CELEBRATING THE AFRICAN MEDICAL AND RESEARCH FOUNDATION (AMREF)

PREAMBLE: On cloudless nights in 1957, children lay on their backs searching for a small red object traversing the sky: the Soviets had launched “sputnik”, the world’s first satellite. Although this also led to accelerating the “space race” and intensifying the “cold war”, imaginations everywhere were captivated by our common primordial fantasy: reaching for the stars. In the same year, three surgeons in Kenya, Michael Wood, Archibald McIndoe and Thomas Rees had a vision that could revolutionize health care in Africa. Sharing in the romance of Africa, its needs, its potential and sense of destiny, they launched a Flying Doctor Service. Over the next 5 decades, men set foot on the moon, satellites explored our solar system, the universe probed was probed with powerful orbital telescopes, robots explored the surface of Mars, and shuttles began servicing an international space station. In the meantime, what began as the Flying Doctor Service became Africa’s largest indigenous health organization: the African Medical and Research Foundation.

Yet, even as we make progress in solving the riddles of the universe, there remains extreme poverty and ill-health throughout Africa, and injustice throughout the world. In this, its 50th anniversary year, we celebrate the AMREF story which continues to unfold. In doing so we have drawn from our opportunity to view the organization at work during a joint donor evaluation in 2005-6, and from their anniversary book A Very African Journey (URL at foot of this article).

THE AMREF STORY
AMREF’s Vision is to seek “better health for Africa”. Its Mission states… “In creating vibrant networks of informed communities that work with empowered health workers in stronger health systems, we aim to ensure every African has access to the good health which is theirs by right.”

Over the past half century, AMREF has truly evolved. Prior to the 1970s, most of its work was service delivery. Under then-chairman, Dunstan Omari (former secretary to the East African Community), the concept of community-based health care was promoted. Advocated by then-lecturers at Nairobi University, Roy Shaffer and Miram Were (now Chair of AMREF), and implemented by Revi Tuluhungwa, Chris Wood and others, a strategy of working more closely with Ministries of Health took root. Since then, AMREF has trained Africans to staff the organization, relying steadily less on foreigners to carry out its work, just as it has been training community health workers for many African governments. Its Flying Doctor Service is now a self-sustaining entity, while AMREF itself still delivers an outreach programme to support essential care and training to rural hospitals. AMREF initiated and now runs community-based programmes in Kenya, Tanzania, Uganda, Ethiopia, Somalia, Sudan and South Africa. Increasingly it has emphasized education, innovation and research, working in partnership with communities, grassroots organizations, governments and donors. It concentrates on finding ways to improve health through projects that address Africa’s unique problems, taking into account: culture, attitudes, economies, politics and environment as critical factors. Based on evidence supported by its operational research, AMREF’s programmes serve as implementation models for Africa, influencing policies and practices by sharing its interventions across the continent.

For decades, AMREF has applied ecosystems principles in the identification of health risks and piloting appropriate health system solutions in rural areas. On the dry plains, trachoma (leading infectious cause of blindness) persists among the Masaai in an environment of little water and swarms of flies; this contrasts with a farming community nestled between two rivers only 15 kilometres away: here trachoma is absent and malaria hyperendemic (where water is plentiful, mosquitoes breed more readily). Clearly, differing environments in conjunction with human behaviour combine to determine health risks. Overlaid on a traditional culture in which each wife shares a one-room home with her children and newborn animals, preparing meals on a contaminated floor, it is in these settings that conditions such as trachoma must be tackled. The WHO “SAFE” protocol was adopted: surgery, antibiotics, face-washing, and environmental improvements. From a primary prevention perspective, the underlying priority is the reverse of this, but one must deal with the most seriously affected first, as this gains immediate attention and promotes the credibility of an integrated approach. Attending to environmental and personal hygiene are also prerequisites to the prevention of a much wider range of conditions. Simple interventions like “leaky tin technology” (a large can of water with a small hole at its base plugged by a thorn), so that clean water can remain uncontaminated and used sparingly, have made the difference in reducing exposure and transmission of such diseases. Two decades ago AMREF realized that episodic clinical teams weres neither effective nor efficient, and that a community approach was needed, emphasizing the role of women. Adopting the WHO “PHASE” campaign (personal hygiene and sanitation education) in 1995, and in partnership with Glaxo Smith Kline, AMREF pioneered this approach in Kenya and Uganda; this has been replicated elsewhere in the world eg., Peru, Tajikistan, Nicaragua, Bangladesh.

AMREF’s operational activities reflect Africa’s disease burdens at the grassroots, including malaria and HIV. For example, the Malaria Partnership Programme in Uganda involves AMREF, Ministries of Health and local NGOs with funding from Glaxo, Smith, Kline. In Kiboga, Kanungu and Kumi districts, AMREF has trained over 1,000 “community medicine distributors” (CMDs) to promote insecticide-treated bednet use and home-based fever management in children who previously would have been treated with ineffective drugs purchased from roadside vendors. Population Services International has underwritten the distribution of nets, using a revolving fund. Within 3 years, 80% of children with malaria in these districts benefited from CMD interventions, supported by AMREF-trained clinical officers, nurses and laboratory technicians, and a marketing effort using radio broadcasts, drama and music, as well as posters in shops, schools and churches. In response to the HIV epidemic, the “Angaza Project” (Swahili: “shed a light”) in Tanzania has implemented 47 counseling and testing sites (more in development), and almost 1,000 counselors trained, supported by a marketing effort using peer educators, music and sports: 0.5 million people have already been tested.

