Spanish Psychiatrist Criado condemned to one year in prison

Spanish Psychiatrist Criado has just been condemned to one year in prison for ‘inappropriate, foul and humiliating’ treatment of his patient. In addition, the psychiatrist, with a practice in Seville, will have to compensate the victim with 5,000 euros for moral damages.

Article is written originally in Spanish by Rosalina Moreno. for the famous legal newsroom CONFILEGAL. [Here it is translated to make it known in other languages]

The 9th Criminal Court of Seville (Spain) has condemned a psychiatrist, José Javier C. F., to one year in prison for a crime against moral integrity, with the aggravating circumstance of undue delay, for the “inappropriate, vulgar and humiliating” treatment of one of his patients.

1 YEAR OF PRISON AND 5.000 EUROS COMPENSATION FOR MORAL DAMAGE

In addition to the prison sentence, he was banned from communicating with or approaching the victim within 300 metres for two years and ordered to pay the victim 5,000 euros in compensation for moral damages.

The ruling, handed down on 31 June (352 /2022), was signed by Judge Isabel Guzmán Muñoz and has just become public.

The patient filed the complaint on 17 December 2015 together with seven other women who reported similar events, but for which these proceedings are not being pursued as they have been declared time-barred on appeal by order of 11 January 2017 by the Seville Provincial Court (Seventh Section).

The case has been handled by lawyer Inmaculada Torres Moreno.

THE PROVEN FACTS

The head of Criminal Court 9 of Seville considers it proven that the plaintiff attended the private consultation of José Javier C. F., in Seville, on 20 and 26 January and 4 and 9 February 2015 – the first of them accompanied by her husband -, receiving “at all times inappropriate, foul and humiliating treatment” by the convicted person, who, “without at any time taking an interest in her psychiatric history, continuously uttered denigrating expressions and enquired about her sex life”.

According to her, he asked her “how many times she had fucked that week” or commented that sending her pills was for nothing “because a good fuck would cure her“, urging her to “wear red thongs, red high heels… because that was what her husband and any man would get her like that” (gesturing with his arm to simulate an erection).

wear red thongs, red high heels… because that was what her husband and any man would get her like that

The judge describes in the ruling various phrases that the psychiatrist uttered to the victim in these consultations, in which he frequently addressed her with expressions such as “crazy” (sometimes even in front of other patients), also telling her “this crazy woman cannot be cured“, while at the same time maintaining a jocular attitude towards her for being a fan of the Real Betis Balompié football club or liking Easter Week.

According to the judge, the victim, who presented depressive episodes of anxiety, “used to leave the consultations in a state of despondency and anxiety“, and after consulting with her husband, she decided to stop going…

THE PLAINTIF’S STATEMENT IS ‘TOTALLY CREDIBLE’.

The prosecution charged him with a continuous crime against moral integrity, articles 74 and 173.1 of the Spanish Criminal Code, and asked that he be sentenced to two years in prison and that he be prohibited from communicating with or approaching the victim within 300 meters for three years, and that he compensate the victim with 6,000 euros.

The private prosecution, for its part, accused him of a crime against moral integrity under article 173.1, and demanded two and a half years in prison, a ban on communication and approaching within 500 meters of the victim for a period of five years longer than the prison sentence imposed and 40,000 euros in compensation for the physical and psychological harm and moral damage caused.

In imposing the prison sentence, the judge particularly valued the “seriousness” of the facts, “damaging with his conduct the integrity of a very vulnerable person, in view of his specific medical situation, and likewise, the fact that the action was not an isolated act“, specifying that “criminal continuity is not penalised as such, since in crimes against moral integrity, degrading treatment is integrated by a reiteration of acts that can be inserted in the typical unit of action provided for in article 173. 1 of the punitive text, which in itself excludes the concept of a continuous offence”.

Guzmán Muñoz indicates that it has not been duly accredited that the victim has suffered objective psychological harm as a result of the actions of the convicted person. However, he explains that the accredited reality of the facts and their content demonstrates a situation of “unavoidable moral damage beyond its objective verification“. She argues that in this case, the moral damage “results from the protected legal right and the seriousness of the action that has criminally damaged her“, and therefore sentences José Javier C. F. to compensate the plaintif with 5,000 euros.

An amount that the judge considers “proportionate and adequate” in view of the circumstances of the case, the context in which the events took place and their description; their duration, as well as the impact that the events have had on the victim, their evolution and the damage to dignity caused, without reaching the amount claimed by the private prosecution, on the grounds that the possible consequences suffered have not been expressly defined.

The judge emphasised that the prosecution’s evidence focused on the victim’s witness statement, which “is totally credible”, being “clear and thorough, despite the time that has elapsed since the events, coherent, with no contradictions and persistent“, is “surrounded by objective peripheral corroborations that reinforce the plausibility of her testimony” and “is supported” by various medical and psychological reports.

Thus, the judge refers to the testimony of the plaintif’s ex-husband, who accompanied her in the first consultation, or that of several patients who went to the psychiatrist’s practice for various mental health problems and who agreed “on the humiliating treatment they were given, with the defendant repeatedly engaging in conduct of a sexual nature, [and them] being subjected to continuous interrogations to find out their sexual tastes, which made them feel humiliated and not treated with respect“.

“These witnesses have narrated their different experiences in the oral trial, which will not be dealt with in this decision, so as not to cause any defencelessness as they have been declared time-barred and cannot be prosecuted, but even if they are not examined, their testimony of reference must be valued,” she explains.

FEELINGS OF ANGUISH AND INFERIORITY

The magistrate highlights that in the case in question, “the victim’s statement, persistent, coherent and objectively corroborated, is rationally sufficient to prove the commission of the crime, despite the fact that the defendant, using his right to defence, denies the facts, even having treated patients in a familiar and close manner, or having used some crude expression with them, as the forcefulness of the statements made contradict his version of the facts“.

In the judge’s opinion, “there is no doubt that the subjection by a psychiatrist to a patient with mental disorders to a situation of humiliation with comments” such as those described in the rulin, constitute the behaviour punishable under article 173 of the Spanish Criminal Code, since “such expressions are not only inappropriate for the doctor-patient relationship, but also created feelings of anguish and inferiority in the victim, likely to humiliate her, taking into account that she was a particularly vulnerable person due to her psychiatric history“.

The sentence is not final. An appeal may be filed against it with the Provincial Court of Seville.

such expressions are not only inappropriate for the doctor-patient relationship, but also created feelings of anguish and inferiority in the victim

Coke (cocaine): the high and... the harder the fall

Coke: the high and… the harder the fall

The beginning

Cocaine named from the Quechua “kúka” is a natural alkaloid synthezised by the coca plant (family of Erythroxylaceae) as a secondary metabolitefor its protection. It is extracted from the leaves to an amount of 0.3 to 1.5%. The use of the coca for religious, medicinal and stimulant purposes has been known since pre-Inca times. The people used to chew coca leaves for at least 8000 years to relieve hunger, to alleviate strenuous activities and also as a stimulant.

