28 October 2011

Is it too late to stop dangerous climate change?

This is the question that has inspired Friends of the Earth to undertake a year-long research project made up of three research reports.
The first report considered the latest science findings, concluded that global temperature increases must be kept below 1.5 degrees to avoid the most devastating effects of climate change, and identified what this means for future emissions. It found that the EU would need to reduce its emissions by 60% by 2020 from 1990 levels, the United States would need to make even deeper cuts and China would need to peak its emissions by 2013 and then reduce them by 5% per year. These are clearly eye-watering reduction targets.
The second report used an adapted DECC 2050 pathways model to see if it's possible for the UK to live within its share of remaining emissions space - what we call a carbon budget. It also considered whether it was possible to do so in a socially just way. It concluded that even with Herculean efforts across all sectors the UK cannot meet its reduction goals without deploying technologies that take carbon out of the air, so-called negative emissions technologies. It did however conclude that reductions could be made without disproportionate impact on poorer households - although it would require a very determined effort to do so.
The final report is a technical analysis of the different potential negative emissions technologies currently being researched. It found that many of the technologies are at a very early stage of development, some bring significant risks, and that the most promising technologies are likely to be extremely expensive - certainly far more costly than action to reduce carbon emissions in the first place. It also found practical limits to the contribution that negative emissions technologies can make - at best, they can only provide a supporting role to emissions reductions. It concluded that dangerous climate change can only be averted if much-accelerated carbon emissions reductions are made across the globe in addition to negative emissions.

27 October 2011

New Health Impact Assessment guide released

Dr Rajv Bhatia from the San Francisco Department of Public Health has published Health Impact Assessment: A guide to practice. It brings together a lot of conceptual and practical knowledge about HIA based on Rajiv's extensive experience. It's also well formatted, making it a pleasure to read and use. Definitely worth a look.

26 October 2011

Does income inequality cause health and social problems? The challenge of evidence reviews

Just a few days ago on the Health Equity JISC Email Network Kate Rowlingson the author of the report ‘Does incomeinequality cause health and social problems?’ posted a critical response by Richard Wilkinson and Kate Pickett which shows the challenges of doing good reviews and how individual reviews while a great shortcut to reading the original papers need to be treated as carefully, and considered as critically, as original research papers.

I respect and commend that fact the Kate Rowlingson forwarded the critical response  to a wider audience and encourages debate.

The recent review was for the well respected UK charitable foundation the Joseph Rowntree Foundation on the links between income inequality and health and social problems.

Click here to download the report.
The report "provides an independent review of the evidence about the impact of inequality. Inequality grew dramatically in the 1980s and has remained at a high level ever since. But should high levels of inequality concern us? This report provides an independent review of the research, paying particular attention
to the evidence and arguments put forward in The Spirit Level by Richard Wilkinson and Kate Pickett, in which it was argued strongly that we should indeed be concerned about income inequality. This report reviews the points made in various critiques that have appeared since The Spirit Level was first published in 2009, alongside the evidence and debate in the broader peer-reviewed literature. The report examines:
  • whether or not there is a link between income inequality and health and social problems;

  • who might be most affected by income inequality; and

  • other possible impacts of income inequality, for example, on the economy"

Critical Response
Richard Wilkinson and Kate Pickett’s response to KarenRowlingson’s report for the Joseph Rowntree Foundation Report ‘Does incomeinequality cause health and social problems?’

" We are glad that an independent report from JRF has reviewedcritical responses to our work and found it to be robust.  The report recognizes that the critics havebeen "far more selective" in their presentation of data.  We are also glad that it cites thestatistical review by Noble (2010), which provides a detailed discussion oftechnical issues relating to The Spirit Level and strongly supports ourapproach.

However, although we very much welcome the generalconclusions of this report, it nevertheless contains a number of errors whichwill lead the reader to underestimate the power of income inequality to affectsocieties.  We regret that neither of uswere invited to participate more fully in the deliberations which led to thisreport.  We commented on a first draftand on the final report, but were told that there was not time for substantialchanges to the final report.  Althoughthe report gives our work a clean bill of health, it is marred by importantinaccuracies likely to mislead many readers.  We deal here only with the most important.

At several points it is said that the size of the effect ofincome inequality “on health and social problems” is small.  There are several mistakes here. First, thesestatements infer from studies of the effects of income inequality on health toall the other outcomes which have been shown to be related to inequality.  In other words a study suggesting that incomeinequality has a small effect on health is interpreted as meaning that incomeinequality also has a small effect on teenage births, violence, imprisonment,child wellbeing, trust etc..

Not only is the inference obviously unsound, but it is madein the face of the much stronger relationships shown for other outcomes, whichare not discussed. The relationships we have reported between inequality andhealth, though statistically significant, are weaker than those with otheroutcomes (see tables of correlation coefficients on p.15 of the JRFreport).  Not only are the relationshipsbetween income inequality and other outcomes much closer, but the magnitude ofdifference in outcomes between more and less equal societies is often vast:three-fold differences in population rates of mental illness, four-folddifferences in the proportion of people who feel they can trust each other,two-and-a-half –fold differences in rates at which pupils drop out of US highschools,  six to ten-fold differences inteenage pregnancy rates, almost ten-fold differences in the proportion of thepopulation in prison and vast differences in child-wellbeing, drug abuse, andsocial mobility. 

