Health

Combating alchohol abuse has always been something of a non-starter in Russian politics. This is, after all, a country whose former president was once found by the Secret Servce thoroughly sauced outside the White House, wearing nothing but his underwear trying to hail a cab so he could get a pizza.

But current President Dmitry Medvedev is trying to change things with a proposal to ban outdoor beer sales in his country, a first step in getting Muscovites to lay off alcohol. He also wants to limit the hours of the day alcohol can be sold.

This week, a bill was submitted to lawmakers that would triple the tax on beer from 3 rubles per liter to 10 rubles per liter by 2012. Wine and spirits would also see a sharp increase.

State prosecutors are also moving to ban liquor sales in airports. Under Russian law, no beverage with alcohol content above 15 percent can be sold in crowded or dangerous places, and prosecutors say this means airports.

Russians drink five gallons of pure ethanol a year, double what is considered dangerous by the WHO. And on average, 30,000 people a year die from alcohol poisoning in the country. Over half of the deaths of the 15 to 54-year-old demographic between 1990 and 2001 are attributed to alcohol.

"I have been astonished to find out that we now drink more than we did in the 1990s, although those were very tough times," Medvedev said.

He is a fan of Soviet Premier Mikhail Gorbachev's anti-alcohol reforms in the 1980s aimed at curbing consumption, even though he acknowledges that the plan had major flaws. Gorbachev destroyed the majority of vineyards and wineries in Georgia, probably the birthplace of wine (This didn't help the growing anti-Russia sentiment in the Southern Caucasus at the time). He also shut down distilleries and breweries. Most notably, the Soviet Union suffered tremendous sugar shortages, because people turned to moon shining. (The Russian word for ‘shine is Samogon) Stores also ran out of window cleaner and aftershave. It is estimated that 13,000-25,000 people died from drinking ill-made moonshine.

Medvedev's plan is much more cautious but many Russians are still wary.

"It's impossible. He doesn't stand a chance," a Russian construction worker told The Los Angeles Times."The Russian man will always be drinking. Russians don't surrender."

ALEXANDER NEMENOV/AFP/Getty Images 

Maureen Lewis and Andre Medici of the World Bank respond to "Brazil's Public Option," a Foreign Policy Web piece by Eduardo J. Gómez from Sept. 2. 

The article "Brazil's Public Option" from Foreign Policy's Web site captures some of the highlights of the country's public health-care system. But it contains some errors and omits some of its most important lessons.  

First, like the rest of Latin America, Brazil is committed to free, universal health care. The government revamped the health-care system when it wrote a new constitution in 1988, at the demise of two decades of military dictatorship. Before 1988, the health-care system was based on two centralized arrangements: a social security-based system tied to formal sector employment, and a public system for everyone else. The Single Unified System (SUS) brought federal financing and provision into a single entity, and decentralized facilities and funding (through transfers) to over 5,500 municipalities. It is hardly comparable to the current movement in the United States to effectively adjust the system and make it more fair.  

The problems of public systems (waiting lists, political interference, and deteriorating and outdated infrastructure) are not unique to Brazil. What is different is the adaptability and creativity that has emerged. It is not lack of federal oversight of municipalities that has proved problematic, but the lack of management and capacity, a problem never addressed. As a result the states have taken the lead in revamping and improving the health-care system. State experimentation to deal with the rigidities and poor incentives of public health care include innovative contract mechanisms that have upgraded quality and reduced costs through management contracts that include removal for nonperformance; public sector reforms that rely on performance contracts with line departments; and radically new delivery models in violence-prone slums where normal health-care delivery is no longer viable.

It should also be pointed out that Brazil's large and vibrant private insurance sector isn't new. Even in the 1990s a quarter of Brazil's population purchased private health insurance.

