Human Mobility and Health: Exploring the Health Conditions of Venezuelan Migrants and Refugees in Colombia

Médecins sans Frontières (MSF) conducted a study to identify health needs and access barriers of Venezuelan migrants and refugees at La Guajira and Norte de Santander Colombian border states. The Migration History tool was used to gather information that included various health-related issues such as referred morbidity, exposure to violence, mental health, and access to health care services. A group migration profile with long-term permanence plans was identified. Was evidenced an important share of young population (50% under 20), indigenous people (20%), and returnees (11%). The respondents referred to a mixed pattern of chronic and acute diseases, for which the main difficulty was accessing diagnosis and continuous treatment. Health-seeking behavior was identified as the main barrier to access health care services. The article compiles main findings on the Venezuelan migrants and refugees’ health conditions, contributing important evidence for the humanitarian responses in migration contexts.

     

Health of Cambodian Refugees

Cambodian refugees have been entering the United States since 1975, with the largest numbers arriving in the early 1980s. While many adjusted satisfactorily to their new environment, many continue having severe difficulty with the resettlement. Studies show that Cambodians are suffering more physical and mental distress than Vietnamese, Hmong, and Laotians. They are experiencing more financial and social distress, as well. This paper describes a small neighborhood home visiting program established 13 years ago to provide follow-up care for Cambodian refugees seen in a University Medical Center and later serving as a community experience for fourth-year medical students. These close contacts with the Cambodian community indicate that for many, especially those who are aging, both health and adjustment appear to be deteriorating. Chronic illnesses and prolonged severe depression are taking the place of the infectious diseases and the personal health problems, like dental disease, that they brought with them when they resettled in America.     

Global Vaccine Action Plan Lessons Learned II: Stakeholder Perspectives

IntroductionThe Global Vaccine Action Plan (GVAP), unanimously endorsed by the World Health Assembly in 2012, defined an ambitious strategy to improve immunization. At the end of the decade, significant progress has been made but four of the five GVAP goals are likely to be missed. This report describes a set of surveys and interviews relating to GVAP, conducted to inform the immunization strategy for the next decade.MethodsThree surveys and two sets of semi-structured interviews were conducted from 2017 to 2019. Respondents consisted of immunization stakeholders at global, regional, and country levels, and included individuals who had been involved in the development and implementation of GVAP or its monitoring, evaluation and accountability (M&E/A) process; national immunization managers; academics; and personnel from non-governmental organizations and civil society organizations.ResultsThe surveys and interviews gave consistent results. They highlighted the value of GVAP in increasing visibility for immunization and the benefits of the GVAP M&E/A framework. The main limitations of GVAP were identified as the limited ownership by countries and other stakeholders leading to incomplete implementation of the strategy and poor accountability for achieving GVAP targets.DiscussionThese results informed the review of GVAP and the development of its successor strategy, the Immunization Agenda 2030. In addition, these surveys and interviews identified two challenges in assessing the value of GVAP: the need to rely exclusively on stakeholder perspectives and difficulties in attributing benefits. These challenges are inherent in evaluating an over-arching strategy such as GVAP and should be factored into interpretation of the results.     

Integrating Biodiversity Management and Indigenous Biopiracy Protection to Promote Environmental Justice and Global Health

