PHM-ARTICLE REQUEST FILE
Item
- Title
- PHM-ARTICLE REQUEST FILE
- extracted text
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PCH Endorsement
RF_COM_E_SUDHA
Re: CMJI 18.1
Subject: Re: CMJI 18.1
Date: Thu, 9 Jan 2003 14:42:11 +0530
From: ”S Morgan” <omai@del3.vsnl.net.in>
Rcply-To: "S Morgan” <smorgan@cmai.org>
To: "Ravi Narayan" <sochara@vsnl.com>
Dear Dr:
Greetings from the Cliristian Medical Association of Indial
0
Hope you have received the issue of CMJI 17.4(1ribai Health).
The theme for our next issue is 18.1 Caring for my neighbour. Kindly send in your article for the Health Advocate column by 30
January 2003. Hope you have received tremendous response for the Asia Social Forum held recently.
Looking forward to hearing from you soon.
With regards,
^Sumaihi Morgan and Rebecca Pandiaraj
ofl
1/10/03 10:08 AM
<e: Outline of Chapkr
Subject: Re: Outline of Chapter
Dale: Thu, 16 Jan 2003 18:55:58 -0800
From: chc <sochara <7 vsni.coni>
To: Vikram Patel <^vikDai;®uoatelccoiii.coni'>
Greetings from ?eoy_es He a j. tn Movement Secretariat at CHC, Bangalore!
,,:e missed
at ASF thzuoh I did mention your book at the Alma Ata
Anniversary -.;?r ksh-op. ~ hc.ve taken over as the Global coordinator of the
r’A.' from
“anaury and just the two week experience of demands and
activities needing response or facilitation have given me serious doubts
of wrie.hr.r it was wise t-_ have agreed to join your group to evolve this
interesting charter which has its own time schedule and deadlines.
?-.chan- ~ should pass m. on to Mani Kailath, one of our team members who
may have more time and is the mental health resource person in our team
as well. He is a public health physician with long standing experience
or CH traInina and alternative mental health initiatives and exoeriments
-d a c-c rehac^ent.
- ■..'ait to hear from you before i pass on the papers or perhaps you could
write to Mani as well 'email: manicecOpol.net.in).
r^ZAcd—
1 of 1
6?
>
01/16/03 18:56:06
outline of chanter .
Subject: outline of chapter
Date: Mon. 13 Jan 2003 19:15:31 +0500
From: Vikram Patel <vikpat@goatelecom.com>
To: <sochara@vsnl.com>, <naomar@ufoa.br>, <leslie_swartz@hms.harvard.edu>,
First, thanks r.o all of you for agreeing to work with me on producing this
chapter for the WHO book on mental health promotion. I had earlier sent you
Lhe outline of the entire book as proposed by the editors and the brief
regarding Chapter 7 which is what we are invited to write.
m the first instance, 1 had approached each of you because of your rich
experience in different regions of the world and in different aspects of
health and development T.et me take this opportunity to introduce each of
sychiatrist working in Brazil who has worked
extensively on social aspects of mental health and, specifically, on issues
jsuch as migration and social change. Leslie is a clinical psychologist who
has worked extensively on cultural aspects of mental health in South
Bfri’ra. Ravi i a a niihlir health dorto ■ who has beer leading a health NGO
aimed no improving people’ rights and participation in health, and is now
the global coordinator of the Peoples Health Movement. I am a psychiatric
epidemiologist working in India, with interests in the socioeconomic
determinants of mental health. All of us, of course, have many more facets
We have been asked to prepare a two page outline of what our chapter will
cover and submit this to the editors by February 15th. They will send their
suggestions by March and our target is to submit our draft chapter by the
end of June. 1 have initiated the process to get
attached this
first drafr. wi th this message. 7 am very aware that this is a very
tentative, first attempt, and I would bo grateful if you could comment on
this, adding/ editing/ commenting freely, using the Track Changes function
in Word. Please send your comments back to me by the end of January. If any
of you wishes to email all of us with general issues or suggestions, please
use the ’reply to all’ function r.o this email. T will collate all the
^suggestions and changes and prepare the next draft by the first wook of
^T’ebruary and send 1L back Lo you for your final comments before submission
to the editors.
JfcA
with regards and best wishes,
Vi kram
X'o
_
x
Name; Chapter 7 outlinc.doc
Hj Chapter 7 outlme.doc!
Type: Winword File (application/msword)
^Encoding: base64
AS Ovo/vc 7^—
THAT ALL TELEPHONE NUMBERS IN GOA ARE CHANGED: ADD A
m’
Dr Vikram Patel
Senior Lecturer, London School of Hygiene & Tropical Medicine
Add: Sanga
841/1 Alto Porvorim, Goa, INDIA 403521
[dine of chapter
email: V^kpatOgoatelecom.com
Tel: 0832-2413527; Fax: +91-832-2415244; Off: +91-832-2414916/ 2417914
Mobile: +91-0-9822132038
Sangar.'n websi r.e: www. sangar.’n . com
London School of Hygiene & Tropical Medicine website: www.lshtm.ac.uk
? oC2
1/14/03 9:49 AM
The Mental Health Dimension of Health Promotion:
Concept, Evidence and Practice
(editors: Drs Helen Herrman, Shekhar Saxena and Rob Moodie)
Draft outline of Chapter 7; The situation across countries
Authors:
© Vikram Patel, Senior Lecturer, London School of Hygiene & Tropical Medicine and
Chairperson. The Sangath Society, India
» Naomar Almeida Filho, President, University’ of Bahia, Salvador, Brasil.
o Leslie Swartz, Professor of Psychology, University of Stellenbosch, South Africa.
* Ravi Narayan, Community Health Cell, Bangalore & Global Coordinator, People's
Health Movement, India.
The earlier chapters in this book describe the global or universal principles of mental
health and health promotion. This chapter will discuss the enormous contrast across
countries, especially between developed and developing countries, with respect to the
determinants of mental health. The chapter will consider the potential impact of the rapid
changes in some of the critical socio-economic influences on mental health in low and
middle income countries.
In the first instance, the chapter will briefly review the evidence on determinants of
mental health, focusing on disorders which are common and disabling, in particular,
common mental disorders (depression and anxiety disorders) and substance abuse. Much
of the evidence suggests that both these disorders are largely determined by social and
economic factors. The chapter will highlight that global or regional factors such as
political instability, gender, violence, globalization of the narcotics trade and criminal
activities, large-scale internal and external migration, and economic globalization, will
have a major role in modifying these influences which, in turn, may have an
unanticipated impact on the mental health of populations. Case examples of the rise in
suicide rates in China and Sri Lanka, the rise in alcohol abuse and related deaths in the
post-Soviet Union nations, migration, urbanization and mental health in Brazil and India,
economic reform and suicide in India, and the rise in substance abuse in some Latin
American and African cities will be used to illustrate the practical significance of these
changes. The issue of social capital as a determinant of mental health, and the impact of
rapid socio-economic change on social capital will also be considered. Two core themes
will underline this section: first, that mental health cannot be seen as separate from other
aspects of health and development so that the achievement of good physical health and
human rights are likely to be the most important aspect of mental health promotion; and
second, that the most important difference between developed and developing countries
may well be that communities in developing countries have lesser and lesser control and
authority over me socio-economic influences on their health and development as the focal
mint for such macro-decision making moves further away from the individual.
Next, the chapter will consider the practical implications of these influences in terms of
potential programs and policies for mental health promotion. We will anempt to review
(he larger literature on the impact of social and economic development policies in
promoting menial health, We acknowledge that it is likely that there will be very little
concrete or specific evidence which demonstrates the impact of social and economic
development policies and programs on mental health promotion, but evidence from the
domain of physical health and other indicators of well being may be used to estimate the
impact on mental health. Examples of such programs or policies may include: the impact
of urban regeneration; micro-credit schemes; literacy promotion; economic policies
aimed at promotion of income equality and protection of the poor; promotion of gender
equality; violence and crime prevention programs etc. In situations where evidence is not
available for these programs in developing countries, relevant evidence from richer
countries will be sought and their applicability to developing countries considered. The
discussion will also consider the types of evidence which should be generated in the
future to study the impact of various programs and policies on mental health promotion.
Dear Reeena
Greetings from People’s Health Movement Secretariat at CHC, Bangalore!
Here is the Health Advocate 1 promised before leaving for the States. Written in a hurry
it may need a little editing.
THE HEALTH ADVOCATE
February 2003.
WAR OR PEACE: WHAT IS YOUR COMMITMENT?
On 15lh February 2003, over a million participated in the largest rally London had seen
for decades. Hundreds of thousands marched through Berlin; two lakhs marched through
Damascus; thousands joined marches in Bulgaria, Romania, Hungary, Brussels. South
Korea. Australia. Malaysia and Thailand; hundreds in Bosnia. Hong Kong and Moscow.
and thousands in Amsterdam. Copenhagen, Johannesburg, Tokyo. Dhaka. It was the
largest anti-war rally in recent decades.
drt
Earlier many braved the cold in many American cities and many joined similar protests in
Delhi and Kolkata and Kerala soon after. The protests were a significant and inspiring
message by peace loving world citizens all over the globe. They were not swayed by the
pro-war rhetoric of Bush and Blair; nor impressed by the machination of the armament
and nuclear transnational corporations all over the world; nor provoked by the
demonstration of some leaders or even stereotyping of one of the important religions of
the world. Men and women, young and old, school children and college students; farmers
and teachers, artists and musicians, disabled and minorities; people of all religions, class
arid ethnicity joined the protest ip an overwhelming groundsjvcll of public opinion. No
more war; no more bombs; no more war and bombs for oil rhetoric please!
Twenty five year ago in 1978, the Alma Ata Declaration on Health for All had clearly
noted that
cn
------- 1
I-----*‘an acceptable level of health for all the people of the world by the year 2000 can be
attained through a fuller and better use of the worlds resources, a considerable part of
which is now spent on armaments and military conflicts. A genuine policy of
independence, peace, detente and disarmament could and should release additional
resources that could well be devoted to peaceful aims and $ particular to the acceleration
of social and economic development of which primary health care, as an essential part
should be allotted its proper share.”
•
J
Twenty two years later, 1995 people from 92 countries gathered at the People’s Health
Assembly in GK Savar, Bangladesh and noted in the People’s Charter for Health that:
----------- '
---------------
“War. violence, conflict and natural disaster devastate communities and destroy human
dignity. They have a severe impact on the physical and mental health of their members.
