Drop of Life

A person can live without food for three weeks, but only three days without water.

Water is vital to the metabolic process, aiding in the digestion, absorption, and transportation of nutrients in the body. The recommended daily water intake is eight
glasses of water or about two liters. This, however, is just the minimum. Depending on the activity, location, and temperature in the area, a person may actually need more than that.

Unfortunately, water scarcity affects four in ten people and the World Health Organization predicts that the number of affected people may rise given the growing global population. While much of the earth is surrounded with water, only three percent are considered freshwater; the rest are too saline for human consumption.

Agricultural demand for water
There are varied factors for the depletion of water sources, including climate change and environmental degradation, but a major culprit was agriculture. With about 70 percent of the world’s water supply consumed by the agriculture sector, it is easy to see why. In the Asia-Pacific region alone, 81.3 percent of freshwater is utilized for agricultural purposes.

While potable drinking water is a key element in nutrition, the paradox is that huge amount of it is required by the agricultural industry to produce food items. Increased agricultural output has been at the forefront of the global fi ght against food insecurity. As the demand for food rises, so is the demand for water needed to
produce these items. While the daily water requirement for each individual is just about two to four liters, the amount of water needed to produce a person’s daily food
requirement ranges from 2,000 to 5,000 liters.

The solution to this problem is not to limit agricultural output, but rather the adoption of sustainable farming practices, as well as a change in food consumption pattern.

When it comes to food consumption pattern, there is a global shift to a meat-based diet, which means more water is needed to produce meat product. As a comparison, producing a kilo of wheat requires about 1000 liters of water. A kilo of meat, on the other hand, requires fi ve to ten times more water to produce.

The next conflict point?
In Tajikistan, people in the town of Taboshar are leaving the community due to acute water shortage, with the local water agency hardly able to meet even just 15 percent of the town’s water needs.

There are two confl icting views on whether water may be the next fl ash points for geo-political confl icts. The US Central Intelligence Agency is but one of the groups
predicting that this might very well be the case; after all, the UNESCO said that one-third of 262 international river basins are shared by two or more countries.

In the Middle East, five countries are sharing the Jordan River basin: Israel, Palestine, Jordan, Lebanon, and Syria. In 2001, tension erupted between Lebanon and Israel when the former attempted to build a pipeline on the Wassani River, which contributes 150 cubic meter of water to the Jordan River. Only the timely intervention of the international community prevented the tension from escalating.

Although there is no major war fought over the control of a water source, there have been periodic clashes, which tend to be localized. In 2000, Chinese police and farmers in Shandong province clashed over the planned diversion of irrigation water to cities and industries.

The other view is more circumspect; water is so vital that nations would benefit more from cooperation in the management of a water source, rather than fi ghting a war for its absolute control.

Prof. Asit Bikwas, a 2006 Stockholm Water Prize awardee, argued that the main issue is not really water scarcity but “bad water management.” He is not alone in this assessment. In the book “Water, a shared responsibility,” the UNESCO – World Water Assessment Programme, acknowledges that “the problem we face today is largely one of governance: equitably sharing this water while ensuring the sustainability of natural ecosystems. At this point in time, we have not yet achieved this balance.”

Addressing the threat of a global water shortage does provide a glimmer of hope, with countries willing to sit down and come up with a compromise on how to better
share a water source. However, it also highlights once more the vulnerability of the poor.

Indeed, when it comes to water allocation, the poor, as always, are left holding an empty jerry can.


Source: Health Alert Asia Pacific, Issue 13, 2008

The pangs of hidden hunger

Micronutrients defi ciency is another indicator of poor nutritional status, and is one that cuts across economic class. Iodine defi ciency, for instance, is a continuing problem even in the affl uent European continent. A 2004 estimate showed that 20 percent of the global population at risk of iodine defi ciency reside in the region.

According to Unicef, for every four persons in the planet, one is suffering from micronutrients defi ciency. The health impacts of micronutrients defi ciency are varied and can be quite staggering: blindness, mental retardation, and even death, particularly for anemic pregnant women.

Iron deficiency
The World Health Organization characterized iron deficiency as “the most common and widespread nutritional disorder in the world.” Establishing the exact magnitude of the problem is hard, but since iron defi ciency is closely tied to anemia, the global prevalence of iron deficiency anemia (IDA) is used as a proxy indicator. IDA is a key indicator of a country’s maternal and child health, and its prevalence refl ects socio-economic disparity: in developing countries, 52 percent of pregnant women are affected with IDA, while the fi gure is down to 23 percent of pregnant women in developed countries.

While the general population is at risk, a new study published at the Pediatrics Journal showed that overweight children are more than twice as likely to have iron deficiency than children with normal body weight. Iodine deficiency A 1994 study showed that there was a drop of up to 13.5 points in the intelligent quotient of populations living in areas with severe iodine defi ciency, as compared to the
population of non-iodine defi cient areas.

The land-locked region of Central Asia is particularly vulnerable to iodine defi ciency due to its mountainous terrain. UNICEF nutrition specialist Arnold Timmer
attributes the depletion of iodine in the region’s soil to erosion and rainfall. The collapse of the Soviet Union, which used to supply the region with iodized salt, added to the problem.

A 2004 study in Uzbekistan showed that prevalence of goiter – an indicator of iodine defi ciency – was 49.6 percent for children and 41.6 percent for adults. Kazakhstan, meanwhile, had a goiter prevalence of 56.5 percent.

Vitamin A deficiency (VAD)
An estimated 21 percent of children worldwide are Vitamin A-defi cient, with the highest concentration located in Asia and Africa. On top of causing blindness, VAD also increases a child’s susceptibility to malaria and diarrhea. Food fortification and breastfeeding The international community is responding to the problem with the adoption of two key strategies: the promotion of breastfeeding and food fortification. Breast milk contains all the essential nutrients needed for a baby’s full development. However, there is still a low adoption of exclusive breastfeeding particularly in poor regions.

With regards to food fortification, it is undeniably a costeffective way of combating micronutrients defi ciency. The Central Asian region’s adoption of salt iodization program has effectively reduced, if not totally eliminated the prevalence of iodine deficiency. Food fortification is indeed effi cient, but policymakers must not make this the major cornerstone of their micronutrients program. Food manufacturers have jumped in on the fortifi cation bandwagon, with the market for fortified foods expected to grow by an average of 10.1 percent between 2005 and 2012. While some of these manufacturers are really driven by a sense of responsibility, governments must still exercise some caution.

The Philippines, for instance, has a Sangkap Pinoy program where food fortifi ed with micronutrients are given a seal. But here lies the problem: some of the products
bearing the Sangkap Pinoy seal are junk foods. Another thing to be considered is economics. Even if fortifi ed foods are readily available, do the people have the means to buy these items?

Sources:
Eliminating Iodine Deficiency in Central Eastern Europe,Commonwealth Independent States and the Baltics by Arnold Timmer. http://www.iccidd.org/media/IDD%20Newsletter/1991-2006/nov2004.htm#g

Iodine deficiency in Europe: a continuing problem. Published by the WHO and UNICEF. http://www.who.int/nutrition/publications/VMNIS_Iodine_defi ciency_in_Europe.pdf

Assessment of Iodine deficiency disorders and monitoring their elimination: A guide to program managers, third edition. Published by the WHO, UNICEF and ICCIDD. http://whqlibdoc.who.int/publications/2007/9789241595827_eng.pdf

http://www.who.int/rhl/pregnancy_childbirth/medical/anaemia/cfcom/en/

http://www.nutraingredients.com/Industry/Vitamin-enrichedfoods-growing-faster-in-SE-Asia-than-Europe8

Obesity in the Asia-Pacific Region

With much of the focus resting on under-nutrition and micronutrients defi ciency, it is easy to dismiss obesity as nothing but a disease peculiar to affl uent nations. However, experts warned that obesity is reaching an epidemic proportion, and should thus be treated as a valid health concern.

Consider these statistics: in 2005, 1.6 billion adults over the age of 15 are overweight and at least 400 million of this number is obese. By 2015, the World Health Organization calculates the number of overweight adults to increase to 2.3 billion, with 700 million of them clinically obese. Each year at least 2.6 million people die from health complications resulting from all the excessive weight.

