Former CDC chief launches $225 million global health initiative

Tom Frieden, former director of the Centers for Disease Control and Prevention, is starting a new initiative to tackle some of global health's thorniest issues: cardiovascular disease and epidemics.

Frieden, a former New York City health commissioner who spent seven years leading the CDC during the Obama administration, said he chose those two issues based on his "unique vantage point of surveying the world and seeing where there were areas that really are at a tipping point." Strategic investment and action in each of these areas can make substantial differences, he said.

The $225 million initiative, called Resolve, announced Tuesday in New York, aims to reduce the global burden of heart disease and stroke, the world's leading causes of death. It also will focus on helping low- and middle-income countries fight infectious disease epidemics by strengthening laboratory networks so emerging threats are identified promptly, and training disease detectives to track and investigate disease outbreaks, including those that circulate in animals and jump to humans.

Frieden led the CDC longer than any director since the 1970s. Some of the major disease outbreaks that took place during his tenure include the 2009 global H1N1 swine flu pandemic, the deadly respiratory virus known as MERS, and the Ebola and Zika epidemics.

Resolve will be housed in a New York-based public health nonprofit organization called Vital Strategies, which operates in more than 60 countries.

The initiative's five-year funding is coming from some of the biggest names in global public health: Bloomberg Philanthropies ($100 million), the Chan Zuckerberg Initiative ($75 million) and the Bill and Melinda Gates Foundation ($50 million).

"I hope five years from now we'll look back and see this was the inflection point for rapid progress in preventing global cardiovascular disease deaths and improving epidemic preparedness," Frieden said. "In a few years, we hope that blood pressure control, sodium reduction, elimination of trans fats and strong public health systems will have become the new normal."

Cardiovascular disease causes about 18 million deaths per year, an estimated 31 percent of all deaths worldwide. In lower-income countries, nearly half of those deaths are in people younger than 70, Frieden said.

Progress has stalled because "there is virtually no money going into this space," he said. "Globally, very few countries are reducing sodium or trans fat or treating high blood pressure effectively."

But with proven strategies, the initiative aims to save more than 100 million lives over 30 years, he said.

In the United States, progress has also slowed in preventing stroke deaths, according to a CDC report last week. The report did not identify the reasons for the slowdown, but other studies have pointed to increased numbers of Americans with stroke risk factors such as high blood pressure, obesity and diabetes.

Global health security was a top priority for the Obama administration, which created a partnership in early 2014 to prevent deadly outbreaks from spreading, and sought to help countries bolster their capacity to detect and monitor infectious diseases in the wake of the Ebola epidemic.

Although the collaboration has resulted in more than 50 countries posting public "report cards" about their readiness to battle epidemics, "the fact is, most countries are still not prepared and there is limited progress in closing the gaps that have been identified," Frieden said. "The world now needs to step up and accelerate these countries to close those gaps."

Bill Gates, co-chairman of the Bill and Melinda Gates Foundation, said: "While our foundation typically focuses on infectious diseases because they disproportionately affect the world's poorest, we are increasingly concerned about the growing rate of cardiovascular disease in low- and middle-income countries."

Resolve will also support and work closely with the World Health Organization, the Bloomberg School of Public Health at the Johns Hopkins University, the CDC, the World Bank and the Campaign for Tobacco-Free Kids.

As CDC director, Frieden was often frustrated by the months-long delays in securing critical funding for pressing public health emergencies, such as Zika.

"One of the things that makes me particularly gratified to have this opportunity is the ability to move quickly" and the freedom to choose where to work and with what organizations, he said.

The initiative will have about 10 to 15 staff members in New York City, but also will be able to draw from Vital Strategies' staff of 100 people in Manhattan and 300 people globally.

A New York native, Frieden is once again working closely with his old boss, former mayor Michael Bloomberg, who supported many of the high-profile public health campaigns Frieden started as head of the city's Department of Health and Mental Hygiene. During Frieden's tenure, the number of smokers dropped significantly, and New York City became the first place in the United States to eliminate trans fats from restaurants and require certain restaurants to post calorie information.

The design of the Resolve initiative will be similar to the program Bloomberg Philanthropies began a decade ago to reduce tobacco use.