>
.
I
especially women and children. Increased arms procurement and an aggressive and
corrupt international arms trade undermine social, political and economic stability and the
'i allocation of resources to the social sector.”
-----The Charier called on People's of the world to
-* Support campaigns and movements for peace and disarmament.
* Support campaigns against aggression and the research production. -7^—and use
weapons of mass destruction and other amis.
t
* Support people’s initiatives to achieve a just and lasting peace.
* Demand that the United Nations and individual States end all kinds of sanctions used as
an instrument of aggression, which can damage the health of civilian populations..
As members of a health network; as members of an association and followers of a ‘peace
ma/er’i what was your response?
Did you join the marches?
Did you email your protest?
Did you talk to your family, your friends, your colleagues, and your associates against
war and stimulate them to support peace?
Did you write against the war?
Did you pray for the peace?
Or
Did you remain passive, uninvolved, disinterested, confused and supported the imminent
war through your silence?
H
A
To live in peace lakes a lot of commitment?.To promote a world in which Wealth for ^11
Now can be a reality needs all of us to be as anti-war as we are anti-disease: as pro-peace
as we are pro-health.
Are you going to respond?
Are you going to make your small voice part of a big bang against war?
Whether war takes place or not in the next few weeks^what would have been your
commitment?
>
?.
1
Warorjfleace .
Peace needs You!!
Ravi Narayan
Coordinator
PHM Secretarial
CHC - Bangalore
Page 1 of 1
Main Identity
rrom:
■ o.
Sent*
/*nt«.C4v*i a.
Subject:
Community Heaith Ceii <sochara@vsni com>
<reenaduke@cm2i.0rg>
Tuesday, March 75, 2003 CHC3 PM
WAR or Peace What is Your commitmcnt(Rccna).doc
The Heaith Advocate
T")eor "Reena
Greetings from People’s Health Movement Secretariat at CTTC. Bangalore!
The ’Health Ad vacate’ sent on 28th February 2003 is not vet acknowledged. Please do so. We are
forwarding it again as a follow up. When is it likely to come out? Should we update it in the context
oi onaoma war?
Regards,
Ravi Narayan
Coordinator.
PHM Secretariat
Community Health Cell wrote:
Dear Reeena
Greetings from People’s Health Movement Secretariat at CHC, Bangalore:
Here is the Health Advocate I promised before leaving for the States.
Written in a hurry., it may need a lirtie editing.
Ravi Narayan
r~._ .
PHM Secretariat
Community Health Ceil
2/367 ’’Srinivasa Nilaya"
Takkasandra 1st Main, I Block Koramangala
•artgoto rejoin the ’’Health for all, NOW" campaign in the 25th anniversary year of the Alma Ata
declaration visit www.TheMiilionSignatureCampflign.org
3/25/03
<e Health Advocatte: WAR OR PEACE: WHAT IS YOUR COMMITMENT?
Subject: The Health Advocatte: WAR OR PEACE; WHAT IS YOUR COMMITMENT?
Date: bn, 28 Feb 2003 13:31:44 +0530
From: Community Health Cell <sochara@vsnl.com>
To: Reena Luke Matai <reena,luke@cmai.org>
Dear Rcccna
at CHC, Bangalore!
Here, is the Health Advocate 1 promised before leaving for the States.
Written in a hurry, it may need a little editing.
■Dorr-
\TO
Cooiulna lox
PHM Secretariat
CIIC — Bangalore
Name: WAR or Peace What is Your
• xr
,
commitment(Reena).doc
WAR or Peace What is Your commitment! Reena). doc >
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3/6/03 CHC11 AM
THE HEALTH ADVOCATE
February 2003,
WAR OR PEACE: WHATTS YOUR COMMITMENT?
On 15th February 2003, over a million participated in the largest rally London had seen
for decades. Hundreds of thousands marched through Berlin; two lakhs marched through
Damascus; thousands joined marches in Bulgaria, Romania, Hungary, Brussels, South
Korea, Australia, Malaysia and Thailand; hundreds in Bosnia, Hong Kong and Moscow;
and thousands in Amsterdam, Copenhagen, Johannesburg, Tokyo, Dhaka. It was the
largest anti-war rally in recent decades.
Earlier many braved the cold in many American cities and many joined similar protests in
Delhi and Kolkata and Kerala soon after. The protests were a significant and inspiring
message by peace loving world citizens all over the globe. 1'hey were not swayed by the
pro-war rhetoric of Bush and Blair; nor impressed by the machination of the armament
and nuclear transnational corporations all over the world; nor provoked by the
demonstration of some leaders or even stereotyping of one of the important religions of
(he world. Men and women, young and old, school children and college students; farmers
and teachers, artists and musicians, disabled and minorities: people of all religions, class
and ethnicity joined the protest in an overwhelming groundswell of public opinion. No
more war; no more bombs; no more war and bombs for oil rhetoric please!
Twenty five year ago in 1978, the Alma Ata Declaration on Health for All had clearly
noted that
I “an acceptable level of health for all the people of the world by the year 2000 can be i
I attained through a filler and better use of the worlds resources, a considerable part of
I which is now spent on armaments and military conflicts. A genuine policy of
I independence, peace, detente and disarmament could and should release additional
| resources that could well be devoted to peaceful aims and in particular to the
I acceleration of social and economic development of which primary health care, as an
| essential part should be allotted its proper share.”
Twenty two years later, 1995, people from 92 countries gathered at the People’s Health
Assembly in GK Savar. Bangladesh and noted in the People’s Charter for Health that:
; uWar, violence, conflict and natural disaster devastate communities and destroy human
| dignity. They have a severe impact on the physical and mental health of their members,
; especially women and children. Increased arms procurement and an aggressive and
i corrupt international aims trade undermine social, political and economic stability and
' the allocation of resources to the social sector.”
!__________________________________
. __________________________________
The Charter called on Peoples of the world to
»
Support campaigns and movements for peace and disarmament.
«
Support campaigns against aggression and the research production, testing and use of
weapons of mass destruction and other arms.
®
Support people’s initiatives to achieve a just and lasting peace.
Demand that the United Nations and individual States end all kinds of sanctions used
as an instrument of aggression, which can damage the health of civilian
populations...
As members of a health network; as members of an association and followers of a 'peace
maker; whal was vourresponse?
®
Did you join the marches?
Did you email your protest?
Did you talk to your family, your friends, your colleagues, and your associates against
war and stimulate them to support peace?
Did you write against the war?
Did you pray for the peace?
Or
Did you remain passive, uninvolved, disinterested, confused and supported the imminent
war through your silence?
To live in peace takes a lot of commitment. To promote a world in which Health for All
Now can be a reality needs all of us to be as anti-war as we are anti disease; as pro-peace
Are you going to respond?
Are you going to make your small voice pan of a big bang against war?
Whether war lakes place or no! in (he next few weeks, whal would have been your
COiiiiliitiLLCut?
War or peace
Peace needs You!!
Ravi Narayan
Coordinator
PHM Secretarial
CHC - Bangalore
iO.
'■ ‘
•
< >• .-
z
:■ - '■ ;
■ • r , - • ■■?
.?/.z
;:-pr
m r<
The Peoples Health Movement: A People’s Campaign
for HEALTH FOR ALL - NOW!
Background
In 1978, in Alma - Ala, the universal slogan Health for All by the year 2000 was
coined. At the same time, the famous Alma Ata Declaration was overwhelmingly
approved, putting people and communities at the center of health planning and health
care strategies, and emphasizing the role of community participation, appropriate
technology and inter-sectoral coordination. The Declaration was endorsed by most of
the governments of the world and symbolized a significant paradigm shift in the
global understanding of Health and Health care. (WHO - UNICEF, 1978).
Twenty five years later, after much policy rhetoric, some concerted but mostly ad-hoc
action, quite a bit of misplaced euphoria; distortions brought about by the growing
role of the market economy that affected health, and a fair dose of governmental and
international health agencies' amnesia, this Declaration remains unfulfilled and
mostly forgotten, as the world comes to terms with the new economic forces of
globalization, liberalization and privatization which have made Health for All a
receding dream.
The People’s Health Assembly in Savar, Bangladesh in December 2000,
and the
People’s Health Movement that evolved from it were both a civil society’s effort to
counter this global laissez faire and to challenge health policy makers around the
world with a Peoples Health Campaign for Health for All-Now!
The People’s Health Assembly
The Global People’s Health Assembly brought together 1450 people from 92
countries, and resulted in an unusual five-day event in which people shared concerns
about the unfulfilled Health for All challenge. The Assembly program included a
variety of interactive dialogue opportunities for all the health professionals and
activists who gathered for this significant event. These events included:
<=> a rally for Health;
meetings in which the testimonies on the health situation from many parts of
the world and struggles of people were shared and commented upon by
multidisciplinary resource persons; (People’s Health Movement 2002)
O parallel workshops to discuss a range of health and health related challenges;
cultural programmes to symbolize the multi-cultural and multiethnic diversity
of the people of the world;
exhibitions and video/film shows; and
an abundance of dialogue, in small and big groups, using formal and informal
opportunities.
The People’s Health Assembly was preceded by a series of pre-assembly events all
over the world. The most exceptional of these was the mobilization in India. For
nearly nine months preceding the Assembly, there were grassroots, local and regional
initiatives of people’s health enquiries and audits; health songs and popular theater;
sub-districts and district level seminars; policy dialogues and translations of national
consensus documents on health into regional languages and campaigns to challenge
medical professionals and the health system to become more Health for All oriented.
Finally, over 2000 delegates converged on Kolkata (Calcutta), mostly coming by five
people’s health trains, and brought ideas and perspectives from seventeen state
2
conventions and 250 district conventions. In Kolkata, the assembly endorsed the
Indian People's Health Charter after the two days of conferences, parallel workshops,
exhibitions, two public rallies for health and cultural programmes. About 300
delegates from this Assembly then traveled to Bangladesh, mostly by bus, to attend
the global Assembly. Similar preparatory initiatives, though less intense, took place in
Bangladesh, Nepal, Sri Lanka, Cambodia, Philippines, Japan and other parts of the
world, including Latin America, Europe, Africa and Australia.
The People’s Charter for Health
Finally, at the end of a full year of mobilization and five days of very intense and
interactive work in Savar, a Global Peoples Health Charter emerged which was
endorsed by all the participants (People’s Health Assembly 2000a). This Charter has
now become:
*=> an expression of our common concerns;
«=> a vision for a better and healthier world;
<=> a call for more radical action;
•=> a tool for advocacy for people’s health; and
a worldwide rallying manifesto for global health movements, as well as for
networking and coalition building.
