Inter Press Service » Health News and Views from the Global South Mon, 27 Feb 2017 17:07:34 +0000 en-US hourly 1 A Day to Remember That Every Child Deserves a Chance Mon, 27 Feb 2017 16:18:07 +0000 Emina Cerimovic

Emina Cerimovic is a disability rights researcher at Human Rights Watch.

By Emina Ćerimović
NEW YORK, Feb 27 2017 (IPS)

The day I met Julija she was playing cheerfully with her baby sister on the floor inside their room in Kragujevac, a small town in southern Serbia. When she saw me – a stranger — on the doorstep, she smiled widely and stretched out her hands, offering a hug. As I held her, I could hear how difficult it was for her to breathe. I looked at her, she smiled and touched my face with her hands and only then did I see that Julija’s fingers were webbed.

Julija was born with Apert Syndrome, a rare genetic condition. Children with this syndrome have fused skull bones, resulting in distorted facial features, vision and hearing loss, trouble with breathing and eating, and learning difficulties. In Julija’s case her fingers and toes were not separated either, which made holding a spoon or picking things up difficult.

Her parents – Jasmina and Ivica – told me about their struggle to provide Julija with the health care she needed to stay alive and to develop. For three months following Julija’s birth in 2012, her parents used every penny they had to ferry their daughter across the country in search of specialists who could help. The repeated advice they received was not helpful: Place your child in an institution. It’s best for you and her. “One doctor even told us that it will be a torment for us to keep her with us and that we might not get anything back in return,” Jasmina told me. “As if my child was a burden for me. None of these doctors were thinking about what is best for the child.”

Emina Ćerimović. Photo Courtesy of HRW

Emina Ćerimović. Photo Courtesy of HRW

By the time she was barely older than 3 months, Julija had undergone surgery twice on her head and had spent a month in intensive care with pneumonia. Because of her severe breathing problems and her need for frequent specialist treatment that Julija could not receive in her hometown, her parents decided, with heavy hearts, to place her in an institution for children with disabilities in Belgrade, Serbia’s capital, where she would have access to emergency care.

However, after only two days, her parents noticed a drastic change in Julija’s spirit. “She was no longer the child she used to be,” Jasmina told me.

After Julija spent 10 months in the institution with only short visits home, Jasmina and Ivica decided to bring her  back home. “When Julija is at home with us, she is one child, and when she is in an institution, she is a different child,” Jasmina said. “She has made much more progress [at home], in terms of her weight and everything else. Her intellectual development, too.”

With Julija back home, her parents worked tirelessly to find help. Ultimately, a relative in Australia made contact with a specialist at the Australian Craniofacial Unit in Adelaide. Supported by private fund raising efforts and the unit itself, in 2015, Juljia underwent life-changing surgery to reshape her skull to make more room for her brain.

When I met Julija in November 2015, surrounded by her loving parents, toys, and a baby sister, she was thriving and happy. Her parents told me she had put on weight and learned to sit, which she was unable to do when her parents brought her back from the institution. A few months after my visit she learned to walk  on her own. In November 2016, her fingers were unwebbed in a hospital in Belgrade.

A child’s ability to access health care needed for survival and development should not have to depend on their parent’s ability to fight for it. Every child has a right to health and health services.
However, Julija’s journey has only just begun. She will need professional support to learn to use her fingers. Her teeth are not growing properly. She still needs another facial and skull operation. She understands everything, her parents told me, but she doesn’t speak yet. And her breathing and her eyes have to be managed constantly.

Julija was not the only child I met in Serbia who was struggling to get much-needed health care. Hundreds of children with developmental disabilities, the majority of whom have a living parent,  are placed in large residential institutions where  they are separated from their families.  Unlike Julija, they don’t have someone who is working tirelessly to ensure their lives are the very best they can be. Instead, they are often neglected because there is not enough staff, and in some cases confined to beds for their entire lives, without any stimulation. Long-term placement of children in institutions leads to  stunted physical, intellectual, emotional, and social development.

A child’s ability to access health care needed for survival and development should not have to depend on their parent’s ability to fight for it. Every child has a right to health and health services.

On February 28, more than 80 countries worldwide are marking the tenth international Rare Disease Day, including Serbia. The Serbian government – and every government around the world– should mark this day by committing to provide all children with disabilities access to the health care they need to stay alive and to grow and develop just like other children. Julija – who was deemed a hopeless case at birth – just celebrated her fifth birthday with family and friends.

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These Women Cannot Celebrate Their Day Mon, 27 Feb 2017 14:18:56 +0000 Baher Kamal This article is part of a series of stories and op-eds that IPS is launching on the occasion of this year's International Women’s Day on March 8.]]> Belinda Mason, Silent Tears “Violence against women and girls is a human rights violation, public health pandemic and serious obstacle to sustainable development.” Ban Ki-moon, former UN Secretary-General

Belinda Mason, Silent Tears “Violence against women and girls is a human rights violation, public health pandemic and serious obstacle to sustainable development.” Ban Ki-moon, former UN Secretary-General

By Baher Kamal
ROME, Feb 27 2017 (IPS)

This is a story that one would wish to never have to write—the story of hundreds of millions of life-givers whose production and productivity have systematically been ‘quantified’ in much detailed statistics, but whose abnegation, human suffering and denial of rights are subject to just words.

It is the story of those women who witness their children die while fleeing wars, or are kidnapped to sell their organs, or recruited as child soldiers.

It is the story of those women who fall prey to human traffickers and are sold as sexual slaves. (The United Nations Office on Drugs and Crime (UNODC) reports that women and girls comprise 71 per cent of human trafficking victims.)

And it is the story of those women and girls who become victims of abhorrent violence by their male relatives; whose rights as workers are routinely abused by their employers, and are even killed by their partners. (In some countries, up to 7 in 10 women will be beaten, raped, abused or mutilated in their lifetimes, according to UN Women).

It is the story of millions of young girls who are forced into inhumane early marriage and pregnancy; of those who are subjected to female genital mutilation. (The UN recognises this practice as a human rights violation, torture and an extreme form of violence–Female genital mutilation denies women and girls their dignity and causes needless pain and suffering, with consequences that endure for a lifetime and can even be fatal, reminds the UN Secretary-General António Guterres.)

“We envisage a world where all women and girls have equal opportunities and rights by 2030. Step It Up asks governments to make national commitments that will close the gender equality gap – from laws and policies to national action plans and adequate investment. NOW is the time to Step It Up!” Credit: UN Women.

“We envisage a world where all women and girls have equal opportunities and rights by 2030. Step It Up asks governments to make national commitments that will close the gender equality gap – from laws and policies to national action plans and adequate investment. NOW is the time to Step It Up!” Credit: UN Women.

Africa and the Arab region are among those areas where FGM is commonly practised. (The African Union concludes that it is an excruciatingly painful practice that violates basic human rights).

Its impact on young girls and women is multi-faceted and touches various aspects of their lives, including their physical, psychological and social well-being, with scars lingering on for the rest of their lives.

It is the story of millions of girls who have no access to education, and when they have it, most of them flee school because of the lack of sanitary services. (A study by the UN human rights office (OHCHR) covering the years spanning 2009 to 2014 reports thousands of attacks against schools in at least 70 different countries, many of which were targeted for advocating girls’ education.)

It is the story of nearly two-thirds of world’s inhabitants who suffer from lack of proper access to reproductive and maternity health care services. (The UN Population Fund stresses that universal access to reproductive health affects and is affected by many aspects of life. It involves individuals’ most intimate relationships, including negotiation and decision-making within these relationships, and interactions with health providers regarding contraceptive methods and options.)

Credit: UNODC

Credit: UNODC

It is also the story of very young girls who are abducted by terror groups to brutally satiate their sexual appetites and blackmailing, such as has been the case of Boko Haram in Nigeria.

And it is the story of those indigenous women who care for whatever remains of their lands, which guard 80 per cent of world’s biodiversity, but whose rights and ancestral knowledge are ignored and even disdained.

It is the story of those women farmers who produce up to 80 per cent of food but have no right to own their land, to agricultural inputs, resources or small credits.

And of those millions of domestic workers whose rights were lately acknowledged – though not sufficiently applied.

And it is the story of a flagrant growing inequality. (OXFAM estimates that, at current trend, it will take women 170 years to be paid the same as men are…Let alone the fact that half of world’s health is in the pockets of just eight individuals—all of them men).

This year’s International Women’s Day will be marked on March 8 under the theme “Women in the Changing World of Work: Planet 50-50by 2030”.

The United Nations says that it will be “a time to reflect on progress made, to consider how to accelerate the 2030 Agenda, building momentum for the effective implementation of the long awaited goals of achieving gender equality and empowering all women and girls.”

The world body has set some key targets of that 2030 Agenda:

• By 2030, ensure that all girls and boys complete free, equitable and quality primary and secondary education leading to relevant and Goal-4 effective learning outcomes.

• By 2030, ensure that all girls and boys have access to quality early childhood development, care and pre-primary education so that they are ready for primary education.

• End all forms of discrimination against all women and girls everywhere.

• Eliminate all forms of violence against all women and girls in the public and private spheres, including trafficking and sexual and other types of exploitation.

• Eliminate all harmful practices, such as child, early and forced marriage and female genital mutilation.

The United Nations also notes that the world of work is changing, with significant implications for women. “We have globalisation, technological and digital revolution and the opportunities they bring, and on the other hand, the growing informality of labour, unstable livelihoods and incomes, new fiscal and trade policies and environmental impacts—all of which must be addressed in the context of women’s economic empowerment.”

All these words and good wishes sound great.

Yet International Women’s Day will represent, above all, another slap in the face of humankind who is still unable (unwilling?) to duly, effectively honour those who gave them life.

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Avoid Patent Clauses in Trade Treaties that can Kill Millions Mon, 27 Feb 2017 14:12:29 +0000 Martin Khor Credit: Bigstock

Credit: Bigstock

By Martin Khor
PENANG, Feb 27 2017 (IPS)

Recently a very interesting article on why there are inequalities in access to health care and how  medicine prices are beyond the reach of many people was published in The Lancet, one of the most prestigious medical journals in the world.

The authors, who are eminent experts in development and public health, pinpointed trade and investment agreements for being one of the greatest health threats.

Reading their powerful commentary leads one to think:  What’s the point of having wonderful medicines if most people on Earth cannot get to use them?   And isn’t it immoral that medicines that can save your life can’t be given to you because the cost is so high?

The article picks on the Trans-Pacific Partnership (TPP), together with the Transatlantic Trade and Investment Partnership (TTIP) as the worst culprits.  It says the TPP’s chapter on intellectual property is “particularly intrusive to health and restricts access to the latest advances in medicines, diagnostic tools and other life-saving medical technologies.”

Martin Khor

Martin Khor

This agreement, say the authors, contains many provisions that “strengthen patent protection that provides monopolies and inevitably leads to high prices.”   They mention provisions that extend the patent terms beyond 20 years required by the WTO; lower the criteria of what can be granted  patents; and “data exclusivity” provisions that put up barriers to generic manufacturers entering markets after the expiry of patents.

This viewpoint article was co-authored by Prof Desmond McNeill (University of Oslo), Dr Carolyn Deere (Oxford University); Prof Sakiko Fukuda-Parr (The New School, New York, and formerly the main author of the UNDP’s Human Development Report for many years), Anand Grover (Lawyers Collective India and formerly the Human Rights Council’s Special Rapporteur for the Right to Health); Prof Ted Schrecker (Durham University, UK) and Prof David Stuckler (Oxford University).

They said that growing evidence suggests that the agreements “will have major and largely negative consequences for health that go far beyond earlier trade agreements.  This situation is particularly disturbing since the agreements have created blueprints for future trade agreements.”

The Nobel Peace Prize winning medical group, Medecins Sands Frontieres (MSF), is even more scathing in its criticism.  “The TPP represents the most far-reaching attempt to date to impose aggressive intellectual property standards that further tip the balance towards commercial interests and away from public health….  In developing countries, high prices keep lifesaving medicines out of reach and are often a matter of life and death.”

This condemnation is just as relevant despite President Donald Trump withdrawing the United States from the TPP. There are efforts underway for the remaining 11 countries to put the TPP into effect without the US.

Moreover, these countries have prepared changes to their laws and policies to comply with the TPP’s provisions, and may implement these even if the TPP actually never comes into effect.

This would be an immense tragedy for public health, because most of these countries did understand that the chapter on intellectual property would have negative effects, but they accepted it as part of a bargain for getting better market access, especially to the US.

Since the TPP is now in suspension, it does not make any sense for the countries to change their patent laws when the benefit of market access is no longer available.

During the TPP negotiations, the other countries managed to dilute some of the very extreme demands of the US, but only to a small extent.  The final intellectual rights chapter still reflects the extreme proposals of the US.

With the TPP in limbo and perhaps in perpetual suspension, there is really no reason why the provisions that have adverse effects should be implemented in the countries that had negotiated the TPP, when there are no benefits to be obtained to offset them.
Moreover, the major developed countries can be expected to make use of the TPP’s intellectual property chapter to inject into negotiations for new trade agreements, for example the RCEP, the Asian regional agreement.

Negotiators, especially from developing countries, and civil society groups should thus be vigilant that the TPP’s provisions that have adverse effects on health are not reproduced in other trade agreements.

Members of the World Trade Organisation are required to implement its intellectual property agreement, known as TRIPS, but they are not obliged to take on any additional obligations.