Read more »

A wake-up call for a return to nutrition basics

More than 800 million people, or about 13 percent of the global population, are classifi ed as undernourished. The defi ciency in essential nutrients is said to be the underlying cause of an estimated 3.5 million deaths each year, mostly in young children and pregnant women. Under-nutrition among pregnant women in developing
countries is reported to lead to one out of six infants born with low birth weight.

In Malaysia, diabetes has reached very alarming proportions. In the first National
Health and Morbidity Survey (NHMS)carried out in 1986, the prevalence of diabetes was 6.3 percent. Just ten years later this figure increased to 8.3 percent. Now, based on the latest NHMS III, conducted in 2006, diabetes prevalence has increased to 14.9 percent.

Diabetes Type II is strongly linked to high sugar consumption and obesity.

Nutrition can be defi ned as the process of taking in the substances needed to nourish and support life and growth. Access to nutritious food is a key element in
achieving a well-balanced nutrition. But as the world becomes more dependent on artifi cially processed food, balanced nutrition is compromised, resulting in chronic
health problems. Worsening the problem is the addition of toxic chemicals on essential food products.

Tainted milk
The recent scandal where four children in China died following the consumption of baby formula milk contaminated with the toxic chemical known as melamine should serve as a wake-up call.

Melamine, used as an ingredient in the manufacture of some plastics and fertilizers, has found its way into food products such as infant formula and confectionaries. It
is abhorrent that melamine has been deliberately added to milk to give the false
impression of higher levels of protein than actually exists.

Authorities try to allay the fears of the public by announcing that the levels of melamine in certain foods are within “permissible levels”. This term should be questioned.

Melamine is a synthetic chemical. It does not occur naturally in food. Should permissible levels be set for substances that are not naturally occurring in food?
By law, there should be a zero tolerance for melamine, as well as other synthetic toxic chemicals in food, rather than waiting for all the evidence to come in, which might be too late – when harm has already been done.

There is the danger of the cumulative doses or ingestions that enhance the harm posed by such chemicals. Furthermore, the full effects of chemicals not meant for humans may not have been studied fully, and for over a suffi ciently long period of time. It is not ethical to conduct such tests on people. In cases such as these, the *Precautionary Principle should be applied and the consumption of this chemical should be fully avoided.

In the case of infants, breast milk is the safest and healthiest choice – fully for the fi rst six months, and thereafter as a complement to solid foods right up to at
least two years. Governments and the community as a whole would need to make a commitment to move in this direction and create a supportive environment.

Buyers beware
Overall, the Consumer Association of Penang (CAP) believes that it is timely for people to move away from eating so much artifi cially-processed foods, and instead
move towards natural healthy produce and home-cooked meals. There are countless additives included in many of the highly-processed foods in the market. Foods are altered so far from their original state. We did not require all these artificial additives at one time. If really needed, there are numerous natural substances such as natural colours or flavours that can be used for food. We do not see that it is possible for the public to take any realistic precautions themselves when it comes to
products on the shelves as it is impossible for people to know which foods contain dangerous chemicals. At the very least, food manufacturers should be required
to list the common names of all additives, such as preservatives, coloring, fl avors, flavor enhancers, antioxidants and conditioners, on the food labels and outer
packaging - as opposed to using numerical or alphabet codes or merely using phrases such as “Permitted Coloring” or “Permitted Conditioners” under the ingredients list. Information on the concentrations of these additives should also be provided.

The excuse sometimes given is that there is not enough space on the food label. We ask - should there be so many additives in a product that the information cannot even fit on a label, and should this be permitted by the authorities?

In view of the rise of critical chronic diseases such as heart disease, diabetes, obesity and high blood pressure, the information on salt, sugar, saturated fats and trans fats should be listed on current food labels. These particular components should be separated out from the general “Nutrition facts” or “Nutritional Labelling” so that the public is not lulled into a false sense of security. Rather, the attention of consumers can be immediately drawn towards taking special note of these ingredients that are linked to adverse health outcomes.

In view of our country’s alarming diabetic rates, which are only expected to worsen over the coming years, CAP believes that much more needs to be done, and with greater sense of urgency. Firm action needs to be taken against the numerous sweets and confectionaries that have fl ooded the market. These products that are being marketed to children are not conducive to health. They contain basically nothing more than sugar, coloring and other additives, which are not even labeled on the
packaging. Children received no nutritional benefit from consuming these products.
Sugary soft drinks, either carbonated or non-carbonated, used to be more of a luxury in the past and they were consumed as a treat. Nowadays, these drinks are sold in abundance everywhere. Vending machines proffering these drinks are also found at many locations, including airports, hospitals and schools. It is also becoming
increasingly common to see these drinks being offered in “jumbo” portions at various restaurants and food joints.


S.M. Mohamed Idris is the president of the Consumers’ Association of Penang (CAP). The organization may be contacted at Tel. No. 60-4-8299511, or through its website at www.en.cap.org.my. Graphics from Consumer Association of Penang.

This article appeared in the Health Alert Asia Pacific newsletter, Issue 13 2008. For copies of the newsletter, please write to hain@hain.org

Nutrition in Asia and the Pacific: An Ugly Portrait

Food and nutrition are human rights. International caucuses such as the 1989 Convention on the Rights of the Child enshrine these and thus deem governments as duty-bound in ensuring that the right to food and nutrition, as part of the overall well-being of a person, is achieved by all of its citizens.

Much as food and nutrition are regarded as basic human rights, the problem of malnutrition persists in many Asian countries. In fact, the concentration of malnutrition in Asia is greatest compared to anywhere else in the world.
The Asian Development Bank reports that one in three preschool children is stunted,
rising to one out of every two children in the countries of South Asia such as India,
Bangladesh, and Nepal.

The most painful subject with regard to under nutrition is the human cost. In 1999 alone, an estimated 2.8 million child deaths in nine low-income Asian countries, or 51 percent of child deaths were associated with malnutrition. (The countries included are Bangladesh, Cambodia, PRC, India, Lao PDR, Nepal, Pakistan, Sri Lanka, and Vietnam).

Different economic, political, and cultural characteristics in the region portray different faces of malnutrition. In many countries of the Asia-Pacifi c Region, under
nutrition is the most common. In some areas however, there are also incidences of over nutrition.

Read more »

ENCOURAGE WIDER PRACTICE OF TRADITIONAL MEDICINE

Western or modern medicine is presently the dominant healthcare system in our country. However, the emphasis on private curative health measures, sophisticated technology, expensive drugs and complicated machinery has given rise to increasingly exorbitant medical costs and also the incidence of medical errors. The critical shortage of medical professionals and support staff has further strained the delivery of medical services.

The detractors of traditional medicine systems are quick to highlight adverse incidents connected to the practice of these systems. However, the public may often not be aware, or may overlook, the magnitude of problems experienced with prescribed conventional modern drugs and treatments.

For example, in the US alone, studies carried out between 1993 and 1998 revealed that there were 12,000 deaths a year from unnecessary surgery, 7,000 deaths a year from medication errors in hospitals, 20,000 deaths a year from other errors in hospitals, 80,000 deaths a year from infections in hospitals, and 106,000 deaths a year from non-error, adverse effects of medication. These deaths per year constituted the third leading cause of death in the United States - after deaths from heart disease and cancer, and way ahead of the next leading cause of death - cerebrovascular disease. (Starfield B. JAMA, 2000)

While recognizing that allopathic medicine has brought health gains to the country, it is obvious that it is becoming increasing difficult to sustain this form of healthcare.

Serious efforts should be given to considering other systems and to incorporating them into the mainstream healthcare delivery system. In other words, there should be pluralism in healthcare delivery.

We will not be alone, as many other countries are already promoting and integrating traditional systems of medicine into their national healthcare and delivery systems.

For instance, in China, traditional medicine systems are officially recognized and integrated into the healthcare system both centrally and at the provincial levels. Hospitals and colleges have been designated for the training in traditional systems.

