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WHO: Tedros Adhanom raised eyebrows with his appointment of Robert Mugabe and new recruitment policies. But the real shocker was his choice of a Russian to head up agency’s tuberculosis fight. January 17, 2018

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The Mugabe appointment “was stupid, but this is a disaster,” said Mark Harrington, executive director of Treatment Action Group. Ahead of the appointment, TAG led an open letter from more than 40 civil society groups asking Tedros to use a transparent, competitive process to choose the next director of the Global TB Program, tasked with fighting the top infectious killer worldwide.

 #NoTedros4WHO

World’s doctor gives WHO a headache


Tedros Adhanom Ghebreyesus raised eyebrows with his appointment of Robert Mugabe and new recruitment policies. But the real shocker was his choice of a Russian to head up agency’s tuberculosis fight.

 

Illustration by Eva Bee for POLITICO

 

Seven months into his tenure, the early moves of the WHO’s first African chief are stoking a backlash.

His supporters say Tedros Adhanom Ghebreyesus promised to shake the institution up. The critics, increasingly emboldened, say he’s undermining the World Health Organization’s effectiveness and putting its funding at risk.

The former Ethiopian health minister turned heads with his appointment of Zimbabwean dictator Robert Mugabe as a goodwill ambassador in October. Meanwhile, behind the scenes, Tedros — as he prefers to be called by Ethiopian tradition — was eschewing the normal hiring process for U.N. agencies, looking to increase gender and geographical diversity as quickly as possible. That’s unsettled some in the Geneva headquarters and the constellation of activists and researchers who work with WHO, who fear an overly political approach is bringing a culture change at the cost of credibility.

The latest disruptive move is his appointment of a little-known Russian official to run the WHO’s tuberculosis program, using a fast-track process, one month after meeting with President Vladimir Putin at a major gathering on the topic in Moscow.

The Mugabe appointment “was stupid, but this is a disaster,” said Mark Harrington, executive director of Treatment Action Group. Ahead of the appointment, TAG led an open letter from more than 40 civil society groups asking Tedros to use a transparent, competitive process to choose the next director of the Global TB Program, tasked with fighting the top infectious killer worldwide.

Reward for being retrograde

The December nomination of Tereza Kasaeva (an official at the Russian health ministry) prompted an editorial in the medical journal the Lancet, which described it as triggering a “potentially disabling controversy.”

“The domestic situation there is horrible. It’s probably one of the worst outside of Africa on TB infections” — Eduardo Gómez, King’s College London

“Russia has a poor record on TB and HIV,” write the editors of the journal, which is widely seen as the voice of the global health establishment. “Her appointment may be regarded as rewarding a country that does not deserve to be rewarded … WHO’s reputation — indeed, its political leverage — depends on the agency’s technical credibility.”

Russia is widely regarded as retrograde in its approach to treating the infectious disease, having developed a raging outbreak after the breakdown of the Soviet Union. Since 2000 or so, overall incidences are down and survival rates are up, but Russia is still a world leader on the proportion of infections that don’t respond to antibiotics; a recent study predicted one in three cases would be antibiotic resistant by 2040.

Kasaeva replaces Mario Raviglione, a leading TB expert with more than 25 years of experience fighting the bacterial infection.

Tedros says he’s just keeping a campaign promise to overhaul the agency in the wake of its high-profile failure to respond quickly to the 2014 Ebola crisis in West Africa. He is the first African to run the WHO — and the first director general chosen with a vote open to all member countries in May, overcoming what he called a “colonial mindset” among backers of his British rival.

Tedros’ advisers have defended his decision to name Mugabe a goodwill ambassador for noncommunicable diseases less than four months into the job as just a misguided effort to build bridges with a regional giant who, despite human rights violations and a long embrace of the tobacco industry, recently expressed openness to new commitments on health.

The offer was quickly retracted, but not before it triggered international condemnation. An opinion piece in the Washington Post even speculated that it was payback to Mugabe for securing the African Union’s support in the WHO election, or to China for its backing.

