SUPERPOWERS AT THE CROSSROADS What lies ahead for the United States and China (and others)

PREAMBLE: The lead-up to the US presidential election filled the airwaves for months, with constant analysis and forecasting, until Barack Obama’s re-election victory over Republican Mitt Romney was firmly secured on November 9th with a comfortable and impressively pluralistic margin in the popular vote in favour of the Democrats and a very large margin in electoral college votes. As world citizens, people of many other lands felt part of the drama unfolding, glued to the TV in our living rooms, as votes were counted.

That same week, on November 8th, China's 18th Communist Party conference began a power shift to a new generation of leaders in a much more formal and tightly controlled process. This process, also subjected to global media scrutiny, will end today, Thursday, November 15, 2012.

Observing these two approaches to transition in national political leadership has been a study in contrasts: the high visibility and overall transparency of the US election, despite its many apparent flaws, in stark contrast to the opacity and lack of participation inherent in the Chinese process, carefully scripted as it was for domestic and international optics.

CHINA

The process in China began with the opening of the week-long 18th party congress by Hu Jintao, during which he gave up his role as party chief to Vice-President Xi Jinping. Seven of the country's nine top leaders will step down, including president Hu Jintao and prime minister Wen Jiabao. All but two of the Politburo standing committee, the country's top political body, will remain. About two-thirds of positions in the other key leadership domains and the Central Committee will change hands. For the 2,270 congress delegates, their elections surely merit the same media attention as their US counterparts did. Whatever one’s opinion on the legitimacy of this type of process, the handover’s results will reverberate eventually around the globe. Unlike the open campaigning of the of the US elections, and the universal adult right to vote (the one person, one vote system), Xi's ascendancy, and Li Keqiang's elevation to replace Premier Wen Jiabao, were determined at the last party congress in 2007, when jockeying for power started.

In China, where a consensus-driven authoritarian system stresses continuity, the general course of future policy will be outlined by the congress's political report, to be hammered out within the party over this year. In this superpower’s election process, even the 82 million Communist party members (less than 6 % of its 1.4 billion people) have no real role in choosing their leader. Females, in particular, are poorly represented in the highest level of Chinese politics: only one woman sits on the 25 member politburo (the party’s central decision-making body), while none sit on the 9-person committee (reduced today to 7) at its core.

Yet, in China citizens are becoming more vocal in expecting better governance and accountability from their officials; the internet has led to greater individual expression, and stories of malfeasance or incompetence spread quickly online. Authorities have stepped up investigations of corruption: 600,000 officials faced punishment for disciplinary violations over the last five years. In 2008, just under 40% of Chinese people deemed corrupt officials a very big problem. That has risen to 50%, according to the Pew Global Attitudes Project. The Chinese leadership is aware of rising scrutiny and expectations by the population. How well it responds to the rising tide of domestic expectations over the coming years will be crucial to its internal stability and global predictability as a potentially great nation.

The UNITED STATES

The United States has perhaps the most complicated electoral system in the world. Admittedly, its electoral structure does provide the greatest opportunity for input on a wide range of issues for decision-making, but at a cost—by demanding so much of the public so frequently it means that many are overwhelmed by the complexity of the system and ultimately fail to vote.

In the United States the conduct of national elections is under state control. Federal elections are therefore taken by states as a convenient opportunity for people to vote as well on other issues, not simply to fill in a ballot to indicate preference for a candidate. This set-up favours persons motivated by interest in the particular state issues in play, and who can spare the time to engage in such a potentially lengthy procedure. Perhaps needless to say, such attributes will not be equitably distributed across all socio-demographic groups, and therefore has the potential to be manipulated so as to influence voter participation.

The President and the Vice President are elected together in a Presidential election indirectly, the winning team being determined by votes cast by an Electoral College whereby particular states have inherited various (differing) allocations of “Electoral College votes” that largely reflect historical influence, rather than contemporary realities. The official winner of the election is the candidate with at least 270 Electoral College votes (President Obama received 365 votes in 2008 or 68%, and 332 in 2012 out of 538 electoral college votes, or 62%). A candidate can win the electoral vote, and yet lose the (nationwide) popular vote. This has happened historically, but clearly did not occur in 2012.

