Attempts by the United States to prolong the retention of variola (smallpox) virus stocks have been thwarted at the World Health Assembly (WHA) that met from 16 to 24 May. The WHA instead decided to put aside the US proposal in favour of resuming the discussion at the 67th WHA in 2014. The decision followed contentious discussions on a draft resolution, proposed by the US and several co-sponsors, that would have allowed continued retention of the existing virus stocks, with a report on progress of research only in five years' time (2017), at the 69th WHA. Despite an informal working group meeting to deliberate the issue, there was no consensus and a decision was then made to defer the discussion on the draft resolution. In the final decision adopted on 24 May, the WHA decided to strongly reaffirm the decisions of previous WHA sessions that the remaining stocks of variola virus should be destroyed. It also reaffirmed the need to reach consensus on a proposed new date for the destruction of variola virus stocks when research outcomes critical to an improved public health response to an outbreak so permit. It further decided to include a substantive item "Smallpox eradication: Destruction of variola virus stocks" on the provisional agenda of the 67th WHA session.
Values, Policies and Rights
While health has always been a part of international relations, the author of this paper argues that it is only in recent years that it has attracted much attention and started the move from an issue of ‘low-politics’ to one of ‘high-politics.’ While the strategies of most governments point to the increasing central role health plays in national strategy, health is still not yet an issue at the heart of government policy. However, research and thinking by groups such as the Chatham House Centre on Global Health and Foreign Policy and the FIOCRUZ Centre for Global Health and International Co-operation can help it became an increasingly important part of it, the author argues. Given increased globalisation and ‘convergence of interest’, there will likely be much more interaction in the future between ministries of health and other ministries, as well as increased priority given to health in foreign policy strategies. The author notes that a call was made in 2009 to the United States (US) President to highlight health as a pillar of US foreign policy, and he predicts that the United States will put more resources into developing a formal foreign relations-based health strategy.
Global health financing has increased dramatically in recent years, indicative of a rise in health as a foreign policy Issue, in the form of global health diplomacy, which informs foreign policy decision-making in the advancement of international co-operation in health. In this paper, the authors review the arguments for health in foreign policy that inform global health diplomacy. These are organised into six policy frames: security, development, global public goods, trade, human rights and ethical/moral reasoning. Each of these frames has implications for how global health as a foreign policy issue is conceptualised. Differing arguments within and between these policy frames, while overlapping, can also be contradictory. This raises an important question about which arguments prevail in actual state decision-making. This question is addressed through an analysis of policy or policy-related documents and academic literature pertinent to each policy framing with some assessment of policy practice. The reference point for this analysis is the explicit goal of improving global health equity. This goal has increasing national traction within national public health discourse and decision-making and, through the Millennium Development Goals and other multilateral reports and declarations, is entering global health policy discussion. Initial findings support conventional international relations theory that most states, even when committed to health as a foreign policy goal, still make decisions primarily on the basis of the ‘high politics’ of national security and economic material interests. Development, human rights and ethical/moral arguments for global health assistance, the traditional ‘low politics’ of foreign policy, are present in discourse but do not appear to dominate practice. While political momentum for health as a foreign policy goal persists, the framing of this goal remains a contested issue. The analysis offered in this article may prove helpful to those engaged in global health diplomacy or in efforts to have global governance across a range of sectoral interests pay more attention to health equity impacts.
In this study, the impact of a government policy change, comprising the provision of rapid diagnostic tests (RDTs) and advice to restrict anti-malarial treatment to RDT-positive individuals, was assessed by describing diagnostic behaviour and treatment decision-making in febrile outpatients <10 years of age in three hospitals in the Kagera and Mwanza Region in northern Tanzania. The researchers found that, prior to policy change, there was no evident association between the actual level of transmission intensity and drug-prescribing behaviour. After policy change, there was a substantial decrease in anti-malarial prescription and an increase in prescription of antibiotics. The proportion of parasite-negative individuals who received anti-malarials decreased from 89.1% to 38.7% in Biharamulo and from 76.9% to 10% in Rubya after policy change. This study shows that an official policy change, where RDTs were provided and healthcare providers were advised to adhere to RDT results in prescribing drugs can be followed by more rational drug-prescribing behaviour. The current findings are promising for improving treatment policy in Tanzanian hospitals.