The significance of this Global People’s Charter is multiple:
<=> it endorses Health as a social/economic and political issue and as a
fundamental human right;
<=> it identifies inequality, poverty, exploitation, violence and injustice as the
roots of ill-health;
3
<=i> it underlines the imperative that Health for All means challenging powerful
economic interests, opposing globalization as the current iniquitous model,
and drastically changing political and economic priorities;
•=> it tries to bring in new perspective and voices from the poor and the
marginalized (the rarely heard) encouraging people to develop their own local
solutions; and
it encourages people to hold accountable their own local authorities, national
governments, international organizations and national and transnational
corporations.
The vision and the principles of the Charter, more than any other document
preceding it, extricates Health from the myopic biomedical-techno-managerialist
approach it has fostered in the last two decades —with its vertical, selective magicbullets-approach to health- and centers it squarely in the more comprehensive
context of today’s global socioeconomic-political-cultural-environmental realities.
However, the most significant gain of the People’s Health Assembly and the
Charier is that, for the first time since Alma Ata, a Health For All action-plan
unambiguously endorses a call for action that tackles the broader determinants of
health. These include: Health as human right; Economic challenges for health;
Social and political challenges in health; Environmental challenges for health;
Tackling war, violence, conflict and natural disasters; Evolving a people
centered health sector; Encouraging people’s participation for a healthy world.
In a nutshell, the People’s Health Movement promotes a wide range of approaches
and initiatives to combat the ill-effects of the triple assault by the forces of
globalization, liberalization and privatization on health, health systems and health
care initiatives. In more detail, these include calls for:
4
•
combating the negative impacts of Globalization as a worldwide economic and
political ideology and process;
•
significantly reforming the International Financial Institutions and the WTO
to make them more responsive to poverty alleviation and the Health for All
Now Movement;
•
a forgiveness of the foreign debt of least developed countries and use of its
equivalent for poverty reduction, health and education activities;
•
greater checks and restraints of the freewheeling powers of transitional
corporations, especially pharmaceutical houses (and mechanisms to ensure
their compliance);
•
greater and more equitable household food security.
•
some type of a Tobin tax that taxes runaway international financial transfers;
•
unconditionally supporting the emancipation of women and the respect of their
full rights;
•
putting health higher in the development agenda of governments;
•
promoting the health (and other) rights of displaced people;
•
halting the process of privatization of public health facilities and working
towards greater controls of the already installed private health sector;
•
more equitable, just and empowered people’s participation in health and
development matters;
•
a greater
focus on
poverty alleviation
in
national and
international
development plans;
.
greater and unconditional access of the poor to the health services and
treatment regardless of their ability to pay;
5
•
strengthening public institutions, political parties and trade unions involved, as
we are, in the struggle of the poor;
•
opposing restricted and dogmatic fundamentalist views of the development
process;
•
greater vigilance and activism in matters of water and air pollution, the
dumping of toxics, waste disposal, climate changes and CO2 emissions, soil
erosion and other attacks on the environment;
.
militant opposition to the unsustainable exploitation of natural resources and
the destruction of forests;
•
protecting biodiversity and opposing biopiracy and the indiscriminate use of
genetically modified seeds;
.
holding violators of environmental crimes accountable;
•
systematically applying environmental assessments of development projects
and people centered environmental audits;
•
opposing war and the current USA - led, blind ‘anti-terrorist’ campaigns;
•
categorically opposing the Israeli invasion of Palestinian towns (having,
among other, a sizeable negative impact on the health of the Palestinian
people;
.
the democratization of the UN bodies and especially of the Security Council;
•
getting more actively involved in actions addressing the silent epidemic of
violence against women;
.
more prompt responses and preventive/rehabilitative measures in cases of
natural disasters;
•
making a renewed call for a comprehensive, a more democratic People’s
Health Care that is given the resources needed
--holding governments
accountable in this task;
•
vehemently opposing the commoditization and privatization of health care
(and the sale of public facilities);
•
independent national drug policies focused around essential, generic drugs;
•
the transformation of WHO, supporting and actively working with its new
Civil Society Initiative (CSI) making sure it remains accountable to civil
society;
•
assuring WHO stays staunchly independent from corporate interests;
•
sustaining and promoting the defense of effective patient’s rights;
•
an expansion and incorporation into People’s Health Care of traditional
medicine;
•
changes in the training of health personnel to assure it covers the great issues
of our time as depicted in our People’s Charter for Health;
•
public health-oriented (and not for-profit) health research worldwide;
•
strong people’s organizations and a global movement working on health
issues;
•
more proactive countering of the media that are at the service of the
globalization process;
•
people’s empowerment leading to their greater control of the health services
they need and get;
.
creating the bases for a better analysis and better concerted actions by its
members through greater involvement of them in the PHM’s website and list
server (pha-exchange);
7
•
fostering a global solidarity network that can support and react out fellow
members when facing disasters, emergencies or acute repressive situations.
As we enter the new millennium, this comprehensive view of actions for Health,
is probably the most significant contribution of the People’s Health Assembly and
the evolving People’s Health Movement. (Schuftan, 2002).
Significant Gains made by the People’s Health Assembly and the Movement:
Noteworthy are the ongoing and growing mobilization process at global level, the
Assembly as a historic first gathering and the movement that is evolving. In more
detail, the gains include the following:
For the first time in decades, health and non-health networks have come together
to work on global solidarity in health. These networks include the International
People’s Health Council (IPHC); Health Action International (HAI); Consumers
International (Cl); the Asian Community Health Action Network (ACHAN); the
Third World Network (TWN); the Women’s Global Network for Reproductive
Rights (WGNRR); Gonoshasthya Kendra (GK) and the Dag Hammaeskjold
Foundation (DHF). In the last couple of years, new networks like the Global
Equity Gauge Alliance (GEGA) and the Social Forum Network are linking with
us.
Even at country level, in some regions, this is beginning to happen. In India, for
instance, this national collective now includes the science movements; the
8
women's movements; the alliance of people’s movements; the health networks
and associations; some research and policy networks and even some trade unions.
Another significant development has been the evolving solidarity PHM has found
for its various collective documents at the global level (People’s Health Assembly
2000b & c). These have included themes such as:
Health in the era of globalization: from victims to protagonists; The political
economy of the assault on health; Equity and Inequity Today', some contributing
social factors; The medicalization of Health Care and the challenge of Health for
All; The environmental crisis: threats to health and ways forward; Communication
as if people mattered: adapting health promotion and social action to the global
imbalances of the 21st century.
Taken together, these documents represent an unprecedented, emerging, global
consensus.
At country level also, such consensus documents to support public education and
policy advocacy have been upcoming. In India, for instance, five little booklets,
now translated into most Indian languages, are now available on the following
five themes: What globalization means people’s health; Whatever happened to
Health for All by the year 2000; Making life worth living by meeting the basic
needs of all; A world where we matter: focus on health care issues of women,
children, street kids, the disabled and the aged; and,
Confronting the
commercialization of health care. These booklets have been published by 18
national networks who form the national coordination committee in India and
represent unprecedented consensus, the first of its kind in five decades!
The People’s Health Assembly itself was an unusual international health meeting
expressing and symbolizing an alternative health and development culture of
9
dialogue and celebration. An extract from the report of two participants in the
adjacent box describes this alternative dialogue.
The People’s Health Assembly - An Alternative Culture of Dialogue
•
The venue was well chosen. GK is one of the most revolutionary and inspiring
community-based health programs in the world. The physical and social
ambience was fabulous! No five star hotel for this huge forum: instead, a spacious
auditorium was built behind a tranquil lake and fields where the GK workers
grow food for the community program. Building the auditorium was no easy task.
Due to heavy rain and tardy funding, two days before the event the vast structure
still had no roof. But miraculously, it was completed at daybreak the morning the
Assembly began - thanks for the valiant day and night efforts of 1000 workers.
•
But how did the GK team manage to feed 1500 people in this rural setting?
Rather than bussing folks to restaurants or trucking in costly catered cuisine, they
built a covey of small bamboo sheds and invited women from neighboring
villages to come prepare traditional food. The chance to perch out-of-doors on
handcrafted
bamboo
stools,
eating
chapattis
and
dhal
while trying to
communicate with the gracious village women, was one of the high points of the
Assembly. It somehow symbolized what we were collectively seeking to achieve:
an innovative yet ancient way of transcending the commercial, hierarchical
barriers that separate people from one another and their dreams. It brought us
down to earth through the common understanding of each and everyone’s most
fundamental right, above all else - to have enough to eat.
.
It was during these communal meals, with six or eight of us activist and
progressives from different parts of the world clustered around a table comparing
our insights, that some of the most meaningful and potentially transformative
interactions of the PHA took place. After attending countless international
conferences and fora over many years, this was a marvelous opportunity to chew
the fat with so many old friends and fellow warriors for social justice.
• The energy and enthusiasm generated by the PH A was enormous!
For all the
diversity, the people present had in common a passionate commitment to change.
Many were spokespersons for disadvantaged groups valiantly struggling to
improve their situations - or at least to survive with dignity - in circumstances
that in recent years have become more and more difficult and oppressive.
Needless to say, an enormous amount of pain, anger, and frustration was vented.
But most important, a great sense of international solidarity emerged.
. ‘TO GIVE THE VOICELESS A VOICE’ was a foremost goal of the People’s
Health Assembly. And indeed, the PHA had strong representation from a wide
spectrum of marginalized and underprivileged groups, many of whom had never
before had a chance to speak at a local council, much less at an international
forum. Speakers from all corners of the earth represented everyone: from
community health workers to traditional birth attendants, from mother’s clubs to
a collective of unemployed alcoholics (from Scotland), from tribals to ethnic
minorities, from migrant workers to refugees, and from commercial sex workers
to activists with AIDS
• The PHA was a marvelous forum for sharing experiences and exchanging ideas.
Events were enlivened by role plays, music, dancing and poster sessions.
Dramatic ‘testimonials’ of personal hardships - many of which brought tears to
the eyes - portrayed the setbacks that people were suffering due to social
injustice, unfair laws, and globalization. To give more people a chance to speak
out, literally hundreds of relatively small concurrent sessions were held, ranging
from women’s rights to genetic engineering and everything else under the sun.
