The South East Asia Regional Office of the World Health Organization (WHO), in partnership with Deakin University, has today (10 February) launched a set of health literacy tools and resources created to improve health and reduce inequalities for much of the world.

The Health Literacy Toolkit was launched at the World Congress of Public Health in Kolkata, India. Health literacy is at the heart of what enables people to understand and engage in health actions and care – from lifesaving treatment, to understanding that smoking is dangerous for one's health and how to prevent disease.

The Toolkit encourages key actions and strategies across governments, health services and with health consumers across the world. People living in Low and Middle-Income (LMIC) countries, such as India, Indonesia and Thailand, particularly those with little education, can have very poor access to quality health information and services. The Toolkit seeks to guide improvements in health and reduce inequities by empowering policymakers, professionals and people to work together to improve access to, and the quality of, healthcare.

"Health literacy is an important and under-recognised factor that is a cause of health inequalities and poor health outcomes across such countries. Practical strategies to tackle health literacy challenges, such as those in this toolkit, are needed to build and enhance the response of health systems," said toolkit co-author Professor Richard Osborne, Deakin University.

The new Health Literacy Toolkit addresses priority health literacy issues in LMIC countries in a package of accessible briefings which are targeted at influential health professionals, politicians, policy makers and to community organisations across the region.

One health inequality the Toolkit covers in case studies are the high rates of maternal deaths in LMIC countries. WHO data indicates that although maternal deaths in India are now about one third of they were 25 years ago (148,000 deaths in 1990) there are still about 50,000 Indian women dying from maternal deaths each year. This contrasts with countries like Australia where maternal death is very rare (about 20 maternal deaths/ year). Improvements in health literacy, through the use of the Toolkit, will help mothers and health professionals work together to ensure all parties are informed and empowered to get and use the best healthcare possible.

"Previous health literacy efforts have mostly focussed on improving individual reading and understanding of health information. However the barriers to healthcare access are often more complex. The next steps in health literacy need to take a whole of community approach to health practice, service delivery and health policy in developing and testing solutions," Professor Osborne said.

Lead toolkit author Dr Sarity Dodson, from Deakin University's Population Health Strategic Research Centre, said the Toolkit would support communities to develop initiatives that more effectively target the root causes of preventable illness and act to engage communities in actions to maintain and improve health.

"In many communities there are large inequalities in health service access. More must be done to address areas such as women's and children's health, and chronic disease such as diabetes," Dr Dodson said.

source: http://medicalxpress.com

In 2019, the European Union will terminate a number of its health support programmes in middle-income countries, including in Indonesia. This will put a lot of pressure on the archipelago's healthcare system, which is heavily staffed by volunteers. EurActiv reports from Jakarta.

More than 28 million in Indonesia still live below the poverty line. And although the economy is growing, the benefits are mainly going to the emerging middle class, deepening existing inequalities.

The government is already struggling to coordinate healthcare for a population spread across more than 6,000 islands, and continues to grapple with high rates of preventable and treatable diseases.

For instance, Indonesia has one of the highest rates of tuberculosis in the world and has the fifth highest number of children suffering from chronic malnutrition, with about 8.8 million children who are stunted.

Despite these alarming figures, in January 2014, the EU decided that the development aid given to Indonesia should focus on other sectors such as education, justice and finance.

In order to meet future healthcare challenges, with help from the World Bank, the Indonesian government introduced several initatives.

The most visible is a large-scale community-development scheme, which is currently witnessing its first successes in fighting malnutrition in the Southeast Asian country's poorest areas.

Launched in 2007, the PNPM Generasi programme gives incentivised block grants to poor, rural communities. The programme takes the idea of conditional cash transfers and repurposes it to enable communities and local health and education providers to work together on targeting three Millennium Development Goals (MDGs): maternal and child health, and universal primary education.

Generasi builds on the KDP programme, a 15-year old plan by the Indonesian government, in which block grants were given directly to poor communities to determine for themselves how to use the funds, whether for infrastructure, health or education opportunities. During these 15 years, the plan helped bring half of the country's 70,000 villages out of poverty.

