Countries need to do more to stop harmful marketing of breast-milk substitutes, says UN

© UNICEF/Zahara Abdul

Lucy Atokoru, 28 breastfeeds her baby at her home in Omugo, Arua District.

    

27 May 2020

Health

Despite efforts to stop the harmful promotion of breast-milk substitutes, countries are still falling short in protecting parents from misleading information, according to a new UN report released Wednesday. 

Titled Marketing of Breast‐milk Substitutes: National Implementation of the International Code – Status report 2020, the study highlights the need for stronger legislation to protect families from false claims about the safety of breast-milk substitutes or aggressive marketing practices, findings that take on increased importance during the COVID-19 pandemic.

The UN World Health Organization (WHO), the UN Children’s Fund (UNICEF) and the International Baby Food Action Network collaborated in the report’s publication.

Impact of aggressive marketing

“The aggressive marketing of breast-milk substitutes, especially through health professionals that parents trust for nutrition and health advice, is a major barrier to improving newborn and child health worldwide,” says Francesco Branca, Director of WHO’s Department of Nutrition and Food Safety.

“Health care systems must act to boost parent’s confidence in breastfeeding without industry influence so that children don’t miss out on its lifesaving benefits.”

WHO and UNICEF encourage women to continue to breastfeed during the pandemic, even if they have confirmed or suspected COVID-19, as evidence indicate it is unlikely that COVID-19 would be transmitted through breastfeeding. “The numerous benefits of breastfeeding substantially outweigh the potential risks of illness associated with the virus,” the authors find.

Of the 194 countries analyzed, 136 have in place some form of legal measure related to the International Code of Marketing of Breast-milk Substitutes and subsequent resolutions adopted by the World Health Assembly. While 44 countries have strengthened their regulations on marketing over the past two years, only 79 countries prohibit the promotion of breast-milk substitutes in health facilities, and only 51 have provisions banning the distribution of free or low-cost supplies within the health care system.

Further, only 19 countries have banned the sponsorship of professional association meetings by manufacturers of breast-milk substitutes, which include infant formula, follow-up formula and growing up milks marketed for use by infants and children up to 36-months old.

Trained healthcare professionals know best

WHO and UNICEF recommend that babies be fed nothing but breast milk for their first six months, after which they should continue breastfeeding – as well as eating other nutritious and safe foods – until two years of age, or beyond.

Babies who are exclusively breastfed are 14 times less likely to die than those who are not, the authors stress. Yet, only 41 per cent of infants 0–6 months old are exclusively breastfed, a rate WHO Member States have committed to increase to at least 50 per cent by 2025.

Inappropriate marketing of breast-milk substitutes continues to undermine efforts to improve breastfeeding rates. Measures to prevent the spread of COVID-19, such as physical distancing, meanwhile hamper community counselling and mother-to-mother support services for breastfeeding - leaving an opening for the breast-milk substitute industry to capitalize on the crisis.

“We must, more than ever, step up efforts to ensure that every mother and family receive the guidance and support they need from a trained health care worker to breastfeed their children, right from birth, everywhere,” stressed UNICEF Chief of Nutrition Victor Aguayo.

The Code bans all forms of promotion of breast-milk substitutes, including advertising, gifts to health workers and distribution of free samples. Labels cannot make nutritional and health claims or include images that idealize infant formula. Instead, labels must carry messages about the superiority of breastfeeding over formula and the risks of not breastfeeding.

Courtesy:UN News

COVID-19 threatens democracy in Southeast Asia

25 May 2020

00Author: Murray Hiebert, Bower Group Asia

COVID-19 has been tough on the health and economies of Southeast Asia, but the region’s fledgling quasi-democracies are also under threat. Efforts to control the virus are giving authoritarian rulers the perfect cover to adopt draconian levers to rein in their opponents and critics.

