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202. Antimicrobial Resistance as an Emerging Threat to National Security
- Author:
- Maxine Builder
- Publication Date:
- 01-2015
- Content Type:
- Working Paper
- Institution:
- Atlantic Council
- Abstract:
- Growing rates of antimicrobial resistance (AMR) pose a threat to public health that could undo many of the medical advances made over the last seventy years, eroding the global medical safety net and posing a significant threat to national security. Diseases once eliminated by a single course of antibiotics show drug resistance, often to several different classes of drugs. Some of the implications of increasing rates of AMR are intuitive, such as longer duration of illness, extended hospital stays, and higher rates of mortality. But other effects of a postantibiotics world are less obvious, such as the inability to perform life-saving operations or the ability for a simple scratch on the arm to kill. Humanity could soon find itself living in a reality in which communicable diseases such as tuberculosis, cholera, pneumonia, and other common infections cannot be controlled. This potentially catastrophic problem still can be abated, and the global health community, including the World Health Organization (WHO), has highlighted AMR as a priority in global health. But all sectors of the international community, not simply those in public health, need to take immediate steps to reverse the current trends and eliminate the systematic misuse of antimicrobial drugs, especially in livestock, and restore the pipeline of new antimicrobial drugs. The significant health and economic costs of AMR are difficult to quantify due to incomplete data that often underreports the extent of the problem, since there are no standard metrics or consensus on methodology to measure rates of AMR. But even the piecemeal statistics that exist paint a bleak picture. In a 2013 report, the US Centers for Disease Control and Prevention (CDC) reports at least two million Americans acquire serious infections to one or more strains of AMR bacteria annually, and at least 23,000 people die of these infections.1 A 2008 study estimated the excess direct costs to the US medical system attributable to AMR infections at $20 billion, with additional estimated productivity losses to be as high as $35 billion.2 With the increase in resistant infections and continuing rise in medical costs, the cost to the American medical system no doubt also has increased. This trend is not a uniquely American problem; it is truly global in scope. The European Union (EU) reports about 25,000 deaths annually due to drug-resistant bacteria, at an overall, combined cost of $2 billion in healthcare costs and productivity losses.3 There were over 14.7 million incidents of moderate-to-severe adverse reactions to antibiotics each year between 2001 and 2005 in China. Of these, 150,000 patients died annually.4 The most recent available data on China estimates that treatment of AMR infections during that same time period cost at least $477 million, with productivity losses of more than $55 million each year.5 A 2005 study of the United Kingdom (UK) found that the real annual gross domestic losses due to AMR were between 0.4 and 1.6 percent.6 Although slightly outdated, this estimate may be a useful guide in assessing the global impact of AMR, and given the trend of increasing resistance, it is likely that the impact will also increase accordingly. That said, it is prudent to repeat that the disparities in the quality of data reporting standards across China, the United States, the United Kingdom, and the European Union make it difficult to directly compare the severity of the impacts AMR has on each entity. The primary cause of AMR globally is antibiotic overuse and misuse, be it from doctors inappropriately prescribing antibiotics to treat viral infections or individuals seeking over-the-counter antibiotics for self-treatment. But another driver, less obvious than overuse in humans, is the use of antimicrobials in livestock, and the ratio of use in animals as compared to humans is astounding. In the United States, about 80 percent of all antibiotics are consumed in either agriculture or aquaculture. Generally, these drugs are administered to livestock as growth promoters and are medically unnecessary. Resistance in livestock quickly spreads to humans, and many community-acquired infections are the result of a contaminated food supply. Although most infections are acquired in the community, most deaths attributed to resistant infections occur in healthcare settings, and healthcare-acquired (or nosocomial) infections are another driver of AMR. At this point, AMR does not pose an immediate and direct threat to national security. Rather, this is a creeping global security crisis. If current trends continue, these drugs upon which the world relies will lose effectiveness. The gains made in fighting infectious diseases will be reversed, and a wide range of routine surgeries and easily treatable infections will become much more dangerous and deadly. This will cause the health of the world's working population to deteriorate, and the economic productivity and social cohesion of the globe to decline. At any time, a “black swan” event—triggered by an outbreak of drug-resistant tuberculosis, cholera, or pneumonia, for example—could prove catastrophic, endangering the fabric of societies and our globalized economy, forcing a stop to international trade and travel to prevent further spread. The issue of AMR is a tragedy of the commons in which individual incentives lead to the overuse and eventual destruction of a shared resource. International cooperation is required to walk back from this ledge and avoid a postantibiotics world, even though it is impossible to completely reverse the damage already done.
- Topic:
- Health, National Security, Infectious Diseases, and Health Care Policy
- Political Geography:
- United States, China, United Kingdom, America, and Europe
203. When Structures Become Shackles: Stagnation and Dynamics in International Lawmaking
- Author:
- Jan Wouters, Joost Pauwelyn, and Ramses A. Wessel
- Publication Date:
- 02-2015
- Content Type:
- Journal Article
- Abstract:
- Formal international law is stagnating in terms both of quantity and quality. It is increasingly superseded by 'informal international lawmaking' involving new actors, new processes, and new outputs, in fields ranging from finance and health to internet regulation and the environment. On many occasions, the traditional structures of formal lawmaking have become shackles. Drawing on a two-year research project involving over 40 scholars and 30 case studies, this article offers evidence in support of the stagnation hypothesis, evaluates the likely reasons for it in relation to a 'turn to informality', and weighs possible options in response. But informal structures can also become shackles and limit freedom. From practice, we deduce procedural meta-norms against which informal cooperation is increasingly checked ('thick stakeholder consensus'). Intriguingly, this benchmark may be normatively superior (rather than inferior) to the validation requirements of traditional international law ('thin state consent').
