Amit Sengupta

Human papillomavirus vaccine trials in India

www.thelancet.com Vol 377 February 26, 2011 719 We therefore believe that the strongest evidence favouring chestcompression-only CPR is in arrest of cardiac cause. We agree with Alexis Descatha and Daniel Jost that most observational studies in chest-compression-only CPR are subject to bias owing to the manifold reasons why some bystanders chose chest compressiononly over standard CPR. We also agree with Toshikazu Abe and Yasuharu Tokuda that neurologically intact survival after out-of-hospital cardiac arrest is paramount, but despite their assertion that no clinical trial showed a signifi cant diff erence between chest-compression-only CPR and standard CPR, the study by Rea and colleagues showed a 25% improvement in neurologically intact survival for patients who received chest-compression-only CPR (p=0·13). We interpret this fi nding as underpowered rather than statistically negative.

Ebola epidemic exposes the pathology of the global economic and political system.

While the current Ebola epidemic spiraled out of control to become the biggest in history, the global public health response has been criticized as “too little, too late.” Many, like the World Health Organization, are asking what lessons have been learned from this epidemic. We present an analysis of the political economy of this Ebola outbreak that reveals the importance of addressing the social determinants that facilitated the exposure of populations, previously unaffected by Ebola Virus Disease, to infection and restricted the capacity for an effective medical response. To prevent further such crises, the global public health community has a responsibility to advocate for health system investment and development and for fundamental pro-poor changes to economic and power relations in the region.

A new Director General for WHO--an opportunity for bold and inspirational leadership.

But further discussion is needed before the election of a new Director-General this November. What challenges are faced by WHO and its new head, and how can individuals and institutions strengthen WHO’s capacity to respond eff ectively to the world’s health challenges? These are not idle questions, for all is not well at WHO. For millions of people, the prospect of a basic level of health security remains a distant hope. Furthermore, as the importance of global and supranational determinants of health increases, so does that of global public-health institutions. In this article, the People’s Health Movement, a worldwide network of individuals and civil society organisations committed to the vision and principles of the 1978 Alma Ata Declaration, identifi es three sets of global health challenges and the kind of response it would like from WHO. We also discuss the constraints and barriers faced by WHO itself, and suggest actions that should be taken by WHO and its new Director-General, as well as by governments and civil society. Key global health challenges Poverty and the global political economy Poverty remains the world’s biggest health problem, underlying the HIV/AIDS crisis, the high mortality attributed to tuberculosis and malaria, and the 30 000 deaths of children every day from preventable and treatable causes. It also results in governments being unable to foster socioeconomic development and invest in eff ective health, welfare, and education systems. Frequent references are made to the World Bank calculation that the number and proportion of people living on less than US

Comment — WHO's weakness is not technical, but due to lack of accountability

1 per day has fallen since the late 1980s. However, less is said about this calculation’s systematic underestimation of the extent of impoverishment. 4

The rise of private medicine in South Asia

Negin and Dhillons proposal that functions presently carried out by WHO should be ‘outsourced’ to the Gates Foundation, the Gates-funded Institute for Health Metrics and Evaluation (IHME), Medicins Sans Frontieres and national drug regulatory agencies such as the US Food and Drug Administration (FDA), lacks evidence, relies on flawed logic and serves to obscure critical causes of WHOs failures, in particular the donor chokehold. Negin and Dhillon cite a Cochrane review of outsourcing of healthcare in low-income and middle-income countries.1 Yet this review found only three studies that met its inclusion criteria all of which had a low quality of evidence and showed a high risk of bias. WHOs accountability is …

Book Review: Amartya Sen, The Country of First Boys and Other Essays

Amit Sengupta and colleagues describe how stagnant public investment in health in South Asia has seen a growth in private practice and may hamper efforts to enable universal health coverage in the region

Social and political remedies needed for the Ebola tragedy

Amartya Sen, The Country of First Boys and Other Essays, New Delhi, The Little Magazine and Oxford University Press, 2015, 328 pp., ₹ 550, ISBN: 978-0-19-873818-3.

Book Review: Global Health Watch 3, An Alternative World Health ReportPeople’s Health Movement, Cape Town, Medact, London, Health Action International, Amsterdam, Medico International, Frankfurt and Third World Network, Penang, Global Health Watch 3, An Alternative World Health Report, London and New York: ZED Books, 2011.

John Tasioulas and Effy Vayena’s (April 25, e42) stimulating Viewpoint on the crucial part played by human rights in directing global health policy correctly emphasises the significance of the moral and legal imperative inherent in the human rights rationale. Where this Viewpoint seems to err is in its use of the right to health moniker—the right to the highest attainable standard of health being a qualified, rather than an absolute right. The term right to heath is appealing, yet, tellingly, lawyers avoided the label right to justice for the analogy of health care. The right to due process can no more guarantee justice than can a health-related intervention guarantee health (not to mention immortality). The term was coined as a shorthand expression during development of health rights by eminent lawyers and academics. Problematically, in apparently purporting to guarantee health, the term risks degrading health rights discourse and health service planning, and confounding patients’ expectations. The most authoritative definition of this right is 65 paragraphs long; it amounts to a set of social arrangements—norms, institutions, and laws—an enabling environment that best secures enjoyment of the right. The authors’ two conclusive points— that some factors important to health are not human rights issues and some are covered by or compete against nonhealth rights law—are inconsequential because the international human right to the highest attainable standard of health requires the enabling environment to be achieved.

The private health sector in India

environment at primary stage has been analysed and concluded that the situation is mixed with expansions of schooling facilities and improvement in infrastructure. It also focuses on the functioning of government schools and emergence of private schools in rural areas. The chapter critically examines the findings of the survey on the teacher-related concerns, such as profile of the teachers, shortage of teachers, pupil–teacher proportion and change in the teaching–learning process. In Chapter 4, the report tries to relate the school and family context of the child. It concludes that the socio-economic context and family attitudes influence educational outcome. In Chapter 5, for the first time, the PROBE survey looks at the situation of middle schooling and examines all aspects for quality schooling at the level in detail. It finds that the demand for middle level schooling has grown substantially over the past decades or so, but children from more disadvantaged groups, particularly girls from these groups, mostly dropped out just after completing grade 5 or between 6 and 8. Chapter 6 of this report takes the stock of ongoing revolution in Himachal Pradesh and critically examines the successful implementation and delivery mechanism of government school in the state. The chapter concludes with how the ‘system works’ and sustained systemic improvement is possible. In Chapter 7, the report presents the conclusion of the survey and discusses the critical areas and concern that require immediate attention and integrated efforts for achieving the goal of education for all. The report PROBE Revisited is not a simple revisit of the 1996 PROBE but the present report goes beyond by extending the focus in many ways. Though it is not an all-India report on elementary education but the outcome of this report may be useful for educationists, planners and policy makers, funding agencies and NGOs, who are involved in planning, administration and implementation of elementary education, and researchers across the social sciences and all those concerned with elementary education in India.