What interventions are effective on reducing inequalities in maternal and child health in low- and middle-income settings? A systematic revie

BMC Public Health
(Accessed 21 June 2014)
http://www.biomedcentral.com/bmcpublichealth/content

Research article
What interventions are effective on reducing inequalities in maternal and child health in low- and middle-income settings? A systematic review
Beibei Yuan, Mats Malqvist, Nadja Trygg, Xu Qian, Nawi Ng and Sarah Thomsen
Author Affiliations
BMC Public Health 2014, 14:634 doi:10.1186/1471-2458-14-634
Published: 21 June 2014
Abstract (provisional)
Background
The deadline for achieving Millennium Development Goals 4 and 5 is approaching, but inequalities between disadvantaged and other populations is a significant barrier for progress towards achieving these goals. This systematic review aims to collect evidence about the differential effects of interventions on different sociodemographic groups in order to identify interventions that were effective in reducing maternal or child health inequalities.
Methods
We searched the PubMed, EMBASE and other relevant databases. The reference lists of included reviews were also screened to find more eligible studies. We included experimental or observational studies that assessed the effects of interventions on maternal and child health, but only studies that report quantitative inequality outcomes were finally included for analysis.
Results
22 articles about the effectiveness of interventions on equity in maternal and child health were finally included. These studies covered five kinds of interventions: immunization campaigns, nutrition supplement programs, health care provision improvement interventions, demand side interventions, and mixed interventions. The outcome indicators covered all MDG 4 and three MDG 5 outcomes. None of the included studies looked at equity in maternal mortality, adolescent birth rate and unmet need for family planning. The included studies reported inequalities based on gender, income, education level or comprehensive socioeconomic status. Stronger or moderate evidence showed that all kinds of the included interventions may be more effective in improving maternal or child health for those from disadvantaged groups.
Conclusion
Studies about the effectiveness of interventions on equity in maternal or child health are limited. The limited evidence showed that the interventions that were effective in reducing inequity included the improvement of health care delivery by outreach methods, using human resources in local areas or provided at the community level nearest to residents and the provision of financial or knowledge support to demand side

A meta-analysis of risk factors for depression in adults and children after natural disasters

BMC Public Health
(Accessed 21 June 2014)
http://www.biomedcentral.com/bmcpublichealth/content

Research article
A meta-analysis of risk factors for depression in adults and children after natural disasters
Bihan Tang, Xu Liu, Yuan Liu, Chen Xue and Lulu Zhang
Author Affiliations
BMC Public Health 2014, 14:623 doi:10.1186/1471-2458-14-623
Published: 19 June 2014
Abstract (provisional)
Background
A number of studies have shown a range of negative psychological symptoms (e.g. depression) after exposure to natural disasters. The aim of this study was to determine risk factors for depression in both children and adults who have survived natural disasters.
Methods
Four electronic databases (PubMed, Embase, Web of Science, and PsychInfo) were used to search for observational studies (case-control, cross-sectional, and cohort studies) about depression following natural disasters. The literature search, study selection, and data extraction were conducted independently by two authors. Thirty-one articles were included in the study, of which twenty included adult participants and eleven included child participants. Summary estimates were obtained using random-effects models. Subgroup analysis, sensitivity analysis, and publication bias tests were performed on the data.
Results
The prevalence of depression after natural disasters ranged from 5.8% to 54.0% in adults and from 7.5% to 44.8% in children. We found a number of risk factors for depression after exposure to natural disasters. For adults, the significant predictors were being female; not married; holding religious beliefs; having poor education; prior trauma; experiencing fear, injury, or bereavement during the disaster; or losing employment or property ,suffering house damage as a result of the disaster. For children, the significant predictors were prior trauma; being trapped during the disaster; experiencing injury, fear, or bereavement during the disaster; witnessing injury/death during the disaster; or having poor social support.
Conclusions
The current analysis provides evidence of risk factors for depression in survivors of natural disasters. Further research is necessary to design interventions to improve the mental health of survivors of natural disasters.

Rotavirus Enteritis in Dadaab Refugee Camps: Implications for Immunization Programs in Kenya and Resettlement Countries

Clinical Infectious Diseases (CID)
Volume 59 Issue 1 July 1, 2014
http://cid.oxfordjournals.org/content/current

Crossing Borders: One World, Global Health
Clive M. Brown and Martin S. Cetron, Section Editors
Rotavirus Enteritis in Dadaab Refugee Camps: Implications for Immunization Programs in Kenya and Resettlement Countries
Maurice Ope, Steve B. Ochieng, Collins Tabu, Nina Marano.
Dadaab refugee camp, established in Kenya in 1991, is host to >500 000 refugees, most of whom are Somali in origin [1]. Annually, the United States resettles approximately 11 000 refugees from Africa, 4000 of them from Kenya. Although substantial progress has been made to provide safe water and improve sanitation in Dadaab, diarrheal disease remains among the leading causes of morbidity and mortality. Several disease outbreaks, including hepatitis E virus [2], cholera [3], and wild poliovirus [4], have been attributed to poor sanitation in the camps…
Editorial comment (C. B.) …Along with the provision of safe water and ensuring proper sanitation and hygiene, important strategies for the control of diarrheal diseases (depending on age) include breastfeeding, using oral rehydration solution, and, if diarrhea is moderate to severe, intravenous fluids, zinc supplementation, and immunization with rotavirus vaccine. Overall, rotavirus vaccine has been shown to be 30% effective against all-cause severe gastroenteritis, and 51%–93% protective against rotavirus gastroenteritis [14–16]. In addition to recommending rotavirus vaccine inclusion in national immunization programs, for countries where diarrheal deaths account for ≥10% of mortality among children aged <5 years, WHO strongly recommends introduction of the vaccine. The prevalence in this refugee camp was twice that value; thus, evaluating rotavirus vaccine as a childhood vaccine in refugee camps will provide important information for its efficacy in this setting and potentially support attaining MDG4 goals.

Incremental cost of increasing access to maternal health care services: perspectives from a demand and supply side intervention in Eastern Uganda

Cost Effectiveness and Resource Allocation
(Accessed 21 June 2014)
http://www.resource-allocation.com/