Dry leaves are also used for tea: the “mate de coca”. Initially starting on the Andean ridge (South America), the use of coca leaves has then spread to neighbour countries as Chile, Uruguay, Argentina and Brazil. From the 16^th Century it started to be exported and from the 19^th Century with its chemical extraction as the psychoactive cocaine powder form it reached the whole world with the development of the routes of communication. Nevertheless, Evo Morales, the President of Bolivia (2006 to 2019) used to say: “la coca no es cocaina” (the coca is not cocaine). 

Nowadays, the cocaine use although under the control of international Conventions, is a matter of public health due to its great addictive potential and toxicity. This is resulting in great psychological dependence, physical disorders  and side effects, producing harming impacts on the individual, the familial cell, the workplace, the society, and finally on the economy of the country. Usually available as an hydrochloride salt (formula: C17H22ClNO4) cocaine has limited medical use as an anaesthetic and vasoconstrictor. This contrasts with the increasing misuse of the cocaine as a central nervous system stimulant since the early years of the twentieth century. The cocaine became popular in the sixties through artists and mass media.

In illicit use and search of the “high”, the cocaine powder (Coke, Snow, etc.) is ritually sniffed/snorted by 69% of the users, from “lines” and absorbed through the nasal mucosa and less commonly (for 2%) intraveinuously injected. The free base, sometimes known as crack, a crystal form, is smokable or heated and inhalated as fumes (for 26%). The ingestion (2% of the users) leads to a loss of psychoactive activity due to enzymatic hydrolysis in the gut.

A typical dose of cocaine or crack for a shoot is 100–200 mg.

Historical points…

• In 1859, Dr. Paolo Mantegazza, (Italy) back from Peru, described the use of coca as medicine;
• In 1860, the chemist Albert Niemann (Germany) isolated and coined the name “cocaine”; 
• In 1863, Angelo Mariani French pharmacist, using coca leaves macerated in Bordeaux wine created the tonic drink “Vin Mariani”;
• In 1885, the U.S. manufacturer Parke-Davis sold cocaine in various forms, stating that cocaine products “supply the place of food, make the coward brave, the silent eloquent and render the sufferer insensitive to pain.”
• In 1886, John S. Pemberton (USA), pharmacist veteran of the Secession war and morphine user  changed his Pemberton’s French Wine Coca in a non-alcoholic then non-cocaine (replaced by caffeine) tonic beverage, inventing the famous “Coca-Cola”.

In Europe

Most of the cocaine available in Europe, using well-organized networks, continues to be smuggled into the largest container ports of the European Union (EU) located in Belgium (Antwerp), the Netherlands (Rotterdam) and Spain (Valencia and Algeciras). In addition to Hamburg (Germany), ports in France (Le Havre, Dunkerque, Marseille), Romania (Constanta), and Italy (Gioia Tauro) have also become significant cocaine entry points. The German authorities have attributed the recent increase in seizures in the port of Hamburg to the activities of Balkan and Albanian-speaking organised crime networks (BundesKriminalAmt, 2021). 

The Southeast European Law Enforcement Center (SELEC) reported that in this part of Europe alone, the cocaine seized in 2020 amounts to 5,821.9 kg, representing a 22.3% increase. The total estimated value (street price) in 2020 is more than 281 million EUR.                                                                                     

According to the European Monitoring Center for Drugs and Drug Addiction (EMCDDA), the cocaine retail market concerns about 14.0 million adults in the European Union (aged 15-64), about 5 % of this age group. This market was worth at least EUR 10.5 billion in 2020; this represents about a third of the illicit market in all drugs and makes cocaine the second-largest market after cannabis. Since the mid-1990s the drug is more affordable for consumers than in the past so the overall cocaine usage in Europe has been on the rise.

Corruption at all levels is broadly used as a facilitator of drug trafficking activities and is a key threat in the EU according to the last EU Serious and Organised Crime Threat Assessment (SOCTA) report (Europol, 2021a).

In addition, the cocaine gotten from the streets could be prepared with variable proportions of caffeine, ammonia, solvents, industrial products such as battery acid, and even gasoline, kerosene and quicklime, increasing their toxicity but a greater profit.

EMCDDA report that cocaine seized at or destined for EU ports in 2020 (378 seizures) was smuggled within legitimate goods (132 tonnes), followed by the rip-on/rip-off method (108 tonnes). 

Cocaine trafficking concerns all EU Member States (Europol, 2021a) via diversified smuggling routes: roads for private cars and lorries, railways, maritime transports, commercial or passengers and light aircraft, and increasingly the post services (Council of Europe, 2021).

Effects and Risks

The cocaine psychoactive substance is a tropane alkaloid as for scopolamine used in World War II,  when the THC of the cannabis is a terpene.  Alkaloids are also present in the pine, citrus, lavender, poppy, etc. About a fifth of the total plant species is synthesizing alkaloids as secondary metabolites such as in plant families from the nightshade (Solanaceae), coca (Erythroxylaceae), bindweed (Convolvulaceae), cabbage/broccoli (Brassicaceae). Not all are psychoactive.    

As for the psychoactive substances, the liposoluble cocaine passes easily through the blood-brain barrier, reaching via the bloodstream and the Central nervous system (CNS) in about five seconds to produce the euphoric effect sought by the user.

In the mid-brain, the target of the cocaine is the Nucleus Accumbens located in the limbic system and  known to be the pleasure center or reward system (Lopez Hill et al. 2011).  In this area the cocaine inhibits the re-uptake from the synaptic cleft of the neurotransmitter dopamine by the presynaptic neurons by blocking their dopamine transporters. Thus, the artificial accumulation of dopamine in the synaptic cleft continuing to stimulate the receptors and the newly synthezised ones on the post-synaptic neurons is creating the lasting euphoric effects: the “high” from snorting may last about 15 to 30 minutes and from smoking 5 to 10 minutes. Injecting provides a quick, strong but short result.

When the use is stopped,  the mechanisms of re-uptake of dopamine are re-activated so the stimulating effect disappears  giving the manifestations of anxiety, feeling of lack and depression. Cocaine interfers also with the activities of the receptors of serotonin (regulation of behaviors, anxiety, learning, etc.) and noradrenaline (alertness, excitment, attention, etc.).

Considering that the nerves of the limbic area (emotions and reward system) are in relation to the cortex pre-frontal (judgement and decision) this explains the compulsive urge for the user to seek for more drug to continue the “high”. This is explaining the overall and powerful addictive effect of cocaine.

Mental effects of cocaine use include an intense feeling of happiness, sexual arousal, loss of contact with reality, paranoia, and agitation (Pomara C., et al. 2012). But also it increases the physical risks of stroke, cardiac arrhythmia, lung injury for smokers, sweating, high blood pressure, body temperature, dilated pupils and sudden cardiac death. The withdrawal symptoms include depression, decreased libido and ability to feel pleasure and increased fatigue feeling.