Money plays a big role in US politics. For example, the cost of the 2012 election was enormous: over $6 billion – on advertisements, organizing, and canvassing (with a sizeable amount spent on attack ads). It is relevant to note that a majority of persons who succeed in this to become members of Congress or Senator, (with some exceptions) are themselves wealthy or have wealthy backers, when compared with the realities that apply to the population as a whole.

In the 2012 US election, the candidates laid out dramatically different programmes, critical to ensure their base support. “Getting out the vote” was crucial to both candidates, with an army of volunteers and big-dollar contributors working with precision to capture ”hearts and minds”. This, at least, is the “positive spin” in a country that still lacks uniform standards for federal elections, and where authority for organizing the process resides with state governments. Oddly, there is no independent election commission as exists in most other western democracies; this is sorely needed in the US given the wide range voting practices, and even breakdowns of antiquated counting machines in some states.

One must also take note of charges of voter suppression in some settings, and insufficient allocation of resources to facilitate voting in areas where the characteristics of the electorate and their political views may differ remarkably from the politics of the state government. Nonetheless, the principle of “getting the vote out” appeared to be clearly the stronger force. In some areas also, individuals stood in line for up to 5 hours to cast their vote: clearly a measure of how important people understood their vote to be in this crucial contest.

The spectacle of the presidential election provides reassurance to the American people that their country, their achievements and their values are extraordinary. Yet, on child poverty, they rank 34th of 35 economically advanced countries; and social mobility is measurably greater in Europe, Australia, and Canada.

Despite the negatives, significant gains were made in 2012: three states voted to legalize same-sex marriage, two others voted to legalize some recreational use of marijuana, and (in contrast with several misogynistic Republican males who lost their seats) more women were elected to the US Senate than ever before.

As far as the most central purpose is concerned: the Presidential election itself, women, minorities and young people made the difference – described (in conservative media) as a “coalition of the ascendant”, this might be more aptly viewed as a shout for values such as truth, tolerance and compassion?

WHAT LIES AHEAD?

China remains the largest holder of US securities; they are each other’s second-largest trading partners. The significant bilateral trade imbalance between them, although decreasing, is a source of tension, as demonstrated by the rhetoric during the US elections. Concerns are rising in the public and private sectors of the US of alleged hacking and espionage by Chinese groups, and the infringement of Intellectual property rights. Chinese investments in sensitive US industries continue to be of controlled (e.g. in oil and high technology).

The Obama administration has worked with China on a broad range of issues, engaging in numerous dialogues: the Strategic and Economic Dialogue, Asia-Pacific geopolitical issues, humanitarian assistance and disaster response. Given President Obama’s multilateral stance, his second term is likely to maintain the emphasis on engagement, ranging from collaboration in economics to the environment, as part of a broader Asia policy. However, more attention is expected regarding China’s participation in organizations such as the World Trade Organization and the G20, with efforts to cultivate their support for broad international norms on issues such as North Korea, Burma/Myanmar and Syria. The Obama team will likely continue encouraging other partners, particularly in Europe, to expand their perspectives on China, taking into account broader strategic and security issues rather than focusing almost exclusively on commercial engagement. Regarding cyber and space security, there is a push by the US in building an international code of conduct.

As these countries move forward from their very different election processes, there is profound uncertainty globally with challenges that impact prosperity and security. China’s trajectory and its international standing is significantly affected by its relationship with the United States: cooperation will lead to a more positive Chinese role, while competition would retard progress on global issues such as the environment, space and cyber security, issues arising in the UN Security Council, trade and development. Nations that are dependent on both countries for economic and/or security reasons would face a difficult position of trying to balance the two.

Envoi: Room for China’s growth and participation is vital, with an emphasis on developing open and transparent relationships. Ensuring clarity and deliberation could do much to maintain relations on a positive trajectory or, at a minimum, ensure that they do not spiral out of control. In this respect, the continuity and maturity of a second Obama administration is a positive outcome, particularly as China goes through its own political transition.

