Abu Dis is a small rural village overlooking the Old City of Jerusalem to the southwest and the Jordan Valley to the east
Hamas’s former chief in Gaza Ismail Haniyeh (AFP)
Tuesday 26 December 2017
Hamas’s former chief in Gaza, Ismail Haniyeh, said during a meeting in the Gaza Strip on Tuesday that the movement had received information of a US plan to offer Palestinian leaders a state with its capital in Abu Dis, a Palestinian village near East Jerusalem.
In a statement to local media, Haniyeh said the US administration had proposed to the Palestinian Authority (PA) that Abu Dis become the future Palestinian capital and become connected to the Al-Aqsa compound with a bridge.
The plan also proposed dividing the West Bank into three sections and creating an autonomous region in the Gaza Strip.
Abu Dis, a small rural village overlooking the Old City of Jerusalem to the southwest and the Jordan Valley to the east, had been named by Saudi Crown Prince Mohammed bin Salman as the future Palestinian state, as reported in the New York Times on 3 December.
"The plan involves building a bridge linking Abu Dis to the Al-Aqsa Mosque compound [in East Jerusalem] with the ostensible aim of ensuring [Palestinians] access to the mosque," Haniyeh said during a meeting with Palestinian tribal leaders.
"There is also a talk of dividing the Al-Aqsa Mosque compound into three separate parts" and creating a “political entity in the Gaza Strip endowed with certain privileges”.
A discussion about a Palestinian capital was flung into the spotlight after US President Donald Trump announced on 6 December that the US would recognise Jerusalem as the capital of Israel.
Commenting on Trump's move, Haniyeh said: “The recent US decision on Jerusalem is part of ongoing efforts to terminate the Palestinian cause within the context of a so-called ‘deal of the century."
The move "has implications for the reconfiguration of the entire region and the [Arab and Muslim] nation… which will come at the expense of Jerusalem and Palestinian rights," added Haniyeh at a meeting in Gaza City with Palestinian tribal leaders.
Jerusalem remains at the heart of the Middle East conflict, with Palestinians hoping that East Jerusalem - occupied by Israel since 1967 - might eventually serve as the capital of an independent Palestinian state.
Why Abu Dis?
Trump's decision shook the Palestinian Authority: it hoped that if Washington was ever to make such a declaration then it would also regard East Jerusalem as the future capital for a Palestinian state, especially after years of US-sponsored talks with the Israelis.
But the suggestion that the future Palestinian capital could instead be Abu Dis flies in the face of the Oslo Accords of 1993 that foresaw East Jerusalem as the eventual capital of a future state.
Abu Dis has been regarded as a potential home for a Palestinian government for two reasons.
The first is geographical. Abu Dis is the closest point to the Old City, which houses some of Islam's holiest sites including the al-Aqsa mosque, managed and controlled by the Jerusalem Islamic Waqf, a religious trust.
For this reason it was planned as the site of the Palestinian Legislative Council, which the PA started to build in Abu Dis in 1995. Founded in the wake of the Oslo Accords, the council was intended to draft Palestinian laws and regulations as well as administer PA institutions.
This file picture shows an F-15S fighter jet of the Royal Saudi Air Force.
Sun Dec 24, 2017 03:13PM
Dozens of Saudi-led coalition military aircraft in addition to hundreds of battle tanks and armored vehicles have been destroyed in the military campaign against Yemen as the Riyadh regime presses ahead with its atrocious airstrikes against its crisis-hit southern neighbor.
The Yemeni army, in a statement released on Sunday, announced that 37 aircraft plus more than 1,200 tanks and armored vehicles have been destroyed ever since the Saudi regime and its allies launched a devastating war on the country more than two and half years ago, Arabic-language al-Masirah television network reported.
Saudi Arabia and its regional allies also lost a dozen Boeing AH-64 Apache attack helicopters, five McDonnell Douglas F-15 Eagle and General Dynamics F-16 Fighting Falcon warplanes plus more than 20 reconnaissance aircraft.
The statement added that ten warships, frigates and a number of gunboats were also destroyed in the Saudi-led military aggression.
