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51. 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

52. 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

53. 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

54. 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

55. Quality and Accountability in Healthcare Delivery: Audit Evidence from Primary Care Providers in India

Author:
Jishnu Das, Alaka Holla, Aakash Mohpal, and Karthik Muralidharan
Publication Date:
02-2015
Content Type:
Working Paper
Institution:
Centre for Policy Research, India
Abstract:
We present among the first direct evidence on the quality of healthcare in low-income settings using a unique and original set of audit studies, where standardized patients were presented to a nearly-representative sample of rural public and private primary care providers in the Indian state of Madhya Pradesh. We report three main findings. First, private providers are mostly unqualified but spent more time with patients, and completed more items on a checklist of essential history and examination items than public providers, while being no different in their diagnostic and treatment accuracy. Second, we identify the private practices of qualified public sector doctors, and show that the same doctors exert higher effort and are more likely to provide correct treatment in their private practices. Third, we find a strong positive correlation between provider effort and prices charged in the private sector, whereas we find no correlation between effort and wages in the public sector. Our results suggest that market-based accountability in the unregulated private sector may be providing better incentives for provider effort than administrative accountability in the public sector in this setting. While the overall quality of care is low in both the public and private sectors, these differences in provider effort may partly explain the dominant market share of fee-charging private providers even in the presence of a system of free public healthcare.
Topic:
Government, Health, Privatization, Health Care Policy, Social Policy, and Rural
Political Geography:
South Asia, India, and Asia

56. East-West Center Working Papers, Environmental Change, Vulnerability, and Governance Series

Author:
Alex S. Forster
Publication Date:
03-2014
Content Type:
Working Paper
Institution:
East-West Center
Abstract:
North Korea is an extremely isolated and impoverished nation. While its political elites are able to enjoy some degree of luxury in spite of UN sanctions, the lower classes suffer from shortages of food, electricity, healthcare, and other basic needs. Many of the lower class and fringe populations reside in rural areas with limited infrastructure, and rely on black markets to survive. Their situation could be dramatically improved if electricity could be provided to their communities to power heating, health clinics, manufacturing facilities, fertilizer plants, and water pumps for agricultural irrigation.
Topic:
Health, Food, and Sanctions
Political Geography:
Asia and United Nations

57. Perceived Risk of Avian Influenza in Poultry Varies with Urbanization in Vietnam

Author:
Jefferson Fox, Melissa L. Finucane, Sumeet Saksena, Nghiem Tuyen, James H. Spencer, Nguyen Lam, Trinh Dinh Thau, Tran Duc Vien, and Nancy D. Lewis
Publication Date:
10-2014
Content Type:
Working Paper
Institution:
East-West Center
Abstract:
Highly pathogenic avian influenza (HPAI) is an important public health concern because of its potential to cause widespread morbidity and mortality in humans and poultry and associated devastating economic losses. In this study we examined how perceptions of and response to the risk of HPAI in poultry vary across communes/wards in the north of Vietnam at different levels of urbanization (rural, transitional, urban). We conducted a quantitative household survey with 1073 respondents. Results suggested that the perceived risk of HPAI in poultry was highest in transitional and rural settings. Respondents in these settings were more likely than respondents in urban settings to agree that the process of change (in urbanization, agricultural practices, or natural habitat) increased the likelihood of an outbreak of HPAI in poultry. Compared with others, respondents in transitional areas reported that they do less planning and perceive vaccines to be more effective, while respondents in rural areas reported less perceived ability to separate infected poultry from others. We also found that the inability to respond is not necessarily because of an inability to perceive change but because, rapid and extensive change poses different challenges for poultry management as communes move from rural to transitional to urban settings. Our results suggest that public and animal health campaigns could be tailored in a way that recognizes the needs of poultry raisers in different settings.
Topic:
Health, Infectious Diseases, and Urbanization
Political Geography:
Asia and Vietnam

