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Global Monitoring Report 2013 : Rural-Urban Dynamics and the Millennium Development Goals
Global Monitoring Report 2013 : Rural-Urban Dynamics and the Millennium Development Goals
Source: World Bank
The Global Monitoring Report 2013: Rural-Urban Dynamics and the Millennium Development Goals examines rural-urban disparities in the achievement of the Millennium Development Goals (MDGs) and how urbanization, if managed well, can contribute to the attainment of these goals. The report provides information about the differences in progress toward the MDGs across geographical areas and recognizes that urban populations are better off than their rural brethren. However, unfettered urbanization can cause migrants and the urban poor to end up in slums where attainment of the MDGs lags. GMR 2013 calls for an integrated strategy to better manage the planning-connecting-financing formula of urbanization. Notwithstanding the importance of urbanization in poverty reduction and MDG attainment, rural areas remain a huge challenge—one that underscores the importance of policies that can improve rural livelihoods. The rural-urban spectrum ranges from small towns to large cities. The general experience is that poverty is lowest in the largest cities and considerably higher in smaller towns. The MDGs reflect the basic needs of all citizens, and governments should aim to meet them fully in both urban and rural areas. However, resources are scarce, so priorities must be set and trade-offs made. The report argues that the sequencing of actions be tailored to local conditions when it comes to the degree of urbanization and rural-urban differences in MDG outcomes. The world has met four global MDG targets. New estimates confirm the 2012 reports that MDG 1.a—reducing the $1.25-a-day poverty rate (2005 purchasing power parity)—was reached in 2010, falling below half of its 1990 value. The world also met part of MDG 7.c—to halve the proportion of people without safe access to drinking water—in 2010. MDG 7.d—to improve significantly the lives of at least 100 million slum dwellers by 2020—was also achieved. Finally, the first part of MDG 3.a—to eliminate gender disparity in primary education— was accomplished in 2010. Global progress on the full MDG 3.a (to eliminate gender disparity in primary and secondary education) is close to being on track. Global Monitoring Report 2013 was prepared jointly by the World Bank and the International Monetary Fund, with consultations and collaborations with regional development banks and other multilateral partners.
Microbes in Pool Filter Backwash as Evidence of the Need for Improved Swimmer Hygiene — Metro-Atlanta, Georgia, 2012
Microbes in Pool Filter Backwash as Evidence of the Need for Improved Swimmer Hygiene — Metro-Atlanta, Georgia, 2012
Source: Morbidity and Mortality Weekly Report (CDC)
Filters physically remove contaminants, including microbes, from water in treated recreational water venues, such as pools. Because contaminants accumulate in filters, filter concentrates typically have a higher density of contamination than pool water. During the 2012 summer swimming season, filter concentrate samples were collected at metro-Atlanta public pools. Quantitative polymerase chain reaction (qPCR) assays were conducted to detect microbial nucleic acid. Pseudomonas aeruginosa was detected in 95 (59%) of 161 samples; detection indicates contamination from the environment (e.g., dirt), swimmers, or fomites (e.g., kickboards). P. aeruginosa detection underscores the need for vigilant pool cleaning, scrubbing, and water quality maintenance (e.g., disinfectant level and pH) to ensure that concentrations do not reach levels that negatively impact swimmer health. Escherichia coli, a fecal indicator, was detected in 93 (58%) samples; detection signifies that swimmers introduced fecal material into pool water. Fecal material can be introduced when it washes off of swimmers’ bodies or through a formed or diarrheal fecal incident in the water. The risk for pathogen transmission increases if swimmers introduce diarrheal feces. Although this study focused on microbial DNA in filters (not on illnesses), these findings indicate the need for swimmers to help prevent introduction of pathogens (e.g., taking a pre-swim shower and not swimming when ill with diarrhea), aquatics staff to maintain disinfectant level and pH according to public health standards to inactivate pathogens, and state and local environmental health specialists to enforce such standards.