China and Korea invested in establishing high quality educational and research institutions years ago. China runs over 40 top-level research institutions exclusively for traditional medicine.

India has been significantly increasing its budget for the promotion of traditional medicine practices such as ayurveda, sidha, unani, naturopathy, Tibetan medicine and homeopathy.

It has been reported that one in eight Singaporeans prefers traditional medical treatment over established Western medicines. There have been calls for increased research into these ancient cures.

Malaysia, being a multiracial country, had a rich base of traditional systems of healthcare which include Malay, Chinese, Indian and indigenous medicine. These non-Western or traditional systems of medicine were practiced for thousands of years before the advent of the colonial era. It was with the arrival of colonialism that they were gradually sidelined in favour of the western concept of medicine.

Now, different health systems tend to be practiced mostly in isolation from each other. By right, there need not be a rigid separation of these delivery systems.

The World Health Organization (WHO) once pointed out that traditional medicine systems serve the health needs of about 80 percent of the world’s population and the goal of health for all cannot be achieved without traditional medicines.

There is a need to move away from the present obsession with only the modern system of medicine and turn to other systems that do not depend on sophisticated technology and other expensive modes of treatment delivery.

Traditional medicine colleges could be set up within existing university frameworks. Some training in Traditional Medicine systems could also be included in the present curriculum of medical schools and teaching hospitals. This would foster better understanding of traditional medicine practices.

There could also be active promotion of traditional systems of medicine by Ministries of Health in their national health programmes. Grants, incentives and other support mechanisms for training, research and setting up of facilities could also be encouraged.

More national and international conferences on traditional medical systems could be convened in order to promote and enhance the importance and to further encourage the understanding of these health systems.


Original article from:
Consumers Association of Penang (CAP),
No. 10, Jalan Masjid Negeri
11600 Penang, Malaysia.

Melamine Poisoning: “ Tip of the Ice Cream”

Like many similar incidents in the past, the melamine poisoning scandal is just a symptom of a decadent global food system characterized mainly by corporate greed and government neglect. The government ridiculously tries to show it is doing something to address the problem by parading to the media hurriedly confiscated milk product, yet at the same time, it downplays the dangers by echoing a familiar corporate whitewash that human will have to ingest unrealistically huge volume of contaminated milk to be poisoned. Just as quickly, Nestle and other companies put out expensive adverts proclaiming that their products are safe, even without undergoing the appropriate tests. These short-sighted and self-serving knee-jerk reactions do not protect the health of consumers but perpetuates the pathetic state of affairs as far as safety is concerned.

Food safety has been a serious concern of government and corporations, particularly with the advent of corporate globalization. WTO provisions related to food safely, for example, clearly subordinate protection of health and environment to corporate interest. Countries, especially the weaker countries, are forced to import food products contaminated with toxic chemicals or substances. Any attempt to ban or restrict such harmful substances, even those already banned in other countries, is met with fierce resistance by corporate giants and their host countries. Such is the case, for example, for pesticides, artificial sweeteners and additives, GMOs, and now melamine.

Exposure to melamine and related chemicals, in fact, is not new. Melamine is a triazine synthetic chemical used, usually with formaldehyde, in a wide range of products such as kitchen dishes and utensils, formica, laminate flooring, whiteboards, furniture, cleaning agents, fabrics, glues, colorants, flames retardants, fertilizers and drugs. Melamine is also a metabolite of cyromazime, a triazine pesticide commonly used in vegetable and chicken farms. In 1987, melamine was demonstrated to be present in coffee, orange juice, fermented milk and lemon juice, originating from migration of melamine from the cup made of melamine-formadehyde resin. From 1979-1987, there was widespread melamine contamination of fish and meat meal in Italy and in 2004, there was nephrotoxicity outbreak in pets in Asia. Again, in 2007, thousand of cats and dogs, mostly in the US, became seriously ill or died of acute renal failure after eating pet food contaminated with melamine and related triazine compounds such as ammelide, ammeline trichloromelamine and cyanuric acid. Hogs, chicken and fish were also found to be contaminated with melamine and cyanuric acid. Cyanuric acid is a common disinfectant used in swimming pools together with chlorine. Cyanuric acid was used as an ingredient in herbicides and is also used in the production of melamine and sponge rubber. It is also an intermediate chemical in the bacterial degradation of melamine and in the production of chlorinated bleaches and whitening agents. Trichloromine is the chlorinated form of melamine and is mainly used as disinfectant and cleaning agent.

Melamine may cause adverse reproductive effects, may affects genetic material and may cause bladder cancer based on animal data. It may also cause skin, eye and respiratory tract irritation and irritation of the digestive tract with nausea, vomiting and diarrhea, and may damage the urinary system. Cyanuric acid and trichloromelamine have pretty much the same spectrum of toxicity as melamine. However, cyanuric acid and trichloromelamine have the greater toxicity potential, particularly, in causing kidney damage, development toxicity and cancer.

By themselves, melamine and cyanuric acid are considered to be of low acute toxicity by regulatory agencies based on standard ask assessment for each chemical. It is from this limited risk assessment that official tolerance level (e.g., “15 cups of milk per day fro several months) are derived. However, multiple source and multiple chemical exposures, including exposure to both melamine and cyanuric acid (which has been found to be much more toxic in combination), is the more likely exposure situation and this should be the basis for assessing risks to human health. Other important triazine compounds must also be considered in the assessment of risks. For example, the triazine herbicides are known to cause neuroendocrine and endocrine related developmental, reproductive and carcinogenic effects.

Despite the limited scientific data and the low acute toxicity attribute to melamine and related traizine compound, much can be said about the potential harm that these chemicals pose to animals and human being. The mechanism of rental toxicity melamine and cyanuric acid is well established and that acute or chronic exposure would likely result in adverse renal toxicity that could lead to renal failure. Existing empirical and scientific data indicate that exposure levels sufficient to cause harm likely to be reached under present circumstances. In fact, the European Food Safety Authority, despite using the conservative risk assessment methodology, came up with this statement, “ in worst case scenarios with the highest level of contamination, children with high daily consumption of milk toffee, chocolate or biscuits containing high level of milk powder would exceed the TDI (tolerable daily intake)”. This assessment did not consider potential additional exposures likely to occur in developing countries, such as, cyanuric acid in swimming pools, melamine from the pesticide cyromazine and in contaminated vegetables, fish and meat, and melamine leachate in kitchen wares. Since milk and milk products from products from China were already banned in Europe at the time of the assessment, the worst case scenario for European children did not even consider potential sources from milk and ice cream!

The extent of harm that melamine and related compounds have caused is not at this time but the problem is not just melamine and simply confiscating products will not solve the problem. Government officials should not downplay the dangers of toxic chemicals contaminating food. Mechanisms for appropriate monitoring and timely intervention should be established. Food safety should be placed high in the political agenda and greed, corporate and otherwise, eliminated. Safe food should be put in the hands of the people!

Original article by:
Romeo F. Quijano, M.D.
Professor
Department of Pharmacology and Toxicology
College of Medicine, University of the Philippines

Where does suicide stand today?

I am featuring a news item from Waiting Room, a magazine compromising news for the health and wellness-conscious and believing that information is power—that it empowers people to take control of their lives and bring about positive change in themselves and the community in which they belong. In reporting and communicating health information, its commitment is to truth, integrity, fairness, professionalism, and excellence so to help establish a responsive and responsible health-care system.

Little being done to curb suicides pushes for a wide attention regarding the soaring rates of both suicide attempts and suicides from “. . . governments that are not committing enough resources to prevention but also in part because suicides are often recorded as violent murders or accidents”.

“There are more than one million people who die by suicide each year in the world, which is more than those who die from war, terrorist attacks, and homicides every year,” Brian Mishara [president of the International Association for Suicide Prevention (IASP)] said.

According to World Health Organization (WHO), the following are the challenges and obstacles why this issue gets scant attention:

 Worldwide, the prevention of suicide has not been adequately addressed due to lack of awareness on suicide as a major problem and the taboo in many societies to discuss openly about it. In fact, only a few countries have included prevention of suicide among their priorities.

