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	Health policies must focus on the needs of individuals by Dr Mercedes Tatay Medecins Sans Frontieres   Dec. 2017   The Universal Health Coverage Forum 2017 will take place in Tokyo, Japan. This major gathering aims to 'stimulate global and country level progress towards Universal Health Coverage (UHC)', which the world has committed to reach by 2030 as part of the Sustainable Development Goals (SDGs). Dr Mercedes Tatay, MSF's International Medical Secretary, will attend the forum and provide a critical reality check based on Medecins Sans Frontieres experience on the ground. On her way to the forum, Dr Tatay answered a few questions.   Why is MSF attending this meeting?   Through the direct provision of free medical assistance to people affected by armed conflict, epidemics, natural disasters and exclusion from healthcare in more than 60 countries, MSF teams see first-hand the barriers that some of the poorest and most discriminated communities face to access healthcare. We want to bring this direct experience to inform international policymakers of their dreadful consequences on people's health and lives and to advocate for non-discrimination and unhindered access to healthcare for all.   As doctors and health professionals, we want to remind delegates at the forum that all their discussions should be about people. Making sure individuals have access to basic healthcare should come before any considerations for return on investment, security or national interest. It's about saving lives and reducing the impact of diseases.   In MSF we are convinced that universal health coverage can only be achieved by removing persistent barriers like unaffordable drugs and charges for healthcare (known as user fees).   For many people it seems normal to pay for medical care: why is MSF fighting against that?   Vulnerable groups, such as pregnant women, those forced from their homes, patients with HIV, tuberculosis, malaria and non-communicable diseases in places like the Central African Republic, Democratic Republic of Congo and Guinea, still need to pay for care. So do refugees in Jordan. This is extremely damaging; evidence proves that making people pay for medical care prevents them from receiving it. Making people pay also reduces the quality of health services, increases financial distress and delays the detection of epidemics and outbreaks; instead of coming to health centres, people get ill or die unreported in their communities.   In these places, MSF doctors and nurses see terrible stories of people who went without basic treatment because of the cost, or were told to buy their own drugs because hospitals had run out. We've also documented stories of patients being held captive in health facilities until they can pay for medical care they have received.   This situation persists, despite progress made in the last decade to expand healthcare for specific groups such as pregnant women, children and people with certaindiseases. Worryingly, the situation could worsen further still as policies to improve access to healthcare are being reversed in many countries, including Afghanistan, Mozambique, and Malawi.   International health funding is being reduced and there is mounting pressure on countries to start paying for their own health services, often at an unrealistic pace, regardless of their actual capacity to do so. This leaves an inevitable funding gap, which some countries look to patients to fill, even though charging these 'user fees' is something that institutions and organisations involved in global health have committed to eliminating.   International health funding cuts now also threaten Sierra Leone's Free Health Care Initiative for women and children. This is quite cynical for a country that lost 10 per cent of its health workforce to Ebola during the 2014-15 outbreak and where access to quality health care remains a major issue.   These examples and others are developed in a new report released by MSF: 'Taxing the ill: How user fees are blocking Universal Health Coverage'.   Is free care an affordable option?   We realise that providing quality care comes at a cost. But when exclusion of care is so clearly linked to patient fees, it is unfair and detrimental to ask them to foot the bill. MSF has had a policy of providing care without charging patients since 2004 (before this date, there were certain places where we charged patients a nominal fee) and this has led to significant increases in the number of people using the services we offer, increasing access and having a positive impact on people's health.   We also know that revenue generated from asking patients to pay is marginal, so people are kept away from healthcare with no real added value for the system. The end result is an increased lack of trust towards health practitioners and a high number of diseases and deaths that could have been prevented. This is obviously counterproductive and unacceptable on so many levels.   