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22. Substance Abuse Policy in Thailand: Current Challenges and Future Strategies
- Author:
- Darika Saingam
- Publication Date:
- 01-2018
- Content Type:
- Working Paper
- Institution:
- Walter H. Shorenstein Asia-Pacific Research Center
- Abstract:
- Substance abuse has been an important social and public health problem in Thailand for decades. The National Household Survey on Substance and Alcohol Use in Thailand, which has been conducted six times, shows that substance abuse has steadily increased. Extrapolated country-wide in recent data, the estimated number of people who have used at least one addictive substance at some time in their lives was 2,964,444 or 5.8% of the total population aged 12 - 65 years. Kratom, Methamphetamine, methamphetamine hydrochloride crystal (ice), and cannabis were the most prevalent substances of abuse. Historical documentation and policy reports were used in this study. The objectives of this study were to complete a document review, determine the effectiveness of previous measures to control illegal substance abuse in Thailand, and consider options for the future. Controlling illegal substance abuse in the future and minimizing total harm requires a delicate balance of efforts to reduce the prevalence, quantity, and harmful effects of substances. Drug policy interventions should be continually evaluated for their effectiveness. The strategies relevant to drug policy, apart from primary prevention, are health services for chronic drug users, reform of criminal sanctions against drug addicts, and legalization of kratom.
- Topic:
- Health, Drugs, and Substance Abuse
- Political Geography:
- Asia and Thailand
23. Dual Practice of Public Hospital Physicians in Vietnam
- Author:
- Ngan Do and Young Kyung Do
- Publication Date:
- 04-2018
- Content Type:
- Working Paper
- Institution:
- Walter H. Shorenstein Asia-Pacific Research Center
- Abstract:
- Although many public hospital physicians in Vietnam offer private service on the side, little is known about the magnitude and nature of the phenomenon of so-called dual practice, let alone the dynamics between the public and private health sectors. This study investigates how and to what degree public hospital physicians engage in private practice. It also examines the commitment of dual practitioners to the public sector. The analysis is based on a hospital-based survey of 483 physicians at 10 public hospitals in four provinces of Vietnam. Nearly half of the participants in the study sample reported themselves as dual practitioners. Various types of private practice were mentioned. Private practice at health facilities owned by the private sector was the most prevalent, followed by private practice delivered at health facilities owned by the dual practitioners themselves. Private practice inside public hospitals was also noted. Dual practitioners were likely to be senior and hold management positions inside their public hospitals. Substantial income differences were found between dual practitioners and those physicians practicing in only the public sector. The majority of dual practitioners, however, reported the willingness to give up private practice if certain conditions were met, such as a basic salary increase or non-pecuniary benefits. The main reasons dual practitioners gave for not leaving the public sector included a sense of public responsibility and opportunities to gain a broader professional network and more training. This study reiterates the significant challenges associated with dual practice, including its financial implications and possible effects on health care quality and access. The need for a high-quality workforce committed to the public sector is particularly critical, given the possibility of universal insurance coverage. Future research should address the need to improve data collection on physicians’ dual practice and incorporate the topic in policy debates on health reform.
- Topic:
- Health, Health Care Policy, Reform, and Hospitals
- Political Geography:
- Asia and Vietnam
24. Economic Dimensions of Personalized and Precision Medicine in Asia: Evidence from Breast Cancer Treatment in Taiwan
- Author:
- Jui-fen Rachel Lu and Karen Eggleston
- Publication Date:
- 04-2018
- Content Type:
- Working Paper
- Institution:
- Walter H. Shorenstein Asia-Pacific Research Center
- Abstract:
- High costs of precision medicine raise concerns about exacerbating income-related disparities in healthcare utilization and health outcomes. One approach to expanding coverage in Asia has been to cover the precision therapy but require the pharmaceutical firm to cover the costs of the companion diagnostic test. Taiwan’s National Health Insurance (NHI) adopted this approach for lung cancer, colorectal cancer and leukemia, but not for the first target therapy covered by NHI, trastuzumab for the treatment of HER2-positive breast cancer. Analyzing a unique dataset linking medical claims, cancer registry data and proxies for income between 2004 and 2015, we find that lower-income patients are more likely to be diagnosed with later stages of breast cancer, and this pattern renders NHI coverage of anti-HER2 therapy pro-poor even before full coverage of the diagnostic tests. Moreover, the expansion of NHI coverage—including the FISH diagnostic test and trastuzumab for early-stage breast cancer—strengthened the pro-poor distribution of genetic testing and target treatment, albeit only marginally. The extent of pharmaceutical company coverage of testing and its impact on patient access are topics of our ongoing research, contrasting breast cancer with colorectal cancer.