Tedros’ first appointments have already transformed the gender and geographic balance within the top ranks, even as they have raised concerns about a closed selection that downplays conventional expertise.

Of eight new directors chosen largely through a fast-track process, including Kasaeva, all but one are women.

Tedros is trying change the recruitment system to eliminate “unconscious biases that make it unfavorable for women to get the positions,” a top Tedros adviser, Senait Fisseha, said in an email. Until that can be accomplished, she said, he had made “limited appointments of diverse and highly qualified women” to move his vision forward.

That’s music to the ears of those who see an endless game of musical chairs that circulates people from one U.N. or international development agency to another. Often that means wealthy Western countries dictating to poorer countries how to deal with their problems in order to receive aid.

Vlad in Geneva

Diversity is a worthy goal, said Global Coalition of TB Activists CEO Blessina Kumar. But it shouldn’t come “at the cost of effectiveness and competency. You can’t trade one for the other,” she said.

“Merit was the first criteria for all appointments, while secondary consideration was given to gender and geographical diversity,” WHO spokesman Gregory Hartl said. “Dr. Tedros also sought to appoint qualified people with country-level experience, as a vital complement to the technical expertise that already exists within WHO. This will help to accelerate progress at the country level.”

Kasaeva’s appointment has proved politically volatile both for Russia’s speckled track record in combatting TB, and because it’s seen as playing into Putin’s hands, helping the Russian president project power on the global health stage while he neglects patients back home.

“The domestic situation there is horrible. It’s probably one of the worst outside of Africa on TB infections,” said King’s College London’s Eduardo Gómez, the author of “Geopolitics in Health: Confronting Obesity, AIDS, and Tuberculosis in the Emerging BRICS Economies.”

In 2012, Russia rejected a $127 million grant from the Global Fund to Fight AIDS, Tuberculosis and Malaria, stifling many of the groups on the ground. On top of that, the federal government cut domestic TB funding in recent years, according to Gómez.

Nonetheless, in mid-November, Russia pledged $15 million toward fighting TB worldwide during a major U.N. TB conference in Moscow. The foreign aid is a typical Putin move, said Gomez. “This is an opportunity to reassert Russia’s dominance in global health.”

Putin addressed the gathering and met with Tedros. A month later, on December 15, Tedros announced Kasaeva’s appointment in an internal WHO email.

“I can’t see what the upside is other than political payback,” Harrington said.

Backlash on Tedros

Defenders say Russia’s TB program is improving — driven in part by Kasaeva — and that she may be the best hope for getting the country to change.

Vadim Testov, a former WHO official now working on Russia’s TB program, said he’s seen the government’s commitment increase over time, and that it’s “ready to provide” financing to make Russia’s domestic TB fight successful. He noted that new regulations from Kasaeva’s team have led to a sharper decrease in TB cases over the last five years.

Kasaeva “will have influence on Russian officials” in her WHO position, Testov predicted.

Many aren’t sold on Tedros’ new approach and fear that global health will suffer — especially if the WHO’s biggest donors get spooked.

The backlash shows the risks from Tedros’ effort to upend the status quo. Defenders say the same-old same-old at the U.N. hasn’t served patients on Ebola, TB or a range of other issues.

“Whatever we’ve been doing for the last quarter century isn’t working that well,” said Salmaan Keshavjee, a Harvard TB expert who has worked on the ground in Russia with Partners in Health.

He argued that WHO recommendations have in the past been ill-suited to Russia’s circumstances and that homegrown experts from emerging, populous economies may be in a better position to solve their own problems and bring a new perspective to the global effort.

“If you want to hold the BRICS countries’ feet to the fire, they have to be involved in health architecture,” Keshavjee said.

Budget strings

But many aren’t sold on Tedros’ new approach and fear that global health will suffer — especially if the WHO’s biggest donors get spooked.

Though ultimately blocked, U.S. President Donald Trump’s proposal to cut back on foreign aid — announced on May 23, the same day Tedros was elected to lead the WHO — has alarmed many in the organization. The recent controversies drive some worry that other large donors like the U.K. or Germany might be tempted to draw the purse strings tighter.

