PacificSci GLOBAL PERSPECTIVES

HEALTH CARE IN CANADA – An Essay

2008-06-15T14:29:00.000-07:00

Preamble: A public consultation on health care, called the Conversation on Health, took place during 2007 in the Canadian province of British Columbia.[1] Our firm made a written submission [2], and now we take the opportunity to transform the core of this into an overview of Canada’s health care, on the premise that this may be of global interest.

NOTE: The essay is written for the Canadian context, so we caution that Canada’s model is NOT readily translatable to most other countries. However, it may be a viable option for economically developed ones that still lack universal coverage.

We reserve the right to change our views on any aspect of this essay as new analysis may emerge to justify revision, and in this sense it may be viewed as a work in progress.

CANADIAN HEALTH CARE – An Overview
Canada’s health system enjoys wide public support. Its most valued features are: universality, portability and no direct fees for insured services, financed by government in accordance with the Canada Health Act (1984). The objective under the Act is "to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers."

While the Canada Health Act resonates politically, not all health modalities are equally recognized. Nor are they equal in terms of need, quality of supporting evidence, nor necessarily affordable. Choices have always have been made. Thus, even though “comprehensiveness” is one of the stated principles, in practice this particular attribute has never been a reality as it refers historically to services deemed “medically necessary” in the context of 3-4 decades ago when the provincial acts supporting universal health care were promulgated. Elements still not adequately recognized include: home care, long term care, dental care, physiotherapy and pharmaceuticals, and others. A relevant question: will universality be applied in future to services not fully financed today?

To the extent that the system delivers on equity therefore, it approaches this only for fully insured medical and hospital-based services; but where coverage is not universal, ability to pay is critical. This contrast reflects how society views health as a public good, what it considers essential, the extent of equity it seeks, and the resources it is prepared to allocate. While the Canadian experience overall has been positive, the commitment and sustainability are remain functions of social values and political will. Canada’s health care system is justifiably a source of pride, but there is still much room for improvement

Health therefore is both a complex social goal and a major enterprise in Canada, mostly now based in the public sector. While compassion and human rights lie at its base, it is also seen in terms of the social and economic benefits it provides to the entire population.

INTER & INTRA JURISDICTIONAL COMPARISONS
A systematic review of 38 studies recently confirmed that Canada’s system leads to health outcomes that are favourable overall when compared with the US private for-profit system, at less than 50% of the cost [3]. However, perhaps more relevant is WHO’s landmark study in 2000 of health systems performance in almost 200 countries, ranking the UK in 18th place, Canada at 31st, and the US (most expensive health care in the world) at 37th. Most European countries performed better than Canada, while Australia’s performance (similar socio-demographics) at 32nd place was virtually tied with Canada [4]. Several other countries also scored better than Canada eg., Singapore, Japan. In our view, rather than dismiss such comparisons (which is unfortunately a defensive reaction in some circles) Canada should study and learn from those systems which appear to be doing better, and (while staying consistent with the core principles of the Canada Health Act) be more prepared to innovate, test and evaluate new approaches. We should also show more interest in the internal comparisons being revealed from within our health and social sectors [5], specifically: why are health conditions so different for different groups within the country, and what can be done about this? The key premise here is to be guided by evidence within the social contract represented by the Canada Health Act.

When one examines overall health status of populations using objective measures, it is tempting to conclude that the health systems of countries with similar socio-economic conditions appear to vary more with regard to cost than performance, irrespective of the public-private mix. However, the type of system does appear to have a strong influence on the indicators of equity. Beyond observing the principle of universality, this is reflected in steadily improving outcomes. A new Canadian study [6] reveals that – over a 25 year period – differences between the richest and poorest quintiles in expected years of life lost amenable to medical care decreased 60% in men and 78% in women. Reductions in rates of death amenable to medical care made the largest contribution to narrowing the socioeconomic mortality disparities. Continuing disparities in mortality in causes amenable to public health suggest that public health initiatives have a potentially important but yet unrealized role in further reducing mortality disparities in Canada.

If we make the political decision that there is probably already enough money in the system, the challenge in achieving better performance necessarily must lie in improving leadership, priority-setting, decision-making and management at all levels: in particular, we must do better on health promotion, public health and preventive medicine. On the other hand, there are many in society and among the ranks of the health professions who believe that the system we have is already doing very well, and – while its underlying principles seem secure – we would adjust its design and the way it is working at our peril. Nonetheless, the existing budget is by definition aligned with the status quo, mostly a legacy of thinking of the early 1970s (when most Canadian provinces launched their particular version of “medicare”). Does it necessarily follow that this is the only formulation we are capable of, or has the time come to expand the scope of health services to more within currently underfinanced sub-sectors eg., pharmacare, dentistry?

LOOKING WHERE THE OBJECT IS LOST, NOT WHERE THE LIGHT IS BEST
When engaged in public debate about health care, as a society Canada tends to focus on the high cost items that preoccupy institutional administrators, while overlooking the powerful forces that preserve our health: healthy living environments and workplaces, primary prevention (eg., nutrition education, childhood immunization, ante-natal care, physical activity, smoking prevention), and social policies (affecting literacy, employment, crime, housing quality and community wellbeing). These are the “upstream factors”. We also become so preoccupied with acute care issues, which are crisis-prone and sometimes glamorized, forgetting not only the upstream factors, but even downstream ones (eg., long-term care, home care) whose availability determines the speed with which acute care patients may move on to more appropriate levels of care.

To the extent that health systems fail, especially with regard to addressing priority needs and the ethic of equity (universality, access, affordability), this most often results from failing to deliver on basic needs, especially for groups that lack power or recognition.

OUR SUGGESTIONS FOR THE CONTINUED STEWARDSHIP OF CANADIAN HEALTH CARE

o That federal and provincial governments continue to recognize health as a public good, recommit to the principles of universality and equity in health services delivery, and curtail private for-profit entities as an alternative in any area of core or essential services. Clearly our governments must continue to ensure that how it puts together services must be in compliance with the Canada Health Act (1984).

o The Government of Canada should be kept under scrutiny regarding the decline in its financial contributions to provincial health services, thereby contravening the Canada Health Act. The “new” federal government must be held accountable for reneging on the Kelowna Accord (investment in aboriginal peoples) and Child Care. These failures to honour prior commitments that enjoyed public support reveal a short-sighted federal political agenda that undermines important determinants of health and social equity.

o Also in the spirit of the Canada Health Act, we urge government to re-examine now what services should be core or essential, and to consider expansion of the scope of publicly financed provisions, with emphasis on the more vulnerable eg., dental provisions for children and the elderly; provisions for new parents eg., maternity leave and child care, and expand the eligibility and/or scope of pharmacare for elderly. This is particularly timely given record governmental budget surpluses in recent years.

o Health care quality and outcomes for Canadian jurisdictions generally compare favorably with those of the US. Nonetheless, the tendency of Canadians to refer to the US performance in health care and outcomes as if this is a desirable norm is misplaced. It makes more sense to learn from the experience of systems elsewhere in the world eg., western Europe, Japan, Singapore, that are better performers than the failing US model. To the extent that Canada looks to the US for systems design support or medical records contracting, this must not threaten privacy; under the current US administration even its own citizens are losing trust regarding the invasion of privacy in the name of security.

o The most critical elements of any health system needs to be public health (ie., population health provisions, including health promotion) and primary health care: to the extent that systems fail, this is often due to failure to support these components. Effort is needed to attract talented individuals to engage in these fields. The responsibility for this lies with professional education institutions, specialty bodies and professional associations, with support from relevant ministries to ensure that effective action is taken.

o There is a need for Canada to strengthen its response to the surging chronic disease burden. The international literature indicates that about half of this burden is potentially preventable through attention to modifiable behaviours eg., smoking, fitness, weight control; and about half of those who do develop these conditions can be prevented from progressing to more complicated forms through attention to secondary prevention eg., blood pressure screening; active glucose monitoring for persons with diabetes.

o When one looks at Canada’s population health internally, it is obvious that there is still a substantial amount of inequity, both regionally eg., northern regions, inner city areas, and by population group eg., First Nations. We therefore recommend that, equity must be given more prominence in the public debate and in government decision making.

References
1. Conversation on Health. Government of British Columbia, Canada (2007): http://www.bcconversationonhealth.ca/EN/401/
2. Pacific Health & Development Sciences. Shaping health in BC – observations and suggestions. Submission to the B.C. Conversation on Health. http://www.bcconversationonhealth.ca/media/PacificSci_COH_Submission.pdf
3. Guyatt GH, Devereaux PJ, Lexchin J, et al. A systematic review of studies comparing health outcomes in Canada and the United States. Open Med 2007;1(1):e27–36.
4. The World Health Report 2000. June 21, 2000. Geneva. http://www.who.int/whr/2000/en/index.html
5. Hertzman C, Irwin LG. It takes a child to raise a community: population-based measurement of early child development. Human Early Learning Partnership. No 1: July 2007. http://www.earlylearning.ubc.ca/
6. James PD, Wilkins R, Detsky, Tugwell, Manuel DG. Avoidable mortality by neighbourhood income in Canada: 25 years after the establishment of universal health insurance. J Epidemiol Community Health 2007; 61:287-296. http://jech.bmj.com/cgi/content/abstract/61/4/287

THE GLOBAL ARMS TRADE - An Atrocity?

