Health Inequality

A third of all deaths in 2010 (16.9 million) were from conditions which were treatable with surgery. That was more than the number of deaths from HIV/AIDS, tuberculosis and malaria combined.

Two-thirds of the world's population have no access to safe and affordable surgery, according to a new study in The Lancet - more than double the number in previous estimates. It means millions of people are dying from treatable conditions such as appendicitis and obstructed labour. Most live in low and middle-income countries.

93% of people in sub-Saharan Africa cannot obtain basic surgical care. Previous estimates have only looked at whether surgery was available. This research considered whether people can travel to facilities within two hours, whether the procedure will be safe, and whether patients can actually afford the treatment.

One of the study's authors, Andy Leather, director of the King's Centre for Global Health, said the situation was outrageous. "People are dying and living with disabilities that could be avoided if they had good surgical treatment," he said.

"Also, more and more people are being pushed into poverty trying to access surgical care."

The study suggests a quarter of people who have an operation cannot in fact afford it.

Numbers of trained surgical specialists per 100,000 people

UK: 35

US: 36

Brazil 35

Japan 17

South Africa: 7

Bangladesh 1.7

Sierra Leone (before Ebola): 0.1

"Unfortunately a lot of people have given up on the hospitals because they can't find surgeons there," said Dr Duffy, consultant obstetrician and gynaecologist who has recently returned from a surgical training camp in central Uganda. "People are living in the community with debilitating conditions and they just can't find the skilled people to help them."

313 million operations are carried out worldwide each year. Just one in 20 operations occur in the poorest countries, where over a third of the world's population lives. There is a global shortfall of at least 143 million surgical procedures every year.

Health Inequality

Poverty seems to have nothing to do with developed countries, such as the United States, the economic powerhouse. However, as it turned out, this is indeed a problem for the world's largest economy.

According to an article by Carol Graham, an expert with the Brookings Institution, although the living standards of the poor in the U.S. now have been improved compared with those in 1970s, poverty is still exacting a high cost - not in terms of water and power bills, but in terms of stress, unhappiness, and pain. The expert found that compared with wealthy people whose monthly household income is larger than 7,500 U.S. dollars, the levels of stress, worry, physical pain, sadness, and anger are all significantly higher among low income cohorts whose monthly household income is lower than 2,000 dollars. The low income group's satisfaction with life as a whole is also significantly lower than wealthy ones. Of these problems troubling the U.S. poor, stress, worry and physical pain are the top three difficulties experienced by the poor. Nearly 45 percent of the poor surveyed experienced stress, over 40 percent reported worry, and about 38 percent of the poor said they experienced physical pain.

A study by Ronald Anderson, a professor at University of Minnesota, said that those with incomes below the poverty line were twice as likely to report chronic pain the mental distress as those earning more than 75,000 dollars in annual income.

Trusting in God-men

A fine article on health-care and religion on the Countercurrents website.

Millions of rural people in India succumb to deaths due to diseases such as malaria, tuberculosis, kala azar and Japanese Encephalitis that could have been avoided with basic medication or treatment. Most of these preventable deaths in villages are due to infections of communicable, parasitic and respiratory diseases. Deaths in villages from conditions like nutritional deficiencies or perinatal deaths are also avoidable if they could have accessed some kind of affordable, basic health care at the right time. Around 40% of the rural morbidity in India is thanks to water born infectious diseases. These diseases are (1) of the gastrointestinal tract - such as diarrhoea, amoebiasis, typhoid fever, infectious hepatitis, worm infestations and poliomyelitis, (2) carried in the air through coughing, sneezing or even breathing -such as measles, tuberculosis, whooping cough and pneumonia, or (3) the difficult ones - like malaria, filariasis and kala-azar. About 100 million people get diarrhoea and cholera every year. There are 12 million tuberculosis cases currently in India with 1.2 million cases added every year. Around 37, 000 cases of measles are reported every year. About 2.3 million episodes and over 1000 malarial deaths occur every year in India. An estimated 45 million people are carriers of microfilaria. Around 1.2 million cases of leprosy exist in India with 500, 000 cases being added every year. More than 85% of rural children are undernourished and around 150, 000 of them die every year.

Many primary causes of ill health are based on factors such as poverty, deprivation and environmental abuse. The health support systems of the poor are clean water, air, forests and land. Threat to these resources is the root cause of their ill health.