References

Dormandy X. Americas Programme Paper AMP PP 2012/01 US Election Note: China Policy after 2012
Chatham House, London, May 2012 http://www.chathamhouse.org/sites/default/files/public/Research/Americas/0512usen_china.pdf

Barack Obama’s Election 2012 Win: the world reacts. The Guardian Wednesday 7 November 2012 http://www.guardian.co.uk/world/2012/nov/07/us-elections-2012-usa

Branigan T. China prepares for power handover but reverberations will be felt worldwide. The Guardian Thursday 1 November 2012 http://www.guardian.co.uk/world/2012/nov/01/china-prepares-power-handover

Elections in the United States. http://en.wikipedia.org/wiki/Elections_in_the_United_States

Agrawal R. 2012 A year of elections (not just in the United States). In: Fareed Zakaria GPS (Global Public Square). http://globalpublicsquare.blogs.cnn.com/2012/11/03/2012-the-year-of-electoral-pandering/

FACT CHECK: REPUBLICAN PARTY STATEMENTS ON HEALTH CARE REFORM

PREAMBLE: Normally we would not presume to comment on an election issue in the United States. However, this principle is based on the assumption that Americans will place their vote based on accurate information regarding the candidates and the issues that are important to them. It is for this reason that, in this issue of Global Perspectives, we make an exception. We are providing this “fact check” because Republican Vice-Presidential candidate Paul Ryan, in his apparent zeal to prevent the successful emergence of universal health care coverage in the United States (as intended by the Patient Protection and Affordable Care Act of 2010), has been making negative references to the comparative performance of universal health care in Canada: these statements by Ryan are demonstrably misleading.

Ryan appears to make it up as he goes along, more in the manner of a carnival barker than as a candidate for the second most powerful national political post in the world. His superficial grasp of health issues seems prone to confuse and mislead his own voter base and the electorate as a whole, even about the performance of health care in his own country. Perhaps this may be expected of a candidate who, after obtaining a general undergraduate degree, then (aside from working briefly as a short order cook in a McDonald’s restaurant) went almost directly into career politics. In our view, the U.S. can and must do much better than this. The core issue is integrity: it is disturbing to think that this callow individual could hold the reins of power in the event that a sitting President passed away.

One of the campaign consequences of this candidate’s glib views on health care (whether this be in the United States, Canada, or anywhere else for that matter), is that it renders it virtually impossible for Republican Presidential candidate Mitt Romney, to discuss health care policy with any coherence, even though this is arguably his most notable success in public office (as former Governor of Massachusetts).

Ironically, because the Patient Protection and Affordable Care Act has been dubbed by Republicans as “Obamacare” (even though similar to the system now in place in Massachusetts) Romney must toe the party line.

No strength of character therefore has been exhibited by either candidate: one (Ryan) is ignorant and cavalier with the facts, while the other (Romney), despite knowing better, has been effectively muzzled by his own party. Surely U.S. Presidential and Vice-Presidential candidates should be morally stronger than this?

However, at least the facts of the matter can be set straight. In the following brief review we take note of: recent assessments of US health care performance against other countries (including Canada), and the main features of the Patient Protection and Affordable Care Act as upheld by the US Supreme Court in June 2012.

Reference:
Bryn Weese. Toronto Sun (on line) First posted Monday August 13, 2012.
http://www.torontosun.com/2012/08/13/romneys-pick-likes-canada Accessed September 15, 2012.


INTERNATIONAL HEALTH CARE COMPARISONS RELEVANT TO THE U.S. PRESIDENTIAL ELECTIONS

The health care system performance of six developed nations on several key parameters, was recently (2008) ranked by the Commonwealth Fund, a respected American foundation that promotes better access, improved quality, and greater efficiency, particularly for society's most vulnerable, including low-income people, the uninsured, minority Americans, young children, and elderly adults.

The countries included in this exercise were: Australia, Canada, Germany, New Zealand, the United Kingdom, and the United States. Notably the United States ranked 6th (last place) overall, and 6th in 5 out of 9 specific parameters; these include: safe care, access, efficiency, equity (fairness), healthy lives, and health expenditure per capita. Of the remaining parameters, it ranked 5th each for quality of care, coordinated care, and patient centred care. Its only first place ranking was for right care.

