What music makes us feel: At least 13 dimensions organize subjective experiences associated with music across different cultures

Featured Journal Content

PNAS – Proceedings of the National Academy of Sciences of the United States
of America
http://www.pnas.org/content/early/
[Accessed 11 Jan 2020]

.
What music makes us feel: At least 13 dimensions organize subjective experiences associated with music across different cultures
Alan S. Cowen, Xia Fang, Disa Sauter, and Dacher Keltner
PNAS first published January 6, 2020. https://doi.org/10.1073/pnas.1910704117
Significance
Do our subjective experiences when listening to music show evidence of universality? And if so, what is the nature of these experiences? With data-driven methodological and statistical approaches, we examined the feelings evoked by 2,168 music excerpts in the United States and China. We uncovered 13 distinct types of experiences that people across 2 different cultures report in listening to music of different kinds. Categories such as “awe” drive the experience of music more so than broad affective features like valence. However, emotions that scientists have long treated as discrete can be blended together. Our results provide answers to long-standing questions about the nature of the subjective experiences associated with music.
Abstract
What is the nature of the feelings evoked by music? We investigated how people represent the subjective experiences associated with Western and Chinese music and the form in which these representational processes are preserved across different cultural groups. US (n=1,591) and Chinese (n=1,258) participants listened to 2,168 music samples and reported on the specific feelings (e.g., “angry,” “dreamy”) or broad affective features (e.g., valence, arousal) that they made individuals feel. Using large-scale statistical tools, we uncovered 13 distinct types of subjective experience associated with music in both cultures. Specific feelings such as “triumphant” were better preserved across the 2 cultures than levels of valence and arousal, contrasting with theoretical claims that valence and arousal are building blocks of subjective experience. This held true even for music selected on the basis of its valence and arousal levels and for traditional Chinese music. Furthermore, the feelings associated with music were found to occupy continuous gradients, contradicting discrete emotion theories. Our findings, visualized within an interactive map (https://www.ocf.berkeley.edu/∼acowen/music.html) reveal a complex, high-dimensional space of subjective experience associated with music in multiple cultures. These findings can inform inquiries ranging from the etiology of affective disorders to the neurological basis of emotion.

The State of Adolescent Sexual and Reproductive Health

Featured Journal Content

Journal of Adolescent Health
December 2019 Volume 65, Issue 6, Supplement, S1-S62
https://www.jahonline.org/issue/S1054-139X(19)X0005-1
Adolescent Sexual and Reproductive Health and Rights: Progress in the 25 Years Since the International Conference on Population and Development and Prospects for the Next 25 years
Edited by Caroline W. Kabiru
.
Review Articles
The State of Adolescent Sexual and Reproductive Health
Mengjia Liang, Sandile Simelane, Guillem Fortuny Fillo, Satvika Chalasani, Katherine Weny, Pablo Salazar Canelos, Lorna Jenkins, Ann-Beth Moller, Venkatraman Chandra-Mouli, Lale Say, Kristien Michielsen, Danielle Marie Claire Engel, Rachel Snow
S3–S15
Published in issue: December 2019
Abstract
In the 25 years since the 1994 International Conference on Population and Development, significant progress has been made in adolescent sexual and reproductive health and rights (ASRHR). Trend analysis of key ASRHR indicators at global, national, and subnational levels indicates that adolescent girls today are more likely to marry later, delay their first sexual experience, and delay their first childbirth, compared with 25 years ago; they are also more likely to use contraceptives. Despite overall progress, however, unequal progress in many ASRHR outcomes is evident both within and between countries, and in some locations, the state of adolescents’ lives has worsened. Population growth in countries with some of the worst shortfalls in ASRHR mean that declining rates, of child marriage, for example, coexist with higher absolute numbers of girls affected, compared with 25 years ago. Emerging trends that warrant closer attention include increasing rates of ovarian and breast cancer among adolescent girls and sharp increases in the proportion of adolescents who are overweight or obese, which has long-term health implications.