Based on data from 20 European countries there were an estimated 473 cocaine-related deaths in 2020 or about 13.5 % of all drug-induced deaths. These results are underestimated.

In Fine…

At a time whenthe governmental debates on eventual drug decriminalization or legalization are gaining all the countries and neglecting the health consequences for their peoples, when the profits and corruption at high levels are taking over the population and youth safety, it is more than ever vital to remind the words of Ms. Johansson of the European Commission (31.3.2022): “The new EU Drugs Strategy 2020-2025 …[has] the aims to ensure a high level of health promotion, social stability and security and contribute to awareness raising”.

The “awareness raising” can be easily achieved through education. Indeed, as for any other subject,

“Education is the progressive discovery of our own ignorance” said William Durant (1885-1981). This ignorance of the drug effects is life endangering when not fatal for the cocaine and drug users!

To contribute to this drug preventive education of the youth (and parents) the Foundation for a Drug Free Europe and its hundred of associations and groups across Europe are delivering lectures, distributing informative booklets (14 booklets on most used drugs of 24 pages, in 17 languages, including on cocaine), educative audiovisual materials and a guide for lessons as part of the Foundation for a Drug-Free World campaign The Truth About Drugs.

Witness to the harming effects of drug use, let’s preventively educate the youth and people so they will be able to realize their full life potentials in a safer society and in a better world!

New Research Shows Vitamin D Deficiency Leads to Dementia

Dementia is diminished cognitive functioning with a loss of ability to remember, think, solve problems, or make decisions — if it has progressed to the point that it interferes with doing everyday activities. It is a broad term, rather than a specific disease. Alzheimer’s disease is a specific type of dementia and the most common, with 6 million Americans afflicted according to the Alzheimer’s Association.

Dementia is not a normal sign of aging, even though it primarily affects older adults at least 65 years of age. According to the Centers for Disease Control and Prevention, nearly 14 million Americans will be suffering from dementia by 2060 and there is a link with vitamin D deficiency.

It is one of the major causes of disability and dependency among older people worldwide, affecting thinking and behaviors as you age. But what if you could stop this degenerative disease in its tracks?

A world-first study from the University of South Australia could make this a reality as new genetic research shows a direct link between dementia and a lack of vitamin D.

Investigating the association between vitamin D, neuroimaging features, and the risk of dementia and stroke, the study found:

• low levels of vitamin D were associated with lower brain volumes and an increased risk of dementia and stroke.
• genetic analyses supported a causal effect of vitamin D deficiency and dementia.
• in some populations, as much as 17 percent of dementia cases might be prevented by increasing everyone to normal levels of vitamin D (50 nmol/L).

Dementia is a chronic or progressive syndrome that leads to deterioration in cognitive function. About 487,500 Australians live with dementia and it is the country’s second leading cause of death. Globally, more than 55 million people have dementia with 10 million new cases diagnosed every year.

Supported by the National Health and Medical Research Council, the genetic study analyzed data from 294,514 participants from the UK Biobank, examining the impact of low levels of vitamin D (25 nmol/L) and the risk of dementia and stroke. Nonlinear Mendelian randomization (MR) – a method of using measured variation in genes to examine the causal effect of a modifiable exposure on disease — were used to test for underlying causality for neuroimaging outcomes, dementia, and stroke.

Senior investigator and Director of UniSA’s Australian Centre for Precision Health, Professor Elina Hyppönen, says the findings are important for the prevention of dementia and appreciating the need to abolish vitamin D deficiency.

“Vitamin D is a hormone precursor that is increasingly recognized for widespread effects, including on brain health, but until now it has been very difficult to examine what would happen if we were able to prevent vitamin D deficiency,” Prof Hyppönen says.

“Our study is the first to examine the effect of very low levels of vitamin D on the risks of dementia and stroke, using robust genetic analyses among a large population.

“Our study is the first to examine the effect of very low levels of vitamin D on the risks of dementia and stroke, using robust genetic analyses among a large population.

“In some contexts, where vitamin D deficiency is relatively common, our findings have important implications for dementia risks. Indeed, in this UK population we observed that up to 17 percent of dementia cases might have been avoided by boosting vitamin D levels to be within a normal range.”

The findings are incredibly significant given the high prevalence of dementia around the world.

“Dementia is a progressive and debilitating disease that can devastate individuals and families alike,” Prof Hyppönen says.

“If we’re able to change this reality through ensuring that none of us is severely vitamin D deficient, it would also have further benefits and we could change the health and wellbeing for thousands.”

“Most of us are likely to be ok, but for anyone who for whatever reason may not receive enough vitamin D from the sun, modifications to diet may not be enough, and supplementation may well be needed.”

Read more

Longevity Secret: Major Gut Health Vitamin D

Do you know which vitamin supports vision?

Reference: “Vitamin D and brain health: an observational and Mendelian randomization study” by Shreeya S Navale, Anwar Mulugeta, Ang Zhou, David J Llewellyn and Elina Hyppönen, 22 April 2022, The American Journal of Clinical Nutrition.DOI: 10.1093/ajcn/nqac107

WHO: The Quality Rights e-training for a paradigm shift in mental health

Michelle Bachelet, UN High Commissioner for Human Rights delivered a statement for the launch of an unheard “Quality Rights” e-training that will help, among other things, put an end to systemic abuses in psychiatry and mental health.

Michelle Bachelet:

Greetings to all. Thank you to the World Health Organization for inviting UN Human Rights to take part in the launch and rollout of this vital e-training. It is an honour to participate.

Today’s launch of the Quality Rights e-training is timely, and its focus on mental health, recovery and community inclusion could not be more crucial.

As we are all aware, the COVID-19 pandemic has demonstrated the devastating social impacts of global health crises. The years of neglect and underinvestment in mental health has been heavily exposed, as has the longstanding stigma of mental health conditions and discrimination against people with psychosocial disabilities.

Their human rights are continuously under threat.

We urgently need a paradigm shift. My Office’s recent report on mental health and human rights highlighted that people with mental health conditions and with psychosocial disabilities face all kinds of discrimination. They are often denied legal capacity on the basis of their disability, forcibly admitted to institutional settings, and coerced into treatment.

This is happening because of outdated laws, policies and practices.

Restoring the dignity and rights of people with mental health conditions and with psychosocial disabilities needs to be our priority. We need to discontinue the use of discriminatory laws and practices and advance towards approaches with equality and non-discrimination at their core. Such approaches must conform with international human rights standards as set out in the Convention on the Rights of Persons with Disabilities.

The Quality Rights e-training will play an essential role in transforming attitudes and practices in mental health. It will provide vital support to countries in their implementation of a rights-based and recovery-oriented approach to mental health services.