‘The authoritarian leaders of Cambodia and the Philippines certainly rode the COVID-19 wave to their advantage in accruing political power and controls, while Thailand and Myanmar are poised to lean in further if they determine the political situation requires it’, says Phil Robertson, Human Rights Watch’s deputy director in Asia.

In Thailand, Prayut Chan-o-cha — a general who seized power in a 2014 coup and then became prime minister through carefully orchestrated elections in 2019 — took advantage of an existing emergency decree to impose sweeping control measures in March. As COVID-19 continues to spread, the control measures grant him the authority to ‘censor or shut down media if deemed necessary’.

For example, a 42-year-old Thai artist was arrested after posting online that he had arrived from Spain and exited Bangkok’s main international airport without any screening. He was charged under the Computer Crimes Act and could be punished for up to five years in prison because his post ‘created panic for the public and eroded their confidence in Suvarnabhumi airport’ — in the words of the Ministry of Digital Economy and Society.

Philippine President Rodrigo Duterte, best known for his brutal war on drugs, signed a law in late March granting himself ‘special temporary power’ for three months. On 1 April, he ordered the police and the military to shoot violators of his ‘enhanced community quarantine’ if they were unruly or threatened law enforcement officers. Three days later, a man in his early 60s, apparently drunk, was shot dead after allegedly threatening police at a checkpoint with a scythe.

In April, the Philippine police arrested seven activists distributing food assistance north of Manila and charged them with violating emergency laws. They were indicted with inciting sedition after anti-government newspapers were found in their vehicle. In early May, ABS-CBN — the country’s largest television broadcaster — was forced off the air in a move many observers interpreted as Duterte’s attempt to further muzzle the media at a time when unbiased reporting on COVID-19 outbreak was needed.

In Myanmar, the military appears to be taking advantage of COVID-19 by leveraging the power it retained during reforms that gave rise to a quasi-civilian government. In late March, the military set up a powerful 10-member COVID-19 taskforce to investigate cases of the virus and suppress ‘disinformation’ by punishing those who create ‘panic among the people’. This taskforce, made up of senior military officers and cabinet ministers appointed by the military, was created two weeks after the government had established a COVID-19 committee led by State Counsellor Aung San Suu Kyi.

The military taskforce runs parallel to the civilian government and ensures that the military retains a high profile as the country prepares for elections before the end of the year. The military also arranged facilities in key cities to quarantine people infected by COVID-19 and sent military helicopters to deliver medical supplies to remote regions of the country.

In Cambodia, where Prime Minister Hun Sen cracked down on opposition political parties and shrunk the country’s political space ahead of 2018 elections, the National Assembly passed a state of emergency law granting Hun Sen greater power in handling the pandemic. Between January and April, Human Rights Watch documented the arrest of at least 30 people on charges of spreading ‘fake news’, including commentaries on the government’s handling of the pandemic.

No opinion polls in Southeast Asia have measured public perceptions about the more authoritarian measures governments introduced to tackle the pandemic. A Gallup poll of Thai attitudes toward the government’s overall handling of the virus in late April found 81 per cent disapproval — the highest among 18 countries. In contrast, 80 per cent of people in the Philippines approved of their government’s handling of the virus, in line with Duterte’s approval ratings during his war on drugs.

Interestingly, the poor rating of the Thai government seems to be due to perceptions of officials not going far enough rather than being too draconian. Veteran politicians criticised Prayut’s administration for not using ‘hard measures’ earlier to control the virus.

There is no evidence that the use of tough policies in Cambodia, the Philippines, Thailand or Myanmar are producing a more effective pandemic response. ‘Any public health practitioner would immediately tell you that responding to a public health crisis requires eliciting the willing cooperation and support of the people’, says Robertson. Using power to arrest, quarantine and curfew violators is an exercise that ‘resembles emptying the ocean with a bucket’. Advances toward democracy in Southeast Asia that came at immense cost are at risk of being steadily eroded away.