Contrasts with Canada are indeed relevant. In particular, for almost half a century, Canadian health care has been guided by the principle of universality (access to core services for everyone) within provincial systems of single payer public administration, with relatively minimal roles for private insurers.

By contrast, alone among developed countries, U.S. health care until now has been dominated by private administration and financing. The high cost of health insurance for those not included in employer-funded plans has resulted in almost 50 million people lacking coverage: insurers denying coverage for pre-existing conditions, and setting caps on life-time payments regardless of medical need. In other words, most health care in the United States is allocated on the ability to pay.

A systematic review of 38 studies reveals that Canada’s system achieves more favorable outcomes when compared with the U.S. predominantly private for-profit system, at less than 50% of the cost.

For more comprehensive global comparison there is the World Health Organization (WHO) landmark study, in 2000, of health systems performance in almost 200 countries. WHO's assessment was based on five indicators: overall population health; health inequalities within the population; overall health system responsiveness (combining patient satisfaction and how well the system acts); distribution of responsiveness (how well people of varying economic status find they are served by the health system); and the distribution of the health system's financial burden within the population (who pays the costs). The findings were both relevant and revealing: France was found to provide the best overall health care followed by Italy, Spain, Oman, Austria and Japan. The United Kingdom ranked 18th, Canada 31st, and the United States 37th (most expensive system in the world). Australia’s performance was ranked 32nd. Most European countries ranked higher than Canada, Australia and the United States.

Dramatic changes are now taking place in the US: under new legislation (the Patient Protection and Affordable Care Act of 2010 to be fully phased in by 2020) of the Obama administration, the US will begin to close the gap on universality and other deficiencies will be addressed. The legislation was upheld by the Supreme Court on June 28, 2012, against challenges by 26 states, several individuals and the National Federation of Independent Businesses.

CONCLUSION
The above brief review of salient facts notwithstanding, as amply demonstrated by the distortions of information evident in the Republican Presidential campaign (see Preamble), there will likely be ongoing political obstructionism from “Tea Party” extremists that will impede progress towards universality.

Background References
The Commonwealth Fund. A Private Foundation working towards a high performance health system. http://www.commonwealthfund.org/About-Us.aspx  Accessed September 15, 2012.

American College of Physicians. Position Paper: Achieving a High-Performance Health Care System with Universal Access: What the United States Can Learn from Other Countries. Ann Intern Med 2008;148:55-75. http://www.annals.org/content/148/1/55.full#T1  Accessed September 15, 2012.

White F, Nanan D. A Conversation on Health in Canada: revisiting universality and the centrality of primary health care. J Ambul Care Manage 2009; 32,2:141-9. http://journals.lww.com/ambulatorycaremanagement/Abstract/2009/04000/A_Conversation_on_Health_in_Canada__Revisiting.9.aspx

Guyatt GH, Devereaux PJ, Lexchin J, et al. A systematic review of studies comparing health outcomes in Canada and the United States. Open Medicine 2007;1,1:E27-36. http://www.pnhp.org/PDF_files/ReviewUSCanadaOpenMedicine.pdf  Accessed September 15, 2012.

The World Health Report 2000 – Health systems: improving performance. Geneva, 2000 http://www.who.int/whr/2000/en/whr00_en.pdf  Accessed September 15, 2012..

Supreme Court of the United States. National Federation of Independent Business et al vs Sebelius, Secretary. Health and Human Services et al. Certiorari to the United States Court of Appeals to the Eleventh Circuit. No 11-393. Decided June 28, 2012. As cited in the Washington Post: Full text of the Supreme Court health-care decision. June 28, 2012. http://www.washingtonpost.com/wp-srv/politics/documents/supreme-court-health-care-decision-text.html  Accessed September 15, 2012.

SUPPLEMENTARY NOTES
The Patient Protection and Affordable Care Act (passed in 2010) core provisions come into effect in 2014 e.g., ability of insurance companies to deny coverage for pre-existing conditions ceases. All provisions are to be phased in by 2020. The Act supports a system far more complicated administratively than in Canada as it remains based on a multitude of insurance providers and gap-filling programs. It will take many years to fully implement, but does have the prospect of bringing the US into line with the principle of universal coverage that has been in observed for decades in all other developed countries.

