IH CONNECT

Per a video from BBC News 2016 is set to be the warmest year on record.  With an observed global temperature rise of 1.2 degrees Celsius, we are rapidly nearing the threshold of 1.5-degree change considered most advantageous to stave off considerable threat.  This figure was agreed upon by representatives of 195 countries at the Paris climate conference in December 2015.  It stands as the first -ever universal, legally binding global climate deal.

Such a deal has come too late for those who live in regions of the world devastated by drought, such as Ethiopia.

Ethiopia is no stranger to the devastation wreaked by drought.  Drought in the early-to-mid 1980s sparked a famine that killed a million people.  Even if, like me, you weren’t alive at the time, you are probably familiar with widely publicized images of skeletal babies, such as in this BBC newscast (Warning: Graphic images).  The disturbing images spurred the first Live Aid concert in 1985.

The present drought in Ethiopia is linked to a super El Niño, exacerbated by rising ocean temperatures.

According to the World Meteorological Organization, the current El Niño is one of the strongest events recorded, which is pushing people already suffering from the effects of climate change deeper into poverty and making them more vulnerable.

Since the drought began in earnest in 2014, Ethiopia’s economy has tanked.  Eighty percent of Ethiopia’s agricultural produce relies on a rainy season that remains elusive.  This is devastating for a country where 85% of people rely on agriculture to make a living.  Ten million Ethiopians will need international aid to survive this drought – on top of 8 million already receiving aid from safety net programs – to the tune of 1.4 billion dollars.

The United States under the Obama administration has been the single largest donor to this cause, totaling $774 million along with $381 million from the Ethiopian government itself.  This type of aid isn’t guaranteed to continue as President-elect Trump’s comments about climate change are scientifically unsound at best.

Besides calling man-made climate warming a hoax invented by China (which China refutes), in the above video, Trump says he is a “huge believer in clean water…crystal, clean water.”  This begs the question water for who?  And where?

An Op-ed piece published in the New York times connects one of Trump’s least talked about points (climate change) with one of his most (immigration):

When you visit the Pentagon, ask the generals about climate change. Here’s what they’ll tell you: A majority of immigrants flooding Europe today are not coming from Syria or Iraq. Three-quarters are from arid zones in central Africa, where the combination of climate change and runaway population growth are making small-scale farming unsustainable.

Will Trump withdraw the US from the Paris climate deal?  If we take him by his word, it’s a possibility:

Any regulation that’s outdated, unnecessary, bad for workers or contrary to the national interest will be scrapped and scrapped completely.  We’re going to do all this while taking proper regard for rational environmental concerns.

As we hover mere tenths of a degree away from potential catastrophe, I ask that Mr. Trump and all present and future leaders consider the global interest ahead of job growth.

Overview of CAPE Conference – Conference Note 3 – Investing in Private Enterprises

Since the private sector has been highlighted as having a significant role to play in reaching the Sustainable Development Goals (SDGs), there have been growing efforts to integrate it into international development financing activities. In my last post, an overview of DE principles used to guide key players in official development assistance (ODA) was provided. This post will focus on development finance institutions (DFIs)  and similar entities that invest public funds into private enterprises.

Public international development agencies make up the majority of donors. Now that donors are able to contribute to DFIs through ODA routes, the claim can be made that DFIs should also be required to follow DE principles as they invest in private enterprises.  Although DFIs are able to operate similarly to ODA, the overall goals and methods of these streams of funding are not perfectly aligned. One reason for this is that DFIs are focused on creating jobs and receiving a return on investment, while ODA focuses on poverty-alleviation. Additionally, each DFI has individual operating guidelines and procedures. The chart below includes items that were discussed at the 2016 CAPE Conference as DE supporters considered whether DFIs should be required to adhere to DE principles:

As a result of this discussion, the recommendations below were compiled and will be presented at the Second High-level Meeting of the GPEDC on November 28th:

• DFIs and other donor-backed investment vehicles should commit to supporting national development strategies. The GPEDC should track whether donors incorporate country preferences into their investment strategies. Attempts to achieve wider ownership of investment decisions would be impractical.
• Countries and donors should commit to harmonising the relevant elements of country results frameworks with those used by DFIs and other donor-backed investment vehicles. No indicator is necessary.
• Donors should commit to putting in place rigorous procedures for identifying groups at risk, consulting affected communities and handling grievances. Monitoring could be based on an independent rating of these.
• Donors should commit to a process that will establish shared transparency requirements when investing public money in private enterprise (PPP). Indicators could include the percentage of PPPs that conform to Open Contracting Partnership data standards, and the percentage of investments where: full beneficial ownership information is available; the upfront investment case is public; some indication of the degree of concessionality is stated.
• Partnership and accountability should apply when formulating investment strategies and monitoring their execution, and in ensuring that those making day-to day investments take full account of the consequences of their decisions on local communities.

The results of the recent U.S. elections have thrown many Americans for a loop.  While we work to unpack a lot of feelings about a Trump presidency, I thought it might be better to talk about another result from last Tuesday.  Colorado became the sixth state to pass a bill that allows terminally ill patients to seek life-ending medication.  Supported by 65% of the constituency, the measure applies to individuals with 6 months to live or less who can self-administer the lethal dose.

The measure requires that people “make two oral requests, separated by at least fifteen days, and a valid written request to his or her attending physician.” It also requires that people be capable of taking the medication unassisted, and stipulates that patients can rescind a request for life-ending medication at any time during the process.

Oregon – along with Washington, Vermont, Montana, California, and most recently Colorado – has had an aid-in-dying measure since 1997.  Winner of a Grand Jury Prize at the 2011 Sundance Film Festival, How to Die in Oregon, an HBO documentary tells the stories of people impacted by this law.  To date, 1,327 prescriptions have been filled with 859 deaths.  The most commonly cited reasons for requesting the prescription include loss of autonomy, decreasing ability to participate in activities that made life enjoyable, and loss of dignity.

So-called aid-in-dying and Death with Dignity measures are highly controversial, perhaps due in part to Dr. Jack Kevorkian’s unabashed commitment to “physician-assisted suicide.”

Forms of assisted suicide are legal in the Netherlands, France, Germany, Switzerland, and Belgium.  While the laws in France, Germany, and Switzerland are more passive, the Netherlands and Belgium are anything but.  Passed in 2002, Belgium law allows doctors to prescribe life-ending drugs to individuals suffering “intractable and unbearable pain.”  This includes pain caused by mental illness.  The Economist produced a documentary about a 24-year-old Belgian woman on her journey to euthanasia due to severe and chronic depression.  In February 2014, Belgium became the first country to allow minors to request euthanasia with parental consent.  To qualify, children must give informed consent, be terminally ill, and beyond all hope of medical intervention.  The first case of physician-assisted suicide of a minor occurred earlier this year.

Of course, euthanasia is fraught with controversy.  The act alone conflicts with the ethical and professional codes of the medical profession:

A physician’s assistance in suicide can indeed be construed as helping the patient: helping in the sense of being an ally in the patient’s quest to fulfill personal goals, or helping by buttressing individual autonomy. However, there are also features of such action that can be qualified as harmful: harmful by sowing confusion in trainees about the conceptual core of traditional clinical methods, or harmful by eroding respect for absolute moral values such as “do not kill.”

Others argue that the Hippocratic Oath is irrelevant including its oft misquoted tenet: “First do no harm.”  In the case of physician-assisted suicide, isn’t harm avoided by allowing patients autonomy and freedom from painful, protracted deaths?  Patients with Amyotrophic lateral sclerosis (ALS), called Lou Gehrig’s disease, remain cognizant while the rest of their body shuts down.  Though progression differs from person-to-person, an individual with ALS can expect to lose mobility, use of hands and arms, the ability to chew and swallow, and finally the ability to breathe without assistance.

The vast majority of deaths in ALS are the result of respiratory failure, a process that progresses slowly over months. Medications can relieve discomfort, anxiety and fear caused by respiratory insufficiency.

Given this prognosis, it is plain to see why an increasing number of ALS patients in Oregon are seeking a death with dignity.  Do you think physician-assisted suicide has a place in public health discourse?