There are many provisions in TRIPS that allow a country to choose policies that are pro-health.  The TPP has clauses that prevent a country from making use of many of these options because they are “TRIPS-plus”, going beyond what the TRIPS obligations.

First, there is a TPP provision that lowers the standards a country can adopt to grant a patent.  Some patent applications are not for genuine inventions but are only made to “evergreen” a patent, to enable its term to continue after it expires.  Under TRIPS, a country can choose not to grant secondary patents for modifications of existing medicines.

The TPP (Article 18.3) requires countries to grant patents for at least one of the following modifications:  new uses of a known product, new methods for using a known product or new processes for using a known product.  Examples include a drug used for treating AIDS is now granted a new patent for treating hepatitis, or a drug in injection form is given a new patent in capsule form.

Second, a provision that enables extending the patent term beyond the 20 years required by TRIPS.   Most countries now count this 20 years from the date of filing the patent application.

The TPP requires the patent term to be extended beyond that if there are “unreasonable” delays in issuing the patents (Article 18.46) or if a delay is caused by the marketing approval process.”  (Article 18.48).     Extending the patent term means delaying affordable treatment for patients for so many more years.

Third, a provision (Article 18.50)  to create “data exclusivity” or “market exclusivity”, that prevents drug safety regulators from using existing clinical trial data to give market approval to generic drugs or biosimilar drugs and vaccines.   Under TRIPS, the clinical test data of a company can be used by a country’s drug regulatory authority as a basis to give safety or efficacy approval for generic drugs with similar characteristics, thus facilitating the growth and use of generic drugs.

Under the TPP, the data of the original company is “protected” and approval of similar drugs on the basis of such data is not allowed.  The period of “exclusivity” is at least 5 years for products containing a new chemical entity, or 3 years for modifications (a new indication, new formulation or new method of administration) of existing medicines.

Fourth, a provision on Biologics (Article 18.51).  For the first time in a trade agreement, the TPP  obliges its members to undertake data protection obligations for “biologics”, a category of products for treating and preventing cancer, diabetes and other conditions.  They are very expensive, some priced above $100,000 for a treatment course, and the clause will enable the prices to remain high for longer periods.   The exclusivity for biologics is for at least 8 years, or 5 years if other measures are also taken.

These provisions on exclusivity give drug companies extra protection, even if the product is not patented or if the patent has expired.  The drugs will be out of reach except for the very wealthy for longer periods.

Fifth, a provision (Article 18.76) that requires TRIPS-plus extra enforcement of intellectual property.  Countries are obliged to provide that the right holder can apply to detain any imported product that is suspected to be  counterfeit or having “confusingly similar trademark”.

This can block legitimate generic medicines from entering the country.   There have already been many cases of drugs being detained and later released when no infringement was found, thus needlessly delaying treatment to patients. The provision will increase the incidence.

All in all, these TRIPS-Plus TPP obligations would make it more difficult for patients to obtain cheaper generics. If these clauses are widely adopted in other trade agreements and made into national laws, this would shorten the lives of millions of people who would be denied treatment.

For example, many millions of people worldwide are afflicted with Hepatitis C, which can lead to liver failure and death. They need the new medicines that have nearly 100% cure rates close but the prices are over $80,000  for a 12-week treatment course.  Even with discounts, very few can afford this.

Some developing countries, making use of TRIPS flexibilities, are able to provide treatment with generic drugs at around $500 per patient, a very small fraction of the original drug’s price. But if the TPP clauses are translated into domestic law, this access could be blocked.

People in the developing countries are the most affected by patent over-protection, but patients in developed countries are not spared. The mainstream Time magazine in October 2016 listed the need to “Reform the Patent Process” as one of the issues the US Presidential election should address.

The Time article commented that many people believe drug companies are “gaming” the system.  “Instead of focusing on developing new cures, they are spending millions tweaking the way existing drugs are administered or changing their inactive ingredients.  Those moves have the effect of extending a drug’s patent and upping the amount of time it can be sold at monopoly prices, but they don’t necessarily help consumers.”

It is high time for a re-think to the system of drug patents.  At the least the situation should not be allowed to worsen further, which would happen if TRIPS-Plus measures are adopted.

The lives and health of millions are at stake.  Sometimes this is forgotten or put as a low priority when pitted against the promise of getting more exports in a free trade agreement.

But with the TPP in limbo and perhaps in perpetual suspension, there is really no reason why the provisions that have adverse effects should be implemented in the countries that had negotiated the TPP, when there are no benefits to be obtained to offset them.

More generally, in all countries, policy makers and people should be on guard not to agree to TRIPS-plus clauses in the trade agreements that they negotiate or sign.

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Huge Health Needs for World’s One Billion Migrants Fri, 24 Feb 2017 17:11:48 +0000 IPS World Desk Credit: IOM

Credit: IOM

By IPS World Desk
ROME/COLOMBO, Feb 24 2017 (IPS)

With an estimated 1 billion migrants today –or one in every seven people– their health needs are huge. Nevertheless, health systems are struggling to adapt and consequently access to health services among migrant populations varies widely and is often inadequate.

This has been the key issue before senior public health officials from over 40 countries, who met on February 23 in Colombo, concluding that addressing the health needs of migrants reduces long-term health and social costs, enhances health security and contributes to social and economic development.

Health systems must be strengthened to provide equitable, non-discriminatory, migrant-centred health services, noted the participants in the 2nd Global Consultation on Migrant Health, which was hosted by the Government of Sri Lanka, the International Organization for Migration (IOM) and the World Health Organization (WHO) in Colombo, Sri Lanka.

The scale of human migration currently witnessed is unprecedented, WHO reminds, there are an estimated 1 billion migrants in the world today, including 250 million international migrants and 763 million internal migrants, the UN body adds. “Some people migrate voluntarily; while others are forcibly displaced, fleeing conflict and war. This has important implications for the health sector.” “With the global volume of remittances sent home by migrants surpassing half a trillion dollars in 2016, the world is increasingly moving towards the realization that migration is an effective poverty-reduction strategy and an important means to respond to workforce shortages caused by demographic shifts” IOM.

On this, IOM said that when one combines the volume of international migration, the large scale of internal migration of an estimated 740 million people worldwide, and the unprecedented and protracted displacement of populations due to unresolved conflicts and natural disasters, we can see that there is urgent need to address the cumulative health needs of people on the move.

“With the global volume of remittances sent home by migrants surpassing half a trillion dollars in 2016, the world is increasingly moving towards the realization that migration is an effective poverty-reduction strategy and an important means to respond to workforce shortages caused by demographic shifts,” adds IOM.

“Yet, despite the clear economic benefits of migration, large groups of migrants remain at risk of social exclusion, discrimination and exploitation…It is important to emphasize that migrants do not generally pose a health risk to hosting communities and they should never be stigmatized or associated with the risk and stigma of importing diseases.”

Rather, it is recognised that conditions surrounding the migration process today, more than ever, can increase the vulnerability of migrants to ill health, particularly for those forced to move and those who find themselves in so called ‘irregular’ situations. In that sense, migration is a social determinant of health.

Sri Lanka is providing leadership on migrant health, the UN health body informs. It is one of the few countries in the world to have a ‘National Migrant Health Policy’, introduced in 2008. Sri Lanka recognizes the contribution of migrants to national and overseas development, the WHO informed.

“Almost 2 million Sri Lankans work overseas, the country hosts a large number of immigrants and receives 2 million tourists annually. Ensuring the health of these migrants and the country’s own population is a top priority.”

Participating health leaders adopted the Colombo Statement, which calls for international collaboration to improve the health and well-being of migrants and their families. The move aims to address the health challenges posed by increasingly mobile populations.

“Protecting the health of mobile populations is a public health and human rights imperative. Ensuring the highest attainable standard of health for all, including migrants and refugees, is something we must all strive towards, and is key to achieving the Sustainable Development Goal of leaving no one behind,” said WHO Regional Director for South-East Asia, Dr. Poonam Khetrapal Singh.

For his part, Dr. Davide Mosca, director of IOM’s Migration Health Division, said “Migrant health must be looked at as a global agenda and the SDGs should be interpreted by linking the call to facilitate orderly, safe and responsible migration and mobility of people… with the achievement of universal health coverage.”

This can only be realised through the implementation of well-managed and coordinated migration policies, which include financial risk protection and equal access to quality health services, he said.

The Colombo Statement calls for mainstreaming migrant health into key national, regional and international agendas and promotes international solidarity for equitable migrant health policies, a shared research agenda and the development of global frameworks to ensure migrant health is protected.

The momentum generated by the Global Consultation will be carried forward to the World Health Assembly – WHO’s annual meeting in May 2017, where 194 countries will deliberate on priority actions to protect migrants’ right to health.

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Aging, Depression and Disease in South Africa Mon, 20 Feb 2017 15:47:04 +0000 Manoj K. Pandey - and Raghav Gaiha Manoj K. Pandey is Lecturer in Economics, Development Policy Centre, Australian National University, Canberra, Australia; Vani S. Kulkarni is Lecturer in Sociology, Department of Sociology, University of Pennsylvania, Philadelphia, USA; and Raghav Gaiha is (Honorary) Professorial Fellow, Global Development Institute, University of Manchester, Manchester, UK.]]> The proportion of persons 60 years and older is projected to almost double during 2000–2030 in South Africa. Credit: Jeffrey Moyo / IPS

The proportion of persons 60 years and older is projected to almost double during 2000–2030 in South Africa. Credit: Jeffrey Moyo / IPS

By Manoj K. Pandey, Vani S. Kulkarni and Raghav Gaiha
Canberra, Philadelphia and Manchester, Feb 20 2017 (IPS)

Old age is often characterised by poor health due to isolation, morbidities and disabilities in carrying out activities of daily living (DADLs) leading to depression.

Mental disorders—in different forms and intensities— affect most of the population in their lifetime. In most cases, people experiencing mild episodes of depression or anxiety deal with them without disrupting their productive activities. A substantial minority of the population, however, experiences more disabling conditions such as schizophrenia, bipolar disorder type I, severe recurrent depression, and severe personality disorders. While common mild disorders are amenable to self-management and relatively simple educational or support measures, severe mental illness demands complex, multi-level care that involves a longer-term engagement with the individual, and with the family. Yet, despite the considerable burden and its associated adverse human, economic, and social effects, governments and donors have failed to prioritise treatment and care of people with mental illness. Indeed, pervasive stigma and discrimination contributes to the imbalance between the burden of disease due to mental disorders, and the attention these conditions receive.

The percentage of the population aged 60 years and above in South Africa rose from 7.1% in 1996 to 8 % in 2011, an increase from 2.8 million to 4.1 million individuals. The proportion of persons 60 years and older is projected to almost double during 2000–2030 because of (i) a marked decline in fertility in the past few decades; (ii) the HIV and AIDS pandemic contributing to this change in the population structure, with a higher mortality of young adults, especially women of reproductive age; and (iii) a rise in life expectancy to 62 years in 2013-– a staggering increase of 8.5 years since the low in 2005.

Four in ten elderly persons in South Africa are poor. More than a third make an average living, and the rich constitute about 27%. Provincial variations show that rural provinces have higher proportions of poor elderly persons compared to those residing in the urban provinces. Racial differences show that elderly Whites and Indians/Asians occupied a higher socio-economic status than black Africans and Coloureds.

Ours is the first study that offers a comprehensive analysis of depression among the old (60+ years) in South Africa, using the four waves of the National Income Dynamics Study (SA-NIDS) (2008, 2010, 2012 and 2014).

A self-reported measure of depression is used. SA-NIDS gives data on not depressed in a week, depressed for 1-2 days, 3-4 days and 5-7 days. We focus on those depressed for ≥ 3 days in a week. Referring to this as a measure of severe depression, its prevalence reduced from 15.3 % among the old in 2008 to 14.5 % in 2014, with a dip to 12.6 % in 2012.

Aging is a major factor in depression. Those in early 60s are generally more depressed than older persons in their 70s and 80s.

Old women were consistently more depressed than old men, as they are subject to violence. It is associated with conflicts over the man’s drinking, the woman having more than one partner, and her not having post-school education. Another factor is that women are typically much more likely to be overweight and obese, leading to non-communicable diseases (NCDs) and subsequently higher depression . A challenging aspect of obesity prevention among black South Africans is the positive perception that both women and men attach to a large body size.

Married men and women are less depressed than others. Marriage thus serves as a barrier to loneliness and a source of support during periods of stress for old persons. However, old persons in larger households without any other old person are more prone to depression. It is not clear whether larger households result in neglect of old persons or their abuse.

Ethnicity matters. The Africans are more prone to depression than the reference group of the Whites and Coloureds. There is limited evidence suggesting that Asians/Indians/Others are less likely to be depressed.

Pensioners are less likely to be depressed despite some evidence in the literature on pooling of pensions with other household resources and denying the pensioner any financial autonomy. Although this can’t be ruled out, it is evident that the favourable effect of pensions in preventing depression is robust.

Of particular significance are the results on multimorbidity (more than one disease at a time). Two combinations of NCDs (diabetes and high BP, and cancer and heart disease) are positively associated with depression. Equally important are the associations between disabilities in activities of daily living or DADLs (e.g. difficulties in dressing,bathing, eating, walking, climbing stairs) and depression. In many cases, both sets of DADLs are positively associated with depression. The relationship between depression and body mass index or BMI categories (underweight, normal, overweight and obese) is not so robust except that in some cases overweight were less likely to be depressed than the reference category of obese.

