Publication Year: within 10 Years / Topic: Health

1. U.S. Health Care from a Global Perspective, 2022: Accelerating Spending, Worsening Outcomes

Author:: Munira Z. Gunja, Evan D. Gumas, and Reginald D. Williams II
Publication Date:: 01-2023
Content Type:: Policy Brief
Institution:: Commonwealth Fund
Abstract:: In the previous edition of U.S. Health Care from a Global Perspective, we reported that people in the United States experience the worst health outcomes overall of any high-income nation.1 Americans are more likely to die younger, and from avoidable causes, than residents of peer countries. Between January 2020 and December 2021, life expectancy dropped in the U.S. and other countries.2 With the pandemic a continuing threat to global health and well-being, we have updated our 2019 cross-national comparison of health care systems to assess U.S. health spending, outcomes, status, and service use relative to Australia, Canada, France, Germany, Japan, the Netherlands, New Zealand, Norway, South Korea, Sweden, Switzerland, and the United Kingdom. We also compare U.S. health system performance to the OECD average for the 38 high-income countries for which data are available. The data for our analysis come from the Organisation for Economic Co-operation and Development (OECD) and other international sources (see “How We Conducted This Study” for details). For every metric we examine, we used the latest data available. This means that results for certain countries may reflect the height of the COVID-19 pandemic, when mental health conditions were surging, essential health services were disrupted, and patients may not have received the same level of care
Topic:: Health, Health Care Policy, Inequality, and Finance
Political Geography:: North America and United States of America

2. U.S. and Global Approaches to Financing Long-Term Care: Understanding the Patchwork

Author:: Celli Horstman, Evan D. Gumas, and Gretchen Jacobson
Publication Date:: 02-2023
Content Type:: Policy Brief
Institution:: Commonwealth Fund
Abstract:: Most United States adults age 65 and older will need long-term care toward the end of their lives.1 Long-term care, provided in the home, community, or in institutional settings like a nursing home, includes medical care as well as personal, nonmedical care for people who are unable to perform activities of daily living, like cooking or bathing. Some services also may support social needs for those unable to perform what are known as instrumental activities of daily living, such as shopping or medication management. In 2018, more than 5 million people in the United States used home health care, including adult day care or home health agency services, and nearly 4 million people resided in nursing homes or residential care communities.2 Despite the widespread need for long-term care, the U.S. has no national program to cover the costs of long-term care. While certain states have implemented their own programs, the resulting patchwork of funding has left many Americans with no sustainable way to pay for the services they require. Other developed countries have comprehensive, national long-term care financing systems featuring broad eligibility and high levels of financial support. In this brief, we analyze data from multiple sources on long-term care costs in the U.S., as well as spending data from the Organisation for Economic Co-operation and Development (OECD), to better understand long-term care financing strategies in 12 high-income countries. In addition to these data, we synthesized initiatives to long-term care funding in these 12 countries. (For details, see “How We Conducted This Study.”) Since the U.S. does not have a national funding strategy, we also focused on individual state approaches. International and U.S. state approaches may provide insights to policymakers seeking to advance comprehensive long-term care funding.
Topic:: Health, Health Care Policy, Inequality, and Social Services
Political Geography:: Global Focus

3. A Future Projection of Post-Covid-19 in Japan: Universal Values and International Cooperation

Author:: Yukio Sakurai
Publication Date:: 01-2023
Content Type:: Journal Article
Journal:: The Rest: Journal of Politics and Development
Institution:: Centre for Strategic Research and Analysis (CESRAN)
Abstract:: This essay aims to clarify the most popular impacts of the COVID-19 pandemic and examine a future projection of Post-COVID-19 in Japan. This is based on interdisciplinary studies, particularly the literature survey on global governance in English and Japanese. Japan has consistently lived after WWII under the principles of freedom, democracy, human rights, and the rule of law. Given the challenges caused by the pandemic, it is unpredictable how much conflict between multiple powers will hinder national security and economic globalization. The following five actions should be executed: Japan should participate in international research activities to envision a future society, Japan should adopt a unique future concept to address ageing populations and social security reform in their international cooperation, a review of neoliberalism, construction of a society that can respond to societal risks, and political leadership and freedom of speech to deal with serious social risks should be championed.
Topic:: Health, Governance, Pandemic, and COVID-19
Political Geography:: Japan and Asia

4. Budget Brief: National Health Mission

Author:: Avani Kapur, Ritwik Shukla, and Sharad Pandey
Publication Date:: 02-2023
Content Type:: Policy Brief
Institution:: Centre for Policy Research, India
Abstract:: National Health Mission (NHM) is Government of India’s (GoI’s) largest public health programme, which aims to achieve universal access to quality healthcare. It consists of two sub-missions: ■ National Rural Health Mission (NRHM); and ■ National Urban Health Mission (NUHM). This brief uses government data to analyse: ■ NHM finances, including proposed and approved budgets, releases, and expenditures; ■ Staff and bed availability; and ■ Outcomes.
Topic:: Health, Governance, Budget, and Public Spending
Political Geography:: South Asia and India

5. Budget Brief: Ayushman Bharat

Author:: Madhur Sharma, Rahul Das, and Avani Kapur
Publication Date:: 02-2023
Content Type:: Policy Brief
Institution:: Centre for Policy Research, India
Abstract:: Ayushman Bharat, under the aegis of the Ministry of Health and Family Welfare (MoHFW), was launched by Government of India (GoI) on 23 September 2018. This brief uses government data to analyse the following components of the scheme: ■ Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY); ■ Establishment of Health and Wellness Centres (HWCs); ■ Ayushman Bharat Digital Mission (ABDM); and ■ Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (PM-ABHIM).
Topic:: Health, Governance, Budget, and Public Spending
Political Geography:: South Asia and India

6. Moving on Up: Multilevel Monitoring and Advocacy for Health Rights

Author:: Abrehet Gebremedhin
Publication Date:: 01-2023
Content Type:: Working Paper
Institution:: Accountability Research Center (ARC), American University
Abstract:: Multilevel approaches to monitoring and advocacy are often used by international development practitioners, particularly in civil society, in efforts to hold governments—from the national to the local—to account for policy implementation. However, such approaches are not yet well understood or identified by many scholars in the social accountability field. This evidence review addresses this gap through a cross-case comparison of multilevel approaches in ten health rights programs across Africa, Asia, and Latin America. It draws on published evaluations, working papers, and peer-reviewed journal articles, as well as insights shared by implementers and researchers. Cases were selected to illustrate health rights initiatives that included monitoring or advocacy activity at a minimum of two different levels: local health facility, district, regional, provincial or national. Four significant findings emerge from this review of evidence: Vertical integration is a relatively common feature of multilevel monitoring and advocacy in these ten cases and is most likely to take place at the lower ends of the health system. However, it is largely implicit, and often not articulated in project design or theories of change. Horizontal organizing—the coordination of civil society action across districts or geographies—is a less visible feature of multilevel approaches to health rights programming than vertical integration. Despite the multilevel nature of health monitoring and advocacy in these ten cases, less than half reported working at the regional or provincial level, indicating a ‘missing middle’ between local and national activity. Escalation—the process by which citizens’ unaddressed claims move upwards to those with greater decision- making powers—is an important mechanism for accountability and one way in which vertical integration can happen. However, escalation is not clearly articulated in much of the gray literature, and therefore merits further research. The findings from this evidence review have implications for strategy, including: the importance of explicitly identifying multilevel tactics for monitoring and advocacy; theorizing the process by which unaddressed claims can be addressed, particularly moving up beyond the local level; emphasizing the importance of the ‘middle’ and ensuring regional and provincial decision-making is leveraged; and looking to link vertical integration with opportunities for horizontal organizing.
Topic:: Civil Society, Health, Accountability, Advocacy, and Monitoring
Political Geography:: Africa, Asia, and Latin America

7. Does Project-Level Aid for Water and Sanitation Improve Child Health Outcomes? Evidence from Household Panel Data in Uganda

Author:: Lynda Pickbourn, Raymond Caraher, and Léonce Ndikumana
Publication Date:: 03-2023
Content Type:: Working Paper
Institution:: Political Economy Research Institute (PERI), University of Massachusetts Amherst
Abstract:: Empirical studies on the effectiveness of aid to the water, sanitation, and hygiene sector (WASH aid) have focused primarily on access to these services as the benchmark for evaluating the effectiveness of aid in this sector. Given the importance of WASH services for public health outcomes, the effectiveness of WASH aid should also be evaluated in terms of its impact on health outcomes. This is especially important in low- and middle-income countries where achieving sustained improvements in child health outcomes remains a challenge. This paper uses geocoded sub-national data on the location of WASH aid projects in Uganda in conjunction with six waves of nationally representative household-level panel survey data to examine the impact of aid-funded WASH projects on the probability of stunting among Ugandan children and infants. Analysing aid effectiveness at the sub-national level avoids the problems of cross-country heterogeneity in aid effectiveness that plagues other studies. Results of the difference-in-differences regression analysis suggest that proximity to an aid-funded WASH project reduces the probability of stunting by 14–21 per cent. The results suggest that scaling up aid to the WASH sector can help improve child health outcomes in the country.
Topic:: Health, Humanitarian Aid, Water, Sanitation, and Child Care
Political Geography:: Uganda and Africa

