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The financial and economic choices societies make determine whether all individuals can enjoy the right to health. Crises quickly expose the values and interests that drive decisions towards health, as [...]

The article calls for papers on advancing the science and practice of primary health care that will be published in the "Bulletin of the World Health Organization."

The article calls for papers for an issue of the periodical "Bull World Health Organ" on the use of the United Nations 2030 agenda for sustainable development to improve global health.

The authors reflect on the importance of access to rehabilitation as a basic human rights and a call for papers by the journal on the promotion of rehabilitation though health policy and systems research. Also cited are the inclusion of rehabilitation in the universal health coverage (UHC) target of the sustainable development goals, and how the coronavirus disease 2019 (COVID-19) pandemic showed the need for rehabilitation in the acute, post-acute and long-term stages of infectious diseases.

A call for papers on BRICS (Brazil, the Russian Federation, India, China and South Africa) countries and global health is presented for a planned issue of the World Health Organization's (WHO) periodical "Bulletin."

The article calls for papers addressing the health of vulnerable populations, constructs of social inclusion and exclusion, interventions for vulnerable populations in the context of sustainable development goals (SDG) at the micro- and macro-policy levels, and factors to vulnerabilities.

The World Health Organization (WHO) set up the messenger ribonucleic acid (mRNA) technology transfer programme in June 2021 with a development hub in South Africa and 15 partner vaccine producers in middle-income countries. The goal was to support the sustainable development of and access to life-saving vaccines for people in these countries as a means to enhance epidemic preparedness and global public health. This initiative aims to build resilience and strengthen local vaccine research, and development and manufacturing capacity in different regions of the world, especially those areas that could not access coronavirus disease 2019 (COVID-19) vaccines in a timely way. This paper outlines the current global vaccine market and summarizes the findings of a case study on the mRNA technology transfer programme conducted from November 2022 to May 2023. The study was guided by the vision of the WHO Council on the Economics of Health for All to build an economy for health using its four work streams of value, finance, innovation and capacity. Based on the findings of the study, we offer a mission-oriented policy framework to support the mRNA technology transfer programme as a pilot for transformative change towards an ecosystem for health innovation for the common good. Parts of this vision have already been incorporated into the governance of the mRNA technology transfer programme, while other aspects, especially the common good approach, still need to be applied to achieve the goals of the programme. [ABSTRACT FROM AUTHOR]

The author discusses how the Global Strategy For Women's and Children's Health for 2010-2015 has catalyzed over 300 stakeholders to make commitments raising over 45 billion U.S. dollars new financing and launched global initiatives for priority issues such as family planning, newborn and child survival. Topics discussed include calls for submissions to a them issue of the "Bulletin" on the health of women, children and adolescents.

The World Health Organization developed the Tricycle surveillance programme to obtain a global picture of antimicrobial resistance, especially in countries with limited surveillance capacity. The programme was developed within a One Health perspective. Tricycle provides a framework for applying a standardized technical protocol to determining the prevalence of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli in three sectors: the human, animal and environment sectors. Regular use of the protocol would enable information to be obtained on time trends and on inter- and intraregional variations, thereby generating dynamic data on antibacterial resistance for decision-makers. To date, 19 countries have begun implementing the Tricycle protocol, while other countries will start implementation in the coming years. The Network for Enhancing Tricycle ESBL Surveillance Efficiency (NETESE) was established to support countries implementing the Tricycle protocol. Currently, NETESE includes representatives from 15 institutions in eight low- or middle-income countries at different stages of Tricycle protocol implementation, and from four European countries involved in devising the protocol. This paper describes the Tricycle protocol, reports the initial experiences of NETESE participants with its implementation and discusses future challenges and opportunities. [ABSTRACT FROM AUTHOR]

Timely access to quality data is a key aspect of global governance and accountability. Data on development and health indicators are important for policymakers, public health experts and donors. With [...]

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. We 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. We 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 calls 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. Le colonialisme, qui implique la domination systemique de terres, de marches, de peuples, de ressources, de cultures ou d'institutions politiques dans le but d'exploiter, de detourner et d'extraire des richesses et des ressources, affecte la sante de nombreuses manieres. Ces dernieres annees, la decolonisation de la sante mondiale a suscite un interet croissant, l'accent etant mis sur la correction des desequilibres de pouvoir entre les pays a revenu eleve et les pays a faible revenu, ainsi que sur la remise en question des idees et des valeurs de certains pays riches qui faponnent la pratique de la sante mondiale. Nous soutenons que la decolonisation de la sante mondiale doit egalement aborder la relation entre les acteurs de la sante mondiale et les formes contemporaines de colonialisme, en particulier les formes actuelles de colonialisme d'entreprise et de colonialisme financiarise qui operent par des systemes mondialises detraction de richesses et de profits. Nous presentons un programme d'action en trois parties destine a decoloniser la sante mondiale. La premiere partie porte sur les asymetries de pouvoir existant entre les acteurs de la sante mondiale des pays a hauts revenus et historiquement privilegies et leurs homologues des pays a faibles revenus et marginalises. La deuxieme partie concerne la colonisation des structures et des systemes de la gouvernance mondiale de la sante elle-meme. La troisieme partie traite de la maniere dont le colonialisme se manifeste a travers le systeme de sante mondial. La lutte contre toutes les formes de colonialisme necessite un anticolonialisme politique et economique ainsi qu'une decolonisation sociale visant a garantir une plus grande diversite nationale, raciale, culturelle et des connaissances au sein des structures de la sante mondiale. El colonialismo, que implica la dominacion sistemica de tierras, mercados, pueblos, bienes, culturas o instituciones politicas para explotar, apropiarse indebidamente y extraer riqueza y recursos, afecta a la salud de muchas maneras. En los ultimos anos ha crecido el interes por descolonizar la salud mundial, en particular para corregir los desequilibrios de poder entre los paises de ingresos altos y los de ingresos bajos, y para cuestionar las ideas y los valores de algunos paises ricos que influyen en la practica de la salud mundial. Sostenemos que la descolonizacion de la salud mundial tambien debe abordar la relacion entre los actores de la salud mundial y las formas contemporaneas de colonialismo, en especial las formas actuales de colonialismo corporativo y financiarizado que operan a traves de sistemas globalizados de extraccion de riqueza y especulacion. Presentamos un programa de accion dividido en tres partes para descolonizar la salud mundial. La primera parte se refiere a las asimetrias de poder que existen entre los actores de la salud mundial procedentes de paises de ingresos altos e historicamente privilegiados y sus homologos de entornos de ingresos bajos y marginados. La segunda parte se refiere a la colonizacion de las estructuras y sistemas de la propia gobernanza de la salud mundial. La tercera parte aborda como se produce el colonialismo a traves del sistema sanitario mundial. Abordar todas las formas de colonialismo exige un anticolonialismo politico y economico, asi como una descolonizacion social destinada a garantizar una mayor diversidad nacional, racial, cultural y de conocimientos dentro de las estructuras de la salud mundial. [phrase omitted], Introduction Medicine and public health have always been shaped by social and political values, (1) as evident in efforts to redress social inequities in health, struggles to realize health as [...]