'User fees' also create or reinforce inefficiencies; they keep patients away from health workers, who are left sitting idle, and leave drugs to expire when they should be used to treat patients.   Affordable solutions do exist. After introducing free care to a district hospital in Lesotho in 2014, the number of women coming to deliver their baby safely increased by 49 per cent in just 18 months. We calculated that making delivery care free across the country would add just 1 USD per inhabitant per year to the country's health budget. This would include not only free delivery care but also provide women with transport and accommodation prior to giving birth.   Although we agree that countries with health access problems need to do all they can to respond to the health needs of their own people, what is expected from them in terms of financing is often unrealistic. They need to be able to fund health infrastructure and provide decent and regular salaries to their health staff, allowing them to do their critical work. This will also help to avoid underpaid health workers charging patients for drugs and consultations to compensate for their low wages.   To put it simply, there's a need for financial resources to remove financial barriers for patients. To make that possible, we also ask donor and policy-making agencies like the World Bank, WHO and other global health initiatives to uphold their commitments to support free health care with funding and technical advice. We want them to leave no doubt about the detrimental effects of asking patients to pay. We don't expect them to tolerate the growth of 'user fees', as we see looming in several countries.   The globally agreed goal of Universal Health Coverage (UHC) by 2030 will remain a distant dream if people are deprived from even the most basic care because they cannot afford it.   Beyond the issue of patients paying for healthcare, are there other issues that MSF will bring to the forum?   Health system strengthening is high on the UHC agenda. We want to see a prioritisation of decent pay for frontline workers and guarantees that patients will not face stock outs of essential drugs. These are essential conditions for the provision of quality health services and which will ultimately make a difference to people who are ill or vulnerable.   We will also express our concerns about the lack of readiness to respond to large-scale epidemics. This is particularly true in places where health systems are weak and where access to health care is already an issue.   Such countries are hesitant to declare epidemics as it may lead to trade or tourism restrictions and create additional economic strains. Without guarantees that the declaration of an epidemic will come with decisive support to respond, lives will continue to be lost unnecessarily. In addition, proper emergency response and surveillance capacity needs to be built within health systems.   We are also concerned that the Global Health Security narrative - which relates to the prevention and management of major infectious disease outbreaks - is too often based on fear, relegating affected populations into a threat, rather than people in acute need. Making all of us healthier depends on making each of us healthier, it's not one group at the expense of the other. The health sector should maintain leadership and muster the political power to respond to epidemics.   Looking back at the Ebola outbreak of 2014-2015, one could wonder if certain countries put more efforts into protecting themselves over providing meaningful support to the people of West Africa who were facing the real medical emergency.   As MSF works in many conflict settings, we will also carry a specific message on the protection of the medical mission in these places. In today's conflicts such as Afghanistan, South Sudan, Syria and Yemen, health structures are increasingly considered as commodities that can be looted or attacked as part of military strategies with impunity. They also escape strong condemnation.   We desperately need all parties involved in conflicts to unambiguously commit to respecting health structures, allowing and supporting the delivery of care to all sick and wounded people, including combatants and those designated as enemies or terrorists.   http://www.msf.org/en/article/health-policies-must-focus-needs-individuals Visit the related web page
