Complete Wellness

People go about their daily lives in Roseau, Dominica. The country’s chief medical officer says climate change is taking a toll on the health of people. Credit: Desmond Brown/IPS

ROSEAU, Dominica, Jan 20 2014 (IPS) – Caribbean countries, struggling to emerge from a slump in exports and falling tourist arrivals brought on by the worldwide economic crisis that began five years ago, have one more thing to worry about in 2014.

Dominica’s chief medical officer, Dr. David John, said climate change and its effects are taking a toll on the health of people in his homeland and elsewhere in the region.“A lot of diseases will essentially create havoc among people who are already poor.” — Dr. Lystra Fletcher-Paul

You have seen what is happening [with] the effects of climate change in terms of our infrastructure, but there are also significant effects with regards to climate change on health,” John said, adding that “these effects relate to the spread of disease including dengue fever and certain respiratory illnesses.”

John said the Dominica government would be seeking assistance from international agencies, including the World Meteorological Organisation (WMO), to mitigate “the effects of climate change on health as it relates to dengue, leptospirosis and viral disease.”

In late 2012, the Ministry of Health in Barbados alerted members of the public about a spike in leptospirosis cases. Senior Medical Officer of Health-North Dr. Karen Springer said then that five people had contracted the severe bacterial infection, bringing the number of cases for the year to 18.

Springer explained that the disease, which includes flu-like symptoms such as fever, headache, chills, nausea and vomiting, eye inflammation and muscle aches, could be contracted through contact with water, damp soil or vegetation contaminated with the urine of infected animals. Bacteria can also enter the body through broken skin and if the person swallows contaminated food or water.

In recent years, dengue has also been on the rise throughout the Caribbean with outbreaks in Dominica, Barbados, Trinidad and Tobago, Puerto Rico and the French islands of Martinique and Guadeloupe, among other places.

Professor of environmental health at the Trinidad campus of the University of the West Indies Dr. Dave Chadee told IPS there is ample “evidence that climate-sensitive diseases are being tweaked and are having a more significant impact on the region .
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He said he co-authored a book with Anthony Chen and Sam Rawlins in 2006 which showed “very clearly” the association between the changes in the seasonal patterns of the weather and the onset and distribution of dengue fever.

“There is enough evidence, not only from the Caribbean region but worldwide, that these extreme events are going to have and going to play a significant role in the introduction and distribution of these sorts of diseases in the region,” Chadee, who previously served as an entomologist at the Insect Vector Control Division of the Ministry of Health in Trinidad and Tobago, told IPS.

“If you look at the various factors that are associated with climate change, the first is heat waves. There has also been a reduction in air quality. You also see an increase in fires and the effects on people’s ability to breathe as well as the association between the Sahara dust and asthma which was demonstrated in Barbados and Trinidad recently.

“The Sahara dust which comes in from Africa brings in not only the sand but also other pathogenic agents within the sand, together with some insecticides which have been identified by people working at the University of the West Indies,” Chadee told IPS.

Dr. Lystra Fletcher-Paul, the Food and Agriculture Organisation (FAO) representative for Guyana, said she has no doubt that climate change has contributed significantly to some of the issues related to diseases in the region.

“If you look at some of the impacts of climate change, for example drought, with drought you are going to increase the amount of irrigation that you are going to be applying to the crops. And irrigation water is a source of pesticides or even chemicals, depending on where that source of water is and that could lead to problems in health,” she told IPS.

“Similarly with the extreme events, if you are talking about floods, there can be contamination of the fresh-water supply.”

The FAO representative is adamant that there is too much “talk” in the Caribbean and too little “implementation .

“We have had the conversation, so what we need to do now is put the systems in place to mitigate and adapt to climate change, she said. Using land-use planning as an example, Fletcher-Paul told IPS, “A lot of what we see happening in St. Vincent and St. Lucia may not necessarily have taken place if we had proper land-use planning.”

A slow-moving, low-level trough on Dec. 24 dumped hundreds of millimetres of rain on St. Vincent and the Grenadines, St. Lucia and Dominica, killing at least 13 people. The islands are still trying to recover.

“So we need to take some hard decisions in terms of where we would allow development to take place or not,” Fletcher-Paul said.

Chadee said the poor would always be at a disadvantage in  climate change scenarios and they will suffer the most from sea level rise when you have salt water intrusion into fertile agricultural land, rendering them unsuitable for food production.

“A lot of diseases will essentially create havoc to people who are already poor. The adaptability of the poor versus the rich within the Caribbean region will be tested because if the poor are no longer able to produce some of their food, this would then lead to health problems.

He explained that if the poor are no longer able to have a particular diet this would make them susceptible to a number of diseases.

“With the Caribbean region having developing states, and especially Small Island Developing States, we do have a unique situation where the resources have to be put in place, especially for adaptation,” Chadee told IPS.

“It’s almost like the wall of the reservoir has been breached and you know that the water is coming. You don’t know how high the water level is going to be but you know it’s coming, so what do you do? And that essentially is the scenario in which we have found ourselves in the Caribbean,” Chadee added.

VIENNA, Mar 17 2014 (IPS) – A top level United Nations conference on drugs has highlighted growing divisions between member states on how to move forward in dealing with global drug problems as calls grow for major reforms in approaches to international drug policy.

The High-Level Review at the latest annual session of the U.N. Commission on Narcotic Drugs (CND) – the chief policymaking body for international drug control in Vienna assessed last week how the organisation is meeting goals for dealing with the global drug problem ahead of the U.N. General Assembly Special Session on Drugs in 2016.”We have been taking a certain approach for 50 years and it hasn’t worked. It’s time to experiment with alternatives.”– Ann Fordham, executive director of NGO, International Drug Policy Consortium

But it ended with a joint ministerial statement that was only agreed at the very last minute after months of fractious debate, with states failing to agree on a common approach to key points, and proposed paragraphs on issues such as the death penalty absent from the final text.

This, say civil society groups promoting global drug policy debate, underlines a growing split in attitudes towards drugs in U.N. member states between those pushing for liberal reforms and those continuing to follow conservative and repressive approaches which evidence is increasingly showing is failing.

Ann Fordham, executive director of the NGO, told IPS at the conference: “The joint ministerial statement always comes out, even if individual member states disagree over some fundamental things. But this year things were much harder, it was much more difficult for countries to agree, and for a while it looked like the unthinkable might happen and they wouldn’t agree and there would be no statement.