Yemeni army soldiers and allied fighters from Popular Committees have also targeted and destroyed hundreds of command centers and border outposts in Saudi Arabia’s southwestern regions of Najran, Jizan and Assir.
The statement further noted that the Saudi-led war on Yemen has incurred huge fiscal losses on the Riyadh regime and its allies. A picture taken on December 23, 2017 shows a Yemeni inspecting destruction at a charity's destroyed food supply storage facility, following a Saudi-led coalition airstrike in the Yemeni port city of Hudaydah. (Photo by AFP)Sovereign wealth funds in the Saudi-led military alliance have been pulling money out of asset managers at a faster rate on record in order to finance the aggression against Yemen and cover arms expenditures.
Moreover, the Yemen war has resulted in a budget deficit of 15 percent of gross domestic product for Saudi Arabia, and decreased the volume of capital reserves from $737 billion to $437 billion.
The volume of Saudi Arabia’s military spending has also steadily increased to exceed $81 billion, making the oil-rich kingdom the world's third largest military spender after the United States and China.
More than 12,000 people have been killed since the onset of Saudi Arabia’s military campaign against Yemen. Much of the Arabian Peninsula country's infrastructure, including hospitals, schools and factories, has been reduced to rubble due to the war.
The Saudi-led war has also triggered a deadly cholera epidemic across Yemen.
According to the World Health Organization’s latest count, the cholera outbreak has killed 2,167 people since the end of April and is suspected to have infected 841,906. Yemenis inspect damage at the site of a reported Saudi-led coalition airstrike, in the northwestern city of Sa’ada on December 20, 2017. (Photo by AFP)On November 26, the United Nations children’s agency (UNICEF) said that more than 11 million children in Yemen were in acute need of aid, stressing that it was estimated that every 10 minutes a child died of a preventable disease there.
Additionally, the UN has described the current level of hunger in Yemen as “unprecedented,” emphasizing that 17 million people are now food insecure in the country.
It added that 6.8 million, meaning almost one in four people, do not have enough food and rely entirely on external assistance.
A recent survey showed that almost one third of families had gaps in their diets, and hardly ever consumed foods like pulses, vegetables, fruit, dairy products or meat.
More than three million pregnant and nursing women and children under the age of five also need support to prevent or cure malnutrition.
US is responsible for 22% of the UN’s annual operating budget
Timing sends message after UN rejects Trump’s recognition of Israeli capital
Nikki Haley at United Nations headquarters on 22 December 2017. Photograph: Mark Lennihan/AP Edward Helmorein New York and Associated Press-Tue 26 Dec ‘17 15.17 GMT
The US government has announced significant cuts in its United Nations budget obligations for 2018-2019 in what will be interpreted as a further ratcheting up of pressure from the Trump administration looking to bend decision-making at the international body to its will.
In a statement released over the holiday, the US Mission to the United Nations said next year’s budget would be slashed by over $285m and unspecified reductions would also be made to the UN’s management and support functions.
The announcement didn’t make clear the entire amount of the budget or specify what effect the cut would have on the US contribution.
“We will no longer let the generosity of the American people be taken advantage of,” US ambassador to the UN Nikki Haley said in a statement. Haley added that the “inefficiency and overspending” of the organization is well-known.
Under the UN charter, the US is responsible for 22% of the the body’s annual operating budget, or around $1.2bn in 2017-2018, and 28.5% of the cost of peacekeeping operations, estimated at $6.8bn over the same period.
In her statement, Haley said she was pleased with the results of budget negotiations, and the US Mission would continue to “look at ways to increase the UN’s efficiency while protecting our interests”.
But the timing of the announcement sends a clear message. On Thursday, the General Assembly voted 128-9 in favor of a resolution condemning the US recognition of Jerusalem as the capital of Israel.
After the vote, Haley reminded the assembly that the US was “by far the single largest contributor to the UN” and would remember the vote “when we are called upon to once again make the world’s largest contribution to the United Nations, and we will remember it when so many countries come calling on us, as they so often do, to pay even more and to use our influence for their benefit”.
