieve? We attribute the following statement to Ken Gude of the Guardian.
“All across the globe, people awoke Wednesday morning November 5, 2008 to a dramatically different world. Americans shook off the 400-year legacy of racism and elected an African-American named Barack Hussein Obama to the nation's highest office. That an experienced and admired war hero was defeated underscores the real significance of the electorate's hunger for change and the promise of an Obama presidency.

But the world that President-elect Obama awoke to on Wednesday morning had already changed. America's military deterrent, its economic power and its standing as a global leader have all nearly collapsed and old and new powers are seeking to fill the void.”

Note: The balance of Ken Gude’s article is paraphrased below as the third item in this issue.

We dedicate this issue of PacificSci Global Perspectives to Senator Obama’s political victory, and wish him whatever success is achievable in his efforts to turn around the abysmal situation described in our opening paragraph. He deserves wide support.

Reference: Ken Gude. The Guardian Newspaper on-line Friday, November 7, 2008 14.00 GMT.

President-Elect OBAMA – An Historic Breakthrough
The proposition that Barack Hussein Obama would become the 44th President of the United States seemed somehow remote. He was an unlikely candidate - he seemed inexperienced and had spent much of his childhood abroad. But mainly because he is black. It says much about the virtues of US democracy that Mr Obama could even have been nominated. But it says much more about perceptions of American democracy abroad that so many doubts prevailed for so long about the final outcome.

Opinion polls consistently gave Mr Obama an unassailable lead. The incumbent Republican President's personal ratings were at record lows. But the world would not believe until it saw it. Contrary to many predictions, race did not dominate the campaign. But it filled the gap between what Americans said they intended to do and what the rest of the world feared they would do. That anxiety played also on the minds of many US citizens. The joy expressed in the US and around the world at the result represents a moment of global realignment with America's best sense of national purpose. For most of its history, the US has perceived itself as a beacon of opportunity and an example to the world. Anti-Americanism, meanwhile, has always drawn strength from the assertion that those ideals are debased by the way the US projects its power abroad and by the raw facts of its unequal society.

A single election will not heal American social divisions, nor will it stop America pursuing its interests overseas, with military power if it so chooses. But by electing as their leader a man whose grandfather was a Kenyan goat-herder and who shares a middle name with the grandson of the Prophet Mohammed, Americans have made it harder for their enemies to portray them as a military nation and one of bigots.

Many challenges lie ahead but these should not detract from the optimism that is felt not only in America but around the world at the result of last week's election. Mr Obama has already proved his skill as a diplomat and politician. The young senator from Illinois once looked like an unconventional candidate. But a majority of US voters decided their choice would not be dictated by conventional thinking, choosing a President first and foremost to defend their own interests.

Source: Adapted from the Editorial: "America has restored the world's faith in its ideals". The Guardian Newspaper on-line Sunday November 9, 2008 00.01 GMT http://www.guardian.co.uk/commentisfree/2008/nov/09/barack-hussein-obama-american-dream#history-byline#history-byline

THE IN-TRAY – Key Issues for the Obama Presidency
In researching this issue, we looked at a number of sources, and settled on the Guardian’s coverage. Here we highlight that newspaper’s selection of key issues that must be tackled by President Obama and his team.

Health Care: Obama's plan (to include treating America's 46 million uninsured) entails using tax credits to coax more businesses into insuring their workers, while setting up a separate new healthcare system at a cost of more than $1 trillion. Can he do that while making good on a vow to reduce insurance fees by $2,500 per household?

Environment: for global climate talks to proceed smoothly next winter, Congress must be coaxed into approving US carbon emissions caps. Liberals will not hesitate to criticize him if he veers too far towards concessions to fossil-fuel producers. If Obama cannot bring Congress around, his advisers suggest he would use the president's regulatory powers to implement his plan for an 80% emissions reduction by 2050.

Energy: Americans pay $700 billion a year to oil-exporting nations. Obama wants to reduce that, and aims to put 1million plug-in hybrid cars into circulation by 2015, a formidable task while US car sales are tumbling. His goal to impose a windfall profits tax on oil companies is sure to draw intense opposition from the business lobby, while his promise to expand untested "clean coal" technology will anger the green movement.

Education: A quarter of US teenagers drop out before graduation, underscoring the need for an education overhaul when George Bush's No Child Left Behind policy expires next year. Obama has called for adding more funding to NCLB and shedding its emphasis on standardized tests. But with at least five states joining legal challenges to NCLB, he may be forced to focus on his less controversial goals, such as expanding early childhood education and community service tuition credits for university students.

Homeland security: Bush cut grants to police and firefighters by hundreds of millions of dollars, leaving a gaping hole in security for urban public transport as well as suburban street corners. Fixing that problem forces Obama to find extra cash during the economic crisis. But the real minefield is domestic surveillance, which alienated Obama from his Democratic base after he supported Bush's grab for new wiretapping powers.

Supreme Court: As many as three US supreme court justices are likely to retire in the next four years, giving Obama an opportunity to nominate justices that share his views on abortion, constitutional rights of terrorism suspects, separation of church and state, and other contentious social and legal issues. But legal analysts say the court's ideological make-up is unlikely to change much in Obama's first four-year term, because the justices likely to retire are firmly in the liberal wing.

Source: The In Tray: Key Issues. The Guardian Newspaper on-line Thursday November 6, 2008. http://www.guardian.co.uk/world/2008/nov/06/uselections2008-barackobama2#history-byline#history-byline

EDITORIAL NOTE: We note the curious omission of the economic collapse in this list, and refer readers to our last issue where this was addressed under title “the Brown Doctrine” http://pacificsci.blogspot.com/2008/10/global-economic-crisis-brown-doctrine.html

CLOSE GUANTANAMO, END TORTURE
According to the opinion expressed by Ken Gude of the Guardian, in contrast to the Bush administration's failed policies, Barack Obama will fight terrorism legally, competently. The following is paraphrased from his article referenced below, leaving in the active links to sources that he utilized in his original article.

President Bush will bequeath Obama numerous ongoing crises in Iraq, Afghanistan, Pakistan, Iran and Israel-Palestine that will demand urgent and sustained attention, constraining his ability to define his own agenda.

This makes it all the more important for President Obama to take US policy in a demonstrably different direction in the areas he can control, starting with the fight against al-Qaida. President Obama must follow through on his pledges to close Guantánamo Bay and renounce torture, and carry forward these changes by also shutting down the secret CIA prisons, ceasing extraordinary rendition and ensuring that all electronic surveillance is within the law and with necessary safeguards to protect against eavesdropping on innocent Americans. Obama will close Guantánamo Bay as one of his first actions as president. He will not be able to simply wave his hand and empty the prison, however, as any responsible policy will take time to implement.

Two early and relatively easy decisions will signal to the US and the world that Obama will chart a very different course than Bush: President Obama should order the release of Salim Hamdan and the remaining Guantánamo Uighurs. Hamdan was the first detainee convicted in a military commission trial, but the Bush administration will not release him even after his sentence expires at the end of the year. The 17 Guantánamo Uighurs are among the greatest tragedies of this sad saga, the Bush administration is fighting a US court decision ordering their release even though it has already determined that they are not enemy combatants.

Announcing the closure of Guantánamo Bay and releasing Hamdan and the Uighurs would change the dynamic surrounding the detention camp and enable the international cooperation required to ultimately empty the prison of the remaining 225 detainees. Obama should stop the military commissions process and begin preparing cases for trial in US courts against those detainees who should face criminal charges. He should institute at Guantánamo reintegration and de-radicalisation programmes that have been used successfully by the US military in Iraq and the Saudi government. And he should establish an international working group to find new homes for detainees that cannot be sent back to their home countries while accelerating transfers for those that can.