How to Compromise on Health Care

Progressives are understandably breathing a sigh of relief following the Senate’s failure to repeal Obamacare and replace it with legislation that would have scaled back health-insurance coverage. But they shouldn’t be too comfortable in their victory — it’s temporary.

President Donald Trump has threatened not to support the Affordable Care Act. If the Trump administration decides not to make critical payments to insurers, or stops enforcing the tax penalty for people who don’t buy insurance, the law could be in serious trouble. And even if the administration continues to support Obamacare’s success, progressives should be clear that the law still needs improvements to ensure that premiums don’t continue to increase at an unsustainable rate, and that households in all parts of the country continue to have access to insurance through the individual market.

What’s needed to move forward? Republicans and Democrats working together.

A major problem with the Affordable Care Act is the way it was passed: on a party-line vote, without support from a single Republican. This made the law vulnerable and created uncertainty about its future among market participants. The unsuccessful GOP repeal-and-replace efforts have been just as divisive. For a policy change of this magnitude to be lasting and stable, it should have at least some bipartisan support.

President Barack Obama’s lasting health-care legacy is winning the fight over whether universal coverage is the right goal. Mr. Obama was correct that it is, and as I’ve argued recently, conservatives should agree. But what is needed to get us there in best way? Let me outline a few corollary goals.

Universal coverage should be pursued in a way that is affordable, both to households and to the government, and that helps lower the trajectory of health-care costs overall. It should lead to higher-quality medical care, to make being insured attractive to households, and should encourage innovation, productivity and technological progress in the health-care sector. It should encourage young and healthy people to be covered in order to balance the risk pool facing insurers, making it attractive for insurers to offer insurance. It should ensure that even the hard-to-cover are insured.

To achieve these goals, both conservatives and progressives are going to have to give ideological ground.

Conservatives in Congress have already given quite a bit. For example, even the most hard-line conservatives in the House voted in favor of the federal government providing subsidies to low-income households to help them purchase health insurance.

But congressional Republicans will have to go further. Subsidies for low-income households need to be generous enough to make insurance against catastrophic medical expenses affordable. Republicans shouldn’t try to cut taxes as part of health reform. And Republicans should accept that we need a robust health-insurance safety net that covers all citizens living in poverty or living with medical conditions that will make insurance prohibitively expensive.

This will involve accepting a larger role for Medicaid than existed before Obamacare, and adequately funding high-risk pools for individuals with pre-existing medical conditions who won’t have access to affordable coverage. It’ll also mean making room for regulation requiring that as long as individuals maintain insurance coverage, they can move from employer coverage to the individual market without being charged higher premiums due to medical conditions.

Progressives have to travel further than this. In order to achieve the goals I laid out, they need to accept that catastrophic health-insurance coverage still counts as coverage. The social problem we face occurs when uninsured individuals get seriously sick or injured, and can’t afford their treatment. Those costs get passed on to the rest of us. The policy solution, then, should focus on the problem of individuals not being insured against very high medical costs — not on insuring for preventative care, or against your annual sinus infection.

In order to encourage the appropriate levels of innovation and productivity, progressives must accept that health insurance — and the market for medical services generally — is too heavily regulated. Obamacare removes choice and options in the individual health-insurance market by specifying what has to be included in insurance plans. In addition, the law’s individual mandate penalizing people who don’t buy insurance is too weak to be effective — but a stronger mandate is both politically untenable and undesirable. So progressives should ditch the mandate and accept another way to encourage young and healthy individuals to be covered: auto-enrollment with an opt-out.

In order to put health-care costs on a sustainable trajectory, progressives must accept that Medicaid, the current health safety net for the poor, needs to change its financing system — in which the federal government matches a share of state spending. They also must accept that market discipline is needed. Catastrophic events are hard to foresee and hard for households to afford, but households should be more exposed to the actual costs of routine care.

Given the current political atmosphere in Washington, I wouldn’t bet on success anytime soon. But these are the right goals, and after the Obama-Trump years, we’ve learned that a bipartisan effort to define universal coverage sensibly and then put it into effect is needed to ensure long-term stability for health policy.


World Health Organization: Gonorrhea becoming harder to treat

The World Health Organization says antibiotic resistance is making Gonorrhea harder and sometimes impossible to treat.

The sexually transmitted disease can cause infertility if untreated and affects an estimated 78 million people each year.