Many potentially useful medicines arise from developing countries’ biodiverse environments and indigenous knowledge. However, global intellectual property rules have resulted in biopiracy, raising serious ethical concerns of environmental justice, exploitation, and health disparities in these populations. Furthermore, state-based approaches have not led to adequate biodiversity protection, management, or resource sharing, which affect access to lifesaving drugs.In response, country delegates adopted the Nagoya Protocol, which aims at promoting biodiversity management, combating biopiracy, and encouraging equitable benefits sharing with indigenous communities. However, the effectiveness of this framework in meeting these objectives remains in question.To address these challenges, we propose a policy building on the Nagoya Protocol that employs a World Health Organization–World Trade Organization Joint Committee on Bioprospecting and Biopiracy.BIOMEDICAL RESEARCH AND the discovery and development of medicines often focus on naturally occurring materials for products and applications. Searching for such compounds in diverse environments (e.g., rainforests, deserts, and hot springs) is deemed “bioprospecting.”1,2 Bioprospecting has resulted in key advances (e.g., making polymerase chain reaction processes stable for medical application) and has led to life-saving advances in medicines and population health.1 It has also established economic value for these resources and supported biodiversity conservation and indigenous communities.2However, biopiracy occurs when bioprospecting is used to appropriate knowledge and biodiversity resources to gain exclusive use through intellectual property rights (IPRs) without benefits for indigenous populations.2,3 In addition to raising serious environmental justice issues, biopiracy adversely affects the health of local populations that fail to benefit from economic and medical gains derived from the biodiversity and indigenous knowledge that originated in their communities. The global health consequences of biopiracy include lack of access to medicines, failure to compensate for valuable traditional knowledge, and depletion of biodiversity resources that are needed by indigenous communities for their own ethnomedicine and health care. These impacts are particularly problematic because the health of these communities can be poor.4 Because of the global nature of bioprospecting, biopiracy, and biodiversity, effective management—including environmental protection and sustainable development approaches—may be best performed through global governance.Global governance, however, has been ineffective in protecting biodiversity from biopiracy. Global IPR rules comprise domestic, multilateral, and supranational systems that establish minimum intellectual property standards. These global IPR systems focus on patent systems and private economic development under the World Trade Organization (WTO) TRIPS regime (Agreement on Trade-Related Aspects of Intellectual Property Rights) and on activities of the World Intellectual Property Organization. However, they have failed to protect indigenous rights, promote access to life-saving drugs, prevent biopiracy, or provide for responsible biodiversity development.5–9 Governance relies on market forces and state entities of independent governments within a defined territory, which preclude the participation and protection of indigenous communities (both in developed and developing countries) that comprise groups of diverse social self-identification. This traditional state-focused governance model has not created incentives for developing countries to invest in adequate conservation, and thus, biodiversity resources in these countries are in danger of being depleted.4,6In response, in October 2010, the UN Convention on Biodiversity adopted the Nagoya Protocol, which attempts to protect biodiversity and sets rules on how nations access and share biodiversity benefits.10 It successfully introduces key components of resource sharing of biodiversity benefits by establishing a framework for norms and rules that may be implemented by member states in the future. However, the protocol does not adequately address several concerns, including the following: a forum for indigenous peoples to adjudicate biopiracy claims, strong penalties to create disincentives for biopiracy, ensured indigenous access to developed drugs, promotion of the planning and implementation of sustainable biodiversity conservation and investment in public health infrastructures in developing countries, and adequate promotion of public–private partnerships (PPPs) that can leverage resources from both public and private stakeholders. We therefore propose a policy employing a joint health–economics committee, a World Health Organization (WHO)–WTO Joint Committee on Bioprospecting and Biopiracy, to address these equity issues and promote sustainable and responsible global governance in biodiversity management.     

A Call to Action: The Global Effort on Women's and Children's Health

Individuals are increasingly turning to the Internet for health-related information. The acquisition of this information influences how people decide to treat an illness or condition, the types of questions doctors are asked, and how people take care of themselves. The power and importance of this information makes it essential that it be accessible to all individuals. This research explored the extent to which Internet-based health information is accessible to visually-impaired individuals who rely on automated screen readers (the most common way that visually-impaired individuals access the Internet). The home pages of 500 individual web sites representing 50 common illnesses and conditions were selected for evaluation. Findings indicate that accessibility is currently very low; only 19 % of examined sites' home pages were accessible. Analyses of reasons why home pages were inaccessible indicate that accessibility could be improved if recommended design and coding changes are implemented.     