AMREF is intimately involved in health systems development in difficult urban settings. As stated by Director-General Dr Michael Smalley: “If health systems are robust then everything else works”. For example, in the Kibera slum nearby Nairobi, a squatter community of some 850,000 live in extreme poverty and overcrowding, in grossly deficient housing and poor environmental conditions. This situation is found in many cities throughout Africa, due to the rural to urban shift of populations. Such shanty-towns are becoming home to 2nd and 3rd generations, and are virtually a permanent feature of these cities. As migrants come from differing backgrounds and cultures, there is ethnic tension and little community solidarity. Nonetheless, it is precisely in this setting that AMREF has been working in close collaboration with the community-based organization Mradi ya Afya Msingi na Maendeleo (MRAMMA), to develop Primary Health Care (PHC), in a manner that reflects the spirit of the Alma Ata Declaration (1978), the most enduring set of principles for PHC development. In partnership for 11 years, the project has reached 100,000 slum dwellers, including such interventions as community organization and leadership development, stimulation of small enterprises, provision of safe water and sanitation, a core package of PHC interventions emphasizing maternal and child health, and a health centre to deal with a range of conditions responsible for the bulk of the disease burden. This community-based effort has succeeded so well that the City of Nairobi, the Ministry of Health and other partners have now joined to uplift the conditions of Kibera.

Among AMREF’s most important roles is the management of knowledge: building capacity through training, and introducing new learning systems. Since 1987, AMREF has run a 1-year diploma in community health, now offered in affiliation with Kenya’s Moi University. Through this rigorous programme have passed almost 500 students from 35 African countries. Innovative ways have also been found to exercise this role in a distributed manner, eg., almost 10,000 students have taken AMREFs correspondence courses. In 1998 the Maridi National Health Institute was started in southern Sudan with AMREF funding and support: this is a 3 year” clinical officer” course, through which over 130 graduates have been trained to become first line practitioners. New learning methods and technologies are being utilized: increasingly teaching is based on the PBL approach (problem-based learning), and an e-learning initiative has been launched in collaboration with the Nursing Council of Kenya with support (funding and technical) from Accenture: to upgrade 22,000 nurses from certificate to diploma level.

Much more could be told about the work of AMREF than is possible in the space of this short report. In South Africa, where the Ministry of Health accepts traditional practitioners within the formal health system (>60% of South Africans consult sangomas), AMREF is working to help determine “best practices”, and to promote the integration of sangomas within health priorities such as HIV counseling, TB treatment, oral rehydration therapy, and checking on immunization status, while also supporting safe and more effective traditional practices. Elsewhere in Africa eg., Kechene District, Ethiopia, AMREF is supporting microcredit schemes for families, simultaneously addressing poverty and health: helping women to develop economically viable small enterprises and to take care of their familes at the same time. In conflict zones eg., northern Uganda and southern Sudan, AMREF is working “to have health systems and informed communities ready to take control of their own lives and… health, once the fighting is over”.

Conclusion: AMREF recognizes far better than most health organizations around the world that 80% of health is made in households and communities; perhaps only 20% is repaired in hospitals and clinics. Redressing the imbalance in Africa requires empowering communities, teaching preventive measures in a way that can be understood, and narrowing the gap between health systems and communities. Priority must be given to operational and applied research: AMREF’s own priorities are development driven, and a research question embodied within all proposals to donors. From this research comes policy making: AMREF sees itself at the interface in this critical process. AMREF’s current 5 year strategy (2006-11) is to strengthen health systems and to provide the evidence. As stated by AMREF Chair, Professor Miriam Were: “In the past we just assumed that people would see how passionate and experienced we were and follow. Now we know it takes hard-nosed science to persuade others… we are beginning to produce the evidence to influence policy-makers”.

Reference: A Very African Journey is available on-line at: http://64.176.64.243/A%20Very%20African%20Journey.pdf
For more about AMREF, visit their website: http://www.amref.org/

OFFICIAL DEVELOPMENT ASSISTANCE AND GLOBAL HEALTH TRENDS

PREAMBLE: During our first 6 months, this report addressed the following global issues: climate change, child development, colonized minorities, food security, human rights, and other news and reviews. In most instances we also addressed the relevance of these issues to Canada, our home base. To locate these issues you may either scan down this issue to earlier issues, or Google search by combining the keywords just noted with the term pacificsci.

This June 2007 issue reviews the vexing issue of official development assistance from wealthy developed countries such as Canada, makes reference to a report on global social and economic trends, then selects reports from a discipline that is essential to understanding global health trends: Health Situation Analysis. This refers to information on health conditions, supported by vital and health statistics critical to strategic and operational development planning. Our selected examples include Africa, the State of the World Children, and Projections of Mortality and Burden of Disease to 2030.

Our sidebar addresses the emergence of “corporate hybrids”, freedom of speech and tolerance for intellectual opinions.

 G7 OFFICIAL DEVELOPMENT ASSISTANCE (ODA)
The most recent confirmed OECD data for ODA (2005) reveal that, although absolute amounts are higher, G7 countries allocate proportionally less Gross National Income (GNI) for international development: 0.30%, compared with .50% for non-G7 nations. Of 22 OECD nations only 5 met the UN target of at least 0.7%: Norway, Sweden, Denmark, the Netherlands, and Luxembourg, none of which are G7 countries. The lowest G7 allocation is made by the USA (0.22%; among 15 non- G7 nations, only Portugal and Greece give less than this), while Canada comes in slightly above the G7 mean at 0.34%. Clearly, both individually and collectively, the G7 should show more leadership.