To call these differences “small” is hopelessly misleading –particularly when these findings are based entirely on data from the mostrespected sources and are not discussed or challenged in any way in thisreport.  Not only that, but researchworkers using data covering different societies have sometimes found evenbigger differences than we do – see for instance the 10-fold differences inhomicide reported both by Daly et al (2001) and, on separate data, by a groupat the World Bank (Fajnzylber et al 2002). Neither of these papers, nor a review of the literature which concludesthat the homicide and inequality link is robust (Hsieh al 1993), is referencedin the report.

The mistake is compounded by the statement on p.11 that thecorrelation coefficients between income inequality and homicides, educationalperformance, life expectancy and infant mortality “fall below the 0.5threshold”.  This statement seems toreflect nothing more than a bizarre confusion between correlation coefficientsand probabilities.  Not only are all therelationships statistically significant (p<0.05 ), but a correlationcoefficient of r = 0.5 means that  25 percent of the variance in one variable is accounted for by the other.  An explanation of even 25 per cent of thevariance in an important outcome is impressive. Some of the other correlation coefficients suggest twice as much of thevariance is explained by income inequality.

Lastly, the statement that the effects of income inequalityare small is based on a paper providing a meta-analysis of studies usingmultilevel models of health and income inequality which substantiallyunderestimated the overall effects of income inequality. Within these multilevelmodels the effects of individual income and/or education are controlled out.However, there is now widening agreement (see for instance M. Marmot’s TheStatus Syndrome) that individual income and education are related to healthsubstantially because they serve as markers of social status. To measure theeffects of inequality after controlling for individual status differences isclearly over-controlling.  We made thispoint clearly in our British Medical Journal editorial (2009) which accompaniedthe original meta-analysis.  Not torecognise this is analogous to thinking you can measure the effects of socialclass hierarchy while controlling for the effects of individual social class.

There are a couple of others points which we think are alsoimportant enough to need a comment.  

First, a point about the difference between the OECD income inequalitydata and the data we used from the UN (which was also given by the WorldBank).  Much the most importantdifference is that Japan is one of the most equal countries in the UN data butappears very much less equal in the OECD data. As we told JRF, part of the explanation is that the OECD data for Japanis (in contrast to that for other countries) based on income before tax.  However, thanks to a grant from the DaiwaAnglo-Japanese Foundation there has now been a thorough analysis of theoriginal Japanese income inequality data which confirms that Japan is indeedone of the more equal countries.  Areport on this work (Ballas D, Dorling D, Nakaya T, Tunstall H, Hanaoka K.Social cohesion in Britain and Japan: a comparative study of two islandeconomies) will be available shortly on The Equality Trust web site at: 

Second, the JRF report suggests that property crime isconspicuously absent from The Spirit Level. It was not included  because wewere unaware of internationally comparable data on property crime.  However, a literature search has now found anumber of papers published in peer reviewed academic journals which look atchanges in property crime and changes in inequality.  A review of these studies has just beensubmitted to a peer-reviewed journal.  Itconcludes that increases in inequality do indeed have a very substantial impacton crime (see: Rufrancos H, Pickett K, Wilkinson R, Income inequality andcrime: a review and explanation of the time-series evidence. Publicationpending)

Third, the JRF Report discusses the range of countries weinclude and ends by saying “Further research could be carried out on a widerrange of countries…”  Of course italready has.  In 2006 we reviewed 168analyses published in peer-reviewed journals of the relation between incomeinequality and health. These covered many different groups of countriesincluding developing countries (see: Wilkinson RG, Pickett KE. Incomeinequality and health: a review and explanation of the evidence. Social Scienceand Medicine 2006; 62: 1768-84.) 

There are a number of other significant errors in the JRFreport where crucial research in the peer-reviewed literature has been missedor issues have not been thought through sufficiently carefully.   We believe that two factors handicapped theproduction of this report: first, the literature is spread over journals ofepidemiology, public health, medicine, neurology, primatology and statisticswhich are often unfamiliar to those in social policy circles, and second, theJRF Advisory Group lacked proponents (but not opponents) of our thesis who knewthe literature well.

Ballas D, Dorling D, Nakaya T, Tunstall H, Hanaoka K. Socialcohesion in Britain and Japan: a comparative study of two island economies. Tobe made available shortly on The Equality Trust web site at:http://www.equalitytrust.org.uk/resources/other/response-to-questions
Daly M, Wilson M, Vasdev S. Income inequality and homiciderates in Canada and the United States. Canadian Journal of Criminology 2001;43: 219-36.
Fajnzylber P, Lederman D, Loayza N. Inequality and violent crime. The Journal of Lawand Economics 2002; 45 (1): 1-40.
Hsieh CC, Pugh MD. Poverty, income inequality, and violent crime: a meta-analysis of recentaggregate data studies. Criminal Justice Review 1993; 18: 182-202..
Marmot MG. The Status Syndrome. Bloomsbury 2004 Rufrancos H,Pickett K, Wilkinson R, Income inequality and crime: a review and explanationof the time-series evidence. (Publication pending) Wilkinson RG, Pickett KE. Incomeinequality and health: a review and explanation of the evidence. Social Scienceand Medicine 2006; 62: 1768-84."

