The World Health Organization's `World Health Assembly' - Takes Place in Geneva this Week (REPORT)

Sixty-sixth World Health Assembly:  daily notes on proceedings  

Notes: Monday, 20 May 2013

World Health Assembly opens with focus on the Post Millennium Development Goals Agenda 

The Sixty-sixth World Health Assembly opened this morning with the election of Dr.  Shigeru Omi, Special Assistant for International Affairs, Ministry of Health, Labour and Welfare of Japan, as its new president. Five vice-presidents were also appointed from Angola, Haiti, Oman, Ukraine, and Nepal, representing their respective regions.

Last 1,000 days for MDGs and the path forward 

In his message, which was read by Mr. Kassym-Jomart Tokayev, Director-General of the United Nations Office in Geneva, UN Secretary-General Ban Ki-moon drew attention to the positive effect the Millennium Development Goals (MDGs) have had on the global health agenda. He noted that the Health Assembly will discuss a number of MDG-related issues, such as implementation of the Global Vaccine Action Plan and recommendations from the UN Commission on life-saving commodities for women and children. He described the pressing challenge presented by the rise in non-communicable diseases, highlighting the role of universal health coverage in ensuring equitable access to health services. He emphasized the continuing need for WHO to handle unforeseen global health events, such as newly emerging viruses.

Dr. Omi observed that reform of WHO, the topic of tomorrow’s plenary discussion, aims to make the Organization more relevant, more effective and more dynamic.

Watch the President’s speech on video

Opening address of the WHO Director-General

In her opening address, WHO Director-General Dr. Margaret Chan reiterated the importance of transparent reporting and vigilance in disease outbreaks, including recent cases of novel coronavirus and influenza H7N9, whilst at the same time maintaining the momentum made in addressing long-standing health issues such as tuberculosis, HIV, malaria; the emerging problem of non-communicable diseases; and eradication of polio.

Dr. Chan reiterated WHO’s refusal to work with the tobacco industry. However, she did not exclude the opportunity for cooperation with the food and beverage industry to address non-communicable diseases, while supporting existing safeguards which ensure no conflicts of interest.

Read the Director-General’s address to the Sixty-sixth World Health Assembly

Watch the Director-General’s address

Health in the post-2015 global development agenda

Member States then moved into a plenary discussion about health in the post-2015 global development agenda, noting the critical links between health and sustainable development. Delegates spoke of the need to both build on existing progress made towards the Millennium Development Goals and to address evolving health challenges, notably non-communicable diseases. Many focused on the need to better address equity issues, echoing the UN Secretary General and WHO Director-General’s comments about the potential for universal health coverage to reduce inequities. Many also referred to the importance of measuring for both quality and quantity when monitoring progress.

Delegates began discussions on a draft global action plan for the prevention and control of non-communicable diseases (A66/9). The action plan comprises a set of actions which, when performed collectively by Member States, UN organizations and other international partners, and WHO, will set the world on a new course to achieve nine globally agreed targets for NCDs (A66/8), including a reduction in premature mortality from NCDs by 25% in 2025. The action plan also contains a monitoring framework, including 25 indicators to track mortality and morbidity; assess progress in addressing risk factors, and evaluate the implementation of national strategies and plans.

A drafting group, co-chaired by Pakistan and the United States of America, will negotiate the final text of a resolution and discuss outstanding issues of the draft action plan. The Assembly will resume discussions on this issue later in the week.

----For more visit the World Health Organization website.

"Saving the World From Madness" (REPORT)

(Video: Sound bites from speakers at the UN WHO Meeting to launch the Quality Rights Tool Kit/NIA SPOONER)

By Dr. Judy Kuriansky

*Recently, the United Nations World Health Organization launched the Quality Rights Tool Kit, which supports countries in assessing and improving the quality of mental health care as a human rights condition. and civil society actors gathered together to lend their support to the project and to discuss how to promote the use of the Tool Kit in countries.  Dr. Judy Kuriansky was there to chronicle the discussion for HUMNEWS.

FACT:   Globally, one in four people will experience a mental health condition in their lifetime. Poor quality services and human rights violations in mental health facilities and social care homes are an everyday occurrence in many countries around the world. People living in mental health facilities are often exposed to inhuman and degrading treatment and many are subject to physical, sexual and emotional abuse. As a result, people with severe mental health conditions in some countries die as much as 10 years younger than the general population. (Source: WHO)

(DRAWING: ArtTherapy) “Derogatory words are used to describe us, such as mentally disturbed, having unsound minds, idiots, lunatics, imbeciles and many other hurtful labels,” declared Mrs. Robinah Alambuya of Uganda, to an invited audience of about 100 health professionals, UN agency officials, the UN Foundation academics, representatives of nongovernmental organizations, journalists and guests.  The diverse group was gathered at the Millennium Hotel Diplomat Ballroom in New York City, across the street from the main United Nations headquarters, for an event sponsored by the World Health Organization (WHO) highlighting abuses in the mental health care system and to launch a landmark product, the WHO QualityRights Toolkit, to address the problem.

“These words and the beliefs from which they derive, devalue us and form the basis of discrimination and the loss of inherent dignity,” Alambuya said. 

SHOWING RESPECT

Representing African women and the voices of survivors of people with psychiatric and psychosocial problems in Africa, Alambuya made a plea for respecting those who deal with mental health distress. In her role as President of the Pan African Network of People with Psychosocial Disabilities monitoring inhumane health care systems, she applauded WHO’s efforts to insure those rights in her keynote speech.

The `Tool Kit' is an awareness and training campaign to provide the public, the private sector,  and government groups with actionable steps to stop human rights violations against people with mental health conditions, in order to improve the quality of care and to promote human rights as including mental health.