Before the vote, the US president, Donald Trump had said at a cabinet meeting: “Let them vote against us. We’ll save a lot. We don’t care. But this isn’t like it used to be where they could vote against you and then you pay them hundreds of millions of dollars ... We’re not going to be taken advantage of any longer.”
On Sunday, Guatemala became the first country to follow the US decision to move its embassy to Jerusalem. Guatemala’s president Jimmy Morales made the announcement via Facebook.
The first email arrived in the inbox of CounterPunch, a left-leaning American news and opinion website, at 3:26 a.m. — the middle of the day in Moscow.
“Hello, my name is Alice Donovan and I’m a beginner freelance journalist,” read the Feb. 26, 2016, message.
The Washington Post examines how, nearly a year into his presidency, Trump continues to reject evidence that Russia supported his run for the White House.(Dalton Bennett, Thomas LeGro, John Parks, Jesse Mesner-Hage/The Washington Post)
Inside Obama's secret struggle to retaliate against Putin's election interference.(Whitney Leaming, Osman Malik/The Washington Post)
Beijing residents gather around the smoking remains of over 20 armoured personnel carriers -- burnt by demonstrators during clashes with soldiers near Tiananmen Square -- on June 4, 1989
At least 10,000 people were killed in the Chinese army's crackdown on pro-democracy protesters in Beijing's Tiananmen Square in June 1989, according to a newly released British diplomatic cable that recounts the bloodshed in gruesome detail.
The document, made public more than 28 years after the event, describes injured girls being bayoneted, bodies being ground up by armoured vehicles and human remains being flushed into the sewers.
"Minimum estimate of civilian dead 10,000," the then British ambassador Alan Donald said in the secret telegram to London seen by AFP at Britain's National Archives.
The estimate, given on June 5, 1989, the day after the crackdown, is almost 10 times higher than that commonly accepted at the time of several hundred to more than a thousand dead.
But experts questioned by AFP said the 10,000 figure seemed credible.
Donald's account gives horrific details of the violence unleashed on the night of June 3-4, when the army entered Beijing to end seven weeks of protests on Tiananmen Square, the symbolic heart of Communist power.
During their advance, armoured personnel carriers "opened fire on the crowd (both civilians and soldiers) before running over them in their APCs", wrote the ambassador.
He said his source was a person who "was passing on information given him by a close friend who is currently a member of the State Council" -- the Chinese cabinet.
He said the source had previously proved reliable "and was careful to separate fact from speculation and rumour".
Once the soldiers arrived in Tiananmen Square, "students understood they were given one hour to leave square but after five minutes APCs attacked," Donald wrote.
A girl wounded during clashes between the army and students near Tiananmen Square being carried out on a cart
"Students linked arms but were mown down including soldiers. APCs then ran over bodies time and time again to make 'pie' and remains collected by bulldozer. Remains incinerated and then hosed down drains."
"Four wounded girl students begged for their lives but were bayoneted," Donald said, adding: "Army ambulances who attempted to give aid were shot up."
At the end of June 1989, the Chinese government had said suppression of the "counter-revolutionary riots" had killed 200 civilians and several dozen police and military.
- 'Primitives' -
Nearly three decades after the crackdown, the communist regime continues to forbid any debate on the subject, mention of which is banned from textbooks and the media, and censored on the Internet.
There was no sign of reaction to the report on Chinese social media, where an army of online censors blocks any reference to the Tiananmen crackdown and most things critical of the Communist Party.
Donald said the atrocities were committed by the 27th Army, who he described as "60 percent illiterate and are called primitives".
He said the crackdown had created deep rifts within the military and that "some members of the State Council considered that civil war is imminent".
Tiananmen Square is the symbolic heart of Chinese Communist power
As to the credibility of the toll, former student protest leader Xiong Yan, who is now an American citizen, said: "I think it's reliable."
China scholar Jean-Pierre Cabestan also said the figure was credible, pointing out that recently declassified US documents gave a similar assessment.
"That's two pretty independent sources which say the same thing," said Cabestan, a professor at Hong Kong Baptist University.
The British ambassador's report was "not particularly astonishing considering how crowded it was in Beijing, the number of people mobilised" against the Chinese government, said Cabestan, who was in the Chinese capital in the days leading up to the crackdown.
