Thursday, 14 February 2013
New Textbook recognizes GUN VIOLENCE AS A PUBLIC HEALTH PROBLEM
PREAMBLE: Not much has changed in the basic facts since John Last wrote 25 years ago:
It is unfortunate that the United States, in many respects among the most civilized of nations, contains the powerful interest group, the National Rifle Association (NRA), that often successfully lobbies against legislation designed to make lethal firearms less readily accessible to youthful and irresponsible purchasers and users of handguns that kill about 20,000 Americans, mostly young adult males, every year… and the NRA has even lobbied with some success to prohibit the Centers for Disease Control and Prevention (CDC) from gathering statistics on deaths and injury resulting from guns – not exactly shooting, perhaps, but trying to bind and gag the messenger. Only in the United States is such a state of affairs tolerated.
Reference: Last JM. Public Health and Human Ecology. 2nd edition. Appleton & Lange. Stamford CT 1998. (© 1st edition 1987 & © 2nd edition 1998; now out of print.)
GUN VIOLENCE - A MAJOR PUBLIC HEALTH PROBLEM IN THE UNITED STATES
So what has changed? The terrible toll from gun violence in the US continues to escalate:
According to the US Centers for Disease Control and Prevention, guns kill more than 31,000 people each year in the U.S., including more than 11,000 homicides. The U.S. homicide rate is seven times the average of other high-income countries.[1]
Yet, most public health textbooks from the United States (there are exceptions) give minimal attention to gun violence. For example, in the index of Public Health & Preventive Medicine (15th edition, 2008), the most comprehensive public health textbook published in the US, the word “gun” does not appear at all. By contrast, in the 12th edition (1986), “gun” was allocated six index lines. Why this apparent reduction in the higher educational recognition of a public health problem, when the problem itself has grown 50% in the interim?
Of course, this does not mean that the issue is going unrecognized in the US public health community. Much to the contrary, for example, on the heels of a deadly massacre of primary school children in December (Newtown CT), on January 14th and 15th, the Johns Hopkins University brought together more than 20 global leaders in gun policy and violence—representing the fields of law, medicine, public health, advocacy and public safety—for the Summit on Reducing Gun Violence in America.
Convened by the University, the Summit, which drew over 450 participants, featured presentations of research findings on a range of gun policy and violence topics, including the enforcement of gun laws, guns and public health, second amendment issues and public opinion on gun policy. Contributors met immediately after the Summit to distill the best research and data into a set of clear and comprehensive policy recommendations to prevent gun violence. These recommendations are available to the public.
“The purpose of putting forth these recommendations is to provide a research-based framework for reducing the staggering toll of gun violence in America,” said Summit organizer Daniel Webster, ScD, MPH, director of the Center for Gun Policy and Research at the Johns Hopkins Bloomberg School of Public Health. “Importantly, most recommended policies have broad public support and would not violate constitutional rights.”
Within weeks of the Summit, the Johns Hopkins University Press will publish the book, Reducing Gun Violence in America: Informing Policy with Evidence and Analysis. Collected for the first time in one volume, this reliable, empirical research and legal analysis will inform the policy debate by helping lawmakers and opinion leaders identify the policy changes that are most likely to reduce gun violence in the U.S…. Copies of the book will be delivered to policymakers from across the country, including members of Congress and the Administration.
In the meantime, Oxford University Press has just published Global Public Health – Ecological Foundations, illustrated at the top of the sidebar at right (see last month’s blog for details). This new general textbook book (now available at bookstores) includes a case study on gun control as a community work in progress in the US; the index makes explicit reference not only to gun control but also to the Brady Bill and the adversarial role of the NRA.
Clearly there is a need to enhance public health education regarding this priority topic, at all levels from community to political leadership, especially in the United States.
References:
1. Bloomberg School of Public Health. Johns Hopkins University. Summit on Reducing Gun Violence in America: Informing Policy with Evidence and Analysis. Special Event January 14-15, 2013. http://www.jhsph.edu/events/gun-policy-summit/
2. White F, Stallones L, Last JM. Global Public Health – Ecological Foundations. Oxford University Press. New York 2013. http://www.oup.com/us/catalog/general/subject/Medicine/PublicHealth/?view=usa&ci=9780199751907
Monday, 14 January 2013
New Textbook Release: GLOBAL PUBLIC HEALTH – ECOLOGICAL FOUNDATIONS
Preamble: The release of "Global Public Health - Ecological Foundations", published byOxford University Press (New York), is imminent. This edition of PacificSci Global Perspectives offers a preview of this important new work by Franklin White, Lorann Stallones and John M Last.
This new book is written for students of public health, development studies and environmental studies. It should also interest many other people in the health sciences who are seeking a broader perspective on the global health and related environmental challenges that face us and our planet.
For information on pricing , ordering and shipping, visit Oxford University Press at: http://www.us.oup.com/us/catalog/general/subject/Medicine/EpidemiologyBiostatistics/?view=usa&sf=toc&ci=9780199751907
ABOUT THE BOOK
Amid ongoing shifts in the world economic and political order, the promise for future public health is tenuous. Will today's economic systems sustain tomorrow's health? Will future generations inherit fair access to health and health care?
An important hope for the health of future generations is the establishment of a well-grounded, global public health system. Global Public Health: Ecological Foundations addresses both the challenges and cooperative solutions of contemporary public health, within a framework of social justice, environmental sustainability, and global cooperation.
With an emphasis on ecological foundations, this book approaches public health principles-history, foundations, topics, and applications-with a community-oriented perspective. By achieving global reach through cooperative, community-based interventions, this text illustrates that the practical application of public health principles can help maintain the health of the world's people.
Blending established wisdom with new perspectives, Global Public Health will stimulate better understanding of how the different streams of public health can work more synergistically to promote global health equity. It is a foundation for future public health measures to be built and to succeed.
