The suicide rate among Americans ages 35 to 64 rose by roughly 28 percent between 1999 and 2010, according to a Centers for Disease Control and Prevention report released Friday, up from 13.7 to 17.6 deaths per 100,000 people (the suicide rate is much higher for middle-aged men, at 27.3, than for women, at 8.1). The increase, the New York Times noted, is raising concerns that "a generation of baby boomers who have faced years of economic worry and easy access to prescription painkillers may be particularly vulnerable to self-inflicted harm."
The numbers are troubling, but how do they compare to rates in other parts of the world? Suicide data is notoriously hard to compile because it is believed to be vastly underreported -- and the level of reporting varies from country to country, which makes comparing rates across nations an inexact science. But a look at World Health Organization data indicates that the United States falls more or less in the middle of the pack for both male and female suicides, with 17.7 male deaths (38th-most among 105 countries) and 4.5 female deaths (40th) per 100,000 people (the transnational statistics are drawn from varying years).
Men commit suicide more often than women in nearly every nation listed by the WHO report. The only exceptions are China (14.8 women vs. 13.0 men) and the tiny island nation of São Tomé and Príncipe, which reports that no men commit suicide there and that women commit suicide at a rate of only 1.8 per 100,000. That data, though, was is from 1987.
Lithuania, meanwhile, has the highest suicide rate among men, with 61.3 deaths for every 100,000 citizens, followed by Russia (53.9), and one of the largest gender gaps, with the rate for Lithuanian women at 10.3. South Korea has the highest rate for women at 22.1 and more parity between genders, with a rate of 39.9 for men.
In 2008, Reuters took an in-depth look at Lithuania's struggle with suicide, noting that high rates are a particularly painful social issue for the post-Soviet Baltic states despite their economic growth:
Pensioners struggle to survive, healthcare facilities are often poor and cases of tuberculosis, a disease often associated with poverty, are far above the EU average.
Tens of thousands of Latvians and Lithuanians have emigrated to seek higher wages and a better life: others seek a more final way out....
Suicide is particularly prevalent in rural communities where unemployment rose following the dissolution of Soviet era collective farms....
People lack the necessary education and professional skills, or are too old to adapt to new realities, and the state has put too little effort in helping them, experts say. In desperation, many turn to alcohol, fuelling their feelings of hopelessness.
It's a phenomenon that prompted one WikiLeaks cable to dub Lithuania the "suicide capital of Europe."
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Kenya's efforts to promote safe sex and combat HIV/AIDS have apparently hit a snag, as religious leaders have accused the government of promoting infidelity instead.
The controversy began when Kenyan health officials teamed up with USAID and a similar agency in the U.K. to sponsor a television advertisement showing two women shopping in the marketplace. One of the women reminds her friend to use a condom while having sex with her boyfriend when her frequently drunk husband is away. The boyfriend is shown in the background, selling shoes and flirting with another woman.
The commercial quickly came under attack from Christian and Muslim leaders who argue that it promotes immorality and infidelity. "The advert depicts this nation as a Sodom and Gomorrah and not one that values the institution of marriage and family," a leader of the Council of Imams and Preachers of Kenya, declared. One woman criticized the ad for using a mother as the main character. "The fact that a mother figure has been used makes it worse because mothers are the people who stand for families and the ones who teach children the good morals," she said. (Past condom ads in Kenya have been decidedly humorous, though they haven't exactly put public-health messages front and center.) The government has since withdrawn the ad.
In an interview with NTV, the head of Kenya's National Aids / STD Control Program (NASCOP), Dr. Peter Cherutich, defended the spot, arguing that Kenyans "cannot bury our heads in the sand." Sexual infidelity is a reality in the country, he explained, and NASCOP is doing its duty by promoting sexual health in light of this fact:
The collaboration that we would like to have with the church is that they become our partners. They teach their congregants and they teach Kenyans how to protect themselves against HIV, by being faithful to their sexual partners. And for those that are not able to be faithful, then they need to use a condom.
"We know for a fact that a big proportion of both men and women have sex outside their regular partnerships," Cherutich told the BBC in another interview. "And so, unfaithfulness, as you would call it, is a reality that we need to address in this country." NASCOP says that it is also trying to fight the stereotype that only men are unfaithful, while emphasizing that the task of using condoms should not be left to men alone.
It's an important conversation -- but one many Kenyans appear ambivalent about having as families gather around the television.
As climate talks continue to grind along in Doha, food security would seem to be a major concern (especially as the U.N. issues warnings about the increasingly desperate food situation in Syria). However, the question of how farmers will feed the world's booming population while adjusting to changing weather patterns appears to have been sidelined even as this year's crippling drought in the U.S. sent grain prices to record highs.
