Dengue Fever: 200,000 cases confirmed in triple frontier = Paraguay, Argentina, Brazil (REPORT)

(Video DengueInfo)

(HN, 3/5/13) - Paraguay, north Argentina & Brazil are in dengue fever alert following the confirmation of over 200,000 cases of the mosquito transmitted viral disease so far this year. The situation is considered worse than in previous years because of a deep rise in the confirmed cases, the circulation of all four sero-types (strains) of dengue (1, 2, 3 and 4) having been detected - and this also means the disease keeps expanding.

Paraguay has admitted 14,987 confirmed cases and at least 17 deaths in the first two months of the year with the tendency to increase. The situation is similar in Argentina particularly in the northern provinces of Salta, Jujuy, Cordoba, Santa Fe, Chaco and Formosa, plus the confirmation of the four serotypes. There are no official figures in Argentina since local officials are reluctant to release them fearing a panic situation.

Brazilian figures suggest that more than 200,000 people were infected in the first seven weeks of 2013 compared to 70,000 in the same period last year with the southern state of Matto Grosso do Sul the hardest hit.

Officials said the cases were likely to increase as the rainy season advances the risk of reproduction of the mosquito which transmits the disease, Aedes Aegypti.

However Brazilian Health Minister Alexandre Padilha revealed that despite the higher incidence, the cases had been less severe than those recorded last year. He said 33 people had died from the flu-like disease in the first seven weeks of 2013 compared to 41 last year.

According to Mr. Padilha, these figures showed that the authorities were following the right strategies in their fight against the fever. He said extra training given to health care professionals and improvements to the network of basic care providers had clearly paid off.

But Mr. Padilha warned state authorities not to let down their guard as the rainy season could exacerbate the situation, with standing water providing an ideal breeding ground for the mosquitoes carrying the disease.

(MAP: World Health Organization) Apart from Mato Grosso do Sul, seven other states across southern and central Brazil have been affected by the epidemic. More than half of the cases have been caused by the Den-4 strain of the virus, which was first detected in Brazil in 2011.

Mr. Padilha said that because the strain was still relatively new to the country, more people were susceptible to infection. There are four known types of dengue fever (strain). Once people are infected by one type, they become immune to that variation, but not to other strains.

Dengue causes a flu-like illness, occasionally lethal and is the leading cause of serious illness and death among children in some Asian and Latin American countries. There is not specific treatment, but early detection, medical care reduces fatality rates of dengue/severe dengue to below 1%.

The disease is spread in tropical and sub-tropical climates, mostly urban and semi-urban areas. The global incidence has grown dramatically and now about half the of the world's population is now at risk.

(Read more at Mercopress)

The WHO must reform for its own health (PERSPECTIVE)

(Video WHO video for World Health Day, April 7, 2012)

By Tikki Pang and Laurie Garrett

The World Health Organization (WHO) is facing an unprecedented crisis that threatens its position as the premier international health agency. To ensure its leading role, it must rethink its internal governance and revamp its financing mechanisms.

The World Health Organization was born in the bifurcated Cold War world in 1948, and every aspect of its charter, mission and organizational structure was molded by diplomatic tensions between NATO and the USSR. However, with the collapse of the Soviet Union and the rise of the new emerging market superpowers, the WHO finds itself trying to straddle a global dynamic for which it was not designed.

Indeed, the WHO now finds itself marginalized in a crowded global health landscape characterized by poor coordination among multiple players. It is no longer the only major actor. At the same time, it faces an internal crisis, with major budget shortfalls and staff layoffs that have resulted in the organization embarking on the most radical reforms in its 64-year history. But the changes do not go far enough. A recent dialogue on WHO reform that we participated in, held by the Council on Foreign Relations in New York in February, identified several key challenges that should be addressed by the agency.

(GRAPH: Flag of the WHO) First and foremost, the WHO should refocus on its original aim of being primarily a 'knowledge broker' that gives advice and information about best practices but stops short of directly implementing programs. It should convene negotiations resulting in internationally binding legal agreements and monitor their implementation. Some of its most successful achievements - such as the Framework Convention on Tobacco Control, the International Health Regulations and the International Classification of Diseases - fall into this category.