Murray Hiebert is Head of Research at Bower Group Asia and Senior Associate of the Southeast Asia Program at the Center for Strategic and International Studies (CSIS), Washington DC. He is author of Under Beijing’s Shadow: Southeast Asia’s China Challenge (Forthcoming: August 2020).

Courtesy:East Asia Forum

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China–US blame game hampers COVID-19 response

17 May 2020

Author: Suisheng Zhao, University of Denver

The world is entangled in the blame game between China and the United States as it confronts the largest public health threat in a century. Each is trying to divert attention from its own missteps to the other side, hampering international cooperation and multilateral responses to the COVID-19 pandemic.

The Chinese government faces strong domestic criticism on their accountability and transparency after suppressing early warnings about COVID-19. Several liberal activists — like Tsinghua University Professor Xu Zhangrun, private entrepreneur Ren Zhiqiang and political activist Xu Zhiyong — publicly denounced the ‘crisis of governance’ provoked by Chinese President Xi Jinping’s concentration of power. While these criticisms were silenced, some foreign organisations and governments filed lawsuits demanding compensation for damages caused by the pandemic.

In response, the central government blamed the mishandling on local leadership and fired the party chief of Hubei province, Jiang Chaoliang, and mayor of Wuhan Ma Guoqiang, along with some health officials. After confinement measures contained the virus, Beijing became increasingly aggressive in spreading conspiracy theories and blaming foreigners. The spokesperson of China’s Foreign Ministry crudely blamed the US military for bringing the virus to China during the Military World Games in October 2019.

In the United States, President Donald Trump was unprepared, ill-equipped and overwhelmed in trying to manage the pandemic. After the World Health Organization (WHO) declared a ’Public Health Emergency of International Concern’ in January, he spent more than a month downplaying the threat and delaying diagnostic testing and stockpiling of essential equipment.

In response to criticism from Democrats and medical professionals, Trump focussed his efforts on rewriting the timeline of his response in a distorted and inaccurate manner and blamed the WHO and China for his failure to contain the pandemic. He temporarily halted funding to the WHO because they took China’s claims about the coronavirus ‘at face value’ and failed to share information about the pandemic. Blaming China for the suppression of early warnings, he is calling for an international investigation into the alleged origin of COVID-19 in a Wuhan lab.

The blame game between the United States and China is eviscerating international cooperation and preventing multilateral institutions from fighting the pandemic. Despite the threat to global security, the UN Security Council (UNSC) is not mobilising global resources against the pandemic.

The UNSC passed Resolution 1308 on HIV/AIDS in Africa in July 2000, transforming a public health concern into an international security matter by recognising the importance of a coordinated international response. The UNSC’s actions helped establish the Global Fund for AIDS, Tuberculosis, and Malaria in 2002. It also passed Resolution 2177 in September 2014, declaring the Ebola outbreak in West Africa a ‘threat to international peace and security’. The resolution empowered the UN secretary-general to create the UN Mission for Ebola Emergency Response — the first UN emergency mission directed at a public health crisis.

But the UNSC failed to issue a resolution or declaration this time. China held the rotating presidency in March and insisted that its involvement in COVID-19 was unwarranted and an intrusion into the sovereign affairs of UN member states. China’s UN envoy explained that this ‘public health’ matter did not fall within the UNSC’s ‘geopolitical’ ambit. Sovereignty became a shell for China to ward off any blame for its initial cover-up of the outbreak.

Washington also dragged its feet, demanding that any resolution specify the Chinese origins of the virus. Beijing blasted Washington for politicising the outbreak and blaming China.

Estonia, a rotating member of the UNSC, proposed a joint statement expressing ‘growing concern about the unprecedented extent of the COVID-19 outbreak in the world, which may constitute a threat to international peace and security’. China rejected the draft because it included a phrase that all countries show ‘full transparency’, interpreting it as a veiled attack on its handling of COVID-19.

