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.
Sunday, 15 July 2012
MILLENNIUM DEVELOPMENT GOALS - 2012 REPORT HIGHLIGHTS
PREAMBLE: 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. Clearly this includes both recipient and donor nations.
Highlights of the Report:
Extreme poverty is falling in every region including Sub- Saharan Africa.
The poverty reduction target was met: the global poverty rate at $1.25 a day fell in 2010 to less than half the 1990 rate. If confirmed, the first target of the MDGs— cutting extreme poverty to half its 1990 level—will have been achieved at the global level well ahead of 2015.
The world has met the target of halving the proportion of people without access to improved sources of water: the proportion of people using an improved water source rising from 76 per cent in 1990 to 89 percent in 2010.
Improvements in the lives of 200 million slum dwellers exceeded the slum target: The share of urban residents in the developing world living in slums declined from 39 per cent in 2000 to 33 per cent in 2012. This achievement exceeds the target of significantly improving the lives of at least 100 million slum dwellers, well ahead of the 2020 deadline.
The world has achieved parity in primary education between girls and boys: Many more children are enrolled in primary school, especially since 2000. Girls benefited the most. The gender parity index value of 97 falls within the margin of error for 100.
Many countries facing the greatest challenges have made significant progress towards universal primary education. Enrolment rates of primary school age children increased markedly in sub-Saharan Africa, from 58 to 76 per cent between 1999 and 2010.
Child survival progress is gaining momentum. Despite population growth, the number of under-five deaths worldwide fell from more than 12.0 million in 1990 to 7.6 million in 2010.
Access to treatment for people living with HIV increased in all regions. At the end of 2010, 6.5 million people were receiving antiretroviral therapy for HIV or AIDS in developing regions. This total constitutes an increase of over 1.4 million people from December 2009, the largest one-year increase ever. The 2010 target of universal access, however, was not reached.
The world is on track to achieve the target of halting and beginning to reverse the spread of tuberculosis. Globally, tuberculosis incidence rates have been falling since 2002, and current projections suggest that the 1990 death rate from the disease will be halved by 2015.
Global malaria deaths have declined. The estimated incidence of malaria has decreased globally, by 17 per cent since 2000. Over the same period, malaria-specific mortality rates have decreased by 25 per cent. Reported malaria cases fell by more than 50 per cent between 2000 and 2010 in 43 of 99 countries with ongoing malaria transmission.
These accomplishments notwithstanding, there remain major challenges:
Inequality detracts from these gains, and advances have slowed: Achievements are unequally distributed across and within regions and countries. Moreover, progress has slowed for some MDGs after the 2008-9 economic crisis and related consequences.
Vulnerable employment has decreased only marginally over twenty years. Defined as share of unpaid family workers and own-account workers in total employment, this fell to 58 per cent from 67 per cent two decades earlier. Women and youth remain the most vulnerable.
Decreases in maternal mortality are far from the 2015 target. Despite improvements, progress is still slow. Reductions in adolescent childbearing and expansion of contraceptive use have continued, but at a slower pace since 2000 than over the decade before.
Use of improved sources of water remains lower in rural areas. While 19 per cent of the rural population used unimproved sources of water in 2010, the rate in urban areas was only 4 per cent. Nearly half of the population in developing regions still lack access to improved sanitation.
Hunger remains a global challenge. 850 million people lived in hunger in the 2006-8 period, 15.5 per cent of the world population. This continuing high level reflects lack of progress on hunger in several regions, even as income poverty decreased. Progress is slow in reducing child undernutrition. Close to one third of children in Southern Asia were underweight in 2010.
The number of people living in slums continues to grow. Despite a reduction in the proportion of urban populations living in slums, the absolute number continues to grow from a 1990 baseline of 650 million. An estimated 863 million people now live in slum conditions.
Gender equality and women’s empowerment remain key challenges. Gender inequality persists and women continue to face discrimination in access to education, work and economic assets, and participation in government. Violence against women continues to undermine efforts to reach all goals.
REFERENCE:
United Nations. The Millennium Development Goals Report 2012. New York 2012. http://mdgs.un.org/unsd/mdg/Resources/Static/Products/Progress2012/English2012.pdf
Highlights of the Report:
Extreme poverty is falling in every region including Sub- Saharan Africa.
The poverty reduction target was met: the global poverty rate at $1.25 a day fell in 2010 to less than half the 1990 rate. If confirmed, the first target of the MDGs— cutting extreme poverty to half its 1990 level—will have been achieved at the global level well ahead of 2015.
The world has met the target of halving the proportion of people without access to improved sources of water: the proportion of people using an improved water source rising from 76 per cent in 1990 to 89 percent in 2010.
Improvements in the lives of 200 million slum dwellers exceeded the slum target: The share of urban residents in the developing world living in slums declined from 39 per cent in 2000 to 33 per cent in 2012. This achievement exceeds the target of significantly improving the lives of at least 100 million slum dwellers, well ahead of the 2020 deadline.
The world has achieved parity in primary education between girls and boys: Many more children are enrolled in primary school, especially since 2000. Girls benefited the most. The gender parity index value of 97 falls within the margin of error for 100.
Many countries facing the greatest challenges have made significant progress towards universal primary education. Enrolment rates of primary school age children increased markedly in sub-Saharan Africa, from 58 to 76 per cent between 1999 and 2010.
Child survival progress is gaining momentum. Despite population growth, the number of under-five deaths worldwide fell from more than 12.0 million in 1990 to 7.6 million in 2010.
Access to treatment for people living with HIV increased in all regions. At the end of 2010, 6.5 million people were receiving antiretroviral therapy for HIV or AIDS in developing regions. This total constitutes an increase of over 1.4 million people from December 2009, the largest one-year increase ever. The 2010 target of universal access, however, was not reached.
The world is on track to achieve the target of halting and beginning to reverse the spread of tuberculosis. Globally, tuberculosis incidence rates have been falling since 2002, and current projections suggest that the 1990 death rate from the disease will be halved by 2015.
Global malaria deaths have declined. The estimated incidence of malaria has decreased globally, by 17 per cent since 2000. Over the same period, malaria-specific mortality rates have decreased by 25 per cent. Reported malaria cases fell by more than 50 per cent between 2000 and 2010 in 43 of 99 countries with ongoing malaria transmission.
These accomplishments notwithstanding, there remain major challenges:
Inequality detracts from these gains, and advances have slowed: Achievements are unequally distributed across and within regions and countries. Moreover, progress has slowed for some MDGs after the 2008-9 economic crisis and related consequences.
Vulnerable employment has decreased only marginally over twenty years. Defined as share of unpaid family workers and own-account workers in total employment, this fell to 58 per cent from 67 per cent two decades earlier. Women and youth remain the most vulnerable.
Decreases in maternal mortality are far from the 2015 target. Despite improvements, progress is still slow. Reductions in adolescent childbearing and expansion of contraceptive use have continued, but at a slower pace since 2000 than over the decade before.
Use of improved sources of water remains lower in rural areas. While 19 per cent of the rural population used unimproved sources of water in 2010, the rate in urban areas was only 4 per cent. Nearly half of the population in developing regions still lack access to improved sanitation.
Hunger remains a global challenge. 850 million people lived in hunger in the 2006-8 period, 15.5 per cent of the world population. This continuing high level reflects lack of progress on hunger in several regions, even as income poverty decreased. Progress is slow in reducing child undernutrition. Close to one third of children in Southern Asia were underweight in 2010.
The number of people living in slums continues to grow. Despite a reduction in the proportion of urban populations living in slums, the absolute number continues to grow from a 1990 baseline of 650 million. An estimated 863 million people now live in slum conditions.
