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Cholera hits east African cities
POLICY AND PEOPLE
Documents could threaten US tobacco deal were “not new” and should not disore than 800 previously confitract Congress from implementing dential tobacco-company docthe deal negotiated earlier this year uments have been released by a US between the industry and attorneys House of Representatives committee general of several states. and posted on the Internet. Under the terms of this settlement, Industry critics say the documents the industry would show that lawyers pay US$368·5 billion hired by the compato the states for the nies heavily directed cost of smokingtobacco-companyrelated medical care, sponsored scientific finance anti-smoking research in an effort to campaigns, and agree undermine or disto tough marketing credit studies linking restrictions. In extobacco use to cancer, change, however, the heart disease, and companies would other diseases. “They No smoke without fire? obtain immunity from show that there was a most lawsuits and would be protected conspiracy in the industry to keep the from punitive damages. “We must people in the dark”, says Stanton learn from, but not be obsessed by, Glantz (University of California, San events past”, the statement reads, Francisco, CA, USA) a long-time “and recognise the value of a compretobacco-industry foe. hensive national policy and In response to the release, four the promise it holds for tobacco companies, Phillip Morris, the future” (see www.house.gov/ RJ Reynolds, Brown & Williamson, commerce/welcome.html). and the Lorillard Tobacco Company, released a joint statement arguing that the issues raised by documents Michael McCarthy Photofusion
M
Canada puts Health Act up for negotiation anada’s political leaders have put Medicare on the negotiating table in the relentless squabble between federal and provincial governments over power and money. Meeting last month to devise a national “policy framework” governing social programmes, Prime Minister Jean Chretien and all provincial premiers except for Quebec separatist leader Lucien Bouchard, struck a deal which includes interpretation and enforcement of the Canada Health Act as a subject for future negotiations. Among the issues to be negotiated in the development of a “framework agreement for Canada’s social union” are: a set of principles governing social policy; “collaborative approaches” to Ottawa’s use of its spending power; and “appropriate dispute-settlement mechanisms between governments”. If ratified, the agreement would require Ottawa to obtain provincial consent before establishing, funding, or setting standards for social policy, both for Medicare and for new initiatives. But predictably, the leaders emerged from the meeting at odds over exactly what they had agreed. The premiers contended that the
C
THE LANCET • Vol 351 • January 3, 1998
federal government had in fact put Medicare on the negotiating table by agreeing to develop a disputes-settlement mechanism in cases where the two levels of government have different interpretations of legislation. But federal Health Minister Allan Rock insisted Ottawa is not abandoning its authority to enforce the five principles of Medicare—accessibility, comprehensiveness, universality, portability, and public administration. Chretien said that the premiers “have a case that we should have a mechanism so that when we realise they are not respecting the five conditions, that before we enforce it, we discuss that with them”. But, he added, “the Canada Health Act is there to stay. The five conditions are there. If somebody was to break away from the conditions, we’ll have to enforce the law”. Earlier, Rock and the federal Finance Minister announced that Ottawa will honour its election promise to freeze federal cash transfers for Medicare to the provinces at Can$12·5 billion per year. Cash transfers had been scheduled to decline to $11 billion.
Cholera hits east African cities
C
holera epidemics are sweeping through east African cities leading WHO to call on governments and medical aid agencies to increase their assistance to control further spread of the disease. By the end of December, the disease had killed about 50 people in two slums in Nairobi, Kenya. Director of medical services, James Mwanzia, issued an alert that the disease might spread to other slums, where latrines are few and no clean water is available. A similar situation has also occurred in Kampala, Uganda, where about 30 people have died and 200 have been admitted to hospital. The situation is more serious on Zanzibar island where cholera has killed about 120 people and left 700 hospitalised in Zanzibar town. On Dec 14, health authorities ordered closure of schools in Zanzibar town and dispatched health units to the affected areas. Unicef and Médecins sans Frontières (MSF) has opened two “cholera camps” to ease pressure on the town’s two hospitals. MSF says that cholera is also spreading fast in Dar es Salaam on the Tanzanian mainland, in Mombasa and Kisumu in Kenya, and Mbale in Uganda. Authorities have attributed the cholera outbreaks to above-average seasonal rains, poor or no sanitation, and contaminated drinking water. Speaking in Nairobi on Dec 19, Maria Neira, who is in charge of the WHO task force on cholera control, said the situation is getting out of hand. Current projections of cholera in east Africa show the start of a potentially dangerous situation, she said. So far, WHO and Unicef have brought together a consortium of medical aid agencies to increase technical assistance, health education, and training and enhancement of laboratory facilities.