Note: OECD rankings do not include Russia, a G8 country (G7 + 1).
Reference: Final ODA Data for 2005. http://www.oecd.org/dataoecd/52/18/37790990.pdf

 SERIOUS QUESTIONS ABOUT CANADA’s ODA
Questions are being raised about Canada’s ODA priorities eg., $30 million in 2006 to China, an emerging political and economic powerhouse. Parliamentarians urging increased aid to truly poor nations say the government’s refusal to support proposed new legislation to guide ODA reveals lack of commitment. “Canada used to be a leader and is now a… laggard” said Alexa McDonough, NDP foreign affairs critic. According to McDonough, the planned 2006 ODA of just over $3 billion represents 0.32 % of GNI, down from 0.34% last year and far off the 0.7% target that Canada helped set. Josee Verner, Minister for international aid, replied “spending in 2007-08 will increase by 8%, in line with the goal of doubling by 2011 the amount spent on ODA in 2001”.
Source: Sue Bailey. The Canadian Press. March 27, 2007
EDITORIAL: an annual increase in absolute expenditures in the order of 8% will simply maintain the status quo with little movement towards the target of 0.7% GNI

 REPORT FROM 8TH GLOBAL DEVELOPMENT CONFERENCE, Beijing. For up-to-date social and economic trends, visit the Global Development Network April 2007 newsletter. Topics include: the rise of Asia in the global economy; growth and poverty in Latin America; structural transformation opportunities in Africa and the Middle East. http://www.gdnet.org/pdf2/research_monitor/2007-April_conference%20edition_Research%20Monitor.pdf

 HEALTH SITUATION OF SUB-SAHARAN AFRICA

The health situation of Sub-Saharan Africa (SSA) is the least favourable of all regions. Following steady declines until the mid-1990s, adult mortality sharply reversed, with the disease burden increasingly dominated by HIV/AIDS superimposed on already heavy burdens from endemic malaria, water-borne diseases, vaccine-preventable diseases, nutritional deficiencies, and other preventable conditions. In some settings, this was compounded by war and civil strife, with consequent increases in violent death, food shortages, poverty and displacement of people, further fueling a rural to urban migration for economic survival. In parts of SSA, adult mortality rates are at their highest in 3 decades; a rapid drop in life expectancy (LE) is seen in 38 countries (LE age 40 or less in 8 of these). Without HIV/AIDS, LE at birth would have been almost 6.1 years higher in 2002. The slippage is not only due to HIV/AIDS: for example, despite major gains in immunization coverage during the 1980s, these have reversed since, reflecting a loss of capacity to deliver primary health care. In the meantime, the health profiles of Africa and the world are not standing still: the pattern is shifting with a steady increase in Non-Communicable Diseases and injuries. Even given Africa’s preoccupation with infectious diseases, which still dominate the disease burden, planners must now be alert to this emerging and future disease burden.
Source: The foregoing brief report is a paraphrased extract from a health situation analysis carried out by PacificSci for an assignment in East Africa completed in 2006.

 THE HEALTH OF THE PEOPLE: THE AFRICAN REGIONAL HEALTH REPORT: A fully comprehensive situation analysis has recently been published by the WHO Regional Office for Africa. http://www.who.int/bulletin/africanhealth/en/index.html

 THE STATE OF THE WORLD’s CHILDREN 2007

This UNICEF report focuses on the discrimination and disempowerment experienced by women and girls. It discusses how gender equality will move the UN Millennium Development Goals forward, and how investment in women’s rights will ultimately produce a dual dividend: advancing the rights of women and children. Seven interventions are advocated:

1. Abolish school fees and invest in girls' education
2. Invest government funding in gender equality
3. Enact legislation to create a level playing field for women and to address domestic as well as gender-based violence
4. Ensure women's participation in politics
5. Involve women's grassroots organizations in policy development
6. Engage men and boys on the importance of gender equality
7. Improve research and data on gender issues.
For the full report as a PDF document: http://www.unicef.org/sowc07/report/report.php

 PROJECTIONS OF MORTALITY & DISEASE BURDEN TO 2030

Revised global and regional projections of mortality and burden of disease by cause for 2005, 2015 and 2030 are now available from the World Health Organization. Principal investigators (CD Mathers & D Loncar) applied separate projection models for males and females, stratified into 7 age groups. The website below offers online access to the article, a working paper, and references to papers on data sources and methods. Detailed results for projected deaths and DALYs can be downloaded as Excel spreadsheets. The analyses were carried out at country level with aggregation into regional or income groups. The investigators used socio-economic projections to model future mortality and morbidity patterns, assuming slower and faster rates of development and population growth, taking into account independent variables: income, education, time, and tobacco use. The results suggest that, from 2002 to 2030, life expectancy will increase throughout the world, with an upward shift in the age of deaths, with considerably fewer younger children dying, while deaths due to cancer and heart disease will increase. Deaths from infectious diseases will decline overall, while mortality from HIV/AIDS will continue to increase. http://www.who.int/healthinfo/statistics/bodprojections2030/en/index.html

Acknowledgment: In constructing our summary, a review by Robert Goldberg on ProCOR (Recommended link in sidebar) was helpful, including his note of caution regarding the quality of data used to develop the predictive models and assumptions utilized.

THANKS FOR VISITING PacificSci GLOBAL PERSPECTIVES!