The U.S. contributes almost a quarter of the WHO’s $4 billion-plus annual budget.

Tedros’ doctorate is in community health, and he served as Ethiopia’s health minister for seven years — winning wide praise for strides in expanding contraception, fighting malaria and, yes, controlling TB.

But it may be his experience as Ethiopia’s top diplomat from 2012 to 2016 that seems most apposite now. During that period, he kept his country in the West’s good graces (and the aid money flowing) despite growing concerns about the regime’s human rights violations, by stressing Ethiopia’s position as a stable, strategic partner in the war on terror.

Tedros’ team includes plenty of conventional choices; Jane Ellison, a Brit, served as something of an olive branch to the WHO’s No. 2 state donor after the U.K. strongly backed its own candidate in a campaign that turned nasty. Tedros also named a German to a long-sought top post after Berlin stepped up donations and raised Tedros’ profile by inviting him to the G20 summit.

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ETHIOPIA MAKES AMONG THE WORST 11 COUNTRIES IN 2017 WORLD HEALTH SYSTEM RANKINGS, WORLD HEALTH ORGANIZATION December 19, 2017

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Odaa OromooOromianEconomist

ETHIOPIA MAKES AMONG THE WORST 11 COUNTRIES IN 2017 WORLD HEALTH SYSTEM RANKINGS, WORLD HEALTH ORGANIZATION:

180 Ethiopia
181 Angola
182 Zambia
183 Lesotho
184 Mozambique
185 Malawi
186 Liberia
187 Nigeria
188 Democratic Republic of the Congo
189 Central African Republic
190 Myanmar

ETHIOPIA MAKES AMONG THE WORST 11 COUNTRIES IN 2017 WORLD HEALTH SYSTEM RANKINGS, WORLD HEALTH ORGANIZATION

World’s excellence in health care delivery:

1 France
2 Italy
3 San Marino
4 Andorra
5 Malta
6 Singapore
7 Spain
8 Oman
9 Austria
10 Japan
11 Norway

We cannot be unprepared for the next global health emergency: Dr. David Nabarro. #WHA70 May 9, 2017

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Dr David Nabarro is the UK Candidate to be the next Director-General of the WHO.
 

Dr. David Nabarro is one of the candidates in the fray for election of the next Director-General of the World Health Organisation (WHO) which will be held on May 23.

He has been preparing for this role for a lifetime, in a career path that has seen him travel to 50 countries and responding to the needs of people with Malaria, HIV/AIDS and Tuberculosis. He has also been pioneering a global movement on improving nutrition across 59 countries.

Besides, Dr. David Nabarro will focus on non-communicable diseases (NCDs), which are currently responsible for 70% of all deaths across the world. He is also committed to addressing the stigma of mental health, including depression which affects a staggering 300 million people globally.

Dr David Nabarro said, “We cannot afford to be unprepared for the next global emergency. I have experience on the ground, in communities and in running international crisis responses to ensure that WHO is ready to respond promptly when, not if, the next crisis hits.”

“Meanwhile we continue to fight a global epidemic of chronic diseases. They are killing more than 40 million people a year. As Director-General, I will champion prevention – it makes absolute sense to invest in preventing and reducing the long-term suffering and costs associated with conditions such as diabetes, cancer and heart disease.”

Dr David Nabarro is the UK Candidate to be the next Director-General of the WHO and has over 40 years of experience working in international public health as a practitioner, educator and public servant.

Reacting to Dr. David Nabarro’s candidacy, Lindiwe Majele Sibanda, CEO of the Food, Agriculture and Natural Resources Policy Analysis Network (FANRPAN) said, “David is one of the most committed, passionate humanitarians I have had the privilege of working alongside. His breadth of experience as a doctor, development expert and multilateral adviser makes him the best choice for WHO’s next Director-General. He is able to bring diverse groups of people together and find solutions to some of the most challenging problems through brave and visionary leadership.”