Thanks to President Bush, it is no longer adequate to assert that the US does not torture detainees in its custody and President Obama must go beyond simply returning to the pre-Bush status quo. The first step is to admit complicity in the torture of detainees in custody. President Obama should make public the legal opinions and policy guidelines that the Bush administration relied upon to craft its interrogation programmes. He should further pledge that all legal opinions developed by his administration related to interrogation and detention will be promptly and freely submitted to the relevant committees and leadership in Congress. Finally, President Obama should clearly and unequivocally publicly renounce torture and put all US government employees and contractors on notice that the torture and abuse of detainees will not be tolerated on his watch. President Obama should take the additional step of ensuring that the US is not complicit through the back door and end the outsourcing of torture by stopping extraordinary renditions and shutting down secret CIA prisons.

Many of Obama's supporters were disappointed in his decision this summer to support the compromise legislation on the National Security Agency's wiretapping programme. Some even worry that this move signals his intention to continue President Bush's warrantless wiretapping scheme, but that interpretation badly misreads both the political circumstances and the bill itself. A presidential campaign is a terrible place for tough policy decisions, and this latest amendment to the Foreign Intelligence Surveillance Act was far from perfect but importantly brought the entire surveillance programme under the jurisdiction of the FISA court. President Obama will now have pre-existing legislative sanction to conduct electronic surveillance with meaningful judicial oversight, which he clearly intends to do, and a strengthened progressive majority in both houses to pursue any additional steps necessary to preserve the liberties of the American people and prevent abuse.

Perhaps no area of US policy was more widely condemned than President Bush's war on terror and Obama must take immediate steps to reverse course or risk saddling all of America with the legacy of George W Bush. Under President Obama, America may come back, but there is no going back to the old order. Those countries who spent the Bush administration railing against American unilateralism must now accept the responsibilities that come with a seat at the table. The challenges we face are immense, and if we are to meet them we must work together in a spirit of cooperation that has not existed for many years, if it ever did. In the US and across the world, this is our time, this is our moment. Are we ready?

Source: Ken Gude. Close Guantanamo, end torture. The Guardian Newspaper on-line Friday, November 7, 2008 14.00 GMT.

Wednesday 15 October 2008

GLOBAL ECONOMIC CRISIS, FINANCIAL REFORMS & "THE BROWN DOCTRINE"

PREAMBLE: Over the past month, the world has faced an unprecedented near-collapse of its banking systems. The crisis is not over yet, and – it may fairly be stated – is due to a combination of poor political leadership in the United States (asleep at the wheel) and a combination of greed, negligence and corruption in its financial industry. This of course does not take the inaction and practices of other countries off the hook, as consequential national and global failures are documented extensively elsewhere, especially in Europe. Clearly, no country (rich or poor) has been spared, and it will take many years for individuals, families, communities and societies as a whole to recover from this crisis of greed, neglect and incompetence.

Perhaps needless to say, the necessities of life and the social fabric of all countries e.g, health and educational systems along with secure food supply, clothing and shelter depend on integrity in our financial systems. Trust must be restored in those systems.

Out of this morass some good has come in the leadership of UK Prime Minister Gordon Brown. He has put forward a 5 point plan which appears to have galvanized the world financial community around new principles, thereby giving some hope for the rest of us.

Implicit in the “Brown Doctrine” is an analysis of what is so seriously wrong with the world financial order. It forms a clear case for supra-national supervision of international finance, which clearly cannot any longer be left to the caprices of any one country.

The key features of the Brown Doctrine now follow, extracted from a media report.

Reference: Saunders D. The man who saved the world banking system. Globe and Mail Oct 15, 2008.

THE BROWN DOCTRINE
British Prime Minister Gordon Brown outlined a five-point program yesterday (October 14, 2008) to reform the world’s financial system. He hopes the principles will be the basis of a new set of global institutions to replace those that have governed international finance since 1944.

Transparency: Banks must fully disclose key information globally, not just nationally. Accounting standards will have to become international, and they must extend to the credit-insurance market, which has been heavily criticized.

Integrity: A worldwide effort is needed to end conflicts of interest, such as those involving rating agencies that receive fees from the firms they rate. Worldwide limits also need to be placed on pay and bonuses in banks, so that they reflect actual results and are no longer able to distort business practices.

Responsibility: All members of company boards must hold full responsibility for the company’s risk, and must not be able to walk away from their institutions. This will require international supervision.

Tighter Regulation: To create “a system with solvency and liquidity”, there must be “adequate protection through the economic cycle” to prevent speculators from distorting markets when they are rising and sort positions from having undue impacts when markets are falling.

New Institutions: The new system of banking cooperation will need “a new international financial architecture for the Global Age”. New institutions will provide “an effective global early warning system for the world economy, to alert us to the risks at hand”, and “globally accepted standards of regulation” and the cross-border supervision of global corporations.

Source: Saunders D. The man who saved the world banking system. Globe and Mail Oct 15, 2008.

Monday 15 September 2008

THE SOCIAL DETERMINANTS OF HEALTH

PREAMBLE: The final report of the WHO Commission on the Social Determinants of Health was released in late August, and may provide a unifying basis for all public health initiatives around the world, whether this be in relation to unfinished agendas such as the provision of potable water, sanitation and hygiene education or to the newer challenges such as the burgeoning impact of non-communicable diseases and the lack of universal access to health care in many countries. The report speaks to the human condition and the need for action on inequities as a leadership priority; this applies to all countries virtually without exception.

INEQUITIES KILLING PEOPLE ON A GRAND SCALE
A child born in a Glasgow, Scotland suburb can expect a life 28 years shorter than another living only 13 kilometres away. A girl in Lesotho is likely to live 42 years less than another in Japan. In Sweden, the risk of a woman dying during pregnancy and childbirth is 1 in 17 400; in Afghanistan, the odds are 1 in 8. Biology does not explain any of this. Instead, the differences between - and within - countries result from the social environment where people are born, live, grow, work and age.
These "social determinants of health" have been the focus of a three-year investigation by an eminent group of policy makers, academics, former heads of state and former ministers of health. Together, they comprise the World Health Organization's Commission on the Social Determinants of Health. The Commission presented its findings to the WHO Director-General Dr Margaret Chan.
"(The) toxic combination of bad policies, economics, and politics is, in large measure responsible for the fact that a majority of people in the world do not enjoy the good health that is biologically possible," the Commissioners write in Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health. "Social injustice is killing people on a grand scale."
"Health inequity really is a matter of life and death," said Dr Chan today while welcoming the Report and congratulating the Commission. "But health systems will not naturally gravitate towards equity. Unprecedented leadership is needed that compels all actors, including those beyond the health sector, to examine their impact on health. Primary health care, which integrates health in all of government's policies, is the best framework for doing so."
Sir Michael Marmot, Commission Chair said: “Central to the Commission’s recommendations is creating the conditions for people to be empowered, to have freedom to lead flourishing lives. Nowhere is lack of empowerment more obvious than in the plight of women in many parts of the world. Health suffers as a result. Following our recommendations would dramatically improve the health and life chances of billions of people.”

Inequities Within Countries
Health inequities – unfair, unjust and avoidable causes of ill health – have long been measured between countries but the Commission documents "health gradients" within countries as well. For example:
Life expectancy for Indigenous Australian males is shorter by 17 years than all other Australian males.
Maternal mortality is 3–4 times higher among the poor compared to the rich in Indonesia. The difference in adult mortality between least and most deprived neighbourhoods in the UK is more than 2.5 times.
Child mortality in the slums of Nairobi is 2.5 times higher than in other parts of the city. A baby born to a Bolivian mother with no education has 10% chance of dying, while one born to a woman with at least secondary education has a 0.4% chance.
In the United States, 886 202 deaths would have been averted between 1991 and 2000 if mortality rates between white and African Americans were equalized. (This contrasts to 176 633 lives saved in the US by medical advances in the same period.)
In Uganda the death rate of children under 5 years in the richest fifth of households is 106 per 1000 live births but in the poorest fifth of households in Uganda it is even worse – 192 deaths per 1000 live births – that is nearly a fifth of all babies born alive to the poorest households destined to die before they reach their fifth birthday. Set this against an average death rate for under fives in high income countries of 7 deaths per 1000.
The Commission found evidence that demonstrates in general the poor are worse off than those less deprived, but they also found that the less deprived are in turn worse than those with average incomes, and so on. This slope linking income and health is the social gradient, and is seen everywhere – not just in developing countries, but all countries, including the richest. The slope may be more or less steep in different countries, but the phenomenon is universal.