What is missing from the article are the innovations and creativity brought to bear at the state and local level (mostly with federal funds) to improve efficiency and effectiveness, an evolving evaluation culture in service delivery that has spurred prevention and outreach (something lacking in the United States), and the willingness to adapt a public system to new circumstances. These are possibly the best lessons for the United States. 

When it comes to using Holocaust metaphors, the power of suggestion is a loaded and delicate thing. Striking the right chord becomes ever more slippery when, for example, you use the most recognizable image of Holocaust evil, Adolf Hitler, to illustrate the recklessness of unprotected sex. But you just about lose any hope of keeping that line clean and clear when you make a Hitler sex video for an AIDS PSA. Which is what a small German AIDS awareness group called, Regenbogen e.V, did. 

While the Telegraph says the clip appears to be a "typical advert" at first glance, I imagine most American viewers won't agree. The act of intimacy being portrayed is basically soft-core porn. It shows two very naked hard-bodies engaged in some very steamy sex. (Warning: this video ain't for the kiddies and is probably not safe for work.) The commercial's obvious-to-the-point-of-insult message, that unprotected sex is very, very dangerous, is hammered home with a rather indelicate ... bang. As the couple reaches climax, the man's face is revealed -- it's Hitler. Scary, indeed.

Not surprisingly the ad, released in Britain to coincide with World AIDS day, has created a storm of controversy. A spokesman for the National AIDS Trust, the group that coordinates World AIDS Day in Britain, had this to say: 

Of course there are many HIV organisations that run their own campaigns, however I think the advert is incredibly stigmatising to people living with HIV who already face much stigma and discrimination due to ignorance about the virus.

"On top of this it fails to provide any kind of actual prevention message (e.g. use a condom) and may deter people to come forward for testing.

"The advert is also inaccurate because in the UK thanks to treatment HIV is a manageable condition that does not necessary lead to AIDS.

Hans Weishäupl, creative director of das comitee, the group that created the ad for Regenbogen e.V, defended the work:  

A lot of people are not aware that Aids is still murdering many people every day. They wanted a campaign which told young people that it is still a threat," he said. "In Germany, Hitler is the ugliest face you can use to show evil." 

Provocative it may be, but successful? I doubt it. Would it be a gross and malicious misinterpretation to use this ad to say that people who have unprotected sex, or people with HIV or AIDS, are as evil as Hitler? Absolutely. Is it a stretch to say there are folks out there who will do just that? Nope.

Using the evil führer's personage for good is a tricky business, one that should perhaps be left to the Charlie Chaplins of the world. 

The Japanese have been as cautious as any nation in trying to avoid swine flu Even before the first case was diagnosed in May, many Japanese were wearing masks overseas, and after the disease spread to the island, thousands of schools were closed, and testing centers were overwhelmed.

And while the thorough response has done little to halt the disease--three people have died from the virus, and on Wednesday the health minister announced a higher number of cases than expected--even politicians are taking a bold new step to prevent infection: ditching the handshake. 

[C]andidate Denny Tamaki is playing it safe. "Shaking hands during an election campaign is key, so this is pretty troubling," Tamaki told the Yomiuri Shimbun.

"It would be bad if I get infected myself and then pass it on to older people with weaker immune systems," said Tamaki, whose home island of Okinawa has been hit hard by the flu.

Meanwhile, students at the British International School in Shanghai are probably glad they set their world handshaking record when they did.

YOSHIKAZU TSUNO/AFP/Getty Images

Spanish Health Minister Trinidad Jimenez launched a new health campaign with recommendations to guard against the spread of swine flu by encouraging people to wash hands frequently, avoid sharing glasses and to refrain from kissing where possible. But just moments before she made her statement, the minister was caught kissing news conference assistants twice on the cheek. Though a common social custom, local media wasted no time in capturing the irony, as weekend papers splashed pictures of Jimenez failing to practice what she preached. To date, Spain has accredited 11 deaths to the virus, giving it the second highest fatality rate in Europe. 