 Reliability of suicide certification and reporting is an issue in great need of improvement.

 It is clear that suicide prevention requires intervention also from outside the health sector and calls for an innovative, comprehensive multi-sectoral approach, including both health and non-health sectors, e.g. education, labour, police, justice, religion, law, politics, the media.

There states, in its website, that approximately one million people died from suicide: a “global” mortality rate of 16 per 100,000 or one death every 40 seconds in the year 2000. In the last 45 years, suicide rates have increased by 60 % worldwide making suicide as the third leading cause of death among those aged 15-44 years (both sexes). Mental disorders (particularly depression and substance abuse) are associated with more than 90 % of all cases of suicide. However, suicide results from many complex sociocultural factors and is more likely to occur particularly during periods of socioeconomic, family and individual crisis situations (http://www.who.int/mental_health/prevention/suicide/suicideprevent/en/, October 2008).

In the Philippines, issues on suicide are rare and that they are only featured if there involve suicide bombings. The latest suicide rate dates back in 1993 which states that the country has a total of 2.1 (suicides per 100, 000 people), 2.5 for males while females with 1.7 (http://www.who.int/mental_health/prevention/suicide/suiciderates/en/, October 2008).

Young Adult Fertility and Sexuality Study 3 (YAFSS) has concluded that young Filipinos are capable of doing drastic acts such as committing suicide.
It is surprising to note that despite the general notion of the youth being in the prime of their life, suicide ideation is substantial with about 12.4 per cent reported that they ever thought of committing suicide. Larger percentage of females than males admitted to suicide ideation (17.1 % vs. 7.3 %) with very little difference across age group (Cruz and Berja, 2004, p. 67).

The rareness of information-drive on suicide is an attestation that it is, up to this day, considered taboo as dictated by influences coming from different cultures, societies, and religions.

If this scenario continues to persist, what will happen, then, to the advocacy which promotes suicide prevention? At surface, where does suicide really stand today? Or does it have a stance?

Perhaps, this is another “culture of silence”.

-Amanah Busran Lao
HAIN Research Associate

Citations:
• “Little being done to curb suicides”. Waiting Room: May-June 2008, page 1.
• World Health Organization. October 24, 2008 .
• World Health Organization. October 24, 2008 .
• Cruz, Grace T., Berja, Clarinda L. Non-Sexual Risk Behavior. Youth Sex and Risk Behaviors in the Philippines. Demographic Research and Development Foundation, Inc. University of the Philippines Population Institute Diliman, Quezon City

A Summary of the 2008 World Health Report “Primary Health Care: Now More Than Ever”

Primary health care was put forward thirty years ago as a set of values, rinciples and approaches aimed at raising the level of health in deprived populations. In all countries, it offered a way to improve fairness in access to health care and efficiency in the way resources were used. Primary health care embraced a holistic view of health that went well beyond a narrow medical model. It recognized that many root causes of ill health and disease lie beyond the control of the health sector and thus must be tackled through a broad whole-of-society approach. Doing so would meet several objectives: better health, less disease, greater equity, and vast improvements in the performance of health systems.

Today, health systems, even in the most developed countries, are falling short of these objectives. Although remarkable strides have been made to improve health, combat disease and lengthen life spans, people worldwide are dissatisfied with existing health systems. One of the greatest worries is about the cost of health care. This is a realistic concern since 100 million people fall into poverty each year paying for health care. Millions more are unable to access any health care.

The source of the problem is that health systems and health development agendas have evolved into a patchwork of components. This is evident in the excessive specialization in rich countries and donor-driven, single disease focused programmes in poor ones. A vast proportion of resources are spent on curative services, neglecting prevention and health promotion that could cut 70% of global disease burden. In short, health systems are unfair, disjointed, inefficient and less effective than they could be. Moreover, without substantial reorienting, today’s struggling health systems are likely to be overwhelmed by the growing challenges of aging populations, pandemics of chronic diseases, new emerging diseases such as SARS, and the impacts of climate change.

“Rather than improving their response capacity and anticipating new challenges, health systems seem to be drifting from one short-term priority to another, increasingly fragmented and without a clear sense of direction,” says World Health Report 2008 entitled Primary Health Care – Now More Than Ever.

With the publication of the report on 14 October, WHO hopes to start a global conversation on the effectiveness of primary health care as a way of reorienting national health systems. WHO Director-General, Margaret Chan, wrote in a recent editorial in the journal The Lancet: “Above all, primary health care offer(s) a way to organize the full range of health care, from households to hospitals, with prevention equally important as cure, and with resources invested rationally in the different levels of care.”

Actually, WHO hopes to revive the conversation. Primary health care was officially launched in 1978, when WHO member states signed the Alma Ata Declaration. That was 30 years ago. A few countries pursued the ideal. But, says Dr Chan: “The approach was almost immediately misunderstood.”

Primary health care was misconstrued as poor care for poor people. It was also seen as having an exclusive focus on first-level care. Some dismissed it as utopian and others thought it a threat to the medical establishment.

In the World Health Report, WHO proposes that countries make health system and health development decisions guided by four broad, interlinked policy directions. These four represent core primary health care principles.

Universal coverage: For fair and efficient systems, all people must have access to health care according to need and regardless of ability to pay. If they do not have access, health inequities produce decades of differences in life expectancies not only between countries but within countries. These inequities raise risks, especially of disease outbreaks, for all. Providing coverage to all is a financial challenge, but most systems now rely on out-of-pocket payments which is the least fair and effective method. WHO recommends financial pooling and pre-payment, such as insurance schemes. Brazil began working towards universal coverage in 1988 and now reaches 70% of its population.

People-centred services: Health systems can be reoriented to better respond to people’s needs through delivery points embedded in communities. The Islamic Republic of Iran’s 17 000 “health houses” each serve about 1500 people and are responsible for a sharp drop in mortality over the last two decades, with life expectancy increasing to 71 years in 2006 from 63 years in 1990. New Zealand’s Primary Health Care Strategy, launched in 2001, has as part of its core strategy an emphasis on prevention and management of chronic diseases. Cuba’s “polyclinics” have helped give Cubans one of the longest life expectancies (78 years) of any developing country in the world. Brazil’s Family Health Programme provides quality care to families in their homes, at clinics and in hospitals.

Healthy Public Policies: Biology alone does not explain many gaps in longevity, such as the 27-year difference in Glasgow’s rich and poor neighborhoods. In fact, much of what impacts health broadly lies outside the influence of the health sector. Ministries of trade, environment, education and others all have their impact on health, and yet little attention is generally paid to decisions in these ministries that have health impacts. WHO believes they should all be part of deliberations and that a “health in all policies” approach needs to be integrated broadly throughout governments. This will require a shift in political calculations since some of the greatest health impacts can be achieved through early childhood development programmes and education of women, but those benefits are unlikely to be seen during a single politician’s term or terms in office.

Leadership: Existing health systems will not naturally gravitate towards more fair, efficient (those that work better) and effective (those that achieve their goals) models. So, rather than command and control, leadership has to negotiate and steer. All components of society – including those not traditionally involved in health – have to be engaged, including civil society, the private sector, communities and the business sector. Health leaders need to ensure that vulnerable groups have a platform to express their needs and that these pleas are heeded. There is enormous potential to be tapped. In half of the world’s countries, health issues are the greatest personal concern for a third of the population. Wise leadership requires knowledge of what works. Yet health systems research is an area that is often severely under funded. In the United States of America, for example, health systems research claims only 0.1% of the nation’s health budget expenditure. Yet research is needed to generate the best evidence as a basis for health decision.

By aiming at these four primary health care goals, national health systems can become more coherent, more efficient, more fair and vastly more effective.

Progress is possible, in all countries. Now, more than ever, there are opportunities to start changing health systems towards primary health care in all countries. The challenges are different for countries with different income levels, but there are commonalities. There is more money being spent on health than ever before and more knowledge to address global health challenges, including better medical technology. There is also now recognition that threats and opportunities in health are shared across the world. Aid is important for some countries, but the vast majority of health spending comes from domestic sources. Even today, in Africa, 70% of all resources for health come from domestic funds. Thus most countries have the ability to start moving towards and enjoying the benefits of primary health care.