(Werner and Sanders, 2000)
11
Another significant gain has been the translation of the People’s Charter for Health
into nearly 40 languages worldwide. These include Arabic, Bangla, Chinese, Danish,
English, Farsi, Finnish, Flemish, French, German, Greek, Hindi, Indonesian, Italian,
Japanese,
Kannada,
Malayalam,
Ndebele,
Nepalese,
Philippine,
Portuguese,
Russian, Shona, Sinhala, Spanish, Swahili, Swedish, Tamil, Urdu, Ukrainian and
now in the process in Tonga, Lithuanian, Norwegian, Welsh ,Thai, Cambodian,
Vietnamese, Pastun, Dhari and Creole. An audio tape in English with Braille titles is
also available. All these have been translated by volunteers, committed to the
People’s Health Movement.
Audio Visual aids including videos for public education, exhibitions, slides, and
other forms of communication are coming up. The BBC Life Series video on the
Health Protesters was a good example.
The movement itself has evolved a communications strategy which includes a
website (www.phmovement.org ); the e-list server group for exchange and
discussion (pha-exchange@kabissa.org); news briefs (nine since January 2001) and
a host of press releases on a wide variety of themes and on special events and crises.
Presentations of the Peoples Health Charter, are constantly taking place in national,
regional and international for a which have included the World Health Organization,
the Global Forum for Health Research (GFHR - Forum 5 & 6) and the World Health
Assembly. The development of a standing relationship between the PHM and WHO
is particularly interesting. In April 2001, the very effective and assertive in-house
lobbying by a visiting PHM Consultant to a WHO research seminar resulted in the
formation of the WHO Civil Society Initiative announced at the World Health
12
Assembly, in May 2001. Six PHM leaders were invited to meet and dialogue with
the Director General. By May 2002, WHO CSI invited PHM to present the People’s
Charter for Health as a Technical Briefing in the World Heath Assembly. 35 PHM
members participated. In May 2003, over 80 PHM delegates from 30 countries
attended the Assembly; made statements on Primary Health Care; TRIPS and other
issues and were invited to meet the DG designate, who welcomed a greater dialogue
with PHM members at all levels so that WHO could be in touch with the realities of
the lives of the poor and the marginalized. The Assembly was preceded by a PHM
Geneva meeting for the 25th Alma Ata Anniversary, which was attended by some
WHO staff, including the PAHO Regional Director. These are all small, but
incremental movements towards a critical collaboration of PHM with WHO!
In many countries of the world, emerging country level PHM circles are beginning
to organize public meetings and campaigns which include taking health to the streets
as a Rights issue. Discussions on the charter by professional associations and public
health schools, articles and editorials in medical/health journals are also beginning to
increase.
Policy dialogues and action research circles on WHO/WHA; poverty and AIDS;
women’s
access
to
heath;
health
research;
access
to
essential
drugs;
macroeconomics and health; public-private partnerships; food and nutrition security
issues are beginning their work.
In short, every day the list offolloyv-up actions increases.
13
Conclusion
To conclude, the People’s Health Assembly and the People’s Health Movement that
has emerged from it has been a rather unprecedented development in the journey
towards the Health for All goal. The movement:
«=i> is a multi-regional, multi-cultural, and multi-disciplinary mobilization
effort;
■=> is bringing together the largest gathering of activists and professionals,
civil society representatives and the peoples representatives themselves,
•=> is evolving global instruments of concern and action, and
is involved in solidarity with the health struggles of people, especially the
poor and the marginalized affected by the current global economic order.
Recognizing that we need a continous, sustained, collective effort, the
People's Health Movement process must remind us, through the People's
Health Charter that a long road lies ahead in the campaign for Health for
All, Now,
References:
1. WHO-UNICEF (1978),
Primary Health Care, Report of the International Conference on Primary
Health Care, 6-12 September, 1978, Alma Ata - USSR.
2. People’s Health Movement (2002),
Voices of the Unheard - Testimonies from the People s Health Assembly,
December 2000, GK Savar - Bangladesh.
14
3. People’s Health Assembly (2000a),
People’s Charterfor Health, People’s Plealth Assembly, 8 December 2000,
GK Savar - Bangladesh.
4. Schuftan, Claudio (2002),
The People 's Health Movement (PHM) in 2002: Still at the fore front of the
Struggle for "Health for All Now”; issue paper-2 for World Health Assembly,
May 2002, People’s Health Movement
5. People’s Health Assembly (2000b)
Discussion papers prepared by PPIA Drafting group, PHA Secretariat, GK
Savar, Dhaka -Bangladesh
6. People’s Health Assembly (2000c),
Health in the era of Globalization, From victims to protagonists - A iscussion
paper by PGA Drafting group, PHA Secretariat, GK Savar, Dhaka - angladesh.
1. Narayan, Ravi (2000)
The People's Health Assembly - A People's Campaign for Health for All Now,
Asian Exchange Vol. 16, NO. 2., P-6-17, 2000
8. Werner, David and Sanders, David (2000)
Liberation from What? A Critical refection on the People’s Health Assembly
2000, Asian Exchange, Vol. 16, No. 2., p 18-30, 2000
15
Page 1 ofi
Main identity
From:
To:
Cc:
Sent:
Subject:
"Sumathi .Morgan" <cmai@del1 .vsnl.net. :n>
<secretariat@phmovement.org>
< p h msec© to uchtel in d i a. n et>
Monday. January 17, 2005 3:05 AM
Health Advocate 19 4
Wish you and your team a very happy and a wonderful New Year!
You must be surprised that I did not bother you for so long. So many things happened and the last issue of CMJI
was gening delayed. Since the country has witnessed the worst disaster, our focus for the 19 4 (Oct-Dec) v/as
shifted from Dalit issues to 77?e role of Christian Medical professionals in the Disaster Management.
As you are doing a jot of work regarding this, it was decided to approach you with the request for the write up of
Advocate focussing on this issue of Disaster Management by medical professionals with the backdrop of
Tsunami.
Your test write-up on The 'Aroles' or the 'Apollos* Whom do we listen to? was not been used yet. We can use it for
our next issue may be with some modifications or as you say.
Since me first issue of rhe year is already been delayed we are trying to work simultaneously on both the issues.
Looking forward to nearing from you soon.
Regards
Sumathi
Reprinted from:
December 2003
VOLUME 1111 NUMBER 1 6
The National Institute of Environmental Health Sciences
National Institutes of Health
U.S. Department of Health and Human Services
Children’s Health I Article
Effect of Endosulfan on Male Reproductive Development
Habibullah Saiyed,1 Aruna Dewan,1 Vijay Bhatnagar,1 Udyavar Shenoy2 Rathika Shenoy,2 Hirehall Rajmohan,3
Kumud Patel,1 Rekha Kashyap,1 Pradip Kulkarni,1 Bagalur Rajan,3 and Bhadabhai Lakkad1
’National Institute of Occupational Health (Indian Council of Medical Research), Meghani Nagar, Ahmedabad, India; department of
Pediatrics, Kasturba Medical College, Mangalore, India; 3Regional Occupational Health Research Centre, Bangalore, India
There is experimental evidence of adverse clTecis of endosulfan on the male reproductive system, but
there arc no human data. Therefore, we undertook a study to examine the relationship between envi
ronmental endosulfan exposure and reproductive development in male children and adolescents. The
study population was composed ol 117 male schoolchildren (10-19 years of age) of a village situated
at the foothills of cashew plantations, where endosulfan had been aerially sprayed for more than 20
years, and 90 comparable controls with no such exposure history. The study parameters included
recording of clinical history, physical examination, sexual maturity rating (SMR) according to Tanner
stages, and estimation of serum levels of testosterone, luteinizing hormone (LH), follicle-stimulating
hormone, and endosulfan residues (70 study and 47 control subjects). Mean ± SE scrum endosulfan
levels in the study group (7.47 ± 1.19 ppb) were significantly higher (p < 0.001) than in controls (1.37
± 0.40 ppb). Multiple regression analysis showed that SMR scoring for development of pubic hair,
testes, penis, and serum testosterone level was positively related to age and negatively related to aerial
exposure to endosulfan (AEE; p < 0.01). Serum LH levels were significantly positively related to A EE
after controlling for age (p < 0.01). The prevalence of congenital abnormalities related to testicular
llescent (congenital hydrocele, undcsccndcd testis, and congenital inguinal hernia) among study and
controls subjects was 5.1% and 1.1%, respectively, but the differences were statistically nonsignifi
cant. Our study results suggest that endosulfan exposure in male children may delay sexual maturity
and interfere with sex hormone synthesis. Our study is limited by small sample size and nonparticipa
tion. Key words: endocrine disruptor, endosulfan, luteinizing hormone, male reproductive develop
ment, sexual maturity rating, testosterone. Environ Health Perspect I I 1:1958-1962 (200.3).
doi:IO. 1289/ehp.6271 available via http://dx.doi.org/\On\U\c 22 September 200.3)
Endosulfan (6,7,8,9,1 0.1 0-hexachloro1,5,5a,6,9,9a-hcxahydro-6,9-mcdiano-2,4,3benzodioxathicpin-3-oxide) is a broadspcctrum insecticide and acaricide first regis
tered for use in the United States in 1954 to
control agricultural insect and mite pests on a
variety of field, fruit, and vegetable crops.
I echiiical-gradc endosulfan is composed of
two stereochemical isomers, Ct-endosulfan and
[3-endosulfan, in concentrations of approxi
mately 70% and 30%, respectively. Use data
from 1987 to 1997 indicate an average
•Lomestic use of approximately 1.38 million
founds of active ingredient per year [U.S.
Environmental Protection Agency (U.S. EPA)
2002). It has been found in at least 162 of the
1.569 current National Priorities List sites by
the U.S. E.PA (I LtzDat 2000). In India, it is
widely used against a variety ol agricultural
pests. During 1999-2000, about 81,000 met
ric tons of endosulfan was manufactured in
India, and in terms of tonnage its production
was next only to mancozcb (103,000 metric
tons) and monocrotophos (95,000 metric
tons) (Anonymous 2001).
Oral LD50 (lethal dose sufficient to kill
50% of population) endosulfan in rats is 80
mg/kg, and it has been classified as a moderately
hazardous (Hass II) pesticide (World Health
Organization (W1 IO) 2002J. Neurotoxicity is
the major end point of concern in acute
endosulfan expo-ure in human beings and
1958
experimental animals. No data arc available
for subacute or chronic exposure to endosul
fan in human subjects; however, the subacute
and chronic toxicity studies of endosulfan
in animals suggest that the liver, kidneys,
immune system, and testes arc the main tar
get organs (Agency for Toxic Substances and
Disease Registry (ATS DR) 2000].