2008-05-15T23:09:00.000-07:00

PREFACE: Every gun that is made, every warship launched, every rocket fired signifies, in the final sense, a theft from those who hunger and are not fed, those who are cold and are not clothed. The world in arms is not spending money alone. It is spending the sweat of its laborers, the genius of its scientists, the hopes of its children… This is not a way of life at all, in any true sense. Under the cloud of threatening war, it is humanity hanging from a cross of iron.
— Former U.S. President, Dwight D. Eisenhower, in a speech on April 16, 1953
To find out who shares responsibility for global militarization, follow the money trail. Regardless of attempts to legitimize the trade, the historical reality is that bribery, corruption and mercenary as well as national self-interest lie at the heart of the trade. This month’s blog highlights the mainstream facts and some relevant reference sources.

WORLD MILITARY EXPENDITURES: World military expenditure in 2006 was estimated at $1204 billion in current prices, an increase of 3.5% in real terms since 2005 and of 37% over the 10-year period since 1997. Average spending per capita increased from $173 in 2005 to $177 in 2006 at constant (2005) prices and exchange rates and to $184 at current prices. The USA is responsible for 46% of the world total, distantly followed by the UK, France, Japan and China with 4-5% each.

USA: The rapid increase in the United States' military spending is to a large extent due to continued costly military operations in Iraq and Afghanistan. Between September 2001 and June 2006, the US Government provided a total of $432 billion in annual and supplemental appropriations under the heading 'global war on terrorism'. This massive increase in US military spending has been one of the factors contributing to the deterioration of the US economy since 2001. In addition to its direct impact of high military expenditure, there are also indirect and more long-term effects. According to one study taking these factors into account, the overall past and future costs until year 2016 to the USA for the war in Iraq have been estimated to $2267 billion.

CHINA: In 2006 China continued its steep increase in military expenditure, for the first time surpassing that of Japan and hence replacing Japan as the country in Asia with the highest level of military expenditure and as the fourth biggest spender in the world. Amid intense discussions on the right level of Japanese military spending, Japan decided, for the fifth consecutive year, to reduce its military spending in 2006 while at the same time focusing its military budget on missile defence.

THE GLOBAL MARKET FOR ARMS: Aside from spending on their own military “needs”, it is fairly obvious from the figures quoted below that the leading arms dealing countries in the world are reaping major economic gains from exporting their military technologies. The only G-8 country not ranking highly on arms exporting is Japan.

Sellers: During the period 2000-2006, the US sold $45.4 billion worth of armaments into the global marketplace, ahead of Russia at $40.5 billion, followed by Germany at $11.6 billion and France at $11.1 billion. This was followed by the UK (7.0), the Netherlands (3.7), Sweden (3.1), Italy (3.0), China (2.9) with Ukraine (2.5) completing the top ten. Israel and Canada came in at 2.3B and 1.3 respectively.

Buyers: A comparison of government spending priorities across samples of countries in different per capita income groups shows that the lower the income group, the higher the priority given to military spending in relation to social spending. For example, UN data sources show that military expenditures exceed public expenditures on health or education for almost every country in South Asia (exception: the Maldives). Developing nations continue to be the primary focus of foreign arms sales activity by weapons suppliers.[2] During the years 1996-2003, the value of arms transfer agreements with developing nations comprised 63.9% of all such agreements worldwide. More recently, arms transfer agreements with developing nations constituted 60.4% of all such agreements globally from 2000-2003, and 53.6% of these agreements in 2003. The top seven recipient countries, comprising 59% of all purchases from 1999-2006, are: India 11%, China 8%, Saudi Arabia 8%, Egypt 6%, UAE 6%, Israel 5% and Pakistan 5%.[3]

References:
1. Stockholm International Peace Research Institute. http://www.sipri.org/contents/milap/milex/mex_trends.html Accessed April 24, 2008.
2. Goliath Business Knowledge on Demand. Conventional Arms Transfers to Developing Nations. http://goliath.ecnext.com/coms2/gi_0199-4561391/Conventional-Arms-Transfers-to-developing.html Accessed April 25, 2008.
3. Anup Shah. Arms Trade – a Major cause of Suffering. October 30, 2007. http://www.globalissues.org/Geopolitics/ArmsTrade/BigBusiness.asp

COMMENTARY
There is clear evidence that the international transfer of arms or the training of foreign security forces can provide repressive governments and abusive armed groups with the means to carry out or intensify gross human rights violations. Arms brokers have been at the center of many of the most disturbing arms deals, including weapons transfers to abusive armed groups and countries under U.N. arms embargoes.[1] From 1998 to 2001, the USA, the UK, and France earned more income from arms sales to developing countries than they gave in aid.
The arms industry is unlike any other. It operates without regulation. It suffers from widespread corruption and bribes. And it makes its profits on the back of machines designed to kill and maim human beings. So who profits most from this murderous trade? The five permanent members of the UN Security Council—the USA, UK, France, Russia, and China. Together, they are responsible for eighty eight per cent of reported conventional arms exports. “We can’t have it both ways. We can’t be both the world’s leading champion of peace and the world’s leading supplier of arms.” Former US President Jimmy Carter, presidential campaign, 1976

References:
1. Amnesty International USA. http://www.amnestyusa.org/our-priorities/arms-trade/page.do?id=1011003&n1=3&n2=24 Accessed April 25, 2008.
2. The Arms Industry. Control Arms Campaign, October 2003. http://www.controlarms.org/the_issues/arms_industry.htm Accessed April 25, 2008.

RECOMMENDED SITE: We close this brief review with reference to a specialized website that we believe lays out the facts in a much more comprehensive manner than we have done:
Reference: Anup Shah. Arms Trade – a Major cause of Suffering. October 30, 2007. http://www.globalissues.org/Geopolitics/ArmsTrade/BigBusiness.asp

SEX RATIOS DESTABLIZING IN ASIA

2008-04-15T08:37:00.000-07:00

PREAMBLE: “Sex ratio” (SR) refers to the ratio of males to females (M:F) in a population. Due to higher life expectancy of females in most populations, SRs tends to decline across adult age groups. Values for the world population are: overall 1.01; at birth 1.06; under 15 years still 1.06; 15-64 = 1.03; and >65 years = 0.79.

We are focusing on this topic because dramatic shifts in sex ratio are taking place in some parts of the world that reveal cultural preferences and social practices favoring the birth/survival of one sex over the other (more often favoring males over females). Other factors influencing the sex ratio of societies include: changing composition by ethnicity and race; civil unrest or warfare; large-scale immigration e.g., male labourers unable to travel with their families; ecological factors eg contaminants in environment; variables affecting mother’s health eg social status, smoking, nutrition, access to support networks.

Our main source for this issue is an analysis carried out by the United Nations Population Fund (UNFPA) which we have summarized below. Further below, we offer a brief commentary, and some focused observations pertaining to India and China.

Feature Report: SEX RATIO IMBALANCES IN ASIA: TRENDS, CONSEQUENCES AND POLICY RESPONSES.
Asia’s population dynamics in recent decades reveal an alarming increase in the sex ratio (SR) within local populations. The ratio at birth (SRB) started to increase in East Asia from 1980-85, and in South-Central Asia from 1985-90, while elsewhere in Asia, SRBs remained relatively constant. In some regions, the SRB exceeds 1.30 e.g., Guangdong and Hainan in China. There are also variations in SR levels within each country in Asia, as well as between religious, ethnic and socio-economic groups; these have been well studied in India. Since, generally, the SR overall has remained relatively stable in Asia, the growing contribution of the younger generation to the growing SR imbalance has offset the opposite progress in SR being made by adults, among which mortality improvements have particularly benefited the female population.

The rise in SRB is linked to the introduction of pre-natal sex selection in many Asian countries following the arrival of ultrasound and amniocentesis technologies in the late 1970s. The deeply rooted preference for sons in Asia is related to a long list of demand factors such as social customs, marriage costs, old-age support, leading parents across cultures and geographic locations to decide against allowing a girl to live, even before her birth. Indeed, if the continent’s overall SR was the same as elsewhere in the world, in 2005 Asia’s population would have included almost 163 million more women and girls.

The ramifications of such an imbalance will continue for decades. While men of marriageable age will suddenly find a dramatic shortage of potential brides, it is girls and women of all ages who will truly feel the brunt of this dynamic, with forecasted increases in gender-based violence, trafficking, discrimination and general vulnerability of women and girls. The main question now concerns the intensity and tempo of the sex-ratio transition in relation to spontaneous social and economic changes, and to government actions. These are, to a large extent, the dimensions that will determine the severity of the crisis, and the overall number of men, women, boys and girls affected.

Key Conclusions:
• The sex ratios of Asian countries are in various phases of transition.
• Gender discrimination, son preference and the resultant unequal status of women and
girls have contributed to an in increasing demand for sex-selection services.
• In many regions, several generations will be affected by a severe marriage squeeze,
regardless of what is done today.
• Initiatives taken today will shape Asian societies in which future generations will live.

The Way Forward:
• Improve monitoring of trends and differentials in SRB and related discriminatory behaviours.
• Coordinate research on the harmful impact of imbalanced SRs already observed in Asia.
• Make eliminating sex selection an immediate priority for government and civil-society
organizations.
• Facilitate sharing of policy experiences across regions and countries in Asia.
• Develop strategies and interventions for greater engagement and accountability by
men and boys in confronting violence against women (including sex selection) and for promoting gender equality, women’s sexual and reproductive health and rights.

Reference: Sex-ratio Imbalance in Asia: Trends, Consequences and Policy Responses. Executive Summary of Regional Analysis. 4th Asia Pacific Conference on Reproductive and Sexual Health and Rights. Oct 29-31, 2007 Hyderabad, India. UNFPA.
http://www.unfpa.org/gender/docs/studies/summaries/reg_exe_summary.pdf

COMMENTARY: Although many factors influence sex ratios, women’s education is the most powerful factor in reducing son preference. Educated women are less likely to prefer sons over daughters, and highly educated women even less so. Women’s exposure to primary-level schooling reduces son preference, and exposure to secondary-level education or higher is even more profound. Moreover, how many women are educated matters: women in villages with higher levels of female literacy are less likely to prefer sons than women in villages where most women are illiterate. Greater exposure to media is associated with weaker son preference, even after controlling for education and wealth.