Climate Change, Kyoto Accord, Europe Responds & Canada Remains Challenged

PREAMBLE: The European Community (EU) takes Climate Change seriously, and is making progress towards its Kyoto targets. On April 26, 2007, Canada’s Conservative government released its first “climate-change plan”. Disappointingly, despite Canada leading the world in reducing ozone destroying chlorofluoro-carbons (Montreal Protocol 1987), signing the Kyoto Protocol (1997), and hosting its ratification (2005), this plan is incapable of meeting Canada’s Kyoto targets. Ranked 27th of 29 by the Organization for Economic Cooperation and Development on Greenhouse Gas (GHG) emissions, Canada remains among the most environmentally delinquent industrialized countries (ref: http://www.environmentalindicators.com/htdocs/indicators.htm). In this edition, adapting material from Global Vision (GV), a British NGO not linked to any political party, we examine Europe’s valid experience in reducing Greenhouse Gases (GHG), and close with an editorial advocating that Canada reconsider all options.

 THE EU APPROACH TO KYOTO
Commitments: In 1997 the EU15 signed the UN Framework Convention on Climate Change (Kyoto Protocol), agreeing to cut Greenhouse Gas (GHG) emissions, by 8% by the 5-year period 2008-12 (annual average emissions over the period) compared with the base year 1990. Under the "burden sharing" scheme of 2002, different member states were allocated different emissions targets: Germany agreed to a 21% cut (possible because of the collapse of much of east Germany's industry) and the UK agreed to a 12.5% cut; Spain was permitted a 15% increase and Greece a 25% increase. In 2004, new member states took different approaches: six (including the Czech Republic) adopted an 8% cut, Hungary and Poland have a target of 6%, while Cyprus and Malta have no targets.

The EU Emissions Trading Scheme (ETS): EU environment ministers have set up an ETS market to trade pollution permits for CO2, the main GHG. The scheme caps the amount of CO2 that industries can produce and allows companies to trade emissions rights within the EU (a "Cap and Trade" scheme). Firms that exceed their emissions limits can buy "allowances" from firms whose emissions are under target levels. The ETS began operating in January 2005. The first trading period (“phase”) runs from 2005 to 2007, to be followed by subsequent 5-year phases. Under ETS, Member States compile a National Allocation Plan (NAP) for each phase. They decide a "cap" for total emissions allowances and then allocate the capped total (in the form of permits) to individual plants and other "installations" according to predetermined criteria. Permit recipients can use their allowances for their own CO2 emissions, sell surplus allowances to others if they have any or, if short, buy the necessary allowances from others through the EU-wide market.

Performance: 2004 data (table in GV link) indicate that, of the EU15, 4 (UK, France, Germany, Sweden) are on track to meet commitments under the accord; 11 are not: Ireland, Portugal by >20%; Spain by >30%. Seven of 8 new countries are within target - the exception is Slovenia. The EU15 overall, are well off target.

Critique: Emissions Trading Schemes can work successfully but the EU's ETS has attracted criticism. Because national governments were left to choose their own targets, problems arose concerning allocation of emissions permits for 2005-07. The UK set stringent targets, whilst most other Member States did not. As a result, UK firms paid nearly £½bn for extra permits from business rivals in other Member States in 2005, whilst (for example) German firms received nearly £300m. Some UK firms, especially electricity companies, reduced their emissions and hence output because they were short of permits, which led to higher UK electricity prices. Other problems: in 2005, member states issued free permits for 1,830m tonnes, whilst emissions were only 1,785m tonnes. When this was realized in April 2006, a secondary market for emissions permits crashed.

The Future: Planning for the period 2008-12 is now underway. The EU claims that it will be tougher and fairer than the first; the UK has submitted plans with a 3% reduction target for CO2 emissions; Germany's plans again are less stringent.

Source: Global Vision (GV) http://global-vision.net/facts/fact10_3.asp (Feb 2007).

EDITORIAL: The European experience is instructive in many ways, but three lessons for Canada are clear: 1) curbing GHGs requires transformational thinking, not business as usual; 2) realities, commitment and performance vary across jurisdictions; and 3) respect for the Kyoto Accord is globally responsible.

Canada has suffered from Prime Minister Harper’s state of denial regarding the environment generally and Kyoto in particular (eg., in a 2002 letter to his party, Harper ridiculed the accord as “a money-sucking socialist scheme”). His hostility to the treaty while in opposition damaged the potential for consensus then, and carries over to his role now. On January 2007, an opinion poll nonetheless revealed environment to be Canada’s No.1 public concern, which caused the Conservative leadership finally to take the matter seriously, albeit still struggling to come to grips with it. However, Canada’s Green Plan, released April 26, 15 months into the term of the government (no longer “new”), falls so far short of what Canada is capable of doing, that energy stocks abruptly gained in value following its announcement! By contrast, the EU achieved consensus in 2005 and is far ahead in all aspects of the process. While rejecting Kyoto, highlights of the Conservative plan include short (2010) and medium term (2015) emission reduction targets, national emission caps (2012), and a domestic ETS (failure to meet Kyoto targets disqualify Canada from the global ETS). But there are many loopholes: although a technology fund will be financed by industries failing to meet targets, new facilities are exempt from any targets for 3 years, while those that prove unable to reduce emissions with existing technology will be exempt from any requirements to make reductions. Climate change activist Al Gore, invited speaker to a Canadian exhibition on green technologies, described the plan as a “fraud… designed to mislead the Canadian people”.

The debate clearly must not stop there. All policy options deserve ongoing consideration, including a carbon tax: fossil fuels taxed in proportion to carbon content, to represent the environmental cost of doing business. Although little new bureaucracy is required, this option was rejected outright by the “new” Environment Minister John Baird with more bluster than brilliance.[1] Meanwhile, south of the border, a Carbon Tax Center (CTC) was launched in New York in January; its aim is: to educate policymakers, opinion leaders, and the public about the benefits of taxing fossil fuel emissions. CTC advocates a carbon tax system because of "predictability, immediacy, transparency, universality, and equity."[2] This deserves more study in Canada, and the novel idea of educating policy-makers is appealing. Critically important is the need for incentives for operational research into cleaner energy systems. Not least, having nuclear technology, Canada should expand this source of clean energy. Combining approaches will more likely succeed than blind adherence or resistance to any given approach.

