IHSJ Reader Issue 29
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Cholera and the Road to Modernity: Lessons from One Latin American Epidemic for Another (Jonathan Weigel, Paul Farmer, Americas Quarterly, July 2012)
The authors discuss what lessons can be learned from the Latin American cholera epidemic of the 1990s and what these lessons mean for vaccination efforts in Haiti. Farmer and Weigel assert that the decline of cholera in Latin America cannot be solely attributed to improved water and sanitation systems because these improvements were not universal across countries, and the persistence of other water-borne diseases indicates that water insecurity remained a problem. Instead, they argue that "claims of causality about the ebb and flow of cholera will always be fraught with biosocial complexity," including environmental and climatic factors. As such, a glorification of the effects of sanitation interventions should not be used as an argument against vaccination. All tools should be employed to fight cholera today.
The Long Uphill Battle against AIDS (The New York Times, July 27, 2012)
The International AIDS Conference was held in the United States for the first time in more than two decades, due partly to a travel ban on HIV-positive individuals being lifted in 2009. While the conference covered many topics, there was a particular emphasis on the possibility of a “cure” or an effective vaccine to allow people to stop taking the drugs that turned AIDS into a chronic disease. While many fear this is far off in the future, there are also concrete steps to take in the present to reduce the spread of the virus and create an “AIDS-free generation.” However, while steps to control the AIDS epidemic in the foreseeable future are feasible, the global community continues to lack the political will and financial contributions to make that vision a reality.
Untangling the Web of Antiretroviral Price Reductions (Medecins Sans Frontieres, July 2012)
By 2015, World Health Organization (WHO) initiatives aim to halve the number of new HIV infections by drastically increasing the number of people on antiretroviral treatment (ART). In order for ART to be scaled up in resource-limited settings, drug prices must be decreased and remain low. This report offers an overview of ART regimens used over time, with an explanation of how generic competition has kept first-line regimens at a low cost, but how second-line regimens for patients who have resistant strains remain expensive due to a global increase in patenting and other intellectual property measures. The authors argue that more governments should use compulsory licenses, which, under international trade laws, can override patents and allow for open generic competition, thereby keeping prices low for public health initiatives. This report also provides a detailed profile of ART drugs and regimens, including dosage, quality and cost over time, in order to better understand how policies have affected drug affordability and accessibility, especially in resource-limited countries.
HEALTH SYSTEMS STRENGTHENING
What We Can Learn from Third-World Health Care (Pauline Chen, The New York Times, July 26, 2012)
Chen presents the American healthcare system as a great international paradox: a nation with the highest health expenditures alongside underperformance in crucial health indicators. Chen suggests that perhaps strengthening the U.S. healthcare system can be best achieved through "reverse innovation," or looking at the ways in which high-quality health care is delivered in low-resource settings. Health Leads, Partners In Health, and PACT are all cited as model organizations that look beyond traditional assumptions regarding the delivery of health care, and instead consider models that incorporate food support, housing, and community health workers to improve overall health. Applying these broad definitions of care has both helped to achieve success in terms of health indicator performance and decreased health spending among the most vulnerable populations.
Associations between Human Rights Environments and Health Longevity: The Case of Older Persons in China (Bethany Brown, Li Qiu, Danan Gu, Health and Human Rights, July 2012)
Human rights are fundamental, universal rights based on personal dignity and worth. Within the range of human rights, civil, political, economic, and social rights are often neglected. This study examined more than 18,000 Chinese adults to quantify the impact of human rights on an aging population. Not surprisingly, results showed that those with adequate access to nutrition, shelter, education, health care, and clean-air environments lived longer, healthier lives than their counterparts whose fundamental rights were not fulfilled. To provide better human rights environments, governments need to support and strengthen comprehensive health systems that provide medical care, but that also treat the underlying determinants of health.
First Cancer Treatment Center in Rwanda Breaks Ground (Archinect, July 2012)
The recent opening of Rwanda’s Butaro Cancer Center for Excellence marked the culmination of a multi-year collaboration between Partners In Health, the Rwandan Ministry of Health, and MASS Design Group, an architectural firm that focuses on designing buildings that improve health and strengthen communities. MASS’s innovative approach to building construction is based on the idea that a building’s design and layout are an integral part of the healing process. For instance, the Butaro Cancer Center utilizes natural cross-ventilation and UV lighting to reduce transmission of airborne infectious diseases. MASS also utilized local labor and resources in the construction process. Mindful of how design and architecture impact patients’ lives, MASS is at the forefront of what Paul Farmer calls “an architecture of social justice.”
Achieving High Coverage in Rwanda’s National Human Papillomavirus Vaccination Programme (Agnes Binagwaho, Claire Wagner, Maurice Gatera, Corine Karema, Cameron Nutt, Fidele Ngabo, Bulletin of the World Health Organization, May 23, 2012)
The average difference between vaccine introduction in rich and poor countries is 15 to 20 years. In an effort to prevent the millions of deaths that would result from such a delay in access, this article outlines how Rwanda’s “public-private-community partnership” has made it the world’s first low-income country to provide universal access to the HPV vaccine. With an initial coverage rate of more than 93 percent after the first course of vaccination, these results indicate that placing an emphasis on health systems strengthening, national ownership, and public-private collaboration is crucial for long-term success.
Trends in Malaria Cases, Hospital Admissions and Deaths Following Scale-Up of Anti-Malarial Interventions, 2000-2010, Rwanda (Corine Karema, Maru Aregawi, et. al, Malaria Journal, July 23, 2012)
Using data collected at hospitals over a 10-year period, a research team was able to retrospectively measure the effects of new malaria interventions on the number of malaria cases, hospital admissions, and deaths. These interventions included the large-scale distribution of insecticide-treated nets (ITN) and the delivery of a new anti-malarial drug, artemether-lumefantrine (ACT). The expansion of treatment and prevention methods resulted in a decline of over 50 percent in malaria cases and deaths after the scale-up of ITN distribution and the advent of ACT delivery.
U.S. Government Accountability Office (GAO) Reports – Ensuring Drug Quality in Global Health Programs and Reform Agenda Developed, but U.S. Actions to Monitor Progress Could be Enhanced
These two recent reports from the U.S. Government Accountability Office summarize research on global health to report to Congress. “Ensuring Drug Quality in Global Health Programs” focuses on medicines being purchased with U.S. funds for global health and highlights the potential for ineffectiveness or harm from drug resistance. The second report discusses how the World Health Organization’s (WHO) reform agenda could be adapted to strengthen monitoring, transparency, and assessment mechanisms.
XIX International AIDS Conference Closing Session (Bill Clinton, Kaiser Family Foundation, July 27, 2012)
Listen to former President Clinton's speech about the need for increased investment to achieve universal access to HIV treatment by 2015 to achieve an AIDS -free generation.