25 October 2011

Inequality, Trust and Sustainability

Really interesting paper, there's quite a bit of quantitative modelling in it. See my take home point below and the interesting figure on page 3 shown poorly below.

Instrumental arguments linking inequality to sustainability often suppose a negative relationship between inequality and social cohesion, and empirical studies of inequality and social trust support the assumption. If true, then redistribution should increase levels of social cohesion and thereby ease the implementation of policies that require collective action to achieve shared benefits.

An examination of the data by the Stockholm Environment Institute (SEI) suggests that at least part of the relationship may be explained by income level, rather than income distribution, suggesting that growth, rather than redistribution, may achieve the same goal.

This paper tests for the possibility and suggests that income is indeed important in explaining differences in levels of social trust. However, the effect of income level is insufficient to explain all of the dependence on income inequality; both income level and income distribution are correlated with social trust. The analysis is done at the income decile level using individual response data from the World Values Survey.

While the analysis is limited by the availability and reliability of the underlying data, the results suggest that neither redistribution nor growth alone is sufficient to raise a low-trust country to a position of medium or high trust. Rather, using the parameters estimated in this paper, a combination of growth with narrowing income distributions could, over a period of perhaps two decades, produce a significant change in levels of social trust.

My take home point from the conclusion:
This analysis support the supposition; inequality matters for social trust. The level of income also matters, but growth by itself appears insufficient. A policy of “broad-based” growth that leaves income distributions unchanged will not effectively move a low-trust society to a medium-trust society, much less to a high-trust society. Perhaps for high-income countries, but certainly for currently low-income countries, the results suggest that a combination of growth with increasing equality is more effective for improving levels of social trust than either growth or redistribution alone.

Source: Inequality, Trust, and Sustainability, Eric Kemp-Benedict, Stockholm Environment Institute, Working Paper No. 2011-01

24 October 2011

Rio Political Declaration on Social Determinants of Health

The bits that really resonated with me are:

We reaffirm that health inequities within and between countries are politically, socially and economically unacceptable, as well as unfair and largely avoidable, and that the promotion of health equity is essential to sustainable development and to a better quality of life and well-being for all, which in turn can contribute to peace and security.

We reiterate our determination to take action on social determinants of health as collectively agreed ... three overarching recommendations of the Commission on Social Determinants of Health:

  • to improve daily living conditions;
  • to tackle the inequitable distribution of power, money and resources; and
  • to measure and understand the problem and assess the impact of action.

We are convinced that action on these determinants, both for vulnerable groups and the entire population, is essential to create inclusive, equitable, economically productive and healthy societies. Positioning human health and well-being as one of the key features of what constitutes a successful, inclusive and fair society in the 21st century is consistent with our commitment to human rights at national and international levels.

Click here to go to the WHO conference website and download the Declaration.

22 October 2011

Hidden Heat: communicating climate change in Uganda

As HIA practitioners, we often assume that everybody knows about and understands what climate changes is and has a view on it just like we do. Most often this is not the case.

This is one of the few reports to examine the communication challenges in a low/middle income country. Through a series of 30 interviews with key climate change communicators, this

report identifies some of the challenges and opportunities of communicating climate
change in Uganda.

Click here to download the full report.

Key messages

  • Central to the fight against climate change in Uganda is effective communication and public engagement.
  • There is a major lack of co-ordination in the communication of climate change information in Uganda. Although several governmental and non-governmental bodies are potentially in a position to act as a central hub for climate change information and engagement, currently they are poorly funded and have a low public profile. Perhaps the most urgent priority for effective communication of climate change in Uganda is the development of a central co-ordinating body that can engage with all sectors of society.
  • The media is not fully engaged in covering climate change – certainly not to the extent warranted by the seriousness of the threat. Training programmes to assist both journalists and editors are essential, but civil society organisations must also improve the way they engage with the media, packaging information in a clear and simple way and actively attracting media attention.
  • Local languages lack terms for many key concepts involved in climate change –including ‘climate change’ itself.  Communicators should attempt to explain climate change using terms that already exist, using graphic examples of local environmental problems and innovative communication methods (e.g. dramatisation) to get the message across.
  • At a national and international level, politicians are not being held to account for taking action on climate change – but this is partly because there is such little awareness of the international causes of climate change. Raising awareness about the role of industrialised nations in causing climate change, and pressuring national politicians to make greater progress at international negotiations is critical.
  • At the local level, politicians tend to be poorly informed about climate change, yet local government structures represent a crucial opportunity for reaching large numbers of ordinary citizens. Sensitisation campaigns should focus on local politicians as a key constituency that can catalyse action on climate change.
  • Indigenous knowledge about land management and the environment is incredibly valuable when trying to engage people on climate change – but it must be supplemented with scientific information about the causes and consequences of climate change. Climate change represents a significant challenge to indigenous ways of understanding the weather and farming – and so people must be supported with additional knowledge and information wherever possible, including the improved dissemination of meteorological information through local radio stations.
  • National politicians have the task of developing a model of sustainable development that provides a higher standard of living for Ugandan citizens, but does not compromise the environment for future generations. This is a major challenge, but one in which as many different sectors of society as possible should be given a voice in. 
  • What does a sustainable Uganda look like? Articulating a positive vision of sustainable development for Uganda will provide a major tool in effectively communicating the message of climate change – what is the alternative?
  • Finally, awareness must be raised about the emerging carbon trading sector. There is the potential for carbon trading to deliver much-needed income to ordinary Ugandan citizens, but there are also major risks. An honest and open dialogue about the risks and benefits of carbon trading for Uganda is an essential first step to accessing the financial advantages that carbon trading may bring.
Hat tip: SDRN Network UK

19 October 2011

WHO World Mental Health Atlas 2011

Click here to go to the WHO page to download the report.