Research
Incremental cost of increasing access to maternal health care services: perspectives from a demand and supply side intervention in Eastern Uganda
Chrispus Mayora, Elizabeth Ekirapa-Kiracho, David Bishai, David H Peters, Olico Okui and Sebastian Olikira Baine
Author Affiliations
Cost Effectiveness and Resource Allocation 2014, 12:14 doi:10.1186/1478-7547-12-14
Published: 19 June 2014
Abstract (provisional)
Introduction
High maternal and infant mortality continue to be major challenges to the attainment of the Millennium Development Goals for many low and middle-income countries. There is now evidence that voucher initiatives can increase access to maternal health services. However, a dearth of knowledge exists on the cost implications of voucher schemes. This paper estimates the incremental costs of a demand and supply side intervention aimed at increasing access to maternal health care services.
Methods
This costing study was part of a quasi-experimental voucher study conducted in two districts in Eastern Uganda to explore the impact of demand and supply – side incentives on increasing access to maternal health services. The provider’s perspective was used and the ingredients approach to costing was employed. Costs were based on market prices as recorded in program records. Total, unit, and incremental costs were calculated.
Results
The estimated total financial cost of the intervention for the one year of implementation was US$525,472 (US$1 = 2200UgShs). The major cost drivers included costs for transport vouchers (35.3%), health system strengthening (29.2%) and vouchers for maternal health services (18.2%). The average cost of transport per woman to and from the health facility was US$4.6. The total incremental costs incurred on deliveries (excluding caesarean section) was US$317,157 and US$107,890 for post natal care (PNC). The incremental costs per additional delivery and PNC attendance were US$23.9 and US$7.6 respectively.
Conclusion
Subsidizing maternal health care costs through demand and supply – side initiatives may not require significant amounts of resources contrary to what would be expected. With Uganda’s Gross Domestic Product (GDP) per capita of US$551 (2012). Incremental cost per additional delivery represents about 5% of Uganda’s GDP per capita to save a mother and probably her new born. For many low income countries, this may not be affordable, yet reliance on donor funding is often not sustainable. Alternative ways of raising additional resources for health must be explored. These include; encouraging private investments in critical sectors such as rural transport, health service provision; mobilizing households to save financial resources for preparedness, and financial targeting for the most vulnerable

Forum for Development Studies – Volume 41, Issue 2, 2014

Forum for Development Studies
Volume 41, Issue 2, 2014
http://www.tandfonline.com/toc/sfds20/current

On the Fractured, Fragmented and Disrupted Landscapes of Conservation
Rune Flikkea*
DOI: 10.1080/08039410.2014.918759
pages 173-182
Published online: 17 Jun 2014
Abstract
Since Agenda 21, drawn up after the UN Conference on Environment and Development held in Rio de Janeiro in 1992, the merger of environmentalism and development has been pitched as a ‘win–win’ scenario often coined as ‘conservation-as-development’. By integrating local populations in the environmental projects ‘conservation-as-development’ claim to overcome negative aspects of the nature–culture divide. Using the arguments forwarded by Cortes-Vazquez, Turner, Semedi and Howell in this issue, the article critically discusses the development of these environmentalist efforts, exemplified by the UNESCO Biosphere reserves and the UN-REDD, to suggest that the natureculture divide keep cropping up in new constellations despite the official rhetoric. It is suggested that a solution is to be found in a serious, ethnographic approach that pays attention to the new social networks and material flows that tie local and global worlds together through these forms of environmentalist practices.

When Are Health Systems Ready for New Vaccines? The Introduction of Pneumococcal Vaccine in Malawi
Lot Jata Nyirendaa*, Kristin Ingstad Sandberga & Judith Justiceb
DOI: 10.1080/08039410.2014.894936
pages 317-336
Published online: 31 Mar 2014
Abstract
Increasing coverage of routine immunisation and new vaccines is key to reaching Millennium Development Goal number four (MDG 4) on reducing child mortality. Malawi, despite a weak health system, is on track to achieve MDG 4, partly because of its high-performing immunisation programme. Among the early adopters of new vaccines, with major support from Global Alliance for Vaccines and Immunisation, Malawi introduced pneumococcal vaccine in 2011 during a time of severe political and economic crisis. This exploratory case study (part of a larger research project on explaining differential immunisation coverage, conducted in 2010 and 2011, using primarily qualitative methods including in-depth interviewing) looks at the decision-making and policy process for vaccine introduction within the broader political–economic context. Based on a framework of benchmarks on preparedness of immunisation systems and assessments of integration with health systems, the study findings suggest that pneumococcal vaccine introduction was more integrated with key health system functions the closer it got to the point of service delivery. Furthermore, although the vaccine introduction succeeded in relation to immunisation targets and prevention of disease, it may have had substantial indirect costs to other targeted health interventions and broader health systems functions at times when basic amenities are in short supply or unavailable. For a donor-dependent country such as Malawi, policy choices are limited to what is on offer – and new vaccines were on offer; other crucial necessities were not. Further research could establish with more certainty the conditions under which vaccine introduction strengthens health systems that are already weak, and when they push systems further into crisis.

Middle East Respiratory Syndrome Corona virus, MERS-CoV. Conclusions from the 2nd Scientific Advisory Board Meeting of the WHO Collaborating Center for Mass Gathering Medicine, Riyadh

International Journal of Infectious Diseases
Vol 24 Complete | July 2014 | Pages 1-54
http://www.ijidonline.com/current

Middle East Respiratory Syndrome Corona virus, MERS-CoV. Conclusions from the 2nd Scientific Advisory Board Meeting of the WHO Collaborating Center for Mass Gathering Medicine, Riyadh
Ziad A. Memish, Abdullah Assiri, Rafaat Alhakeem, Saber Yezli, Malak Almasri, Alimuddin Zumla
Jaffar A. Al-Tawfiq, Christian Drosten, Ali Albarrak, Eskild Petersen
published online 12 May 2014.
The 2nd Scientific Advisory Board Meeting of the Global Center for Mass Gathering Medicine, Ministry of Health, Riyadh, Kingdom of Saudi Arabia, met April 28 – 29 in Riyadh to discuss risk of infectious diseases and research and surveillance during Hajj. Due to the on-going outbreak of MERS-CoV and especially the recent increase in case detection in Jeddah, (138 MERS cases were reported from Jeddah between 11 to 26 April 2014), the agenda for the second day was focused on MERS-CoV, both in relation to the risk it presents for the forthcoming Umrah during Ramadan and the Hajj, but also in the Kingdom of Saudi Arabia and the Middle East in general. The Ministry of Health used the opportunity to ask the Scientific Advisory Board to review the MERS-CoV situation globally with specific attention to MERS in the country and review case definition, infection control guidelines and risk assessment to nationals, residents, health care workers, family contacts, camel owners, and travelers to KSA, and the future control.

Knowledge Management for Development Journal – Vol 10, No 1 (2014)

Knowledge Management for Development Journal
Vol 10, No 1 (2014)
http://journal.km4dev.org/journal/index.php/km4dj/index

Designing knowledge management interventions in agricultural research for development
Simone Staiger-Rivas, Sophie Bertha Alvarez, José Antonio Arana, Fanny Howland, Flavia Cunha, Brayan Valencia, Armando Muñoz, Karina Feijoo
Abstract
The International Center for Tropical Agriculture (CIAT, its Spanish acronym) developed a methodology by which its research programs and projects can design knowledge management (KM) plans according to impact pathways. For 2 years, the KM group of the Center’s Decision and Policy Analysis Research Area applied concepts of Theory of Change (ToC) to four pilot projects to identify, design, and implement appropriate KM interventions and derive lessons.
The article first presents the Center’s own ToC for KM, highlighting thematic areas and tools by which KM can contribute directly to desired impact and research results. KM interventions for each of the four projects are discussed, drawing on five lessons learned. These dealt with (1) the benefits of using ToC, (2) KM’s contribution to organizational strengthening and partnerships, (3) importance of integrating the knowledge manager into the scientific team, (4) opportune use of information and communication technologies (ICTs), and (5) KM’s role as the connecting element between administration, coordination, and research.