Readers interested in further information on the Patient Protection and Affordable Care Act in the U.S., as upheld by their Supreme Court, a summary of its key features is available at the following site.
Senate Democrats http://dpc.senate.gov/healthreformbill/healthbill04.pdf

Wikipedia has also been updated on this topic although their full article is much longer and history more detailed http://en.wikipedia.org/wiki/Patient_Protection_and_Affordable_Care_Act

MILLENNIUM DEVELOPMENT GOALS – OUR UNDERACHIEVING “LEADERSHIP”

PREAMBLE: Under the auspices of the United Nations, from 20 to 22 September 2010, a Summit on the Millennium Development Goals (MDGs) will be held in New York. With only five years left until the 2015 deadline to achieve the MDGs, UN Secretary-General Ban Ki-Moon has called on world leaders to attend the summit to accelerate progress towards these goals, the overall aim of which is to reduce World Poverty. Visit the Summit website! http://www.un.org/en/mdg/summit2010/

Despite the dire need of over a billion people living in poverty around the world, the initial intentions behind the goals and efforts to showcase what had been achieved, it is increasingly clear that few if any of the MDGs will be achieved by the target year of 2015. Clearly there is a crying need for a strong reaffirmation with donor policies and resources to match.

Unfortunately, recent years have witnessed a track record littered with false promises and broken commitments and in some instances shallow comprehension of what is needed to resolve on the major issues underlying world poverty. All too often, “world leaders” have pandered to their domestic political bases rather than genuinely taking on these issues.

A case in point is Canada’s minority Conservative government whose leader Stephen Harper and fundamentalist colleagues ensured that this country’s commitment to address maternal and child health (MCH) excluded access to safe abortion, and made only weak provisions for the inclusion of family planning within Canadian funding commitments.

In fact, it is estimated that 20 million unsafe abortions occur around the world annually and that 70,000 of these result in the woman's death. Clearly there must be more emphasis on the provision of family planning, and removal of barriers to this practice and also quite obviously access to safe abortion, as a core element of a harm reduction strategy.

Harper’s approach to maternal health is in effect a northern echo of the Bush administration’s “global gag rule” (no funding for MCH unless abortion is specifically excluded), since repudiated by the Obama administration. Ironically, women in Canada long ago won the right to chose, so it is invidious that “Harper’s Canada” discriminates against these practices abroad.

There is still hope that Canada may amend this approach reasonably soon, with the return of a more compassionate philosophy. What is needed is to change the party in power, the only currently viable alternative being the Liberal Party of Canada, with (virtually guaranteed) support from all other parties: only the Conservatives (with little more than 30% public support) are holding up the need for enlightened policy.

We therefore endorse the following statement (Globe and Mail, Feb 2, 2010) made by the leader of that party, and of the official opposition Michael Ignatieff: “We want to make sure that women have access to all the contraceptive methods available to control their fertility because we don’t want to have women dying because of botched procedures, we don’t want to have women dying in misery.” This quote regains resonance in light of the looming MDG Summit next week in New York.

This example of Maternal and Child Health (MDG 5) is but one of the MDGs falling short of sufficient progress for any of them to be achieved by 2015 without an infusion of more genuine commitment by “world leaders” such as Mr Harper.

The eight MDGs are now listed for ease of reference:

Goal 1: Eradicate Extreme Poverty and Hunger
Goal 2: Achieve Universal Primary Education
Goal 3: Promote Gender Equality and Empower Women
Goal 4: Reduce Child Mortality
Goal 5: Improve Maternal Health
Goal 6: Combat HIV/AIDS, Malaria and other diseases.
Goal 7: Ensure Environmental Sustainability
Goal 8: Develop a Global Partnership of Development.

NOTE: This internationally agreed framework of 8 goals and 18 targets is complemented by 48 technical indicators to measure progress towards the Millennium Development Goals. These indicators have since been adopted by a consensus of experts from the United Nations, IMF, OECD and the World Bank.

