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41. Five Urgent Questions on Ecological Security

Author:
Dan Smith and Rod Schoonover
Publication Date:
04-2023
Content Type:
Commentary and Analysis
Institution:
Stockholm International Peace Research Institute (SIPRI)
Abstract:
The increasing pressure of ecological disruption on people and on security means that ideas and policy on peace and security must increasingly address the need for ecological security. This paper poses five research questions concerning: (a) amplification of antimicrobial resistance (pathogens that are increasingly drug-resistant); (b) the physiological consequences of pollution; (c) the loss of nature’s contribution to people’s well-being; (d) local and regional ecological tipping points; and (e) detrimental organisms and processes that thrive in the rapidly changing planet. Each question has a human health dimension, with likely socio-economic impacts and effects on behaviour, as well as potential effects on security and political stability. Understanding these issues is essential if appropriate responses are to be developed. More research is needed in both the natural and the social sciences, with interdisciplinary work that is in close contact with the policy world. The situation is urgent and policy responses cannot wait until all the answers are known and uncertainty has been fully eliminated.
Topic:
Security, Health, Pollution, and Ecology
Political Geography:
Global Focus

42. Planetary health: A holistic vision for people and the planet

Author:
Danielle Brady
Publication Date:
09-2023
Content Type:
Working Paper
Institution:
European Policy Centre (EPC)
Abstract:
The nexus between health and the environment has been underscored by crises such as COVID-19 and the climate crisis. As awareness of policy interlinkages grows, so does the need for more coordinated EU and national policymaking. Calls for a more holistic approach have long been recognised, but the pandemic has further emphasised the importance of dismantling existing barriers in policymaking to improve the health status of people, animals, and the planet. This Discussion Paper, funded by Sitra, the Finnish Innovation Fund, advocates for implementing a planetary health approach across all levels of governance to encourage transdisciplinary action and puts forward ten recommendations: Pursue coordinated policymaking by breaking down silos. Appoint an Executive Vice President for the Well-being Economy. Plan and implement national roadmaps and establish common indicators. Create best practices platforms. Adopt planetary health for health systems. Promote education on planetary health. Adopt a European-wide communication campaign. Invest in research and innovation. Foster the integration of the European Health Data Space with future data spaces. Work with international partners to adopt a global planetary health approach. Planetary health offers many benefits for health and the environment. However, without concentrated efforts to move beyond the traditional siloed approach to policymaking, the benefits may never be realised.
Topic:
Climate Change, Health, European Union, and COVID-19
Political Geography:
Global Focus

43. Policy landscape 2023

Author:
Ben Zaranko, Jonathan Portes, Mike Brewer, Paul Cheshire, and Carole Willis
Publication Date:
09-2023
Content Type:
Special Report
Institution:
UK in a Changing Europe, King's College London
Abstract:
What are the public policy challenges confronting the UK? What plans do the parties have for addressing them? To what extent are these plans fit for purpose? As Parliament returns from its summer recess, Full Fact and UK in a Changing Europe have partnered to produce a series of evidence led, research-based assessments of the key issues that politicians will confront. To do this, we brought together a group of leading experts from respected institutions including the Health Foundation, the Institute for Fiscal Studies, and the Royal United Services Institute. We asked each of them to consider, based on the findings of their own research, the challenges the country faces in their area of expertise, the immediate and longer-term issues politicians will need to address, and the potential implications of any choices they might make. We selected the issues based on the Ipsos issues index, and added security, defence and foreign affairs, which did not figure amongst the public’s priorities in July of this year. The intention of the collection is to inform and not persuade. Each article in this collection is the responsibility of its author.
Topic:
Climate Change, Education, Health, Politics, European Union, Economy, Brexit, Economic Growth, Public Policy, Fiscal Policy, Housing, and Standard of Living
Political Geography:
United Kingdom and Europe