That doesn't mean, however, that the race for food security hasn't already begun. As the authors of the recently released book The Global Farms Race argue, cash-rich but resource-poor governments have been quietly making controversial bids for the arable fields of foreign lands to shore up their own food security. Since the 2008 global food crisis, these "land grabs" -- considered an economic lifeline by supporters and neocolonialism by critics -- have been booming. The editors of the book note a 2011 Oxfam study that claimed nearly 230 million hectares of land have been sold or leased since 2001, mostly after 2008 (that's about the size of Western Europe). In one of the most publicized deals, the South Korean company Daewoo Logistics leased 3.2 million acres in Madagascar in 2008 to grow corn and palm oil so that the company could "ensure our food security." The deal, which was eventually canceled, was so unpopular domestically that it contributed to an uprising that helped to oust Madagascar's President Marc Ravalomanana.
While that deal fell apart, countless others have gone through, sparking debates over the economic, environmental, and political implications of exporting crops from food-insecure countries. As Michael Kugelman, co-editor of the book with Susan L. Levenstein, said at a book launch event at the Wilson Center on Tuesday, this development marks "a new phase of the global food crisis" -- one that may help countries importing food, but has grave implications for the countries hosting the crops. One of the disaster scenarios of these large-scale investments is that they will recreate scenes straight out of the Irish Potato Famine, during which crops were shipped out of the starving nation to feed wealthy foreigners. But equally urgent are the day-to-day economic, environmental, and political ramifications of the deals, from the effects of clearing forest to make way for new farmland to the implications of replacing food crops with biofuels.
Defenders of this type of direct foreign investment often tout the willingness of investors to share technology -- such as seeds for drought-resistant plants and satellite monitoring for crops -- with the host nation. However, corrupt governments willing to offer deals that don't benefit their own populations compromise these promises of development. (Unlike the land-grabs of yore, host governments solicit many of these deals. According to Kugelman, Pakistan offered a 100,000-strong security detail to protect the property of foreign investors and other countries have offered "fire sales" on land in the form of tax write-offs).
As the book acknowledges, these deals are most likely here to stay, so the focus is on minimizing the potential conflict over the contentious real estate. Many of the policy recommendations provided by the book lean toward community supported agriculture programs: Wealthy nations contracting directly with small-scale farmers to meet food needs while also providing them with the technology and capital to improve their yields. While that's all well and good, the willingness and ability of foreign investors to abide by these recommendations seems doubtful, especially given the difficulty of enforcing even well-established international economic rules.
The inability of the current multilateral climate talks to make meaningful headway on even a single key issue highlights the inherent problem with these arrangements. "You can have all the rules and regulations for land rights," contributor Derek Byerlee, the World Bank's former Rural Strategy advisor, said on Tuesday, "But you have to be able to implement them."
News of a new "seal flu" has many fearing a repeat of the 2009 swine flu outbreak that infected more than 5.7 million in the United States before peaking as a level 5 on the WHO's 6-point pandemic alert. The H3N8 flu virus was discovered after the mysterious death of nearly 200 harbor seals off the United States' northeastern coast. Describing it as "a combination we haven't seen in disease before," researchers warned that the new strain of influenza A could have severe repercussions for human health.
The real shock of the story may be the public realization that such doe-eyed creatures could cause harm. While mosquitoes and ticks, those pesky harbingers of West Nile, dengue fever, cholera, Lyme disease, and Kyasanur fever (among other assorted viral, fungal, and bacterial pathogens) are universally hated, it's hard to believe the Earth's more cuddly creatures could breed evil. Here's another 13 to ruin your next trip to the petting zoo:
Peacocks are dying in droves in Pakistan's Thar Desert region in an outbreak scientists believe is linked to Newcastle disease. Highly contagious in birds, the viral infection is currently rare in humans. Its unique replication properties make it a potential candidate for agroterrorism, but more positive headway been made in its use as a human cancer treatment.
Found primarily in Latin America, armadillos are better known for their unique defense mechanism than their role as a global disease vector. Beneath their shell, however, these mammals shield leprosy, a rare bacterial infection that attacks the skin and nervous system. Though associated more with the bible than modern medicine, the disease remains active throughout the world -- with armadillos responsible for more than a third of infections in the United States.
The world's largest mammal offers plenty of real estate for influenza A, a viral flu strain with the most potential for interspecies transmission. Luckily, the chances for accidental contact remain slim -- just another reason to skip the whale meat.
Monkeys and apes
Described by malaria researchers as a "reservoir for human disease," monkeys and apes are widely known for harboring emerging zoonotic diseases. The HIV virus originated in African monkeys and strains of malaria, Ebola, and monkeypox virus continue to be created or transmitted by monkey and ape populations -- not to mention the cases of measles, rabies, tuberculosis, salmonellosis, shigellosis, amebiasis, balatidiasis, herpes B, giardiasis and helminthes believed to have appeared first in man's closest relative.
Dogs and cats
While many a dog-lover cheered reports of a feline parasite's negative impact on human dopamine production, man's best friend carries its own risks. Though undulant fever is more commonly associated with other species, human cases of the leptospirosis bacteria, an infection whose effect ranges from flu-like symptoms to liver and kidney failure, encephalitis, and pulmonary involvement, have been reported to originate in dogs.