Former student leader Feng Congde, now also based in the United States, pointed out that Donald had sent another telegram three weeks later putting the death toll at between 2,700 and 3,400.
Feng said that toll was quite credible and fitted with figures from the Chinese Red Cross, who at the time estimated 2,700 fatalities, and by student committees based on hospital reports.
Former Indian navy officer Kulbhushan Sudhir Jadhav's mother Avanti (C) and wife, Chetankul arrive to meet him at Ministry of Foreign Affairs in Islamabad, Pakistan December 25, 2017. REUTERS/Faisal Mahmood Sanjeev Miglani-DECEMBER 26, 2017
NEW DELHI (Reuters) - India denounced Pakistan on Tuesday for its handling of the visit of the wife and mother of Kulbhushan Sudhir Jadhav, an Indian man on death row, saying they were harassed and prevented from talking to the prisoner freely.
A spokesman for Pakistan’s foreign ministry did not respond to requests for comment on the issue.
Jadhav, a former officer in the Indian navy, was arrested in March 2016 in the Pakistani province of Baluchistan, where there has been a long-running conflict between security forces and separatists, and he was convicted of planning espionage and sabotage.
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His wife and mother were allowed to meet him behind a glass window on Monday, eight months after he was sentenced to death, but that gesture of goodwill appeared to have quickly descended into acrimony.
Indian foreign ministry spokesman Raveesh Kumar said Jadhav’s family had been subjected to harassment when they arrived to meet him.
“The Pakistani press was allowed on multiple occasions to approach family members closely, harass and hector them and hurl false and loaded accusations about (Shri) Jadhav,” Kumar said in a statement.
Ties between the nuclear-armed neighbours are in a deep chill and Jadhav’s case has added to long-running tensions, with each accusing the other of supporting cross-border violence.
India says Jadhav is innocent and won an injunction from the World Court to delay his execution, arguing he was denied diplomatic assistance during his trial by a military court.
Former Indian navy officer Kulbhushan Sudhir Jadhav's mother Avanti (2nd L) and wife, Chetankul, (2nd R) arrive to meet him at Ministry of Foreign Affairs in Islamabad, Pakistan December 25, 2017. REUTERS/Faisal Mahmood
CONFESSION
Pakistan authorities say Jadhav confessed to being assigned by India’s intelligence service to plan, coordinate and organise espionage and sabotage activities in Baluchistan “aiming to destabilise and wage war against Pakistan”.
On Monday, Pakistan released a picture of Jadhav’s mother, Avanti, and wife, Chetankul, seated at a desk and speaking to him from behind the glass partition. Islamabad said it had honoured its commitment to give access to the family.
But India said the two women had been asked to change their dress and to remove personal jewellery and the red dot that Hindus wear on their foreheads on the pretext of security. Jadhav’s mother was not allowed to speak in her native Marathi language and was frequently interrupted.
Pakistani authorities also refused to return the shoes that Jadhav’s wife had worn, Kumar said, warning against potential mischief. He didn’t elaborate.
India and Pakistan often accuse each other of sending spies and several people are held in prisons for years in both countries, some of them on death row, to be used as bargaining chips in their troubled relationship.
Kumar said Jadhav appeared to be under considerable stress and under coercion during the meeting with his family.
“Most of his remarks were clearly tutored and designed to perpetuate the false narrative of his alleged activities in Pakistan. His appearance also raises questions of his health and well-being,” Kumar added.
Paolo takes an oath as he testifies at a Senate hearing on drug smuggling in Pasay, Metro Manila, Philippines, on Sept 7, 2017. Source: Reuters
26th December 2017
AFTER being linked to a drug smuggling case, Philippine President Rodrigo Duterte’s eldest son quit as vice-mayor of the southern city of Davao on Monday, citing personal problems from a failed marriage as among reasons for the move.
Paolo Duterte announced his resignation during a special session of the Davao City Council. Davao is President Duterte’s hometown and its mayor is Paolo’s younger sister, Sara Duterte-Carpio.
“There are recent unfortunate events in my life that are closely tied to my failed first marriage,” Paolo said, in a statement made available to media.
