Health equity in economic and trade policies

Gold Mining in Uganda
Berry I: Magnum Pro, March 2017

The author argues that fair trade isn’t only about coffee and bananas. The Fairtrade Foundation points out that it doesn’t matter what the commodity is, people should get a fair price for the work they do. African gold miners are often exploited, but the author argues that workers do not have a choice; it’s dig or starve and it’s accept a pittance for their labors or work harder the following day. The Fairtrade Foundation is reported to have intervened and to be gradually improving conditions on mines. In this photo - essay Ian Berry reflects on the Ugandan gold trade as efforts are made to encourage fairer trading practices. He follows the gold from Ugandan mines to the London workshops of jewellers.

The health impact of sexual violence among women in a platinum mining belt
Zhang M; Steele S; Shroud A; Van Cutsem G; Khan J; Barnwell G; Hill J; Duncan K: Medecins Sans Frontières, 2017

New analysis of data detailing the extent of sexual violence in the Rustenburg area indicates that one in five HIV infections (approximately 6,765 of all female cases) and one in three cases of depression among women (5,022 cases) are attributable to rape and intimate-partner violence (IPV), while one in three women inducing abortion (1,296 cases) was pregnant as a result of sexual violence. These results have emerged from an in-depth 2015 survey conducted by Medecins Sans Frontiers (MSF) among more than 800 women living in communities along the mining belt where the health consequences of sexual violence remain largely unaddressed and demand urgent action. Much additional suffering could have been prevented if survivors had been able to access a basic package of healthcare services, but opportunities are missed each day to prevent HIV infection, psychological trauma, and unwanted pregnancy for victims of sexual violence in on the platinum mining belt, because there are too few health facilities with the capacity to provide essential care. As South Africa finalises its next five-year National Strategic Plan (NSP) on HIV, TB and STIs (2017-2022), MSF is calling for the inclusion of ambitious targets for increasing sexual violence survivors’ access to medical and psychosocial services at all health facilities. Key interventions include providing post-exposure prophylaxis (PEP) to prevent HIV and other sexually transmitted infections, psychosocial support including trauma counselling, emergency contraception, other basic medical services (e.g. first aid), and the option of forensic examination..

The Mozambican debt crisis: How a sovereign state was sold
Serumaga M: Pambazuka news 808, February 2017

The author reports on 2013 loans taken without parliament approval in Mozambique totaling $2 billion. External funders suspended credit to Mozambique because of the loans, and the national currency fell by 70% in 2016. Restructuring the loans means imposed austerity on a population already living in extreme austerity and eventually repaying the creditors from revenues derived from Mozambique’s natural gas deposits that come on the market in 2023. The author presents information on the case, the funders and the implications for other African countries.

What Does the End of Africa's Boom Mean for Universal Health Coverage?
Russo, G; Bloom, G: IDS Rapid Response Briefing 16, 2017

According to the authors, achieving universal health coverage by 2030, as stated in UN Global Goal 3, will require substantial increases in health spending and the proportion funded through taxation or social insurance to make health care affordable for all. Not only will institutions need to be established to ensure sustainable arrangements for social finance, it will also be vital to ensure that health financing is resilient to economic and other shocks if Global Goal 3 is to be realised. This is argued to present a major challenge in Africa, where an economic downturn is projected in a number of resource-dependent countries, such as Mozambique and Guinea Bissau and where countries such as Sierra Leone have weakened health systems. The response to these challenges by governments and development partners, will have important effects on how well people, and the health services on which they rely, cope in the short term and longer-term evolution of health coverage.

Antibiotic Resistance in the Food Chain: A Developing Country-Perspective
Founou L; Founou R; Essack S: Frontiers in Microbiology, 2016

Food animals are considered as key reservoirs of antibiotic-resistant bacteria with the use of antibiotics in the food production industry having contributed to the actual global challenge of antibiotic resistance (ABR). There are no geographic boundaries to impede the worldwide spread of ABR. If preventive and containment measures are not applied locally, nationally and regionally, the limited interventions in one country, continent and for instance, in the developing world, could compromise the efficacy and endanger ABR containment policies implemented in other parts of the world, the best-managed high-resource countries included. Multifaceted, comprehensive, and integrated measures complying with the One Health approach are thus imperative to ensure food safety and security, effectively combat infectious diseases, curb the emergence and spread of ABR, and preserve the efficacy of antibiotics for future generations. The World Health Organisation, World Organisation for Animal Health, and the Food and Agriculture Organisation recommend implementing national action plans encompassing human, (food) animal, and environmental sectors to improve policies, interventions and activities that address the prevention and containment of ABR from farm-to-fork. This review covers (i) the origin of antibiotic resistance, (ii) pathways by which bacteria spread to humans from farm-to-fork, (iii) differences in levels of antibiotic resistance between developed and developing countries, and (iv) prevention and containment measures of antibiotic resistance in the food chain.