The Political, Research, Programmatic, and Social Responses to Adolescent Sexual and Reproductive Health and Rights in the 25 Years Since the International Conference on Population and Development
Venkatraman Chandra-Mouli, B. Jane Ferguson, Marina Plesons, Mandira Paul, Satvika Chalasani, Avni Amin, Christina Pallitto, Marni Sommers, Ruben Avila, Kalisito Va Eceéce Biaukula, Scheherazade Husain, Eglé Janušonytė, Aditi Mukherji, Ali Ihsan Nergiz, Gogontlejang Phaladi, Chelsey Porter, Josephine Sauvarin, Alma Virginia Camacho-Huber, Sunil Mehra, Sonja Caffe, Kristien Michielsen, David Anthony Ross, Ilya Zhukov, Linda Gail Bekker, Connie L. Celum, Robyn Dayton, Annabel Erulkar, Ellen Travers, Joar Svanemyr, Nankali Maksud, Lina Digolo-Nyagah, Nafissatou J. Diop, Pema Lhaki, Kamal Adhikari, Teresa Mahon, Maja Manzenski Hansen, Meghan Greeley, Joanna Herat, Danielle Marie Claire Engel
S16–S40
Published in issue: December 2019
Abstract
Among the ground-breaking achievements of the International Conference on Population and Development (ICPD) was its call to place adolescent sexual and reproductive health (ASRH) on global health and development agendas. This article reviews progress made in low- and middle-income countries in the 25 years since the ICPD in six areas central to ASRH—adolescent pregnancy, HIV, child marriage, violence against women and girls, female genital mutilation, and menstrual hygiene and health. It also examines the ICPD’s contribution to the progress made. The article presents epidemiologic levels and trends; political, research, programmatic and social responses; and factors that helped or hindered progress. To do so, it draws on research evidence and programmatic experience and the expertise and experiences of a wide number of individuals, including youth leaders, in numerous countries and organizations. Overall, looking across the six health topics over a 25-year trajectory, there has been great progress at the global and regional levels in putting adolescent health, and especially adolescent sexual and reproductive health and rights, higher on the agenda, raising investment in this area, building the epidemiologic and evidence-base, and setting norms to guide investment and action. At the national level, too, there has been progress in formulating laws and policies, developing strategies and programs and executing them, and engaging communities and societies in moving the agenda forward. Still, progress has been uneven across issues and geography. Furthermore, it has raced ahead sometimes and has stalled at others. The ICPD’s Plan of Action contributed to the progress made in ASRH not just because of its bold call in 1994 but also because it provided a springboard for advocacy, investment, action, and research that remains important to this day.

Forward, Together: A Collaborative Path to Comprehensive Adolescent Sexual and Reproductive Health and Rights in Our Time
Marina Plesons, Claire B. Cole, Gwyn Hainsworth, Ruben Avila, Kalisito Va Eceéce Biaukula, Scheherazade Husain, Eglė Janušonytė, Aditi Mukherji, Ali Ihsan Nergiz, Gogontlejang Phaladi, B. Jane Ferguson, Anandita Philipose, Bruce Dick, Cate Lane, Joanna Herat, Danielle Marie Claire Engel, Sally Beadle, Brendan Hayes, Venkatraman Chandra-Mouli
S51–S62
Abstract
The 1994 International Conference on Population and Development established a basis for the advancement of adolescent sexual and reproductive health and rights (ASRHR) that endures today. Twenty-five years later, our vision for the future warrants reflection based on a clear understanding of the opportunities and challenges before us. Inclusion of adolescents on global, regional, and national agendas; increased investment in ASRHR policies and programs; renewed commitments to universal health coverage; increased school enrollment; and advances in technology are all critical opportunities we can and must leverage to catalyze progress for adolescents. At the same time, a range of significant challenges remain, have newly emerged, or can be seen on the horizon, including persistent denial of adolescent sexuality; entrenched gender inequality; resistance to meaningfully engaging adolescents and young people in political and programmatic processes; weak systems, integration, and multisectoral coordination; changes in population dynamics; humanitarian and climate crises; and changes in family and community structures. To achieve as much progress toward our vision for ASRHR as possible, the global ASRHR community must take strategic and specific steps in the next 10 years within five areas for action: (1) mobilize and make full use of political and social support for ASRHR policies and programs; (2) increase and make effective use of external and domestic funding for ASRHR; (3) develop, communicate, apply, and monitor enabling and protective laws and policies for ASRHR; (4) use and improve available ASRHR data and evidence to strengthen advocacy, policies, and programs; and (5) manage the implementation of ASRHR strategies at scale with quality and equity.