	Students from 3,000 schools: 'Protect Kids Not Guns' by Amnesty, VPC, Giffords Law Center, agencies USA   Sep. 2018   Amnesty International report declares gun violence in the United States to be a human rights crisis.   The U.S. government has allowed gun violence to become a human rights crisis, according to 'In the Line of Fire: Human Rights and the U.S. Gun Violence Crisis', a new report from Amnesty International. The report examines how all aspects of American life have been compromised in some way by the unfettered access to guns, with no attempts at meaningful national regulation.   While most countries have licensing and regulation systems in place for firearms, the United States lacks measures like a national registration, and 30 states allow handguns to be owned without a license or permit.   'The U.S. government is prioritizing gun ownership over basic human rights. While many solutions have been offered, there has been a stunning lack of political will to save lives', said Margaret Huang, executive director of Amnesty International USA. 'Despite the huge number of guns in circulation and the sheer numbers of people killed by guns each year, there is a shocking lack of federal regulations that could save thousands'.   Acknowledging the decades of work by impacted communities and activists, the Amnesty International report aims to support those efforts by placing the problem of gun violence in the framework of universally recognized human rights, and offering solutions within that framework that the U.S. should adopt to address the crisis.   "The ability to go about your daily life in security and dignity, free from fear, is at the very cornerstone of human rights. No one's human rights can be considered secure as long as our leaders fail to do anything about gun violence" - Margaret Huang, Executive Director of Amnesty International USA   In 2016 - the last year stats were available - over 38,000 people were killed and 116,000 suffered non-fatal injuries due to firearms in the United States.   The report examines the ways in which gun violence affects communities of color, where gun violence is the leading cause of death for men and boys between the ages of 15 and 34, who are 20 times more likely to be killed by a gun than their white counterparts. Women facing domestic violence and children are also disproportionately affected.   While the report offers many different recommendations for each of the focus areas, the overarching call is for national laws that would eliminate the current inadequate and arbitrary patchwork of state laws that leave people in some states more vulnerable to gun violence than others.   Among the recommendations are: Comprehensive background checks; National regulations for licensing and registering firearms, and required training for gun ownership; Ban on semi-automatic assault rifles and other military-grade weapons; Investment in evidence-based community violence reduction and prevention programs; Mandatory safe-storage laws.   Congress should also pass a federal law prohibiting carrying guns in public 'unless there is a credible justification for doing so', Amnesty argues.   The report notes that while mass shootings have profound emotional and psychological effects and could be prevented by banning assault rifles and high-capacity firearms, such mass events only account for less than one percent of gun deaths. More common and less publicized are individual incidents that pervade everyday life in communities across the country.   The report also explores the consequences for the thousands of people who survive gun violence. On average, more than 317 people are shot every day and survive - at least long enough to get to the hospital.   The mental, physical, and financial consequences of their injuries shape their lives forever. This is a public health crisis of astonishing proportion, with remarkably little government response, given the life-long effects on many survivors.   http://www.amnesty.org/en/latest/news/2018/09/gun-violence-human-rights-crisis/   * Access the 220 page report: http://bit.ly/2MqYKlz   Gun violence is a daily tragedy that affects the lives of individuals around the world.   Easy access to firearms - whether legal or illegal - is one of the main drivers of community-wide gun violence. Governments must use common-sense gun reform to stop the violence and protect people's rights. No one's human rights can be considered secure if national leaders fail to do anything about gun violence.   How many people die from gun violence worldwide?   More than 500 people die every day from gun violence. 44% of all killings globally involve gun violence. There were 1.04 million firearm-related deaths globally between 2012 and 2016   The majority of victims and perpetrators are young men, but women are particularly at risk of intimate partner firearms violence, and sexual violence can also be facilitated by firearms.   An estimated 2,000 people are injured from gunshots every single day. At least 2 million people are living with firearm injuries around the globe. Millions of more people suffer the severe psychological effects that gun violence - or the threat of gun violence - brings to individuals, families and their wider community.   Gun violence is a global human rights issue.   