I am particularly pleased that the e-training is being integrated and delivered in the context of the Special Initiative for Mental Health. Dr Tedros, I commend you for your vision in creating and accelerating the implementation of this initiative and WHO’s commitment to keep mental health high on the human rights, sustainable development and humanitarian agendas.

My Office is committed to continue our collaboration and to support this excellent initiative. I will be inviting all staff to undertake the training, and – through our web and social media channels as well as at high-level events – to actively disseminate it to relevant audiences throughout the world.

As we recover from the pandemic, we have a crucial opportunity to find the path towards better, more inclusive, sustainable societies. Tools such as this can help us take the steps on that path.

Thank you.

RELATED

STATEMENTSStatement by Dainius PurasSpecial rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health

NEWSCOVID-19 has exacerbated the historical neglect of dignified mental health care, especially for those in institutions: UN expert

PRESS RELEASESThe world must change the way mental health challenges are addressed, UN expert says

Irfan Virji Discusses the Benefits of Running

MOMBASA, KENYA, January 24, 2022 /EINPresswire.com/ — Running is one of the world’s oldest forms of exercise. Since humans first appeared on earth, we’ve been running and racing for sport and enjoyment as well as necessity. Today it’s popular as a sport that costs nothing and can be done almost anywhere, at any time that’s convenient for one. Whether their interested in running alone or in marathons, this form of exercise carries many benefits, says Irfan Virji. From ones physical health to ones mental health, running can help them improve and evolve into the person one want to be. 

Running Helps One Lose Weight

Like every form of cardio, running is a great way to burn calories and lose weight, says Irfan Virji. When one run, it moves their entire body and requires the use of all of their major muscle groups. This requires a lot of energy. The average person can burn about 100 calories per mile while running. The more one run, the more calories one burn, and the more weight one lose over time.

Running Improves the Quality of Ones Sleep Says Irfan Virji

Exercise helps improve the quality of ones sleep in several ways. First, it burns off energy and tires out ones body, which can help one fall asleep more quickly. Secondly, running releases endorphins and other feel-good chemicals that help combat stress and anxiety–both of which can prevent one from sleeping well. 

If one run outside rather than in a gym, one may also experience extra sleep benefits, Irfan Virji says. Being outside, especially early in the morning or late in the afternoon, exposes us to sunlight. Our circadian rhythms (the biological clock inside us that keeps track of time and controls sleep) are set by the sun. Being outside early in the morning or late in the afternoon can signal to our brains what time it is, keeping us in sync with sunrise and sunset. This makes it easier to fall asleep and stay asleep when we’re supposed to. 

Running Can Help Ones Knees and Back 

Because one use ones knees so much while running, one may assume that over time, running is bad for ones joints. And while running is an impact sport, studies have found that running is actually good for ones back and knees, explains Irfan Virji. 

When studying marathon runners versus the general population, the rate of arthritis in runners was well below average. This suggests that the movement and use of the knee joints actually helped protect against developing arthritis. 

In another study of first-time marathon runners, researchers found that the condition of their bone marrow and articular cartilage (the cartilage found in knees and other joints that allows them to move and bend) actually improved for at least six months after the races. 

The same is true for the cartilage between discs in the vertebrae of the back. Middle-aged, long-term runners had less back pain and lower lumbar IVD decline. This means the height of the discs in their back remained the same rather than declining which can cause rubbing and pain.

The abuse of psych drugs for emotional problems forces a response from Catalan Health department

The pandemic has increased the demand for mental health care by between 20% and 30%, according to data cited by Óscar Pino, coordinator of the Benito Menni adult mental health centre (l’Hospitalet) and member of the Col-legi de Psicologia de Catalunya. The indicators report increases in the number of suicides, in the number of emergencies linked to infant-juvenile mental pathologies, in eating disorders… The rates of emotional distress tend to worsen and, with them, one of the problems that alarms the health authorities: the excessive use of psychotropic drugs.

Original article in Spanish at LA VANGUARDIA by Antoni López Tovar

“We have a problem as a society, which is that we always look for the easy answer first: ‘I don’t feel well, go to a psychologist or psychiatrist, and take a pill’. We are a pill-popping society,” said the Catalan Minister of Health, Josep Maria Argimon. Spain is the country in the world with the highest consumption of benzodiazepines (psychotropic drugs used for mild cases of insomnia, anxiety or emotional disorders) per 1,000 inhabitants, according to the latest report of the International Narcotics Control Board, with data from 2019. The Spanish Medicines Association indicates that 91.07 doses of sedatives, anxiolytics and hypnotics were consumed per 1,000 inhabitants in 2020, an increase of 4.5% over the previous year, and the latest Alcohol and Drugs Survey by the Ministry of Health reveals that 31.1% of Spaniards aged 75 or over have consumed hypnosedatives, with or without prescription, in the last year.

“We have a problem as a society”, says Catalan health councillor Argimon with regard to the use of psychotropic drugs.

One of the objectives of the reinforcement of emotional health in the Catalan Generalitat’s 2021-2025 health plan is to “de-medicalise a large part of this malaise that the pandemic has exacerbated, but which we must not confuse with mental illness”, according to Minister Argimon.

“We live in a society in which everything has to be resolved quickly, but there are circumstances in life that are inherent to the fact that we are alive. Situations of conflict, work, professional and family difficulties cause certain emotional discomforts, but we should not psychologise or psychiatrisise what is not necessary,” explains Joan Vegué, president of the Generalitat’s advisory council on mental health and addictions.

Where is the boundary between discomfort and pathology? “Sometimes it is blurred. We professionals have the tools to understand that something is an adaptive reaction that involves a certain sadness, fear, uncertainty, but that is not pathology. Exacerbated anxiety, sleeping badly for many days… this is already a symptom, a malaise that generates dysfunctionality and must be treated”, explains Vegué.

The shortest way

A few minutes to see a depressed patient, who even requires medication, and the prospect of a waiting queue for a specialist. The circumstances are ripe for the family doctor to prescribe psychotropic drugs. The incorporation of psychologists into primary care aims to avoid this. Along the same lines are programmes to improve coping strategies. But there is a lack of psychiatrists and clinical psychologists. “I am much more concerned about the lack of accessibility to adequate mental health care than the overuse of drugs,” says Narcís Cardoner.

In Pino’s opinion, the threshold of the illness varies: “It depends on the person, not everything works for everyone, but the frequency and intensity of the symptoms and the fact that they affect your daily life is fundamental. You may not be able to go to work, you may have stopped doing activities that were pleasurable for you.

“If the system were really optimal, we could address many things,” explains Narcís Cardoner, president of the Catalan Society of Psychiatry of the Academy of Medical Sciences of Catalonia. “In a public health system, there are always many attitudes of users that could be corrected: just because you have a fever, you don’t have to go to the emergency room. But the risk of not being able to respond to all needs is currently more important than the percentage of people who make a demand that is not entirely justified”.

