Wednesday is World Toilet Day, created by the United Nations in 2001 to raise awareness about lack of available sanitation around the world. Currently, 2.5 billion people globally don't have access to improved sanitation facilities – meaning more people have access to mobile phones than to toilets.

Lack of access to sanitation creates a host of health problems, making it easier for diseases to spread, infecting drinking water and contributing to undernourishment and poverty. A child dies every 20 seconds because of poor sanitation, according to the U.N. It can also impact future economic opportunities because lack of sanitation can negatively affect school attendance, especially for girls. In 2013, 1,000 children died every day due to diarrheal disease because of poor sanitation.

The U.N. campaign to end open defecation seeks to eliminate the need for people to defecate outside, frequently with no privacy. According to a joint report from the World Health Organization and UNICEF, 1 billion people are forced to defecate in the open due to lack of sanitation facilities. This causes a range of diseases from cholera and typhoid to polio and hepatitis. It also costs the world $260 billion a year, with 20 of the most affected countries in South Asia and sub-Saharan Africa.

The U.N. promotes access to safe and clean toilets as a part of its 2015 Millennium Development Goals, a series of benchmarks countries strive to reach to reduce poverty, mortality rates and inequality around the world. Seventy-seven countries have met the goal for sanitation. U.N. Secretary-general Ban Ki-moon says 1.25 billion women and girls would have better health and safety with the improvement of sanitation facilities.

Catarina de Albuquerque, the U.N. special rapporteur on the right to water and sanitation, said women and girls in particular are negatively impacted by lack of access to sanitation facilities. Gender-based violence and sanitation is the theme of this year's World Toilet Day.

"In many countries, social or cultural norms prevent girls and women from using the same sanitation facilities as male relatives, for instance the father-in-law, or prohibit the use of household facilities on the days women and girls menstruate," de Albuquerque said.

Improved sanitation is also harder to come by in rural areas than urban ones. In 2012, nearly 1.8 billion people living in a rural area lacked access, while 756 million did in urban areas.

Oceania is the only developing region not to see an increase in improved sanitation between 1990 and 2012. Open defecation was highest in Southern Asia at 65 percent in 1990 but fell to 38 percent in 2012, marking the largest drop in any region. Western and Eastern Asia only rates of 3 percent and 1 percent respectively. India is the country with largest population practicing open defecation, with 597 million people lacking access to proper sanitation facilities.

source: http://www.usnews.com

Mercury contamination is a "public health emergency," according to a prominent Indonesian environmentalist, and the new government of President Joko Widodo should move quickly to halt trade in the toxic heavy metal.

Yuyun Ismawati, a 2009 winner of the Goldman Environmental Prize for her work on sustainable waste management, called on Mr. Widodo to halt the illegal smuggling of hundreds of tons of mercury into Indonesia, most of which is used in small-scale gold mining operations.

Ms. Ismawati, a co-founder of the environmental group BaliFokus, said doctors have identified more than three dozen suspected cases of advanced mercury poisoning. She estimates that at least 5 million people are exposed to the toxic heavy metal in the air and food in mining communities.

The amount of mercury illegally brought into Indonesia has been rapidly increasing, reaching about 500 tons in 2013, she said in an interview with the Wall Street Journal.

"We have to stop the mercury from coming into the country," she said. "This is a public health emergency."

Mr. Widodo, who took office four weeks ago and is still organizing his administration, campaigned on a platform of improving health care and other social services.

BaliFokus is among several environmental groups that have met over the past two weeks with newly appointed Forestry and Environment Minister Siti Nurbaya to talk about environmental priorities.

Much of their discussion has focused on complaints by environmentalists that President Widodo combined forest management and the environment in one ministry, which advocates fear could weaken environmental protection.

Sonia Buftheim, a BaliFokus toxics program officer who attended one session, said she told the minister that the widespread use of mercury in small-scale gold mining was creating a public health emergency. She said Ms. Nurbaya noted her concerns but did not comment on the issue.

An assistant to the minister confirmed that the discussion took place but the minister and her staff did not respond to questions from the Journal about the threat posed by mercury.

Small-scale gold miners use the liquid metal to bind tiny particles of gold and create a small lump of amalgam. Miners and traders then burn off the mercury with a blowtorch, leaving only the gold.
Typically, they use no protective gear to keep from inhaling the mercury vapors.

Most of the airborne mercury settles into the soil and water, where it can be absorbed by fish and rice and enter the human food supply, endangering the health of the entire community.

Mercury poisoning can cause tremors, headaches, muscle weakness and mood swings, among other symptoms. It often goes unrecognized because it can take years to develop and its symptoms are similar to other ailments. It also can cause birth defects.