More commonly associated with rats, plague seems to have chosen prairie dogs as its modern rodent host. One leg of a complex threesome that includes mice and fleas, prairie dog coteries across North America have been struck by a mass outbreak of bubonic and sylvatic plague. In an effort to cull the epidemic, the U.S. Department of Agriculture has implemented a mass fumigation campaign.
While flying foxes are their natural reservoir, the Hendra and Nipah viruses have adapted to survive within horses where they take residence alongside anthrax. Worse, equine encephalitis virus, a pathogen listed as a global priority by the Global Early Warning System for Major Animal Diseases, Including Zoonoses, has spread globally. Transmitted by mosquitos, the virus can be fatal in both horses and humans.
Rabbits and hares
Guinea pigs and hamsters
However popular with the preschool set, guinea pigs and hamsters are still rodents. Next time your kid asks to bring one home remember - these furry beasts are disease vectors of lymphocytic choriomeningitis, leptospirosis, yersiniosis and salmonellosis. Handle with gloves.
TIMM SCHAMBERGER/AFP/Getty Images
As Bill Gates unveiled his plan this week to rid the world of polio, health officials in the northern Nigerian state of Kano announced their own assault on the disease. "The government will henceforth arrest and prosecute any parent that refuses to allow health workers to vaccinate his child against child-killer diseases, particularly polio," said a health ministry official.
This news, which was announced at the outset of the government's four-day vaccination campaign targeting six million children, marks a shift in government policy toward immunization programs in the north of the country. Nigeria's polio vaccination program stalled for more than a year after Muslim leaders raised doubts over the inoculations' safety in the summer of 2003 -- resulting in bans issued by some northern state governments. One leader went so far as to claim that the vaccine was "being used for the purpose of depopulating developing countries, and especially Muslim countries." Other rumors claimed that the vaccines were contaminated with HIV and caused infertility in Muslim girls.
Although it ended in 2004, the immunization ban led to a resurgence of polio outbreaks within previously polio-free regions of Nigeria, as well as in surrounding countries.
This time around, Kano officials aren't taking any chances on noncompliant communities. Officials, who have not yet detailed the punishment or fines that would meet unwilling parents, clearly mean business: The mandate extends even to medical workers, who will be held responsible for reporting unwilling parents.
The recent vaccination effort in Kano comes after UNICEF Deputy Representative Jacques Boyer's recent visit to the capital city, during which he highlighted the challenges of eradicating polio in Nigeria, one of only four nations where polio is endemic. Boyer pointed out that while Nigerian polio cases dropped dramatically -- from 338 in 2009 to 21 in 2010 -- there has been a recent rise, with 20 cases reported in the last six months.
A July 2011 report by the Global Polio Eradication Initiative (GPEI) partially attributed this rise to distraction brought on by the recent national elections. While the report's authors praised Nigeria's government for "showing greater commitment to eradicating polio," they also noted that Kano failed to meet indicators of progress and "remains a smouldering risk that could yet undermine the whole eradication effort." With of the weight of polio eradication hanging over them, officials had better hope the threat of imprisonment does the trick.
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Just one week after the acquittal of fiery far-right politician Geert Wilders, the Dutch parliament struck another blow against multiculturalism in the Netherlands yesterday with the passage of a bill banning ritual animal slaughter. The bill requires that all animals be stunned before being slaughtered, a requirement that conflicts with halal and kosher stipulations that animals be fully conscious.
The bill was initially proposed by the Party of the Animals, which holds two seats in the 146-seat Dutch parliament and maintains that ritual methods of slaughter are inhumane. It gained support from centrists on similar grounds, but Wilders's Freedom Party has also been a longtime proponent. In fact, it was Wilders who first raised the issue in 2007 when he objected to halal meat being served at a public school in Amsterdam.
The ban has provoked a furious reaction from Jewish and Muslim leaders in the Netherlands and Europe. From Reuters:
"The very fact that there is a discussion about this is very painful for the Jewish community," Netherlands Chief Rabbi Binyomin Jacobs told Reuters. "Those who survived the (second world) war remember the very first law made by the Germans in Holland was the banning of schechita or the Jewish way of slaughtering animals."
It should be noted that a last-minute amendment attached to the bill states that halal and kosher slaughterhouses will be able to apply for special permits if they can show that their methods do not cause more pain than non-ritual methods. But some are skeptical of the permit process's efficacy, and the European Jewish Congress is already considering challenging the law in court.
The bill awaits confirmation in the parliament's upper house, though it passed easily in the lower house and enjoys widespread public support. If passed, it will put the Netherlands in the company of a handful of countries that have outlawed ritual animal slaughter. Revisions to New Zealand's animal welfare code made kosher slaughter illegal as of this May, while bans in a number of Scandinavian and Baltic countries date back to anti-Semitic measures passed before World War II.
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This is extremely disturbing:
U.S. government medical researchers intentionally infected hundreds of people in Guatemala, including institutionalized mental patients, with gonorrhea and syphilis without their knowledge or permission more than 60 years ago.