“Swept Away” — Abuses against Sex Workers in China
“Swept Away” — Abuses against Sex Workers in China
Source: Human Rights Watch
This 51-page report documents abuses by the police against female sex workers in Beijing, including torture, beatings, physical assaults, arbitrary detentions, and fines, as well as a failure to investigate crimes against sex workers by clients, bosses, and state agents. The report also documents abuses by public health agencies, such as coercive HIV testing, privacy infringements, and mistreatment by health officials.
Roxarsone, Inorganic Arsenic, and Other Arsenic Species in Chicken: A U.S.-Based Market Basket Sample
Source: Environmental Health Perspectives
Background: Arsenic-based drugs are permitted in poultry production. Inorganic arsenic (iAs) causes cancer and maybe other adverse health outcomes. The contribution of chicken consumption to iAs intake, however, is unknown.
Objectives: To characterize arsenic species profile in chicken meat and estimate bladder and lung cancer risk associated with consuming chicken produced with arsenic-based drugs.
Methods: Conventional, conventional antibiotic-free, and organic chicken samples were collected from grocery stores in ten US metropolitan areas from December 2010 to June 2011. 116 raw and 142 cooked samples were tested for total arsenic, and 78 samples ≥10µg/kg dry weight underwent speciation.
Results: Total arsenic geometric mean (GM) in cooked chicken meat samples was 3.0 µg/kg (95% CI: 2.5, 3.6). Among 78 cooked samples that were speciated, iAs concentrations were higher in conventional samples (GM = 1.8 µg/kg; 95% CI: 1.4, 2.3) than antibiotic-free (GM = 0.7 µg/kg; 95% CI: 0.5, 1.0) or organic (GM = 0.6 µg/kg; 95% CI: 0.5, 0.8) samples. Roxarsone was detected in 20 of 40 conventional samples, one of 13 antibiotic-free samples, and none of the 25 organic samples. iAs concentrations in roxarsone-positive samples (GM = 2.3 µg/kg; 95% CI: 1.7, 3.1) were significantly higher than in roxarsone-negative samples (GM = 0.8 µg/kg; 95% CI: 0.7, 1.0). Cooking increased iAs and decreased roxarsone concentrations. Compared to organic chicken consumers, we estimated that conventional chicken consumers would ingest an additional 0.11µg/day iAs (in an 82g serving). Assuming lifetime exposure and a proposed cancer slope factor of 25.7 (mg kgBW-1 day-1)-1, this could result in 3.7 extra lifetime bladder and lung cancer cases per 100,000 exposed-persons.
Conclusions: Conventional chicken meat had higher iAs concentrations than conventional antibiotic-free and organic chicken meat samples. Cessation of arsenical drug use could reduce exposure and the burden of arsenic-related disease in chicken consumers.
‘Globesization’: ecological evidence on the relationship between fast food outlets and obesity among 26 advanced economies
‘Globesization’: ecological evidence on the relationship between fast food outlets and obesity among 26 advanced economies
Source: Critical Public Health
The aim of this study was to investigate the relationship between the density of fast food restaurants and the prevalence of obesity by gender across affluent nations. Data on Subway’s restaurants per 100,000 people and proportions of men and women aged 15 years or older with a body mass index higher or equal than 30 kg/m2 were obtained for 26 of 34 advanced economies. Countries with the highest density of Subway restaurants such as the USA (7.52 per 100,000) and Canada (7.43 per 100,000) also tend to have a higher prevalence of obesity in both men (31.3% and 23.2%, respectively) and women (33.2% and 22.9%, respectively). On the other hand, countries with a relatively low density of Subway restaurants such as Japan (0.13 per 100,000) and Norway (0.19 per 100,000) had a lower prevalence of obesity in both men (2.9% and 6.4%, respectively) and women (3.3% and 5.9%, respectively). Unadjusted linear regression models showed a significant correlation between the density of Subway’s outlets and the prevalence of adult obesity (β = 0.46; p = 0.02 in men and β = 0.48; p = 0.013 in women). When the data were weighted by population size, the associations became substantially stronger in both men and women (β = 0.85; p = 0.0001 and β = 0.84; p = 0.0001, respectively). Covariate adjustment did not reduce the size of the associations. Our study raises serious concerns about the diffusion of fast food outlets worldwide and calls for coordinated political actions to address what we term ‘globesization’, the ongoing globalization of the obesity epidemic.