Shock of a family member’s death (in the last 24 months) was robustly linked to higher incidence of depression. There is some evidence suggesting that this shock had stronger effects on women relative to men.

As loneliness and lack of support during a difficult situation can precipitate stress leading to depression, we experimented with measures of social capital and trust as barriers to depression, and the mediating role of preference for the same neighbourhood.

Although social capital doesn’t have a significant negative effect on depression, social trust does. Besides, the mediating role of preference for the current neighbourhood is confirmed in most cases. An exceptional case is that of the Africans for whom neither social capital nor social trust is of any consequence except the mediating role of preference for the current neighbourhood.

The burden of depression in terms of shares of depressed in total depressed has risen in the more affluent wealth quartiles-especially that of the most affluent. However, likelihood of depression remained lower among the third and fourth quartiles, implying that the likelihood of depression was higher in the poorest (or the least wealthy). It is somewhat surprising that despite marked inequalities even among the Africans, there is no wealth effect on depression.

Although older people are in worse health than those younger, older people use health services much less frequently. These patterns of utilization arise from barriers to access, a lack of appropriate services and the prioritization of services towards the acute needs of younger people.

A larger ethical issue is rationing of health care to older people on the notion that health services are scarce and must be allocated to achieve the greatest good for the greatest number of people. WHO 2015 rejects this view on two counter-arguments: older people have made the greatest contribution to socioeconomic development that created these services; and they are entitled to live a dignified and healthy life.

Mental health care continues to be under-funded and under-resourced compared to other health priorities in the country; despite the fact that neuropsychiatric disorders are ranked third in their contribution to the burden of disease in South Africa, after HIV/AIDS and other infectious diseases. In fact, mental health care is usually confined to management of medication for those with severe mental disorders, and does not include detection and treatment of other mental disorders, such as depression and anxiety disorders.

From this perspective, the proposed National Mental Health Policy Framework and Strategic Plan 2013-2020 is a bold and comprehensive initiative.

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Improved Cookstoves Boost Health and Forest Cover in the Himalayas Fri, 17 Feb 2017 11:13:23 +0000 Athar Parvaiz Women and children are the primary victims of indoor air pollution in poor, rural areas of India. Credit: Athar Parvaiz/IPS

Women and children are the primary victims of indoor air pollution in poor, rural areas of India. Credit: Athar Parvaiz/IPS

By Athar Parvaiz
DARJEELING, India, Feb 17 2017 (IPS)

Mountain communities in the Himalayan region are almost entirely dependent on forests for firewood even though this practice has been identified as one of the most significant causes of forest decline and a major source of indoor air pollution.

Improper burning of fuels such as firewood in confined spaces releases a range of dangerous  air pollutants, whereas collection of firewood and cooking on traditional stoves consumes a lot of time, especially for women.

The WHO estimates that around 4.3 million people die globally each year from diseases attributable to indoor air pollution. Women and children are said to be at far greater risk of suffering the impacts of indoor pollution since they spend longer hours at home.

Data from the Government of India’s 2011 Census shows that 142 million rural households in the country depend entirely on fuels such as firewood and cow dung for cooking.

Despite heavy subsidies by successive federal governments in New Delhi since 1985 to make cleaner fuels like LPG available to the poor, millions of households still struggle to make the necessary payments for cleaner energy, which compels them to opt for traditional and more harmful substances.

This has prompted environmental organisations like Bangalore-based Ashoka Trust for Research in Ecology and Environment (ATREE) to help mountain communities minimise the health and environmental risks involved in using firewood for cooking in confined places.

IPS spoke with the Regional Director of ATREE for northeast India, Sarala Khaling, who oversees the Improved Cooking Stoves (ICS) project being run by the organisation in Darjeeling, Himalayas. Excerpts from the interview follow.

The Improved Cooking Stove (ICS) keeps this kitchen in India’s Himalaya region smoke-free. Credit: Athar Parvaiz/IPS

The Improved Cooking Stove (ICS) keeps this kitchen in India’s Himalaya region smoke-free. Credit: Athar Parvaiz/IPS

IPS: What prompted you to start the ICS programme in the Darjeeling Himalayan region?    

Sarala Khaling: In many remote forest regions of Darjeeling we conducted a survey and found out that people rely on firewood because it is the only cheap source in comparison to LPG, kerosene and electricity. Our survey result found that around Singhalila National Park and Senchal Wildlife Sanctuary, the mean fuel wood consumption was found to be 23.56 kgs per household per day.

Therefore, we thought of providing technological support to these people for minimizing forest degradation and indoor pollution which is hazardous to human health and contributes to global warming as well. That is how we started replacing the traditional cooking stoves with the improved cooking stoves, which consume far less fuel wood besides reducing the pollution.

IPS: How many ICS have you installed so far?  

SK: Till now ATREE has installed 668 units of ICS in different villages of Darjeeling. After the installation of ICS, we conducted another survey and the results showed reduction of fuel wood consumption by 40 to 50 per cent and also saved 10 to 15 minutes of time while cooking apart from keeping the kitchens free of smoke and air pollution.

We have trained more than 200 community members and have selected “ICS Promoters” from these so that we can set up a micro-enterprise on this. There are eight models of ICS for different target groups such as those cooking for family, cooking for livestock and commercial models that cater to hostels, hotels and schools.

IPS: When did the project begin? 

SK: We have been working on efficient energy since 2012. This technology was adopted from the adjacent area of Nepal, from the Ilam district. All the models we have adopted are from the Nepalese organization Namsaling Community Development Centre, Ilam. This is because of the cultural as well as climatic similarities of the region. Kitchen and adoption of the type of “chulah” or stove has a lot to do with culture. And unless the models are made appropriate to the local culture, communities will not accept such technologies.

IPS: Who are the beneficiaries?

SK: Beneficiaries are local communities from 30 villages we work in as these people are entirely dependent on the fuel wood and live in the forest fringes.

IPS: What are the health benefits of using ICS? For example, what can be the health benefits for women and children? 

SK: Women spend the most time in the kitchen, which means young children who are dependent on the mothers also spend a large part of their time in the kitchen. The smokeless environment in the kitchen definitely must be having a positive effect on health, especially respiratory conditions. Also the kitchen is cleaner and so are the utensils. And then using less fuel wood means women spend lesser time collecting them thus saving themselves the drudgery.

IPS: What is the feedback from the beneficiaries? 

SK: The feedback has been positive from people who have adopted this technology. They say that ICS takes less fuel wood and it gives them a lot of comfort to cook in a smoke free environment. Women told us that their kitchens are looking cleaner as so also the utensils.

IPS: How much it costs to have a clean stove? And can a household get it on its own? 

SK:  It costs around INR 2500 (37 dollars) to make a stove. ATREE supports only the labour charges for making a unit. Of course we support all the training, mobilising, monitoring and outreach and extension. Yes, there are many houses outside of our project sites who have also adopted this technology. The material used for making the clean stove is made locally like bricks, cow dung, salt, molasses and some pieces of iron.

IPS: Since you say that you are training local people to make these stoves, do you have any target how many households you want to cover in a certain time-period? 

SK:  We are looking to provide 1200 units to as many households. But, depending on the uptake, we will scale up. Our main objective is to make this sustainable and not something that is handed out as free. Our model is to select community members and train them.

We want these trained community members become resource persons and organise themselves into a micro-enterprise of ICS promoters. We want these people to sell their skills to more and more villages because we believe people will pay to make and adopt this technology. We are noticing that this has already started happening.

IPS: Have you provided this technology to any hostels, hotels etc?

SK: Yes, government schools who have the midday meal systems have also adopted this. There are about half a dozen schools which are using ICS and we are mobilizing more to adopt this technology.

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Indigenous Peoples Lands Guard 80 Per Cent of World’s Biodiversity Thu, 09 Feb 2017 11:15:56 +0000 Baher Kamal In much of the Andes, soil erosion is thought to be one of the most limiting factors in crop production. Soil is vulnerable to erosion where it is exposed to moving water or wind and where conditions of topography or human use decrease the cohesion of the soil.  ©IFAD/ Juan I. Cortés

In much of the Andes, soil erosion is thought to be one of the most limiting factors in crop production. Soil is vulnerable to erosion where it is exposed to moving water or wind and where conditions of topography or human use decrease the cohesion of the soil. ©IFAD/ Juan I. Cortés

By Baher Kamal
ROME, Feb 9 2017 (IPS)

They are more than 370 million self-identified peoples in some 70 countries around the world. In Latin America alone there are over 400 groups, each with a distinct language and culture, though the biggest concentration is in Asia and the Pacific– with an estimated 70 per cent. And their traditional lands guard over 80 per cent of the planet’s biodiversity.

They are the indigenous peoples.

They have rich and ancient cultures and view their social, economic, environmental and spiritual systems as interdependent. And they make valuable contributions to the world’s heritage thanks to their traditional knowledge and their understanding of ecosystem management.

“But they are also among the world’s most vulnerable, marginalized and disadvantaged groups. And they have in-depth, varied and locally rooted knowledge of the natural world, “says the Rome-based International Fund for Agricultural Development (IFAD).

“Unfortunately, indigenous peoples too often pay a price for being different and far too frequently face discrimination,” the Fund, which hosts on Feb 10 and 13 on Rome the Global Meeting of the Indigenous People Forum in the Italian capital.

During this biennial meeting, the United Nations specialised agency will bring together representatives of Indigenous Peoples’ Organisations from across the world, as well as leaders of partner bodies to engage in a direct dialogue and improve participation of indigenous peoples in the Fund’s country programmes.

Credit: IFAD

Credit: IFAD

Over the centuries, the Indigenous peoples “have been dispossessed of their lands, territories and resources and, as a consequence, have often lost control over their own way of life. Worldwide, they account for 5 per cent of the population, but represent 15 per cent of those living in poverty.”

One of the most effective ways to enable indigenous peoples to overcome poverty, it adds, is to support their efforts to shape and direct their own destinies, and to ensure that they are the co-creators and co-managers of development initiatives.

Rights of Indigenous People

The United Nations Declaration on the Rights of Indigenous Peoples, adopted by the General Assembly on Sep. 13, 2007, establishes a universal framework of minimum standards for the survival, dignity, well-being and rights of the world’s indigenous peoples.

Key facts

• There are more than 370 million self-identified indigenous people in the world, living in at least 70 countries
• Most of the worlds' indigenous peoples live in Asia
• Indigenous peoples form about 5,000 distinct groups and occupy about 20 per cent of the earth's territory
• Although indigenous peoples make up less than 6 per cent of the global population, they speak more than 4,000 of the world's 7,000 languages
• One of the root causes of the poverty and marginalization of indigenous peoples is loss of control over their traditional lands, territories and natural resources
• Indigenous peoples have a concept of poverty and development that reflects their own values, needs and priorities; they do not see poverty solely as the lack of income
• A growing number of indigenous peoples live in urban areas, as a result of the degradation of land, dispossession, forced evictions and lack of employment opportunities

Source: IFAD

The Declaration addresses individual and collective rights; cultural rights and identity; and rights to education, health, employment and language. And it outlaws discrimination against indigenous peoples and promotes their full and effective participation in all matters that concern them.

It also ensures their right to remain distinct and to pursue their own priorities in economic, social and cultural development. The International Day of the World’s Indigenous Peoples is observed on Aug. 9 every year.

Announcing the Forum, IFAD noted that it has more than 30 years of experience working with indigenous peoples. In fact, since 2003, an average of about 22 per cent of the Fund’s annual lending has supported initiatives for indigenous peoples, mainly in Asia and Latin America.

Since 2007, it has administered the Indigenous Peoples Assistance Facility (IPAF). Through small grants of up to 50,000 dollars, it supports the aspirations of indigenous peoples by funding micro-projects that strengthen their culture, identity, knowledge, natural resources, and intellectual-property and human rights.

To help translate policy commitments into action, it has established an Indigenous Peoples’ Forum that promotes a process of dialogue and consultation among indigenous peoples’ organisations, IFAD staff and member states.

The Fund empowers communities to participate fully in determining strategies for their development and to pursue their own goals and visions by strengthening grass-roots organisations and local governance.

Land is not only crucial to the survival of indigenous peoples, as it is for most poor rural people – it is central to their identities, the Fund reports. “They have a deep spiritual relationship to their ancestral territories. Moreover, when they have secure access to land, they also have a firm base from which to improve their livelihoods.”

According to this international Fund, indigenous peoples and their knowledge systems have a special role to play in the conservation and sustainable management of natural resources.

The first global meeting of the Indigenous Peoples' Forum at IFAD was held in Rome on 11-12 February 2013. ©IFAD/Giulio Napolitano

The first global meeting of the Indigenous Peoples’ Forum at IFAD was held in Rome on 11-12 February 2013. ©IFAD/Giulio Napolitano

Indigenous Women’s Untapped Potential

The also named “bank of the poorest” as it provides grants and low-interest credits to the poorest rural communities, recognises indigenous women’s untapped potential as stewards of natural resources and biodiversity, as guardians of cultural diversity, and as peace brokers in conflict mitigation.

Nonetheless, it says, indigenous women are often the most disadvantaged members of their communities because of their limited access to education, assets and credit, and their exclusion from decision-making processes.

This ‘bank of the poorest’ is a specialised agency of the United Nations, which was established as an international financial institution in 1977, being one of the major outcomes of the 1974 World Food Conference, which was organised in response to the food crises of the early 1970s that primarily affected the Sahelian countries of Africa.