8. Non-economic loss and damage: closing the knowledge gap

Author:: International Centre for Climate Change and Development (ICCCAD)
Publication Date:: 01-2023
Content Type:: Policy Brief
Institution:: International Centre for Climate Change and Development (ICCCAD)
Abstract:: Climate-related loss and damage is escalating, with many countries experiencing new forms of climate impact, of increasing intensity. The focus until now has been on calculating the economic repercussions of climate risk. Its wider impacts and resulting hidden costs of climate change — such as loss of cultural heritage — are less understood and harder to quantify. This knowledge gap on non-economic loss and damage, which is largely due to limited coordination around research and sparse evidence originating from the global South, urgently needs addressing. This briefing proposes a comprehensive approach for building the evidence base on non-economic loss and damage, particularly the creation of a Loss and Damage Research Observatory. This online platform will lay the foundations for a collaborative South–South–North community of practitioners, ultimately leading to informed policy on this critical area of climate action.
Topic:: Climate Change, Health, Displacement, Conservation, Indigenous, Resilience, and Biodiversity
Political Geography:: Global Focus

9. The UN’s Response to the COVID-19 Infodemic

Author:: Gabriel Delsol and Albert Trithart
Publication Date:: 05-2023
Content Type:: Policy Brief
Institution:: International Peace Institute
Abstract:: The COVID-19 pandemic has been accompanied by a related “infodemic.” This infodemic emerged as widespread demand for information about the public health emergency was met with large volumes of false and misleading information. Many of the national and international institutions leading the response to the COVID-19 pandemic, including the UN, quickly recognized that they also needed to respond to the infodemic. This led to a quick, broad-based response by a broad array of UN agencies and partners. To date, however, there has been no systematic mapping or assessment of the range of initiatives across the UN system. To begin filling that gap, this paper provides an overview of the UN system’s response to the COVID-19 infodemic across four areas: monitoring harmful information related to COVID-19; dispelling false information and providing authoritative information; building information resilience; and setting the agenda. It then assesses some of the successes and challenges of the response across four areas: external partnerships, including with governments, civil society, academia, and social media companies; coordination within the UN system; financial, human, and technological capacity; and impact assessment. The report concludes that the UN’s infodemic response finds itself at a pivotal point: Due to donor fatigue around COVID-19, funding for the infodemic response is falling even while the need for a robust infrastructure to address infodemics and other information disorders may be increasing. UN entities working to address the infodemic and other information disorders should therefore consider the following: Engaging in a consultative process to develop a shared understanding of the infodemic by defining its specific harms in relation to each of their mandates; Sustaining and building capacity to counter infodemics and other information disorders, both in communications departments and in other sections working on infodemic management; Adopting a more standardized, system-wide approach to the use of new technologies and engagement with technology platforms; and Continuing to strengthen long-term information resilience by building the capacity of governments to manage infodemics and supporting strong, independent media.
Topic:: Health, Science and Technology, United Nations, and COVID-19
Political Geography:: Global Focus

10. Disease Mix and How Economic Freedom Matters for Health Outcomes

Author:: Vincent Geloso, Kelly Hyde, and Ilia Murtazashvili
Publication Date:: 03-2023
Content Type:: Working Paper
Institution:: The Cato Institute
Abstract:: We investigate the institutional foundations of public health. We argue that a key distinction in analysis of disease is between diseases of commerce (diseases associated with movement of people and with affluence) and diseases of poverty (primarily noncommunicable diseases that depend on wealth and income). We show that the mix of disease – the ratio of communicable diseases and those associated with longevity to diseases of poverty – increases in economically free countries. We argue that increasing burdens of diseases of commerce reflects the quality of institutions, as those diseases are better than living shorter, brutish lives where diseases of poverty claim many lives. This analysis also highlights an institutional trade‐off: economically free institutions reduce certain types of disease while contributing to others.
Topic:: Health, Infectious Diseases, Economy, Institutions, and Public Health
Political Geography:: Global Focus

11. Valuing Longer, Healthier Lives: Assessing the Productivity of Health Spending in South Korea

Author:: Karen Eggleston
Publication Date:: 03-2023
Content Type:: Special Report
Institution:: East-West Center
Abstract:: This research studies the link between medical spending and health outcomes in South Korea, providing evidence on the productivity of medical spending over recent decades. The author advocates for the Korean government to develop a “satellite account for health” to complement national income and product accounts. Current measures do not account for changing quality nor give providers any incentive for cost-effective substitution between forms of treatment for a given condition. By leveraging existing strengths of Korea’s National Health Insurance and health outcome data, Korea can develop an accurate measure of medical productivity and a more accurate measure of overall economic productivity, while becoming a global pioneer of “health satellite accounts” for overall populations. Such a productivity metric built on condition-specific net value can help Korea increase the “bang for the buck” from medical spending, mitigate wasteful spending, and promote high-value innovations for longer, healthier lives.
Topic:: Health, Public Spending, and Productivity
Political Geography:: Asia and South Korea

12. FACTORING THE SMART POWER IN THE INDIA-EUROPEAN UNION ENGAGEMENTS: A SCOPING REVIEW

Author:: Nippun Gupta, Bawa Singh, Aslam Khan, and Jaspal Kaur
Publication Date:: 03-2023
Content Type:: Working Paper
Institution:: Institute for Research and European Studies (IRES)
Abstract:: Power is a critical factor in several types of diplomacy. India-EU relations are a classic case of how changing geopolitics prompted diplomatic acumen. This scoping review assesses the changing relations of both partners as a manifestation of Smart Power. The dynamic relations from normative-based to pragmatic and inclusive interests based are evaluated. Their value-based relations are put under international relations theories. Their changing factors of cooperation are used to justify their smart diplomacy, where contemporary relations are less likely to be affected by multilateral interests. To solidify claims of smart power in their relations, the recent TRIPS waiver schism illuminated health diplomacy between the two regions. This health diplomacy discourse promotes smart power diplomacy between India and the EU, where new avenues of cooperation emerge despite pandemic disagreements. The article explores how hybrid power is better than soft and hard power in silos by systematically searching and selecting the existing knowledge in the contemporary context.
Topic:: Diplomacy, Health, Bilateral Relations, European Union, Soft Power, Hard Power, and Smart Power
Political Geography:: Europe, South Asia, and India

13. INFORMING GLOBAL HEALTH DIPLOMACY: EXAMINING HEALTH AND PEACE THROUGH THE LENS OF THE GLOBAL BURDEN OF DISEASE

Author:: Tomislav Mestrovic, Driton Kuqi, and Goran Bandov
Publication Date:: 07-2023
Content Type:: Journal Article
Journal:: Journal of Liberty and International Affairs
Institution:: Institute for Research and European Studies (IRES)
Abstract:: In this study, we aimed to examine the interconnectedness of health and peace, recognizing its significance within global health diplomacy, international relations, and human rights. For that purpose, we used the results from previous and ongoing Global Burden of Disease studies, which represent a comprehensive systematic appraisal of health problems and risks affecting populations worldwide. This paper could use its methodological underpinnings to analyze the impact of war, conflict, and terrorism on mortality and overall human health. In 2000, war and conflict were responsible for an estimated 310,000 deaths globally, compared to 2019, when this number decreased to 69,000. Recent findings reinforced the association between war, conflict, and increased all-cause mortality. Interpersonal violence also significantly contributed to human health loss resulting from disrupted peace. In Europe, disability-adjusted life years due to injury – including those caused by conflict – declined between 2000 and 2019. As we prioritize global health, peace-building initiatives, and global health diplomacy, big data will increasingly play a substantial role in accurately predicting and describing the health effects related to conflicts.
Topic:: Diplomacy, Health, Terrorism, Conflict, Peace, and Disease
Political Geography:: Global Focus

14. The Labor Market Effects of Disability Benefit Loss

Author:: Anikó Bíró, Cecília Hornok, Judit Krekó, Dániel Prinz, and Ágota Scharle
Publication Date:: 09-2023
Content Type:: Working Paper
Institution:: Kiel Institute for the World Economy (IfW)
Abstract:: Disability benefits are costly and tend to reduce labor supply. While spending can be contained by careful targeting, correcting past flaws in eligibility rules or assessment procedures may entail welfare costs. We study a major reform in Hungary that reassessed the health and working capacity of a large share of beneficiaries. Leveraging age and health cutoffs in the reassessment, we estimate employment responses to loss or reduction of benefits. We find that among those who left disability insurance due to the reform 58% were employed in the primary labor market, 6% participated in public works and 36% were out of work without benefits in the post-reform period. The consequences of leaving disability insurance sharply differed by pre-reform employment status. 81% of beneficiaries who had some employment in the pre-reform year worked, while only 33% of those without pre-reform employment did. The gains of the reform in activating beneficiaries were small and strongly driven by pre-reform employment status. This points to the importance of combining financial incentives with broader labor market programs that increase employability.
Topic:: Health, Employment, Economy, Disability, Fiscal Policy, Insurance, Labor Market, and Welfare State
Political Geography:: Europe and Hungary

15. Five Urgent Questions on Ecological Security

Author:: Dan Smith and Rod Schoonover
Publication Date:: 04-2023
Content Type:: Commentary and Analysis
Institution:: Stockholm International Peace Research Institute
Abstract:: The increasing pressure of ecological disruption on people and on security means that ideas and policy on peace and security must increasingly address the need for ecological security. This paper poses five research questions concerning: (a) amplification of antimicrobial resistance (pathogens that are increasingly drug-resistant); (b) the physiological consequences of pollution; (c) the loss of nature’s contribution to people’s well-being; (d) local and regional ecological tipping points; and (e) detrimental organisms and processes that thrive in the rapidly changing planet. Each question has a human health dimension, with likely socio-economic impacts and effects on behaviour, as well as potential effects on security and political stability. Understanding these issues is essential if appropriate responses are to be developed. More research is needed in both the natural and the social sciences, with interdisciplinary work that is in close contact with the policy world. The situation is urgent and policy responses cannot wait until all the answers are known and uncertainty has been fully eliminated.
Topic:: Security, Health, Pollution, and Ecology
Political Geography:: Global Focus