In recent years, there has been growing
concern about toxicity ol a number of chemi
cals, including pesticides, on the male repro
ductive system (Murray ct al. 2001; Sharpe
2001). Reported effects of endosulfan on the
male reproductive system in experimental
animals have been variable, depending on
species, age at exposure, dose, duration of
exposure, and study end points. Routine gross
and histopathologic examination of the repro
ductive organs of male mice that consumed
doses of 7.3 mg/kg/day for 13 weeks (I locchst.
Unpublished data) or 2.5-5.0 mg/kg/day
lor 2 years [Hack et al. 1995; Hoechst.
Unpublished data; National Cancer Institute
(NCI) 1978) revealed no toxic effects. Later
on, more detailed studies in adult rats exposed
to 2.5. 5, and 10 iAg/kg/day endosulfan for
5 days per week for 10 weeks showed reduced
intlatesticular spermatid counts, sperm abnor
malities, and changes in the marker enzymes
ol testicular activities, such as lactate dehy
drogenase, sorbitol dehydrogenase, y-glutamyl
transpeptidase, and glucose-6-phosphate
dehydrogenase, providing further evidence
of effects on spermatogenesis (Khan and Sinha
1996; Sinha et al. 1995). Exposure of younger
animals (3 weeks old) showed marked depletion
of spermatid count as well as decreased daily
sperm production at a dose of 2.5 mg/kg/day
(Sinha et al. 1997), which was earlier seen only
at 5 mg/kg/day in adult rats by the same investi
gators (Sinha ct al. 1995). More recent studies
have shown that exposure of pregnant rats
to endosulfan at 1 mg/kg/day from day 12
through parturition leads to decreased sper
matogenesis in offspring (Sinha et al. 2001).
Dalsenter et al. (1999) reported similar observa
tions at 3 mg/kg/day but not at 1.5 mg/kg/day,
and they attributed this to strain variation
(Dalsenter et al. 2003). Thus, experimental
studies suggest that endosulfan can affect the
male reproductive system and also that these
effects arc likely to be greater if exposure occurs
during the developmental phase.
Environmental exposure to a single chemi
cal over a long period of time is very rare. We
came across a situation where endosulfan
was the only pesticide that had been aerially
sprayed two to three times a year for more
than 20 years on cashew nut plantations situ
ated on hilltops in some villages of northern
Kerala, India (figure 1). The population living
in the valley had a significant chance of expo
sure to this pesticide during aerial spray and
subsequently through other contaminated
environmental media. I his population, there
fore, provided a unique opportunity to study
the long-term health effects of endosulfan. In
this article, we report the effects of endosulfan
on male reproductive development.
Materials and Methods
Selection of study and control areas. "I he
exposed population was defined as school
children who were permanent residents ol the
Address correspondence to I LN. Saiyed. Director,
National Institute ol Occupational Health. Meghani
Nagar. Ahmedabad .380016, India. Telephone: 9179-268-6351. Eax: 91-79-268-6110. E-mail:
saiyed ImCT’yahoo. com
We gratefully acknowledge the Ministry of 1 Ic.thh
and family Welfare. Government of India, for spon
soring this study; volunteers who participated in the
study; and the pediatricians from Department of
Pediatrics, Kasturba Medical College. Mangalore.
India.
The authors declare they have no competing
financial interests.
Received 10 February 200.3; accepted 22 September
200.3.
volume 1111 number 161 December 2003
•
Environmental Health Perspectives
Children's Health | Endosulfan and male reproductive development
village situated below the cashew plantations
where endosulfan had been sprayed aerially.
This village had 12 first-order streams origi
nating from the cashew plantations. Most of
the habitations were along the valleys and
close to the stream banks. Most of the inhabi
tants depended on runoft water for irrigation
purposes, The control population was selected
from schoolchildren of another village situated
approximately 20 km away. I’he population of
this village was comparable with the exposed
population in socioeconomic status, ethnicity,
and occupational characteristics but without
any history of aerial endosulfan spray. 'I’he
control village did not have streams.
Selection oj study and control subjects.
The mam study was carried out to explore the
effects of endosulfan exposure on growth and
development in 619 schoolchildren of both
sexes (5—19 years) and 416 comparable con
trols. r\ll male children (272 exposed and 135
controls) older than 10 years were asked to
participate in a sexual maturity rating (SMR)
study; 1 17 (43%) exposed and 90 (67%) con
trols participated in SMR examination For
the hormone study, every other student who
participated in the SMR study was requested
to donate a blood sample.
Study parameters. The study parameters
included recording of clinical history in a
specially designed pro forma physical examina
tion, assessment of SMR by Tanner’s classi
fication (Marshell and Tanner 1969), and
estimation of serum levels of testosterone,
luteinizing hormone (LH), follicle-stimulating
hormone (PSI I), and endosulfan residues.
House in the valley
Ethical aspects. This study was approved by
the ethics committee of the National Institute
of Occupational I leahh. Parents, who were
requested to accompany their children at the
time of examination, were told the objectives of
the study, and a consent form in local language
was read aloud to them. The children were
examined only alter one of the parents gave
written consent. In addition, special consent of
the child was taken lor the SMR study, and
only in willing cases were blood samples col
lected I he SMR examination was carried our
by pediatricians observing necessary privacy
required lor this delicate examination.
Collection, storage, and transport of blood
samples. Five milliliters of venous blood were
collected from each willing individual between
1000 and 1200 hr on the day of examination
and was centrifuged at 5,000 rpm for 5 min in
the field laboratory. Scrum was separated anti
stored at —20°C in a nearby hospital. I he
scrum samples were air-shipped under dry ice
to the laboratories at National Institute of
Occupational I leahh, Ahmedabad, India. To
avoid observer bias, the samples were coded
before being handed over lor analysis.
Chemicals and standard control materials
for analysis of endosulfan in serum samples.
All the chemicals and reagents used in the
extraction and cleanup of endosulfan residues
were highly pure HPLC (high-performance
solvents filtered through 0.2-p filters and
packed under nitrogcn)-grade obtained from
Qualigcns Fine Chemicals (Glaxo India Ltd.,
Mumbai, India) and were checked for any
pesticide contamination. Glassware used was
free from residue contamination. Standard
reference materials of a-endosulfan (99.0%),
P-endosulfan (99.0%), and endosulfan sulfate
(99.0%) were a gift from M/s Excel Ltd.,
(Mumbai, India), which is the largest manu
facturer of endosulfan in India.
Extraction of residues from serum.
Extraction was modified from techniques
described in Dale et al. (1966) and U.S. EPA
(1980). Briefly, serum (0.5 mL) was pipetted
into a graduated stoppered centrifuge rube,
6 mL of hexane was added, and it was rotated
in a slow-spced Roto-rac (National Institute
4.0 x 106
Stream flowing
through the valley
Pond formed <
by.the stream
houses in the valley. Water streams formed in the
hills pass through residential zones In the valley.
a-Endosulfan
RT = 36.8 min
3.0 x IO6
Endosulfan sulfate
RT = 67.0 min
30
Figure 1. Cashew nut plantations on the hills and
oLOccupational Health, Ahmedabad, India)
for 2 hr. The organic layer was transferred
into another graduated tube and was evapo
rated to dryness under a stream of nitrogen.
The final volume was made up with hexane
corresponding to the expected concentration
of the residue. A suitable aliquot was injected
into a gas chromatograph with an electron
capture detector. We calculated the recoveries
of endosulfan residues, which ranged from 88
to 102%. In addition, fortified samples were
studied as a part of quality assurance and
quality control.
Instrumentation and quantij'ication. We
used a gas chromatograph (model 6890)
equipped with a Micro Electron Capture
Detector, a capillary column (HP 5, 60 m,
0.25 mm inner diameter, film thickness
0.25 pm; all these items from Hewlett Packard
Agilent Plus; Agilent Technologies, Little
Fall, DF., USA), and Nj (ultra high purity,
99.999% grade) as carrier gas for the quantifi
cation of endosulfan residues. Ihe initial oven
temperature was 80°C with ramp rate of 20°C
per min to 200°C. I’he injector port tempera
ture was 220“C (splitle.s.s mode), and detector
temperature was 275"C. We quantified the the
samples by comparing the peak area of each
with those of their respective standards. The
retention times of a-endosulfan, p-endosulfan,
and endosulfan sulfate were at 38.9, 52.5, and
67.2 min, respectively (Figure 2A,B).
Hormone analyses. We estimated testos
terone, LH, and FSH in 50 pL and 100 pL
scrum samples of study and control subjects
using radioimmunoassay kits procured from
Immunotech (Marseille, France). We used a
Wallac 1470 Wizard autogamma counter
(Perkin Elmer, Turku, Finland) to count
radioactivity with detection efficiency of 78%
for I125 and negligible cross talk with other iso
topes. Equipment and glassware were segregated
to prevent cross-contamination. The hormones
were estimated in serial dilutions of scrum along
with parallel curves to standard. All the samples
for hormone estimations were processed in one
assay to rule our interassay variations. We per
formed a linearity study to assess the sensitivity
of the hormone assays by serial dilution of a
40
70
Figure 2. Chromatograms of a-endosulfan, p-endosulfan, and endosulfan sulfate. RT, retention time.
(A) Standard chromatogram of a-endosulfan, p-endosulfan, and endosulfan sulfate. (8) Chromatogram
of a-endosulfan, p-endosulfan, and endosulfan sulfate in blood sample of a study subject.
Environmental Health Perspectives • volume 1111 number 161 December 2003
1959
Children's Health | Endosulfan and male reproductive development
age in study and control individuals. The
regression lines indicate that average serum
levels for the same age arc higher in the study
group.
Endosulfan exposure. Endosulfan was
detected in serum samples of 78% of the chil
dren in the study group and 29% of the chil
dren in the control group. Tabic 4 shows the
scrum endosulfan levels in the study and con
trol groups. I’he levels of endosulfan in the
study group children arc significantly higher
(/>< 0.001).
Discussion
Our study results, after controlling for age,
showed significantly lower SMR scores and
serum testosterone levels and higher levels of
scrum LH in the study group compared with
controls. To link these changes with endosul
fan exposure, we should look at two issues:
biologic plausibility of the cause-effect rela
tionship and pathways of endosulfan exposure.