- Topic:
- Health, Health Care Policy, Economic Inequality, and Medicine
- Political Geography:
- Taiwan and Asia
25. Infrastructure, Gender and Violence: Women and Slum Sanitation Inequalities in Delhi
- Author:
- Susan Esme Chaplin and Reetika Kalita
- Publication Date:
- 10-2017
- Content Type:
- Special Report
- Institution:
- Centre for Policy Research, India
- Abstract:
- In Delhi, as in many other Indian cities, millions of men, women and children who live in slums and informal settlements haveto daily confront the lack of adequate sanitation facilities. These sanitation inequalities have a greater impact on the health and socioeconomic status of women and girls because of their greater social vulnerability to sexual violence; there is also the role played by biology in their need for privacy, safety and cleanliness. Men and boys, on the other hand, tend to use public urinals and open defecation (OD) sites generally more frequently, because their need for privacy during these sanitation activities is not such a cause for concern. In addition, women and girls are forced every day to risk using precarious spaces for their sanitation activities that may expose them to gender-based violence and harassment and not satisfy their biological and socio-cultural needs. These urban sanitation inequalities also negatively impact the time women have available for paid employment as well as their daily domestic responsibilities, as they have to spend each morning queuing for toilets or getting up earlier to go with other women to OD sites. For adolescent girls this can often mean being late for school, which threatens their education and future life choices. India failed to meet Millennium Development Goal No. 7 (adopted by the United Nations in 2000) relating to halving the proportion of people without access to basic sanitation. In terms of toilet usage across India, the Census 2011 found that 81 percent of urban households had a private toilet or latrine. But when it came to slum households, only 66 percent had a toilet, meaning that 34 percent had to either use a community or public toilet or resort to OD (Ministry of Housing and Urban Poverty Alleviation & National Buildings Organisations 2013, p. 60). In reality, there are an estimated 41 million urban dwellers still practising OD because of a lack of access to improved sanitation (WaterAid 2016). OD is a compulsion, not a choice, and creates particular risks and imposes a variety of harms upon women and children that men and boys do not suffer. Who or what is responsible for such socioeconomic consequences of the lack of adequate sanitation infrastructure in Indian cities which perpetuate gender inequalities? How do harms like gender-based violence impact the everyday lives of women and girls living in slums in particular? This project report examines these issues using the notion of infrastructural violence and then examines the harms and suffering caused by a lack of sanitation infrastructure in two long-established localities in Delhi: Mangolpuri and Kusumpur Pahari. Mangolpuri is a resettlement colony in the northwest region of Delhi with an estimated population of more than 350,000. It is interspersed with eight JJCs clusters of varying sizes. Kusumpur Pahari is located in the heart of south Delhi, near Jawaharlal Nehru University, and now has five blocks of JJCs and an estimated population of nearly 50,000.
- Topic:
- Development, Gender Issues, Health, Children, Women, Income Inequality, and Sanitation
- Political Geography:
- South Asia, India, and Asia
26. Bird Flu — It’s What’s for Dinner: What Human Population Growth and Climate Change Mean for the Future of Avian Influenza Outbreaks
- Author:
- Nahid Bhadelia
- Publication Date:
- 07-2017
- Content Type:
- Journal Article
- Journal:
- Fletcher Security Review
- Institution:
- The Fletcher School, Tufts University
- Abstract:
- China is currently experiencing its fifth epidemic of “bird flu,” or avian influenza H7N9, since 2013 when it was first noted to cause human infections. The virus, which is mainly transmitted from poultry to humans, is also prone to limited human-to-human transmission. To date, there have been 1,258 human cases, with one-third of those cases (460) occurring during this year’s epidemic alone.[1] There are many “subtypes” of avian influenza circulating in birds around the world and most of these viruses cause limited or no human infections. However, two avian influenzas subtypes causing high human mortality have jumped from birds to humans in the last decade, H5N1 and then H7N9. The significant potential of this class of viruses to cause a human pandemic is a global public health concern, particularly because the conditions leading to the rise of these infections are becoming more favorable — for the viruses.