The WHO Mental Health Atlas 2011 represents the latest estimate of global mental health resources available to prevent and treat mental disorders and help protect the human rights of people living with these conditions.

It presents data from 184 WHO Member States, covering 95% of the world’s population. 

The focus is on mental health care governance and services.

Key messages:

1. Resources to treat and prevent mental disorders remain insufficient
  • Globally, spending on mental health is less than two US dollars per person, per year and less than 25 cents in low income countries.
  • Almost half of the world's population lives in a country where, on average, there is one psychiatrist or less to serve 200,000 people. 

2 . Resources for mental health are inequitably distributed
  • Only 36% of people living in low income countries are covered by mental health legislation. 
  • In contrast, the corresponding rate for high income countries is 92%. Dedicated mental health legislation can help to legally reinforce the goals of policies and plans in line with international human rights and practice standards. 
  • Outpatient mental health facilities are 58 times more prevalent in high income compared with low income countries. 
  • User / consumer organizations are present in 83% of high income countries in comparison to 49% of low income countries. 

3. Resources for mental health are inefficiently utilised
  • Globally, 63% of psychiatric beds are located in mental hospitals, and 67% of mental health spending is directed towards these institutions.

4. Institutional care for mental health disorders may be slowly decreasing worldwide
  • Though resources remain concentrated in mental hospitals, a modest decrease in mental hospital beds was found from 2005 to 2011 at the global level and in almost every income and regional group.

This map of mental health legislation and legislation in other laws is interesting (Page 23). Page 18 has a map on mental health policy.

Evaluation of the Millennium Villages Project, interesting exchange on methods

The Millennium Villages Project (MVP) was launched in 2006 as part of the effort to achieve the Millennium Development Goals (MDG). UNDP is the Project’s implementing partner and the project is supported by among others the Earth Institute at Columbia University.

Currently 80 Millennium Villages are clustered into 14 different sites in 10 countries. Each cluster site is located in a distinct agro-ecological zone which together and the project should reach around 500.000 people. The main premise of the project was to develop an innovative integrated approach to rural development, the MVP simultaneously addresses the challenges of extreme poverty in many inter-connected areas: agriculture, education, health, infrastructure, gender equality and business development.

There is an interesting debate going on regarding the evaluation of this very complex project consisting of different interventions in a variety of geographical settings. There are some who are doubtful about the methods used for the evaluation and therefore the results. While others defend the approach used for evaluation. The HIA community will surely find very interesting this exchange as it is not dissimilar from our own discussions about methodology and tools.

17 October 2011

Bronx affordable and healthy housing

Via Verde, as described on the project's website, represents a new model for affordable, green and healthy urban living.
Via Verde won a competition over 4 years ago sponsored by the New York City Department of Housing Preservation. The project is an impressive public-private partnership, comprising 71 cooperative homes targeting middle-income households and 151 rental apartments targeting low-income households.
The four players began the right way, by asking people in the neighborhood what kind of building they wanted. The future inhabitants replied that they wanted a healthy place to live.

16 October 2011

WHO Interactive Atlases on Health Equity in Europe

One of the goals of the project is to improve availability of and access to evidence on inequalities in health system performance, including quality of care and the structural determinants of such inequalities across countries and regions in Europe.

To meet this goal, publicly available socioeconomic and health-related indicators from EUROSTAT databases have been used to produce the atlases. The NUTS 2 regions are the main geographical units of analysis. Variables displayed in maps, graphs and tables represent more than 600 individual indicators.

The atlases aim not only to provide more visibility to the sub-national patterns of health and their determinants but also to analyse how such an integrated information system and its underlying data can inform policy across European countries. 

The added value is to: 
  • improve insight into the regional dimension of social inequalities in health across counties; 
  • provide a tool for increased engagement of the public and the media in the dialogue with the competent authorities on health policy and action; and 
  • provide a pilot for a more regular monitoring and assessment of the magnitude of social inequalities in health and the impact of the relevant policies, interventions and services.

To analyse and display data, following interactive atlases have been developed in the project:
  1. Correlation map atlas allows a quick visualization of two variables in maps and their association in a graph, where correlation analysis can also be performed. You may use the filter function to select only one country or country group.
  2. Atlases of social inequalities allow visualization of difference between the target value and the value in a region or group of regions. The target value is the population weighted average of the most advantaged quintile of the population. Differences between the target and the individual region are visualized as absolute differences (area target differences) and as relative differences (area target ratios).
  3. Regional comparison atlas allows quick comparison of several key indicators between a limited numbers of regions. Please use the Ctrl key and mouse to select the regions of interest.

Hat tip: David McDaid via the JISC Health Equity Network

13 October 2011

Indoor spraying with bendiocarb reduces malaria transmission

Indoor spraying with the insecticide bendiocarb has dramatically decreased malaria transmission in many parts of Benin, new evidence that insecticides remain a potent weapon for fighting malaria in Africa despite the rapid rise of resistance to pyrethroids.

