IHSJ Reader     March 2012     Issue 20         

Note: Triple asterisk (***) indicates subscription-only sources.



 No One Should Die of Tuberculosis in the 21st Century (Salmaan Keshavjee, Sophie Beauvais, Huffington Post, March 24, 2012)
On World TB Day, Dr. Salmaan Keshavjee, a senior TB specialist at Partners In Health and the Director of the Program in Infectious Disease and Social Change in the Department of Global Health and Social Medicine at Harvard Medical School, and Sophie Beauvais from Harvard’s Global Health Delivery Project, draw attention to the growing prevalence of drug-resistant tuberculosis. Drug-resistant tuberculosis (DR-TB) strains are resistant to the simplest form of TB treatment and usually require months of treatment with five or more medications. While DR-TB can spread from person to person, it can also result from weak health systems, inadequate treatment, and insufficient care. The authors call for two important steps to be taken to fight this deadly disease. First, the Global Fund to Fight AIDS, TB, and Malaria should increase the supply of quality-assured second-line drugs and work to ensure the lowest prices are being paid for second-line TB medicines. Second, the United States Government should push for drug-resistant tuberculosis to be higher up on the global health agenda.

No More Crying, No More Dying. Towards Zero TB Deaths in Children (Stop TB Partnership and World Health Organization, March 2012)
At least half a million infants and children become ill with TB and as many as 70,000 die of the disease each year. In order to make progress towards the goal of “zero TB deaths” among children, this Stop TB Partnership and World Health Organization brief recommends a renewed focus on childhood TB. Critical priorities include: active pediatric TB case finding, especially among families affected by TB and HIV; integration of TB, HIV, and maternal and child health services; and increased investment in research and development for new tools and diagnostics such as child-friendly treatment formulations and easy-to-use pediatric TB diagnostics. Partners In Health welcomes the renewed focus on comprehensive, integrated health programs and calls for increased investment in community health workers in order to expand high-quality health care to the poor who are disproportionately affected by TB.

Tuberculosis Control and Elimination in 2012 and Beyond (The Lancet, March 24, 2012)
In this World TB Day editorial, the Lancet highlights global success in tuberculosis control while calling for further action to ensure that targets can be met. Despite the growing funding gap, tuberculosis incidence has been falling, more people are being treated, and fewer people are dying from the disease. But in order to sustain progress and meet the ambitious target of zero TB deaths among children by 2015, TB must be included on the G20 agenda in July.



America Is Stealing the World’s Doctors (Matt McAllester, The New York Times, March 7, 2012)
What Is Not Owned Cannot Be Stolen: Stop Dehumanizing African Health Workers (Michael Clemens, Center for Global Development Blog, March 12, 2012)
In this New York Times article, journalist Matt McAllester explores some of the difficult issues facing medical professionals in Zambia and other under-resourced countries. Though the notion that “America is stealing doctors” has been rightfully rebuked (see CGD blog), the article does lay bare the immense challenges facing health workers in weak, underfunded public health systems. Dilapidated infrastructure, understaffed clinics, and shortages of medicine and supplies all compound the health worker crisis. In order to the reverse this so-called brain drain, international partners should invest in robust national health plans to ensure that health workers are fairly compensated and accessing the tools they need to practice their lifesaving trade.  



***Maternal Morbidity: Neglected Dimension of Safe Motherhood in the Developing World (Karen Hardee, Jill Gay, Ann Blanc, Global Public Health, March 16, 2012)
The “safe motherhood” and “maternal mortality” discourse largely overlooks the disproportionate toll of maternal morbidity on impoverished women. Yet for every woman who dies in pregnancy or childbirth, another 20 women suffer from pregnancy-related morbidity including anaemia, maternal depression, infertility, fistula, uterine rupture and scarring, and genital and uterine prolapse. Efforts to tackle maternal mortality and morbidity must be integrated at the research, policy, and program level through improved data collection, expanded access to comprehensive women’s health care, and a focus on tackling the underlying drivers of maternal morbidity such as undernutrition.

Reducing Neonatal Mortality in Resource Poor Settings (Kim Dickenson, British Medical Journal, March 21, 2012)
Despite the advancements made in reducing child deaths, maternal mortality, and deaths from communicable diseases, progress in reducing neonatal mortality (deaths within the first month of life) lags far behind. More than 40% of all deaths in children under five occur in the first month of life. Authors of this study argue that the Millennium Development Goal for reducing child mortality cannot be met without targeted and substantial reductions in neonatal mortality.



Why the Affordable Care Act’s Individual Purchase Mandate is Both Constitutional and Indispensable to the Public Welfare (Lawrence Gostin, O’Neill Institute for National and Global Health Law, March 19, 2012)
Lawrence Gostin of the O’Neill Institute for National and Global Health Law at Georgetown Law provides a short briefing paper on the constitutionality of the Affordable Care Act’s individual purchase mandate. The author argues the constitutionality of the mandate is rooted in the Commerce Clause, the Necessary and Proper Clause, and the “limiting principle” of individual liberty. The Affordable Care Act and its individual mandate are critical to achieving universal access to health care.



 Putting Inequality in the Post-2015 Picture (Claire Melamed, Overseas Development Institute, March 2012)
This Overseas Development Institute paper reviews proposals for integrating inequality into a post-2015 Millenium Development Goals (MDGs) framework. The Millennium Development Goals have been the focus of global and national efforts on poverty reduction since 2000.  Yet marginalized populations in every region of the world consistently lag behind in making progress on universal health and poverty indicators. A specific focus on equity would encourage governments and their partners to prioritize hard-to-reach groups in their efforts to obtain the MDGs.



The White Savior Industrial Complex (Teju Cole, The Atlantic, March 21, 2012)
Teju Cole’s recent tweets about the “white savior” were shared widely and sparked criticism from many. In this article, he extrapolates on the changes Americans must make in their attempts to “help” Africa. Instead of focusing on saving Africa, Americans should consider the impact of US foreign policies and lobby their representatives to support policies that will encourage and amplify the voices of marginalized communities throughout the world.

Case Studies in Global Health: Video Library available (Global Health Delivery Project, Harvard University, March 12, 2012)
The Harvard University Extension School and faculty have made all lectures for the course “Case Studies in Global Health: Biosocial Perspectives” available to the public free of charge. Check out these inspiring 2011 lectures from Paul Farmer, Arthur Kleinman, Anne Becker, Salmaan Keshavjee, and others, and let us know what you think!