“But while there was one in the end, and although it was full of watered-down language, it shows there are growing fractures between states on how to approach drug problems and just how big those differences are.”

A number of U.N. member states have recently either undertaken or are planning fundamental reforms to their drugs policies.

In December last year Uruguay became the first country to legalise commercial sales of marijuana and regulate its production. Commercial sales of marijuana began in the U.S. state Colorado in January while sales of marijuana will begin in Washington state in June.

These developments came just months after Latin American leaders used U.N. platforms to deride the body’s approach to drugs. The president of Guatemala told the U.N. General Assembly that the regulated supply of illicit drugs should be considered while his Colombian counterpart told the same body that the U.N. s conventions “gave birth to the war on drugs …. that war has not been won.”

These reforms have been praised by many third sector organisations working with drug users and pushing for debate on drug policy. They say reform is desperately needed and a traditional punitive criminal approach to dealing with global drug problems has been shown to have failed.

But the U.N. has slammed drug legalisation. (UNODC) executive director Yury Fedotov told journalists just days before the start of the Vienna Conference that Uruguay’s decision to legalise cannabis sales was “not a solution to dealing with world drug problems.”

The U.N.’s International Narcotics Control Board has labelled the country’s government “pirates” for going against the U.N.’s conventions on drugs.

The apparent distance between U.N. drugs policy bodies’ thinking on drugs and that of individual member states was further evidenced at the conference itself.

Individual country representatives – particularly those from Latin America which has seen decades of horrific violence connected with the drugs trade spoke vociferously of the need to move away from criminalisation of drug use to a health-based approach to drugs problems.

Colombian minister of justice Gomez Mendez told delegates: “…people have been sacrificed in our actions to tackle the drug problem….we call for more effective ways to achieve the objectives stated in international agreements.

Meanwhile, representatives of the Ecuadorian government spoke of “the failure of present drug policies” and said “many voices are calling for a change in paradigm in the understanding and approach to the drug phenomenon.”

This was backed up by civil society representatives who spoke in special sessions and meetings during the conference.

Senior U.N. officials too emphasised the importance of preventive measures, rather than punitive criminal justice legislation, in helping deal with problems caused by drugs.

Michel Kazatchkine, U.N. Special Envoy for HIV/AIDS in Eastern Europe and Central Asia, said at the conference that “ciminalisation of drug use, restrictive drug policies and aggressive law enforcement practices are key drivers” of serious public health threats such as of HIV and hepatitis C epidemics among people who inject drugs.”

However, despite these warnings, the joint ministerial statement was released without the use of the term ‘harm reduction’ as such language is still deemed unacceptable by countries like Russia which stringently enforce severely punitive anti-drug policies.
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This, argued civil society groups at the conference, shows that the U.N.’s drug policy bodies have abrogated their responsibility as leaders in dealing with the global drug problem, focusing on punitive measures rather than a health-based approach.

Joanne Ceste, deputy director of the told IPS: “For a long time, UNODC has abdicated its responsibility as the global leader for HIV prevention, treatment and care among drug users because it has had such a hard time getting serious about real advocacy on decriminalisation of minor offences.”

However, there is hope that the current divisions between member states’ views on drug policy could end up providing the impetus for important debate ahead of the U.N. General Assembly special session on drugs in 2016.

Fordham told IPS: “What was interesting about watching negotiations on the joint ministerial statement is that usually when they can’t agree, member states just say, ‘OK, let’s just reaffirm what we said last time’, which was in 2009.

“But this time, even though the eventual statement is much weaker than we would have liked, there were many states that said, ‘no we can’t go back to that. Things have changed, we need to come to new agreements on drugs policy’.”

She added: “There are some governments now, ahead of 2016, that are really pushing for global drugs policy to be debated. We have been taking a certain approach for 50 years and it hasn’t worked. It’s time to experiment with alternatives.”

Ibrahim Sobeh and his son Mahmud with the device they built for domestic fuel production. Credit: Khaled Alashqar/IPS.

GAZA CITY , May 7 2014 (IPS) – On the roof of a modest house amidst the alleys of Nusseirat refugee camp in central Gaza Strip, Ibrahim Sobeh and his sons spent more than 200 days working on a primitive device that converts waste plastic into fuel.

“The idea came when I watched smoke emissions from a fireplace I made in my house,” Sobeh tells IPS. “I thought how to exploit these fumes and vapours. That prompted me to search online to find there were already attempts in America to exploit fumes emitted by burning hay to produce fuel, and this was the start.”In harsh conditions where survival is a struggle, not many are thinking of the environment, or even of long-term damage to their health.

Fifty-six-year-old Sobeh, who got a diploma in electricity from the United Nations Works and Relief Agency (UNRWA) Institute in Gaza 30 years ago, tells IPS how he faced considerable difficulties because of lack of raw materials. And, he had to borrow money from a friend.

Fuel in Gaza is extremely expensive and it is not available on a regular basis as a result of the blockade imposed on Gaza,” says Sobeh. “This is precisely what prompted me to look for a way to produce fuel domestically, which finally succeeded. But the project requires substantial financial support for its development.”

The device exposes plastic waste composed of oil molecules to high temperature in an Oxygen-free airtight box leading to degradation of the constituent particles of plastic into vapours. These are then passed through metal channels where the fumes are cooled. This results in liquid fuel somewhere between gasoline, diesel and kerosene.

We produce one litre of fuel from 1.5 kg of plastic waste,” son Mahmud Sobeh tells IPS. “Diesel-run electrical and mechanical machines were successfully run on this fuel output. We have sent samples to the laboratories of the Islamic University of Gaza for scientific examination.”

These are desperate measures, and energy expensive in breaking down the plastic. But then Gazans are in a desperate situation.

The fuel crisis in Gaza has been ongoing for eight years now as Israel controls the amount of fuel entering Gaza through the Abu Salim crossing between Gaza and Israel. Gaza s only power plant also runs on scarce diesel. Blackouts that last hours are a daily feature.

A litre of Israeli gasoline costs seven shekels (two dollars). A litre of fuel smuggled from Egypt cost half as much before the Egyptian army demolished the tunnels between North Sinai and the southern town Rafah after the dismissal of former Egyptian president Mohammed Morsi. This exacerbated the electricity and fuel crisis in Gaza.

Dr. Sameer Afifi, director of the centre for environmental studies and scientific laboratories at the Islamic University of Gaza tells IPS that the Sobehs’ project was conducted under primitive conditions and the quality may therefore be not quite good. But still it is promising.”