Scientists with Benin’s Entomologic Research Center in Cotonou evaluated the effects of two applications of bendiocarb in homes throughout the West African country over an eight-month period in 2009. They found that after “indoor residual spraying” which involves applying insecticide on walls where mosquitoes are likely to land, none of the 350,000 household members living in the treated homes “received infected bites” from the malaria-carrying mosquito Anopheles gambiae.

Moreover, none of the mosquitoes collected from the treated homes tested positive for the Plasmodium falciparum—the world’s most deadly malaria parasite. The absence of infected bites and parasites was seen as evidence that malaria transmission had fallen precipitously in an area where mosquitoes have developed resistance to permethrin and other members of a popular class of insecticides known as pyrethroids.

“Our success in drastically reducing malaria transmission by spraying homes with bendiocarb, which is not a pyrethroid, is very important because pyrethroid-resistance is emerging not just in Benin but also in Kenya, Niger, Nigeria, Mali, Cameroon and many other African countries,” said Gil Germain Padonou, MSc, a medical entomologist, who co-authored the study. “Our results should provide reassurance that despite the rise in pyrethroid resistance, indoor spraying can continue to play a vital role in reducing the incredible burden of malaria across Africa.”

The successful lifecycle of the malaria parasite depends on constantly moving from mosquitoes to humans and from humans back to the mosquito. Indoor spraying and bednets disrupt this lifecycle by broadly preventing mosquitoes from an opportunity to feed on infected blood and thus obtain and transmit the malaria parasite. The researchers believe that where there was indoor spraying, malaria transmission likely continued at a very low level difficult to detect. They conclude that it would have required analyzing "thousands of mosquitoes to find any positive for malaria parasites."

While the study did not formally collect data on how the spraying affected malaria illnesses and deaths, Padonou said there are anecdotal reports from doctors in the region of a “significant reduction in malaria cases” in their clinics following the IRS campaign. Virtually all of Benin’s 9.3 million people are at risk of malaria infections. Each year, malaria sickens more than a million people in Benin and kills thousands. Malaria accounts for about a quarter of all hospital admissions in Benin and a third of the deaths in children under five.

Bendiocarb has been deployed in the fight against malaria despite the fact that it has been voluntarily withdrawn from the U.S. market due to safety concerns. The World Health Organization has approved its use – with strict safety protocols - for indoor spraying programs to combat malaria. Padonou said investigators in Benin monitored for both human and environmental exposures and found no evidence of any adverse events.

The indoor spraying campaign in Benin was conducted by the country’s National Malaria Control Program, with support from the U.S. through the President’s Malaria Initiative. This is part of a broad effort to find alternatives to pyrethroids, the mainstay of public health campaigns against malaria, chiefly through the distribution of insecticide-treated bednets (ITNs) and indoor spraying campaigns. Malaria experts point to wider use of both interventions—coupled with greater access to malaria medicines and diagnostics—as a key reason why malaria deaths in Africa have dropped by more than a third over the last decade, which represents about 1.1 million lives saved.

However, there are fears that insecticide resistance could stall or even reverse this progress.

“Insecticide resistance has been lurking for several years now as a spoiler for the incredible success we have seen in fighting malaria, particularly in Africa, where most of the world’s malaria deaths occur,” said Peter J. Hotez, MD, PhD, president of the American Society of Tropical Medicine and Hygiene. “We need to intensify support for efforts to develop and test new insecticides and seek better strategies for using them, such as rotating among several different compounds that make it harder for mosquitoes to become resistant. Keeping a constant flow of new products and technologies in pipeline requires funding. If we backpedal now on research and development, we could lose not only the chance to eradicate malaria, but there is also the very real potential we could see an uptick in absolutely preventable malaria diseases, especially among children. This would be unacceptable by any metric.”

Padonou and his colleagues worked with the Malaria Control Program to evaluate the capacity of both indoor spraying with bendiocarb and much wider use of ITNs (which continue to be treated with pyrethroids) to interrupt malaria transmission.

Indoor spraying was tested in homes in what is known as the plateau region of Benin, which alternates between wet and dry seasons. But in swampy, frequently flooded areas of Benin, there was concern that indoor spraying with any malaria-killing insecticides could produce toxic runoff into local waterways. Therefore, public health officials opted for increased distribution of ITNs as the primary tool for reducing transmission

The study reports that both indoor spraying and treated bednets demonstrated a capacity to significantly decrease malaria transmission. For the areas that received indoor spraying, infected bites declined by 94 percent overall during the eight-month study, though in some villages scientists believe infected bites stopped altogether. No one living in a treated home received an infected bite. Bites from infectious mosquitoes also declined substantially in areas where there was increased distribution of ITNs, though the drop was about 5 percent less than what was achieved via indoor spraying.

In contrast, in an area of Benin that received neither indoor spraying nor increased access to treated nets, each resident received an average of 120 infected bites over the same period.

“The best way to control malaria would be to use both indoor spraying and treated bednets, at the same time,” Padonou said. Bednets protect people from mosquitoes that may first land and “feed” on a human before lighting on a treated surface and indoor spraying kills mosquitoes en masse offering protection even when you are not sleeping. “Such an approach is too expensive for most national malaria programs and should be reserved for areas that have a particularly high level of malaria.”