The means by which such agreements are reached has changed, and the organization needs to adapt. In 1948, the WHO acted as a knowledge-and-standards broker between states, working almost exclusively with ministries of health and government leaders. In the twenty-first century, however, the WHO's credibility and relevance depend on its ability to exert a normative influence through the Internet, informing the global citizenry about all aspects of health - from relevant treaties to drug safety to disease outbreaks. Currently, the organization's website, is nearly impossible to navigate, akin to a well-stocked library with no catalog system. It needs an overhaul to be useful to the global citizenry.

The WHO not only needs to better communicate and coordinate with its global partners; it also needs to make improvements within, starting with its internal governance. The organization must enhance the relationship between its Geneva headquarters and its powerful regional offices. Guidance from Geneva is sometimes ignored, even contradicted, by the regional directors and their offices. Although the WHO was born with a clear top-down leadership structure, it has morphed over the decades into something closer to a partnership: Geneva 'suggests' policies that its regional partners may accept, ignore or amend. It is often difficult to tell whether the tail is wagging the dog. For example, the Pan American Health Organization, which is one of the regional offices of the WHO, may choose to design and implement a Chagas disease eradication strategy having sought little or no input from Geneva. To avoid tensions, the organization should more clearly apportion 'core' versus 'support' roles played by the various parties.

(PHOTO: Dr. Margaret Chan is the Director-General of WHO, appointed by the World Health Assembly on 9 November 2006/WHO)The internal changes must also involve improved finances. In 1990, the agency was by far the largest player on the global health field, with an annual budget of nearly $1.2 billion; the next biggest budget at the time was that of US government global health programs, which totaled $850 million. By 2010, the WHO's budget, after years of increases, fell back to that 1990 level, making it the fourth largest spender in the global health landscape, behind the now-mammoth $7.5 billion US program, the $3 billion Global Fund to Fight AIDS, Tuberculosis and Malaria and the $2.2 billion collective pile of smaller nongovernmental organizations. This year, the WHO seems to be falling further behind in the hierarchy, trailing the GAVI Alliance and the Bill & Melinda Gates Foundation.

Until recently, the WHO garnered more than 80% of its budget in the form of voluntary donations, largely given by the wealthiest countries for earmarked programs. The agency's core support is derived from proportional levies on member nations, which have remained unchanged for years despite the rising costs of WHO operations. Moreover, the WHO's revenues are received in US dollars, but its Geneva operational and payroll costs must be met in Swiss francs. Because the WHO has not practiced currency hedging, a 32% increase in the value of the franc against the dollar, as occurred in 2011, cannot be accommodated without severe institutional fiscal pain.

In addition to practicing currency hedging, the WHO must identify a range of financing innovations with a goal of increasing institutional resilience. Such financing mechanisms may include, for example, the establishment of an endowment fund, a multiyear financing framework, or the use of a Robin Hood tax, which reaps financing from miniscule taxation of very large currency transactions. Both of these options were highlighted by a 5 April report from a consultative expert working group convened by the WHO.

And, like any multibillion-dollar company, the WHO should have an effective 'marketing' strategy built around rigorous, external evaluations that demonstrate the value of its activities.

The world needs an aggressive and scientifically solid health leader. Governance and the setting of normative standards cannot be accomplished with a slew of loosely connected health initiatives, nongovernmental organizations and bilateral programs. The only entity with a charter, a legislative body and a mandate to fill that role is the WHO, and it must do so decisively.

--- This commentary originally appeared in NATURE.  Tikki Pang is a visiting professor at the National University of Singapore and former director of Research Policy & Cooperation at the World Health Organization in Geneva, Switzerland.  Laurie Garrett is a senior fellow for global health at the Council on Foreign Relations in New York, NY, USA.

In India, Empower the Health-Care Consumer with Knowledge (PERSPECTIVE)

(PHOTO: `The Prescription' - Health education must be expanded to create awareness of secondary prevention, the working of the health-care system & the importance of health insurance/K. Gopinathan)By Poongothai Aladi Aruna

To enjoy the fruits of economic reforms holistically, it is mandatory for India to focus on health education.