The recommendations can be implemented in developing and developed nations by all stakeholders, and even includes those with mental disabilities themselves.

"IT CAN HAPPEN TO ANYONE"

Dr. Michelle Funk, Coordinator of Mental Health Policy and Service Development in the Mental Health and Substance Abuse department at WHO, pointed out the extent of the problem with "One in four people will experience a mental health condition in their lifetime," she said.

Suicide is among the top three cause of death in young people aged 15-34 worldwide. Qualified caregivers are scarce with less than one psychiatrist serving 200,000 in almost half the world populations. Yet poor quality services and human rights violations are pervasive in social care homes and mental health facilities where patents are often exposed to inhuman and degrading treatment. And worse, to physical, emotional and even sexual abuse. 

“It is a scandal that still today many mental health facilities are places of violence and harmful treatments practices rather than places of care and support," said Funk. “One of the most important points to note about this tool kit is that it establishes the key standards that need to be met in all inpatient and outpatient mental health and social care facilities across the world.” She went on to praise the role of the governments of Spain and Portugal in providing funds to help produce the toolkit.

NOTABLE ADVOCATES

Panelists at the June 28^th event represented a wide range of perspectives about the issue, including UN and government officials, an African woman with disabilities, and a former prisoner from the slums of India.

Hollywood film producer Gary Foster described his evolution to become a mental health advocate when producing the film “The Soloist“ - a true life story about a former cello prodigy who developed a mental health condition and became homeless on the streets of Los Angeles. Foster, who also produced “Sleepless in Seattle” and "The Score” spent time on skid row where he discovered that all people have “dream for success.”  

Serving as an important example of how the campaign goals can be accomplished, Ambassador Carlos Enrique Garcia Gonzalez, Deputy Permanent Representative of El Salvador to the UN, described his government’s recent advances in ambitious health care reform, including a social development component with a human rights approach - pointing out how abuses of mental health are not an isolated issue, because mental health care extends to all facets of society, and is integrally tied to attitudes and poverty. 

Often times, people with psychosocial disabilities become homeless, are abandoned by their families, and are detained against their will by authorities - neglected in inferior conditions. Therefore, mental health services need to encompass access to decent work, education and quality of life. 

Panelist Julian Eaton, a psychiatrist and mental health advisor from the West Africa Office of CBM in Togo, discussed how "the value of technology in such a campaign, particularly the use of mobile phones, is revolutionary". 

The initiative builds on WHO’s Mental Health and Development Report, published in 2010 and is also based on the framework of the UN Convention on the Rights of Persons with Disabilities, which asserts that “human rights standards that must be respected, protected and fulfilled in all facilities”.

(Video: WHO)

A short film was shown of cruel and deplorable conditions in a care center, showing emaciated patients, chained to beds, crying out and lying in excrement. Ambassador Gonzalez pointed out that mental health workers themselves, who have to work in substandard conditions, are another victimized group. 

As a psychologist who has worked in many mental health institutions with psychiatric patients, I asked Michele Funk whether a solution would be to allot needed funds for improvements in these facilities.  “No", she responded, “They must be shut down, and new ones opened.”

CRITICS, SUPPORTERS

While generally lauded, the Toolkit is not without criticism.  Alambuya expressed concern about the emphasis on a medical model of service delivery that does not adequately take into account the social problems faced by persons with mental disabilities, saying, "The voices of people with disabilities must be heard, using the popular phrase, `Nothing about us, without us'”.

(PHOTO: Adolescents are generally perceived as a healthy age group; yet an estimated 10-20% of them experience a mental health problem/WHO)In a powerful close to the panel, Gregory David Roberts, speaking from personal experience of his being imprisoned and overcoming drug abuse, the author of the best-selling novel “Shantaram”  recounted the story of a fellow inmate - mentally challenged - who had been abused by the other prisoners; and who despite consistently smiled.  One day the man found unhatched eggs, and put them under his armpits until they hatched.  The baby pigeons became valued and protected in the jail, eventually taming hard-hearted cruel prisoners.  The experience prompted Roberts to learn lessons about his shame for not defending the man, and about the power of people of mental disability to transform others.

Roberts recounted another story of a mentally challenged young man who would have been arrested had it not been for the community people who chained him up near them, where he could be cared for and protected from arrest,  underscoring his point that community-based programs are key.

More launches of the toolkit campaign will be held to gain more visibility for the project.

“Everyone should have access to mental health care,” said His Excellency Mr. Nassir Abdulaziz Al-Nasser, President of the sixty-sixth session of the United Nations General Assembly. Recommending mainstreaming of mental health care, he noted that his own state of Qatar introduced a resolution to the UN General Assembly to introduce and International Day of Autism.  "If we all consider human rights together," he said, “We can make a difference.”  

- Dr. Judy Kuriansky is the Main United Nations NGO Representative for the International Association of Applied Psychology and a member HUM's Board of Advisors.  A licensed clinical psychologist in the Departments of Clinical Psychology at Columbia University Teachers College, she is world renowned as a humanitarian who has led workshops on peace, trauma recovery, crisis counseling and on her unique East/West intervention programs around the world, from Argentina to India, Singapore, the Czech Republic, Israel, the UAE, and Iran. She has worked in disaster relief and psychological first aid at Ground Zero after 9/11, after SARS in China, bombings in Jerusalem, earthquakes in Australia and Haiti, the tsunami in Sri Lanka and the tsunami/earthquake in Japan, information about which is on www.DrJudy.com. An award-winning journalist and accomplished author, she is a tireless advocate for media which sheds light.

