Structural adjustment, state capacity and child health: evidence from IMF programmes.

BACKGROUND: Consensus is growing that policy reform programmes by the International Monetary Fund (IMF)-an international organization mandated with upholding global financial stability and assisting countries in economic turmoil-produce adverse effects on public health. However, this consensus is unclear about which policies of these programmes underlie these effects. This article fills parts of this gap by examining the impact of four kinds of IMF policies (fiscal policy, public-sector employment, privatization of state-owned enterprises and price liberalization) on public-health expenditure, child vaccination and child mortality. METHODS: We conducted time-series cross-section analyses for up to 128 developing countries over the 1980-2014 period using observational data on health outcomes and IMF conditionality for different policy areas. IMF effectiveness research faces two types of potential biases: self-selection into IMF programmes and IMF policy conditions. We deployed instrumental variables in a seemingly unrelated regression framework to address both types of endogeneity, besides traditional remedies such as the use of fixed effects on countries and years. RESULTS: IMF policy conditions on public-sector employment are negatively related to child health. A change from the minimum to the maximum number of such policy conditions decreases vaccination (which ranges from 0 to 100) by 10.97% [95% confidence interval (CI): 1.16 to 20.79]. This effect is robust against different sets of control variables. In addition, IMF programmes increase the share of government expenditure devoted to public health in developing countries by 0.91 percentage points (95% CI: 0.15 to 1.68). CONCLUSIONS: These findings suggest that IMF policies-particularly those that require public-sector reforms-undermine health by weakening the capacity of states to deliver vaccination. Therefore, international financial institutions need to increase their awareness of the public-health impact of their policy prescriptions. Strengthening state capacity in times of economic crisis would ensure that increased health spending also delivers quality healthcare.

Trade challenges at the World Trade Organization to national noncommunicable disease prevention policies: A thematic document analysis of trade and health policy space.

BACKGROUND: It has long been contested that trade rules and agreements are used to dispute regulations aimed at preventing noncommunicable diseases (NCDs). Yet most analyses of trade rules and agreements focus on trade disputes, potentially overlooking how a challenge to a regulation's consistency with trade rules may lead to 'policy or regulatory chill' effects whereby countries delay, alter, or repeal regulations in order to avoid the costs of a dispute. Systematic empirical analysis of this pathway to impact was previously prevented by a dearth of systematically coded data. METHODS AND FINDINGS: Here, we analyse a newly created dataset of trade challenges about food, beverage, and tobacco regulations among 122 World Trade Organization (WTO) members from January 1, 1995 to December 31, 2016. We thematically describe the scope and frequency of trade challenges, analyse economic asymmetries between countries raising and defending them, and summarise 4 cases of their possible influence. Between 1995 and 2016, 93 food, beverage, and tobacco regulations were challenged at the WTO. 'Unnecessary' trade costs were the focus of 16.4% of the challenges. Only one (1.1%) challenge remained unresolved and escalated to a trade dispute. Thirty-nine (41.9%) challenges focussed on labelling regulations, and 18 (19.4%) focussed on quality standards and restrictions on certain products like processed meats and cigarette flavourings. High-income countries raised 77.4% (n = 72) of all challenges raised against low- and lower-middle-income countries. We further identified 4 cases in Indonesia, Chile, Colombia, and Saudi Arabia in which challenges were associated with changes to food and beverage regulations. Data limitations precluded a comprehensive evaluation of policy impact and challenge validity. CONCLUSIONS: Policy makers appear to face significant pressure to design food, beverage, and tobacco regulations that other countries will deem consistent with trade rules. Trade-related influence on public health policy is likely to be understated by analyses limited to formal trade disputes.

True Dopers or Negligent Athletes? An Analysis of Anti-Doping Rule Violations Reported to the World Anti-Doping Agency 2010-2012.

BACKGROUND: The sanction that an athlete receives when an anti-doping rule violation has been committed depends on the specific circumstances of the case. Anti-doping tribunals decide on the final sanction, following the rules of the World Anti-Doping Code. OBJECTIVES: To assess the athletes' degree of fault based on the length of sanctions imposed on them to feed policy-related discussions. METHODS: Analysing data from the results management database of the World Anti-Doping Agency for anonymous information of anti-doping rule violations in eight selected sports covering the years 2010-2012. RESULTS: Four out of ten athletes who committed an anti-doping rule violation received a suspension that was lower than the standard. This is an indication that tribunals in many instances are not convinced that the athletes concerned were completely at fault, that mitigating circumstances were applicable, or that full responsibility of the suspected violation should not be held against them. Anabolic agents, peptide hormones, and hormone modulators lead to higher sanctions, as do combinations of several anti-doping rule violations. CONCLUSIONS: This first analysis of information from the World Anti-Doping Agency's results management database indicates that a large proportion of the athletes who commit anti-doping rule violations may have done this unintentionally. Anti-doping professionals should strive to improve this situation in various ways.