While big power rivalry paralysed the UN response to the pandemic, the G7 meeting in March also failed to agree on a joint declaration because of US Secretary of State Mike Pompeo’s insistence on describing COVID-19 as the ‘Wuhan virus’ and the others gave up in disgust. The G20 meeting on the following day was unable to coordinate a global economic strategy to protect critical global supply chains and avoid deepening the recession. The China–US infighting prevented convening another G20 meeting in April.

The WHO remains the technical focal point for the pandemic response within the UN system, but it lacks the authority to cut through political obstacles. Turning the tide on the pandemic and dealing with its economic fallout will require unprecedented international cooperation — including prompt collective decisions on matters that are fundamentally political in nature, rather than purely technical.

The COVID-19 pandemic could be a moment for the United States and China to tackle a shared challenge. The pandemic is a non-traditional security threat that transcends rivalry and enmity, diluting the concept of a zero-sum military-led national security threat. Like an earthquake or climate change, COVID-19 is non-discriminatory and unbiased when it comes to wealth, ethnicity, nationality, ideology and systems of government.

Unfortunately, the global leadership needed for international cooperation is absent when it is required most urgently. The blame game between the two largest economies is hampering the global coordination and multilateral responses that are now urgently needed.

Suisheng Zhao is Professor and Director of the Center for China–US Cooperation at the Josef Korbel School of International Studies, The University of Denver. He is Editor of The Journal of Contemporary China.

This article is part of an EAF special feature series on the novel coronavirus crisis and its impact.

Courtesy:East Asia Forum

Growth, interrupted: COVID-19 and China’s 2020 economic outlook

17 May 2020

Author: Justin Yifu Lin, Peking University

In order to realise its goals to double 2010 GDP and per capita GDP by 2020, China needs to achieve at least 5.6 per cent growth this year. This growth target would not have been difficult to achieve if not for the unexpected outbreak of COVID-19 in January.

China took effective measures to suppress the pandemic. The whole country was under lockdown in February. In March, control measures were relaxed and production and business started to resume. But many export-oriented enterprises encountered a sudden drop or cancellation of orders due to the impact of COVID-19 in Europe, the United States and other parts of the world. China’s GDP fell 6.8 per cent year-on-year in the first quarter of 2020.

The risk of a possible second wave of COVID-19 infections means prevention measures need to be instilled and normalised as China embarks on the long road to economic recovery. In the second quarter, China’s economic growth is likely to experience a slow recovery. China’s growth in 2020 will depend on a rebound in the third and fourth quarters.

The World Trade Organization predicts that global merchandise trade will decline by between 13 per cent and 32 per cent this year. China’s growth will thus depend mainly on the increase of its domestic investment and consumption demands. If the growth rate can reach 10 per cent in the third and fourth quarters, the annual growth rate will be between 3 per cent and 4 per cent.

From the perspective of China’s fiscal and monetary policy space, and bearing in mind the government’s implementation capacity, it is not impossible to achieve a growth rate of 5 per cent or higher for the year by stimulating domestic investment and consumption. But to achieve this, year-on-year growth in the third and fourth quarters will need to reach about 15 per cent.

Considering the need to normalise epidemic prevention and control measures as well as the uncertainties facing the global economy, China should preserve some room for policy leeway over the coming years. According to the IMF’s World Economic Outlook released in April, the global economy will contract by 3 per cent in 2020. If China can grow 3 to 4 per cent this year, it will be a great achievement.

As long as it maintains 3 to 4 per cent growth next year, the goals of doubling its 2010 GDP and per capita GDP will be achieved by 2021. In this once-in-a-century global pandemic and economic recession, it is entirely understandable and reasonable to postpone a target set 10 years ago by one year.