Emergencies

Emergencies

Ebola – DRC+
Public Health Emergency of International Concern (PHEIC)

Ebola Outbreak in DRC 74: 07 January 2020
Situation Update
Since the last Situation Report 73 issued on 24 December 2019, 28 new confirmed Ebola virus disease (EVD) cases were reported from five health zones in two affected provinces in the Democratic Republic of the Congo between 23 December 2019 to 5 January 2020. The new confirmed cases in the past 14 days are from Butembo, Katwa, Kalunguta, Mabalako and Mambasa. The source of exposure for the four new cases reported from Mambasa Health Zone, Ituri Province is currently under investigation. Mambasa Health Zone had previously not had a confirmed case for 66 days. Similarly, the source of exposure of the initial case reported in Kalunguta at the end of December is still under investigation…

…As of 5 January 2020, a total of 3390 EVD cases, including 3272 confirmed and 118 probable cases have been reported, of which 2233 cases died (overall case fatality ratio 66%). Of the total confirmed and probable cases, 56% (1903) were female, 28% (956) were children aged less than 18 years, and 5% (168) were healthcare workers.

::::::
::::::

POLIO
Public Health Emergency of International Concern (PHEIC)
http://polioeradication.org/polio-today/polio-now/this-week/

Summary of new viruses this week (AFP cases and ES positives):
:: Afghanistan — two WPV1 cases and two WPV1 positive environmental samples;
:: Pakistan — 11 WPV1 cases, 13 WPV1 positive environmental samples and two cVDPV2 positive environmental samples;
:: Malaysia — one cVDPV2 and one positive environmental samples;
:: Zambia — one cVDPV2 case.

::::::
::::::

Editor’s Note:
WHO has posted a refreshed emergencies page which presents an updated listing of Grade 3,2,1 emergencies as below.

WHO Grade 3 Emergencies [to 11 Jan 2020]

Democratic Republic of the Congo
:: Ebola Outbreak in DRC 74: 07 January 2020
[See Ebola above for detail]

Mozambique floods – No new digest announcements identified
Nigeria – No new digest announcements identified
Somalia – No new digest announcements identified
South Sudan – No new digest announcements identified
Syrian Arab Republic – No new digest announcements identified
Yemen – No new digest announcements identified

::::::

WHO Grade 2 Emergencies [to 11 Jan 2020]
Measles in Europe
:: Strengthening national laboratories’ oversight capacity to support measles and rubella elimination 08-01-2020
[See Milestones above for detail]

Afghanistan – No new digest announcements identified
Angola – No new digest announcements identified
Burkina Faso [in French] – No new digest announcements identified
Burundi – No new digest announcements identified
Cameroon – No new digest announcements identified
Central African Republic – No new digest announcements identified
Ethiopia – No new digest announcements identified
HIV in Pakistan – No new digest announcements identified
Iran floods 2019 – No new digest announcements identified
Iraq – No new digest announcements identified
Libya – No new digest announcements identified
Malawi floods – No new digest announcements identified
MERS-CoV – No new digest announcements identified
Myanmar – No new digest announcements identified
Niger – No new digest announcements identified
occupied Palestinian territory – No new digest announcements identified
Sudan – No new digest announcements identified
Ukraine – No new digest announcements identified
Zimbabwe – No new digest announcements identified

::::::

WHO Grade 1 Emergencies [to 11 Jan 2020]

Chad – No new digest announcements identified
Djibouti – No new digest announcements identified
Kenya – No new digest announcements identified
Mali – No new digest announcements identified
Namibia – viral hepatitis – No new digest announcements identified
Tanzania – No new digest announcements identified

::::::
::::::

UN OCHA – L3 Emergencies
The UN and its humanitarian partners are currently responding to three ‘L3’ emergencies. This is the global humanitarian system’s classification for the response to the most severe, large-scale humanitarian crises. 
Syrian Arab Republic
:: Syrian Arab Republic: Recent Developments in Northwestern Syria Situation Report No. 5 – As of 8 January 2020

Yemen – No new digest announcements identified

::::::

UN OCHA – Corporate Emergencies
When the USG/ERC declares a Corporate Emergency Response, all OCHA offices, branches and sections provide their full support to response activities both at HQ and in the field.
Editor’s Note:
Ebola in the DRC has bene added as a OCHA “Corporate Emergency” this week:
CYCLONE IDAI and Kenneth – No new digest announcements identified
EBOLA OUTBREAK IN THE DRC – No new digest announcements identified

::::::
::::::