India [1]: One of the biggest concerns in India with regard to son preference is that decades of policy efforts have not achieved positive change, and worsening sex ratios indicate a deteriorating situation. Most government policy related to son preference has focused on reducing sex-selective abortion, but it also important to address the underlying parental motivation. One important source for policy inspiration on this issue would be to better understand the motivations and social norms of women and communities who do not express son preference. Attention needs to be focused also on what is happening to surviving girls i.e., their health and nutritional discrimination. A specific category of surviving girls is much more vulnerable than the rest - girls with older sisters.

China [2]: Chinese authorities have pledged tough measures to control fetus-gender testing and sex-selective abortions, warning that people who illegally test the gender of fetuses and perform sex-selective abortions or who kill, abandon or injure infant girls or ill-treat their mothers, will be severely punished. Medical procedures that use ultra-sound technology to check fetal health will be more closely supervised. In an attempt to halt the growing imbalance, a "Care for Girls" campaign was launched nationwide in 2000 to promote gender equality. Cash incentives are offered to girl-only families in the countryside. Authorities also pledged to continue the 33-year-old family planning policy, as the country still faces huge challenges from a growing population. Formulated in the early 1970s, the family planning policy encourages late marriages and late childbearing, and limits most urban couples to one child and most rural couples to two. The policy is credited with preventing 400 million births but faces a challenge in rural regions, where the traditional preference for male heirs has not changed. The authorities promised to continue to improve family planning services in rural areas and help girl-only families.

References:
1. Son Preference and Daughter Neglect in India. What happens to Living Girls? Rohini Pande and Anju Malhotra. 2006 International Center for Research on Women.
http://www.icrw.org/docs/2006_son-preference.pdf
2. Rising sex-ratio imbalance ‘a danger’. Xinhua, China Daily. Updated: 2007-01-23 07:16. http://www.chinadaily.com.cn/china/2007-01/23/content_789821.htm

HUMANITARIAN SITUATION IN GAZA WORST IN FOUR DECADES

2008-03-15T11:31:00.000-07:00

PREAMBLE: This issue features a report recently released by six international humanitarian NGOs (Amnesty International, Christian Aid, CAFOD, CARE, OXFAM, Save the Children, Trocaire), documenting the situation in Gaza as the worst since the 1967 war between Israel and its neighbours. The deterioration can be attributed mostly to the period since mid-2007 when Israel imposed a blockade. For "balance", we cite two reports from Israeli media; we also recognize that – like Canadians and their government –the views of all Israelis are not necessarily reflected in the policies of their government.

Canadian Complicity: This report should be of particular concern for Canadians, especially because Canada (under the minority Conservative government of Stephen Harper) is the only member country to vote against a recent United Nations Human Rights Council motion calling for immediate international action to force Israel to allow fuel, food, medicine and other essential items to be sent to the Gaza Strip, to reopen border crossings and to end its “grave violations” in the occupied Palestinian territory. References: 1. http://presscue.com/node/45049 2. http://radio.un.org/detail/8975.html

The UN Human Rights Council motion expressed deep concern about the “incessant and repeated Israeli military attacks and incursions,” which had killed and injured many Palestinian civilians. The resolution demanded “that the occupying power, Israel, lift immediately the siege it has imposed on the occupied Gaza Strip, restore continued supply of fuel, food and medicine and reopen the border crossings.” It called for protection of civilians in occupied Palestine in line with human rights law and international humanitarian law, and urged all parties to refrain from violence against civilians.

The text also called on the Office of the High Commissioner for Human Rights (OHCHR), to report to the Council at its next session on the progress made towards implementing the resolution. The High Commissioner Ms. Arbour (a respected Canadian jurist) told the Council’s special session that the situation for both Palestinians and Israelis will continue to deteriorate unless both parties to the conflict and the international community take broader steps to action. “All parties concerned should put an end to the vicious spiral of violence before it becomes unstoppable,” she said. “To this end, they must ensure accountability for breaches of international humanitarian law and violations of international human rights law through credible, independent, and transparent investigations.”

Ms. Arbour added that the Israeli practice of collective punishment, disproportionate use of force and targeted killings continued, as did the Palestinian militants’ practice of indiscriminate firing of mortars and rockets into Israel.

Shortly afterwards, in early March 2008, Louise Arbour tended her resignation. While denying pressure to leave, there is no doubt she has been under continuing pressure from various interests for being such a forceful advocate for human rights. While Ms Arbour gave family reasons for stepping down, the fact that her own country Canada voted uniquely against this UN Human Rights Council resolution should not be ignored.
Reference: http://www.amnesty.org/en/news-and-updates/news/un-high-commissioner-human-rights-resigns-20080310

Feature Report: A HUMANITARIAN IMPLOSION.
Basic Services: The blockade is destroying public service infrastructure in Gaza. The Israeli government prevents repair and maintenance of electricity and water service infrastructure in Gaza by prohibiting the import of spare parts. The impact of this is amplified by Israel’s parallel punitive restrictions on fuel and electricity. Hospitals cannot generate electricity to keep lifesaving equipment working or to generate oxygen, while 40-50 million tons of sewage continues to pour into the sea daily 14. In September 2007, an UNRWA survey in Gaza revealed a nearly 80% failure rate in schools grades four to nine, with up to 90% failure in Mathematics. In January 2008, UNICEF reported that schools in Gaza had been canceling classes that are high on energy consumption, such as IT, science labs and extra curricular activities.

Basic Medical Supplies and Access to Treatment: As a result of fuel and electricity restrictions, hospitals are currently experiencing power cuts lasting for 8-12 hours a day. There is currently a 60-70 % shortage reported in the diesel required for hospital power generators. According to the World Health Organization, the proportion of patients given permits to exit Gaza for medical care decreased from 89.3% in January 2007 to 64.3% in December 2007, an unprecedented low. It is important to note that even those patients who are granted permits to exit Gaza are often denied access at the crossing itself. Twenty-seven such cases were reported in the month of October alone. WHO has been monitoring the access of patients to specialized health services not available within Gaza. One main indicator monitored since October 2007 is the death of patients due to lack of access to referral services. During the period October-December 2007, WHO has confirmed the deaths of 20 patients, including 5 children.

A New Policy for Gaza: The blockade has effectively dismantled the economy and impoverished the population. Israel’s policy affects the civilian population of Gaza indiscriminately and constitutes a collective punishment against ordinary men, women and children. The measures taken are illegal under international humanitarian law. Israel has the right and duty to defend itself against indiscriminate rocket attacks against its civilian population, but the current policy fails to provide Israel with increased security and has led to increasing polarization. As the head of UNRWA has pointed out, ‘Hungry, unhealthy, angry communities do not make good partners for peace.’ International efforts should be directed towards securing a swift end to the blockade of Gaza. Israel’s current policy of isolation and refusal to engage with all elements of the Palestinian leadership only closes doors to negotiations while reinforcing the political and humanitarian crisis. There is an urgent need for Palestinian dialogue and reconciliation in order to create and sustain a credible and effective peace process with Israel. The international community must provide the political support to facilitate such an undertaking. To date, failure to address the situation in Gaza has harmed both Palestinians and Israelis and has been detrimental to the broader peace process itself.

Source: Amnesty International, Christian Aid, CAFOD, CARE, OXFAM, Save the Children and Trocaire. The Gaza Strip: a humanitarian implosion. Embargoed until March 6, 2008 http://my.ynet.co.il/pic/news/5.3.08/embargoedGazalowreswithout.pdf

As Reported in the Israeli Media
ISRAEL NEWS: The situation for 1.5 million Palestinians in the Gaza Strip is worse now than it has ever been since the start of the Israeli military occupation in 1967. The current situation in Gaza is man-made, completely avoidable and, with the necessary political will, can also be reversed. Gaza has suffered from a long-term pattern of economic stagnation and plummeting development indicators. The severity of the situation has increased exponentially since Israel imposed extreme restrictions on the movement of goods and people in response to the Hamas take over of Gaza and to indiscriminate rocket attacks against Israel. This report illustrates the gravity of the current situation across key sectors.

According to the report, the economic isolation of the 1.5 Palestinians living in Gaza has worsened unemployment and poverty and caused education and health services to deteriorate. Over a million people – 80% of the families - in the Strip are currently dependent on food supply from international aid agencies, compared to 63% of the families in 2006. Additionally, the number of trucks allowed to enter Gaza daily currently stands at only 45, compared to an average of 250 in the past. The Israeli ban on the transfer of raw materials has led to the freezing of 95% of industrial projects. As a result, almost all the factories in the Strip have gone bankrupt and forced to close.

Hamas' takeover of the Strip has also had a devastating effect on the local economy. Between June and September 2007, the rate of Palestinians earning less than $1.2 a day rose from 55% to 70%. The unemployment rate in Gaza currently stands at 40% and experts believe it might soon reach 50%. In the last year alone, some 75,000 people have lost their jobs.

Hike in Food Prices: The closure on the Strip and the collapse of the local economy have also contributed to a sharp increase in food prices. In 2007, Gazans spent 62% of their income on food supplies, compared to only 37% in 2004. The prices of flour and milk climbed 34% and 30% respectively between May and July 2007. Rice prices jumped by 20% over the same period.

As a result of the limited fuel and electricity supply, hospitals in Gaza face long power cuts, which last up to 12 hours a day. The report states that 18.5% of Palestinians who applied for medical treatment outside the Strip were rejected in 2007 and that the number of Palestinians who were approved treatment outside Gaza dropped by 25%. Twenty people awaiting an entry permit to Israel to receive medical treatment have died between October-December 2007, including five children.