South Centre Statement on the Amendment to the WTO TRIPS Agreement to Ease Access to Affordable Medicine
South Centre: Geneva, January 2017

An amendment to the TRIPS Agreement that aims to facilitate the access to affordable medicines has entered into force upon approval by two thirds of the WTO members. The amendment reflects the recognition by WTO Members of the need for the continued enhancement of global intellectual property rules to allow Members to systematically take measures to protect public health. The United Nations Secretary General’s High Level Panel on Access to Medicines has highlighted the importance of designing legislation that allows for quick, fair, predictable and implementable compulsory licenses for legitimate public health needs, and recommended WTO Members to revise the paragraph 6 system in order to find a solution that enables a swift and expedient export of pharmaceutical products produced under compulsory license. The South Centre stresses the continued importance for Least-Developed Countries (LDCs) to make full use of the special status they enjoy in not being required to adopt rules on patent protection and most other rules of the TRIPS Agreement, in order to build their technological capabilities and reduce obstacles to affordable access to medicines. The LDCs would not need, in this case, to make use of the system. Close attention will need to be paid to the design of national implementing legislations and the feedback from potential user entities of the system on any hurdles they may face that diminish interest in its use. The evaluation of the system must continue in the TRIPS Council. The South Centre offers to provide assistance to countries in examining national implementing legislations, and providing information to potential interested parties. Templates for facilitated implementation and meeting of conditions required under the system may be provided.

TRIPS amendment on access to cheaper drugs comes into force
Third World Network: SUNS #8387 January 2017

A protocol amending the WTO TRIPS Agreement that would enable developing countries with insufficient or no manufacturing capacities in the pharmaceutical sector to import cheaper generic medicines produced under compulsory licencing came into force on Monday, 23 January. The annex to the protocol amending the TRIPS Agreement contains a new Article which contains five paragraphs on the obligations of exporting Members in relation to compulsory licences, AND the modification of obligations to the extent necessary to enable a pharmaceutical product produced or imported under a compulsory licence to other countries within a regional trade agreement. "This is an extremely important amendment. It gives legal certainty that generic medicines can be exported at reasonable prices to satisfy the needs of countries with no pharmaceutical production capacity, or those with limited capacity," said WTO Director-General Roberto Azevedo. Ambassador Modest Mero of Tanzania, Chair of the TRIPS Council, underlined the importance of the entry into force of the first-ever amendment of the multilateral agreements administered by the WTO but also a concrete response by trade ministers to address the concerns in the area of public health.

Walter Rodney and the racial underpinnings of global inequality
Paschal T: Pambazuka News, January 2017

While inequality has become a topic of increased popularity and politicization in recent years, most of the attention has focused on how 1% own an increasingly large share of the world’s wealth, rather than on inequalities between nations. In a global context in which national borders and citizenship pose few barriers to the mobility of capital, the reality is also a story of the world’s richest nations continuing to reap a disproportionate amount of the globe’s profits. Contemporary analyses of global inequality, capitalism, and development would benefit from the lessons of earlier works concerned with similar questions decades before. One example is the classic work written by Walter Rodney, How Europe Underdeveloped Africa. While some contemporary accounts recognise that the problems of African countries do not lie exclusively in Africa, they do not go far enough. Piketty’s discussion of the extraction of wealth from the African continent, for example, is largely independent from his analysis of the accumulation of wealth in other parts of the globe. For Rodney, it was impossible to explain development and the accumulation of wealth in one region without deeply understanding its relations to other regions of underdevelopment and the extraction of wealth. This relation, he argued was not accidental; it was endemic to capitalism itself.

Antibiotic Resistance in the Food Chain: A Developing Country-Perspective
Founou L; Founou R; Essack S: Frontiers in Microbiology, 2016, doi: https://doi.org/10.3389/fmicb.2016.01881

Food animals are considered as key reservoirs of antibiotic-resistant (ABR) bacteria with the use of antibiotics in the food production industry having contributed to the global challenge. There are no geographic boundaries to impede the worldwide spread of ABR, and limitations in the interventions in one country could compromise the efficacy and endanger containment policies implemented in other parts of the world. Multifaceted, comprehensive, and integrated measures complying with the One Health approach are argued to be imperative to ensure food safety and security, effectively combat infectious diseases, curb the emergence and spread of ABR, and preserve the efficacy of antibiotics for future generations. Countries are urged to follow the World Health Organisation, World Organisation for Animal Health, and the Food and Agriculture Organisation of the United Nations recommendations to implement national action plans encompassing human, (food) animal, and environmental sectors to improve policies, interventions and activities that address the prevention and containment of ABR from farm-to-fork. This review covers (i) the origin of antibiotic resistance, (ii) pathways by which bacteria spread to humans from farm-to-fork, (iii) differences in levels of antibiotic resistance between developed and developing countries, and (iv) prevention and containment measures of antibiotic resistance in the food chain.

Marketing of breast-milk substitutes: national implementation of the international code: status report 2016
World Health Organisation: WHO Geneva, 2016

This report provides updated information on the status of implementing the International Code of Marketing of Breast-milk Substitutes and subsequent relevant World Health Assembly resolutions (“the Code”) in and by countries. It presents the legal status of the Code, including - where such information is available - to what extent Code provisions have been incorporated in national legal measures. The report also provides information on the efforts made by countries to monitor and enforce the Code through the establishment of formal mechanisms. Its findings and subsequent recommendations aim to improve the understanding of how countries are implementing the Code, what challenges they face in doing so, and where the focus must be on further efforts to assist them in more effective Code implementation.

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