16. Planetary health: A holistic vision for people and the planet

Author:: Danielle Brady
Publication Date:: 09-2023
Content Type:: Working Paper
Institution:: European Policy Centre (EPC)
Abstract:: The nexus between health and the environment has been underscored by crises such as COVID-19 and the climate crisis. As awareness of policy interlinkages grows, so does the need for more coordinated EU and national policymaking. Calls for a more holistic approach have long been recognised, but the pandemic has further emphasised the importance of dismantling existing barriers in policymaking to improve the health status of people, animals, and the planet. This Discussion Paper, funded by Sitra, the Finnish Innovation Fund, advocates for implementing a planetary health approach across all levels of governance to encourage transdisciplinary action and puts forward ten recommendations: Pursue coordinated policymaking by breaking down silos. Appoint an Executive Vice President for the Well-being Economy. Plan and implement national roadmaps and establish common indicators. Create best practices platforms. Adopt planetary health for health systems. Promote education on planetary health. Adopt a European-wide communication campaign. Invest in research and innovation. Foster the integration of the European Health Data Space with future data spaces. Work with international partners to adopt a global planetary health approach. Planetary health offers many benefits for health and the environment. However, without concentrated efforts to move beyond the traditional siloed approach to policymaking, the benefits may never be realised.
Topic:: Climate Change, Health, European Union, and COVID-19
Political Geography:: Global Focus

17. Policy landscape 2023

Author:: Ben Zaranko, Jonathan Portes, Mike Brewer, Paul Cheshire, and Carole Willis
Publication Date:: 09-2023
Content Type:: Special Report
Institution:: UK in a Changing Europe, King's College London
Abstract:: What are the public policy challenges confronting the UK? What plans do the parties have for addressing them? To what extent are these plans fit for purpose? As Parliament returns from its summer recess, Full Fact and UK in a Changing Europe have partnered to produce a series of evidence led, research-based assessments of the key issues that politicians will confront. To do this, we brought together a group of leading experts from respected institutions including the Health Foundation, the Institute for Fiscal Studies, and the Royal United Services Institute. We asked each of them to consider, based on the findings of their own research, the challenges the country faces in their area of expertise, the immediate and longer-term issues politicians will need to address, and the potential implications of any choices they might make. We selected the issues based on the Ipsos issues index, and added security, defence and foreign affairs, which did not figure amongst the public’s priorities in July of this year. The intention of the collection is to inform and not persuade. Each article in this collection is the responsibility of its author.
Topic:: Climate Change, Education, Health, Politics, European Union, Economy, Brexit, Economic Growth, Public Policy, Fiscal Policy, Housing, and Standard of Living
Political Geography:: United Kingdom and Europe

18. Inequality in Chile: Perceptions and Patterns

Author:: Ignacia Lecaros, Daniela Paz Cruzat, Ricardo Pommer Muñoz, Pablo Tillan, and Michael Walton
Publication Date:: 09-2023
Content Type:: Working Paper
Institution:: The John F. Kennedy School of Government at Harvard University
Abstract:: Chile has pioneered many things: a market-oriented, “neoliberal” approach to development; an impressive transition from authoritarianism to democracy; innovations in social policy; and an extraordinary series of street protests between 2006 and 2019. While often lauded as a model of economic and social development, the protests reflect acute concerns over perceived failures in the Chilean political, economic and cultural system, concerns that were profoundly inflected with issues of inequality and lack of fairness. To inform this contrast, this paper undertakes a systematic assessment of the perceptions and perspectives of Chilean citizens, both in the context of the protests and in their broader expressed views in surveys. The core theme is that “the street was right”, in the specific sense that the protests reflected much wider sentiments across social classes over perceived inequities in economic advancement, social provisioning, and the undignified “treatment” by state actors and elites. The paper then compares these perceptions with some of the “objective” measures of inequality. While alternative measures indicate modest declines in some measures of inequality, Chile remains a very high inequality society, in relation to income, wealth, and education. These perceptions and patterns are central to Chile’s current development challenges, in ways that resonate with the position of many countries in today’s polarized environment. This is the first of two papers, with the sequel exploring the underlying drivers of inequality and implications for policy direction.
Topic:: Education, Health, Inequality, Protests, State, Perception, and Fairness
Political Geography:: South America and Chile

19. The Guinea Worm, President Carter and Me: A Journey Through Health Diplomacy

Author:: Lisa Rotondo
Publication Date:: 05-2023
Content Type:: Journal Article
Journal:: American Diplomacy
Institution:: American Diplomacy
Abstract:: In September 2001, just days before 9/11, I arrived in Pissila, Burkina Faso for my Peace Corps assignment. I was eager to get to work helping my new home community do surveillance for a neglected tropical disease (NTD) called dracunculiasis, or Guinea worm disease. As a Peace Corps Volunteer in rural Burkina Faso, I biked from village to village, asking community members if they were aware of anyone with Guinea worm disease, an infection that has impacted both humans and animals since ancient times. Thanks, in part, to the work of volunteers before me, I never actually saw a person with Guinea worm disease during my two years as a volunteer. Burkina Faso was on the brink of eliminating the disease, and I remember thinking that the children in my community would never know the word for Guinea worm in their language, Moorè; it would not be in their vocabulary because they would never have to worry about it. I’ve reflected on that more than once during my career in public health. Knowing that we are truly making diseases history has been the drive underlying my efforts for the last two decades.
Topic:: Diplomacy, Health, Memoir, and Public Health
Political Geography:: Africa, United States of America, and Burkina Faso

20. How to Strengthen Gender Equality Policies? A Review of Data, Policies and Processes

Author:: Gizem Fidan and Itır Akdoğan
Publication Date:: 06-2023
Content Type:: Special Report
Institution:: Turkish Economic and Social Studies Foundation (TESEV)
Abstract:: This report presents recommendations for improving gender equality policies in Turkey. To this aim, it reviews data comparing Turkey and the European Union, studies policy documents and analyses experiences of experts and decision makers on gender inequality focusing on 17 sub-headings in such domains as work, money, knowledge, time, power/ representation, health and digital inclusion.
Topic:: Health, Inequality, Representation, Inclusion, Gender, and Work
Political Geography:: Europe and Turkey

21. Evaluating The Social and Economic Consequences of Global Warming On African Women

Author:: Eyesiere-Hope Essien
Publication Date:: 04-2023
Content Type:: Policy Brief
Institution:: Women of Color Advancing Peace, Security and Conflict Transformation (WCAPS)
Abstract:: By Eyesiere-Hope Essien of the Climate Change Working Group Global warming is significantly impacting developing countries and the effects are far-reaching which is having a devastating impact on African women and their communities, leading to adverse social and economic consequences. Climate change has resulted in an increase in temperature, more extreme weather events, rising sea levels, and a decrease in water availability. As a result, African women are facing a growing number of challenges related to food insecurity, water scarcity, and healthcare access. They are at greater risk of poverty, displacement, and exploitation. These issues can be further exacerbated by a lack of access to education and employment opportunities. It is essential to understand the nature of these impacts and to take action to mitigate them and ensure African women have the resources and skills to adapt to the changing environment.
Topic:: Climate Change, Development, Health, Water, Women, and Food Security
Political Geography:: Africa

22. Community Health Workers as Rights Defenders: Exploring the Collective Identity of the Mitanins of Chhattisgarh, India

Author:: Shriyuta Abhishek and Samir Garg
Publication Date:: 12-2023
Content Type:: Special Report
Institution:: Accountability Research Center (ARC), American University
Abstract:: This Working Paper discusses the Mitanin program, a state-run community health worker program in Chhattisgarh state, India. It is based on a year-long reflection and action research exercise by the implementing organization, the State Health Resource Centre (SHRC). It argues that the collective identity of these community health workers (Mitanins) is central to their work defending the social and economic rights of their community. Collective identity often plays an important role in social movements for people’s economic and political rights. However, government-funded workers rarely get involved in such movements. The authors wanted to understand whether collective identity plays a role in driving the multi-issue activism of community health workers. A composite definition of this collective identity emerged from the research. Throughout the interviews and discussions, the Mitanins described their collective identity as a sense of solidarity that all Mitanins share with the community they serve and belong to, and a feeling of sisterhood with other women and each other. It is the shared experience of being a group of empowered women with a common mission who must use their knowledge and compassion to support the people they serve. The value system underpinning their mission dictates that people should not be denied their rights. The Mitanins’ collective identity is layered; they are not merely frontline health workers, but women who care deeply about their community. They are problem-solvers, activists, and community leaders. Their collective action and collective identity as women leaders in solidarity with the community is mutually reinforcing, and has enabled them to undertake multi-issue activism and transform themselves into frontline rights defenders. The authors conducted a state-wide survey along with focus group discussions and in-depth interviews. The survey (n=558) aimed to establish what proportion of Mitanins are involved in multi-issue activism. It found that in the preceding three years, 84 percent had taken rights-based action in at least one of three domains: food security and nutrition (68 percent); healthcare (56 percent); and gender-based violence (21 percent). They refer to these actions as ‘rights-based’ because they involve negotiation and confrontation with local elites and government officials, as well as writing formal complaints to government officials. Other than rights-based actions, Mitanins also provide information to community members about their rights and entitlements to health programs, food security, and nutrition under government programs—information that is often not readily accessible to poor people in India. This paper analyzes the patterns of autonomous collective action through discussion, interviews, and the rights-based songs and slogans written by Mitanins. The authors argue that the Mitanins’ collective identity was formed due to two main factors: the program’s movement-building approach; and the degree of autonomy enjoyed by Mitanins. The movement-building approach nurtured the activist tendencies of Mitanins, and the voluntary nature of their work allowed them to retain their autonomy vis-à-vis the health system bureaucracy
Topic:: Health, Human Rights, Women, and Communal Identity
Political Geography:: South Asia and India