References: 1. Carbon tax proposal stirs political debate in Canada. Mar 5, 2007 http://www.corporateknights.ca/info/news/page.asp?name=platts_carbon_tax
2. Carbon Tax Center. Mar 31, 2007 http://www.carbontax.org/

Early Child Development - Policy Shifts, Global Viewpoints, and the Evidence Base.

PREAMBLE: In this issue we maintain our focus on Canadian policy shifts that are of global interest, assuming Canada’s reputation for enlightened social policy. Unfortunately this reputation is being undermined by a neo-conservative ideology. Over a million Canadian children live in poverty and cannot access child care support. In support of child friendly interventions, we include evidence reviewed by the US-based RAND Corporation showing that childhood intervention programs yield benefits in behavior, educational progression and attainment, delinquency and crime, and labor market success, among other domains. Well-trained caregivers and smaller child-to-staff ratios offer more favorable results. Economic studies have shown that well-designed early childhood interventions generate a favourable economic return on this social investment.

 CANADA’s SLIPPAGE ON CHILD CARE PROVISIONS
In 2005, after many years of educational research, advocacy and negotiation, early learning and child care agreements were reached between the Government of Canada and its provinces, laying a foundation for a system to meet the needs of all Canadian families. Canceling them, as the incoming Conservative government did in 2006 in favour of family income supplements only, was a major set-back to the evolution of a national child care program, and represented a net reduction of $4 billion in child care funding. While family income support in itself may be a valid policy goal, it will never substitute for early learning and child care services that are of quality, available and affordable.

EDITORIAL COMMENT: Perhaps the most historically surprising feature of this policy shift is that the idea of a national child care programme was first proposed in 1970 by Brian Mulroney’s Progressive Conservatives (the “PCs” were an ancestor of the Conservative Party of Canada). Evidently today’s Conservatives are now dominated by the social philosophy of the former far right Alliance Party which cobbled with the former PCs to spawn the party. Unfortunately, the new party seems to lack the capacity to accept a sound initiative launched under the previous Liberal government, even one which originated with the PCs, and that was at its grassroots non-partisan. As noted by the New Democratic Party (Denise Savois MP, personal communication): without child care, many parents (mostly mothers) can’t fully participate in the workforce. This undermines their equality, and many children also lose out on vital early learning opportunities when quality child care is scarce or unavailable.

UPDATE: In response to widespread criticism of it’s lack of coherent policy in this area, in March 2007 the Conservative government announced additional federal-provincial transfers of money ostensibly for child care spaces, and a scheme of tax credits for businesses to create child care; opposition critics note that such transfers can be readily clawed back or reallocated, and reflect a massive cut in the support originally intended for child care, and that such tax credit schemes are an inadequate response to the needs. A private members bill, The Early Learning and Child Care Act, will be studied by a parliamentary committee this month; if not supported in favour of Canada's children, this will become an election issue.

 PERSPECTIVE OF THE ORGANIZATION FOR ECONOMIC CO-OPERATION AND DEVELOPMENT (OECD)
In October 2004, the OECD described Canada's child-care system as “a chronically under-funded patchwork of programs with no overarching goals”. It found a shortage of available regulated child-care spaces – enough for fewer than 20 % of children 6 years and younger with working parents. By contrast, the following estimates apply to other OECD countries: UK, 60 %; Belgium, 63%; France, 69%; Denmark, 78%. The OECD recommended that Canada double its child-care spending to reach the OECD average.
For more in-depth on Day Care in Canada: http://www.cbc.ca/news/background/daycare/

 THE EVIDENCE – HOW IMPORTANT IS EARLY CHILDHOOD?
As part of a recent study, RAND researchers synthesized what is known from the scientifically sound research literature about the short- and long-term benefits from early intervention programs, the features that are associated with more-effective programs, and the economic gains (attractive benefit: cost ratios) that accrue from investing additional resources in early childhood. There is increasing recognition that the first few years of a child’s life are a particularly sensitive period in the process of human development, laying a foundation in childhood and beyond for cognitive functioning; behavioral, social, and self-regulatory capacities; and physical health. Yet many children face stressors during these years that can impair their healthy development. Early childhood intervention programs are designed to mitigate the factors that place children at risk of poor outcomes. Such programs provide supports for the parents, the children, or the family as a whole. These supports may be in the form of learning activities or other structured experiences that affect a child directly or that have indirect effects through training parents or otherwise enhancing the care-giving environment.

The research brief linked below describes work documented in Early Childhood Interventions: Proven Results, Future Promise by Lynn A. Karoly, M. Rebecca Kilburn, and Jill S. Cannon, MG-341-PNC, 2005, 200 pp, ISBN: 0-8330-3836-2

Source: RAND Corporation. RAND Research Briefs
http://www.rand.org/pubs/research_briefs/RB9145/index1.html
Note: We selected RAND for their review in part because we appreciate that this think tank normally enjoys support from across the political spectrum, including Conservatives.

Global and Local Perspectives on Colonized Minorities in Developed Countries

PREAMBLE: Colonized racial, cultural or religious minorities exist throughout the world, and are to be found nested within powerful societies. For examples, consider Tibet now within China, the Ainu of Japan, the Dalits of India, Amerindian enclaves in the Caribbean, tribal minorities in Africa, Boznian Muslims in former Yugoslavia, the Kurds of Iraq, others in all continents and among the Pacific islands. In choosing to highlight the situation of indigenous minorities in western industrialized countries, our example is Canada only because this is our home base. The issues here apply to several economically advanced western countries where it is sometimes said that one may find “3rd world conditions in 1st world settings”. Because these countries claim leadership for human rights, they also must live up to these principles.
[For a flavour of Canadian politics, scan column at right.]