That world conference resolved that “an International Fund for Agricultural Development should be established immediately to finance agricultural development projects primarily for food production in the developing countries.”

One of the most important insights emerging from the Conference was that the causes of food insecurity and famine were not so much failures in food production but structural problems relating to poverty, and to the fact that the majority of the developing world’s poor populations were concentrated in rural areas.

Since its creation, IFAD invested 18.4 billion dollars to help 464 million rural poor people.

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US, EU Food Standards Major Hurdle for Caribbean Exporters Tue, 07 Feb 2017 13:14:27 +0000 Jewel Fraser Oraine Halstead (left) and Rhys Actie tend tomatoes in a greenhouse at Colesome Farm at Jonas Road, Antigua. Credit: Desmond Brown/IPS

Oraine Halstead (left) and Rhys Actie tend tomatoes in a greenhouse at Colesome Farm at Jonas Road, Antigua. Credit: Desmond Brown/IPS

By Jewel Fraser
PORT OF SPAIN, Trinidad, Feb 7 2017 (IPS)

As Caricom countries struggle to move away from their traditional reliance on a single industry or major crop in the face of growing economic uncertainty worldwide, they are finding it increasingly difficult to enter markets in the EU and North America with new types of food products.

But tariffs are no longer the main barriers to accessing important markets, according to a document produced by the ACP-EU Overcoming Technical Barriers to Trade (TBT) programme.Latin America and the Caribbean provide over 90 per cent of the fruits and nearly 80 per cent of all vegetables imported by the US. Nonetheless, some countries in the region have “very high rejection rates” at US ports of entry.

The ACP-EU is of the view that “Non-tariffs barriers will become the main challenge of the future multilateral trade system.” Specifically, technical barriers related to compliance with sanitary and phytosanitary standards (SPS) in export markets and other standards including those relating to labelling and packaging.

The EU considers these technical, non-tariff, barriers to trade so challenging for its African, Caribbean and Pacific (ACP) partners that it provided 15 million euros starting in 2013 to help those developing countries upgrade their processes and become compliant, thus giving them a better chance of success on the EU and North America markets.

The Caribbean Agribusiness Association (CABA) is one Caribbean organisation that was able to access funding to help its members move toward HACCP (Hazard Analysis and Critical Control Point) certification, which the ACP-EU TBT programme identified as a crucial requirement. Since the early 2000s, the US and EU have stipulated that foods entering their markets must have HACCP certification.

Ten of CABA’s members were present at a regional conference, held at the Radisson Hotel in Port-of-Spain Jan. 29-30, to report on the benefits they received from the HACCP training. They heard some sobering statistics with regard to the EU and US food industry that provided context for the TBT programme.

Dr. Andre Gordon, chief executive officer of TSL Technical Services Limited, told delegates that each year, the UK records approximately one million cases of food-borne illnesses, of which about 20,000 require hospitalisation, and 500 deaths are recorded. The cost to the UK of dealing with food-borne illnesses is 1.4 billion pounds annually.

In the US, approximately 48 million cases of food-borne illnesses are recorded annually, resulting in 128,000 hospitalisations and 3,000 deaths. The cost to the US of dealing with food-borne illnesses is approximately 77.7 billion dollars annually, the delegates heard.

The 2016 report, “Addressing Food Losses due to Non-Compliance with Quality and Safety Requirements in Export Markets: the case of Fruits and Vegetables from the Latin America and the Caribbean Region,” by two Food and Agriculture Organization (FAO) experts, underlined how much is at stake for Caribbean agribusiness exporters.

The report reveals that Latin America and the Caribbean (LAC) provide over 90 per cent of the fruits and nearly 80 per cent of all vegetables imported by the US. Nonetheless, some countries in the region have “very high rejection rates” at US ports of entry, including Jamaica, Bolivia and the Dominican Republic, the document states.

The report said, “While many LAC countries have a good rate of acceptance in comparison with other countries exporting to the USA and EU, a few countries within LAC perform very poorly, revealing great disparity in preparedness for export trading within the region.” The report noted that “Multiple handling failures along the chain are likely the cause of the most frustrating complaints by international buyers.”

Dr. Gordon, who oversaw the Jamaica ackee industry’s transformation that made it compliant with US Food and Drug Administration regulations in the early 2000s so that it could gain access to the US market, explained to IPS the obstacles facing Caribbean exporters.

“The problem in general with all agribusiness companies in the Caribbean is typically lack of technical capacity and knowledge of the requirements and lack of the resources to implement the systems as required,” he said.

However, Dr. Gordon said, “The cultural change that is required is probably the biggest single limitation to implementing and sustaining certification systems…If the management and ownership [of agribusinesses] do not have a vision of becoming global players then the effort and resources required are going to seem unattainable and not good value for money. A lot of firms have issues with understanding the value for money proposition of embarking on a certification programme.”

The briefing paper “SPS measures lead to high costs and losses for developing countries”, published not long after the EU mandated HACCP certification for all exporters to the EU, noted that “As the income level of developing countries is far smaller, …the opportunity cost of compliance is relatively far higher than that for developed country exporters.

“The rapid change in SPS measures, regulations and notifications of new regulations is another problem facing developing countries in preparing for compliance. It also imposes extra costs on investors and exporters and creates uncertainty for them.”

However, the paper’s author concluded, “while the cost of compliance is high, the cost of lack of compliance is even higher” because of loss of market share or reduced access to markets.

Dr. Gordon revealed that in 2010, the Caribbean had the second highest level of food rejections of any region at US ports of entry.

A March 2016 FAO report highlighted other issues hindering Caribbean agribusinesses in their efforts to export. The report states: “A number of deep-seated challenges inhibit Caribbean agriculture diversification and competitiveness: the small and fragmented nature of most farm units; the absence of strong farmer grass-roots organizations; the cost of agricultural labor; the ageing demographics of Caribbean farmers; an education system that does not prepare youth to seek employment opportunities in the agricultural sector; and extension systems that have historically focused on managing the traditional export crops.”

The problem of small farm units is being addressed head on, said CABA’s president Vassel Stewart, with the formation of CABEXCO, a new umbrella organisation for SMEs in the Caricom agribusiness sector, which will jointly procure raw materials and services as well as market its members’ products and reach out to new buyers.

The resulting economies of scale will also hopefully make it easier to bear the cost of becoming compliant with US and EU food export regulations.

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Want to Prevent Stroke, Diabetes, Cancer? Get Moving… Now! Thu, 02 Feb 2017 13:23:02 +0000 Baher Kamal Worldwide, 81 per cent of school-aged children are not active enough. Photo: WHO

Worldwide, 81 per cent of school-aged children are not active enough. Photo: WHO

By Baher Kamal
ROME, Feb 2 2017 (IPS)

Tired, lazy, bored, laying down long hours watching TV or seated checking your email? Wrong. And dangerous: not enough exercise contributes to cancer, diabetes, depression and other non-communicable diseases.

The warning is bold and comes from the United Nations top health organisation, which is urging people to get up and get active.

And the risks of inactivity are expanding alarmingly: according to a new document by the World Health Organization (WHO), less and less people are active in many countries – with nearly a quarter of all adults and more than 80 per cent of adolescents being too sedentary.

WHO’s Global Action Plan for the Prevention and Control of NCDs [Non-Communicable Diseases] 2013-2020 recommends that inactive people start with “small amounts of physical activity” and then gradually increase duration, frequency and intensity over time.

“Physical activity can be any activity –not just sport– that uses energy… from playing and doing household chores to gardening and dancing… Any activity, be it for work, to walk or cycle to and from places, or as part of leisure time, has a health benefit,” according to the Geneva-based UN agency.

Not really sure? See these 10 facts that the United Nations top health agency has prepared:

Fact 1: Physical Activity Reduces Risk of Disease

Physical activity reduces the risk of coronary heart disease and stroke, diabetes, hypertension, various types of cancer including colon cancer and breast cancer, as well as depression.

Physical activity is also fundamental to energy balance and weight control. Globally, about 23 per cent of adults and 81 per cent of school-going adolescents are not active enough. Generally, women and girls are less active than men and boys, and older adults are less active than younger adults.

Photo: WHO/A Loke

Photo: WHO/A Loke

Fact 2: It Helps to Maintain a Healthy Body

People who are physically active:

* improve their muscular and cardio-respiratory fitness;
* improve their bone and functional health;
* have lower rates of coronary heart disease, high blood pressure, stroke, diabetes, cancer (including colon and breast cancer), and depression;
* have a lower risk of falling and of hip or vertebral fractures; and
* are more likely to maintain their weight.

Fact 3: It Is Not the Same as Sport

Physical activity is any bodily movement produced by the skeletal muscles that uses energy. This includes sports, exercise, and other activities such as playing, walking, household chores, gardening, and dancing.

Any activity, be it for work, to walk or cycle to and from places, or as part of leisure time, has a health benefit.

Fact 4: Moderate, Vigorous Physical Activity Bring Benefits

Intensity refers to the rate at which the activity is being performed. It can be thought of as how hard a person works to do an activity. The intensity of different forms of physical activity varies between people.

Depending on an individual’s relative level of fitness, examples of moderate physical activity could include: brisk walking, dancing, or household chores.

Examples of vigorous physical activity could be: running, fast cycling, fast swimming, or moving heavy loads.

Fact 5: 60 Minutes a Day for People 5–17 Years Old

People aged 5–17 should have at least 60 minutes of moderate to vigorous physical activity daily. More than 60 minutes of physical activity a day brings additional health benefits.

Photo: WHO/S Volkov

Photo: WHO/S Volkov

Fact 6: 150 Minutes a Week for People 18–64 Years Old

Adults aged 18–64 should do at least 150 minutes of moderately intense physical activity each week, or at least 75 minutes of vigorous activity throughout the week, or an equivalent combination of moderate and vigorous activity.

In order to be beneficial for cardio-respiratory health, all activity should be performed in bouts of at least 10 minutes duration.

Fact 7: Adults Aged 65 and Above

The main recommendations for adults and older adults are the same. In addition, older adults with poor mobility should do physical activity to enhance balance and prevent falls 3 or more days per week.
When older adults cannot do the recommended amount of physical activity due to health conditions, they should be as physically active as their abilities and conditions allow.

Fact 8: All Healthy Adults Need to Be Physically Active

Unless specific medical conditions indicate the contrary, WHO’s recommendations apply to all people – irrespective of gender, race, ethnicity, or income level.

These recommendations also apply to individuals with chronic non-communicable conditions, not related to mobility, such as hypertension or diabetes. Adults with disabilities should also follow WHO’s recommendations.

Fact 9: Some Physical Activity Is Better than None

Inactive people should start with small amounts of physical activity and gradually increase duration, frequency, and intensity over time. Inactive adults, older adults, and those with disease limitations will have added health benefits when they become more active.

Pregnant women, postpartum women, and persons with cardiac conditions may need to take extra precautions and seek medical advice before striving to achieve the recommended levels of physical activity.

Fact 10: Supportive Environments, Communities Help People Be Physically Active

Urban and environmental policies have huge potential to increase levels of physical activity. These policies should ensure that:

* walking, cycling and other forms of active transportation are accessible and safe for all;
* labour and workplace policies encourage physical activity;
* schools have safe spaces and facilities for students to spend their free time actively; and
* sports and recreation facilities provide opportunities for everyone to be physically active.

Still there? Get up! Move… now!

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How a Spring Revival Scheme in India’s Sikkim Is Defeating Droughts Wed, 01 Feb 2017 13:48:07 +0000 Athar Parvaiz Women are always hit hardest by water scarcity as they have to travel longer distances to fetch water, which increases their workload and compromises their ability to perform other essential and livelihood functions. Credit: Pem Norbhu

Women are always hit hardest by water scarcity as they have to travel longer distances to fetch water, which increases their workload and compromises their ability to perform other essential and livelihood functions. Credit: Pem Norbhu

By Athar Parvaiz
GANGTOK, India, Feb 1 2017 (IPS)

Bina Sharma, a member of the Melli Dhara Gram Panchayat Unit in the southern part of India’s northeastern Himalayan state of Sikkim, is a relieved woman.

For the past three years, Sharma said, she has received hardly any complaints from villagers about water disputes.Before the village’s water crisis subsided, students of the local Nelligumpa Secondary School had to regularly take two litres of water from their homes to the school.

“Until a few years back, our springs were staying almost dry for five months from December to April. During those months I often used to get complaints from the villagers against their fellow villagers as they would fight for water,” Sharma told IPS.

People in most parts of the mountainous Sikkim, and those in other mountainous areas across the region, use spring water for their personal consumption, kitchen gardens, farms, cattle and poultry. According to Sikkim First, an economic and political journal, about 80 per cent of Sikkim’s rural households depend on springs for drinking water and irrigation.

From experts in Gangtok to laymen in the far-off villages, everyone agrees that erratic rains and frequent droughts have resulted in the drying up of springs in many parts of the state, especially in south. Some say that the problem became worse after the 2011 earthquake in Sikkim.

Many studies, including the IPCC’s 5th Assessment Report, have reported changes in precipitation and temperature in the Himalayan region in recent years, but the International Centre for Integrated Mountain Development (ICIMOD) says there is a major need for more research on Himalayan precipitation processes, as most studies have excluded the Himalayan region due to the region’s extreme, complex topography and lack of adequate rain-gauge data.