In the past, the impact of financial and economic crises on the economy were generally felt on the demand side. COVID-19, on the other hand, has shocked both the demand and supply side at the same time. Previously the Chinese government mainly relied on monetary and fiscal policies to support infrastructure investment that created jobs and stabilised economic growth. This time, in addition to new infrastructure projects, China needs to support household consumption and help small- and medium-sized enterprises weather this difficult storm.

To increase consumption, China can issue vouchers to the urban poor, middle and low-income families and the unemployed, and raise the standard of minimum living insurance and assistance to low-income families in the countryside.

According to a Tsinghua University survey, 85 per cent of private enterprises in March will struggle to survive over the next three months. Bankruptcy of enterprises will lead to an increase in unemployment. Additionally, once the pandemic is over, bankrupt enterprises will face numerous difficulties as they rebuild. The protection of enterprises is therefore critical as it protects jobs and maintains the foundation of the Chinese economy. In terms of supporting enterprises, China can delay loan repayments, increase loans to enterprises and reduce their taxes and rental expenses.

Overall, the Chinese government should take advantage of its favourable fiscal and monetary policy space to stabilise the financial system, increase credits to help enterprises, invest in new infrastructure and provide necessary support for families adversely affected by the pandemic. These measures will help to expand domestic demand, maintain social stability and eliminate the bottleneck of future economic growth. China has the ability to maintain a reasonable growth rate in 2020. Like it has since 2008, China will drive the world’s economic growth and recovery as it emerges from the coronavirus crisis.

Justin Yifu Lin is Dean of the Institute of New Structural Economics and Professor of the School of National Development at Peking University.

This article is part of an EAF special feature series on the novel coronavirus crisis and its impact.

Courtesy:East Asia Forum

Pitfalls of competitive connectivity in Asia

16 May 2020

Author: Jürgen Rüland, University of Freiburg

Geopolitical competition between the United States and China is most tangible in Asia. In 2011, Washington responded to China’s growing influence in the region with its ‘Pivot to Asia’. Two years later, Beijing countered with its Belt and Road Initiative (BRI) — a US$1 trillion infrastructure development program connecting Asia with Europe via land, sea and the polar route. Although promoted as a way to improve regional integration and economic growth, the BRI is widely viewed as China’s grand strategy to maximise its global clout.

The BRI triggered competing infrastructure schemes. In 2015, Japan launched its ‘Partnership for Quality Infrastructure’ and in 2016, ASEAN amended its Master Plan on ASEAN Connectivity. Then in 2018, the United States passed the Better Utilization of Investments Leading to Development (BUILD) Act and the European Union released its EU–Asia Connectivity scheme.

Connectivity has become the buzzword for poor countries in the process of jump-starting industrialisation and for more advanced economies trying to avoid the middle-income trap. Most Asian countries want a share of the infrastructure cake. Infrastructure is a prerequisite for economic growth, but there are big questions about its sustainability.

As donors compete for projects with the strategic objective of strengthening their influence in recipient countries, projects must be affordable and implemented quickly. China seeks to increase its attractiveness as a partner by promising speedy planning and implementation without the intrusive conditionalities of multilateral donors like the World Bank and most Western donors. This prompted even Japan — a member of the OECD Development Assistance Committee and the Asian Development Bank — to announce faster project execution. Other donors like India, South Korea, Thailand and Malaysia are, like China, more interested in effective project completion than in social and environmental sustainability.

Many infrastructure projects ignore best practices. Dam projects, special economic zones, railways, roads and power plants can displace those living on or near project sites. Many are resettled with little, no or markedly delayed compensation. Subsistence farmers, fishermen and indigenous people lose their livelihood and face permanent poverty. Stakeholder consultation is absent and jobs remain an empty promise. Chinese contractors often bring their own workforce, while in other cases the bulk of jobs go to internal migrants.

Special industrial zones — celebrated as providing mass employment — rarely live up to this promise as they have long gestation periods of up to 10 years before becoming fully operational. The jobs they provide offer low pay and poor working conditions.