'Exert greater pressure on Israel': The report's authors call on the UK government and the European Union to exert pressure on the Israeli government to lift the blockade on Gaza and refrain from limiting fuel and electricity supply to the Strip. The groups also urge the UK and EU to help mediate a truce between the Palestinian factions, in order to facilitate talks between Israel and the PA. The report further calls on the Palestinian terror groups to cease rocket attacks and refrain from targeting civilians, and urges Israel to stop strikes in Gaza.

Source: Israel News March 6, 2008/yNetNews.com Mar 6, 2008
http://www.ynetnews.com/articles/0,7340,L-3515538,00.html

JERUSALEM POST: For more on Israel’s rejection of the report, laying blame on Hamas, visit Jerusalem Post, March 7, 2008. http://www.jpost.com/servlet/Satellite?pagename=JPost%2FJPArticle%2FShowFull&cid=1204546412033

CANADIAN POLITICS TRUMPS NUCLEAR SCIENCE, HEALTH AND SAFETY

2008-02-15T00:08:00.000-08:00

PREAMBLE: This issue draws attention to the apparent disregard for nuclear safeguards recently revealed by Canada’s “new” government. The minority Conservative government’s failure to respect the role of the Canadian Nuclear Safety Commission puts into question whether Canada takes nuclear safety seriously. For a synopsis of this episode, we paraphrased and updated the core content of a January 2008 article in The Star by Walkom (acknowledged below). Further down, we summarize a report from the Canadian Medical Association Journal that reveals the manipulative attitude of the Canadian medical isotope industry, paraphrased from a CTV News report. The main story is how Canada’s government put politics ahead of public health and safety. Clearly there are questionable commercial and political practices in Canada at present.
For late breaking news on this story, visit our sidebar.

CANADA’S AND NUCLEAR SAFETY – FIRE THE MESSENGER!
OTTAWA Jan 17, 2008: Doubts have been raised among experts around the world about Canada's ability to effectively regulate reactors, uranium mines, fuel manufacturers and other potentially dangerous installations. This is because Prime Minister Stephen Harper says that his Conservative government fired the country's top nuclear regulator for not doing her job. However, to the contrary, the evidence reveals that Canadian Nuclear Safety Commission (CNSC) head Linda Keen was fired because she was doing her job. As specified in the Nuclear Safety and Control Act, this was to ensure that radioactive material is created and used safely.

Two years ago, CNSC renewed Atomic Energy of Canada Ltd.'s (AECL) operating licence for a reactor at Chalk River (Ontario) that produces medical isotopes. As a condition of licensing, AECL was required to upgrade safety systems on the 50-year-old reactor by installing two new pumps. During a routine inspection in November 2007, inspectors found that the pumps had not been installed. CNSC shut the reactor down so that AECL would comply with its order.

Then media stories began to appear suggesting that Canada faced a severe isotope shortage that could lead to some medical tests and treatments being delayed. This promptly became a cause celebre for federal politicians seeking to make political hay of the regulatory agency. However, despite some local isotope shortages (that could have been averted by better federal-provincial health service planning) there is no record of anyone's health being harmed during this “crisis”. By the time politicians inserted themselves, AECL had already installed one of the pumps and was readying the second. On December 11, an AECL official told the House of Commons that the necessary safety upgrades could be completed with just 16 more days of reactor down time. Shortly after, Prime Minister Stephen Harper accepted the resignation of Michael Burns, chair of AECL (a heavily subsidized but under-funded Crown corporation), effective Dec 31.

The government's “case” against the regulatory agency, articulated by Natural Resources Minister Gary Lunn at a Commons committee (January 16), is that it was Keen's job to get Chalk River up and running. In fact, as the minister responsible for AECL, that task belonged to him. Lunn's additional “arguments” also make little sense. He characterized AECL's failure to meet the CNSC safety standards as a "dispute" between two agencies – which is rather like suggesting that someone who breaks the law is having a "dispute" with the judge! He also insisted the issue was one of "licensing" rather than safety, even though the rationale for licensing a reactor is to ensure its safe operation! And he made the disturbing claim, not reflected in law, that the government has the right to fire any head of the regulatory commission at will and without cause even though this would render impotent CNSC as a quasi-judicial commission that has its own legal mandate for good reason.

The game being played by Harper’s Conservatives is highly questionable. Green Leader Elizabeth May is probably close to the truth when she says he is trying to defang the regulatory watchdog at the behest of Canada's nuclear industry.

Source: Adapted from Thomas Walkom. The Star. Jan 17, 2008. http://www.thestar.com/News/Canada/article/294886

HOW CANADA COULD HAVE AVOIDED THE ISOTOPE "CRISIS"
CTV NEWS: Canada could have avoided the alleged isotope “crisis” if Canadian supplier MDS Nordion had joined international efforts to co-ordinate global production, a report in the Canadian Medical Association Journal (CMAJ) says. This states that MDS Nordion wouldn't co-operate with Europe's two large isotope suppliers (Nuclear Research and Consultancy Group in the Netherlands, and the Institut National des Radioelements in Belgium). These suppliers share concerns about safety and distribution, and co-ordinate production schedules to ensure one reactor is always running. They also communicate with another isotope supplier, Nuclear Technology Products in South Africa but apparently can't pry information out of MDS Nordion, which provides about half the world's supply, made at AECL’s Chalk River reactor.

Kevin Charlton of the Netherlands' Nuclear Research and Consultancy Group told CMAJ that "Nordion is represented at our meetings. (But) either AECL doesn't tell Nordion or they don't allow Nordion to tell us.'' The CMAJ article says Nordion did not grant an interview for the piece, but quoted an e-mail message in which Nordion said it was "focused and committed to providing medical isotopes to the medical community." Neither AECL or MDS Nordion responded to requests for reaction to the report in the CMAJ.

As reported in our opening article (above) the federal government instead very noisily laid the entire blame for the shortage on the nuclear regulatory agency! It fired CNSC president Linda Keen, arguing that she failed to take into account the impact of the reactor closure on isotope supply. Keen says she couldn't authorize the startup of the reactor because she was legally bound to ensure the safety of Canadians from nuclear accidents. Health Minister Tony Clement maintained the government had no choice but to legislate reopening the reactor given Keen's “intransigence” and the “absence of an alternate supply”. He insisted that the four other isotope-producing reactors in the world could not have filled the gap left by the Chalk River shutdown.

In contradiction to Canada’s Conservative politicians, University of Texas Professor Alan J. Kuperman, Policy Analyst for the Nuclear Control Institute in the United States, told CMAJ it's not in MDS Nordion's commercial interests to join in international contingency planning with rival suppliers. "They see themselves as the big dog,'' said Kuperman. ''They are not going to share information with the small ones nipping at their heels.'' Kuperman maintained there is plenty of "surplus capacity'' among isotope suppliers but MDS Nordion and AECL didn't want competitors to pick up the slack when the AECL reactor was shut down. "Instead, they went to the public and the Canadian government. That was misleading and… socially irresponsible.''

Source: The Canadian Press Mon. Feb. 4 2008 8:32 PM ET http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20080131/chalk_river_080204/20080204?hub=Canada&s_name=

Editorial Comment:
So who to believe in this vaudeville production - the politicians and their industry bed-fellows, or the scientists and regulators? To the extent that there was an incipient health care crisis, the actual shortage of medical isotopes appears to have been minimal and would have been contained without political posturing. Fundamentally, there would have been no “crisis” if the respective Conservative Ministers for Natural Resources and Health had been doing their jobs. Instead, as a smokescreen for their own negligence and incompetence, vicarious though these may be as is Harper's ultimate responsibility for AECL as a Crown corporation (although to his credit, AECL President Burns resigned for that), they fired the regulator! Unbelievable? Sadly no, comic opera is in the Canada's “new” political tradition.

Given that AECL’s Chalk River reactor is the world’s largest supplier of medical isotopes, and its uncooperative behaviour (as documented by CMAJ), it has been speculated that Canada’s Conservative government was acting in cahoots with AECL and MDS Nordion to protect a lucrative export market, and needed a scapegoat. The end result of this raucous episode, designed to sow confusion over whose role it really is to do what, is to attract world attention to Canada’s willingness to sacrifice nuclear safety to the whims of politics and commercial profit. One likely outcome is that Canada will now face new, more ethical and more scientifically advanced (e.g., cyclotron technology) competition from other countries capable of scaling up isotope production.

On the abuse of a senior public servant acting with due diligence, the episode revealed the unsavoury mindset of a Prime Minister on the brink of mendacity when he almost unbelievably alleged that the regulatory decision was “partisan” because Keen was appointed by the previous government! This crass use of the bully pulpit exposes the PM for the partisan “leadership” he himself so clearly personifies. As for the unmanly Cabinet ministers busily holding his coattails, having fallen so short of the responsibilities required of their own portfolios, their instincts for political survival apparently led them to embellish this complex cover-up.

Except for the fact that the underlying issue of nuclear safety is so important, the whole episode could be rewritten as a farce (definition: a light dramatic work in which highly improbable plot situations, exaggerated characters, and often slapstick elements are used for humorous effect); but even then we would need better actors than currently offered up by Canada’s “new” government.

Due to the critical debate on Canada’s role Afghanistan, which diverted media attention immediately following this fiasco, the Conservatives may have escaped the full measure of public scrutiny that this deserved. For this reason, we are shining this light on the story for our global readers so that they may be aware of the kind of governance we are now experiencing in Canada.