The Generasi programme is currently active in eight provinces, including the West Bandung District, which consists of 165 villages with a population of about 1.5 million people, where 20% lives below the poverty line. In the Cihampelas village, less-affluent families can seek counseling on maternal and child health, family planning, nutrition and immunisation. Many of the healthcare counselors are caters: volunteers with faith-based organisations.

One cater told EurActiv that she often teaches young mothers how to cook healthy meals for their children, "because many of these mothers serve their children chocolate bars. They don't know how important healthy food is".

This is significant, as only 37% of Indonesian children consume a minimum of acceptable diets; 14% of children have suffered diarrhea in the last two weeks; only 42% are breast fed exclusively for the first 6 months of their life; and 12% live below the poverty line.

In Cihampelas, families are also taught how to grow their own fruit and vegetable gardens with cucumbers, papaya, bananas and nuts. One cater said that for most families in the village, 90% of their diet now comes from their gardens.

23-year-old Sofi Awati, who is pregnant with her second child and has one five-year old son, has used the Cihampelas health community to get both free tuberculosis vaccines and to learn how to cultivate such a garden. "My son now likes the food that I cook," she said.

The children who live in Cihampelas not only benefit from the health services. In a two-room, bright-coloured house which is used as a one classroom school, they receive free primary school education from two volunteers who formerly worked as teachers, while their mothers are taught the importance of getting an education in the other room.

But most importantly, Cihampelas has its own Posyandu, an integrated village health post, which serves as first line of care for many Indonesians. Among other things, they register births, weigh babies, maintain growth charts and immunisations.

19-year-old Vani, who is seven months pregnant with her first child, dropped out of high school when she married her husband in March last year. She told EurActiv that she regretted dropping out and wants to go back to school after giving birth so that she can get an education and the family can live on a bigger budget.

Vani said she wants to give birth in the home that belongs to the Cihampelas's local midwife, Ebulili, instead of having to walk to the local hospital. She added that the price of giving birth also plays a part: While she would have to pay Ebulili 700,000 Indonesian Rupiah (€ 49), the hospital would charge her 2 million Rupian (€ 140) 'for a birth without complications'.

In Generasi's latest impact evaluation, its biggest impact was cutting malnutrition and stunting. Childhood malnutrition was reduced by 2.2 percentage points, or nearly 10% over the control group in areas where Generasi was implemented.

source: http://www.euractiv.com

The number of Ebola cases in West Africa has gone up for the first time this year, the World Health Organization says, warning that the coming rainy season could complicate efforts to contain the disease.

In an update published online Wednesday, the U.N. health agency said there were 124 confirmed cases last week, up from 99 the week before.

WHO said there are continuing problems tracking the spread of the virus. Only 21 percent of new cases in Sierra Leone were from known contacts, meaning health officials have no idea how the majority of new patients are being infected and where the virus might be lurking.

In Guinea, about half of new patients were from contacts of other cases, and 10 of 34 prefectures in the country reported at least one security problem or refusal to cooperate with international aid efforts in the last week. Ebola is also continuing to spread to new areas in Guinea, close to the border with Mali.

WHO noted that a single unsafe burial in Guinea in early January sparked nearly a dozen confirmed cases. The bodies of people killed by Ebola are highly infectious and traditional burial practices that involve washing or kissing the body are extremely risky.

"A rise in incidence shows that the (Ebola) response still faces significant challenges," WHO said, adding that the wet season will make it hard to get to remote areas.

To date, the virus is believed to have killed nearly 9,000 people and the death rate is estimated to be between 50 and 60 percent in West Africa for people hospitalized with the disease.

At a WHO Ebola meeting last month, the agency's chief Dr. Margaret Chan said data showed that "we have bent the (epidemic) curve and avoided the worst-case scenario," after earlier predicting there might be as many as 10,000 cases per week. She said the agency was focused on getting to zero cases but that "high-risk situations" were still occurring.

source: http://www.usnews.com/

Over the course of the last 30 years, I have watched women's cancers go from being a disease that only affects affluent countries to being a global problem. If there was ever any truth to the notion that cancer is mostly a rich country's problem, the facts no longer support it. The numbers of deaths each year from breast cancer are now equally split between developed and developing countries.

