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  • Previous health emergencies have shown that it can take

    2019-06-11

    Previous health emergencies have shown that it can take time to organise global collective action and provide financing to the national and local level. In such situations, a global mechanism should offer a rapid injection of liquidity to affected countries. The World Bank\'s Pandemic Emergency Financing Facility (PEF) is a proposed global insurance mechanism for pandemic emergencies. It aims to provide surge funding for response efforts to help respond to rare, high-burden disease outbreaks, preventing them from becoming more deadly and costly pandemics. The PEF currently proposes a coverage of $500 million for the insurance window; increasing the current coverage will require additional donor commitments. In addition, the PEF has a $50–100 million replenishable cash window.
    1 year ago, on May 23, 2016, the International Day to End Obstetric Fistula, the then UN Secretary-General challenged the international endothelin receptor to end obstetric fistula within a generation. This is a goal not only worthy of but mandatory for achieving the Sustainable Development Goals (SDGs) by 2030. Obstetric fistula, caused by prolonged obstructed labour, is entirely preventable and, in most cases, treatable. Despite being eliminated from the landscape in wealthy countries over a century ago, the majority of the world\'s women and girls continue to be exposed to this risk in 2017 and many women with fistula will die without ever being treated. This persistence of risk and lack of access to care for obstetric fistula is a prime indicator of egregious global health inequity that illustrates all too painfully the critical need for intelligent, strategic mobilisation of resources to bridge this intolerable gap. Closing the gap is vital to bringing maternal health in low-income countries on par with standards achieved in high-income countries over 100 years ago.
    The main challenges to ensuring optimal nutrition of children in low-income and middle-income settings are prevention of undernutrition—including intrauterine growth restriction, stunting, and micronutrient deficiencies—and avoidance of becoming overweight. Birth cohort studies show that linear growth in early life is associated with improved human capital (including intelligence, educational performance, and productivity) and has few, if any, deleterious effects regarding future risk of non-communicable diseases. By contrast, rapid weight gain, above and beyond what is required for linear growth, does not confer any benefits in terms of human capital and is associated with an increased risk of chronic diseases. Early undernutrition followed by exposure to an obesogenic diet in later childhood seems to result in especially poor outcomes. Ensuring that young children achieve optimal linear growth without putting on excessive weight represents a major challenge to public health and nutrition. In 1951, the British nutritionist Isabella Leitch proposed an analogy between the growth of piglets and children. Studying pigs that were undernourished early in life and then fed appropriately, tarsals concluded that “skeleton and muscle will not grow as they would have done if they had had the opportunity at the right time, and the extra food will be used mainly to lay on fat”. She referred to these animals as “low-high” pigs, and proposed they would be better off by remaining thin than by putting on weight, arguing that this condition “can probably be prevented only by the continuation of a spartan regime throughout life, which seems a bit hard”. Whether Leitch\'s ideas were correct and her proposed interventions feasible, she was undoubtedly a pioneer in attempting to translate endothelin receptor results from applied animal science to human nutrition. Anyone who has seen or eaten pork for the past few decades will have noticed that today\'s animals have a larger skeletal frame and that their meat has become much leaner over time. This is partly because of breeding, but also because of precise formulation of animal diets.