Features
- Ecological approach to public health
- Full global scope, including developing countries
- Describes integrative approaches that are locally applicable
- Community-centric approach to public health
1. History, Aims and Methods of Public Health
2. Scientific Basis of Public Health
3. Philosophical and Ethical Foundations of Public Health
4. Community Foundations of Public Health
5. Health of Populations: health situation analysis & public health surveillance
6. An Integrated Approach to Disease Prevention and Control
7. Air, Water and Food Safety and Security
8. Public Health Organization and Function in Evolving Health Systems
9. Global Ecology and Emerging Health Challenges
Epilogue
Reviews
"Global Public Health: Ecological Foundations is stunning proof of the power of global thought and focused scholarship. It is simultaneously ambitious in scope and simple in approach, and the result is the definitive textbook for anyone studying public health at any level. I warmed to this book from the first page and could not put it down."
Professor of Public Health Leadership, Epidemiology, and Health Policy
Gillings School of Public Health, University of North Carolina
"People across the globe are more connected now than ever before. This important new work by White, Stallones, and Last clearly articulates the power of this connectedness and the potential to improve health across the levels of an ecological framework. The authors effectively communicate the core principles of public health and relate these to a variety of critical global health issues."
Professor and co-director, Prevention Research Center in St. Louis
Washington University in St. Louis, St. Louis, Missouri
Product Details
About the Author(s)
Franklin White, MDCM, MSc, FRCPC, FFPH, is President of Pacific Health & Development Sciences, Inc., in Victoria, British Columbia, and Adjunct Professor at University of Victoria and Dalhousie University.
Lorann Stallones, PhD, MPH, is Professor of Psychology and Director, Graduate Degree Program in Public Health at Colorado State University, Colorado School of Public Health.
John M. Last, MD, DPH, FRACP, FRCPC, FFPH, FACPM is Emeritus Professor of Epidemiology at the University of Ottawa; he is the author of Public Health and Human Ecology and A Dictionary of Public Health, and former editor in chief of Public Health and Preventive Medicine ("Maxcy-Rosenau-Last"), and A Dictionary of Epidemiology .
Acknowledgement: This information has been copied from the Oxford University Press (New York) site: http://www.us.oup.com/us/catalog/general/subject/Medicine/EpidemiologyBiostatistics/?view=usa&sf=toc&ci=9780199751907 Accessed January 14, 2013.
Sunday, 16 December 2012
INTERNATIONAL & GLOBAL DEVELOPMENT – YEAR IN REVIEW - 2012
PREAMBLE: This is our 6th annual review of topics covered over the preceding year. Our 2011 review was presented in January this year (an aberration due to a scheduling conflict), but this time we return to our usual practice and close the year with our review.
As is our custom, we lead with praise (“flowers”) and criticism (“fertilizer”) in 3 categories: global stewardship, international development, and human rights. A synopsis of monthly blog themes follows.
1. Global Stewardship
For 2012, flowers for leadership go to the Gates Foundation, and the government of Japan, both of which demonstrated great integrity with their support for the Global Fund for AIDS, Tuberculosis and Malaria (GFATM), at a time when several European countries hid behind sanctimony and hypocrisy while withholding their funding (next para).
The fertilizer award goes emphatically to Germany, Ireland, and Sweden and the European Commission for suspending funding to the Global Fund (GFATM). In part, this decision was made ostensibly due to corruption in recipient countries, even though this was limited to only 4 countries (among over a hundred recipients) and was discovered, investigated and openly reported by the Global Fund itself. This level of corruption, independently analysed, is significantly lower than that of the EURO block. The truth behind this decision is that Europe itself has been financially mismanaged, with bank failures, corruption and mismanagement.
The decisions of these European entities smack of old style colonialism: arrogance from the top down. It damages their hard won (or restored) reputations for being global leaders. To use developing countries and the Global Fund as a scapegoat for this is unconscionable. Instead, these particular European entities should have had the intestinal fortitude to own up and say “sorry, we can’t afford this now, because we ourselves are in such a mess”.
Corollary: With this backdrop, it is amazing that Europe still “won” the 2012 Nobel Peace Prize
2. International Development
Flowers for this category go to many Developing Countries collectively for the real progress in addressing the long-standing lack of potable drinking water, as documented by WHO and UNICEF, and in line with one of the major planks of the Millennium Development Goals (MDGs).
The fertilizer award in this category goes to China. In November, China's 18th Communist Party conference underwent a power shift to a new generation of leaders in a tightly orchestrated process, characterized by opacity and lack of public participation, and with virtually no representation of women in the governing structure, carefully scripted although all this was for domestic and international optics. If China wants to be viewed as a leader in international development, it has to do much better than this in its own internal development
3. Human Rights
We offer flowers to countries now engaging in Truth and Reconciliation processes, whether this be for the indigenous people of Canada, the stolen generations of Australia, and the export of (allegedly) parentless children by the UK following the second world war (yet to be fully acknowledged by the British government). There are many more examples than this, in many countries and cultures, a historical legacy that moves forward with us all until properly confronted to address past wrongs and grievances, and to achieve a meaningful resolution.
the other end of the spectrum, we can only confer a deposit of rather smelly fertilizer to Canada (Harper government), for reducing refugee access to routine medical care: reduction of ‘basic’ coverage, including primary and preventive care, and ‘supplemental’ coverage similar to that available to many low-income Canadians. This is both short-sighted and wrong-headed.
January (2012): "2011 AS WE RECORDED IT..." if you would also like to revisit the prior year, here is a direct link: http://pacificsci.blogspot.ca/2012/01/international-global-development-year.html
February: MAJOR PROGRESS IN MALARIA CONTROL: THE ROLE OF THE GLOBAL FUND, ITS DETRACTORS AND SUPPORTERS.