Gun violence can lead to a violation of the most fundamental human right, the right to life. Countries have an obligation to protect people from gun violence by taking measures to combat actual or foreseeable threats to life.   Firearm violence impacts on other human rights by creating a culture where people do not feel safe, denying them the right to personal security. In turn, this fear can undermine rights of freedom of expression and peaceful assembly. When communities are blighted by persistent gun violence, basic services such as health and education can suffer.   Gun violence is particularly prevalent in the Americas where easy access to firearms, weak regulation or poor implementation of laws designed to combat firearms violence prevail.   In Latin America and the Caribbean, corruption, organized crime and a dysfunctional criminal justice system further fuel the problem. Percentage of killings committed with firearms: 72% in Brazil; 91.1% in El Salvador; 58.9% in Honduras. Among wealthier, developed countries, the USA is an outlier. Wide access to firearms and loose regulations lead to more than 30,000 men, women, and children being killed with guns each year in the USA   http://www.amnesty.org/en/what-we-do/arms-control/gun-violence/   24. Mar. 2018   Students lead huge U.S. anti-gun rallies (Reuters, agencies)   Chanting 'never again', hundreds of thousands of young Americans and their supporters answered a call to action from survivors of last month's Florida high school massacre and rallied across the United States on Saturday to demand tighter gun laws.   In some of the biggest U.S. youth demonstrations for decades, protesters called on lawmakers to confront the issue.   At the largest March For Our Lives protest, demonstrators jammed Washington's Pennsylvania Avenue where they listened to speeches from survivors of the Feb. 14 mass shooting at Marjory Stoneman Douglas High School in Parkland, Florida.   The massive March For Our Lives rallies aim to break legislative gridlock that has long stymied efforts to increase restrictions on firearms sales in a nation where mass shootings like the one in Parkland have become frighteningly common.   'Politicians: either represent the people or get out', Cameron Kasky, a 17-year-old junior at Marjory Stoneman Douglas, told the crowd. Another survivor, David Hogg, said it was a new day. 'We're going to make sure the best people get in our elections to run not as politicians, but as Americans. Because this is not cutting it', he said, pointing at the white-domed Capitol behind the stage.   Youung marchers filled streets in cities including Atlanta, Baltimore, Boston, Chicago, Los Angeles, Miami, Minneapolis, New York, San Diego and St. Louis. More than 800 demonstrations were scheduled across the United States demanding action on gun violence.   http://wapo.st/2I2e1aY http://wapo.st/2G9gwb1 http://wapo.st/2GqgOgK http://edition.cnn.com/2018/03/24/us/march-for-our-lives-latest/index.html http://cbsn.ws/2I2kRx6 http://www.nytimes.com/2018/03/24/us/march-for-our-lives.html http://bit.ly/2G9ujhu http://bit.ly/2pI2MwW http://bit.ly/2GaWv3x http://www.theguardian.com/us-news/commentisfree/2018/mar/23/parkland-students-manifesto-americas-gun-laws http://www.theguardian.com/us-news/series/parkland-student-takeover http://everytownresearch.org/school-shootings/ http://www.vice.com/en_us/topic/voices-of-school-shooting-survivors   14 March 2018   Hundreds of thousands of students poured out of classrooms across the US on Wednesday in an unprecedented expression of mourning and a demand for action to stem the country's epidemic of gun violence.   Students from an estimated 3,000 schools marched carrying signs that read 'Enough' and chanting, 'Gun violence has got to go'. In Connecticut, Washington and New York, the signs read: 'Protect Kids Not Guns'.   The mass student walkout fell one month after a student gunman killed 17 people at Marjory Stoneman Douglas high school in Parkland, Florida, in the deadliest high school shooting in the country's history. Survivors of that massacre joined other student activists to organize Wednesday's demonstration.   'There were lots of emotions, many people were crying. We were thinking of the 17 we lost', said Florence Yared, a third-year student at Stoneman Douglas, who joined 3,000 of her schoolmates on the school's football pitch, where exactly one month ago many were running for their lives.   The protesters called for new gun safety legislation, including a ban on assault weapons and high-capacity magazines, and the introduction of universal background checks.   They also opposed the additional fortification of schools with fences and armed guards, policies endorsed by the NRA, America's powerful gun lobby group.   Recent polling has indicated that as many as seven in 10 Americans want stricter gun laws, the highest such figure in 20 years. A recent Monmouth University poll found that 83% of Americans support requiring comprehensive background checks for all gun purchasers, including private sales between two individuals.   