Gender refers to the social relationships between males and females in terms of their roles, behaviours, activities, attributes and opportunities, and which are based on different levels of power. Gender interacts with, but is distinct from, the binary categories of biological sex. In this paper we consider how gender interacts with the 2030 agenda for sustainable development, including sustainable development goal (SDG) 3 and its targets for health and well-being, and the impact on health equity. We propose a conceptual framework for understanding the interactions between gender (SDG 5) and health (SDG 3) and 13 other SDGs, which influence health outcomes. We explore the empirical evidence for these interactions in relation to three domains of gender and health: gender as a social determinant of health; gender as a driver of health behaviours; and the gendered response of health systems. The paper highlights the complex relationship between health and gender, and how these domains interact with the broad 2030 agenda. Across all three domains (social determinants, health behaviours and health system), we find evidence of the links between gender, health and other SDGs. For example, education (SDG 4) has a measurable impact on health outcomes of women and children, while decent work (SDG 8) affects the rates of occupationrelated morbidity and mortality, for both men and women. We propose concerted and collaborative actions across the interlinked SDGs to deliver health equity, health and well-being for all, as well as to enhance gender equality and women's empowerment. These proposals are summarized in an agenda for action. [ABSTRACT FROM AUTHOR]

The article discusses the importance of sexual health to the overall health and wellbeing of people. Topics include steps to make universal sexual and reproductive health rights a reality, reasons for obstacles to advancing sexual health as part of a comprehensive approach to sexual and reproductive health and rights, and the call for papers by the journal for a 2024 theme issue on sexual health and well-being.

Objective To systematically review published studies of interventions to reduce people's intake of dietary trans-fatty acids (TFAs). Methods We searched online databases (CINAHL, the CRD Wider Public Health database, Cochrane Database of Systematic Reviews, Ovid®, MEDLINE®, Science Citation Index and Scopus) for studies evaluating TFA interventions between 1986 and 2017. Absolute decrease in TFA consumption (g/day) was the main outcome measure. We excluded studies reporting only on the TFA content in food products without a link to intake. We included trials, observational studies, meta-analyses and modelling studies. We conducted a narrative synthesis to interpret the data, grouping studies on a continuum ranging from interventions targeting individuals to population-wide, structural changes. Results After screening 1084 candidate papers, we included 23 papers: 12 empirical and 11 modelling studies. Multiple interventions in Denmark achieved a reduction in TFA consumption from 4.5 g/day in 1976 to 1.5 g/day in 1995 and then virtual elimination after legislation banning TFAs in manufactured food in 2004. Elsewhere, regulations mandating reformulation of food reduced TFA content by about 2.4 g/ day. Worksite interventions achieved reductions averaging 1.2 g/day. Food labelling and individual dietary counselling both showed reductions of around 0.8 g/day. Conclusion Multicomponent interventions including legislation to eliminate TFAs from food products were the most effective strategy. Reformulation of food products and other multicomponent interventions also achieved useful reductions in TFA intake. By contrast, interventions targeted at individuals consistently achieved smaller reductions. Future prevention strategies should consider this effectiveness hierarchy to achieve the largest reductions in TFA consumption. [ABSTRACT FROM AUTHOR]

Artificial intelligence holds great promise in terms of beneficial, accurate and effective preventive and curative interventions. At the same time, there is also awareness of potential risks and harm that may be caused by unregulated developments of artificial intelligence. Guiding principles are being developed around the world to foster trustworthy development and application of artificial intelligence systems. These guidelines can support developers and governing authorities when making decisions about the use of artificial intelligence. The High- Level Expert Group on Artificial Intelligence set up by the European Commission launched the report Ethical guidelines for trustworthy artificial intelligence in 2019. The report aims to contribute to reflections and the discussion on the ethics of artificial intelligence technologies also beyond the countries of the European Union (EU). In this paper, we use the global health sector as a case and argue that the EU's guidance leaves too much room for local, contextualized discretion for it to foster trustworthy artificial intelligence globally. We point to the urgency of shared globalized efforts to safeguard against the potential harms of artificial intelligence technologies in health care. [ABSTRACT FROM AUTHOR]

Objective This paper provides a comprehensive overview of hospital payment systems based on diagnosis-related groups (DRGs) in low- and middle-income countries. It also explores design and implementation issues and the related challenges countries face. Methods A literature research for papers on DRG-based payment systems in low- and middle-income countries was conducted in English, French and Spanish through Pubmed, the Pan American Health Organization's Regional Library of Medicine and Google. Findings Twelve low- and middle-income countries have DRG-based payment systems and another 17 are in the piloting or exploratory stage. Countries have chosen from a wide range of imported and self-developed DRG models and most have adapted such models to their specific contexts. All countries have set expenditure ceilings. In general, systems were piloted before being implemented. The need to meet certain requirements in terms of coding standardization, data availability and information technology made implementation difficult. Private sector providers have not been fully integrated, but most countries have managed to delink hospital financing from public finance budgeting. Conclusion Although more evidence on the impact of DRG-based payment systems is needed, our findings suggest that (i) the greater portion of health-care financing should be public rather than private; (ii) it is advisable to pilot systems first and to establish expenditure ceilings; (iii) countries that import an existing variant of a DRG-based system should be mindful of the need for adaptation; and (iv) countries should promote the cooperation of providers for appropriate data generation and claims management. [ABSTRACT FROM AUTHOR]

Low fruit and vegetable consumption is an important contributor to the global burden of disease. In the wake of the United Nations High-level Meeting on Non-Communicable Diseases (NCDs), held in September 2011, a rise in the consumption of fruits and vegetables is foreseeable and this increased demand will have to be met through improved supply. The World Health Organization, the Food and Agriculture Organization and the World Bank have highlighted the potential for developing countries to benefit nutritionally and economically from the increased production and export of fruit and vegetables. Aid for Trade, launched in 2005 as an initiative designed to link development aid and trade holistically, offers an opportunity for the health and trade sectors to work jointly to enhance health and development. The Aid for Trade work programme stresses the importance of policy coherence across sectors, yet the commonality of purpose driving the Aid for Trade initiative and NCD prevention efforts has not been explored. In this paper food supply chain analysis was used to show health policy-makers that Aid for Trade can provide a mechanism for increasing the supply of fruits and vegetables in developing countries. Aid for Trade is an existing funding channel with clear accountability and reporting mechanisms, but its priorities are determined with little or no input from the health sector. The paper seeks to enable public health policy-makers, practitioners and advocates to improve coherence between trade and public health policies by highlighting Aid for Trade's potential role in this endeavour. [ABSTRACT FROM AUTHOR]

This paper considers how operational research and management science can improve the design of health systems and the delivery of health care, particularly in low-resource settings. It identifies some gaps in the way operational research is typically used in global health and proposes steps to bridge them. It then outlines some analytical tools of operational research and management science and illustrates how their use can inform some typical design and delivery challenges in global health. The paper concludes by considering factors that will increase and improve the contribution of operational research and management science to global health. [ABSTRACT FROM AUTHOR]

Most scarcities that underpin health disparities within and among countries are not natural; rather, they result from policy choices and the operation of social institutions. Using examples from the United States of America: the Chicago heat wave and hurricane Katrina, this paper develops "denaturalizing scarcity" as a strategy for enquiry to inform public-health ethics in an interconnected world. It first describes some of the resource scarcities that are of greatest concern from a public-health perspective, and then outlines two (not mutually exclusive) lines of ethical reasoning that demonstrate their importance. One of these involves the multiple relationships that link rich and poor across national borders in today's interconnected world. The paper then briefly describes ways in which globalization and the associated institutions are linked to health-threatening scarcities. The paper concludes that denaturalizing scarcity represents a valuable alternative to mainstream health ethics, directing our attention instead to why some settings are "resource poor" and others are not. [ABSTRACT FROM AUTHOR]