What is certain is that production of fuel in such manner would be environmentally damaging, and could be harmful to health. Former environment minister Yusef Abu Safieh tells IPS that production of such fuel must be subject to an in-depth scientific studies.
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The incomplete combustion of plastic may result in release of other hydrocarbons that are hazardous, some of them carcinogenic.  Any material that is not fully combusted results in production of fumes and dangerous substances,” Abu Safieh tells IPS.

But citizens in Gaza still look at such attempts with hope. “Ordinary fuel is not readily available due to high prices, and this makes us look for locally produced fuel that helps us to overcome the energy crisis and relieve us of an economic burden, Shadi Abu Samra, 35, from Al-Shati refugee camp tells IPS.

The Sobeh experiment is now driving others to look at such measures to produce fuel. In harsh conditions where survival is a struggle, not many are thinking of the environment, or even of long-term damage to their health.

An elderly displaced man carries a sack of rations on his shoulder. The Pakistan Army has distributed 30,000 ration packs of 110 kg each. Credit: Ashfaq Yusufzai/IPS

PESHAWAR, Pakistan, Jul 1 2014 (IPS) – Three days ago, Rameela Bibi was the mother of a month-old baby boy. He died in her arms on Jun. 28, of a chest infection that he contracted when the family fled their home in Pakistan’s North Waziristan Agency, where a full-scale military offensive against the Taliban has forced nearly half a million people to flee.

Weeping uncontrollable, Bibi struggles to recount her story.

“My son was born on Jul. 2 in our own home,” the 39-year-old woman tells IPS. “He was healthy and beautiful. If we hadn’t been displaced, he would still be alive today.”

“My wife is expected to deliver a baby within a fortnight, But the doctors say the child will be premature due to the stressful journey we undertook to get here.” — Jalal Akbar, a former resident of the town of Mir Ali in North Waziristan Agency
But Bibi does not have the luxury of grieving long for her little boy.

Soon she will have to dry her eyes and begin the grim task of providing for herself and her two young daughters, who now comprise some of the 468,000 internally displaced people (IDPs) seeking refuge from the Pakistan army’s airstrikes on the militant-infested mountainous regions that border Afghanistan.

Launched on Jun. 15, the army’s campaign was partly motivated by terrorist attacks on the Karachi International Airport that killed 18 people in early June.

Having failed since 2005 to flush out the militants from the Federally Administered Tribal Areas (FATA), the army is now focusing all its firepower on the 11,585-square-kilometre North Waziristan Agency, where insurgent groups have enjoyed a veritable free reign since escaping the U.S. occupation of Afghanistan over a decade ago.

Some political pundits are cheering what they call the government’s “hard line” on the terrorists. But what it means for a civilian population already weary from years of war is homeless, hunger and sickness.

Most of the displaced have collapsed, fatigued from hours of travel on dirt roads in 45-degree heat, in massive camps in Bannu, an ancient city in the Khyber Pakhtunkwa (KP) province.

Already groaning under the weight of nearly a million refugees who have arrived in successive waves over the last nine years, KP is completely unprepared to deal with this latest influx of desperate families.

With tents serving as makeshift shelters, and the blistering summer heat threatening to worsen over the coming weeks, medical professionals here are warning of a full-blown health crisis, as doctors struggle to cope with a long line of patients.

Many traveled for hours on dirt roads, in 45-degree heat, to reach safe ground, with no food or water along the way. Credit: Ashfaq Yusufzai/IPS

Muslim Shah, a former resident of North Waziristan, has just arrived in Bannu after a 45-km journey on an unpaved road with his wife and children.

He is being treated at a rudimentary ‘clinic’ in the camp for severe dehydration, and recovering from a stomach flu caused by consumption of contaminated water along the way.

The frail-looking man tells IPS he is concerned for his family’s health in an unsanitary environment, gesturing to a nearby filthy canal where his children are bathing amongst a herd of buffalos.

“We have examined about 28,000 displaced people,” Dr. Sabz Ali, deputy medical superintendent at the district headquarters hospital (DHQ) of Bannu, told IPS.

About 25,000 of these, he said, are suffering from preventable diseases caused by sun exposure, lack of nutrition, and consumption of unclean water.

On Jun. 29, the government relaxed its curfew, giving families a tiny window of escape before resuming its operation Monday.

Families who left in the allotted timeframe are expected to descend on Bannu soon, prompting an urgent need for preemptive and coordinated efforts to avert an outbreak of diseases, Ali asserted.

“Given the soaring temperatures, we fear outbreaks of communicable water and vector-borne diseases, like gastroenteritis and diarrhoea, as well as vaccine-preventable childhood diseases such as polio and measles,” he said.

Seeking some relief from the 41-degree heat, displaced children in Bannu join a herd of buffalos for a bath in a filthy canal. Credit: Ashfaq Yusufzai/IPS

Ahmed Noor Mahsud (59) and his family of four epitomise the unfolding crisis.

Mahsud himself is bed-ridden as a result of a heat stroke caused by walking 40 km in sweltering heat, while his sons – aged 14, 15 and 20 – have been suffering with diarhhoea, fever and headaches since they arrived in the camp on Jun. 22.

The family has had very little access to clean water for nearly a week, which is exacerbating their illness.

According to public health specialists like Ajmal Shah, who was dispatched by the KP health department, exhaustion among IDPs has even led to some cases of cardiac arrest.

Out in the desert, families are also at risk of snake and scorpion bites, and could suffer long-term psychological stress as a result of the trauma, Shah told IPS.

About 90 percent of the displaced are extremely poor, having lived well below the poverty line for over a decade due to the eroding impacts of terrorism on the local economy. Few can afford private care and must wait patiently for thinly-spread doctors to make their rounds.

But for people like 30-year-old Jalal Akbar, a former resident of the town of Mir Ali in Waziristan, patience is almost impossible.

“My wife is expected to deliver a baby within a fortnight,” he told IPS anxiously. “But the doctors say the child will be premature due to the stressful journey we undertook to get here. She requires bed rest, but we have been unable to find a proper home.”

The exhausted man fears their eviction will deprive him of his first child.

Another major crisis looming on the horizon is a food shortage, which will only add to the woes of the displaced.