Analyzing knowledge profiles as a tool for the building of organizational knowledge
Monika Roper
Abstract
Knowledge management instruments should ensure exchange processes between knowledge producers, providers and users. The present article analyses and compares the application of knowledge inventories, designed to support the transfer and conversion of individual into collective knowledge. Each inventory consists of several knowledge profiles by which knowledge is collected, analyzed, documented and made accessible in a compact and rapid form. The profiles are generated through individual or collective interviews with the participants if the knowledge area to be inventoried.
This knowledge profiles are adapted from an approach developed by GTZ and IFAD (2009) for international development cooperation projects. The present paper makes a comparative analysis of the use of this instrument in for knowledge management initiatives in environmental policies and projects in Brazil. The institutional context of this area is characterized by a great diversity of actors and different visions and requirements for knowledge management. Institutionalization processes are still very recent, leading to high staff turnover and many cases of knowledge loss. In this context, approaches that focus on individuals as knowledge carriers are particularly suitable to introduce knowledge management concepts.
The comparative analysis of the application of knowledge inventories shows that a very simple instrument can be helpful to build up institutional knowledge based on the experiences and perceptions of those directly involved. In addition, quality gains can be added to the process when future users of the knowledge are directly involved in the compilation of the inventories.

The Lancet – Jun 21, 2014 [116E rotavirus vaccine]

The Lancet
Jun 21, 2014 Volume 383 Number 9935 p2099 – 2184
http://www.thelancet.com/journals/lancet/issue/current

Editorial
Vaccine development and developing countries
The Lancet
Participation of patients in medical research requires that a balance is struck—between anticipated benefits and potential harms of the new treatment being assessed, and with a view to the broader value of evidence accrued for guiding clinical practice and future research. Tensions can arise, however. Research in low-income settings has sometimes been perceived to be of greater potential benefit to those in high-income countries, where a drug may be marketed after licensing. In an extreme case, at the time of an outbreak of influenza A H5N1 virus in 2006—07, researchers in Indonesia were unable to share clinical samples with their counterparts in high-income countries, owing to a perceived lack of reciprocity for the benefits of research. This disappointing, and unusual, event underscores the need for a shared and participatory agenda in health research.

In today’s Lancet, Nita Bhandari and colleagues present an excellent example of successful clinical research in a developing country. They report a phase 3 clinical trial of Rotavac, an oral 116E strain rotavirus vaccine, in India. They document an efficacy of about 54% against severe rotavirus gastroenteritis in infants. Drawing on funding and technical support from Indian and international sources, development of this vaccine against an attenuated human—bovine reassortant virus has taken some 30 years to come to fruition.

Although oral rotavirus vaccines—the licensed Rotarix and RotaTeq—have been available for some years, Rotavac has the potential to be a powerful and affordable vaccination option. India has a larger burden of rotavirus deaths than any other country, with most rotavirus admissions occurring in the first year of life. Rotavac can therefore be expected to be of great benefit in reducing childhood mortality from diarrhoea, contingent on future licensing and introduction in India, and subject to ongoing monitoring of adverse events including intussusception. Availability of an additional rotavirus vaccine could also prove to be of benefit in other developing countries.

In an accompanying Viewpoint, Maharaj Bhan and coauthors describe the collaborative international process which led to the development of Rotavac. They discuss the economic landscape for vaccine development that has influenced the vaccine’s creation and will continue to affect its provision alongside competing vaccines. In a Comment in this issue, Brian Greenwood discusses the ethics of randomised vaccine trials. The setting in which a vaccine is to be used, for instance a low-income country, is expected to affect the protection achieved and necessitates rigorous evaluation. In what circumstances, however, is it appropriate for people in a trial’s control group to be denied a vaccine of expected health benefit in order to establish efficacy in those allocated by chance to an experimental group? Again the question of balance comes into play, which could involve provision of another licensed vaccine to people in the control group. Questions of this nature will continue to exercise researchers and policy makers, especially in resource-poor countries.
Vaccines cross borders readily given their relative ease of administration and durable effects. Not only have vaccines contributed to long-term health gains in high-income countries and the decisive eradication of smallpox, but vaccination campaigns in developing countries have played an important part in reducing neonatal mortality. Yet the ongoing setbacks in the global mission to control poliomyelitis, which have included violent targeted opposition to polio vaccination projects in Pakistan, emphasise the political dimension of health programmes and of vaccination in particular.

There is no shortage of disease targets in need of vaccines. Although development of vaccines against HIV continues to pose serious challenges for both basic and clinical researchers, vaccines against malaria and dengue (both infectious diseases that cause major burdens of morbidity and mortality concentrated in developing countries) are in advanced stages of clinical assessment. In the future, while development of new vaccines will remain costly in terms of time and research effort, the Rotavac story could prove inspiring for a world planning new health aspirations and challenges for the post-MDG era—a combination of research creativity and entrepreneurial ingenuity shaping future medical treatments brought about by and for the people of developing countries.

.Editorial
World Refugee Day: caring for the forcibly displaced
The Lancet
Preview |
Last week, after jihadist groups took over the second-largest city in Iraq, Mosul, an estimated 300 000 people were forced to leave their homes. Increasing numbers of people are bereft of food, water, or medical care as the conflict continues. WHO expects the health situation to deteriorate because of the complications of bringing human resources and logistics to affected areas. The number of refugees is growing worldwide. 6•5 million people were internally displaced in Syria by the end of last year, with 2•5 million refugees having fled to surrounding countries such as Lebanon, Jordan, and Turkey.

Comment
The use of a placebo in vaccine trials
Brian Greenwood
Preview
Injecting an infant, who cannot consent, with a saline solution that can do no good is not an activity that anyone would want to undertake lightly, yet this is what happens frequently in the course of paediatric vaccine trials. When the efficacy and safety of a novel vaccine is being assessed for the first time, societies, ethics committees, and parents accept this course of action on the grounds that although the vaccinated infant cannot derive any benefit from participating in the trial, other infants might do so in the future.

Comment
116E rotavirus vaccine development: a successful alliance
Shabir A Madhi, Umesh D Parashar
Preview
In The Lancet, Nita Bhandari and colleagues’ study1 about the efficacy of the new 116E rotavirus vaccine in Indian infants offers an opportunity to address the substantial lag in translation of scientific progress for the benefit of the world’s most vulnerable population. Vaccination is considered to be second only to access to potable water in its potential cost-effectiveness as a health-care strategy for improving child health. Most childhood deaths from vaccine-preventable diseases, such as Haemophilus influenzae type b (Hib), Streptococcus pneumoniae, and rotavirus, happen in low-income countries.