Reflections on Primary Health Care 30 years after Alma Ata and the Challenges Ahead

The recently released World Health Report on PHC (WHO Oct 2008) is an attempt to bring PHC again to the forefront of our priorities in global health. Good for that!

But the world has changed in these 30 years.

In 1978, we did not have:
· Neoliberal globalization.
· Selective, vertical health programs (many of them aggressively pushed by public-private partnerships -- PPPs that started, because they did not trust WHO…).
· A big health manpower crisis (only in part due to the AIDS pandemic).
· The magnitude of economic impediments to access to health by poor people with increasing inequities and disparities between the haves and the have nots.
· Increasing privatization and commercialization/commoditization of health services as a result of globalization *.
· Intellectual property issues (patent issues) used against the interest of poor countries and poor patients.

We also did not have:
· An energetic and active civil society.
· The People's Health Movement (PHM) and its global network.

Therefore, as a PHM member, on top of seeing PHC and Alma Ata as still alive, I think PHC-in-2008-and-beyond needs to address these (and other unmentioned) "did not have" issues as challenges at local, national and global level.

For this to happen, WHO is to recuperate its moral and political leadership in PHC, in health overall, and in proactively addressing the social determinants of health as per the recommendations of the ad-hoc WHO Commission that just released its report.

To go beyond well-meaning pronouncements, this will clearly need some internal reorganization in this UN agency. The question is whether its leadership plans such a reorientation.

PHM does not shy away from a political approach to PHC and is not really fighting its opponents; it is rather bringing the level of the discussion to a higher level. Therefore, it has published an alternative report to the World Health Report of 2008 --the Global Health Watch 2 (being released today, see www.phmovement.org ).

PHM challenges the concept that good health is an imperative for increased economic productivity: Instead, it insists and departs from the premise that health is an inalienable Human Right.
Health is not either a technical or a political issue: it is both…and pro-poor health interventions mean nothing if not concomitantly accompanied by poverty reduction actions that are pro-health.

Based on patients registers at health facilities, statistics want to make us believe that 50% of the poor choose to seek private health care. Such a fallacy hides the real fact that 50% of the poor do not seek any care (and thus escape facility-based statistics!). So, let us stop using the slogan "those who can pay should pay" without carefully weighing its meaning.

I am a perennial optimist. I hope recent developments mean a real new window of opportunity for PHC. But WHO/member states/civil society interactions will have to become more of a 'two-way street'. I am sure PHM will play its role in achieving this.

Claudio Schuftan, Ho Chi Minh City
cschuftan@phmovement.org
______________
*: The myth that private health providers are more efficient has to be broken once and for all. Without trying to generalize, it is still true that, in the private sector, the following facts are prevalent:
· An irrational use of drugs, of polypharmacy and an overuse of antibiotics, vitamins and steroids.
· An overuse of injectables.
· A veritable 'ultrasound epidemic'.
· An excessive numbers of cesarean sections and tonsillectomies performed.
· Private insurance companies cherry picking the healthier patients and leaving the others for the public sector to care for (or offering minimum coverage packages to the poor that end up in 1st, 2nd and 3rd class medicine).
· A penetration of transnational health corporations in developing countries using GATS provisions (that PHM denounces).
· Public hospitals opening private wards 'that will (allegedly) generate income to subsidize the public wards', but most of the times ending up being subsidized by the public sector since they undercharge private patients.
· Health tourism springing up in many countries with the consequent internal brain drain.
· A conspicuous absence of private practitioners in remote and poor areas.
· A very limited role of this sector in preventive and promotive health actions and a minimal role in TB and in AIDS, and
· A resistance of medical associations to any measures directed at regulating private practice.

---
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Social Determinants of Health

By Alberto G. Romualdez, M.D.
Malaya, Tuesday, 7 October 2008

In 2005, the late Director-General of the World Health Organization, Dr. Lee Jun-Wok, set up the Commission on the Social Determinants of Health. Its job was to marshal evidence on what could be done to promote health equity. Last month, after working for three years, the Commission issued its final report entitled “Closing the Gap in a Generation – Health Equity through Action on the Social Determinants of Health”.

Chaired by a well-respected epidemiologist, Professor Michael Marmot of the United Kingdom, the Commission’s members were a diverse group ranging from a former president of Chile to health ministers and health experts to a Nobel laureate in economics. But despite their different backgrounds, the Chairman noted that “everyone connected to the Commission were united in three concerns: a passion for social justice, a respect for evidence, and a frustration that there appeared to be far too little action on the social determinants of health.”

“Closing the Gap” did not reveal any startlingly new findings about the relationships between social status and health. However, its methodical exposition of the evidence on these relationships and how widespread they were across the globe provides documentation that should initiate action by responsible authorities not only in the health sector but at all levels and areas.

For the Philippines, the findings of the Commission underscored the fact that, as repeatedly asserted in past forums, our country situation mirrors the global situation in almost all aspects especially in the disgraceful health inequities between the rich minority and the poor majority of Filipinos.

The recommendations on the approaches to reducing health inequities are also very much applicable to our situation. These approaches are based on an all-encompassing concern for social justice which, the report asserts, “is a matter of life and death. It affects the way people live, their consequent chance of illness, and their risk of premature death.”

The Commission proposes three overarching recommendations for dealing with inequities in health. It is obvious from these that reforming the health sector to deal with inequality cannot be the business of the health sector alone because not all the factors that promote inequity are within its sphere.

The first of these is to improve living conditions for all because “the inequities in how society is organized mean that the freedom to lead a flourishing life and to enjoy good health is unequally distributed between and within societies. This inequity is seen in the conditions of early childhood and schooling, the nature of employment and working conditions, the physical form of the built environment, and the quality of the natural environment.”

The second overarching recommendation is to tackle the inequitable distribution of power, money, and resources because “inequity in the conditions of daily living is shaped by deeper social structures and processes. The inequity is systematic, produced by social norms, policies, and practices that tolerate or actually promote unfair distribution of and access to power, wealth, and other necessary social resources.”

The third recommendation is to measure and understand the problem and to assess the impact of action because “the world is changing fast and often it is unclear the impact that social, economic, and political change will have on health in general and on health inequities in particular. Action on the social determinants of health will be more effective if basic data systems, including vital registration and routine monitoring of health inequity and the social determinants of health are in place.”

“Closing the Gap in a Generation” is a very important document that will help to understand the underpinnings of health inequity. It should be required reading for individuals who have any interest in trying to remedy the problem of inequity in the Philippine health system. The document provides materials to support the argument that it is time to elevate the level of politicization of health from that of parochial self-interests and petty patronage to a national issue of common concern.

Unfortunately, despite the fact that polls show that health is a priority issue for most Filipinos, politicians’ have for the most part shown a rather shallow appreciation of the issues. It is for this reason that political campaigns for any post always feature medical missions and distributions of medicines (mostly unnecessary). The most common promise of politicians to their constituents is to build yet another hospital or health center or health station.

Hopefully, the publication of “Closing the Gap in a Generation” coupled with the promotion of the attainment of the millennium development goals will encourage deeper thinking about the situation of health in the Philippines. Perhaps a true concern for the health of poor Filipinos will also convince some of the more conservative religious groups to reconsider their stance on reproductive health, information and services which will empower poor couples to become responsible couples, allow them to pay more attention to their family needs, and avoid the many health risks associated with reproductive ignorance.