Most who flock to the god-men for miracle cures in India are from the groups of poor women, dalits and backward communities. They work as small farmers, agricultural labourers and artisans. They struggle hard at their work places under adverse weather conditions to produce food and other commodities for their urban counterparts. When they get sick, they have no one else to turn to except their God and these god-men who claim to have miracle cures for their ailments. They look for solutions in quacks, sorcerers and god-men. India has many such individuals, families and trusts (which are managed like modern corporations) who claim to have miracle cures for all kind of ailments. They often have a very huge fan following in the rural heartland of India. They are omnipresent and they travel to many places to conduct mass healing sessions in emotionally charged gatherings. These god-men like the shamans of yester years play multiple roles as a magician, medicine person, miracle-worker, healer, priest, mystic and master of all spiritual energies and enjoy the company of powerful business tycoons and politicians.

Such healing individuals who claim shamanic powers are not limited to Hinduism only, they present in all other religions including Islam and Christianity. Thousands of people from Kerala rush to ‘divine healing centres’ set up around the clout of healing Christian priests who are believed to have the ability to perform miracles, exorcise demons and heal afflictions.

It does not matter even if the evidence of healing offered by these God-men does not stand up to scientific scrutiny. Their followers continue to believe in the testimony of those who got healed, though their healing is only a subjective experience. Critics of faith healers are usually dealt with personal attacks and they are blamed of not having enough faith. They gather support from members of their mother religion by crying ‘attack on their holy faith by nonbelieving outsiders’. They survive as medical science too does not have answers to all the questions about health, diseases and the multiple ways through which healing takes place.

In theory, the government provides some kind of health services - a three tier structure of health care consisting of Community Health Centres, Primary Health Centres and Subcentres is set up for the rural areas. But whatever limited services exist in the rural areas are either nonfunctional, dysfunctional, or are with extremely ‘poor quality’. Most often the service providers, especially doctors are not present in the rural facilities. India has just six doctors and nine hospital beds for every 10,000 of its people, compared to 14 doctors and 30 hospital beds in China. About 75% of health infrastructure, medical manpower, and other health resources are concentrated in urban areas where 28% of the populations live in villages. A recent survey of 15,000 households across 12 states noted that about half the people in India and over three-fifths of those who live in rural areas have to travel beyond 5 km to reach a healthcare centre. The survey further points out that the availability of healthcare services is skewed towards urban centers with these residents, who make up only 28% of the country's population, enjoying access to 66% of India's available hospital beds, while the remaining 72%, who live in rural areas, have access to just one-third of the bed.

Villages in the heartland of India are inhabited by poor landless laborers, small holders, and artisans. They spent their money mostly on food and some money on clothing and housing. Considering their ‘subsistence existence’, spending money on health care is indeed a luxury to them. Most of them could not afford to buy health care from the urban centers just because they are poor. Therefore in case of extreme illnesses, the rural masses turn to the private providers for which they have to borrow money from the money lenders. Many studies  have shown that medical treatment is the most important cause of rural indebtedness, next only to dowry in the rural India. Those who are indebted and those who are unable to afford a loan finally turn to quacks, sorcerers and god-men. Not only in remote rural and tribal areas but also in urban slums, the phenomenon of god-men is rampant and these god-men meet a felt need of these ailing masses.

The problem of poor access to health care by the masses is well documented by researchers umpteen times. The policy and program measures to deal with this issue are also known to experts. What we lack is the political will and guts to implement certain drastic measures. Today we are left with two options in front of us. We can either continue to leave the health care of the masses to shamans, sorcerers and godmen; and when they rally behind their miracle cures, we can blame them for their ignorance and superstitious habits and plan media campaigns to educate them! Or we can take bold steps to ensure universal access to health care.

The full article by Kandathil Sebastian, a DevelopmentConsultant and Public Health Researcher, can be read here.

Primum Non Nocere

First do no harm

Dr Gary G. Kohls, a retired physician with a 40 year medical career, is a critic of what he calls the  Big Business of Medicine.

