World Immunization Week

You might have noticed that last week was World Immunization Week. This was the WHO’s attempt to give impetus to the continuing need for immunization:

http://www.who.int/immunization/newsroom/events/immunization_week/en/

Figures show how access to immunization is a source of health injustice: 6.62 million children in Africa, 8.35 million in South East Asia and 0.46 million in Europe are not fully immunized. And immunization is a major way to promote children’s health - vaccine-preventable deaths account for 20% of the 8.8 million deaths of children under 5 globally each year.  More figures can be found at: 

http://www.who.int/immunization_monitoring/data/SlidesGlobalImmunization.pdf

The week has also highlighted the WHO and UNICEF’s "Global Immunization Vision and Strategy 2006-2015". Its main strategic areas are to:

1. immunize so called "hard to reach" infants and other age groups through a greater focus on the district level;

2. increase both availability and affordability of new life-saving vaccines; 3. deliver supplementary health interventions, such as insecticide-treated nets against malaria, vitamin A supplements, and deworming medicine during immunization contacts, especially for the "hard to reach" and

4. strengthen cross-border collaboration and coordination to ensure a reliable supply of vaccine, sustainable financing of vaccination and epidemic preparedness.

These renewed calls for attention to childhood immunization are of course to be greatly welcomed. These are ‘old’ problems that have still not been solved despite the global wealth that would have enabled global immunization many years ago.

It would be great to add in to the equation attention to some of the newer issues: for example, two safe and effective vaccines have been developed that protect against 70% of cervical cancer cases. Whereas in the UK the Department of Health has enabled vaccines against the human papilloma virus (which causes 99% of all cervical cancers) to be readily available for 12-13 year old girls, thus saving 400 lives each year, this is not the case in the poorer countries. 80% of the 275,000 women who die each year from cervical cancer live in developing countries. Vaccines against the HPV are cheap and available. The GAVI Alliance is beginning to roll out a vaccination programme and hopes to have vaccinated 28 million girls by 2020.  See their website for lots more information: http://www.gavialliance.org/

The Millennium Development Goals: Making Healthy Progress?

This was the title of a two hour seminar and discussion given by Myles Wickstead on April 26th, chaired by me and hosted by our Institute for Health and Wellbeing. It keys into some of our concerns, that is, whether the MDGs will be met by 2015. Clearly, not all of them will be. Myles is well qualified to present such a seminar and discussion, as he was, from early 2004 to late 2005, Head of Secretariat to the Commission for Africa (CfA). The Commission’s Report ‘Our Common Interest’ formed the basis of the G8 Gleneagles Communique on Africa. The Commission in September 2010 produced a follow-up Report – ‘Still Our Common Interest’ – to report on progress against the CfA’s recommendations. Myles has a long history of involvement with, and working in, Africa, and from 2000 to 2004 was based in Addis Ababa as British Ambassador to Ethiopia and Djibouti.

Myles is now Visiting Professor (International Relations) at the Open University and is on the Boards of a number of NGOs, Trusts and Foundations. He is currently Chair of One World Media (OWM); and Board member of the Baring Foundation, the Comic Relief International Grants Committee, the II Foundation (International Inspiration is delivering the Olympic legacy to reach 12 million children in 20 partner countries) and the Advisory Council of Wilton Park. He is a Specialist Advisor to the Parliamentary International Development Select Committee.

Following the Millennium Summit in 2000, the International Community drew up a set of 'Millennium Development Goals' (MDGs), designed to map progress against the objective of reducing absolute poverty in the world. Those Goals were largely around education and health outcomes. Three years before those Goals are targeted to be achieved in 2015, the seminar looked critically at what progress is being made. There is an obvious contradiction – whilst economic progress is a key means of reducing poverty, especially in an era where aid plays a reduced role, this conflicts with the goals of creating more sustainable environments, to be debated in Rio+20. Development of the type seen in the global North compromises the planet – and unless climate change is addressed, there’s little point talking about health promotion of the planet’s people. So how in the future, could goals be set which reduce poverty but also pay attention to the planet’s health?