All of us involved in the work of global health, and women's health in particular, need to better understand what we are up against. And a 2014 report by the Council on Foreign Relations (CFR) does exactly that.

I was honored to be a member of CFR's task force on noncommunicable disease (NCD) to study the emerging global health crisis in low- and middle-income countries. NCDs such as cancer, cardiovascular disease, and diabetes are now the leading cause of death and disability in these countries, where they killed almost 8 million people in 2013 before their 60th birthday.

The bottom line is people are succumbing to disease so much faster, so much younger, and with such worse outcomes than they did in high-income countries.

For women in LMICs, it's as if the last quarter-century of medical advancement never happened. When they feel a lump in their breast, or experience the first signs of other cancers, they don't know what it is or what to do. Sometimes women assume that if they don't feel any pain then they're healthy. Often they're too afraid to say anything, much less to look for help -- which in many cases wouldn't be there anyway. This constellation of issues leads women to delay evaluation of breast cancers for months or sometimes years, during which time the cancers can grow and spread.

Sadder still, hundreds of thousands of those deaths could be avoided -- especially among women, who often die from the very cancers that are most treatable and curable. Cervical cancer, for example, can be prevented with the use of a vaccine, or caught in its earliest phases before it actually is cancer with the potential for spread. And among breast cancer cases detected early, the great majority of women now survive once they are provided prompt and effective treatment. And treatment is easier and better tolerated when the cancers they are treating are early.

We face an unacceptable gap between the global crisis and the global response. The U.S. government has not sufficiently focused on the problem of NCDs, and our international development and health programs lag behind. Our task force uncovered that we spend $10 million on NCDs out of a global health budget of more than $8 billion. The global picture isn't any better: Aid for NCDs represented just 1.2 percent of total development assistance for global health in 2011.

Our report presents a path forward to help save women's lives. It is data-driven and presents short-term, medium-term, and long-term recommendations for action and an investment case for each recommendation.

Take cervical cancer, for example. Cervical cancer is the single biggest cause of cancer death for women in sub-Saharan Africa, and also the most preventable. If every HIV clinic in Africa were to offer a simple screening for cervical cancer, the added expense would be slight, and we'd be going directly at the very people most at risk. We must also increase access to the effective vaccines that exist for preventing HPV infection.

The United States and private sector partners should increase their investment in the HPV vaccine and integrate screen-and-treat programs for cervical cancer into PEPFAR platforms, building on the success of the Pink Ribbon Red Ribbon initiative on both fronts. Rarely do you find such a natural pairing of vital missions. In fighting one disease from a platform built to treat another, we can save many lives.

With respect to breast cancer, between 1990 and 2013, premature deaths in low-income countries from breast cancer grew 90 percent. During this same period in the United States, breast cancer death rates declined by one third.

The reason for this disparity is that people in poor countries have little access to the diagnostic tests and curative treatment that is widely available for breast cancer in wealthier countries. The per capita cost of mammography screening exceeds the capacity of many low-income countries to pay, and may not be appropriate for settings wherein women often present with easily palpable, visible, or ulcerated tumors. By contrast, clinical breast exams are affordable (and necessary) for countries at all economic levels and can catch cancer at a much earlier stage for treatment. Appropriate breast cancer treatment depends on an accurate pathology diagnosis, which in turn requires the availability of tissue sampling procedures. Chemotherapy and radiotherapy are available on a limited basis in middle-income countries, but often not in poorer nations.

In response, the CFR task force calls on U.S. leadership to support resource-level-appropriate guidelines for the management of treatable and curable cancers. Breast cancer provides a good model. With the support of the Susan G. Komen organization, the Breast Health Global Initiative was formed and has since produced a comprehensive set of resource-adapted, stage-specific guidelines for breast cancer management including early detection, diagnosis, treatment and palliative care. These guidelines provide the playbook for governments on how to prioritize scarce resources and where to make investments.

There is much the United States and its allies can do to help developing countries meet the NCD challenge at relatively modest cost. By placing the cancer crisis far higher on the global health agenda, we have it in our power to spare millions from needless suffering and death.

source; http://www.huffingtonpost.com/

3 February, 2015 Yesterday marked a huge step forward in getting an international commitment to tackle epilepsy on a world-wide basis. A new resolution to prioritise epilepsy care in a coordinated way around the world was approved by the Executive Board of the World Health Organisation (WHO).