As our feature for this issue, we present below a September 10, 2010 IPS Inter-Press Service report by Aprille Muscara (full reference below).

GLOBAL DEVELOPMENT BLUEPRINT REVEALS URGENT UPHILL BATTLE
By Aprille Muscara

UNITED NATIONS, Sep 10, 2010 (IPS) - A document outlining the U.N.'s strategy to achieve the Millennium Development Goals (MDGs) by 2015 was finalised Thursday after months of heated negotiations.

The text, titled "Keeping the Promise – United to Achieve the Millennium Development Goals", will be formally signed off on by world leaders at the upcoming MDG summit, which is to be held here from Sep. 20-22.

The final 27-page version, obtained by IPS, differs considerably from the 14-page "zero draft" base text from which member states inserted, amended and removed passages.

However, non-governmental organisations (NGOs) worry that the completed text, called an outcome document, falls short of the substantial action plan it was hoped to be and is instead a rehash of already-made promises and generalised commitments.

"This document lacks the adrenaline boost to accelerate the MDGs, and with only five years left, world leaders coming together in New York must commit to concrete actions that will ensure all people are lifted from poverty in our lifetime," said Emma Seery, a spokesperson for Oxfam International.

Over the years, NGOs and aid groups have advocated for a human rights-based approach to tackling the MDGs. A review of the document at different draft stages reveals the addition of key human rights language, such as inclusion of the right to development, the right to food, the right to health and the right to education.

"We recognize that the respect, promotion and protection of human rights is an integral part of effective work towards achieving the MDGs," the final document states.

But notably absent from the list is access to clean water and sanitation, which the U.N. in a resolution declared a basic human right in late July. The resolution proved to be a divisive one, however, with 41 countries, including the United States, Britain and Canada abstaining from the vote.

Although water and sanitation is not explicitly framed as a human right in the final outcome document, they appear frequently throughout as basic needs essential to achieving the MDGs.

Absent, as well, is the assertion "that gender equality is a basic human right, a fundamental value and an issue of social justice" – a statement that was inserted during the draft process but failed to make it through to the end. The final version reads: "We acknowledge the importance of gender equality and empowerment of women to achieve the MDGs."

Indeed, the evolution of the outcome document, which at one point ballooned to 38 pages, reflects a process of political wrangling over touchy wording. With its numerous additions and amendments, the final product is at once more specific in its language yet still general in its pledges.

Language on peace and security matters appears to have been especially contentious. For instance, references to "armed violence," present in the zero draft, and "transnational crime" and "trafficking in persons," introduced in subsequent drafts, as posing threats to the attainment of the MDGs have been removed entirely in favour of the more benign "conflict."

However, one instance of both "foreign occupation" and "terrorism" – new additions – as hindering achievement of the MDGs appear in the final version, reflecting a political compromise between the Group of 77, a coalition of developing countries, and the European Union and the United States.

In the final stages of ironing out problematic language, the E.U. and U.S. and the G77 were often on opposing sides in typical developed-developing, North-South fashion.

It is common practice, a U.N official told IPS, for the relevant parties to go to extremes in their proposed amendments in anticipation of having to make concessions.

Thus, the G77's insertions that claim the current global financial structure – from trade to aid – is "non- inclusive," "ineffective" and "inadequate" for developing countries were removed in place of more watered down wording stressing the need to further reform international financial systems.

A greater focus on the particular needs of the developing world, rural populations and specific mention of regional efforts by the global South in attaining the MDGs are also additions, reflecting G77 bargaining.

Meanwhile, the importance of parliaments, national ownership in developmental efforts and mutual accountability for commitments made towards achieving the MDGs suggest concessions made to the West.

Among the other numerous differences from the zero draft is an acknowledgement of the impact of the world financial crisis, volatile food and energy prices and humanitarian emergencies in stunting developmental gains. And of the eight goals, the document characterises maternal health, MDG5, as making the slowest progress. [Emphasis Added]

Also added is a litany of references to U.N. conventions, agreements and agencies, which serves to reinforce the commitments and goals made in those forums, but also highlights the world body's role in ensuring the accountability of governments.