 GLOBAL PERSPECTIVE ON COLONIZED MINORITIES
“Continuing disparities between the health of indigenous people and the non-indigenous settlers of Australia, Canada, New Zealand and the United States … is a matter of major concern within each country. In each country the legacies of colonial dispossession, land alienation, forcible relocation, suppression of indigenous cultural practices, values and beliefs, loss of language, disruption of families, violations of indigenous inherent sovereignty and right to self-determination, treaties, international law and indigenous cultural law, and other factors, have resulted in indigenous peoples experiencing a deplorable health status compared to non-indigenous settlers.”

Source: International Network of Indigenous Health Knowledge and Development http://www.inihkd.org/ Accessed Feb 4, 2007

 LOCAL PERSPECTIVES - CANADA’S FIRST NATIONS PEOPLE
Education: 44% of Aboriginal people aged 20-24 lack high school education, compared to 19% for Canada as a whole. Only 23% of Aboriginals aged 18-29 had completed post secondary education, compared to 43% in the rest of Canada.
Health: Infant mortality 20% higher than Canada; Type 2 diabetes 3 times more frequent; Suicide 3 to 11 times more frequent.
Housing: On-reserve, the estimated shortage is 20 to 35,000 units, and growing by 2,200 units per year. Off-reserve, the housing need is 76% higher than non-Aboriginal households. In northern Canada, housing needs are 130% higher.
Economic Opportunities: The unemployment rate among Aboriginal peoples is 19.1%,; the national rate is 7.4%. On reserves, unemployment is about 29%. Median employment income is two-thirds of the average for non-Aboriginal Canadians.

Reference: Government of Canada - Background information for the Kelowna Accord.http://www.pco.gc.ca/default.asp?Language=E&Page=archivemartin&Sub=newscommuniques&Doc=news_release_20051125_661_e.htm

 The KELOWNA ACCORD – a 2-Act Play or a 3-Act Play?
“Act 1”– A New Beginning
The Kelowna Accord (Nov 25, 2005) seemingly bound the Canadian government, provincial governments, and Canada’s First Nations to invest $5.1 billion over 5 years to close the gap between Aboriginal and other Canadians in education, health, housing and opportunities.[1] An operational plan contained 5-year targets over 10-years to ensure focused and accountable actions. Former Prime Minister Paul Martin acknowledged the Assembly of First Nations for taking the important step of proposing the establishment of a First Nations Auditor General and an Ombudsman.[2] He stated: "With this plan, we have made an important step forward in honouring our commitment to close the gap in the quality of life that now exists between Aboriginal peoples and other Canadians."[1]

“Act 2” - Another Broken Promise
Despite this promising start, on gaining power in January 2006, a new minority federal Conservative government (receiving only 36% of the popular vote) reneged, ostensibly because the Accord had not yet found its way into the federal budget, the election having intervened. Their own budget (despite a big surplus) cut the initiative by 80%, the residue going to a limited number of programs and housing provisions. Reflecting public opinion across the country, mostly favouring the Accord, the BC First Nations Leadership Council released an open letter to Prime Minister Stephen Harper, Hon. Jim Flaherty, Minister of Finance and Hon. Jim Prentice, Minister of Indian Affairs and Northern Development.[3] B.C. provincial Premier Gordon Campbell, at an inter-ministerial meeting, stated: "… the least that any Canadian can expect is when a government makes a commitment of resources, that those resources are going to flow."[4]

“Act 3” – Will there be one?
The Harper government will launch a new federal budget on March 19. Although there have been no statements to indicate a change in thinking that would reflect renewed respect for the Accord, this may be the last real opportunity for the “new” government to act in good faith towards it.

References: 1. Privy Council Office. Government of Canada. Press Release Nov 25, 2006http://www.pco.gc.ca/default.asp?Language=E&Page=archivemartin&Sub=newscommuniques&Doc=news_release_20051125_661_e.htm
2. Patterson LL. Aboriginal roundtable to Kelowna Accord: policy negotiations 2004-5. May 2006 http://www.parl.gc.ca/information/library/PRBpubs/prb0604-e.htm
3. Union of BC Indian Chiefs. Open Letter to Prime Minister Stephen Harper, Hon. Jim Flaherty, Minister of Finance and Hon. Jim Prentice, Minister of Indian Affairs and Northern Development. May 4, 2006. http://www.ubcic.bc.ca/files/PDF/FNLC_NR_2006FedBudget_openletter.pdf
4. Aboriginal leaders seek to revive Kelowna Accord. Canadian Press. July 26 2006 . http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20060725/aboriginal_mtg_060725/20060726?hub=Canada&s_name=

EDITORIAL COMMENT: Although our "new" government (when viewed from a politically Conservative perspective) may well have the best interests of Canada at heart, there is no doubt that the initial excuse not to implement the Kelowna Accord is no longer valid. About to launch a new budget in March, with a massive surplus in hand (thanks to a continuing strong economy), if the Conservatives do not now address the intent of the Accord at proper scale, this will confirm a steady drift to the political right, consistent with odd examples of out-dated thinking expressed on behalf of this regime (see: review of Canadian political flavours in column at right). It is therefore both timely and critical for Stephen Harper to show leadership on the situation facing aboriginal Canadians, and to emerge from the current policy fog as a Prime Minister for all Canadians. We will monitor the situation and comment further after the budget.