Liberian FaithVonic artist fights pandemic through musical education

Faith Vonic is a 25 years old Afropop and “Hipco” (HipHop) Female Artist born and raised in Liberia, West Africa. She started singing at the age of 10 at her school and covering various musical artist on her YouTube channel. In 2012, she began writing and producing her own records, and officially began her journey as a dynamic cutting edge Artist within the Liberian music industry. Her distinct sound and knack for creativity and pushing the envelope has made Faithvonic a force to be reckoned with, rising to the top of the music industry.

Faith was raised by a single mother in Liberia, with challenging circumstances including being a survivor of SGBV and mental abuse at a young age. Music became faith coping/ escape mechanism during her childhood, and she utilized her music as the medium to communicate and express her experiences, feelings, and thoughts with the intention to help and inspire other young girls who may have been in similar situations. Through the confidence brought by her music and talent, she decided to turn her passion into a career.

Faith stage name was inspired by both a combination from her first name and mother’s name; as she applauds her mother’s strength as a driving force behind her music journey. Her mother’s name is Yvonne, so Faith +Yvonne birth the stage name FaithVonic.

In 2014, faith came in contact with ActionAid Liberia as an effort to provide Ebola awareness support through a collective music group called LATA. Since then Faith has been partnering with AAL through Activista, Safe Cities Campaign, and has also been a Girls Rights Ambassador for ActionAid on various interventions. As a youth activist, Faith works with young girls across the country empowering them to advocate for their rights, and supporting them around building their self-confidence and self –esteem.

In addition to being a musical artist, Faith is also a budding fashion designer, graphic designer, content creator, and video director expanding her portfolio, versatility, and market reach. Furthermore, Faith has 4 siblings and loves being a sister and role model to them.

 Faith’s goal is to see more Liberian young women with the confidence to utilize music, art, and creative activism to express themselves and advocate for their rights.

“The love I have for music is one of the best way I can express my feelings and also inspire others”

FaithVonic, 22

She believes through her music the world gets to see her Country Liberia and the beauty of it from all angles. With 60% of Liberia’s population being under 35, and the increased impact of COVID-19 on young people and especially young women, Faith knew she needed to utilize her talents to support awareness initiatives, even in her own way – utilizing creative activism. Faith also knew the country is at a pivotal moment, and hadn’t survived the Ebola outbreak, solidarity music was needed to bring the country/region/continent together, highlighting our strength, beauty in our diversity, and hope that we can once again overcome another pandemic even amid challenges. In collaboration with ActionAid Liberia, Faith was able to birth the “Africa Fight” Coronavirus Awareness Song- which will be officially released on all platforms soon.

What happens if you eat cherries every day?

What happens if you eat cherries every day

The season of fruits and berries has arrived. And already on every counter, you can find ripe, tasty, and most importantly, healthy cherries – it’s hard to resist. But what will happen to the body if you include it in your daily diet? Let’s tell you now.

Memory may improve

Sweet cherries are rich in anthocyanin, a compound that has a beneficial effect on memory and brain function in general.

Record: A South African woman gave birth to 10 babies conceived naturally

Gossiame Tamara Sitole, 37, and her husband now have 6-year-old twins

A 37-year-old South African woman broke the Guinness World Record after giving birth to 10 babies in a hospital in Pretoria, Pretoria News reported.

Gossiame Tamara Sitole and her husband Teboho Coteci already have 6-year-old twins and were shocked when doctors initially told Gossiame that they saw 6 babies in the video area. The woman became pregnant naturally and was never treated for infertility, as is common in multiple pregnancies.

The WHO seeks to end human rights violations in psychiatry

The mental health care services in Europe and globally in the main continues to be provided in psychiatric wards and hospitals. As The European Times is documenting human rights abuses and coercive practices in these facilities are common. The World Health Organization (WHO) in new guidance material released this week evidence that providing community-based mental health care that is both respectful of human rights and focused on recovery is proving successful and cost-effective.

Mental health care recommended in the new guidance by WHO should be located in the community and should not only encompass mental health care but also support for day-to-day living, such as facilitating access to accommodation and links with education and employment services.

WHO’s new “Guidance on community mental health services: promoting person-centred and rights-based approaches” further affirms that mental health care must be grounded in a human rights-based approach, as recommended by the WHO Comprehensive Mental Health Action Plan 2020-2030 endorsed by the World Health Assembly in May 2021.

Fast transition to redesigned mental health services required

“This comprehensive new guidance provides a strong argument for a much faster transition from mental health services that use coercion and focus almost exclusively on the use of medication to manage symptoms of mental health conditions, to a more holistic approach that takes into account the specific circumstances and wishes of the individual and offers a variety of approaches for treatment and support,” said Dr Michelle Funk of the Department of Mental Health and Substance Use, who led the development of the guidance.

Since the adoption of the United Nations’ Convention on the Rights of Persons with Disabilities (CRPD) in 2006, an increasing number of countries have sought to reform their laws, policies and services related to mental health care. All European countries have signed and ratified this Convention. However, to date, few countries have established the frameworks necessary to meet the far-reaching changes required by international human rights standards.

Reports from around the world highlight that severe human rights abuses and coercive practices are still far too common in countries of all income levels. Examples include forced admission and forced treatment; manual, physical and chemical restraint; unsanitary living conditions; and physical and verbal abuse.

The majority of government mental health budgets still goes to psychiatric hospitals

According to WHO’s latest estimates, governments spend less than 2% of their health budgets on mental health. Furthermore, the majority of reported expenditure on mental health is allocated to psychiatric hospitals, except in high-income countries where the figure is around 43%.

The new guidance, which is intended primarily for people with responsibility for organizing and managing mental health care, presents details of what is required in areas such as mental health law, policy and strategy, service delivery, financing, workforce development and civil society participation in order for mental health services to be compliant with the CRPD.

It includes examples from countries including Brazil, India, Kenya, Myanmar, New Zealand, Norway and the United Kingdom of community-based mental health services that have demonstrated good practices in respect of non-coercive practices, community inclusion, and respect of people’s legal capacity (i.e. the right to make decisions about their treatment and life).

Services include crisis support, mental health services provided within general hospitals, outreach services, supported living approaches and support provided by peer groups. Information about financing and results of evaluations of the services presented are included. Cost comparisons provided indicate that the community-based services showcased produce good outcomes, are preferred by service users and can be provided at comparable cost to mainstream mental health services.

“Transformation of mental health service provision must, however, be accompanied by significant changes in the social sector,” said Gerard Quinn, UN Special Rapporteur on the Rights of Persons with Disabilities. “Until that happens, the discrimination that prevents people with mental health conditions from leading full and productive lives will continue.”

Council of Europe wants to enforce harmful coercive psychiatric treaments – UN experts oppose

Independent UN human rights experts called on Friday for a European body of intergovernmental experts to stop legislation supporting coercive mental health measures.