On the environmental front, the dams along the Mekong, the Salween and their tributaries negatively impact sedimentation, fish migration and biodiversity. They cause soil erosion and the salinisation of the Mekong Delta. This severely endangers inland fisheries and agriculture in Southeast Asia’s rice bowl, which depends on sediment flow.

While China and Japan seek to produce clean energy at home, they still finance and export coal-fired power plants to many parts of Asia. Although they cease to export subcritical low-efficiency coal technology and now build ‘supercritical’ and ‘ultra-supercritical’ plants, the great number of plants planned or under construction will markedly increase carbon dioxide emissions. Coal-fired power plants also emit other pollutants like toxic gases, coal ash and acid rain, causing serious health problems for people living near the sites.

Apart from the unbridled competition among provider countries, another reason for the low social and environmental standards of many infrastructure projects is the developmental state model that catapulted Asia’s economic frontrunners to advanced economies within a short time. Developing countries seek to kick-start rapid industrialisation and economic growth with state regulation of markets, advancements in productivity, close interaction between state and business elites, a strong state that tightly controls civil society and a belief in technocratic rationality. Commitments to equality, social welfare and environmental sustainability are largely absent.

As China and Japan seek to persuade aid recipients to follow their developmental state model, many infrastructure projects reflect traits of the developmental state in a path-dependent way. They prioritise rapid economic growth and industrialisation over social and environmental concerns. For the developmental state, aggregate gains count while individual suffering caused by rapid modernisation takes a backseat. Contractors are often state-owned enterprises or companies closely linked to the state. Civil society protest against the projects is muzzled by local authorities and problems are believed to be solvable by advanced technology.

This is not an argument against infrastructure modernisation. It is an appeal for socially and environmentally sustainable infrastructure. The infrastructure programs championed by Western donors in the 1960s and 1970s and the great number of ‘white elephants’ they produced, stimulated learning the hard way. Meanwhile, international organisations such as the International Commission on Large Dams, the United Nations, the World Bank and the OECD have set standards for sustainable infrastructure.

There is no need to repeat the mistakes of the past. As geopolitical competition in Asia intensifies, embracing best practices can help the region’s infrastructure development to evade a race to the bottom in environmental policy and prevent the production of a large cohort of losers as a result of modernisation. The recent Cambodian decision to put on hold plans for two mainstream Mekong dams indicates re-thinking in the right direction.

Jürgen Rüland is Professor Emeritus in the Department of Political Science at the University of Freiburg.

This article is drawn from the author’s recent publication ‘Old Wine in New Bottles? How Competitive Connectivity Revitalises an Obsolete Development Agenda in Asia’ in the Journal of Contemporary Asia.

Courtesy:East Asia Forum

Malaysia needs innovative fiscal measures for sustainable health financing

15 May 2020

Author: Yen Lian Tan, Southeast Asia Tobacco Control Alliance

Non-communicable diseases (NCDs) accounted for 73 per cent of total deaths in Malaysia in 2015, with half of these being due to cardiovascular diseases. This health burden is growing as the prevalence of NCD risk factors continue to rise among Malaysians.

The now abolished Malaysian Health Promotion Board (MySihat) complemented the Ministry of Health’s (MOH) role in the prevention and control of NCDs by promoting healthy lifestyles. Its work was in line with the priority areas of the Malaysia–WHO Country Cooperation Strategy 2016–2020.

MySihat, established as a statutory body by the Malaysian Health Promotion Board Act (Act 651), was a semi-autonomous entity within the MOH. Since its inception in 2006, it has promoted healthy lifestyles and chronic disease prevention programs. MySihat initially proposed to secure stable financing by imposing an earmarked tax on tobacco, alcohol and other harmful products. But a lack of political commitment changed the funding sources. MySihat was offered funding through the treasury budget’s allocation for health. But the MOH makes the final decision on the distribution of funds.