At least one good thing comes out of this experience: the example of the principled Ms Keen on standing by her duty as the nuclear regulator. Despite being undermined by federal politicians, as a leader in her field (biosketch below), she wins respect from the science policy community.

The issue has not gone away, and there are calls for a public inquiry. However, most of the political parties are keeping their heads down now; the only party to have shown much gumption on the issue is the Green Party of Canada. It could well return as an election issue.

BIOSKETCH – Linda Keen
Linda J Keen was President of the CNSC since January 2001, and her term was renewed in 2005. As President, she chaired a quasi-judicial tribunal that sets regulatory policy and makes licensing decisions related to nuclear facilities. With 4,500 licenses covering all aspects of the industry from mining to refining, power and research reactors to clinics and industrial uses, CNSC provides regulatory oversight on behalf of Canadians. The CNSC is also the Canadian agency that implements measures respecting international control of the development, production, transport and use of nuclear energy and substances. The CNSC is crucial to Canada’s adherence to global agreements respecting the non-proliferation of nuclear weapons and explosive devices.

Ms. Keen was Chair of the International Nuclear Regulators Association (INRA) in 2003. She is now President of the Convention on Nuclear Safety, involving international peer review among 65 signatory countries to ensure worldwide nuclear safety. She was Honorary Chair of the 2006 Women in Nuclear Conference, held in Canada for the first time, and the keynote speaker of the 2005 International Conference of Women in Science and Engineering held in Seoul, South Korea. In January 2007, Ms. Keen was instrumental in establishing the Heads of Federal Administrative Tribunals Forum and is serving as the first Chair of this network. She was appointed in May 2007 as a director of the Canadian Council of Administrative Tribunals.

Source: http://209.85.173.104/search?q=cache:V1LSrNXXj8AJ:www.cnsc-ccsn.gc.ca/eng/about/organization/ljkeen/+linda+keen&hl=en&ct=clnk&cd=1&gl=ca

WORLD DEVELOPMENT CALLS FOR INVESTMENT IN AGRICULTURE 2008

2008-01-15T01:01:00.001-08:00

PREAMBLE: The World Development Report 2008 (reference link below) calls for greater investment in agriculture in developing countries. This annual World Bank report warns that the sector must be placed at the center of the development agenda if goals of halving extreme poverty and hunger by 2015 are to be realized.

o While 75% of the world’s poor live in rural areas in developing countries, a mere 4% of official development assistance goes to agriculture.
o In Sub-Saharan Africa, a region heavily reliant on agriculture for overall growth, public spending for farming is also only 4% of total government spending and the sector is still taxed at relatively high levels.
o GDP growth originating in agriculture is about four times more effective in raising incomes of extremely poor people than GDP growth originating outside the sector.

Said World Bank Group President Robert B. Zoellick: “At the global level, countries must deliver on vital reforms such as cutting distorting subsidies and opening markets, while civil society groups, especially farmer organizations, need more say in setting the agricultural agenda.”

In this issue we focus on Malawi as a Case Study of the role of new subsidies to enhance agricultural production, despite decades of donor proscription not to subsidize, and take note of a World Trade Organization investigation into the use by the United States of truly massive trade-distorting farm subsidies in violation of international commerce rules.

Reference : World Development Report 2008: Agriculture for Development. http://econ.worldbank.org/WBSITE/EXTERNAL/EXTDEC/EXTRESEARCH/EXTWDRS/EXTWDR2008/0,,contentMDK:21410054~menuPK:3149676~pagePK:64167689~piPK:64167673~theSitePK:2795143,00.html

Case Study - ENDING FAMINE IN MALAWI
After a disastrous corn harvest in 2005, almost 40% of Malawi’s 13 million people needed emergency food aid. Move forward to 2007, and Malawi is selling more corn to the UN’s World Food Programe than any other country in southern Africa. Farmers explain the extraordinary turnaround with one word: fertilizer.

Over the past 20 years, the World Bank and some rich nations Malawi depends on for aid have periodically pressed this small, landlocked country to adhere to free market policies and cut back or eliminate fertilizer subsidies, even as the USA and Europe extensively subsidized their own farmers. But after the 2005 harvest, the worst in a decade, Bingu wa Mutharika, Malawi’s newly elected president, decided to follow what the West practiced, not what it preached, reinstating and deepening fertilizer subsidies.

The country’s successful use of subsidies is contributing to a broader reappraisal of the crucial role of agriculture in alleviating poverty in Africa and the pivotal importance of public investments in the basics of farm economies: fertilizer, improved seed, education, credit and agricultural research. Malawi’s leaders long favored fertilizer subsidies, but reluctantly acceded to donor prescriptions, often shaped by foreign-aid fashions in Washington, that featured faith in private markets and antipathy to public intervention.

In a withering evaluation of the World Bank’s record on African agriculture, the bank’s own internal watchdog concluded in October not only that removal of subsidies had led to exorbitant fertilizer prices in African nations, but that the bank itself often failed to recognize that improving Africa’s declining soil quality was essential to lifting food production.

In Malawi, deep fertilizer subsidies and lesser ones for seed, abetted by good rains, helped farmers produce record-breaking corn harvests in 2006 and 2007. An independent evaluation, financed by the USA and the UK, found that the subsidy program accounted for a large share of this year’s increase in corn production. The harvest also helped the poor by lowering food prices and increasing wages for farm workers.

Malawi’s determination to heavily subsidize fertilizer and the payoff in increased production are beginning to change donor attitudes, say economists who have studied Malawi’s experience. The UK (DFID) contributed $8 million to the subsidy program last year. Bernabé Sánchez, an economist with the agency in Malawi, estimated the extra corn produced because of the $74 million subsidy was worth $120 million to $140 million. The US, which has shipped $147 million worth of American food to Malawi as emergency relief since 2002, but only $53 million to help Malawi grow its own food, has not provided any financial support for the subsidy program, except for helping pay for the evaluation of it. Over the years, the USAID has focused on promoting the role of the private sector in delivering fertilizer and seed, and saw subsidies as undermining that effort. But Alan Eastham, the US ambassador to Malawi, said in a recent interview that the subsidy program had worked “pretty well,” though it displaced some commercial fertilizer sales. And the World Bank now sometimes supports the temporary use of subsidies aimed at the poor and carried out in a way that fosters private markets.

In Malawi, bank officials now support Malawi’s policy, though they criticize the government for not having a strategy to eventually end the subsidies, and... say there is still a lot of room for improvement in how the subsidy is carried out. “The issue is, let’s do a better job of it,” said David Rohrbach, a senior agricultural economist at the bank. Though donors are ambivalent, Malawi’s farmers have embraced the subsidies. And the government moved this year to give its people a more direct hand in their distribution.

Source: Adapted from the article by Celia Dugger. Ending Famine, Simply by Ignoring the Experts. New York Times Dec 2, 2007 http://www.nytimes.com/2007/12/02/world/africa/02malawi.html

WORLD TRADE ORGANIZATION INVESTIGATION INTO US SUBSIDIES
GENEVA (AP) — The WTO has opened an investigation into whether the US was violating international commerce rules that limited subsidies to American farmers, three days after the US Senate approved a $286 billion farm bill. Brazil and Canada, frustrated by US resistance to cutting back on subsidies, asked the WTO to condemn Washgton for exceeding permitted levels of what it called trade-distorting handouts to American producers of crops like corn, cotton, rice, soybean and wheat. The panel is expected to issue a first ruling in 2008. The dispute system often takes years before a final decision is reached, but can force countries to change their legislation or face billions of dollars in retaliatory sanctions. The battle over farm subsidies could become a landmark dispute for the WTO because Brazil’s complaint includes payments for ethanol production. The trade body has largely steered clear of energy issues in its 12-year history.

Source: Bradley S. Klapper. Associated Press. December 18, 2007

INTERNATIONAL & GLOBAL DEVELOPMENT - YEAR IN REVIEW 2007

2007-12-15T00:01:00.000-08:00

LATE BREAKER: For a thought-provoking critical analysis of what the Bhutto assassination on December 27 means for Pakistan and the "war on terror", see the new addition in our sidebar.

PREAMBLE: This issue also completes our first full year of blogging. Drawing from topics covered during the year, we offer below: overviews views on three major issues for humankind, followed by paraphrases from our monthly themes in 2007.

THREE LEADING ISSUES FROM 2007: Flowers or Fertilizer?
1. GLOBAL STEWARDSHIP: In our view, the lead issue here is Climate Change (May, October), which is already displacing some of the world’s vulnerable populations, and ultimately threatening life on this planet. This is followed closely by global food security (February) and displacement by rich countries of grain for use as automotive fuel, thereby creating pressure on its use in food in developing countries, and even the price of food in developed ones, impacting on access and affordability. Flowers: to the European Community for its global leadership on climate. Fertilizer: To Canada’s Conservative government which has set the world’s worst example of procrastination on climate.

Note: At the recently concluded UN Climate Summit in Bali, Canada received a “Fossil Award” for its dismal performance on addressing climate change, while the tactics adopted by our Conservative government to undermine the developing global consensus on the need for binding targets now were described by numerous observers as "hypocritical" and “deceitful”.

2. INTERNATIONAL DEVELOPMENT: Viewed broadly, we consider the leading issue here to be Maternal & Child Health (April, November). The determinants include gender inequality, global poverty, and insufficient policy and program development at all levels. Even in developed western countries this is an issue: taking our own country Canada as an example, the “new” Conservative government’s reneged on the Kelowna Accord to improve conditions for aboriginals, and failed to ensure an adequate child care platform (March, April). Further, with the exception of the Nordic nations, official development assistance from wealthy developed countries is still far less than targets agreed decades ago. Flowers: Norway, whose 4.7 million people already contribute almost $4 billion a year to aid developing countries ($850 for each Norwegan man, woman and child). Fertilizer: The powerful G7 nations for allocating proportionally less Gross National Income (GNI) for international development: 0.30%, compared with .50% for non-G7 nations.