The impact of IMF conditionality on government health expenditure: A cross-national analysis of 16 West African nations.

How do International Monetary Fund (IMF) policy reforms-so-called 'conditionalities'-affect government health expenditures? We collected archival documents on IMF programmes from 1995 to 2014 to identify the pathways and impact of conditionality on government health spending in 16 West African countries. Based on a qualitative analysis of the data, we find that IMF policy reforms reduce fiscal space for investment in health, limit staff expansion of doctors and nurses, and lead to budget execution challenges in health systems. Further, we use cross-national fixed effects models to evaluate the relationship between IMF-mandated policy reforms and government health spending, adjusting for confounding economic and demographic factors and for selection bias. Each additional binding IMF policy reform reduces government health expenditure per capita by 0.248 percent (95% CI -0.435 to -0.060). Overall, our findings suggest that IMF conditionality impedes progress toward the attainment of universal health coverage.

How do the approaches to accountability compare for charities working in international development?

Approaches to accountability vary between charities working to reduce under-five mortality in underdeveloped countries, and healthcare workers and facilities in Canada. Comparison reveals key differences, similarities and trade-offs. For example, while health professionals are governed by legislation and healthcare facilities have a de facto obligation to be accredited, charities and other international organizations are not subject to mandatory international laws or guidelines or to de facto international standards. Charities have policy goals similar to those found in the Canadian substudies, including access, quality, cost control, cost-effectiveness and customer satisfaction. However, the relative absence of external policy tools means that these goals may not be realized. Accountability can be beneficial, but too much or the wrong kind of accountability can divert resources and diminish returns.

[Anti-doping policy development process in the sports world (1968~1999): focusing on IOC activities and passive response from Korea].

This study investigated the anti-doping policy promoted by the IOC historical sociologically focusing on the period from 1968 to 1999. Public opinion surrounding doping control has emerged as a large amount of drug possession by athletes who had participated in the 1952 Olympics was caught, as well as following the accident where an athlete had died during the competition as a result of doping. From 1960, as many doping cases in sports games were exposed, several international organizations proclaimed fight against doping in order to seek a preventive measure. In 1961, the IOC newly established a medical commission within the organization. It was decided to implement doping control and female sex testing at the same time for all athletes who participated in the 1967 Olympics, and they were implemented from 1968 winter and summer Olympic Games. In 1971, the provisions for the tests were prescribed as mandatory on the IOC charter. From 1989, the OCT system was introduced as a measure to overcome limitations of the detection during competition period. As political problems and limitations emerged, WADA (World Anti-Doping Agency) was established in 1999 to professionally manage and push for doping control. Female sex testing policy contributed to preventing males from participating in female competition by deceiving their gender to some extent. However, it was abolished due to strong public condemnation such as women's rights issues, social stigma and pain, and gender discrimination debate. In 1984, a doping control center was established in Korea, which enabled drug use or doping in the sports world to emerge to the surface in our society. Korea Sports Council and KOC articles of association that supervise doping related matters of Korean athletes were revised in 1990. The action of inserting doping related issue in the articles of association was taken 20 years after the start of IOC doping policy. Beginning with two international competitions in the 1980s, Korean athletes experienced doping test directly, yet education about doping was limited. However, some national team level athletes tested positive on the doping test and underwent disciplinary action. In addition, athletic federation or leaders acquiesced athletes doping made secretly; this indicated that South Korea was also not free from doping. It was found that Korea world of sports showed very passive countermeasures and development process.

[On the improvement of the legal support of the food safety in the conditions of trade and economic integration of states-members of the Customs union and the Russian Federation's accession to the WTO].

In the article priority activities of The Federal Service for the Oversight of Consumer Protection and Welfare on improvement of standard legal support of safety of foodstuff and control of compliance of foodstuff to legislation requirements are reported. The main documents directed on harmonization of the international requirements with national ones and requirements of the Customs union on safety of foodstuff are submitted. Work within a framework of Russian Federation's accession to the WTO is described. And data on control of quality and safety of foodstuff are provided also.

Health law and policy in the European Union.

From its origins as six western European countries coming together to reduce trade barriers, the European Union (EU) has expanded, both geographically and in the scope of its actions, to become an important supranational body whose policies affect almost all aspects of the lives of its citizens. This influence extends to health and health services. The EU's formal responsibilities in health and health services are limited in scope, but, it has substantial indirect influence on them. In this paper, we describe the institutions of the EU, its legislative process, and the nature of European law as it affects free movement of the goods, people, and services that affect health or are necessary to deliver health care. We show how the influence of the EU goes far beyond the activities that are most visible to health professionals, such as research funding and public health programmes, and involves an extensive body of legislation that affects almost every aspect of health and health care.

Lot-to-lot variability of test strips and accuracy assessment of systems for self-monitoring of blood glucose according to ISO 15197.