New From the GAO
New GAO Reports
Source: Government Accountability Office
1. Security Force Assistance: More Detailed Planning and Improved Access to Information Needed to Guide Efforts of Advisor Teams in Afghanistan. GAO-13-381, April 30.
http://www.gao.gov/products/GAO-13-381
Highlights - http://www.gao.gov/assets/660/654290.pdf
2. National Preparedness: Efforts to Address the Medical Needs of Children in a Chemical, Biological, Radiological, or Nuclear Incident. GAO-13-438, April 30.
http://www.gao.gov/products/GAO-13-438
Highlights - http://www.gao.gov/assets/660/654265.pd
New From the GAO
New GAO Reports
Source: Government Accountability Office
1. Toxic Substances: EPA Has Increased Efforts to Assess and Control Chemicals but Could Strengthen Its Approach. GAO-13-249, March 22.
http://www.gao.gov/products/GAO-13-249
Highlights – http://www.gao.gov/assets/660/653277.pdf
2. State and Local Governments’ Fiscal Outlook: April 2013 Update. GAO-13-546SP, April 29.
http://www.gao.gov/products/GAO-13-546SP
The media and intellectuals’ response to medical publications: the anti-depressants’ case
The media and intellectuals’ response to medical publications: the anti-depressants’ case
Source: Annals of General Psychiatry
During the last decade, there was a debate concerning the true efficacy of anti-depressants. Several papers were published in scientific journals, but many articles were also published in the lay press and the internet both by medical scientists and academics from other disciplines or representatives of societies or initiatives. The current paper analyzes the articles authored by three representative opinion makers: one academic in medicine, one academic in philosophical studies, and a representative of an activists’ group against the use of anti-depressants. All three articles share similar gaps in knowledge and understanding of the scientific data and also are driven by an ‘existential-like’ ideology. In our opinion, these articles have misinterpreted the scientific data, and they as such may misinform or mislead the general public and policy makers, which could have a potential impact upon public health. It seems that this line of thought represents another aspect of the stigma attached to people suffering from mental illness.
Leveraging Public Information about Pathogens for Disease Outbreak Investigations
Leveraging Public Information about Pathogens for Disease Outbreak Investigations
Source: MITRE Corporation
With recent technological advances in DNA sequencing and access to information via internet databases, the amount of information about pathogen strains in the public domain is growing rapidly. This information can be leveraged to help identify the origins of pathogens that cause disease outbreaks. This report describes potential uses for public data in outbreak investigations, key data types, the formats and locations of pathogen data in public sources, and tools MITRE is designing for assembling and integrating information during disease outbreak investigations.
Globalization, Climate Change, and Human Health
Globalization, Climate Change, and Human Health
Source: New England Journal of Medicine
he global scale, interconnectedness, and economic intensity of contemporary human activity are historically unprecedented, as are many of the consequent environmental and social changes. These global changes fundamentally influence patterns of human health, international health care, and public health activities. They constitute a syndrome, not a set of separate changes, that reflects the interrelated pressures, stresses, and tensions arising from an overly large world population, the pervasive and increasingly systemic environmental impact of many economic activities, urbanization, the spread of consumerism, and the widening gap between rich and poor both within and between countries.