“His energy is amazing! His expertise in addressing wicked problems such as climate change and malnutrition is unparalleled which is why I am confident that David will ensure WHO is fit to face the challenges of the next decade and that the poorest and most vulnerable do not get left behind.”

Dr. David Nabarro said that should he be elected Director-General, his goal is for everyone, everywhere to have universal access to the healthcare they need, especially women and children and added that WHO’s role is to provide rapid and high quality support to governments and their citizens.

WEF: How to grow old like an athlete March 9, 2017

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How to grow old like an athlete

Ageing is not a fixed process – we can change its trajectory


By James Hewitt, WEF, Head of Science & Innovation, Hintsa Performance

Published  Thursday 2 February 2017


Driving an F1 car is not a particularly healthy thing to do… I want to live a quality life when I’m old, and not suffer from horribly degenerated discs.

—Four-Time Formula One World Champion, Sebastian Vettel

The question of how to maximise ‘health span’ – the period of life during which we are generally healthy and free from serious disease – is increasingly prevalent both in and out of sport.

Global average lifespan doubled during the 20th Century, and this trend continues. Someone who is 50 today could expect to live until they are 83. A baby born in 2007 in the US, UK, Japan, Italy, Germany, France or Canada has a 50% chance of living until they are over 100.

It’s likely that we will live and work for more years than any generation before us. For many, this will be a necessity as much as a choice, as the increasing social costs of an ageing population are pushing back retirement age in many countries. These changes will have significant economic, social and psychological impacts, but one of the key questions we need to ask concerns the kind of life we’re hoping for, over this time course.

Lifespan or ‘health-span’

Different parts of our body and brain mature at different rates, so it’s very difficult to say what human ‘peak age’ might be. However, it’s clear that the first phase of life is dominated by growth, while declines become more apparent in the second half.

Many of us assume that the ageing process is a fixed process, that we reach our peak then begin an irreversible decline. This hasn’t stopped an entire industry from trying to make an impact, though.

The global market for anti-aging products, technologies and services is expected to grow from $282 billion in 2015, to $331 billion in 2020.

It seems that many of us would prefer to ‘die young as late as possible’, but while we’re living longer, we’re living ‘sicker’.

Sport as a laboratory

Studying ageing is a challenge, because as we get older, the number of confounding factors in observational research increases. The longer we live, the more choices we make, the wider variety of environments, stimuli and stresses we are exposed to. This can distort results, making it difficult to discern the difference between natural declines in health and performance from deteriorations that occur as a result of lifestyle factors and poor choices.

In contrast, the world of sport represents a fascinating ‘laboratory’ for studying human potential in the absence of sedentary behaviour. In athletic competition, cardiovascular, respiratory, neuromuscular as well as cognitive systems must all work well individually, and as a system, making it one of the best testing grounds for how our body and brain should work together at their best.

Physical inactivity is a primary cause of many of the chronic ailments which afflict an ageing population, but the high levels of physical activity among masters athletes mean that they should be free from many of the negative effects of sedentary behaviour. Any declines in athletic performance mirror the changes in the body and mind that occur as we age, rather than being a result of inactivity or other intervening lifestyle factors.

The performance of masters athletes can provide us with a biological model to understand what healthy, optimum aging looks like.

—Inherent ageing in humans: The case for studying master athletes: Editorial

Compressed ageing

The performance changes in masters sporting events display a ‘curvilenear,’ rather than linear, pattern. Instead of reaching a peak in their 30s, before experiencing an inexorable and linear decline, masters athletes retain close-to-peak performance for much longer, experiencing a gentler decline, followed by a rapid drop-off in the latter part of life.

In July 2016, 85 year-old Hiroo Tanaka, from Japan, ran the 100 metres in 15.19 seconds.

The findings among masters athletes reflect the aim that many of us have: maximise ‘healthspan’ by reaching a peak, then maintaining our health, physical and cognitive capacities for as long as we can, compressing ill health into as short a period as possible.

