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R.R.
Frerichs Posting
Faced
with dwindling financial support, the World Health Organization (WHO) has
elected a new leader, who is trying to get off to a good start. As noted in the
current Lancet (see below), WHO in the future will "back its case
with solid evidence and thereby be a better advocate for health towards a
broader audience of decision-makers." The implication is that research will
be more critically reviewed, and epidemiological outcomes that are practical to
address and feasible to achieve in developing country settings will guide future
programs -- a welcome change.
"World
Health Assembly winds up on a sober note"
Alan
McGregor, The Lancet 351(9115) May 23, 1998
After
more than 2 days of heated discussions, the 51st World Health Assembly (Geneva,
Switzerland, May 11-16) avoided a split by a compromise on the issue of funding
for WHO's six regions. Proposals to switch a proportion of funding--especially
from south-east Asia -- to Africa, with some going also to Eastern Europe and
former communist states, were strenuously opposed by developing countries. In
what was described as "a landmark decision", the Assembly finally
agreed that funding for the 28 "least-developed countries" would not
be affected, and that the reduction for any region would not exceed 3% per year
over a 6-year period.
WHA
president, Rahdial al-Mousawi, Health Minister of Bahrain, spoke of "the
enormous tasks ahead of us" in combating disease, promoting health
universally, and reducing glaring disparities between rich and poor. Delegates
from the 191 member states had earlier adopted a declaration on "Health for
all for the 21st century" to supersede WHO's previous, unrealistic,
"Health for all by the year 2000".
Having
already indicated that two priorities must be malaria and tobacco, the new
Director-General, Gro Harlem Brundtland, said that the reorganisation of WHO
would be focused initially on four areas, although details are not yet
available. The areas are monitoring, rolling back and, where possible
eradicating communicable diseases; fighting non-communicable diseases; helping
countries build sustainable health systems, "emphasising the situation of
women and mothers, so critical in giving children a safe and healthy start in
life"; and ensuring that "WHO will speak out for health, back its case
with solid evidence and thereby be a better advocate for health towards a
broader audience of decision-makers".
Judging
by the applause, WHA's favourite guests were US First Lady Hillary Clinton and
Cuban President Fidel Castro. The former made sound sense "To improve
health for all, we must make progress in the fight against poverty; to fight
poverty, we must ensure health care for all." The latter pointed out that,
according to UN estimates, "the cost of universal access to basic
health-care services would be $25 billion a year--that is 3% of the $800 billion
currently devoted to military expenditures".
UNAIDS
also is facing a funding shortage, due to many reasons, including the inward
view of many Americans and Europeans now that more effective therapy is
available.
As
the rage has subsided in the wealthier societies, so has funding, leaving public
health officials in the developing world with fewer resources to address their
expanding problems. While UNAIDS recognizes the problem (see below), recognition
is not enough. More experimentation is needed, with new solutions that address
the epidemic as being caused by a biological agent, rather than being the
consequence of past and present social ills.
Like
WHO, UNAIDS would do well to "back its case with solid evidence" and
promote dialog with"a broader audience of decision-makers."
"U.N.
expert says more funding vital to stopping AIDS"
Reuters
News Service, May 25, 1998
GENEVA
- The global AIDS epidemic can only be controlled if much more funding is made
available for developing countries where it is still spreading rapidly, the
United Nations UNAIDS program said Monday.
Executive
director Peter Piot also told a meeting of the UNAIDS governing body that his
organization, which links six U.N. agencies, had entered a new phase in the
fight against the disease. "With current funding levels, the world simply
cannot bring this global epidemic under control," he declared. National
funding was often "woefully inadequate" and foreign aid was
distributed very unequally between countries, said Piot, appealing to the
international community to increase support.
"There
are very many development problems but AIDS is unique in the rate at which the
epidemic is expanding, its selective elimination of adults during their most
productive years, and its devastating impact on social and economic gains."
Piot said the new phase in the struggle against the disease and the HIV virus
that causes it was marked by wider-than-ever gaps between the areas where it was
receding and those where it was out of control. Paradoxically, he said, this
came at a time "when we know that prevention works and that a worsening
epidemic is not inevitable." The gaps, he added, "demand our
action."
Last
month, U.S. health officials said the rate at which people in the United States
were being infected with HIV was relatively stable while the increase in AIDS
cases was slowing due to new drug treatments.
But
estimates issued by UNAIDS and the World Health Organization (WHO) at the end of
last year put the number of people around the world living with HIV infection at
30 million, more than 90 percent of them in developing countries.
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