The Lost Count: Malaria Quantification and People on the Move

Live Savers: Mosquito nets help protect the most vulnerable, including pregnant women and infants. © UNHCR/Zalmaï

In the global efforts to combat malaria, accurate assessment of the public health burden of the disease and its distribution is central to monitoring, control, and decision-making. In an article published this month in The Lancet found that, the 2010 Malaria World Report released by the World Health Organization (WHO) underestimated global malaria mortality by 50 percent. The study led by Dr. Christopher J L Murray from Institute for Health Metrics and Evaluation (IHME) in Seattle estimated the 2010 malaria mortality to be 1.2 million compared to 655 thousands reported by WHO. The study used subnational population data to analyze trends in malaria mortality from 1980 to 2010. The study also found that there has been a systematic underestimation of global malaria mortality. Some of the limitations cited in the paper were the lack of representativeness and misclassification of deaths in the subnational data due to the variability in intensity of malaria transmission, incompleteness, and inconsistency of surveillance data. In addition, results from time-trend and time-series data analysis, which was used in this paper, can be affected if there is migration within the population under review.

We believe at ICMHD that this raises the problem of how to quantify malaria incidence, prevalence, and mortality when there are very large numbers of people on the move who do not fall within national health registration systems. The 2011 World Development Report estimated that by the end of 2009 there were some 42.3 million people displaced globally as a result of conflict, violence, and human rights violations. Of these, 27.1 million were internally displaced persons (IDPs) while 15.2 million were refugees outside their country of nationality or country of habitual residence. The United Nations and the United Nations World Tourism Organization has projected that by 2020 there will be 50 million environmental refugees and nearly 1.6 billion international tourist arrivals.

These figures make evident the urgency in developing more consistent methods on measuring malaria distribution and identifying populations at risk. The different approaches that have been used in determining malaria incidence, prevalence, and mortality have led to highly variable results. Moreover, many malaria trends analyses rarely factor in migrating populations.

At ICMHD we think that unless the international community is willing to pay more attention to migrants and other people on the move, malaria control efforts will fail.

By Talubezie Kasongo

Climate Change: A health hazard?

Pakistan 2010 Floods (Daniel Berehulak/Getty Images)

In November 2011, a group of ministers and senior representatives of governments from Africa, Asia, the Caribbean, Latin America, and the Pacific met in Dhaka, Bangladesh, to discuss the threat of climate change and the growing vulnerability of countries to the prospect of global warming. The Secretary General of the UN, Ban Ki Moon, was also present. The conclusion of the Climate Vulnerable Forum Dhaka Ministerial Meeting was to call for more concerted action to help countries adapt to the impact of climate change and take steps to mitigate its impact by creating carbon sinks, disseminating environmentally sound technologies and establishing a balance in the energy mix by focusing on renewable and alternative energy.

The emphasis the Dhaka ministerial meeting placed on limiting global warming, in this case to 1.5 degrees Celsius above pre industrial levels and progressively reducing greenhouse gas emissions, is symptomatic of the challenges facing the response to climate change. For while reducing greenhouse gas emissions will remain an essential goal to achieve, this will be difficult in an era of economic crisis and the felt need by countries to stimulate new industries and employment at the cost of greenhouse gas emissions.

As we move further into what is already a serious situation, it would be perhaps more important to address the fact that climate change is displacing millions of people and is expected to uproot and forcibly move some 250 million people in the coming years. At a time when countries everywhere are raising barriers to immigration and making life more difficult for refugees, asylum seekers, and economic migrant workers of all kinds, the prospect of up to 250 million people moving in search of human security portends massive social, economic, political and health challenges. This is where we should be placing our attention and finding ways of preparing for what may be involved.

Accommodating displaced people will constitute, if it does not already do so, a massive challenge in terms of availability of land, of housing, of sound water and sanitation, social and health services. At ICMHD we believe that a large proportion of the people who will be displaced will move towards large towns and cities either within their own countries or in neighboring ones. Many of these towns and cities are already overwhelmed. Unplanned and poorly coordinated rural urban migration has outpaced the capacity of many of them to absorb and provide the conditions needed for healthy life. The vastly overcrowded shantytowns and slums that now characterize many cities in developing countries are not only making the protection of health difficult, but are actually producing the conditions that facilitate disease.