Ms. Ismawati said an estimated 2 million gold miners operate in 22 of Indonesia's 34 provinces, including on Java, Sumatra, Sulawesi, Borneo and Lombok. Mercury is sold openly at shops in mining communities, she said.

She urged the government to ban the use of mercury in gold mining and to provide treatment for people suffering from mercury poisoning.

source: http://blogs.wsj.com/

The World Health Organization (WHO) says the global campaign to eliminate measles is in trouble as progress toward that goal has stalled. WHO reports about 145,700 children died from measles in 2013, an increase of 23,700 from the previous year.

WHO says a decline in routine measles vaccine coverage has resulted in large outbreaks of this highly contagious disease in recent years. It also has stalled global efforts to eradicate measles by 2015.

The U.N. agency says measles immunization efforts are hampered by lack of money, weak health systems and not enough awareness of the importance of vaccinating children against this killer disease. It notes it only costs about one dollar to vaccinate a child.

WHO estimates 15.6 million deaths have been prevented through vaccination between 2000 and 2013.

Dr. Robert Perry of the WHO Department of Immunization, Vaccines and Biologicals, says these huge reductions in mortality are tapering off because of poor vaccine coverage.

"So, now we are in a crossroads," he said. "We need adequate funding. We need to find ways to increase the first dose coverage and to increase the uptake of a second dose in routine as well as conducting high quality campaigns or we are likely to see more outbreaks like we have seen in the last few years."

The World Health Organization reports in 2013 large outbreaks occurred in China, Democratic Republic of Congo and Nigeria. It reports more than 70 percent of global measles deaths occurred last year in just six countries - India, Nigeria, Pakistan, Ethiopia, Indonesia, and Democratic Republic of Congo.

Perry says conflict-ridden Iraq and Syria and neighboring countries are having serious problems with measles outbreaks.

"These are countries, especially like Syria and Jordan that had very good coverage, had essentially eliminated measles and blocked any measles transmission," he said. "Because of the conflict in Syria, there has been huge population movement, so now there is - the population that used to be all vaccinated now is not vaccinated in Syria and they have moved to other countries. So, now these countries have big populations of kids that are not being reached. And, the conflict in Iraq and Syria is having a bad effect on the ability of teams to reach children. So, there is a lot of measles in those countries."

Perry notes conflict in Africa is having a similar effect on efforts to reduce death from measles.

He says the conflict between the government and Boko Haram militants in northeast Nigeria is creating great instability and making large vaccination campaigns virtually impossible.

Although Central African Republic also is hard hit by conflict, he says it was possible to mount a successful measles vaccination campaign there last year. But he adds a number of areas were off limits because of fighting, so many children have been missed.

source: http://www.voanews.com

A major new Series on health and ageing, published in "The Lancet", warns that unless health systems find effective strategies to address the problems faced by an ageing world population, the growing burden of chronic disease will greatly affect the quality of life of older people. As people across the world live longer, soaring levels of chronic illness and diminished wellbeing are poised to become a major global public health challenge.

Effective health interventions increasing life expectancy

Worldwide, life expectancy of older people continues to rise. By 2020, for the first time in history, the number of people aged 60 years and older will outnumber children younger than 5 years. By 2050, the world's population aged 60 years and older is expected to total 2 billion, up from 841 million today. Eighty per cent of these older people will be living in low-income and middle-income countries.

The increase in longevity, especially in high-income countries (HICs), has been largely due to the decline in deaths from cardiovascular disease (stroke and ischaemic heart disease), mainly because of simple, cost-effective strategies to reduce tobacco use and high blood pressure, and improved coverage and effectiveness of health interventions.

Challenge of ageing healthily

However, although people are living longer, they are not necessarily healthier than before – nearly a quarter (23%) of the overall global burden of death and illness is in people aged over 60, and much of this burden is attributable to long-term illness caused by diseases such as cancer, chronic respiratory diseases, heart disease, musculoskeletal diseases (such as arthritis and osteoporosis), and mental and neurological disorders.

This long-term burden of illness and diminished wellbeing affects patients, their families, health systems, and economies, and is forecast to accelerate. For example, latest estimates indicate that the number of people with dementia is expected to rise from 44 million now, to 135 million by 2050.

"Deep and fundamental reforms of health and social care systems will be required," says Dr John Beard, Director of the Department of Ageing and Life Course at the WHO, and co-leader of the Series with Dr Ties Boerma and Dr Somnath Chatterji, also from WHO. "But we must be careful that these reforms do not reinforce the inequities that drive much of the poor health and functional limitation we see in older age."