PHILIPPE DESMAZES/AFP/Getty Images

The Globe and Mail's Norman Spector thinks Canadian Prime Minister Stephen Harper missed a chance at the "three amigos" summit to help out Barack Obama and gain some political points that could be used to sway the president on "buy America" provisions:

On health care reform -- a question he knew he would be asked and had obviously prepared -- he ducked instead of helping the President counter Republican disinformation by seconding Mr. Obama’s observation that the Canadian model is not on the table. Most gratingly, with an insipid smile on his face, Mr. Harper referred to provincial jurisdiction over health care — a half-truth, at best, given the constraints set out in federal legislation.

In interview with ABC's Jake Tapper, that Spector also links to, Harper does seem to be bending over backwards not to defend his own country's healthcare system.Given how divorced from reality the U.S. healthcare debate has become, I'm not sure how much Haper really could have helped Obama. It's not as if the assurances of a  Canadian Prime Minister -- even a conservative one -- are really going to assuage those who see "Obamacare" as creeping socialism. Ducking the question and staying as far away from the U.S. debate as possible is not exactly a profile in courage, but is probably prudent.

(Hat tip: Matthew Yglesias)

Anxiety over swine-flu infection is mounting, casting a particularly long shadow of caution and concern in Britain. Last week, Sir Liam Donaldson, the UK's chief medical officer, predicted that the country could see as many as 65,000 deaths by this fall, and yesterday newspapers reported that British airlines may ban passengers exhibiting symptoms from traveling. While there have only been 29 reported deaths so far in Britain, it appears the storm of H1N1 is coming early. And now it's jeopardizing a holy journey. 

Today, health officials from the Association of British Hujja warned Muslims to reconsider this year's pilgrimage to Mecca, releasing this statement:

British pilgrims have always been at high risk of infections due to the crowded conditions at ceremonies, accommodation sites and on public transport. Therefore pilgrims must follow the guidelines issued by the authorities and they should be vaccinated against the swine flu virus once this vaccine is available at least two weeks before their departure to perform pilgrimage."

The notice came after officials in Saudi Arabia advised all travelers to be vaccinated prior to making the trip, adding that those most vulnerable, "pregnant women, children, chronically ill and elderly people," should simply stay at home this year. Other countries in the Middle East and Africa have issued similar warnings. Egypt did so after a woman, infected during a recent trip to Saudi Arabia, died of swine flu earlier this month -- the first H1N1-related death in the country. 

Ramadan begins late next month, and there's no real sign yet how many Muslims planning to make the annual pilgrimage will be affected. Some 25,000 Muslims are expected to come from Britain alone. So far, religious leaders, like Egypt's top cleric, are looking to the World Health Organization for guidance "on whether to issue a fatwa or decree barring all Egyptians from making the pilgrimage."

So far, the death toll worldwide is 700, according to the WHO, representatives of which have said the virus is spreading with "unprecedented speed."

It's enough to make anyone look forward to getting their shots this year.

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Official Iranian news agency Fars has reported that two pilgrims recently returned from the Hajj have contracted swine flu. Mecca plays host to about two million Muslims every year including nearly 12,000 from the United States and 25,000 from the United Kingdom, both of whom top the World Health Organization's table of reported swine flu cases. Fears about the rapid spread of the pandemic during the Hajj have prompted swift action from countries across the Middle East, which have as yet reported relatively few cases. Saudi Arabia has already put in place facilities at its major airports to quarantine pilgrims suspected of carrying the H1N1 virus.

Meanwhile in England, the Bishop of Chelmsford has advised that churches remove holy water which, when exposed in stoups, can easily become a source of infection. Revered John Gladwin recommended that parishioners exhibiting flu-like symptoms should stay at home where possible, and priests who must make pastoral visits "wear sterile gloves, an apron and a face mask." He also said those taking holy communion should not drink wine from the chalice if ill, and would still receive the full communion by taking the wafer of bread alone.

Luis Acosta/AFP/Getty images