FT Health: Lessons from the Oxfam scandal

There has been an important debate this week over the responsibilities of humanitarian aid organisations, focused on how Oxfam handled the departure of its head of mission in Haiti in 2011 following allegations of sexual exploitation.

Much of the scrutiny is justified. Development groups which preach best practice and work in vulnerable zones themselves need to demonstrate it, and should be held to the highest standards. Oxfam clearly handled the case too lightly.

But there has also been too much rapid-fire indignation, and a risk of conflating different issues and agendas. Any judgment needs to distinguish moral attitudes to sex work from laws and guidelines.

There is a need for detailed scrutiny of such events, but also due process. Registers of vetted employees could have some value. Transparency is not a simple solution. The Charities Commission, for instance, is largely a passive recipient of annual filings rather than an active watchdog which would have acted if Oxfam’s disclosures had been more detailed.

There is little evidence that the non-profit sector is worse than others in terms of harassment, although its procedures and controls are often weaker than those of companies and governments. Even if funders impose new conditions on Oxfam and other beneficiaries, there is certainly no case to reduce foreign aid overall.

Three questions

We spoke to Stewart Cole, the newly appointed (and first non-French) director of the Pasteur Institute.

What inspired you to become a scientist?

While I was at school, I contracted paratyphoid, and went into a coma and an isolation unit. I got very interested in infectious diseases, and decided to study microbiology, never thinking I would get to where I did. I studied at Cardiff and Sheffield, and left the UK in 1979, which was no great period in British history. I did post-doc work in Sweden and Germany, and joined the Pasteur Institute before joining the Institute of Technology in Switzerland. I worked a lot on tuberculosis and leprosy.

Has there been any sensitivity about you as the first non-French head of the Pasteur Institute?

None whatsoever. I thought this might act against me, particularly after Brexit. But when I spoke to the board of governors, they thought [my appointment] was a good sign which showed that Pasteur was open to the world. Modernisation is probably the wrong word, but we are moving into different territory. The Institute is very international.

What are your strategic priorities?

We need to find alternative sources of income, including strengthening our intellectual property side with more translational research. We must intensify our research on emerging infectious diseases. We need to work more on antimicrobial resistance, doing front-end work where the pharmaceutical industry has wound down their research activities. And we should explore neuro-degenerative disease like Alzheimer’s, where there is growing evidence that there is a microbial component.

Chartwatch

Gender equality A UN report says lack of control over resources, gender-based violence, the burden of unpaid care and domestic work, longer working hours and unhealthy work conditions are all problematic for women's health. Maternal mortality figures show the need for better access to quality sexual and reproductive healthcare.

News round-up

Preventing pandemics The world must act faster to prevent infectious disease outbreaks, according to the UN's disaster risk operation. They could also have huge economic effects. Here are the WHO's top ten threats to global health in 2018. (Reuters, Cidrap, WHO)

The US and global health Activists fought back after budget proposals from the White House detailed reductions for the State Department and USAID — the two main conduits for overseas spending on health — as well as individual organisations such as The Global Fund, Gavi and the CDC. (Foreign Policy, Kaiser Family Foundation)

Trouble brewing Helen Clark, former New Zealand prime minister and chair of the UN Development Group, was among those criticising Unitar, the UN's training and research arm, for linking up with mega brewer Anheuser-Busch InBev to promote road safety. The deal follows the Global Fund's controversial tie-up with Heineken. (Twitter, The Lancet)

Questions for Gates Bill and Melinda Gates talk in their annual letter about what happens when they disagree; whether they impose their values on others; and why they work with companies but not on climate change. “We’ve been looking at how we might expand our work in the US beyond education.” (Gatesnotes)

Healthy cities City majors — “the new health ministers” as the WHO's Maria Neira calls them — met in Copenhagen to discuss air pollution and other urban problems. Long-term planning, cycling incentives and equal worth for physical and mental health are just some lessons to be learned from the Danish capital. (Twitter, Guardian)