Wealth is Not Necessarily a Determinant
Economic growth is raising incomes in many countries but increasing national wealth alone does not necessarily increase national health. Without equitable distribution of benefits, national growth can even exacerbate inequities.
While there has been enormous increase in global wealth, technology and living standards in recent years, the key question is how it is used for fair distribution of services and institution-building especially in low-income countries. In 1980, the richest countries with 10% of the population had a gross national income 60 times that of the poorest countries with 10% of the world's population. After 25 years of globalization, this difference increased to 122, reports the Commission. Worse, in the last 15 years, the poorest quintile in many low-income countries have shown a declining share in national consumption.
Wealth alone does not have to determine the health of a nation's population. Some low-income countries such as Cuba, Costa Rica, China, state of Kerala in India and Sri Lanka have achieved levels of good health despite relatively low national incomes. But, the Commission points out, wealth can be wisely used. Nordic countries, for example, have followed policies that encouraged equality of benefits and services, full employment, gender equity and low levels of social exclusion. This, said the Commission, is an outstanding example of what needs to be done everywhere.

Solutions from Beyond the Health Sector
Much of the work to redress health inequities lies beyond the health sector. According to the Commission's report, "Water-borne diseases are not caused by a lack of antibiotics but by dirty water, and by the political, social, and economic forces that fail to make clean water available to all; heart disease is caused not by a lack of coronary care units but by lives people lead, which are shaped by the environments in which they live; obesity is not caused by moral failure on the part of individuals but by the excess availability of high-fat and high-sugar foods." Consequently, the health sector – globally and nationally – needs to focus attention on addressing the root causes of inequities in health.
“We rely too much on medical interventions as a way of increasing life expectancy” explained Sir Michael. “A more effective way of increasing life expectancy and improving health would be for every government policy and programme to be assessed for its impact on health and health equity; to make health and health equity a marker for government performance.”

Recommendations
Based on this compelling evidence, the Commission makes three overarching recommendations to tackle the "corrosive effects of inequality of life chances":
Improve daily living conditions, including the circumstances in which people are born, grow, live, work and age.
Tackle the inequitable distribution of power, money and resources – the structural drivers of those conditions – globally, nationally and locally.
Measure and understand the problem and assess the impact of action.

Improving Daily Living Conditions:
Improving daily living conditions begins at the start of life. The Commission recommends that countries set up an interagency mechanism to ensure effective collaboration and coherent policy between all sectors for early childhood development, and aim to provide early childhood services to all of their young citizens. Investing in early childhood development provides one of the best ways to reduce health inequities. Evidence shows that investment in the education of women pays for itself many times over.
Billions of people live without adequate shelter and clean water. The Commission's report pays particular attention to the increasing numbers of people who live in urban slums, and the impact of urban governance on health. The Commission joins other voices in calling for a renewed effort to ensure water, sanitation and electricity for all, as well as better urban planning to address the epidemic of chronic disease.
Health systems also have an important role to play. While the Commission report shows how the health sector can not reduce health inequities on its own, providing universal coverage and ensuring a focus on equity throughout health systems are important steps.
The report also highlights how over 100 million people are impoverished due to paying for health care – a key contributor to health inequity. The Commission thus calls for health systems to be based on principles of equity, disease prevention and health promotion with universal coverage, based on primary health care.

Equitable Distribution of Resources:
Enacting the recommendations of the Commission to improve daily living conditions will also require tackling the inequitable distribution of resources. This requires far-reaching and systematic action.
The report foregrounds a range of recommendations aimed at ensuring fair financing, corporate social responsibility, gender equity and better governance. These include using health equity as an indicator of government performance and overall social development, the widespread use of health equity impact assessments, ensuring that rich countries honour their commitment to provide 0.7% of their GNP as aid, strengthening legislation to prohibit discrimination by gender and improving the capacity for all groups in society to participate in policy-making with space for civil society to work unencumbered to promote and protect political and social rights. At the global level, the Commission recommends that health equity should be a core development goal and that a social determinants of health framework should be used to monitor progress.

Commit to Measurement:
The Commission also highlights how implementing any of the above recommendations requires measurement of the existing problem of health inequity (where in many countries adequate data does not exist) and then monitoring the impact on health equity of the proposed interventions. To do this will require firstly investing in basic vital registration systems which have seen limited progress in the last thirty years. There is also a great need for training of policy-makers, health workers and workers in other sectors to understand the need for and how to act on the social determinants of health.
While more research is needed, enough is known for policy makers to initiate action. The feasibility of action is indicated in the change that is already occurring. Egypt has shown a remarkable drop in child mortality from 235 to 33 per 1000 in 30 years. Greece and Portugal reduced their child mortality from 50 per 1000 births to levels nearly as low as Japan, Sweden, and Iceland. Cuba achieved more than 99% coverage of its child development services in 2000. But trends showing improved health are not foreordained. In fact, without attention health can decline rapidly.

Is this feasible?:
The Commission has already inspired and supported action in many parts of the world. Brazil, Canada, Chile, Iran, Kenya, Mozambique, Sri Lanka, Sweden, and the UK have become 'country partners' on the basis of their commitment to make progress on the social determinants of health equity and are already developing policies across governments to tackle them. These examples show that change is possible through political will. There is a long way to go, but the direction is set, say the Commissioners, the path clear.

Source: Adapted from Press Release Aug 28. World Health Organization. Geneva http://www.who.int/mediacentre/news/releases/2008/pr29/en/index.html
Full details are available on the website at http://www.who.int/social_determinants/final_report/en/index.html The Executive Summary (40 pages) may be downloaded at http://www.who.int/social_determinants/final_report/csdh_finalreport_2008_execsumm.pdf

Thursday 14 August 2008

SELECTED WEB RESOURCES ON GLOBAL HEALTH with an acknowledgement to ProCOR

PREAMBLE: This issue highlights some of the work of an organization we respect for its efforts to bring together a virtual community of health professionals from around the world. ProCOR is devoted to examining health and related social issues of relevance to developing countries, with particular reference to cardiovascular diseases. ProCor's monthly "Resource Update" (edited by Juan Ramos) highlights relevant materials. A recent Resource Update on ProCOR listed a number of websites that offer valuable information about health and/or health resources around the world. The following are selected from this list in order to further disseminate ProCOR’s efforts in this regard, as well as to draw attention to the health communications work of ProCOR:

For more information about ProCOR itself, visit their website at: http://www.procor.org/ For other sites that we regularly recommend, see column at right for “Recommended Global Links”.

