Sanctions and the struggle for health in South Africa.
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This commentary describes the role of a major antiapartheid health organization, the National Medical and Dental Association (NAMDA), in reinforcing and maintaining international pressure on the racist South African government. NAMDA was a constituent of the Mass Democratic Movement (MDM), which was at the forefront in the struggle for freedom in South Africa. NAMDA endorsed the programs of the banned African National Congress (ANC), which included a range of sanctions. Debates within NAMDA on enlarging sanctions into an academic boycott are summarized. The development of a policy of selective academic support, which approved academic exchanges in accord with the aims of the MDM, is explained. Indirect evidence shows that international pressures created by specific types of economic sanctions and the forms of academic boycott decided on by NAMDA achieved their objectives. I have highlighted the tension between these strategies, which resulted in the isolation of the apartheid regime, as well as the responsibility to protect the most vulnerable from the burdens that resulted from these policies. (+info)
Economic sanctions as human rights violations: reconciling political and public health imperatives.
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The impact of economic sanctions on civilians has frequently been studied by public health specialists and specialized agencies of the United Nations (UN). This commentary explores some of the difficulties of the claim that sanctions constitute violations of human rights. The deprivation suffered by civilian populations under sanctions regimes often are violations of economic, social, and cultural human rights; however, the attribution of responsibility for those violations to the "senders" of sanctions (the UN Security Council or the US government, for example) is difficult to sustain, particularly in light of the efforts made by these entities to provide for humanitarian exemptions and humanitarian aid. A more productive approach to avoiding civilian harm is to prefer, as a matter of policy, arms embargoes, severing of communications, and international criminal prosecutions over trade embargoes. Promising recommendations have been formulated regarding "smart sanctions," which target regimes rather than people, and "positive sanctions" in the form of incentives. Health and human rights professionals have specific and important tasks in implementing such a restructured approach to sanctions. (+info)
Pneumococcal vaccines: World Health Organization position paper.
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Pneumococcal diseases are a major public-health problem all over the world. The etiological agent, Streptococcus pneumoniae (the pneumococcus) in surrounded by a polysaccharide capsule. Differences in the composition of this capsule permit the serological differentiation between about 90 capsular types, some of which are frequently associated with pneumococcal disease, others rarely. Invasive pneumococcal infections include pneumonia, meningitis, and febrile bacteremia; among the common non-invasive manifestations are otitis media, sinusitis, and bronchitis. At least one million children die of pneumococcal disease every year, most of these being young children in developing countries. In the developed world, elderly persons carry the major disease burden. Conditions associated with increased risk of serious pneumococcal disease include HIV infection, sickle-cell anaemia, and a variety of chronic organ failures. Vaccination is the only available tool to prevent pneumococcal disease. The recent development of widespread microbial resistance to essential antibiotics underlines the urgent need for more efficient pneumococcal vaccines. Immunity following pneumococcal disease is directed primarily against the capsular serotype involved. The currently licensed pneumococcal vaccine is based on the 23 most common serotypes, against which the vaccine has an overall protective efficacy of about 60% to 70%. Children aged < 2 years, and persons suffering from various states of immunodeficiency, for example HIV infection, do not consistently develop immunity following vaccination, thus reducing the protective value of the vaccine in some major target groups for pneumococcal disease. However, in the healthy elderly population, the polysaccharide vaccine provides relatively efficient protection against invasive pneumococcal disease. Extensive clinical trials are now under way with a new generation of pneumococcal vaccines. These protein-polysaccharide combinations, known as conjugate vaccines, contain 7-11 selected polysaccharides bound to a protein carrier, and induce a T-cell dependent immune response. These vaccines are likely to be protective even in children < 2 years of age, and may reduce pneumococcal transmission through a herd effect. (+info)
A national facility for small area disease mapping and rapid initial assessment of apparent disease clusters around a point source: the UK Small Area Health Statistics Unit.
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BACKGROUND: Reports of disease clusters are often received by district health authorities and are, in some cases, associated with concerns about a pollution source. The Small Area Health Statistics Unit (SAHSU) has developed a Rapid Inquiry Facility, which will produce an estimated relative risk for any given condition for the population within defined areas around a point source, relative to the population in a local reference region. The system can also facilitate the production of annual reports and other health studies for Departments of Public Health Medicine through the creation of ward-level maps to illustrate disease variation across small areas. METHODS: The facility uses routinely collected morbidity, mortality and population data at a small area scale, together with the computing facilities and expertise necessary to run such analyses quickly and efficiently. Using this facility SAHSU can supply a report within three working days. To aid interpretation, smoothed small area maps that account for sampling variability in the observed data can also be produced. RESULTS: The paper reports on two case studies where the pilot system has been utilized by health authorities for both point source analyses and small area disease mapping. CONCLUSIONS: We believe that this facility would be of considerable use to districts. The local knowledge and expertise of the local public health specialist is essential in the interpretation and presentation of the facility's output. Feedback from public health specialists is helping SAHSU refine the output of the facility, so as to make the information presented as comprehensive and as useful as possible. (+info)
Circular epidemiology.
