Disability as deprivation of capabilities: Estimation using a large-scale survey in Morocco and Tunisia and an instrumental variable approach.

The capability approach pioneered by Amartya Sen and Martha Nussbaum offers a new paradigm to examine disability, poverty and their complex associations. Disability is hence defined as a situation in which a person with an impairment faces various forms of restrictions in functionings and capabilities. Additionally, poverty is not the mere absence of income but a lack of ability to achieve essential functionings; disability is consequently the poverty of capabilities of persons with impairment. It is the lack of opportunities in a given context and agency that leads to persons with disabilities being poorer than other social groups. Consequently, poverty of people with disabilities comprises of complex processes of social exclusion and disempowerment. Despite growing evidence that persons with disabilities face higher levels of poverty, the literature from low and middle-income countries that analyzes the causal link between disability and poverty, remains limited. Drawing on data from a large case control field survey carried out between December 24th, 2013 and February 16th, 2014 in Tunisia and between November 4th, 2013 and June 12th, 2014 in Morocco, we examined the effect of impairment on various basic capabilities, health related quality of life and multidimensional poverty - indicators of poor wellbeing-in Morocco and Tunisia. To demonstrate a causal link between impairment and deprivation of capabilities, we used instrumental variable regression analyses. In both countries, we found lower access to jobs for persons with impairment. Health related quality of life was also lower for this group who also faced a higher risk of multidimensional poverty. There was no significant direct effect of impairment on access to school and acquiring literacy in both countries, and on access to health care and expenses in Tunisia, while having an impairment reduced access to healthcare facilities in Morocco and out of pocket expenditures. These results suggest that public policies in Morocco and Tunisia must create additional and targeted opportunities for persons with disabilities through innovative social arrangements to improve wellbeing.

Addiction research centres and the nurturing of creativity. Monitoring the European drug situation: the ongoing challenge for the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA).

The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) is the designated hub for drug-related information in the European Union. The organization's role is to provide the European Union (EU) and its Member States with a factual overview of European drug problems and a common information framework to support the drugs debate. In order to achieve its mission, the EMCDDA coordinates and relies on a network of 30 national monitoring centres, the Reitox National Focal Points. The Centre publishes on a wide range of drug-related topics, across epidemiology, interventions, laws and policies. Every November, the EMCDDA publishes its Annual Report, providing a yearly update on the European drug situation, translated into 23 EU languages. In line with its founding regulation, the EMCDDA has a role acting as an interface between the worlds of science and policy. While not a research centre in the formal sense, the results the Centre generates serve as catalysts for new research questions and help to identify priorities. Current challenges facing the agency include continuing to increase scientific standards while maintaining a strong institutional role, as well as supporting European efforts to identify, share and codify best practice in the drugs field.

Khat use and monitoring drug use in Europe: the current situation and issues for the future.

AIM OF THE STUDY: To review the information available on the use of khat (Catha edulis) in the EU, and to assess the future use of this drug and related substances. MATERIAL AND METHODS: Khat is not controlled by international law and it has not been systematically included in the list of illicit drugs monitored in the EU. The current principal source of information on khat use in Europe is the early-warning system set up to monitor new and emerging drugs. Further information was obtained from official national reports to the EMCDDA and from the scientific literature. RESULTS: Across Europe, the use of khat is low. Khat use is limited to countries with immigrant communities from countries where khat use is common (such as Ethiopia, Somalia and Kenya). Information on the prevalence of khat use in the general population is scarce. Data on seizures provide an insight on the situation, though these may be difficult to interpret. The most recent estimates suggest that Europe accounts for about 40% of the khat seized worldwide. CONCLUSION: The shortage of data on the use and patterns of use of khat in Europe does not allow an evaluation of the needs for health and social interventions in communities in which the drug is used. But seizures of the plant are increasing in the EU, and more synthetic derivatives of the pharmacologically active ingredients of the plant (cathine and cathinone) are appearing on the market. Some of these, like mephedrone, have significant potential for future diffusion, and are likely to play a greater role on the European drug scene of the future.

Poverty, vulnerability, and provision of healthcare in Afghanistan.

This paper presents findings on conditions of healthcare delivery in Afghanistan. There is an ongoing debate about barriers to healthcare in low-income as well as fragile states. In 2002, the Government of Afghanistan established a Basic Package of Health Services (BPHS), contracting primary healthcare delivery to non-state providers. The priority was to give access to the most vulnerable groups: women, children, disabled persons, and the poorest households. In 2005, we conducted a nationwide survey, and using a logistic regression model, investigated provider choice. We also measured associations between perceived availability and usefulness of healthcare providers. Our results indicate that the implementation of the package has partially reached its goal: to target the most vulnerable. The pattern of use of healthcare provider suggests that disabled people, female-headed households, and poorest households visited health centres more often (during the year preceding the survey interview). But these vulnerable groups faced more difficulties while using health centres, hospitals as well as private providers and their out-of-pocket expenditure was higher than other groups. In the model of provider choice, time to travel reduces the likelihood for all Afghans of choosing health centres and hospitals. We situate these findings in the larger context of current debates regarding healthcare delivery for vulnerable populations in fragile state environments. The 'scaling-up process' is faced with several issues that jeopardize the objective of equitable access: cost of care, coverage of remote areas, and competition from profit-orientated providers. To overcome these structural barriers, we suggest reinforcing processes of transparency, accountability and participation.

Quite a lot of smoke but very limited fire--the use of methamphetamine in Europe.

INTRODUCTION AND AIMS: This paper provides an overview of the historical development, current situation and potential future diffusion of methamphetamine (MA) use in Europe. DESIGN AND METHODS: The analysis is based on a review of published and grey literature, as well as data collected as part of the ongoing monitoring of the drug situation in Europe. Some qualitative surveys among high-risk populations do exist, but overall the general low prevalence of methamphetamine use in most of Europe means that the data available to explore patterns of use are limited. RESULTS: In many parts of Europe, amphetamine use is well established and the injecting of amphetamines has historically constituted an important component of the drug problem in many Nordic countries. Methamphetamine problems are long documented in the Czech and Slovak republics, but there is no current evidence of widespread use of MA elsewhere in Europe. Concern that MA use is spreading in Europe is prompted by some reports of use among high-risk groups. However, the evidence available suggests that even in high-risk populations, the use of MA currently remains uncommon. Europe accounted for less than 1% of worldwide MA seizures in 2005, and over the period 2004-05 European ephedrine seizures amounted for 6% of the global figure. DISCUSSION: The spread of MA use is limited and no strong evidence exists that significant diffusion is occurring. It appears likely that methamphetamine diffusion in Europe is impeded by a strong market for other stimulant drugs [cocaine, amphetamine and methylenedioxymethamphetamine (MDMA)]. The future potential for the diffusion of MA may be influenced by factors such as: the relative availability and popularity of other drugs; possible 'leakage' from areas of historical high prevalence; travel by young Europeans to areas of high prevalence; and how users perceive MA as a desirable, suitable and cost-effective alternative to other stimulants available on the European illicit drug market.