In recent decades, international connectivity has increased on many fronts, including the flow of information, movements of people, trading patterns, the flow of capital, regulatory systems, and cultural diffusion. These exponential increases in demographic, economic, commercial, and environmental indexes have been labeled the Great Acceleration. Remarkably, the resultant environmental effects are now altering major components of the Earth system. The current geologic epoch is being called the Anthropocene (successor to the Holocene epoch) in recognition of the global force that Homo sapiens has become, pushing or distorting Earth’s great natural global systems beyond boundaries considered to be safe for continued human social and biologic well-being. The loss of biodiversity, the greatly amplified global circulation of bioactive nitrogen compounds, and human-induced climate change have already reached levels that are apparently unsafe.
These changes pose fundamental threats to human well-being and health. For example, a positive relationship has been observed between regional trends in climate (rising temperatures and declining rainfall) and childhood stunting in Kenya since 1975, indicating that as projected warming and drying continue to occur along with population growth, food yields and nutritional health will be impaired. These human-induced climatic changes often act in concert with environmental, demographic, and social stressors that variously influence regional food yields, nutrition, and health. Furthermore, at the current level of global connectedness and interdependence, the environmental impact of human activity has a wider geographic range, although its influence may be offset somewhat by more effective global alerts and more rapid distribution of food aid. The extreme heat and wildfires in western Russia in the summer of 2010 destroyed one third of that country’s wheat yield, and the subsequent ban on exported grain contributed to a rise in the price of wheat worldwide, exacerbating hunger in Russia (where flour prices increased by 20%) and in low-income urban populations in countries such as Pakistan and Egypt. On the economic front, the recent global financial crisis has underscored the domino-like interdependence of national economies.
The Unpaid Health Bill – How coal power plants make us sick
The Unpaid Health Bill – How coal power plants make us sick
Source: Health and Environment Alliance
How is coal pollution making us sick? A new report launched on 7 March 2013 by the Health and Environment Alliance (HEAL) aims to provide an overview of the scientific evidence of how air pollution impacts health and how emissions from coal power plants are implicated in this. It presents the first-ever economic assessment of the health costs associated with air pollution from coal power plants in Europe as well as testimonies from leading health advocates, medical experts and policy makers on why they are concerned about coal.
The report develops recommendations for policy-makers and the health community on how to address the unpaid health bill and ensure that it is taken into account in future energy decisions.
CRS — Publishing Scientific Papers with Potential Security Risks: Issues for Congress
Publishing Scientific Papers with Potential Security Risks: Issues for Congress (PDF)
Source: Congressional Research Service (via Federation of American Scientists)
The federal government generally supports the publication of federally funded research results because wide dissemination may drive innovation, job creation, technology development, and the advance of science. However, some research results could also be used for malicious purposes.
Congress, the Administration, and other stakeholders are considering whether current policies concerning publishing such research results sufficiently balances the potential benefits with the potential harms. The current issues under debate cut across traditional policy areas, involving simultaneous consideration of security, science, health, export, and international policy. Because of the complexity of these issues, analysis according to one set of policy priorities may adversely affect other policy priorities. For example, maximizing security may lead to detriments in public health and scientific advancement, while maximizing scientific advancement may lead to security risks. Accounting for such trade-offs may allow policymakers to establish regulatory frameworks that more effectively maximize the benefits from such “dual-use,” i.e., potentially beneficial and also potentially harmful, research while mitigating its potential risks.
The issue of balancing scientific publication with security concerns has a long historical context, but the current consideration began in late 2011, when two groups of U.S. government-funded scientists submitted papers to academic journals detailing genetic modifications that increase the transmissibility of a deadly influenza strain. Although these research results may improve pandemic influenza preparedness and response, they may also increase the probability that a highly contagious and deadly influenza strain will be introduced, either accidently or deliberately, into the human population. Stakeholders, including the Department of Health and Human Services, the World Health Organization, journal publishers, and scientists, debated whether the possible benefits of publication outweighed the potential harms. The editors of the scientific journals decided to publish modified versions of both papers.
The controversy surrounding the publication of these influenza experiments revealed weaknesses in the existing federal mechanisms to identify and balance potential benefits of life science research and security trade-offs. Responding to these cases, the Administration released new government-wide policies to address some of these flaws. These new policies establish roles for federal funding agencies, institutions, and scientists to regularly review life science research portfolios and develop methods to mitigate security risks.
