Health Equity: 07/12/10

Monday, July 12, 2010

[EQ] Access: how do good health technologies get to poor people in poor countries?

Access : how do good health technologies get to poor people in poor countries?

Laura J. Frost & Michael R. Reich.

Harvard Center for Population and Development Studies

Published in the Harvard Series on Population and International Health

Available online PDF [264p.] at: http://www.accessbook.org/download/AccessBook.pdf

“…..Many bottlenecks thus block access to health technologies in developing countries. Sometimes the barriers seem to overwhelm all efforts to expand access

to beneficial health technologies.

A growing literature examines the challenges that confront efforts to address particular barriers (such as pricing or patents or end-user demand). As part of this project, we conducted a literature review on specific barriers to access and produced an annotated bibliography of 44 selected recent articles.4 But few studies have comprehensively explored the many social, economic, political, and cultural processes that shape access to health technologies in developing countries—including how such technologies are perceived differently by key players.

Despite progress with placing access to medicines on the global policy agenda, enormous problems persist in the access gap for all sorts of health technologies— not just medicines. While the most contentious debates have focused on drugs and vaccines, similar problems exist for other kinds of health technologies.

The problems with access to diagnostics, for example, have remained relatively unexplored in policy debates. And the focus on certain types of access barriers (especially pricing and patents) has tended to obscure other important barriers to access, such as distribution, delivery, and adoption problems. Too often, the assumption has been that once a medicine is included in a list of essential medicines, the problems of access are solved.

This perspective overlooks the problems of distribution, delivery, and demand. For instance, even after praziquantel (the medicine for treatment of schistosomiasis) declined in price during the 1990s, serious problems of access persisted, especially in the poorest countries of the world (where the disease existed). When patents for praziquantel expired, more producers entered the global market, but these changes alone did not produce access. In chapter 3, we explore what happened with praziquantel, why problems in access persisted, and what has recently changed to improve the situation.

This book explores the challenges and approaches to improving access to health technologies for poor people in poor countries. Our goals are to develop and illustrate a way to think systematically about the barriers to access and to identify strategies that can help improve access……”

Content

Preface

CHAPTER 1, The Issue of Access
CHAPTER 2, The Access Framework

CHAPTER 3, Praziquantel: Access to Medicines

CHAPTER 4, Hepatitis B Vaccine: Access to Vaccines

CHAPTER 5, Malaria Rapid Diagnostic Tests: Access to Diagnostics

CHAPTER 6, Norplant: Access to Contraceptives

CHAPTER 7, Vaccine Vial Monitors: Access to Devices

CHAPTER 8, Female Condoms: Access to Dual Protection Technologies

CHAPTER 9, Synthesis: No Success Without Access

GLOSSARY

* * *

This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues. [DD/ KMC Area]

“Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.
------------------------------------------------------------------------------------
PAHO/WHO Website
Equity List - Archives - Join/remove: http://listserv.paho.org/Archives/equidad.html
Twitter http://twitter.com/eqpaho





IMPORTANT: This transmission is for use by the intended
recipient and it may contain privileged, proprietary or
confidential information. If you are not the intended
recipient or a person responsible for delivering this
transmission to the intended recipient, you may not
disclose, copy or distribute this transmission or take
any action in reliance on it. If you received this transmission
in error, please dispose of and delete this transmission. 

Thank you.

[EQ] The Food System: a prism of present and future challenges for health promotion and sustainable development

The Food System:
a prism of present and future challenges for health promotion and sustainable development

Available online PDF [27p.] at: http://bit.ly/9wBwCk

White paper has been authored by Ilona Kickbusch on behalf of Health Promotion Switzerland. July 2010

“…………In the 21st century, the purpose of governance should be healthy and sustainable development. There is a growing recognition of the significance of building a bridge between the health promotion agenda and the sustainability agenda: in many cases, the best choices for health are also the best choices for the planet; and the most ethical and environmental choices are also good for health. But too frequently, the two agendas are dealt with in separate debates and policy arenas.

There has not yet been a deep enough effort to link the two agendas and to ensure that they support each others’ normative and strategic goals in a more systematic manner. There is also growing awareness of how interconnected many of the major challenges that we face at the beginning of the 21st century are – and policy makers know that working in silos or only at the national level does not provide solutions.

Yet it remains difficult to engage other sectors in joint policy action at all levels of governance, in particular around “wicked problems” for which there is no easy or quick solution. This applies in particular to the greatest challenge in today’s world, the increasing inequity between and within countries – with the burdens of unsustainable development falling disproportionably on the poorest. It is therefore one of the key goals of the healthy3 initiative to move from a “silo” to “systems” approach.

Health promotion has always been dedicated to working with others: health is everybody’s business. Ensuring a commitment to health across government and by many different societal actors is critical for addressing the major social determinants of health. For many human beings, it is good governance that makes the difference between life and death – it provides access to education, health care, social protection, the rule of law and participation in the economy. It is from this understanding that policy concepts such as health in all policies and investment for health, approaches such as health in the settings of everyday life, and instruments such as health impact statements have been developed.