“These, among others, include the maligning of my reputation in the recent name-dropping incident in the Bureau of Customs’ smuggling case and the very public squabble with my daughter.”
In September, Paolo refuted allegations he was personally linked to a shipment of US$125 million worth of narcotics from China amid his father’s fierce crackdown on the drug trade that has claimed the lives of thousands.
Brushing aside the allegations as “baseless”, Paolo denied suggestions that he may have helped ease the entry of the drug shipment at a port in Manila.
Senator Antonio Trillanes, a staunch critic of the president, displayed to the Senate panel photographs of Paolo Duterte beside a businessman who was behind the shipment in which the alleged drugs were found.
A lawyer whispers to Paolo during a Senate hearing on drug smuggling in Pasay, Metro Manila, Philippines, September 7, 2017. Source: Reuters
Trillane first presented two photos of Paolo with Kenneth Dong, an alleged “middleman” who facilitated the massive shipment of methamphetamine in May.
Dong verified that it was him and Paolo in the pictures. Trillanes then showed another photo of Dong with Paolo’s brother, Sebastian.
Trillanes said the photos proved that Dong was a “family friend” of the Duterte family. He also presented photos as “evidence” that the president’s eldest son was involved in graft at the country’s Customs Bureau.
More recently, Paolo has been involved in an online spat with Isabelle, his 15-year-old daughter from his first wife. Paolo has called her “embarrassing” on Facebook after she complained on Twitter about being treated badly by her father.
President Duterte has repeatedly said he would resign if critics could prove any members of his family were involved in corruption.
There’s no way we’ll be able to grapple with the coming health crises unless we fix the gaping problem of women’s empowerment in global health.
Aida Abdulla speaks to Dr Samrin Farouk Habbani at the Khartoum Breast Care Centet on Oct. 15, 2015. (Ashraf Shazly/AFP/Getty Images)
BYLAURIE GARRETT-
Since the Harvey Weinstein sexual atrocities first came to light in early October, nearly every day has brought news of another male authority figure who has used his power to impose himself sexually upon women, even girls. People worldwide are learning that the glass ceiling that has long held females below top leadership positions in their professions is tied to egregious sexual obstacles that women have always known about, but most men now profess shock and dismay to discover.
As the global conversation about sexual predators expands into larger issues about power and the inequitable workplace, it’s remarkable to consider how gender issues play out in professions that are overwhelmingly female, yet still controlled predominantly by men. Public health is the perfect example, both of this imbalance in power in a female-majority field and of the impact that inequity has on the activities and products produced by the profession. The majority of people working in health worldwide are female — by far. But the majority of their bosses and global leadership are men.
Worldwide, women make up about 42 percent of the paid labor force, but 75 percent of the paid medical and health force in countries that provide gender breakdown data. If community health workers are added, the gender imbalance rises to as high as a ratio of 90 percent female to 10 percent male in many countries, though that element of the labor force is often uncounted and unpaid, or grossly underpaid. Whether inside hospitals, on the ground during epidemics, or in general sanitation and public health services, systems are typically strongly hierarchical — with physicians and corporate managers at the top, and community-based primary care or prevention workers at the bottom. Those top slots tend to be filled by men, while the vast ranks of front-line work have a female face.
In this post-Weinstein world that brings daily denunciations of powerful men, it is easy to forget that female advancement bumps up against glass ceilings, regardless of such malfeasance. In the United States, where women by some reckonings earn 77 cents to every dollar grossed by male peers, pay and power comingle: attaining higher-earning jobs typically also means accessing more powerful positions in the workplace pecking order. This holds true in the European Union as well, where women earn 84 cents compared to one euro garnered by work-matched male peers. Or in Japan, where women typically earn 25.7 percent less than their job-matched male peers. Across the Organization for Economic Cooperation and Development, men earn an average of 16 percent more than their job-matched female peers — and a whopping 21 percent more in high-end jobs, such as senior management, engineering, corporate leadership, and top academic positions.