Adapting to changes, the Sikkim way

Thankfully, Sharma said, the water security scheme of Sikkim’s rural development department for recharging the springs “seems to be working in our village” since it was started in 2012. “We get water all year round now,” she said.

According to the people and the government officials in Sikkim, hundreds of springs and the lakes in Sikkim have been drying up, especially from November to May in recent years. This has compelled the government to think of a scheme to revive the drying springs and lakes by artificially recharging the springs.

The brain behind devising this innovative scheme is Sandeep Thambe, an Indian Forest Service officer with a mechanical engineering background who has also carried out extensive research on water and environmental issues in Sikkim and is currently a professor at the Indian Institute of Forest Management (IIMF), Bhopal.

Hari Maya Pradhan, a woman who lives alone in her home in Melli Dhara, said that she had decided to give up rearing poultry and cattle as a livelihood option because she had to endure so many hardships to access water. “But now I feel a lot better after the villagers worked hard and dug up the ponds [which help in recharging the springs],” Pradhan, who has two cows and a small poultry unit, told IPS.

Before the village’s water crisis subsided, students of the local Nelligumpa Secondary School had to regularly take two litres of water from their homes to the school.

“Many times we protested and were preparing to take all our students to Gangtok to stage a protest demonstration. But our woes got automatically addressed when our springs started producing water in the dry season as well,” said Norbhu Tshering, the school in-charge.

Connected to nature    

In almost all parts of Sikkim, people directly connect plastic pipes to the small springs spread above their habitations to avail the natural water supply. But in the south and western parts of Sikkim, getting water from the springs all through the season has become impossible for more than a decade.

In 2009, this prompted Tambe, who then served in the Sikkim government’s Rural Development Department, to start the Dhara Vikas (or Spring Development) programme for reviving and maintaining the drying springs and lakes particularly in southern and western parts of the state.

The scheme was later launched under the centrally sponsored Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA), with technical support from other government agencies and organisations like WWF (India) and People’s Science Institute Dehradun.

According to Tambe, the core thrust of Dhara Vikas is to catch the surface runoff water and use it to recharge groundwater sources after identifying the specific recharge areas of springs accurately through scientific methods by digging staggered contour trenches and percolation pits.

“With increasing population, degrading health of watersheds and impacts of climate change, the lean period discharge of these springs is rapidly declining,” Tambe said, adding that artificial recharging has thankfully shown encouraging results.

He said that less than 15 per cent of the rainwater, as has been estimated in various studies, is able to percolate down to recharge the springs, while the remaining flows down as runoff often causing floods.

“Hence, a need was felt to enhance the contribution of that rainwater in ground water recharge, thereby contributing to rural water security,” Tambe told IPS.

Women, Tambe said, are always hit hardest by water scarcity as they have to travel longer distances to fetch water, which increases their workload and compromises their ability to perform other essential and livelihood functions. Reduced access to water, he said, also impacts health, hygiene, and sanitation.

Sarika Pradhan of Sikkim’s Rural Development Department said that 51 springs and four lakes in 20 drought-prone Gram Panchayats of Sikkim have been revived so far as the rural development department has mapped 704 springs in the village spring atlas, which provides information about all the mapped springs.

Her colleague, Subash Dhakal, said that trenches and percolation pits have been dug over an area of 637 hectares under MGNREGA for reviving these springs and lakes with an average cost of 250,000 rupees (USD 3,787) per spring.

*Research for this story was supported by a grant through The Forum of Environmental Journalists in India (FEJI) in collaboration with the Ashoka Trust for Research in Ecology and Environment (ATREE) Media Fellowships in Environmental Conservation, 2016.

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Kenyans Turn to Wild Fruits and Insects as Drought Looms Tue, 31 Jan 2017 12:10:53 +0000 Miriam Gathigah Once fertile agricultural land in Kenya is being degraded by encroachment and the effects of climate change. Credit: Miriam Gathigah/IPS

Once fertile agricultural land in Kenya is being degraded by encroachment and the effects of climate change. Credit: Miriam Gathigah/IPS

By Miriam Gathigah
NAIROBI, Jan 31 2017 (IPS)

Too hungry to play, hundreds of starving children in Tiaty Constituency of Baringo County instead sit by the fire, watching the pot boil, in the hope that it is only a matter of minutes before their next meal.

Unbeknownst to them, the food cooking inside the pot is no ordinary supper. It is actually a toxic combination of wild fruits and tubers mixed with dirty water, as surrounding rivers have all run dry.“We are now facing severe effects of desertification because we are cutting down more trees than we can plant." --Hilda Mukui

Tiaty sits some 297 kilometers from the capital Nairobi and the ongoing dry spell is not a unique scenario.

Neighbouring Elgeyo Marakwet and Turkana County are among the counties spread across this East African nation where food security reports show that thousands are feeling the impact of desertification, climate change and rainfall shortage.

“In most of these counties, mothers are feeding their children wild fruits and tubers. They boil them for at least 12 hours, believing that this will remove the poison they carry,” Hilda Mukui, an agriculturalist and soil conservationist, told IPS.

Teresa Lokwee, a mother of eight children, all of them under the age of 12, who lives in Tiaty, explains that the boiling pot is a symbol of hope. “When our children see that there is something cooking, the hope that they will soon enjoy a meal keeps them going.”

Mukui, who was head of agriculture within the Ministry of Agriculture and worked in most of the affected counties for more than two decades, says that rainfall deficit, shortage of water and unusually high temperatures is the scenario that characterizes 23 out of the 47 counties in Kenya.

The situation is so dire that in Baringo County alone, 10 schools and 19 Early Childhood Development Schools are empty as children join other family members in search of water.

“Sometimes once you leave in the morning to search for water, you return home in the evening,” Lokwee told IPS.

In other affected counties, especially in Western Kenya, communities have resorted to eating insects such as termites which were previously taboo.

Though these unconventional eating habits are a respite for starving households, experts warn that this is a ticking time bomb since the country lacks an insect-inclusive legislation and key regulatory instruments.

In the Kenya Bureau of Standards, which assesses quality and safety of goods and services, insects are labeled as impure and to be avoided.

But if predictions by the Ministry of Water and Irrigation are anything to go by, the worst is yet to come as the country watches the onset of what experts like Mukui call a crisis after the failure of both the long and short rains.

“We are now facing severe effects of desertification because we are cutting down more trees than we can plant,” she explains.

She added that Vision 2030 – the country’s development blueprint – calls for the planting of at least one billion trees before 2030 to combat the effects of climate change, but the campaign has been a non-starter.

Mukui told IPS it is no wonder that at least 10 million people are food insecure, with two million of them facing starvation.

According to the United Nations Convention to Combat Desertification (UNCCD), which works in countries such as Kenya buckling under the weight of desertification, land degradation and severe drought, the number of people living on degraded agricultural land is on the rise.

Agriculture is the mainstay of the economy, with at least 45 percent of government revenue being derived from this sector.

Mukui says it is consequently alarming that at least 10 million of the estimated 44 million Kenyans live in degraded agricultural areas, accounting for an estimated 40 percent of the country’s rural community.

Other statistics by UNCCD show that though arid and semi-arid lands constitute about 80 percent of the country’s total land mass and are home to at least 35 percent of the country’s population, areas that were once fertile for agriculture are slowly becoming dry and unproductive.

A survey by the Kenya Forest Service has revealed that not only is the country’s forest cover at seven percent, which is less than the ten percent global standard, an estimated 25 percent of the Mau Forest Complex – Kenya’s largest water catchment area – has been lost due to human activity.

Within this context, UNCCD is working with various stakeholders in Kenya to ensure that at least five million hectares of degraded land is restored. According to Executive Secretary Monique Barbut, there is a need to ensure that “in the next decade, the country is not losing more land than what it is restoring.”

“Land issues must become a central focus since land is a resource with the largest untapped opportunities,” she said.

Research has shown that the state of land impacts heavily on the effectiveness of policies to address poverty and hunger.

Restoring forest cover in Kenya is key. Since 1975, official government statistics show that the country has suffered 11 droughts – and the 12th is currently looming.

The cost implications that the country continues to suffer can no longer be ignored. UNCCD estimates that the annual cost of land degradation in Kenya is at least five percent of the country’s Gross Domestic Product. And addressing land degradation can earn the country four dollars for every one dollar spent in land restoration efforts.

Barbut has, however, commended the country’s efforts to address desertification caused by both human activity and the adverse effects of climate change, particularly through practical and sustainable legislation.

Mukui says that UNCCD works through a country-specific National Action Programme which Kenya already has in place. “What we need is better coordination and concerted efforts among the many stakeholders involved, government, communities, donors and the civil society, just to name a few,” she said.

Efforts to enhance the country’s capacity to combat desertification by the UNCCD include providing financial and technical resources to promote management of local natural resources, improving food security and partnering with local communities to build sustainable land use plans.

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Demonstrating the Power of Partnerships: The Potential for Universal Health Care in Kenya Mon, 30 Jan 2017 07:05:28 +0000 Dr Stephen Karau Dr Stephen Karau, Kenya’s Ambassador/Permanent Representative to The United Nations, WTO & Other International Organizations in Geneva, Switzerland. @DrKarau ]]>

Dr Stephen Karau, Kenya’s Ambassador/Permanent Representative to The United Nations, WTO & Other International Organizations in Geneva, Switzerland. @DrKarau

By Dr Stephen Karau
GENEVA, Jan 30 2017 (IPS)

Even as the global community set out the 17 Sustainable Development Goals last year, a realization that stood out is that no single unit has the wherewithal to achieve such lofty goals – they will only be achieved through partnerships.

Ambassador Stephen Karau

Ambassador Stephen Karau

There has been a lot of discussions and good intentions regarding public-private partnerships, but not enough practical, on-the-ground support to make such partnerships effective and truly transformational.

One of the areas where the need for partnerships has been most obvious is the pursuit of universal health coverage, which falls under SDG 3 of Good Health and Wellbeing.

On 20 January 2017, I was delighted to represent my government at a World Economic Forum side-event in Davos. Our underlying aim is to pave the way forward of an initiative that is being spearheaded with the Government of Kenya and the United Nations in Kenya that aims to accelerate progress towards Universal Health Coverage (UHC) in support of the broader attainment of the SDGs. We are pleased with the enthusiasm and support of the Government of Netherlands, Philips and Unilever.

I was inspired by the engaging discussions with various executives from the private sector on how we could establish a platform and shape a process in Kenya for realizing partners’ common goal of significantly increasing private sector investments and large-scale, financially sustainable Public Private Partnerships in Primary Health Care (PHC).
While the Kenya Government has put in place commendable efforts to increase allocation to the health sector and provide health protection, more still can be done to engage the private sector, where innovation, technical know-how, and efficiency are abundant.

President Uhuru Kenyatta has demonstrated personal interest in the health sector, with a flagship programme being the provision of free maternity services in public hospital, and the very successful advocacy programme by the Kenya First Lady known as the Beyond Zero Campaign.

However, the majority of the country’s population still relies on out-of-pocket spending and other means such as informal borrowing to finance health care. Often this leads to financial hardship, and nearly one million Kenyans are pushed below the poverty line every year as a result of prohibitive health care expenses. This indicates the need to accelerate the policies and galvanize support around the realization of UHC.

Through championing multi-stakeholder and cross-sector partnerships this can be realized.

As a diplomat but also trained doctor with experience in the public and private sectors and having served for 24 years in the Kenyan military, I personally understand the complexities of partnering and how different interests can pose a challenge. But I also know how rewarding successful collaboration can be when partners demonstrate trust in each other, openly share ideas and join forces behind a shared purpose.

My friend and colleague, Siddharth Chatterjee, the United Nations Resident Coordinator in Kenya has said that Kenya can lead the way in achieving universal health coverage in Africa, I say enthusiastically, “yes we can”.

The recently released report of the Better Business, Better World by the Business & Sustainable Development Commission states that sustainable business models could open economic opportunities worth up to US$12 trillion and increase employment by up to 380 million jobs by 2030. Putting the Sustainable Development Goals at the heart of the world’s economic strategy could unleash a step-change in growth and productivity.

However, this will not happen without radical change in the business and investment community. Real leadership is needed for the private sector to become a trusted partner in working with government and civil society to fix the economy.

In Kenya we are already witnessing the fruits of such leadership and private sector engagement from which we can learn and build on. One such example is the Private Sector Health Partnership Kenya. Through this platform companies as Philips, Unilever, Safaricom, Merck (MSD), Huawei and GSK, in partnership with the national and county governments, are helping to build models with the potential for scaling-up the delivery of healthcare for vulnerable and poor populations in low-resource settings.

Initial support has focused on innovative solutions that enable leapfrogging obstacles occurring in local health systems in Mandera, Migori, Marsabit, Wajir, Isiolo and Lamu. These six counties have a combined population of approximately 10% of the national population but contribute close to 50% of the country’s maternal deaths.

For the private sector partners, it is not a partnership driven by corporate social responsibility ideals, but an opportunity to create the basis for future growth, for example by setting off a positive cycle of health and employment, which can create new markets.

It clearly shows the willingness of both public but also private partners to embrace the sustainability agenda and find shared-value partnership models in order to leave-no-one-behind.

Let me finish by reiterating what Hon Dr Mailu, Cabinet Secretary for Health in Kenya, also shared in his video message to the participants of the WEF Davos side-meeting: “In Kenya, we are committed to partnerships that are dynamic and mutually beneficial. I believe that as we start talking more, we will find additional ways to share our expertise and resources to achieve our common goals. We want to explore new ideas and platforms, offering an open invitation to work together”.