According to a by United Nations Office for the Coordination of Humanitarian Affairs (OCHA), “The Pakistan Army has distributed 30,000 ration packs each of 110 kg. The WFP has provided food rations to over 8,000 families while a number of NGOs and charity organisations are also carrying out relief activities.”

Still, those like Ikram Mahsud, a displaced tribal elder, fear that the worst is yet to come.

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“We lack good food, and the non-availability of sanitation facilities like latrines, detergent and soap [means] our people are destined to suffer in the coming days,” he told IPS, adding that requests for clean water and sanitation facilities have fallen on deaf ears.

Women and children currently comprise 74 percent of the IDPs, prompting the World Health Organisation (WHO) to point out, in a Jun. 30 report, the urgent need for “mass awareness campaigns among women to promote use of safe drinking water, hygienic food preparation and storage.

“Information regarding benefits of hand-washing before eating and preparation of food, use of impregnated bed nets to avoid mosquitoes’ bites and prevent occurrence of malaria should also be encouraged,” the agency noted.

WHO says it had sent medicines for 90,000 people to Bannu, but experts here feel this will fall short in the face of a spiraling crisis.

(END)

Women and children are badly affected by the rise in alcohol consumption in Sri Lanka’s Northern Province. Credit: Amantha Perera/IPS

DHARMAPURAM, Aug 3 2014 (IPS) – Back in the day when the separatist Liberation Tigers of Tamil Eelam (LTTE) ran a de-facto state in Sri Lanka’s Northern Province, alcohol consumption was closely monitored, and sternly frowned upon.

But after government forces destroyed the militant group in 2009, ushering a new era into a region that had lived through three decades of civil conflict, strict rules governing the brewing and sale of spirits have lost their muscle.

Plagued by poverty, trauma and a lack of employment opportunities, civilians in the former war zone are increasingly turning to the bottle to drink their troubles away.

“There is worryingly high casual and habitual use of alcohol in the region. Drinking hard liquor by the end of the day is becoming a [norm],” Vedanayagam Thabendran, district officer for social services for the Kilinochchi district in the Northern Province, about 240 km from the capital Colombo, told IPS.

Available data on alcohol consumption trends back his assessment.

“There is a visible shift in consumption patterns in the war-affected areas from the days of the LTTE. They did not allow the northern citizens to drink moonshine [freely].” — G D Dayaratna, manger of the health and economic policy unit at the Institute of Policy Studies (IPS)
According to a December 2013 survey by the Alcohol and Drug Information Centre (ADIC), a national non-governmental organisation, the northern district of Mullaitivu had the second highest alcohol consumption rate in the island, with 34.4 percent of the population identifying as ‘habitual users of alcohol’.

The covered 10 of the 25 districts in the country, including two in the Northern Province.

“Frequency of alcohol consumption was highest in Mullaitivu district, among the ten districts surveyed. In both the Jaffna and Mullaitivu districts, beer consumption was higher than arrack (hard liquor) consumption,” said Muttukrishna Sarvananthan, who heads the Jaffna-based Point Pedro Institute of Development.

The researcher told IPS that “anecdotal evidence and alcohol sales figures” indicate a link between the end of the civil war and the rise in alcohol consumption.

District official Thabendran said that alcohol abuse was more pronounced in interior villages that had once fallen under the purview of the LTTE. He identified one such village as Dharmapuram, located about 17 km northeast of Kilinochchi Town.

“We keep getting regular reports of domestic disputes because of alcohol consumption and we know that there are a lot of places (in that village) where illegal alcohol is available,” he stated.

Humanitarian workers in the region said that Dharmapuram has acquired the nickname ‘booze centre’ because of the free availability of illicit liquor.

“One of the disturbing trends is the prevalence of female headed households that have begun to sell illicit liquor as an easy income-generation method,” said a humanitarian worker who wished to remain anonymous because he was working with the families in question.

Homemade brews – typically derived from coconut, palmyra flowers or sugarcane – are cheap to make and easy to procure. Women in the north say they earn about 100 rupees (0.7 dollars) per litre of local moonshine.

A man sits in his makeshift kitchen in the village of Dharmapuram after returning home drunk. Credit: Amantha Perera/IPS

Drinkers say that illegal alcohol can be obtained for less than one-fifth the price of the lowest-grade legal liquor.

“I haven’t seen this much alcohol here for almost 50 years,” Arumygam Sadagopan, a 60-year-old resident of Dharmapuram, admitted.

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A retired education officer, Sadagopan told IPS that habitual drinking, especially among men, is exacerbating poverty and fueling domestic violence. He added that his neighbour’s family was now at “breaking” point due to the husband’s daily bouts of drinking.

“He has two school-going children who now mostly see their father drunk, reeking of alcohol and arguing or fighting with their mother,” he stated.

The end of the war in May 2009 not only removed restrictions on easy access to liquor outlets, it also removed social barriers that had kept consumption in check.

“There is a visible shift in consumption patterns in the war-affected areas from the days of the LTTE. They did not allow the northern citizens to drink moonshine (freely),” said G D Dayaratna, manger of the health and economic policy unit at the think-tank (IPS).

He also said that the LTTE kept a close tab on alcohol production in areas they controlled. All such safeguards crumbled along with the demise of the armed group.

Still, the situation is not specific to the former war zone. Islandwide alcohol production and consumption have seen sharp increases since the end of the conflict.

In  2013 the Excise Department earned over 66 million rupees (over 500,000 dollars) in duties from the sale of alcohol, an increase of 10 percent from 2012.

In 2009 Sri Lanka produced 41 million liters of hard liquor and 55 million liters of beer, but by 2013 hard liquor production had touched 44 million liters, while beer production was an astonishing 120 million liters.

According to the World Health Organisation (WHO), the among people aged 15 years and older between 2008 and 2010 was 20.1 litres.

There are no official figures available for the quantity of illegal, homemade alcohol but a 2002 found that 77 percent of all liquor consumed in Sri Lanka was illicitly brewed. In 2013, fines for illegal liquor touched 127 million rupees (975,000 dollars).

Social workers like Thabendran said that the worst cases of alcohol abuse were visible in poor households in the northern province, where men were either unemployed or engaged in backbreaking daily paid manual labour.

Men who engage in hard, manual labour are the primary consumers of alcohol in Sri Lanka s Northern Province. Credit: Amantha Perera/IPS

There are no official figures for full unemployment rates in the north. However, in the two districts where figures are available – 9.3 percent in Kilinochchi and 8.1 percent in Mannar they were over twice the national rate of four percent.