- SELECTED WEB RESOURCES ON GLOBAL HEALTH -
African Network for Health Knowledge Management and Communication: Agency that explores harnessing modern information and communication technologies (ICTs) for community health and development in Africa. http://www.afriafya.org/

Books for Africa: Organization that distributes medical and nursing textbooks to 18 African countries. http://www.booksforafrica.org/

Challenges and successes in reducing health disparities - Workshop summary: Textbook summary of a workshop on challenges and successes in reducing health disparities held on 31 July 2007 in St. Louis, Missouri, USA. Entire textbook is available free online. National Academies Press, 2008. http://books.nap.edu/catalog.php?record_id=12154

Community guide to environmental health: Illustrated guide on global crisis in environmental health for health promoters, development workers, educators, activists, and community leaders in rural or urban settings. Materials from the book are available for free download. www.hesperian.org/projects_inProgress_communityGuide.php

Global Health Action: Open access journal of hands-on approaches to global public health challenges. Umeå Centre for Global Health Research. www.co-action.net/journals/gha

Global Smokefree Partnership: Multi-partner initiative to promote effective smoke-free policies worldwide. Helps advocates access evidence, request assistance, and take action in support of smoke-free policies. http://www.globalsmokefree.com/

Growth report - Strategies for sustained growth and inclusive development: Report examining how developing countries can achieve fast, sustained, and equitable growth. International Bank for Reconstruction and Development, 2008. PDF (10.3 MB): www.growthcommission.org/storage/cgdev/documents/Report/GrowthReportfull.pdf

Health and Human Rights: Open access international journal dedicated to advancing health as an issue of fundamental human rights and social justice. http://www.hhrjournal.org/

HIFA2015 website: Advocacy and knowledge-sharing network of 1500 members from 110 countries with the shared goal: Every person worldwide will have access to an informed healthcare provider by 2015. Email discussion group archives available at www.dgroups.org/groups/hifa2015. http://www.hifa2015.org/

International Fruit and Vegetable Alliance: Global alliance that supports efforts to increase intake of fruit and vegetables worldwide. Provides a toolkit for starting a "5 a day" program. http://www.ifava.org/

International research community on multimorbidity: Electronic network focused on research questions relevant to international communication on multimorbidity in primary care. www.med.usherbrooke.ca/cirmo

Libraries, literacy, and poverty reduction - A key to African development: Paper outlining affordable and achievable library strategies for poor communities to promote development. Book Aid International, 2006. PDF (302 KB): www.bookaid.org/resources/downloads/advocacy/Libraries_Literacy_Poverty_Reduction.pdf

MobileActive strategy guide #2: Using mobile phones in advocacy campaignsGuide offering strategies, case studies, lessons learned, and a how-to section for advocacy organizations using mobile phones to advance their causes. Encourages the adoption of mobile phones by NGOs to build constituent lists, influence political causes, and raise money. MobileActive, 2007. PDF (955 KB): http://mobileactive.org/files/MobileActiveGuide2_0.pdf

Primary health care for older people: A participatory study in 5 Asian countriesStudy report on healthy ageing and access to quality primary health care services. Focuses on improving stroke and diabetes management. HelpAge International, 2008.www.helpage.org/News/Latestnews/G61d

Scientists without Borders: Initiative to mobilize and coordinate science-based efforts that improve the quality of life in the developing world. Website homepage provides options for low- or high-bandwidth connection. New York Academy of Sciences. http://scientistswithoutborders.nyas.org/default.aspx

Sharing Knowledge Handbook 2: Handbook for men and women working in villages, towns, and rural areas who wish to transform their communities through information sharing. Oxfam Horn of Africa Capacity Building Program, 2004.www.oxfam.ca/news-and-publications/publications-and-reports/sharing-knowledge-handbook-2

SimIns health financing policy tool 2.1: Computerized tool to aid in health financing policy decisions. Projects health expenditure and funding for a 10-year time period; evaluates feasibility of alternative mixes of financing sources, including social health insurance, community-based health insurance, and government budget lines. WHO, 2008.www.who.int/health_financing/tools/simins

Thomas McKeown, meet Fidel Castro: Physicians, population health and the Cuban paradox: Open access article about Cuba's "first world" population health status despite a minimal economic base. Healthcare Policy/Politiques de Santé 2008; 3(4): 21-32http://www.longwoods.com/product.php?productid=19916

World Diabetes Day materials: Materials for World Diabetes Day, 14 November 2008, available for free download. International Diabetes Federation, 2008.www.worlddiabetesday.org/materials

Tuesday 15 July 2008

CHILD-SOLDIER INCARCERATED IN GUANTANAMO BAY

PREAMBLE: This month we depict the situation of a Canadian youth held at the offshore US prison camp at Guantanamo Bay, Cuba, a site selected by the US military for detention of “enemy combatants” so as to circumvent the normal jurisdiction of US laws and to exert military control over due process.

The background on Guantanamo Bay itself is instructive. The US assumed territorial control over this Cuban region under the 1903 Cuban-American Treaty, which granted the US a perpetual lease. The Cuban government today considers the US presence to be illegal, arguing that the Treaty violates Article 52 of the 1969 Vienna Convention on the Law of Treaties, which declares a treaty void if its conclusion has been procured by the threat or use of force in violation of international law. Article 4 of the document, however, states that the Convention shall not be retroactively applied to treaties made before itself.

[Ed Note: this background information is taken mostly from Wikipedia; it appears that the exemption in the Vienna Convention was required to obtain the consent of countries which would then otherwise immediately have been in contravention].

Late Breaker: To the original blog we have added on July 21 a statement from former Prime Minister Paul Martin (scan down).

CHILD-SOLDIER INCARCERATED IN GUANTANAMO BAY
The Toronto-born Omar Khadr, captured at the age of 15 years (legally a “child-soldier”) following a military action in Afghanistan, is the youngest prisoner held at Guantanamo Bay.

The only Western citizen remaining in Guantanamo, Khadr is unique in that Canada has refused to seek extradition or repatriation despite the urgings of Amnesty International, UNICEF, the Canadian Bar Association and other prominent organizations.

He has spent six years in the prison camp charged with war crimes and providing support to terrorism after allegedly throwing a grenade that killed a US soldier. In February 2008, the Pentagon accidentally released documents that revealed that although Khadr was present during the firefight, there was no other evidence that he had thrown the grenade. In fact, military officials had originally reported that another of the surviving militants had thrown the grenade just before being killed. Khadr himself had been shot in the back.

In 2005, a Canadian court ruled that “conditions at Guantanamo Bay do not meet Charter Standards” (Canada’s Charter of Rights and Freedoms). Yet Khadr has been repeatedly refused appropriate intervention by the Canadian government, thus failing to provide an impartial judicial process which is impossible to obtain through the US “military justice” system. In the week ending June 7, 2008 a U.S. military judge dropped charges against Omar Khadr. The Pentagon said immediately that it would appeal that ruling.

Revealed July 15, 2008 (Globe and Mail) is evidence that the Canadian Canadian Security Intelligence Service (“CSIS”) was complicit in the detention and maltreatment of this citizen. This is born out by the release today of video footage under court order [this is now on Youtube http://www.youtube.com/watch?v=aQHFFbD_-Pg].

In commentary, a statement in today's (July 15) Globe and Mail authored by Ed Broadbent for Rights and Democracy, and Alex Neve, Secretary-General of Amnesty International Canada, declares: “In terms of Canadian and international human rights law – indeed by the standards of the US Bill of Rights – what Mr Khadr is being subjected to by the US military commission at Guantanamo Bay is a travesty of justice.”

According to a Canadian Department of Foreign Affairs official (one Jim Gould) who had a split role between gathering intelligence and ascertaining the prisoners well being, he met “a ‘screwed up young man’ whose trust had been abused by just about everyone who had ever been responsible for him” (Globe and Mail front page and p 2, July 15, 2008) . This depiction now clearly includes Canada’s prime minister.

It is invidious that Prime Minister Harper still does not get it. There are issues here of international human rights as well as Canadian Charter rights, not to forget the Geneva Conventions which the Bush administration deliberately put aside. As Prime Minister, Harper has the power to require that Khadr be transferred to Canada, and it is long overdue for him to act on this. His failure to do so isolates him among his international peers, and makes both him and his country appear morally weak, especially when all other western countries have succeeded in having their imprisoned nationals repatriated to face due process on their own turf.

Canada continues to act in a subservient manner to the discredited Bush administration. Foreign Minister Peter MacKay recently stated that he would not approach Washington about the case "until such time as the process and the appeals process has been exhausted". MacKay said he had asked U.S. Secretary of State Condoleezza Rice to ensure that a medical and psychological assessment be done on Khadr. Clearly Canada must regain an independent foreign policy.

Alex Neve, Secretary-General of Amnesty's Canadian chapter, said in June 2008 that it was clear that Khadr and the 380 other prisoners held at the U.S. naval base on Cuba had no chance of being treated fairly. (REUTERS June 14, 2008. http://www.alertnet.org/thenews/newsdesk/N14455347.htm )
"It is time, long past time in fact, for the Canadian government to intervene publicly and forcefully and unequivocally demand that Omar Khadr's stay at Guantanamo Bay must now come to an end," he told a news conference.