"While some interventions will be universally applicable, it will be important that countries monitor the health and functioning of their ageing populations to understand health trends and design programmes that meet the specific needs identified", adds Dr Ties Boerma, Director of the Department of Health Statistics and Informatics at WHO. "Cross-national surveys such as the WHO Study on Global Ageing and Adult Health (SAGE), the Gallup World Poll, and other longitudinal cohorts studies of ageing in Brazil, China, India, and South Korea, are beginning to redress the balance and provide the evidence for policy, but much more remains to be done."

Strategies must go beyond health sector

However, the responsibility for improving quality of life for the world's older people goes far beyond the health sector, say the Series authors.

Strategies are needed that better prevent and manage chronic conditions by extending affordable health care to all older adults and take into consideration the physical and social environment. Examples include changing policies to encourage older adults to remain part of the workforce for longer (e.g., removing tax disincentives to work past retirement age), emphasising low-cost disease prevention and early detection rather than treatment (eg, reducing salt intake and increasing uptake of vaccines), making better use of technology (eg, mobile clinics for rural populations), and training health-care staff in the management of multiple chronic conditions.

According to Dr Chatterji, also from the Department of Health Statistics and Information Systems at WHO, "Collectively, we need to look beyond the costs commonly associated with ageing to think about the benefits that an older, healthier, happier, and more productive older population can bring to society as a whole.

source: http://www.who.int/

Scientists involved in trials of experimental drug treatments for the Ebola epidemic in west Africa should not be compelled to withhold them from some patients, says the World Health Organisation, despite objections from the US that it is the only way to be sure they work.

The Food and Drug Administration, which licences medicines in the US, believes the Ebola drug trials should be set up in west Africa on the "gold standard" model designed to provide a conclusive answer as to whether they have an effect. The FDA says the trials should be randomised and controlled – which means giving experimental drugs to one group of patients, selected at random, but not to others, so death rates and other outcomes in the two groups can be compared.

Other scientists, including those at the University of Oxford who are currently preparing for trials in the epidemic region, say that with a death rate of 70% and fear and suspicion of hospitals running high in the three worst affected countries in west Africa, it is not possible to run the sort of trial that would be standard in the UK or US. Instead, they are designing alternatives that will reach an answer but without depriving some patients of a drug that might possibly help them survive. The virus has claimed more than 4,800 lives since the outbreak began in December.

A meeting of the WHO's ethics working group has supported that view, concluding that an alternative approach may be preferable in the very difficult circumstances of Sierra Leone, Liberia and Guinea.

"In the context of the current Ebola epidemic in west Africa – where the disease has a high fatality rate, and there are tensions between local communities, governments and healthcare workers – it may not be acceptable or feasible to conduct randomised placebo-controlled trials. Some members of the working group argued that in certain situations, it may also be unethical to do so," say the formal minutes of the meeting.

A trial without a control group that fails to come up with a clear result to show whether a drug is helping or harming patients could also be considered unethical, the group acknowledged. But, it goes on, representatives at the ethics meeting from Guinea and Liberia, "expressed their view that individually randomised placebo-controlled trials would not be acceptable to local communities because such trials would deny a new experimental treatment to some participants."

Trudie Lang, professor of global health research at the University of Oxford and part of a team working to get drug trials started in west Africa with unprecedented speed using funding from the Wellcome Trust, said she did not believe the traditional gold-standard randomised controlled model was possible in the Ebola epidemic. "We have had health workers murdered. There is very fragile trust in the health systems," she said. At the meeting, a doctor in charge of treatment centres said she would not put her staff at risk by denying drugs to some of the patients but not others. It could be particularly difficult if some members of a family were randomly selected to receive the experimental treatment while others were not.

Lang and colleagues are designing trials that will still come up with the answers – for instance by comparing survival rates now at a specific treatment centre with survival rates once all patients are given a certain drug. As there are several potential Ebola drugs being rushed into production, it may also be possible to compare one against another. "It is not a lower scientific standard - it is just a different scientific approach which is used in other settings, such as cancer trials. This design works when you are looking for a large change in outcome, so in Ebola, as in cancer, we are looking for a large increase in survival. In this situation it is appropriate not to randomise," she said.

But the US regulatory body does not agree. Speaking at the American Society for Hygiene and Tropical Medicine meeting in New Orleans, Dr Edward Cox of the FDA said randomised controlled trials (RCTs) would be a "very informative" way to find out about the effect of the new drugs although there was "no question there are challenges in implementing such a design in a setting like west Africa".

While he accepted that there was "a range of opinions" about the appropriateness of RCTs, he said that giving patients who did not get drugs the best possible standard of care, with fluids and blood transfusions, "can have a very positive impact on outcomes in patients with Ebola virus disease".