- Topic:
- Climate Change, Environment, Health, and Infectious Diseases
- Political Geography:
- China, Asia, and Global Focus
27. Does Unplanned Urbanization Pose a Disease Risk in Asia? The Case of Avian Influenza in Vietnam
- Author:
- Sumeet Saksena
- Publication Date:
- 01-2017
- Content Type:
- Special Report
- Institution:
- East-West Center
- Abstract:
- Cities are expanding very rapidly in Asia, often without adequate housing, transportation, water, or sanitation. ese new “peri-urban” areas may be hot spots for disease, both in humans and domestic animals. Research into the possible link between unplanned urban expansion and disease outbreaks compared patterns of land-use change with two major outbreaks in Vietnam of highly pathogenic avian in uenza (HPAI, subtype H5N1) that killed millions of chickens between 2003 and 2005. Work began by classifying communes into land-use categories: rural, peri-urban, urban, and urban core. e study found that peri-urban communes had at least a 150 percent higher risk of experiencing an H5N1 outbreak than did other types of commune, and that urbanization entails a spatial convergence of several key risk factors for H5N1 transmission. By focusing prevention programs on communes with these factors, the Vietnamese government can potentially improve disease prevention at lower cost. is research may also help explain the epidemi- ology of other infectious diseases, both in humans and livestock.
- Topic:
- Health, Urbanization, and International Development
- Political Geography:
- Asia
28. Odisha Urban Sanitation Policy and Strategy 2017
- Author:
- Centre for Policy Research
- Publication Date:
- 12-2016
- Content Type:
- Special Report
- Institution:
- Centre for Policy Research, India
- Abstract:
- Over the past four years, the national policy environment and institutional response to sanitation have undergone a substantial change. The launch of the Swachh Bharat Mission (Urban) and Atal Mission for Rejuvenation and Urban Transformation (AMRUT) have catapulted sanitation into the league of priority sectors. In the backdrop of such developments, Housing and Urban Development Department under the Government of Odisha sought to revise the Urban Sanitation Strategy 2011 with the able support from the Centre for Policy Research (CPR) supported by the Bill and Melinda Gates Foundation. The revised Odisha Urban Sanitation Strategy 2017 and Odisha Urban Sanitation Policy 2017 make crucial strides towards the achievement of a Clean Odisha. The purview of the strategy has been expanded to address gaps in the entire sanitation value chain for the management of not only solid waste, but also liquid waste including faecal sludge/septage and menstrual hygiene. The revised strategy is grounded in the principles that have underpinned the Odisha government's efforts so far to provide the people with equitable and safe access to sanitation, along with establishing the most advanced sanitation infrastructure. Over the next ten years, concerned departments will work towards six objectives: (a) achieving open defecation free and (b) open discharge free urban areas; (c) effectively managing and treating solid waste; (d) ensuring that sewage, (e) septage/faecal sludge and liquid waste are safely treated and disposed; and (f) ensuring safety guidelines are followed in physical handling and management of waste. In addition, providing women and girls with safe access to menstrual hygiene has also been included as an objective in the revised strategy.
- Topic:
- Development, Health, Infrastructure, Governance, Public Policy, and Sanitation
- Political Geography:
- South Asia, India, and Asia
29. Disability Rights in Global Perspective
- Author:
- Karen Nakamura
- Publication Date:
- 04-2016
- Content Type:
- Video
- Institution:
- Clarke Forum for Contemporary Issues
- Abstract:
- Grassroots disability movements such as mad pride and crip pride have pushed themselves to the forefront of conversations across the world about diversity and inclusion, but there has also been considerable setbacks in recent years. Karen Nakamura discusses disability rights social movements and how they have fundamentally changed the social contract and fabric in various countries.
- Topic:
- Health, Human Rights, Social Movement, Health Care Policy, Social Justice, Disability, and Mental Health
- Political Geography:
- Japan, Asia, North America, Global Focus, and United States of America
30. Reforming the Liability Regime for Air Pollution in India
- Author:
- Shibani Ghosh
- Publication Date:
- 12-2015
- Content Type:
- Working Paper
- Institution:
- Centre for Policy Research, India
- Abstract:
- The recent uproar about the toxic levels of pollution in the country’s national capital region has once again brought to fore the failure of the regulatory and legal mechanisms in India to control air pollution. Despite an early legislative acknowledgment of the issues relating to air pollution, and regulatory mechanisms set up consequently, India has not been able to restrict the sharp upward trajectory of air pollution. While several issues with regard to the legal and regulatory regime governing air quality in the country deserve serious and urgent consideration, this paper focuses on one issue in particular – the liability regime for violation of air quality standards. The paper is divided into three parts. The first part discusses the relevant provisions of the law pertaining to liability - civil and criminal - for causing air pollution. The second part identifies three critical issues that have emerged in the current liability regime: (1) the Pollution Control Boards do not have the power to levy penalties; (2) criminal prosecution is not an effective solution; and (3) the National Green Tribunal Act does not provide complete relief. The third and final part of the essay proposes a way forward. It is suggested that the Pollution Control Boards need to be granted additional enforcement powers, and administrative fines for violations should be introduced, albeit with certain conditions.
- Topic:
- Environment, Health, Governance, Law Enforcement, Law, Reform, and Pollution
- Political Geography:
- South Asia, India, and Asia