***
The initial confusion and delays in the response of Philippine health authorities to the melamine contaminated food products from China reflects the inherent weaknesses of the food and drug regulatory system now in place. It turns out that this problem came at a very awkward time for the Bureau of Food and Drugs. Its Deputy Director, who was effectively the agency’s main trouble-shooter, had just resigned. There had just been a reshuffle of division chiefs that had cause a level of demoralization because it had been done to appease a powerful multinational food company at the behest of the Department of Trade and Industry. Hopefully, after things settle back to normal following this melamine affair, the story behind the turmoil of the country’s food and drug safety agency can be told as one of the basis for reforms of food and drug regulations expected with the passage of a pending BFAD strengthening law.
(Dr. Romualdez’ e-mail address is: alberto.romualdez@gmail.com)

Cervical Cancer and Human Papillomavirus

Reading through The Philippine Star, I bumped into an advertisement which presents a husband lying in bed and trying to feel the presence of his deceased wife. What makes this interesting is the question flashed below which goes Naisip mo na ba kung gaano kasakit matulog at gumising na mga-isa?. Apparently, this seeks to inform readers that a woman has an eighty percent chance of already being infected with human papillomavirus (HPV) when she reaches fifty and that there are ten women who die of cervical cancer hence, ten new widowers everyday.

This advertisement brought me back to an article entitled A survivor’s battle with cervical cancer by Annie A. Jambora which was released last August fifth in Philippine Daily Inquirer. This highlights the experience of Josefina de la Cruz with cervical cancer, country’s second leading cause of death among Filipino women. Other than her menstrual period which takes much longer than usual, sometimes going for full ten days, she was feeling fine. In August 2001, exactly ten years after her mother succumbed to the same disease, she was diagnosed with multiple myoma.

Although the diagnosis is not a life-threatening condition, she nevertheless pushed through with all the necessary medical procedures. However, it was just last year when she figured out that the cancer was actually caused by HPV which she, unknowingly, had acquired from her husband.

Cervical Cancer
The Harvard Guide to Women’s Health defines cervical cancer as a disease that develops gradually starting with abnormal cell changes called preinvasive lesions (also called low-grade squamous intraepithelial lesions, or SIL; or dysplasia). These sometimes revert to normal cells. Nevertheless, these cell changes are considered a precancerous condition. In time (sometimes a full decade), some precancerous cells may develop into localized cancer, called carcinoma in situ, which affects the outer surface of the cervix (Carlson, Eisenstat, Ziporyn, 1996, p. 130).

World Health Organization states, in its website, that all cervical cancer cases (99%) are linked to genital infection with HPV, which is the most common viral infection of the reproductive tract.

Human Papillomavirus (HPV)
Cervical cancer, human papillomavirus (HPV), and HVP vaccines-Key points for policy makers and health professionals provides main points on this virus.

 HPVs are a family of viruses that are extremely common worldwide. There are more than 100 types.
 They are deoxyribonucleic acid (DNA) viruses that infect skin or mucosal cells.
 At least 13 of these types are oncogenic (cancer-causing).
 HPV is estimated to cause
-100% of cancer cases,
-90% of anal cancer cases,
-40% of cases of cancers of the external genitalia (vulva, vagina and penis),
-at least 12% of oropharyngeal cancer cases, and
-at least 3% of oral cancer cases.
 HPV types 16 and 18 cause approximately 70% of all cervical cancers worldwide.
 Almost 500 000 cases of cervical cancer and 274 000 cervical cancer deaths occurred in 2002.
 About 80% of cervical cancer deaths occur in developing countries.

In the article which was mentioned earlier, it is stated that HPV, affecting both men and women, can be acquired only through skin contact. Men are generally spared from the deadly virus and only serve as carriers even if they use condoms. These do not protect a woman from contacting the said virus since the scrotum is still exposed.

It is wonderful knowing that newsprint media have started realizing the importance of writing on cervical cancer and human papillomavirus (HPV) as one of its causes. Untold stories of women, we can now finally conclude, are beginning to be told.


Citations:
• “Naisip mo na ba kung gaano kasakit matulog at gumising na mga-isa?”. The Philippine Star: September 24, 2008, page 13.
• Jambora, Annie A. “A survivor’s battle with cervical cancer”. Philippine Daily Inquirer: August 05, 2008, page C1.
• Carlson, Karen J., Eisenstat, Stephanie A., Ziporyn, Terra. The Harvard Guide to Women’s Health. Cambridge, Massachusetts: Harvard University Press, 1996.
• World Health Organization. September 29, 2008 .
• “Cervical cancer, human papillomavirus (HPV), and HVP vaccines-Key points for policy makers and health professionals”. September 29, 2008 .

Original article by Amanh B Lao, research associate, HAIN.

One Best Medicine

Amidst the soaring prices of medical commodities world wide, there constantly remains one best, yet, inexpensive medicine: laughter.

Despite the idea that consumers might have taken for granted the significance of laughing these days, researchers are continuing exploring further on how laughter - combined with an active sense of humor - helps from relieving stress to combating diseases.

Laughter and the brain
An article, published in Wikipedia, states that modern neurophysiology links laughter to the activation of the ventromedial prefrontal cortex and other parts of limbic system. The latter, which is considered to be a primitive part of the brain, is involved in emotions and helping us with basic functions necessary for survival. There are two known structures in the limbic system that involve in producing laughter: amygdale and hippocampus.

Cardiovascular disease
According to the research (May 11, 2007) spearheaded by Michael Miller, M.D., director of the Center for Preventive Cardiology at the University of Maryland School of Medical Center and associate professor of medicine at the University of Maryland School of Medicine, cardiovascular disease - today’s leading cause of death (World Health Organization) - can be prevented by laughter. He admitted that the team does not know yet why laughing protects the heart but stated that mental stress is associated with impairment of endothelium, the protective barrier lining our blood vessels, causing a series of inflammatory reactions that lead to fat and cholesterol build-up in the coronary arteries and ultimately to a heart attack. Hence, the need for a regular hearty good laugh is recommended.

Other areas
Melissa B. Wanzer, EdD, professor of communication studies at Canisius College in Buffalo, NY, looked, in her new research, at how humor helps medical professionals cope with their difficult jobs. She found out that if employees view their managers as humor-oriented, they also view them as more effective. She also added that self-disparaging humor, making fun of oneself, is a very effective form of humor communication especially when it is done appropriately with available props. Humor, she noted, is indeed beneficial in other areas as well.

Laughter as part of its culture
Ranked second by Axa Life Outlook Index (November 28, 2007) as happiest and optimistic people in Asia, it is not that surprising to know that Beethoven del Valle Bunagan, popularly known as Michael V, is featured on Reader’s Digest Asia in commemoration for its 5th Annual Humour Special alongside two other foreign comedians (Readers’ Digest, September 2008).

“Filipinos are able to find even the slimmest silver lining in a tropical thunderstorm. There isn’t one scandal in government which hasn’t been made into a joke. Instead of being horrified, we laughed about Imelda’s shoes. Instead of cringing in shame at Joseph Estrada’s incompetence as President, we made legions of Erap jokes. Hello, Garci? A ringtone was made out of it! (Maricar, 2008)”.

In his article entitled Power of Laughter, Jose Javier Reyes went deeper by explaining this behavior based on socio-cultural and historical aspects. “Caught between a rock and a hard place, Filipinos say "bahala na." Literally, it means "come what may." Figuratively, it means much more. The phrase derives from Bathala, the ancient Filipino's Supreme Being, caretaker of life on earth and beyond, from whom all providence comes. The invocation of "banal na" affirms a trust in divine wisdom. Filipinos know that the natural order of events will take their course, leaving no room for angst nor the predilection to take each event apart and delve for spiritual malaise . . . After all, at earlier times in their past, they have witnessed similar upheavals. And to what end? The Spaniards came and the Spaniards went. So did the Japanese and the Americans. Like the land itself, only the Filipinos, with their passionate Christian belief that suffering is but a stepping stone to a happy ending, endures. Ambition, politics, and men who try to control deserve the reception they get, laughter. Natural forces receive a similar reception. If one listens closely though, it becomes apparent that Filipino humor does not jeer at nature's destructiveness but rather expresses an optimism in its healing powers. Having lived closed to the earth, they know that nature gives and takes in a cycle as eternal as life and death.”

As what Robert R. Province, Ph.D. said, laughter is genetic. It is a mechanism everyone has and is part of universal human vocabulary. There are thousands of languages, hundreds of thousands of dialects, but everyone speaks laughter in pretty much the same way. Thus, everyone can laugh.

