Health equity in economic and trade policies

Developing an agenda for the decolonization of global health
McCoy D, Kapilashrami A, Kumar R, et al: Bulletin of the World Health Organization 102:2, 130–136, 2024

Colonialism, which involves the systemic domination of lands, markets, peoples, assets, cultures or political institutions to exploit, misappropriate and extract wealth and resources, affects health in many ways. In recent years, interest has grown in the decolonization of global health with a focus on correcting power imbalances between high-income and low-income countries and on challenging ideas and values of some wealthy countries that shape the practice of global health. The authors argue that decolonization of global health must also address the relationship between global health actors and contemporary forms of colonialism, in particular the current forms of corporate and financialized colonialism that operate through globalized systems of wealth extraction and profiteering. They present a three-part agenda for action that can be taken to decolonize global health. The first part relates to the power asymmetries that exist between global health actors from high-income and historically privileged countries and their counterparts in low-income and marginalized settings. The second part concerns the colonization of the structures and systems of global health governance itself. The third part addresses how colonialism occurs through the global health system. Addressing all forms of colonialism is argued to call for a political and economic anticolonialism as well as social decolonization aimed at ensuring greater national, racial, cultural and knowledge diversity within the structures of global health.

Mining-Affected Communities: The Elephant Not in the Room
Bailey L: Natural Resource Governance Institute, Blog post: 9 February 2024

At the Mining Indaba in Cape Town in the week of February 5-9 countless references were made to mining-affected citizens of African countries. However, the author of this blog notes that absent from almost all of the rooms where this word was repeatedly invoked were…members of mining-affected communities. Tengi George-Ikoli shared an African adage: “A man’s head should not be shaved in his absence.” Community voices are observed to be essential in spaces like Indaba to ensure that decision makers account for the social, economic and environmental impacts of mining and minimize them. One place that was replete with community stakeholders was Alternative Mining Indaba, which has operated in distant parallel to the main Indaba for 15 years. However the author argues in this blog that until communities and civil society have a more fixed and prominent seat at the table, and agendas reflect the importance of their voices, progress on challenges such as adding value to raw commodities will be difficult.

Common but Differentiated Responsibilities: The Equity Principle Guiding Climate Change, and the Reforms for Pandemic Prevention, Preparedness & Response
Tcholakov Y: Geneva Health Files, Switzerland, 2023

While low and middle income countries have called for the principle of Common but Differentiated Responsibilities (CBDR) to be embedded to meet equity objectives in the on-going global health negotiations on climate change and pandemic preparedness, drawing on environmental policies, they face resistance from other countries. The author suggests two possible scenarios ahead: In the first, the CBDR principle is broadly accepted and implemented in a more equitable and effective pandemic response that acknowledges the differentiated capacities of nations and allocates obligations accordingly, through inclusive global health governance. In a second scenario, if the CBDR principle is rejected or adopted in a very diluted form, the author argues that the pandemic accord may struggle to meet its objectives. An uneven distribution of responsibilities could overwhelm less capable nations during health crises, leading to an inefficient and unjust response. Failure to consider the unique needs and vulnerabilities of developing countries could perpetuate existing global health inequities, diminishing the resilience of the global health system in the face of future crises and putting all populations at greater risk. The author proposes that striving towards equity and inclusion through the careful implementation of the CBDR principle may prove vital in realising a pandemic accord capable of meeting the challenges of global health crises.

Congo’s Forgotten Uranium: How the DRC was used to make the first nuclear bomb
Audu V: The Republic, Nigeria, 2023

On 06 August 1945, the United States dropped the world’s first atomic bomb on Hiroshima, Japan during the Second World War. A large amount of uranium used in making the first atomic weaponry was sourced from the Shinkolobwe mine in the Katanga province of the DRC, mined by workers who worked under secret contracts and low wages for the United States national security. To prevent information from leaking, Shinkolobwe was erased from maps. Misinformation was spread to make it appear that uranium was sourced from Canada, whose ores yielded 0.03% uranium while Congolese ores yielded 65% uranium. In a 2004 assessment of the mine, the United Nations found ‘high risks of mine collapse and potential chronic exposure to ionizing radiation’, recommending that the mine remain closed, while local Congolese families are reported to believe that their history has been tarnished by the uranium exploitation and use.

Climate change and health risks in Mukuru informal settlement in Nairobi, Kenya knowledge, attitudes and practices among residents
Andersen JG, Kallestrup P, Karekezi C et al. BMC Public Health 23:393;1-12, 2023

This study investigated how inhabitants of Mukuru informal settlement in Nairobi, Kenya in 2021 experienced climate change and its health impacts, and assessed related knowledge, attitudes and practices, using a cross-sectional study. Out of 402 study participants, 76% had heard of climate change before the interview, 91% reported that climate change was affecting their community, and 93% were concerned with the health-related impact of climate change. Having lived in Mukuru for more than 10 years and living in a dwelling close to the riverside were factors significantly associated with experiencing a climate change related impact, including chronic respiratory conditions, vector-borne diseases, infectious diarrhoea, malnutrition and cardiovascular disease. With most respondents knowledgeable about climate change and experiencing its impact, the authors propose that policy makers, planners and researchers to work locally with affected communities on mitigation and adaption strategies.