World Trade Organization (WTO)

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Trump’s Global Gag a Devastating Blow for Women’s Rights Wed, 25 Jan 2017 17:49:02 +0000 Erika Guevara-Rosas 1 Guess How Much Water Your Daily Food Consumes Mon, 23 Jan 2017 15:49:31 +0000 IPS News Desk Millions of family farmers in developing countries already suffer from lack of access to freshwater. Photo: FAO

Millions of family farmers in developing countries already suffer from lack of access to freshwater. Photo: FAO

By IPS News Desk
ROME/BERLIN, Jan 23 2017 (IPS)

The facts are clear. So are the consequences. And the facts are that it takes between one and three tonnes of water to grow one kilogramme of cereal; that a kilogramme of beef takes up to 15 tonnes of water to produce; and that it is estimated that between 2,000 and 5,000 litres of water are needed to produce a person’s daily food.

Meantime, the consequences are that growing water scarcity is now one of the leading challenges for sustainable development, and it is poised to intensify as the world’s population continues to swell and climate change intensifies.

José Graziano da Silva, Director General of the UN Food and Agriculture Organisation (FAO), while presenting these findings, warned that competition for water will intensify as humanity’s numbers exceed 9 billion people around 2050.

In fact, already millions of family farmers in developing countries suffer from lack of access to freshwater, while conflicts over water resources already surpass those tied to land disputes in some regions, the FAO chief said at the Global Forum for Food and Agriculture which took place on Jan. 19-21 in Berlin.

Additionally, climate change is already altering hydrological regimes everywhere, he added, citing estimates that around one billion people in dry regions may face increasing water scarcity in the near future. These are regions with a high concentration of extreme poverty and hunger.

“Agriculture is both a major cause and casualty of water scarcity. Farming accounts for around 70 per cent of fresh water withdrawals in the world today, and also contributes to water pollution due to pesticides and chemicals.”

To tackle these challenges, the international community created a standalone sustainable development goal (SDG) on water and wove better management of this key natural resource throughout the entire architecture of the SDGs, Graziano da Silva said.

He urged participants to rise to the food security challenges posed by water scarcity on two fronts: first, promoting ways to both use less water and use it more efficiently, and secondly, by taking steps to secure access to water — especially for poor family farmers.

“Doing so will not prevent a drought from occurring, but it can help in preventing droughts from resulting in famine and socioeconomic disruption.”

One-Third of Food Either Lost or Wasted

Graziano da Silva also said that cutting back on food waste has an important role to play in using water more wisely. Each year, one-third of world food production is either lost or wasted — that translates into a volume of agriculture water wasted equal to around three times the volume of Lake Geneva.

At the last UN Climate Change Conference FAO launched a global framework for coping with water scarcity in agriculture to support such efforts, he added.
This framework seeks to support the development and implementation of policies and programmes for the sustainable use of water in agriculture and encourage cooperation among different stakeholders, including civil society, the private sector, financing institutions and development organisations.

The Berlin Global Forum for Food and Agriculture, organised by the German Federal Ministry for Food and Agriculture (BMEL), takes place every year, bringing together high-level decision makers, technical experts, researchers and farmers to discuss pressing issues affecting agriculture worldwide.

The Forum’s theme this year is “Agriculture and Water – Key to Feeding the World.”

It is in fact so key to feeding the world that FAO projects that irrigated food production will increase by more than 50 per cent by 2050, but the amount of water withdrawn by agriculture can increase by only 10 per cent, provided that irrigation practices are improved and yields increase.

The world contains an estimated 1.400 million cubic kilometres of water. But only 0.003 per cent of this amount, about 45.000 cubic kilometres, are “fresh water resources” that can be used for drinking, hygiene, agriculture and industry. Not all of this water is accessible because part of it flows into remote rivers during seasonal floods.

In California, wastewater is sanitized and blended with groundwater, supporting large-scale crop production. Credit: FAO

In California, wastewater is sanitized and blended with groundwater, supporting large-scale crop production. Credit: FAO

Using Wastewater in Agriculture?

Now that food demand and water scarcity are on the uptick, it’s time to stop treating wastewater like garbage and instead manage it as a resource that can be used to grow crops and help address water scarcity in agriculture, according to FAO.

Properly managed, wastewater can be used safely to support crop production — directly through irrigation or indirectly by recharging aquifers — but doing so requires diligent management of health risks through adequate treatment or appropriate use.

How countries are approaching this challenge and the latest trends in the use of wastewater in agriculture production was the focus of discussions by a group of experts in Berlin’s annual Global Forum for Food and Agriculture.

“Although more detailed data on the practice is lacking, we can say that, globally, only a small proportion of treated wastewater is being used for agriculture, most of it municipal wastewater, “ said Marlos De Souza, a senior officer with FAO’s Land and Water Division.

But increasing numbers of countries –Egypt, Jordan, Mexico, Spain and the United States, for example– have been exploring the possibilities as they wrestle with mounting water scarcity.

“So far, the reuse of wastewater for irrigation has been most successful near cities, where it is widely available and usually free-of-charge or at low cost, and where there is a market for agricultural produce, including non-food crops. But the practice can be used in rural areas as well –indeed it has long been employed by many smallholder farmers.”

Water is of course fundamental for food production, and the intensifying scarcity of this important natural resource –likely to be more intense in a context of climate change– has very significant implications for humanity’s ability to feed itself.

Globally, population growth and economic expansion are placing increasing pressure on freshwater resources, with the overall rate of groundwater withdrawals steadily increasing by 1 per cent per year since the 1980s. And those pressures are now increasingly being exacerbated by climate change.

Already, agriculture accounts for 70 per cent of global freshwater withdrawals — with demand for food estimated to grow by at least 50 per cent by 2050, agriculture’s water needs are poised to expand. Yet demand from cities and by industries is on the rise as well.

Untreated wastewater, however, often contains microbes and pathogens, chemical pollution, antibiotic residues, and other threats to the health of farmers, food chain workers, and consumers –and it also poses environmental concerns.

A number of technologies and approaches exist that are being utilised around the globe to treat, manage, and use wastewater in agriculture, many of them specific to the local natural resource base, the farming systems in which they are being used, and the crops that are being produced, De Souza said.

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A Crisis of Overweight and Obesity in Latin America and the Caribbean Mon, 23 Jan 2017 14:41:44 +0000 Eve Crowley The change in the eating habits in Latin America and the Caribbean has led to an increase in overweight and obesity in the region. Credit: Eduardo Bermúdez / FAORLC

The change in the eating habits in Latin America and the Caribbean has led to an increase in overweight and obesity in the region. Credit: Eduardo Bermúdez / FAORLC

By Eve Crowley
SANTIAGO, Jan 23 2017 (IPS)

Obesity and overweight have spread like a wildfire throughout Latin America and the Caribbean, threatening the health, well-being and food and nutritional security of millions of people.

According to the new publication of the United Nations Food and Agriculture Organization (FAO) and the Pan American Health Organization (PAHO), the Panorama of Food and Nutrition Security, close to 58 percent of the inhabitants of the region are overweight (360 million people) while obesity affects 140 million people, 23 percent of the regional population.

In almost all countries of the region, overweight affects at least half the population, with the highest rates observed in the Bahamas (69 percent), Mexico (64 percent) and Chile (63 percent).

Over the last 20 years there has been a rapid increase in the prevalence of overweight and obesity across the population, regardless of their economic, ethnic or place of residence, although the risk is higher in net food-importing regions and countries, which consume more ultra-processed foods.

Eve Crowley, acting regional representative of FAO for Latin American and the Caribbean. Credit: Max Valencia/FAORLC

Eve Crowley, acting regional representative of FAO for Latin American and the Caribbean. Credit: Max Valencia/FAORLC

This situation is particularly serious for women, since in more than 20 countries in Latin America and the Caribbean, the rate of female obesity is 10  percentage points higher than that of men. The impact has also been considerable in children: 3.9 million children under 5 live with overweight in our region, 2.5 million in South America, 1.1 million in Central America and 200 000 in the Caribbean.

How did we get here? According to FAO and PAHO, a key factor has been the change in the region’s eating habits.

Economic growth in recent decades, increased urbanization, higher average income and the integration of the region into international markets reduced the consumption of traditional preparations based on cereals, legumes, fresh fruits and vegetables, and increased consumption of ultra-processed products, with high amounts of sugars, salt and fats.

To curb the rise in overweight and obesity, countries in the region can draw on some of the valuable experiences they gained in their fight against hunger. Today, undernourishment affects only 5.5 percent of the regional population, while stunting in children has also dropped from 24.5 percent in 1990 to 11.3 percent in 2015, a reduction of 7.8 million children.

However, it should be noted that although hunger has declined, it has not been eradicated: there are still 34 million people unable to access the food they require for a healthy and active life, which means that the region faces a double burden of malnutrition.

According to the FAO / PAHO Panorama, combating both malnutrition and obesity requires a healthy diet that includes fresh, healthy, nutritious and sustainably produced foods. The key to progress is to promote sustainable food systems that link agriculture, food, nutrition and health.

In order to eradicate all forms of malnutrition, States should encourage the sustainable production of fresh, safe and nutritious foods as well as ensuring their diversity, supply and access, especially for the most vulnerable in regions that are net importers of foods.

These measures should be complemented with policies to strengthen family farming, short production and food marketing circuits, public procurement systems linked to healthy school feeding programs and nutritional education programs.

Fiscal measures should also be implemented to discourage the consumption of junk food, improve food labeling and warnings with regard to high sugar, fat and salt content, and regulate the advertising of unhealthy foods to reduce their consumption.

These policies are more urgent than ever in light of the current signs of stagnation in regional economic growth, which pose a significant risk to food and nutrition security.

Governments should maintain and increase their support to the most vulnerable to avoid undoing their advances in the fight against hunger and to reverse the current rise in obesity and overweight, working together through initiatives such as the Community of Latin American and Caribbean States’s Plan for Food Security, Nutrition and Hunger Eradication.

Although there are significant variations according to subregions and countries, Latin America and the Caribbean considered as a whole has a food availability that far surpasses the requirements of all its population, thanks to its great agricultural performance. However, in several countries, this process of agricultural development is currently unsustainable, due to the consequences it is having on the ecosystems of the region. The sustainability of food supply and its future diversity are under threat unless we change the way we do things.

The region must make more efficient and sustainable use of land and other natural resources. Countries must improve their techniques of food production, storage and processing, and put a stop to food losses and waste, as 127 million tons of food end up in the trash every year in Latin America and the Caribbean.

To meet the Sustainable Development Goals, and especially SDG2 / Zero Hunger, which aims to eradicate undernourishment by 2030, the region needs to act on the complex interactions between food security, sustainability, agriculture, nutrition and health, to build a hunger and malnutrition free Latin America and the Caribbean.

The eradication of hunger and malnutrition is not a task that can be left to the indifferent hand of the market. On the contrary, governments must exercise their will and sovereignty to develop specific public policies that attack the conditions that perpetuate hunger, overweight and obesity, as well as their consequences on the health of adults and children. Only by turning the fight against malnutrition into State policy can we put a stop to the rise of malnutrition in the region.

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360 Million of 625 Million People Are Overweight in Latin America and Caribbean Fri, 20 Jan 2017 18:36:14 +0000 Orlando Milesi FAO acting regional representative Eve Crowley (C) during the launch of the Panorama of Food and Nutrition Security in Latin America and the Caribbean 2016, at FAO headquarters in Santiago. The report , where it was warned that overweight affects 360 million people in the region. Credit: FAO

FAO acting regional representative Eve Crowley (C) during the launch of the Panorama of Food and Nutrition Security in Latin America and the Caribbean 2016, at FAO headquarters in Santiago. The report , where it was warned that overweight affects 360 million people in the region. Credit: FAO

By Orlando Milesi
SANTIAGO, Jan 20 2017 (IPS)

In Latin America and the Caribbean 360 million people are overweight, and 140 million are obese, warned the United Nations Food and Agriculture Organisation (FAO) and the Panamerican Health Organisation (PAHO).

“The rise in obesity is very worrying. At the same time the number of people who suffer from hunger has diminished in the region. We need to strengthen our efforts and have food systems with improved nutrition based on sustainable production methods to reduce those figures,” Eve Crowley, FAO acting regional representative, said Thursday at the organisation‘s headquarters in Santiago.

At the regional FAO office in Santiago on Thursday Jan. 19 the two organisations launched the Panorama of Food and Nutrition Security in Latin America and the Caribbean 2016, which sounded the alarm about the phenomenon in this region of just over 625 million people.

The problem, highlighted the report, largely affects children and women, increasing chronic diseases, driving up medical expenses for countries and individuals, and posing a threat to the quality of the future labour force that national development plans will require.

At the same time, the region has considerably reduced hunger: today only 5.5 per cent of the population of Latin America and the Caribbean is undernourished, the Caribbean being the area with the highest prevalence (19.8 per cent), largely because Haiti has the highest malnutrition rate in the world: 53.4 per cent.

Chronic child malnutrition (low height for age) in Latin America and the Caribbean also dropped, from 24.5 per cent in 1990 to 11.3 per cent in 2015, which translates into a decrease of 7.8 million children.

Despite the progress made, currently 6.1 million children still suffer from chronic malnutrition: 3.3 million in South America, 2.6 million in Central America, and 200,000 in the Caribbean. About 700,000 million children suffer from acute malnutrition, 1.3 per cent of them under the age of five.

