From Alma Ata to the Global Fund: The history of International health policy is a report prepared by the Italian Global Health Watch, published in the journal of Social Medicine (Volume 3, Number 1, January, 2008). This paper traces the evolution of international health policies and international health institutions, starting from the birth of the World Health Organization, the setting up of the Health for All targets at the Alma Ata conference 1978 and the rise of neo-liberal policies promoted by international financial institution from 1980 to the present. The paper looks at different issues surrounding public-private partnerships and the setting up of the Global Fund to fight AIDS, Tuberculosis and Malaria and the influence of these institutions on the health system in poor countries. For having access to a copy of this report click here.

Last week in a Medical Care Class at the BU school of public health, we discussed about the health market, professor said that the health market is an imperfect market, because it doesn't have the characteristics and assumptions adhered to a perfect market. A perfect market has some assumptions like rationality of the market actors, no transaction cost (no information cost and taxes), no price taking behavior and there is sufficiently large number of participants such that no individual can affect the market and freedom of decision. Professor told us that the health market is imperfect because the following assumption is not a case in this market (1):

Power Equal
Real competition and choice
Full information
No price fixing
Transparent to buyer and seller

Patient and doctors don't have an equal power, in most areas competition is not a case since there is no different health providers. For example in some countries only one neurosurgeon works, or because of the insurance policy patients are not allowed to visit any doctor that they wish.

But my question is what about we look at the health care as a fundamental human right, if so; we can not simply analyze the health system from a market perspective. In this case health is not only a commodity with all of characteristics related to goods, it is a right, and we need to take into the account the costs of providing a right for citizens and in some cases it can be an imperfect market.

(1) Courtesy of Professor Bill Bicknell

Surprisingly Health and Human Right as a unique field (one concept) is a young, but rapidly growing and dynamic field. When we think about public health, unconsciously we consider it as a human right, these two words had evolved parallel but it took a long time until finally this field was introduced as a unique concept. The first time that human rights were explicitly named in a public health strategy was only in the late 1980s, when people looked at rights of HIV/AIDS patients seriously. Prof. Jonathan Mann's observations were one of the early efforts to highlight the field.

Jonathan Mann’s 3 basic observations:

• Human rights abuses can dramatically affect health
• Health can be dramatically worsened when human rights are ignored
• Health and human rights can act synergistically

Today I learned about Jonathan Mann Award for Global Health & Human Rights, the deadline for nominees is January 15th, 2008. I believe this award and the announcement around it, can help to internalize this field among health policy makers and practitioners. For more info click here.

I wrote this note last week before knowing about Iowa caucus's result. Today is the day of New Hampshire primary vote. We are looking forward to learn about the results of "Super Tuesday" and so on. It is too soon to even predict who actually will be the parties' candidates. But I like to write down my thought here and see what will happen.

I am not a political analyst or even activist. But for some reason that back to my personal experiences I can see somehow the Nov 5th 2008 headlines (Election Day will be Nov 4th 2008)

Republican candidate John McCain now holds only a slight lead, down from an advantage of almost 5000 votes. Democratic candidate Barack Obama in a statement congratulated the winner of the race. Democratic National Committee Chairman in a separate statement asked all of stakeholders including Supreme Court to think about some modifications in the Electoral College System and asked for a change in this regime.
Last night Hynes Convention Center in Boston was full of thousands of democratic supporters who shouted and sometimes crying in supporting Senator Obama the candidate of change.

When we talk about needs assessment we can look at it in an individual or population based frameworks. In an individual framework, finding the basic needs of an individual is not so difficult, everybody needs shelter, clean water, education, food and so on. But when we talk about population needs assessment, it would be complicated in some degrees. In fact in a population level, measurement of health outcomes and needs related to health outcome makes it challengeable.

We have to define the health outcome, we have to define needs, we have to find appropriate and validated measures to be able to understand the current health situation. Using some traditional measures like mortality and morbidity, not only just give us the negative sides of health outcomes but also just give us the extreme and absolute sides of the health outcomes and there is no news about the spectrum of health outcomes and a level of change.

Despite the difficulty of finding the appropriate definition and measure for delivering a needs assessment project we almost always follow some common steps.
The fundamental question for the program's needs assessment:
• Who is the target population?
• What are the target population's needs?
• Which groups within the target population have these needs?
• Geographically, where are those in need?
• What is currently being done to aid those in need, by whom and where?
• What and where are the unmet needs?
• How well did we do in addressing those needs in the past?
• What has changed since we started?

An articulate and well designed needs assessment project is a powerful tool for informing policy makers for supporting and financing the programs for addressing the unmet needs in a population.

Medicine targets individuals to diagnose disease and offer medical treatments to relieve symptoms and if it is possible, to cure. Physicians see individuals who have access to medical care, so what about the rest who don’t have access, how we can reach to these people, how we can make sure those people who suffer actually have any access, dealing with this kind of problems in a population framework comes as a matter of public health mission. Under public health umbrella you have this chance to address these issues in a population based paradigm.

Public health seeks to understand the conditions necessary for well being. Public health not only tries to understand these conditions but also tries to deliver interventions to address the issues. Public health is practice based knowledge, it is complicated, it is difficult to address, it is a multidimensional knowledge, and it is really a multi disciplinary field. Public health professionals believe that the population’s health condition deeply affected by social, economic, cultural and political context in which people live. Public health is a matter of human right, justice, and equity and it is all about change. Public health scholars or activists have a common desire and it is change. Changing from current status to a better condition with less suffer and pain.

I love to be in this field, the field of challenge and change. It is difficult and innovative field. I remember when I visited Lahore in Pakistan; I went to visit the Alameh Iqbal Lahoori’s tomb, a politician and a poet who wrote poems in Persian. There was a meaningful poem on the wall of his tomb.He says “The meaning of human is innovation, since moon and sun do their job as they did for years”. I am in this field to make a difference and serve marginalize and vulnerable folks, I hope I can.