Biologic plausibility. There are reports of
testicular toxicity’ of endosulfan manifested as
^creased spermatogenesis and testicular hormionc synthesis (steroidogenesis), as evidenced
by a decrease in spermatid count in testes and
in sperm count in the cauda epididymis and by
changes in marker enzymes for testicular
steroidogenesis in adult animals (Chitra et al.
1999; Singh and Pandey 1989, 1990; Sinha et
al. 1995). These effects were seen at much
lower dosages and shorter durations if exposures
occurred during the prenatal or prepubertal
periods (Dalscntcr et al. 1999; Sinha et al.
1995, 1997, 2001). Singh and Pandey (1990)
also reported profound decreases in the levels of
plasma LH, ESH, and testosterone associated
with decrease in testicular testosterone in puber
tal rats exposed to endosulfan for 30 days.
Thus, our observations of low testosterone lev
els in male children conform with the animal
studies. Lower SMR scores appear to reflect
lower scrum testosterone levels for age. In our
study, it is not possible to confirm disturbed
spermatogenesis observed in animal studies.
The higher prevalence of congenital abnor
malities related to testicular descent observed
in the study group should not be overlooked
simply because it failed to achieve statistical
significance (which may be due to small sample
size), because there is indirect evidence of
endosulfan exposure associated with undesccndcd testes in a human population from
Spain. Garcia-Rodrigucz et al. (1996) reported
a higher incidence of hospital admissions to
University of Granada Hospital for cryptorchi
dism from districts near the Mediterranean
coast, where there is intensive use of pesticides.
A subsequent study reported endosulfan iso
mers and/or metabolites in adipose tissue of
40% of children who were admitted to the
same hospital for a variety of reasons (Olea et
al. 1999), indicating that significant endosulfan
exposures occurred in the region. In the pre
sent study, there is a definite history of endo
sulfan exposure that is likely to have occurred
during the prenatal period.
Pathways of endosulfan exposure in the
study population. In our study, we estimated
endosulfan residues in biologic and environ
mental samples. The practice of aerial spraying
of endosulfan was discontinued in December
2000. Scrum endosulfan residue levels were
Table 3. Summary of the multiple regression analysis for serum testosterone levels against age, history of
AEE, and serum LH levels.
Dependent
variable
Testosterone
Exposure
Age
LH
b
SE
b
SE
b
SE
0.37“
0.06
-0.62"
0.21
1.09"
0.20
No of observations: study = 67; control = 46. Overall /T7 = 0.61. "p < 0.001
significantly higher in the
than in the control group even 10 months after
the last aerial spray (October 2001). Moreover,
endosulfan residues were detected in water
(> 0.03 ppb) and pond sediments (> 0.3 ppb)
only in the study area 1.5 years (June 2002)
after the last aerial spray. This signifies that
low-level endosulfan exposures continued to
occur probably by translocation from the hill
tops to the valley in the study area long after the
aerial spray. This is supported by the report of
Regional Remote Sensing Service Center
(RRSSC), Bangalore, India (Nageswara Rao
PP. Personal communication). On the basis of
analysis of satellite pictures of the study area,
the RRSSC reported, “The watershed charac
teristics are favorable for any aerially sprayed
toxicant to reach the soil-water-plant contin
uum in a very short span of time and get accu
mulated” (Nageswara Rao PP. Unpublished
report). Endosulfan has a half life of 60-800
days in soil (ATSDR 2000). Frank et al. (1982)
have also reported that because of its persis
tence in soil, endosulfan residues were detected
in water samples throughout the year (outside
the spray season) with storm runoff. The
results of several laboratory and greenhouse
studies indicate that a- and p-cndosulfan arc
strongly adsorbed to soil (Bowman et al. 1965;
El Beit et al. 1981a, 1981b). The study area
has an annual rainfall of 140 inches. Twelve
first-order streams originate from the cashew
plantations. It is likely that endosulfan sticking
on the soil is carried by runoff water during
most of the year.
We have measured endosulfan levels only
once in serum samples. These individual endo
sulfan measures may or may not accurately
reflect the chronic levels and/or levels during
critical developmental phases. However, the
effect of this would be to decrease power of the
study (via an increase in random misclassifica
tion of exposure) and thus bias toward the
null. We believe that even single estimations of
scrum endosulfan levels validate that children
exposed to endosulfan via aerial spraying do, on
average, have higher exposures than children in
the control group.
Finally, it is important to discuss and
resolve the following weaknesses of the study.
First is nonparticipation in SMR study: 57%
of the exposed and 33% of the control partici
pants did not agree to undergo SMR examina
tion. However, growth-related end points
(height, weight, and skin-fold thickness) were
Table 4. Mean ± SE levels (ppb) of serum endosulfan
in study and control subjects.
a-Endosulfan
p-Endosulfan
Figure 6. Serum testosterone levels according to
Figure 7. Serum LH levels according to age and
age and AEE.
AEE.
Environmental Health Perspectives • volume 1111 number 161 December 2003
Endosulfan sulfate
Total endosulfan
Control (n= 45)
Study {/> = 70)
0.87 ± 0.23
0.40 * 0.17
0 10 10 08
4 24 ± 0 74“
1.77 ±0.36"
1.37 ± 0.40
1.47±033“
7.47 ±1.19"
"p <0.001.
1961
To
The Editor
Down To Earth
Dear Ms Sunita Narain,
I found your article on the endosulphan very comprehensive and well
investigated. Since you mentioned the visit of Mr Ganesan to CHC I would like to add
something more from that interaction. The conversation was basically around the industries
concern about the ‘misinformed activists’ campaign against endosulphan, which was a ‘relatively
safe pesticide alternative’ today. As a health training and policy action group committed to
community health concerns and action initiatives, I informed him that we were neither anti
industry or anti-pesticide per se but pro people’s health and our concerns and interests were
around ‘evidence’ of dangers to community health of any nature. Also as an Occupational Health
consultant I have been interested in this issue ever since I did a large ICMR study on
Occupational Health hazards of tea plantation workers including pesticide hazard.
I requested him to provide us with all the information the association/industry had about
endosulphan, which he promptly gave me in a note with questions and answers on endosulphan.
Over the last few months two of our younger team members Dr Anur Praveen and Dr Rajkumar
Natarajan have done a detailed literature review. I am sending this to you as our commitment to
public education so that your readers can decide whether this is ignorance of an industry or a
deliberate misinformation campaign.
At the end of last month we facilitated a very interesting three day Community Health
Environment Skill Share (CHESS), where over 100 professionals and activists gathered from all
over the country to share their concerns about pesticides, mines, industrial hazards and other
environmental hazards and explore ways and means of studying them and collecting health
evidence. We had the unique privilege of a presentation by Dr Sayed, Director of National
Institute of Occupational Health who summarised the findings of their study on endosulphan in
Kasargod, which has been submitted to the National Human Rights Commission. The findings
not only substantiate the literature review we have compiled in CEIC but is a sound, scientific,
evidence based contribution to the controversy. As a contribution to people’s science I think
Down To Earth should formally write to NHRC and NIOH (on behalf of your readers and the
affected victims of the endosulfan disaster) to release this report and make it a public document
to support the right of information.
The ICMRs ethical guidelines for bio medical research on human subjects (2000) highlights
that “researchers have a responsibility to make sure that the public is accurately informed
about results without raising false hopes or expectations.”
Regards,
Dr Ravi Narayan
Community Health Cell Adviser, CI-IC, Bangalore
sochara@vsnl.com
INDUSTRY VERSUS SCIENCE - IGNORANCE OR MISINFORMATION
Compiled by Dr Amir Praveen and Dr Rajkumar Natarajan ( CHC)
Questions
Answers
( What the Industry provided us*)
What is
Endosulfan?
Endosulfan is a popular insecticide
used worldwide in more than 60
countries including USA, Japan, many
European and Asian countries. It is
recommended for control of insect
pests in a variety of field and
plantation crops such as Cotton,
Vegetables, Wheat, Paddy, Mango,
Cashew, Tobacco, Coffee, Tea,
Sugarcane, Spices, etc.,
Agricultural scientists call Endosulfan
as a “selective insecticide” as it has a
very low toxicity towards beneficial
insects such as honeybees and insect
predators/parasites and crop pests. It is
therefore considered to be the most
ideal insecticide for use in IPM
(Integrated Pest Management) systems.
* Note provided by Mr Ganesan of
Pesticide Manufacturers Association
What we have to say......
(The actual facts)
- Endosulphan is an organochlorine
pesticide belonging to the same family
(cylodiene sub group ) as Aldrin, Endrin,
Dieldrin, Heptachlor, Chlordane and
Mirex all of which are Persistent Organic
Pollutants (POPs) and banned by the
International POPs Convention Treaty.
(Quijano. R. F., International Journal of
Occupational Health, 2000)
- Endosulfan itself is banned in Germany,
Singapore, Norway, Sweden and Belize.
Its use in rice fields is not allowed in
Bangladesh, Indonesia, Korea and
Thailand.
- Its use is severely restricted in USA, UK,
Japan, Russia, Australia, Great Britain,
Finland, Netherlands, Denmark, Sri lanka,
Thailand, and Kuwait. (Hoeshcst, 1991;
IRPTC, 1993; PRC, 1994)
- Latest data reveal it is highly toxic to
bees, aquatic animals and other wildlife. It
is moderately to highly toxic according to
scale of Hodge and Stemer(1956).
- It is easily absorbed in the body
following ingestion, inhalation and skin
contact. (IPCS, WHO-EHC 40, 1984.)
- There is no authority or reference
quoting endosulfan as a selective or ideal
insecticide.
- Acute intoxication or systemic toxicity
causes neurological manifestations like
irritability, restlessness, muscular
twithicng, seizures, cyanosis, pulmonary
oedema and death. (IPCS, WHO-EHC 40,
1984 and
Gosselin. R. Et al, Toxicoloogy of
Commerical Products, 1984.)
2. Does
endosulfan
belong to the
insecticide
group 6
Chlorinated
Hydorcarbons”
similar to
DDT?
3. How does
WHO rank
endosulfan for
its toxicity?
No.
Insecticides of Organo chlorine group
contain mainly the elements Carbon,
Hydrogen and Chlorine. Whereas,
Endosulfan additionally contains
oxygen and sulphur in a functional
sulphite group. Hence, in 1986, WHO
reclassified Endosulfan as sulfurous
ester of a chlorinated cyclic diol. In he
handbook of International Union of
Pure and Applied Chemistry (IUPAC),
Endosulfan is designated as sulphite.