"This will be challenging but it is very important to be able to understand what these products are doing," he said. "If we can quickly figure out which products are helping patients, it will be possible then to move forward to scaling those products up and making them available to more patients."

There are several drugs in the pipeline that scientists hope to trial in west Africa, all of them in early stages of development and some of which have not yet been tested in humans. Some are in pill form, while others would have to be given as injections or infusions and they work in a variety of ways. Most were designed to act against other viruses than Ebola. No announcement has yet been made as to which drug will be trialled first, but the hope is to get more than one going before the end of the year.

source: http://www.theguardian.com

The provision of numerous cards, including the Healthy Indonesia Card and Smart Indonesia Card, to disadvantaged people across the country is the first step towards improving their welfare, President Joko Widodo (Jokowi) said.

"This is just the first step towards improving their welfare," President Jokowi stated while launching the Healthy Indonesia Card and Smart Indonesia Card at the Central Post Office here on Monday.

On the occasion, the president was accompanied by Coordinating Minister for Human Development and Culture Puan Maharani, Social Minister Khofifah Indar Parawansa, and Minister of Basic and Intermediate Education and Culture Anies Baswedan, among others.

Here, Jokowi pointed out that improving public health services at hospitals and public health clinics were among other measures to be taken in this regard.

He further added that the distribution of these cards was expected to reach 19 districts/municipalities and nine provinces by the end of 2014.

Moreover, the head of state also explained that funding for non-cash assistance programs in the future will be increased and is expected to reach all provinces in the country. In keeping with this goal, he urged the public to make proper use of these cards.

According to the president, the government will gradually launch the programs of Prosperous Family Saving, Smart Indonesia, and Healthy Indonesia for the benefit of the 15.5 million disadvantaged people.

Meanwhile, Secretary of the National Team for the Acceleration of Poverty Reduction (TNP2K), Bambang Widianto, noted that the government had distributed Prosperous Family Cards (KKS), SIM Cards, Smart Indonesia Cards (KIP) and Healthy Indonesia Cards (KIS) to 1 million disadvantaged families in the preliminary stages of the programs.

"All these programs are part of a new era in the improvement of the welfare of disadvantaged people through savings accounts, furtherance of education and provision of health services," Widianto remarked.

He affirmed that the government had distributed KIPs to 157,943 of 1 million school-age children and KISs to 4,451,508 individuals in the preliminary stages of the programs.

source: http://www.antaranews.com

The rapid propagation in recent years of infectious diseases such as Malaria, Chikungunya and even Ebola is one more example of how climate change threatens global health security.

"Climatic changes also affect temperatures and regional climates, the conditions on which, for instance, in the continent of Africa, mosquitoes may spread from one region to another," Achim Steiner, executive director of the UN Environment Programme (UNEP) , told Efe news agency on Friday in a telephone interview from Nairobi.

The UNEP chief spoke ahead of Sunday's release in Copenhagen of the Fifth Assessment Report from the Intergovernmental Panel on Climate Change.

"Diseases will move as the world warms and we may in many parts of the world indeed see either the return or the arrival of diseases that in recent times have simply not occurred in those regions," he said.

That development, he said, will add "extra stress to the health infrastructure, the health system and ultimately the health and well-being of these populations in those countries".

Awareness of the link between climate and health has prompted environmental scientists to forge closer links with international bodies focused on health, Steiner said.

"That is why my colleague, Margaret Chan, who heads the World Health Organisation, convened a meeting in Geneva on climate change and health," he said.

"And her conclusion was that a climate agreement in Paris is not just only a climate change agreement, it is also a global health agreement, because clearly the connection between environmental change arise from global warming and greater health risk factors is very direct in many different respects," Steiner said.

World leaders are due to meet in Paris next year with the aim of producing a new pact on controlling emissions of greenhouse gases to take the place of the Kyoto Protocol.

Besides the effect on climate, carbon emissions also cause direct damage to human health, according to the UNEP director.

Emissions of carbon and other pollutants are "responsible for approximately seven million premature deaths every year worldwide", Steiner said. "That is more by far more than the combined premature deaths arising from HIV/AIDS and malaria combined."

"We need to, first of all, get a clearer scientific understanding on how these linkages (between climate change and health) are occurring, secondly to anticipate its impact and thirdly, to put in place the right policy and response measures," Steiner said.

There are, he said, "large economies such as Brazil which has taken significant steps in terms of, for instance, the main sources of greenhouse gases, carbon dioxide in this case arising from deforestation".