This issue was dedicated to major successes taking place in malaria control, largely due to support from the Global Fund, despite decisions by several European entities (Germany, Ireland, and Sweden and the European Commission itself) to suspend funding to the Global Fund on AIDS, Tuberculosis and Malaria (GFATM). See Global Stewardship (above) for further discussion. Thankfully, the Bill and Melinda Gates Foundation, being evidence-based, stepped in to shore up Global Fund finances due to this donor default. Also, former Japanese prime minister Naoto Kan said his country would contribute $340 million to the fund this year. Two years ago, Japan contributed $200 million, but it gave only $110 million last year because of domestic needs from the earthquake and tsunami. Of course many other countries are honoring their pledges, even as many of them also have financial challenges at this time.
March: GLOBAL DRINKING WATER GOAL MET FIVE YEARS AHEAD OF SCHEDULE
This issue gave visibility to real progress in addressing the long-standing lack of potable drinking water in many developing countries. Our source is a new report from WHO and UNICEF entitled Progress on Drinking Water and Sanitation 2012 Update. Despite real progress, challenges remain for some regions, particularly sub-Saharan Africa, especially in rural settings where the burden of poor water supply falls most heavily on girls and women. Equivalent progress also is not being made with regard to sanitation.
At the other end of the spectrum it is important to take note of recognition by the UN General Assembly of “water and sanitation as a human right". Unfortunately, there were abstentions, notably including Canada (Harper government again!). This abstention is curious, given that Canada’s indigenous people suffer disproportionately from poor water and sanitation.
April: APOLOGIES FOR PAST WRONGS AND GRIEVANCES
Here we addressed at a conceptual level the many contemporary political debates concerning recent and past conflicts. These demonstrate that perceptions matter in today’s politics, and that conflicts do not necessarily resolve by ending a war or signing a treaty. Negotiating an agreement can send a positive signal to the parties involved that they are willing to end the injustices and violence, but the emotional issues created can set the stage for resumption of hostilities even after a negotiated settlement is reached. Thus, in order for a conflict to be truly resolved there needs to be a lengthy process of reconciliation aimed at eradicating the emotional barriers between those involved and resuming trust between the victims and perpetrators. In this blog we offered an overview of underlying issues, mostly from a generic standpoint, keeping in mind that there are numerous conflicts of this nature around the world.
May: PUBLIC HEALTH IN THE MIDDLE EAST Reconnaissance of Issues and Developments
Over the past decade, this region has been dealing with social and political unrest, much of this of an extreme nature, largely resulting from a lack of good governance combined with negative geopolitical dynamics that have given scant regard to the wellbeing of the general populace. Countries in the region face many common challenges: social and economic development, status of women, environmental control and regulation, a highly mobile migrant workforce and other demands of a globalized economy.
This reconnaissance contained two sections: first, the published perspectives of the World Bank and WHO/EMRO, and second, observations on the emergence of two networks: public health associations, and membership of national public health institutes in a new global organization. It focused on the value of “healthy public policy”, the main aim of which is to create supportive environments to enable people to lead healthy lives, to make health choices possible or easier for citizens. In the pursuit of healthy public policy, government sectors concerned with agriculture, trade, education, industry, and communications need to take into account health when formulating policy, so as to benefit populations, communities and individuals.
June: CANADA RENEGES ON REFUGEE HEALTH
Canada’s federal government announced cuts to health services for refugees, to come into effect on June 30, 2012. These include reduced ‘basic’ coverage: primary and preventive care, and ‘supplemental’ coverage similar to that available to many low-income Canadians.
These changes are extremely short-sighted: diverting care for people in greatest need to urgent care settings, and may even give rise to public health threats such as tuberculosis especially if diagnosis is delayed or the condition left untreated. To deny health care to refugees is to inappropriately burden both Canada’s health system and the health of Canadians. This is both socially unjust and contradicts the principles of the Canada Health Act.
PacificSci thus joined with all organizations calling for the Federal government to rescind these proposed changes before they are implemented. The refugee health program should continue to provide basic benefits similar to provincial/territorial health care plans and supplemental benefits similar to what provinces and territories provide under social welfare.
July: MILLENNIUM DEVELOPMENT GOALS - 2012 REPORT HIGHLIGHTS
The MDG Report 2012 was launched in New York by UN Secretary-General Ban Ki-moon on July 2, 2012. Several MDG targets have been met well ahead of the 2015 target date. The report states that meeting remaining targets remains possible if Governments keep their commitments made over a decade ago.
Highlights: Extreme poverty is falling in every region including Sub- Saharan Africa. The world has met the target of halving the proportion of people without access to improved sources of water. Improvements in the lives of 200 million slum dwellers exceeded the slum target. The world has achieved parity in primary education between girls and boys. Many countries facing the greatest challenges have made significant progress towards universal primary education. Child survival progress is gaining momentum. Access to treatment for people living with HIV increased in all regions. The world is on track to achieve the target of halting and beginning to reverse the spread of tuberculosis. Global malaria deaths have declined.
These accomplishments notwithstanding, there remain major challenges:
Achievements are unequally distributed across and within regions and countries; progress has slowed for some MDGs after the 2008-9 economic crisis and related consequences; vulnerable employment has decreased only marginally over twenty years; decreases in maternal mortality are far from the 2015 target; use of improved sources of water remains lower in rural areas; hunger remains a global challenge; the number of people living in slums continues to grow; gender equality and women’s empowerment remain key challenges.
August: NEW GLOBAL JOURNAL OF MEDICINE AND PUBLIC HEALTH LAUNCHED
Illustrating a positive trend in research capacity development in developing countries, the Global Journal of Medicine and Public Health was launched early in 2012, honouring the principle that medical and public health practices must be appropriate to settings where they are applied.
An Inaugural Editorial is accessible at : http://www.gjmedph.org/uploads/EDITORIAL-Vo1No1.pdf
Readers may also visit the CURRENT ISSUE of the journal at: http://www.gjmedph.org/Current.aspxv
September: FACT CHECK: REPUBLICAN PARTY STATEMENTS ON HEALTH CARE REFORM
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 important to them. It is for this reason that, in this issue of Global Perspectives, we made 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 (the Patient Protection and Affordable Care Act of 2010), was making negative references to the comparative performance of universal health care in Canada: these statements by Ryan were demonstrably misleading.