The global transition to current low levels of habitual physical activity among children and adolescents began in the second half of the last century. Low physical activity harms health in both the short term (during childhood and adolescence) and long term (during adulthood). In turn, low physical activity could limit progress towards several sustainable development goals, undermine noncommunicable disease prevention, delay physical and mental health recovery from the coronavirus disease 2019 pandemic, increase health-care costs and hinder responses to climate change. However, despite the importance of physical activity, public health surveillance among children and adolescents is very limited globally and low levels of physical activity in children is not on the public health agenda in many countries, irrespective of their level of economic development. This article details proposals for improvements in global public health surveillance of physical activity from birth to adolescence based on recent systematic reviews, international collaborations and World Health Organization guidelines and strategies. Empirical examples from several countries illustrate how improved surveillance of physical activity can lead to public health initiatives. Moreover, better surveillance raises awareness of the extent of physical inactivity, thereby making an invisible problem visible, and can lead to greater capacity in physical activity policy and practice. The time has arrived for a step change towards more systematic physical activity surveillance from infancy onwards that could help inform and inspire changes in public health policy and practice globally. Durant la seconde moitie du siecle dernier, l'activite physique des enfants et adolescents a commence a baisser a l'echelle mondiale pour atteindre le faible niveau actuel. La sedentarite a des effets nefastes sur la sante, tant a court terme (pendant l'enfance et l'adolescence) qu'a long terme (a l'age adulte). Elle peut egalement entraver la progression vers de nombreux objectifs de developpement durable, compromettre les efforts de prevention des maladies non transmissibles, retarder la guerison physique et mentale liee a la pandemie de maladie a coronavirus 2019, accroitre les depenses en soins de sante et freiner les reactions au changement climatique. Pourtant, malgre l'importance que revet l'activite physique, rares sont les dispositifs de surveillance de la sante publique mis en place pour les enfants et adolescents dans le monde. En outre, la lutte contre la sedentarite chez les plus jeunes ne figure pas parmi les priorites de sante publique dans la plupart des pays, quel que soit le niveau de developpement economique de ces derniers. Le present article detaille une serie de propositions visant a ameliorer la surveillance de la sante publique en matiere d'activite physique de la naissance a l'adolescence, fondees sur des revues systematiques recentes, des collaborations internationales ainsi que des strategies et lignes directrices de l'Organisation mondiale de la Sante. Des exemples empiriques provenant de plusieurs pays illustrent comment cette amelioration peut deboucher sur des initiatives de sante publique. De plus, une meilleure surveillance permet de sensibiliser a l'ampleur de cette inactivite, donnant ainsi de la visibilite a un probleme jusqu'alors invisible, et peut renforcer les capacites politiques et pratiques relatives a l'activite physique. Il est temps de proceder a un changement en profondeur afin de surveiller plus systematiquement l'activite physique des le plus jeune age, en vue d'orienter et d'encourager l'evolution des politiques et pratiques en la matiere dans le monde. La transicion mundial hacia los niveles bajos actuales de actividad fisica regular entre ninos y adolescentes comenzo en la segunda mitad del siglo pasado. La disminucion de la actividad fisica perjudica la salud tanto a corto plazo (durante la infancia y la adolescencia) como a largo plazo (durante la edad adulta). A su vez, la falta de actividad fisica podria limitar el progreso hacia varios objetivos de desarrollo sostenible, socavar la prevencion de enfermedades no transmisibles, retrasar la recuperacion de la salud fisica y mental tras la pandemia de la enfermedad por coronavirus de 2019, aumentar los costes de la atencion sanitaria y dificultar las respuestas al cambio climatico. No obstante, a pesar de la importancia de la actividad fisica, la vigilancia de la salud publica entre los ninos y los adolescentes es muy limitada a nivel mundial y los niveles bajos de actividad fisica en los ninos no se incluyen en la agenda de salud publica de muchos paises, sea cual sea su nivel de desarrollo economico. En este articulo, se detallan propuestas para mejorar la vigilancia de la actividad fisica en la salud publica a nivel mundial, desde el nacimiento hasta la adolescencia, a partir de recientes revisiones sistematicas, colaboraciones internacionales y directrices y estrategias de la Organizacion Mundial de la Salud. Ejemplos empiricos de varios paises ilustran como una mejor vigilancia de la actividad fisica puede conducir a iniciativas de salud publica. Asimismo, una mejor vigilancia aumenta la concienciacion sobre el alcance de la inactividad fisica, haciendo evidente un problema poco visible, y puede conducir a una mayor capacidad en la politica y la practica de la actividad fisica. Ha llegado el momento de dar un paso adelante hacia una vigilancia mas sistematica de la actividad fisica desde la infancia que podria ayudar a informar e inspirar cambios en la politica y la practica de la salud publica en todo el mundo., Introduction The World Health Organization (WHO) recognizes that physical activity in childhood is essential for healthy development, for short- and long-term physical and mental health, for the achievement of several [...]

This paper explores the possibility of integrating knowledge mapping into a conceptual framework that could serve as a tool for understanding the many complex processes, resources and people involved in a health system, and for identifying potential gaps within knowledge translation processes in order to address them. After defining knowledge mapping, this paper presents various examples of the application of this process in health, before looking at the steps that need to be taken to identify potential gaps, to determine to what extent these gaps affect the knowledge translation process and to establish their cause. This is followed by proposals for interventions aimed at strengthening the overall process. Finally, potential limitations on the application of this framework at the country level are addressed. [ABSTRACT FROM AUTHOR]

This paper reviews the health dimension and sociocultural, economic, and ecological determinants of health in existing global scenario studies. Not even half of the 31 scenarios reviewed gave a good description of future health developments and the different scenario studies did not handle health in a consistent way. Most of the global driving forces of health are addressed adequately in the selected scenarios, however, and it therefore would have been possible to describe the future developments in health as an outcome of these multiple driving forces. To provide examples on how future health can be incorporated in existing scenarios, we linked the sociocultural, economic, and environmental developments described in three sets of scenarios (special report on emission scenarios (SRES), global environmental outlook-3 (GEO3), and world water scenarios (WWS)) to three potential, but imaginary, health futures ("age of emerging infectious diseases", "age of medical technology", and "age of sustained health"). This paper provides useful insights into how to deal with future health in scenarios and shows that a comprehensive picture of future health evolves when all important driving forces and pressures are taken into account. [ABSTRACT FROM AUTHOR]

Abstract Following early success with a number of high-profile partnerships, WHO is increasingly working with the private for-profit sector. In so doing, the organization finds itself in the maelstrom of a vibrant debate on the roles of public, civic, and commercial entities in society and on the appropriate modes of interaction among them. This paper examines WHO's involvement with the commercial sector, particularly in partnerships. WHO's approach to this sector is outlined and the criticisms levelled at public-private partnerships are reviewed. An indication is given of the steps recently taken by WHO to confront the concerns that have been expressed. The paper argues that partnership between WHO and the commercial sector is inevitable and that it presents considerable opportunities, but also significant risks, for the organization and for public health. A strategy is proposed for directing the debate on issues critical to WHO and its role in the promotion and protection of public health. [ABSTRACT FROM AUTHOR]

This section will publish short contributions from readers containing a view, a hypothesis or a point for discussion on an issue of public health interest. Contributions (850 words, no references) [...]