- Topic:
- Environment, Health, and International Law
204. Lawrence O. Gostin. Global Health Law
- Author:
- Stéphanie Dagron
- Publication Date:
- 02-2015
- Content Type:
- Journal Article
- Abstract:
- Lawrence O. Gostin's new book begins with the sentence '[t]his is a unique moment to offer a systematic account of global health law' and he is right. The book under review is published at a time when the most influential international institutions are emphasizing the necessity for multilateral cooperation in the field of public health. For example, the United Nations General Assembly (UNGA) addresses this point in its current deliberations on the post-2015 Millennium Development Goals Agenda. Contemporary globalization has irrevocably made borders porous to capital, services, goods, and persons. Global social, economic, and political changes, such as increasing industrialization, urbanization, environmental degradation, migration, drug trafficking, and the marketing strategies of transnational corporations (e.g., in the food, pharmaceutical, and tobacco industries) have a significant impact on health. This impact is transnational and intersectoral: global health hazards go beyond the control of individual nation states and extend beyond the restricted field of health care.
- Topic:
- Economics, Health, Migration, United Nations, Food, and Law
205. Financial Inclusion and Global Regulatory Standards: An Empirical Study across Developing
- Author:
- Mariana Magaldi de Sousa
- Publication Date:
- 03-2015
- Content Type:
- Working Paper
- Institution:
- Centre for International Governance Innovation
- Abstract:
- Expanding the access of financial services to low-income households and other disadvantaged groups has become an important public policy goal in the past decade. Many developing economies have encouraged the introduction of a variety of programs, services and branchless banking instruments ranging from automatic teller machines to cell phones to reach people for whom traditional, branch-based structures, had not. After the 2008 global financial crisis, the leaders of the Group of Twenty (G20) recognized the need to further promote these initiatives as key components in the development of healthy, vibrant and stable financial systems that contribute to sustainable economic growth and lower levels of income inequality. As a result, financial inclusion has become one of the new areas of international financial regulation coordination, alongside shadow banking, resolution regimes and new capital requirements.
- Topic:
- Development, Economics, and Health
206. The Face of African Infrastructure: Service Availability and Citizens' Demands
- Author:
- Vijaya Ramachandran, Benjamin Leo, and Robert Morello
- Publication Date:
- 02-2015
- Content Type:
- Working Paper
- Institution:
- Center for Global Development
- Abstract:
- The need for infrastructure improvements is a top-tier economic, political, and social issue in nearly every African country. Although the academic and policy literature is extensive in terms of estimating the impact of infrastructure deficits on economic and social indicators, very few studies have examined citizen demands for infrastructure. In this paper, we draw upon survey data to move beyond topline estimates of national infrastructure access rates towards a more nuanced understanding of service availability and citizen demands at the regional, national, and sub-national level. We find a predictable pattern of infrastructure services across income levels—lower income countries have fewer services. The survey data also allows us to observe the sequencing of infrastructure services. On the demand side, survey respondents are most concerned with jobs and income-related issues, as well as with the availability of infrastructure: specifically transportation and sanitation. These priorities transcend demographic factors, including gender and location (urban/rural).
- Topic:
- Health
- Political Geography:
- Africa
207. Why Are Indian Children So Short?
- Author:
- Seema Jayachandran and Rohini Pande
- Publication Date:
- 04-2015
- Content Type:
- Working Paper
- Institution:
- The John F. Kennedy School of Government at Harvard University
- Abstract:
- India's child stunting rate is among the highest in the world, exceeding that of many poorer African countries. In this paper, we analyze data for over 174,000 Indian and Sub-Saharan African children to show that Indian firstborns are taller than African firstborns; the Indian height disadvantage emerges with the second child and then increases with birth order. This pattern persists when we compare height between siblings, and also holds for health inputs such as vaccinations. Three patterns in the data indicate that India's culture of eldest son preference plays a key role in explaining the steeper birth order gradient among Indian children and, consequently, the overall height deficit. First, the Indian firstborn height advantage only exists for sons. Second, an Indian son with an older sibling is taller than his African counterpart if and only if he is the eldest son. Third, the India-Africa height deficit is largest for daughters with no older brothers, which reflects that fact that their families are those most likely to exceed their desired fertility in order to have a son.
- Topic:
- Health, Poverty, Children, and International Development
- Political Geography:
- Africa, South Asia, and India
208. The Negative Impact of Drug Control on Public Health: the global crisis of avoidable pain
- Author:
- Global Commission On Drug Policy
- Publication Date:
- 10-2015
- Content Type:
- Special Report
- Institution:
- Global Commission On Drug Policy
- Abstract:
- Ninety-two percent of the world’s supply of morphine is consumed by just 17 percent of the global population, with consumption primarily concentrated in the global north and 75 percent of the world’s population does not have access to any pain relieving drugs. The reasons for this have little to do with issues of cost or scarcity of supplies- and everything to do with with the prohibition and repressive stand the world has taken on drugs. This Global Commission report explores the current crisis related to the lack of access to controlled medicines and makes concrete policy recommendations to Member States and UN agencies on ways to improve these conditions. This report is available in English, Spanish, Russian, French and Arabic.
- Topic:
- Health, War on Drugs, Drugs, Public Health, and Medicine
- Political Geography:
- Global Focus