-Amanah Busran Lao, HAIN

Citations:
•
• Murray, Michelle “Laughter is the "Best Medicine" for Your Heart” May 11, 2007 < http://www.umm.edu/features/laughter.htm>
•
• “Go Ahead and Laugh” January 26, 2008
• Siti Rohani “Three Funny Men” Readers’ Digest, September 2008
• Cheryl Arcibal “Filipinos 2nd happiest people in Asia-study” November 28, 2007 GMANews.TV
• Maricar “Filipino Humor a Hindrance?” February 5, 2008
• Jose Javier Reyes “The Power of Laughter”

Investments and Profits in Mining: Implications on Health

The recent boom in commodity prices has aroused growing investor interest in opportunities for mineral extraction in low-income countries. In last developed and developing countries, most foreign direct investments (FDI) are in extractive industries. Kazakhstan, Mali, Mongolia and Papua New Guinea are among the countries that have emerged as major recipients of FDI in metal mining.

Foreign companies account for varying shares of metallic mineral and diamond production in individual host countries. Based on the value of production at the mining stage, of 33 major mining countries of the world, foreign affiliates were responsible for virtually all production in 2005 in some least developed countries, such as Guinea, Mali, the United Republic of Tanzania and Zambia, as well as in Argentina, Botswana, Gabon, Ghana, Mongolia, Namibia and Papua New Guinea. In another 10 major mining countries – a mix of developed, developing, and transition economies – foreign affiliates accounted for between 50 percent and 86 percent of all production.

Social Implications of Mining
Minerals account for a small share of world production and trade. Nonetheless, their supply is essential for the sustainable development of a modern economy. They are basic, essential and strategic raw materials for the production of a wide range of industrial and consumer goods, military equipment, infrastructure, inputs for improving soil productivity, and also for transportation, energy, communications and countless other services.

As such, mineral exploitation continues to be undertaken mostly by transnational corporations in developed countries and in the developing and underdeveloped countries where policies and regulations tend to be weak. As regulations in these countries tend to be lax, mining corporations tend to be negligent of their social responsibilities to the local communities and even to the mineworkers; as well as adhering to environmental standards.

However, with new investments in mineral exploitation these countries are confronted with challenges the economic concerns, extending to environmental, social (including health) and political dimensions.

Activities in the extractive industries can have health and safety impacts not only on people working in those industries (occupational health and safety of mineworkers), but also on nearby communities, for example, through air and water pollution resulting from those activities.

Health concerns in Mining
Mining in general has been identified as among the most hazardous industries. However, the occupational safety and health implications vary significantly between different mining activities and countries. In the working environment of a surface mine, for example, airborne contaminants (such as rock dust and fumes), excessive noise, vibration and heat stress can create health problems for mineworkers who are subject to a frequent and prolonged exposure to them. They are exposed to various potentially toxic or harmful materials or agents, including, but not limited to, fuels, reagents, solvents, detergents, chemicals, coal dust, silica dust, diesel particulate matter (DPM), asbestos, noise, welding fumes, poisonous plants, trona dust, and metal dust.

The impact of environmental accidents is larger in scope, destroying marine ecosystems, agricultural lands and displacing whole communities from their sources of livelihoods. People living near a mining area also experience long-term health complications which are often debilitating.

Environmental disasters and health issues
One of the major and more controversial issues surrounding mining especially large-scale industrial mining operations is the spate of environmental disasters major mining corporations (and lately, medium and junior mining corporations) are involved in.

Environmental disasters mostly involve the collapse of mine tailings dams containing toxic chemicals from treating mineral ores, that spills into rivers and oceans, agricultural areas and contaminating main water systems and food sources. More often, corporations walk away leaving the local communities and governments to pick up the pieces from the immense devastation wrought by the mining corporation’s gross disregard for environmental standards and safety of the local communities.

The Marcopper Mine Tailings disaster in Marinduque in 1996 is one of the biggest industrial mining disaster in recorded history. On 24 March 1996, toxic mine tailings at the rate of 5-10 cubic meters per second were disgorged into the Makulapnit and Boac rivers. It was estimated that the total amount of mine sludge spilled into the rivers was 1.5 million cubic meters. On top of the economic and environmental devastations it caused, it also affected the people’s health. Years after the disaster, heavy metal poisoning, respiratory problems, and skin lesions were the top health concerns in the affected communities.

United front
As conditions and experiences of mineworkers and communities in developing and underdeveloped countries across the globe are identical, peoples in these countries have the option to organize, unite, mobilize and assert for their sovereign rights as a people over their mineral resources. United, they have the power to lobby for development policies and projects that responds to their development needs.

References:
[1] UNCTAD. “World Investment Report 2007”
[2] Scott, Douglas F. and Grayson, Larry R. “Selected Health Issues in Mining”. (Spokane Research Laboratory, National Institute for Occupational Safety and Health, Spokane, WA and University of Missouri, Rolla – undated)
[3] Corpuz, Victoria T. “The Marcopper Toxic Mine Disaster -Philippines’ Biggest Industrial Accident” (Third World Network - http://www.twnside.org.sg/title/toxic-ch.htm)
[4] Patterson, Kelly. “Oxfam International report highlights continuing problems at Marinduque.” (April 14, 2005, http://www.minesandcommunities.org/article.php?a=1272)

Author: Jennifer Haygood-Guste, Issue 12, Health Alert Asia Pacific
For request of copies of Health Alert Asia Pacific, you may write to hain@hain.org

Hazards of Climate Change

The United Nations Environment Program (UNEP) pronounced that climate change is one of today’s most critical global challenges. Its effects have far-reaching and terrifying consequences that could lead to sickness and death. The World Health Organization (WHO) expressed its deep concern, particularly on climate change’s effects on human health. The WHO said climate change has caused the recent increase in many infectious diseases, such as the HIV and AIDS, hantavirus, hepatitis C, SARS, among others.

“The total current estimated burden is small relative to other major risk factors. However, in contrast to many other risk factors, climate change and its associated risks are increasing rather than decreasing over time,” the WHO said. For instance, projections from the health institution showed that by 2030, some regions experiencing climate change will likely see a 10 percent increase in diarrhea incidences.

Getting Sick
“Vectors, pathogens and hosts each survive and reproduce within a range of optimal climatic conditions: temperature and precipitation are the most important, while sea level elevation, wind, and daylight duration are also important,” it said.

Further, climate change also increases changes in various vector-borne infectious diseases, particularly for malaria in regions bordering current endemic zones. The organization even singled out malaria as a disease of great public health concern. The WHO considered this as the disease that is most sensitive to long-term climate change. In its recent study, the WHO found that in the last century, malaria epidemics were periodically experienced in the Punjab region of India brought about by excessive monsoon, rainfall, and high humidity.

In fact, reports said that malaria has already reached Bhutan and new areas in Papua New Guinea for the first time. In the past, mosquitoes that spread the disease were unable to breed in the cooler climates there, but warmer temperatures have helped vector-borne diseases to flourish.

Singapore, on the other hand, has seen a correlation between rising temperatures and the number of dengue fever cases. Degue fever cases increased ten-fold in areas in Singapore with a mean annual temperature of up to 26.9 Celsius in 1978 to 28.4 Celsius 20 years later.

This year, the Philippines’ Department of Health (DOH) projected that there will be around 40,000 dengue cases during the rainy season or from June to October.
The DOH already reported 10,497 dengue cases from January to April or a 36.4 percent increase from last year’s 7,697 cases.

The agency said the regions with the most reported cases are the National Capital Region with 2,750, Central Luzon with 1,736, and Central Visayas with 1,384. Deaths from the disease also increased from 88 to 116 during this period, mostly in Central Visayas.

Other Dangers to Health
Malaria and other vector-borne diseases are not the only risks to health posed by climate change. There are other risks that bring even more unquantifiable health impacts.

These include health impacts caused by changes in air pollution; the altered transmission of other infectious diseases; insufficient food production due to the effect of climate change on plant pests and diseases; drought and famine; population displacement due to natural disasters, crop failure, water shortages; destruction of health infrastructure; conflicts over natural resources; and direct impacts of heat and cold.