The resolution received strong support and calls on member states of WHO to take action to tackle epilepsy care. It places equal importance on both medical care and the social aspects of living with epilepsy. It also focuses on everyone epilepsy impacts on including people with epilepsy and those who care for them.

As part of the resolution, it has been suggested that WHO should put together plans and documents which member states can use to implement the actions set out in the resolution.

The Executive Board, which approved the resolution, is made up of 34 health professionals from each member state. Given members' specialist knowledge it is able to give direction to the priorities, decisions and policies of WHO. Its recommendation for the resolution will be submitted to a meeting of WHO's General Assembly in May.

Twenty-eight countries spoke in support of the resolution and suggestions were put forward to strengthen the resolution. Some of the statements from members states were extremely strong and supported the need for improved healthcare services and measures to reduce stigma and discrimination.

Philip Lee, chief executive of Epilepsy Action, said: "This new resolution is excellent news for people with epilepsy across the world. It will highlight the impact of epilepsy and the action needed at a country level to tackle the health and social problems associated with the condition.

"Epilepsy Action is a member of the International Bureau of Epilepsy (IBE) and collectively we have supported the need for this resolution to ensure that the voice of epilepsy is heard across the globe."

source: https://www.epilepsy.org.uk/

Traditional medicine has been practiced in the world for centuries. Passed along from generations to generations, some of the herbal remedies have over the years been crystallized and led to a number of discoveries and large developments in the modern pharmacological industry. The use of herbal remedies has expanded globally, gaining more popularity and is readily being incorporated into modern day health care, not only in the developing world but also in the developed countries.

Although herbal remedies are popular all across Asia, with companies from China and Malaysia as the current market leaders, it is Indonesia that has the biggest and fastest-growing traditional medicine business in the region. According to a report by Euromonitor International, by 2017 the turnover is expected to reach $800 million per year, up 55% from about $500 million in 2012.

Regarded as a highly lucrative market, some of the biggest pharmaceutical companies have muscled their way into what was once a solely family-operated, small-scale industry. One of the early players is Sido Muncul, which used to be a small-scale company but has now risen up the ranks. Together with Deltomed Laboratories, they are Indonesia's two main leading contenders in the herbal medicine market. Sido Muncul sells over 200 million sachets of the cold medication Tolak Angin, currently its biggest marketable product.

With its abundant natural resources, Indonesia has no shortage of roots, herbs, spices, or fruits to be continuously examined and explored for new and improved herbal medicines. Of the 30,000 species of flowers and plants found in the many rain forests all across Indonesia, over a 1,000 have been recognized to have significant medicinal potential and many of those are regularly used to produce herbal medicines.

There has been a significant rise in the demand for Indonesian herbal remedies in the international markets as well. Huge markets like Australia, much of Europe, and America have all been successfully penetrated by companies from Indonesia. The government also provides strong support for the industry, implementing policies such as the 'Back to Nature, Use Indonesian Traditional Medicine' movements that safeguard the interests of the Indonesian herbal medicine developers and promote the products for health care services.

However, further development will require more concrete actions, such as establishment of Diploma programs in Traditional Medicine, to produce scientifically minded experts in the field, establishment of alternative health service centers, as well as standardization and better quality control in the production line. If done properly, these will help enable Indonesia's herbal medicinal industry to produce better products and benefit more people.

http://www.globalindonesianvoices.com/

The tragic Ebola outbreak in West Africa has underscored the imperative of strengthening health systems at both the national and global level. But, though Ebola has focused the world's attention on systemic shortcomings, the goal must be to combat the abiding epidemics that are quietly inflicting suffering and death on populations worldwide.

Ebola has undoubtedly wrought tremendous agony. But it is not the first – or the most devastating – pandemic the world has faced. In fact, smallpox is the deadliest disease known to humanity; until Edward Jenner developed the vaccine in 1796, it was the leading cause of death in Europe. Before its eradication in 1980, it killed an estimated 300-500 million people.