Researchers are now on the lookout for bendiocarb resistance. Padonou said there is early evidence of resistance in a mosquito population in neighboring Burkina Faso, demonstrating a need to develop multiple alternatives to pyrethroids.

Dramatic Decrease in Malaria Transmission after Large-Scale Indoor Residual Spraying with Bendiocarb in Benin, an Area of High Resistance of Anopheles gambiae to Pyrethroids
Am J Trop Med Hyg 2011 85:586-593 [Subscription required]

Source: Americal Journal of Tropical Medicine and Hygiene Press Release

11 October 2011

Morbidity and Mortality weekly report at CDC is celebrating 50 years with a special issue on public health

The Morbidity and Mortality Weekly Report (MMWR) series is prepared by the Centers for Disease Control and Prevention (CDC) and the current issue celebrates the 50 years of activity with a special number. The articles included in the special issue are:
The Cornerstone of Public Health Practice: Public Health Surveillance, 1961–2011
Evolution of Epidemic Investigations and Field Epidemiology during the MMWR Era at CDC — 1961–2011
Laboratory Contributions to Public Health
History of Statistics in Public Health at CDC, 1960–2010: the Rise of Statistical Evidence
Changing Methods of NCHS Surveys: 1960–2010 and Beyond
Vaccine-Preventable Diseases, Immunizations, and MMWR — 1961–2011
Control of Health-Care–Associated Infections, 1961–2011
AIDS: the Early Years and CDC’s Response
Fifty Years of Progress in Chronic Disease Epidemiology and Control
Injury Prevention, Violence Prevention, and Trauma Care: Building the Scientific Base
Environmental Health in MMWR — 1961–2010
Occupational Epidemiology and the National Institute for Occupational Safety and Health
Trends in Global Health and CDC’s International Role, 1961–2011.
Advice to a Modern-Day Rip Van Winkle: Changes in State and Local Public Health Practice

10 October 2011

Community Water Supply in the Niger Delta

A Survey of the Community Water Supply of some rural Riverine Communities in the Niger Delta region, Nigeria: Health implications and literature search for suitable interventions

B Ordinioha, Nigerian Medical Journal

Water is a fundamental human need. This is the basis for target 10, goal 7 of the Millennium Development Goals which sets to reduce the proportion of people without access to safe water by half by 2015. This study assessed the access to safe water supply in 22 riverine communities in the Niger delta region of Nigeria.

Materials and Method:
The study was carried out using a descriptive cross-sectional study design, with the data collected using a structured interviewer-administered questionnaire, field observations and focused group discussions. The questionnaire was administered to female heads of household, and used to collect information on the main source of drinking water, the time it took for the round trip to the main water sources, and methods used for the treatment of water of suspicious quality. An inventory of all the community water facilities in the communities was also taken, and information collected on the functionality of the facilities, and how they were constructed, operated and maintained. A sample of the water from each of the facilities was also collected in a sterile container for microbiological analysis.

A total of 456 questionnaires were administered and retrieved. The most common source of drinking water was surface water (37.9%), and most (61.2%) of the water drawers spent less than 15 minutes to complete the round trip to the water sources. There were an average of 17 community water supply facilities, but only 23.8% of the facilities were functional during the study. Most of the functional facilities were being managed by community members. More than two third (67.9%) of the samples tested were found to contain significant numbers of Escherichia coli.

The communities had easy access to water supply, but most of the facilities were either contaminated or nonfunctional. The management of the facilities by members of the communities, and the promotion of point-of-use purification systems are hereby advocated.

Other interesting articles in the current issues are:

8 October 2011

Human Rights and the Environment

An interesting post on the SSPP Blog. Click here to check out the full blog

Human Rights and the Environment: What's the connection?
"...The question of whether and how to apply human rights to the environment is far from academic. An international rule of law has begun to emerge, if intermittently and painfully, over the last century. More recently, environmental destruction has become an international issue, most prominently regarding climate change but also regarding air and water pollution crossing boundaries, toxic substances shipped around the world, and biodiversity shrinkage. Indeed, there is something of a race going on between international instruments to preserve the environment (for the sake of humanity, if not for the ecosystems themselves) and the tide of environmental degradation. In this race, degradation is ahead and widening its lead. The United Nations is a frail, contentious institution with power allocated asymmetrically, but it’s all we’ve got. The emerging concept that all humans have rights to a safe, clean, healthy, supportive environment may be one key in the quest for sustainability."


To further explore sustainability, increase scientific discovery, and enhance scholarly communication, read the Sustainability: Science, Practice, & Policy open access ejournal and visit the free Researcher's Toolkit.

7 October 2011

Inequalities in child development begin prenatally and in the first years of life, new Series from The Lancet

In 2007 The Lancet published a series of articles investigating the factors impeding children younger than 5 years from low-income and middle-income countries to attain their developmental potential. The series found that more than 200 million children worldwide could not fully develop primarily because of poverty, nutritional deficiencies, and inadequate learning opportunities.

In this new Series, the authors review new evidence on the mechanisms and causes of developmental inequality and economic implications and strategies to promote early child development. The follow-up Series documents progress in reduction of risk factors for poor development, such as inadequate cognitive stimulation, intrauterine growth restriction, HIV infection, and societal violence.