The Sentinel

Human Rights Action :: Humanitarian Response :: Health :: Education :: Heritage Stewardship ::
Sustainable Development
__________________________________________________
Week ending 4 January 2020

This weekly digest is intended to aggregate and distill key content from a broad spectrum of practice domains and organization types including key agencies/IGOs, NGOs, governments, academic and research institutions, consortia and collaborations, foundations, and commercial organizations. We also monitor a spectrum of peer-reviewed journals and general media channels. The Sentinel’s geographic scope is global/regional but selected country-level content is included. We recognize that this spectrum/scope yields an indicative and not an exhaustive product. Comments and suggestions should be directed to:

David R. Curry
Editor
GE2P2 Global Foundation – Governance, Evidence, Ethics, Policy, Practice
david.r.curry@ge2p2center.net

PDF: The Sentinel_ period ending 4 Jan 2020

Contents
:: Week in Review  [See selected posts just below]
:: Key Agency/IGO/Governments Watch – Selected Updates from 30+ entities   [see PDF]
:: INGO/Consortia/Joint Initiatives Watch – Media Releases, Major Initiatives, Research:: Foundation/Major Donor Watch -Selected Updates
:: Journal Watch – Key articles and abstracts from 100+ peer-reviewed journals  [see PDF]

 

The Sentinel resumes publication after an end-of-year holidays break.
This edition of 4 January 2020 begins the seventh year of weekly publication.

Happy 75th Birthday, United Nations!

Happy 75th Birthday, United Nations!
United Nations Department of Economic and Social Affairs
2 January 2020, New York
The United Nations makes a difference in the lives of everyone, everywhere. From providing food and assistance to 91.4 million people in 83 countries, supplying vaccines to 45 per cent of the world’s children, to working with 196 countries to keep global temperature rise well below 2 degrees Celsius. The examples are many of how this 193-Member-State strong global organization makes an impact on the ground. This year, we will commemorate and reflect on the organization’s first 75 years of existence by inviting YOU to join the largest-ever global conversation.

The United Nations saw the light of day in 1945, when it was created in the wake of the devastating World War II, with pledges to save future generations from the atrocities of war and reiterate faith in fundamental human rights. Since then, the organization has played a vital role on the world stage, bringing countries together in addressing problems that transcend national boundaries and which no country can solve on their own…

Through this UN75 initiative, the United Nations is embarking on the largest, most inclusive conversation on the role of global cooperation in building the future we want. The organization is calling on people from all walks of life to join dialogues hosted both online and offline, throughout the year. By bringing together people’s voices and views in this way, the organization seeks to find out how enhanced international cooperation can help realize a better world by 2045, when the UN will celebrate its 100th birthday…
Through this worldwide listening exercise, the UN75 initiative aims to foster a greater sense of global citizenship and to empower a critical mass of international actors to address global issues. The views and ideas generated, will be presented by the Secretary-General to world leaders and senior UN officials on 21 September 2020 at a high-level event to mark the anniversary…

For more information: UN75 – Shaping our future together

::::::

In First Annual Budget Since 1973, Fifth Committee Approves $3.07 Billion for 2020, Concluding Main Part of Seventy-Fourth Session
Delegates Clash over Funding for Mechanism Investigating Serious Crimes in Syria
General Assembly Fifth Committee
GA/AB/4350 27 December 2019
21st Meeting (AM)
The Fifth Committee (Administrative and Budgetary) concluded the main part of its seventy fourth session on Friday, approving resources totalling $3.07 billion for 2020, its first annual budget since 1973 and $200 million more than the $2.87 billion outlay proposed by Secretary General António Guterres in early October.

With the new one year fiscal cycle for its regular budget, the Organization temporarily leaves behind more than four decades of biennium budgets and a year in which it grappled with a severe liquidity crunch. The cash crisis has forced the Organization to limit staff hiring and travel, the hours of operation at the New York Headquarters and carry out other cost saving emergency measures.