In recent years, a wide range of diagnostic tests has become available for use in resource-constrained settings. Accordingly, a huge number of guidelines, performance evaluations and implementation reports have been produced. However, this wealth of information is unstructured and of uneven quality, which has made it difficult for end-users, such as clinics, laboratories and health ministries, to determine which test would be best for improving clinical care and patient outcomes in a specific context. This paper outlines a six-step guide to the selection and implementation of in vitro diagnostic tests based on Médecins Sans Frontières' practical experience: (i) define the test's purpose; (ii) review the market; (iii) ascertain regulatory approval; (iv) determine the test's diagnostic accuracy under ideal conditions; (v) determine the test's diagnostic accuracy in clinical practice; and (vi) monitor the test's performance in routine use. Gaps in the information needed to complete these six steps and gaps in regulatory systems are highlighted. Finally, ways of improving the quality of diagnostic tests are suggested, such as establishing a model list of essential diagnostics, establishing a repository of information on the design of diagnostic studies and improving quality control and postmarketing surveillance. [ABSTRACT FROM AUTHOR]

Objective To describe the temporal and geographical distribution of Zika virus infection and associated neurological disorders, from 1947 to 1 February 2016, when Zika became a Public Health Emergency of International Concern (PHEIC). Methods We did a literature search using the terms "Zika" and "ZIKV" in PubMed, cross-checked the findings for completeness against other published reviews and added formal notifications to WHO submitted under the International Health Regulations. Findings From the discovery of Zika virus in Uganda in 1947 to the declaration of a PHEIC by the World Health Organization (WHO) on 1 February 2016, a total of 74 countries and territories had reported human Zika virus infections. The timeline in this paper charts the discovery of the virus (1947), its isolation from mosquitos (1948), the first human infection (1952), the initial spread of infection from Asia to a Pacific island (2007), the first known instance of sexual transmission (2008), reports of Guillain-Barré syndrome (2014) and microcephaly (2015) linked to Zika infections and the first appearance of Zika in the Americas (from 2015). Conclusion Zika virus infection in humans appears to have changed in character as its geographical range has expanded from equatorial Africa and Asia. The change is from an endemic, mosquito-borne infection causing mild illness to one that can cause large outbreaks linked with neurological sequelae and congenital abnormalities. [ABSTRACT FROM AUTHOR]

A robust health infrastructure in every country is the most effective long-term preparedness strategy for global health emergencies. This includes not only health systems and their human resources, but also countries' legal infrastructure for health: the laws and policies that empower, obligate and sometimes limit government and private action. The law is also an important tool in health promotion and protection. Public health professionals play important roles in health law -- from the development of policies, through their enforcement, to the scientific evaluation of the health impact of laws. Member States are already mandated to communicate their national health laws and regulations to the World Health Organization (WHO). In this paper we propose that WHO has the authority and credibility to support capacity-building in the area of health law within Member States, and to make national laws easier to access, understand, monitor and evaluate. We believe a strong case can be made to donors for the funding of a public health law centre or unit, that has adequate staffing, is robustly networked with its regional counterparts and is integrated into the main work of WHO. The mission of the unit or centre would be to define and integrate scientific and legal expertise in public health law, both technical and programmatic, across the work of WHO, and to conduct and facilitate global health policy surveillance. [ABSTRACT FROM AUTHOR]

Maintaining quality, competitiveness and innovation in global health technology is a constant challenge for manufacturers, while affordability, access and equity are challenges for governments and international agencies. In this paper we discuss these issues with reference to rapid diagnostic tests for malaria. Strategies to control and eliminate malaria depend on early and accurate diagnosis. Rapid diagnostic tests for malaria require little training and equipment and can be performed by non-specialists in remote settings. Use of these tests has expanded significantly over the last few years, following recommendations to test all suspected malaria cases before treatment and the implementation of an evaluation programme to assess the performance of the malaria rapid diagnostic tests. Despite these gains, challenges exist that, if not addressed, could jeopardize the progress made to date. We discuss recent developments in rapid diagnostic tests for malaria, highlight some of the challenges and provide suggestions to address them. [ABSTRACT FROM AUTHOR]