In the health world, the pay and power differentials are all the more egregious given that females make up the vast majority of the labor force: 34 percent of current physicians in the United States are female, but the balance in medical schools shows women are gaining rapidly, especially in prestigious institutions. Georgetown University in the 2015-2016 school year, for example, graduated 100 female medical students versus 92 men. All of the University of California medical schools have roughly a 50/50 gender balance. Harvard University’s 2015-2016 graduating class has 77 women to 87 men; Johns Hopkins 50 women to 61 men. And the balance weighs heavily in favor of women in the nursing profession, where more than 90 percent are women in the United States.
Laurie Garrett is senior fellow for global health at the Council on Foreign Relations and a Pulitzer Prize winning science writer.
Recent studies show that female physicians earn 27 percent less than men in their same medical specialties, and male registered nurses make about $5,000 per year more than female peers. Female primary care physicians earn an average of $197,000 per year versus the average $229,000 earned annually by their male counterparts; the gender differential among specialists is a whopping $94,000.
Women are more likely than men to choose health careers, starting with their undergraduate options and continuing through post-graduate studies. In Japan, for example, 60 percent of graduates from health-related collegiate programs were women in 2012. In the United States, 79 percent of master’s degrees in public health in 2016 were awarded to women, but men went on to earn far more money, according to available data. The earnings range for women with such degrees was $41,703 to $76,537, while men in the field earned between $44,477 to $86,072 — a $10,000 per year difference at the high end. Because men are more likely to attain positions of power in public health and medicine, they earn more than women and have greater influence over the directions and priorities the fields take. Women are, of course, more likely to have time gaps in their lifetime employment due to pregnancy and childcare.
From the 1960s to the 1980s, nearly every major direction in the field of global health, including allocations of hundreds of millions of dollars given by institutions such as the Rockefeller Foundation, World Bank, and World Health Organization, were decided by a handful of Western men. Probably not coincidentally, such problems as high mortality rates associated with pregnancy received little attention, while dramatic campaigns to eradicate diseases using new scientific tools topped policy and financial interest.
Women in the field of health complain that it is difficult to have their ideas and innovations taken seriously, noting that “the chances of a woman receiving a prize was nine out of 100,” an indicator of successful implementation of novel global health-related schemes. Even in fields where they outnumber men nine to one, women are less likely to have their ideas for solving health problems, such as maternal deaths, taken seriously and fully funded either by grants or awards.
Though there have been two female WHO directors-general since its 1948 inception, the balance of power remains decidedly tipped toward men. One measure of that power is the constitution and leadership of delegations to the annual World Health Assembly, the governing body of WHO and health’s power center in the United Nations. In 2005, only 16 percent of the national delegations were led by women, rising to 23 percent by 2015. Over that period, female leadership at the assembly fell from 10 percent down to 5 percent for the nations in the Middle East.
“In thinking about the future of global health leadership, I ask my peers in global health, particularly the men, to think about why men control the majority of public health decisions and how best to change that to ensure that women also progress as leaders in the field,” health consultant Nina Schwalbe, who served as acting chief of health at UNICEF, recently wrote.
Women in the field are starting to get publicly pissed off. A new organization, Women in Global Health, has formed to address these issues. In October, more than 400 health leaders — mostly women — from 68 countries and representing more than 250 organizations and institutions, gathered at Stanford University to debate the reasons for gender disparities in the field and suggest solutions. The inaugural 2017 Women Leaders in Global Health Conference last month published a “Call to Action” delineating seven issues the high-level professionals want improved.
Beyond such fairness and finance issues, these gender disparities have enormous consequences for public health and medical care, in particular for the size of the health care labor force and the nature of issues that gain attention in the form of policy priority and resources. To put it bluntly, the quality of your care — in a clinic, hospital, pharmacy, or dentist’s office — depends on the resolution of the gender imbalances in health and medicine. There Aren’t Enough Health Care Workers in the World
Depending on who is doing the counting, and what factors are included in their tally, the world is currently short 18 million doctors, dentists, nurses, community health workers, technicians, optometrists, lab workers, public health experts, and other health care workers. Worse, achieving the lofty United Nations Sustainable Development Goals by 2030 will require adding another 40 million health professionals to the global labor pool. Bad as this gap is, it will only worsen in coming years as an increasing percentage of the global population advances into senior ages, needing closer and more complex care. Moreover, rising prosperity, with more nations entering the ranks of middle-income countries, means swelling demand for improved clinical care and essential public health services, such as clean water and uncontaminated food.
