Feeds:
Posts
Comments

Archive for June, 2023

Dr Natalie Daley, Co-Chair of the Faculty of Public Health’s Sexual and Reproductive Health Special Interest Group

June is Pride Month, an opportunity for the LGBTQ+ community and its allies to celebrate the influence and contributions of LGBTQ+ people in our society. However, it is also a chance to reflect on the significant discrimination they continue to face and the adverse impact this has on their health.

The sexual and reproductive health inequalities faced by gay, bisexual and other men who have sex with men (GBMSM) are well documented. However, a population whose sexual and reproductive health needs are poorly understood and frequently overlooked are women who have sex with women (WSW). Research into the sexual health of WSW is limited1 and this group has frequently been perceived as low risk for sexually transmitted infections (STIs)2.

However, newly released data from the UK Health Security Agency shows that rates of chlamydia diagnoses have increased from 90.6 per 100,000 in 2018 to 221.8 per 100,000 in 2022. Over the same period, similar patterns are seen for gonorrhoea and herpes, rising from 51.2 to 174.6 per 100,000 and 45.7 to 124.1 per 100,000 respectively3. Despite evidence that bisexual women are twice as likely to develop cervical cancer, WSW have typically not been the focus of cervical screening initiatives4.

There are a number of factors that are likely to be contributing to increasing rates of STI diagnoses, poor outcomes in other aspects of sexual and reproductive health, and limited understanding of the needs of WSW. These include:

  • Misinformation – a parliamentary enquiry into health and social care and the LGBT community was told that many women who exclusively have sex with women had been told incorrectly by healthcare professionals that they do not need to be screened for cervical cancer5
  • Lack of perceived risk – women themselves, as well as the healthcare professionals looking after them, may perceive their risk of contracting STIs as low1,6.
  • Poor access to services – lesbian and bisexual women have been found to be much less likely to go for cervical screening than heterosexual women5. This may in part be related to having been told that they do not need to be screened.
  • Heteronormative attitudes towards health promotion – despite WSW, including those who exclusively have sex with other women, being at risk of STIs, primary prevention initiatives focus on the use of condoms, with little reference to dental dams7.
  • Discrimination – a parliamentary enquiry heard evidence that a large proportion of frontline workers in health and social care did not consider a person’s sexual orientation to be relevant to their needs5.

It is clear that more needs to be done to understand and adequately address the sexual and reproductive health needs of WSW. This should include:

  • Improved training for healthcare staff to increase their understanding of the sexual and reproductive health needs of WSW and reduce misinformation.
  • More health promotion initiatives focused on the sexual and reproductive health needs of WSW and incorporation of specific messaging into broader campaigns on women’s and LGBTQ+ sexual and reproductive health.
  • Better representation of WSW in sexual and reproductive health research.
  • Ensuring that healthcare services are LGBTQ+ inclusive, with the specific needs of WSW explicitly addressed.

The Faculty of Public Health’s Sexual and Reproductive Health Special Interest Group will continue to take advantage of opportunities to raise awareness of these issues and seeks to work with partners to address them.

FOOTNOTES

[1] https://www.sciencedirect.com/science/article/pii/S0213911122000334#bib0190

[2] https://sti.bmj.com/content/76/5/345

[3] https://www.gov.uk/government/statistics/sexually-transmitted-infections-stis-annual-data-tables

[4] http://data.parliament.uk/writtenevidence/committeeevidence.svc/evidencedocument/women-and-equalities-committee/health-and-social-care-and-lgbt-communities/written/91084.html

[5] https://publications.parliament.uk/pa/cm201919/cmselect/cmwomeq/94/9406.htm

[6] https://www.fsrh.org/documents/a-hidden-population-what-are-the-sexual-health-needs-of-women/

[7] https://www.tht.org.uk/sites/default/files/2020-02/State%20of%20The%20nation%20Report.pdf

Read Full Post »

Hadjer Nacer and Isobel Braithwaite, on behalf of the Faculty of Public Health’s Africa and Sustainable Development Special Interest Groups. Originally published on People’s Health Tribunal.

Background – about the People’s Health Tribunal

The People’s Health Tribunal is a collaborative initiative, involving the People’s Health Movement, Medact, Race & Health, Tipping Point, We the People Nigeria, Muslims for Human Rights (MUHURI), and StopEACOP, alongside other organisations and individuals, bringing together some of the communities in Africa that have been affected by the extractive activities of these companies and uniting their voices, which formed part of a longer-term process following on from the People’s Health Hearing at COP26. The tribunal process itself – taking the explicit form of mock class action suits, and adopting a radical reparative justice lens – was developed over a year of co-creation work, guided by African organisers. It delivered a verdict from a panel of judges – experienced indigenous and environmental justice leaders, aiming to build North-South solidarity in demanding reparative justice. By sharing how extraction has caused harm to their health, their communities, and their land, participants are collectively working towards holding fossil fuel corporations to account. 

It ran over two sessions on May 13th and 20th, with recordings available here. The testimonies were interpreted into 6 languages, reflecting the principle of language justice that the Tribunal’s organisers sought to centre, alongside broader principles of access, care and inclusion. Over an emotionally impactful and at times harrowing 5-hour session, people from the Niger Delta, South Africa, Mozambique and Uganda shared testimonies from direct and indirect lived experience of these corporations’ impacts on their health and their communities, outlined in detail below.