"His case should be dealt with appropriately under the Canadian justice system, taking account of the evidence against him as well as the fact that Omar Khadr was a 15-year-old minor in a war zone ... Canada can no longer remain silent." Neve said Britain, France, Germany and Australia had succeeded in repatriating their citizens from the base.

"This truly is a deep, unforgivable injustice," said Neve, who released an open letter to Prime Minister Stephen Harper urging Ottawa to act. The letter was signed by five former Canadian foreign ministers as well as 111 academics, lawyers and legislators.

LATE BREAKER Globe and Mail July 21: Former Prime Minister Paul Martin said yesterday that Canada should lobby to bring back... Khadr. "I think Bill Graham, who was foreign affairs minister at the time, said it best. Which was, 'If we had known then what we know now, then we would have taken strenuous steps to repatriate Mr Khadr to Canada' ", Mr Martin told CTV's Question Period in an interview broadcast yesterday.

HISTORICAL QUOTE : “Justice delayed is justice denied”.
William Gladstone - British politician (1809 - 1898).

Sunday 15 June 2008

HEALTH CARE IN CANADA – An Essay

Preamble: A public consultation on health care, called the Conversation on Health, took place during 2007 in the Canadian province of British Columbia.[1] Our firm made a written submission [2], and now we take the opportunity to transform the core of this into an overview of Canada’s health care, on the premise that this may be of global interest.

NOTE: The essay is written for the Canadian context, so we caution that Canada’s model is NOT readily translatable to most other countries. However, it may be a viable option for economically developed ones that still lack universal coverage.

We reserve the right to change our views on any aspect of this essay as new analysis may emerge to justify revision, and in this sense it may be viewed as a work in progress.

NEW NOTE January 25, 2013: Due to the popularity of this posting (based on our web traffic statistics) we wish to alert readers to a related article: White F, Nanan D. A Conversation on Health in Canada: revisiting universality and the centrality of primary health care. J Ambul Care Manage. 2009;32(2):141-149.  Full FREE access to that article has been arranged at the following site: http://www.phabc.org/modules.php?name=Contentpub&pa=showpage&pid=173

CANADIAN HEALTH CARE – An Overview
Canada’s health system enjoys wide public support. Its most valued features are: universality, portability and no direct fees for insured services, financed by government in accordance with the Canada Health Act (1984). The objective under the Act is "to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers."

While the Canada Health Act resonates politically, not all health modalities are equally recognized. Nor are they equal in terms of need, quality of supporting evidence, nor necessarily affordable. Choices have always have been made. Thus, even though “comprehensiveness” is one of the stated principles, in practice this particular attribute has never been a reality as it refers historically to services deemed “medically necessary” in the context of 3-4 decades ago when the provincial acts supporting universal health care were promulgated. Elements still not adequately recognized include: home care, long term care, dental care, physiotherapy and pharmaceuticals, and others. A relevant question: will universality be applied in future to services not fully financed today?
To the extent that the system delivers on equity therefore, it approaches this only for fully insured medical and hospital-based services; but where coverage is not universal, ability to pay is critical. This contrast reflects how society views health as a public good, what it considers essential, the extent of equity it seeks, and the resources it is prepared to allocate. While the Canadian experience overall has been positive, the commitment and sustainability are remain functions of social values and political will. Canada’s health care system is justifiably a source of pride, but there is still much room for improvement

Health therefore is both a complex social goal and a major enterprise in Canada, mostly now based in the public sector. While compassion and human rights lie at its base, it is also seen in terms of the social and economic benefits it provides to the entire population.

INTER & INTRA JURISDICTIONAL COMPARISONS
A systematic review of 38 studies recently confirmed that Canada’s system leads to health outcomes that are favourable overall when compared with the US private for-profit system, at less than 50% of the cost [3]. However, perhaps more relevant is WHO’s landmark study in 2000 of health systems performance in almost 200 countries, ranking the UK in 18th place, Canada at 31st, and the US (most expensive health care in the world) at 37th. Most European countries performed better than Canada, while Australia’s performance (similar socio-demographics) at 32nd place was virtually tied with Canada [4]. Several other countries also scored better than Canada eg., Singapore, Japan. In our view, rather than dismiss such comparisons (which is unfortunately a defensive reaction in some circles) Canada should study and learn from those systems which appear to be doing better, and (while staying consistent with the core principles of the Canada Health Act) be more prepared to innovate, test and evaluate new approaches. We should also show more interest in the internal comparisons being revealed from within our health and social sectors [5], specifically: why are health conditions so different for different groups within the country, and what can be done about this? The key premise here is to be guided by evidence within the social contract represented by the Canada Health Act.

When one examines overall health status of populations using objective measures, it is tempting to conclude that the health systems of countries with similar socio-economic conditions appear to vary more with regard to cost than performance, irrespective of the public-private mix. However, the type of system does appear to have a strong influence on the indicators of equity. Beyond observing the principle of universality, this is reflected in steadily improving outcomes. A new Canadian study [6] reveals that – over a 25 year period – differences between the richest and poorest quintiles in expected years of life lost amenable to medical care decreased 60% in men and 78% in women. Reductions in rates of death amenable to medical care made the largest contribution to narrowing the socioeconomic mortality disparities. Continuing disparities in mortality in causes amenable to public health suggest that public health initiatives have a potentially important but yet unrealized role in further reducing mortality disparities in Canada.

If we make the political decision that there is probably already enough money in the system, the challenge in achieving better performance necessarily must lie in improving leadership, priority-setting, decision-making and management at all levels: in particular, we must do better on health promotion, public health and preventive medicine. On the other hand, there are many in society and among the ranks of the health professions who believe that the system we have is already doing very well, and – while its underlying principles seem secure – we would adjust its design and the way it is working at our peril. Nonetheless, the existing budget is by definition aligned with the status quo, mostly a legacy of thinking of the early 1970s (when most Canadian provinces launched their particular version of “medicare”). Does it necessarily follow that this is the only formulation we are capable of, or has the time come to expand the scope of health services to more within currently underfinanced sub-sectors eg., pharmacare, dentistry?
LOOKING WHERE THE OBJECT IS LOST, NOT WHERE THE LIGHT IS BEST
When engaged in public debate about health care, as a society Canada tends to focus on the high cost items that preoccupy institutional administrators, while overlooking the powerful forces that preserve our health: healthy living environments and workplaces, primary prevention (eg., nutrition education, childhood immunization, ante-natal care, physical activity, smoking prevention), and social policies (affecting literacy, employment, crime, housing quality and community wellbeing). These are the “upstream factors”. We also become so preoccupied with acute care issues, which are crisis-prone and sometimes glamorized, forgetting not only the upstream factors, but even downstream ones (eg., long-term care, home care) whose availability determines the speed with which acute care patients may move on to more appropriate levels of care.

To the extent that health systems fail, especially with regard to addressing priority needs and the ethic of equity (universality, access, affordability), this most often results from failing to deliver on basic needs, especially for groups that lack power or recognition.