23. Activating Spaces, Scaling Up Voices: Community-based Monitoring and Planning of Health Services in Maharashtra, India

Author:: Abhay Shukla, Shweta Marathe, Deepali Yakkundi, Trupti Malti, and Jonathan Fox
Publication Date:: 06-2023
Content Type:: Working Paper
Institution:: Accountability Research Center (ARC), American University
Abstract:: From 2007, the Indian government’s National Health Mission (NHM) supported civil society networks to carry out large-scale participatory monitoring to improve health service access and quality under the Community-based Monitoring and Planning (CBMP) program. In the state of Maharashtra, this social accountability initiative endured more than a decade and a half, despite constraints and unpredictable government funding. The CBMP program in Maharashtra supported state-wide civil society networks to enable active citizen participation in health oversight committees. It was rooted in a broad network of diverse community-based organizations and civil society organizations that work with socially excluded communities, led by Support for Advocacy and Training to Health Initiatives (SATHI). The CBMP network combined many social accountability tools into a multilevel strategy, using community assessments of health services and local meetings with clinic staff to inform problem-solving efforts at local, district, and state levels of the health system. This government-funded civil society initiative worked with local officials to convene public dialogues and to activate previously dormant official oversight bodies, animated by a parallel network of autonomous monitoring committees. This Working Paper presents SATHI’s analysis of the CBMP program’s strategy and institutional dynamics, and documents its lasting effects on two participatory oversight institutions: Village Health, Sanitation, and Nutrition Committees (VHSNCs)—part of local government, and Rogi Kalyan Samitis (Patient Welfare Committees)—part of the health system. Field research, carried out shortly before the pandemic, compared the activation of these hybrid oversight bodies in areas with and without a legacy of intensive CBMP action. Key findings include: Official participatory spaces for citizen engagement with the health system were much more active in districts where CBMP networks had intensively promoted grassroots capacity for voice. Frontline health system responsiveness to issues that could be addressed locally—identified as ‘CBMP-sensitive’—was very high. But the health system’s degree of responsiveness to problem-solving efforts decreased at higher levels. The period of intensive CBMP effort to build grassroots awareness and capacity was limited to six years. Nevertheless, that effort had lasting effects on the levels of activity of local hybrid health oversight bodies. The pandemic revealed additional evidence of the medium-term survival and institutional impact of CBMP-enabled social networks.
Topic:: Civil Society, Health, Governance, Accountability, Community, Monitoring, Planning, Monitoring, and and Evaluation (PME)
Political Geography:: South Asia and India

24. Are Financial Barriers Affecting the Health Care Habits of American Men?

Author:: Munira Z. Gunja, Evan D. Gumas, and Reginald D. Williams II
Publication Date:: 07-2022
Content Type:: Policy Brief
Institution:: Commonwealth Fund
Abstract:: Whether it’s stubbornness, an aversion to appearing weak or vulnerable, or other reasons, men go to the doctor far less than women do.1 While behavioral and cultural norms may have a lot to do with the care-seeking habits of American men, the fact remains that the United States is the only high-income country that does not ensure all its residents have access to affordable health care. Roughly 16 million U.S. men are without health insurance, and affordability is the reason that people most often cite for why they do not enroll in a health plan.2 Do income level and financial stress help explain why men do not get needed care and experience worse health outcomes? Using data from the Commonwealth Fund’s 2020 International Health Policy Survey and the Organisation for Economic Co-operation and Development (OECD), we compare health care accessibility, affordability, and health status for adult men in 11 high-income countries. We also examine measures of income and income-related stress, where the data allow, to understand the role income insecurity might play in American men’s relatively low use of health care.
Topic:: Health, Finance, Medicine, and Gender
Political Geography:: North America and United States of America

25. Rising concern, falling performance: Health-sector challenges evident before and after onset of COVID-19 pandemic

Author:: Carolyn Logan and Tosin Salau
Publication Date:: 07-2022
Content Type:: Policy Brief
Institution:: Afrobarometer
Abstract:: As Africa and the world begin to regroup now that the worst ravages of the COVID-19 pandemic appear to be past, it is an opportune time to take stock of the state of health care systems on the continent. The pandemic is not over – South Africa is just coming out of its fifth wave of infection (Al Jazeera, 2022), and there may be more to come (Landman, Irfan, & Resnick, 2022). In the meantime, the Africa Centres for Disease Control and Prevention (2022) and national governments continue to scale up their vaccination campaigns. But the war in Ukraine and global economic deterioration have finally supplanted COVID-19 at the top of the news cycle. In the early stages of the pandemic, many assessments warned of the possibly extreme vulnerability of Africans to the pandemic based in part on the many challenges already facing health care systems across much of the continent (Mattes, Logan, Gyimah-Boadi, & Ellison, 2020). While the direst predictions did not come to pass in most countries – South Africa being a notable exception – the pandemic has highlighted gaps in health systems amid the recognition that the next global health crisis could hit harder if improvements and preparations are not made. Taking a longer-term view, the United Nations Sustainable Development Goals (SDGs) also highlight the need to strengthen health systems (United Nations, 2018). SDG#3 focuses on good health and well-being. But Afrobarometer’s SDG Scorecards, based on our most recent data from 34 countries surveyed in Round 8 (2019/2021), show that from the perspective of citizens, only a handful of countries have been making significant progress toward achieving this SDG (Afrobarometer, 2021). Instead, a growing number of Africans report going without medical care, and the share who cite health as one of their country’s most important problems is also on the rise. Even among those who do get care, increasing proportions report finding it difficult, and having to pay bribes, to obtain the medical services they need. Not surprisingly, citizens are also increasingly critical of their governments’ performance in this sector: For the first time in two decades of Afrobarometer polling, a majority of respondents say their governments are performing badly on improving basic health services. Moreover, the evidence suggests that the challenges wrought by the pandemic were not the cause of these increasingly negative reviews: The downward trends were already under way before COVID-19 entered the picture, and in fact, in some cases the trends appear to be somewhat less negative since the onset of the pandemic.
Topic:: Health, Inequality, Pandemic, and COVID-19
Political Geography:: Africa

26. Planetary Health: Managing Competing Tensions

Author:: Margareth Sembiring
Publication Date:: 05-2022
Content Type:: Commentary and Analysis
Institution:: Centre for Non-Traditional Security Studies, S. Rajaratnam School of International Studies
Abstract:: After more than two years of the COVID-19 pandemic, wars present a stark reminder of how difficult it is to stay committed to environmental causes when crises arise.
Topic:: Environment, Health, International Cooperation, Pandemic, and COVID-19
Political Geography:: Global Focus

27. Planetary Health: Reflections from Asia

Author:: Margareth Sembiring
Publication Date:: 06-2022
Content Type:: Working Paper
Institution:: Centre for Non-Traditional Security Studies, S. Rajaratnam School of International Studies
Abstract:: Planetary Health is a concept that advocates the care of the planet for human own survivability. It underscores the health implications of environmental degradation brought about by human activities and development progress, and calls for a systemic approach that considers and addresses socio-environmental trade-offs of certain policy and/or economic objectives. In view of multiple crises that have been happening in recent years – from the COVID-19 pandemic to the war in Ukraine – which have further negatively affected the environment, understanding how Planetary Health can be applied to address continuing environmental decline is critical. Planetary Health is a relatively new term in Asia. Drawing from the discussions in the 6th NTS-Asia Consortium Annual Conference in April 2022, this NTS Insight maps the different ways Indonesia, India, Bangladesh, Japan, and China engage Planetary Health in their specific contexts. The interpretations of the concept are likely to influence the trajectory of its implementation.
Topic:: Health, International Cooperation, Recovery, Pandemic, and COVID-19
Political Geography:: Asia

28. Planetary health: An alternative framework for disaster governance in ASEAN?

Author:: S. Nanthini and Lina Gong
Publication Date:: 08-2022
Content Type:: Commentary and Analysis
Institution:: Centre for Non-Traditional Security Studies, S. Rajaratnam School of International Studies
Abstract:: The COVID-19 pandemic has accelerated the search for a better way of managing human activities and their environmental impact thereby zeroing in on the specific actions needed to maintain a balance for Planet Earth’s sustainability.
Topic:: Environment, Health, International Cooperation, Governance, Sustainability, and COVID-19
Political Geography:: Asia and ASEAN

29. Human Development and Mental Health: New Approaches and Metrics Needed

Author:: Julius Caesar Trajano
Publication Date:: 09-2022
Content Type:: Commentary and Analysis
Institution:: Centre for Non-Traditional Security Studies, S. Rajaratnam School of International Studies
Abstract:: The latest UN study reiterated the importance of mental wellbeing and psychological resilience in human development and security. A change in approach and metrics is necessary to improve tackling of mental health issues while simultaneously managing contemporary challenges such as climate change, conflict prevention, and protection of the environment.
Topic:: Development, Environment, Health, International Cooperation, United Nations, Mental Health, and Resilience
Political Geography:: Global Focus