Maximise growth, minimise decay

If you’re younger than 35, there is still time to maximise ‘peak’ health and fitness. Ideally, you should aim to start from as high a point as possible, before the influence of ‘decay’ becomes more pronounced. However, if you’re older than 35, significant improvements are still possible.

It’s never too late to change your trajectory for the better. Studies have demonstrated that even 90 year-olds can improve their strength and power, with the appropriate training regimen and significant benefits are possible from relatively small ‘doses’ of physical activity.

Movement is medicine

Physical activity sets off a cascade of ‘signals’ which, if repeated, improve the function of our body and brain, diminishing the risk of cardiovascular disease and metabolic disorders, reducing anxiety and enhancing concentration and attention.

Movement is medicine. The benefits of physical activity far outweigh the possibility of adverse outcomes in almost every population, and increasing your levels of physical activity is one of the few interventions that has been demonstrated as beneficial across age-ranges, ethnic groups, and spectrums of physical ability.

Physical activity levels in our leisure time have remained relatively constant over the past few decades. However, sedentary activities at home, such as watching TV or consuming other media, coupled with technological advances in the workplace, mean that we spend a lot more time sitting over the course of an average week than we used to.

As our weekly minutes of physical activity decreases, risk of premature death significantly increases. There seems to be a dose-response association between total sitting time and the risk of dying from anything. In contrast, simply moving more, and moving more regularly, has a powerful influence on reducing the risk of disease, death and improving quality of life.

Does regular exercise let us get away with slumping at our desks?

The benefits of regular exercise are widely known, but even for physically active knowledge workers, morning exercise regimens are typically followed by extended periods of sedentary time, in the office, during commutes and at home. Unfortunately, it appears that we can’t ‘out-exercise’ our desk-jockey lifestyles.

In 2009, researchers studied 17,013 people aged between 18-90 years old. They found a dose-response relationship between sitting time and dying from anything. More significantly, they also found that this risk was independent of overall physical activity levels. It doesn’t matter how active you are. If you sit down for long periods, you are increasing your risk for chronic disease.

These findings have been supported by a number of other studies. Those of us sitting for 11 hours or more, per day, are at the greatest risk, regardless of how much physical activity we do.

Sitting for six hours per day, versus three hours, significantly elevates our risk of death, especially from cardiovascular disease, in both men and women.

—Leisure time spent sitting in relation to total mortality in a prospective cohort of US adults

Many physical activity programmes fail because their goals are too ambitious. The key is to start doing something. Don’t let perfection be the enemy of ‘good enough’. The following four actions may provide you with some ideas about where to begin. (It’s recommended to consult a medical professional before starting a new exercise programme.)

1) Move more. Take a moment and consider how long you spend sitting each day. Simply moving more, and moving more regularly throughout the day, even if you have to set an alarm to remind yourself to stand up and walk around now and again, can have a powerful influence on reducing the risk of disease, death and improving quality of life.

2) Move slow. Aiming to accumulate 10,000 steps each day has become a common means to increase daily physical activity. While some studies have not been supportive, many have demonstrated that increasing step count, and trying to integrate additional steps into your day to reach the 10,000 target, can be beneficial in terms of increasing physical activity and health.

3) Move fast. High Intensity Interval Training (HIIT) involves repeated bouts of high-intensity effort, followed by varied recovery times. A typical HIIT session could last between 20 and 60 minutes, but even shorter sessions have been demonstrated to be beneficial. A 2012 study among healthy, but sedentary men and women, demonstrated that 10-minute high-intensity cycling sessions, repeated three times per week for six weeks, improved health and fitness markers, including a 28% increase in insulin sensitivity and 12-15% improvement in VO2 max.