Viewpoint
Team science and the creation of a novel rotavirus vaccine in India: a new framework for vaccine development
Maharaj K Bhan, Roger I Glass, Krishna M Ella, Nita Bhandari, John Boslego, Harry B Greenberg, Krishna Mohan, George Curlin, T S Rao
Preview
In The Lancet, findings from Nita Bhandari and colleagues’ phase 3 clinical trial1 show the safety and efficacy of the 116E rotavirus vaccine against severe rotavirus gastroenteritis in Indian infants. The vaccine has an efficacy similar to that of two licensed oral rotavirus vaccines—RotaTeq (Merck) and Rotarix (GlaxoSmithKline)—when tested in low-income settings.2,3 However, the timeline of development has been unique and unconventional. The vaccine was not the product of a major multinational manufacturer, but rather, the result of work by team science, based in India.

Changes in Hospitalizations for Pneumonia After Universal Vaccination With Pneumococcal Conjugate Vaccines 7/13 Valent and Haemophilus influenzae Type b Conjugate Vaccine in a Pediatric Referral Hospital in Uruguay

The Pediatric Infectious Disease Journal
July 2014 – Volume 33 – Issue 7 pp: 675-788,e162-e182
http://journals.lww.com/pidj/pages/currenttoc.aspx

Changes in Hospitalizations for Pneumonia After Universal Vaccination With Pneumococcal Conjugate Vaccines 7/13 Valent and Haemophilus influenzae Type b Conjugate Vaccine in a Pediatric Referral Hospital in Uruguay
Pírez, María Catalina MD*; Algorta, Gabriela MD*; Chamorro, Flavia MD*; Romero, Claudia MD*; Varela, Adriana MD; Cedres, Alejandra MD*; Giachetto, Gustavo MD*; Montano, Alicia MD*
Abstract
Background: In 1994, Uruguay included Haemophilus influenzae b (Hib) conjugated vaccine in a 3 + 1 schedule. In March 2008, 7-valent pneumococcal conjugate vaccines (PCV7) was included in a 2 +1 schedule. In 2010, 13-valent PCV replaced PCV7. Catch-up immunization was offered. The aim of this study was to describe the etiology of community-acquired pneumonia (CAP) in children 0–14 years of age hospitalized at the Hospital Pediatrico-Centro Hospitalario Pereira Rossell between 2003 and 2012.
Methods: Annual hospitalization rates (per 10,000 discharges) for CAP and bacterial-confirmed CAP in children 0–14 years of age was described prior PCV7 vaccination (2003–2007), during the year of implementation of PCV7 (2008) and after the introduction of PCV7 (2009–2012). Data regarding age, strains isolated from pleural fluid and/or blood, vaccination status, pneumococcal and H. influenzae serotypes were obtained from Hospital Pediatrico-Centro Hospitalario Pereira Rossell databases and vaccination records.
Results: Hospitalization rates for CAP and pneumococcal CAP between prevaccine years and the last year after introduction of vaccination with PCV (2012) significantly decreased by 78.1% and 92.4%, respectively. Significant reduction for 13-valent PCV vaccine serotypes and significant increase for nonvaccine serotypes was observed. A decrease in Staphylococcus aureus pneumonia was observed. Hospitalization rates for H. influenzae CAP remain stable before and after pneumococcal vaccination.
Conclusions: Three years after PCV7/13 introduction into the routine vaccination schedule, there was a rapid and significant reduction in rates of CAP and P-CAP. An increase of etiology of CAP by other agents was not observed.

Improving Ethical and Participatory Practice for Marginalized Populations in Biomedical HIV Prevention Trials: Lessons from Thailand

PLoS One
[Accessed 21 June 2014]
http://www.plosone.org/

Research Article
Improving Ethical and Participatory Practice for Marginalized Populations in Biomedical HIV Prevention Trials: Lessons from Thailand
Dan Allman mail, Melissa Hope Ditmore, Karyn Kaplan
Published: June 20, 2014
DOI: 10.1371/journal.pone.0100058
Abstract
Background
This paper presents findings from a qualitative investigation of ethical and participatory issues related to the conduct of biomedical HIV prevention trials among marginalized populations in Thailand. This research was deemed important to conduct, as several large-scale biomedical HIV prevention trials among marginalized populations had closed prematurely in other countries, and a better understanding of how to prevent similar trial closures from occurring in the future was desired.
Methods
In-depth key informant interviews were held in Bangkok and Chiang Mai, Thailand. Interviews were audio recorded, transcribed, translated and thematically analyzed. The Good Participatory Practice Guidelines for Biomedical HIV Prevention Trials (GPP) guided this work.
Results
Fourteen interviews were conducted: 10 with policymakers, academic and community-based researchers and trial staff and four with representatives of non-governmental organizations (NGOs). Suggested ways to improve ethical and participatory practice centered on standards of HIV prevention, informed consent, communication and human rights. In particular, the need to overcome language and literacy differences was identified. Key informants felt communication was the basis of ethical understanding and trust within biomedical HIV prevention trial contexts, and thus fundamental to trial participants’ ability to exercise free will.
Discussion
Biomedical HIV prevention trials present opportunities for inclusive and productive ethical and participatory practice. Key informants suggested that efforts to improve practice could result in better relationships between research stakeholders and research investigative teams and by extension, better, more ethical participatory trials. This research took place in Thailand and its findings apply primarily to Thailand. However, given the universality of many ethical considerations, the results of this study can inform the improvement of ethical and participatory practice in other parts of the world where biomedical HIV prevention trials occur, and where clinical trials in marginalized populations continue.

Pediatric Oncology as the Next Global Child Health Priority: The Need for National Childhood Cancer Strategies in Low- and Middle-Income Countries

PLoS Medicine
(Accessed 21 June 2014)
http://www.plosmedicine.org/

Policy Forum
Pediatric Oncology as the Next Global Child Health Priority: The Need for National Childhood Cancer Strategies in Low- and Middle-Income Countries
Sumit Gupta mail, Roberto Rivera-Luna, Raul C. Ribeiro, Scott C. Howard
Published: June 17, 2014
DOI: 10.1371/journal.pmed.1001656
Summary Points
:: As is already the case in high-income countries, cancer represents the leading cause of non-accidental death among children in a growing number of middle-income countries
:: Meaningful declines in global childhood cancer mortality will require moving beyond the current situation through the establishment of national childhood cancer strategies
:: Key components of such strategies include financial coverage, accreditation of childhood cancer centers, mandatory childhood cancer reporting and registration, development of national standards of care, and the creation of national childhood cancer governing bodies
:: Challenges to implementing such strategies include a paucity of implementation research, formal policy evaluation, and costing data
:: The ideal structure of such strategies in low-income countries is currently unknown, given severe resource constraints, deficits in infrastructure, and competing health needs

Enabling the genomic revolution in Africa

Science
20 June 2014 vol 344, issue 6190, pages 1317-1424
http://www.sciencemag.org/current.dtl

Policy Forum
Research Capacity
Enabling the genomic revolution in Africa
The H3Africa Consortium
Corresponding author. Charles Rotimi, Center for Research on Genomics and Global Health, National Human Genome Research Institute, NIH, Bethesda, MD 20892–5635, USA
Overview
Our understanding of genome biology, genomics, and disease, and even human history, has advanced tremendously with the completion of the Human Genome Project. Technological advances coupled with significant cost reductions in genomic research have yielded novel insights into disease etiology, diagnosis, and therapy for some of the world’s most intractable and devastating diseases—including malaria, HIV/AIDS, tuberculosis, cancer, and diabetes. Yet, despite the burden of infectious diseases and, more recently, noncommunicable diseases (NCDs) in Africa, Africans have only participated minimally in genomics research. Of the thousands of genome-wide association studies (GWASs) that have been conducted globally, only seven (for HIV susceptibility, malaria, tuberculosis, and podoconiosis) have been conducted exclusively on African participants; four others (for prostate cancer, obsessive compulsive disorder, and anthropometry) included some African participants (www.genome.gov/gwastudies/). As discussed in 2011 (www.h3africa.org), if the dearth of genomics research involving Africans persists, the potential health and economic benefits emanating from genomic science may elude an entire continent.