The gun policy reform group Everytown for Gun Safety reported a 25% leap in members in the two weeks after the Parkland shooting.   'While Congress sits on its hands, students like my son will stand and walk out of school this morning to demand action on gun violence', tweeted Shannon Watts, the founder of the gun safety group Moms Demand Action, on Wednesday morning. 'Next we march. Then we vote to #ThrowThemOut'.   Gun safety activists are focused on the midterm elections in November as an opportunity to expunge pro-gun legislators, whose ranks are increasingly out of proportion with the national mood.   A number of gun control bills are currently pending in the US Congress, including bills that fit with the student protesters demands relating to assault weapons and background checks. But Congress in the past has repeatedly taken up such legislation only to shelve it, year after year, including in the wake of the 2012 shootings at Sandy Hook elementary school in Newtown, Connecticut.   Ninety-six Americans are killed each day by guns, and Americans overall are 25 times more likely to be murdered with a gun than people in other developed countries, gun control advocates say.   http://www.vox.com/2018/3/14/17114430/school-walkout-gun-control-photos http://www.vox.com/2018/2/15/17017342/parkland-florida-school-mass-shooting http://marchforourlives.com/walkouts http://marchforourlivespetition.com/ http://edition.cnn.com/2018/03/14/us/national-school-walkout-gun-violence-protests/index.html http://bit.ly/2FQ5DxF http://www.nytimes.com/interactive/2016/us/mass-shootings-timeline.html   Feb. 2018   My generation will not stand for this, by Cameron Kasky. (CNN)   (Cameron Kasky is a 17-year-old junior at Marjory Stoneman Douglas High School. He and his brother survived a school shooting at their Parkland, Florida, high school where 17 people died, when a former student opened fire with an assault rifle).   I thought it was going to be a wonderful day. My high school, Marjory Stoneman Douglas, was full of cheerful students -- many of whom were celebrating Valentine's Day with one another. Even those who didn't have a Valentine seemed like they could find reasons to smile.   But then, of course, everything changed. Toward the end of the day, I went to pick up my little brother Holden from the special needs classroom. As we exited the school, the fire alarm went off. And as we retreated to the parking lot, per fire drill procedure, we were told to run back inside.   It was very confusing, especially since I was surrounded by special needs students. But the truth is, nobody really knew what was going on. We huddled in a room, listening to terrifying noises we couldn't quite identify, and spent an hour plagued by uncontrolled anxiety.. waiting for answers. Waiting for somebody to either come in and shoot us or come in and tell us everything was going to be OK.   Eventually, the SWAT team came in. We were escorted to an evacuation location and, after hours of confusion and terror, my brother and I made it home.   Though we made it home, 17 people didn't. Those 17 people were murdered on the grounds of a school that has always felt like the safest place to be in a town that's been called the safest town in Florida.   We can't ignore the issues of gun control that this tragedy raises. And so, I''m asking - no, demanding - we take action now.   Why? Because at the end of the day, the students at my school felt one shared experience -- our politicians abandoned us by failing to keep guns out of schools.   But this time, my classmates and I are going to hold them to account. This time we are going to pressure them to take action. One of the most frustrating arguments I've heard is that it wasn't the Republican Party that killed those people and it wasn't the National Rifle Association -- it was the shooter himself. I understand where they are coming from. I do not believe this was a direct attack from the Republicans or their close allies at the NRA.   However, the shooter is not the only one responsible for this tragedy. While the alleged shooter may have had several issues, he also lived in a society where Sen. Marco Rubio refuses to take responsibility for the role gun culture may have played in this tragedy.   And there is no denying that the NRA continues to donate millions of dollars to politicians at every level of government. Then those politicians -- often "family values" conservatives -- rile up their base by making them think that "liberals" are going to take their guns away. Not knowing any better, some of these people stockpile guns in advance of a gun ban that never comes, and the gun manufacturers and the NRA make millions.   But the truth is that the politicians are to blame. The Republicans, generally speaking, take large donations from the NRA and are therefore beholden to their cruel agenda.   