Methodological considerations in implementing the WHO Global Survey for Monitoring Maternal and Perinatal Health

OBJECTIVE: To set up a global system for monitoring maternal and perinatal health in 54 countries worldwide. METHODS: The WHO Global Survey for Monitoring Maternal and Perinatal Health was implemented through a network of health institutions, selected using a stratified multistage cluster sampling design. Focused information on maternal and perinatal health was abstracted from hospital records and entered in a specially developed online data management system. Data were collected over a two- to three-month period in each institution. The project was coordinated by WHO and supported by WHO regional offices and country coordinators in Africa and the Americas. FINDINGS: The initial survey was implemented between September 2004 and March 2005 in the African and American regions. A total of 125 institutions in seven African countries and 119 institutions in eight Latin American countries participated. CONCLUSION: This project has created a technologically simple and scientifically sound system for large-scale data management, which can facilitate programme monitoring in countries.     

WHO: How It Is Making Public Health a Global Cause

ITP is a common disease that is sorely in need of better management. Treatment strategy requires consideration of both long-term benefits and long-term hazards of each available therapeutic option. This discussion reviews conventional therapy as well as newer approaches to refractory ITP, including immunosuppressants, vinca alkaloids, colchicine, androgens, tamoxifen, and plasmapheresis.     

A Brief Talk on How to Promote China Health and Quarantine at Points of Entry in the Framework of Global Health

Global health concerns about the health of the global population and the concepts of global health are gradually being accepted by all of the countries in the world.China health and quarantine at points of entry(POEs) is an integral part of global health,and its duty of prevention and control of the communicable diseases in POEs is consistent with the duty of global health to promote the health of global population.Under the principle of "prevention first",health and quarantine organ carries out the work of disease prevention and control and international travel health care,the reinforcement of core capacity at POEs,and focuses on human rights protection.All the same,there are some gaps with the requirements of global health,such as the inadequate of health promotion planning capacity,ethics awareness and legal protection.The future work of health and quarantine should change ideas on communicable diseases prevention at POEs,focus more on ethical consideration,and should optimize system architecture and human resources,strengthen cooperation,maintain core capacity at POEs,thus to build points of entry public health system with Chinese characteristics,meanwhile to apply the concepts of global health deeply into every aspects of health and quarantine at POEs.     

A Recommended Package of Long-Term Care Services to Promote Healthy Ageing Based on a WHO Global Expert Consensus Study

ObjectivesTo reach consensus on a minimum list of long-term care (LTC) interventions to be included in a service package delivered through universal health coverage (UHC).DesignA multistep expert consensus process.Setting and ParticipantsMultinational and multidisciplinary experts in LTC and ageing.MethodsThe consensus process was composed of 3 stages: (1) a preconsultation round that built on an initial list of LTC interventions generated by a previous scoping review; (2) 2-round surveys to reach consensus on important, acceptable, and feasible interventions for LTC; (3) a panel meeting to finalize the consensus.ResultsThe preconsultation round generated an initial list of 117 interventions. In round 1, 194 experts were contacted and 92 (47%) completed the survey. In round 2, the same experts contacted for round 1 were invited, and 115 (59%) completed the survey. Of the 115 respondents in round 2, 80 participated in round 1. Experts representing various disciplines (eg, geriatricians, family doctors, nurses, mental health, and rehabilitation professionals) participated in round 2, representing 42 countries. In round 1, 81 interventions achieved the predetermined threshold for importance, and in round 2, 41 interventions achieved the predetermined threshold for acceptability and feasibility. Nine conflicting interventions between rounds 1 and 2 were discussed in the panel meeting. The recommended list composed of 50 interventions were from 6 domains: unpaid and paid carers' support and training, person-centered assessment and care planning, prevention and management of intrinsic capacity decline, optimization of functional ability, interventions needing focused attention, and palliative care.Conclusions and ImplicationsAn international discussion and consensus process generated a minimum list of LTC interventions to be included in a service package for UHC. This package will enable actions toward a more robust framework for integrated services for older people in need of LTC across the continuum of care.