At the close of the day long and at times contentious meeting, Fifth Committee Chairman Andreas D. Mavroyiannis (Cyprus) thanked the delegates and the Secretariat staff for their dedication and hard work. The Secretariat handled more than 1,300 questions submitted in writing by Fifth Committee members scrutinizing an initial proposed programme budget resolution with more than 500 paragraphs…

The public health crisis of underimmunisation: a global plan of action

Featured Journal Content

Lancet Infectious Diseases
Volume 20, ISSUE 1, P1, January 01, 2020
http://www.thelancet.com/journals/laninf/issue/current
Personal View
The public health crisis of underimmunisation: a global plan of action
Lawrence O Gostin, James G Hodge Jr, Barry R Bloom, Ayman El-Mohandes, Jonathan Fielding,
Peter Hotez, Ann Kurth, Heidi J Larson, Walter A Orenstein, Kenneth Rabin, Scott C Ratzan, Daniel Salmon
[Excerpts]
Summary
Vaccination is one of public health’s greatest achievements, responsible for saving billions of lives. Yet, 20% of children worldwide are not fully protected, leading to 1·5 million child deaths annually from vaccine-preventable diseases. Millions more people have severe disabling illnesses, cancers, and disabilities stemming from underimmunisation. Reasons for falling vaccination rates globally include low public trust in vaccines, constraints on affordability or access, and insufficient governmental vaccine investments. Consequently, an emerging crisis in vaccine hesitancy ranges from hyperlocal to national and worldwide. Outbreaks often originate in small, insular communities with low immunisation rates. Local outbreaks can spread rapidly, however, transcending borders. Following an assessment of underlying determinants of low vaccination rates, we offer an action based on scientific evidence, ethics, and human rights that spans multiple governments, organisations, disciplines, and sectors.

.

Introduction
Vaccination is among public health’s greatest achievements, saving billions of lives. Global scourges such as smallpox have been eradicated, with polio nearing eradication. Childhood diseases (such as measles, mumps, and pertussis) have substantially diminished through modern vaccination practices. Yet, one in five children worldwide are not fully protected, resulting in 1·5 million child deaths annually from diseases that are preventable by vaccination, including diarrhoea and pneumonia, equating to one death every 20 s.1 Millions more people have severe disabling illnesses, cancers, and disabilities from infections caused by underimmunisation. Ten highly populous countries with suboptimal immunisation systems account for over 70% of the world’s unvaccinated children.1

Despite vast benefits, immunisation levels are falling among specific populations in countries at all wealth levels. Reasons vary, ranging from low public trust in vaccines to constraints on affordability or access. The WHO rates vaccine hesitancy—reluctance or refusal to vaccinate despite vaccine availability—as among the top ten global health threats for 2019.2 Overall, both WHO and UNICEF report in 2019 that global immunisation rates for common childhood vaccines have flat-lined at 86% over the past decade.2, 3 Country rates vary widely, from 25% in Equatorial Guinea to 96% in Norway.3 Vaccinations in many countries are falling below levels needed for so-called herd immunity, or community protection, resulting in outbreaks. The global incidence of measles increased by 30% over the previous year in 2017 alone, with major diphtheria outbreaks in multiple regions.4

The vaccination crisis ranges from hyperlocal to national and worldwide. Outbreaks often originate in small, insular communities with low vaccination rates. Yet, local outbreaks can spread rapidly, transcending borders. Mass migration and international travel propel infectious diseases across the globe. Anti-vaccine messaging targets local communities, but is also disseminated widely on internet platforms and social media. Multiple forces driving the resurgence of childhood diseases also threaten immunisation campaigns, such as for polio and malaria.

The remarkable promise of immunisation has stubbornly stalled, with losses measured in deaths and human suffering.5 In 2018, 20 million children missed out on lifesaving measles, diphtheria, and tetanus vaccines.3 Underlying this public health crisis is a striking paradox—vaccines are victims of their own success. Immunisations are remarkably effective, closely monitored, and very safe. Consequently, many clinicians and parents have not seen the consequences of vaccine-preventable diseases and underestimate their harms. Governments also fail to adequately invest in vaccines, from research to cold storage and delivery.

There are no simple solutions to this problem, but innovative policies and programmes working in concert would substantially increase vaccination rates. We offer an action plan based on scientific evidence, ethics, and human rights. Crucially, an effective response must be multidisciplinary and multisectoral, spanning governments, international organisations, the private sector, and civil society. Our plan begins with an examination of underlying determinants of low vaccination rates…

.

Generating sustainable solutions
Underimmunisation is a global crisis requiring sustainable solutions. We offer a three-pronged strategy: innovative financing for vaccine affordability, accessibility, and availability; evidence-based health communication campaigns at local, national, and global levels; and law reform that has public acceptance and is fairly implemented.