To ensure equitable access to medicines and vaccines, organizational efforts and purchase volumes have been pooled in joint procurements and negotiations for decades in some regions of the world, as well as globally through supranational procurement mechanisms. In Europe, countries started to collaborate on procurement and negotiations recently when it became increasingly difficult to ensure access to high-priced medicines, even in high-income countries. Two European country collaborations (the Nordic Pharmaceutical Forum and the Baltic Procurement Initiative) have successfully concluded at least one joint tender process for medicines and vaccines and the Beneluxa Initiative has concluded its first successful joint price negotiation. This article describes the experiences of these country collaborations. Challenges observed included: legal barriers; institutional and organizational differences between health-care systems in member countries; and the risk that suppliers will be reluctant to cooperate with country collaborations. Although these collaborations helped improve access to medicines and vaccines for the countries involved, in situations such as a global health crisis, larger-scale, more-inclusive initiatives are needed. In the current coronavirus disease 2019 (COVID-19) pandemic, COVID-19 Vaccines Global Access (COVAX) initiative established a global procurement mechanism to ensure the equitable distribution of COVID-19 vaccines globally. Despite differences in organization and scale, the European country collaborations and COVAX have some similarities: (i) their success depends on the increased purchasing power associated with pooled order volumes; (ii) expert knowledge and previous procurement experience is pooled; (iii) they perform other collaborative activities that go beyond procurement alone; and (iv) they actively involve external partners and stakeholders. Depuis des decennies, certaines regions du monde ont uni leurs efforts pour s'organiser, negocier et effectuer des achats groupes de grandes quantites afin d'assurer un acces equitable aux medicaments et vaccins. Des mecanismes d'acquisition supranationaux ont fait de meme a l'echelle planetaire. En Europe, des Etats ont recemment commence a collaborer en matiere d'achat et de negociation lorsqu'il est devenu de plus en plus difficile de garantir l'acces a des medicaments couteux, y compris dans les pays a haut revenu. Deux collaborations entre pays europeens (le Forum pharmaceutique nordique et l'Initiative d'acquisition de la Baltique) ont mene a bien au moins un processus d'offre conjoint pour des medicaments et vaccins, tandis que l'Initiative Beneluxa a conclu sa premiere negociation tarifaire conjointe. Cet article decrit les experiences liees a ces collaborations entre nations. Plusieurs defis se sont poses, notamment des obstacles juridiques; des differences institutionnelles et organisationnelles entre les systemes de sante des Etats membres; et enfin, le risque que les fournisseurs soient peu enclins a accepter ces collaborations entre pays. Bien que ces collaborations aient ameliore l'acces aux medicaments et vaccins pour les pays impliques, des initiatives plus globales et a plus grande echelle sont necessaires dans des situations telles qu'une crise sanitaire mondiale. Durant l'actuelle pandemie de maladie a coronavirus 2019 (COVID-19), l'initiative COVAX (COVID-19 Vaccines Global Access) a abouti a un dispositif d'approvisionnement mondial pour veiller a distribuer equitablement des vaccins contre la COVID-19 dans le monde. Malgre des variations d'organisation et d'echelle, les collaborations entre Etats europeens partagent des similitudes avec le COVAX: (i) le succes de ces deux demarches depend d'un accroissement du pouvoir d'achat combine a des volumes de commande groupes; (ii) elles mettent en commun les connaissances approfondies et experiences passees; (iii) elles menent d'autres activites collectives qui depassent le simple cadre de l'acquisition; et enfin, (iv) elles impliquent activement une serie d'intervenants et de partenaires externes. Para garantizar un acceso equitativo a los medicamentos y las vacunas, los esfuerzos organizativos y los volumenes de compra se han unido en adquisiciones y negociaciones conjuntas durante decadas en algunas regiones del mundo, asi como a nivel mundial a traves de mecanismos de adquisicion supranacionales. En Europa, los paises empezaron a colaborar en las adquisiciones y negociaciones recientemente, cuando se hizo cada vez mas dificil garantizar el acceso a los medicamentos con precios altos, incluso en los paises de renta alta. Dos colaboraciones de paises europeos (el Foro Farmaceutico Nordico y la Iniciativa de Adquisicion del Baltico) han concluido con exito al menos un proceso de licitacion conjunta de medicamentos y vacunas, y la Iniciativa Beneluxa ha concluido con exito su primera negociacion conjunta de precios. Este articulo describe las experiencias de estas colaboraciones entre paises. Entre los retos observados se encuentran: las barreras legales, las diferencias institucionales y organizativas entre los sistemas sanitarios de los paises miembros y el riesgo de que los proveedores se muestren reacios a cooperar con las colaboraciones entre paises. Aunque estas colaboraciones ayudaron a mejorar el acceso a los medicamentos y las vacunas para los paises implicados, en situaciones como una crisis sanitaria mundial, se necesitan iniciativas a mayor escala y mas inclusivas. En la actual pandemia de la enfermedad por coronavirus (COVID-19), la iniciativa Acceso global a las vacunas de la COVID-19 (COVAX, por sus siglas en ingles) establecio un mecanismo de adquisicion mundial para garantizar la distribucion equitativa de las vacunas contra la COVID-19 en todo el mundo. A pesar de las diferencias de organizacion y escala, las colaboraciones de los paises europeos y COVAX tienen algunas similitudes: i) su exito depende del mayor poder adquisitivo asociado a los volumenes de pedidos mancomunados; ii) se ponen en comun los conocimientos de los expertos y la experiencia previa en materia de adquisiciones; iii) realizan otras actividades de colaboracion que van mas alla de la mera adquisicion; e iv) implican activamente a socios y partes interesadas externas. [phrase omitted], Introduction Access to essential medicines has become a major challenge globally. Even high-income countries with health-care systems based on social solidarity are increasingly struggling to afford the high price of [...]

Objective We investigated associations between changes in national food energy supply and in average population body weight. Methods We collected data from 24 high-, 27 middle-and 18 low-income countries on the average measured body weight from global databases, national health and nutrition survey reports and peer-reviewed papers. Changes in average body weight were derived from study pairs that were at least four years apart (various years, 1971-2010). Selected study pairs were considered to be representative of an adolescent or adult population, at national or subnational scale. Food energy supply data were retrieved from the Food and Agriculture Organization of the United Nations food balance sheets. We estimated the population energy requirements at survey time points using Institute of Medicine equations. Finally, we estimated the change in energy intake that could theoretically account for the observed change in average body weight using an experimentally-validated model. Findings In 56 countries, an increase in food energy supply was associated with an increase in average body weight. In45 countries, the increase in food energy supply was higher than the model-predicted increase in energy intake. The association between change in food energy supply and change in body weight was statistically significant overall and for high-income countries (P< 0.001 ). Conclusion The findings suggest that increases in food energy supply are sufficient to explain increases in average population body weight, especially in high-income countries. Policy efforts are needed to improve the healthiness of food systems and environments to reduce global obesity. [ABSTRACT FROM AUTHOR]

Rising incomes, the spread of personal insurance, lifestyle factors adding to the burden of illness, ageing populations, globalization and skills transfer within the medical community have increased worldwide demand for organ transplantation. The Global Observatory on Donation and Transplantation, which was built in response to World Health Assembly resolution WHA57.18, has conducted ongoing documentation of global transplantation activities since 2007. In this paper, we use the Global Observatory’s data to describe the current distribution of – and trends in – transplantation activities and to evaluate the role of health systems factors and macroeconomics in the diffusion of transplantation technology. We then consider the implications of our results for health policies relating to organ donation and transplantation. Of the World Health Organization’s Member States, most now engage in organ transplantation and more than a third performed deceased donor transplantation in 2011. In general, the Member States that engage in organ transplantation have greater access to physician services and greater total health spending per capita than the Member States where organ transplantation is not performed. The provision of deceased donor transplantation was closely associated with high levels of gross national income per capita. There are several ways in which governments can support the ethical development of organ donation and transplantation programmes. Specifically, they can ensure that appropriate legislation, regulation and oversight are in place, and monitor donation and transplantation activities, practices and outcomes. Moreover, they can allocate resources towards the training of specialist physicians, surgeons and transplant coordinators, and implement a professional donor-procurement network. [ABSTRACT FROM AUTHOR]

Brazil, the Russian Federation, India, China and South Africa -- the countries known as BRICS -- are currently undergoing a deep epidemiological transition that is mainly driven by rapid economic growth and technological change. The changes being observed in the distribution of the burden of diseases and injuries -- such as recent increases in the incidence of road traffic injuries -- are matters of concern. BRICS may need stronger institutional capacity to address such changes in a timely way. In this paper, we present data on road traffic injuries in BRICS and illustrate the enormous challenge that these countries currently face in reducing the incidence of such injuries. There is an urgent need to improve road safety indicators in every country constituting BRICS. It is imperative for BRICS to invest in system-wide road safety interventions and reduce the mortality and morbidity from road traffic injuries. [ABSTRACT FROM AUTHOR]

Brazil, the Russian Federation, India, China and South Africa -- the countries known as BRICS -- represent some of the world’s fastest growing large economies and nearly 40% of the world’s population. Over the last two decades, BRICS have undertaken health-system reforms to make progress towards universal health coverage. This paper discusses three key aspects of these reforms: the role of government in financing health; the underlying motivation behind the reforms; and the value of the lessons learnt for non-BRICS countries. Although national governments have played a prominent role in the reforms, private financing constitutes a major share of health spending in BRICS. There is a reliance on direct expenditures in China and India and a substantial presence of private insurance in Brazil and South Africa. The Brazilian health reforms resulted from a political movement that made health a constitutional right, whereas those in China, India, the Russian Federation and South Africa were an attempt to improve the performance of the public system and reduce inequities in access. The move towards universal health coverage has been slow. In China and India, the reforms have not adequately addressed the issue of out-of-pocket payments. Negotiations between national and subnational entities have often been challenging but Brazil has been able to achieve good coordination between federal and state entities via a constitutional delineation of responsibility. In the Russian Federation, poor coordination has led to the fragmented pooling and inefficient use of resources. In mixed health systems it is essential to harness both public and private sector resources. [ABSTRACT FROM AUTHOR]