Sarvananthan estimates that unemployment could be above 20 percent here in Dharmapuram, while employment in the informal sector, which includes agriculture, forestry, fisheries and day labour, hovers at just about 30 percent.

Poverty levels are also high in the province, with four of its five districts recording rates higher than the national average of 6.7 percent.

The three districts where the war was most intense, Kilinochchi, Mannar and Mullaittivu, record poverty rates of 12.7 percent, 20.1 percent and 28.8 percent respectively, according to the latest released in April.

“When you look at alcohol consumption patterns, you see they have a direct correlation with the type of employment. Manual labourers and daily wage earners are more likely to consume alcohol at the end of the day,” Dayaratna pointed out.

Sadagopan has a simple solution to the alcohol menace, at least in the short term. “The laws against illicit brewing and selling should be strictly enforced,” he said. “The problem is, since our villages are in the interior, enforcement is lax.”

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Millions of women in Pakistan do not have access to family planning services. Credit: Zofeen Ebrahim/IPS

UNITED NATIONS, Sep 19 2014 (IPS) – The U.N. s post-2015 development agenda has been described as the most far-reaching and comprehensive development-related endeavour ever undertaken by the world body.

But where does population, family planning and sexual and reproductive health rights (SRHR) fit into the proposed 17 Sustainable Development Goals (SDGs), which are an integral part of that development agenda?”We must continue to fight until every individual, everywhere on this planet, is given the opportunity to live a healthy and sexual reproductive life.” — Purnima Mane, head of Pathfinder International

Of the 17, Goal 3 is aimed at ensuring healthy lives and promoting well-being for all at all ages, while Goal 5 calls for gender equality and the empowerment of all women and girls.

But when the General Assembly adopts the final list of SDGs in September 2015, how many of the proposed goals will survive and how many will fall by the wayside?

Meanwhile, SRHR will also be a key item on the agenda of a special session of the General Assembly next week commemorating the 20-year-old Programme of Action (PoA) adopted at the landmark International Conference on Population and Development (ICPD) in Cairo in 1994.

In an interview with IPS, Dr. Babatunde Osotimehin, executive director of the U.N. Population Fund (UNFPA) said, Twenty years ago, we were able to secure commitments from governments on various aspects of poverty reduction, but more importantly the empowerment of women and girs and young people, including their reproductive rights.

But the battle is not over, he said.

Today, we are on the cusp of a new development agenda, and we, as custodians of this agenda, need to locate it within the conversation of sustainable development a people-centred agenda based on human rights is the only feasible way of achieving sustainable development, he declared.

Purnima Mane, president and chief executive officer of Pathfinder International, told IPS, We are delighted the final set of [proposed] SDGs contains four critical targets on SRHR: three under the health goal and one under the gender goal.

The inclusion of a commitment to universal access to sexual and reproductive health care services, including family planning, information and education, and the integration of reproductive health into national strategies and programmes, is necessary and long overdue, she said.

But we have not reached the finish line yet, cautioned Mane, who oversees an annual budget of over 100 million dollars for sexual and reproductive health programmes in more than 20 developing countries.
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The SDGs still need to be adopted by the General Assembly, and we must all continue to raise our voices to ensure these SRHR targets are intact when the final version is approved, she added.

Mane said civil society is disappointed these targets are not as ambitious or rights-based as they should be.

And translating the written commitment into actionable steps remains a major challenge and is frequently met with resistance. We must retain our focus on these issues, she said.

Sivananthi Thanenthiran, executive director of the Malaysia-based Asian-Pacific Resource Research Centre for Women (ARROW) working across 17 countries in the region, told IPS it is ideal to have SRHR captured both under the gender goal as well as the health goal.

The advantages of being part of the gender goal is that the rights aspects can be more strategically addressed because this is the area where universal commitment has been lagging the issues of early marriage, gender-based violence, harmful practices all of which have an impact on the sexual and reproductive health of women, she pointed out.

The advantages of being part of the health goal is that interventions to reduce maternal mortality, increase access to contraception, reduce sexually transmitted diseases, including HIV/AIDS, are part and parcel of sound national health policies,  Thanenthiran said.

It would be useful for governments to learn from the Millennium Development Goals (MDGs) process and ensure that the new goals are not implemented in silos, she added. Public health concerns should be addressed with a clear gender and rights framework.

Maria Jose Alcala, director of the secretariat of the High-Level Task Force for ICPD, told IPS what so many governments and stakeholders around the world called for throughout the negotiations was simply to affirm all human rights for all individuals and that includes SRHR.

The international community has an historic opportunity and obligation to move the global agenda forward, and go beyond just reaffirming agreements of 20 years ago as if the world hasn t changed,and as if knowledge and society hasn t evolved, she noted.

We know, based on ample research and evidence, based on the experiences of countries around the world, as well as just plain common sense, that we will never achieve poverty eradication, equality, social justice, and sustainable development if these fundamental human rights and freedoms are sidelined or traded-off in U.N. negotiations, Jose Alcala said.

Sexual and reproductive health and rights are a must and prerequisite for the post-2015 agenda if we are to really leave nobody behind this time around, she declared.

Mane told IPS, As the head of Pathfinder, I will actively, passionately, and strongly advocate for SRHR and family planning to be recognised and aggressively pursued in the post-2015 development agenda.

She said access to SRHR is a fundamental human right. We must continue to fight until every individual, everywhere on this planet, is given the opportunity to live a healthy and sexual reproductive life.

Asked about the successes and failures of ICPD, Thanenthiran told IPS there is a need to recognise the progress so far: maternal mortality ratios and infant mortality rates have decreased, access to contraception has improved and life expectancy increased.

However, much remains to be accomplished, she added. It is apparent from all recent reports and data that SRHR issues worldwide are issues of socio-economic inequality.

In every country in the world, she noted, women who are poorer, less educated, or belong to marginalised groups (indigenous, disabled, ethnic minorities) suffer from undesirable sexual and reproductive health outcomes.

Compared to their better educated and wealthier sister citizens, these women and girls are more likely to have less access to contraception, have pregnancies at younger ages, have more frequent pregnancies, have more unintended pregnancies, be less able to protect themselves from HIV and other sexual transmitted diseases, suffer from poor maternal health, die in childbirth and suffer from fistula and uterine prolapse.

Hence the sexual and reproductive health and rights agenda is also the equality agenda of this century, she added.