:: Vaccine affordability, accessibility, and availability
Projected global funding shortfalls of $7·2 billion (between 2016 and 2020) undermine immunisation goals.36
WHO’s 2013 Global Vaccine Action Plan estimated $60 billion needed for 94 LMICs from 2011 to 2020,37 nearly half of which is unsecured through government or philanthropic sources. WHO also seeks an additional $10 billion for its own operations by 2023, including $667 million to “strengthen routine vaccination and health systems” and $1·6 billion for polio eradication.38
Most costs focus on immunisation services, including management, training, social mobilisation, and surveillance. Rapid deployment of vaccines in response to emerging threats is also essential to save lives and reduce costs.

WHO’s Action Plan partners focus on the entire vaccine pipeline—from research, price, storage, and delivery to robust health systems. Dedicated funding for national immunisation programmes is an essential driver for national and global initiatives. Gavi, for example, generates long-term resources through the international finance facility for immunisation and advanced market commitments to support pneumococcal vaccines. A global campaign to raise financing to scale should be a major priority, especially for low-income countries that are unable to pay for or administer vaccines across their populations. Solidarity for universal vaccine availability is warranted because deficiencies in any country threaten populations worldwide. Each government must assure robust national immunisation systems, but the international community also shares responsibility to fill gaps in capacity through enhanced coordination, forecasting, and manufacturer incentives. Global partnerships like the Coalition for Epidemic Preparedness Innovations (CEPI) align public and private actors to fund, develop, and equitably distribute vaccines.

:: Trustworthy information environment
Resources alone, of course, cannot ensure high immunisation rates if the public distrusts the quality, safety, or effectiveness of vaccines. Gaining trust has become difficult with the rise of nationalist populism, which often questions science and casts doubt on expert opinions. The public cannot rely on the media to provide unbiased or accurate messages. Although some parents remain vehemently opposed to vaccinations, most are open to non-judgmental messages and want the best for their children. Altering the informational environment to afford greater salience to accurate, science-based messages could assuage parental concerns. WHO, governments, and partners (eg, philanthropists, industry, and civil society) should sustainably fund evidence-based engagement and health communication strategies that are proactive, timely, and credible, and tailored to specific audiences. WHO is generating a hub for vaccination acceptance and demand to provide reliable information and tools. Governments should similarly develop national and regional campaigns, including an emphasis on behavioural changes. Key components of effective communication campaigns include objective messaging in traditional and social media designed to assuage fears and promote accurate health information and immunisation outcomes. Campaigns should recruit well trusted spokespeople such as leaders in sport, entertainment, and religion. Health engagement is often the most effective at the community level through local leaders, teachers, and religious figures.

Governments should also adopt transparent, lawful, and measured regulations to correct or remove disinformation from the internet and social media. In the same way that states limit malicious hate speech and violent images, they can sensibly regulate patently false or misleading vaccine information. Social media enterprises should be held accountable for rooting out irresponsible vaccine rumours pervading their platforms. For example, searches for vaccine-related terms on Pinterest are automatically diverted to trustworthy vaccine sources like WHO and CDC.39 Furthermore, internet search engines should prioritise reliable scientific sources over anti-vaccine websites.

Traditional and social media play a special role in open and free societies, and their independence is highly valued. Encouraging self-regulation and ethical corporate responsibility could avoid formal regulation. Governments at the 2019 G20 Summit, for example, asked social media companies to remove violent, terrorism-related messages and images. Facebook agreed to assess its policies governing anti-vaccination information and advertising on its site. YouTube has begun taking down misleading videos and images. Moreover, Amazon is removing anti-vaccination videos, books, and documentaries.

:: National or regional law reform
Governments can use legal tools successfully to increase vaccination rates. Efficacious vaccination laws can lead to higher immunisation coverage.30 Vaccination mandates passed in France and Italy are associated with increased vaccine rates.40 A meta-analysis of European laws, however, did not find a strong link between vaccination laws and coverage.24 These disparate findings might suggest that legal approaches tailored to local cultures work best.

Vaccination laws must exempt people for legitimate medical reasons, such as infants and immunosuppressed individuals. Yet, overzealous reliance on non-medical exemptions can result in preventable outbreaks.27 Multiple US studies conclude that school vaccination laws with fewer exemptions lowered the incidence of childhood diseases. Governments should consider repealing or restricting permissive religious and philosophical exceptions. Such reforms are consistent with freedoms of religion and conscience because they do not target particular religious or other communities, but are applied fairly and equally throughout society. Parents are responsible for not placing their own, and other, children at risk of serious infections. Well tailored laws can also help reduce the number of people objecting to vaccinations due to misinformation.