The global community is thinking now about what happens after 2015 – how should new goals be develop? What will be the priorities? How could the richer countries be mobilized to achieve that halving of the numbers living in poverty that was hoped for?

This month, Myles Wickstead wrote an open letter to David Cameron urging more action on the Millennium Development Goals and on developing a vision post-2015: 

http://africanarguments.org/2012/04/16/the-millennium-development-goals-what-next-mr-cameron-by-myles-wickstead/

Read it and see what you think

April 26 2012 - Peace as a precondition for health

Peace, as the Ottawa Charter amply pointed out, is the first precondition for health. Freedom from violence, feeling safe, as well as peace of mind, are essential prerequisites for our wellbeing. No nation knows this as well, perhaps, as Sierra Leone, especially on the day that Charles Taylor has been found guilty of war crimes and of providing the means to foment the conflict in Sierra Leone.

In the ten years since the end of that ten-year conflict, I have met many Sierra Leoneans, and although they all acknowledge the problems facing reconstruction, few venture any thoughts about the conflict itself. Too painful, no doubt. And one of the phone calls during that war that remains seared in my mind was one from a Sierra Leonean graduate of ours, who phoned me to ask for help – she was surrounded by rebel forces and didn’t know what to do. I was helpless to offer any aid, and for years afterwards I wondered what had happened to her, before hearing that she had survived.

We now are supporting some of the reconstruction efforts by enabling health promotion professionals to access our Masters course run in The Gambia: 16 so far.

Peace was lost in Sierra Leone in 1991 when soldiers from the Revolutionary United Front, backed, it was argued, by the Liberian warlord Charles Taylor, who overthrew the President of Sierra Leone, Joseph Momoh.  The National Provisional Ruling Council under Valentine Strasser, a 25-year-old army Captain lasted until 1996 when this too fell part. In the meantime the RUF carried out murder, rape, mutilation (the horrifying practice of cutting off the arms of victims for example), and recruiting child soldiers. 50,000 people are estimated to have died in the decade of conflict.

Whilst Taylor’s trial has gained a lot of publicity in the West, Sierra Leoneans are more distanced from it, possibly as the proceedings have been in The Hague.  The six million people of one of the poorest countries in the world are as concerned about simply making a living. The forthcoming presidential elections are also on people’s minds.

Many people in the UK know of Sierra Leone through Tony Blair’s intervention to try to stop the conflict, and also because of the films about ‘blood diamonds’. Many Africans feel that these natural resources lead to loss of peace; whilst in Zambia recently, colleagues there hoped that oil would not be found, as they know what conflicts this could lead to. In Sierra Leone, two companies, London Mining and African Minerals, are mining iron ore and magnetite. This could lead to the creation of many jobs, whilst revenue from royalties and taxation could do much to reverse the country’s fortunes. However, tensions have already risen, with one woman killed and a number injured in the last fortnight when police intervened between people and the mining companies. Reports suggest that there were no lights in the hospital that the injured were taken to and there was no fuel for the generator. The IMF meanwhile, sees the economy as being in good shape, with a predicted 34.9% economic growth this year. This demonstrates how ‘peace’ and ‘progress’ are seen so differently from different vantage points, and how peace, once lost, takes so long to recover.

This week I am doing a teaching session on advocacy, in our Professional practice module on the MSc Public Health – Health Promotion.  We have, inevitably, discussed advocacy before on the course – it’s one of the three main activities of health promotion outlined by the Ottawa Charter. This teaching session will reinforce some earlier teaching and also get students to think about how they can incorporate advocacy into their professional practice. 

One talking point regarding advocacy is the potential contradiction that we believe that people have within them the capacity to take control of their health for themselves – to be empowered – so why do people also need advocates?

Two examples might explore this point – firstly the celebrity chef and activist Jamie Oliver’s campaign on obesity and better school meals, and secondly the work of organizations such as Survival, which campaign for the rights of indigenous peoples.