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. 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.
October: ADDRESSING SOCIAL INEQUITIES:............ Fact Sheets - 10 PROMISING PRACTICES
As part of a 2009 Canadian Health Services Research Foundation Fellowship, the Sudbury & District Health Unit (which is located in Northern Ontario, Canada) identified 10 practices that are promising in their potential to reduce social inequities in health in our communities.
The fact sheets are designed to help public health practitioners and community partners apply each of the 10 Promising Practices to reduce social inequities in health. They have a common format that identifies essential components, key issues, and tools and resources for each Promising Practice.
The 10 Promising Practices Fact Sheets
1.Targeting With Universalism - http://bit.ly/OXBqsq
2.Purposeful Reporting - http://bit.ly/OSPYMm
3. Social Marketing - http://bit.ly/O6Pf8T
4. Health Equity Target Setting - http://bit.ly/Ml0s7m
5. Equity-Focused Health Impact Assessment - http://bit.ly/ONRCfq
6. Competencies/Organizational Standards - http://bit.ly/PHgx2Q
7. Contribution to the Evidence Base - http://bit.ly/P7KpuM
8. Early Childhood Development - http://bit.ly/Nq1Xgz
9. Community Engagement - http://bit.ly/NgalCF
10. Intersectoral Action - http://bit.ly/MBQPwB
November: SUPERPOWERS AT THE CROSSROADS What lies ahead for the United States and China (and others)
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 secured on November 9th with a large and impressively pluralistic margin in the popular vote and a very large margin in electoral college votes.
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.
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.
December: INTERNATIONAL & GLOBAL DEVELOPMENT – YEAR IN REVIEW 2012… This Issue!
AND A HAPPY NEW YEAR!
We extend to readers our best wishes for 2013, with hopes that the global challenges of recent years will be better understood and more humanely managed going forward. PacificSci will continue to offer an independent view.
As is our custom, we lead with praise (“flowers”) and criticism (“fertilizer”) in 3 categories: global stewardship, international development, and human rights. A synopsis of monthly blog themes follows.
1. Global Stewardship
For 2012, flowers for leadership go to the Gates Foundation, and the government of Japan, both of which demonstrated great integrity with their support for the Global Fund for AIDS, Tuberculosis and Malaria (GFATM), at a time when several European countries hid behind sanctimony and hypocrisy while withholding their funding (next para).
The fertilizer award goes emphatically to Germany, Ireland, and Sweden and the European Commission for suspending funding to the Global Fund (GFATM). In part, this decision was made ostensibly due to corruption in recipient countries, even though this was limited to only 4 countries (among over a hundred recipients) and was discovered, investigated and openly reported by the Global Fund itself. This level of corruption, independently analysed, is significantly lower than that of the EURO block. The truth behind this decision is that Europe itself has been financially mismanaged, with bank failures, corruption and mismanagement.
The decisions of these European entities smack of old style colonialism: arrogance from the top down. It damages their hard won (or restored) reputations for being global leaders. To use developing countries and the Global Fund as a scapegoat for this is unconscionable. Instead, these particular European entities should have had the intestinal fortitude to own up and say “sorry, we can’t afford this now, because we ourselves are in such a mess”.
Corollary: With this backdrop, it is amazing that Europe still “won” the 2012 Nobel Peace Prize
2. International Development
Flowers for this category go to many Developing Countries collectively for the real progress in addressing the long-standing lack of potable drinking water, as documented by WHO and UNICEF, and in line with one of the major planks of the Millennium Development Goals (MDGs).
The fertilizer award in this category goes to China. In November, China's 18th Communist Party conference underwent a power shift to a new generation of leaders in a tightly orchestrated process, characterized by opacity and lack of public participation, and with virtually no representation of women in the governing structure, carefully scripted although all this was for domestic and international optics. If China wants to be viewed as a leader in international development, it has to do much better than this in its own internal development
3. Human Rights
We offer flowers to countries now engaging in Truth and Reconciliation processes, whether this be for the indigenous people of Canada, the stolen generations of Australia, and the export of (allegedly) parentless children by the UK following the second world war (yet to be fully acknowledged by the British government). There are many more examples than this, in many countries and cultures, a historical legacy that moves forward with us all until properly confronted to address past wrongs and grievances, and to achieve a meaningful resolution.
the other end of the spectrum, we can only confer a deposit of rather smelly fertilizer to Canada (Harper government), for reducing refugee access to routine medical care: reduction of ‘basic’ coverage, including primary and preventive care, and ‘supplemental’ coverage similar to that available to many low-income Canadians. This is both short-sighted and wrong-headed.
January (2012): "2011 AS WE RECORDED IT..." if you would also like to revisit the prior year, here is a direct link: http://pacificsci.blogspot.ca/2012/01/international-global-development-year.html
February: MAJOR PROGRESS IN MALARIA CONTROL: THE ROLE OF THE GLOBAL FUND, ITS DETRACTORS AND SUPPORTERS.
This issue was dedicated to major successes taking place in malaria control, largely due to support from the Global Fund, despite decisions by several European entities (Germany, Ireland, and Sweden and the European Commission itself) to suspend funding to the Global Fund on AIDS, Tuberculosis and Malaria (GFATM). See Global Stewardship (above) for further discussion. Thankfully, the Bill and Melinda Gates Foundation, being evidence-based, stepped in to shore up Global Fund finances due to this donor default. Also, former Japanese prime minister Naoto Kan said his country would contribute $340 million to the fund this year. Two years ago, Japan contributed $200 million, but it gave only $110 million last year because of domestic needs from the earthquake and tsunami. Of course many other countries are honoring their pledges, even as many of them also have financial challenges at this time.
March: GLOBAL DRINKING WATER GOAL MET FIVE YEARS AHEAD OF SCHEDULE
This issue gave visibility to real progress in addressing the long-standing lack of potable drinking water in many developing countries. Our source is a new report from WHO and UNICEF entitled Progress on Drinking Water and Sanitation 2012 Update. Despite real progress, challenges remain for some regions, particularly sub-Saharan Africa, especially in rural settings where the burden of poor water supply falls most heavily on girls and women. Equivalent progress also is not being made with regard to sanitation.