30. Is Doughnut Economics a Means Towards Achieving Planetary Health?

Author:: Jonathan Ramakrishna
Publication Date:: 11-2022
Content Type:: Working Paper
Institution:: Centre for Non-Traditional Security Studies, S. Rajaratnam School of International Studies
Abstract:: With the advent of climate change, the global focus is no longer lingering alone on climate change mitigation and has shifted towards climate adaptation as well. The 2015 Paris Agreement’s target of restricting the average temperature rise in the 21st century to well below two degrees Celsius compared to pre-industrial levels is increasing unlikely, given the inaction of states and the global lack of progress in meeting Paris Agreement goals. As nations scramble to meet Nationally Determined Contributions (NDCs) and effectively design climate policies, the global crisis has given rise to a new domain, Planetary Health. Planetary Health, an interdisciplinary field, is described as a solutions-focused discipline which aims to analyse, mitigate, and resolve human disruption to Earth’s natural systems in the new Anthropocene epoch. The Anthropocene epoch, on the other hand, is established as a geological climate where human activity is drastically altering earth’s systems to an extent that will be reflected in fossil records. Planetary Health inextricably links human health to the health of the planet and illustrates the interdependency of the two, and this relationship has been substantiated by findings which concur that countries with higher ecological threats concurrently experience greater social vulnerability. When climate-induced disasters occur due to human action, there are subsequent consequences on food, water, energy, and human security. The consequences are disproportionately felt by vulnerable communities in states that lack resources and capabilities to address the consequent impacts on human security, and climate instability is a driving force behind political instability. Thus, there is cause for concern not only for the planet’s health but also for human health as the environment’s health continues to dwindle in the Anthropocene Epoch. As such, the concept of Planetary Health is a response to threatened climate security and human security.
Topic:: Economics, Health, International Cooperation, and Strategic Stability
Political Geography:: Global Focus

31. Digital Health Credentials and COVID-19: Can Vaccine and Testing Requirements Restart Global Mobility?

Author:: Lawrence Huang
Publication Date:: 04-2022
Content Type:: Special Report
Institution:: Migration Policy Institute (MPI)
Abstract:: More than two years into the COVID-19 pandemic, rising vaccination levels and widespread testing in many countries are giving governments and the public increasing confidence in international travel. A central part of efforts to restart mobility are digital health credentials, which verify a person’s vaccination, testing, and/or recovery status. These credentials help to minimize the risk of travelers carrying the virus, and unlike paper credentials that must be manually inspected in airports and at borders, digital credentials can be automatically verified. But even as digital health credentials are becoming increasingly common, gaps in international coordination and technical integration issues between different credential systems remain. As a result, migrants and travelers moving between—and at times within—countries must navigate a complex maze of digital systems. This report examines the implications of digital health credentials for international travel and for immigrants’ and travelers’ access to domestic services and venues that also use such credentials. It also explores the implications for specific groups: tourists and business travelers, students, labor migrants, asylum seekers and refugees, and unauthorized migrants. Finally, it offers policy recommendations to facilitate mobility and minimize risks for people on the move.
Topic:: Health, Immigration, Border Control, Employment, Mobility, Vaccine, and COVID-19
Political Geography:: Global Focus

32. Supporting Water Programming in the Sahel

Author:: Conor M. Savoy and Alexandra Norris
Publication Date:: 09-2022
Content Type:: Special Report
Institution:: Center for Strategic and International Studies
Abstract:: The Sahel region of Africa is one of the most climate-affected regions in the world. Temperatures are rising 1.5 percent faster than the global average rate. Increasing temperatures and irregular rainfall have resulted in regular droughts and floods that disrupt traditional agropastoral patterns and contribute to broader instability and fragility. Lake Chad, a crucial water and livelihood source for 30 million people in the Sahel, has shrunk by 90 percent since 1960, displacing 2.3 million people and creating a humanitarian crisis. Periods of prolonged and intense drought and improper land use have degraded much of the soil in the Sahel. In Burkina Faso, over one-third of farmland is degraded, meaning some land cannot sustain agriculture even when there is enough rainfall. A rapidly increasing population, coupled with the impact of climate change, means more people are competing for diminishing water resources. This results in a vicious cycle of population growth, land degradation, and food instability. The greater the population, the greater the demand for food and the greater the use of unsustainable farming practices, exacerbating food scarcity and demand for additional farmland. As the U.S. Agency for International Development (USAID) updates its water strategy, it is important to examine the interplay of economic and conflict fragility, irregular migration, climate change, and water availability in the Sahel to identify interventions for greater resilience. In a region like the Sahel, water is critical to resilience and adaptation to the effects of climate change. While water strategy is not a cure-all, it can improve outcomes for other challenges. The Biden administration recently announced the new Partnership for Global Infrastructure and Investment (PGII), an initiative to mobilize private capital investment in infrastructure. The four pillars of this initiative—climate and energy security, digital connectivity, health and health security, and gender equality and equity—could support additional investments in water infrastructure.
Topic:: Climate Change, Environment, Health, Water, and Infrastructure
Political Geography:: Africa and Sahel

33. The Ending the HIV Epidemic in the U.S. Initiative: An Interim Assessment and Policy Recommendations

Author:: Jeffrey L. Sturchio, Mackenzie Burke, and Maclane Speer
Publication Date:: 10-2022
Content Type:: Special Report
Institution:: Center for Strategic and International Studies
Abstract:: The Ending the HIV Epidemic in the U.S. (EHE) initiative is a promising federal program launched by the U.S. Department of Health and Human Services (HHS) in February 2019 with the aim of reducing new HIV infections by 75 percent by 2025 and 90 percent by 2030 (from a baseline of more than 38,000 new diagnoses in 2017). While the EHE initiative set ambitious targets for ending the HIV epidemic in the United States in the context of a sound and sensible plan, it is at present off track. Now, three years in—at the midpoint of the first EHE phase, which has a target of reducing new HIV infections to 9,250 people or fewer by 2025—is an opportune moment to assess its status and the challenges it faces. After a review of progress to date, this report examines the collision between the logical plan behind the EHE initiative and the complicated patchwork of programs that provide HIV prevention, care, and treatment to the diverse communities affected across all EHE jurisdictions. The analysis is informed by several roundtable discussions convened by CSIS with the participation of a representative group of people living with HIV/AIDS (PLWHA), community advocates, physicians, service providers, researchers, and policymakers who are implementing the EHE initiative around the country. The report concludes with policy recommendations in four areas: (1) meet people where they are by building programs that are centered on the needs of populations directly affected by the HIV epidemic; (2) address flexibility in design and implementation; (3) improve data, metrics, and accountability; and (4) heighten political advocacy to ensure future funding of the EHE initiative. A strong theme that runs throughout the report is that lessons from the global HIV response—the importance of building interventions from the ground up, of engaging with affected communities, and of taking an integrated approach across a spectrum of biomedical, clinical, social, behavioral, economic, and political dimensions—can inform and strengthen the U.S. domestic response to HIV/AIDS.
Topic:: HIV/AIDS, Health, Medicine, and Epidemic
Political Geography:: North America and United States of America

34. Transforming Health Crises with Pandemic Therapies Image

Author:: Katherine E. Bliss and J. Stephen Morrison
Publication Date:: 11-2022
Content Type:: Special Report
Institution:: Center for Strategic and International Studies
Abstract:: The CSIS Commission on Strengthening America’s Health Security convened a working group on Covid-19 therapies in the fall of 2021 to develop policy recommendations aimed at strengthening U.S. leadership and global action to ensure development of, access to, and uptake of Covid-19 therapies worldwide. Drawing on insights gleaned through private meetings and roundtable discussions with pharmaceutical manufacturers, government officials, representatives of multilateral organizations, and nongovernmental organizations, and building on points raised in an interim report published in July 2022.
Topic:: Health, Pandemic, COVID-19, and Health Crisis
Political Geography:: Global Focus