Endosulfan is a Persistent Organic
Pollutant belonging to the organocholrine
group and cyclodiene sub group. It
belongs to the same family as Aldrin,
Endrin, Dieldrin, Heptachlor, Chlordane
and Mirex all of which are Persistent
Organic Pollutants (POPs) and banned by
the International POPs Convention Treaty.
(Quijano. R. F., International Journal of
Occupational Health, 2000)
The UN body WHO has classify
pesticides as follolw.
Class la : Extemely Hazardous
Class lb : Highly I-Iazardous
Class II : Moderately Hazardous
Class III : Slightly Hazardous
WHO basis for Class II (moderately
hazardous) is based on LD 50 value taken
from company generated* acute toxicity
rate . (Quijano. R. F., International Journal
of Occupational Health, 2000)
*This data wets challenged because the
lab that did theses tests was charged with
fraudulent practice.
Endosulfan comes under the Class II
“Moderately Hazardous” pesticide.
Although endosulfan is classified as
sulphurous acid ester of chlorinated cyclic
diol by WHO, it is still an organochlorine
and its degenerated product endosulfan
sulfate is very persistent and as toxic as
the parent compound.(ASTDR, US Dept
of health & human Services, 1993)
In India, endosulfan is classified as an
“extremely hazardous4* pesticide (ITRC,
1989)
According to USEPA, endosulfan is
classified as “extremely hazardous” class I b (US Environmental Protection
Agency, Consolidated Chemicals List, 2nd
February, 1990)
EXTONET classified it as a highly toxic
chemical. (European union, 1998)
Fate in Environment4. What is the
fate of
endosulfan in
the
environment?
&
5. Is use of
endosulfan
safe for man
and
environment?
Degradation and dissipation of
Endosulfan is rather fast from all
compartments of the environment
(soil, water, air and organisms). In
Indian conditions, dissipation of total
Endosulfan residues occurs to the
extent of 95% within 28 days after
application. On most fruits and
vegetables 50% of Endosulfan residues
is lost within 3-7 days after
application. In soil, it is degraded by
microorganisms. It is practically
insoluble in water. The half line of
Endosulfan in water is estimated to be
4 days.
At the recommended rate/s and
method/s of application, Endosulfan is
safe to man and environment and is
unlikely to lead to any user or public
health problems.
Studies and reviews by WHO/FAO
and US show that Endosulfan does not
have carcinogenic/mutagenic
/teratogenic effects. Endosulfan does
not cause endocrine disruption.
Endosulfan enjoys good user safety
record, though used in a variety of
situations worldwide.
In soilThe time taken for the concentration of
endosulfan sulfate to reduce to half its
concentration in soil is 60- 800 days
(Stewart and Cairns, Journal of
Agricultural Food Chemicals, 1974)
Endosulfan was found in soil after 3 years
of usage. (Rao DMR, Murthy AS, Journal
of Agricultural Food Chemicals, 1974)
Concentration of endosulfan in sediment
is 32,000 times greater than in the water
column.(NRCC,1975)
In waterThe time taken for the concentration of
endosulfan to reduce to half its
concentration in water in 3-days - 5
months depending upon pH of water, O2
(dissolved in water) and pollution in
water.
(NRCC, 1975)
Endosulfan has been found in
groundwater at deep soil layers upto 20
days after spraying. (Paningbatan EP et al,
The Phillipine Agriculturist, 1991.)
Endosulfan is lethal to fish, even at
acceptable levels in water bodies. (IPCS,
WHO-EHC 40, 1984)
In air
Endosulfan has been carried over long
distances and found in air and snow
samples in Arctic regions.
(Gregor and Grummer, 1989)
Endosulfan bioaccumulates in aquatic
species like fishes, (Naquvi SM,
Vaishnavi C, Comp Biochem Physiol C,
1993; Fernandez Casalderrey A, et al,
Comp Biochem Physiol C, 1991; IPCS,
WHO-EHC 40, 1984) Kingfishers that fed
on fish which were killed or incapacitated
by endosulfan aerial spray died.
(Douthwaite, 1982)
Endosulfan and its residues have been
found in foods like vegetables, crops and
infant foods. (Pordrebarac DS, 1984,
Bureau of Plant Industry Phillipines,
1995)
Safety of endosulfan for man and
environmentNo chemical pesticide is completely safe!!
There has been no studies on to prove the
toxicity of endosulphan as it is ethically
and legally not permissible to perform
tests on humans with pesticides. However,
sufficient proof is available on the
mutagenic , carcinogenic, teratogenic and
geno toxic effects on animals. Naturally,
these studies are used to predict the
possible effects on human beings.
Endocrine disruptionEndosulfan has reproductive and
endocrine disrutping effects leading to
reproductive toxicity and changes in
reproductive organs. (Soto A, Colbom. T,
Van Saal F. S., Environmental Health
Perspectives, 1994)
Mutagenicity (Cancer causing)
A 1992 study concluded that endoulfan
could act as a tumour promoter.
(Fransson-Steen R, et al, Carcinogenesis,
1992)
It has produced high rates of
lymphosarcoma (cancer of lymph
nodes)(Industrial Biotest, 1965)
Genetic defects (genotoxicity)
Endosulfan has caused damaged to genes,
chromosomes and cell cycle kinetics.
(Yaquan Lu, et al, Environmental Health
Perspectives, 2000; ASTDR, 1993)
Birth defects
Low birth weight and adverse behavioral
effects have been noted on the offspring
of exposed rats. Endosulfan may produce
both maternal and developmental toxicity
in humans. (ASTDR, 1993)
Nervous system:
Acute intoxication or systemic toxicity
causes neurological manifestations like
irritability, restlessness, muscular
twitching, seizures. Long term effects of
exposure to endosulfan have caused
seizures and mental retardation. (ASTDR,
1993)
ImmunotoxicityThis is the most sensitive endpoint of
endosulfan toxcity and humans are at risk
of adverse immune effects.. (ASTDR,
1993)
In environmentEndosulfan is lethal to fish, even at
acceptable levels in both fresh water and
sea water. (IPCS, WHO-EHC 40, 1984)
Endosulfan has been proven toxic for
terrestrial birds and organisms like
beetles, mallards, kingfishers. (IPCS,
WHO -EHC 40,1984, Hudson et al, 1972)
The National Wildlife Federation US
states that endosulfan is extremely toxic to
wildlife and acutely toxic to bees. (NWF,
1987)
The Danish government has classified
endosulfan as acutely toxic to birds.
(Hanson OC, Ecotoxicological
Evaluation of Endosulfan, 1993)
Toxicity of endosulfan in roots and leaves
have been reported. (IPCS, WHO-EHC
40, 1984)
Released by CHC, Bangalore in public interest to support the campaign against
hazardous use ofpesticides.
WHOEHC: World Health organization Environmental Health Criteria
IPCS:
International Program on Chemical Safety
A TSDR: Agency for Toxic Substances and Disease Register, Atlanta
ITRC:
Industrial Toxicology Research Centre
Page 1 of 1
Ssnfc
"PHM - Secretariat’’ <secretariat@phmovement.org>
"Anant Bhan" <anant.bhan@utoronto.ca>
"C’audio" <ciaudio@hcmc.netnarn.vn>; ’'rakhal gaitonde" <subharakhal@rediffmail.com>;
"Community Health Cell" <chc@sochara.org>
Tuesday, April 05, 2005 4:45 PM
Re: Urgent: Article on PHM
reedngs from PHM Secretariat (Global)!
1 have been swamped by global mail ever since I returned after a 10 day trip to Chile and Ecuador. Go
ahead and write an article. You can get Rakhal, Claudio and perhaps Thelma to join you in the article.We
could discuss at the Steering Group meeting. Claudio is the best bet for such papers, since he
coordinates the PHM Exchange and has access to all the documents.
Best wishes
Ravi
4/5/05
Page 1 of2
From:
To:
Senft:
Sosfejecft:
"Anant 3han" <anant.bhan@utoronto.ca>
<secretariat@phmovement.org>; <ravi@phmovernent.org>
Wednesday, March 30, 2005 10:01 AM
Urgent: Article on PHM
Dear Dr. Ravi,
Greetings from ? oronto!
Hope that you are doing well. I am doing fine - busy with course, but now it is entering the final stage, and I
will be returning in end June to India.
We were exploring writing an article on the PHM for a major medical journal at the IHF before the WSF in
Mumbai and there were preliminary discussions over email with Rakhal and Vikram Patel which I had about it,
but it did not happen.
I got in touch with the editors of PLOS Medicine (www.plosmedicine.org) which is a new peer reviewed and
open access high quality medical journal. As you can see from their mail below they are very interested in
having an article on PHM for their July 2005 issue to coincide with the PHA-II. This is an excellent oppununity
for us to further publicize the work of the PHM in the global health arena and also raise our concerns on the
present global health structures.
[ need to get back to them immediately as the time lines are tight- so I would need a quick response from
you:1) 3 hope this is fine with PHM, i wanted to check with you before I proceeded with this.
2) Do yo have any suggestions on who else might be interested in working with me on this- we will have to do
this over email, and within the next three-four weeks so it has to be folks who can spare that kind of time.
3) As is evident from the mail, they would prefer authors from developing countries
Please do let me know what you think, so that I can get back to the editors as soon as possible.
Thanks and please convey my regards to everybody in the CHC/PHM family
5I
Best,
Anant
— Original Message —
From: Gavin Yamey
7©: Anant Bhan
Seiraft: Tuesday, March 29, 2005 6:45 PM
Snolbjecft: Article on PHM
Dear Anant,
^-<2.
The timing of your suggestion is excellent, as it would be great for us to publish something in our July issue to Lje c<suk
coincide with the People’s Health Assembly.
The only problem (not a big problem) is that we are publishing your essay in June, and we would be reluctant
to have two sole authored pieces from you in two consecutive issues. Would you be able to ask 2 or 3 co
authors on board from PHM—ideally based in developing countries themselves? This would also make for a
broader and more inclusive piece.
J
The best format would be a “Health in Action” article. These are about 1000-1500 words, with up to 20
references. The idea is that you take readers through the following issues:
*Why was PHM needed: what was the background? What problem was PHM trying to address?
‘What is PHM: what does it do? How does it work?