Governments must commit to reducing these inequalities and carry these learnings from ICPD at 20 into the post-2015 development agenda,  Thanenthiran said.

Edited by Kitty Stapp

The writer can be contacted at [email protected]

An Ebola treatment centre in Kenema, Sierra Leone, on the day of a visit from Anthony Banbury, Special Representative of the Secretary-General and Head of the UN Mission for Ebola Emergency Response (UNMEER). Credit: UN Photo/Ari Gaitanis

WASHINGTON, Nov 13 2014 (IPS) – The United States proposed Tuesday that the international community write off 100 million dollars in debt owed by West African countries hit hardest by the current Ebola outbreak. The money would be re-invested in health and other public programming.

U.S. Treasury Secretary Jack Lew will be detailing the proposal later this week to a summit of finance ministers from the Group of 20 (G20) industrialised countries. If the idea gains traction among G20 states, that support should be enough to approve the measure through the International Monetary Fund (IMF), where the United States is the largest voting member.”The plan is for that money to be re-invested in social infrastructure, including hospitals and schools … to deal with the short-term problem of Ebola but also the long-term failure of the health systems that allowed for this outbreak.” — Jubilee USA’s executive director Eric LeCompte

“The International Monetary Fund has already played a critical role as a first responder, providing economic support to countries hardest hit by Ebola,” Lew said in a statement to IPS.

“Today we are asking the IMF to expand that support by providing debt relief for Sierra Leone, Liberia and Guinea. IMF debt relief will promote economic sustainability in the worst hit countries by freeing up resources for both immediate needs and longer-term recovery efforts.”

These three countries together owe the IMF some 370 million dollars, according to the U.S. Treasury, with 55 million dollars due in the coming two years. Yet there are already widespread fears over the devastating financial ramifications of Ebola on Guinea, Liberia and Sierra Leone, in addition to the epidemic’s horrendous social impact.

Last month, the World Health Organisation warned that the virus now threatens “potential state failure” in these countries. The World Bank, meanwhile, estimates that the virus, which has already killed more than 5,000 people and infected more than 14,000, could cost West African countries some 33 billion dollars in gross domestic product.

Of course, much of the multilateral machinery is often too cumbersome to respond to a fast-moving viral outbreak. Yet there is reason to believe that the U.S. plan could have both immediate and long-term impacts.

That’s because the plan would see the IMF tap a unique fund set up in the aftermath of the 2010 Haiti earthquake, which facilitated the cancellation of nearly 270 million dollars of Haitian debt to the IMF. Called the Post-Catastrophe Debt Relief (PCDR) Trust, it is aimed specifically at responding to major natural disasters in the world’s poorest countries.

Originally, the PCDR Trust was capitalised with more than 420 million dollars. Today, a U.S. Treasury spokesperson told IPS, the trust has some 150 million dollars in it – money that would be available almost immediately.

“Our proposal is for the IMF to provide debt relief for these Ebola-affected nations from this trust,” the spokesperson said. “The U.S. would like to see around 100 million dollars put toward this effort, however the precise amount will need to be determined in consultations with the IMF and its membership.”
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The IMF, meanwhile, says it is preparing to consider the proposal. In September the Washington-based agency made available 130 million dollars in immediate support to Guinea, Liberia and Sierra Leone.

“We are very glad that some donors have expressed an interest in increasing support for the Ebola-affected countries. We are reaching out to all donors to see how we might be able to take this forward … using all the tools available to us,” an IMF spokesperson told IPS.

“[Debt relief] decisions are made according to the merits of the particular case and this would be approached in the same way. We would expect the Board to be briefed soon on this topic.”

Ebola’s “natural disaster”

For development and anti-poverty advocates, debt obligations on the part of poor countries constitute a key obstacle to a government’s ability to respond to critical social needs, both in the short and long term.

In the West African epicentre of the current Ebola outbreak, many analysts have held chronic low national health spending directly responsible for allowing the epidemic to spiral out of control. And when looking at feeble public sector spending, it is impossible not to take into account often crushing debt burdens.

For instance, Guinea spent a little more than 100 million dollars on public health in 2012 but paid nearly 150 million dollars that same year on internationally held debt, according to World Bank figures provided by Jubilee USA, an anti-debt advocacy network that has spearheaded the push for the United States to make the current proposal.

“As bad as Ebola has been, some of these countries have far greater challenges with deaths from malaria than from Ebola,” Eric LeCompte, Jubilee USA’s executive director, told IPS.

“The amount is incredibly important because it cancels a significant portion of the debt completely. And the plan is for that money to be re-invested in social infrastructure, including hospitals and schools … to deal with the short-term problem of Ebola but also the long-term failure of the health systems that allowed for this outbreak.”

LeCompte was also involved in the creation of the Post-Catastrophe Debt Relief Trust, in the aftermath of the Haitian earthquake. His office has advocated for the fund’s monies to be used since then – for instance, to react to flooding in Pakistan and Typhoon Haiyan in the Philippines.

But he says these and other proposals have been rejected by the IMF’s membership, on the rationale that these countries were developed enough to be able to mobilise financing in other ways. (The IMF PCDR funds are for response to “the most catastrophic of natural disasters” in “low-income countries”, when a third of a country’s population has been affected and a quarter of its production capacity destroyed.)

Not only are Guinea, Liberia and Sierra Leone among the poorest countries in the world, but the Ebola outbreak there has a potentially direct impact on the rest of the globe.

“This is a very clear opportunity to point to the 150 million dollars left in that fund and to note that Ebola is every bit the same as the Haitian earthquake in terms of being a regional calamity,” LeCompte says.

“The difference is that this is also a long-term investment in the very problems that allow Ebola to spread. So we’d be not only addressing the current issue, but also the next disease outbreak in that region.”

It is unclear whether there is a mechanism in place to top up the PCDR Trust in the future. The IMF states that “Replenishment of the Trust will rely on donor contributions, as necessary.”

But for his part, LeCompte says the fund has the potential to fill a significant gap: offering a pot of money, immediately available, that could be quickly mobilised to deal with true crises afflicting the world’s poorest countries, from hurricanes to major financial defaults.

Edited by Kitty Stapp

The writer can be reached at [email protected]

Local women’s NGO, Vois Blong Mere, campaigns for women’s rights in Honiara, capital of the Solomon Islands. Credit: Catherine Wilson/IPS

SYDNEY, Jan 28 2015 (IPS) – Women now face a better chance of surviving breast cancer in the Solomon Islands, a developing island state in the southwest Pacific Ocean, following the recent acquisition of the country’s first mammogram machine.