Malaria spread feared as WHO releases action plan to tackle global spread of insecticide-resistant mosquitoes (REPORT)

(Video World Malaria Day, 2012/WHO)

By Amy Maxmen

The war to bring malaria to heel has made slow but steady progress during the past decade, with the overall mortality rate dropping by more than 25% since 2000. A key factor in this progress has been improved control of mosquitoes, which transmit the Plasmodium parasite — a potent killer that claimed an estimated 655,000 lives in 2010 alone. But health officials fear that the spread of insecticide-resistant mosquitoes could bring about a resurgence of the disease. To help combat this threat, on May 15, the World Health Organization (WHO), based in Geneva, Switzerland, issued a strategic plan to curb the spread of resistance.

“We don’t want to wait for failures to happen,” says David Brandling-Bennett, the senior adviser for infectious diseases at the Bill & Melinda Gates Foundation in Seattle, Washington, who advised on the document.

Such failures could reverse the recent drop in malaria mortality credited to insecticide spraying in the home and coating of bed nets, which save about 220,000 children’s lives each year, according to the WHO. Insecticide resistance could also result in as many as 26 million further cases a year, the organization predicts, costing an extra US $30 million to $60 million annually for tests and medicines.

The WHO report says that insecticide-resistant mosquitoes already inhabit 64 malaria-ridden countries (see map).

The problem is particularly acute in sub-Saharan African countries such as Benin, Burkina Faso, Cameroon, Côte d’Ivoire, Ghana, Ethiopia and Uganda, where mosquitoes are frequently resistant to compounds known as pyrethroids and even to the organochloride DDT, venerable tools of mosquito control. Because they are extremely safe for children, effective against mosquitoes and affordable, pyrethroids are the only insecticides used to treat bed nets, as well as the first choice for household spraying.

Health authorities in Somalia, Sudan and Turkey have also reported sporadic resistance to the two other classes of insecticides recommended by the WHO for safe and effective household spraying: carbamates and organophosphates. Resistance has probably evolved several times independently, and is now spreading as extensive use of pyrethroids and other insecticides favors resistant mosquitoes. “In 2004, there were pockets of resistance in Africa, and now there are pockets of susceptibility,” says Janet Hemingway, chief executive of the Innovative Vector Control Consortium (IVCC), a product-development partnership based in the United Kingdom.

(MAP: Global malaria map, 2012/WHO) Among other things, the WHO recommends rotating the classes of pesticides used to spray houses, and developing safe and effective non-pyrethroid insecticides that can be used to treat bed nets. To implement all of the WHO’s suggestions would cost $200 million - on top of the $6 billion that the WHO requested last year to fund existing malaria-control programs. Rob Newman, director of the Global Malaria Program at the WHO, hopes that the report will draw more funds to the table as donors grasp the situation. “If we can stop pyrethroid resistance from spreading, it will be cheaper in the long run,” Newman says.

“In 2004, there were pockets of resistance in Africa, and now there are pockets of susceptibility.”

But the two largest players in malaria aid - the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the US President’s Malaria Initiative (PMI) - have not yet pledged additional money to fight resistance. Their spending on mosquito control is already high - in 2009, 39% of the Global Fund’s malaria expenditures went towards insecticide-treated bed nets and household spraying, as did 59% of the PMI’s in 2010.  

For now, pyrethroids are the only class of insecticides approved by the WHO for bed nets, and where spraying is concerned they are less costly than the alternatives. Vestergaard Frandsen, a company based in Lausanne, Switzerland, says that it has in the pipeline a bed net coated with a non-pyrethroid insecticide - one that does not belong to any of the four WHO-approved classes - and that the company expects to bring this to market within the next five years. It is also one of several companies partnering with the IVCC to create innovative mosquito-control products.

(PHOTO: Malaria `home test'/NoProphalactics)In the meantime, health officials may be able to keep malaria at bay by swapping insecticides. The report notes that in Colombia, for instance, mosquitoes regained susceptibility to pyrethroids after five years of treatment with an organophosphate. But some African countries lack the surveillance needed to spur such an approach. To address that deficiency, the report urges that a global database be set up to track the spread of resistance, and that entomologists be trained and hired at surveillance stations. That could prove the most challenging goal of all.

“Nobody wants to fund capacity building,” says Newman. “Donors would rather say they purchased $10,000 in bed nets than pay a salary.”

African ministers of health realize the need to manage resistance but can’t do much without outside funds, explains Maureen Coetzee, a medical entomologist at the University of the Witwatersrand in Johannesburg, South Africa. “In some countries, malaria control means one person sitting in one room, and he’s lucky if he’s got a chair,” she says.

- This report originally appeared by Amy Maxmen at Nature.

The WHO must reform for its own health (PERSPECTIVE)

(Video WHO video for World Health Day, April 7, 2012)

By Tikki Pang and Laurie Garrett

The World Health Organization (WHO) is facing an unprecedented crisis that threatens its position as the premier international health agency. To ensure its leading role, it must rethink its internal governance and revamp its financing mechanisms.

The World Health Organization was born in the bifurcated Cold War world in 1948, and every aspect of its charter, mission and organizational structure was molded by diplomatic tensions between NATO and the USSR. However, with the collapse of the Soviet Union and the rise of the new emerging market superpowers, the WHO finds itself trying to straddle a global dynamic for which it was not designed.

Indeed, the WHO now finds itself marginalized in a crowded global health landscape characterized by poor coordination among multiple players. It is no longer the only major actor. At the same time, it faces an internal crisis, with major budget shortfalls and staff layoffs that have resulted in the organization embarking on the most radical reforms in its 64-year history. But the changes do not go far enough. A recent dialogue on WHO reform that we participated in, held by the Council on Foreign Relations in New York in February, identified several key challenges that should be addressed by the agency.