"Brazil has made a tremendous contribution by reducing deforestation, perhaps one of the most significant steps in moving away from a business as usual scenario that we had 10 years ago," Steiner said.

He also offered praise for Nicaragua, which he described as being "on the forefront of mainstreaming renewable energy technology in its power and electricity generator sector".

"We see in the Latin American region significant investments, for instance, in low carbon and building infrastructure efficiencies happening from Colombia to Peru," Steiner added.

"So I think what we are seeing in the year 2014 is a recognition that every country has an interest in acting on the threat of climate change, doing as much as it can within the means available to it domestically and counting on the international climate agreement and also green climate financing for funds to further assist countries in moving faster and more ambitiously," he said.

The 20th session of the UN Conference of the Parties on Climate Change, known as COP20, will be held Dec 1-12 in Peru's capital.

The Lima gathering is supposed to produce a draft accord that can be signed next year in Paris.

"We have, in a sense, the choice now to make a judgment. We face an enormous risk that if we don't move into a low carbon future now that we would have lost that choice to even make it 20 to 50 years down the line," Steiner said.

source: http://articles.economictimes.indiatimes.com/

A delegation of the UNAIDS Programme Coordinating Board (PCB) conducted a field visit to Indonesia from 22 to 24 October to see how the country has implemented an integrated and decentralized response to AIDS that has accelerated the strategic use of HIV treatment, increased testing and counselling and strengthened HIV prevention services for key populations.

Indonesia demonstrates how a multisectoral approach to HIV, combined with consistent leadership at all levels, is helping the country to stabilize the epidemic, accelerate treatment and provide innovative and comprehensive HIV services. The country's AIDS response is guided by an investment strategy, developed with support from UNAIDS, which focuses resources and efforts where they are most needed.

"Indonesia's response shows that cross-sectoral engagement and leadership—including impressive and vibrant civil society involvement—is critical for turning strategies into action," said UNAIDS Deputy Executive Director Jan Beagle, who was leading the visit. "As we look towards ending the AIDS epidemic by 2030, continued commitment at all levels will be key to effective impact—for AIDS and the broader health and development agenda."
According to national estimates, 638 000 people are living with HIV across Indonesia, and latest national data show that new infections are stabilizing, although there are increases among men who have sex with men. Indonesia's epidemic is largely concentrated among key populations, including sex workers and their clients, men who have sex with men, people who inject drugs and transgender people. While national HIV prevalence is low, a higher burden of HIV is found among key populations and in certain geographic areas, such as urban settings and in the Papua provinces.

The delegation, which included members from Australia, Brazil, El Salvador, Iran (Islamic Republic of), Luxembourg, Ukraine and Zimbabwe, as well as the PCB NGO delegation and UNAIDS Cosponsors, met with a range of national partners, including senior government representatives at the national, provincial and city levels, the National AIDS Commission, development partners, civil society organizations and the United Nations Country Team. The delegation also visited several sites to see examples of scaling up access to HIV testing and treatment and ways of addressing stigma and discrimination.

During a meeting with the PCB delegation, the Acting Governor of Jakarta, Basuki Tjahaja Purnama, highlighted the city government's response to HIV in the capital. The Acting Governor underscored the significant investments that the local government has made to HIV programmes, including increasing access to HIV treatment, and expressed his commitment to prioritize health, education, employment and housing for people living with HIV, ensuring that no one is left behind.

Over the past years, Indonesia has increased its domestic financing to 42% of its total spending on AIDS. Throughout the visit, political commitment to further increase domestic funding was emphasized at all levels. However, government officials also stressed that international financing remains critical to scaling up the response, in particular for accelerating access to HIV treatment.

Community-friendly services key to a sustainable response

At a gathering of civil society groups, including networks of people living with and most affected by HIV, the delegation was presented with an overview of how youth organizations are mobilizing young Indonesians, as part of the ACT 2015 initiative, to ensure that HIV and sexual and reproductive health and rights remain a priority for the country's new government and in the next development era.

Site visits to a number of public and private HIV service-providing institutions in Jakarta and Denpasar showcased how community-friendly and community-led services are improving uptake of services and reducing stigma and discrimination. Examples included the country's main HIV treatment referral hospital in Jakarta, which runs programmes to sensitize staff on the specific needs of key populations at higher risk, and the Yayasan Kertipraja Foundation and the Bali Medika Clinic in Denpasar, where a number of programmes are led by key populations and provide easy-to-access services after work hours and on Saturdays. As well as increasing demand among key populations, such programmes have also led to early uptake of HIV treatment. The National AIDS Commission, with support from UNAIDS, is looking at how to further replicate and scale up such models across the country.

source: http://www.unaids.org/