The G20 Makes Early Childhood Development a Priority

World wide roughly 200 million children under the age of five, in low and middle income countries, will fail to meet basic developmental milestones. Such deficits affect health across the lifespan, the ability to contribute to the national economy, and the ability to stop the cycle of poverty. With this knowledge in mind the United Nations made a point of linking their sustainable development goals to children’s issues, specifically early childhood development (ECD). Recently the G20, with Argentina as the new chair, have placed an emphasis on ECD in the international community by adding it to their own sustainability goals. The G20 has recognized that ECD must be incorporated into all programs, not just within child centric programs and that an emphasis must be placed on children under five years of age.

Programmatic areas have remained siloed focusing on nutrition and ensuring school aged children receive an education. While these initiatives play a role in ECD they only focus on topical areas and do not formally integrate ECD, newborn to age five, into programmatic work. The G20 has created a case for cross collaboration within programmatic and policy level work, even laying out funding streams for such work. This puts the G20 in line with World Health Organization guidelines, including guidelines around integration of ECD in emergency situations. When you are already servicing families and their children, especially in low income programmatic settings, it is easy to add in basic ECD education. For example, when providing breastfeeding support to mothers this is a wonderful opportunity to briefly discuss the need to talk and sing to the child in order to develop language acquisition. Another example is to provide pamphlets, that match the health literacy level of the community, around positive parenting and age appropriate milestones at an immunization drive.  

ECD doesn’t just apply to children – it applies directly to the child’s environment: families, caregivers, and national leadership. ECD focuses a lot on positive parenting to encourage positive brain development and language acquisition. The World Health Organization just released a guideline that discusses nurturing care within ECD, highlighting strategies and policies focusing on the environment that impacts ECD. A really interesting piece that the G20 highlights is the need for better trained child care providers. The G20 ties it back to economics – if a family, mothers in particular, feels comfortable leaving their child in the care of someone else they are able to contribute to their local and national economy in a greater way. There is also the money saving aspect for countries who invest in programs that promote ECD in children under the age of five. As discussed in the literature, children’s brains are rapidly developing arguably from in the womb through the first 1,000 days of life, and programs that focus on this age group provide a larger cost saving than programs that focus on children over five. This is because potential developmental delays are prevented, thus not as much money is needed to get a child back on their developmental track. Also, at such a young age with the focus predominantly being on environmental factors the cost is solely around training and educating front line staff, not actual school aged interventions.

Again – it is great news to have a group like G20 make ECD a priority, especially for children under five. It brings the topic back to the front of the global health stage and proves that it can be easily incorporated into programmatic work.

Kenya Just Banned a Homosexuality Test

Suspicion of having gay sex or relationships is illegal in Kenya and punishable by 14 years in jail. As a result, a group of activists and human rights lawyers in Kenya have been challenging this criminal code and fighting laws that punish LGBT people for being in a relationship or having sex.

One of the most prominent organization leading the issue is the National Gay and Lesbian Human Rights Commission in Nairobi, an organization arguing that LGBT communities are being unfairly targeted. In 2016, the commission received 193 reports of violations, mostly cyber-bullying, blackmail, verbal assault, and physical assault. Other forms of violence and discrimination include eviction, employer termination, or “corrective” rape. Most recently, forced anal exams were still carried out in Kenya despite being considered a degrading form of torture and having no medical merit; while straight people who have anal sex are not considered criminals. Forced anal examinations are usually performed by a healthcare provider at the request of law enforcement officials. These examinations are intended to cause emotional and physical pain and offer no potential benefits to the individual. This could also result in serious mental health concerns such as depression or suicide. This forced homosexuality test is not only a violation of medical ethics but a violation of health equity.

It originated when two men were found and arrested by police because they were thought to be gay. During this time, the court ruled against them and had them get the tests. Little is known about the true prevalence of this practice but the fact that it was codified in legal systems is astonishing. This ruling was reversed in Kenya in March 2018. Many are trying to determine if the ruling on forced anal testing could be an indicator for a turning point for LGBT cases. Promoting equality through health is extremely valuable, especially in this instance, and addressing any barriers could improve the overall health around the LGBT community.

To this day at least nine countries, several of which are in Africa, force anal examinations to investigate or punish alleged same-sex behaviors between consenting men or transgender women. A study from 2016 found that Kenya and several other countries use anal examinations as a means of determining a man’s sexuality. Tunisia, Egypt, Turkmenistan, Cameroon, Lebanon, Uganda, and Zambia, and Tanzania and possibly some others that have reported some instances, such as Syria, are included.  Law enforcement officials should never order the examinations since they lack evidentiary value. Doctors should not conduct them and courts should not admit them into evidence.

Stand up for gun violence prevention with a few actions you can take in the coming week

Dear IH Friends,

Here is a message from our colleagues at APHA and the MCH Gun Violence Prevention Workgroup:

Now is the time to stand up for gun violence prevention (GVP) in our Nation.  Many of you have asked what you can do to promote the public health approach to gun violence prevention. Below are actions to take in the coming week:

1.    Please plan on attending one of over 817 March for Our Lives events worldwide on Saturday, March 24th. Click on this link to register for the March:  March for Our Lives (https://event.marchforourlives.com/event/march-our-lives-events)

Possible Signage for the March for our Lives:

-Gun violence is a public health crisis.