The WHO issued a large analysis in 2013 of the global workforce, concluding that the gap between rising medical and public health needs worldwide and available skilled personnel was so severe that it represents the primary stumbling block to implementation of universal health coverage. The report noted that there has been an enormous growth in the numbers of low-skilled community health workers and midwives, especially in poor countries, but, “There is a current deficit of about 7.2 million skilled health professionals.” A projection model driven by population growth would lead to a global deficit of about 12.9 million by 2035.”
A 2013 national survey showed the United States has 809,000 clinically practicing physicians, with shortages affecting the quality and access to patient care felt most acutely for primary care in rural and Southern areas. By 2025, it is projected that the United States will need 90,000 more physicians than current medical school matriculation can produce. Changes in immigration law under the Donald Trump administration, coupled with tax reform provisions that would affect how students’ loans and scholarships are paid for and taxed, could further diminish prospects of reaching America’s physician-needs levels.
The Tax Cuts and Jobs Act passed by Congress just days before Christmas eliminates certain tuition tax deductions families have long used to offset college costs. It changes tax deductions on donations to universities and revenues colleges earn from their endowments — constrictions that two deans of schools of public health tell me will severely reduce fellowships and financial aid for graduate and medical students. Though provisions that would have taxed fellowships and student financing for graduate and medical students were eliminated in the final hours of the bill’s debate, medical schools may be hard-hit by the bill’s repeal of individual deductions for medical expenses — a measure that experts predict will change patient choices regarding elective treatments and ultimately lower revenues for teaching hospitals, which typically handle a larger share of the nation’s poorer and middle-class patients.
The deficit is even more pronounced on the nursing side, where the federal Bureau of Labor Statistics estimates more than 1 million jobs will be vacant by 2022 due to a combination of inadequate nurse-training programs, limits on immigration for foreign-trained workers, burnout of the overworked existing labor force, lack of adequate pay, and rising needs for the aging American population. According to the American Nursing Association, some 700,000 nurses will retire over the next seven years, while support for schools of nursing nationwide has plummeted 30 percent since 1971, forcing educators to turn away nearly 80,000 worthy applicants annually.
Similar crises face the health labor force all over the world. Richer countries are compensating for inadequate numbers of personnel by poaching doctors, nurses, dentists, and other health workers from middle-income countries like Thailand, the Philippines, India, and Caribbean nations. Those countries, in turn, lure personnel from poorer places like South Africa, Sri Lanka, Guatemala, and Vietnam. And patients throughout the entire chain, from specialty hospitals in Manhattan down to unsupplied clinics in rural Indian villages, suffer. According to multiplestudies by such august institutions as the World Bankand Harvard University, worldwide need for health care workers, especially skilled personnel, cannot be met in the first half of this century unless millions more can be trained and those who have skills can be retained in the labor force.
Remarkably, none of these major reports issued on the health care worker crisis mention the gender distribution of the labor force, failing to note the tremendous disincentives women have for staying on the job. The reports (which are mostly authored by men) largely underscore low morale and the inability to retain trained health workers as key obstacles to filling the needs levels in every nation on the planet. None of the reports note, for example, that women are likely to take time off after giving birth, only to discover that their jobs are no longer available, or that possibilities for advancement in the ranks are closed off to them: Essentially, they pay a price for birthing children. None note burnout among female nursesand community health workers, many of whom feel they have no possibility of advancement despite strong job performance.
Women in Global Health Leadership Make a Real Difference There is evidence of striking differences in emphasis for public health and medicine based on leadership gender.
Female health leaders promote access to contraceptives, empowerment programs for girls, women’s rights to family planning and maternity care, safe abortions, and protecting environmentalassaults on children’s health. When more women are in government, the health and education of children rises in priority for legislation and financing. A survey of the OECD nations found that female leadership in all levels of governance, including health, is the primary driver for classic public-goods financing — meaning things like an increased focus on public schools, hospitals, clean water, and sanitation programs.