Gender equality and women’s empowerment remain key challenges. Gender inequality persists and women continue to face discrimination in access to education, work and economic assets, and participation in government. Violence against women continues to undermine efforts to reach all goals.
REFERENCE:
United Nations. The Millennium Development Goals Report 2012. New York 2012. http://mdgs.un.org/unsd/mdg/Resources/Static/Products/Progress2012/English2012.pdf
Friday, 15 June 2012
CANADA RENEGES ON REFUGEE HEALTH
PREAMBLE: On June 30th, 2012, refugees in Canada will face drastic cuts to their health insurance coverage. Numerous professional organizations have launched a National Day of Action, in protest to this dereliction of duty by the federal government, currently controlled by the Conservative Party of Canada. It appears, that the “Harper government” is losing its social conscience, demonstrating a failure of authentic leadership.
By selecting this topic for the June 2012 blog, Pacific Health & Development Sciences (PacificSci) adds its support to this protest.
We acknowledge the sources cited for the factual content presented, but take responsibility for our reconstruction of the situation.
The Situation: CHANGES TO CANADA’S REFUGEE HEALTH CARE COVERAGE
Canada’s federal government recently announced major changes to the Interim Federal Health (IFH) program, including substantial cuts to health services for refugees, to come into effect on June 30, 2012. These include reduction of ‘basic’ coverage, including primary and preventive care, and ‘supplemental’ coverage similar to that available to many low-income Canadians.
These changes are extremely short-sighted. They will result in 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.
Refugees have often fled situations that involved trauma and significant health impacts. Canada should provide care that facilitates health and well-being throughout the settlement process. The impact on pregnant women, children, and those with chronic diseases, is of particular concern.
It should be obvious to any fair-minded observer that the proposed changes will complicate the refugee settlement process, exacerbating barriers and inequities in access to health care and the potential for good health outcomes among an already disadvantaged group. This is both socially unjust and contradicts the principles of the Canada Health Act.
Resolution: PacificSci thus joins with all organizations now 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.
References:
1. PHABC Position on Changes to Health Care Coverage for Refugees. http://www.phabc.org/userfiles/file/PHABCPositiononChangestoHealthCareCoverageforRefugees(1).pdf Accessed June 15, 2012.
2. Press Release. Canadian Doctors for Refugee Care, Reading Page. http://www.doctorsforrefugeecare.ca/further-reading.html Accessed June 15, 2012.
3. Brindamour M, Meili R. Treat Refugees with care. Star Phoenix, June 15, 2012. http://www.thestarphoenix.com/health/Treat+refugees+with+care/6785828/story.html#ixzz1xvQdbfO2 Accessed June 15, 2012.
Wednesday, 16 May 2012
PUBLIC HEALTH IN THE MIDDLE EAST Reconnaissance of Issues and Developments
PREAMBLE: Over the past 15 years, PacificSci principals have had the opportunity to be involved in aspects of public health development in countries grouped within the Eastern Mediterranean Regional Office of the World Health Organization (WHO/EMRO), specifically Kuwait, Pakistan and the United Arab Emirates (UAE). This has been by virtue of both full time geographically-based work (1998-2003), as well as short term consultancies and collegial links.
These countries and their neighbours in the region face many common and similar challenges in terms of social and economic development, status of women, environmental control and regulation, a highly mobile migrant workforce and other demands of competing in a globalized economy.
Over the past decade especially, the region as a whole has also 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.
Good public governance, referring to how public institutions function responsively, transparently, and with accountability, is a key mechanism through which the values of development are secured for people. These values include equality of treatment, freedom to choose, opportunities to participate in the process, and not least of all - justice. Such governance recognizes the integrity, rights, and needs of everyone within the state, and is essential to reducing poverty and stimulating growth.[1]
Good governance also embodies the value of “healthy public policy”, characterized by explicit concern for health and equity in all areas of policy and by accountability for health impact. The main aim of health public policy is to create a supportive environment to enable people to lead healthy lives. Such a policy makes health choices possible or easier for citizens. It makes social and physical environments health-enhancing. In the pursuit of healthy public policy, government sectors concerned with agriculture, trade, education, industry, and communications need to take into account health as an essential factor when formulating policy. Healthy public policy benefits populations, communities and individuals.[2]
This brief Reconnaissance consists of two sections: first, the published perspectives of the World Bank and WHO/EMRO, and secondly, our own observations of the emergence of two important networks: public health associations, and membership of national public health institutes in a new global organization.
Note: Minor edits were made to this posting on May 17 and 18, 2012.
PUBLIC HEALTH IN THE MIDDLE EAST
– Regional Perspectives
A DECADE AGO, the World Bank supported a regional conference in Beirut which led to a major report entitled Public Health in the Middle East and North Africa – meeting the challenges of the twenty-first century.[3]
Based on discussion elaborated in chapters of this report, six priorities emerged: 1. Leadership and Political Will 2. A New View of Public Health 3. Data and Surveillance 4. Partnerships and Collaboration 5. Emerging Health Problems 6. Public Health “Best Buys”
The report stated that “the status of public health practitioners is a significant problem. One of the main challenges facing public health in the... region is the recruitment and retention of appropriate skills and expertise, in terms of both quality and quantity.”
The persistence of an outmoded view of public health therefore is part of the challenge in this region, and could be the greatest obstacle to change: a view of public health as an adjunct to the health care system, rather than as a strategic force for a healthy population.
The challenge therefore is to envision what public health throughout the region could become within a reasonable period, say 15-20 years, then determine how to take it there. Insightful leadership with political support can lead this change.
It is on this particular issue regarding outmoded concepts of public health that the following selected extracts from the 2002 World Bank summary of priority issue #2 (above) justify consideration (bullets added and sequence adjusted for emphasis) and are highly applicable to the region:
A New View of Public Health:
• Countries should undertake assessments of their public health functions and capacity in the near future…. steps should be taken to build capacity and broaden the scope of public health beyond the activities of physicians….
• Public health infrastructure should not be an adjunct to curative health systems. Rather it should be part and parcel of a comprehensive health system that blurs the boundaries between curative and public health services.
• There must be greater multisectoral commitment to healthy public policies; this can be accomplished by developing objectives and targets for healthy populations and lifestyles, including the necessary laws and regulations.
• Developing community based health promotion programs can be an effective way to increase the health literacy of communities.
Now moving to a more recent review by World Bank regional specialists [4], disease-surveillance systems as reviewed by the WHO Regional Office WHO/EMRO) were considered mostly inadequate, with insufficient commitment, lack of practical guidelines, overwhelming reporting requirements, lack of transparency, shortage of human resources, and poor analysis of data. It is stated that: “this deficit in the capability to assess and monitor population health will have to be addressed if effective plans for public health capacity building are to be put in place”.
Equally critical, the World Bank reviewers considered that, while many public-health services are well-established, management functions such as inter-sectoral policymaking, public information and education, and quality assurance, are underdeveloped.
Further, when compared with other world regions, the limited interaction between governments and civil society is considered likely to reduce the social dividend by not meeting rising expectations in the population.
The review argued that higher health sector spending will not translate into effective results if investments are not well managed or directed towards cost-effective solutions, and concludes that new institutional capacities and governance structures are needed.
New Public Health Networks
In some countries, there are organized public health professional and lay networks. These are generally found in larger countries, although with varying levels of vitality e.g., national public health associations exist in Egypt, Ethiopia, Iran, Lebanon, Pakistan, Sudan and Yemen. At the other extreme, the Gulf states so far generally lack this type of non-governmental support for public health; these entities typically have much smaller national populations (with the exception of Saudi Arabia with 27.4 million people, of whom some 19 million are nationals). Such associations have the opportunity to affiliate with a long-standing and reputable international body: the World Federation of Public Health Associations (WFPHA).[5]
Note: The six Arab states bordering the Arabian Gulf: Saudi Arabia, UAE, Qatar, Kuwait, Bahrain and Oman form the Gulf Cooperation Council (GCC). Although Iraq is an Arab state and shares a small border with the Gulf, it is generally not included within this grouping.