3. HUMAN RIGHTS ABUSES: Still topping the list continues to be the War in Iraq (January, August). Primary responsibility is shared between the Bush and Blair regimes (not equally) for promoting false rumours of weapons of mass destruction, unsupported by UN inspections led by Hans Blix. While insurgents share responsibility for the mayhem and catastrophe, the end results include over half a million Iraqis killed (a genocide?), massive numbers of refugees, and the undermining of Geneva Conventions that were born out of the worst excesses of World War 2. Flowers: Pastor Martin Niemoller (1892-1984). Fertilizer: George Bush (most dangerous US President in history).

Historical Notes:
1) For a revealing 2003 interview of Hans Blix, visit: http://www.truthout.org/docs_03/041203A.shtml
2) For an October 2006 update on JHU estimates of Iraqi deaths: http://www.jhsph.edu/publichealthnews/press_releases/2006/burnham_iraq_2006.html

2007 AS WE RECORDED IT:
⁭ January: PEACE, SECURITY, HEALTH & HUMAN RIGHTS: In our first issue of 2007, we took note of the incoming UN Secretary General Ban Ki-moon, acknowledging the immense contribution of former Secretary-General Kofi Annan, focused on war and peace in the Middle East, and completed the transfer of reports and commentaries from our News & Reports site (as announced in our December 2006 posting).

⁭ February: GLOBAL FOOD SECURITY – A MATTER OF SURVIVAL: In 1996, the World Food Summit set a target to halve the number of undernourished people by 2015. However, in 2007, it appears unlikely that this target will be met. This issue focused on the conflict between grain for fuel or for food, the stalled Doha round, and food security.

⁭ March: COLONIZED MINORITIES IN DEVELOPED COUNTRIES: Colonized racial, cultural or religious minorities exist throughout the world, within powerful societies eg., Tibet in China, Japan's Ainu, India's Dalits, Amerindian enclaves in the Caribbean, tribal minorities in Africa, Boznian Muslims, the Kurds of Iraq, others in all continents and among the Pacific islands. The issues apply to several economically advanced western countries where it is sometimes said that one may find “3rd world conditions in 1st world settings”. Because these countries claim leadership for human rights, they also must live up to these principles.

⁭ April: EARLY CHILD DEVELOPMENT – POLICY SHIFTS, GLOBAL VIEWPOINTS, AND THE EVIDENCE BASE: This issue focused on Canadian policy shifts of global interest. Sadly, Canada’s reputation for enlightened social policy is being undermined by a neo-conservative ideology. Over a million Canadian children live in poverty and cannot access child care. In support of child-friendly interventions, we included evidence reviewed by the US-based RAND Corporation showing that childhood intervention programs yield benefits in behavior, educational progression and attainment, delinquency and crime, and labor market success, among other domains.

⁭ May: CLIMATE CHANGE, KYOTO ACCORD, EUROPE RESPONDS & CANADA REMAINS CHALLENGED: The European Community (EU) takes Climate Change seriously, and is making progress towards its Kyoto targets. On April 26, 2007, Canada’s Conservative government released its first “climate-change plan”. Despite Canada leading the world in reducing ozone destroying chlorofluoro-carbons (Montreal Protocol 1987), signing the Kyoto Protocol (1997), and hosting its ratification (2005), this plan is incapable of meeting Canada’s Kyoto targets. Ranked 27th of 29 by the OECD on Greenhouse Gas (GHG) emissions, Canada remains among the most environmentally delinquent industrialized countries.

⁭ June: OFFICIAL DEVELOPMENT ASSISTANCE & GLOBAL HEALTH TRENDS: This issue reviews the vexing issue of development assistance from wealthy developed countries such as Canada, references a report on global social and economic trends, then selects reports from a discipline essential to understanding global health trends: Health Situation Analysis. Selected examples included Africa, the State of the World Children, and Projections of Mortality and Burden of Disease to 2030.

⁭ July: CELEBRATING THE AFRICAN MEDICAL AND RESEARCH FOUNDATION: In 1957, three surgeons in Kenya had a vision that could revolutionize health care in Africa. They launched a Flying Doctor Service (FDS). Over the next 5 decades, men set foot on the moon, satellites explored our solar system, the universe was probed with powerful orbital telescopes, robots explored the surface of Mars, and shuttles began servicing an international space station. In the meantime, with poverty and ill-health still pervading the planet, FDS became Africa’s largest indigenous health organization: the African Medical and Research Foundation.

⁭ August: FIRST THEY CAME... VIGNETTES IN THE DISMANTLING OF DEMOCRATIC MYTHS: In this issue we offered a selection of extracts from reputable sources that focus on the disastrous trajectory of the current US administration in undermining the beliefs that underpin western democracies. We dedicate the issue to Pastor Martin Niemoller (1892–1984), whose famous poem “First they came…” about the inactivity of German intellectuals during the Nazi rise to power and the subsequent purging of their chosen targets, group by group, most devastatingly to German Jews.

⁭ September: THIRD WORLD AID TO FIRST WORLD COUNTRIES: This issue featured the "brain drain" from sub-Saharan Africa, citing a report from Juan Ramos of ProCOR (website listed in sidebar). Practical responses re examined: striving for better compensation for indigenous health professionals, attention to policies that determine recruitment and retention of health professions in low income countries, fixing the ethics of western firms that raid poor countries to meet the service demands of rich ones, and finding ways to compensate third world "donor" countries for their loss of human resources. Through official inaction, "first world" countries benefit from a massive subsidy from the "third world", equal to the direct and indirect costs of their investment in this health human resource, and the opportunity costs entailed by its loss.

⁭ October: IS CLIMATE CHANGE AN ACT OF AGRESSION?: In this issue we abstracted an article carried by The Economist (on-line Sept 24th, 2007) that reported on Ugandan President, Yoweri Museveni's declaration that climate change is an act of aggression by the rich world against the world’s poor. We also noted a statement from the Church World Service (CWS): "The issue... is how climate change frames development and justice", said Rajyashri Waghray, CWS director, education & advocacy.

For stark contrast we noted Canada’s uncertain posture, quoting from a Globe and Mail Editorial (September 26): “Prime Minister Stephen Harper’s progress from a climate-change skeptic to an environmental convert has been a perplexing odyssey. After a half-hearted attempt to tackle greenhouse-gas emissions late last year, his Conservative government hurriedly introduced new regulations and incentives, which made a good start in fostering reductions. Earlier…(in September), in Australia, he even announced his personal commitment to ‘careful environmental stewardship’. That seemed heartfelt. Now it is fair to question the sincerity of that conversion. On… (Sept 24), at a UN climate change conference aimed at saving the Kyoto Protocol, Mr Harper announced that Canada had asked to join a rival climate-change pact, the Asia-Pacific Partnership. The six members of that pact include nations that have refused to ratify the protocol, such as the United States, and others among the world’s worst polluters, such as India and China. Together they account for nearly half of all greenhouse gas emissions”.

⁭ November: MATERNAL MORTALITY: WHAT DO SOUTH ASIA, THE UNITED STATES, AND AFRICA SHARE?: Maternal Mortality represents the largest rich-poor disparity tracked by the World Health Organization. On the heels of a study released by the United Nations (UN), the Women Deliver Global Conference in London, 18-20 October, assessed high levels of maternal mortality round the world. Little progress has been made in reducing maternal deaths in many countries. Areas of major focus were South Asia, parts of Africa, and even the United States, as it lags the developed world in its maternal health performance. The conference was supported by non-governmental, intergovernmental and development agencies as well as private sector and philanthropic entities aiming to create the political will to improve the health of pregnant mothers and their children, and to strengthen health systems around the world to prevent the deaths during pregnancy or childbirth of "one woman every minute of every day ".

“The eradication of poverty and hunger… cannot be achieved if questions of population and reproductive health are not addressed”. Kofi Annan

HOLIDAY GREETINGS: We extend to readers our best wishes for the holiday season and the New Year. We hope you found our selections during 2007 thought provoking and factually informative, and that you will continue to monitor this report.

MATERNAL MORTALITY: What do South Asia, the United States and Africa share?

2007-11-01T02:13:00.000-07:00

PREAMBLE: Maternal Mortality represents the largest rich-poor disparity tracked by the World Health Organization. On the heels of a study recently released by the United Nations (UN), the Women Deliver Global Conference in London, 18-20 October, assessed high levels of maternal mortality round the world. Delegates learned that little progress has been made in reducing maternal deaths in many countries. Areas of major focus were South Asia, parts of Africa, and even the United States came under scrutiny, as it lags the developed world in its maternal health performance. The conference was supported by non-governmental, intergovernmental and development agencies as well as private sector and philanthropic entities aiming to create the political will to improve the health of pregnant mothers and their children, and to strengthen health systems around the world to prevent the deaths during pregnancy or childbirth of "one woman every minute of every day ".

Visit Our Sidebar, with reference to the topic: "BEYOND THOSE HEALH CARE NUMBERS - commentary on a vacuous analysis", for our views on the US need to improve its health system.

SOUTH ASIA
Status of Women reflected in Preventable Deaths: "Maternal mortality levels are a key indicator of the status of women in society. They show how well a country's health service is performing and what cultural position women hold in society," says UNICEF spokesperson Katey Grusovin. South Asia's high maternal mortality rates account for almost half of all maternal deaths globally. UNICEF says that the lack of adequate resources and knowledge not only results in preventable maternal deaths, but it severely impacts on children who are left motherless. Some studies suggest that these children are 10 times more likely than their peers to die within two years of their mothers' deaths. "In South Asia, every year around 188,000 women die from complications in pregnancy and childbirth." Several countries in South Asia are responsible for the bulk of these mostly preventable deaths: India with 117,000 annual maternal deaths, Afghanistan 26,000, Bangladesh 21,000, and Pakistan 15,000. In many countries, the majority of births occur at home in rural areas without qualified medical help.