Asked whether the difficulty of access to natural, good quality foods is due to the high prices or to a flawed production and distribution system, Crowley told IPS that it is “a combination of factors“.

“We talk about a food system because it involves a set of factors – from supplies to which foods are available at a national level. For example in Latin America there is a great availability of sugary foods and meat. But ensuring physical availability and access to nutritious, healthy, affordable fresh food in every neighborhood is still hard to achieve,” she said.

“There is evidence that food high in bad calories, from ultra-processed sources, is less expensive than healthy food, and this poses a dilemma to guaranteeing good nutrition for the entire population, particularly people in low-income households,” she said.

Crowley said there are changes in consumption patterns, with people shifting away from their traditional diets based on legumes, cereals, fruits and vegetables toward super-processed foods rich in saturated fats, sugar and sodium, which are backed by extensive advertising.

A girl wearing traditional dress from Bolivia’s highlands region shows a basket with fruit during a school exhibit in La Paz to promote good eating habits among students.. Programmes to promote healthy eating are spreading through schools in Latin America, to address problems such as malnutrition and overweight. Credit: Franz Chávez/IPS

A girl wearing traditional dress from Bolivia’s highlands region shows a basket with fruit during a school exhibit in La Paz to promote good eating habits among students.. Programmes to promote healthy eating are spreading through schools in Latin America, to address problems such as malnutrition and overweight. Credit: Franz Chávez/IPS

She called for better information, nutrition warnings, taxes on unhealthy foods, and subsidies for healthy foods necessary for the population.

With the exception of Haiti (38.5 per cent), Paraguay (48.5 per cent) and Nicaragua (49.4 per cent), overweight affects more than half of the population of the countries in the region, with Chile (63 per cent), Mexico (64 per cent) and the Bahamas (69 per cent) showing the highest rates, states the report.

Erick Espinoza, a physical education teacher in a private school in a middle-class neighborhood in Santiago, sees the problem of the change in eating and behavioural habits of his students, aged six to 10, which is a reflection of what is happening throughout the region, and in particular in the countries with the highest overweight and obesity rates.

“As snacks, they don’t bring fruit, only potato chips, crackers or cookies, fizzy drinks, juice or milk high in sugar. And they don’t just bring a small package, but sometimes two or three packages or even a big one,” he told IPS, referring to the snack during recess.

Since 2016, kiosks that sell food in Chilean schools have been prohibited from selling foods high in sugar, sodium or fat. “They have to sell fruit, but the kiosk is not doing well because the children don’t buy fruit or yoghurt, but bring other things from home,“ said the teacher.

Alexandra Carmona, a teacher at a municipal school for children aged four to 17 in a low-income neighborhood in Santiago, pointed to a different problem.

“There was an obese boy who was really bullied. Everybody would say ‘hey fattie‘, ‘hey grease ball‘. So I called the parents to tell them what was happening, but they didn’t give it any importance,“ she told IPS. The boy ended up in a special school even though he had no learning disability.

At her school, the school provides meals, but many children won‘t accept the legumes and balanced diet that is offered.

The Panorama reports that 7.2 per cent of children under five years old in the region are overweight, which means a total of 3.9 million children, including 2.5 million in South America, 1.1 million in Central America and 200,000 in the Caribbean.

The countries with the highest rates of overweight in children under five years old are Barbados (12 per cent), Paraguay (11.7 per cent), Argentina (9.9 per cent), and Chile (9.3 per cent).

The report also points out that several countries have adopted taxes on sugary beverages, including Barbados, Chile, Dominican Republic and Mexico, while others such as Bolivia, Ecuador, Peru and Chile have laws on healthy nutrition which regulate advertising and labeling of food products.

With respect to the countries that stand out in sales per person of ultra-processed products, the report says that Argentina, Chile, Mexico and Uruguay exceed the regional average of 129.6 kilograms per inhabitant. Mexico ranks first, with 214 kg per inhabitant, and Chile is second with 201.9 kg.

In 30 of the 33 countries studied , more than half of the population over 18 is overweight, and in 20 of them obesity among women is at least 10 percent higher than among men.

According to PAHO Director Carissa F. Etienne, “the region is facing a two-fold burden of malnutrition, which has to be fought with a balanced diet which includes fresh, healthy and nutritious foods, produced in a sustainable manner, besides addressing the main social factors that lead to malnutrition.”

In addition to the lack of access to healthy foods, she mentioned the difficulty of access to clean water and sewage services, education and health services, and social protection programmes, among others.

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Why Polio Campaigns Must Reach Every Last Child in Kenya Fri, 20 Jan 2017 09:23:32 +0000 Rudi Eggers and Werner Schultink Credit: ©UNICEFKENYA/2011/MODOLA


By Rudi Eggers and Werner Schultink
NAIROBI, Jan 20 2017 (IPS)

For a long time, no person in Kenya suffered the devastating disability that is caused by polio. In fact, the only reminder in the early 2000s was the victims in the streets of Nairobi, many of whom had been paralyzed as children and adults. Their lives were ravaged by this terrible, vaccine-preventable disease.

A five-day polio campaign that started on 18 January, 2017 targets more than 2.9 million children below the age of 5 years in fifteen counties. Children in high-risk areas -- some of whom have never had access to immunization services before -- will have an opportunity to be vaccinated against polio.
Sadly, in 2013 a large outbreak of polio in Nigeria spread across the continent, affecting several countries on its way east. Kenya was not spared.  Fourteen new polio cases were confirmed. The polio virus struck those that were unvaccinated – the most vulnerable and the most excluded — children in areas with poor access to health services, refugees, and nomadic communities.  Fortunately, a rapid response by the Kenyan Government brought the polio outbreak under control, and the last case was reported in July 2013.  At that time, it seemed that the country was well on the road to being declared polio-free.

However, recently, concerned scientists have pointed to the increasing risk of polio, particularly the large numbers of children who remain unvaccinated, especially those in vulnerable populations in the northern part of the country and in the informal settlements of Nairobi and Mombasa.  Furthermore, the notion that the African continent was free from the polio virus was shattered when four new polio cases were reported in northern Nigeria. Given the previous experience, health experts and Ministries of Health recommended that the areas with low vaccination rates should be targeted with vaccination campaigns, specifically designed to reach those that missed out on the routine vaccinations.

Since the establishment of the Expanded Programme of Immunization (EPI) in 1980, Kenya deserves credit for reaching majority of the children with life-saving vaccines. But there is still a lot more work that needs to be done; progress in the country is very uneven and many children remain unvaccinated. It is estimated that 400,000 (3 out of 10) children still do not receive all the required scheduled doses of vaccines by their first birthday. This build-up of under-immunized children has previously contributed to outbreaks of polio. Most of these children come from poor families, the urban informal settlements and the hard-to-reach parts of the country, particularly arid and semi-arid (ASAL) regions where access to health services is limited.

A child receives vaccination against polio in a Mother and Child Health (MCH) Clinic at Mukuru Health Centre, in Nairobi, Kenya.  Credit: ©UNICEFKENYA/2016/NOORANI

A child receives vaccination against polio in a Mother and Child Health (MCH) Clinic at Mukuru Health Centre, in Nairobi, Kenya. Credit: ©UNICEFKENYA/2016/NOORANI

As long as there is a child out there who has contracted this disease, no matter where they live or who they are – all children everywhere are not safe. The four cases confirmed in October 2016 in the current polio outbreak in Nigeria place other African countries, including Kenya, at risk of importing the wild polio virus, due to the unaccounted number of unvaccinated children across the continent as well as the high population movement.

In the final push towards eradicating polio by 2018, Kenya with its strict monitoring system for the safety and quality assurance of vaccines, has already proved that it has the capacity to make the whole country polio-free. A five-day polio campaign that started on 18 January, 2017 targets more than 2.9 million children below the age of 5 years in the fifteen counties of Bungoma, Busia, Garissa, Isiolo, Lamu, Mandera, Marsabit, Nairobi, Samburu, Tana River, Trans Nzoia, Turkana, Wajir, West Pokot and Uasin Gishu. Children in high-risk areas — some of whom have never had access to immunization services before — will have an opportunity to be vaccinated against polio.

To ensure that all vulnerable children are reached, the exercise will be relying on the steadfast commitment of vaccination teams and the communities they serve. These heroic women and men in most cases walk long distances from house-to-house, often in the most dangerous of circumstances to reach all children. Communities where the polio campaign is backed and encouraged by religious and community leaders have much higher rates of protection than those that lack this support.

As part of the worldwide campaign to eradicate polio, there is need for everyone to rally behind this polio vaccination campaign, to reach each and every child regardless of their geographical location of their status in society. We have a responsibility to protect hundreds of thousands of children in Kenya from being paralyzed for life; from being excluded from their communities; and from being denied their right to a full and productive life.

In 2017 and beyond, no child in Kenya should suffer the consequences of a vaccine-preventable disease, for every child deserves to live in a polio-free world.

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A Women’s March on the World Fri, 20 Jan 2017 04:27:24 +0000 Tharanga Yakupitiyage Participants in the 2015 New York March for Gender Equality and Women's Rights. Credit: UN Photo/Devra Berkowitz.

Participants in the 2015 New York March for Gender Equality and Women's Rights. Credit: UN Photo/Devra Berkowitz.

By Tharanga Yakupitiyage
NEW YORK, Jan 20 2017 (IPS)

Just one day after the inauguration of President-elect Donald Trump, hundreds of thousands of women are expected to attend one of the largest demonstrations in history for gender equality.

Starting out as a social media post by a handful of concerned women, the Women’s March on Washington quickly transformed, amassing over 400 supporting organisations representing a range of issues including affordable and accessible healthcare, gender-based violence, and racial equality.

“It’s a great show of strength and solidarity about how much women’s rights matter—and women’s rights don’t always take the front page headlines,” Nisha Varia, Advocacy Director of Human Rights Watch’s Women’s Rights Division told IPS.

Despite the variety of agendas being put forth for the march, the underlying message is that women’s rights are human rights, Executive Director of Amnesty International USA Margaret Huang told IPS.

“All people must be treated equally and with respect to their rights, no matter who is in positions of authority and who has been elected,” she said.

Organisers and partners have stressed that the march is not anti-Trump, but rather is one that is concerned about the current and future state of women’s rights.

“It’s not just about one President or one candidate, there’s a much bigger banner that we are marching for…our rights should not be subject to the whims of an election,” Kelly Baden, Center for Reproductive Rights’ Interim Senior Director of U.S. Policy and Advocacy told IPS.

The health system also risks returning to a time when many insurance plans considered pregnancy a pre-existing condition, barring women from getting full or any coverage.

“It’s about women, not Trump,” she continued.

The rhetoric used during the election is among the concerns for marchers as it reflects a troubling future for women’s rights.

During his campaign, President-elect Trump made a series of sexist remarks from calling Fox News host Megyn Kelly a “bimbo” to footage showing him boasting of sexual assault. Though Trump downplayed his remarks as “locker room talk,” his rhetoric is now being reflected in more practical terms through cabinet nominations.

Huang pointed to nominee for Attorney-General Jeff Sessions who has a long and problematic record on women’s rights including voting against the reauthorisation of the Violence Against Women Act, rejecting anti-discrimination protections for lesbian, gay, bisexual and transgender (LGBT) people, and opposing the Lilly Ledbetter Fair Pay Act of 2009 which addresses pay discrimination.

During her confirmation hearing, Nominee for Secretary of Education Betsy DeVos wouldn’t say if she would uphold title IX which requires universities to act on sexual assault on campuses.

According to the National Sexual Violence Resource Center, one in five women and one in 16 men are sexually assaulted while in college.

The new administration has also recently announced cuts to the Department of Justice’s Violence Against Women Grants, which distribute funds to organisations working to end sexual assault and domestic violence.

“There is no question that we’re going to have some challenges in terms of increasing protections for women’s rights over the next few years,” said Huang to IPS.

Meanwhile, Varia pointed to other hard fought gains that risk being overturned including the Affordable Care Act (ACA). The ACA, which U.S. Congress is currently working to repeal, provides health coverage to almost 20 million Americans by prohibiting insurers from denying insurance plans due to pre-existing conditions and by providing subsidies to low-income families to purchase coverage.

If repealed, access to reproductive services such as contraception and even information will become limited. The health system also risks returning to a time when many insurance plans considered pregnancy a pre-existing condition, barring women from getting full or any coverage.

“Denying women access to the types of insurers or availability of clinics that can help them get pre-natal checks and can help them control their fertility by having access to contraception—these are all the type of holistic care that needs to be made available,” Varia said.

The U.S. is one of the few countries in the world where the number of women dying as a result of child birth is increasing, Varia noted.

In Texas, maternal mortality rates jumped from 18.8 deaths per 100,000 live births in 2010 to 35.8 deaths in 2014, the majority of whom were Hispanic and African-American women. This constitutes the highest maternal mortality rate in the developed world, closer in numbers to Mexico and Egypt than Italy and Japan, according to World Bank statistics.

A UN Working Group also expressed their dismay over restrictive health legislation, adding that the U.S. is falling behind international standards.

Though the ACA repeal and potential defunding of Planned Parenthood, another key reproductive services provider, threatens all women, some communities are especially in danger.

Francis Madi, a marcher and Long Island Regional Outreach Associate for the New York Immigration Coalition, told IPS that immigrant and undocumented immigrant women face additional barriers in accessing health care.