Interestingly, national public health institutes are also reaching out among themselves, by affiliating with a recently formed International Association of National Public Health Institutes (IANPHI).[6] Among EMRO countries, these include Afghanistan, Iran, Jordan, Morocco, Pakistan and Saudi Arabia. Turkey and Israel are also members of IANPHI, but not included within the WHO-EMRO group of countries (they are considered within WHO-EURO).
In other words, these governmental public health agencies are starting to link up within an international network. According to their website, IANPHI spearheads improvements in national public health systems through a peer-assistance evaluation, grant support and efforts focused on NPHI advocacy, collaboration, and sustainability. It provides direct funding to governments in low-resource countries to build and strengthen national public health capacity through development of NPHIs. It does this through grants to support NPHI to NPHI evaluations, longer term capacity building initiatives, and seed grants to assist particular research agendas.
All this may make it attractive for other Middle Eastern countries to consider both supporting the development of public health associations and also joining this global intergovernmental agency network, particularly those who need to build capacity... and (when it comes down to it) who doesn't?
Developing a national public health association, especially, is a way of strengthening the role of civil society in a domain that can only be in the best interests of the population.
Envoi –Springtime for Public Health in the Middle East?
Prerequisites for health and social development everywhere are peace and justice; nutritious food and clean water; education and decent housing; a useful role in society and an adequate income; conservation of resources and the protection of the ecosystem. These increasingly appear to be the aspirations of Middle Eastern peoples, and indeed throughout the greater Eastern Mediterranean Region.
The vision of healthy public policy is the achievement of these fundamental conditions for healthy living. The achievement of global health rests on recognizing and accepting interdependence both within and between countries. Commitment to global public health will depend on securing the means of international cooperation, especially to act on issues that cross national boundaries.[6]
While the road ahead will have its challenges, and will require new forms of leadership, the international networking that is starting to emerge in the Middle East may well be a forerunner of an “Arab Spring for public health”. If so, this can only be to the ultimate benefit of all who live in the region.
References
1. World Bank. Better Governance for Development in the Middle East and North Africa: Enhancing Inclusiveness and Accountability. 2011. http://web.worldbank.org/WBSITE/EXTERNAL/COUNTRIES/MENAEXT/EXTMNAREGTOPGOVERNANCE/0,,contentMDK:20261216~pagePK:34004173~piPK:34003707~theSitePK:497024,00.html Accessed May 14, 2012.
2. Report on the Adelaide Conference. Healthy Public Policy. 2nd International Conference on Health Promotion April 5-9, 1988 Adelaide South Australia. http://www.who.int/healthpromotion/conferences/previous/adelide/en/index1.html Accessed May 14, 2012.
3. Pierre-Lousie AM, Akala FA, Karam HS. Public health in the Middle East and North Africa: meeting the challenges of the twenty-first century. World Bank Institute. WBI Learning Resources Series. The World Bank 2004.
4. Akala FA, El-Saharty S. [The aWorld Bank, Middle East and North Africa Region, Human Development Sector, Washington, DC] Public-health challenges in the Middle East and North Africa. The Lancet (2006) 367: 961-4.
5. World Federation of Public Health Associations. http://www.wfpha.org/ Accessed May 16, 2012.
6. Public Health Institutes of the World (IANPHI). http://www.ianphi.org/ Accessed May 13, 2012.
These countries and their neighbours in the region face many common and similar challenges in terms of social and economic development, status of women, environmental control and regulation, a highly mobile migrant workforce and other demands of competing in a globalized economy.
Over the past decade especially, the region as a whole has also 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.
Good public governance, referring to how public institutions function responsively, transparently, and with accountability, is a key mechanism through which the values of development are secured for people. These values include equality of treatment, freedom to choose, opportunities to participate in the process, and not least of all - justice. Such governance recognizes the integrity, rights, and needs of everyone within the state, and is essential to reducing poverty and stimulating growth.[1]
Good governance also embodies the value of “healthy public policy”, characterized by explicit concern for health and equity in all areas of policy and by accountability for health impact. The main aim of health public policy is to create a supportive environment to enable people to lead healthy lives. Such a policy makes health choices possible or easier for citizens. It makes social and physical environments health-enhancing. In the pursuit of healthy public policy, government sectors concerned with agriculture, trade, education, industry, and communications need to take into account health as an essential factor when formulating policy. Healthy public policy benefits populations, communities and individuals.[2]
This brief Reconnaissance consists of two sections: first, the published perspectives of the World Bank and WHO/EMRO, and secondly, our own observations of the emergence of two important networks: public health associations, and membership of national public health institutes in a new global organization.
Note: Minor edits were made to this posting on May 17 and 18, 2012.
PUBLIC HEALTH IN THE MIDDLE EAST
– Regional Perspectives
A DECADE AGO, the World Bank supported a regional conference in Beirut which led to a major report entitled Public Health in the Middle East and North Africa – meeting the challenges of the twenty-first century.[3]
Based on discussion elaborated in chapters of this report, six priorities emerged: 1. Leadership and Political Will 2. A New View of Public Health 3. Data and Surveillance 4. Partnerships and Collaboration 5. Emerging Health Problems 6. Public Health “Best Buys”
The report stated that “the status of public health practitioners is a significant problem. One of the main challenges facing public health in the... region is the recruitment and retention of appropriate skills and expertise, in terms of both quality and quantity.”
The persistence of an outmoded view of public health therefore is part of the challenge in this region, and could be the greatest obstacle to change: a view of public health as an adjunct to the health care system, rather than as a strategic force for a healthy population.
The challenge therefore is to envision what public health throughout the region could become within a reasonable period, say 15-20 years, then determine how to take it there. Insightful leadership with political support can lead this change.
It is on this particular issue regarding outmoded concepts of public health that the following selected extracts from the 2002 World Bank summary of priority issue #2 (above) justify consideration (bullets added and sequence adjusted for emphasis) and are highly applicable to the region:
A New View of Public Health:
• Countries should undertake assessments of their public health functions and capacity in the near future…. steps should be taken to build capacity and broaden the scope of public health beyond the activities of physicians….
• Public health infrastructure should not be an adjunct to curative health systems. Rather it should be part and parcel of a comprehensive health system that blurs the boundaries between curative and public health services.
• There must be greater multisectoral commitment to healthy public policies; this can be accomplished by developing objectives and targets for healthy populations and lifestyles, including the necessary laws and regulations.
• Developing community based health promotion programs can be an effective way to increase the health literacy of communities.
Now moving to a more recent review by World Bank regional specialists [4], disease-surveillance systems as reviewed by the WHO Regional Office WHO/EMRO) were considered mostly inadequate, with insufficient commitment, lack of practical guidelines, overwhelming reporting requirements, lack of transparency, shortage of human resources, and poor analysis of data. It is stated that: “this deficit in the capability to assess and monitor population health will have to be addressed if effective plans for public health capacity building are to be put in place”.
Equally critical, the World Bank reviewers considered that, while many public-health services are well-established, management functions such as inter-sectoral policymaking, public information and education, and quality assurance, are underdeveloped.
Further, when compared with other world regions, the limited interaction between governments and civil society is considered likely to reduce the social dividend by not meeting rising expectations in the population.
The review argued that higher health sector spending will not translate into effective results if investments are not well managed or directed towards cost-effective solutions, and concludes that new institutional capacities and governance structures are needed.