Key messages
• Exposure to biological and psychosocial risks affects the developing brain and compromises the development of children
• Inequalities in child development begin prenatally and in the first years of life
• With cumulative exposure to developmental risks, disparities widen and trajectories become more firmly established
• Reducing inequalities requires early integrated interventions that target the many risks to which children in a particular setting are exposed
• The most effective and cost-efficient time to prevent inequalities is early in life before trajectories have been firmly established
• Action or lack of action will have lifetime consequences for adult functioning, for the care of the next generation, and for the wellbeing of societies

6 October 2011

Communication (technology), communities and climate change, how to transfer these experiences in HIA practice?

An interesting post on how the use of Information and Communities Technologies ICTs can influences cultural identities. “On the one hand, the use and appropriation of ICT tools can contribute to strengthen cultural identity through the documentation and sharing of indigenous knowledge and traditions, the production of local content…. But on the other, the increased penetration of ICTs could undermine the cultural identity of marginalised rural communities by introducing new forms of exclusion,…”

The role of ICTs is increasingly important in disaster management and in adaptation to climate change. What can the HIA community learn from these cases and how can we increase its use in the HIA practice?

“Health Impact Assessment and NEPA” Course Nov' 14-16, North Carolina, USA

The Duke Environmental Leadership (DEL), Nicholas School of the Environment, Duke University,  has announced a new “Health Impact Assessment (HIA) and NEPA” course through its Certificate in the National Environmental Policy Act (NEPA) program.

Developed and led by Dr. Aaron Wernham— a world-recognized leader in Health Impact Assessment (HIA) and Director of the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts—the course will address and explain how HIA helps with decision making as well as meeting procedural requirements for analyzing health effects.

Ray Clark, Chair of the NEPA Education and Certificate Program, called the new HIA course an overdue program of study,

“Decision makers in many fields need a tool to help them understand the health consequences of proposed actions. This course provides that tool.” Not only is the topic timely, as the National Research Council recently released the report “Improving Health in the United States: The Role of Health Impact Assessment,” but can also be applied broadly for identifying and addressing human health in various sec-tors, like transportation, agriculture and energy.

The emerging practice of HIA has shown promise as a way to meet the procedural requirements of NEPA, as well as provide a general tool for decision making on projects. Co-lead instructor Dinah Bear—Attorney at Law and former General Counsel to the Council on Environmental Quality (CEQ) — speaks to the relationship between HIA and NEPA, “Modeled closely after environmental impact assessment (EIA), HIA has become standard practice in much of Europe, Asia, Australia, and Canada. The National Academy of Sciences released a report this fall on HIA's place in the United States, including recommendations on integration of HIA into the NEPA process."

The course will provide an introduction and overview of methods to assess health effects relying on recent experience in the U.S. and review the National Academy of Sciences report on a framework and guidance on HIA. This course will also:

1. Introduce participants to the procedures, steps and methods used in HIA.

2. Explain how HIA can be used in analysis and decision making.

3. Demonstrate the use of HIA in the context of several in-depth case studies.

4. Introduce participants through hands-on exercises to a set of procedures that can be used to determine when health effects should be included in an analysis, and what scope of health effects should be considered.

The course will be held November 14-16, 2011, as a two-and-a-half day course, and will be immediately followed by - Climate Change and NEPA. Both courses will count to-wards the Certificate in NEPA requirements. Participants will have the option to register for either class alone or receive a discount for registering for both.

Funding for tuition may be available through the Bill Cohen Memorial Scholarship

To register for a seat in either or both of these courses, click here to visit theDEL Exec Ed Upcoming Courses website.

Health Impact Assessment and NEPA:Registration on or by October 17= $1400
Registration after 
October 17$1475
Climate Change Under NEPA
Registration on or by October 17= $1400
Registration after 
October 17$1475

There is a 10% discount for registering for and attending both courses held within this week.
Registration on or by October 17= $2520
Registration after 
October 17$2655

For further details please contact the DEL Program at del@nicholas.duke.edu, 919-613-8082.

Source: Duke University

5 October 2011

World Habitat Day focuses on cities and climate change

The United Nations has designated the first Monday of October every year as World Habitat Day. This year, World Habitat Day was celebrated on 3 October 2011 and the Global Celebration was hosted by the Government of Mexico.

The topic this year is "Cities and Climate Change". UN-HABITAT chose the Cities and climate change theme for the 2011 because it is important to see what cities are doing about climate disruption: This means their pollution and environmental footprint, as well the impact in turn of climate change problems on cities, especially on the poorest and those least able to cope when a weather-related disaster strikes.

In a separate statement, UN Special Rapporteurs on Housing Raquel Rolnik and on Internationally Displaced Persons Chaloka Beyani underscored the adverse effects of climate change on informal settlements and sub-standard housing.

"States and the international community can no longer afford to ignore the specific vulnerabilities of informal settlers to climate change-induced disasters, and the increasing risks they face," they warned, further noting that close to a third of the global population live in slums vulnerable to serious environmental hazards.

Last year statement from the UN Secretary General on occasion of 2010 World Habitat Day was exactly about the billion people who live in slums and other sub-standard housing around: "The urban poor are too often condemned to a life without basic rights, hope of an education or decent work."

He further mentioned that "Lacking adequate provision of freshwater, electricity, sanitation or health care, they suffer privations that all too often provide the tinder for the fires of social unrest".