Evidence-to-policy gap on hepatitis A vaccine adoption in 6 countries: Literature vs. policymakers’ beliefs

Vaccine
Volume 32, Issue 32, Pages 4013-4110 (7 July 2014)
http://www.sciencedirect.com/science/journal/0264410X/32/32

Evidence-to-policy gap on hepatitis A vaccine adoption in 6 countries: Literature vs. policymakers’ beliefs
Original Research Article
Pages 4089-4096
Sachiko Ozawa, Lois A. Privor-Dumm, Angeline Nanni, Emily Durden, Brett A. Maiese, Chizoba U. Nwankwo, Kimberly G. Brodovicz, Camilo J. Acosta, Kathleen A. Foley
Abstract
Background
National vaccine adoption decisions may be better understood by linking multiple data sources. When examining countries’ decisions to adopt the hepatitis A vaccine, applying multiple research methods can facilitate assessments of gaps between evidence and policy. We conducted a literature review on hepatitis A and stakeholder interviews about decisions to adopt the vaccine in six countries (Chile, India, South Korea, Mexico, Russia, and Taiwan).
Methods
A systematic literature review was conducted across five literature databases. The review identified and abstracted 340 articles, supplemented by internet search. In addition, we interviewed 62 experts and opinion leaders on hepatitis A and/or vaccines. Data from the two sources were analyzed to identify gaps around epidemiologic data, economic data, and barriers/facilitators of hepatitis A vaccine adoption.
Results
Epidemiologic data gaps were found in Chile and Russia, where stakeholders believed data to be more solid than the literature documented. Economic data on hepatitis A was found to be weak across all countries despite stakeholders’ agreement on its importance. Barriers and facilitators of vaccine adoption such as political will, prioritization among vaccines, and global or local recommendations were discussed more by stakeholders than the literature. Stakeholders in India and Mexico were not concerned with the lack of data, despite growing recognition in the literature of the epidemiological transition and threat of outbreaks.
Conclusions
Triangulation of results from two methods captured a richer story behind vaccine adoption decisions for hepatitis A. The discrepancy between policymakers’ beliefs and existing data suggest a decline in priority of hepatitis A or weak investment in data collection. Filling the confirmed data gaps in seroprevalence or economic data is important to help guide policy decisions. Greater communication of the risk of hepatitis A and the benefits of the vaccine may help countries undergoing the epidemiologic transition.

The benefits of redesigning Benin’s vaccine supply chain

Vaccine
Volume 32, Issue 32, Pages 4013-4110 (7 July 2014)
http://www.sciencedirect.com/science/journal/0264410X/32/32

The benefits of redesigning Benin’s vaccine supply chain
Original Research Article
Pages 4097-4103
Shawn T. Brown, Benjamin Schreiber, Brigid E. Cakouros, Angela R. Wateska, Hamadou M. Dicko, Diana L. Connor, Philippe Jaillard, Mercy Mvundura, Bryan A. Norman, Carol Levin, Jayant Rajgopal, Mélanie Avella, Caroline Lebrun, Erin Claypool, Proma Paul, Bruce Y. Lee
Abstract
Introduction
New vaccine introductions have put strains on vaccine supply chains around the world. While increasing storage and transportation may be the most straightforward options, it is also important to consider what financial and operational benefits can be incurred. In 2012, suboptimal vaccine coverage and impending vaccine introductions prompted the Republic of Benin’s Ministry of Health (MOH) to explore ways to improve their vaccine supply chain.
Methods
Working alongside the Beninese MOH, we utilized our computational model, HERMES, to explore the impact on cost and vaccine availability of three possible options: (1) consolidating the Commune level to a Health Zone level, (2) removing the Commune level completely, and (3) removing the Commune level and expanding to 12 Department Stores. We also analyzed the impact of adding shipping loops during delivery.
Results
At baseline, new vaccine introductions without any changes to the current system increased the logistics cost per dose ($0.23 to $0.26) and dropped the vaccine availability to 71%. While implementing the Commune level removal scenario had the same capital costs as implementing the Health Zone scenario, the Health Zone scenario had lower operating costs. This increased to an overall cost savings of $504,255 when implementing shipping loops.
Discussion
The best redesign option proved to be the synergistic approach of converting to the Health Zone design and using shipping loops (serving ten Health Posts/loop). While a transition to either redesign or only adding shipping loops was beneficial, implementing a redesign option and shipping loops can yield both lower capital expenditures and operating costs.

From Google Scholar+ [to 21 June 2014]

From Google Scholar+ [to 21 June 2014]
Selected content from beyond the journals and sources covered above, aggregated from a range of Google Scholar monitoring algorithms and other monitoring strategies.

Earth Perspectives
2014, 1:11
doi:10.1186/2194-6434-1-11
Essay
Climate information for humanitarian agencies: some basic principles
Erin Coughlan de Perez1 and Simon J Mason2*
Author Affiliations
1 Red Cross/Red Crescent Climate Centre, PO Box 28120, 2502 The Hague, KC, Netherlands
2 International Research Institute for Climate and Society, The Earth Institute of Columbia University, PO Box 1000, Palisades, NY 10965, USA
Abstract
Since 2005, the International Federation of Red Cross and Red Crescent Societies and the Red Cross Red Crescent Climate Centre have had an ongoing partnership with the International Research Institute for Climate and Society (IRI) to connect end-users with providers of climate information. This partnership has enabled and encouraged the uptake of climate information in the humanitarian sector. From the perspective of the climate service provider, attempts to address problems of salience, credibility and legitimacy have been made by adopting the following set of principles: prioritize immediate user needs; provide only information that is relevant to the user context; provide decision support; right-scale rather than down-scale; and maintain ownership and partnership in design. Examples are presented of how these principles have been applied, highlighting not only the need to improve forecasts and their presentation, but also to address obstacles to the practical use of climate information.