New Public Health Networks
In some countries, there are organized public health professional and lay networks. These are generally found in larger countries, although with varying levels of vitality e.g., national public health associations exist in Egypt, Ethiopia, Iran, Lebanon, Pakistan, Sudan and Yemen. At the other extreme, the Gulf states so far generally lack this type of non-governmental support for public health; these entities typically have much smaller national populations (with the exception of Saudi Arabia with 27.4 million people, of whom some 19 million are nationals). Such associations have the opportunity to affiliate with a long-standing and reputable international body: the World Federation of Public Health Associations (WFPHA).[5]
Note: The six Arab states bordering the Arabian Gulf: Saudi Arabia, UAE, Qatar, Kuwait, Bahrain and Oman form the Gulf Cooperation Council (GCC). Although Iraq is an Arab state and shares a small border with the Gulf, it is generally not included within this grouping.
Interestingly, national public health institutes are also reaching out among themselves, by affiliating with a recently formed International Association of National Public Health Institutes (IANPHI).[6] Among EMRO countries, these include Afghanistan, Iran, Jordan, Morocco, Pakistan and Saudi Arabia. Turkey and Israel are also members of IANPHI, but not included within the WHO-EMRO group of countries (they are considered within WHO-EURO).
In other words, these governmental public health agencies are starting to link up within an international network. According to their website, IANPHI spearheads improvements in national public health systems through a peer-assistance evaluation, grant support and efforts focused on NPHI advocacy, collaboration, and sustainability. It provides direct funding to governments in low-resource countries to build and strengthen national public health capacity through development of NPHIs. It does this through grants to support NPHI to NPHI evaluations, longer term capacity building initiatives, and seed grants to assist particular research agendas.
All this may make it attractive for other Middle Eastern countries to consider both supporting the development of public health associations and also joining this global intergovernmental agency network, particularly those who need to build capacity... and (when it comes down to it) who doesn't?
Developing a national public health association, especially, is a way of strengthening the role of civil society in a domain that can only be in the best interests of the population.
Envoi –Springtime for Public Health in the Middle East?
Prerequisites for health and social development everywhere are peace and justice; nutritious food and clean water; education and decent housing; a useful role in society and an adequate income; conservation of resources and the protection of the ecosystem. These increasingly appear to be the aspirations of Middle Eastern peoples, and indeed throughout the greater Eastern Mediterranean Region.
The vision of healthy public policy is the achievement of these fundamental conditions for healthy living. The achievement of global health rests on recognizing and accepting interdependence both within and between countries. Commitment to global public health will depend on securing the means of international cooperation, especially to act on issues that cross national boundaries.[6]
While the road ahead will have its challenges, and will require new forms of leadership, the international networking that is starting to emerge in the Middle East may well be a forerunner of an “Arab Spring for public health”. If so, this can only be to the ultimate benefit of all who live in the region.
References
1. World Bank. Better Governance for Development in the Middle East and North Africa: Enhancing Inclusiveness and Accountability. 2011. http://web.worldbank.org/WBSITE/EXTERNAL/COUNTRIES/MENAEXT/EXTMNAREGTOPGOVERNANCE/0,,contentMDK:20261216~pagePK:34004173~piPK:34003707~theSitePK:497024,00.html Accessed May 14, 2012.
2. Report on the Adelaide Conference. Healthy Public Policy. 2nd International Conference on Health Promotion April 5-9, 1988 Adelaide South Australia. http://www.who.int/healthpromotion/conferences/previous/adelide/en/index1.html Accessed May 14, 2012.
3. Pierre-Lousie AM, Akala FA, Karam HS. Public health in the Middle East and North Africa: meeting the challenges of the twenty-first century. World Bank Institute. WBI Learning Resources Series. The World Bank 2004.
4. Akala FA, El-Saharty S. [The aWorld Bank, Middle East and North Africa Region, Human Development Sector, Washington, DC] Public-health challenges in the Middle East and North Africa. The Lancet (2006) 367: 961-4.
5. World Federation of Public Health Associations. http://www.wfpha.org/ Accessed May 16, 2012.
6. Public Health Institutes of the World (IANPHI). http://www.ianphi.org/ Accessed May 13, 2012.
Saturday, 14 April 2012
APOLOGIES FOR PAST WRONGS AND GRIEVANCES
PREAMBLE: Disputes over past conflicts often overshadow present and future relations of peoples and states for generations.
Contemporary political debates concerning recent and past conflicts are extensive in number, demonstrating 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 offer an overview of the underlying issues, mostly from a generic standpoint, keeping in mind that there are numerous conflicts of this nature around the world. In preparation, references 1, 2 and 3 were used extensively, while references 4 and 5 also gave additional valuable perspective.
We also include extracts from a Case Study by Frank Brennan S.J. (reference 1) as Visiting Presidential Scholar, Santa Clara University. He is a professor of law in the Institute of Legal Studies at the Australian Catholic University and officer of the Order of Australia (AO) for services to Aboriginal Australians, particularly as an advocate in the areas of law, social justice and reconciliation.
APOLOGIES FOR PAST WRONGS AND GRIEVANCES
Disputes over a common history after past conflicts often overshadow the present and future relations of peoples and states for many generations. Contemporary political debates concerning conflicts in the recent as well as the more distant past are extensive in number, demonstrating that past 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 cause a danger of resuming hostilities even after coming to a negotiated settlement. 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.
But what measures can most effectively bring about reconciliation and accommodate the process of restoring trust? Justice generally demands that the perpetrators are punished, and that victims are restored to the position they were in before the injustice occurred. Often this is done either by restoring a stolen property, or, when this is impossible, victims should receive compensation equal to the value of what was unjustly taken from them, possibly accompanied by compensation for the harm resulting from the wrong. This is considered to be sufficient enough to address the moral trauma incurred by the victim and satisfy feelings of vengeance. But what if the initial perpetrators and the victims cannot be clearly identified because they no longer exist? Who should be held accountable for past injustices, what measures should be taken to correct the wrongs committed in the past, or indeed should anything be done at all?
National apologies serve as official acknowledgments of collective responsibility for historical injustices delivered by states to other states or communities. An apology is usually delivered by individuals representing the state, but having a distinctly political character is perceived to be indicative of the opinion of the collective – usually, the nation. National apologies have received a great deal of attention in a variety of academic disciplines such as law, sociology, psychology and philosophy, triggered by the large number of apologies issued lately as well as the perception that they could in a way repair the past thus contributing to settling the emotional issues brought about by historic injustice. However, have apologies become too commonplace, such that what it means to deliver or receive a national apology is likely to be vague and ambiguous? Further, are we in an “age of apology” for nations and other institutions, or is there a greater historical consciousness operating; or, are we witnessing simply a trend of a “culture of confession”, which at another level, accessible media sites and celebrity hosts bring to the forefront?
Happily, or at least optimistically, we are progressing towards ensuring emerging human rights globally and a role for morality in international affairs. In recent decades, aggrieved groups have made claims for the recognition of past or present victimization, seeking apologies as the means by which their history is officially acknowledged, and their identity reclaimed. As the distance between event and apology lengthens, the “apology moment” is made more possible as present leaders who were not personally implicated in past policies enable the separation of the personal from the political.
The collective or political apology has emerged as a rhetorical tool in international relations, national politics, truth commissions, and the self-reflective practice of a range of institutions, including churches. The stated purpose is usually reconciliation, though damage control or self-justification may also be suspected. Yet how do we make sense of what is happening, and develop an accounting of the possibilities and limits of such apologies?