At the other end of the spectrum it is important to take note of recognition by the UN General Assembly of “water and sanitation as a human right". Unfortunately, there were abstentions, notably including Canada (Harper government again!). This abstention is curious, given that Canada’s indigenous people suffer disproportionately from poor water and sanitation.
April: APOLOGIES FOR PAST WRONGS AND GRIEVANCES
Here we addressed at a conceptual level the many contemporary political debates concerning recent and past conflicts. These demonstrate that perceptions matter in today’s politics, and that conflicts do not necessarily resolve by ending a war or signing a treaty. Negotiating an agreement can send a positive signal to the parties involved that they are willing to end the injustices and violence, but the emotional issues created can set the stage for resumption of hostilities even after a negotiated settlement is reached. Thus, in order for a conflict to be truly resolved there needs to be a lengthy process of reconciliation aimed at eradicating the emotional barriers between those involved and resuming trust between the victims and perpetrators. In this blog we offered an overview of underlying issues, mostly from a generic standpoint, keeping in mind that there are numerous conflicts of this nature around the world.
May: PUBLIC HEALTH IN THE MIDDLE EAST Reconnaissance of Issues and Developments
Over the past decade, this region has been dealing with social and political unrest, much of this of an extreme nature, largely resulting from a lack of good governance combined with negative geopolitical dynamics that have given scant regard to the wellbeing of the general populace. Countries in the region face many common challenges: social and economic development, status of women, environmental control and regulation, a highly mobile migrant workforce and other demands of a globalized economy.
This reconnaissance contained two sections: first, the published perspectives of the World Bank and WHO/EMRO, and second, observations on the emergence of two networks: public health associations, and membership of national public health institutes in a new global organization. It focused on the value of “healthy public policy”, the main aim of which is to create supportive environments to enable people to lead healthy lives, to make health choices possible or easier for citizens. In the pursuit of healthy public policy, government sectors concerned with agriculture, trade, education, industry, and communications need to take into account health when formulating policy, so as to benefit populations, communities and individuals.
June: CANADA RENEGES ON REFUGEE HEALTH
Canada’s federal government announced cuts to health services for refugees, to come into effect on June 30, 2012. These include reduced ‘basic’ coverage: primary and preventive care, and ‘supplemental’ coverage similar to that available to many low-income Canadians.
These changes are extremely short-sighted: diverting care for people in greatest need to urgent care settings, and may even give rise to public health threats such as tuberculosis especially if diagnosis is delayed or the condition left untreated. To deny health care to refugees is to inappropriately burden both Canada’s health system and the health of Canadians. This is both socially unjust and contradicts the principles of the Canada Health Act.
PacificSci thus joined with all organizations calling for the Federal government to rescind these proposed changes before they are implemented. The refugee health program should continue to provide basic benefits similar to provincial/territorial health care plans and supplemental benefits similar to what provinces and territories provide under social welfare.
July: MILLENNIUM DEVELOPMENT GOALS - 2012 REPORT HIGHLIGHTS
The MDG Report 2012 was launched in New York by UN Secretary-General Ban Ki-moon on July 2, 2012. Several MDG targets have been met well ahead of the 2015 target date. The report states that meeting remaining targets remains possible if Governments keep their commitments made over a decade ago.
Highlights: Extreme poverty is falling in every region including Sub- Saharan Africa. The world has met the target of halving the proportion of people without access to improved sources of water. Improvements in the lives of 200 million slum dwellers exceeded the slum target. The world has achieved parity in primary education between girls and boys. Many countries facing the greatest challenges have made significant progress towards universal primary education. Child survival progress is gaining momentum. Access to treatment for people living with HIV increased in all regions. The world is on track to achieve the target of halting and beginning to reverse the spread of tuberculosis. Global malaria deaths have declined.
These accomplishments notwithstanding, there remain major challenges:
Achievements are unequally distributed across and within regions and countries; progress has slowed for some MDGs after the 2008-9 economic crisis and related consequences; vulnerable employment has decreased only marginally over twenty years; decreases in maternal mortality are far from the 2015 target; use of improved sources of water remains lower in rural areas; hunger remains a global challenge; the number of people living in slums continues to grow; gender equality and women’s empowerment remain key challenges.
August: NEW GLOBAL JOURNAL OF MEDICINE AND PUBLIC HEALTH LAUNCHED
Illustrating a positive trend in research capacity development in developing countries, the Global Journal of Medicine and Public Health was launched early in 2012, honouring the principle that medical and public health practices must be appropriate to settings where they are applied.
An Inaugural Editorial is accessible at : http://www.gjmedph.org/uploads/EDITORIAL-Vo1No1.pdf
Readers may also visit the CURRENT ISSUE of the journal at: http://www.gjmedph.org/Current.aspxv
September: FACT CHECK: REPUBLICAN PARTY STATEMENTS ON HEALTH CARE REFORM
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 important to them. It is for this reason that, in this issue of Global Perspectives, we made 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 (the Patient Protection and Affordable Care Act of 2010), was making negative references to the comparative performance of universal health care in Canada: these statements by Ryan were demonstrably misleading.
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. 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.
October: ADDRESSING SOCIAL INEQUITIES:............ Fact Sheets - 10 PROMISING PRACTICES
As part of a 2009 Canadian Health Services Research Foundation Fellowship, the Sudbury & District Health Unit (which is located in Northern Ontario, Canada) identified 10 practices that are promising in their potential to reduce social inequities in health in our communities.
The fact sheets are designed to help public health practitioners and community partners apply each of the 10 Promising Practices to reduce social inequities in health. They have a common format that identifies essential components, key issues, and tools and resources for each Promising Practice.
