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I wrote this headline earlier this month after the US announced more graphic designs for cigarette and other tobacco packaging and had intended to come back to it. I also started writing another post on a recent issue of The Lancet that covered various global studies on tobacco use. That’ll come at a later date. This month has been busy for me, and I hope to continue to post regularly. A lot is going on in public health that affects regional policies, including the recent International AIDS Society conference and the upcoming UN High Level Meeting on NCDs. I’ll try my best to bring more information about these events.

In the meantime, back to  what this post was meant to be about…what impact, if any, do graphic labels on cigaret and other tobacco products has on its use? The U.S. Food and Drug Administration, the regulatory agency for tobacco advertising, will begin requiring these images next year. Now, tobacco use has not been a mjpr issue among Caribbean youths. However, studies show behavior change once many people migrate to the United States. For the Unites States, this is

“a significant advancement in communicating the dangers of smoking.”

Now, having lived in Europe, I am used to seeing these images and oftentimes, their advertising go much further than the US ever will. However this is a start, as much of our merchandise from the region, including tobacco products, comes from US distributors.

In addition to the graphic images, more research is showing the impact of global mass media campaign:

“more than 1.9 billion people live in the 23 countries that have implemented at least one strong campaign within the last two years”

According to the WHO report on the global tobacco epidemic, 2011. “We are pleased that more and more people are being adequately warned about the dangers of tobacco use,” says WHO Assistant Director-General for Noncommunicable Diseases and Mental Health, Dr Ala Alwan. “At the same time, we can’t be satisfied that the majority of countries are doing nothing or not enough. We urge all countries to follow the best-practices for reducing tobacco consumption and to become Parties to, and fully implement, the WHO Framework Convention on Tobacco Control.”

What activities does your country engage in to reduce tobacco use? Do you see graphic images on packaging in your country? In your opinion, what impact does it have on reducing tobacco use? Do you anticipate these labels making their way to the Caribbean? How can our local governments and regional public health agencies prevent the uptake of smoking and other tobacco use among Caribbean people?

Source: http://www.who.int/mediacentre/news/releases/2011/tobacco_20110707/en/index.html

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On the periphery of the IAS 2011 conference which took place in Rome from 17-20 July 2011, UNAIDS in collaboration with the Global Coalition on Women and AIDS (GCWA), ATHENA, Salamander Trust, WECARe+ and Network Persone Seropositive convened a town hall dialogue to discuss how the HIV response facilitates the achievement of sexual and reproductive health and rights for all women, including women living with HIV, at every stage of their lives.

For women living with HIV stigma and discrimination and gender-based violence acutely affect their access to comprehensive services and human rights. Within health services, they often face a lack of choice with regard to family planning; disapproval from service providers with regard to meeting sexuality and fertility desires; and violation of their sexual and reproductive rights in the form of coerced or forced abortion or sterilization. Participants agreed that advancing the health and rights of women in all their diversity is fundamental to the success of the HIV response, just as the HIV response is a critical avenue for achieving sexual and reproductive health and rights for women.

The event was also used as a platform to launch a report Community Innovation: Achieving sexual and reproductive health and rights for women and girls through the HIV response. Compiled by UNAIDS and the ATHENA Network, it presents case studies pioneering community undertakings to advance women’s sexual and reproductive health and rights through the HIV response and vice-versa, from different community perspectives. This report recognizes that women face unique challenges to access and fulfil their sexual and reproductive health and rights, including gender-based violence, and therefore have less access to HIV prevention, care and support services.

“Women and girls at every level and throughout different stages of their lives must be supported to demand quality services that meet their needs and those of their community,” said UNAIDS Deputy Executive Director, Programme, Dr Paul De Lay.

Learning from these community case studies is an opportunity to enhance the AIDS response, in light of the Millennium Development Goals and the 2011 Political Declaration on HIV/AIDS. The case studies indicate that for responses to be effective they must include the empowerment and inclusion of women in all their diversity, dedicate attention to sexual and reproductive health, including improvements in maternal and child health, and address the socio-cultural practices underlying gender inequality.

UNAIDS Getting to zero: strategy 2011-2015 also places gender equality and human rights as one of three core pillars. This report is part of that commitment to ensuring that women and girls’ rights are met through the HIV response and it was undertaken in the context of the UNAIDS Agenda for accelerated country action for women, girls, gender equality and HIV.

“UNAIDS continues to be a strong advocate for women’s health and rights, as well as to strongly stand against stigma and discrimination amongst all marginalized groups. We will continue to do so until we have achieved the vision of zero discrimination,” said Dr De Lay.