,

Conclusion
The global crises of underimmunisation risks hard-won gains in preventing infectious diseases. Resurging childhood diseases and fragile global vaccination campaigns necessitate concerted action. Our action plan focuses on the prime causes of underimmunisation: vaccine availability, public distrust, and lax immunisation laws. Immunisation is a potent public health tool. Finding the political will and holding governments accountable are essential. Countless lives can be saved if the international community sustainably funds vaccination systems, assures reliable information, and safeguards the common good through meaningful law reform.

Lancet Editorial – Youth without freedom [UN Global Study on Children Deprived of Liberty]

Featured Journal Content

The Lancet Child & Adolescent Health
Volume 4, ISSUE 1, P1, January 01, 2020
https://www.thelancet.com/journals/lanchi/issue/current
Editorial
Youth without freedom
The 30th anniversary of the UN Convention on the Rights of the Child (UNCRC) on Nov 20, 2019, is a chance to reflect on the global status of children’s rights. A report by UNICEF addresses the progress made in the past three decades, including reduced child mortality rates and increased global access to education, but notes many outstanding challenges such as increasing poverty, dangers posed by climate change, and declining vaccination rates. A Viewpoint by Jeff Goldhagen and colleagues discusses these threats to children’s health through a rights, justice, and equity lens.

One focus of the convention is a child’s right to an appropriate justice system, protection from danger and conflict, and provision of humane detention when necessary. It stresses that deprivation of a child’s liberty should only be used as a measure of last resort, and for the shortest appropriate period of time. The UN Global Study on Children Deprived of Liberty, published on Nov 20, 2019, is therefore timely because it provides the first comprehensive data determining the magnitude of the issue of children deprived of liberty, its possible justifications and root causes, as well as conditions of detention and their harmful effect on the health and development of children.

The UN study indicates that at least 1·3 million children are globally deprived of liberty per year; an estimated 410 000 in the administration of justice, 330 000 in migration-related detention, 35 000 in armed conflict situations, and 1500 for national security reasons. An additional 19 000 children are living with their primary caregivers in prisons and a further 1 million children are in temporary police custody. Lesbian, gay, bisexual, transgender, and intersex children and adolescents, boys, and those with a disability are at increased risk, and constitute a disproportionate share of institutionalised youth. External risk factors also contribute—eg, ineffective child welfare systems, insufficient support for family environments, low minimum age of criminal responsibility, harsh sentencing, discrimination, socioeconomic hardships, and a lack of resources for the administration of justice.

The UNCRC specifies that when children cannot live with their families, “the State should endeavour to provide a family-like environment where they can develop their personality, their emotional relationships with others, their social and educational skills and their talents”. Due to the formative nature of childhood, deprivation of liberty during development can have highly detrimental effects on a child’s physical and mental health. Although there is little evidence that detention alone is a primary cause of health problems, living in overcrowded conditions increases the risk of communicable diseases, unnecessary restrictions on movement and physical activity negatively affect development, and abuse or neglect while in detention often cause or compound mental and cognitive health problems, such as anxiety, depression, or regression of language. Often, health problems in children deprived of liberty are further exacerbated by limited accessibility to and low quality of health care.

On Nov 21, WHO released a status report on prison health in Europe detailing the health status of those incarcerated in the region. The data present a dire situation, showing enormous health disparities between people detained in prison and those living in the community, and highlighting the increased risk of suicide and self-harm. The report suggests that prisons and other institutions should be considered as public health opportunities, where existing health conditions can be treated and improved, and interventions to promote healthy lifestyles and positive behavioural changes can be administered. Such approaches are particularly appealing in the context of youth detention. While adolescence is a period of unique vulnerability, it also offers great potential because many children and young people are receptive to behavioural change and interventions are applied early enough for any lifestyle modifications to make enormous gains in future health outcomes.

The UN study shows that sentencing children to custodial prison sentences remains widespread, despite recommendations that even when a child has committed a crime, alternative solutions such as probation, foster care, or education and vocational training programmes should be considered. Where alternatives to custodial prison sentences cannot be found, it is imperative that detained youth are able to access the same standard of health care as available in the community. The UNCRC declares that all children and adolescents have a right to the highest attainable standard of health. We must not accept anything less for those young people deprived of their liberty.