35. Rethinking & Revisiting Diplomacy Volume XXIII, Number 1

Author:: Richard M. O'Meara, Sylvia Paola, Claude Rakisits, William Maley, Stephen F. Sener, Mathew J. Martin, Ivelaw L. Griffith, and Ilan Kelman
Publication Date:: 08-2022
Content Type:: Journal Article
Journal:: The Journal of Diplomacy and International Relations
Institution:: School of Diplomacy and International Relations, Seton Hall University
Abstract:: Since the turn of the century, we have seen conflicts emerge, stabilize, and deteriorate as the world has shifted towards a period of post-colonization and globalization. In the past two decades, we have seen the rise, fall, and resurgence of the Taliban in Afghanistan. We have seen the near-century-old conflict in Palestine-Israel and Jammu-Kashmir heighten with civilian lives at stake. Myanmar marched forward with a democratically elected leader yet fell victim to a military coup d’état. The COVID-19 pandemic brought a multitude of conflicts, impacting individual countries and the global world on three levels: political, economic, and social. This global health crisis brought to the forefront a new type of diplomacy: health diplomacy. The current status of these conflicts, amongst others, pushes us to question the traditional nature of diplomacy and understand what must be done to reconfigure diplomacy for the next era. This year’s issue seeks to serve as a discourse on the failures and the future of diplomacy processes. The twenty-third volume of the Journal contains seven articles on a variety of different conflicts and current diplomacy processes, serving either as case studies or recommendations. The first four articles focus on traditional diplomacy processes and the last four focus on health diplomacy. Richard M. O’Meara analyzes the cases of wars in Afghanistan and Ukraine, arguing that not only is it crucial for practitioners and scholars to understand the beginning and end of war, but that we they must also understand as well as the conduct of battle. Examining the historical and legal definition of preventative diplomacy, Sylvia Paola evaluates the contemporary approaches and non-traditional security threats to preventative diplomacy, focusing on Mexico’s strategy for preventive diplomacy during its time as a United Nations Security Council member. Alluding to the possibility of peace in the South Asian subcontinent, Claude Rakisits outlines a three-step grand plan to carve the path to a free and demilitarized Jammu and Kashmir. Utilizing a 1½ track dialogue, focusing on the rights of self-determination, Rakisits posits that the resolution of the issue of Jammu and Kashmir, as a result, lead to peace between Pakistan and India. William Maley explores why “regional solutions” to refugee crises, especially in the case of Australia, may not be the answer to solving the refugee problem because of the influence of a state’s domestic politics favoring itself over the good of the people. When these traditional modes of diplomacy fail, what comes next? As Stephen F. Sener and Matthew J. Martin explore this same question, their answer is: health diplomacy. Focusing on past efforts of health diplomacy, Sener and Martin offer solutions to contribute to global health diplomacy and expand on how this will become a lifeline for state relations. As vaccination continues to be a key driver in the discourse of health diplomacy, Ivelaw Lloyd Griffith studies the gap in vaccine diplomacy dynamics in relation to the power players and the nature of their investment in a combination of humanitarianism and geopolitics. With the diplomatic arena expanding beyond nation-states, it is key to take into consideration the influence of non-state actors such as pharmaceutical companies and multi-lateral organizations. Ilan Kelman examines the potential for health diplomacy during the COVID-19 pandemic from a disaster diplomacy perspective, analyzing its impact on peace, cooperation, and diplomacy between countries. His analysis suggests that while pandemic-related actions may complement existing peace and cooperation efforts, COVID-19 alone is unlikely to lead to new and sustainable diplomatic initiatives for a more peaceful future. As the world continues to grapple with conflicts, traditional modes of diplomacy are being challenged, and health diplomacy is emerging as a critical element in state relations. The articles presented in this volume provide insights into the complexities of various conflicts and offer recommendations for practitioners and scholars alike. It is clear that diplomacy in the next era must be reconfigured to adapt to the changing global landscape, and health diplomacy must be embraced as a vital component of state relations.
Topic:: Security, Diplomacy, Health, War, Refugees, Vaccine, COVID-19, Military, and Russia-Ukraine War
Political Geography:: Afghanistan, South Asia, Ukraine, Kashmir, Caribbean, and Mexico

36. Consumption of New and Emerging Tobacco and Nicotine Products in Zambia: Implications for Policy

Author:: Shimukunki Manchishi, Edna Kabala, and Mulenga Chonzi Mulenga
Publication Date:: 04-2022
Content Type:: Working Paper
Institution:: Zambia Institute for Policy Analysis and Research (ZIPAR)
Abstract:: The global economy has in recent years observed a rapid increase in the consumption of New and Emerging Tobacco and Nicotine Products (NETNPs). Consumers of the NETNPs in Zambia and elsewhere justify consumption of these products on grounds that they are less harmful and expose them to fewer health risks compared to traditional tobacco smoke. However, studies have shown that these NETNPs do not entirely filter out harmful chemicals from tobacco as presumed by many people, and in some cases may even expose smokers to more smoke over longer periods of time as is the case of water pipe (shisha). This study investigated the consumption and taxation of NETNPs in Zambia to generate knowledge and come up with evidence-based policy recommendations aimed at informing appropriate stakeholders on the consumption and taxation of NETNPs. The study employed a mixed methodology encompassing a desk review, a survey of 400 respondents and key informant interviews. In terms of the consumption of NETNPs, the study revealed that a majority of those surveyed consume water pipe, which ranked highest among the NETNPs consumed in Zambia. Other NETNPs commonly consumed include bidis, e-cigarettes and dry snuff (nsunko). The consumption of these products varied according to the economic status of the consumers, with products such as snus and e-cigarettes being much more preferred and consumed by those in employment because they can afford more costly products. Meanwhile, products such as water pipe and bidis were the products of choice among those not employed and this could also be attributed to the relatively lower cost of the products. Regarding the socio-demographic characteristics of the surveyed sample, the study established that most of the consumers of NETNPs were young, unmarried males. A notable finding in the study was that those who had attained tertiary level of education were the biggest consumers of NETNPs. With regards to taxation of NETNPs, the study has found that there is potential to increase taxes substantially based on consumers’ willingness to pay which would require very high tax levels to deter consumption. This would require the government to considerably increase excise taxes on these products which would ultimately increase their price and hence curtail their consumption. The study has established that the taxation of all tobacco products in Zambia is the sole responsibility of the ZRA which draws its mandate from various provisions of the Zambian law. Broadly there are eight categories used to classify tobacco and nicotine products based on the HS codes. This broad classification forms the basis for taxation of tobacco and nicotine products in Zambia. The study has established that there are four main taxes applied on tobacco products in Zambia, these include: a 25% customs duty levied on the value of the product imported; a VAT of 16% on the value of the product; a 5% surtax; and excise duty of 145% of the value for duty purposes (VDP) or K355 per kg for all tobacco products.
Topic:: Health, Digital Economy, Business, Tax Systems, Public Policy, Tobacco, Public Health, and Gender
Political Geography:: Africa and Zambia

37. CPLP: the first twenty-five years

Author:: Joseph Marques
Publication Date:: 07-2022
Content Type:: Journal Article
Journal:: Conjuntura Austral: Journal of the Global South
Institution:: Conjuntura Austral: Journal of the Global South
Abstract:: The decision by Conjuntura Austral to dedicate a special issue to the 25th anniversary of the establishment of the Community of Portuguese Language Countries (CPLP) is to be commended. The uniqueness of the organization justifies a timely review of a small sample of its activities to date. Created in 1996, the CPLP adopted three main vectors of activity:1) the promotion and dissemination of the Portuguese language; 2) cooperation in a wide array of domains (i.e., education, health, science and technology, defense, agriculture, public administration, communication, justice, public safety, culture, sport and social communication, sustainable development, etc.); and 3) political and diplomatic coordination, especially in multilateral forums. The organization also agreed to adhere to several fundamental political principles such as the respect of the sovereignty of each member country; non-interference in domestic issues; reciprocal treatment; peace, democracy, rule of law, human rights, and social justice; territorial integrity of each member state; and the commitment to the promotion of development and cooperation. In addition to a common language and shared cultural heritage, the uniqueness of the CPLP results from the union of nine non-contiguous member states into a privileged geocultural space – the lusosphere – dedicated to the active promotion of its three main goals across four continents. It is a privileged forum for a “pluricontinental dialogue” in Portuguese. In addition, each country contributes by bringing its history, its unique interpretation of the “lusosphere” as well as its regional context (i.e., membership in the European Union, Mercosur, Southern African Development Community, Economic Community of West African States, etc.) as well as economic opportunities to the group. By joining, member countries reinforce the group’s collective projection onto the world stage as well as the opportunity to expand each member country’s diplomatic footprint. While each member had different reasons to join (i.e., maximize politicaldiplomatic cooperation, language promotion, widen access to technical cooperation, etc.), all believe that the CPLP can bolster the group’s overall political and diplomatic prestige while enhancing their collective and individual prospects. This special issue consists of six articles ranging from language to health, security and defense issues, business negotiations and civilian-military relations. It covers but a few topics from a long list of issues which, after the first twentyfive years of this new international organization, warrant the attention and critical review of academic scholars.
Topic:: Security, Foreign Policy, Defense Policy, Diplomacy, Health, Business, Language, Indigenous, and Civil-Military Relations
Political Geography:: Africa, Europe, Brazil, South America, Southeast Asia, and Community of Portuguese Language Countries (CPLP)

38. Building public trust to successfully deploy AI in EU healthcare

Author:: Danielle Brady
Publication Date:: 01-2022
Content Type:: Policy Brief
Institution:: European Policy Centre (EPC)
Abstract:: COVID-19 has underscored the importance of digital health: the digitalisation of healthcare would improve health systems’ resilience and service delivery, empower citizens, and bolster research and innovation. However, despite the many benefits of introducing technologies like artificial intelligence (AI) into the European healthcare sector, it also raises questions on its impact on the healthcare workers, the potential for new inequalities, privacy issues and public trust. Not to mention, broader questions on the ethics and social implications of AI. The EU’s Proposal for a Regulation Laying Down Harmonised Rules on Artificial Intelligence and the European Health Data Space address many of these concerns, but cannot combat them all alone. Without public trust, acceptance and understanding, AI’s full potential in healthcare will not be realised. Attention must be given to the communication of the benefits of AI in healthcare to the public, Europeans’ digital literacy, the upskilling of the EU health workforce, and the investment in AI technologies. Clear and convincing explanations regarding AI use in healthcare are required so that citizens understand their benefit and trust that their personal data will be handled safely. If the EU and its member states fail to build trust in the deployment of AI in healthcare, Europe will miss a chance to reap all the benefits that AI offers to its citizens and their health.
Topic:: Health, European Union, Regulation, Artificial Intelligence, COVID-19, Digitization, and Trust
Political Geography:: Europe