Philip Morris has recently brought claims against Australia (2011) and Uruguay (2010) under international investment agreements (IIAs). The claims allege that Philip Morris is entitled to compensation following the introduction of innovative tobacco packaging regulations to reduce smoking and prevent noncommunicable diseases (NCDs). Since tobacco control measures are often viewed as a model for public health nutrition measures, the claims raise the question of how investment law governs the latter. This paper begins to answer this question and to explain how governments can proactively protect policy space for public health nutrition in an era of expanding IIAs. The authors first consider the main interventions proposed to reduce diet-related NCDs and their intersection with investment in the food supply chain. They then review the nature of investment regimes and relevant case law and examine ways to maximize policy space for public health nutrition intervention within this legal context. As foreign investment increases across the food-chain and more global recommendations discouraging the consumption of unhealthful products are issued, investment law will increase in importance as part of the legal architecture governing the food supply. The implications of investment law for public health nutrition measures depend on various factors: the measures themselves, the terms of the applicable agreements, the conditions surrounding the foreign investment and the policies governing agricultural support. This analysis suggests that governments should adopt proactive measures -- e.g. the clarification of terms and reliance on exceptions -- to manage investment and protect their regulatory autonomy with respect to public health nutrition. [ABSTRACT FROM AUTHOR]

Objective: To present the available data on the money spent by Member States of the World Health Organization (WHO) on remunerating health workers in the public and private sectors. Methods: Data on government and total expenditure on health worker remuneration were obtained through a review of official documents in WHO's Global Health Expenditure Database and directly from country officials and country official web sites. Such data are presented in this paper, by World Bank country income groups, in millions of national currency units per calendar year for salaried and non-salaried health workers. They are presented as a share of gross domestic product (GDP), total health expenditure and general government health expenditure. The average yearly change in remuneration (i.e. compound annual growth rate) between 2000 and 2012 as a function of these parameters was also assessed. Findings: On average, payments to health workers of all types accounted for more than one third of total health expenditure across countries. Such payments have grown faster than countries' GDPs but less rapidly than total health expenditure and general government health expenditure. Remuneration of health workers, on the other hand, has grown faster than that of other types of workers. Conclusion: As they seek to attain universal health coverage (UHC), countries will need to devote an increasing proportion of their GDPs to health and health worker remuneration. However, the fraction of total health expenditure devoted to paying health workers seems to be declining, partly because the pursuit of UHC calls for strengthening the health system as a whole. [ABSTRACT FROM AUTHOR]

Human resources for health have been recognized as essential to the development of responsive and effective health systems. Low- and middle-income countries seeking to achieve universal health coverage face human resource constraints -- whether in the form of health worker shortages, maldistribution of workers or poor worker performance -- that seriously undermine their ability to achieve well-functioning health systems. Although much has been written about the human resource crisis in the health sector, labour economic frameworks have seldom been applied to analyse the situation and little is known or understood about the operation of labour markets in low- and middle-income countries. Traditional approaches to addressing human resource constraints have focused on workforce planning: estimating health workforce requirements based on a country's epidemiological and demographic profile and scaling up education and training capacities to narrow the gap between the "needed" number of health workers and the existing number. However, this approach neglects other important factors that influence human resource capacity, including labour market dynamics and the behavioural responses and preferences of the health workers themselves. This paper describes how labour market analysis can contribute to a better understanding of the factors behind human resource constraints in the health sector and to a more effective design of policies and interventions to address them. The premise is that a better understanding of the impact of health policies on health labour markets, and subsequently on the employment conditions of health workers, would be helpful in identifying an effective strategy towards the progressive attainment of universal health coverage. [ABSTRACT FROM AUTHOR]

Objective To assess the effectiveness of interventions to improve the mental health of women in the perinatal period and to evaluate any effect on the health, growth and development of their offspring, in low- and middle-income (LAMI) countries. Methods Seven electronic bibliographic databases were systematically searched for papers published up to May 2012 describing controlled trials of interventions designed to improve mental health outcomes in women who were pregnant or had recently given birth. The main outcomes of interest were rates of common perinatal mental disorders (CPMDs), primarily postpartum depression or anxiety; measures of the quality of the mother-infant relationship; and measures of infant or child health, growth and cognitive development. Meta-analysis was conducted to obtain a summary measure of the clinical effectiveness of the interventions. Findings Thirteen trials representing 20 092 participants were identified. In all studies, supervised, non-specialist health and community workers delivered the interventions, which proved more beneficial than routine care for both mothers and children. The pooled effect size for maternal depression was −0.38 (95% confidence interval: −0.56 to −0.21; I2 = 79.9%). Where assessed, benefits to the child included improved mother-infant interaction, better cognitive development and growth, reduced diarrhoeal episodes and increased immunization rates. Conclusion In LAMI countries, the burden of CPMDs can be reduced through mental health interventions delivered by supervised non-specialists. Such interventions benefit both women and their children, but further studies are needed to understand how they can be scaled up in the highly diverse settings that exist in LAMI countries. [ABSTRACT FROM AUTHOR]

Abstract The problem of how to mitigate the impact of pharmaceutical patents on the delivery of essential medicines to the world's poor is as far from being resolved as it has ever been. Extensive academic commentary and policy debate have achieved little in terms of practical outcomes. Although international instruments are now in place allowing countries to enact legislation that permits the generic manufacture of patented pharmaceuticals, many countries have not yet enacted appropriate legislation and most of those that have yet to make use of it. One major problem is that the requirements of international instruments and implementing legislation are seen as being so stringent as to be unworkable. This paper calls for fresh attempts to enact workable legislation that fits within the prescribed requirements of international law without going beyond them. It argues that high-income nations should refocus on their moral obligation to enact appropriate legislative mechanisms and provide appropriate incentives for their use. Draft legislation currently being considered in Australia is used to illustrate how workable legislative frameworks can be developed. [ABSTRACT FROM AUTHOR]