According to the WHO, data from 77 countries, shows the disease has developed resistance to some antibiotics and an increasing number of countries are finding that the infection can become completely untreatable.

Some health experts say the disease is evolving and becoming resistant because of the other bacteria that can cause it.

Every time doctors use a new class of antibiotics to treat the infection, the bacteria evolve to resist them.

Right now in the United States, the current class of antibiotics is working but experts say it's only a matter of time before they become ineffective too.

"And to prevent that, or to get a head of that I should say, we have studies out and we are looking at it in ongoing surveillance of the resistance and research,” said Clinical Services Nurse Manager Vonda Pabon.

According to the CDC, North Carolina ranks at the top of the 50 states for the rate of STD cases per 100,000 people and is ranked number three when it comes to Gonorrhea.



New Director-General Begins Work at WHO

The World Health Organization’s new director-general, Dr. Tedros Adhanom Ghebreyesus, began his five-year term Saturday.

The former Ethiopian health and foreign minister is the first African chosen to head the organization.

Tedros, who goes by his first name, won the office by a clear majority, defeating British and Pakistani candidates in May in the first WHO election decided by member countries.

He is facing a slew of challenges as he takes the helm of the sprawling organization with a funding shortfall of approximately $2.2 billion that is
responsible for improving health care around the world.

After his election, he said the concept of health as a human right would be at the heart of whatever he does at WHO.

“Half of our population does not have access to health care.” He said that could and should be remedied through universal health care coverage, which would address the issue of health as a human right and act as a spur to development.

“All roads should lead to universal health coverage and it should be the center of gravity of our movement,” he said.

Tedros has said one of his first orders of business would be to strengthen WHO’s ability to respond swiftly and effectively to emergencies because “epidemics can strike at any time” and the WHO must be prepared.

Tedros is taking over the reins of the organization from Margaret Chan of China who led WHO for nearly ten years.

Credit : Voice of America (VOA)


WHO: United States Among Least Polluting Nations on the Planet

Despite recent attempts to paint the United States as a major global polluter, according to the World Health Organization (WHO), the U.S. is among the cleanest nations on the planet.
In the most recent WHO report on air pollution, the United States was listed as one of the countries with the cleanest air in the world, significantly cleaner in fact than the air in Germany, Italy, Switzerland, the UK, Japan, Austria and France.

While France and other G7 countries lamented the U.S. exit from the Paris climate accord, America’s air is already cleaner than that of any other country in the G7, except Canada with its scant population.

Following standard practice, the WHO measures air pollution by the mean annual concentration of fine suspended particles of less than 2.5 microns in diameter. These are the particles that cause diseases of all sorts and are responsible for most deaths by air pollution.

According to the WHO, exposure to particulate matter increases the risk of acute lower respiratory infection, chronic obstructive pulmonary disease, heart disease, stroke and lung cancer.

The report, which analyzed the “annual median concentration of particulate matter with an aerodynamic diameter of 2.5 μm or less (PM2.5) for both urban population and rural and urban population” found that the United States was one of the most pollution-free nations in the world.

The annual mean concentrations of particulate matter in the air range from less than 10 to over 100 µg/m3, the report states. At the very low end of the spectrum, the United States has a concentration of just 8, while China has a concentration more than seven times higher at 59, India at 66, Egypt at 101 and Saudi Arabia with the worst air pollution at 127.

“The mean annual concentration of fine suspended particles of less than 2.5 microns in diameter is a common measure of air pollution,” the WHO states.

The WHO report is corroborated by a series of other such studies on air and water pollution.

In a recent list of the 25 cleanest cities in the world, the only country to boast three cities among the cleanest on the planet was the United States of America, with Chicago coming in second place, Honolulu coming in fourth, and Portland, OR, coming in sixteenth. Unsurprisingly, no cities from China, Russia or India made the list at all.

Similarly, another list of the 15 most polluted cities in the world featured three cities from China, three cities from Saudi Arabia, and a whopping seven cities from India. No U.S. city made the list.

A third list, ranking the ten cleanest and ten most polluted cities in the world, placed two U.S. cities on the list of cleanest cities on the planet. The list of the most polluted cities in the world was led by two cities from China followed by two more cities from India. Two Russian cities also made the list. Again, no U.S. cities were found here.