“It is often said that the real clinical trials of new drugs start when the brief pre-marketing studies — involving only hundreds or occasionally thousands of test subjects — have been approved by the FDA, for that is when millions of unsuspecting, but excited patients get their first prescriptions of the latest wannabe blockbuster drug that they saw presented so appealingly on TV.
Big Business argues that the profitability of business enterprises depends on getting new products into the marketplace quickly in order to generate profits as soon as possible. Thus, paying for thorough, independent long-term studies (especially with watchdog agency oversight) is only grudgingly accepted by the profit-driven investors on Wall Street.
In light of the current corporate reality of profit maximization (and that goes for HMOs, hospitals and most clinics, especially the for-profit kinds with their multimillionaire CEOs), we physicians should be the ones who make sure that no harm is being done because of the drugs we prescribe. Throughout history, physicians have always accepted, as a sacred trust, the duty to warn patients about the potential dangers of their treatments, and there are many. ..
...n order for a patient to give fully informed consent to a treatment option, he or she must be given thorough information about the risks, safety and efficacy of the treatment both short-term and long-term, which, in the case of most psychiatric drugs, is virtually impossible to do given the lack of long-term studies that were done prior to FDA approval and the poor post-marketing surveillance that is done. Medical malpractice suits commonly revolve around the issue of adequate informed consent.
Patients deserve to know whether or not psychotropic drugs are addicting or dependency-inducing, are capable of causing withdrawal symptoms or whether or not the patient can be sickened or intoxicated by the drugs. Patients also deserve to know about the existence alternative therapies which, in the case of mental health issues, utilize good psychotherapy and nutritionally-based, life-style alterations, approaches that are often falsely discredited by medical trade association groups like the AMA, the APA and their medical journals. The giant multinational corporations that generously fund such groups, are always looking for ways to eliminate the competition in order to achieve a near-monopoly for the sale of their substances.
The time-honored Precautionary Principle says that an ethical business, governmental agency or culture should err on the side of caution before new chemicals, technologies, procedures, services, food additives, drugs, surgical procedures, etc are introduced into the marketplace (and the environment) – and only then should they be allowed on the market when there is absolute proof that the substances are not dangerous to the environment (which includes human/animal life, the water supply, the soil and the air – i.e., our fragile planet).

So when medical industries wish to market new synthetic chemical substances that have the potential to adversely affect human or environmental health (even years or decades into the future) the Precautionary Principle requires that adequate and aggressive long-term studies (funded by agencies totally independent of those who want to profit from the substance) be undertaken and then only approved when it has been proven to be totally safe.

So, under the Precautionary Principle, regulatory agencies must be given permission to aggressively withhold the marketing approval of potentially carcinogenic, disease-producing, neurotoxic or immune system-destroying products from the environment from where they may be ingested, inhaled or otherwise absorbed into the bodies of potential victims.
Therefore, before potentially dangerous substances are allowed onto the grocery store shelves or into our pharmacies, hospitals, clinics and then, inevitably, into our bodies, the Precautionary Principle says that they should be first proven that they will do no harm, short-term or long-term.
As was documented in last week’s Duty to Warn column America has a drug-induced dementia, suicide, violence and mental ill health epidemic on its hands that should be obvious to every critical thinker that looks at the evidence. But because there are not many in the medical professions with the time (or willingness) to look at the evidence, the epidemic will surely continue to worsen because of the continued chronic use of non-curative drugs that are, in America, too often used as first-line “treatment”. Both psychiatric drug-induced brain disruption and psychiatric drug withdrawal syndromes can be mistaken for mental illnesses of unknown cause.
We can do better for our patients — and our dying planet — if we just go back to the honorable past traditions exemplified in the Hippocratic Oath and the Precautionary Principle.

From Dissident Voice

abortion

The death of Savita Halappanvar, an Indian dentist in Ireland, due to refusal of abortion by doctors in Dublin has outraged every human being who loves life. Irish laws prohibit abortion though a 1992 court ruling suggested that it could be permitted if there is ‘real and substantive’ risk to the life of mother. However, it fell on the deaf years as doctors failed to respond to her deteriorating condition which resulted in her untimely death.  It was not possible to fly her to England where abortion is not illegal at the eleventh hour, as her condition was extremely critical.

It is ironical that a pro-lifers do not want to talk about the rights of the mothers to have good health and the right to life.