Many of those infected were encouraged to pass the infection onto others as part of the study.
About one third of those who were infected never got adequate treatment.
Secretary of State Hillary Clinton and Health and Human Services Secretary Kathleen Sebelius offered apologies for the experiments today.
The experiments, which took place from 1946-1948, were discovered by Wellesley Women's Studies professor Susan Reverby in the course of her study on another infamous STD study, the Tuskeegee Syphillis Experiment. You can read her findings here.
The New York office director of UNAIDS, Bertil Lindblad, is worried about the one region of the world where HIV infections are increasing, even as rates in the rest of the world level off. It's not in Africa or Asia, or even Latin America. It's Eastern Europe -- countries like Russia and Ukraine -- where a recent UNICEF report notes that increases in infection rates of as high as 700 percent have been seen since 2006.
"There is an urgent need for the whole Eastern European and Central Asian region to act quickly," Lindblad said this morning. "This is really quite scary given the fact that there is denial, and so much stigma and homophobia [in that region.] This could really create huge problems if HIV continues to spread from smaller groups in the population to wider."
It's HIV/AIDS's silent crisis, one that has been underway for the last decade. The region is home to a quarter of all injection drug users in the world (3.7 million), and this is where the epidemic is believed to have begun. These users are young -- most of them teenagers. But from there, HIV spread to sex workers (the majority of whom are also under 30), and now has fully moved into the everday lives of men and women in the region, married and unmarried. A mark of the epidemics progression -- from specific populations into the majority -- is the new incidence of HIV among women, who account for 40 percent of all new infections (that's up from only 24 percent at the turn of the century.)
The stigma attached to the disease -- and more importantly, to the groups of people percieved to be the majority infected with it -- is the biggest obstacle to doing anything about the disease. "Those living with HIV have been silenced and excluded, and risky behaviours borne of futility and hopelessness have been sanctioned or repressed," the UNICEF report notes. Government officials are said to be resistant to admitting the scale of the problem, and today that country remains a difficult places for AIDS advocacy, says Lindblad, who formerly worked in the UNAIDS office in Moscow.
But where there is challenge such as this, there is also often opportunity. Russia, I would think, should have a very serious interest in addressing this crisis. For starters, because AIDS threatens to exacerbate its larger demographic problem -- that of a fast-shrinking population. But the other point might be even more convincing: The injection drug users are using heroin. And that heroin comes from Afghan poppies. For Russia, tackling the illegal drug market in Afghanistan -- one which fuels the insurgency -- is a serious national security issue.
Of course, good old fashioned peer pressure might help edge them along as well. And when the U.N. General Assembly meets later this month, one of the side conversations, according to Lindblad, will be a discussion on HIV/AIDS "co-hosted by the government of China, the government of Nigeria, and UNAIDS," specifically, the Chinese premier and the Nigerian president (South Africa's President Jacob Zuma was also supposed to come, but had to cancel.) "That could influence other big countries such as Russia, for example, to turn around."
DENIS SINYAKOV/AFP/Getty Images
Imagine for a moment that you're a government minister in a poor or fairly poor country. You've got a limited budget and you've also got a lot of work to do -- children are undernourished, you need to increase the numbers of them that go to school, and maternal mortality is leaving behind ranks of young orphans. Let's also say that, like most countries in the world, yours is a bit unequal. So here's the question: If you want to cut poverty rates, who should you target? The lower middle class -- the "low-hanging fruit" that doesn't have far to go? Or the most destitute of the population?
For years, the answer has been the former. It seems logical: If you can only spend so much, why not help the category that is closest to overcoming poverty? Surely, the most destitute have too far to go to benefit from the limited aid available. This is the approach that countries such as Nigeria, Ghana, Pakistan, and Vietnam have taken in recent years. And they have made some progress.
But you'd be wrong, according to a new study released today by UNICEF. Based on rigorous data tests from 15 countries, the researchers found that the best way to reduce poverty is to start at the bottom, not in the middle. And the difference is a lot. For every $1 million spent on anti-poverty measures, you would "avert 60 percent more deaths" if you help the poorest first, according to the study. The reason for this is simple: if you're destitute, and you recieve a bit of aid, say a cash transfer of $100 a month, that will boost your income by a massively larger percentage than if you are middle-income. Put in another context, if you are a women with no access to healthcare during childbirth, a trained midwife will mean much more to you than it would to a woman with basic care already.
This isn't wonky. It's big -- really big -- not least because it is something of a rethink of the way that governments, including the United States, have been doing development. One of the biggest focuses of the Obama administration's $63 billion Global Health Initiative, for example, is to build up health "systems" -- training healthcare workers, improving facilities, etc. This study says, that kind of thing is great -- but it's also not the most efficient solution. Health systems are usually not accessible to the poorest of the poor because of cultural barriers, poor transportation, or a pure and simple lack of information. Healthcare has to come directly to the communities.