There are many examples of political leaders expressing regret, remorse or apologising to the victims or their descendants for past wrongdoings. The Vatican remains the leader in the number of apologies issued by a political body, having delivered more than 300 apologies for the crimes perpetrated by the Catholic Church throughout years; Queen Elisabeth II apologised for the wrongs done to Maoris in New Zealand; British Prime Minister Tony Blair apologised for the lack of help during the potato famine in Ireland in 1840s; German Chancellor Willy Brandt in 1970 acknowledged responsibility for the Holocaust; In 1988, the US Congress apologised to Japanese Americans for their internment and discriminatory treatment during World War II. In 2008, the US Senate passed the Indian Health Care Improvement Act acknowledging "a long history of official depredations and ill-conceived policies by the United States Government regarding Indian tribes" and offering "an apology to all Native Peoples on behalf of the United States." Following a number of separate apologies by states, the US congressional apologised for slavery in June 2009; in Australia 2008, the national Parliament apologised to the Aboriginal people; in 2008 an apology was made by Canadian Prime Minister Stephen Harper to former students of Indian Residential Schools.
To the extent that representatives of institutions view apologies as a sign of strength rather than weakness, residing in a moral universal larger than the narrow interests of any one group, then collective apologies are likely to proliferate. Yet, political apologies may also reflect a particular historical moment. What are political apologies about, at root - justice, or reconciliation? Are they about collective memories, or psychological healing? Are complicated calculations of self-interest involved? Are they about meeting a need for a victimized group? How have particular apologies affected a situation? What does effectiveness look like? And do they provide previously unrecognized windows into the nature and function of the institution apologizing? Clearly, further work needs to be done when constructing, analyzing and determining the outcomes of an “apology”.
For some, national apologies are seen as empty symbolic politics, a way of winning favour without paying a real price with (practical) monetary restitution. Others perceive symbolic gestures such as apologies as an important element in acknowledging responsibility, but insist that they ought to be followed by material commitments.
In the academic literature, an apology is perceived as the central and most important element in rectifying past injustices, without which attempts to renew the relationship between the parties involved remains focused on retributive means, based on punishment and easing the feelings of vengeance. Ideally, rectification and reconciliation should be aimed towards establishing positive relations in the future, rather than settling the debts with the past and instituting punishment. Therefore attaching worth to only practical and financial means of rectification can contribute to justice but is not sufficient to eliminate the emotional barriers between the victims and the perpetrators. What is crucial for any conflict to truly be resolved is the phase of reconciliation, which morally accommodates the victims and the perpetrators, establishing new relations of trust, not tainted by past misconducts.
If closely examined, how far do national apologies go towards the “ideal”, and how much does self-interest motivate the act, with little necessary dialogue from both sides, and diminished moral meaning?
Reparative action should only be motivated by the wish to repair the implications of injustices, instead of being means of achieving a potentially favourable result: using a theoretical framework of “virtue ethics”, it expresses the agent’s moral character and acts as the starting point for further discussion.
One of the basic reasons for scepticism about national apologies, transgenerational responsibilities and reparative action in general is the objection that they misidentify the victims and the perpetrators, with the present players “standing in” those acting out and being on the receiving end of past transgressions. However, ignoring past wrongdoings simply because the perpetrators or the victims are no longer alive seems blind to the role historic debates and outcomes play in contemporary politics and life. The basic moral principles of responsibility should apply to all transgenerational searches for justice alike. In order for apologies to be taken seriously, certain guiding principles or standards to follow would enhance their effectiveness.
Until more consideration and discussion is devoted to this research, the debate around national apologies will remain contested and divided, and past discriminations and injustices will continue to hinder progressive relationships beneficial to all.
Extracts - A Case Study by Frank Brennan
In Australia 2008, "the Parliament of Australia" uttered the performative "sorry", and only after all State and Territory Parliaments, churches and other social welfare agencies had done the same. It apologised in its own name acknowledging that earlier parliaments and governments had "inflicted profound grief, suffering and loss" on persons who were their "fellow Australians." The parliament saw its apology as a first step acknowledging the past followed by a second step: "laying claim to a future that embraces all Australians." The parliament pledged itself and future parliaments to "a future based on mutual respect, mutual resolve and mutual responsibility." This apology by the elected parliament came eleven years after individual citizens had started a concerted national campaign of personal apologies for past wrongs and present ongoing consequences.
Brennan suggests the following lessons from the Australian experience:
1. A national apology must be a response to sustained requests by identifiable victims.
2. A national apology must build upon individual apologies and apologies by agencies involved in previous wrongdoing, and not substitute for them.
3. The "we" who apologise must not speak on behalf of the living who are not willing parties to the apology.
4. The "we" who apologise must not presume to speak on behalf of the deceased, applying contemporary moral standards to past behaviour which was legal and judged justifiable at the time.
5. The "we" who apologise must intend to express through their performative utterance of the word "sorry" not only sympathy and regret but also collective responsibility for the ongoing effects of past actions, which "we" now have cause to regret, offering sympathy and entitled assistance to the victims still living and their descendants who have also been affected by those past actions.
6. The "we" who apologise should identify with the collective "we" of the past, who, being the same agent in the polity, approved these past actions or who, at least, failed to counter these past actions when having a duty to act in the interests of the victims.
7. The victims and their descendants should be willing to accept the apology.
8. The "we" (binding the future collective "we") and the victims and their descendants should be prepared to commit themselves to putting the past behind them and working together for a new future.
9. The apology should be backed by a firm commitment by the "we" to make resources available to put right the ongoing adverse effects of past actions, while also leaving open the possibility of payment of compensation (reparations) in proven cases of wrongs committed on identifiable persons.
REFERENCES
1. Brennan F. Stepping Forward to Right Historical Wrongs: National Apologies - Lessons From Down Under. Markkula Center for Applied Ethics. Santa Clara University. March 2008 http://www.scu.edu/ethics/practicing/focusareas/global_ethics/apologies.html Accessed April 14, 2012.
2. Kaleja A. The Role of National Apologies in Rectifying Historical Injustices. MSc International Political Theory University of Edinburgh. August, 2010 PDF document http://www.google.ca/#hl=en&sugexp=frgbld&gs_nf=1&cp=66&gs_id=4&xhr=t&q=The+Role+of+National+Apologies+in+Rectifying+Historical+Injustices&pf=p&sclient=psy-ab&site=&source=hp&oq=The+Role+of+National+Apologies+in+Rectifying+Historical+Injustices&aq=f&aqi=&aql=&gs_l=&pbx=1&bav=on.2,or.r_gc.r_pw.,cf.osb&fp=1d8e567df3a74d9a&biw=1280&bih=822 Accessed April 14, 2012.
3. Bergen JM. Reconciling Past and Present. A Review Essay on Collective Apologies.
Journal of Religion, Conflict, and Peace. Volume 2. Issue 2, Spring 2009
http://www.religionconflictpeace.org/node/52 Accessed April 14, 2012.
4. Pettigrove G. Apologies, Reparations and the Question of Inherited Guilt. Public Affairs Quarterly (2003), 17,4: 319-348. http://www.jstor.org/discover/10.2307/40441363?uid=3739400&uid=2129&uid=2&uid=70&uid=3737720&uid=4&sid=56037396173 Accessed April 14, 2012.
5. Human Rights and Equal Opportunity Commission, Bringing Them Home: The Stolen Children Report. Australian Government Publishing Service, 1997. http://www.hreoc.gov.au/social_justice/bth_report/index.html Accessed April 14, 2012.
Contemporary political debates concerning recent and past conflicts are extensive in number, demonstrating 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 offer an overview of the underlying issues, mostly from a generic standpoint, keeping in mind that there are numerous conflicts of this nature around the world. In preparation, references 1, 2 and 3 were used extensively, while references 4 and 5 also gave additional valuable perspective.