39. April 2022 Issue

Author:: Stephen Hummel, F. John Burpo, Jeremy Hershfield, Andrew Kick, and Kevin J. O'Donovan
Publication Date:: 04-2022
Content Type:: Journal Article
Journal:: CTC Sentinel
Institution:: The Combating Terrorism Center at West Point
Abstract:: The COVID-19 pandemic has claimed nearly one million American lives. It has upended many more and produced disastrous consequences around the world. But it could have been even more catastrophic had Western nations and companies not developed highly effective vaccines. As the world hopefully begins to emerge from the pandemic, it is important to reassess the global biological threat landscape, including the possibility that bioterrorists or other bad actors might seek to exploit advances in biotechnology to engineer a future pandemic. In a joint effort, the Combating Terrorism Center and the Department of Chemistry and Life Science at West Point have assembled some of the best and brightest thinkers in the counterterrorism, policy, and scientific communities around the world for their perspectives and analysis on the evolution of the biological threat picture. The result is a two-volume set of special issues, with the second volume being published next month. The feature article of this volume anticipates how bioterrorists may exploit tunable viral agents in a new age of bioterrorism. The article is authored by Major Stephen Hummel and Colonel F. John Burpo with Lieutenant Colonel Jeremy Hershfield, Lieutenant Colonel Andrew Kick, Kevin O’Donovan, and Colonel Jason Barnhill. They write: “Components of a disease such as transmissibility, lethality, and the infectious window can potentially be modified for desired tactical, operational, or strategic effects. While this capability is currently beyond the skills and knowledge of the biology enthusiast, a trained individual would possess such skills and knowledge, though they may lack the necessary material and infrastructure support. Hence, it is necessary to develop and maintain capabilities that can respond to a variety of pathogens and possible effects.” This issue features an interview with Lawrence Kerr, who until his retirement from government service earlier this year was the Director of the Office of Pandemics and Emerging Threats in the Office of Global Affairs at the U.S. Department of Health and Human Services. We also interview Brad Ringeisen, the Executive Director of the Innovative Genomics Institute. Before his retirement from government service in July 2020, Dr. Ringeisen served as the Director of the Biological Technologies Office at the Defense Advanced Research Projects Agency (DARPA). Filippa Lentzos, Gregory Koblentz, and Joseph Rodgers argue “the biological risk landscape is rapidly evolving and presents significant new challenges to preventing the accidental, reckless, or malicious misuse of biology. At the same time, oversight systems to ensure that life sciences research is conducted safely, securely, and responsibly are falling behind. An urgent overhaul to realign biorisk management with contemporary risks is needed.”
Topic:: Health, Counter-terrorism, Risk, Pandemic, and Bioterrorism
Political Geography:: Global Focus

40. Estimating Japan’s Return on Investment from an Ambitious Program to Incentivize New Antibiotics

Author:: Rachel Silverman and Adrian Towse
Publication Date:: 12-2022
Content Type:: Policy Brief
Institution:: Center for Global Development
Abstract:: Anti-microbial drugs form the backbone of modern medicine. Yet their lifespan is naturally limited; over time, use of these drugs selects for mutations that survive exposure those same drugs, driving “anti-microbial resistance,” or AMR. Already, drug-resistant infections kill an estimated 23,210 Japanese citizens every year. In the absence of sufficient research and development (R&D) investment for new antimicrobials, deaths from drug-resistant infections could increase dramatically in the coming decade. To address this growing crisis and solve market failures that prevent the development of new antibiotics, the government of Japan is considering a new program that would provide minimum guaranteed revenue to the successful developers of new antibiotics. In this note, we present the results of a modelling exercise to estimate the likely return on investment (ROI) from such a program, assuming it is paired with complementary and proportionate efforts from Japan’s G7 partners. The results are necessarily imprecise due to several uncertain parameters, but nevertheless provide evidence of a very high expected ROI that is robust to different inputs and assumptions.
Topic:: Health, Science and Technology, Health Care Policy, and Medicine
Political Geography:: Japan and Asia

41. Estimating the UK's Return on Investment from an Ambitious Program to Incentivize New Antibiotics

Author:: Rachel Silverman and Adrian Towse
Publication Date:: 12-2022
Content Type:: Policy Brief
Institution:: Center for Global Development
Abstract:: Anti-microbial drugs form the backbone of modern medicine. Yet their lifespan is naturally limited; over time, use of these drugs selects for mutations that survive exposure those same drugs, driving “anti-microbial resistance,” or AMR. Already, drug-resistant infections kill an estimated 7,600 citizens of the United Kingdom (UK) every year. In the absence of sufficient research and development (R&D) investment for new antimicrobials, deaths from drug-resistant infections could increase dramatically in the coming decade. To address this growing crisis and solve market failures that prevent the development of new antibiotics, the UK has set up “subscription models” for purchasing antibiotics; this has been applied to two drugs thus far, and the model is under consideration for a broader rollout. In this note, we present the results of a modelling exercise to estimate the likely return on investment (ROI) from an expanded program to incentivize new antibiotics, assuming it is paired with complementary and proportionate efforts from the UK’s G7 partners. The results are necessarily imprecise due to several uncertain parameters, but nevertheless provide evidence of a very high expected ROI that is robust to different inputs and assumptions.
Topic:: Health, Science and Technology, Health Care Policy, and Medicine
Political Geography:: United Kingdom and Europe

42. Estimating Canada’s Return on Investment from an Ambitious Program to Incentivize New Antibiotics

Author:: Rachel Silverman and Adrian Towse
Publication Date:: 12-2022
Content Type:: Policy Brief
Institution:: Center for Global Development
Abstract:: Anti-microbial drugs form the backbone of modern medicine. Yet their lifespan is naturally limited; over time, use of these drugs selects for mutations that survive exposure those same drugs, driving “anti-microbial resistance,” or AMR. Already, drug-resistant infections kill an estimated 5,400 Canadian citizens every year. In the absence of sufficient research and development (R&D) investment for new antimicrobials, deaths from drug-resistant infections could increase dramatically in the coming decade. To address this growing crisis and solve market failures that prevent the development of new antibiotics, the Government of Canada is considering a new program that would provide minimum guaranteed revenue to the successful developers of new antibiotics. In this note, we present the results of a modelling exercise to estimate the likely return on investment (ROI) from such a program, assuming it is paired with complementary and proportionate efforts from Canada’s G7 partners. The results are necessarily imprecise due to several uncertain parameters, but nevertheless provide evidence of a very high expected ROI that is robust to different inputs and assumptions.
Topic:: Health, Science and Technology, Investment, and Medicine
Political Geography:: Canada and North America

43. An Ambitious USG Advanced Commitment for Subscription-Based Purchasing of Novel Antimicrobials and Its Expected Return on Investment

Author:: Rachel Silverman and Adrian Towse
Publication Date:: 11-2022
Content Type:: Working Paper
Institution:: Center for Global Development
Abstract:: Antimicrobial drugs form the backbone of modern medicine. Yet their lifespan is naturally limited; over time, use of these drugs selects for mutations that survive exposure to those same drugs, driving “antimicrobial resistance,” or AMR. Already, drug-resistant infections kill an estimated 35,000 Americans and 1.27 million global citizens every year. In the absence of sufficient research and development (R&D) investment for new antimicrobials, deaths from drug-resistant infections could increase dramatically in the coming decade. However, the R&D pipeline for new antimicrobials remains sparse, constrained by an array of market failures that prevent private companies from capturing a sufficient private return on investment (ROI) despite the very high social value of new antimicrobials. Widespread recognition of these market failures among experts and policymakers has driven a search for creative solutions, and generated enthusiasm for the use of pull mechanisms which could help incentivize antibiotic development. One particularly promising pull approach—so-called “subscription models”—would offer guaranteed annual payments to successful antibiotic developers delinked from sales volumes. A subscription approach is included in the pending PASTEUR Act, which is legislation introduced by lawmakers in the US House of Representatives and Senate and endorsed in President Biden’s 2023 budget request. In this paper, we consider the expected return on investment for such a program—that is, an ambitious new program to incentivize antibiotic development via a US government subscription-based pull mechanism (though not necessarily the PASTEUR Act, per se). We construct an illustrative subscription program from first principles, with parameters drawn (where possible) from the literature and some simplifying and deliberately conservative assumptions about program design and remuneration. We model the 10- and 30-year costs and benefits of such an initiative, both from the US domestic perspective and from a global welfare perspective. We find that the program is likely to generate a very high social ROI in both the short and long-term. From the US domestic perspective—considering both the value of averted death/disease and associated hospital costs—ROI is calculated at 6:1 over a 10-year time horizon and 28:1 over a 30-year time horizon. From the global perspective—exclusively considering the health value of DALYs (Disability Adjusted Life Years) averted—ROI grows to 27:1 over a 10-year time horizon and 125:1 over the full 30-year program duration. Sensitivity analysis suggests that the overall high returns are robust under a wide variety of alternative assumptions and scenarios. Based on these high social returns, we encourage the US Congress to urgently finance and authorize a subscription program for new antimicrobials, with particularly consideration for the PASTEUR Act.
Topic:: Health, Science and Technology, Innovation, and Medicine
Political Geography:: North America and United States of America

44. The Next Game Changers: A Priority Innovation Agenda for Global Health

Author:: Cordelia Kenney and Rachel Silverman
Publication Date:: 10-2022
Content Type:: Working Paper
Institution:: Center for Global Development
Abstract:: Over the last century, scientific and technological innovation has led to unprecedented improvements in health outcomes—yet research and development (R&D) investments and progress to address health threats has been uneven. Commercial R&D has focused where investors can expect substantial financial returns: rich countries, the diseases that affect them, and high-tech solutions designed for the richest and most sophisticated systems. Despite supplemental funding from philanthropic and government grants, R&D to address many leading causes of death and disability—especially those that primarily affect low- and middle-income countries (LMICs) or insure against future risk—has been consistently underfunded relative to potential health gain. This implies that many untapped opportunities remain to dramatically improve global health and welfare via biomedical innovation. In this paper, we report the results of a horizon-scanning exercise to source opportunities for global health R&D investment—that is, high-value potential biomedical innovations which are currently underfunded but which could be transformative for health, quality of life, and health security in LMICs and around the world. Drawing from a literature review and expert interviews with researchers, economists, funders, advocates, and implementers, we lay out an expansive and high-promise (though non-comprehensive) biomedical innovation agenda for global health spanning the unfinished MDG agenda; non-communicable diseases; and global health security. We conclude with a discussion of implications for research, funding, and practice.
Topic:: Development, Health, Science and Technology, Innovation, and Emerging Technology
Political Geography:: Global Focus