(GRAPH: Flag of the WHO) First and foremost, the WHO should refocus on its original aim of being primarily a 'knowledge broker' that gives advice and information about best practices but stops short of directly implementing programs. It should convene negotiations resulting in internationally binding legal agreements and monitor their implementation. Some of its most successful achievements - such as the Framework Convention on Tobacco Control, the International Health Regulations and the International Classification of Diseases - fall into this category.

The means by which such agreements are reached has changed, and the organization needs to adapt. In 1948, the WHO acted as a knowledge-and-standards broker between states, working almost exclusively with ministries of health and government leaders. In the twenty-first century, however, the WHO's credibility and relevance depend on its ability to exert a normative influence through the Internet, informing the global citizenry about all aspects of health - from relevant treaties to drug safety to disease outbreaks. Currently, the organization's website, is nearly impossible to navigate, akin to a well-stocked library with no catalog system. It needs an overhaul to be useful to the global citizenry.

The WHO not only needs to better communicate and coordinate with its global partners; it also needs to make improvements within, starting with its internal governance. The organization must enhance the relationship between its Geneva headquarters and its powerful regional offices. Guidance from Geneva is sometimes ignored, even contradicted, by the regional directors and their offices. Although the WHO was born with a clear top-down leadership structure, it has morphed over the decades into something closer to a partnership: Geneva 'suggests' policies that its regional partners may accept, ignore or amend. It is often difficult to tell whether the tail is wagging the dog. For example, the Pan American Health Organization, which is one of the regional offices of the WHO, may choose to design and implement a Chagas disease eradication strategy having sought little or no input from Geneva. To avoid tensions, the organization should more clearly apportion 'core' versus 'support' roles played by the various parties.

(PHOTO: Dr. Margaret Chan is the Director-General of WHO, appointed by the World Health Assembly on 9 November 2006/WHO)The internal changes must also involve improved finances. In 1990, the agency was by far the largest player on the global health field, with an annual budget of nearly $1.2 billion; the next biggest budget at the time was that of US government global health programs, which totaled $850 million. By 2010, the WHO's budget, after years of increases, fell back to that 1990 level, making it the fourth largest spender in the global health landscape, behind the now-mammoth $7.5 billion US program, the $3 billion Global Fund to Fight AIDS, Tuberculosis and Malaria and the $2.2 billion collective pile of smaller nongovernmental organizations. This year, the WHO seems to be falling further behind in the hierarchy, trailing the GAVI Alliance and the Bill & Melinda Gates Foundation.

Until recently, the WHO garnered more than 80% of its budget in the form of voluntary donations, largely given by the wealthiest countries for earmarked programs. The agency's core support is derived from proportional levies on member nations, which have remained unchanged for years despite the rising costs of WHO operations. Moreover, the WHO's revenues are received in US dollars, but its Geneva operational and payroll costs must be met in Swiss francs. Because the WHO has not practiced currency hedging, a 32% increase in the value of the franc against the dollar, as occurred in 2011, cannot be accommodated without severe institutional fiscal pain.

In addition to practicing currency hedging, the WHO must identify a range of financing innovations with a goal of increasing institutional resilience. Such financing mechanisms may include, for example, the establishment of an endowment fund, a multiyear financing framework, or the use of a Robin Hood tax, which reaps financing from miniscule taxation of very large currency transactions. Both of these options were highlighted by a 5 April report from a consultative expert working group convened by the WHO.

And, like any multibillion-dollar company, the WHO should have an effective 'marketing' strategy built around rigorous, external evaluations that demonstrate the value of its activities.

The world needs an aggressive and scientifically solid health leader. Governance and the setting of normative standards cannot be accomplished with a slew of loosely connected health initiatives, nongovernmental organizations and bilateral programs. The only entity with a charter, a legislative body and a mandate to fill that role is the WHO, and it must do so decisively.

--- This commentary originally appeared in NATURE.  Tikki Pang is a visiting professor at the National University of Singapore and former director of Research Policy & Cooperation at the World Health Organization in Geneva, Switzerland.  Laurie Garrett is a senior fellow for global health at the Council on Foreign Relations in New York, NY, USA.

Polio Victim on Front-lines of War Against Crippling Disease in Nigeria (EXCLUSIVE REPORT)

Mallam Aminu Ahmed Wada. In 1965, a few years after polio vaccine was widely available in the west, he was struck by polio. Both of his legs are completely paralysed. He moves on two wooden crutches which are just a few inches high. His mobility depends on the strength of his arms and shoulders. CREDIT: M Bociurkiw/HUMNEWS(HN, August 13, 2011) - Even amid the congestion and chaos of Nigeria's second-largest city, it's almost impossible to miss the roadside property of the Kano Polio Victims Trust Association.

Scrap metal, wheel-chairs, and small, custom-made motorized vehicles for polio victims seems to stretch for as far as the eye can see.

One of the first people to greet you will be Mallam Aminu Ahmed Wada, polio victim-turned-campaigner. His association started about a decade ago with just a few members and now has more than 2000.

In the mid-1960s, a few years after polio vaccine was widely available in the west, Wada was struck by polio. Both of his legs are completely paralysed, and he moves on two wooden crutches which are just a few inches high.

As Wada speaks, sparks fly all around him as welders work wonders with metal pieces to construct these amazing devices. Some are simply plastic lawn chairs on bike wheels, with hand-operated controls for steering.

The devices transform the lives of polio victims, allowing them to travel to job, classes - and around the dusty streets of Kano.

The NGO buys scrap metal and transform it into wheel-chairs, motorized chairs and crutches for polio victims - which are then sold to the state government and others. Part of the association's work is to employ people struck by polio; Rotary International is one of its key supporters.

Wada is a tireless campaigner for polio eradication. He often travels with vaccination teams, urging mothers to vaccinate their children against the crippling disease that has struck thousands of kids in Nigeria, particularly the north.