The 10 Promising Practices Fact Sheets
1.Targeting With Universalism - http://bit.ly/OXBqsq
2.Purposeful Reporting - http://bit.ly/OSPYMm
3. Social Marketing - http://bit.ly/O6Pf8T
4. Health Equity Target Setting - http://bit.ly/Ml0s7m
5. Equity-Focused Health Impact Assessment - http://bit.ly/ONRCfq
6. Competencies/Organizational Standards - http://bit.ly/PHgx2Q
7. Contribution to the Evidence Base - http://bit.ly/P7KpuM
8. Early Childhood Development - http://bit.ly/Nq1Xgz
9. Community Engagement - http://bit.ly/NgalCF
10. Intersectoral Action - http://bit.ly/MBQPwB
November: SUPERPOWERS AT THE CROSSROADS What lies ahead for the United States and China (and others)
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 secured on November 9th with a large and impressively pluralistic margin in the popular vote and a very large margin in electoral college votes.
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.
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.
December: INTERNATIONAL & GLOBAL DEVELOPMENT – YEAR IN REVIEW 2012… This Issue!
AND A HAPPY NEW YEAR!
We extend to readers our best wishes for 2013, with hopes that the global challenges of recent years will be better understood and more humanely managed going forward. PacificSci will continue to offer an independent view.
Thursday, 15 November 2012
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/
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/
Monday, 15 October 2012
ADDRESSING SOCIAL INEQUITIES:............ Fact Sheets - 10 PROMISING PRACTICES
PREAMBLE: As part of a 2009 Canadian Health Services Research Foundation Fellowship (Executive Training in Research Application – EXTRA), the Sudbury & District Health Unit (which is located in Northern Ontario, Canada) identified 10 practices that are promising in their potential to reduce social inequities in health in our communities.
These fact sheets are designed to help public health practitioners and our community partners apply each of the 10 Promising Practices to reduce social inequities in health. They have a common format that identifies essential components, key issues, and tools and resources for each Promising Practice.
Source: Sudbury and District Health Unit. 10 Promising Practices Fact Sheets. http://www.sdhu.com/content/healthy_living/doc.asp?folder=22203&parent=3225&lang=0&doc=13088 Accessed October 15, 2012.
In bringing these fact sheets to the attention of our readers, we also wish to acknowledge the service performed by the EQUIDAD Listserve, which is maintained by the Pan American Health Organization (PAHO/WHO). The following report about the 10 fact sheets is extracted verbatim from the PAHO posting on this topic. Full information on each of the 10 promising practices can be accessed using the URL link provided alongside each of them.
Reference: PAHO/WHO EQUIDAD@LISTSERVE.PAHO.ORG The 10 Promising Practices Fact Sheets. Thursday, August 09, 2012 9:23 AM
THE 10 PROMISING PRACTICES FACT SHEETS
The Sudbury & District Health Unit (SDHU) – August 2012
Website: http://bit.ly/OXNPwH
As part of a Canadian Health Services Research Foundation Fellowship (Executive Training in Research Application – EXTRA), the Sudbury & District Health Unit identified 10 practices that are promising in their potential to reduce social inequities in health in our communities.
These fact sheets are designed to help public health practitioners and our community partners apply each of the 10 Promising Practices to reduce social inequities in health. They have a common format that identifies essential components, key issues, and tools and resources for each Promising Practice.
1.Targeting With Universalism - http://bit.ly/OXBqsq
Every citizen deserves the opportunity to be healthy and to practise healthy behaviours. Thus, health promotion and protection programs and services endeavour to ensure that everyone has access to programs and services. Services designed for general access—by everyone, in the same way—constitute a universal approach.
However, evidence shows that individuals who benefit most from “universal” health programs and services are often those who have more money, more time, more social support, higher literacy, and better preceding health. In some cases, universal programs may increase health inequities such that the health of those who are socially advantaged improves more than the health of those who are socially disadvantaged. …”
2.Purposeful Reporting - http://bit.ly/OSPYMm
“….The World Health Organization, among others, identifies the importance of reporting purposefully on the relationship between health and social inequities in all health status reports. The WHO document The Social Determinants of Health: Developing an evidence base for political action highlights the link between sharing knowledge of health inequities and political action.
Similarly, Closing the Gap in a Generation, notes that “ensuring that health inequity is measured . . . is a vital platform for action” (p. 2). Thus, intentional and public presentation of evidence about health inequities can be part of a broad strategy for change…”
3. Social Marketing - http://bit.ly/O6Pf8T
“….Social marketing is “the systematic application of marketing alongside other concepts and techniques, to achieve specific behavioural goals, for a social good”. (p. 451)1 Social marketing involves defining and understanding target audiences so that interventions and health communications can be tailored to audience needs and preferences.
With the objective of reducing health inequities, social marketing interventions for local public health practice can create positive social change and improve the health of vulnerable populations by two approaches:
The first tailors behaviour change interventions to more disadvantaged populations (with the goal of levelling-up).
The second, less conventional approach, uses social marketing to change the understanding and ultimate behaviour of decision makers and the public to take or support action to improve the social determinants of health inequities….”
4. Health Equity Target Setting - http://bit.ly/Ml0s7m
“….As understood by the National Health Service (NHS) in the United Kingdom, “targets are a way of ensuring that resources and effort are directed at tackling health inequalities in an explicit and measurable way”. (p. 9)1 Many countries have incorporated target setting into their intersectoral work on social inequities in health. However, as the World Health Organization highlights, the exact nature of the targets appears to be important, since some targets may be more enabling of progress than others.2
Although target setting is not universally supported in the literature, it appears to hold some promise as part of a strategy for reducing health inequities and may have a role at the local public health level….”
5. Equity-Focused Health Impact Assessment - http://bit.ly/ONRCfq
“….Health impact assessment (HIA) is a structured method to assess the potential health impacts of proposed policies and practices. HIA enables decision makers to highlight and enhance the positive elements of a proposal, and minimize the aspects that may result in negative health outcomes1. By evaluating a broad range of evidence, HIAs are a useful way to assess the impact of proposals (either policy or specific practice) at the general population level. However, they are also recognized as a promising method to address the underlying social and economic determinants of health and resulting health inequities2.