The UNAIDS Reference Group on HIV and Human Rights has called on UN Member States to reaffirm the focus on human rights that has driven thirty years of progress in the global HIV response. This statement sets out five non-negotiables for Member States as they negotiate the outcome document for the High-Level Meeting between now and June 8. It states that the outcome document should reaffirm the emphasis on a human rights approach that mutually obliges rich and poor nations to fulfil the human right to health and that respects, protects and fulfils the human rights of people living with, affected by and vulnerable to HIV and AIDS, as well as reaffirm Member States’ shared responsibility to realise the human right to health by setting clear targets for funding the HIV response. Governments should also commit to utilising, to the fullest extent possible, flexibilities under the TRIPS agreement to lower the price of essential medicines, as well as remove laws, policies, practices, stigma and discrimination that block effective responses to AIDS. They should reaffirm the centrality of people living with HIV to the response as well as their human rights to non-discrimination, treatment as prevention, and meaningful participation.
A controversial United States-based project that pays drug users and alcoholics to undergo sterilisation or long-term contraception, is alleged in this article to be setting its sights on women living with HIV in South Africa. The Founder of Project Prevention is reported to have confirmed that they were making plans to offer similar services to women living with HIV in South Africa as well as drug users, in co-operation with local non-governmental organisations. However a government official in the Maternal, Child and Women’s Health in the Department of Health is reported to have said they would approach the Human Rights Commission if the project started operating in South Africa, and that doctors found involved in such medical interventions could be reported to the Health Professions Council of South Africa.
A Ugandan health lobby group, the Centre for Health Human Rights and Development, has petitioned the Constitutional Court over the alarming number of maternal deaths in government health facilities - currently, Uganda has one of the highest maternal mortality rates in the world. The group is arguing that government neglect is responsible, manifested in the ‘careless manner’ in which government hospital staff handle expectant mothers before, during and after birth. They are hoping the Constitutional Court will declare that it is a violation of the right to health when health workers and government fail to take required essential care during pre- and post-natal stages. The petitioners also want financial compensation from government for the affected families.
In this study, the authors set out to determine whether countries with high gender empowerment have a higher female-to-male smoking prevalence ratio. They explored the relationship between the United Nations Development Programme’s gender empowerment measure (GEM) and the female-to-male smoking prevalence ratio (calculated from the World Health Organisation’s 2008 Global Tobacco Control Report). Because a country’s progression through the various stages of the tobacco epidemic and its gender smoking ratio are thought to be influenced by its level of development, they explored this correlation as well, with economic development defined in terms of gross national income (GNI) per capita and income inequality (Gini coefficient). In their findings, the authors note that gender smoking ratio was significantly and positively correlated with the GEM. In addition, the GEM was the strongest predictor of the gender smoking ratio after controlling for GNI per capita and for Gini coefficient. Whether progress towards gender empowerment can take place without a corresponding increase in smoking among women remains to be seen, the authors conclude. They argue for stronger tobacco control measures in countries where women are being increasingly empowered.
In this paper, the authors examine the growing convergence between human rights and development thinking, particularly with regard to social and economic rights. They ask how the dialogue between human rights and development can contribute to furthering progress on the Millennium Development Goals (MDGs). They argue that developing countries need to secure relatively good rates of economic growth to make progress, but may be hampered by the fact that they remain far behind the developed world in terms of technology. Given a good enabling environment, most developing economies would be able to raise productivity fairly rapidly by absorbing existing knowledge from abroad, rather than inventing it for themselves. The rapid growth of South-South trade and investment flows among developing countries would be another supportive factor, but the authors caution that economic growth alone will not guarantee reaching MDG outcomes: governments need to ensure that the economic benefits of growth are equitably distributed.
This paper examines parental control and monitoring and the implications of this on young people's sexual decision making in a rural setting in North-Western Tanzania. Data collection involved 17 focus group discussions and 46 in-depth interviews conducted with young people aged 14-24 years and parents/carers of young people within this age-group. The researchers found that parents were motivated to control and monitor their children's behaviour for reasons such as social respectability and protecting them from unwanted pregnancies and sexually transmitted diseases. Children from single-parent families reported that they received less control and researchers noted that a father's presence in the family seemed important in controlling the activities of young people, while a mother's did not appear to. Girls received more supervision compared to boys. Despite parents making efforts to control and monitor their young people's sexual behaviour, the researchers conclude that parents are faced with major challenges, such as too little time available to spend with their children, which make it difficult for them to monitor them effectively. The researchers argue that there is a need for interventions, such as parenting skills-building, that might enable parents to improve their relationships with their children and help guide their sexual behaviour.