"Look at me," Wada begs watching mothers during one rally. "Do you want your children to be like me? Please vaccine them."

In 2003, Islamic leaders in northern Nigeria organized a boycott of polio vaccinations, claiming that the vaccines were a Western plot to infect Muslims and make them infertile. But an enthusiastic campaign by UNICEF and others has helped to reduce the case load.

But total polio elimination - the hope of campaigners ranging from Wada to billionaire philanthropist Bill Gates - appears elusive. In Kano alone there have been six cases in the last three months, according to a HUM correspondent in West Africa.

Wada's son, Umar, was also paralysed by the virus in 2004. This was the time Kano State completely rejected polio vaccine because of the boycott. "I woke up in the night to find Umar's leg was weak," says Wada. "We took him to the hospital, but there was nothing we could do." 

Wada, and his wife Hadiza, have nine children. Hadiza is also a polio victim and moves around on crutches.

These devices transform the lives of polio victims in the northern Nigerian state of Kano. CREDIT: Christine McnabAlthough the numbers of cases have plummeted - last year there were only about 20 recorded cases -Wada is the first to tell you that there is no room for complacency. Recently, he presented a non-motorized wheelchair to a young polio victims in Kano state during the launch of a vaccination campaign.

Polio (poliomyelitis) mainly affects children under five years of age. One in 200 infections leads to irreversible paralysis (usually in the legs). Among those paralysed, 5% to 10% die when their breathing muscles become immobilized, according to the World Health Organization (WHO).

There is no cure for polio, it can only be prevented. Once polio strikes, it cripples the victim for life. Prevention is primarily through polio vaccine, administered multiple times.

Only four countries in the world remain polio-endemic, down from more than 125 in 1988. The remaining countries are Afghanistan, India, Nigeria and Pakistan.

With files from Christine Mcnab

On World No Tobacco Day The Ubiquitous Hookah Comes Under Attack (NEWS BRIEF)

A Hookah lounge in the UK(HN, May 31, 2011) -- On World No Tobacco Day the World Health Organization (WHO) once again warns smokers and others of the dangers of smoking. While the dangerous habit is declining it is still the leading preventable cause of death.

This year, WHO says more than 5 million people will die from a tobacco-related heart attack, stroke, cancer, lung ailment or other disease. That does not include the more than 600,000 people – more than a quarter of them children – who will die from exposure to second-hand smoke.

Now with use of the so-called Hookah, or water-pipe (also known as "shisha" and "narghile"), proliferating globally - including in the United States - WHO is taking a tough stand on the exotic habit - saying it is no less safe than ordinary smoking.

That the practice is seen to be safe is an "unsubstantiated belief" and reinforced by misleading marketing, WHO says. In an advisory note, the Geneva-based organization says that the label of a popular water-pipe tobacco brand sold in South-West Asia and North America claims 0.5% nicotine and zero percent tar.

The New York Times reports today that many US campuses, where Hookah smoking is becoming extremely popular among college students, are banning the practice all together because of health concerns. Several municipalities are following suit. The habit is also popular among young people in Brazil and European countries.

Hookah pipes and accessories are now easily available online and there is no lack of on-line forums celebrating the practice, such as the Hookah Forum.

Hookah smoking is especially popular in US cities with large numbers of immigrants from the Middle East. The aromatic smoke, filtered through a water bowl, seems to lull users into thinking that the health effects are minimal.

But WHO says that, because the inhaled air passes over not just the tobacco but heated charcoal as well, that users are inhaling very harmful charcoal combustion products.

"Contrary to ancient lore and popular belief, the smoke that emerges from a water-pipe contains numerous toxicants known to cause lung cancer, heart disease and other disease," WHO says. It adds that because the tobacco products contain nicotine it can cause addiction.

Alarmingly, WHO calculates that because a typical Hookah session can last up to more than one hour and include as many as 200 puffs, the water-pipe smoker may therefore inhale as much smoke during one session as a cigarette smoker would inhale consuming 100 cigarettes or more."

WHO says that in South-West Asia and North Africa, it is not uncommon for children to smoke with their parents.

Globally, the highest rates of water-pipe smoking are in North Africa, the Eastern Mediterranean region and South-East Asia, WHO says. Most street cafes in Cairo offer water-pipes, alongside cups of strong coffee, and the practice often replaces alcohol in bars and cafes during the holy month of Ramadan in such cities as Amman, Jordan.

The annual death toll from the global epidemic of tobacco use could rise to 8 million by 2030. Having killed 100 million people during the 20th century, tobacco use could kill 1 billion during the 21st century, WHO said.

- HUMNEWS staff

Resurgence of Polio in DR Congo Causes Alarm (Report)

The polio vaccine is administered through drops into the mouth. CREDIT: Christine McNab(HN, March 4, 2011) - The global health community is concerned about a massive outbreak of polio in the Democratic Republic of Congo (DRC).

The DRC has witnessed a sharp resurgence of polio as conditions in the country continue to complicate vaccination efforts, potentially undermining global eradication of the crippling disease. From January 2010 to February 2011 there were 112 new cases - up from only three in 2009.

In neighbouring Republic of Congo, the same disease has killed 169 people and paralyzed 409, according to the World Health Organization (WHO).

Although polio usually strikes children under five, in both countries it is mainly adults who have been infected.

“Vaccination campaigns only started in this country [DRC] in the mid-1980s. Those now over 30 years of age have mostly not been vaccinated,” Health Minister Victor Makwenge Kaput told IRIN late last year.

The outbreak in the DRC is serious enough to warrant a visit by UNICEF's Executive Director Tony Lake, who flew to the capital, Kinshasa, this week to meet with key government officials and to visit sites where health workers are battling the rapidly spreading outbreak .