We also include extracts from a Case Study by Frank Brennan S.J. (reference 1) as Visiting Presidential Scholar, Santa Clara University. He is a professor of law in the Institute of Legal Studies at the Australian Catholic University and officer of the Order of Australia (AO) for services to Aboriginal Australians, particularly as an advocate in the areas of law, social justice and reconciliation.
APOLOGIES FOR PAST WRONGS AND GRIEVANCES
Disputes over a common history after past conflicts often overshadow the present and future relations of peoples and states for many generations. Contemporary political debates concerning conflicts in the recent as well as the more distant past are extensive in number, demonstrating that past 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 cause a danger of resuming hostilities even after coming to a negotiated settlement. 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.
But what measures can most effectively bring about reconciliation and accommodate the process of restoring trust? Justice generally demands that the perpetrators are punished, and that victims are restored to the position they were in before the injustice occurred. Often this is done either by restoring a stolen property, or, when this is impossible, victims should receive compensation equal to the value of what was unjustly taken from them, possibly accompanied by compensation for the harm resulting from the wrong. This is considered to be sufficient enough to address the moral trauma incurred by the victim and satisfy feelings of vengeance. But what if the initial perpetrators and the victims cannot be clearly identified because they no longer exist? Who should be held accountable for past injustices, what measures should be taken to correct the wrongs committed in the past, or indeed should anything be done at all?
National apologies serve as official acknowledgments of collective responsibility for historical injustices delivered by states to other states or communities. An apology is usually delivered by individuals representing the state, but having a distinctly political character is perceived to be indicative of the opinion of the collective – usually, the nation. National apologies have received a great deal of attention in a variety of academic disciplines such as law, sociology, psychology and philosophy, triggered by the large number of apologies issued lately as well as the perception that they could in a way repair the past thus contributing to settling the emotional issues brought about by historic injustice. However, have apologies become too commonplace, such that what it means to deliver or receive a national apology is likely to be vague and ambiguous? Further, are we in an “age of apology” for nations and other institutions, or is there a greater historical consciousness operating; or, are we witnessing simply a trend of a “culture of confession”, which at another level, accessible media sites and celebrity hosts bring to the forefront?
Happily, or at least optimistically, we are progressing towards ensuring emerging human rights globally and a role for morality in international affairs. In recent decades, aggrieved groups have made claims for the recognition of past or present victimization, seeking apologies as the means by which their history is officially acknowledged, and their identity reclaimed. As the distance between event and apology lengthens, the “apology moment” is made more possible as present leaders who were not personally implicated in past policies enable the separation of the personal from the political.
The collective or political apology has emerged as a rhetorical tool in international relations, national politics, truth commissions, and the self-reflective practice of a range of institutions, including churches. The stated purpose is usually reconciliation, though damage control or self-justification may also be suspected. Yet how do we make sense of what is happening, and develop an accounting of the possibilities and limits of such apologies?
There are many examples of political leaders expressing regret, remorse or apologising to the victims or their descendants for past wrongdoings. The Vatican remains the leader in the number of apologies issued by a political body, having delivered more than 300 apologies for the crimes perpetrated by the Catholic Church throughout years; Queen Elisabeth II apologised for the wrongs done to Maoris in New Zealand; British Prime Minister Tony Blair apologised for the lack of help during the potato famine in Ireland in 1840s; German Chancellor Willy Brandt in 1970 acknowledged responsibility for the Holocaust; In 1988, the US Congress apologised to Japanese Americans for their internment and discriminatory treatment during World War II. In 2008, the US Senate passed the Indian Health Care Improvement Act acknowledging "a long history of official depredations and ill-conceived policies by the United States Government regarding Indian tribes" and offering "an apology to all Native Peoples on behalf of the United States." Following a number of separate apologies by states, the US congressional apologised for slavery in June 2009; in Australia 2008, the national Parliament apologised to the Aboriginal people; in 2008 an apology was made by Canadian Prime Minister Stephen Harper to former students of Indian Residential Schools.
To the extent that representatives of institutions view apologies as a sign of strength rather than weakness, residing in a moral universal larger than the narrow interests of any one group, then collective apologies are likely to proliferate. Yet, political apologies may also reflect a particular historical moment. What are political apologies about, at root - justice, or reconciliation? Are they about collective memories, or psychological healing? Are complicated calculations of self-interest involved? Are they about meeting a need for a victimized group? How have particular apologies affected a situation? What does effectiveness look like? And do they provide previously unrecognized windows into the nature and function of the institution apologizing? Clearly, further work needs to be done when constructing, analyzing and determining the outcomes of an “apology”.
For some, national apologies are seen as empty symbolic politics, a way of winning favour without paying a real price with (practical) monetary restitution. Others perceive symbolic gestures such as apologies as an important element in acknowledging responsibility, but insist that they ought to be followed by material commitments.
In the academic literature, an apology is perceived as the central and most important element in rectifying past injustices, without which attempts to renew the relationship between the parties involved remains focused on retributive means, based on punishment and easing the feelings of vengeance. Ideally, rectification and reconciliation should be aimed towards establishing positive relations in the future, rather than settling the debts with the past and instituting punishment. Therefore attaching worth to only practical and financial means of rectification can contribute to justice but is not sufficient to eliminate the emotional barriers between the victims and the perpetrators. What is crucial for any conflict to truly be resolved is the phase of reconciliation, which morally accommodates the victims and the perpetrators, establishing new relations of trust, not tainted by past misconducts.
If closely examined, how far do national apologies go towards the “ideal”, and how much does self-interest motivate the act, with little necessary dialogue from both sides, and diminished moral meaning?
Reparative action should only be motivated by the wish to repair the implications of injustices, instead of being means of achieving a potentially favourable result: using a theoretical framework of “virtue ethics”, it expresses the agent’s moral character and acts as the starting point for further discussion.
One of the basic reasons for scepticism about national apologies, transgenerational responsibilities and reparative action in general is the objection that they misidentify the victims and the perpetrators, with the present players “standing in” those acting out and being on the receiving end of past transgressions. However, ignoring past wrongdoings simply because the perpetrators or the victims are no longer alive seems blind to the role historic debates and outcomes play in contemporary politics and life. The basic moral principles of responsibility should apply to all transgenerational searches for justice alike. In order for apologies to be taken seriously, certain guiding principles or standards to follow would enhance their effectiveness.
Until more consideration and discussion is devoted to this research, the debate around national apologies will remain contested and divided, and past discriminations and injustices will continue to hinder progressive relationships beneficial to all.
Extracts - A Case Study by Frank Brennan
In Australia 2008, "the Parliament of Australia" uttered the performative "sorry", and only after all State and Territory Parliaments, churches and other social welfare agencies had done the same. It apologised in its own name acknowledging that earlier parliaments and governments had "inflicted profound grief, suffering and loss" on persons who were their "fellow Australians." The parliament saw its apology as a first step acknowledging the past followed by a second step: "laying claim to a future that embraces all Australians." The parliament pledged itself and future parliaments to "a future based on mutual respect, mutual resolve and mutual responsibility." This apology by the elected parliament came eleven years after individual citizens had started a concerted national campaign of personal apologies for past wrongs and present ongoing consequences.
Brennan suggests the following lessons from the Australian experience:
1. A national apology must be a response to sustained requests by identifiable victims.
2. A national apology must build upon individual apologies and apologies by agencies involved in previous wrongdoing, and not substitute for them.
3. The "we" who apologise must not speak on behalf of the living who are not willing parties to the apology.
4. The "we" who apologise must not presume to speak on behalf of the deceased, applying contemporary moral standards to past behaviour which was legal and judged justifiable at the time.