But just a week ahead of World Cancer Day, celebrated globally on Feb. 4, many say that the benefit of having advanced medical technology, in a country where mortality occurs in 59 percent of women diagnosed with cancer, depends on improving the serious knowledge deficit of the disease in the country.

“While cancer is included on the NCD [non-communicable diseases] list, very little attention and resources are specifically addressing women and breast cancer awareness.” — Dr. Sylvia Defensor, senior radiologist at the Ministry of Health and Medical Services in Fiji
“Breast cancer is a health issue that women are concerned about in the Solomon Islands, but adequate awareness of it among women is not really prioritised,” Bernadette Usua, who works for the local non-governmental organisation, Vois Blong Mere (Voice of Women), in the capital, Honiara, told IPS.

Rachel, a young 24-year-old woman living with her two children, aged three and five years, in one of the country’s many rural villages, did not know what breast cancer was when she detected a lump in her breast in August 2013.

But the lump grew larger prompting her to travel to Honiara several months later to see a doctor.

“She went to the central hospital and was advised to have her left breast removed, but due to the little knowledge that she and her husband had about what it would be like, both were afraid of the surgery,” Bernadette Usua, who is Rachel’s cousin, recounted.

“So they just left the hospital without any medication or other assistance, and went home,” she continued.

Rachel tried traditional medicine available in her village, but the cancer and pain became more aggressive. Usua remembers next seeing her cousin in July of last year.

“She was sitting on her bed night and day with extreme pain, unable to lie down and sleep. But she was still brave as she nursed herself, washed herself and cooked for her children. She cried and prayed until she passed away in September,” Usua recalled.

Breast cancer is the most common cancer in women worldwide and in the Solomon Islands, where it accounted for 92 of more than 200 diagnosed cases in 2012. But its incidence in the developing world, where 50 percent of cases and 58 percent of fatalities occur, is rapidly rising.

Low survival rates of around 40 percent in low-income countries, compared to more than 80 percent in North America, are due mainly to late discovery of the disease in patients and limited diagnosis and treatment offered by under-resourced health centres.

Last year Annals of Global Health that of 281 cancer cases identified in women in the Solomon Islands in 2012, 165 did not survive, while in Papua New Guinea and Fiji fatalities occurred in 2,889 of 4,457, and 418 of 795 diagnosed cases, respectively.

Insufficient public knowledge about the disease is an issue across the region.

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“Currently public health education and promotion is focussing heavily on the control of NCDs [non-communicable diseases] as a whole. While cancer is included on the NCD list, very little attention and resources are specifically addressing women and breast cancer awareness,” said Dr. Sylvia Defensor, senior radiologist at the Ministry of Health and Medical Services in Fiji, a Pacific Island state home to over 880,000 people.

In the Solomon Islands, mammograms, or x-rays of the breast, will now be free to all female citizens who comprise about 49 percent of the population of more than 550,000. This is after installation of digital mammography equipment, funded by the national First Lady’s Charity, in Honiara’s National Referral Hospital.

Dr. Douglas Pikacha, general surgeon at the hospital, explained that mammograms were vital to early detection of breast disease and the saving of women’s lives through early treatment, such as surgery and chemotherapy.

Mammography is considered the most effective form of breast cancer screening by the World Health Organisation (WHO), with some evidence that it can reduce subsequent loss of life by an estimated 20 percent, especially in women aged 50-70 years.

But with more than 80 percent of the population residing in rural areas and spread over more than 900 different islands, Josephine Teakeni, president of Vois Blong Mere, is deeply concerned about the fate of many women who are located far from the main health facilities in the capital. An estimated 73 percent of doctors and all medical specialists in the country are based at the National Referral Hospital.

She says that reliable breast cancer screening and diagnosis is urgently needed in provincial hospitals if the mortality rate is to be reduced. Most patients must travel an average of 240 kilometres to reach the National Referral Hospital, commonly by ferry or motorised canoe, given the prohibitive expense of internal air services.

There is also a in the country with 0.21 doctors per 1,000 people and Teakeni claims that “while waiting for an operation the delay can result in full advancement of the cancer and death.”

However, there is a further challenge with almost half of all women diagnosed with breast cancer refusing a mastectomy, which involves the partial or entire surgical removal of affected breasts, even though it may result in the patient’s recovery, the Ministry of Health reports.

“Many prefer traditional treatment to mastectomy because they believe it is more womanly to have their breast than to live without it,” Pikacha said.

The high risk of cancer mortality is another factor impacting gender inequality in the Pacific Island state where entrenched cultural attitudes and widespread gender violence, experienced by 64 percent of women and girls, hinders improvement of their social and economic status.

Teakeni believes that an urgent priority is dramatically improving “awareness among women about the signs and symptoms of breast cancer, and even simple tests that women can do themselves, such as checking the breast for lumps while having a shower,” as well as the importance and impact of medical treatment.

Still, the installation of the new mammogram machine gives women on this island something, however small, to celebrate.

Edited by

Outgoing Namibian President Hifikepunye Pohamba was Monday named winner of the Ibrahim Prize for Achievement in African Leadership, believed to be the most lucrative individual award in the world.

The award, with an initial $5 million prize and an annual $200,000 gift for life, “recognises and celebrates African leaders who have developed their countries, lifted people out of poverty and paved the way for sustainable and equitable prosperity,” according to organisers the Mo Ibrahim Foundation.

The foundation, founded by and named after the Sudanese born philanthropist, grants the award to democratically elected African heads of state or government who have left office democratically in the previous three years, served their constitutionally mandated term, and demonstrated “exceptional leadership.”

At the event in Nairobi, President Pohamba was named just the fourth winner of the prize since its inception in 2007, and the first winner since 2011.

“During the decade of Hifikepunye Pohamba s Presidency, Namibia s reputation has been cemented as a well-governed, stable and inclusive democracy with strong media freedom and respect for human rights,” said Salim Ahmed Salim, Chair of the Prize Committee.

“President Pohamba’s focus in forging national cohesion and reconciliation at a key stage of Namibia s consolidation of democracy and social and economic development impressed the ‎Prize Committee.”

Pohamba became president of Namibia in 2004, and will be succeeded later in March by president-elect Hage Geingob.