To this end, the final document requests a "Special Event" to take place during the 68th session of the general assembly in 2013, two years shy of the deadline, to follow up on efforts made toward achieving the MDGs.

Ultimately, despite its acknowledgement of the uneven advances made thus far, the document reflects the urgent uphill battle left on the path to 2015.

"Progress on other MDGs is fragile and must be sustained to avoid reversal," it states.

Source: Muscara A. Development Blueprint Reveals Urgent Uphill Battle. IPS Inter-Press Service. Geneva Sept 10, 2010. http://www.ipsnews.net/news.asp?idnews=52788

MATERNAL MORTALITY – AN INTEGRITY TEST FOR POLITICIANS

PREAMBLE: One of the world’s most intractable public health problems is the high mortality of women due to pregnancy related causes. Over several decades (until recently), maternal mortality in developing countries appears to have been non-responsive to a range of interventions, perhaps because of inadequate intervention design or the inability to scale these to a level that can have impact on population health. In many countries, social and health policies that could facilitate the status of women, particularly in their right to make independent decisions with regard to their own health, have remained underdeveloped; it is of low priority in the world’s male-dominated political systems. Health services also have been inadequate to help lower maternal mortality: insufficient attention to prevention and inadequate access to treatment services of quality when critically needed.

Most donor countries recognize maternal health as a global public health priority. However, in Canada (under the regime of Conservative Prime Minister Stephen Harper), this global imperative is being sacrificed to partisan politics of the most ill-informed kind: it risks becoming a platform for the “religious right” to rail against the use of donor funds for abortion rather than to address in a holistic manner the most important needs of women that can assure improvement in their health.

Only last year, the administration of US President Barack Obama rescinded the global “gag order” of the preceding Bush regime, that required recipients of US aid – even in the realm of reproductive health – to deny access to safe abortion services if accepting US funds. This enlightened policy shift brings the US international development policy in line with that of the global community generally. It is ironic therefore that Canada – once a leader in this respect – appears to be taking a giant step backwards. Given the removal of access to safe abortions from the frame of reference, it is extremely doubtful that a recent Request for Proposals to guide the policy of the Canadian government in this regard, could attract anyone with a rigorous track record in this area of international health development.

Taking Africa as an example, as the recent "African Century" series of articles in the Globe and Mail (ref: May 11, 2010 issue) makes clear, more than 90% of Africans live in countries where abortion is restricted. It is legally prohibited in 14, while in others it is only permitted only to preserve the life or physical health of the woman. As a result, virtually all of the estimated 5.6 million abortions performed annually in Africa are unsafe, carrying with an unconscionable risk of complications and death.

Simply put, along with access to contraception, antenatal care, safe deliveries, reliable transportation to advanced care when this is urgently required (otherwise known as emergency obstetric care, which includes surgical intervention if needed as well as prompt treatment of post-partum infection and hemorrhage), access to safe abortion is part of any coherent plan to improve reproductive health and reduce maternal mortality. Knowing all this, and both the health and international development arms of the Canadian government surely should know this, to specifically and deliberately exclude funding of safe abortions in an aid package aimed at reducing maternal mortality would render the donor complicit in those deaths.

We labeled this issue “Maternal Mortality – an Integrity Test for Politicians” after realizing that many politicians are intellectually challenged by the technical nature of what is scientifically sound evidence regarding the nature of the problem at hand, and what works or doesn’t in addressing it. It is also an ethical test… in essence whether they (the ruling political party) are in it for cheap political gains among their home base, or whether higher reasoning will prevail in the interests of the health of millions of women around the world. Just how the G8 countries deal with this in their upcoming meetings will be a direct reflection of their collective political integrity. Based on public utterances to date, it seems like all the G8 countries except Canada may pass this test.

For the lead item of this month’s blog, we therefore attach below the polite but authoritative view of the Lancet on Canada’s G8 Leadership. This we follow by the first good news in many decades, that maternal mortality globally is finally being reduced.