Important Lessons from the African Vaccine Manufacturer That Could Not Sell a Single Dose
Cullinan K: Health Policy Watch, 11 May 2023

Regional vaccine production features in the draft pandemic accord, but there is still a long road before this becomes a reality. Aspen Pharmacare invested millions of dollars in scaling up its South African production plant to make COVID-19 vaccines – yet it never sold a single vial. Three key factors combined to undermine Aspen’s vaccines. First, despite the hype about the need for African-produced vaccines, African governments failed to buy the locally-made vaccines. While the pandemic accord currently being negotiated is almost certain to support regional vaccine production, setting this up is complex and the COVID-era failures offer a number of sobering and cautionary lessons. Then Aspen became caught in a political stand-off between Africa and Europe about the fate of African-produced vaccines which delayed production by months. When that was eventually resolved, the world had fallen for mRNA vaccines and no longer wanted the viral vector vaccine that Aspen had been licensed to produce by Johnson & Johnson. With the waning of COVID-19, maintaining countries’ and companies’ interest in building regional vaccine manufacturing ability is a challenge and the authors suggest that Aspen’s difficulties should be well noted.

Push for African vaccine independence
Musoke R: The Independent, Uganda, March 2023

A consortium of African civil society organisations has kick-started a campaign to change the continent’s situation regarding vaccines and other essential pharmaceutical products. Afya Na Haki, a Kampala-based health policy thinktank is working with partners from Uganda, Nigeria, Rwanda, Tanzania, South Africa, Kenya, Senegal and Zimbabwe in a programme called “Advancing Regional Vaccine Manufacturing and Access in Africa (ARMA). ARMA programme’s objective is “advancing African advocacy and research approaches that strategically enhance vaccine manufacturing and access in Africa,” T to ensure that commitments and resolutions made by the African Union and individual African countries are actually implemented.

Ultra-processed food for infants and toddlers; dynamics of supply and demand
Dunford E, Popkin B: Bulletin of the World Health Organisation 101:5;358–360, 2023

he global baby food market has grown from US$ 9.6 billion in 2010 to US$ 17.9 billion in 2022. Emerging economies offer opportunities for baby food manufacturers and now represent half of all global baby food sales. The authors used data from Euromonitor International to assess sales trends of milk formula, growing-up formula and baby foods during the past decade as well as the level of sugar sold in the infant and toddler feeding sector. The consumption of commercially prepared baby foods in many cases may exceed consumption of homemade foods for infants and toddlers, with concerns about the nutritional composition, sweet taste and long-term health effects of these products. The data raise major questions about the role infant and toddler food companies play in rising global obesity levels and the double burden of malnutrition in low- and middle-income countries. The diets of infants and young children worldwide are undoubtedly becoming increasingly highly processed, a trend mirrored by increased global consumption of ultra-processed foods. The five largest global formula companies are Nestlé, Danone, Abbott, RFC and RBMJ with four out of these five companies present in more than 100 countries. The authors observe that policy-makers need to ensure these products and the companies who manufacture them are more closely monitored and their marketing more tightly regulated.

A Snapshot Of Wealth In Africa
Durden T: Zerohedge, Online, 2022

The continent of Africa contains more than 50 countries, but, as Visual Capitalist details, just five countries account for more than half of total wealth on the continent: South Africa, Egypt, Nigeria, Morocco, and Kenya. Despite recent setbacks in Africa’s largest economies, wealth creation has been strong in a number of areas, and total private wealth is now estimated to be US$2.1 trillion. There are an estimated 21 billionaires in Africa today. Drawing from the latest Africa Wealth Report, this article looks at where all that wealth is concentrated around the continent.

Open Letter Sets Bill Gates Right About Global Food Insecurity
TWN: Info Service on Sustainable Agriculture, TWN, November 2022

An open letter to Bill Gates from the Community Alliance for Global Justice and co-signed by 50 other organisations warns that Gates fundamentally misdiagnoses the problem of food insecurity as relating to low productivity, leading him to recommend the replication of Green Revolution technologies, including more fertilizer. However, the letter points out that the world does not need to increase production as much as to assure more equitable access to food. Moreover, the authors assert that the Green Revolution did very little to reduce the number of hungry people in the world and caused long-term soil degradation, and increased inequality and indebtedness. The letter points to the many tangible, ongoing proposals and projects that work to boost productivity and food security such as agro-ecological programs, and invites Gates to step back and learn from those on the ground.