‘What kind of impact and successes has PHM had? Give specific and concrete examples. For example,
CQ- A-C
Jo O/J >(4?
cU u,
I
Page 2 of 2
what did the last People’s Health Assembly achieve?
*What are the difficulties and challenges facing PHM?
*The future: where is PHM heading?
You can see some examples of Health in Action articles at:
http://dx.doi.org/10.1371/journal.pmed.0020046
http://dx.doi.org/10.1371/journal.pmed.0020011
For us to get this into the July issue, and allowing time for peer review, we’d need the piece in four weeks’
time. Is this possible?
I look forward to hearing from you,
Sincerely
Gavin Yamey
Fmms Anant Bhan [mailto:anani.bhan@utoronto.ca]
Friday, March 25, 2005 12:20 PM
T©: Gavin Yamey
Siafejocis Re: Peer Review Report Atcched
Dear Gavin,
Thanks for your mail, and for pointing out the article on the PHM GHW.
I was working as a trainee in community health and as a technical volunteer with the global secretariat of the
Peoples Health Movement which is based in Bangalore, India for some time, and that helped me develop
linkages within the movement.
The PHM is an innovative grassroots movement and they are suggesting some interesting alternatives to the
global health order.
Take care and have a nice weekend,
Anant
I — Original Message —
I From: Gavin Yamey
To: Anant Bhan
'
Wednesday, March 23, 2005 7:21 PM
I SaubjscR: RE: Peer Review Report Attched
' Dear Anant
; Thanks for this suggestion, which I will share with my colleagues/
I The PHM did contribute to an article in our launch issue, on the Global Health Watch, at
I http://medicine.plosjoumals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0010003 But
I it may still be good to have a piece about the PHM itself. I’ll get back to you.
Best wishes
I
|| Gavin
3/30/05
Page 1 of 1
ft/T ° r® f w <2V? ■'■
□ Oc e~L J l
J U G.L 0)7
? mm:
<davidmccoy@xyx.demon. co. uk>
'"Lynette Martin" <lmartin@uwc.ac.za>; <fran.baum@flinders.edu.au>;
<claudio@hcmc.netnam.vn>; <d.Iegge@latrobe.edu.au>; <secretariat@phmovement.org>;
<ctddsf@vsnLcom>
Semi:
Tuesday, March 08, 2005 5:33 PM
Subject: Re: VERY URGENT! Chapter
Dear all - just by way of addition, YES please send me comments by Sunday morning to have best
chance of your comments being acted upon. I’m sorry for the short turnaround time, but as you know
we have been working flat out on getting several chapters completed in time for the publisher’s
deadline.
he chapter is over 17,000 words long - so bear in mind the fact that we cannot extend the length.
1 hanks again!!
lmartin@uwc.ac .za wrote:
> ** High Priority **
> Dear Ravi, David, Claudio, Amit, Fran,
> I am attaching the latest (near-final) version of the proposed chapter
> for Global Health Watch on Health Systems. Dave McCoy has been working
> very hard and long to pull this together. As you may know, both the
> process and content/emphasis have resulted in much controversy. While I
> have made extensive comments on several occasions and believe that the
> chapter now is MUCH improved from earlier versions, I still have some
> reservations about it. Nonetheless, it needs to soon go to the printers
> (March 12 is the deadline). I have only just received this version and
> am forwarding it now to all of you in the hope that you will be able to
> make comments and get them to Dave McCoy (to whom I am copying this
> request as soon as possible.
> Best regards,
> David Sanders
> Prof David Sanders/Lynette Martin
> School of Public Health
> University of the Western Cape
> Private Bag X17
> Bellville, 7535
> Cape, South Africa
> Tel: 27-21-959 2132/2402
> Fax: 27-21-959 2872/959 1224
>CeIl: 082 202 3316
.
£
M
2"
4/20/05
Page 1 of2
'
Sufejssl:
"UNNiKRISHNAN P.V. (Dr)" <unnikru@yahoo.com>
"PHA Global" <pha-exchange@kabissa.org>; <pha-ncc@yahoogroups.com>; <PHAEurope@yahocgroups.com>; "IPHCWORLDWIDEY" <IPHOWORLDWJDE@yahoogroups.com>
Tuesday, April 26, 2005 2:26 PM
[pha-ncc] 'Asiafrica: Linking the Two Continents') focuses on news, information around the
HIV/AIDS pandemic in Asia and Africa
FYI:
---- Original Message----From: IPS Asia-Pacific [mailto:ipsasia@ipsnews.net ]
Subject: asiafrica
’Asiafrica: Linking the Two Continents' ) focuses on news,
information
around the HIV/AIDS pandemic in Asia and Africa, linkages between
them
and lessons that the two regions can learn from each other. A follow-up
project from the XV International AIDS Conference in Bangkok, Thailand,
this initiative is coordinated by Inter Press Service (IPS)
Asia-Pacific, supported by the Rockefeller Foundation. IPS Asia-Pacific
and IPS Africa are cooperating on this project.
http://ngo.c.topica.com/maadrDyabgmn4bpfCYdb/
Below are the first features, and watch out for more...
PM rpM rV-A|P5
INDIA
Deadly Mix: Drugs, HIV and Insurgency at the Border
by Ranjit Devraj, Churachandpur
Perhaps no place on earth deserves free anti-retrovira
which helps slow the spread of HIV/AIDS, more than thi
of 240,000 people in the north-east Indian state of Ma
the porous India-Burma border.
drugs (ARVs),
remote district
pur, just on
http://ngo.c.topica.com/maadrDyabgmn5bpfCYdb/
ZIMBABWE
Secrets and Silence Around AIDS
by Kudzai Makombe, Harare
As AIDS affects a growing number of women and girls in sub-Saharan
Africa, a timely novel -- entitled ’Secrets of a Woman's Soul' has been
released by first-time Zimbabwean author Lutanga Shaba.
http://ngo.c.topica.com/maadrDyabgmn6bpfCYdb/
CHINA
Children Orphaned by AIDS Battle Double Stigma
by Antoaneta Bezlova, Beijing
The 2001 scandal in central China's Henan province — over the huge
4/27/05
Page 2 of 2
number of poor people becoming infected with HIV through the sale of
their blood — forced a slow, painful change in Beijing’s complacent
attitude toward an emerging AIDS crisis.
http://ngo.c.topica.com/maadrDyabgmn7bpfCYdb/
Other Resources:
Training Manual for the Media: Gender, HIV/AIDS and Rights
The manual was developed by an experts group and tested in two IPS
journalists training workshops in South Africa and Jamaica. Download
pdf version of the manual.
The Language of HIV/AIDS: A Tool for Journalists/Newsrooms
This tool was prepared for a briefing for journalists by IPS-Asia
Pacific, ahead of the production of the ’TerraViva’ conference
newspaper edition at the XV International AIDS Conference, Bangkok,
Thailand, July 2004. Download pdf file.
IPS Asia-Pacific is the regional headquarters of Inter Press Service
(IPS) news agency. The World Service is available at www.ipsnews.net
For feedback on this page, pls write editors@aidsasiafrica.net or
ipsasiaOipsnews.net
Yahoo? Groups Links
o To visit your group on the web, go to:
http://groups.yahoo.com/group/pha-ncc/
o To unsubscribe from this group, send an email to:
pha-ncc-unsubscribe@yahoogroups.com
z Your use of Yahoo! Groups is subject to the Yahoo! Terms of Service.
4/27/05
Page 1 of I
WmW
Fr©m:
T©:
Senft:
Swlbjecft:
"Anant Bhan" <anant.bhan@utoronto.ca>
"PHM - Secretariat" <secretariat@phmoveraeni.org>
Tuesday, April 19, 2005 7:49 PM
Re: important: Request for information about PHM
Dear Dr. Ravi,
' hanks a lot for the materials- ven; useful!
■ wiB send the draft article to you for comments soon.
Best wishes,
Anant
o
4/20/05
Page 1 of 1
F:-;••???:
To:
SubrwE:
"PHM - Secretariat* <secretariat@phmovement.org>
"Anant Brian'* <anant.bhan@utoronto.ca>
Tuesday, April 19, 2005 6:03 PM
Perspective on Global Development and Technology.doc; ^arayanSchurian.doo; WHO Case
study.doc
Re: Important: Request for information about PHM
Greetings from PHM Secretariat (Global)!
Please check the PHM website and I am requesting Srinidhi to send you two articles that answer some of
your questions. An article by Claudio Schuftan and myself in a recently published book on Globalization
Health from Berkeley and some comments by the editors and authors in the same book (other articles
on the PHM in the global context). We also enclose a case study on PHM and WHO which documents a
^hanging relationship of'total ignoring’ to ’active engagement'. You can send me a draft of your article to
ent upon nitty gritty.
emativf'y send it also to Claudio who manages our PHM Exchange (claudio@hcmc.netnam.vn) and he
i also comment and peer review the article.
Best wishes
I
4/19/05
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Main Identity
From:
To:
Sent:
Subject:
"Anant Bhan" <anant.bhan@utoronto.ca>
"PHM - Secretariat" <secretariat@phmovement.org>; <ravi@phmovement.org>
Tuesday, April 19, 2005 12:23 AM
Important: Request for information about PHM
Dear Dr. Ravi,
As you know, I am presently writing a short article on PHM to be probably published in medical journal in its
July issue to coincide with the 2nd Peoples Health Assembly in Ecuador to be held in July. In discussion with
the editor, we want to focus on the following.Health in Action article- 1000-1500 words, taking the readers through the following issues:*Why was PHM needed' what was the background? What problem was PHM trying to address?
*What is PHM: what does it do? How does it work?
*What kind of impact and successes has PHM had? Give specific and concrete examples. For example,
what did the last People’s Health Assembly achieve?
*What are the difficulties and challenges facing PHM?
*The future: where is PHM heading?
I know you are very busy, but I request you to send me your thoughts and ideas on these topics about PHM
and also any other suggestions for the article Also I would appreciate any documents relevant to the article
that you can email to me.
I am working on a very short time line as the editors want the article to reach them by the end of this month,
hence I request you to kindly reply to this request at the earliest possible for you.
Thanks a lot in advance.
Anant Bhan
PHM- India/Canada
PS I wrote to Rakhal, Dr. Thelma and Claudio Rakhal said no, Claudio has sent me some stuff, and Dr.
Thelma has not yet replied to me. I wrote to Vikram Patel and he has said yes.
- Media
RF_COM_E_SUDHA.pdf
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