Values, Policies and Rights

Alcohol: Ongoing efforts to reduce harmful consumption
Molenaar B: Health Diplomacy Monitor 2(5): 6-8, November 2011

The Global Strategy to Reduce the Harmful Use of Alcohol has much to learn from learn from the Framework Convention on Tobacco Control, according to this article. Over the years, many have called for the creation of a Framework Convention on Alcohol Control. Despite this push and despite the fact that alcohol and tobacco are relatively equal in terms of global disease burden, the international community has been less willing to be tough on the alcohol industry. The debate around alcohol is less clear in some ways than work on tobacco. In the case of tobacco, the efforts have focused on eliminating use. In terms of alcohol, the debate is about reducing the harmful level of consumption. In many countries, consumption of alcohol is acceptable and forms part of many cultural events. But the author notes that we need to pay increased attention to the harm alcohol consumption can inflict on others. Often the debate is framed in terms of the individual right to have a drink, neglecting the true extent of the level of harm others can be exposed to by the drinker.

All for universal health coverage
Garrett L, Mushtaque A, Chowdhury R and Pablos-Méndez Ariel: The Lancet 374(9697): 1294–1299, 10 October 2009

Debate has emerged that pits health-systems support against targeted health campaigns. In classical terms, the debate may be framed as the Bismarck model versus the Beveridge model, but this dichotomy is increasingly viewed as being as false as that which seeks to pit vertical schemes of health against horizontal. In truth, development of systems capable of delivering health, generally, or specifically targeted campaigns and health initiatives, all rely on the existence of health financing mechanisms that offer universal access to health. The specific nature of such financing schemes and service delivery models will vary between nations. To assume that universal health coverage necessarily requires a single-payer government mechanism would be a mistake, and adherents to that position doom the people of the poorest nations to generations of medical deficiency. Whether a nation chooses a mixed economy model of coverage, single-payer mode, donor-issued voucher mechanism, or other innovative models of universal financing is not the issue. Provision of universal health coverage is the issue facing the entire global health construct. Sadly, for most of the world's populations universal health coverage remains a mirage, blurred further out of focus by the present world financial crisis.

All roads lead to universal health coverage
Ghebreyesus T: The Lancet, 17 August 2017

All roads lead to universal health coverage—and this is the top priority at WHO, Dr Ghebreyesus the WHO director general has asserted. The key question of universal health coverage is an ethical one. Should fellow citizens die because they are poor? Or should millions of families be impoverished by catastrophic health expenditures because they lack financial risk protection? Universal health coverage is a human right. The world has agreed on universal health coverage in Sustainable Development Goal 3.8. He asserts that universal health coverage is ultimately a political choice and responsibility of every country and national government. Countries have unique needs, and tailored political negotiations will determine domestic resource mobilisation. He indicates that WHO will catalyse proactive engagement and advocacy with global, regional, and national political structures and leaders including heads of state and national parliaments. Beyond benchmarking, countries learn from their peers, especially those they see as having similar political or economic contexts. WHO will thus document best practices in universal health coverage at the country level. Once this learning has occurred, countries may request technical assistance and WHO should be prepared to provide technical assistance to countries based on their specific needs, across the full range of health-related Sustainable Development Goals. He further posits that universal health coverage and health emergencies are cousins—two sides of the same coin. Strengthening health systems is the best way to safeguard against health crises. Outbreaks are inevitable, but epidemics are not and strong health systems are the best defence to prevent disease outbreaks from becoming epidemics. Achieving universal health coverage will require innovation. Given that what is measured is managed, data matters and WHO will track progress on how the world is meeting the health-related Sustainable Development Goal indicators. Finally he observes that universal health coverage is not an end in itself: its goal is to improve all health-related Sustainable Development Goals.

Almost Two Years Passed, No Member State Has Ratified SADC Employment and Labour Protocol
Southern Africa Coordination Council (SATUCC), 8 June 2016

Two years after it was signed in August 2014, SATUCC reports that no Member State has ratified the SADC Employment and Labour Protocol as of June 2016. The SADC Employment & Labour Protocol was developed to serve as legal framework for the cooperation of SADC Member States on matters concerning employment and labour in line with Article 22 of the SADC Treaty which provides as follows: “Member States shall conclude protocols as may be necessary in each area of cooperation, which shall spell out the objectives and scope of, and institutional mechanisms for cooperation and integration”. This Protocol was then finally endorsed by nine Member States during the SADC Heads of States Summit held in Victoria Falls, Zimbabwe in August of 2014. These are: DRC, Lesotho, Malawi, Mozambique, Namibia, Seychelles, South Africa, Zambia and Zimbabwe. However, for this Protocol to enter into force, it is required that at least 10 Member States representing two-thirds ratify it. Since then, no single Member State has ratified the Protocol. It is against this that the SADC Ministers of Labour and Social Partners during their meeting on 12th May 2016, directed the SADC Secretariat with support of the ILO to conduct a study to establish the problems and challenges underlying the non-ratification of the Protocol and further explore ways how to promote its ratification by Member States. SATUCC is conducting a regional campaign on the ratification and implementation of the SADC Employment and Labour Protocol.