44. Inequality in Chile: Perceptions and Patterns

Author:
Ignacia Lecaros, Daniela Paz Cruzat, Ricardo Pommer Muñoz, Pablo Tillan, and Michael Walton
Publication Date:
09-2023
Content Type:
Working Paper
Institution:
The John F. Kennedy School of Government at Harvard University
Abstract:
Chile has pioneered many things: a market-oriented, “neoliberal” approach to development; an impressive transition from authoritarianism to democracy; innovations in social policy; and an extraordinary series of street protests between 2006 and 2019. While often lauded as a model of economic and social development, the protests reflect acute concerns over perceived failures in the Chilean political, economic and cultural system, concerns that were profoundly inflected with issues of inequality and lack of fairness. To inform this contrast, this paper undertakes a systematic assessment of the perceptions and perspectives of Chilean citizens, both in the context of the protests and in their broader expressed views in surveys. The core theme is that “the street was right”, in the specific sense that the protests reflected much wider sentiments across social classes over perceived inequities in economic advancement, social provisioning, and the undignified “treatment” by state actors and elites. The paper then compares these perceptions with some of the “objective” measures of inequality. While alternative measures indicate modest declines in some measures of inequality, Chile remains a very high inequality society, in relation to income, wealth, and education. These perceptions and patterns are central to Chile’s current development challenges, in ways that resonate with the position of many countries in today’s polarized environment. This is the first of two papers, with the sequel exploring the underlying drivers of inequality and implications for policy direction.
Topic:
Education, Health, Inequality, Protests, State, Perception, and Fairness
Political Geography:
South America and Chile

45. The Guinea Worm, President Carter and Me: A Journey Through Health Diplomacy

Author:
Lisa Rotondo
Publication Date:
05-2023
Content Type:
Journal Article
Journal:
American Diplomacy
Institution:
American Diplomacy
Abstract:
In September 2001, just days before 9/11, I arrived in Pissila, Burkina Faso for my Peace Corps assignment. I was eager to get to work helping my new home community do surveillance for a neglected tropical disease (NTD) called dracunculiasis, or Guinea worm disease. As a Peace Corps Volunteer in rural Burkina Faso, I biked from village to village, asking community members if they were aware of anyone with Guinea worm disease, an infection that has impacted both humans and animals since ancient times. Thanks, in part, to the work of volunteers before me, I never actually saw a person with Guinea worm disease during my two years as a volunteer. Burkina Faso was on the brink of eliminating the disease, and I remember thinking that the children in my community would never know the word for Guinea worm in their language, Moorè; it would not be in their vocabulary because they would never have to worry about it. I’ve reflected on that more than once during my career in public health. Knowing that we are truly making diseases history has been the drive underlying my efforts for the last two decades.
Topic:
Diplomacy, Health, Memoir, and Public Health
Political Geography:
Africa, United States of America, and Burkina Faso

46. How to Strengthen Gender Equality Policies? A Review of Data, Policies and Processes

Author:
Gizem Fidan and Itır Akdoğan
Publication Date:
06-2023
Content Type:
Special Report
Institution:
Turkish Economic and Social Studies Foundation (TESEV)
Abstract:
This report presents recommendations for improving gender equality policies in Turkey. To this aim, it reviews data comparing Turkey and the European Union, studies policy documents and analyses experiences of experts and decision makers on gender inequality focusing on 17 sub-headings in such domains as work, money, knowledge, time, power/ representation, health and digital inclusion.
Topic:
Health, Inequality, Representation, Inclusion, Gender, and Work
Political Geography:
Europe and Turkey

47. Evaluating The Social and Economic Consequences of Global Warming On African Women

Author:
Eyesiere-Hope Essien
Publication Date:
04-2023
Content Type:
Policy Brief
Institution:
Women of Color Advancing Peace, Security and Conflict Transformation (WCAPS)
Abstract:
By Eyesiere-Hope Essien of the Climate Change Working Group Global warming is significantly impacting developing countries and the effects are far-reaching which is having a devastating impact on African women and their communities, leading to adverse social and economic consequences. Climate change has resulted in an increase in temperature, more extreme weather events, rising sea levels, and a decrease in water availability. As a result, African women are facing a growing number of challenges related to food insecurity, water scarcity, and healthcare access. They are at greater risk of poverty, displacement, and exploitation. These issues can be further exacerbated by a lack of access to education and employment opportunities. It is essential to understand the nature of these impacts and to take action to mitigate them and ensure African women have the resources and skills to adapt to the changing environment.
Topic:
Climate Change, Development, Health, Water, Women, and Food Security
Political Geography:
Africa