In response, preparations are underway to go door to door to vaccinate more than 14 million children by the end of May.

"Eradicating polio in DRC and everywhere requires an absolute commitment by government and its partners to vaccinate every child,” said Lake.  “UNICEF will do everything we can to support the DRC’s collective effort to defeat this evil virus once and for all.”

Since hitting its peak in the U.S. in 1952, the number of cases has gone down 99%; now, there are less than 1,500 known cases of polio worldwide.

There are just four polio-endemic countries: India, Nigeria, Pakistan and Afghanistan. While these numbers have been dropping, philanthropist Bill Gates says the majority of outbreaks in 2010 were actually in countries that had been polio-free. The virus travelled back across borders into countries like Tajikistan and Congo.

- HUMNEWS staff, files

Rich Countries Diseases Driving Poor Deeper Into Poverty - WHO (Report)

(HN, December 8, 2010) - Diseases that have traditionally been the leading cause of death in industrialized countries - such as cancers, diabetes, cardiovascular and chronic lung disease - are now mostly found in poorer countries, and are increasing the circle of poverty.

So-called noncommunicable diseases now account for 60 percent of all deaths - or more than 35 million - and of these - a whopping 80 percent occur in low and middle income countries, according to the World Health Organization (WHO).Even in this high altitude village in Lesotho, tobacco products, sodas and sweets are easy to obtain. CREDIT: Michael Bociurkiw/HUMNEWS

"The main burden is on low and middle income countries," said Dr. Ala Alwan, WHO Assistant Director-General, Noncommunicable Diseases and Mental Health.

Alarmingly, Africa will see the highest increase in mortality from noncommunicable diseases -  25 percent in the next decade.

Noncommunicable diseases account for 80-85% of mortality and share the same risk factors - such as an unhealthy diet and alcohol abuse.

A high proportion of the deaths are pre-mature, occurring in people under 60-years-old. "They are not only an enormous health problem, but also have very negative socio-economic consequences," said Alwan.

The problem for poorer countries, WHO says, is that treatment of these chronic diseases are expensive. "Health care costs are increasing and in poor populations a significant proportion of families with a family member with cancer or heart diseaes, will experience what we call 'catastrophic expenditure' - which drive the family below the poverty line," Alwan said at a media briefing in Geneva, monitored by HUMNEWS.

He said that when families are driven further into poverty, the risk factors increase - such as tobacco use, diabetes and obesity. For example, the highest rates of smoking is in developing countries: about 60 percent of men in certain poor countries use tobacco prods.

Of 10 countries with the highest prevalence of diabetes in the world, almost all are in developing populations. The Pacific island nation of Nauru now has the highest prevalence of diabetes (about 30 percent) in the world, followed by the Gulf States.

"We now have clear evidence that the magnitude of diabetes is increasing in developing populations - including India and China," Alwan said.

"So there have been repeated initiatives to find solutions to address this increasing problem. What we want to highlight is these are largely preventable, said Alwan, adding that by addressing tobacco control, unhealthy diets and physical inactivity a substantial amount of illness and premature death can be averted.

Noncommunicable diseases, such as cancer, are expensive to treat in developing countries so the most effective way to manage the epidemic is through prevention, experts say. The high rates of increase in cancer in the developing world was a key issue at the 2010 Clinton Global Initiative in New York.

The active engagement of non-health sectors - such as agriculture, finance, trade, education, information and transportation - are crucial to addressing the epidemic. For example, increasing the price of tobacco products is "one of the most effective ways" of decreasing smoking, Alwan said.

While there is no prospect for negotiation with the tobacco industry, Alwan said, the food sector might be able to come up with such tactics as reformulation of food products and more responsible marketing. WHO is also pressing countries to reduce the amount of salt in food products.

Poorer countries complain that the epidemic of noncommunicable diseases is not a priority of development agencies and donor countries. They are also calling for indicators and benchmarks - such as the MDGs - to assist the battle against noncommunicable diseases.

The UN General Assembly will be hosting a high-level global meeting on noncommunicable diseases in 2011.

- HUMNEWS staff

Cholera Cases in Haiti Set to Rise; Fears of Instability (NEWS BRIEF)

(HN, November 17, 2010) - The number of cholera cases in Haiti is expected to rise significantly beyond the latest figure of 11,000 as case monitoring improves and as health officials try to get ahead of an epidemic that is already causing political instability ahead of the November 28 presidential elections.

Cholera cases have now been found in every Haiti province, known as departments, as well as the capital Port-au-Prince. So far in Haiti, more than 11,000 cases have been cited and about 1000 people have died from the disease.

UN officials said as data collection improves, numbers will inevitably rise.

"We expect to have, once that data comes in, a significant increase in recorded cases. So people should not be surprised at that," said Nigel Fisher, the U.N. humanitarian coordinator in Haiti.Canadian Nigel Fisher leads the UN response in Haiti

Fisher said emphasis is continuing on educating the public about the disease and making sure they have access to oral rehydration salts and tablets to chlorinate their water. Plans are also being made to increase the number of cholera treatment centers across the country. 'It is [cholera] spreading and we have to contain, if not [the] number of cases, we have to try to contain the number of deaths," he said.

Today, Médecins Sans Frontières (MSF) said there are "acute deficiencies" in the well-established preventative actions that are essential to controlling the spread of the epidemic. It said activities such as the distribution of clean drinking water, positioning of oral rehydration points in affected communities, waste removal, and safe burial of victims of the epidemic, all remain far below the needs.

UN officials fear the outbreak may be used by some faction to increase instability: on Monday protestors directed their anger at UN peacekeeping forces - claiming UN personnel were responsible for importing cholera into the country.

Separately, health officials have confirmed the first case of cholera in Haiti's neighbour, the Dominican Republic.