Global Food Security - A Matter of Survival

 PREAMBLE: In 1996, the World Food Summit set a target to halve the number of undernourished people by 2015. However, in 2007, it appears unlikely that this target will be met. One key to success is the Doha round of trade negotiations where 1st world priorities conflict with 3rd world needs. In this issue we focus on the conflict between grain for fuel or for food, the stalled Doha round, and examine global food security.

 ETHANOL DEMAND MAY DESTABILIZE THE FOOD SUPPLY
Global competition for corn supplies is generating social instability due to soaring prices out of reach in lower income countries that depend on this staple. The rationale of wealthy countries is to reduce dependence on foreign oil, despite ethanol’s low efficiency and corrosive properties. According to the Earth Policy Institute, an epic competition between the world’s 800 million motorists and its 2 billion poor people is emerging (1): the corn needed to fill a 25 gallon tank with ethanol would feed a poor family for a year. The US ethanol boom is sending shockwaves through the food chain: corn for ethanol is now sought-after by petroleum companies, supported by new government subsidies and mandates: even before the price hikes, ethanol production cost the US taxpayer $11 billion from 1979-2000 (US Government Accounting Office (2)), while the soaring cost of corn in the US recently pushed up the cost of tortillas in Mexico by a third. Facing protests, Mexican President Felipe Calderon responded with price controls on corn-based products (3). The projected savings to US and Canadian automotive fuel supplies from adding ethanol could be achieved several times over, at a fraction of the cost, by raising auto fuel efficiency standards by 20%, levels already exceeded in Europe and Asia.

References: 1) Brown L. Distillery demand for grain to fuel cars vastly understated – world may be facing highest grain prices in history. Earth Policy Institute. Jan 4, 2007-1. http://www.earth-policy.org/Updates/2007/Update63.htm 2) Reguly E. Lining up at the ethanol trough. Globe and Mail B2. Jan 25, 2007. 3) McKenna B. America’s appetite for ethanol poised to take corn from mouths of the poor. Globe and Mail B11. Jan 23, 2007.

 WORLD TRADE NEGOTIATIONS – THE DOHA ROUND
This series of negotiations commenced in 2001 in Doha, Qatar. The aim is to lower trade barriers world-wide, among countries of widely varying economic circumstances. Talks have stalled due to a stand-off between the world’s richest countries and developing ones. Although the round addresses all sectors, the impasse pertains to agriculture. Developing countries need “fair trade” to stimulate rural development and efficiency in production and distribution (1). However, protectionism rampant in developed nations, posing in the guise of other agendas eg., intellectual property rights, the “cultural value” of farming, international labour practices, quality control, professed anxiety about disease importation and even bioterrorism. Lack of progress can be laid at the feet of western agribusiness and the farm lobby. Rich country agricultural subsidies total over $300 billion annually, 6 times the value of development assistance. The average EU cow is subsidized at $2.50 per day; more than most Africans live on (2). Food security is an ethical challenge.

The July 2006 talks in Geneva failed to reach agreement on reducing subsidies and lowering import taxes - negotiations will take months to resume. A successful outcome is increasingly unlikely because the trade authority granted under the Trade Act of 2002 to US President Bush expires in 2007. Any pact will then require approval by an increasingly protectionist US Congress, which in turn discourages the willingness of other countries to participate. As WTO Director-General Pascal Lamy stated in a recent prospective, “If the global trading system is to be relevant, it is the responsibility of all members, in particular the big elephants, to meet this challenge”(3).

References: 1) UNDP. Human Development Report. Millennium Development Goals: a compact among nations to end human poverty. New York: Oxford UP 2003. 2) Williams J. 50 facts that should change the world. Icon Books 2004. 3) Lamy P. Doha’s Final Deadline. The World in 2007. 21st ed. The Economist.

 GLOBAL FOOD SECURITY – AN OVERVIEW
Nutrition throughout life determines growth, development and disease susceptibility. Although enough food is produced to feed everyone, maldistribution results in hunger and malnutrition, affecting millions. Most vulnerable are the poor, the marginalized, women, and children. Children are most vulnerable, suffering irreversible growth retardation by stunting and wasting, and impaired cognitive development that impacts throughout life; females are twice as likely as males to experience malnutrition.

Food security would exist if all people, at all times, had physical and economic access to sufficient, safe and nutritious food to meet their dietary needs and preferences. Food insecurity results from unavailability, unstable supplies, insufficient purchasing power, inappropriate distribution, or inadequate household utilization. The UN’s Food and Agricultural Organization estimates that 852 million people were undernourished in 2000-2, >95% in developing countries.(1) Barriers to food security can be overcome by economically viable and environmentally sustainable means; however, trade practices and policies associated with deregulated markets mitigate against this goal.

Though food and nutrition insecurity is generally declining worldwide, progress in South Asia is sluggish, while the problem is worsening in Africa due to conflicts, droughts, floods, and economic downturns. The number of undernourished African, estimated at 204 million (1999–2001), is double that of two decades earlier. Food shortages are so severe in East and Central Africa that they require regular international intervention.

Reference: Food and Agricultural Organization. The State of Food Security in the World 2004. Rome: Food and Agricultural Organization of the United Nations; 2004.