ICMHD believes that far more attention should be given to this part of the climate change challenge than it has received to date. This is where meaningful action is probably possible in a shorter time frame and could help avert a major global disaster.

By Manuel Carballo

Health G20 : Promoting Health and Development on the G20’s Agenda

Health G20: A briefing on health issues for G20 leaders

Health G20 has been created by the International Centre for Migration, Health and Development in Geneva, Switzerland and the Dasman Diabetes Institute in association with Pro-Brook Publishing. The ICMHD Executive Director, Dr Manuel Carballo, and the Director, Professor Kazem Behehani,  are editors of the publication. Pro-Brook Publishing is a specialist publisher in the global healthcare arena.

The objective of Health G20 is to promote health and development on the G20’s agenda. Underlying all economies is a healthy population, Health G20 is there to brief world leaders on key disease areas, common problems and new developments to ensure that healthcare is not left off the agenda of this powerful grouping.

Health G20 could not have been published without the assistance of the Supporters. These Supporters range from healthcare NGOs, UN agencies, commercial companies and academic institutions (See Supporters)

Asylum seeking: Seeing the positive

Asylum seeking is not new, and is in principle governed by well established and ratified international laws and principles. People have been fleeing persecutions of one kind or another for centuries and the world has seen fit to codify how to respond to this. Legislation apparently has not made it any easier.  In a recent article from Canada, Anabelle Nicoud (La Presse, February 6^th 2012 http://tinyurl.com/7qnadzb) has highlighted some of the problems asylum seekers arriving in Canada are encountering, and what in turn, the cost of these problems are to the state.  She refers specifically to the arrival in August 2011 of 492 Sri Lankans who were handcuffed on arrival and then incarcerated for about 3 ½ months during which time their cases were estimated at a cost to the state of 22 million Canadian dollars.

In Switzerland, 2012 has started out with highly publicized concerns about the growing number of asylum seekers arriving in the country (a 45% increase since 2010) and the unwillingness and/or inability of some local authorities to accommodate them. Last week, 400 residents of Pully, a small relatively well-to-do town close to Lausanne, met to protest the idea of opening an underground civil protection shelter to hold 50 asylum seekers.  Civil defense facilities have been increasingly dedicated to housing asylum seekers in Switzerland, and most recently a psychiatric institution has been partially given over to the task as well.

In 2011 the 27 EU countries, with a total population of over 500 million people, received some 66,000 asylum seekers applications. Insignificant as this number may seem, asylum seekers have nevertheless become a major political, social and economic challenge in the EU as elsewhere. Why this should be so is not clear. Most EU countries (as well as Canada) receiving asylum seekers are ageing quickly and in need of new human resources. Theoretically these countries would benefit from employing young able bodied people who clearly want to be socially and economically integrated. Doing so would also help to cut the cost of the prolonged administrative procedures that prevent asylum seekers from quickly inserting themselves, working, paying taxes and contributing socially.

Employing asylum seekers would also help to raise self-esteem. Fleeing from persecution is never easy and most asylum seekers suffer from trauma and a perceived sense of powerlessness and loss of control.  Typically homesick, anxious and depressed because of what they have gone through and the people they have left behind, asylum seekers are fragile.  Fear of not being able to meet the often complex and unclear legal/administrative requirements of the countries they arrive in is erosive of both their physical and psychological health, which is again a cost to the state.  In the EU where of the 55,000 decisions taken on asylum seekers in the first quarter of 2011, only 1 in 4 were positive, and the administrative process can take years.

Much could be gained by if governments would recognize the potentially positive impact of quickly integrating asylum seekers in the community. The global number of asylum seekers is small and the world has already defined their rights.  People fleeing persecution and threats to their lives deserve better, and we should never lose sight of the fact that although some people are clearly more at risk than others, we are ultimately all at risk if becoming asylum seekers.

by Manuel Carballo