Misery of mental health Mental illness is the single most important contributor to misery, according to The Global Happiness Council, a think-tank concerned with happiness and wellbeing. Mental ill health accounts for far more unhappiness than physical illness but remains largely untreated. (Global Happiness Council)

Measles strategy Ending measles would save 22m lives by 2030, but what is the best way to achieve this? Some argue for piggybacking on current campaigns while others say it is prudent to focus on one global disease at a time and wait until polio is gone. A study suggests measles vaccination has a wider positive effect on child mortality. (Wired, Frontiers of Public Health)

US drug prices A White House report aimed to tackle high drug prices but without curbing innovation. Companies say other countries pay unfairly low prices and that cutting their profits will stifle breakthroughs. American hospitals are fighting back against monopoly pricing by creating their own supply of critical medicines. (White House, NYT, Boston Globe)

Bearing gifts to Greeks Ten Greek politicians have been accused of allegedly taking bribes from Novartis in return for illegally raising drug prices and allowing the Swiss pharma giant privileged access to the Greek market. (FT)

'I was locked in a steel cage' Peter Humphrey, the British corporate investigator arrested in China while working for GSK, looks back on 23 harrowing months in jail. (FT Magazine)

Sick buildings and healthy homes “Personalised indoor environments” could tackle many of the problems affecting workers' health. The UK's Institution of Mechanical Engineers argues that adapting homes to enable older people to remain independent could save the NHS “billions of pounds” a year. Suggestions range from remote monitoring systems to moving plug sockets to eye-level positions. (Harvard Gazette, Digital Health, iMechE)

Getting the measure of marijuana US Attorney General Jeff Sessions came under fire for his attempts to link cannabis use to the opioid crisis which some say could make the epidemic worse. The Lancet examines the evidence for medical marijuana. (Vox, NYT, The Lancet)

Gut, mood and memory Researchers are discovering remarkable new links between gut bacteria and the brain. Problems from poor sleep to memory loss could be helped by manipulating the microbiome, the trillions of bacteria living inside healthy human bodies. (FT)

The 'cognitive prosthetic’ A brain implant that boosts memory could be a way of achieving the same effects humans have always experienced from caffeine, nicotine, drugs such as Ritalin, or a quick run around the park. (NYT)

Best from the Journals

Surgical infections Patients undergoing surgery in poorer countries are more likely to develop infections which may be linked to drug-resistant bacteria. They also have higher antibiotic use and are more likely to be infected with bacteria that are resistant to medicine. (The Lancet)

Action on nutrition The UN Decade of Action on nutrition will succeed only if there is political commitment at country level. This needs to take into account a nation's institutions; political and societal contexts; knowledge, evidence and framing; and capacities and resources. (BMJ)

Processed food fears A new study associates with a bigger risk of cancer the consumption of ultra-processed foods, which in some countries account for up to half of daily energy intake. UK supermarkets have been told to ditch fatty foods at checkouts. (BMJ, The Times)

Assisted dying More than a quarter of North Americans are now able to choose a medically-assisted death. Although such plans often cause controversy, most places have found that once the political decision has been made this tends to subside. (BMJ)

Medical messaging Modern tools such as WhatsApp have already overtaken traditional methods such as the pager for communication between clinicians during emergencies, but the race is on to find a healthcare-specific solution robust enough to use during situations such as terror attacks. (BMJ)

Campaigning in poetry The Bigger Picture Project uses hip hop and spoken word poetry to raise awareness of type 2 diabetes among black and minority ethnic youth in the US. Over the past decade, rates have tripled in American Indian, doubled in African American, and increased up to 50 per cent in Asian and Hispanic youth. (JAMA)

Podcast of the week

The loneliness experiment The BBC has launched what it hopes will be the world's largest ever survey on loneliness and health, developed by British psychologists in a collaboration with the Wellcome Collection. (BBC Health Check, 27m)

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Final thought

Sponsorship and sport Aspiring athletes viewing their Olympic idols will be subjected to ads from the likes of McDonald's and Coca-Cola. But why are the world's greatest sporting events still promoted by products that cause obesity? Should they be treated the same way as tobacco sponsors — banned from the Olympics since 1988? (The Guardian)