Equity-focused health impact assessment (EfHIA) specifically includes questions such as “Is this proposal likely to affect those who are already disadvantaged? Is it likely to impose new health burdens on specific groups? Is it likely to change exposure to, and/or distribution of, risk factors or specific determinants of health (for example, living conditions, access to services)?”2 By applying an equity lens to HIAs, it becomes clear that virtually every policy has winners and losers—some groups benefiting more than others….”
6. Competencies/Organizational Standards - http://bit.ly/PHgx2Q
“….Competencies and organizational standards guide our daily practice. The Public Health Agency of Canada1 identifies 36 core competencies for public health encompassing essential knowledge, attitudes, and skills. Most importantly, these competencies were developed for practice within the context of the values of public health and include, for example, equity, social justice, community participation, and determinants of health. The core competencies for public heath offer a solid foundation for local public health staff recruitment and skill development.
As building blocks for effective public health practice, organizational standards provide benchmarks for public health units….”
7. Contribution to the Evidence Base - http://bit.ly/P7KpuM
“….When public health staff are asked about their capacity to address social inequities in health, a frequent issue that emerges is a lack of “best practices” to guide their interventions. The EXTRA Research Fellowship was carried out, in part, to help address these staff needs. However, it confirmed the existence of a gap in the evidence base with respect to effective local public health practice to reduce social inequities in health.
The evidence that does exist is often produced by practitioners working in a service delivery context in which publishing is not a priority. The evidence produced is often preliminary, small scale and specific to a particular context. Therefore, practice-based evidence might not be accepted for publication in traditional academic outlets….”
8. Early Childhood Development - http://bit.ly/Nq1Xgz
“…..Early child experiences establish the foundational building blocks for development across the life stages. Furthermore, with the greatest gains experienced by the most deprived children, investments in early child development have been referred to as powerful equalizers.
Early child experiences influence language, physical, social, emotional and cognitive development, which in turn, and throughout the lifecourse, affect learning, educational, economic, and social success, and health. Early childhood development (ECD), nurturing environments, and quality childhood experiences are important for positive human development and health. Early child experiences contribute to positive developmental outcomes, and subsequently health, through a number of pathways, including psychological, behavioural, and physical….”
9. Community Engagement - http://bit.ly/NgalCF
“…..As a strategy to reduce health inequities, community engagement is the process of involving community stakeholders in the development and implementation of policies, programs, and services. In Closing the gap in a generation, the World Health Organization highlights the need to “empower all groups in society through fair representation in decision-making about how society operates, particularly in relation to its effect on health equity, and create and maintain a socially inclusive framework for policy-making.”
Working with community professionals and agency representatives is one approach to engagement. However, building relationships with target populations and service users is also key to identifying community strengths and challenges….”
10. Intersectoral Action - http://bit.ly/MBQPwB
“…..A comprehensive strategy to promote health includes health care when individuals are ill and addresses the underlying causes of poor health where people live, work, learn, and play. These underlying causes are, in part, the result of social, economic, and political actions from different community sectors and all levels of government and industry.
Safe and affordable housing, access to parks and recreational activities, quality health care, early childhood education, safe streets, public transportation, and opportunities for meaningful employment are just some of the many factors that influence an individual’s opportunities for health and well-being….”
DISCLAIMER: PacificSci lays no claim to any the material contained in this issue of our blog. Our intent is to add our efforts to disseminate this valuable work, which is clearly in the international public interest.
Saturday, 15 September 2012
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
Wednesday, 15 August 2012
NEW GLOBAL JOURNAL OF MEDICINE AND PUBLIC HEALTH LAUNCHED
PREAMBLE: A decade ago, the Global Forum for Health Research observed that only 10% of worldwide expenditure on health research and development is devoted to the problems that primarily affect the poorest 90% of the world's population.[1] Step by step this situation is transforming: the quantity and quality of research from emerging economies is growing, while knowledge synthesis is becoming steadily more collaborative and global in scope. Another epiphany also has emerged: lessons from developing countries are of value to developed ones.
Earlier this year, illustrating a positive trend in research capacity development in developing countries, the Global Journal of Medicine and Public Health was launched, honouring the principle that medical and public health practices must be appropriate to the settings where they are applied.
As noted in the inaugural editorial [2], most established journals sustain their scientific rigour by serving known investigators in developed countries. By contrast, new entries open up participation so that, research and practice that is more sensitive to varying social, cultural and economic conditions around the world, has a fairer chance of being disseminated.
Disclaimer: Our decision to devote this issue of PacificSci Global Perspectives to the Global Journal of Medicine and Public Health (GJMEDPH) is consistent with our pro bono support for this venture, for which Franklin White (President, Pacific Health & Development Sciences Inc.) serves as Executive Editor. This piece is not an official statement by the journal, and the opinions expressed are those of the writer in support of this initiative.
GLOBAL JOURNAL OF MEDICINE AND PUBLIC HEALTH
Note: The following material was re-edited on April 11, 2013 to accurately reflect the location of the GJMEDPH editorial office.
The Global Journal of Medicine and Public Health (GJMEDPH) is a peer reviewed journal with an internationally diverse editorial board, coordinated by Editor in Chief Dr SM Kadri, with editorial offices in Srinagar, India. As an open access journal, it is committed to rapid, low cost and accessible publication of relevant articles.
Journal Policies and Issues to date may be accessed via the URL in the Invitation at the foot of this article.
The types of article accepted include original manuscripts, review articles, case reports, and letters to the editor. Emphasizing prevention and control of conditions that are important in terms of public health as well as clinical impact, its scope includes attention to the underlying determinants and related social and environmental approaches, not only clinical interventions. The Journal also features a continually updated column on News Around the World.
With balance and objectivity, GJMEDPH defers to authentic experience. It aims to stimulate debate on how medicine and public health can synergize to address globally important issues.