CANADA'S G8 HEALTH LEADERSHIP
The Lancet May 8th, 2010
As a World Report in The Lancet today shows, Canada's pledge, as host of this year's G8 Summit, to make maternal and child health one of its key issues is moving forward. At a meeting in Halifax, Nova Scotia (April 27—28), the G8 development ministers agreed to back Canada's provisional set of principles to improve the health of women and children in developing nations.

Canada should be praised for making maternal and child health a priority issue for the G8. As an Article by Margaret Hogan and colleagues in today's issue shows, around 350 000 women die during childbirth every year. 9 million children younger than 5 years also die every year. Most of these deaths are preventable. Canada's health plan to address this situation is still thin on details but it promises to include training and support for frontline health workers; better nutrition and provision of micronutrients; treatment and prevention of diseases such as pneumonia, diarrhoea, malaria, and sepsis; screening and treatment for sexually transmitted diseases, including HIV/AIDS; family planning; immunisation; and clean water and sanitation.

However, a few key elements are missing from the framework. For example, there is no talk of emergency obstetric care. This omission is likely to be an oversight and should be rectified. Improving access to safe abortion services is also absent from the plan. Sadly, this omission is no accident, but a conscious decision by Canada's Conservative Government not to support groups that undertake abortions in developing countries.

This stance must change. 70 000 women die from unsafe abortions worldwide every year. The Canadian Government does not deprive women living in Canada from access to safe abortions; it is therefore hypocritical and unjust that it tries to do so abroad. Although the country's decision only affects a small number of developing countries where abortion is legal, bans on the procedure, which are detrimental to public health, should be challenged by the G8, not tacitly supported. Canada and the other G8 nations could show real leadership with a final maternal health plan that is based on sound scientific evidence and not prejudice.

Source: The Lancet, Volume 375, Issue 9726, Page 1580, 8 May 2010

SUMMARY: Maternal mortality for 181 countries, 1980—2008: a systematic analysis of progress towards Millennium Development Goal 5
(Note: Details of source and authorship given below)
Background: Maternal mortality remains a major challenge to health systems worldwide. Reliable information about the rates and trends in maternal mortality is essential for resource mobilisation, and for planning and assessment of progress towards Millennium Development Goal 5 (MDG 5), the target for which is a 75% reduction in the maternal mortality ratio (MMR) from 1990 to 2015. We assessed levels and trends in maternal mortality for 181 countries.

Methods: We constructed a database of 2651 observations of maternal mortality for 181 countries for 1980—2008, from vital registration data, censuses, surveys, and verbal autopsy studies. We used robust analytical methods to generate estimates of maternal deaths and the MMR for each year between 1980 and 2008. We explored the sensitivity of our data to model specification and show the out-of-sample predictive validity of our methods.

Findings: We estimated that there were 342 900 (uncertainty interval 302 100—394 300) maternal deaths worldwide in 2008, down from 526 300 (446 400—629 600) in 1980. The global MMR decreased from 422 (358—505) in 1980 to 320 (272—388) in 1990, and was 251 (221—289) per 100 000 livebirths in 2008. The yearly rate of decline of the global MMR since 1990 was 1•3% (1•0—1•5). During 1990—2008, rates of yearly decline in the MMR varied between countries, from 8•8% (8•7—14•1) in the Maldives to an increase of 5•5% (5•2—5•6) in Zimbabwe. More than 50% of all maternal deaths were in only six countries in 2008 (India, Nigeria, Pakistan, Afghanistan, Ethiopia, and the Democratic Republic of the Congo). In the absence of HIV, there would have been 281 500 (243 900—327 900) maternal deaths worldwide in 2008.

Interpretation: Substantial, albeit varied, progress has been made towards MDG 5. Although only 23 countries are on track to achieve a 75% decrease in MMR by 2015, countries such as Egypt, China, Ecuador, and Bolivia have been achieving accelerated progress.

Funding: Bill & Melinda Gates Foundation

Source: Hogan MC, Foreman KJ, Naghavi M, Ahn SY, Wang M, Makela SM, Lopez AD, Lozano R, Murray CJL. Maternal mortality for 181 countries, 1980—2008: a systematic analysis of progress towards Millennium Development Goal 5. The Lancet, 375, 9726, 1609 - 1623, 8 May 2010.

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.