In Geneva yesterday Fadéla Chaib of the World Health Organization (WHO) said there was a scientific consensus that cholera will remain an issue in Haiti for several years to come. WHO is preparing for more cases, mostly in remote areas, opening new treatment centers. Several levels of assistance are being offered to cholera-affected people, Chaib said, underscoring that mild cases are being treated at the community level and serious ones referred to cholera treatment centers. Social mobilization and education efforts are now very important, given that many Haitians were very scared and know little about cholera. 

Last week, the UN launched a new $163.8 million appeal for Haiti. Elisabeth Byrs of the Office for the Coordination of Humanitarian Affairs (OCHA) said it is intended for the purchase water purification tablets and rehydration salts, to increase the number of medical staff and to train medical personnel.

(News Brief) Cholera in Haiti and Nigeria

Photo UNICEF – A baby in Haiti suffers from diarrhea (HN, October 27, 2010) --- Over 3000 cases of cholera have been reported in Haiti this week resulting in over 250 deaths so far. More than 1,500 people have been hospitalized with a variety of diarrhea-related side effects, including dehydration, vomiting and abdominal pain. The confirmed cases are clustered around the Artibonite River in a region two hours north of the capital, Port-au-Prince. Additional cases of watery diarrhea in Port-au-Prince are worrying health officials who are working to prevent the spread of the disease into the crowded camps of displaced.

The United Nations Children’s Fund (UNICEF)  Haiti's Chief of Health, Dr. Jean-Claude Mubalama, said the situation was hectic and the local hospital in Saint-Marc was overwhelmed with sick people.

"The people here—the medical [staff] and the nurses—are not very familiar with this kind of disease," said Mr. Mubalama. As a result, UNICEF is managing the available resources, as well as coordinating with government and local partners, to try to treat people as quickly as possible, he added.

North of St. Marc, additional cases have appeared in the small community of Dessalines.

Photo: An MSF staff member attends to patients receiving treatment at the St. Nicholas Hospital in St. Marc"We have 35 hospitals beds, but we now have 61 patients spread throughout the hospital," says Dr. John Fequier, director of Claire Heureuse in Dessalines. Only 5 years out of medical school, Dr. Fequier is quick to admit he has never seen anything like this.

Dr. David Olson of Doctors without Borders/ Médecins Sans Frontières (MSF) medical advisor and cholera specialist in Haiti says “The best way to contain the spread of cholera is through prevention, and ensuring people have access to clean drinking water” . He adds that “ in refugee settings in conflict areas, people are forced to seek water wherever they can find it. By contrast, in many of the displacement camps in Port-au-Prince, people are provided with water that is less likely to be contaminated. This will hopefully mitigate the threat."

Nigeria
In Nigeria a cholera outbreak has led to 40,000 cases and resulted in 1,555 deaths, the United Nations confirmed yesterday.

According to the United Nations Children’s Fund (UNICEF) the number of cases is three times higher than last year and seven times higher and in 2008. The disease’s spread seems to be largely contained in Nigeria, where new cases are still being reported in the country, particularly in the northeast.

Women and children account for 80 percent of the cases, according to the UN report.

Two-thirds of rural Nigerians do not have access to safe drinking water or proper sanitation.

In the African nations of Cameroon, Chad and Niger there have been far more cases of cholera than usual this year according to the United Nations

The statistics from the World Health Organization (WHO) are that the disease kills about 120,000 people per year.

Causes

Cholera is caused by a bacterial infection of the intestine and, in severe cases, is characterized by diarrhea, vomiting and leg cramps, according to the Centers for Disease Control (CDC) . In such cases, rapid loss of body fluids can lead to dehydration and shock. Without treatment death can occur within hours.

A person can get cholera by drinking water or eating food contaminated with the bacteria. During epidemics, the source of the contamination is often the feces of an infected person, and infections can spread rapidly in areas where there is poor sewage treatment and a lack of clean drinking water.

Treatment

According to the World Health Organization (WHO) Cholera is an easily treatable disease. The prompt administration of oral rehydration salts to replace lost fluids nearly always results in cure. In especially severe cases, intravenous administration of fluids may be required to save the patient's life.

- HUM News Staff

(REPORT) Child Mortality Rate Drops by a Third Since 1990

Fewer children are dying before they reach their fifth birthdays, with the total number of under-five deaths falling by one third in the past two decades, according to fresh estimates by the United Nations Children’s Fund (UNICEF). Between 1990 and 2009, the number of children below the age of five who died annually fell from 12.4 million to 8.1 million. The global under-five mortality rate dipped from 89 deaths per 1,000 live births to 60 during that period. “The good news is that these estimates suggest that 12,000 fewer children are dying each day around the world compared to 1990,” UNICEF said in a press release accompanying the data, issued ahead of next week’s UN-hosted world leaders’ summit in New York on the Millennium Development Goals (MDGs). However, the agency stressed, “the tragedy of preventable child deaths continues.” Some 22,000 children under the age of five continue to die every day, with 70 per cent of these deaths occurring within their first year of life. Under-five mortality increasingly becoming concentrated in a few countries, with half of all deaths of children below five occurring in just five countries in 2009: India, Nigeria, the Democratic Republic of the Congo (DRC), Pakistan and China. Sub-Saharan Africa – where one in eight children do not live to see their fifth birthday – continues to be home to the highest rates of child mortality. That is nearly 20 times the average for developed regions. UNICEF cautioned that although the pace of decline of child mortality has picked up in the past decade, it is still not enough to meet the MDG target of a two-thirds decline between 1990 and 2015. The new figures were published in this year’s Levels & Trends in Child Mortality, issued by the UN Inter-agency Group for Child Mortality Estimation, bringing together several UN entities, The estimates are developed with oversight and advice from independent experts from academic institutions. Earlier this week, a new report by UNICEF, the World Health Organization (WHO), the UN Population Fund (UNFPA) and the World Bank found that the number of women dying due to complications during pregnancy and childbirth has decreased by 34 per cent from an estimated 546,000 in 1990 to 358,000 in 2008. While the progress is notable, the annual rate of decline is less than half of what is needed to achieve the MDG target of reducing the maternal mortality ratio by 75 per cent between 1990 and 2015, the publication stressed.