It also represents an investment in health research infrastructure for development settings.
For example, recent decades have witnessed a big push to promote “best practices”, mostly driven by the science base of developed countries. Related to this, legitimate questions arise about the kind of evidence needed to determine the relevance of their adoption in other settings. When such questions arise in western countries, they are put to the test through replication research to determine their applicability. By contrast, western best practices are typically adopted in developing countries uncritically, often as an extension of western training, even though conditions may be very different, and locally developed approaches desirable.[2]
GJMEDPH thus represents one new investment in the developing research infrastructure that is aimed at closing this gap. This will help implementers better understand how the complex array of contextual factors, such as politics, socio-cultural norms and beliefs, and the fiscal environment, can influence everything from replicability and adaptation to potential scale-up success.[2,3]
Because of the inevitable lag between evidence and action, all too often decision makers are not necessarily well versed in new approaches. GJMEDPH therefore encourages dissemination of research findings in ways that are policy-relevant.
The journal, which has already published three bimonthly issues in its first year, is now included in Index Copernicus and Ulrich's Periodicals Directory, the standard library directory and database providing information about popular and academic magazines, scientific journals and other serial publications. It aspires to be included in Index Medicus, once those criteria are met.
Invitation
Readers may visit the CURRENT ISSUE of the journal at: http://www.gjmedph.org/Current.aspx
Consistent with its mission, GJMEDPH welcomes submissions from anywhere in the world.
REFERENCES
1. Global Forum on Health Research. The 10/90 report on health research 1999. World Health Organization. Geneva. 1999.
2. White F. Launching the Global Journal of Public Health (inaugural editorial) GJMEDPH, 2012; 1(1) 1-2. http://www.gjmedph.org/uploads/Editorial.pdf Accessed August 15, 2012.
3. Yamey G. Scaling Up Global Health Interventions: A Proposed Framework for Success. PLoS Med 2011; 8, 6: e1001049. doi:10.1371/journal.pmed.1001049 http://www.plosmedicine.org/article/info:doi%2F10.1371%2F journal.pmed.1001049 Accessed Aug 15, 2012.
Earlier this year, illustrating a positive trend in research capacity development in developing countries, the Global Journal of Medicine and Public Health was launched, honouring the principle that medical and public health practices must be appropriate to the settings where they are applied.
As noted in the inaugural editorial [2], most established journals sustain their scientific rigour by serving known investigators in developed countries. By contrast, new entries open up participation so that, research and practice that is more sensitive to varying social, cultural and economic conditions around the world, has a fairer chance of being disseminated.
Disclaimer: Our decision to devote this issue of PacificSci Global Perspectives to the Global Journal of Medicine and Public Health (GJMEDPH) is consistent with our pro bono support for this venture, for which Franklin White (President, Pacific Health & Development Sciences Inc.) serves as Executive Editor. This piece is not an official statement by the journal, and the opinions expressed are those of the writer in support of this initiative.
GLOBAL JOURNAL OF MEDICINE AND PUBLIC HEALTH
Note: The following material was re-edited on April 11, 2013 to accurately reflect the location of the GJMEDPH editorial office.
The Global Journal of Medicine and Public Health (GJMEDPH) is a peer reviewed journal with an internationally diverse editorial board, coordinated by Editor in Chief Dr SM Kadri, with editorial offices in Srinagar, India. As an open access journal, it is committed to rapid, low cost and accessible publication of relevant articles.
Journal Policies and Issues to date may be accessed via the URL in the Invitation at the foot of this article.
The types of article accepted include original manuscripts, review articles, case reports, and letters to the editor. Emphasizing prevention and control of conditions that are important in terms of public health as well as clinical impact, its scope includes attention to the underlying determinants and related social and environmental approaches, not only clinical interventions. The Journal also features a continually updated column on News Around the World.
With balance and objectivity, GJMEDPH defers to authentic experience. It aims to stimulate debate on how medicine and public health can synergize to address globally important issues.
It also represents an investment in health research infrastructure for development settings.
For example, recent decades have witnessed a big push to promote “best practices”, mostly driven by the science base of developed countries. Related to this, legitimate questions arise about the kind of evidence needed to determine the relevance of their adoption in other settings. When such questions arise in western countries, they are put to the test through replication research to determine their applicability. By contrast, western best practices are typically adopted in developing countries uncritically, often as an extension of western training, even though conditions may be very different, and locally developed approaches desirable.[2]
GJMEDPH thus represents one new investment in the developing research infrastructure that is aimed at closing this gap. This will help implementers better understand how the complex array of contextual factors, such as politics, socio-cultural norms and beliefs, and the fiscal environment, can influence everything from replicability and adaptation to potential scale-up success.[2,3]
Because of the inevitable lag between evidence and action, all too often decision makers are not necessarily well versed in new approaches. GJMEDPH therefore encourages dissemination of research findings in ways that are policy-relevant.
The journal, which has already published three bimonthly issues in its first year, is now included in Index Copernicus and Ulrich's Periodicals Directory, the standard library directory and database providing information about popular and academic magazines, scientific journals and other serial publications. It aspires to be included in Index Medicus, once those criteria are met.
Invitation
Readers may visit the CURRENT ISSUE of the journal at: http://www.gjmedph.org/Current.aspx
Consistent with its mission, GJMEDPH welcomes submissions from anywhere in the world.
REFERENCES
1. Global Forum on Health Research. The 10/90 report on health research 1999. World Health Organization. Geneva. 1999.
2. White F. Launching the Global Journal of Public Health (inaugural editorial) GJMEDPH, 2012; 1(1) 1-2. http://www.gjmedph.org/uploads/Editorial.pdf Accessed August 15, 2012.
3. Yamey G. Scaling Up Global Health Interventions: A Proposed Framework for Success. PLoS Med 2011; 8, 6: e1001049. doi:10.1371/journal.pmed.1001049 http://www.plosmedicine.org/article/info:doi%2F10.1371%2F journal.pmed.1001049 Accessed Aug 15, 2012.
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