The Bubonic plague of the fourteenth century killed 75-100 million people – more than half of Europe's population. Nearly 75 million people, or 3-5% of the world's population, died in just a few months during the 1918 influenza pandemic – more than twice the number of people killed in World War I.

The world continues to grapple with HIV/AIDS, which has already caused more than 40 million deaths and infects a similar number of people today, with 95% of the epidemic's victims living in developing countries. Only when HIV/AIDS began to gain traction in advanced countries were highly effective anti-retroviral therapies developed – therapy that most of the poor people suffering from the disease could not access or afford.

Similarly, the failure of governments, multilateral organizations, and NGOs to respond quickly enough to the Ebola outbreak reflects the fact that the disease has ravaged poor countries. But, at a time of unprecedented global interconnectedness, everyone has a stake in ensuring that adequate health-care systems and structures are in place to address such a pandemic. Achieving this requires providing the needed investment; after all, effective national health systems and agile surveillance are the first lines of defense against outbreaks of disease.

At this point, Ebola is not only a health crisis, but also a humanitarian, economic, and political crisis. To be sure, some progress has been made. The United Nations Mission for Ebola Emergency Response's "70/70/60" plan – to isolate 70% of Ebola patients and ensure that 70% of burials are conducted safely within 60 days – has largely been implemented, reducing the number of new cases considerably. But people are still suffering and dying – often owing to a lack of access to credible information or adequate treatment.

Of course, when it comes to safeguarding the health of populations, there is a fine line between protecting the public and impinging on individual rights. That is why all public-health interventions must focus first and foremost on scientific facts, and avoid emotional or panicked responses.
In this context, the imposition of mandatory quarantines on travelers from Ebola-affected countries was an obvious policy failure – just as they were when authorities tried to contain the Black Death of 1350 in Europe or the Plague of London in 1665. Instead of wasting time on fear-based strategies, the international community must leverage human and financial resources to ensure fact-based, concerted, collective action. Such a united approach is possible; indeed, it has happened before.

At the turn of the century, the establishment of institutions like the Global Fund to Fight AIDS, Tuberculosis, and Malaria, the Bill and Melinda Gates Foundation, and GAVI, the Vaccine Alliance, coincided with a renewed effort to improve global health. The UN's commitment to the Millennium Development Goals – which included four health-related targets, covering nutrition, maternal and child health, and infectious diseases – reflected a political consensus to improve health worldwide. This institutional architecture has facilitated considerable progress in many of these areas; for example, the under-five mortality rate has plummeted by 49% since 1990.

But there is far more to be done. In regions like Southeast Asia and Sub-Saharan Africa, maternal and child health and infectious diseases remain priorities. In fact, the ten countries with the highest child mortality rates are all located in Sub-Saharan Africa; a baby born in West Africa is 30 times likelier to die before the age of five than one born in Western Europe.

Even within countries, massive inequalities remain. For example, there is a ten-fold difference in infant mortality between municipalities in the Mexican states of Guerrero and Nuevo León.

Moreover, silent epidemics have taken hold, particularly in lower-income countries, as the combination of mega-trends like urbanization, population aging, obesity, sedentary lifestyles, smoking, and alcohol consumption has spurred the rise of chronic non-communicable diseases (NCDs). For adults in most countries, cancer, diabetes, and cardiovascular disease have become leading causes of disability and death.

Emerging infectious diseases like Ebola may be more compelling, but the health impact of chronic NCDs, not to mention their high and growing social and economic costs, is substantially larger. There is no time to waste. Policymakers must pursue aggressive action to curb the spread of risk factors like the consumption of tobacco, alcohol, and obesogenic foods.

The world is facing a three-prong health challenge: We must build sustainable national and global health systems that can respond quickly and effectively to crises like Ebola; eliminate or control infectious diseases; and address the quietly rising epidemic of chronic NCDs. To succeed on all three fronts, we need sustained investment in health infrastructure, management, and personnel.

Equality is key. This means improving access to health care and education. But it also means addressing the deeper social inequities that extend beyond the public-health agenda. In formulating the post-2015 development goals, world leaders must remember that health is a fundamental human right.

source: http://www.project-syndicate.org/

Under Indonesian law, the minimum age of marriage for girls is a tender 16 years; for boys, the minimum is 19.