Alternative Civil Society Astana Statement on Primary Health Care
Public interest civil society organisations and social movements: open for endorsements up to 15 November

Members of public interest civil society organisations and social movements, some of whom are participants at the Global Conference on Primary Health Care, produced this statement to re-affirm a commitment to primary health care (PHC) in pursuit of health and well-being for all, aiming to achieve equity in health outcomes. The statement is a re-affirmation of the Alma Ata declaration, which to PHM and others remains the ultimate declaration on primary health care; the principles are clear and remain relevant. This authors invite organisations who agree with the views expressed to sign on to the statement.

Amnesty International Report 2009
Amnesty International: 2009

The Amnesty International Report 2009 is a record of the state of human rights during 2008 in 157 countries and territories around the world. It depicts the systemic discrimination and insecurity that hinders the application of the law, where states pick and choose the rights they are willing to uphold, and those they would rather suppress. The report presents five regional overviews highlighting the key events and trends that dominated the human rights agenda in each region in 2008. It further takes a country-by-country survey of human rights, summarising the human rights situation in each country. The regional overviews reveal that, in Africa, there is still an enormous gap between the rhetoric of African governments and the daily reality where human rights violations remain the norm: violent protests and poverty continued in many African countries, exacerbated by repressive attitudes of governments towards dissent and protest. Governments have failed to provide basic social services, like health services, address corruption and be accountable to their people.

An assessment of mental health policy in Ghana, South Africa, Uganda and Zambia
Faydi E, Funk M, Kleintjes S, Ofori-Atta A, Ssbunnya J, Mwanza J et al: Health Research Policy and Systems 9(17), 8 April 2011

This paper reports the results of an assessment of the mental health policies of Ghana, South Africa, Uganda and Zambia. The WHO Mental Health Policy Checklist was used to evaluate the most current mental health policy in each country. All four national policies addressed community-based services, the integration of mental health into general health care, promotion of mental health and rehabilitation. Only the Zambian policy presented a clear vision, with the other three countries spelling out values and principles, the need to establish a coordinating body for mental health, and to protect the human rights of people with mental health problems. None included all the basic elements of a policy, nor specified sources and levels of funding for implementation. Only Uganda sufficiently outlined a mental health information system, research and evaluation, while only Ghana comprehensively addressed human resources and training requirements. No country had an accompanying strategic mental health plan to allow the development and implementation of concrete strategies and activities. The authors recommend strengthening capacity of key stakeholders in public (mental) health and policy development, the creation of a culture of inclusive and dynamic policy development, and coordinated action to optimise use of available resources.

Anchoring universal health coverage in the right to health: What difference would it make?
World Health Organisation Policy Brief: November 2015

Universal Health Coverage UHC is a critical component of the new Sustainable Development Goals (SDGs) which include a specific health goal: “Ensure healthy lives and promote wellbeing for all at all ages”. Within this health goal, a specific target for UHC has been proposed: “Achieve UHC, including financial risk protection, access to quality essential health care services and access to safe, effective, quality and affordable essential medicines and vaccines for all”. In this context, the opportunity exists to unite global health and the fight against poverty through action that is focussed on clear goals. For WHO, “UHC is, by definition, a practical expression of the concern for health equity and the right to health”; thus promoting UHC advances the overall objective of WHO, namely the attainment by all peoples of the highest possible standard of health as a fundamental right, and signal a return to the ideals of the Declaration of Alma Ata and the WHO Global Strategy for Health for All by the Year 2000. Yet some argue that the “current discourse on UHC is in sharp contrast with the vision of Primary Health Care envisaged in the Alma Ata declaration of 1978”. The underlying assumption of this paper is that efforts towards achieving UHC do promote some, but not necessarily all, of the efforts required from governments for the realisation of the right to health. While this publication explores how efforts to advance towards UHC overlap with efforts to realise the right to health, its main focus is the gaps that exist between UHC efforts and right to health efforts.

Angola: Should intentional HIV/AIDS infection be a crime?
IRIN Africa, 30 May 2008

Proposed reforms to Angola's Penal Code have divided opinion in the country about whether HIV-positive people who intentionally infect others with the virus should be punished. The law under discussion calls for a sentence of between three and 10 years in prison for those who knowingly pass on infectious diseases, including HIV. Some argue that the law will act as a deterrent; others say it will bring more problems than benefits.

Antibiotic resistance has a language problem
Mendelson M; Balasegaram M; Jinks T: Nature, May 2017

Clinicians have long known that microbes such as bacteria, viruses and fungi are becoming alarmingly resistant to the medicines used to treat them. But a global response to this complex health threat — commonly termed 'antimicrobial resistance' — requires engagement from a much broader array of players, from governments, regulators and the public, to experts in health, food, the environment, economics, trade and industry. The authors argue that people from these disparate domains are talking past each other. Many of the terms routinely used to describe the problem are misunderstood, interpreted differently or loaded with unhelpful connotations. In 2017, the United Nations formed an interagency group to coordinate the fight against drug resistance urging that, as one of its first steps, the group coordinate a review of the terminology used by key actors. They proposed that drug-resistant infection be the overarching term used (in English) to describe infections caused by organisms that are resistant to treatment, including those caused by bacteria that do not respond to antibiotics. They also noted that a blame narrative is unhelpful, failing to acknowledge symbiotic relationships with bacteria. Because terminology has geographic, disciplinary and societal variations that affect understanding and interpretation, research is argued to be needed to optimize the lexicon across different countries and languages.

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