This is, by the way, useful for another another global problem that has arisen in recent years: massive inequality. The world has lifted millions out of poverty (thanks to China and India mostly, but they weren't alone.) But those who remained poor have gotten poorer, and those who were rich have gotten richer. How great would it be if the way to tackle absolute poverty (the numbers of poor) and relative poverty (the inequality factor) was actually the same? Pretty great. As UNICEF Exectuive Director Anthony Lake put it today, "We have an extraordinary opportunity to do not only the right thing but the most practical thing."
Now, to convince the politicians...
Editors note: I am in New York this week on a generous fellowship from the United Nations Foundation, covering the lead-up to the Millennium Development Goals Summit at the U.N. General Assembly starting on Sept. 20.
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For those of you who don't subscribe to the bimonthly print edition of Foreign Policy, you're missing a great feature: the FP Quiz. It has eight intriguing questions about how the world works.
The question I'd like to highlight this week is:
Which of these three countries has the highest annual death rate?
a) Germany b) Iraq c) Kenya
(The photo above is of half-buried headstones at Arlington National Cemetery during last month's D.C.-area "snowpocalypse.")
Answer after the jump ...
Win McNamee/Getty Images
For those of you who don't subscribe to the bimonthly print edition of Foreign Policy, you're missing a great feature: the FP Quiz. It has eight intriguing questions about how the world works.
The question I'd like to highlight this week is:
After Mexico, which OECD country has the highest rate of teen births?
a) Czech Republic b) Turkey c) United States
Answer after the jump …
Christopher Furlong/Getty Images
It seems like Uganda is taking two steps forward and one step backward
this week in terms of securing human rights for its citizens. Amid
growing debate regarding the national Anti-Homosexuality Bill, the Ugandan parliament unanimously passed
a law which not only outlaws the practice of female genital
mutilation, but imposes a strict punishments of ten year to life-long
sentences for convicted perpetrators.
Not a single parliamentary member spoke against the bill, and Francis Epetait, Uganda's shadow health minister explained the reasoning:
"This practice has left so many women in misery. So we are saying no. We cannot allow women to be dehumanised."So as gender activists celebrate in Uganda, national rights advocates still cringe as the likelihood of the passage of the Anti-Homosexuality Bill looms nearer. The Ugandan Civil Society Coalition on Human Rights and Constitutional Law released a statement yesterday to mark International Human Rights day in which they call the pending bill an "unprecedented threat to Ugandan's human rights:
“Uganda today stands at a crossroads. We can either turn further towards an agenda of divisionism and discrimination, and pay the costs in terms of internal suppression of our own citizens coupled with international isolation and marginalization, or we can embrace diversity, human rights and constitutionalism.”
SHAUN CURRY/AFP/Getty Images
Ireland is cautious when it comes to defending its stance against abortion. Voters approved the Lisbon treaty on EU integration earlier this year only after stringent guarantees from other EU countries that EU law would not force Ireland to relinquish its ban on the procedure, which was backed by a 1983 referendum.
So, after all that, it's ironic that the challenge to its constitutionally enshrined "right to life of the unborn" is instead coming in the form of a human rights case before a different European body: the 47-member Council of Europe. The case could have continent-wide implications, if the European Court of Human Rights rules in favor of the three women bringing the case, establishing some protection of abortions sought on medical grounds.
As a signatory of the European Human Rights Convention, Ireland would have to change its laws if the court finds in favor of the women -- identified as A, B and C in the court documents. Abortion is currently permitted only in cases of significant risk to the mother, but the women's lawyer argued today that even in those cases abortion is effectively out of reach due to doctor's fear or unwillingness to risk falling afoul the narrow parameters allowed.
The court's ruling, expected in a few months, might have implications for other EU countries, such as Poland and Malta, which have very restrictive abortion laws. Two years ago, the same court found in favor of a Polish woman denied an abortion despite medical recognition that the pregnancy endangered her eyesight, forcing the government to pay her compensation and provide a legal framework for access to lawful, medical need abortions.
Research published in the British Medical Journal says there is no public evidence that Tamiflu reduces complications associated with influenza. Researchers attempting to review data about the Roche produced drug -- dubbed "our best line of defence" against swine flu by the British health secretary -- found the Swiss laboratory wouldn't permit public access to the studies on the drugs.
Tamiflu might shorten influenza suffering by a day or so they said, based on information in the public domain, but it's not clear that chances of serious complications, like pneumonia, would be affected by Tamiflu. Such meager results mean it might not be worth confronting the side-effects, which include: "insomnia, nausea, bad dreams, abdominal pain, headache and a rare neuropsychiatric disease that caused some users to attempt to harm themselves."
This is understandably a problem for the governments around the world who have stockpiled huge quantities of the drug to prescribe for H1N1, contributing to Roche's estimated $2.65 billion in revenues this year from Tamiflu. In a very entertaining, but not too enlightening analogy, a Brit scientist tried to explain the situation policy makers now find themselves in when deciding to use the drug:
But I suppose that once you've gone and bought lots of doses, then it's a bit like the situation with gun control in the US. If you have a gun in the house, it is much easier to use it. But it does not mean it's the right thing to do."