Civilised society allows people their right to choose their life. They also offer medical option to men and women to decide about their body. Abortion is a right of a woman to protect her life and they would only use it in dire circumstances. Nobody would opt for an abortion in happy state of mind. It is her body and she has a right to secure herself first. There are circumstances when people are forced to do so.

division of labour

Doctors and nurses appear to work harmoniously together but the traditional role of the doctor as the dominant professional means nurses face both structural and professional inequalities. The nursing profession is denied opportunities to contribute to patient care and that hinders the development of equal and collaborative working relationships. Evidence suggests when nurses and doctors work as equal partners, patients have better health outcomes. If you pay a visit to your local doctor, there’s a good chance you’ll spend some time with a nurse.

Nurses in general practice provide specialist health services, education and advocacy. For patients with long-term health complaints, having a nurse involved in care can improve health outcomes and have increased patient participation in continuing care and encouraged lifestyle changes. The general practitioner has traditionally been the sole custodian of care but as the number of nurses in general practice increases, it’s likely that this traditional role will be challenged.

Nurses who enter the workforce today are prepared for clinical independence, critical thinking, and professionalism. No longer do they view themselves as doctors'“handmaidens”. Nor are nurses substitute doctors in general practice – they meet the needs of patients by approaching problems in a different way. They seek to understand how a person is experiencing both their health and their illness so the nurse acts as an advocate for the patient. Collaborative partnerships between nurses and doctors in general practice will result in comprehensive primary health care – the beneficiaries will be patients and the community.

Simple is best

Dhaka is surrounded by water, but it is so polluted that very little of it is drinkable. That, plus the very poor sanitation across the city, means that the people of the Bangladeshi capital not only have to scramble daily for clean water supplies but are also regularly in danger of the silent killer that is cholera. Dhaka has two cholera outbreaks each year: roughly, one before and one after the monsoon. Left untreated, cholera can kill in hours and it spreads quickly, which is why it so terrifies people.You can start being ill at ten the morning and be dead by two in the afternoon.

If you don't like hospitals then you would hate Dhaka Hospital during one of the Bangladeshi capital's regular cholera epidemics. The emergency ward was seething with men, women and children, many of them severely dehydrated and fighting for life. Patients moaned as nurses connected them with intravenous needles to bags of saline. Hospital orderlies pushed away trolleys piled with buckets of diarrhoea and vomit. And all the while more patients arrived, by wheelchair or stretcher, or half-carried by fretful relatives, until they spilled out into makeshift wards set up in the parking lot. It looked like pandemonium, but it wasn't. The Cholera Hospital, as locals call it, is efficient and deceptively high-tech. Look closely, and you will see that medical staff track each patient with handheld computers. And it is unrivalled at treating large numbers of patients with potentially fatal diarrhoeal diseases such as cholera.

"If you arrive alive at our hospital," its director Mark Pietroni told us, "then you leave alive." Patients who were stretchered into Dhaka Hospital were walking out within 24 hours.

Oral rehydration solution (ORS), a simple mixture of salt, sugar and water, is used to treat cholera and other diarrhoeal diseases. ORS is thought to have saved more than 50 million lives. ORS is the primary weapon in Dhaka Hospital's fight against cholera.

http://english.aljazeera.net/programmes/witness/2011/07/201171974227416827.html

TCM

Western medicines are making China's ancient medical practices increasingly redundant, but their high price tag is also pushing millions further into poverty. The proportion of Chinese using Traditional Chinese Medicine in the formal medical sector fell from 25 per cent in 1991 to 14 per cent in 2004, according to a survey published in Social Science and Medicine last July. A century ago there were 800,000 practitioners of traditional medicine in China, but the numbers have steadily fallen. In 1999, the Government introduced licensing for practitioners and the number dropped to 200,000.

Western medicine comes with a Western price tag and high health costs are forcing increasing numbers of poorer workers into poverty, amounting to 2-3 per cent of the population every year. Between 1993 and 2003 costs rose six times for out-patients and four times for in-patients. Patients in hospital still check their bills daily and, if their money is running out, discharge themselves early.
China is a nation hooked on the idea that any illness can be cured with the right drugs – and the bigger the dose the better.a young man with his eyes closed, wearing a blue face mask, is also being treated with intravenous antibiotics for a cold. In the West such treatment would never be countenanced – colds are caused by viruses and antibiotics, which tackle bacteria, are regarded as rarely necessary. Moreover, intravenous administration of drugs is reserved for the most seriously ill patients.