48. Community Health Workers as Rights Defenders: Exploring the Collective Identity of the Mitanins of Chhattisgarh, India

Author:
Shriyuta Abhishek and Samir Garg
Publication Date:
12-2023
Content Type:
Special Report
Institution:
Accountability Research Center (ARC), American University
Abstract:
This Working Paper discusses the Mitanin program, a state-run community health worker program in Chhattisgarh state, India. It is based on a year-long reflection and action research exercise by the implementing organization, the State Health Resource Centre (SHRC). It argues that the collective identity of these community health workers (Mitanins) is central to their work defending the social and economic rights of their community. Collective identity often plays an important role in social movements for people’s economic and political rights. However, government-funded workers rarely get involved in such movements. The authors wanted to understand whether collective identity plays a role in driving the multi-issue activism of community health workers. A composite definition of this collective identity emerged from the research. Throughout the interviews and discussions, the Mitanins described their collective identity as a sense of solidarity that all Mitanins share with the community they serve and belong to, and a feeling of sisterhood with other women and each other. It is the shared experience of being a group of empowered women with a common mission who must use their knowledge and compassion to support the people they serve. The value system underpinning their mission dictates that people should not be denied their rights. The Mitanins’ collective identity is layered; they are not merely frontline health workers, but women who care deeply about their community. They are problem-solvers, activists, and community leaders. Their collective action and collective identity as women leaders in solidarity with the community is mutually reinforcing, and has enabled them to undertake multi-issue activism and transform themselves into frontline rights defenders. The authors conducted a state-wide survey along with focus group discussions and in-depth interviews. The survey (n=558) aimed to establish what proportion of Mitanins are involved in multi-issue activism. It found that in the preceding three years, 84 percent had taken rights-based action in at least one of three domains: food security and nutrition (68 percent); healthcare (56 percent); and gender-based violence (21 percent). They refer to these actions as ‘rights-based’ because they involve negotiation and confrontation with local elites and government officials, as well as writing formal complaints to government officials. Other than rights-based actions, Mitanins also provide information to community members about their rights and entitlements to health programs, food security, and nutrition under government programs—information that is often not readily accessible to poor people in India. This paper analyzes the patterns of autonomous collective action through discussion, interviews, and the rights-based songs and slogans written by Mitanins. The authors argue that the Mitanins’ collective identity was formed due to two main factors: the program’s movement-building approach; and the degree of autonomy enjoyed by Mitanins. The movement-building approach nurtured the activist tendencies of Mitanins, and the voluntary nature of their work allowed them to retain their autonomy vis-à-vis the health system bureaucracy
Topic:
Health, Human Rights, Women, and Communal Identity
Political Geography:
South Asia and India

49. Activating Spaces, Scaling Up Voices: Community-based Monitoring and Planning of Health Services in Maharashtra, India

Author:
Abhay Shukla, Shweta Marathe, Deepali Yakkundi, Trupti Malti, and Jonathan Fox
Publication Date:
06-2023
Content Type:
Working Paper
Institution:
Accountability Research Center (ARC), American University
Abstract:
From 2007, the Indian government’s National Health Mission (NHM) supported civil society networks to carry out large-scale participatory monitoring to improve health service access and quality under the Community-based Monitoring and Planning (CBMP) program. In the state of Maharashtra, this social accountability initiative endured more than a decade and a half, despite constraints and unpredictable government funding. The CBMP program in Maharashtra supported state-wide civil society networks to enable active citizen participation in health oversight committees. It was rooted in a broad network of diverse community-based organizations and civil society organizations that work with socially excluded communities, led by Support for Advocacy and Training to Health Initiatives (SATHI). The CBMP network combined many social accountability tools into a multilevel strategy, using community assessments of health services and local meetings with clinic staff to inform problem-solving efforts at local, district, and state levels of the health system. This government-funded civil society initiative worked with local officials to convene public dialogues and to activate previously dormant official oversight bodies, animated by a parallel network of autonomous monitoring committees. This Working Paper presents SATHI’s analysis of the CBMP program’s strategy and institutional dynamics, and documents its lasting effects on two participatory oversight institutions: Village Health, Sanitation, and Nutrition Committees (VHSNCs)—part of local government, and Rogi Kalyan Samitis (Patient Welfare Committees)—part of the health system. Field research, carried out shortly before the pandemic, compared the activation of these hybrid oversight bodies in areas with and without a legacy of intensive CBMP action. Key findings include: Official participatory spaces for citizen engagement with the health system were much more active in districts where CBMP networks had intensively promoted grassroots capacity for voice. Frontline health system responsiveness to issues that could be addressed locally—identified as ‘CBMP-sensitive’—was very high. But the health system’s degree of responsiveness to problem-solving efforts decreased at higher levels. The period of intensive CBMP effort to build grassroots awareness and capacity was limited to six years. Nevertheless, that effort had lasting effects on the levels of activity of local hybrid health oversight bodies. The pandemic revealed additional evidence of the medium-term survival and institutional impact of CBMP-enabled social networks.
Topic:
Civil Society, Health, Governance, Accountability, Community, Monitoring, Planning, Monitoring, and and Evaluation (PME)
Political Geography:
South Asia and India