Climate change alters weather patterns, resulting in increased precipitation and more severe storms and hurricanes. The death toll of such natural disasters is quite staggering: in Myanmar alone, an estimated 20,000 died from a cyclone that ripped through the country.

The warmer climate also poses a threat to global food security.

Due to these, the WHO warned that the world may see more malnutrition cases in the near future and estimated that by 2030, a significant increase will be seen in Southeast Asia, posing greater health risks for a significant part of the world’s population. A preview of things to come happened early this year when southeast Asia experienced a rice shortage due to downfall in productions.

Reports even stated that Asia-Pacific is already experiencing the effects of global warming. Estimates say that climate change was directly or indirectly linked to some 77,000 deaths each year in the region. The WHO said that this accounted for about half the global total of deaths blamed on climate change.

This figure, however, does not include deaths linked to urban air pollution, which kills more than 400,000 people in China every year.

Further, heat-related deaths in Shanghai, China, jumped three times above the norm in 1998 when a massive summer heat wave drove temperatures to about 40 degrees Celsius.

“Overall, although the estimates of changes in risk are somewhat unstable because of regional variation in rainfall, they refer to a major existing disease burden entailing large numbers of people,” the WHO said.

Because of the frightening consequences of changing weather patterns, the UN has appealed to various governments all over the world to seriously find ways to address climate change.

Whether or not this appeal will be considered remains to be seen. But while the UN waits for a concerted effort from major economies such as the United States to address climate change, global weather conditions continue to deteriorate and cause untold misery to billions of people.

Article by Jennifer Ng for Health Alert Asia Pacific newsletter, Issue 12, 2008

To request of copies of Health Alert Asia Pacific, you may write to hain@hain.org

What Price Development?

The Industrial Revolution was the main engine that brought unprecedented economic wealth to the global community in a relatively short period. Such wealth, however, came with a steep cost: environmental degradation.

The revolution was aided, to a large extent, by the abundance of natural resources available back then. Industrialists wasted no time in plumbing the deep earth for oil to fuel its machineries. Trees were felled down and mountains were blasted to extract precious metals and minerals hidden in its bowel. As mankind marched towards a progressive civilization, it left in its wake a plundered environment.

Pollution
Water and air pollution have grave health consequences, such as high incidences of cholera and respiratory diseases. Developed countries have been quick to address the persistent problem of pollution by imposing stringent measures.

In contrast, least developed and developing countries continue to reel from the health costs of pollution. In the “World’s Worst Polluted Places,” released by Blacksmith Institute, poor countries dominate the list; two cities/provinces each in India (Sukinda and Vapi) and China (Linfen and Tianying) made it to the top ten. The cities/provinces are either located in mining areas or industrial estates. Because of the extractive nature of these industries, water, soil, and air in the mentioned regions are severely contaminated with toxic chemicals. In Tianying, lead in soil and air is ten times the national average, while in Vapi, its groundwater is contaminated with mercury.

In these areas, researchers found that there are higher incidences of cancer, skin and respiratory diseases, and birth defects.

Denuded forests
Data from the Food and Agricultural Organization (FAO) show that 13 million hectares of forests are lost every year due to deforestation. Although the rate of forest loss is going downward, the slow progress is still not enough to cover what has already been lost. According to FAO, for the 2000 – 2005 period, 37 countries lost at least one percent of their forest cover every year. In contrast, only 20 countries managed to expand their forest covers by at least one percent.

Deforestation skews ecological equilibrium, often with disastrous consequences. Forests are home to a variety of species, all of which rely on each other for survival. The loss of a specie’s habitat could spell extinction for that particular specie, which could trigger a domino effect in the food chain.

With a diminishing forest cover, a community is more prone to flashfloods and landslides since there are no more trees to hold the soil together. The people of Aurora, a Philippine province, know this all too well. When a typhoon hit the province in 2004, it triggered a flashflood – blamed on rampant illegal logging in the province - which claimed the lives of thousands of people. In the aftermath, thousands of illegally cut logs were seen floating – along with the bodies of victims who drown in the flood.

Nature strikes back
As nature struggles to regain its equilibrium, mankind is now facing a new threat: global warming. As the earth’s temperature rises, it brings about a myriad of interrelated problems.

With global warming, glaciers and sea ices are melting at a faster rate. The Intergovernmental Panel on Climate Change warns that by 2080, sea level could rise by a low of nine centimeters to a high of 69 centimeters.

Island-nations dotting the Pacific and Indian Oceans, as well as coastal communities, are at risk of being totally engulfed by a rising sea level. The World Wildlife Foundation reported that many villagers in Saoluafata in Samoa have already moved further inland because of the receding coastline. Tuvalu and Kiribati, on the other hand, face the possibility of a potable water shortage because saltwater has already penetrated some of its groundwater sources.

In a press release, the United Nations Economic and Social Commission for Asia and the Pacific warned that the Asia-Pacific region is more vulnerable to the threat due to the double burden of higher population density and lower natural resource endowment per capita.

“Asia and the Pacific has a population density that is 1.5 times the global average, the lowest freshwater availability per capita of all global regions, a biologically productive area per capita that is less than 60 per cent of the global average and arable and permanent crop land per capita that is less than 80 per cent of the global average,” it says.


Equitable and sustainable use of resourcesEnvironmental degradation has political and economic dimensions, and it is not a mere coincidence that poor countries are often the ones bearing the brunt of environmental plunder. Least developed and developing countries are rich in natural resources, but through international trade instrumentalities and government corruptions, these resources are mined and extracted by transnational corporations. The communities affected are left holding an empty bag, as they struggle to deal with the health consequences of environmental degradation.

Equitable use of resources should also be prioritized - along with sustainability - in the development of an earth-friendly agenda. Talks of environmental sustainability would be rendered meaningless unless the issue of equitability is addressed.

Article by Ross Mayor for Health Alert Asia Pacific newsletter, Issue 12, 2008

Sources:
FAO Forest Resources Assessment 2005.
http://www.fao.org/forestry/28813/en/
World Wildlife Foundation.
http://www.panda.org/about_wwf/what_we_do/climate_change/problems/impacts/sea_levels/index.cfm

Other useful sources of information:
Blacksmith Institute. www.blacksmithinstitute.org
Intergovernmental Panel on Climate Change. www.ipcc.ch
United Nations Economic and Social Commission for Asia and the Pacific. www.unescap.org

For request of copies of Health Alert Asia Pacific, you may write to hain@hain.org

Endangered Environment, Endangered Health

Global warming and the attendant climate change that comes with it have been acknowledged as new threats to global health security. This year’s World Health Day theme - World Health Day 2008: protecting health from climate change - further underscores the urgency of dealing with global warming.

In a statement released to the media, World Health Organization Director General Dr. Margaret Chan warned that the rising global temperature “can affect some of the most fundamental determinants of health: air, water, food, shelter and freedom from disease." "The core concern is succinctly stated: climate change endangers human health," she added.

The tolls from climate change-induced deaths are already staggering. In a summary report of the World Health Day 2008: protecting health from climate change, the following annual death tolls were released:

• 800,000 from pollution-related diseases
• 1.8 million from diarrheal diseases caused by lack of potable water and unsanitary conditions
• 3.5 million from malnutrition
• 60,000 from natural disaster.

This 12th issue of Health Alert discusses key issues surrounding global warming. The editorial, “What price development?” shows how the race for economic progress practically leaves the environment in ruins. “Hazards of climate change,” meanwhile, discusses in details how climate change poses a challenge in global health security.

“Investments and profits in mining: implications on health” shows how the mining industry affects the environment and the people’s health. The author maintains that current mining practices employed by transnational corporations leave the community more vulnerable to diseases and disasters.

Climate change also alters the weather pattern, resulting in more severe disasters. The last two articles, “Tsunami postscript: rebuilding a nation after a disaster” and “Towards achieving disaster-resilient community,” offers valuable tips on how to deal with disasters.


For request of copies of Health Alert Asia Pacific, you may write to hain@hain.org