-We need more funding for gun violence prevention research

-Gun violence is a public health issue

2.    Visit the APHA website Gun Violence Page:   Gun Violence. (https://www.apha.org/topics-and-issues/gun-violence)

3.     Share AJPH Gun Violence Research. (http://ajph.aphapublications.org/topic/gunviolence)

4.    Get active in your communities. Engage at the grassroots level.  Join your local GVP organizations and promote a public health approach to end the gun violence epidemic.

In collaboration,

The APHA Intersectional Council (ISC) and MCH Gun Violence Prevention Workgroups

Happy #InternationalWomensDay!

A message from our section chair, Laura Altobelli


In 1909 and 1917, women organized to demand better wages, equal working conditions, and the right to vote.

In 1975, the United Nations established March 8 for the annual recognition of these struggles.

On this International Women’s Day, the tendency is to think that today celebrates women just for BEING WOMEN — instead of its true meaning….THE GLOBAL STRUGGLE FOR EQUAL RIGHTS OF WOMEN.

Today is to commemorate the hard work that has not yet ended, and to celebrate those women (and some men), past, present, and future, who push the boundaries toward empowerment of women and girls and gender equality in all aspects of life.

Today is an annual call to continue the struggle.

In international health and global development work, this is arguably the most important of our callings — to reach the 5th Sustainable Development Goal: to ‘achieve gender equality and empower all women and girls,’ after which all other SDGs will be easier to reach.

Have a good day and keep up the struggle!

Achieving health equity in global health through workforce diversity

This International Women’s Day we honor the achievements of women leaders working to advance the health and well-being of people all over the world. Their path to success was certainly not easy. It was fraught with numerous challenges; challenges that are not only experienced by those of us working in global health but by women across all industries.

We are considered either too soft and feminine or too bossy and pushy to be seen as competent leaders. Our work culture lacks family-oriented, work-life balance policies which enable us to contribute to our field in significant ways. We lack female mentors to encourage us to grow and push us to overcome any obstacles we encounter in our career. We work for organizations where the people who make the big decisions on what policies and programmatic areas to focus on are men. The struggles we face trying to advance in our careers are reflected in the lack of gender equality in the global health workforce. While women make up 70% of the global health workforce, only 25% of leadership positions in global health are held by women.

We have known for a long time that when women are given equal opportunities for leadership at all levels of decision-making in economic, political, and public life, everyone in society does better. Female leaders in health “promote access to contraceptives, empowerment programs for girls, women’s rights to family planning and maternity care, safe abortions, and protecting environmental assaults on children’s health.” In addition, women leaders at all levels of governance have shown to be the primary driver toward financing public goods such as health, education, hospitals, clean water, and sanitation. Women’s participation and leadership in economic, political, and public life is so critical to advancing societies that it is even written into one of the sustainable development goals. When women have a voice at all levels of decision-making, we are closer to eliminating the inequities that lead to disparities in health.

More global health organizations are recognizing the need for women leaders and organizations such as Women in Global Health are working toward achieving gender equality in global health leadership. Last year the World Health Organization’s newest Director-General, Dr Tedros Adhanom, appointed eight women to senior leadership, effectively outnumbering the men. In doing so, he took one big leap toward achieving gender equity at the WHO – a goal that was first set in 1997 and that took two decades to realize.

Gender equality is not the only type of diversity we need to strive toward in our global health leadership however. Diversity in global health leadership must also focus on inclusion of people from different ages, race and ethnicity, sexual orientation, social class, geography, religion, and other characteristics of personal identity.  As a woman and a first-generation Filipino-American working in global health in the United States, I often find myself at global health and public health conferences and meetings wondering why there are very few leaders that encompass the diversity that I represent on stage (and occasionally even in the audience). The people who make the decisions with the biggest impact in global health must reflect the diversity of the people we serve.  

Learning from, understanding, and seeing the world through another person’s point of view is at the heart of working in global health and a driving reason for why I chose to work in this field. In order to truly reflect the diversity of this field though, the definition of diversity itself needs to go far and beyond the characteristics of one’s personal identity. To fully be inclusive, we must also be open to learning from, understanding, and seeing the world through the perspectives of individuals in the global health workforce with diverse backgrounds, life experiences, and competencies. Our field could benefit from the ideas of diverse individuals in solving some of the world’s most pressing global health problems. These ideas cannot always come out of our own echo chambers. 

Achieving diversity in the global health workforce is everyone’s job. It requires each one of us to recognize and overcome the personal biases (whether they are subconscious or not) which prevent us from hiring and working with more diverse talent. For those of us responsible for making decisions, we must work to create policies at all levels which not only promote but require inclusion. It’s only then that we can achieve true diversity in our workforce and our leadership. It’s only then that we can progress further in achieving health equity.

Stay tuned for part two of my series on Achieving health equity in global health through workforce diversity in which I will discuss different ideas for how we can achieve diversity in the global health workforce.