3 October 2011

Job Posting: Senior Officer, Health Impact Project

The Pew Health Group
The Pew Health Group seeks to improve the health and well-being of all Americans. Based on research and critical analysis, the program advocates policies that reduce unacceptable health risk, especially in the areas of consumer, food and prescription drug safety, toxics in products and antibiotic overuse in farms animal production.

The Health Impact Project
The Health Impact Project is a collaboration of the Robert Wood Johnson Foundation (RWJF) and The Pew Charitable Trusts (PCT). The project, which is managed out of the Pew Health Group, is designed to promote the use of health impact assessments (HIAs) as a way to informed decisions on policies, programs and projects outside the health sector at the local, state, tribal and federal level. HIAs are used to identify the likely impacts of these decisions and help policy makers avoid unintended risks, reduce unnecessary costs and leverage opportunities to improve the health of their communities.

Position Overview
This position, based in Pew’s Washington, D.C. office, will report to the director of the Health Impact Project. The senior officer will be responsible for conducting and drafting health impact assessments of at least two federal-level decisions, and will conduct or oversee the activities of contractors in the conduct of several additional HIAs of decisions at the tribal, state or municipal level. The senior officer will be responsible for all aspects of the health impact assessment process, including: conducting the required research; identifying, vetting and assembling an appropriate team of consultants; engaging stakeholders; outreach to policy makers, including state and federal agencies; and other activities as the need arises. The senior officer will also work with the director and communications officer to synthesize data on the conduct and outcomes of HIA in order to build a compelling case for their use and to present these data to policy makers, private sector stakeholders and other audiences. The position is funded through December, 2013, with the possibility of renewal depending on the initiative’s progress and identification of sources of funding.

The senior officer will also help design and implement research and analysis efforts for the Health Impact Project, coordinate convenings, manage special projects and support other programmatic investments. The senior officer may also undertake special projects and/or new initiatives. 

Click here to go to the application website.

  • Under the direction of the director, conduct and draft two health impact assessments of federal-level policies selected by the Health Impact Project, engage stakeholders and decision-makers at each step of the HIA process, develop and carry out effective dissemination plans for the HIA findings and recommendations. 
  • Oversee all aspects of the report review and production process, in coordination with the communications officer, to ensure timely dissemination of HIA findings to decision-makers and other stakeholders.
  • Comply with all relevant laws and restrictions on the use of Pew funds for lobbying.
  • Identify, vet and select appropriate contractors to conduct HIAs or to address specific research questions germane to an HIA and manage all aspects of contractor activity.
  • Collect and analyze data regarding HIA outcomes in order to build a compelling case for their use in sectors and decisions where HIAs appear likely to add value. Present the results of this research to policy makers in agencies, legislatures and Congressional staff offices, as well as media, potential allies and others in order to build awareness of the field.
  • Oversee and contribute to other research needs that may arise in the course of the activities of the Health Impact Project.
  • Assist program staff in processing contracts and sub grants for the Health Impact Project. Help ensure that contracts and sub grants to be submitted to the managing director and president are complete, accurate and timely. 
  • Work with the project manager to facilitate and coordinate administrative aspects of the Health Impact Project, such as budgets, shared files, staff meetings and project public forums and convenings. 
  • Contribute to content for newsletters, mailings and other communications vehicles designed to ensure that internal and external audiences are kept apprised of project updates.
  • Contribute to and participate in tasks of the project and PHG as assigned, as well as broader Pew-wide projects and/or committees as needed 

  • A masters degree in public health or a related field. An advanced degree in medicine or science (an MD or Ph.D.) is preferred. 
  • A minimum of ten years of relevant professional experience, including outstanding research, analytical and writing skills; experience in leading multi-disciplinary teams and synthesizing reports based on research from several disciplines. Health impact assessment experience is preferred but not required. Experience in another relevant field such as regulatory impact assessment or cost-benefit analysis may suffice. 
  • Excellent written and oral communications skills including:
  • Experience synthesizing and summarizing large amounts of information, focusing quickly on the essence of an issue, as well as identifying, understanding and proposing solutions that address different policy perspectives. 
  • Experience working with academics, nonprofits and other entities conducting research and policy analysis, helping ensure the results are rigorous, policy relevant and timely and are communicated clearly and persuasively to target audiences. 
  • Strong systems skills including Microsoft office products required; database and online research applications preferred. 
  • Ability to work professionally and collegially within a creative, fast-paced corporate culture that emphasizes excellence and teamwork. 
  • Demonstrated time- and project-management skills, including development and timely completion of work plans for complex, long-term projects; and maintaining a high level of organization. Ability to set priorities and identify resources. 
  • Ability to work independently with limited supervision. Flexible and able to routinely juggle multiple competing priorities and work in teams of both support and senior staff to meet project goals.
  • Experience engaging stakeholders—including policy makers, community members and policy makers - in scientific and policy contexts.
  • Operating effectively within diverse political and policy environments and addressing conflicting policy perspectives in a way that maximizes programmatic objectives. Writing clear and cogent materials that effectively translate scientific information and policy issues for policy makers, community members, the media and other audiences.



It is anticipated that the individual in this position will travel within the U.S.

Pew offers a competitive salary and an excellent benefits package including four weeks of vacation annually, a generous 401(k) plan and flexible benefit options.

Source: Aaron Wernham, via LinkedIn