The full article is at http://www.unaids.org/en/resources/presscentre/featurestories/2011/july/20110719womenias/

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“WHEN presented with the question, ‘what would you do if you find out that your spouse or child’s father has molested your child?’, many mothers’ instinctive response is ‘I would kill him!’ — instinctive because a protective mother hen can’t fathom the loss of her child’s innocence in that brutish way. But in reality, and when faced with the actual situation, this promise is rarely acted out. In fact, some mothers live in silent denial, others resent the child, some choose to blame the child, and depending on the age, the mother may even put the child out of the household. Still others will simply accept it.”

“She told me not to tell anyone and that she felt it was her fault because she did not get up when he was doing it, even though she told him to stop and turned away. That broke my heart. Here she was, struggling with the guilt and not talking to anyone about it.”

“Daddy touch me there”  from the Jamaican Observer is one of the best and most powerful articles I’ve read from across the region addressing child sexual abuse, particularly by a parent or someone in a parent role. More information is needed-more interventions-to encourage children to speak up about being abused. We need to let our children know that it’s safe to speak up, and that doing so is best for everyone. My main critique of the article is that the abuse survivors were mainly females. As much as there is stigma about child sexual abuse among out islands, there is much more concerning the abuse of young boys. Let’s encourage more reporters to focus on this area and to write the stories of young people–male or female–who oftentimes lack a voice.

The full article is available at : http://www.jamaicaobserver.com/magazines/allwoman/Daddy-touched-me-there_9046634#ixzz1RNagXKL8

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Millions of people around the world live on a few dollars a day. Even in the wealthiest of countries, some populations experience the greatest disparity. This graph, available at Good.is shows what percentage of a country’s population is living on <$10 and >$10.  It is disconcerting that no Caribbean countries were included.

A larger graph is available at http://awesome.good.is/transparency/web/1106/global-poverty/flash.html

Music Mondays: T.O.K’s ‘Footprints’ addresses youth violence

“‘Hurry up and come back’, was the first thing she said to her son the day his life was taken…” “Footprints” starts out with the harrowing act of youth violence…the sad image of a mother sending her son off only to not have him return. This seems to be commonplace in our society.

This song is one of the most powerful of the last decade and I remember it being in heavy rotation around the Caribbean region when it first came out. What I do not remember is any major discussion about it’s message. Rising youth violence and crime is not just an individual issue, it is a population issue and has implications for population health.

During my time in the U.S. Virgin Islands, I saw many funerals for young people killed by the barrel of  a gun or the blades of a knife. I have two very young cousins who are growing up without fathers because of this violence. I know of a family in constant pain because of the choices of one child. Almost every day, there are news stories from across the region of youth committing violent acts against one another…of youth deaths…premature deaths.

I remember a few years ago, there was a case in Antigua where a (Black) young man allegedly killed a (White, foreign) young woman while she was on vacation. The news reports–and the online comments below the report–worked to demonize the young man as a ‘no-good’ foreigner whose sole goal in life was to bring negative attention to the island. Among those comments were a few dissenting voices–some knowing the conditions under which he grew up–questioned the system that seeks to limit options for immigrant children. Someone went as far as to say that the young man had spent much to his formative years in Antigua, and therefore much of his socialization occurred there; so to paint him as a foreigner is to direct attention to the wrong issues.

He would be considered one of the many at-risk young people around the region today, having many of the risk factors associated with rising violence: poverty, lack of opportunities, no significant bonds with adults, lack of a connection with educational institutions, and the presence of cultural values that encourage and reinforce risky behavior. You see, as a society, we are quick to say that drugs and alcohol are the culprits. Yet we somehow fail to see that there are also underlying factors for drugs and alcohol use.

Just last week, Barbados hosted an inaugural working group on preventing crime by focusing on vulnerable youth and at-risk populations. Although held under the Caribbean Basin Security Initiative, there seems to be an active consciousness to thinking about violence as a public health issue. By the end of the meeting, there was greater emphasis on fighting “the scourge of youth violence where youths are disproportionately represented in the ranks of both victims and perpetrators of crime and violence in the Caribbean.” (See full article here.)

Like CBSI, there are many other initiatives attempting to research the issue of violence across the region and to implement viable interventions:

A few years ago, the Wellcome Trust started the ‘Fighting Back: tacking violence in the Caribbean’ project “to map the full extent of the problem and get to the heart of its possible causes.” The hope is to use the information gathered to design more effective intervention and prevention programs. More information can be found here.

The World Bank is also attempting to address this issue with their Toolkit for At-Risk Youths. You can read more about it here and here.

The IADB also has cases form various islands on developing protective factors and mitigating risk factors here.

Imagine, this post started while reflecting on a song; a song that details many of the risk factors for engaging if violence.