Based on these experiences, the healthy3 initiative wants to take health promotion concepts and strategies one step further by exploring three questions:

1. How can joint policy goals be developed so that health promotion can contribute to addressing major challenges facing humankind such as food, water, fuel, changing consumption patterns, climate change and the environment?

2. Through which strategies can a high level of complementarity and integration be achieved between health and the environmental, economic and social impacts?

3. What conceptual framing and common language can help move a shared agenda forward?..............”

Content:

1 Introduction

2 The conceptual base of the health promotion and the sustainable development agenda

3 How food links health promotion and sustainable development

3.1 The food system

3.2 The links between food, health and sustainable development

3.3 The challenges: equity, health, sustainability

3.3.1 A more equitable food system

3.3.2 The challenge: a healthier food system

3.3.3 The challenge: a more sustainable food system

4 The governance of food and health

4.1 The governance challenges in relation to the food system

4.2 The governance responses at the global level by the UN system

4.2.1 Food justice: combining the right to food and health

4.2.2 Food security: ensuring the access to food as a key dimension of health and human security

4.2.3 Food sovereignty: addressing powerlessness and democratic deficit

4.3 Governance at the national level: the emergence of comprehensive national food policies

4.4 Governance at the local level: the emergence of local food policies

5 Recommendations

5.1 General recommendations

5.2 Global sustainable and healthy food policies

5.3 National sustainable and healthy food policies

5.4 Encouraging local action for sustainable and healthy food policies

6 Outlook and way forward

7 References

* * *





IMPORTANT: This transmission is for use by the intended
recipient and it may contain privileged, proprietary or
confidential information. If you are not the intended
recipient or a person responsible for delivering this
transmission to the intended recipient, you may not
disclose, copy or distribute this transmission or take
any action in reliance on it. If you received this transmission
in error, please dispose of and delete this transmission. 

Thank you.

[EQ] Who, and what, causes health inequities?

Editorial:

Who, and what, causes health inequities?
Reflections on emerging debates from an exploratory Latin American/North American workshop

Nancy Krieger1, Margarita Alegría2, Naomar Almeida-Filho3, Jarbas Barbosa da Silva 4, Maurício L Barreto5, Jason Beckfield 6, Lisa Berkman7, Anne-Emanuelle Birn8, Bruce B Duncan9, Saul Franco10, Dolores Acevedo Garcia11, Sofia Gruskin12, Sherman A James13, Asa Christina Laurell14, Maria Inês Schmidt15, Karina L Walters16

Website: http://bit.ly/bOEiKj

Published Online First 27 June 2010 - J Epidemiol Community Health doi:10.1136/jech.2009.106906

“………….Rapidly rising interest - from national and international health organisations, governments, civil society, the private sector and myriad academic disciplines - in what has become known as the ‘social determinants of health’1 2 is welcome to the many, in and outside of public health, who have long held that issues of social justice and the public's health are inextricably linked (box 1).2 3 As inevitably happens, however, when an issue gets ‘mainstreamed’, a multiplicity of disparate voices enter the discussion, informed by not only different disciplinary vantages, but also divergent values, priorities and politics….”

1 Department of Society, Human, Development and Health, Harvard School of Public Health, Boston, Massachusetts, USA

2 Department of Psychiatry, Harvard Medical, School, Boston, Massachusetts, USA

3 Universidade Federal Da, Bahia (UFBA) and Professor of Epidemiology and Director, Instituto De Saude, Coletiva, UFBA, Bahia, Brazil

4 Health Surveillance and Disease Management, Pan American Health Organization PAHO/WHO, Washington, DC, USA

5 Department of Epidemiology, Universidade, Federal da Bahia Instituto de Saude Coletiva, Salvador, Brazil

6 Department of Sociology, Harvard, University, Cambridge, Massachusetts, USA

7 Harvard Center for Population Studies and Development, Harvard University, and Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA

8 Department of International Development, Studies and Canada Research Chair in International Health, University of Toronto, Toronto, Canada

9 Department of Social Medicine, Graduate, Studies Program in Epidemiology, School of Medicine, Federal University of Rio, Grande do Sul, Porto Alegre, RS, Brazil

10 Doctorado Interfacultades en Salud Pública, Universidad Nacional de Colombia, Bogatá, Colombia

11 Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts, USA

12 Department of Global Health and Population; Director, Program on International Health and Human Rights, Harvard School of Public Health, Boston, Massachusetts, USA

13 Sanford School of Public Policy, Duke University, Durham, North Carolina, USA

14 Department of Health of the Legitimate Government of Mexico, Mexico City, Mexico

15 Department of Social Medicine, Graduate Studies Program in Epidemiology, School of Medicine, Federal, University of Rio Grande do Sul, Porto Alegre, RS, Brazil

16 William P. and Ruth Gerberding University, Professorship, University of Washington, School of Social Work, Indigenous, Wellness Research Institute, Seattle, Washington, USA

* * *





IMPORTANT: This transmission is for use by the intended
recipient and it may contain privileged, proprietary or
confidential information. If you are not the intended
recipient or a person responsible for delivering this
transmission to the intended recipient, you may not
disclose, copy or distribute this transmission or take
any action in reliance on it. If you received this transmission
in error, please dispose of and delete this transmission. 

Thank you.