And with mine own hand wrought to make it grow,

And this was all the harvest that I reap'd,

I came like water, and like wind I go
-- Omar Khayyam

Source : the Houtan Foundation website

What is your definition of National Interest? You can’t find any Iranian name in the list of terrorists who attack western interests in the previous years. Why you deliver irresponsible talks and try to help people call us terrorist.

Last year I applied for changing my visa status from Research Scholar to Full time student. This is a 2-3 month process. Now it is more than 1 year that I am waiting for this change. My case is on pending. I bet each time you deliver a speech; people try to consider my file one more time, because you are the president of my country.

I am an Iranian physician; I served people in poor areas as a volunteer Doc for a decade. If I wasn’t an Iranian I had lots of choices for funding and scholarship in the school of public health, but since I am an Iranian student I am not eligible for applying to almost all of scholarships available for people like me from developing countries.
My visa is on pending and it means I am not allowed to even work as a student and use my summer for doing my practicum. I am not able to work as a research or teaching assistants.

Mr. Ahmadinejad, what is your definition of National Interests? I never use any governmental fund in my whole life; I am a self employed and stand on my own feet. Why you make life of people like me difficult with your irresponsible talks.
You have two ears and one tongue. I recommend you to listen more than giving talks. If you turn your volume down, maybe you hear this voice.

The site brings organizations together with each other and their clients on-line, taking the concept of a local "drop in center" to the internet.The goal of HIVConnect.net is to deepen the interaction between clients and the organizations that seek to support them.

Starting the policy in the right time and attention to the window of opportunity is another lesson. This policy was legitimate and politically sustainable because of the Fatwa by the leader of the Islamic Revolution. The policy was operationally and administratively feasible, because of the extensive health network around the country with more than 16000 health houses in rural and urban area. Also the policy was substantively valuable, because it answered real needs of the society, and the willingness for development and country reconstruction after the war was something desirable for the nation.

Taking a gender approach and appreciating the role of both women and men was another message of this success story. The policy tried to change the values, beliefs of the people toward family size and fertility, and the family planning activities. Now the small family size is a norm in Iran. Thus, it would be so difficult for any policy makers to change this norm.

President said:

A lady high school teacher contacted me sometimes ago, that we have a 16 years old girl in our school, a third year high school student in Math Physics major.
She has told her teacher that she in her house discovered nuclear energy. The teacher asked me to do something about it. I asked them to have a meeting in school and asked the student some questions and find out how serious it is. They had a meeting, asked questions and found out that it is serious. They informed me I called the chief of nuclear energy organization. I told him” Dear sir, a high school student claiming something like this. I asked him to investigate and if it is true support her. They invited our nuclear scientists who are younger than 25 on the average.”
They sat and had a meeting; they invited the student and questioned her. They saw that she is right, they told her let’s see what you are doing in your house. They went to the house, They realized that this 3 rd year high school student with help of her older brother has bought some parts from the market and attached them together, and had really produced nuclear energy, Now they have taken her there and she has become a nuclear scientist Now she has bodyguard, a car, driver and etc.
This is self confidence

“Could it be that Mahmoud Ahmadinejad is working for us? He is after all doing an excellent job for Israel. This week, while Teheran is divided between pragmatic elements calling to suspend Iran's nuclear program (or at least enter dialog with the US,) and militant elements who are not prepared to make any concessions – militant Ahmadinejad should definitely be supported.
It would be bad news for Israel if the Iranian nuclear program was halted now because international pressure would wane, a new American president would come to power and the smart Iranians would renew the project later on. Fortunately we have Ahmadinejad who insists that his country be isolated and trumpeted as the world's problem child.

• He brought the Iranian nuclear issue to the top of the international agenda..
• Ahmadinejad has pitted the US against Iran, while virtually pushing it to take military action against his country.
• The Iranian president has lost European support to such an extent that countries such as Germany, France and Britain are insisting on expanding sanctions on Iran
• He united the whole world behind Israel due to his foolish denial of the Holocaust.
• By his own doing, Ahmadinejad is building the great Sunni camp against the Shiites and Iran.
• Due to Iran's Shiite enthusiasm, the rift between Iran and Syria - its only ally - is also growing. The Syrians feel very uncomfortable with the Shiite ambition for hegemony, which could ultimately come at their expense.
• The unofficial international economic embargo against Iran is expanding, and is likely to soon become official if the Security Council makes such a decision.
• Ahmadinejad is also increasingly losing Russian support.
• Internally Ahmadinejad has also achieved quite a lot by inciting entire sectors within Iran against him and the Ayatollah regime, while insisting on imposing a radical and conservative line on the entire country without understanding the direction of history, which is distancing itself from the conservative line. “

So it seems president Ahmadinejad, is a precious agent in favor of his country enemies.

Iranian nation says “we don't deserve this treatment, especially during Iranian American Heritage Month”.
We refer western community to learn about our ancestors from different sources rather than Hollywood, and keep in mind that the first human right declaration was written by Cyrus the Great in 2500 years ago also you may find the name of Cyrus in Bible, who gave freedom to Jews and built the second temple for them and let them to practice their religion.

Now I am working to do an analysis of the population’s policy in Iran. We look back to explore the determination of the policy, how this policy got into the agenda, were initiated and formulated and what is the policy content. For this exploration we use the health policy triangle method, in this approach actors are in the center of the policy and context, content and process are on the corners of the triangle. Learning about Iran experience can be useful for adaptation population policy in the Islamic world. Many developing countries with fast growing population can profit by learning from Iran’s model in promoting population stability.