Donald Li, a Hong Kong GP and adviser to the Shanghai government, says Chinese patients are sceptical of the value of advice given by doctors, but place great faith in the power of medicinal drugs."The belief is that there is a therapeutic value from the drug, but no value in telling me what I should do. Injections and intravenous treatment are liked. This is a culture that seeks intravenous treatment," he says.

But economics plays a part, too. Charges levied by hospitals are set deliberately low by local councils, often too low to cover the cost of the service. Hospitals have to make up the difference in the cost of drugs and diagnostic tests which are not controlled. They charge heavily for them – and encourage patients to have more. The situation is aggravated by doctors' poor rates of pay. They depend on bonuses paid by hospitals from the income generated by drugs and tests. All the incentives in the system are thus aligned, but towards the wrong objectives."There is over-diagnosis, over-treatment and bad practice," said Professor Li. "It all comes back to doctors' low salaries. If they were properly paid they wouldn't need to do these things."

Food for Thought

According to the Lancet nutrition series (January 2008), 178 million children under 5 suffer from nutritional deficiencies - 55 million acute and 19.3 million severely acute (wasting).

Unlike many diseases, malnutrition has a cure - a balanced diet, regular consumption of fortified foods, supplements when local foods don't have the nutrients needed, and animal-based products like milk, fish, eggs and cheese.

One solution is to increase spending on nutrition. According to the Lancet nutrition series, $300 million a year is spent on nutrition while $6 billion is spent on HIV/AIDS.

"Nutrition can only be sustainable if people ultimately pay for it," said Dr. Alfred Sommer, dean emeritus of the Johns Hopkins Bloomberg School of Public Health.

What he means is for people to pay in pounds and pence , dollars and cents . No matter how well meaning those experts and NGOs are , they are bound by the confines of the capitalist system and the most obvious solution of actually providing such nutition freely is simply beyond their ken .

shit jobs

Who will do the dirty work is frequently the refrain from those who oppose a moneyless wageless society . All i can say that those who are forced by poverty to perform the sewer work in Delhi won't be expected to do it.

Omar Kumar gets drunk every day before he goes to work. It is the only way he can cope with spending hours chest-deep in Delhi's stinking sewers. "I have to drink alcohol -- if I don't, I cannot work," he said, after another shift unblocking tunnels beneath the Indian capital's slums, suburbs and factories. Health problems, and drug and alcohol addiction, are common among beldars who spend eight hours a day wading through sewage, said Hemlata Kansotia, a social worker
Kumar, a 30-year-old father of four, is one of thousands of men employed as "beldars," climbing down filthy manholes eight feet (2.4 metres) deep, dressed only in underpants and equipped with little more than a hoe and a wooden bar.
"When inside, the stench is so strong it hits you in your face," said Kumar's brother-in-law Vinod, also a sewage worker. "It is like descending into hell. Rats, cockroaches, mosquitoes. Dirty sludge and human waste all around. I hate my job but I have to earn money for my children."

"Sewer cleaners are operating in working conditions wholly incompatible with human dignity and hazardous to health," Delhi High Court Justice A.P. Shah stated in his ruling.

A 2005 report by a New Delhi-based Centre for Education and Communication, a think tank, found that half the city's sewage workers were malnourished or suffered from chronic illnesses.

Ashish Mittal, one of the doctors who wrote the report, said the High Court's intervention was desperately needed.
"Many workers die of asphyxiation," he said. "The sewers are full of noxious and dangerous gases -- hydrogen sulphide, methane, carbon monoxide -- from decomposing industrial, household and even hospital waste.A confined space without much oxygen can also cause syncope, which is a sudden loss of consciousness due to a stoppage of blood to the brain. Its long-term effects can be debilitating."
The manholes are too narrow for workers to wear protective suits, so skin problems and respiratory tract infections are also common, Mittal said

The Price of Life

A Brazilian judge has ordered Rio de Janeiro state and city to start using private hospitals to help cope with a surge in cases of dengue fever.