Poor Transportation and Inadequate Service Provisions: In the region if a woman does not survive the often long and perilous journey to hospital, there is every chance there will be no doctor, nurse or anaesthetist on duty to help her, nor any drug or blood supplies available with which to treat her. "And if there are - payment for these services may be well beyond the means of the women and her family," says Grusovin.

Gender Insensitivity: South Asia has been described as the most "gender insensitive region in the world". UNICEF says that from birth women are given a smaller share of food (60% of women in their childbearing years suffer from malnutrition), a larger share of work and little or no say in their own healthcare. They are likely to marry earlier and have had little or no education and live on or below the poverty line.

The Face of Huge Economic Disparities: "Throughout the region there is a huge disparity between its desolate performance on most indicators of human development on the one hand, and the stunning economic growth and prosperity experienced in several countries on the other," a UNICEF report says. "The fact that these positive developments have failed to trickle down to the poorest sectors of society is due to a host of factors, including religious and cultural practices, political and economic exclusion and gender bias." UNICEF says that steps to tackle the problem should be simple to implement. For example, 2.3 million South Asian infants who die annually could be saved along with their mothers if obstetric care was improved.

Is a Woman’s Life Worth Saving? The experience of Kalama, a 26-year-old Nepalese woman, is typical of many. She was brought to a District Hospital with labour complications. The hospital is a 3-hour walk from her village, so she had to be carried on a stretcher. She was admitted with full dilation of the cervix. The labour was prolonged, and she did not have energy to synchronise her efforts with labour contractions. The baby had to be vacuum delivered, asphyxiated and died. UNICEF says in many hospitals of the region there are no facilities to help mothers who lose their babies at birth. Says Grusovin "These women are dying not because we don't have the means to save them, but because we (the world) have not determined whether they are worth saving."

Poverty: The continual loss of millions of women from every generation has devastating implications for surviving family members, affecting infant survival rates and forcing young girls to leave school to care for siblings. Families then sink deeper into poverty. In short, the health of the mother is critical not only to her family, but to her nation.

Sources: 1. BBC News on-line: http://news.bbc.co.uk/2/shared/spl/hi/picture_gallery/07/south_asia_fighting_maternal_mortality/html/4.stm
2. Women Deliver Global Conference: http://www.womendeliver.org/overview/index.htm

UNITED STATES
Oct 13 (IPS) - Despite its enormous wealth and advanced technology, the United States (US) lags far behind other industrialized countries, and even some developing ones, in providing health care to women during pregnancy and childbirth. The US. ranks 41st in a new analysis of maternal mortality rates in 171 countries released by the UN.

The survey shows that even a developing country like South Korea is ahead of the US. "Women are unnecessarily dying from pregnancy and childbirth complications because the U.S. is moving in a wrong direction," said Beneva Schulte of Women Deliver, a Washington-based group campaigning for women's reproductive rights and access to health care.

Based on 2005 estimates, the UN analysis suggests that one in 4,800 women inthe US carry a lifetime risk of death from pregnancy. By contrast, among the 10 top-ranked industrialized countries, fewer than one in 16,400 are facing a similar situation. The reason? According to experts, in many European countries and Japan in the industrialized world, women are guaranteed good-quality health and family planning services that minimize their lifetime risk.

Many independent experts and sympathetic legislators hold the current US public health policy responsible for its dismal record because some 47 million US citizens have no access to health insurance, most of them African Americans and other minorities. According to Congresswoman Lois Capps, a California Democrat, "Even if we have the best technology, not everyone has the access to health care."

Responding to inquiries by IPS, a US public health official identified "racial disparity" as the most significant factor underlying the high U.S. maternal mortality rate. "Black women are 4 times more vulnerable than whites," Eve Lackritz, chief of the Maternal and Infant Health branch of the Centers for Disease Control (CDC), told IPS. In Lackritz's view, obesity and hypertension are two leading causes of pregnancy-related risks in the US.

Source: Maternal Mortality Shames Superpower U.S.By Haider Rizvi http://www.ipsnews.net/news.asp?idnews=39642

AFRICA & the MILLENNIUM DEVLOPMENT GOALS:
There are 10 countries, all in Africa (except Afghanistan), where high fertility and shattered health care systems cause extreme risks for pregnant women. In Somalia, Mali, Chad, and Niger, more than one in every 15 women is likely to die of pregnancy-related causes. In Niger, one in 7 women is vulnerable to death during pregnancy.

This analysis comes at a time when many development agencies and UN officials are trying to evaluate how far the world has progressed in meeting the Millennium Development Goals (MDGs) agreed upon by the world leaders 7 years ago. When the leaders attended a summit in New York in September 2000, they agreed that the MDGs must be achieved by 2015, a commitment that included initiatives to reduce maternal mortality by 75%.

Many experts believe that nothing much has changed since then for millions of poor women with regard to economic wellbeing and access to health care. As reported by the Lancet medical journal, at the current pace, there is almost no hope that the world will be able to achieve the 75% target. Annually, about 20 million women undergo unsafe abortions, which, according to the journal, is a major factor in maternal deaths and illness.

Reproductive rights activists say that governments must take drastic steps to reverse the situation if they are serious in meeting the MDGs on reducing the maternal mortality rates in the next seven years. "We still have the situation we had 20 years ago," said Ann Starrs of the independent group Family Care International in a statement. "Half a million women die every year from the complications of childbirth."

A recent study by Harvard University professor Ken Hill found that between 1990 and 2005, maternal deaths did fall, but by less than one percent a year. Hill and many other researchers estimate that at least 10 to 20 million women suffer injuries from the complications of childbirth every year. Experts say this suffering could be easily avoided if international donors contributed just $ 6.1 billion over the next seven years. (Editorial Comment: To place this global amount in local perspective, Canada's conservative government just anounced a reduction of 1% in its Goods and Services Tax, a cut of $34 billion annually).

Sources: 1. Haider Rizvi http://www.ipsnews.net/news.asp?idnews=39642
2. The Lancet Blog. Oct 18, 2007. http://blogs.thelancet.com/archive/2007/10/12/women-deliver

IS CLIMATE CHANGE AN ACT OF AGRESSION?

2007-10-01T05:33:00.000-07:00

PREAMBLE: In this issue we abstract an article carried by The Economist (on-line edition Sept 24th, 2007). The article reported on Ugandan President, Yoweri Museveni's declaration that climate change is an act of aggression by the rich world against the world’s poor. We also note, on the same topic, the following statement from the Church World Service (CWS): "The issue for CWS is how climate change frames development and justice", said Rajyashri Waghray, who directs education and advocacy for the CWS.

For stark contrast we note Canada’s uncertain posture, now quoted from a Globe and Mail Editorial of September 26: “Prime Minister Stephen Harper’s progress from a climate-change skeptic to an environmental convert has been a perplexing odyssey. After a half-hearted attempt to tackle greenhouse-gas emissions late last year, his Conservative government hurriedly introduced new regulations and incentives, which made a good start in fostering reductions. Earlier…(in September), in Australia, he even announced his personal commitment to ‘careful environmental stewardship’. That seemed heartfelt. Now it is fair to question the sincerity of that conversion. On… (Sept 24), at a UN climate change conference aimed at saving the Kyoto Protocol, Mr Harper announced that Canada had asked to join a rival climate-change pact, the Asia-Pacific Partnership. The six members of that pact include nations that have refused to ratify the protocol, such as the United States, and others among the world’s worst polluters, such as India and China. Together they account for nearly half of all greenhouse gas emissions”.

And now The Economist’s discussion of the Ugandan Prime Minister’s proposition, and their assessment of the situation and implications in Africa...

CLIMATE CHANGE AS AN ACT OF AGGRESSION
At a recent African Union summit, Uganda's president, Yoweri Museveni, declared climate change an act of aggression by the rich world against the world’s poor. Indeed, if predictions of the UN's Intergovernmental Panel on Climate Change (IPCC) hold true, climate change may have a graver effect on Africa than on any other continent. One may well ask…Why should the poorest die for the continued excesses of the richest?

According to The Economist, the IPCC's most recent regional report raises the spectre of rising mortality. It predicts a minimum 2.5°C increase in temperature in Africa by 2030; drylands bordering deserts may get drier, wetlands bordering rainforests may get wetter. The panel suggests the supply of food in Africa will be “severely compromised” by climate change, with crop yields in danger of collapsing in some countries.

In the drylands, water may become a critical issue. Soaring temperatures and erratic rainfall may dry up surface water. Between 75m and 250m Africans, out of the 800m or so now living in sub-Saharan Africa, may be short of water. The soil will hold less moisture, bore-holes will become contaminated, and women and girls will have to walk ever greater distances to fetch water. Vegetative cover will recede. The IPCC guesses that 600,000 square kilometres (232,000 square miles) of cultivable land may be ruined.

Warming may also hurt animal habitats and biodiversity. More algae in freshwater lakes will hit fishing. The glaciers of Uganda's Rwenzori mountains, of Tanzania's Kilimanjaro and of Kenya's eponymous mountain may disappear; only 7 of the 18 glaciers recorded on Mount Kenya in 1900 still remain. At the same time, a likely rise in sea levels may threaten the coastal infrastructure of northern Egypt, the Gambia, the Gulf of Guinea and Senegal.