 Book Review: BANKER TO THE POOR - micro-lending and the battle against world poverty. Muhammad Yunus. Founder of Grameen Bank. Public Affairs New York 2003.
We selected this book because of Muhammad Yunus’s recent award of the 2006 Nobel Prize for Peace. Scanning the web, we selected the closing paragraph of a review by Tom McInerny: “What this book cannot show is his quiet, captivating demeanor, which verges on the spiritual To learn the secret of his man’s goodness, one looks for a sign, a indication of how and why he was called. That secret is his ability to ask ‘Why not?’… where others have willingly supported the status quo, embraced stagnation and elevated what is to the level of what must be.” http://www.grameen-info.org/book/hungary.htm

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Peace, Security, Health & Human Rights

PREAMBLE: In our first issue of 2007, we take note of the new UN Secretary General, focus on war and peace in the Middle East, and complete the transfer of reports and commentaries from our News & Reports site (as announced in our December posting).

 KOFI ANNAN ADMINISTERS OATH OF OFFICE TO SUCCESSOR Statement by Secretary-General-Designate (synopsis)
United Nations Secretary-General-designate Ban Ki-moon, of South Korea, stood before the world’s nations mindful of the oath he had just taken and that the sentiments, loyalty, discretion and conscience, together with the principles of the Charter, would be his watchwords as he carried out his duties. He told Mr. Annan: “Your courage and vision have inspired the world” and stated that "by strengthening the three pillars of the UN, security, development and human rights, the UN family could build a more peaceful and prosperous world for future generations."
December 14, 2006 http://www.maximsnews.com/1006mnundecember29333.htm

 FOCUS ON IRAQ & PALESTINE .............................................

THE HUMAN COST OF THE WAR IN IRAQ: A survey led by the Bloomberg School of Public Health, Johns Hopkins University, reveals that approximately 600,000 people have been killed in violence that began with the US invasion of Iraq in March 2003. http://www.stat.columbia.edu/~gelman/stuff_for_blog/iraq1.pdf

PRESIDENT FORD DISAGREED ON THE INVASION: In an embargoed 2004 interview (publishable only after his death on December 26, 2006) Ford revealed that he believed that President Bush, Vice President Cheney and Secretary Rumsfeld erred in justifying the war as one aimed at eliminating Saddam Hussein’s weapons of mass destruction and said he would have pushed alternatives, such as sanctions, much more vigorously.
http://www.washingtonpost.com/wp-dyn/content/article/2006/12/27/AR2006122701558.html

INVESTORS PROFIT: War is a disaster, but not for Lockheed Martin (LM). The world’s largest arms merchant (F-16 fighters, Patriot missiles, radar, satellites) turns mayhem into money. For the first 9 months of 2006, revenues rose 7% to $28.78 billion and profit jumped 43% to $1.8 billion (US taxpayers foot the bill), creating shock and awe on Wall Street. Like other firms that profit from conflict, LM claims “We are a company that values ethics, integrity, teamwork, and pursues superior performance”.
Adapted from: John Heinzl, Globe and Mail, December 30, 2006.

Book Review: PALESTINE - PEACE NOT APARTHEID: This book offers a critical analysis of the crisis in Palestine and Israel. It is unique, coming as it does from the 2002 Nobel Peace Prize awardee, former US President Jimmy Carter, who states: "Peace will come to Israel and the Middle East only when the Israeli government is willing to comply with international law, with the Roadmap for Peace, with official American policy, with the wishes of a majority of its own citizens - and honor its own previous commitments - by accepting its legal borders. All Arab neighbors must pledge to honor Israel's right to live in peace under these conditions." Highly recommended. For negative views, visit: http://blog.washingtonpost.com/worldopinionroundup/2006/12/jimmy_carter_palestinian_sympa.html

CAN INTERNATIONAL PUBLIC HEALTH LAW HELP PREVENT WAR? This question was posed during the lead up to the invasion of Iraq, in the belief that prevention of war (the ultimate violence) is one of the most critical steps mankind can make to protect public health. Given the serious potential for future premeditated wars in our times, there is value in revisiting this idea: http://www.who.int/bulletin/volumes/81/3/Letter0303.pdf

 FOCUS ON AFRICA .............................................

A TASTE OF REALITY - African Medical and Research Foundation (AMREF): For Africa's health realities, offers a Film Catalogue with such titles as: Gulu, TV-Slum, Speak Africa, Baba Mandela, & Big Brother AIDS. To access AMREF, winner of the 2005 Gates Award for Global Health, see AMREF’s link in column at right (Recommended Global Links).

Book Review: COMMISSION ON AFRICA REPORT: This report, chaired by Tony Blair, calls for G8 nations to end extreme poverty in the world's most desperate continent. Reference: Our Common Interest - The Commission for Africa: an argument. Penguin 2005. For the full report and background document visit the relevant link in column at right.

Book Review: BODY COUNT: Not to be confused with a novel of this title, this documents how the Bush Administration, allied with the Christian Right, joined the Vatican to promote abstinence as the preferred strategy for the HIV/AIDS pandemic, and how some African leaders fell in line, denying life-saving drugs while drug companies moved to protect patent rights and profits. Reference: Peter Gill. Body Count - how they turned AIDS into a catastrophe. Profile Books. London 2006. ISBN-10 1 86197 923 1.

 COMMENTARIES .....................................................

MAKING MARKETS WORK FOR THE POOR - CARE Canada's Approach: While a strong civil society and public sector infrastructures are essential for social development, international cooperation increasingly embraces stimulation of a vibrant private sector. Visit the relevant link in column at right.

FIRST WORLD CONCERNS - GDP: A POOR MEASUREMENT OF GROWTH: GDP, widely imagined to measure prosperity, is misleading as it does not reflect wealth disparities, and may rise even as fortunes of middle and lower income people falter.
http://www.sightline.org/publications/enewsletters/CSNews/CS_10_05_economy

THANKS FOR VISITING PacificSci GLOBAL PERSPECTIVES!