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Circular epidemiology can be defined as the continuation of specific types of epidemiologic studies beyond the point of reasonable doubt of the true existence of an important association or the absence of such an association. Circular epidemiology is an extreme example of studies of the consistency of associations. A basic problem for epidemiology is the lack of a systematic approach to acquiring new knowledge to reach a goal of improving public health and preventive medicine. For epidemiologists, research support unfortunately is biased toward the continued study of already proven hypotheses. Circular epidemiology, however, freezes at one point in the evolution of epidemiologic studies, failing to move from descriptive to analytical case-control and longitudinal studies, for example, to experimental, clinical trials. Good epidemiology journals are filled with very well-conducted epidemiologic studies that primarily repeat the obvious or are variations on the theme. (+info)
Is the domestic dog (Canis familiaris) a reservoir host of American cutaneous leishmaniasis? A critical review of the current evidence.
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Originally associated with forested areas, the transmission cycle of American cutaneous leishmaniasis (ACL) has now adapted to the domestic environment in at least 9 Latin American countries. Several studies have suggested that the domestic dog (Canis familiaris), which is already incriminated as the primary reservoir host of zoonotic visceral leishmaniasis (ZVL), may have a reservoir role in the domestic transmission of human ACL caused by Leishmania braziliensis, L. panamensis, and L. peruviana. This article reviews more than 90 studies reporting ACL infections in dogs, and concludes that as yet there is only circumstantial evidence to support that claim. Almost no data are available on the infectiousness of dogs to sandfly vectors of ACL, and there are few indications that either dog ownership or dog abundance are risk factors for ACL. Nevertheless, it has been proposed that incidence of ACL in humans could be reduced by targeting infected dogs. While this control strategy has been used for many decades against ZVL in Latin America, Europe, and Asia, there is little evidence to demonstrate its effectiveness either in theory or in practice. Particular concerns over the sensitivity and specificity of diagnostic tools, low compliance rates among dog owners, and cost-effectiveness are likely to apply equally to ACL control. (+info)
Powerful connections for public health: the National Library of Medicine and the National Network of Libraries of Medicine.
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As incorporated in Healthy People 2010 objectives, data and information systems and a skilled workforce are 2 of the critical components of the public health infrastructure. The National Library of Medicine (NLM) and the National Network of Libraries of Medicine (NN/LM) are important resources for improving Internet access and providing related training to the public health workforce and to those in training for public health careers. The NLM and the NN/LM have joined forces with the Centers for Disease Control and Prevention, the Health Resources and Services Administration, the Association of State and Territorial Health Officials, the National Association of County and City Health Officials, and the Public Health Foundation. The goal of this collaboration is to improve electronic resources useful in public health practice and increase awareness of them, to train public health professionals to use electronic information services, and to help public health agencies obtain the equipment and Internet connections needed to use these services effectively. The databases, outreach programs, and connection grants available to public health professionals from the NLM, and the training and ongoing support available from the NN/LM for accessing these programs and services, are described. (+info)
Achieving a public health recommendation for preventing neural tube defects with folic acid.
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OBJECTIVES: This study examined 3 approaches to achieving the public health recommendation that all women of child-bearing age ingest 0.40 mg of folic acid per day to reduce the occurrence of neural tube defects (NTDs). METHODS: A total of 1136 mothers of infants with major malformations from the Boston and Philadelphia areas, whose pregnancies began from 1993 to 1995, were interviewed within 6 months of delivery about vitamin supplementation, dietary intakes, and other factors. RESULTS: Seventy-one percent of the 1136 women in the study did not take folic acid--containing supplements daily before conception, but the proportion decreased over the years of the study. Women not taking supplements consumed an average of 0.25 mg of naturally occurring folates daily. On the basis of dietary intakes reported by women not taking folic acid supplements, a simulation of cereal grain fortification with folic acid at the level required by the US Food and Drug Administration showed that an average of only 0.13 mg of folic acid would be ingested daily. CONCLUSIONS: With consumption of folic acid only through dietary intake, sizeable portions of the childbearing population would receive less than the level of folic acid recommended for preventing NTDs. Even with food fortification, women of childbearing age should be advised to take folic acid--containing supplements on a daily basis. (+info)