On Twitter, the foundation wrote that Namibia has “shown improvement in 10 out of 14 sub-categories of the [Ibrahim Index of African Government],”a framework that calculates good governance in areas including rule of law, human rights, economic opportunity and human development.

Mohamed ‘Mo’ Ibrahim called Pohamba “a role model for the continent.”

“He has served his country since its independence and his leadership has renewed his people’s trust in democracy. His legacy is that of strengthened institutions through the various initiatives introduced during his tenure in office,” he said.

The Ibrahim prize is not awarded unless judges can find a candidate of sufficient quality.

Former Mozambique president Joaquim Chissano was the inaugural winner in 2007, followed by Botswana president Festus Mogae in 2008. The next and most recent winner was Pedro Pires, former president of Cape Verde, in 2011 after judges did not award the prize in 2009 or 2010. Prizes were not awarded in 2012 and 2013.

Children who work on tobacco farms in the U.S. are vulnerable to nicotine poisoning, especially when handling wet tobacco leaves. Credit: MgAdDept/CC-BY-SA

UNITED NATIONS, Apr 6 2015 (IPS) – For many young people, the summer is synonymous with free time, relaxation, or family vacations. For less fortunate kids the summer means labour, with scores of youths taking on part-time work to support their families.

In the U.S., not only is this work not optional, it is also unhealthy – especially for those unfortunate enough to seek employment on the country’s tobacco farms.

“The hardest of all the crops we’ve worked [with] is tobacco. You get tired. It takes energy out of you. You get sick, but then you have to go right back to the tobacco the next day.” — Dario, a child labourer interviewed by Human Rights Watch (HRW)
A recent string of policies aimed at addressing child labour in this major industry signals a turning point – but activists say the uphill battle is not yet over.

Human Rights Watch (HRW) recently released a detailing conditions of child labour in four of the country’s main tobacco-producing states – North Carolina, Kentucky, Tennessee, and Virginia – which together account for 90 percent of domestic tobacco production. In 2012, the total value of tobacco leaves produced in the U.S. touched 1.5 billion dollars.

According to the report, most of these children, sometimes as young as 12 years old, come from Hispanic immigrants families, and work on tobacco farms to help their families to pay rent and bills, and buy food and school supplies.

Margaret Wurth, co-author of the report and children s rights researcher at HRW, told IPS that many children “chose to do this difficult job because there are no other job opportunities in the communities where they live […].”

Out of the 141 children interviewed by HRW, two-thirds suffered from acute nicotine poisoning, or Green Tobacco Sickness (GTS) while working on plantations. GTS happens when workers absorb nicotine through their skin while handling tobacco plants, especially when the leaves are wet.

Sixteen-year-old Dario, who has worked on farms in Kentucky, said in an interview with HRW, “The hardest of all the crops we’ve worked [with] is tobacco. You get tired. It takes energy out of you. You get sick, but then you have to go right back to the tobacco the next day.”

Typical symptoms include dizziness, vomiting, nausea, and headaches. Some children also reported that employers did not guarantee training courses or safety equipment. Some had to work barefoot; others wore only socks as they worked in fields thick with mud, according to HRW research.

Fabiana, 14, said to HRW, “I wore plastic bags because our clothes got wet in the morning. They put holes in the bag so our hands could go through them […]. Then the sun comes out and you feel suffocated in the bags. You want to take them off.”

A giant industry in need of reform

According to the Centers for Disease Control and Prevention, in 2012 the U.S. produced nearly 800 million pounds of tobacco. The U.S. is the fourth leading tobacco producer in the world, after China, Brazil and India but unlike its competitors, the U.S. does not regulate the age of its employees on the tobacco fields, according to Alfonso Lopez, Democratic representative of the Virginia House of Delegates.

Recently, Virginia had the chance to become the first U.S. state to enact a law on child labour in tobacco plantations, in order to set a standard for all tobacco growers to protect children. But the proposed bill was defeated.

“My would prohibit hiring children under 18 to work in direct contact with tobacco leaves, or dried tobacco, with the exception of children who received parental consent to work in family farms,” Lopez explained to IPS.

Pressure from advocates, and studies like the one produced last year by HRW are slowly bearing fruit, with two large associations of tobacco farmers – the Tobacco Growers Association of North Carolina (TGANC) and the Council for Burley Tobacco in Kentucky – adopting new policies that prevent the hiring of children under the age of 16, and requiring parental consent for children aged 16-17.

This, in turn, led to two major U.S. tobacco companies – the Virginia-based Altria Group, parent company of Philip Morris USA, and the R. J. Reynolds Tobacco Company (RJRT) – adopting similar policies, for the safety of children working along the tobacco supply chain, Wurth said.

In 2014, three companies Philip Morris USA, Reynolds American Inc., and Lorillard accounted for 85 percent of U.S. cigarettes sales.

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An Altria Group spokesperson, Jeff Caldwell, told IPS that in 2014, Altria signed the global to eliminate any form of child labour in the tobacco supply chain worldwide, promoted by the Eliminating Child Labour in Tobacco Growing Foundation (ECLT).

In 2015, Altria started buy tobacco directly from growers, instead of buying it from third parties, in order to ensure that growers were not hiring children under 18, Caldwell added.

“We also have a very robust programme to train our growers and communicate to all of them the standardised U.S. tobacco good agricultural practices, to ensure that all of these growers are aware of, trained on, and in compliance with policies and laws that govern tobacco growing in order to protect children,” he added.

However, these measures only apply to farms that are part of large corporate supply chains, said Lopez.

“Most of the major buyers of U.S.-grown tobacco have adopted child labour standards more protective than U.S. law. But I think that without a stronger [federal] regulatory framework, dozens of children will inevitably be left out,” he remarked.

Last week the U.S. Department of Labour released a , issued jointly by the Occupational Safety and Health Administration (OSHA) and the National Institute for Occupational Safety and Health.

A Department of Labour Spokesperson told IPS that the bulletin focuses on the hazards of working in unsafe and unhealthy working conditions. The guidelines are designed to educate tobacco companies, farmers, and workers on preventing the effects of GTS, through appropriate training and working equipment.

The guidelines recommend the use of gloves, long sleeve shirts, long pants and water-resistant clothing when handling tobacco leaves to prevent exposure to nicotine, while recognising that children may suffer worse consequences than adults if these regulations aren’t met, the spokesperson added.

However, the bulletin made no explicit mention of child labour, nor did it specify ways to tackle the problem through more concrete regulation.

Edited by