With such relatively clean air throughout America, how can even reputable news agencies like Reuters continue spreading the well-worn lie that the United States is one of the “biggest polluters” in the world?

Rather than follow the time-tested practice used by the World Health Organization, which measures levels of disease-causing pollutants that get into people’s lungs, some have played a shell game, swapping a new measure of “pollution” based solely on emissions of carbon dioxide.

The problem with this ploy is that carbon dioxide is not a pollutant and it is dishonest to say it is. CO2 is colorless, odorless and completely non-toxic. Plants depend on it to live and grow, and human beings draw some into their lungs with every breath they take to no ill effect whatsoever.

Growers regularly pump CO2 into greenhouses, raising levels to three times that of the natural environment, to produce stronger, greener, healthier plants.

Current levels of carbon dioxide concentration in the environment are substantially lower than they have been during earlier periods in the planet’s history. Without human intervention, the concentration of CO2 has climbed as high as 7,000 parts per million (ppm) in prior eras, whereas at present the concentration is just over 400 ppm.

Some experts, such as UN climate scientist Dr. Indur Goklany, have defended rising CO2 levels as a good thing for humanity. Goklany has argued that the rising level of carbon dioxide in the earth’s atmosphere “is currently net beneficial for both humanity and the biosphere generally.”

“The benefits are real, whereas the costs of warming are uncertain,” he said.

While the United States must remain vigilant to keep the level of real, dangerous pollutants to a minimum, it may take some consolation in the fact that among G7 nations, it has the cleanest air of all.


World Health Organization Deploys New Technology For Ebola Fight

"I'm doubtful that the pigs actually carry Ebola, but we have to test them, " says epidemiologist Fabian Leendertz of the Robert Koch Institute in Berlin, who has been consulted by the Institute of National Biomedical Research in Kinshasa about the potential link, Science reported.

Although when the corpse was tested it was free of Ebola virus.

The country's public health officials had reported at least 43 cases of suspected Ebola and four deaths.

Makur Koriom, Undersecretary in the Ministry of Health, said a team of health officials would be dispatched to all border areas of South Sudan shares with DR Congo to conduct surveillance and health education among communities in Western Equatoria state.

"The Likati health district is in a remote area, but contact tracing is essential to contain the outbreak in its focus; the DRC can rely on very experienced health workers for this objective, " Yokouidé Allarangar, WHO representative in the DRC, said in a statement earlier this month. This is resulting in early identification of suspect cases detected in the affected zone.

On Tuesday that the corpse of a young man was flown in onboard a Kenya Airways flight and quarantined by the Port Health Services (PHS) to ascertain if the death of the deceased was caused by the Ebola virus, since the DRC is now facing another outbreak of the deadly haemorrhagic fever.

South Sudan suffered Ebola outbreak in 2004 after World Health Organization reported 20 cases including 5 deaths from Ebola hemorrhagic fever (EHF) in Yambio County which borders DR Congo.

One of the technologies being used to detect Ebola in DRC is GeneXpert, which was primarily developed to detect cases of tuberculosis, but has been adapted to enable rapid testing of many pathogens - HIV, malaria, STIs, and Ebola.

However, the commissioner said as soon as the dead body was brought in from DRC, the officials of Port Health, Nigeria Centre for Disease Control, NCDC and the Lagos State Ministry of Health investigated the cause of death of the remains and took samples for laboratory investigation.

Nigeria has been on the alert since the recent outbreak in DRC Congo.

"In the field, OraQuick can test blood or saliva samples for Ebola in just half an hour", the United Nations health agency said. Health authorities in this country are recognized throughout the African region and the world as experts in responding to outbreaks of this disease.


Have a Tax Rate That Disincentivises Cigarette Smuggling: Farmers' Body

New Delhi: Farmers' body FAIFA on Monday asked the government to have a taxation policy that disincentivises cigarette smuggling in India, ahead of a crucial meeting of the GST Council later this week.

The Federation of All India Farmer Associations (FAIFA), a non-profit organisation representing farmers across states such as Andhra Pradesh, Telangana, Karnataka and Gujarat, said cigarette smuggling has hit tobacco farmers supplying to legitimate manufacturers in India.

It urged Finance Minister Arun Jaitley "to protect the interests of Indian FCV tobacco farmers through balanced and uniform taxation under GST".