50. Health Financing in Times of Multiple Crises: Analysis and Recommendations

Author:
Christoph Strupat, Pooja Balasubramanian, Srinivasa Reddy Srigiri, and Anna-Katharina Hornidge
Publication Date:
01-2023
Content Type:
Policy Brief
Institution:
German Institute of Development and Sustainability (IDOS)
Abstract:
The COVID-19 pandemic has exposed the fragility of health systems and highlights the need for renewed efforts to finance pandemic preparedness, prevention and response (PPR) mechanisms, and universal health coverage (UHC). Two lessons emerge from this global health challenge. First, it has shown that global problems need global solutions, as well as the agency of local and national actors to make them work, so it is recommended that public health be considered a global public good. This requires solidarity between rich and poor countries to attain a globally “highest attainable standard” for managing pandemics and other public health emergencies. The provision of such a global public good requires substantial public resources. Furthermore, the focus should not only be on preventing the spread of diseases but also on detecting and fighting infectious diseases at their source. The second lesson is that prevention is a good investment, as it costs less than remedial interventions at later stages. Health systems can be considered as the means by which health priorities, such as pandemic PPR and UHC, can be operationalised. Studies show that health systems that could effectively leverage both robust health security core capacities (e.g. laboratories) and fundamental UHC interventions (e.g. accessible health facilities) were often in a better position to protect their citizens against the negative impacts of the COVID-19 pandemic. Focusing on the landscape of health financing in low- and middle-income countries (LMICs), it becomes clear that during the COVID-19 pandemic there was a substantial increase in international health financing. However, continued high out-of-pocket expenditure (OOPE) in LMICs points to a structural imbalance in health financing, which is one of the major barriers for achieving SDG3. Further contribution from international development assistance and an increase in domestic government expenditure by LMICs through improved mobilisation of domestic resources is therefore impera-tive. Funding gaps to achieve PPR and UHC in LMICs are small in relation to the projected costs of a pandemic such as COVID-19. However, as global debt levels soar, fiscal spaces to close these funding gaps become smaller. The following policy options for governments and international development partners should be considered to protect and improve spending on health in times of shrinking fiscal spaces: reallocation within budgets towards health, better priority-setting of health financing, and greater use of debt-to-health swaps, health taxes and national health insurance schemes. Importantly, investment in health is critical not just for the health benefits, but also because of the positive socio-economic impacts that result, in excess of the level of investment. Improved well-being and health outcomes translate into higher productivity and income, with a benefit–cost ratio of nine for low-income countries and 20 for lower-middle income countries. Given the high rates of unemployment in many LMICs, investments that create jobs in the healthcare sector are also beneficial for other sectors. Evidence shows that for every healthcare professional job that is created, 3.4 jobs are created on average in other sectors. As a large proportion of healthcare workers is female, these new jobs can be an opportunity for young women, in particular, and can help to promote female empowerment and gender equality. Altogether, these long-term benefits affirm that investment in health can enable large spillover effects on the social and economic dimensions of sustainable development and the implementation of the 2030 Agenda for Sustainable Development.
Topic:
Health, Governance, Finance, Crisis Management, and COVID-19
Political Geography:
Global Focus