5. The "we" who apologise must intend to express through their performative utterance of the word "sorry" not only sympathy and regret but also collective responsibility for the ongoing effects of past actions, which "we" now have cause to regret, offering sympathy and entitled assistance to the victims still living and their descendants who have also been affected by those past actions.
6. The "we" who apologise should identify with the collective "we" of the past, who, being the same agent in the polity, approved these past actions or who, at least, failed to counter these past actions when having a duty to act in the interests of the victims.
7. The victims and their descendants should be willing to accept the apology.
8. The "we" (binding the future collective "we") and the victims and their descendants should be prepared to commit themselves to putting the past behind them and working together for a new future.
9. The apology should be backed by a firm commitment by the "we" to make resources available to put right the ongoing adverse effects of past actions, while also leaving open the possibility of payment of compensation (reparations) in proven cases of wrongs committed on identifiable persons.
REFERENCES
1. Brennan F. Stepping Forward to Right Historical Wrongs: National Apologies - Lessons From Down Under. Markkula Center for Applied Ethics. Santa Clara University. March 2008 http://www.scu.edu/ethics/practicing/focusareas/global_ethics/apologies.html Accessed April 14, 2012.
2. Kaleja A. The Role of National Apologies in Rectifying Historical Injustices. MSc International Political Theory University of Edinburgh. August, 2010 PDF document http://www.google.ca/#hl=en&sugexp=frgbld&gs_nf=1&cp=66&gs_id=4&xhr=t&q=The+Role+of+National+Apologies+in+Rectifying+Historical+Injustices&pf=p&sclient=psy-ab&site=&source=hp&oq=The+Role+of+National+Apologies+in+Rectifying+Historical+Injustices&aq=f&aqi=&aql=&gs_l=&pbx=1&bav=on.2,or.r_gc.r_pw.,cf.osb&fp=1d8e567df3a74d9a&biw=1280&bih=822 Accessed April 14, 2012.
3. Bergen JM. Reconciling Past and Present. A Review Essay on Collective Apologies.
Journal of Religion, Conflict, and Peace. Volume 2. Issue 2, Spring 2009
http://www.religionconflictpeace.org/node/52 Accessed April 14, 2012.
4. Pettigrove G. Apologies, Reparations and the Question of Inherited Guilt. Public Affairs Quarterly (2003), 17,4: 319-348. http://www.jstor.org/discover/10.2307/40441363?uid=3739400&uid=2129&uid=2&uid=70&uid=3737720&uid=4&sid=56037396173 Accessed April 14, 2012.
5. Human Rights and Equal Opportunity Commission, Bringing Them Home: The Stolen Children Report. Australian Government Publishing Service, 1997. http://www.hreoc.gov.au/social_justice/bth_report/index.html Accessed April 14, 2012.
Friday, 16 March 2012
GLOBAL DRINKING WATER GOAL MET FIVE YEARS AHEAD OF SCHEDULE
PREAMBLE: One of our most visited blogs is entitled “Drawing attention to a global pandemic – diarrhoeal disease” (October 15, 2009). This addresses one of the more neglected issues on the international and global public health agenda, especially when compared with AIDS, Tuberculosis and Malaria and Vaccine Preventable Diseases (all of which are also important priorities). Compared to these, diarrhoeal disease strangely receives much less attention by many donor health agencies and their information outlets. Perhaps this is because some of the solutions so capital-intensive that some donors prefer to look the other way. Or perhaps it is because the problem is perceived to be “local” and does not significantly threaten developed countries with importation: onward transmission is not likely to occur in nations with advanced water and sanitation infrastructures. Yet diarrhoeal disease is one of the most severe burdens for many low income countries, vying with acute respiratory infections as the leading cause of child mortality, and simultaneously causing serious morbidity across the age spectrum.
In this issue of PacificSci Global Perspectives, we are therefore pleased to give visibility to real progress in addressing the long-standing lack of portable 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. The WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation (JMP), reports every two years on access to drinking water and sanitation worldwide and on progress towards related targets under Millennium Development Goal 7 (environmental sustainability). This 2012 report is based on data gathered from household surveys and censuses, including both recent and older data sets that have come to the attention of the JMP. The estimates presented here describe the situation as of end-2010 and supersede those of the JMP update published in March 2010.
Despite real progress however, 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 (the world’s rich nations) we also need to take note of the recognition by the UN General Assembly, in 2010, of “water and sanitation as a human right" provides additional political impetus towards the ultimate goal of providing everyone with access to these vital services. Unfortunately, there were a number of abstentions, including Canada (Harper government). See: GA/10967 http://www.un.org/News/Press/docs/2010/ga10967.doc.htm This abstention is curious, to say the least, given that Canada’s indigenous people suffer disproportionately from poor water and sanitation.
PROGRESS ON DRINKING WATER AND SANITATION: 2010 UPDATE
Published jointly by UNICEF and World Health Organization 2012, the full report is available online as a PDF file [66p.]. The full reference and URL are supplied at foot of this page.
The report brings welcome news:
the Millennium Development Goals (MDG) drinking water target, which calls for halving the proportion of the population without sustainable access to safe drinking water between 1990 and 2015, was met in 2010, five years ahead of schedule.
However, the report also shows why the job is far from finished. Many still lack safe drinking water, and the world is unlikely to meet the MDG sanitation target. Continued efforts are needed to reduce urban-rural disparities and inequities associated with poverty; to dramatically increase coverage in countries in sub-Saharan Africa and Oceania; to promote global monitoring of drinking water quality; to bring sanitation ‘on track’; and to look… towards universal coverage.
Since 1990, more than 2 billion people have gained access to improved drinking water sources. This achievement is a testament to the commitment of Government leaders, public and private sector entities, communities and individuals who saw the target not as a dream, but as a vital step towards improving health and well-being. Of course, much work remains to be done. There are still 780 million people without access to an improved drinking water source. And even though 1.8 billion people have gained access to improved sanitation since 1990, the world remains off track for the sanitation target. It is essential to accelerate progress in the remaining time before the MDG deadline (2015).
As we approach the 2015 target date for the MDGs, WHO and UNICEF are addressing current monitoring challenges and those that lie ahead. The safety and reliability of drinking water supplies and the sustainability of both water supply sources and sanitation facilities are not addressed by the current set of indicators used to track progress. Accordingly, this report details work under way to refine both indicators and methods of monitoring, as part of the 2010-2015 JMP strategy. It also discusses the beginnings of a process to develop new water, sanitation and hygiene goals, targets and indicators beyond 2015, in alignment with the human right to water and sanitation and the mandate of the UN Special Rapporteur on the Human Right to Water and Sanitation.
OTHER HIGHLIGHTS
Huge disparities exist. While coverage of improved water supply sources is 90 per cent or more in Latin America and the Caribbean, Northern Africa and large parts of Asia, it is only 61 per cent in sub-Saharan Africa. Coverage in the developing world overall stands at 86 per cent, but it is only 63 per cent in countries designated as ‘least developed’. Similar disparities are found within countries – between the rich and poor and between those living in rural and urban areas.
Complete information about drinking water safety is not available for global monitoring. Systematically testing the microbial and chemical quality of water at the national level in all countries is prohibitively expensive and logistically complicated; therefore, a proxy indicator for water quality was agreed upon for MDG monitoring. This proxy measures the proportion of the population using ‘improved’ drinking water sources, defined as those that, by the nature of their construction, are protected from outside contamination, particularly faecal matter. However, some of these sources may not be adequately maintained and therefore may not actually provide ‘safe’ drinking water. As a result, it is likely that the number of people using safe water supplies has been over-estimated.