Women are also smart, accountable managers. According to the New York-based stock analyst company MSCI, putting more women on the boards of directors of major companies, philanthropies, universities, and other institutions results in resounding improvements: “Companies that had strong female leadership generated a Return on Equity of 10.1% per year versus 7.4% for those without,” and tended to encounter fewer legal conflicts and government scrutiny for possible malfeasance. MSCI found a direct correlation, for example, between decreased bribery and increased female board leadership.
According to the International Monetary Fund and the World Bank, nearly all achievements in economic development for poor and middle-income countries hinge on improvements in gender equity and leadership. Last year, South Africa’s President Jacob Zuma and France’s then-President François Hollande issued the U.N. High-Level Commission on Health Employment and Economic Growth — the only such document calling attention to the crisis in health labor that specifically addresses gender issues. It calls for the world to: “Maximize women’s economic participation and foster their empowerment through institutionalizing their leadership, addressing gender biases and inequities in education and the health labour market, and tackling gender concerns in health reform processes.”
That’s a start.
Sex and the Glass Ceiling
The list of men publicly accused since early October of sexual misconduct in the workplace has grown so long that we’ve all lost count. The #MeToo “Silence Breakers” are Timemagazine’s Person of the Year, and tens of thousands of tweets from all over the world reveal sexual predators and debate gradations of misbehavior. The public is increasingly wondering how to score the moral and legal differences between the likes of former Alabama senatorial candidate Roy Moore and orchestra conductor James Levine (both accused of forcing their sexual demands on teenagers) versus retired public radio host Garrison Keillor and former President George H.W. Bush, both allegedly having pinched adult women’s butts during a photo shoot.
There is a wide moral and legal gap between rape and unwanted kissing, soliciting 14-year-old boys and girls for sex versus pinching a 40-year-old woman’s rear end. A serial abuser like Harvey Weinstein clearly stands on far shakier moral ground than a crude prankster. Sadly, the gradients of immorality are likely to be decided by lawyers, corporate human resources departments and legislative ethics committees — places where fear of lawsuits, politics, and male interests dominate.
We are at a public moment unlike any we have ever seen, with the president of the United States a confessed pussy-grabber and tens of thousands of women all over the world stepping forward to denounce their assailants. Institutions of gravitas are shaken to their cores: the Metropolitan Opera Company, the Nobel Prize, the New York Times, and the boardrooms of Silicon Valley. As Melinda Gates put it, “From board rooms to presidential palaces to mats spread on the ground in the world’s poorest villages, the message from women is the same: Me too. Me too. Me too.”
Lost behind the lurid details of talk show hosts’ erect penises and Hollywood’s “casting couches” are the occupational realities most women face every single day, affecting their and their families’ lives: job equality, glass ceilings, access to health care, and the gender imbalance in power.
The great primate researcher Frans de Waal did a series of “fairness studies” on monkeys, as he described in an entertaining TED talk, putting animals side by side, separated by clear glass. The female animals perform a task and are rewarded with food. One consistently receives delectable grapes as reward, the other undesirable cucumber slices as payment for identical task performance. When the cucumber-receiving monkey realizes her peer is getting better grape-pay she rebels,
throwing the vegetable away, howling and pounding the glass. This sense of reciprocity and fairness has been shown in similar de Waal experiments done on a range of primates, birds, and other species. It is in our DNA: Whether we are chimpanzees, pigeons, or people, we know when we’re getting screwed.
Global health seems a fitting place to start developing genuine systems of gender reciprocity and fairness. Well-managed and staffed public health and medical care are in all of our interests. Fairness and leadership are concepts we all understand but find difficult to implement in practice. Surely, we can start down the implementation road to leadership and fairness with professions that are already overwhelmingly female. And maybe, once the 90 percent of America’s nurses have equal pay and power with their 10 percent male counterparts, we can take on more ambitious targets, like legislatures, oval-shaped offices, and the boardrooms of the Fortune 500.
Aida Abdulla speaks to Dr Samrin Farouk Habbani at the Khartoum Breast Care Centet on Oct. 15, 2015. (Ashraf Shazly/AFP/Getty Images)