OUR SUGGESTIONS FOR THE CONTINUED STEWARDSHIP OF CANADIAN HEALTH CARE

o That federal and provincial governments continue to recognize health as a public good, recommit to the principles of universality and equity in health services delivery, and curtail private for-profit entities as an alternative in any area of core or essential services. Clearly our governments must continue to ensure that how it puts together services must be in compliance with the Canada Health Act (1984).

o The Government of Canada should be kept under scrutiny regarding the decline in its financial contributions to provincial health services, thereby contravening the Canada Health Act. The “new” federal government must be held accountable for reneging on the Kelowna Accord (investment in aboriginal peoples) and Child Care. These failures to honour prior commitments that enjoyed public support reveal a short-sighted federal political agenda that undermines important determinants of health and social equity.

o Also in the spirit of the Canada Health Act, we urge government to re-examine now what services should be core or essential, and to consider expansion of the scope of publicly financed provisions, with emphasis on the more vulnerable eg., dental provisions for children and the elderly; provisions for new parents eg., maternity leave and child care, and expand the eligibility and/or scope of pharmacare for elderly. This is particularly timely given record governmental budget surpluses in recent years.

o Health care quality and outcomes for Canadian jurisdictions generally compare favorably with those of the US. Nonetheless, the tendency of Canadians to refer to the US performance in health care and outcomes as if this is a desirable norm is misplaced. It makes more sense to learn from the experience of systems elsewhere in the world eg., western Europe, Japan, Singapore, that are better performers than the failing US model. To the extent that Canada looks to the US for systems design support or medical records contracting, this must not threaten privacy; under the current US administration even its own citizens are losing trust regarding the invasion of privacy in the name of security.

o The most critical elements of any health system needs to be public health (ie., population health provisions, including health promotion) and primary health care: to the extent that systems fail, this is often due to failure to support these components. Effort is needed to attract talented individuals to engage in these fields. The responsibility for this lies with professional education institutions, specialty bodies and professional associations, with support from relevant ministries to ensure that effective action is taken.

o There is a need for Canada to strengthen its response to the surging chronic disease burden. The international literature indicates that about half of this burden is potentially preventable through attention to modifiable behaviours eg., smoking, fitness, weight control; and about half of those who do develop these conditions can be prevented from progressing to more complicated forms through attention to secondary prevention eg., blood pressure screening; active glucose monitoring for persons with diabetes.

o When one looks at Canada’s population health internally, it is obvious that there is still a substantial amount of inequity, both regionally eg., northern regions, inner city areas, and by population group eg., First Nations. We therefore recommend that, equity must be given more prominence in the public debate and in government decision making.

References1. Conversation on Health. Government of British Columbia, Canada (2007): http://www.bcconversationonhealth.ca/EN/401/
2. Pacific Health & Development Sciences. Shaping health in BC – observations and suggestions. Submission to the B.C. Conversation on Health. http://www.bcconversationonhealth.ca/media/PacificSci_COH_Submission.pdf
3. Guyatt GH, Devereaux PJ, Lexchin J, et al. A systematic review of studies comparing health outcomes in Canada and the United States. Open Med 2007;1(1):e27–36.
4. The World Health Report 2000. June 21, 2000. Geneva. http://www.who.int/whr/2000/en/index.html
5. Hertzman C, Irwin LG. It takes a child to raise a community: population-based measurement of early child development. Human Early Learning Partnership. No 1: July 2007. http://www.earlylearning.ubc.ca/
6. James PD, Wilkins R, Detsky, Tugwell, Manuel DG. Avoidable mortality by neighbourhood income in Canada: 25 years after the establishment of universal health insurance. J Epidemiol Community Health 2007; 61:287-296. http://jech.bmj.com/cgi/content/abstract/61/4/287

Thursday 15 May 2008

THE GLOBAL ARMS TRADE - An Atrocity?

PREFACE: Every gun that is made, every warship launched, every rocket fired signifies, in the final sense, a theft from those who hunger and are not fed, those who are cold and are not clothed. The world in arms is not spending money alone. It is spending the sweat of its laborers, the genius of its scientists, the hopes of its children… This is not a way of life at all, in any true sense. Under the cloud of threatening war, it is humanity hanging from a cross of iron.
— Former U.S. President, Dwight D. Eisenhower, in a speech on April 16, 1953
To find out who shares responsibility for global militarization, follow the money trail. Regardless of attempts to legitimize the trade, the historical reality is that bribery, corruption and mercenary as well as national self-interest lie at the heart of the trade. This month’s blog highlights the mainstream facts and some relevant reference sources.

WORLD MILITARY EXPENDITURES: World military expenditure in 2006 was estimated at $1204 billion in current prices, an increase of 3.5% in real terms since 2005 and of 37% over the 10-year period since 1997. Average spending per capita increased from $173 in 2005 to $177 in 2006 at constant (2005) prices and exchange rates and to $184 at current prices. The USA is responsible for 46% of the world total, distantly followed by the UK, France, Japan and China with 4-5% each.

USA: The rapid increase in the United States' military spending is to a large extent due to continued costly military operations in Iraq and Afghanistan. Between September 2001 and June 2006, the US Government provided a total of $432 billion in annual and supplemental appropriations under the heading 'global war on terrorism'. This massive increase in US military spending has been one of the factors contributing to the deterioration of the US economy since 2001. In addition to its direct impact of high military expenditure, there are also indirect and more long-term effects. According to one study taking these factors into account, the overall past and future costs until year 2016 to the USA for the war in Iraq have been estimated to $2267 billion.

CHINA: In 2006 China continued its steep increase in military expenditure, for the first time surpassing that of Japan and hence replacing Japan as the country in Asia with the highest level of military expenditure and as the fourth biggest spender in the world. Amid intense discussions on the right level of Japanese military spending, Japan decided, for the fifth consecutive year, to reduce its military spending in 2006 while at the same time focusing its military budget on missile defence.

THE GLOBAL MARKET FOR ARMS: Aside from spending on their own military “needs”, it is fairly obvious from the figures quoted below that the leading arms dealing countries in the world are reaping major economic gains from exporting their military technologies. The only G-8 country not ranking highly on arms exporting is Japan.

Sellers: During the period 2000-2006, the US sold $45.4 billion worth of armaments into the global marketplace, ahead of Russia at $40.5 billion, followed by Germany at $11.6 billion and France at $11.1 billion. This was followed by the UK (7.0), the Netherlands (3.7), Sweden (3.1), Italy (3.0), China (2.9) with Ukraine (2.5) completing the top ten. Israel and Canada came in at 2.3B and 1.3 respectively.

Buyers: A comparison of government spending priorities across samples of countries in different per capita income groups shows that the lower the income group, the higher the priority given to military spending in relation to social spending. For example, UN data sources show that military expenditures exceed public expenditures on health or education for almost every country in South Asia (exception: the Maldives). Developing nations continue to be the primary focus of foreign arms sales activity by weapons suppliers.[2] During the years 1996-2003, the value of arms transfer agreements with developing nations comprised 63.9% of all such agreements worldwide. More recently, arms transfer agreements with developing nations constituted 60.4% of all such agreements globally from 2000-2003, and 53.6% of these agreements in 2003. The top seven recipient countries, comprising 59% of all purchases from 1999-2006, are: India 11%, China 8%, Saudi Arabia 8%, Egypt 6%, UAE 6%, Israel 5% and Pakistan 5%.[3]

References:
1. Stockholm International Peace Research Institute. http://www.sipri.org/contents/milap/milex/mex_trends.html Accessed April 24, 2008.
2. Goliath Business Knowledge on Demand. Conventional Arms Transfers to Developing Nations. http://goliath.ecnext.com/coms2/gi_0199-4561391/Conventional-Arms-Transfers-to-developing.html Accessed April 25, 2008.
3. Anup Shah. Arms Trade – a Major cause of Suffering. October 30, 2007. http://www.globalissues.org/Geopolitics/ArmsTrade/BigBusiness.asp

COMMENTARY
There is clear evidence that the international transfer of arms or the training of foreign security forces can provide repressive governments and abusive armed groups with the means to carry out or intensify gross human rights violations. Arms brokers have been at the center of many of the most disturbing arms deals, including weapons transfers to abusive armed groups and countries under U.N. arms embargoes.[1] From 1998 to 2001, the USA, the UK, and France earned more income from arms sales to developing countries than they gave in aid.
The arms industry is unlike any other. It operates without regulation. It suffers from widespread corruption and bribes. And it makes its profits on the back of machines designed to kill and maim human beings. So who profits most from this murderous trade? The five permanent members of the UN Security Council—the USA, UK, France, Russia, and China. Together, they are responsible for eighty eight per cent of reported conventional arms exports. “We can’t have it both ways. We can’t be both the world’s leading champion of peace and the world’s leading supplier of arms.” Former US President Jimmy Carter, presidential campaign, 1976

References:
1. Amnesty International USA. http://www.amnestyusa.org/our-priorities/arms-trade/page.do?id=1011003&n1=3&n2=24 Accessed April 25, 2008.
2. The Arms Industry. Control Arms Campaign, October 2003. http://www.controlarms.org/the_issues/arms_industry.htm Accessed April 25, 2008.