For weeks, hospitals in Rio have been struggling to cope with the latest outbreak of dengue, a disease which is spread by one type of mosquito and which in extreme cases can be fatal. This had meant patients, including old people and children, passing through indescribable agony and embarrassment as they waited hours for treatment, as well as running the risk of losing their lives.

At least 54 people have died across Rio state since the start of the year while the number of people infected is now said to have passed 43,000. Brazil's Health Minister has acknowledged that incomplete information means the death toll and the number of cases reported are almost certainly much higher.

The judge accused the authorities of neglect and indifference to sufferers of the mosquito-borne fever. They had failed to act to prevent and contain the epidemic, she said. Judge Patricia Cogliatti de Carvalho has now ruled that the state and city have to send patients with dengue to private hospitals and clinics when demand exceeds the capacity of public hospitals.
The state would then have to pay for the treatment within 20 days.

In her ruling, the judge spoke of the "neglect and indifference" shown by the authorities in relation to dengue.

The rich get wealthier and healthier

New government research has found “large and growing” disparities in life expectancy for richer and poorer Americans, paralleling the growth of income inequality in the last two decades.

While life expectancy for the nation as a whole has increased, the researchers said, yet affluent people have experienced greater gains, and this, in turn, has caused a widening gap.

“the growing inequalities in life expectancy” mirrored trends in infant mortality and in death from heart disease and certain cancers.The gaps have been increasing despite efforts by the federal government to reduce them.

Dr. Singh , a demographer at the Dept. of Health and Human Services , said last week that federal officials had found “widening socioeconomic inequalities in life expectancy” at birth and at every age level.

In 1980-82 people in the most affluent group could expect to live 2.8 years longer than people in the most deprived group (75.8 versus 73 years). By 1998-2000, the difference in life expectancy had increased to 4.5 years (79.2 versus 74.7 years), and it continues to grow .

In 2000 men in the most deprived counties had 10 years’ shorter life expectancy than women in the most affluent counties (71.5 years versus 81.3 years). The difference between poor black men and affluent white women was more than 14 years (66.9 years vs. 81.1 years).

18000 Americans killed by insurance companies

The United States is the only major industrialised nation without universal health insurance writes Karen Davis, President of the Commonwealth Fund. The number of uninsured people has increased from 40 million in 2000 to nearly 47 million in 2005.

Gaps in coverage lead to inequalities in access to care, poor quality care, lost economic productivity, and avoidable deaths. The Institute of Medicine estimates that 18,000 lives are lost annually as a consequence of gaps in coverage.

The problem is getting worse, not diminishing, she warns. The fragmented, uncoordinated healthcare system is plagued by high administrative costs and missed opportunities to control chronic conditions and prevent life threatening conditions.

If the US hopes to achieve a high performance health system that is value for money, it will have to tackle the perplexing problems of access, quality, and cost, and overcome considerable political and economic obstacles, as well as institutional resistance to change, she concludes.

The Mothers Day Massacre

Up to one million pregnant women worldwide die each year from largely avoidable causes, a Commons international development committee report said .

It warned that for every woman who dies in childbirth in the UK, up to 1,000 die in the poorest countries. For each woman who dies, 30 further women will become disabled, injured or ill owing to pregnancy .

Better access to family planning services alone would cut maternal death and disability by at least 20%, the MPs said.

The report warned that it looked unlikely that the millennium development goal of cutting the number of maternal deaths by 75% by 2015 would be met.

The MPs said there had been little progress in reducing deaths in the last 20 years.

Health Racism

Emergency room doctors are prescribing strong narcotics more often to patients who complain of pain, but minorities are less likely to get them than whites, a new study finds.

Even for the severe pain of kidney stones, minorities were prescribed narcotics such as oxycodone and morphine less frequently than whites. Minorities were slightly more likely than whites to get aspirin, ibuprofen and similar drugs for pain. The analysis of more than 150,000 emergency room visits over 13 years found differences in prescribing by race in both urban and rural hospitals, in all U.S. regions and for every type of pain.

Linda Simoni-Wastila of the University of Maryland, Baltimore, School of Pharmacy said the race gap finding may reveal some doctors' suspicions that minority patients could be drug abusers lying about pain to get narcotics. The irony, she said, is that blacks are the least likely group to abuse prescription drugs.