There are two caveats to this gloomy scenario: 1) some parts of Africa may benefit from climate change. Increased rainfall in highland areas in eastern Africa could, for example, be beneficial. 2) though climate-change models have improved, they have been unreliable in Africa; the detail is guesswork.

Still, states The Economist, some scientists think that climate change may be even crueler to parts of Africa than the IPCC predicts. The important point, they say, is not the degree of warming but the continent's vulnerability to it. A University of Pretoria study estimates that Africa might lose $25 billion in crop failure due to rising temperatures and another $4 billion from less rain. The already impoverished drylands would suffer most. Some cite the war in Sudan's Darfur region as proof of the damage done by climate change, soil erosion and overpopulation.

Unfortunately, in the opinion of The Economist, few African leaders have grasped the scale of the challenge... Most oil-producers have squandered their bonanza. Nigeria has failed to plan for how to stem the dreadful pollution in its oil-producing Delta region or to prevent desertification tearing at the fabric of its dry Muslim north. South Africa is only just beginning to own up to its coal addiction. Uganda's Mr Museveni is fighting off a rare insurrection from his supporters against plans to turn a piece of Ugandan rainforest over to farming. The World Meteorological Organisation says that weather-data collection in Africa has recently got worse, just as the need for accurate figures has grown; many of the automatic weather stations it helped set up have fallen into disrepair. The African Union has done little to sound the climate-change alarm.

Kenya's president, Mwai Kibaki, says that Africa should “join hands” with its friends in the rich world over climate change. He wants more carbon-trading projects to come to Africa; so far, most have gone to Asia. His advisers admit that Mr Kibaki's ambitious plan to turn Kenya into an industrial country by 2020 worries environmentalists, but say that reforestation, thermal power and better management of water and grazing would, if they materialized, offset the damage.

Africa emits far less carbon than other continents, so its recently faster-growing economies do not gravely menace its environment. Some rich-country consumers, however, want to punish African countries for air freighting northwards some of their produce, from flowers to wine.
Hardier new varieties of staple crops, drip irrigation schemes and technologies such as solar power should help Africa adapt to climate change. But so can simple shifts in policy. For instance, a government decision in Burkina Faso to let farmers own the trees on their land has increased the country's tree cover.

The Economist’s conclusion: As the G8 rich countries are failing so far to fulfill the promises they made in 2005 to boost aid to Africa, the continent should not expect much new money to protect the environment. In the short run, Africa's own politicians need to take a lead, even if the people most culpable for the damage done by climate change live elsewhere.

Sources:
. Church World Service and partners prepare to act on climate change. May 2, 2007. http://www.churchworldservice.org/Educ_Advo/news/2007/climatechange.html
. Globe and Mail. Lead Editorial. Sept 26, 2007.
. Economist.com. Global Warming in Africa – drying up and flooding out. Sept 24, 2007. http://www.economist.com/world/africa/displaystory.cfm?story_id=9163426

COMMENT: What is important about the contrasting viewpoints presented, from those of President Museveni, to the Church World Service, The Economist, to the anti-Kyoto stance of Prime Minister Harper and the Asian-Pacific partnership, is that ultimately they highlight climate change as an ethical issue that almost inevitably will come up as a focus for discussion at the UN negotiations on climate change scheduled for Bali in December.

THIRD WORLD AID TO FIRST WORLD COUNTRIES... The “Brain Drain”

2007-09-01T04:19:00.000-07:00

PREAMBLE: In this issue we feature the "brain drain" (migration of professionals from low-resource settings to more developed ones) from sub-Saharan Africa. The report was developed by Juan Ramos, Program Coordinator of ProCOR, a web community focusing on cardiovascular disease problems in the developing world, that offers free-ranging debate on a range of related health and social issues (SEE: Recommended Links in sidebar, adjacent to June 1 blog below). The crisis is enormous, and some potential solutions are outlined in the report. It is to be hoped that there will be some practical response to these, such as striving for better compensation for indigenous health professionals, attention to policies that determine recruitment and retention of health professions in low income countries, fixing the ethics of western firms that raid poor countries to meet the service demands of rich ones, and finding ways to compensate third world "donor" countries for their loss of human resources. Through official inaction, "first world" countries benefit from a massive subsidy from the "third world", equal to the direct and indirect costs of their investment in this health human resource, and the opportunity costs entailed by its loss.

Also in the main section below we elevate an item previously presented in our sidebar: on "Corporate Hybrids". Your host, Pacific Health & Development Sciences Inc. (PacificSci), is an example of such an organization, now in its 4th year of operation.

In our sidebar: Once again we focus on Canada's political scene, with a brief capsule on Prime Minister Stephen Harper’s limited popularity, as revealed in a recent poll. We then focus on a troubling police action that may have been politically directed. Whether or not one agrees or disagrees with opposition on any given policy issue, the legal and democratic right to protest is supposed to be protected in our society. However, the recent undermining of a legal protest in a designated area adjacent to the “Security and Prosperity Summit” (involving the leadership of Canada, Mexico and the US) through use of agents provocateurs has alarmed our civil society. That Canada’s police forces were used to discredit the use of this right is cause for serious concern, and it is disturbing that the Honourable Stockwell Day, Minister for Public Security is ignoring calls for a public inquiry, issuing statements designed to diminish political accountability.

BRAIN DRAIN FROM SUBSAHARAN AFRICA
Significant numbers of African-trained health workers migrate every year to developed regions, leaving severely crippled health systems in countries where life expectancy is only age 50 and 16% of children die before age five. However, the critical shortage of health care workers in many parts of the world is beginning to receive attention from donors and international agencies. Donors are increasingly realizing that without enough trained workers to deliver drugs, vaccines and care, funding projects will not have the desired effects.

The population of sub-Saharan Africa totals over 660 million, with a ratio of fewer than 13 physicians per 100,000. The continent bears 24% of the global burden of disease but has only 3% of the health care workforce and 1% of the world's financial resources. Africa suffers more from brain drain due to economic conditions, wage differentials, rapid population growth among young people and conflict than any other continent.The worker shortage derives from a combination of underproduction, internal maldistribution and emigration of trained workers. Sub-Saharan Africa needs approximately 700,000 physicians to meet the Millennium Development Goals. Many African countries cannot meet widely accepted basic standards for health care coverage by physicians, nurses and midwives. An additional 2.4 million physicians, nurses and midwives are needed, along with an additional 1.9 million pharmacists, health aides, technicians and other auxiliary personnel.

Fewer health professionals from African countries than from other countries work in the US, according to the Least Developed Countries Report 2007. Data from the report demonstrate that the percentage of doctors practicing in the US relative to the total number of doctors back home range from 43% in Liberia to 10% in Zambia. This would not be a problem if the number of doctors remaining in their country of origin was sufficient to meet the needs of the population, but this is not the case. For example, Zambia has only seven doctors per 100,000 people, compared with the US level, which is close to 300. Even though the absolute number of professionals from the poorest countries working abroad may be small, the impact on professional services back home can be severe.

Efforts to retain workers focus on health care systems. For example, Swaziland provides HIV/AIDS services for health care workers who, practicing in high-prevalence areas with minimal resources for safety measures, are at an increased risk for occupational exposure. Other efforts build on the belief that providing workers with needed resources for care motivates them to stay and work in their home countries.Improved wages are also a key to retention. Salary support can help motivate health care workers to remain in their countries, even if it means working with fewer resources. Other types of inducements have been offered, such as lunch allowances, care loans and affordable housing.Some countries have begun to recruit trainees from rural areas. In South Africa, local students can receive scholarships for health care training on the condition they agree to return to their home district to practice. A study of the program found that trainees from rural areas were three to eight times as likely as those from urban areas to practice in rural regions after graduation.

The documented shortage of health care workers has inspired the American Public Health Association to pass a policy statement on "Ethical Restrictions on International Recruitment of Health Professionals to the United States." The policy addresses the role of the US in exacerbating the international crisis, calling on employers to adopt voluntary codes for ethical recruitment and on the government to contract only with employers who have done so. The future of global health and development in the 21st century lies in the management of the crisis in human resources for health.

More information is available from these resources on brain drain:
* "Providing the providers-remedying Africa's shortage of health care workers." N Engl J Med 2007; 356(25): 2564-67.http://content.nejm.org/cgi/content/extract/356/25/2564
* The Brain Drain of Health Professionals from Sub-Saharan Africa to Canada (3.5 MB):http://www.queensu.ca/samp/sampresources/samppublications/mad/MAD_2.pdf
* The Least Developed Countries Report 2007 (2.54 MB):http://www.unctad.org/en/docs/ldc2007_en.pdf

Source: Juan Ramos. ProCOR. Aug 9, 2007 Jramos3@partners.org
NOTE: To visit ProCOR, scan column at right to locate URL under “Recommended Links”.

CORPORATE HYBRIDS
“… organizations driven by both social purpose and financial promise that fall somewhere between traditional companies and charities…distinct from those operating in the government, business and non-profit sectors…Whatever participants call it, the fourth sector faces challenges. Current legal and tax structures draw strict lines between for-profits and non-profits… The social benefits that fourth-sector firm seek to unlock are not easily quantified and often take decades, not quarters, to attain.”

Reference: Stephanie Strom. The New York Times. May 6, 2007.

COMMENT: By definition, PacificSci is a hybrid or "fourth sector" organization. Ineligible for grants available to non-profits, nor driven by the bottom line as a purely business enterprise, nor financially underwritten by the tax payer as are universities, government bodies and international agencies, yet our contractual work, advocacy efforts and pro bono activities are all guided by our secular humanist mission: seeking solutions to the health and social impacts of development. Now in its 4th year, our philosophical model is proving operationally viable and productive.