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91. Tackling the Triple Transition in Global Health Procurement

Author:
Rachel Silverman, Amanda Glassman, Kalipso Chalkidou, and Janeen Madan Keller
Publication Date:
06-2019
Content Type:
Working Paper
Institution:
Center for Global Development (CGD)
Abstract:
There have been impressive gains in global health over the past 20 years, with millions of lives saved through expanded access to essential medicines and other health products. Major international initiatives backed by billions of dollars in development assistance have brought new drugs, diagnostics, and other innovations to the fight against HIV, malaria, tuberculosis, and other scourges. But behind these successes is an unacceptable reality: in many low- and middle-income countries, lifesaving health products are either unavailable or beyond the reach of the people who need them most. While each country’s context is unique, a reliable, affordable, and high-quality supply of health products is a vital necessity for any health system. In its absence, lasting health gains will remain elusive.
Topic:
Health, Public Health, Pandemic, Procurement, and Medicine
Political Geography:
Global Focus

92. Vaccine Introduction and Coverage in Gavi-Supported Countries 2015-2018: Implications for Gavi 5.0

Author:
Roxanne Oroxom and Amanda Glassman
Publication Date:
06-2019
Content Type:
Working Paper
Institution:
Center for Global Development (CGD)
Abstract:
With a vision of “creating equal access to new and underused vaccines,” Gavi set several coverage-specific targets for 2020 as part of its Phase IV strategy, including the immunization of an additional 300 million children, increased pentavalent 3 and measles-containing vaccine (MCV) 1 coverage, and greater equity in coverage across wealth quintiles.[1] The strategy also called for broadening protection through improved routine coverage and the introduction of new vaccines.[2]
Topic:
Health, Children, Public Health, and Vaccine
Political Geography:
Global Focus

93. Global Immunization and Gavi: Five Priorities for the Next Five Years

Author:
Amanda Glassman, Cordelia Kenney, and Janeen Madan Keller
Publication Date:
06-2019
Content Type:
Working Paper
Institution:
Center for Global Development (CGD)
Abstract:
Child vaccination remains among the most cost-effective uses of public and aid monies.[1] In a highly contested funding environment where priorities must be set for the allocation of scarce concessional resources, investment in expanding the availability and coverage of cost-effective vaccination must come at the top of the list. Gavi’s mission—saving children’s lives and protecting people’s health by increasing equitable use of vaccines—remains highly relevant. Gavi and its partners have made enormous progress towards increasing equity in the introduction of vaccines; children living in the lowest-income countries now have access to the same set of vaccines as those living in high-income countries. Gavi and partners have also contributed to increased coverage; immunization rates are higher in Burundi and Rwanda, for example, than in many places in the United States and Europe. Yet the effects of under-immunization anywhere can have global implications everywhere, as recent outbreaks illustrate. New or dormant threats are also a new reality—newly vaccine-preventable diseases like Ebola or virulent flu strains can spread swiftly and lethally in an interconnected world.
Topic:
Health, Public Health, Vaccine, and Immunization
Political Geography:
Global Focus

94. Tackling the Triple Transition in Global Health Procurement

Author:
Rachel Silverman, Janeen Madan Keller, Amanda Glassman, and Kalipso Chalkidou
Publication Date:
07-2019
Content Type:
Working Paper
Institution:
Center for Global Development (CGD)
Abstract:
There have been impressive gains in global health over the past 20 years, with millions of lives saved through expanded access to essential medicines and other health products. Major international initiatives backed by billions of dollars in development assistance have brought new drugs, diagnostics, and other innovations to the fight against HIV, malaria, tuberculosis, and other scourges. But behind these successes is an unacceptable reality: in many low- and middle-income countries, lifesaving health products are either unavailable or beyond the reach of the people who need them most. While each country’s context is unique, a reliable, affordable, and high-quality supply of health products is a vital necessity for any health system. In its absence, lasting health gains will remain elusive. Access to medicines, diagnostics, devices, and equipment is driven in large part by the efficiency of their procurement. Procurement is, therefore, central to the efforts of low- and middle-income countries to improve health, meet the Sustainable Development Goals, and achieve universal health coverage. Health product purchasing in low- and lower-middle-income countries already makes up a sizeable share of overall health spending; in fact, in just a subset of these countries, spending on health products totals an estimated $50 billion per year.[1] Procurement is not only essential to the missions of global health entities like the Global Fund, Gavi, UNICEF, UNFPA, and PEPFAR, but it also represents big money. In the case of the Global Fund, health product procurement accounts for $2 billion per year,[2] or almost half of its 2017 disbursements.[3] Yet despite its importance, procurement is an underappreciated health system function. Today’s procurement systems are hobbled by inefficiencies that leave some of the poorest countries paying some of the highest drug prices in the world.
Topic:
Health, Public Health, Transition, and Procurement
Political Geography:
Global Focus