Humanities
2014, 3(2), 232-243
doi:10.3390/h3020232
Article
The (de) Militarization of Humanitarian Aid: A Historical Perspective
Marc-Antoine Pérouse de Montclos
Author affiliation
Received: 11 March 2014; in revised form: 2 June 2014 / Accepted: 6 June 2014 / Published: 16 June 2014
Abstract:
Humanitarian workers often complain that international aid to victims of armed conflicts is more and more militarized because relief organizations are embedded into peacekeeping operations, used as a “force multiplier”, or manipulated as an instrument of diplomacy by proxy. Historically, however, charity has always been a military issue in times of war. We can distinguish four types of militarization of relief organizations in this regard. First is the use of charities to make “war by proxy”, as in Afghanistan or Nicaragua in the 1980s. The second pattern is “embedment”, like the Red Cross during the two world wars. The third is “self-defense”, as with the Order of Saint John of Jerusalem (now Malta) in the 12th Century. The fourth, finally, is the model of “International Brigades” alongside the Spanish Republicans in 1936 or various liberation movements in the 1970s. In comparison, humanitarian aid today appears to be much less militarized. However, this perception also depends on the various definitions of the word “humanitarian”.

American Journal of Clinical Pathology
July 2014; 142 (1)
http://ajcp.ascpjournals.org/content/current
Laboratory Turnaround Times in Response to an Abrupt Increase in Specimen Testing After a Natural Disaster
Kevin Taylor1, Peter George, MBBS1,2 and Joanne M. Deely, PhD3
Author Affiliations
1From Canterbury Health Laboratories,
2University of Otago, and
3Canterbury District Health Board, Christchurch, New Zealand.
Abstract
Objectives: Understanding how key indicators change during extreme circumstances could help laboratories maintain high standards when responding to disasters. We assessed the effects of an earthquake on turnaround times (TATs) at a hospital laboratory.
Methods: We examined TATs for 709,786 potassium tests and 196,795 urine cultures from February 2010 to January 2013. Hospital and community data were evaluated separately and compared during the transport, registration (accessioning), and analysis time phases.
Results: After the earthquake, the laboratory undertook approximately 70% of the nonacute community specimen testing. Initially, community transport times increased by 20 to 27 hours and remained 2 to 3 hours above prequake levels. Registration time increased by 10 to 20 minutes (hospital) and 30 to 45 minutes (community) for a short period. During the initial few months, community urine culture analysis time increased by more than 50 hours.
Conclusions: The increase in specimen numbers affected short- and long-duration test TATs differently. Streamlining and automating processes reduced registration and analysis times. Increased transport time was outside the control of the laboratory.

Systems and Information Engineering Design Symposium (SIEDS), 2014
25-25 April 2014; Page(s):334 – 339
Improving situational awareness for humanitarian logistics through predictive modeling
Racette, Mark P. ; Department of Systems and Information Engineering, University of Virginia ; Smith, Christopher T. ; Cunningham, Michael P. ; Heekin, Thomas A. more authors
Abstract
Humanitarian aid efforts in response to natural and man-made disasters often involve complicated logistical challenges. Problems such as communication failures, damaged infrastructure, violence, looting, and corrupt officials are examples of obstacles that aid organizations face. The inability to plan relief operations during disaster situations leads to greater human suffering and wasted resources. Our team used the Global Database of Events, Location, and Tone (GDELT), a machine-coded database of international events, for all of the models described in this paper. We produced a range of predictive models for the occurrence of violence in Sudan, including time series, general logistic regression, and random forest models using both R and Apache Mahout. We also undertook a validation of the data within GDELT to confirm the event, actor, and location fields according to specific, pre-determined criteria. Our team found that, on average, 81.2 percent of the event codes in the database accurately reflected the nature of the articles. The best regression models had a mean square error (MSE) of 316.6 and the area under the receiver operating characteristic curve (AUC) was 0.868. The final random forest models had a MSE of 339.6 and AUC of 0.861. Using Mahout did not provide any significant advantages over R in the creation of these models.

Annals of Operations Research
June 2014
Modeling the impact of donor behavior on humanitarian aid operations
M. Ali Ülkü, Kathryn M. Bell, Stephanie Gray Wilson
Abstract
Whether in-kind or cash, coordinated help organizations such as the American Red Cross, count on donations to help those in need when and after disasters happen. Yet, it has been observed that the type (in-kind versus cash) and the quality of donations largely impact the success of meeting urgent demand in humanitarian operations. In particular, unsolicited items hamper the synchronization of logistical operations and hence may create more problems than solutions. This research sheds light on the behavioral and decision making aspects of a donor while developing analytical models of how that behavior can be influenced by soliciting a minimum amount of cash donation, which in turn mitigates the negative impact of unsolicited items. We investigate the literature on donor psychology and feed those extant findings to the analytical model. We provide explicit expressions for the optimal solicitation amount and the impact of that amount on maximizing the donor’s likelihood to donate cash, as opposed to in-kind items. Also provided are some execution insights through extensive sensitivity analysis.

ICC: Policy Paper on Sexual and Gender-Based Crimes

Policy Paper on Sexual and Gender-Based Crimes
International Criminal Court – Office of the Prosecutor
June 2014 – 44 pages

:: Press Release (excerpt)
This comprehensive Policy Paper will guide the Office of the Prosecutor in its work in fighting against impunity for sexual and gender-based crimes, and promote transparency and clarity, as well as predictability in the application of the legal framework of the Rome Statute to such crimes. In turn, the policy will contribute to ensuring not only the effective investigation and prosecution of sexual and gender-based crimes, but also to enhancing access to justice for victims of these crimes, through the ICC. Sexual and gender-based crimes are among the gravest under the Rome Statute and investigating and prosecuting such crimes is a key priority for the Office.

:: Policy Paper Executive Summary (excerpts)
1. Over the past few decades, the international community has taken progressive steps to put an end to impunity for sexual and gender-based crimes. The Statute of the ICC is the first international instrument expressly to include various forms of sexual and gender-based crimes — including rape, sexual slavery, enforced prostitution, forced pregnancy, enforced sterilisation, and other forms of sexual violence — as underlying acts of both crimes against humanity and war crimes committed in international and non-international armed conflicts. The Statute also
criminalises persecution based on gender as a crime against humanity. Sexual and gender-based crimes may also fall under the Court’s jurisdiction if they constitute acts of genocide or other acts of crimes against humanity or war crimes. The Rules of Procedure and Evidence (‚Rules‛) and the Elements consolidate important procedural and evidentiary advancements to protect the interests of victims and enhance the effectiveness of the work of the Court.
2. Recognising the challenges of, and obstacles to, the effective investigation and prosecution of sexual and gender-based crimes, the Office elevated this issue to one of its key strategic goals in its Strategic Plan 2012-2015. The Office has committed to integrating a gender perspective and analysis into all of its work, being innovative in the investigation and prosecution of these crimes, providing adequate training for staff, adopting a victim-responsive approach in its work, and paying special attention to staff interaction with victims and witnesses, and their fa ilies and communities. It will increasingly seek opportunities for effective and appropriate consultation with victims’ groups and their representatives to take into account the interests of victims.
3. The Office recognises that sexual and gender-based crimes are amongst the gravest under the Statute. Consistent with its positive complementarity policy, and with a view to closing the impunity gap, the Office seeks to combine its efforts to prosecute those most responsible with national proceedings for other perpetrators.
4. The Office pays particular attention to the commission of sexual and gender-based crimes at all stages of its work: preliminary examination, investigation, and prosecution. Within the scope of its mandate, the Office will apply a gender analysis to all crimes within its jurisdiction, examining how those crimes are related to inequalities between women and men, and girls and boys, and the power relationships and other dynamics which shape gender roles in a specific
context. In addition to general challenges to investigations conducted by the Office, such as security issues related to investigations in situations evidence; lack of forensic or other documentary evidence, owing, inter alia, to the passage of time; and inadequate or limited support services at national level. The Office will pay particular attention to these crimes from the earliest stages in order to address such challenges. The establishment of contacts and networks within the community will be prioritised to the extent possible to support the operational activities of the Office, particularly with regard to augmenting its access to
information and evidence.
5. Article 68(1) of the Statute obliges the Office to take various measures to protect the safety, physical and psychological well-being, dignity, and privacy of victims and witnesses, particularly during its investigation and prosecution activities with regard to sexual and gender-based crimes and crimes against children. The Office will strive to ensure that its activities do not cause further harm to victims and witnesses…
…14. The Office also recognises the crucial role that civil society plays in preventing and
addressing sexual and gender-based crimes. The Office will seek to support and strengthen cooperation with these organisations, particularly those which have experience in documenting sexual and gender-based crimes and working with victims of these crimes. The Office will enhance its institutional capacity to investigate and prosecute sexual and gender-based crimes with the assistance of its Gender and Children Unit (‚GCU‛) and the Special Gender Adviser to the Prosecutor. The Office recognises the need to strengthen its in-house expertise on sexual and gender-based crimes relating to women and girls, and men and boys, both in conflict and non-conflict situations. It will continue to recruit persons with the required expertise and experience in this field….