A couple of years ago, two incidents made me realize that the importance of health education - as an invaluable tool, key to preventive and diagnostic health care - is poorly understood. The first was when a group of women instigated by higher officials in their beedi company made a representation to me that they were against the government's idea of a logo with a skull stating “smoking is injurious to health” on the beedi packets they produce, as that would be detrimental to their livelihood.  The second was during the Assembly session when an elected member requested the then transport minister to go easy on government drivers reprimanded for drunken or rash driving.

These two case scenarios are not straightforward livelihood issues but are rather complex with a negative impact on the health, economic, and social well-being of our country. Health education is very often construed to be within the realms of sanitation, hygiene, maternal and childcare, yet even in these areas the impact of health education is incomplete and patchy. In developed countries, health education is a key component of the healthcare system and the budget.

Empowering the health-care consumer with the knowledge to understand the health-care system and to question health-care providers should be the goal of health literacy programs.

(PHOTO: Open sewage is often the main water supply in Africa/HUMNEWS)Inadequate sanitation, sub-optimal reproductive health and prevalence of life-threatening infectious diseases were all global phenomena a few hundred years ago. Industrialization and affluence alone did not contribute to optimal human development indicators in developed nations but intensive social engineering through vigorous health education programs contributed to these positive changes. India with its inherent diversity, paradoxes and its recently acquired economic prosperity, has to battle with communicable, non-communicable illnesses and psychosocial disorders.

A rise in road traffic accidents, illnesses related to alcohol, tobacco consumption and psychosocial disorders are increasingly affecting the most productive age group of our country. The long-term repercussions of these preventable deaths can become a huge burden to the nation's economy. Hence there is an urgent need not to restrict health education to primary prevention but expand it to create awareness of secondary prevention, the working of the health-care system, the importance of health insurance, etc.

For positive behavioral changes

To combat these public health problems with our limited health resources and to obtain maximum gain it is essential to create an innovative health education policy that would lead to intrinsic positive behavioral changes amid our general populace. Health education leads to empowerment and emancipation of health-care consumers resulting in a standardised quality health-care system.

Postgraduate, graduate and diploma courses on health education with adequate job opportunities should be created for health educators. Research suggests that an improvement in health literacy has a positive effect on the nation's economy.  A World Bank report indicates that the economic impact of inadequate sanitation in India in 2006 was Rs.1.7 trillion, and in 2010, Rs.2.4 trillion.

(PHOTO: Interestingemails.com) The Planning Commission of India states that India accounts for 9.5 per cent of the total 1.2 million deaths from road traffic accidents, incurring an annual loss of Rs.550 billion. If just these public health problems alone can result in a loss of several trillion rupees, the amount of both direct and indirect losses to the exchequer will be an unimaginable sum when the remaining diseases are calculated.

Undoubtedly the economic reforms have uplifted millions from poverty, but one major illness, an unexpected death or severe injury from a road traffic accident will push them back to their below the poverty (starting) line. Cost-benefit analysis, cost-effective analysis and cost utility analysis are useful and powerful tools for decision making.

To enjoy the fruits of economic reforms holistically, it is mandatory for India to focus on health education, as the huge savings will enable us to achieve the millennium development goals that would in turn lead to the creation of an effective social security system on a par or even superior to what is there in the developed nations. As Mahatma Gandhi said, “it is health that is real wealth, and not pieces of gold or silver.”

---This opinion editorial originally appeared in The Hindu. The author is a practicing obstetrician and gynecologist in India; and a former Tamil Nadu Minister.

With US Health Law Debate at Supreme Court, A Look at the State Of Global Health Care (REPORT)

(Video BNBalenda)

(HN, March 27, 2012) - As the US Supreme Court takes up a controversial healthcare reform bill - the signature campaign issue of President Barack Obama's 2008 election promises - the fate of US citizens healthcare system remains in the hands of just 9 people.  

After two days of hearings at the high court where lawyers on both sides are presenting arguments, the Justices appear closely divided along ideological lines with the majority of questions to the Obama administration's lawyer being about whether Congress had the power to require people to buy medical insurance; the main sticking point of the law.

The court will hear a third and final day of arguments on Wednesday. 26 of the 50 states and a small-business trade group are challenging a law they say would essentially define where the limits would be on US federal power if people opposed to insurance were forced to buy coverage.

The court's ruling on the insurance requirement, which takes effect in 2014 according to current law passed by the US Congress in 2010, could decide the fate of the massive multi-part healthcare overhaul meant to improve access to medical care and extend insurance to more than 30 million Americans.