95. Classification of Psychoactive Substances: When Science Was Left Behind

Author:
Global Commission On Drug Policy
Publication Date:
01-2019
Content Type:
Special Report
Institution:
Global Commission On Drug Policy
Abstract:
In Classification of Drugs: when science was left behind, the Global Commission on Drug Policy explains how the biased historical classification of psychoactive substances has contributed to the "world drug problem". It is the first-ever comprehensive report providing a political reading of the current evaluation and classification, or "scheduling" of drugs according to their harms. Psychoactive substances should be classified with regard to their potential for dependence and other harms. This is not the case today, where some substances are legally available because they are considered beneficial (medicines) or culturally important (alcohol), while others are seen as destructive, and are strictly prohibited. The classification of drugs is at the core of the international drug control system. As such, governments must ensure that such a classification is pragmatic and based on science and evidence, makes clear the benefits and harms of drugs, and allows for responsible legal regulatory models to control drugs.
Topic:
Health, War on Drugs, Drugs, Alcohol, Public Health, and Medicine
Political Geography:
Global Focus

96. Girls Leading: From Rural Economies to Global Solutions

Author:
Catherine Bertini
Publication Date:
10-2019
Content Type:
Special Report
Institution:
Chicago Council on Global Affairs
Abstract:
An estimated 3 billion of the world’s 6.9 billion people live in rural areas of the developing world. More than 60 percent of them live in poverty. Poverty affects women and girls disproportionately; rural girls face the triple challenges to their empowerment and well-being by virtue of their youth, gender, and location. Investing in rural girls’ health and safety, as well as their personal and professional development, has the potential to transform rural economies. Girls Leading: From Rural Economies to Global Solutions—available as both a fully online digital experience and as a PDF—is a collection of diverse perspectives from 20 authors around the world. The authors share their research and stories of personal struggle and triumph to highlight the needs of rural girls and solutions to the challenges they face. The report also includes recommendations, arranged by age group, for critical moments in a girl’s life where both small and large actions can make a huge difference. Many of the most pressing global issues—climate change, economic development, health, and education—demand that we consider rural girls. The world changes as their lives change. Join the conversation at #GirlsLeading.
Topic:
Climate Change, Development, Education, Gender Issues, Health, Poverty, Children, Women, Economy, Youth, and Rural
Political Geography:
Global Focus

97. The Looming Global Obesity Threat

Author:
Roger Thurow
Publication Date:
10-2019
Content Type:
Special Report
Institution:
Chicago Council on Global Affairs
Abstract:
This paper seeks to raise awareness of the growing global obesity epidemic and the need to address the economic, security, and humanitarian threats it poses for the United States and the world. While the development community—including global agriculture, health, and security practitioners—has been focused on combatting undernutrition, the number of people who are obese or overweight has been on the rise and is now on par with the 2 billion who are food insecure. In western countries where the epidemic started, obesity is not just an enormous health and economic burden, but a national security threat. Seventy percent of 17-to 24-year-olds in America are reported to be unfit to serve in the military, with being overweight and obese as the leading disqualifier. An increasingly sedentary lifestyle and growing reliance on unhealthy processed food has spread to low and middle-income countries around the world. Many of these countries are experiencing a “double burden” of malnutrition, in which people who are overweight or have obesity coexist with those experiencing undernutrition, threatening the growth and vitality of their societies. So far, policy responses from national governments have been slow and inadequate. The costs of the epidemic have not yet been viewed as urgent enough to generate the public demand or political will to act. The view of obesity as a global “syndemic,” along with undernutrition and climate change, has the potential to help rally attention to the challenge. The paper calls for local, national, and global efforts to recognize obesity as the economic, moral, and security crisis that it is and to summon the political will to end the epidemic.
Topic:
Security, Health, Economy, and Non-Traditional Threats
Political Geography:
Global Focus