It is not clear whether the 113th Congress will agree with the Administration that the new policies sufficiently address all of the dual-use issues brought to light by this recent controversy. Congress could decide to allow the new policies to be fully implemented before evaluating them. Alternatively, Congress could require agencies to implement new, different processes to identify potential research of concern prior to funding; require federal prepublication review of all potential research of concern to establish appropriate limits on the distribution of the research results; require federal licensing of researchers permitted to conduct such experiments and access results; and limit such research to the most safe and secure laboratories. All of these options might, however, reduce the number and quality of research studies undertaken. This report describes the underlying controversy, the potential benefits and harms of publishing these manuscripts, the actions taken by domestic and international stakeholders, and options that may improve the way research is handled to minimize security concerns.
CRS — Public Mass Shootings in the United States: Selected Implications for Federal Public Health and Safety Policy
Source: Congressional Research Service (via Federation of American Scientists)
This report focuses on mass shootings and selected implications they have for federal policy in the areas of public health and safety. While such crimes most directly impact particular citizens in very specific communities, addressing these violent episodes involves officials at all levels of government and professionals from numerous disciplines.
This report does not discuss gun control and does not systematically address the broader issue of gun violence. Also, it is not intended as an exhaustive review of federal programs addressing the issue of mass shootings.
New From the GAO
New GAO Reports
Source: Government Accountability Office
INSPECTORS GENERAL
USDA Office of Inspector General Resources, Accomplishments, Coverage, and Quality
GAO-13-245, Mar 22, 2013
NATIONAL PREPAREDNESS
Improvements Needed for Measuring Awardee Performance in Meeting Medical and Public Health Preparedness Goals
GAO-13-278, Mar 22, 2013
Adverse health consequences of the Iraq War
Adverse health consequences of the Iraq War
Source: The Lancet
The adverse health consequences of the Iraq War (2003—11) were profound. We conclude that at least 116 903 Iraqi non-combatants and more than 4800 coalition military personnel died over the 8-year course. Many Iraqi civilians were injured or became ill because of damage to the health-supporting infrastructure of the country, and about 5 million were displaced. More than 31 000 US military personnel were injured and a substantial percentage of those deployed suffered post-traumatic stress disorder, traumatic brain injury, and other neuropsychological disorders and their concomitant psychosocial problems. Many family members of military personnel had psychological problems. Further review of the adverse health consequences of this war could help to minimise the adverse health consequences of, and help to prevent, future wars.
Free registration required to access full text.
Interventions to reduce suicides at suicide hotspots: a systematic review
Interventions to reduce suicides at suicide hotspots: a systematic review
Source: BMC Public Health
Background
‘Suicide hotspots’ include tall structures (for example, bridges and cliffs), railway tracks, and isolated locations (for example, rural car parks) which offer direct means for suicide or seclusion that prevents intervention.
Methods
We searched Medline for studies that could inform the following question: ‘What interventions are available to reduce suicides at hotspots, and are they effective?’
Results
There are four main approaches: (a) restricting access to means (through installation of physical barriers); (b) encouraging help-seeking (by placement of signs and telephones); (c) increasing the likelihood of intervention by a third party (through surveillance and staff training); and (d) encouraging responsible media reporting of suicide (through guidelines for journalists). There is relatively strong evidence that reducing access to means can avert suicides at hotspots without substitution effects. The evidence is weaker for the other approaches, although they show promise.
Conclusions
More well-designed intervention studies are needed to strengthen this evidence base.