Five UN experts issued a statement calling upon the Council of Europe’s Committee on Bioethics to withdraw a draft  Additional Protocol to the Oviedo Convention – a treaty protecting the human rights of people with regard to biology and medicine – that would codify a  mental health policy based on coercion and bring “stigmatization and fear to people with psychosocial disabilities”. “Overwhelming evidence from the European Disability Forum, Mental Health Europe and other organizations and growing consensus within the United Nations including at the World Health Organization (WHO), show that forced admission to medical institutions and coercive treatments in institutions will bring harmful effects such as pain, trauma, humiliation [and] shame”, the experts said. This is incompatible with contemporary human rights principles and standards.

Quell the draft

If adopted during a vote in early June, the draft Additional Protocol would continue to allow all the 47 State parties of the Council of Europe to use coercive measures against people with mental health conditions, including their forcible committment to psychiatric institutions.

The coercive approach to mental health is “doing harm to people with disabilities” and “we should not go backwards to authorize this outdated approach”, the experts said, adding that individutals with psychosocial disabilities “have the right to live in the community and to refuse medical treatment”.

“We call upon all State delegations to object to the draft Additional Protocol in the upcoming meeting and we urge the Council of Europe to end legitimizing forced institutionalization and the use of coercion against persons with disabilities, including older persons with disabilities”, they underscored.

Be part of the future

The controversial draft treaty has also aroused opposition within Europe and from the international community.

Voices within the Council of Europe, such as the Council of Europe’s Parliamentary Assembly and the Council of Europe’s Commissioner for Human Rights have all been vocal against the draft Protocol.

“When there are efforts worldwide to reform mental health policy, it comes to our surprise that the Council of Europe, a major regional human rights organization, is planning to adopt a treaty that would be a setback to reverse all positive developments in Europe and spread a chilling effect elsewhere in the world”, the experts said.

They stressed that the Council of Europe now has “a unique opportunity to shift away from old-fashioned coercive approaches” to mental health, towards concrete steps to promote supportive mental health services and realize human rights for all “without discrimination on the grounds of disability”.

“We urge the Council of Europe to be part of the future and not part of the past in mental health”, concluded the experts.

Click here for the names of the experts who endorsed in this statement.

Special Rapporteurs and independent experts are appointed by the Geneva-based UN Human Rights Council to examine and report back on a specific human rights theme or a country situation. They are not UN staff nor paid for their work.

SPIEGEL involved Merkel and Borissov in a scheme to supply low-quality masks from Bulgaria

The German army has ordered protective clothing from Bulgaria for hundreds of thousands of euros, which is of poor quality, but about which Chancellor Angela Merkel seems to have personally spoken to then-Prime Minister Boyko Borissov.

This is what SPIEGEL magazine says in an investigation indicating how the company Venera Style from Haskovo received an offer for such products, although until then it only made clothing. At the beginning of the pandemic, however, Venus offered to deliver two-layer masks – 85% cotton, 15% elastane – to Germany in the spring of 2020.

The publication comes months after the start of a massive scandal over the supply of substandard masks, which accused Merkel’s allies of corruption and put her party – the Christian Democrats – at a disadvantage on the eve of the parliamentary elections.

This is presented as remarkable at a time when Bulgaria needs them as much as Germany and has even imposed an export ban.

“Then why is Bulgaria sending masks to Germany?” The publication asks. And second, this business enjoys the highest level of support, such as that of Chancellor Angela Merkel, Defense Minister Annegret Kramp-Karenbauer and others, such as the chair of the Armed Forces Procurement Service. Kramp-Karenbauer is even preparing his personal assistant to board a plane to take samples from Sofia.

The Bundeswehr makes quick purchases, although the goods are questionable, as is their quality. “Letters received from SPIEGEL mention political reasons several times.” Protective suits are also sent to the Bundeswehr’s nuclear, biological and chemical weapons protection department.

“Commands from above”

Here SPIEGEL draws attention to the direction of commands “from above” – ​​”not Bulgarian suppliers send their goods to Germany to be inspected, and the personal assistant of the Minister must take samples along with a team ready to fly to Bulgaria.

The next day. “The office and the ministry did not even comment on how much the flight cost or why the issue was so” politically important “- people familiar with the case say such a thing has never happened before.

It turns out that at a time when the Ministry of Health is flooded with proposals for masks and in violation of the procedure under which the Bundeswehr usually places orders. In addition, the production from Bulgaria does not have any identification marks or quality certificates.

In addition, samples show that the products are of poor quality; the conclusion is even that the user of the masks is not protected. It is the same with suits that can only be washed at a temperature of 30 to 40 degrees, which is not enough to eliminate viruses, and therefore can only be used once. However, the procurement service was activated and the process was declared “highly political”. A request is made to conclude the largest possible contract with Bulgarian companies to meet the needs of the army.

This includes orders small for Germany but serious for the clothing company Venus, covered by three contracts for six days: 200,000 masks for 246,000 euros. Another 11,000 protective suits are ordered from other manufacturers, despite obvious doubts about the quality.

Subsequent delivery of samples of suits and visors in April is also of poor quality, without certificates; a license is issued for limited use, the visors – for single use.

“But why are Bulgarian contracts so important in Berlin? The office is silent; talks with international partners are confidential,” SPIEGEL wrote. The magazine asked if the federal government should not have at least checked which companies were involved, especially if they were from a country that is the latest in the EU in the Transparency International Corruption Perceptions Index.

Borissov and the companies in the scheme deny any allegations. In the Bundeswehr, however, protective suits are practically in stock, as are visors – some of these goods are not applicable for medical purposes, others may even be dangerous to consumers.

In Europe, 24 million of 15-34 young people are using psychoactive drugs

Popularized in the 1960’s by artists and mass media such as : “Lucy in the Sky with Diamonds” (LSD) by the Beatles, “Cocaine” by J.J. Cale, “Purple Haze” (cannabis) by Jimmy Hendrix, etc., drugs use have extensively developed to become part of our culture since the middle of the last century with the psychedelic musics, the Beat Generation (Kerouac, Ginsberg, Cassady, etc.), the psychologist Timothy Leary “pope of the LSD” and the counter-cultural hippie movement. Drugs invaded all the aspects of society, becoming a symbol of rebellion among the youth, a political, cultural and social dissent and a new style of life. On the last 2020 European Drug Report of EMCDDA mentioned that in Europe, 24 million young people are using psychoactive drugs, of which 18 million use cannabis.

The problem

The main drug used in Europe is the cannabis with marijuana and hashish as joint, bong (smoked), the bhang (a drink) and used in Space cakes. For the youth, cannabis is the entrance door to the world of drugs. If initially it was used as a “soft drug” or “recreative drug” with a 0,2% of THC (the liposoluble psychoactive substance), rapidly with genetic engineering technics it reached a 20-30 % THC range with a toxicity level interfering with many vital functions of the body and worse for children.