ANTONIO SCORZA/AFP/Getty Images
Where is the worst place for children to be born in 2009, especially girls? Surprise! Afghanistan. Today, UNICEF published a special report titled State of the World's Children; Daniel Toole, UNICEF regional director for South Asia, told a news briefing in Geneva earlier today:
Afghanistan today is without a doubt the most dangerous place to be born.
After eight years since the U.S. invasion, this is just one more incentive to encouarge the Obama administration to make a decision on its role in the region.
More optimistically, the reports highlights signatory countries of the UN's Convention on the Rights of the Child who have shown marked improvement, including India, Serbia and Sierra Leone.
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Over a million people die unnecessarily from malaria in Africa, according to a survey by ACTWatch. The group released a study of seven countries in Africa today, it found that most people in these countries are obtaining ineffective anti-malarials in the private market, due to the low availability and high prices of the far more successful Artemisinin combination therapy (ACT). ACT costs 20 times more than the older medications to which malaria has developed resistance. At about $11 it's 65 times more than the average daily wage in many of these countries.
Malaria needs to be treated with speed, explained Dr. Desmond Chavasse, speaking from the Pan-African Malaria conference being held in Nairobi. Children must receive medication within 48 hours of displaying malarial symptoms if they are to survive. This is why ACTs must get "out through the marketplace, so they are available at the end of the supply chain, in small shops, at affordable prices."
The study, funded by the Bill and Melinda Gates foundation, is intended to provide baseline information for a program that will subsidize ACT medication.
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Combating alchohol abuse has always been something of a non-starter in Russian politics. This is, after all, a country whose former president was once found by the Secret Servce thoroughly sauced outside the White House, wearing nothing but his underwear trying to hail a cab so he could get a pizza.
But current President Dmitry Medvedev is trying to change things with a proposal to ban outdoor beer sales in his country, a first step in getting Muscovites to lay off alcohol. He also wants to limit the hours of the day alcohol can be sold.
This week, a bill was submitted to lawmakers that would triple the tax on beer from 3 rubles per liter to 10 rubles per liter by 2012. Wine and spirits would also see a sharp increase.
State prosecutors are also moving to ban liquor sales in airports. Under Russian law, no beverage with alcohol content above 15 percent can be sold in crowded or dangerous places, and prosecutors say this means airports.
Russians drink five gallons of pure ethanol a year, double what is considered dangerous by the WHO. And on average, 30,000 people a year die from alcohol poisoning in the country. Over half of the deaths of the 15 to 54-year-old demographic between 1990 and 2001 are attributed to alcohol.
"I have been astonished to find out that we now drink more than we did in the 1990s, although those were very tough times," Medvedev said.
He is a fan of Soviet Premier Mikhail Gorbachev's anti-alcohol reforms in the 1980s aimed at curbing consumption, even though he acknowledges that the plan had major flaws. Gorbachev destroyed the majority of vineyards and wineries in Georgia, probably the birthplace of wine (This didn't help the growing anti-Russia sentiment in the Southern Caucasus at the time). He also shut down distilleries and breweries. Most notably, the Soviet Union suffered tremendous sugar shortages, because people turned to moon shining. (The Russian word for ‘shine is Samogon) Stores also ran out of window cleaner and aftershave. It is estimated that 13,000-25,000 people died from drinking ill-made moonshine.
Medvedev's plan is much more cautious but many Russians are still wary.
"It's impossible. He doesn't stand a chance," a Russian construction worker told The Los Angeles Times."The Russian man will always be drinking. Russians don't surrender."
ALEXANDER NEMENOV/AFP/Getty Images
The city council of Nairobi passed a series of by-laws yesterday outlining new illegal activities for the streets of Kenya's capital. Newly outlawed activities include blowing one's nose in public without using a hankercheif and spitting into trash cans. Another of the laws criminalizes loud noise.
This particular ordinance may have the biggest impact on the economy of Nairobi, in which street hawkers, cab drivers and store owners rely on verbally cajoling customers into their services. One resident argued the city is just trying to make money, either from imposed fines or bribes, and directly ignoring the needs of its citizens:
"We get our daily bread here,We are not making noise. The council must know that we are self-employed."
The city maintains that the purpose of the news laws is to make the city more habitable and reduce general nuisance.
China's food and drug administration has approved the world's first vaccine for the H1N1 virus and the government has announced plans to 5 percent of the Chinese population by the end of this year. Not everyone's so sure about it though:
Skeptics, however, have a hard time believing that a one-dose vaccine lacking a special substance called an adjuvant -- which primes the body to react to the dead virus and produce antigens against it more efficiently and effectively -- can work as well as a two-dose one.
"It would be hard for me to imagine a single-shot vaccine without an adjuvant," says Barry R. Bloom, the former dean of Harvard's School of Public Health. "My understanding in trials here is that you need more than one shot with just the straight virus to get a good enough immune response."
The study that preceded the vaccine's approval tested it on 1,614 participants from age three to over 60, according to Sinovac's head of investor relations, Helen Yang.