ILO adopts new Protocol to tackle modern forms of forced labour

ILO adopts new Protocol to tackle modern forms of forced labour
Press release | 11 June 2014
A new legally binding ILO Protocol on Forced Labour aims to advance prevention, protection and compensation measures, as well as to intensify efforts to eliminate contemporary forms of slavery.
Excerpt
The Protocol, supported by a Recommendation, was adopted by government, employer and worker delegates to the International Labour Conference (ILC) and brings the existing ILO Convention 29 on Forced Labour, adopted in 1930, into the modern era to address practices such as human trafficking. Guy Ryder, ILO Director-General, said, “The Protocol and Recommendation mark a major step forward in the fight against forced labour and represent a firm commitment among governments, employer and worker organizations to eliminate contemporary forms of slavery.” Forced labour violates the human rights and dignity of millions of women and men, girls and boys. It contributes to the perpetuation of poverty and stands in the way of the achievement of decent work for all,” he added. There are currently an estimated 21 million forced labour victims worldwide. A recent ILO report estimates that US$ 150 billion in illegal profits are made in the private economy each year through modern forms of slavery. “The new instruments will complement and strengthen existing international law, in particular the UN Protocol to prevent, suppress and punish trafficking in persons, especially women and children,” said David Garner, President of the ILC Committee on Forced Labour and Australian Government representative.

Climate Justice and the Right to Health

Climate Justice and the Right to Health – A Special Issue
Health and Human Rights, Volume 16, Issue 1, http://www.hhrjournal.org/
Foreword
Mary Robinson, Former President of Ireland and President of the Mary Robinson Foundation – Climate Justice. President of the Mary Robinson Foundation-Climate Justice
Excerpt
…In recent years, climate justice is emerging as a discipline that addresses the interlinked challenges of climate change, human rights, and development. At a time when the need for multidisciplinary research is gaining ground, climate justice provides a useful framing for interdisciplinary collaborations.

Climate justice highlights the impacts of climate change on the vulnerable, marginalized, and poor, who are disproportionally affected by extreme weather events, such as floods, storms, and droughts, and slow onset events, such as sea level rise and glacial melt. They are the people who have their homes destroyed, face increasing struggles to feed themselves and their families, and are more susceptible to diseases while having their access to health care diminished.
Climate change is already undermining many of their basic human rights—to food and water, to shelter and health. Climate justice points out that the undermining of these essential rights is an injustice—largely because those who are most affected by the negative impacts are least responsible for the causes of the problem. The concept shows how global develop¬ment issues and climate change are inextricably linked, as for example when the incidence of a disease like malaria, that we have been making progress on eradicating, starts to rise again due to climatic changes….

…Articles in this special issue examine the disproportionate impacts of climate change on vulnerable groups, including indigenous peoples. A case is made for climate change mitigation policies informed by human rights and with clear health and equity co-benefits. The links between climate justice and the right to health are presented, including an analysis of the links between the right to food and the right to health in the context on increasing dependency on food aid of low nutritional value. Several papers present a strong case for human rights law guiding procedural responses to climate change and its negative impacts on health….

…It is important at this juncture, with two international processes working on issues of human development and climate change coming to conclusion in 2015, that the value of a climate justice approach is demonstrated and used to inform these policy frameworks. This special edition is a welcome contribution to this endeavor.
Editorial: The Great Procrastination
Jay Lemery, MD, co-editor of this special issue on climate justice, is Associate Professor of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, and President, Wilderness Medical Society.
Carmel Williams, PhD, is the Executive Editor of the Health and Human Rights Journal and a Fellow of the François-Xavier Bagnoud Center for Health and Human Rights, Harvard University
Paul Farmer, MD, PhD, is Editor-in-Chief of the Health and Human Rights Journal, Kolokotrones University Professor at Harvard Univer¬sity, and Chair of the Department of Global Health and Social Medicine at Harvard Medical School.

We wonder, given the evidence underlying the mounting climate crisis, if future gener¬ations will regard ours—amongst the epochs of history—as “The Great Procrastination.” Squandering time, dithering on action, and engaging in half-measures woefully incapable of addressing a threat that our best science warns will be more catastrophic and less reversible each year.

The health effects of anthropogenic climate change are increasingly apparent and acceler-ating at an ominous pace. Global warming will now continue under all future scenarios, and immediate action can only slow, not reverse, the rate of warming. Our risk assessment has yet to translate into meaningful mitigation and, even with this knowledge, major industrial nations are continuing to invest significantly in new carbon-based energy technologies.

This issue of the Health and Human Rights Journal explores a range of threats to human health from climate change, and examines these dangers as issues of human rights. Imme-diate morbidity and mortality impacts from extreme weather events and sea level rise are known and visible; less obvious and more insidious are health threats arising from the on-going displacement, disenfranchisement, and deprivation brought about by the effects of climate change.

The people who will suffer most are those who were most vulnerable to begin with, living in regions of the world with perilous human security, pervasive poverty, little fulfillment of human rights, geo¬graphic disadvantage, and contributing the least to¬wards greenhouse gas emissions. It is in these places that the threat-multiplying effects of climate change will denigrate human dignity, health, and potential the most. It is in these same disadvantaged settings that fragile health systems are least able to cope with the increased demands they will face.
Responsibility, governance, and accountabil¬ity for climate change remain elusive. There is a chasm between apparent comprehension of the se¬riousness of climate threats and appetite for policy change and effective personal action. Ambitious long-term energy policies are absent and the com¬plex science of climate change is subject to political lobbying, corporate greed, and rampant skepticism. This leads to an unnecessary and deliberate sense of confusion that undermines an imperative for intervention. Without a clear mandate for action, policymakers ignore the long-term threat for short-term gains. It’s still easier to win elections in 2014 by supporting fracking than by promoting a cap-and-trade program to control greenhouse gas emissions. Human health is the price we are already paying.