"If anybody argues they have no social biases that sway clinical practice, they have not been thoughtful about the issue or they're not being honest with themselves," said Dr. Thomas L. Fisher, an emergency room doctor at the University of Chicago Medical Center

Bush - no cash for kids health

"What a sad day that the president would say that rather than insuring millions of children, 'I don't want to raise the cigarette tax,' " said House Speaker Nancy Pelosi.

President Bush vetoed an expansion of the federally funded, state-run health insurance program for poor children for a second time Wednesday, telling Congress the bill "moves our country's health care system in the wrong direction."

The bill would have expanded the State Children's Health Insurance Program by adding another 4 million children whose families still can't afford private insurance to the 6 million already covered by the program whose parents earn too much to qualify for Medicaid .

The reform would have been financed by a 61 cents increase in the federal tax on a pack of cigarettes.

"They never told us that it would kill you,"

A story of working class courage

It is estimated that up to 56,000 Australians will be affected by asbestos-related illnesses by 2020 . Asbestos was mined in Western Australia until the 1960s and widely used in building products – until the dangers of exposure to its dust became clear. Australia has one of the world's highest rates of asbestos-related disease.

Some people submitted to their fate, but not Bernie Banton, who led a protracted international battle for proper compensation for himself and his fellow victims. Yesterday, the man who became the human face of a struggle for justice – a familiar figure who breathed with the help of an ever-present portable oxygen bottle connected via tubes to his nose – died of an asbestos-related cancer . He had fought James Hardie Industries, a multinational building products company and Australia's biggest asbestos manufacturer, earned him admiration from many. He battled to the very end. In 2001, the company bowed to pressure and set up a foundation to compensate victims of diseases caused by its products. But the sum it set aside – A$293m (£123m) – was laughable. When that fact was pointed out, the company refused to increase the fund. Then it moved its headquarters from Sydney to the Netherlands, saying this was for tax reasons. Critics accused of it of trying to avoid lawsuits.

Just last week, knowing he had only days to live, Bernie was still fighting for compensation for other sufferers from his hospital bed. "What a wonderful opportunity I've had to represent all those victims out there, and to be able to fight for them who were not well enough to do it," he told the assembled media.

The large plant where Bernie worked was one of Hardie's deadliest work environments. Of his 137 fellow employees, who included his two brothers, fewer than 10 are still alive.

John Howard's Health minister, Tony Abbott, was forced to apologise to Mr Banton last month after accusing him of staging a "stunt" when he handed in a 17,000-name petition to his office. Mr Abbott also suggested that Mr Banton's motives were "not pure". The petition requested a government subsidy for a new palliative drug for mesothelioma – the disease with which Mr Banton was diagnosed in August and which was ultimately to kill him.

Sick and Forgotten

Previously posted was how the US treats its loyal ex-servants in the military at Homes Fit For Heroes .

But it doesn't stop at lack of homes . 1.8 million veterans or 12.7 percent of non-elderly veterans had no health insurance in 2004, up 290,000 since 2000, a study found.

Of the 1.768 million uninsured, 645,628 were Vietnam-era veterans while 1,105,891 were veterans who served during other eras including the Iraq and Gulf Wars. Of the medical uninsured veterans, 56.5 percent were older than 44.

More than 26 percent of uninsured veterans reported that they had failed to get needed care due to costs; 31.2 percent had delayed care due to costs; 49 percent had not seen a doctor within the past year; and two-thirds failed to receive preventive care.

Nearly two-thirds of uninsured veterans were employed. The report states that many uninsured veterans are barred from VA care because of a 2003 Bush Administration order that halted enrollment of most middle income veterans.

“Since President Bush took office the number of uninsured vets has skyrocketed, and he’s cut eligibility, barring hundreds of thousands of veterans from care,” said Dr. David Himmelstein, co-author of the study and co-founder of Physicians for a National Health Program. “This administration has put troops in harm’s way overseas and abandoned them and their families once they got home.”

Is it no wonder then that the US military is experiencing a "suicide epidemic" with veterans killing themselves at the rate of 120 a week, according to an investigation .

At least 6256 US veterans committed suicide in 2005 - an average of 17 a day , with veterans overall more than twice as likely to take their own lives as the rest of the general population.

While the suicide rate among the general population was 8.9 per 100,000, the level among veterans was between 18.7 and 20.8 per 100,000. That figure rose to 22.9 to 31.9 suicides per 100,000 among veterans aged 20 to 24 - almost four times the non-veteran average for the age group.