45. A Fund for Global Health Security and Pandemic Preparedness

Author:: Amanda Glassman, Eleni Smitham, and Erin Collinson
Publication Date:: 05-2022
Content Type:: Policy Brief
Institution:: Center for Global Development
Abstract:: The COVID-19 crisis has served as a painful demonstration that no country is fully prepared for a pandemic and that the existing global health architecture remains ill-equipped to finance pandemic prevention, preparedness, and response (PPR). The rationale for preventing and containing pandemics is self-evident: the price of preparedness is a fraction of the cost of responding to catastrophic outbreaks, both in terms of human and economic well-being.[1] In the aftermath of the 2003 SARS outbreak, 2009 H1N1 pandemic, and the 2014-2016 West Africa Ebola outbreak, experts called for scaling up sustainable financing to ensure the world was better prepared to face that next global health threat. But even amid efforts to better understand and measure preparedness gaps,[2] little action was taken to mobilize financing and incentivize investments in strengthening detection, prevention, and response capabilities. As global health threats evolve, countries’ capacity to prepare for and respond to disease outbreaks is increasingly a global imperative. Now is the time to take concrete steps toward establishing sustained financing for pandemic PPR to help bring an end to the ongoing COVID-19 pandemic, combat future health security threats, and break the costly cycle of neglect.
Topic:: Security, Health, Pandemic, and COVID-19
Political Geography:: Global Focus

46. Prioritizing Public Spending on Health in Lower-Income Countries: The Role of the Global Financing Facility for Women, Children and Adolescents

Author:: Janeen Madan Keller, Rachel Silverman, Julia Kaufman, and Amanda Glassman
Publication Date:: 12-2022
Content Type:: Working Paper
Institution:: Center for Global Development
Abstract:: The Global Financing Facility (GFF), launched in 2015, is a partnership backed by a multi-donor World Bank trust fund that aims to “prioritize and scale-up evidence-driven investments to improve reproductive, maternal, newborn, child, and adolescent health and nutrition (RMNCAH-N) interventions” in low- and lower middle-income countries. A major component of the GFF’s operational model is centered around the investment case, described by the GFF as “a description of the changes that a country wants to see with regard to reproductive, maternal, newborn, child, and adolescent health (RMNCAH) and a prioritized set of investments required to achieve these results.” Looking retrospectively at investment cases and associated ongoing World Bank operations, this paper aims to shed light on specific aspects of the GFF’s operating model, approach, theory of change, and results to date related to the “development of a costed and prioritized investment case,” and whether the investment case helps to prioritize public spending on health in the real world. The portfolio-wide findings suggest that the GFF delivers a clear value-add within the global health architecture by directing more funding to flow directly through governments via increased World Bank lending for RMNCAH-N (especially in the context of COVID-19-related service disruptions and fiscal contractions). The role of the investment case in aligning and prioritizing resources behind a consensus set of highest-value RMNCAH-N interventions within a specific funding envelope is less well documented in the public domain; GFF efforts to directly influence government RMNCAH-N spending decisions and their efficiency seem to occur primarily through follow-on resource mapping and expenditure tracking. The paper concludes with three recommendations for the GFF and its donors: (1) pursue a deliberate strategy for prioritization of RMNCAH-N services and products within the realistic budget constraint to advance evidence-based decisions on certain trade-offs; (2) increase transparency and public visibility into GFF-supported activities and funding, especially related to RMNCAH-N product procurement and overall resource tracking; and (3) explore incentives for increased donor co-financing within the framework of World Bank projects as a strategy to pool and channel more resources through government coffers.
Topic:: Health, Children, Women, Public Spending, and Gender
Political Geography:: Global Focus

47. India–East Africa: A Not So Healthy Relationship?

Author:: Isabelle Saint-Mezard and Françoise Nicolas
Publication Date:: 02-2022
Content Type:: Special Report
Institution:: Institut français des relations internationales (IFRI)
Abstract:: Due to historical as well as geographical reasons, India and East Africa have long been close partners. In the recent period however, and even more so since the early 2000s, these ties have tightened as a result of combined efforts by the government of India and its business community. The presence of communities of Indian origin in several East African countries has also acted as a catalyst. East Africa is perceived as a valuable partner both by Indian authorities and by Indian private companies. Although the two types of Indian players may not explicitly coordinate their actions, their interests dovetail nicely in this particular region. The health sector sticks out as one major sector on which Indian actors focus in East Africa. It provides a striking example of the multilayered complementarity between India and East Africa, on the one hand, and between public and private Indian players’ interests on the other. However, India’s activism in the health sector is not necessarily perceived positively by the East African host countries. Despite some technology transfers and efforts by the Indian actors, be they public or private, to promote capacity-building, East African countries find themselves in a situation of dependence as a result of Indian companies exporting and producing drugs, building hospitals, improving hospital management and Information Technology (IT) infrastructure, or digitalizing healthcare. However, the major point of tension pertains to the promotion of medical tourism. Although offshore healthcare comes with many benefits, it is unlikely to be sustainable for the East African economies in the long run. Moreover, the money spent on medical tourism could arguably be used more usefully to develop local medical facilities and competence. The recent developments in the context of the pandemic have made the associated risk very clear. The challenge in the coming years will be for the two parties to find a way to better balance their relationship and set it on firmer ground – in other words, to make it healthier.
Topic:: Foreign Policy, Health, Bilateral Relations, and Partnerships
Political Geography:: Africa, South Asia, and India

48. Social Policy Expansion and Retrenchment After Latin America’s Commodity Boom

Author:: Sara Niedzwiecki and Jennifer Pribble
Publication Date:: 05-2022
Content Type:: Working Paper
Institution:: Kellogg Institute for International Studies
Abstract:: The literature on social policy expansion and retrenchment in Latin America is vast, but scholars differ in how they explain the outcomes, arriving at different conclusions about the role of democracy, left parties, favorable economic conditions, and social movements in shaping reform. What can welfare state developments since the end of the commodity boom teach us about the theoretical power of these arguments? This paper engages this question, seeking to explain recent incidents of social policy reform in 10 presidential administrations in Argentina, Brazil, Chile, and Uruguay. Using a combination of crisp-set qualitative comparative analysis (csQCA) and case studies, we identify multiple paths toward social policy expansion and retrenchment that involve the absence and presence of electoral competition, economic resources, party ideology and linkage mechanism, social movement pressure, international pressure, and legacies. The results show that while both parties of the left and right expanded social programs, only the right engaged in retrenchment, yet partisanship alone is insufficient for explaining reform outcomes, as the variable must appear in combination with other factors depending on the party’s linkage mechanism. The results provide new insight into the politics of social policy reform in Latin America, showing the relevance of complex forms of causality.
Topic:: Health, Poverty, Social Movement, Democracy, Inequality, Public Policy, and Political Parties
Political Geography:: Brazil, Argentina, South America, Uruguay, Latin America, and Chile

49. Does an effective government lower COVID19’s health impact? Evidence from Viet Nam

Author:: Duc Anh Dang and Ngoc Anh Tran
Publication Date:: 06-2022
Content Type:: Working Paper
Institution:: United Nations University
Abstract:: Government effectiveness has played an important role in tackling the crisis caused by the coronavirus (COVID-19) pandemic. This paper discusses the different aspects of government effectiveness in explaining the variation in the COVID-19 confirmed cases and death levels in Viet Nam. We use the Provincial Governance and Public Administration Performance Index in 2019 to measure the quality of government effectiveness at the local level. The findings show the importance of health system capacity in the battle against COVID-19. We find that increased government transparency is significantly associated with lower confirmed rates. For the impact of the level of participation, we find that provinces that have higher quality of village head elections or where people have more opportunities to participate tend to have lower infected cases, especially where people participate in the formal and informal association and have voted in the National Assembly election.
Topic:: Government, Health, Pandemic, and COVID-19
Political Geography:: Vietnam and Southeast Asia

50. Health and ethnic inequalities in Mozambique with special reference to leprosy

Author:: Isabel Maria Casimiro and Júlio Machele
Publication Date:: 05-2022
Content Type:: Working Paper
Institution:: United Nations University
Abstract:: The subject of this paper is health and ethnic inequalities in Mozambique, with special reference to leprosy. It is argued that the health policies and strategies adopted in the colonial and post-colonial periods led to an unequal distribution not only of certain diseases but also of health infrastructures. The colonial regime, by neglecting and creating ineffective leprosaria in central and northern Mozambique, ‘ethnicized’ Lazarus disease, a fact corroborated by its current unequal distribution. In turn, post-colonial health policies and health coverage failed to take this inequality into account. The current National Leprosy Control Program aims to end leprosy and thus eliminate its identification with the ethnolinguistic groups in northern and central Mozambique. This qualitative study, which draws on reports from the Ministry of Health and NGOs, statistics, and observations, falls within the scope of the social sciences, with an emphasis on the comparative historical-sociological method.
Topic:: Health, Inequality, Ethnicity, and Leprosy
Political Geography:: Africa and Mozambique

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