- UN News, UNICEF

Number of Young Women Smokers in Developing Countries Skyrockets

(HN, June 4, 2010) Young women in developing countries are being targeted by "seductive" advertising from the large tobacco companies and all governments must take immediate action to protect them from harmful messages, says the World Health Organization (WHO).

 WHO says female business owners are prime targets for seductive offers from tobacco companies, such as branded umbrellas or kiosks

The world health body says that if current trends continue, women could soon be on par with men in terms of rates of death due to smoking, creating what one expert called "a very perverse equality."

"The tobacco industry is spending heavily on seductive advertisements that target women - especially in low and middle income countries. The advertisements try to dupe women into believing that tobacco use is associated with beauty and liberation," Dr. Douglas Bettcher, Director of the WHO Tobacco Free Initiative, told a recent press briefing in Geneva. "In effect they have had to offshore their marketing strategies, look for greener pastures."

Of the world's more than one-billion smokers, only about 200 million are women - but WHO warns those numbers could change rapidly.

Experts believe the tobacco industry has made the shift towards women and young adults in order to compensate for the drop off in tobacco use from smokers who have died from cancer, emphysema, heart attacks, stroke, asthma, tuberculosis and other tobacco-related diseases. One WHO expert accused the major tobacco companies of using "predatory marketing strategies" to lure women in developing countries into taking up the smoking habit, adding that state-owned tobacco companies tend to be less aggressive than the multinationals.

Said Bettcher: "They need to always be refreshing these pools and that's why they are looking to low and middle income countries over the last decade - looking at new populations such as young women to light up and support their profit motives."

Among the venues used to lure women and young girls to tobacco are women's magazines and the fashion industry, WHO says. "The industry has studied what makes women 'tick' in the developed and developing countries," said the WHO's Peju Olukoya, adding that they use sporting and music events that draw many young people. In some countries, free cell phones and text messaging campaigns are used heavily to promote cigarettes.

In Egypt, one WHO expert said, tobacco companies are trying to lure more women by producing cigarette packages to resemble perfume boxes. In Nigeria, cigarette companies build stalls with branded umbrellas and even fund school supplies. "As a result of this, the acceptability for the use of cigarettes by women is gradually increasing., In the past cigarettes have always been associated with the red light district in town," said Olukoya, a native of Nigeria.

She added that Big Tobacco sends confusing messages in many developing countries - by promoting slimness in cultures where this is not necessarily valued and by putting forward smoking as liberating. As for messaging to young men: "It's all about the macho..a big man smokes a big cigarette."

Bettcher says the industry's marketing strategy is having its desired impact. In half of the 151 countries surveyed by WHO, about as many girls smoke as boys. "In some of the countries, in fact, even more girls smoke than boys." Countries where there are more girl smokers than boy smokers include: Uruguay, Mexico, Cook Islands, Croatia, Argentina, Senegal, Chile, Colombia and Bulgaria.

Said Bettcher of the rise of female smokers: "This is a serious red flag. It could mean that we are on the cusp of a much worse global tobacco epidemic amongst women. Girls and boys who smoke are likely to remain smokers as adults."

Bettcher said that one can expect "an explosion" in adult women's tobacco use rates in the coming years. "We simply cannot allow this trend to continue. All governments must take action to protect women from tobacco advertising and promotional sponsorship.

"We must empower women to protect themselves and their families from the harms of tobacco use."

Bettcher added that women need to be protected from second hand smoke, especially in countries where women feel powerless. Smoke-free areas in restaurants and help to cope with addiction are among the steps recommended.

Of the 430,00 adults who die from second-hand smoke each year, well over half - 64 percent - are women. And of the more than 5 million people who die from tobacco use each year, about 1.5 million are women. "Most of these tobacco-related deaths occur in low and middle income countries, which can least afford such dreadful losses," said Bettcher.

By 2030, there could be as many as 8 million people who die from tobacco, of which 2.5 million will be amongst women.

In the Asia-Pacific region, more than 8 per cent of girls between 13 and 15, or around 4.7 million girls, are using tobacco products, said WHO.

Betcher called the new trends - where women became as likely as men to die of smoke-related reasons - a "very perverse equality."

WHO chose as the theme for the recent World No Tobacco Day 2010 as "Gender and Tobacco With an Emphasis on Marketing to Women."  WHO recommends that tobacco advertising and sponsorship should be completely banned. In the US alone, 11 percent of advertising and promotional expenditures in 1996 came from the tobacco industry; in 2005 $13.11 billion was spent on tobacco advertising and promotions.

In 2006, only 17 countries in the world had comprehensive bans against tobacco advertising, and Bettcher said some wealthy countries "dont do very well" in terms of enforcing bans. In response to bans, tobacco companies have become more sophisticated, turning to such tactics as product placement in movies and sponsorships of popular events.

That tobacco companies are tailoring their marketing strategies increasingly towards women in developing countries is nothing new. In 2003, the American Cancer Society flagged the issue as very serious. "The tobacco industry has intensified its marketing strategies -- especially those targeting women -- in developing countries,” said Michael J. Thun, vice president of epidemiology and surveillance research for the American Cancer Society. “International measures such as the WHO Framework Convention on Tobacco Control are essential to help countries protect themselves.”

Staff, files