Anderson Wachira Kigotho
WHO 1997 figures for cholera in Horn of Africa (up to Dec 19) Cases 1991 17 200 6724 600 mainland 34 449 Zanzibar 570 Djibouti Kenya Somalia Uganda Tanzanian
Deaths 41 555 248 1 1720 122
Wayne Kondro
45
Documents could threaten US tobacco deal were “not new” and should not disore than 800 previously confitract Congress from implementing dential tobacco-company docthe deal negotiated earlier this year uments have been released by a US between the industry and attorneys House of Representatives committee general of several states. and posted on the Internet. Under the terms of this settlement, Industry critics say the documents the industry would show that lawyers pay US$368·5 billion hired by the compato the states for the nies heavily directed cost of smokingtobacco-companyrelated medical care, sponsored scientific finance anti-smoking research in an effort to campaigns, and agree undermine or disto tough marketing credit studies linking restrictions. In extobacco use to cancer, change, however, the heart disease, and companies would other diseases. “They No smoke without fire? obtain immunity from show that there was a most lawsuits and would be protected conspiracy in the industry to keep the from punitive damages. “We must people in the dark”, says Stanton learn from, but not be obsessed by, Glantz (University of California, San events past”, the statement reads, Francisco, CA, USA) a long-time “and recognise the value of a compretobacco-industry foe. hensive national policy and In response to the release, four the promise it holds for tobacco companies, Phillip Morris, the future” (see www.house.gov/ RJ Reynolds, Brown & Williamson, commerce/welcome.html). and the Lorillard Tobacco Company, released a joint statement arguing that the issues raised by documents Michael McCarthy Photofusion
M
Canada puts Health Act up for negotiation anada’s political leaders have put Medicare on the negotiating table in the relentless squabble between federal and provincial governments over power and money. Meeting last month to devise a national “policy framework” governing social programmes, Prime Minister Jean Chretien and all provincial premiers except for Quebec separatist leader Lucien Bouchard, struck a deal which includes interpretation and enforcement of the Canada Health Act as a subject for future negotiations. Among the issues to be negotiated in the development of a “framework agreement for Canada’s social union” are: a set of principles governing social policy; “collaborative approaches” to Ottawa’s use of its spending power; and “appropriate dispute-settlement mechanisms between governments”. If ratified, the agreement would require Ottawa to obtain provincial consent before establishing, funding, or setting standards for social policy, both for Medicare and for new initiatives. But predictably, the leaders emerged from the meeting at odds over exactly what they had agreed. The premiers contended that the
C
THE LANCET • Vol 351 • January 3, 1998
federal government had in fact put Medicare on the negotiating table by agreeing to develop a disputes-settlement mechanism in cases where the two levels of government have different interpretations of legislation. But federal Health Minister Allan Rock insisted Ottawa is not abandoning its authority to enforce the five principles of Medicare—accessibility, comprehensiveness, universality, portability, and public administration. Chretien said that the premiers “have a case that we should have a mechanism so that when we realise they are not respecting the five conditions, that before we enforce it, we discuss that with them”. But, he added, “the Canada Health Act is there to stay. The five conditions are there. If somebody was to break away from the conditions, we’ll have to enforce the law”. Earlier, Rock and the federal Finance Minister announced that Ottawa will honour its election promise to freeze federal cash transfers for Medicare to the provinces at Can$12·5 billion per year. Cash transfers had been scheduled to decline to $11 billion.
Cholera hits east African cities
C
holera epidemics are sweeping through east African cities leading WHO to call on governments and medical aid agencies to increase their assistance to control further spread of the disease. By the end of December, the disease had killed about 50 people in two slums in Nairobi, Kenya. Director of medical services, James Mwanzia, issued an alert that the disease might spread to other slums, where latrines are few and no clean water is available. A similar situation has also occurred in Kampala, Uganda, where about 30 people have died and 200 have been admitted to hospital. The situation is more serious on Zanzibar island where cholera has killed about 120 people and left 700 hospitalised in Zanzibar town. On Dec 14, health authorities ordered closure of schools in Zanzibar town and dispatched health units to the affected areas. Unicef and Médecins sans Frontières (MSF) has opened two “cholera camps” to ease pressure on the town’s two hospitals. MSF says that cholera is also spreading fast in Dar es Salaam on the Tanzanian mainland, in Mombasa and Kisumu in Kenya, and Mbale in Uganda. Authorities have attributed the cholera outbreaks to above-average seasonal rains, poor or no sanitation, and contaminated drinking water. Speaking in Nairobi on Dec 19, Maria Neira, who is in charge of the WHO task force on cholera control, said the situation is getting out of hand. Current projections of cholera in east Africa show the start of a potentially dangerous situation, she said. So far, WHO and Unicef have brought together a consortium of medical aid agencies to increase technical assistance, health education, and training and enhancement of laboratory facilities.
Anderson Wachira Kigotho
WHO 1997 figures for cholera in Horn of Africa (up to Dec 19) Cases 1991 17 200 6724 600 mainland 34 449 Zanzibar 570 Djibouti Kenya Somalia Uganda Tanzanian
Deaths 41 555 248 1 1720 122
Wayne Kondro
45