But the case for climate change is becoming easi¬er to make, as Mary Robinson (former President of Ireland and former United Nations High Commis¬sioner for Human Rights) states in her foreword to our special issue on Climate Justice and the Right to Health. In early 2014, the Intergovernmental Panel on Climate Change released its Fifth Assess¬ment Report (AR5). The report uses best available evidence to describe the diverse and multi-faceted health threats related to climate change. The prev¬alence of heat-related illness, food insecurity, and waterborne and vectorborne infectious disease is predicted to increase this century, especially among vulnerable populations living in developing coun¬tries. AR5 also links climate change with worsening human security through population displacement, violent conflict, and poverty entrenchment.

The human rights based approach to climate justice
In its resolution on human rights and climate change (2009), the Human Rights Council noted that climate change-related impacts have a range of implications, both direct and indirect, for the effec¬tive enjoyment of human rights, including the right to life, the right to adequate food, the right to the highest attainable standard of health, the right to adequate housing, the right to self determination, and human rights obligations related to access to safe drinking water and sanitation. The resolution also recognized that the effects of climate change will be felt most acutely by those segments of the population who are already vulnerable and mar¬ginalized due to factors such as geography, pover¬ty, gender, age, indigenous or minority status, and disability.

Adopting a rights-based approach to climate change action begins by recognizing the obligations of states to respect, protect, and fulfill all human rights threatened by climate change. It then requires states to begin a transparent and participatory pro¬cess with their own people, and international part¬ners, to determine a plan of mitigation and adapta¬tion, addressing the rights of the most vulnerable first.

In order to avoid “The Great Procrastination” as the rightful definition of this generation, it is imper¬ative that states affirm their commitment to human rights by:
:: acknowledging the irrefutable science link¬ing climate change to human health; and
::: proactively instituting climate change mit¬igation in a participatory, transparent, and accountable manner.

Climate justice seeks redress for those whose hu¬man rights are threatened by climate change. It requires international institutional action, organi¬zation, and global governance that promote equity, and avoid historic patterns of further disadvan¬taging the developing world. By invoking person¬al action, we have the opportunity to keep the cli¬mate change conversation relevant to individuals worldwide. Until most people, especially those in positions of influence, understand that immediate action is needed to prevent even more negative out¬comes and suffering associated with climate change, our procrastination will continue and pressure on political leaders will remain too little.

The Universal Declaration of Human Rights was created in response to global outrage at the human suffering and atrocities of the Second World War. The world united to ensure that humankind would never again experience such loss of dignity and freedom. Unabated climate change poses exactly this threat; it is imperative that we use our human rights entitlements to guide the process and actions to mitigate such disaster.

Speech: The global state of play of DRR [UNISDR]

Speech: The global state of play of DRR
Speech by SRSG Margareta Wahlström, Head of UNISDR
Opening of Asia Europe Meeting (ASEM) Manila Conference on Disaster Risk Reduction and Management
5 June 2014, Manila, Philippines
Excerpt

Excellencies, distinguished delegates, ladies and gentlemen, I am honoured to be invited to contribute to this Asia Europe Meeting (ASEM) Manila Conference on Disaster Risk Reduction and Management, titled “Post- Haiyan – A Way Forward”.

Your presence here today illustrates the importance and timeliness to understand and learn from the experiences of the Typhoon Haiyan (Yolanda). This will be an important contribution to the 3rd UN World Conference on Disaster Risk Reduction being held in Sendai, Japan on 14 -18 March 2015…
…As specified in the 2013 UN General Assembly Resolution, the objectives of the Third UN World Conference on Disaster Risk Reduction include:
– To complete assessment and review of the implementation of the HFA.
– To consider the experience gained through the regional and national strategies and plans for disaster risk reduction and their recommendations as well as relevant regional agreements under the implementation of the HFA.
– To adopt a post-2015 framework for disaster risk reduction
– To identify modalities of cooperation based on commitments to implement a post-2015 framework for disaster risk reduction.
– To determine modalities for periodic review of the implementation of a post-2015 framework for disaster risk reduction…

…Excellencies, ladies and gentlemen, let me now talk to you about the post-2015 framework for disaster risk reduction…
…It is important to understand what the underlying risk drivers are: it is about unequal economic development, badly planned and managed urban and regional development; the decline of regulatory ecosystem services; poverty and inequality; weak governance; and climate change.
Existing patterns indicate that exposure of people and assets in both higher and lower-income countries has increased faster than vulnerability has decreased, thus generating new risk and a steadily increase in socio-economic losses. The on-going creation of new risk coupled with the existing risk, requires continued efforts in reducing vulnerability. Many governments are now faced with increasing levels of contingent liability and sovereign risk.

This vicious cycle can be interrupted with a combined approach aiming to prevent future risk creation, reduce existing levels of risk, and strengthen socio and economic resilience, targeting both the public and private sectors.
In summary, the next “Plan of Action” will therefore require three mutually-supportive goals:
1. Preventing the creation of new risk by the adoption of risk-informed growth and development pathways
2. Reducing existing risk
3. Strengthening resilience by socio and economic measures that enable countries and people to absorb loss, minimize impact and recover.

Based on the above, it is now clear that the post-2015 framework for DRR needs to:
– Incorporate the prevention of new risk creation and reduction of existing risk as a component of sustainable development and in integrate this in governance.
– Promote the full engagement and empowerment of local communities, leaders, and administrators and the respect of local and indigenous knowledge with the understanding that while the causes and consequences of risk may be national, trans-boundary or global in scope, disaster risks have local and specific characteristics
– Promote all-of-society engagement and empowerment, effective equality, inclusion and non-discriminatory participation, and assumption of responsibility by all stakeholders for preventing new risk creation and reducing existing risks
– Promote aligned and clear responsibilities and action across private stakeholders and all public institutions, including the executive and legislative branches, at local and central level are indispensable for effective disaster risk management, and to coherently monitor and review progress.
– Promote the development of freely available, publicly accessible science-based risk information, to promote risk informed decision-making.
– Realize that preventing new and reducing existing risk of disaster constitute an international legal duty aimed at protecting persons, their livelihoods and property, while respecting their human rights.

Excellencies, distinguished guests, ladies and gentlemen, I believe that just as the 2004 Indian Ocean tsunami transformed how affected countries committed themselves to disaster risk reduction, so too the concrete lessons and experiences from Typhoon Yolanda may lead to positive changes for the benefit of present and future generations….
…The lessons to be learned from Typhoon Yolanda will have wider application across the world and must be incorporated into the new 2015 global agreement on disaster risk reduction, which will succeed the current Hyogo Framework for Action.