58. Role of Urbanization, Land-Use Diversity, and Livestock Intensification in Zoonotic Emerging Infectious Diseases

Author:
Jefferson Fox, Duong Nong, Miguel Castrence, James Spencer, Sumeet Saksena, Nguyen Lam, Tran Duc Vien, Michael Epprecht, Chinh Tran, Melissa Finucane, and Bruce Wilco
Publication Date:
10-2014
Content Type:
Working Paper
Institution:
East-West Center
Abstract:
Emerging infectious diseases (EIDs) continue to significantly threaten human and animal health. While there has been some progress in identifying underlying proximal driving forces and causal mechanisms of disease emergence, the role of distal factors is most poorly understood. This article focuses on analyzing the statistical association between highly pathogenic avian influenza (HPAI) H5N1 and urbanization, land-use diversity and poultry intensification. A special form of the urban transition—peri-urbanization—was hypothesized as being associated with 'hot-spots' of disease emergence. Novel metrics were used to characterize these distal risk factors. Our models, which combined these newly proposed risk factors with previously known natural and human risk factors, had a far higher predictive performance compared to published models for the first two epidemiological waves in Viet Nam. We found that when relevant risk factors are taken into account, urbanization is generally not a significant independent risk factor. However, urbanization spatially combines other risk factors leading to peri-urban places being the most likely 'hot-spots'. The work highlights that peri-urban areas have highest levels of chicken density, duck and geese flock size diversity, fraction of land under rice, fraction of land under aquaculture compared to rural and urban areas. Land-use diversity, which has previously never been studied in the context of HPAI H5N1, was found to be a significant risk factor. Places where intensive and extensive forms of poultry production are collocated were found to be at greater risk
Topic:
Health, Infectious Diseases, and Urbanization
Political Geography:
United States and Asia

59. Insecticide Resistance and Malaria A Threat Decades in the Making

Author:
William G. Brogdon, Anthony Fiore, S.P. Kachur, Laurence Slutsker, and Robert A. Wirtz
Publication Date:
12-2014
Content Type:
Working Paper
Institution:
Center for Strategic and International Studies (CSIS)
Abstract:
Insecticide (DDT) use to control malaria was first employed successfully in the antimalaria program in Greece in 1947. By 1951, DDT success in controlling malaria was reported in 22 countries. However, that year also saw the first report of DDT resistance, in Anopheles sacharovi in Greece. By 1954, resistance to DDT among mosquitos was known to be a global problem, documented in Europe, the Americas, Africa, and Asia. The World Health Organization–led Global Malaria Eradication Program (GMEP) began in 1955, when resistance was already pronounced worldwide. Scientists did not identify the underlying biochemical mechanism contributing to insecticide resistance until 1958. By then, insecticide resistance was recognized by many to be a major contributor to the ultimate dismantling of GMEP, given the limited capabilities and knowledge of the time. Consequently, the global focus shifted from malaria “eradication” to malaria “control” in the late 1960s.
Topic:
Environment, Health, and Infectious Diseases
Political Geography:
Africa, Greece, and Asia

60. U.S. Support Essential to Ambitious Global Introduction of Inactivated Polio Vaccine

Author:
Nellie Bristol
Publication Date:
12-2014
Content Type:
Working Paper
Institution:
Center for Strategic and International Studies (CSIS)
Abstract:
Earlier this fall, Nepal became the first low - income country to introduce the inactivated polio vaccine (IPV) into its immunization system. Many more countries will have to follow suit to meet the ambitious deadlines laid out in the Global Polio Eradication Initiative's (GPEI) Polio Eradication Endgame Strategic Plan 2013 – 2018. The plan calls for global introduction of at least one dose of IPV into routine childhood immunization schedules followed by eventual withdrawal of the widely used oral polio vaccine (OPV). Currently, 75 mostly high - and middle - income countries use the injectable IPV in their immunization systems, leaving 119 that need to do so by the end of 2015 to keep with the plan's schedule.
Topic:
Health and Health Care Policy
Political Geography:
Asia and Nepal