Female genital schistosomiasis as a result of chronic infection with Schistosoma haematobium (commonly known as bilharzia) continues to be largely ignored by national and global health policy-makers. International attention for large-scale action against the disease focuses on whether it is a risk factor for the transmission of human immunodeficiency virus (HIV). Yet female genital schistosomiasis itself is linked to pain, bleeding and sub- or infertility, leading to social stigma, and is a common issue for women in schistosomiasis-endemic areas in sub-Saharan Africa. The disease should therefore be recognized as another component of a comprehensive health and human rights agenda for women and girls in Africa, alongside HIV and cervical cancer. Each of these three diseases has a targeted and proven preventive intervention: antiretroviral therapy and pre-exposure prophylaxis for HIV; human papilloma virus vaccine for cervical cancer; and praziquantel treatment for female genital schistosomiasis. We discuss how female genital schistosomiasis control can be integrated with HIV and cervical cancer care. Such a programme will be part of a broader framework of sexual and reproductive health and rights, women's empowerment and social justice in Africa. Integrated approaches that join up multiple public health programmes have the potential to expand or create opportunities to reach more girls and women throughout their life course. We outline a pragmatic operational research agenda that has the potential to optimize joint implementation of a package of measures responding to the specific needs of girls and women. [phrase omitted] [phrase omitted] La schistosomiase genitale feminine, resultant d'une infection chronique a Schistosoma haematobium (egalement connue sous le nom de bilharziose), continue d'etre largement ignoree par les responsables des politiques de sante nationales et internationales. Si le monde lui accorde son attention en vue de mener une action a grande echelle contre la maladie, c'est surtout pour determiner s'il s'agit d'un facteur de risque pour la transmission du virus de l'immunodeficience humaine (VIH). Pourtant, la schistosomiase genitale feminine est associee a des douleurs, des saignements et peut engendrer l'hypofertilite, voire la sterilite. Par consequent, celles qui en souffrent sont souvent stigmatisees, et le probleme est courant dans les regions endemiques d'Afrique subsaharienne. Cette maladie doit donc etre consideree comme composante a part entiere d'une approche globale de la sante et des droits humains pour les femmes et filles africaines, a l'instar du VIH et du cancer du col de l'uterus. Chacune de ces trois maladies fait l'objet d'une intervention preventive ciblee qui a deja fait ses preuves: le traitement antiretroviral et la prophylaxie pre-exposition pour le VIH; le vaccin contre le papillomavirus humain pour le cancer du col de l'uterus; et l'administration de praziquantel pour la schistosomiase genitale feminine. Le present document se penche sur la maniere d'integrer la schistosomiase genitale feminine dans la prise en charge du VIH et du cancer du col de l'uterus. Un tel programme fera partie d'un cadre plus vaste consacre aux droits et a la sante sexuelle et reproductive, a l'emancipation des femmes et a la justice sociale en Afrique. Les approches integrees qui regroupent plusieurs programmes de sante publique permettent d'elargir des perspectives ou de creer des opportunites visant a atteindre un plus grand nombre de filles et de femmes tout au long de leur vie. Nous exposons les grandes lignes d'un programme de recherches pragmatiques et operationnelles capable d'optimiser la mise en reuvre conjointe d'une serie de mesures qui repondent aux besoins specifiques des filles et des femmes. [phrase omitted] Los responsables de formular las politicas sanitarias nacionales y globales siguen ignorando en gran medida la esquistosomiasis genital femenina como consecuencia de la infeccion cronica por Schistosoma haematobium (conocida comunmente como bilharziasis). La atencion internacional para adoptar medidas de gran alcance contra la enfermedad se centra en determinar si es un factor de riesgo para la transmision del virus de la inmunodeficiencia humana (VIH). Sin embargo, la propia esquistosomiasis genital femenina esta vinculada al dolor, las hemorragias y la infertilidad o subfertilidad, lo que conduce al estigma social, ademas de ser un problema comun para las mujeres de las areas en donde la esqulstosomlasls es endemica en el Africa subsaharlana. Por consiguiente, la enfermedad debe ser reconocida como otro componente de un programa integral de salud y de derechos humanos para las mujeres y las ninas de Africa, junto con el VIH y el cancer de cuello uterino. Cada una de estas tres enfermedades tiene una intervencion preventiva especifica y comprobada: la terapia antirretroviral y la profilaxis previa a la exposicion para el VIH; la vacuna contra el virus del papiloma humano para el cancer de cuello uterino; y el tratamiento con praziquantel para la esquistosomiasis genital femenina. Se analiza como el control de la esquistosomiasis genital femenina se puede integrar con la atencion del VIH y el cancer de cuello uterino. Ese programa formara parte de un marco mas amplio de salud y de derechos sexuales y reproductivos, de empoderamiento de la mujer y de justicia social en Africa. Los enfoques integrados que unen multiples programas de salud publica tienen el potencial de ampliar o crear oportunidades para llegar a mas ninas y mujeres a lo largo de sus vidas. Se describe a grandes rasgos un programa de investigacion operacional pragmatico que tiene el potencial de optimizar la implementacion conjunta de una serie de medidas que respondan a las necesidades especificas de las ninas y de las mujeres., Introduction Gynaecological schistosomiasis as a result of chronic infection with Schistosoma haematobium (commonly known as bilharzia) has been described in the medical literature since the 1940s. (1,2) In the early [...]

Three decades since the human immunodeficiency virus (HIV) was identified, the pandemic of acquired immunodeficiency syndrome (AIDS) has developed into diverse epidemics around the world. In many populations, HIV infection has become endemic. While there is good progress on expanding access to treatment, with an estimated 6.6 million people on antiretroviral therapy at the end of 2010, prevention efforts are still highly inadequate with 2.6 million new infections occurring in 2009. Demand for treatment is increasing while funding is becoming more scarce and activism is waning. In 2007, the Joint United Nations Programme on HIV/AIDS (UNAIDS) established an independent forum called aids2031 to take a critical look at the global HIV/AIDS response. This paper outlines four key areas for a redesigned AIDS response based on the deliberations of this initiative and on the learning and experience of the first three decades of the epidemic: (i) a new culture of knowledge generation and utilization; (ii) transformed prevention and treatment to increase effectiveness; (iii) increased efficiency through better management and maximizing synergies with other programmes; and (iv) investment for the long term. Across all these areas is a strong emphasis on local capacity building, leadership, programme priorities and budgets. [ABSTRACT FROM AUTHOR]

Objective To estimate the cost of scaling up childhood immunization services required to reach the WHO-UNICEF Global Immunization Vision and Strategy (GIVS) goal of reducing mortality due to vaccine-preventable diseases by two-thirds by 2015. Methods A model was developed to estimate the total cost of reaching GIVS goals by 2015 in 117 low- and lower-middle-income countries. Current spending was estimated by analysing data from country planning documents, and scale-up costs were estimated using a bottom-up, ingredients-based approach. Financial costs were estimated by country and year for reaching 90% coverage with all existing vaccines; introducing a discrete set of new vaccines (rotavirus, conjugate pneumococcal, conjugate meningococcal A and Japanese encephalitis); and conducting immunization campaigns to protect at-risk populations against polio, tetanus, measles, yellow fever and meningococcal meningitis. Findings The 72 poorest countries of the world spent US$ 2.5 (range: US$ 1.8-4.2) billion on immunization in 2005, an increase from US$ 1.1 (range: US$ 0.9-1.6) billion in 2000. By 2015 annual immunization costs will on average increase to about US$ 4.0 (range US$ 2.9-6.7) billion. Total immunization costs for 2006-2015 are estimated at US$ 35 (range US$ 13-40) billion; of this, US$ 16.2 billion are incremental costs, comprised of US$ 5.6 billion for system scale-up and US$ 8.7 billion for vaccines; US$ 19.3 billion is required to maintain immunization programmes at 2005 levels. In all 117 low- and lower-middle-income countries, total costs for 2006-2015 are estimated at US$ 76 (range: US$ 23-110) billion, with US$ 49 billion for maintaining current systems and $27 billion for scaling-up. Conclusion In the 72 poorest countries, US$ 11-15 billion (30%-40%) of the overall resource needs are unmet if the GIVS goals are to be reached. The methods developed in this paper are approximate estimates with limitations, but provide a roadmap of financing gaps that need to be filled to scale up immunization by 2015. [ABSTRACT FROM AUTHOR]