I admire the achievements of Jamie Oliver – he has chosen to spend his time giving a chance to young people from difficult backgrounds to develop a career in the restaurant business and he has lobbied the UK government for over a decade, to provide better school meals in order to tackle the obesity epidemic among children. He has asserted recently that he’s mystified that academies (schools which are freed from local authority controls) are being allowed to determine what food should be on offer, whereas local authority schools need to conform to national guidelines. As one million children now attend academies, this affects a lot of children. He complains in the Observer newspaper (22.04.12) that the coalition government is doing ‘nothing’ to tackle the obesity crisis.

Jamie Oliver certainly has impact. His books sell in more than 100 countries and his television series called School Dinners was shown in 80 countries.  One spinoff has been his Ministry of Food projects, and Bradford, one of our neighbouring towns, hosts one of these, in a shop on a shopping street. It provides food and cooking sessions for all sorts of people who want to learn about food – boys who have been in young offenders institutes, recent widowers, mothers who have never learnt to cook and children. The Bradford Centre, mostly funded by the local council is doing a lot to tackle the skills and knowledge deficits around this basic life skill of being able to cater for yourself, but its funding is not secure, and elsewhere, despite Oliver’s wish for such a centre in all cities, Ministries of food haven’t materialized.

Jamie Oliver has achieved a huge amount, however, and his role as a celebrity has obviously helped. He has access to politicians and other key players that most advocates can only dream about. He gets things done – often fuelled by his own money. Again, not all advocates can do this. But here is one young man with a passion for food, a good team behind him and a lot of media-savvy. He creates momentum and media interest, so that professional bodes such as the Academy of Medical Royal Colleges can add its concern over ‘junk food’ and obesity and question the senior politicians such as the Health Secretary Andrew Lansley who seems to prefer to develop ‘responsibility deals’ with the food industry rather than tackle the issues through legislation.

The other example of advocacy is of a small London-based NGO, Survival International, which advocates on behalf of indigenous peoples whose way of life is threatened. Recently it has been advocating and campaigning on behalf of the Awá people of the Amazon. They are described as the world’s most threatened ‘tribe’, almost at the point of extinction and one of only two nomadic hunter-gatherer tribes left in the Amazon. Back in 1982 the European Union gave Brazil $600 million to build a railway from the iron ore mines in the Carajás Mountains to the coast. The railway cut through the Awá’s lands that in turn brought roads, and with it, loggers. Not only has a third of the rainforest in the Awá territory been felled but also the Awá have been subjected to disease. Awá people also report violence, massacres and whole families being wiped out by the land grabbers. Although Brazil seems to be making some inroads into stopping illegal logging, much more needs to be done. Europe has been part of causing this problem. It needs to be part of finding solutions. Another celebrity, the actor Colin Firth, has become involved as an advocate, arguing that one man – the Brazilian minister of justice – can take action to keep out the loggers. But time is running out and the Awá people are despairing – they cannot achieve what they need without advocates and without outside help. The largest least-contacted tribe in the Amazon, the Yanomami, survived due to a 20-year campaign that secured the protection of their lands in 1992. The Awá need a similar effort.

It is not only in less developed regions that indigenous peoples are threatened. As of now, the UN has decided to investigate the situation facing Native Americans, the first time in its history that the UN has done so. The USA has 2.7 million Native Americans, living in areas with a range of social problems, often on marginalized land, with high unemployment, poor health and other social ills. The mission will be headed by Prof Anaya of the University of Arizona, and will see how the UN declaration on the rights of indigenous peoples, which the US signed up to in 2010, is being upheld. Thus the UN can also play a major role as an advocate for those groups facing health injustice and threats to their wellbeing.

There are many excellent guides to doing advocacy and how to incorporate it into health promotion practice. We use the one by Ritu Sharma, for example, An Introduction to Advocacy: A Training Guide, (produced by Support for Analysis and Research in Africa (SARA)␣ Health and Human Resources Analysis in Africa (HHRAA)␣ USAID, Africa Bureau, Office of Sustainable Development), which is available on the web.

Friday 20 April 2012

This is a new blog to share interesting things I've noticed relevant to health promotion - written as Professor of Health Promotion at Leeds Metropolitan University. Watch this space!