More than 780 million people remain unserved. Although the MDG drinking water target has been met, it only calls for halving the proportion of people without safe drinking water. More than one tenth of the global population still relied on unimproved drinking water sources in 2010. The last two decades have seen impressive increases in the use of both piped connections to a dwelling, plot or yard and other improved sources, such as protected dug wells, boreholes, rainwater collection and standpipes.
Wide variations are found in the rate at which regions have improved coverage. In general, regions in which coverage was already high have made more modest gains, rising by only a few percentage points over 20 years. Of note are the impressive gains in Eastern Asia, which added 23 percentage points, and the small decline in coverage in the Caucasus and Central Asia and in Oceania. The results show that the majority of countries lagging behind on the drinking water target are in sub-Saharan Africa. In fact, only 19 out of 50 countries in that region are on track to meet the target by 2015.
Regarding the number of people who have gained access to an improved drinking water source since 1990, the progress of India and China not only dominates their respective regions, but represents nearly half of the global progress towards the drinking water target. If only the developing world is considered, China and India represent more than half of the people who have gained access.
For the first time, data on the use of unimproved sources have been disaggregated into two categories: surface water and other unimproved sources. The latter includes unprotected dug wells, unprotected springs and water delivered by cart or tanker. Surface water includes water collected directly from rivers, lakes, ponds, irrigation channels and other surface sources. The use of surface water stands at a surprisingly high 3 per cent of the global population, or 187 million people. Most of these people – 94 per cent – are rural inhabitants, and they are concentrated in sub-Saharan Africa. In fact, 19 per cent of rural dwellers in sub-Saharan Africa and 39 per cent of rural residents in Oceania rely on surface water for drinking and cooking.
Source: UNICEF & WHO. Progress on Drinking Water and Sanitation: 2010 Update. Released 2012. http://www.who.int/water_sanitation_health/publications/2012/jmp2012.pdf Accessed March 16, 2012.
In this issue of PacificSci Global Perspectives, we are therefore pleased to give visibility to real progress in addressing the long-standing lack of portable 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. The WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation (JMP), reports every two years on access to drinking water and sanitation worldwide and on progress towards related targets under Millennium Development Goal 7 (environmental sustainability). This 2012 report is based on data gathered from household surveys and censuses, including both recent and older data sets that have come to the attention of the JMP. The estimates presented here describe the situation as of end-2010 and supersede those of the JMP update published in March 2010.
Despite real progress however, 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 (the world’s rich nations) we also need to take note of the recognition by the UN General Assembly, in 2010, of “water and sanitation as a human right" provides additional political impetus towards the ultimate goal of providing everyone with access to these vital services. Unfortunately, there were a number of abstentions, including Canada (Harper government). See: GA/10967 http://www.un.org/News/Press/docs/2010/ga10967.doc.htm This abstention is curious, to say the least, given that Canada’s indigenous people suffer disproportionately from poor water and sanitation.
PROGRESS ON DRINKING WATER AND SANITATION: 2010 UPDATE
Published jointly by UNICEF and World Health Organization 2012, the full report is available online as a PDF file [66p.]. The full reference and URL are supplied at foot of this page.
The report brings welcome news:
the Millennium Development Goals (MDG) drinking water target, which calls for halving the proportion of the population without sustainable access to safe drinking water between 1990 and 2015, was met in 2010, five years ahead of schedule.
However, the report also shows why the job is far from finished. Many still lack safe drinking water, and the world is unlikely to meet the MDG sanitation target. Continued efforts are needed to reduce urban-rural disparities and inequities associated with poverty; to dramatically increase coverage in countries in sub-Saharan Africa and Oceania; to promote global monitoring of drinking water quality; to bring sanitation ‘on track’; and to look… towards universal coverage.
Since 1990, more than 2 billion people have gained access to improved drinking water sources. This achievement is a testament to the commitment of Government leaders, public and private sector entities, communities and individuals who saw the target not as a dream, but as a vital step towards improving health and well-being. Of course, much work remains to be done. There are still 780 million people without access to an improved drinking water source. And even though 1.8 billion people have gained access to improved sanitation since 1990, the world remains off track for the sanitation target. It is essential to accelerate progress in the remaining time before the MDG deadline (2015).
As we approach the 2015 target date for the MDGs, WHO and UNICEF are addressing current monitoring challenges and those that lie ahead. The safety and reliability of drinking water supplies and the sustainability of both water supply sources and sanitation facilities are not addressed by the current set of indicators used to track progress. Accordingly, this report details work under way to refine both indicators and methods of monitoring, as part of the 2010-2015 JMP strategy. It also discusses the beginnings of a process to develop new water, sanitation and hygiene goals, targets and indicators beyond 2015, in alignment with the human right to water and sanitation and the mandate of the UN Special Rapporteur on the Human Right to Water and Sanitation.
OTHER HIGHLIGHTS
Huge disparities exist. While coverage of improved water supply sources is 90 per cent or more in Latin America and the Caribbean, Northern Africa and large parts of Asia, it is only 61 per cent in sub-Saharan Africa. Coverage in the developing world overall stands at 86 per cent, but it is only 63 per cent in countries designated as ‘least developed’. Similar disparities are found within countries – between the rich and poor and between those living in rural and urban areas.
Complete information about drinking water safety is not available for global monitoring. Systematically testing the microbial and chemical quality of water at the national level in all countries is prohibitively expensive and logistically complicated; therefore, a proxy indicator for water quality was agreed upon for MDG monitoring. This proxy measures the proportion of the population using ‘improved’ drinking water sources, defined as those that, by the nature of their construction, are protected from outside contamination, particularly faecal matter. However, some of these sources may not be adequately maintained and therefore may not actually provide ‘safe’ drinking water. As a result, it is likely that the number of people using safe water supplies has been over-estimated.
More than 780 million people remain unserved. Although the MDG drinking water target has been met, it only calls for halving the proportion of people without safe drinking water. More than one tenth of the global population still relied on unimproved drinking water sources in 2010. The last two decades have seen impressive increases in the use of both piped connections to a dwelling, plot or yard and other improved sources, such as protected dug wells, boreholes, rainwater collection and standpipes.
Wide variations are found in the rate at which regions have improved coverage. In general, regions in which coverage was already high have made more modest gains, rising by only a few percentage points over 20 years. Of note are the impressive gains in Eastern Asia, which added 23 percentage points, and the small decline in coverage in the Caucasus and Central Asia and in Oceania. The results show that the majority of countries lagging behind on the drinking water target are in sub-Saharan Africa. In fact, only 19 out of 50 countries in that region are on track to meet the target by 2015.
Regarding the number of people who have gained access to an improved drinking water source since 1990, the progress of India and China not only dominates their respective regions, but represents nearly half of the global progress towards the drinking water target. If only the developing world is considered, China and India represent more than half of the people who have gained access.
For the first time, data on the use of unimproved sources have been disaggregated into two categories: surface water and other unimproved sources. The latter includes unprotected dug wells, unprotected springs and water delivered by cart or tanker. Surface water includes water collected directly from rivers, lakes, ponds, irrigation channels and other surface sources. The use of surface water stands at a surprisingly high 3 per cent of the global population, or 187 million people. Most of these people – 94 per cent – are rural inhabitants, and they are concentrated in sub-Saharan Africa. In fact, 19 per cent of rural dwellers in sub-Saharan Africa and 39 per cent of rural residents in Oceania rely on surface water for drinking and cooking.
Source: UNICEF & WHO. Progress on Drinking Water and Sanitation: 2010 Update. Released 2012. http://www.who.int/water_sanitation_health/publications/2012/jmp2012.pdf Accessed March 16, 2012.
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