Stanford researcher David B. Lewis, who is involved in studies that test how adjuvants can improve seasonal flu vaccines, says it could be misleading to lump the results of all age groups together.
The WHO has also expressed some reservations about the size of China's vaccination plan, noting that "adverse effects that are too rare to show up in a large clinical trial could become apparent when much larger numbers of people receive the vaccine."
Given the speed at which China rushed this vaccine into production and the past record of the country's pharmaceutical industry, I think I would take my chances with the swine flu.
Even as it has become clear that the swine flu pandemic (at least in its current mutation) isn't much more serious or deadly than normal flu, stories of prominent people getting infected with it continue to be covered as if they had contracted bubonic plague.
Probably the best way to put swine flu stories in perspective is to just remove the words "swine" or "H1N1" from before the words "flu" and "virus." For instance:
Colombian President Alvaro Uribe has contracted the [...] flu virus and is being treated by doctors while continuing to work from his residence, government spokesman Cesar Velasquez said on Sunday.
That doesn't sound so bad, now does it?
I'm sorry for sounding flip. H1N1 is a legitimate public health concern that continues to claim lives around the globe. But still, when I see headlines like "Bangladesh reports first H1N1 flu death," I have to wonder how many how many people in that country have died of normal flu (or any number of other diseases) this year without it warranting international media attention.
Chip Somodevilla/Getty Images
No, this is not a Mel Brooks movie:
On Monday morning an Arkia airlines plane took off from Ben Gurion Airport carrying rabbis and kabbalists and flew over the country in a flight aimed at preventing the swine flu virus from spreading in Israel through prayers.
"The purpose of the flight was to stop the epidemic, thus preventing further deaths," explained Rabbi Yitzhak Batzri whose father, Rabbi David Batzri had initiated the flight. "We are certain that because of our prayers danger is already behind us," he added.
During the flight the passengers blew the shofar seven times and said prayers intended for abolishing illnesses.
There have been over 2,000 recorded cases of swine flu in Israel.
Hat tip: On Deadline
Iraq's cabinet has announced that it plans to ban smoking in all public places, the first such law in the Middle East:
The stance is particularly aggressive — and perhaps unenforceable — especially in a nation where cigarettes sell for as little as 40 cents a pack and smoking in public areas and workplaces is widespread. But it coincides with the government’s attempts to improve living conditions here, like Prime Minister Nuri Kamal al-Maliki’s order on Wednesday to remove blast walls from most of Baghdad within 40 days.Given what else is on their plate, I would hope that Iraqi police won't be devoting a whole of their time to enforcing this.
Time reports that for tobacco companies, Africa is the next great unsold frontier.
Driven in no small part by commodity booms, Africa has seen rapid economic growth in the last decade, and tobacco companies are betting on a pattern of rising incomes leading to higher smoking rates. With few smokers and increasing disposable income, the market logic makes sense:
In Ghana, the male smoking rate (which in most places in the world is higher than the female rate) is only 8%; in the Democratic Republic of Congo, it's 14%; in Nigeria, it's 12%. Compare that with 31% in India, 56% in Malaysia and a whopping 61% in China.
Along with increasing marketing and production within the continent, cigarette companies are also preemptively aiming for good publicity.
Tobacco companies have jumped into the corporate-social-responsibility game, doing all manner of benevolent work across Africa and Asia. In 2005, Philip Morris paid $5 billion to buy Indonesian cigarette-maker Sampoerna, a company that was already pouring money into scholarships for local students. British American does similar work in Malaysia, and in Nigeria has devoted 1% of its local profits to improving access to drinking water, health care and vaccines. That kind of largesse buys the companies a measure of indebtedness.
"It's hard to tell a village, 'You shouldn't accept these new wells or bicycles because it's from industry,' " says Stella Bialous, an adviser to the World Health Organization. "[But] when it comes time to pass regulatory things the company doesn't think reasonable, they can call in their chips. They have all these little groups dependent on their money."
Though the Sudanese children pictured above seem to have gotten the message that cigarettes are dangerous (and have bloody fangs), it will be hard to prevent smoking from taking off in the conditions of poor regulation, low healthcare, and low life expectency common to many African countries.
Isam Al-Haj/AFP/Getty Images
Some innovative thinking from India's Minister of Health and Family Welfare, who presents a new argument for rural electrification:
“If there is electricity in every village, then people will watch TV till late at night and then fall asleep. They won’t get a chance to produce children,” Mr Azad said. “When there is no electricity there is nothing else to do but produce babies.”
He added: “Don’t think that I am saying this in a lighter vein. I am serious. TV will have a great impact. It’s a great medium to tackle the problem . . . 80 per cent of population growth can be reduced through TV.”
I suspect Azad is pulling that number out of thin air, but in general, he may have a point. People need to pass their evenings somehow.
Hat tip: Marginal Revolution
Reports have emerged of people intentionally mixing with friends who have flu.
Their reasoning is that it is best to be infected before the winter when the virus could become more deadly.