RECOMMENDED SITE: We close this brief review with reference to a specialized website that we believe lays out the facts in a much more comprehensive manner than we have done:
Reference: Anup Shah. Arms Trade – a Major cause of Suffering. October 30, 2007. http://www.globalissues.org/Geopolitics/ArmsTrade/BigBusiness.asp

Tuesday 15 April 2008

SEX RATIOS DESTABLIZING IN ASIA

PREAMBLE: “Sex ratio” (SR) refers to the ratio of males to females (M:F) in a population. Due to higher life expectancy of females in most populations, SRs tends to decline across adult age groups. Values for the world population are: overall 1.01; at birth 1.06; under 15 years still 1.06; 15-64 = 1.03; and >65 years = 0.79.

We are focusing on this topic because dramatic shifts in sex ratio are taking place in some parts of the world that reveal cultural preferences and social practices favoring the birth/survival of one sex over the other (more often favoring males over females). Other factors influencing the sex ratio of societies include: changing composition by ethnicity and race; civil unrest or warfare; large-scale immigration e.g., male labourers unable to travel with their families; ecological factors eg contaminants in environment; variables affecting mother’s health eg social status, smoking, nutrition, access to support networks.

Our main source for this issue is an analysis carried out by the United Nations Population Fund (UNFPA) which we have summarized below. Further below, we offer a brief commentary, and some focused observations pertaining to India and China.

Feature Report: SEX RATIO IMBALANCES IN ASIA: TRENDS, CONSEQUENCES AND POLICY RESPONSES.
Asia’s population dynamics in recent decades reveal an alarming increase in the sex ratio (SR) within local populations. The ratio at birth (SRB) started to increase in East Asia from 1980-85, and in South-Central Asia from 1985-90, while elsewhere in Asia, SRBs remained relatively constant. In some regions, the SRB exceeds 1.30 e.g., Guangdong and Hainan in China. There are also variations in SR levels within each country in Asia, as well as between religious, ethnic and socio-economic groups; these have been well studied in India. Since, generally, the SR overall has remained relatively stable in Asia, the growing contribution of the younger generation to the growing SR imbalance has offset the opposite progress in SR being made by adults, among which mortality improvements have particularly benefited the female population.

The rise in SRB is linked to the introduction of pre-natal sex selection in many Asian countries following the arrival of ultrasound and amniocentesis technologies in the late 1970s. The deeply rooted preference for sons in Asia is related to a long list of demand factors such as social customs, marriage costs, old-age support, leading parents across cultures and geographic locations to decide against allowing a girl to live, even before her birth. Indeed, if the continent’s overall SR was the same as elsewhere in the world, in 2005 Asia’s population would have included almost 163 million more women and girls.

The ramifications of such an imbalance will continue for decades. While men of marriageable age will suddenly find a dramatic shortage of potential brides, it is girls and women of all ages who will truly feel the brunt of this dynamic, with forecasted increases in gender-based violence, trafficking, discrimination and general vulnerability of women and girls. The main question now concerns the intensity and tempo of the sex-ratio transition in relation to spontaneous social and economic changes, and to government actions. These are, to a large extent, the dimensions that will determine the severity of the crisis, and the overall number of men, women, boys and girls affected.

Key Conclusions:
• The sex ratios of Asian countries are in various phases of transition.
• Gender discrimination, son preference and the resultant unequal status of women and
girls have contributed to an in increasing demand for sex-selection services.
• In many regions, several generations will be affected by a severe marriage squeeze,
regardless of what is done today.
• Initiatives taken today will shape Asian societies in which future generations will live.

The Way Forward:
• Improve monitoring of trends and differentials in SRB and related discriminatory behaviours.
• Coordinate research on the harmful impact of imbalanced SRs already observed in Asia.
• Make eliminating sex selection an immediate priority for government and civil-society
organizations.
• Facilitate sharing of policy experiences across regions and countries in Asia.
• Develop strategies and interventions for greater engagement and accountability by
men and boys in confronting violence against women (including sex selection) and for promoting gender equality, women’s sexual and reproductive health and rights.

Reference: Sex-ratio Imbalance in Asia: Trends, Consequences and Policy Responses. Executive Summary of Regional Analysis. 4th Asia Pacific Conference on Reproductive and Sexual Health and Rights. Oct 29-31, 2007 Hyderabad, India. UNFPA.
http://www.unfpa.org/gender/docs/studies/summaries/reg_exe_summary.pdf

COMMENTARY: Although many factors influence sex ratios, women’s education is the most powerful factor in reducing son preference. Educated women are less likely to prefer sons over daughters, and highly educated women even less so. Women’s exposure to primary-level schooling reduces son preference, and exposure to secondary-level education or higher is even more profound. Moreover, how many women are educated matters: women in villages with higher levels of female literacy are less likely to prefer sons than women in villages where most women are illiterate. Greater exposure to media is associated with weaker son preference, even after controlling for education and wealth.

India [1]: One of the biggest concerns in India with regard to son preference is that decades of policy efforts have not achieved positive change, and worsening sex ratios indicate a deteriorating situation. Most government policy related to son preference has focused on reducing sex-selective abortion, but it also important to address the underlying parental motivation. One important source for policy inspiration on this issue would be to better understand the motivations and social norms of women and communities who do not express son preference. Attention needs to be focused also on what is happening to surviving girls i.e., their health and nutritional discrimination. A specific category of surviving girls is much more vulnerable than the rest - girls with older sisters.

China [2]: Chinese authorities have pledged tough measures to control fetus-gender testing and sex-selective abortions, warning that people who illegally test the gender of fetuses and perform sex-selective abortions or who kill, abandon or injure infant girls or ill-treat their mothers, will be severely punished. Medical procedures that use ultra-sound technology to check fetal health will be more closely supervised. In an attempt to halt the growing imbalance, a "Care for Girls" campaign was launched nationwide in 2000 to promote gender equality. Cash incentives are offered to girl-only families in the countryside. Authorities also pledged to continue the 33-year-old family planning policy, as the country still faces huge challenges from a growing population. Formulated in the early 1970s, the family planning policy encourages late marriages and late childbearing, and limits most urban couples to one child and most rural couples to two. The policy is credited with preventing 400 million births but faces a challenge in rural regions, where the traditional preference for male heirs has not changed. The authorities promised to continue to improve family planning services in rural areas and help girl-only families.

References:
1. Son Preference and Daughter Neglect in India. What happens to Living Girls? Rohini Pande and Anju Malhotra. 2006 International Center for Research on Women.
http://www.icrw.org/docs/2006_son-preference.pdf
2. Rising sex-ratio imbalance ‘a danger’. Xinhua, China Daily. Updated: 2007-01-23 07:16. http://www.chinadaily.com.cn/china/2007-01/23/content_789821.htm

Saturday 15 March 2008

HUMANITARIAN SITUATION IN GAZA WORST IN FOUR DECADES

PREAMBLE: This issue features a report recently released by six international humanitarian NGOs (Amnesty International, Christian Aid, CAFOD, CARE, OXFAM, Save the Children, Trocaire), documenting the situation in Gaza as the worst since the 1967 war between Israel and its neighbours. The deterioration can be attributed mostly to the period since mid-2007 when Israel imposed a blockade. For "balance", we cite two reports from Israeli media; we also recognize that – like Canadians and their government –the views of all Israelis are not necessarily reflected in the policies of their government.