"We appeal to the government to have a taxation policy that disincentivises cigarette smuggling in India," FAIFA General Secretary Murali Babu said in a statement.

He further said GST is an opportunity for the government to ensure illicit trade is eradicated from the country by removing distortions and address tobacco taxation in India.

It will bring back lost livelihood opportunities of the tobacco farmers, he added.

FAIFA said a steep increase in excise duty in the recent past has led to growth of smuggling of cigarettes in India due to the high tax arbitrage.

Illegal cigarette trade is more than 20 per cent of the cigarette industry in India, making the country the 4th largest and fastest growing illicit market in the world, it claimed.

It has resulted in revenue losses of approximately Rs 9,200 crore and is growing annually, it added.
A shift in consumption to smuggled cigarettes has affected Indian tobacco farmers adversely as the illegal cigarettes do not use Indian tobacco, FAIFA said.

The demand of the farmers' body comes ahead of the meeting of the all-powerful GST Council to be held in Srinagar on May 18-19, where it is expected to give final nod to four rules and also fix GST rates for major commodities and services.

The four rules pertain to how input tax credit is to be calculated and claimed, valuation of supply of goods and services, method for intimation for opting for composition levy and transitional rules.


Ageing is “a good thing” for the world – World Health Organisation

Ageing on the whole is “a good thing” for the world, and governments should not see it as a “threat”, Dr Paul Ong, Technical Officer, Innovation for Healthy Ageing at the World Health Organisation, tells GovInsider.

Ong believes that there’s a need to shift current perceptions of ageing as a burden to society – being old is, in fact, a sign of “successful development,” he says. “It means that a majority of people are now living to a much older age.”

“Fertility rates have dropped because our babies are now surviving, rather than families having lots and lots of babies to ensure that they have a few children who make it to adulthood,” Ong continues. “We now have this opportunity to enjoy the life that I think all human beings deserve.”

Shifting perceptions of ageing

With a 2015 report on ageing and health, WHO wants to encourage governments to tackle ageism in three ways. First, they must reorient the language surrounding ageing. “Shifting the language from viewing ageing as essentially a cost to society to something that needs investing in, is one of the key actions you need to take.”

Secondly, governments need to reorient healthcare systems to be more age-friendly, with greater focus on chronic disease management. Ong notes that in the early development stage of societies, contemporary healthcare systems were developed to treat individual diseases and acute medical episodes. As populations age, chronic illnesses become the norm, and this presents a challenge for the healthcare systems of today.

“We know from studies in Sweden and Australia that by the time people are 70 or 75, nearing 80, they will have multiple chronic illnesses,” shares Ong. “Tackling chronic illnesses just simply as individual diseases, trying to cure these things – and many of them are not exactly curable – it’s not the most useful approach.”

Governments then need to adopt an approach where they can best manage these “baskets” of chronic conditions, enabling the elderly to be active as much as possible. “Just because I have arthritic pain does not mean that going to the church, temple or mosque is not important me.”

Age-inclusive environments for the future

Finally, governments need to look beyond encouraging the population to embrace healthy ageing – it is time that the environments the elderly live in also reflect age inclusivity. In European cities like Geneva, trams and buses have steps that can be lowered, and the city boasts ramps and walkways that enable wheelchair-bound citizens to get around. “In Japan, even the ancient castles and monuments have lifts so that older people basically can enjoy these icons of cultural heritage,” Ong says.

Age-inclusive design, he adds, is not just about older people – it’s also about “encouraging important technology” that will compel both creative and economic growth, and spur new industries in the future. “In the same way that a self-driving car is a very interesting piece of technology, it is actually good for older people, and potentially a very important part of age-friendly technology and environments,” Ong notes.

For all of these key factors to come together, governments must remember that ageing is a “multi-sectorial” issue, Ong notes. After all, environments are made up of multiple sectors, whether that be sanitation or transportation, agriculture, and governments will need to look at how these intersect together so that they can best design environments for the elderly.

“Like any other person, older people need to have decent nutrition, live in sanitary environments, and get around – just that specifically in each of these areas, they have more challenges that need to be attended to,” Ong concludes.

Soon, the future could very well bring driverless cars and specially-equipped trams that make our cities a little bit friendlier for the silver generation.