4) Move heavy. After turning 50, muscle mass begins to decrease at a rate of 1-2% per year, and muscle strength declines at 1.5–5% per year. Having more functional muscle may be associated with a ‘whole-body neuro-protective effect’ and while more research is required, muscular strength appears to play an important and independent role in the prevention of cardiovascular heart disease. Being in the top 25% of muscle mass for your age-group appears to be a significant positive predictor of longevity. Peak muscle power is an important predictor of how well we’ll function in old-age. Try to include resistance training as part of your life, at least two-times per week. This could involve completing 8-12 repetitions, of 8-10 different exercises, that target all major muscle groups.

Scientific Research: Iodine deficiency and women’s health: Colonialism’s malign effect on health in #Oromia May 18, 2015

Posted by OromianEconomist in Africa, Micronutrient deficiency in Oromia.
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Iodine deficiency and women’s health: Colonialism’s malign effect on health in Oromia region, in Ethiopia

http://www.scirp.org/Journal/PaperInformation.aspx?PaperID=31970#.VVo8N7lVikp

 

Author(s),  Begna Dugassa

ABSTRACT

Objectives: Iodine is an essential nutrient needed for the synthesis of hormone thyroxin. Hormone thyroxin is involved in the metabolism of several nutrients, the regulation of enzymes and differentiation of cells, tissues and organs. Iodine deficiency (ID) impairs the development of the brain and nervous system. It affects cognitive capacity, educability, productivity and child mortality. ID hinders physical strength and causes reproductive failure. The objective of this paper is to explore if the health impacts of ID are more common and severe among women. Design: Using primary data (notes from a visit) and secondary data, this paper examines if the effects of ID are more common and severe among Oromo women inEthiopia. Findings: The health impacts of ID are more common and severe among women. Conclusions: ID is an easily preventable nutritional problem. In Oromia, the persistence of ID is explained by the Ethiopian government’s colonial social policies. Preventing ID should be seen as part of the efforts we make to enhance capacity building, promote health, gender equity and social justice. Implications: Iodine deficiency has a wide range of biological, social, economic and cultural impacts. Preventing ID can be instrumental in bringing about gender equity and building the capacity of people.

Cite this paper

Dugassa, B. (2013) Iodine deficiency and women’s health: Colonialism’s malign effect on health in Oromia region, in Ethiopia. Health, 5, 958-972. doi: 10.4236/health.2013.55127.

References

[1] Dugassa, B. and Negassa, A. (2012) Understanding the ecology of iodine deficiency and its public health implications: The case of oromia region in Ethiopia. Journal of Community Nutrition & Health, 1, 4-17.
[2] UNICEF (2008) Sustainable elimination of iodine deficiency, progress since the 1990. World Summit for Children. http://www.childinfo.org/files/idd_sustainable_elimination.pdf
[3] Iodine Network (2012) Country profiles Ethiopia. http://iodinenetwork.net/countries/Ethiopia.htm#6
[4] WHO (2007) Iodine deficiency in Europe: A continuing public health problem. In: Anderson, M., De Benoist, B., Darnton-Hill, I. and Delange, F., Eds., France. http://whqlibdoc.who.int/publications/2007/9789241593960_eng.pdf
[5] WHO (2010) Ethiopia: Health profile. http://www.who.int/gho/countries/eth.pdf
[6] WHO (2010) Kenya: Health profile. http://www.who.int/gho/countries/ken.pdf
[7] Stewart, G., Carter, J., Parker, A. and Alloway, B. (2003) The illusion of environmental iodine deficiency. Environmental Geochemistry and Health, 25, 165-170. doi:10.1023/A:1021281822514
[8] Meletis, C. and Zabriskie, N. (2007) Iodine, a critically overlooked nutrient. Alternative & Complementary Therapies, 13, 132-136. doi:10.1089/act.2007.13309
[9] Hetzel, B. and Mano, A. (1989) A review of experimental studies of iodine deficiency during fetal development. Journal of Nutrition, 119, 145-151.
[10] Ingenbleek, Y. and Jung, L.B. (1999) A new iodized oil for eradicating endemic goiter. In: Abdulla, M., Bost, M., Gamon, S., Arnaud, P. and Chazot, G., Eds., New Aspects of Trace Element Research, Smith-Gordon, London.