Canadian Complicity: This report should be of particular concern for Canadians, especially because Canada (under the minority Conservative government of Stephen Harper) is the only member country to vote against a recent United Nations Human Rights Council motion calling for immediate international action to force Israel to allow fuel, food, medicine and other essential items to be sent to the Gaza Strip, to reopen border crossings and to end its “grave violations” in the occupied Palestinian territory. References: 1. http://presscue.com/node/45049 2. http://radio.un.org/detail/8975.html

The UN Human Rights Council motion expressed deep concern about the “incessant and repeated Israeli military attacks and incursions,” which had killed and injured many Palestinian civilians. The resolution demanded “that the occupying power, Israel, lift immediately the siege it has imposed on the occupied Gaza Strip, restore continued supply of fuel, food and medicine and reopen the border crossings.” It called for protection of civilians in occupied Palestine in line with human rights law and international humanitarian law, and urged all parties to refrain from violence against civilians.

The text also called on the Office of the High Commissioner for Human Rights (OHCHR), to report to the Council at its next session on the progress made towards implementing the resolution. The High Commissioner Ms. Arbour (a respected Canadian jurist) told the Council’s special session that the situation for both Palestinians and Israelis will continue to deteriorate unless both parties to the conflict and the international community take broader steps to action. “All parties concerned should put an end to the vicious spiral of violence before it becomes unstoppable,” she said. “To this end, they must ensure accountability for breaches of international humanitarian law and violations of international human rights law through credible, independent, and transparent investigations.”

Ms. Arbour added that the Israeli practice of collective punishment, disproportionate use of force and targeted killings continued, as did the Palestinian militants’ practice of indiscriminate firing of mortars and rockets into Israel.

Shortly afterwards, in early March 2008, Louise Arbour tended her resignation. While denying pressure to leave, there is no doubt she has been under continuing pressure from various interests for being such a forceful advocate for human rights. While Ms Arbour gave family reasons for stepping down, the fact that her own country Canada voted uniquely against this UN Human Rights Council resolution should not be ignored.
Reference: http://www.amnesty.org/en/news-and-updates/news/un-high-commissioner-human-rights-resigns-20080310

Feature Report: A HUMANITARIAN IMPLOSION.
Basic Services: The blockade is destroying public service infrastructure in Gaza. The Israeli government prevents repair and maintenance of electricity and water service infrastructure in Gaza by prohibiting the import of spare parts. The impact of this is amplified by Israel’s parallel punitive restrictions on fuel and electricity. Hospitals cannot generate electricity to keep lifesaving equipment working or to generate oxygen, while 40-50 million tons of sewage continues to pour into the sea daily 14. In September 2007, an UNRWA survey in Gaza revealed a nearly 80% failure rate in schools grades four to nine, with up to 90% failure in Mathematics. In January 2008, UNICEF reported that schools in Gaza had been canceling classes that are high on energy consumption, such as IT, science labs and extra curricular activities.

Basic Medical Supplies and Access to Treatment: As a result of fuel and electricity restrictions, hospitals are currently experiencing power cuts lasting for 8-12 hours a day. There is currently a 60-70 % shortage reported in the diesel required for hospital power generators. According to the World Health Organization, the proportion of patients given permits to exit Gaza for medical care decreased from 89.3% in January 2007 to 64.3% in December 2007, an unprecedented low. It is important to note that even those patients who are granted permits to exit Gaza are often denied access at the crossing itself. Twenty-seven such cases were reported in the month of October alone. WHO has been monitoring the access of patients to specialized health services not available within Gaza. One main indicator monitored since October 2007 is the death of patients due to lack of access to referral services. During the period October-December 2007, WHO has confirmed the deaths of 20 patients, including 5 children.

A New Policy for Gaza: The blockade has effectively dismantled the economy and impoverished the population. Israel’s policy affects the civilian population of Gaza indiscriminately and constitutes a collective punishment against ordinary men, women and children. The measures taken are illegal under international humanitarian law. Israel has the right and duty to defend itself against indiscriminate rocket attacks against its civilian population, but the current policy fails to provide Israel with increased security and has led to increasing polarization. As the head of UNRWA has pointed out, ‘Hungry, unhealthy, angry communities do not make good partners for peace.’ International efforts should be directed towards securing a swift end to the blockade of Gaza. Israel’s current policy of isolation and refusal to engage with all elements of the Palestinian leadership only closes doors to negotiations while reinforcing the political and humanitarian crisis. There is an urgent need for Palestinian dialogue and reconciliation in order to create and sustain a credible and effective peace process with Israel. The international community must provide the political support to facilitate such an undertaking. To date, failure to address the situation in Gaza has harmed both Palestinians and Israelis and has been detrimental to the broader peace process itself.

Source: Amnesty International, Christian Aid, CAFOD, CARE, OXFAM, Save the Children and Trocaire. The Gaza Strip: a humanitarian implosion. Embargoed until March 6, 2008 http://my.ynet.co.il/pic/news/5.3.08/embargoedGazalowreswithout.pdf

As Reported in the Israeli Media
ISRAEL NEWS: The situation for 1.5 million Palestinians in the Gaza Strip is worse now than it has ever been since the start of the Israeli military occupation in 1967. The current situation in Gaza is man-made, completely avoidable and, with the necessary political will, can also be reversed. Gaza has suffered from a long-term pattern of economic stagnation and plummeting development indicators. The severity of the situation has increased exponentially since Israel imposed extreme restrictions on the movement of goods and people in response to the Hamas take over of Gaza and to indiscriminate rocket attacks against Israel. This report illustrates the gravity of the current situation across key sectors.

According to the report, the economic isolation of the 1.5 Palestinians living in Gaza has worsened unemployment and poverty and caused education and health services to deteriorate. Over a million people – 80% of the families - in the Strip are currently dependent on food supply from international aid agencies, compared to 63% of the families in 2006. Additionally, the number of trucks allowed to enter Gaza daily currently stands at only 45, compared to an average of 250 in the past. The Israeli ban on the transfer of raw materials has led to the freezing of 95% of industrial projects. As a result, almost all the factories in the Strip have gone bankrupt and forced to close.

Hamas' takeover of the Strip has also had a devastating effect on the local economy. Between June and September 2007, the rate of Palestinians earning less than $1.2 a day rose from 55% to 70%. The unemployment rate in Gaza currently stands at 40% and experts believe it might soon reach 50%. In the last year alone, some 75,000 people have lost their jobs.

Hike in Food Prices: The closure on the Strip and the collapse of the local economy have also contributed to a sharp increase in food prices. In 2007, Gazans spent 62% of their income on food supplies, compared to only 37% in 2004. The prices of flour and milk climbed 34% and 30% respectively between May and July 2007. Rice prices jumped by 20% over the same period.

As a result of the limited fuel and electricity supply, hospitals in Gaza face long power cuts, which last up to 12 hours a day. The report states that 18.5% of Palestinians who applied for medical treatment outside the Strip were rejected in 2007 and that the number of Palestinians who were approved treatment outside Gaza dropped by 25%. Twenty people awaiting an entry permit to Israel to receive medical treatment have died between October-December 2007, including five children.

'Exert greater pressure on Israel': The report's authors call on the UK government and the European Union to exert pressure on the Israeli government to lift the blockade on Gaza and refrain from limiting fuel and electricity supply to the Strip. The groups also urge the UK and EU to help mediate a truce between the Palestinian factions, in order to facilitate talks between Israel and the PA. The report further calls on the Palestinian terror groups to cease rocket attacks and refrain from targeting civilians, and urges Israel to stop strikes in Gaza.

Source: Israel News March 6, 2008/yNetNews.com Mar 6, 2008
http://www.ynetnews.com/articles/0,7340,L-3515538,00.html

JERUSALEM POST: For more on Israel’s rejection of the report, laying blame on Hamas, visit Jerusalem Post, March 7, 2008. http://www.jpost.com/servlet/Satellite?pagename=JPost%2FJPArticle%2FShowFull&cid=1204546412033

INSPIRATIONAL WELCOME ............................... from T.S.Eliot's "Little Gidding"

If you came this way From the place you would come from... It would be the same at the end of the journey... If you came, not knowing what you came for, It would be the same... And what you thought you came for Is only a shell, a husk of meaning... From which the purpose breaks only when it is fulfilled If at all.