Health Centers and Family Planning: Results of a Nationwide Study
Health Centers and Family Planning: Results of a Nationwide Study (PDF)
Source: George Washington University, School of Public Health & Health Services
Community health centers (CHCs) provided primary health care to over 20 million patients in 2011, 60% of whom are women and 25% of whom are women of childbearing age. Health centers play a central role in women’s health, because of their mission to furnish a full range of primary and preventive care services, including family planning and birth control for women of reproductive age. As a result of the Affordable Care Act, which provide for historic insurance expansions, broad first-dollar coverage of family planning services, and direct investment in CHCs, it is projected that health center capacity will virtually double by 2019, and accordingly, the role of health centers in the provision of women’s health care services can be expected to grow significantly. This study examines how health centers fulfill their family planning mission.
Fact Sheet — Alcohol Overdose: The Dangers of Drinking Too Much
Fact Sheet — Alcohol Overdose: The Dangers of Drinking Too Much
Source: National Institute on Alcohol Abuse and Alcoholism
Celebrating at parties, cheering a favorite sports team, and simply enjoying a break from work are common activities throughout the year. For some people, these occasions also may include drinking—even drinking to excess. And the results can be deadly.
Although many people enjoy moderate drinking, defined as 1 drink per day for women or 2 for men, drinking too much can lead to an overdose. An overdose of alcohol occurs when a person has a blood alcohol content (or BAC) sufficient to produce impairments that increase the risk of harm. Overdoses can range in severity, from problems with balance and slurred speech to coma or even death. What tips the balance from drinking that has pleasant effects to drinking that can cause harm varies among individuals. Age, drinking experience, gender, the amount of food eaten, even ethnicity all can influence how much is too much.
Underage drinkers may be at particular risk for alcohol overdose. Research shows that people under age 20 typically drink about 5 drinks at one time. Drinking such a large quantity of alcohol can overwhelm the body’s ability to break down and clear alcohol from the bloodstream. This leads to rapid increases in BAC and significantly impairs brain function.
As BAC increases, so do alcohol’s effects—as well as the risk for harm. Even small increases in BAC can decrease coordination, make a person feel sick, and cloud judgment. This can lead to injury from falls or car crashes, leave one vulnerable to sexual assault or other acts of violence, and increase the risk for unprotected or unintended sex. When BACs go even higher amnesia (or blackouts) can occur.
Environmental Decisions in the Face of Uncertainty
Environmental Decisions in the Face of Uncertainty
Source: Institute of Medicine
The U.S. Environmental Protection Agency (EPA) is one of several federal agencies responsible for protecting Americans against significant risks to human health and the environment. EPA estimates the nature, magnitude, and likelihood of risks to human health and the environment; identifies the potential regulatory actions that will mitigate those risks and protect public health and the environment; and uses that information to decide on appropriate regulatory action. Uncertainties in the data and analyses on which these decisions are based enter into the process at each step. As a result, the informed identification and understanding of the uncertainties inherent in the process is an essential feature of environmental decision making.
The EPA asked the IOM to provide guidance to its decision makers and their partners in states and localities on approaches to managing risk in different contexts when uncertainty is present. It also sought guidance on how information on uncertainty should be presented to help risk managers make sound decisions and to increase transparency in its communications with the public about those decisions.
Countering the Problem of Falsified and Substandard Drugs
Countering the Problem of Falsified and Substandard Drugs
Source: Institute of Medicine
Falsified and substandard medicines provide little protection from disease and, worse, can expose consumers to major harm. Bad drugs pose potential threats around the world, but the nature of the risk varies by country, with higher risk in countries with minimal or non-existent regulatory oversight. While developed countries are not immune, – negligent production at a Massachusetts compounding pharmacy killed 44 people from September 2012 to January 2013 – the vast majority of problems occur in developing countries where underpowered and unsafe medicines affect millions.
It is difficult to measure the public health burden of falsified and substandard drugs, the number of deaths they cause, or the amount of time and money wasted using them. The FDA asked the IOM to assess the global public health implications of falsified, substandard, and counterfeit pharmaceuticals to help jumpstart international discourse about this problem. At the international level, productive discussion relies on cooperation and mutual trust. This report lays out a plan to invest in quality to improve public health.