Because of this age disparity and the dangerously low age requirement for teen girls, young women in Indonesia face health risks that range from complications in pregnancy to gender-based violence, both of which can — and all too frequently do — result in death.

Nationwide, 6 percent of boys and 13.7 percent of girls aged 15-19 are already married, according to the Central Statistics Agency's (BPS) 2010 census. Data from the Ministry of Health's 2013 National Basic Health Research Survey (Riskesdas), though, found that 42 percent of adolescent women aged 15-19 had been married. The 2010 census also found that more than 22 million Indonesian girls and boys aged 10-14 were already married, with the proportion evenly split between the genders.

This practice persists despite the official age requirements due to a loophole that permits families to circumvent the marriage law if they grant their permission — effectively rendering it moot. It's common enough in some areas to raise concerns among public health officials.

Girls aged 10 to 15 are at five times greater risk of death in pregnancy — and those aged 16 to 19 at a twice greater risk — compared to women aged 20 to 25, according to a 2013 white paper commissioned by the United Nations Population Fund (UNFPA).

Although just 1.9 percent of women 
and girls in Indonesia say their ideal age for having their first child is 19 years or younger, according to BPS' 2012 Indonesian Demographic Health Survey, the same survey found that 9.5 percent of teen girls had given birth or were pregnant, suggesting we should be alarmed for their health, rights and preparation for marriage.

Births in early marriage contribute to the nation's worsening maternal mortality ratio: for every 100,000 live births, an 
estimated 359 women and girls die during their pregnancy, according to the 2012 IDHS. That's a 
significant increase from 2007, when the figure stood at 223.

Tellingly, the same survey found that fewer than 10 percent of never-married girls and boys between the ages of 15 and 19 had been exposed to messages in the media urging them to postpone marriage.

A grassroots movement that calls itself Koalisi 18+ (Coalition 18+) is dedicated to increasing Indonesia's minimum age of marriage and strengthening enforcement to eradicate early and coerced marriages.

"Inexperienced and vulnerable young brides are not physically, mentally and emotionally ready for marriage and pregnancy, as they are still at a crucial age of development," said Anggara, one of Koalisi 18+'s founders. "Early marriages deprive girls of 
educational opportunities and their 
fundamental rights. They perpetuate a vicious cycle of poverty and death, with teens forced to give birth to infants and raise families without proper knowledge and access to health services."

Koalisi 18+ has started an online 
petition on Change.org to increase the minimum age of marriage for girls 18-years-old, the same age it also seeks to set for adolescent boys. The petition has so far gathered 13,000 signatures and counting, just 1,000 shy of the group's goal before submitting it plans to submit its petition to the Constitutional Court in an effort to revise the law.

"Public awareness of girls' rights, welfare and equality has to be promoted, as well as the importance of them reaching their full potential for themselves, their children and the country," Anggara said. "Laws alone cannot provide the solution."

Since its founding last July, Koalisi 18+ has been busy with social media 
campaigns such as #stopperkawinananak and #aksi2015 on Twitter, empowering women through education and seminars. Koalisi 18+ also works with other groups such as Yayasan Kesehatan Perempuan (Women's Health Foundation).

Due to conservative religious beliefs, cultural conceptions, family shame and honor, economics, poor education and sexual taboos, early marriages and 
pregnancies have become a dangerous tradition passed on across generations.

"Nothing positive can come from 
early marriages," said Koalisi 18+ campaign manager Reza Gardi. 
 "Marriage should be a beautiful chapter that is experienced by one's own voluntary choice. Let's give our girls the right to be educated, the right to their own body and the right to live a normal childhood."

He also adds that disempowered and vulnerable young brides are mostly 
married to men twice their age, elevating the risk of physical and mental violence throughout their lives, and enabling, in his words, a pedophilic culture and sexual abuse in Indonesia.

"Marriage is not just merging of two bodies," said psychologist Anna Surti Ariani, the founder of Pranikah, a foundation devoted to the sanctity of marriage. "There are other underlying issues that is attached to it. Therefore, marriage requires mental, emotional as well social preparedness and stability, which can't be found in early marriages."

source: http://thejakartaglobe.beritasatu.com