Despite the 1961 Single Convention on Narcotic Drugs of the UNODC classifying cannabis on Schedule IV, decades of lobbying and challenges by vested interests, with WHO Recommendations, acting to declassify cannabis and related cannabinoids, it was agreed on December 2, 2020, thanks to some wise government representatives, UNODC, INCB and experts to only re-reclassify cannabis in Schedule I, so, still under control and only accessible for scientific and medical purpose.

The last 2020 European Drug Report of EMCDDA mentioned that in Europe, 24 million of 15-34 young people are using psychoactive drugs (with 18 million of cannabis users) and it is estimated that at least 9,000 overdose deaths occurred, the mean age being 42 but starting at 15 years old.

This report also put the stress on the overall high social costs of drugs supported by the society, going far beyond the use of the drugs themselves:

• for the public health with healthcare and treatment: 135 000 people entered treatment related to cannabis use,
• for the public safety: traffic accidents, gangs, crimes, terrorism,
• for the lost in labor productivity, money laundering,
• for undermining states governance by corruption of officials,
• for the degradation of environment due to waste toxic chemicals, deforestation, soil degradation and water issues .

Moreover, the drug market in Europe is increasing. It represents a minimum of 30 billion Euros per year shared as: some 12 billion for cannabis (39% of the EU drug market ) coming from Morocco and EU; 9 billion for cocaine (31%) from Central and South America; 7,5 billion for heroin/opioids (25%) from Afghanistan; 1 billion for amphetamine and methamphetamine and 0,5 billion for MDMA (5%) from the EU, Middle East (captagon) and Africa.

In addition currently, some 730 new psychoactive substances (NPS) are found on the European retail market, gathering the synthetic cannabinoids, synthetic opioids and benzodiazepines.

And more, the drug market is linked with criminal activities such as human trafficking (sexual exploitation, forced labor, organ harvesting), child exploitation and migrant smuggling.

The solution

A lot has been discussed about the drug problem, Conventions were written and signed by governments, including on the drug protection of the most vulnerable: the children (CRC article 33, 1989).

What is missing is a basic Education on the drug subject: what they are and what they do. This should be set up as an early primary prevention education, before the youth are contacted by the dealers boasting of the illusory quality of their products in order to better trap the ignorant and by omitting to talk about the following disastrous use consequences. This education is first under the responsibility of the parents, then the surrounding civil society and above all implemented by the government, when not serving special interests.

Leonardo da Vinci said already in the 15th century: It is ignorance that blinds us and misleads us and Will Durant in the 20th century added: Education is a progressive discovery of our own ignorance.

To educate the youth and empower them against the harmful effects of drug use are the main priorities of the Foundation for a Drug Free Europe and its hundred associations and groups across twenty European countries, through the Drug Education Prevention Program The Truth About Drugs which are cooperating with more and more countries in the world to put an end to the production by putting and end to the demand. More information about the organization at: www.fdfe.eu

• UNODC: United Nations Office on Drugs and Crime
• WHO: World Health Organization
• INCB: International Narcotics Control Board
• EMCDDA: European Monitoring Centre for Drugs and Drug Addiction
• CRC: Convention on the Rights of the Child

Iceland’s ring road: Europe’s most sustainable road trip

Depending on the time of year, Iceland can be cloaked in an ethereal palette of green or white, as it experiences the lightest of nights or the darkest of days. And either landscape makes for an idyllic backdrop to a road trip that puts sustainability front and centre.

The capital of Reykjavik embodies traditional Scandinavian design and is home to only 200,000 inhabitants (including legendary artist Björk for half of the year), yet innovation is the driving force behind the bright facades. These principles extend throughout Iceland’s countryside – the island nation is mostly powered by geothermal energy combined with other renewable sources that make it close to 100 per cent green.

Travellers seeking to explore the home of the elves – or huldufólk – take to the ring road. This highway that borders the island was carefully built around the residences of these spirits, in order not to disturb them. And tourists can create even less disturbance by renting a whisper-quiet electric car in the capital; it won’t run low on power as there are plenty of high-speed chargers available to use along the route.

Hellisheidi Geothermal Power Plant

(Arni Saeberg)

Opportunities to be a part of the rural environment abound on this classic Icelandic road trip, with wild camping allowed on uncultivated land (as long as it’s for one night only) and free campsites available for those looking to pitch up for longer. For those who prefer two wheels to four, the route is used by so many cyclists that drivers happily share the quiet roads. All journeys turn up something unexpected: multiple waterfalls carve their way through the basalt; lagoons hide among the jagged rock formations; pearlescent glaciers and tiny churches built miles from civilisation appear when you least expect them.

Recommended

The ring road also provides access to the famed geothermal blue lagoon and spa retreat – another example of sustainability, powered by the landscape. It’s built using durable, camouflaging materials to make the structure a continuation of the moss-covered volcanic rock that encircles it, plus has its own sustainable skincare line made from the silica, algae and minerals found here, as well as serving local, organic food in its restaurants.

Multiple waterfalls carve their way through the basalt; lagoons hide among the jagged rock formations

Locally sourced food is easy to come by in Iceland. Everything from tomatoes and cucumbers to bananas – cultivated in geothermal and solar-powered greenhouses outside Reykjavík – is grown here. The abundance of energy and water means that Friðheimar, one of the oldest greenhouses that’s a half-hour drive inland from the ring road, is able to supply 70 per cent of the country’s tomatoes. Dessert sauce, mixers, juice, chutney and pickles all come from their bumper crop. In the restaurant, tourists can enjoy the novelty of a cheesecake made from green tomato, cinnamon and lime followed by a coffee or beer infused with this surprisingly versatile ingredient.

As green as the road trip itself might be, what about the journey to get there? Carbon offsetting is often seen as an abstract, nebulous concept, but not here: Iceland leads the way on carbon capture by dissolving carbon dioxide in water and turning it into rock. It may sound like science fiction, but Carbfix is happy to bring tourists behind the curtain for a guided tour of this ground-breaking facility.

Road trippers can make a stop at the Blue Lagoon

(Blue Lagoon)

Silja Y Eyþórsdóttir from Carbfix offers an insight into Iceland’s sustainable approach, which started much earlier than other countries. “In the 1950s, Iceland decided to move away from fossil fuels for their district heating system and switched to geothermal heat, perceived as an expensive and bold move at the time. The transition came with a lot of investment in new infrastructure, and it wasn‘t easy, but it paid off in the end.”

It’s why they’ve just started building the Coda Terminal facility in west Iceland, where CO2 emissions from Northern Europe will be transported by boat to be turned to stone, providing storage for three million tonnes per year when it’s complete.

Perhaps the huldufólk are sharing their wisdom with their fellow islanders; not only is a trip around Iceland’s ring road beautiful, it could also provide a vision for the sustainable future of travel.

New WHO report reveals urgency of confronting tobacco use among women

A new report by WHO/Europe about women and the tobacco epidemic has been launched. The report, “Through a gender lens: women and tobacco in the WHO European Region”, has revealed that, although tobacco use among women is decreasing overall, the rate is going down at a much slower pace than in men, and in some countries it is increasing.