"Those numbers clearly show an epidemic of mental health problems,'' veterans' rights advocate Paul Sullivan said .

There are 25 million veterans in the United States, 1.6 million of whom served in Afghanistan and Iraq . Having served the interests of US capital they are discarded .

The other war in Afghanistan

There is another war going on in Afghanistan - one which is being ignored by the media - and that is the class war .

The Safi fur and wool factory, in Herat city, western Afghanistan, has more than 350 female and 300 male workers who earn only 300 Afghanis (US$6) for their 48-hour, six-day week. The factory produces coats, jackets, hats and other garments for the European and North American markets. There are more than 1,500 women working in four such factories in Herat city. Workers have to separate fur from goats’ hair and weave sheep’s wool without protective gloves or masks.

Ahmad Zia Rahmani, a lung and chest diseases specialist at the Herat city hospital, says workers in fur and wool factories are vulnerable to virulent microbes, which harm the respiratory system and cause chest infections. “Sheep’s wool and goats’ hair usually contain harmful bacteria which can easily be transferred to a human via close contact and inhalation,” Rahmani said. Mothers who regularly breastfeed their babies and consume food at the factory can also transfer dangerous microbes to their children if they do not wash their hands with antibacterial soap, Rahmani added.

Jamila has worked in the factory for more than a year and recently experienced an unrelenting pain in her chest. “First, I was coughing and now I feel a terrible pain in my chest,” the 32-year-old said. “Doctors and medicine are expensive,” she said.

In the past 12 months, seven women workers of the wool and fur factories in Herat have died due to respiratory diseases and chest infections.

According to Afghanistan’s labour law, public and private employers should provide medical insurance to employees who work in hazardous environments. However, there are too many hurdles - including poor law enforcement institutions, lack of awareness about women's rights and conservative traditions - which constrict the law on paper with weak or no practical power. Almost all workers in factories in Herat province have no written contract with their employers, particularly in the private sector. Workers and employers have only verbal agreements, which do not cover medical and hazard insurance.

Meanwhile

Iran is deporting thousands of Afghans . Most deportees are young, single men who migrated to Iran mostly in search of employment and economic opportunities, aid agencies say. Provincial officials, however, are concerned that hundreds of women, children and elderly people have also been evicted.
The UN Refugee Agency (UNHCR) says there are more than 900,000 registered Afghan refugees in Iran. However, the large numbers of Afghans who do not have refugee status and are considered illegal are not protected by UNHCR. Since April, some 200,000 Afghans living in Iran illegally have been deported .

USA - Free health care ? Not even for kids

The Bush administration, fighting efforts by states and Congress to expand a popular U.S. health program for children in low-income families, is making it more difficult for families to sign up.
In an Aug. 17 letter to state health officials, the administration imposed new standards that White House spokesman Tony Fratto said today would prevent the State Children's Health Insurance Program, or Schip, from becoming "essentially a middle-class entitlement.''
President George W. Bush has threatened to veto bills passed by the House and Senate to expand funding for Schip, which now covers 6 million children. [SCHIP was created in 1997 to help insure children whose families earned too much to qualify for Medicaid but not enough to afford insurance on their own.]

The new policy sets more-restrictive standards for states that want to expand eligibility to households above 250 percent of the poverty level, which amounts to $51,625 in annual income for a family of four. Tens of thousands of children would become uninsured in at least 23 states that provide, or plan to provide, coverage exceeding these limits . Under the new rules, a state must show that a child whose family earns more than 250 percent of the poverty level has been uninsured for at least one year before being signed up for coverage. In addition, the state must demonstrate that at least 95 percent of its children from families making less than 200 percent of the poverty level have been enrolled either in Schip or Medicaid.

"This drastic change in policy sets states up to fail and jeopardizes coverage for tens of thousands of children in low- income, working families,'' said Senator Max Baucus, a Montana Democrat and chairman of the Senate Finance Committee, in a statement.

"I can't try and guess what kind of mind-set would foster this, but it's certainly penny-wise and foolish,'' said Representative Pete Stark, a California Democrat, in a telephone interview today. The proposal "cuts down the ability of the states to provide medical care to children."