This funding mechanism is often limited and varies yearly depending on the availability of funds. Allocation is determined by the past year’s performance and competition with other programs. MySihat received an annual allocation of RM36 million (US$8.2 million) in 2007 but it dwindled to RM5.5 million (US$1.3 million) in 2016 and was maintained that amount until 2018.

MySihat spent 42 per cent of its budget between 2008–2018 to support the implementation of various health promotion programs at the community level. It collaborated with more than 1000 groups and organisations over that period and supported cross-sector partnerships between government, non-governmental organisations (NGOs) and the community. Such partnerships build the capacity to strengthen health promotion knowledge and skills among health-related and community-based organisations, benefitting millions nationwide.

In June 2018, Health Minister Dr Dzulkefly Ahmad announced a cabinet decision to abolish MySihat as part of the government’s rationalisation plan. Health advocates and NGOs have expressed their concerns.

MySihat’s responsibilities were transferred to other MOH departments without addressing the funding source problems for the annual health promotion programs. Most of the health budget is allocated to curative (acute) health care over preventive health promotion initiatives. The 2020 budget allocated the health sector RM30.6 billion (US$7 billion). But the allocation for prevention and control programs was unclear, and the country’s NCD burden remains unabated.

Health promotion needs multi-sectoral collaboration and a new sustainable financing mechanism for innovative health promotion programs. Additional fiscal resources are needed to achieve the 17 Sustainable Development Goals in the United Nations’ 2030 Agenda.

One way is to impose a surcharge tax on health-harming products, like tobacco, to generate a secure funding stream for health promotion. Its consumption contributes to all four major NCDs. This is in line with recommendations from the Article 6 Guidelines and Article 26 of the World Health Organization Framework Convention on Tobacco Control. Earmarking tobacco tax revenue would strengthen the effectiveness and sustainability of current health literacy and NCD prevention programs. This has been successful in 30 other countries.

Adopting and adapting experiences from the Thai Health Promotion Foundation (ThaiHealth) and other health promotion foundations worldwide would help to shape a new health promotion foundation in Malaysia. Thailand is the first ASEAN country to establish an autonomous health promotion agency. Since ThaiHealth’s establishment in 2001, it has received funding through a 2 per cent surcharge levied on alcohol and tobacco excise tax.

The ThaiHealth funding mechanism has been effective in securing a reliable source of funding for health promotion. The funding for Thai Health has increased from 3.1 million baht (US$95,500) in 2010 to 4.4 million baht (US$135,500) in 2017, enabling it to implement short-, medium- and long-term health promotion programs across the country. In 2017, a 2.9 million baht (US$89,300) fund was allocated for some major NCD risk reduction programs such as tobacco and alcohol control, and traffic accident prevention.

Such an allocation is a small investment compared to the economic cost of 280 billion baht (US$8.6 billion) — or 2 per cent of GDP — attributed to NCDs due to premature deaths and loss of productivity in the workforce in 2013. Many countries regard ThaiHealth as the gold standard for health promotion models.

To address the problems faced by MySihat, the Malaysian government should replace MySihat with an autonomous agency, using surcharge tax to secure a predictable and stable budget for health promotion programs. It will be a win-win policy for health as well as the budget.

Yen Lian Tan is the Knowledge and Information Manager at the Southeast Asia Tobacco Control Alliance (SEATCA).

Courtesy:East Asia Forum

UN rights chief warns against mishandling the lifting of COVID-19 lo

14 May 2020

The UN Human Rights High Commissioner on Thursday warned of potential risks as more countries move to lift lockdown measures put in place to contain COVID-19 spread.

Michelle Bachelet -- a former doctor, health minister and Head of State -- acknowledged the challenge facing governments as they grapple with the medical crisis, while also trying to save their economies from collapsing.