Health has gained recognition as a foreign policy concern in recent years. Political leaders increasingly address global health problems within their international relations agendas. The confluence of health and foreign policy has opened these issues to analysis that helps clarify the tenets and determinants of this linkage, offering a new framework for international health policy. Yet as health remains profoundly bound to altruistic values, caution is required before generalizing about the positive outcomes of merging international health and foreign policy principles. In particular, the possible side-effects of this framework deserve further consideration. This paper examines the interaction of health and foreign policy in humanitarian action, where public health and foreign policy are often in direct conflict. Using a case-based approach, this analysis shows that health and foreign policy need not be at odds in this context, although there are situations where altruistic and interest-based values compete. The hierarchy of foreign policy functions must be challenged to avoid misuse of national authority where health interventions do not coincide with national security and domestic interests. [ABSTRACT FROM AUTHOR]

Most countries have acceded to at least one global or regional covenant or treaty confirming the right to health. After years of international discussions on human rights, many governments are now moving towards practical implementation of their commitments. A practical example may be of help to those governments who aim to translate their international treaty obligations into practice. WHO's Essential Medicines Programme is an example of how this transition from legal principles to practical implementation may be achieved. This programme has been consistent with human rights principles since its inception in the early 1980s, through its focus on equitable access to essential medicines. This paper provides a brief overview of what the international human rights instruments mention about access to essential medicines, and proposes five assessment questions and practical recommendations for governments. These recommendations cover the selection of essential medicines, participation in programme development, mechanisms for transparency and accountability, equitable access by vulnerable groups, and redress mechanisms. [ABSTRACT FROM AUTHOR]

Despite a growing global commitment to the provision of antiretroviral therapy (ART), its availability is still likely to be less than the need. This imbalance raises ethical dilemmas about who should be granted access to publicly-subsidized ART programmes. This paper reviews the eligibility and targeting criteria used in four case-study countries at different points in the scale-up of ART, with the aim of drawing lessons regarding ethical approaches to rationing. Mexico, Senegal, Thailand and Uganda have each made an explicit policy commitment to provide antiretrovirals to all those in need, but are achieving this goal in steps — beginning with explicit rationing of access to care. Drawing upon the case-studies and experiences elsewhere, categories of explicit rationing criteria have been identified. These include biomedical factors, adherence to treatment, prevention-driven factors, social and economic benefits, financial factors and factors driven by ethical arguments. The initial criteria for determining eligibility are typically clinical criteria and assessment of adherence prospects, followed by a number of other factors. Rationing mechanisms reflect several underlying ethical theories and the ethical underpinnings of explicit rationing criteria should reflect societal values. In order to ensure this alignment, widespread consultation with a variety of stakeholders, and not only policy-makers or physicians, is critical. Without such explicit debate, more rationing will occur implicitly and this may be more inequitable. The effects of rationing mechanisms upon equity are critically dependent upon the implementation processes. As antiretroviral programmes are implemented it is crucial to monitor who gains access to these programmes. [ABSTRACT FROM AUTHOR]

Asthma is a very common chronic disease that occurs in all age groups and is the focus of various clinical and public health interventions. Both morbidity and mortality from asthma are significant. The number of disability-adjusted life years (DALYs) lost due to asthma worldwide is similar to that for diabetes, liver cirrhosis and schizophrenia. Asthma management plans have, however, reduced mortality and severity in countries where they have been applied. Several barriers reduce the availability, affordability, dissemination and efficacy of optimal asthma management plans in both developed and developing countries. The workplace environment contributes significantly to the general burden of asthma. Patients with occupational asthma have higher rates of hospitalization and mortality than healthy workers. The surveillance of asthma as part of a global WHO programme is essential. The economic cost of asthma is considerable both in terms of direct medical costs (such as hospital admissions and the cost of pharmaceuticals) and indirect medical costs (such as time lost from work and premature death). Direct costs are significant in most countries. In order to reduce costs and improve quality of care, employers and health plans are exploring more precisely targeted ways of controlling rapidly rising health costs. Poor control of asthma symptoms is a major issue that can result in adverse clinical and economic outcomes. A model of asthma costs is needed to aid attempts to reduce them while permitting optimal management of the disease. This paper presents a discussion of the burden of asthma and its socioeconomic implications and proposes a model to predict the costs incurred by the disease. [ABSTRACT FROM AUTHOR]

Vaccines that are designed for use only in developing countries face regulatory hurdles that may restrict their use. There are two primary reasons for this: most regulatory authorities are set up to address regulation of products for use only within their jurisdictions and regulatory authorities in developing countries traditionally have been considered weak. Some options for regulatory pathways for such products have been identified: licensing in the country of manufacture, file review by the European Medicines Evaluation Agency on behalf of WHO, export to a country with a competent national regulatory authority (NRA) that could handle all regulatory functions for the developing country market, shared manufacturing and licensing in a developing country with competent manufacturing and regulatory capacity, and use of a contracted independent entity for global regulatory approval. These options have been evaluated on the basis of five criteria: assurance of all regulatory functions for the life of the product, appropriateness of epidemiological assessment, applicability to products no longer used in the domestic market of the manufacturing country, reduction of regulatory risk for the manufacturer, and existing rules and regulations for implementation. No one option satisfies all criteria. For all options, national infrastructures (including the underlying regulatory legislative framework, particularly to formulate and implement local evidence-based vaccine policy) must be developed. WHO has led .work to develop this capacity with some success. The paper outlines additional areas of action required by the international community to assure development and use of vaccines needed for the developing world. [ABSTRACT FROM AUTHOR]

Abstract Analysed in this paper are national health accounts estimates for 191 WHO Member States for 1997, using simple comparisons and linear regressions to describe spending on health and how it is financed. The data cover all sources — out-of-pocket spending, social insurance contributions, financing from government general revenues and voluntary and employment-related private insurance — classified according to their completeness and reliability. Total health spending rises from around 2–3% of gross domestic product (GDP) at low incomes (US$ 7000). Surprisingly, there is as much relative variation in the share for poor countries as for rich ones, and even more relative variation in amounts in US$. Poor countries and poor people that most need protection from financial catastrophe are the least protected by any form of prepayment or risk-sharing. At low incomes, out-of-pocket spending is high on average and varies from 20–80% of the total; at high incomes that share drops sharply and the variation narrows. Absolute out-of-pocket expenditure nonetheless increases with income. Public financing increases faster, and as a share of GDP, and converges at high incomes. Health takes an increasing share of total public expenditure as income rises, from 5–6% to around 10%. This is arguably the opposite of the relation between total health needs and need for public spending, for any given combination of services. Within public spending, there is no convergence in the type of finance — general revenue versus social insurance. Private insurance is usually insignificant except in some rich countries. [ABSTRACT FROM AUTHOR]

The author of this article presents a modest proposal for the trustworthiness of a health research. Research that merits attention ask important questions and proposes significant answers. This can be seen from papers that become classics, such as James Lind's "Treatise of the Scurvy," Richard Doll's "Preliminary Report on Smoking and Carcinoma," or Geoffrey Rose's argument for focusing on "The determinants of Incidence Rates Rather Than the Determinants of Individual Cases." Such papers are also characterized by a high degree of clarity. Therefore, it is suggested for professional researchers to do more trustworthy work, and subject it to the most exacting standards of clarity possible.

The article discusses Kenya's preparation for a full e-procurement functionality that includes electronic bidding to support efforts to have a broader availability to essential health care. Topics discussed include the limited impact of paper bidding on illegal activities like bid-rigging, the advantages of going digital which include electronic record-keeping and the elimination of the funding gap for procurement of medical facilities with the e-procurement.