Most state and federal forms of coverage such as the ACA prohibits providing government-subsidised insurance to anyone who cannot prove a legal immigration status. Even for those who can, insurance is still hard or too expensive to acquire, making programs like Planned Parenthood essential.

“I can’t even do my job as an organiser asking for immigrant rights if I’m not able to access the services I need to live here,” Madi told IPS.

Madi highlighted the opportunity the march brings in working together through a range of issues and identities.

“I’m going because as a woman and an immigrant and an undocumented immigrant as well…it’s very important to attend this march to show we can work together on our issues,” she told IPS.

“If we don’t organize with each other, we can’t really achieve true change,” she continued.

In its policy platform, organisers of the Women’s March on Washington also stressed the importance of diversity, inclusion and intersectionality in women’s rights.

“Our liberation is bound in each other’s,” they said.

This includes not only women in the U.S., but across the world.

“There’s definitely going to be an international voice in this, not just U.S. activists,” Huang told IPS.

Marching alongside women in Washington D.C. on January 21st will be women in nearly 60 other countries participating in sister marches from Argentina to Saudi Arabia to Australia.

“Women are concerned that a loss of a champion in the U.S. government will have significant impacts in other countries,” Huang said. Of particular concern is the reinstatement of the “global gag rule” which stipulates that foreign organisations receiving any U.S. family planning funding cannot provide information or perform abortions, even with funding from other sources. The U.S. does not fund these services itself.

The policy not only restricts basic right to speech, but analysis shows that it has harmed the health of low-income women by limiting access to family planning services.

The US Agency for International Development (USAID) is the world’s largest family planning bilateral donor.

Though the march is important symbolic act of solidarity, it is just the first step.

“We are also part of a bigger movement—we need to come together and be in solidarity on Saturday and then we need to keep doing the hard work [during[ the long days and months and years of organising that we have ahead of us,” Baden said.

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Kenya Can Lead the Way to Universal Health Care in Africa Mon, 16 Jan 2017 11:14:21 +0000 Siddharth Chatterjee The UN in Kenya works with the Keyan Government and partners to ensure health services are delivered where they are most needed. (Credit: UNDP Kenya/James Ochweri)

The UN in Kenya works with the Keyan Government and partners to ensure health services are delivered where they are most needed. (Credit: UNDP Kenya/James Ochweri)

By Siddharth Chatterjee
NAIROBI, Jan 16 2017 (IPS)

Consider this: every year, nearly one million Kenyans are pushed below the poverty line as a result of unaffordable health care expenses.

For many Kenyan families, the cost of health care is as distressing as the onset of illness and access to treatment. A majority of the population at risk can hardly afford the costs associated with basic health care and when faced with life threatening conditions, it is a double tragedy-inability to access health care and lack of resources to pay for the services.

According to the World Health Organisation, a large percentage of poor households in Kenya cannot afford health care without serious financial constraints as most are dependent on out of pocket payments to pay for services.  Nearly four out of every five Kenyans have no access to medical insurance, thus a large part of the population is excluded from quality health care services.

In 2015, UN Member States endorsed the 17 Sustainable Development Goals (SDGs), expected to guide the development agenda through 2030. The endorsement of the SDG 3 – Good health and wellbeing; formally enshrined Universal Health Coverage (UHC) as a development priority for all countries.

UHC has the potential to transform the lives of millions of Kenyans—guaranteeing access to lifesaving health services while helping individuals and families avoid crippling health expenses and the poverty trap.

Nearly four out of every five Kenyans have no access to medical insurance, thus a large part of the population is excluded from quality health care services.
The situation is not unique to Kenya, but also a case in point for many other developing countries. As a result, UHC has been identified as a key development goal for enhancing countries’ health systems globally.  It is an all-encompassing development issue, including as it does, the full spectrum of essential, quality health services from health promotion to prevention, treatment, rehabilitation as well as palliative care.

Protecting people from the consequences of out-of-pocket health expenditure, which in Kenya forms about a fifth of family spending, is critical. It reduces the risk of people using up their life savings, selling of assets, or borrowing, threatening the financial future of their families as out of pocket health expenditure is also the most inequitable and inefficient.

However, achieving UHC is a formidable challenge because Africa as a continent requires about 50 percent more doctors to achieve UHC, compared to Europe which needs only about 3 percent more. The continent still lags far behind the rest of the world in provision of basic health care services such as immunisation, water and sanitation as well as family planning.

Much of the problem lies with the low prioritisation of health. Less than ten countries in Sub-Saharan Africa have met the Abuja declaration committing to allocate 15 percent of their annual government spending on provision of health care.

Kenya is one of the countries that is yet to reach the Abuja threshold, but several indicators show that the country can be an inspiration for the rest of the continent in achieving UHC by 2030.

One of the steps in the right direction is the government’s move to eliminate payments for primary and maternal health services in public facilities. This has led to tangible improvements in maternal and child health, with maternal mortality ratio falling from 488 to 362 deaths per 100,000 live births between 2008 and 2014.

With consensus that maternal health is a major driver of overall health and economic development, the Government of Kenya in partnership with the United Nations family and the World Bank, with strong support from the governments of the United States of America, United Kingdom, Japan, Germany, Denmark and Norway who have focussed on counties with the highest maternal and child deaths. Significant gains have also been made as a result of the First Lady of Kenya’s Beyond Zero campaign.

Arnaud Bernaert, Head of Global Health and Health Care at the World Economic Forum, remarked that, “Kenya’s efforts has led to an innovative public-private partnership mechanism that has the potential of building business models that will offer the best of both public and private sector in scaling-up the delivery public health services in low-resource settings”.

Another positive direction is the devolution of health – a constitutional change that shifted responsibility for healthcare provision to county governments. This seeks to achieve universal coverage by bringing health decisions closer to citizens, ensuring efficient and equitable resource distribution, thereby improving access to health facilities as well as services.

Recent changes to the National Health Insurance Fund (NHIF) has expanded the coverage for formal sector employees by adding outpatient care and a new initiative specially targeting informal sector has recently been introduced. The new national scheme offers a comprehensive family cover for US$ 60 (6000 Kenyan Shillings) covering both outpatient and inpatient services. New initiatives such as health insurance subsidies for the poor, severely disabled and elderly will help to bring more vulnerable people under comprehensive health insurance cover.

Kenya is already a leader in technological innovation.  This is a capability that must be harnessed to improve health systems to help bring down costs of delivering health care services through telemedicine, reducing inefficiencies in provider payment systems and generating better data.

These improvements could significantly help ameliorate the financial stress that is currently the most significant barrier to achievement of UHC. Some studies have shown that technical efficiency is a big flaw in Kenya’s health facilities, with one reporting that public dispensaries are operating at only 47 percent efficiency.

Kenya is part of various initiatives for developing sustainable financing for health services such as the Global Financing Facility, a partnership that will catalyse greater investments in health services, with a particular focus on women, adolescents and children.

The momentum is already with the country and in keeping with the spirit of the SDGs, Kenya must lead in the moral imperative of ensuring that none of the people who cannot pay for health care are left behind.

Kenya can undoubtedly lead the way in achieving universal health care.

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Is Cash Aid to the Poor Wasted on Tobacco and Alcohol? Sat, 14 Jan 2017 21:07:11 +0000 Baher Kamal Zambia’s Social Cash Transfer Programme is implemented by the Ministry of Community Development, Mother and Child Health and has been operating since 2003. As of December 2014, it reached 150,000 households and there are concrete plans to scale it up nation-wide in the near future. Photo: FAO

Zambia’s Social Cash Transfer Programme is implemented by the Ministry of Community Development, Mother and Child Health and has been operating since 2003. As of December 2014, it reached 150,000 households and there are concrete plans to scale it up nation-wide in the near future. Photo: FAO

By Baher Kamal
ROME, Jan 14 2017 (IPS)

Not at all. Or at least not necessarily. The fact is that cash transfer programmes –regular money payments to poor households—are meant to reduce poverty, promote sustainable livelihoods and increase production in the developing world. One in four countries on Earth are applying them. But are they effective?

That depends. In some countries, like Brazil, the so-called Bolsa Família is cited as one of the key factors behind the positive social outcomes this Latin American giant has achieved in recent years.

The programme is an innovative social initiative taken by the Brazilian Government, says the World Bank (WB), which has provided technical and financial support to it.

In fact, Bolsa Família reaches 11 million families, more than 46 million people, a major portion of the country’s low-income population. The model emerged in Brazil more than a decade ago and has been refined since then.

Poor families with children receive an average of 70.00 R (about 35 US dollars) in direct transfers. In return, they commit to keeping their children in school and taking them for regular health checks.

And so Bolsa Família has two important results: helping to reduce current poverty, and getting families to invest in their children, thus breaking the cycle of inter-generational transmission and reducing future poverty.

Although relatively modest in terms of resources when compared with other Brazilian social programs, such as Social Security, the Bolsa Família programme may be the one that is having the greatest impact on the lives of millions of low-income Brazilians, according to the WB.

But what about other countries and regions?

The Food and Agriculture Organisation of the United Nations (FAO) on Jan. 4 reported that during the past decade, an increasing number of governments in sub-Saharan Africa have launched cash transfer programmes that target the most vulnerable groups, including subsistence farmers, people with disabilities and HIV/AIDS, as well as families caring for elderly and disabled.

But “although local economies and numerous households have benefited from this social protection measure, critics remain doubtful.”

Five Common Myths

Whatever the case is, there are at least five common myths about cash transfers.

FAO elaborated the following list aimed at evaluating how they play an important role in improving food and nutrition security and reducing rural poverty, based on evaluations carried out in seven African countries – Ethiopia, Ghana, Kenya, Lesotho, Malawi, Zambia and Zimbabwe.

Myth: Cash will be wasted on alcohol and tobacco

Reality: Alcohol and tobacco represent only 1 to 2 per cent of food expenditures in poor households. Across six countries in Africa where FAO and partners carried out evaluations of cash transfer initiatives, no evidence of increased expenditures was found.

In Lesotho, for example, alcohol expenditures have actually decreased after the introduction of cash transfer programmes.

Myth: Transfers are just ‘hand-outs’ and do not contribute to development.

Reality: In Zambia, cash transfers increased farmland by 36 per cent, and with that the use of seeds, fertilisers and hired labour, which resulted in stronger market engagement, and prompted the use of more agricultural inputs.

The country recorded an overall production increase of 36 per cent. Furthermore, the majority of programmes show a significant increase in secondary school enrolment and in spending on school uniforms and shoes.

Cash transfers... are they more than just hand-outs?. Photo: FAO

Cash transfers… are they more than just hand-outs?. Photo: FAO

Myth: Cash causes dependency and laziness.

Reality: In several countries, including Malawi and Zambia, research shows a reduction in casual wage labour and a shift to more productive and on-farm activities.

In fact, in sub-Saharan Africa cash transfers lead to positive multiplier effects in local economies and significantly boost growth and development in rural areas.

Thus, cash does not create dependency, but rather spurs beneficiaries to invest more in agriculture and to work more.

Myth: Transfers lead to price inflation and disrupt local economies.

Reality: Ethiopia, Ghana, Kenya, Lesotho, Malawi, Zambia and Zimbabwe were all part of the Protection to Production project, which, among other things, analysed the productive and economic impacts of cash transfer programmes in sub-Saharan Africa.

None of the seven case study countries experienced inflation.

Beneficiaries represent only a small share of the community (15 to 20 per cent), and because they come from the poorest households and have a low purchasing power, they do not buy enough to affect market prices, thus enabling local economies to meet the increased demand.

In Ethiopia, for every dollar transferred by the programme, about 1.5 dollars are generated for the local economy.

Myth: Child-focused grants increase fertility.

Reality: In Zambia, cash transfers showed no impact on fertility. In Kenya, adolescent pregnancy even decreased by 34 per cent and in South Africa by over 10 per cent.

Meanwhile, FAO, together with its partners, continues to generate evidence on the impacts of social protection interventions to reduce poverty and hunger.

Findings have shown that the implementation of such programmes leads to increased food consumption, better nutrition, improved school enrolment, reduced child labour, economic development, agricultural investment and many other benefits, it says.

“Cash transfer programmes have become an increasingly important tool in finding the path out of poverty and have contributed to making a long-term impact on the lives of many families.”

So far, so good.

The fact, however, is that there are still almost a billion people who still live in extreme poverty (less than 1.25 US dollar per person per day) and 795 million still suffer from chronic hunger, according to this UN leading agency in the filed of food and agriculture.

“Most of the extreme poor live in rural areas of developing countries and depend on agriculture for their livelihoods… They are so poor and malnourished that their families live in a cycle of poverty that passes from generation to generation.”

What About Women?

The case of women is particularly flagrant – although representing nearly half of all rural workers worldwide, with peaks of up to 60 per cent in some developing countries—they have always been among the poorest of the poor.

FAO informs that their main goal is economic growth rather than the economic empowerment of their beneficiaries –-who are usually ultra-poor people; however, evidence of their development impacts is contributing to a shift in how policy-makers perceive these programmes.

On the specific case of women, it says that in many countries, the majority of cash transfers beneficiaries are poor and vulnerable women.

“As a result, it is often claimed that cash transfers have an empowering effect on women based on the assumption that, as the main recipients of the transfers, women gain greater control over financial resources.

Nevertheless, “available evidence on empowerment outcomes is far from being conclusive, particularly as to whether cash transfers actually improve women’s bargaining power and decision-making in the household.”

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