I'm just a high school student, and I do not pretend to have all of the answers. However, even in my position, I can see that there is desperate need for change - change that starts by folks showing up to the polls and voting all those individuals who are in the back pockets of gun lobbyists out of office. http://cnn.it/2GoIaS4   http://marchforourlives.com/sign/   U.S. gun death rate rises for the second straight year. (Giffords Law Center)   Today, as the Centers for Disease Control and Prevention released new data showing a spike in the U.S. gun death rate for the second straight year, former U.S. Congresswoman Gabrielle Giffords, welcomed the introduction of a new, life-saving background checks bill that would close loopholes in federal gun laws that let dangerous people buy guns without a background check on the Internet and at gun shows. The bill would also make it easier for states to submit records to the National Instant Criminal Background Check System (NICS). The bipartisan bill is sponsored by Congressman Mike Thompson (D-CA) and Congressman Peter King (R-NY).   Congresswoman Gabrielle Giffords: 'Our elected leaders are at a crossroads. They can continue to ignore the reality of gun violence - which last year alone took the lives of 38,000 Americans, or they can choose to do something about it. They can continue to bend to the will of the gun lobby and the NRA, and pass dangerous and regressive bills that put our safety in jeopardy, or they can follow the direction of the 94 percent of Americans who support requiring background checks for all gun sales.   I applaud Congressman Thompson and Congressman King for their leadership in introducing this bill, and for showing other leaders in the nation's capital that saving lives from gun violence shouldn't be a partisan idea. It's a common sense proposal that will make our communities safer from gun violence'.   About Background Checks:   The Gun Control Act of 1968 made it illegal for prohibited purchasers, such as convicted felons, to purchase or possess firearms, and in 1993, the Brady Act strengthened this law by requiring background checks on gun purchases. But the Brady Act only requires background checks for sales by licensed firearms dealers: unlicensed sellers, whether they do business online, at gun shows, or from the trunk of their car, are not required to conduct background checks on gun buyers.   The FBI uses the National Instant Criminal Background Check System (NICS) to determine whether a potential buyer is prohibited from purchasing firearms. Over 90 percent background checks are done instantly. Since the NICS system has been in place, over 225 million background checks have been conducted, most instantaneously. Over two million firearms sales to prohibited purchasers have been denied since passage of the Brady Act in 1993.   The correlation between strong background check laws, chief among them universal background checks, and reduced gun death rates is well-documented. For example, in 2007 Missouri repealed its permit-to-purchase handgun law, which required background checks on all handgun sales, and saw its gun homicide rate jump 25%, its share of crime guns recovered in-state grew 25%, and its share of crime guns recovered within two years of their original sale double, a key indicator of crime gun trafficking. Conversely, Connecticut saw its gun homicide rate drop 40% and its gun suicide rate drop 15% after implementing a permit-to-purchase handgun law that required applicants to pass a background check in order to purchase a handgun from any seller.   Background checks save lives. In states that require background checks for all handgun sales 47% fewer women are shot to death by their intimate partners, there are 53% fewer firearm suicides, and 53% fewer law enforcement officers are shot to death by handguns.   Background checks are overwhelmingly popular. A recent poll taken after the Las Vegas shooting found 94 percent of Americans support universal background checks for all gun sales. http://bit.ly/2zmogGk   http://lawcenter.giffords.org/ http://www.bradycampaign.org/ http://www.vpc.org/ http://www.vpc.org/press/press-release-archive/ http://everytown.org/in-the-news/ http://www.csgv.org/ http://www.nytimes.com/interactive/2017/11/06/opinion/how-to-reduce-shootings.html http://www.vox.com/policy-and-politics/2017/11/6/16615218/ted-cruz-gun-control-sutherland-springs-texas-shooting http://www.newyorker.com/news/daily-comment/a-mass-shooting-in-texas-and-false-arguments-against-gun-control http://www.nytimes.com/interactive/2017/12/19/opinion/domestic-violence-guns.html http://www.pbs.org/wgbh/frontline/film/gunned-down/   (In the last 20 years, 2 million people have been shot in the U.S., and 600,000 of those lost their lives. More Americans have died from gun violence, than in all the wars in American history).
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