Outside the venerable Washington, DC courthouse, thousands of people demonstrated for and against the law which many in US politics call "Obamacare".  After the three day presentations, the Court is scheduled to take some time, and release its decision on whether or not the law is constitutional sometime in late summer; making the healthcare issue a central campaign theme again in November 2012 US presidential election. 

A hard fought US Republican candidate race has been playing out for months between former US state of Massachusetts Governor Mitt Romney, former US House of Representatives Speaker Newt Gingrich, former US Senator Rick Santorum, and US Congressman Ron Paul - all of whom have significant professional experience with the healthcare issue.

But for the US public, the physicians community, and the American insurance industry the delay in deciding where the healthcare system is going is troubling and for many, means the - expensive - difference between life and death. 

(GRAPH: NatGeo 2007 table showing relationship between health care costs, life expectancy) The United States spends more on medical care per person than any country, yet life expectancy is shorter than in most other developed nations and many developing ones. Annual U.S. healthcare spending totals $2.6 trillion, about 18% of the annual GDP, or $8,402 per person according to the US Department of Health and Human Services.

A New York Times/CBS News poll showed that a narrow majority of Americans oppose the individual mandate, 51% to 45%, but strongly supported other provisions of the law covering pre-existing medical conditions and allowing young adults to stay on their parents' health insurance plans. Roughly 15% of Americans lack insurance coverage, a factor in life span which contributes to an estimated 45,000 deaths a year.

HEALTHCARE IN OTHER COUNTRIES

In other countries, the decision to create a universal or government supported health care system has been an easier one, long decided upon.

32 of the 33 developed nations of the world have universal health care, with the United States being the lone exception. The following list, compiled from World Health Organization sources, shows the start date and type of  system used to implement universal health care in each developed country; and a `universal health care plan' can mean having both public and private insurance and medical providers.

(GRAPH: Blue countries have a government health system, green going there, orange 2-tier/WHO)These are in order of date of system:  Norway, 1912, Single Payer; New Zealand, 1938, Two Tier; Japan, 1938, Single Payer; Germany, 1941, Insurance Mandate; Belgium, 1945, Insurance Mandate; United Kingdom, 1948, Single Payer; Kuwait, 1950, Single Payer; Sweden, 1955, Single Payer; Bahrain, 1957, Single Payer;  Brunei, 1958, Single Payer; Canada, 1966, Single Payer; Netherlands, 1966, Two-Tier; Austria, 1967, Insurance Mandate; United Arab Emirates, 1971, Single Payer; Finland, 1972, Single Payer; Slovenia, 1972, Single Payer; Denmark, 1973, Two-Tier; Luxembourg, 1973, Insurance Mandate; France, 1974, Two-Tier; Australia, 1975, Two Tier; Ireland, 1977, Two-Tier; Italy, 1978, Single Payer; Portugal, 1979, Single Payer; Cyprus, 1980, Single Payer; Greece, 1983, Insurance Mandate; Spain, 1986, Single Payer; South Korea, 1988, Insurance Mandate; Iceland, 1990, Single Payer; Hong Kong, 1993, Two-Tier; Singapore, 1993, Two-Tier; Switzerland, 1994, Insurance Mandate; Israel, 1995, Two-Tier.

System Types:

Single Payer: The government provides insurance for all residents (or citizens) and pays all health care expenses except for copays and coinsurance. Providers may be public, private, or a combination of both.

Two-Tier: The government provides or mandates catastrophic or minimum insurance coverage for all residents (or citizens), while allowing the purchase of additional voluntary insurance or fee-for service care when desired. In Singapore all residents receive a catastrophic policy from the government coupled with a health savings account that they use to pay for routine care. In other countries like Ireland and Israel, the government provides a core policy which the majority of the population supplement with private insurance.

Insurance Mandate: The government mandates that all citizens purchase insurance, whether from private, public, or non-profit insurers. In some cases the insurer list is quite restrictive, while in others a healthy private market for insurance is simply regulated and standardized by the government. In this kind of system insurers are barred from rejecting sick individuals, and individuals are required to purchase insurance, in order to prevent typical health care market failures from arising.

---HUMNEWS, with research from WHO, Wikipedia, NatGeo.