The global noncommunicable diseases action plan includes a target to reduce global prevalence of tobacco use by 30% by 2025 relative to 2010. However, estimates project the Region will miss this target entirely and will be the only WHO region in the world expected to fall short, by as much as 3.8%, of the 30% relative reduction target among women.

In light of these figures, it is important to refocus tobacco control efforts across the Region to actively confront tobacco industry attempts to hook women and girls on tobacco products and to promote gender-transformative policies as a high priority.

The tobacco industry is finding innovative ways to promote its deadly products to women, such as via social media influencers and the funding of women’s groups. Old tactics of gendered product design and packaging remain a challenge for tobacco control. Substantive action on this element of tobacco marketing is critical to tackle the high smoking rates among women and girls.

There is a pressing need for interventions that prevent the uptake of smoking among girls. The tobacco industry is actively aiming at young women and girls in a number of ways to encourage addiction to tobacco products, so early prevention is crucial. The situation is challenging: WHO estimates that 12% of girls aged 13–15 are current tobacco users in the Region – 1.5 times the global average of 8%.

Women advocates have been at the frontline of the struggle against tobacco for generations, pushing to prioritize the empowerment of women and girls in the face of the public health crisis. Margaretha Haglund has been working tirelessly for action on women and tobacco throughout her career. She was President of the International Network of Women Against Tobacco (INWAT) from 1997–2006 and has worked as an expert for thinktanks and governments, implementing women-tailored policies for tobacco prevention and cessation.

“This publication can be an important tool to inspire countries to implement gender-sensitive strategies in tobacco control,” she says. “So far, not enough countries have taken action, so inspiration is hugely important. Sharing examples of the tobacco industry’s marketing towards women and girls and information on novel products are particularly welcome.”

Significant obstacles – the tobacco industry and lack of political will

Mrs Haglund identifies 2 significant obstacles for women-focused tobacco control that she has encountered in her career: the tobacco industry itself and lack of political support for tobacco control action. “The tobacco industry uses the lack of political will to stop, delay and weaken tobacco control legislation,” she says, “The industry is gradually becoming aware that the conventional cigarette will no longer be accepted by society due to its dramatic effects on health, environment and economy. Therefore, we’re also seeing an increase in ‘pure’ nicotine products, flavoured to entice new generations into nicotine addiction.”

Mrs Haglund emphasizes a central strategy for fighting against the tobacco industry: the importance of countries ratifying and observing the WHO Framework Convention on Tobacco Control (FCTC), a treaty adopted by the World Health Assembly in 2003, in full. “There is no magic bullet to reduce smoking prevalence in women,” she says. “But all countries need the same thing: the implementation of the FCTC at its highest level.”

The WHO FCTC is a strong policy framework that covers every angle of tobacco control. One of the most significant elements of the treaty is Article 13, which advocates a comprehensive ban on tobacco advertising, promotion and sponsorship (TAPS). This is an important policy plank for countries to consider, which would close the loopholes that allow the continued promotion of tobacco products to women and girls. Nonetheless, as of 2019, only 7 countries in the Region had a comprehensive ban on all forms of direct and indirect tobacco advertising.

Protecting women from the harms of tobacco is enshrined in the WHO FCTC as a guiding principle which declares “the need to take measures to address gender-specific risks when developing tobacco control strategies” (Article 4.2.d). To support this, countries should ensure tobacco control data is gender-disaggregated, and that questions of gender are mainstreamed throughout all policy, planning and decision-making.

“Through a gender lens: women and tobacco in the WHO European Region” also highlights the need to tailor interventions to different groups of women. This means using an intersectional lens that understands that “women” is not one homogeneous group, but that women’s experiences overlap with a great number of social determinants of health and identities. Successful strategies to reduce women’s smoking prevalence are sensitive to these contexts. They are also gender-transformative and challenge – rather than reproduce – harmful gender stereotyping in their campaigns and messages.

The health situation for women and tobacco in the Region is deeply concerning: many countries are behind the curve in challenging the deadly strategies of the tobacco industry. But examples of best practice in tobacco control are readily available, and concrete steps forward can be taken to turn the tide on tobacco. With strong political will, it is possible to ensure the health and well-being of women and girls across the Region.

Can people afford to pay for health care in Moldova?

Health system reforms in the Republic of Moldova have expanded the number of people benefiting from publicly financed health care and the range of services covered. Better access has reduced unmet need for health care. However, this greater use of services has increased people’s exposure to out-of-pocket payments – for example, through co-payments for outpatient medicines. A new report released by WHO finds that around 1 in 6 households in the Republic of Moldova experiences catastrophic health spending.

Medicines – largest single driver of financial hardship

Financial hardship is heavily concentrated among poor people, pensioners and people living in rural areas. Outpatient medicines are the largest single driver of catastrophic out-of-pocket payments and their contribution to financial hardship has increased over time.

For poorer households, inpatient care is the second-largest driver of catastrophic health spending, perhaps linked to informal payments for hospital care (the use of cash or presents to secure services), which have also increased.

Financial protection undermined by gaps in coverage

The share of the population covered by the Republic of Moldova’s national health insurance fund has increased in recent years, but over 10% of the population still lacks coverage, mainly because entitlement is linked to payment of health insurance contributions. The number of people who work in the informal sector and cannot afford to pay contributions is significant.

For those who are covered by the health insurance fund, financial protection may be undermined by the limited range of publicly financed outpatient medicines, heavy co-payments for these medicines, underdeveloped strategic purchasing and the practice of informal payments.

As a result of these gaps in coverage, poorer households are at high risk of being uninsured, facing financial barriers to access and experiencing catastrophic health spending.

Pandemic demonstrates value of universal health coverage

In working to control the COVID-19 outbreak, the Republic of Moldova has used reserve funds to guarantee free hospital treatment for everyone, regardless of health insurance status. As the longer-term economic disruption caused by COVID-19 becomes more evident, this short-term measure could be turned into a permanent feature. De-linking entitlement to all health services – not just hospital care – from payment of contributions would ensure that everyone is covered.

Re-designing the coverage of outpatient medicines will also help strengthen financial protection – for example, by extending the range of outpatient medicines covered, ensuring that poor households and people with chronic conditions are exempt from co-payments and introducing a cap on co-payments for everyone.

Moving towards universal health coverage requires a commitment to steadily increasing public spending on health. This is even more important in the context of COVID-19, which demands greater public investment in health, better use of existing resources and policy responses carefully designed to reduce unmet need and financial hardship for people at risk of poverty and social exclusion.

“Universal health coverage must remain a policy objective that is central to the agenda of recovery and rebuilding in the coming months,” said Dr Natasha Azzopardi-Muscat, Director of the Division of Country Health Policies and Systems in the WHO Regional Office for Europe.