Michelle Bachelet

✔@mbachelet

When drawing up plans to lift #lockdowns, States should consult affected communities, as well as those on the #COVID19 front-lines. Participation builds trust and better compliance with measures to restrict contagion.#WeAreAllInThisTogether

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“Balancing the economic imperatives with the health and human rights imperatives during the COVID-19 pandemic is going to be one of the most delicate, daunting and defining experiences for all leaders and all governments. Their place in history will be decided by how well or how badly they perform over the coming months”. she said, speaking from Geneva to journalists.

“If their response is based on the interests of a particular elite - causing the disease to flare up again in other less privileged or marginalized communities - it will rebound on everyone.”

Danger of COVID-19 second wave

COVID-19 continues to disrupt the lives of billions across the planet, including countless workers and students who are now confined to their homes in efforts to protect lives from the deadly disease.

More than four million cases were recorded globally as of Thursday, and more than 290,000 deaths, according to the World Health Organization (WHO).

“If an affected country comes out of lock-down too hastily, there is a danger that a second wave, costing many more lives, will be triggered sooner and more destructively than would otherwise be the case,” said Ms. Bachelet.

“If the re-opening of societies is mishandled, all the huge sacrifices made during the initial lock-down will have been for nothing. However, the damage to individuals and to economies, will not just be retained - it will be significantly amplified. “

WHO guidelines paramount

The UN rights chief posited considerations for lifting lockdowns, focused primarily on WHO guidance which stresses that transmission needs to be controlled while healthcare systems must be able to detect, test, isolate and treat every case, and trace contacts.

She pointed to South Korea, New Zealand and Germany as countries that have followed this advice from the outset.

However, she added that “we can also learn lessons” from South Korea and Germany which have seen a resurgence of COVID-19 cases since relaxing their lockdown and emergency measures.

Neglect in care homes ‘horrifying’

Ms. Bachelet also underlined the need to address disease risk in vulnerable locations such as care homes, psychiatric institutions, refugee camps and detention centres.

“And are there plans in place to ensure isolation and specialised treatment for all those who may become exposed to COVID-19 in the future? The neglect of elderly people in care homes in some countries during the first wave of the pandemic has been horrifying”, noted the High Commissioner.

Special measures are also needed in high-density residential areas such as slums, and other areas without adequate water, sanitation or healthcare facilities.

Similarly, plans to ease lockdowns should include specific measures for high-risk groups, which include racial and ethnic minorities, migrant workers, people with disabilities, those with existing underlying health conditions, and the elderly.

“Never before has it been sostarkly clear that it is important for all of us that no one is left out of social protection schemes. And in some countries such schemes barely exist”, she said, highlighting the need to support poorer nations.

Safer workspaces and public transportation

Turning to the workplace, Ms. Bachelet said authorities will have to ensure employees are protected when they return to their jobs. For example, those whose work involves contact with the public will need to be provided with masks, sanitizers and shielding materials. Additionally, public transport will need to be made as safe as possible.

“When lifting lockdowns, those without stable incomes, those not able to work remotely, and all those in essential jobs - which is not just health workers - will face the highest risks. It is finally starting to be noticed that disproportionate numbers of essential workers are migrants, and that most of them, despite being ‘essential’ are often very poorly paid”, she added.

Moving forward will also mean consulting with citizens in decisions that affect their lives, including how to lift emergency measures.

Participation, she said, builds greater trust in the authorities and better compliance with public health measures.

“As a former politician, I know how difficult it can be for national leaders and ruling parties to take politics out of the equation. But this pandemic will not be contained by politics or ideologies, or by a purely economic focus. It will be contained by careful, sensitive, science-guided policymaking, and by responsible, humane leadership”, said Ms. Bachelet.

“Letting politics or economics drive the response at the expense of health and human rights will cost lives and do even more damage in both the short and long terms. Such approaches are simply not sustainable. And they will not be sustainable in the future either. We will not be able simply to return to the ‘normal’ economy, and other parts of the pre-COVID-19 status quo, when the pandemic is over. That should be the most important lesson learned from this crisis.”