98. The Rise of Metropolitanism: The International Order and Sub-national Actors

Author:
Kelly M. McFarland
Publication Date:
09-2019
Content Type:
Special Report
Institution:
Institute for the Study of Diplomacy, Edmund A. Walsh School of Foreign Service, Georgetown University
Abstract:
The growth and international clout of cities and sub-state actors has been unparalleled in recent decades. These players seek agency in the international arena, forming networks for cross-border cooperation on issues like climate change, health, transnational crime, and migration. ISD’s working group report, “The Rise of Metropolitanism: The International Order and Sub-national Actors,” explores how mayors, governors, and other sub-state actors both challenge and contribute to diplomacy at the national and international levels. How will these new networks find their voice in the international arena?
Topic:
Climate Change, Crime, Diplomacy, Health, International Cooperation, Migration, Transnational Actors, Urban, and Cities
Political Geography:
Global Focus

99. Digital Democracy

Author:
Brian Budd, Nicole Goodman, Sarah Shoker, Dominik Stecula, Sara Bannerman, Tony Porter, Netina Tan, Chelsea Gabel, Liam Midzain-Gobin, Devin Ouellette, Norwin Tabassum, Catherine Frost, Marcel Goguen, Brian Detlor, Amelia Joseph, Andrea Zeffiro, and Angela Orasch
Publication Date:
10-2019
Content Type:
Working Paper
Institution:
Institute on Globalization and the Human Condition, McMaster University
Abstract:
As we approach the third decade of the 21st century, there are numerous disturbing signs that two world-historical accomplishments that had seemed so promising are in serious trouble. The first of these is digital networks, which had promised to bring the world closer together, bringing broader popular participation and engagement and new ways of generating wealth and wellness. However, today anxieties about digital networking are proliferating, sparked by growing levels of digital surveillance, the effects of digital devices on our mental health and sociality, and the loss of jobs to artificial intelligence. The second troubled historical accomplishment is democracy, which at the end of the Cold War seemed to be expanding inexorably, but which now is challenged by growing authoritarianism and popular discontent with democratic governments. Freedom House’s 2019 report, entitled “Democracy in Retreat”, documents the 13th consecutive year of weakening democratic norms around the world (2019). These two global developments are related, due to the negative impact of “fake news” spread digitally on elections or the disruptive effects of digitization on the type of social cohesion that should be an important precondition for and effect of democracy. However, the relationships between digitization and democracy are multidimensional and complex, and much work remains to identify and analyze them. This working paper contributes to addressing this need by bringing together a set of interdisciplinary contributions, exploring different facets of the relationship between digitization and democracy in a variety of settings, from the local through to the global. This introduction to the working paper provides an overview of some key issues and literatures relevant to the relationship between digitization and democracy, including the historical shift in assessments of this relationship from optimism to concern; analysis of more specific ways that digitization and democracy interact; and the increasingly global aspects of the problem and the challenges this poses to governance. The final section of this introduction provides a summary of the individual contributions that follow. These short papers were presented at a workshop at McMaster University in September 2018 and then revised for this set of working papers to bring out their common themes more consistently. This final section of the introduction emphasizes the inter-relatedness of digitization and democracy in various settings. This type of global and multidimensional mapping of the problem is crucial if these problems, and the fears about our global futures that accompany them, can be diagnosed, treated, and overcome.
Topic:
Health, Democracy, Media, Surveillance, and Digitization
Political Geography:
Global Focus

100. Toward A Drug-Free Society: The Singapore Approach

Author:
Ng Ser Song
Publication Date:
09-2019
Content Type:
Research Paper
Institution:
Brown Journal of World Affairs
Abstract:
Illicit drug use exacts a high cost on abusers, their families, and ultimately society as a whole. Livelihoods are lost, relationships are destroyed, children suffer, and the wider community pays a hefty price through a resulting worsened crime situation. Singapore has hence adopted a harm-prevention approach to drugs, incorporating educational, legal, and rehabilitative measures. While we acknowledge that there is a variety of approaches to drug policy globally, our approach has worked well for our local context and enabled people here to live to their fullest potentials.
Topic:
Crime, Health, Law, Criminal Justice, and Drugs
Political Geography:
Singapore and Global Focus