Does this qualify for a Darwin Award?
Anne Applebaum has an interesting piece over at Slate arguing that while the reaction to swine flu may have been overblown, we should ultimately be grateful for it:
Before "that panic was ridiculous" becomes the conventional wisdom, let's be frank about it: Where infectious diseases are concerned, panic is good. Panic is what we want. Without panic, nothing happens. Up to 500 million people will get malaria this year, and more than 1 million of them will die, mostly in very poor countries. Yet there is no fear of malaria in the rich world; there is no hysterical media coverage, and thus there is still no satisfactory prevention or cure.
By contrast, designs for preventions and cures for swine flu are already, after a mere two weeks of hyperattention, well on track. The U.S. Centers for Disease Control and Prevention has not only developed a test kit to detect the presence of the H1N1 virus that causes the flu; it has already shipped this test kit to all 50 states, plus Puerto Rico and several other countries. Genetic sequences of the virus have been analyzed and databased. A vaccine will probably be ready in time for flu season next fall. Boxes of Tamiflu have been transported to guarded warehouses around the globe, where they await distribution.[...]
if the H1N1 virus mutates into something really dangerous, we'll all be in trouble. But not in as much trouble as we would be if it hadn't been for that brief, possibly ludicrous but nevertheless useful moment of mass hysteria that brought us such terrific headlines over the past couple of weeks.
All of this is true. But I'm not sure about the conclusion. First, I don't really understand Applebaum's argument that infectious disease, in particular, are an issue that benefits from public hysteria as opposed to any other threat. If the media was doing a public service by treating thirty deaths in Mexico like the black death, shouldn't they be trying to work people into a panic over nuclear terrorism or global warming? The argument that "Without panic, nothing happens" could apply to any number of very real threats, but I'd still prefer not to live in a state of perpetual terror.
Beyond that, is a state of panic really the best time to be making critical decisions? There were certainly some rational government responses to the flu. But there were also quite a number that were really, really stupid. Thankfully, the U.S. government resisted the urge to do anything too drastic in response to swine flu, (congress wasn't exactly a big help) but from Japanese Internment to Gitmo, the United States has done some very regrettable things during times of high public fear. I'm not sure it's wise to make it a regular thing. I also think its likely that the hysteria over the swine flu outbreak could make us less likely to take it seriously if a real pandemic should emerge.
This has to qualify as the most dangerously stupid swine-flu overreaction yet:
Haitian officials rejected a Mexican aid ship carrying 77 tons of much-needed food aid because of ''unfounded'' swine flu fears, Mexico's ambassador said Wednesday.
The Mexican navy ship El Huasteco was to arrive May 2 in Port-au-Prince carrying rice, fertilizer and emergency food kits to help the impoverished country respond to chronic hunger and devastating tropical storms.
But Mexican Ambassador Zadalinda Gonzalez y Reynero said Haitian officials told her April 29 they would not accept the ship, which was still in Mexican waters near the Yucatan peninsula at the time.
''The crew was in perfect health and there was no risk at all,'' Gonzalez y Reynero told The Associated Press, adding that the cargo and 64 sailors aboard the ship had all been screened in Mexico.
24 percent of children in Haiti suffer from chronic undernutrition. Glad the country has its priorities in order.
"We should call this Mexican flu and not swine flu," Israeli deputy health minister Yakov Litzman -- an ultra-Orthodox Jew -- said April 27. He stated that the reference to pigs is offensive to Jews and Muslims, whose respective religions prohibit consumption of pork. Pork producers -- likely worried about their product's image -- also have reservations about the name "swine flu."
Of course, Mexicans probably find "Mexican flu" offensive, but the name does seem to fit with the tradition of naming flu pandemics after the places where they were originally identified. On the other hand, there's debate about whether the current swine flu even originated in Mexico. "It was a human who brought this to Mexico," the Mexican ambassador to China told the New York Times, saying that the person was from someplace in "Eurasia." (The virus contains part of a swine flu virus of Eurasian origin.)
Meanwhile, "North American influenza" is the name suggested by the World Organisation for Animal Health. Additionally, "H1N1 virus" was the term used by U.S. Agriculture Secretary Tom Vilsack and Homeland Security Secretary Janet Napolitano at an April 28 news conference. They avoided using "swine flu" because they didn't want to mislead people into thinking they could get the illness by eating pork.
RAUL ARBOLEDA/AFP/Getty Images
Mosquito net manufactures are teaming up with the provincial administration and village elders in several parts of Kenya in an effort to apprehend and prosecute people who use the products for purposes other than covering beds.
According to Dr Elizabeth Juma, who is the head of malaria control under the Ministry of Public Health and Sanitation, there has been evidence of people turning the nets into fishing gear especially in Nyanza Province. Now a different group has discovered another lucrative business venture, and are using the nets to make wedding dresses.
Easterly notes: "Net promoters seem to consistently underestimate the challenge of spreading the scientific knowledge about the risks of getting malaria from mosquito bites."
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