BACKGROUND: Accurate and reliable blood glucose (BG) measurements require that different test strip lots of the same BG monitoring system provide comparable measurement results. Only a small number of studies addressing this question have been published. METHODS: In this study, four test strip lots for each of five different BG systems [Accu-Chek® Aviva (system A), FreeStyle Lite® (system B), GlucoCheck XL (system C), Pura™/mylife™ Pura (system D), and OneTouch® Verio™ Pro (system E)] were evaluated with procedures according to DIN EN ISO 15197:2003. The BG system measurement results were compared with the manufacturer's measurement procedure (glucose oxidase or hexokinase method). Relative bias according to Bland and Altman and system accuracy according to ISO 15197 were analyzed. A BG system consists of the BG meter itself and the test strips. RESULTS: The maximum lot-to-lot difference between any two of the four evaluated test strip lots per BG system was 1.0% for system E, 2.1% for system A, 3.1% for system C, 6.9% for system B, and 13.0% for system D. Only two systems (systems A and B) fulfill the criteria of DIN EN ISO 15197:2003 with each test strip lot. CONCLUSIONS: Considerable lot-to-lot variability between test strip lots of the same BG system was found. These variations add to other sources of inaccuracy with the specific BG system. Manufacturers should regularly and effectively check the accuracy of their BG meters and test strips even between different test strip lots to minimize risk of false treatment decisions.

World Trade Organization activity for health services.

Since the establishment of a multilateral trading system and the increasing mobility of professionals and consumers of health services, it seems strongly necessary that the World Trade Organization (WTO) undertakes negotiations within the General Agreement on Trade in Services (GATS), and that WTO's members attempt to reach commitments for health-related trade in services. How important is the GATS for health policy and how does the GATS refer to health services? What are the current negotiations and member's commitments?

Governing sex workers in Timor Leste.

This paper argues that international security forces in Timor Leste depend upon civilian partners in HIV/AIDs "knowledge networks" to monitor prostitutes' disease status. These networks produce mobile expertise, techniques of government and forms of personhood that facilitate international government of distant populations without overt coercion. HIV/AIDs experts promote techniques of peer education, empowerment and community mobilisation to construct women who sell sex as health conscious sex workers. Such techniques make impoverished women responsible for their disease status, obscuring the political and economic contexts that produced that status. In the militarised context of Timor Leste, knowledge of the sexual conduct of sub-populations labelled high risk circulates among global HIV/AIDs knowledge networks, confirming their expert status while obscuring the sexual harm produced by military intervention. HIV/AIDs knowledge networks have recently begun to build Timorese sex worker organisations by contracting an Australian sex worker NGO to train a Timorese NGO tasked with building sex worker identity and community. Such efforts fail to address the needs and priorities of the women supposedly empowered. The paper engages theories of global knowledge networks, mobile technologies of government, and governmentality to analyse policy documents, reports, programmes, official statements, speeches, and journalistic accounts regarding prostitution in Timor Leste.

Is international agricultural research a global public good? The case of rice biofortification.

The status of international agricultural research as a global public good (GPG) has been widely accepted since the Green Revolution of the 1960s and 1970s. While the term was not used at the time of its creation, the Consultative Group on International Agricultural Research (CGIAR) system that evolved at that time has been described as a 'prime example of the promise, performance and perils of an international approach to providing GPGs'. Contemporary literature on international agricultural research as a GPG tends to support this view and focuses on how to operationalize the concept. This paper adopts a different starting point and questions this conceptualization of the CGIAR and its outputs. It questions the appropriateness of such a 'neutral' concept to a system born of the imperatives of Cold War geopolitics, and shaped by a history of attempts to secure its relevance in a changing world. This paper draws on a multi-sited, ethnographic study of a research effort highlighted by the CGIAR as an exemplar of GPG-oriented research. Behind the ubiquitous language of GPGs, 'partnership' and 'consensus', however, new forms of exclusion and restriction are emerging within everyday practice, reproducing North-South inequalities and undermining the ability of these programmes to respond to the needs of projected beneficiaries.

Non-testing approaches under REACH--help or hindrance? Perspectives from a practitioner within industry.

Legislation such as REACH strongly advocates the use of alternative approaches including in vitro, (Q)SARs, and chemical categories as a means to satisfy the information requirements for risk assessment. One of the most promising alternative approaches is that of chemical categories, where the underlying hypothesis is that the compounds within the category are similar and therefore should have similar biological activities. The challenge lies in characterizing the chemicals, understanding the mode/mechanism of action for the activity of interest and deriving a way of relating these together to form inferences about the likely activity outcomes. (Q)SARs are underpinned by the same hypothesis but are packaged in a more formalized manner. Since the publication of the White Paper for REACH, there have been a number of efforts aimed at developing tools, approaches and techniques for (Q)SARs and read-across for regulatory purposes. While technical guidance is available, there still remains little practical guidance about how these approaches can or should be applied in either the evaluation of existing (Q)SARs or in the formation of robust categories. Here we provide a perspective of how some of these approaches have been utilized to address our in-house REACH requirements.