Key takeaways and reflections

The enormous profits of fossil fuel companies like Shell and Total ($39.9 and $36.2 billion per year respectively in 2022) come at the expense of the health and wellbeing of the people living on the frontlines of extraction, as well as contributing towards energy poverty and ill health in Global North countries like the UK. The Tribunal testimonies made us reflect on the extent of the damage that is being caused to the people living closest to sites of fossil fuel extraction and the many forms that this violence takes, including what Paul Farmer termed ‘structural violence’. 

The health impacts we heard about are multi-faceted and cumulative. They included:

  • Direct health harms from environmental pollution, and from climate-related extreme weather events such as flooding, drought and heatwaves;
  • Psychological distress and indirect physical health harms due to loss of livelihood, income, food insecurity and loss of community identity;
  • Psychological distress and physical health harms from displacement, conflict and/or the use of police or (para/)military force against civilians to protect corporate interests;
  • Psychological distress and indirect physical health harms due to the repeated disempowerment of individuals and communities.

One theme that came out repeatedly from the testimonies was how both Shell and Total have exploited problematic power dynamics or other inequalities that are already present in these settings and inherent in their colonial histories, whilst often also exacerbating them (from conflict and instability, to misogyny, to poor governance/corruption) in order to gain access for their extractive practices and maximise profits. Vulnerable groups will continue to be impacted the worst, including women, children and minoritised groups, unless they are held to account.

There is a need to shine a light on the health impacts of fossil fuel companies’ actions, including by giving more of a voice to those directly affected, as the Tribunal’s organisers have carefully sought to do. We argue that the public health community, acting with principles of solidarity and decolonisation in mind, must help to stand with those affected in demanding justice, and exposing the racist practices of the fossil fuel industry. Africa is one of the regions hardest hit by the dual impacts of extraction and climate change, however African voices are seldom heard and hardly represented in the international area, risking exclusion and leaving climate justice out of the equation. For example, when it comes to climate litigation against private sector actors, unsurprisingly, fossil fuel companies head the list of the most frequent defendants1. The majority of this activity is impacting communities in the Global South, yet most of the cases are filed in the US, Australia and Europe2.

The Faculty of Public Health’s Global Health and Climate and Health Committees advocate for public health approaches to global health challenges. The tribunal demonstrates the extensive impact of political, commercial and legal decisions (or lack thereof) on the health of communities living close to extraction sites. It also shows the importance of the global public health community supporting the work of building diverse and powerful coalitions with those most impacted by these crises. Both committees’ strategies aim to facilitate FPH members to form alliances with partners globally to collaborate and coordinate, and the Tribunal offers an example of such a collaborative way of working between many groups, across multiple countries. The Tribunal brought together global partners and building stronger links with this movement should offer an opportunity for the FPH’s global networks working on issues of climate, health and justice to further their work, in solidarity with communities on the frontlines of both climate change and the direct harms of extractive industries.

Testimonies from the Tribunal:

Total: Mozambique and Uganda

In the first session, we heard emotional and powerful testimonies from communities in Uganda and Mozambique on how Total is impacting the social and economic functioning of communities. Omar, from Muslims for Human Rights (MuHuRi) explained how Total is exploiting its former colonies and its communities, causing displacement, ecological damage and is associated with serious international human rights abuses. We heard stories of displacement, dispossession and emotional impact from Rabia Issa from Mozambique who spent her life farming and was forced to move to a new area: “I’ve spent my whole life in farming, and when Anadarko (Anadarko Petroleum Corporation, a subcontractor employed by Total) arrived, I was told to move. I didn’t want to move to Quitanda. I lost all my stuff, my assets were included in the price of the land, which my husband deemed to own, despite my hard work cultivating it. I’m still crying until today, everyone knows that I didn’t benefit from the machambas. I refuse to go to quitendo, my heart doesn’t go there”. 

We also heard from people who were displaced multiple times from the Maganja community, after spending their whole life farming and fishing. They were promised compensation and land, which they never received. In the words of two of the testimony-givers:

“Since I arrived in Paloma, Total started resettling people in Quitinda. I didn’t want to go there, we don’t see any advantage. None of the promises have been fulfilled. We practised agriculture and fishery all our lives, we lived close to the sea, our fields and our fishing have been lost. We didn’t receive any compensation, and now when we call them, they take a long time to respond.”

“I’m from Quitopo, my mother and father were from Quitopo, I arrived in Milamba when I got married, up until this age, my life is farming (machambas)”.

Total created a socio-economic disaster in Mozambique; it brought suffering, and destroyed the lives of people. Fishing communities who lived by the water for generations, were displaced with no access to sea, and farmers were given smaller remplacement lands. The climate impact of the extraction is impacting fish, flora and fauna. Mozambique has faced horrific violence since 2017 and Total energies was aware of this when they took on the project and exploited the politically unsettled context; however, due to ongoing violence, they are now planning to pull out of the project without paying compensation that had been promised, citing ‘force majeure’. The gas industry has also played an important role in the recent political issues and conflict in Mozambique, which has led to the displacement of 1 million people. Yet in a country that holds substantial gas reserves, only 30% of its population have access to electricity. 

We also heard from communities in Uganda, where Total is leading the development of the East African Crude Oil Pipeline (EACOP). This will transport crude oil 1400km from Uganda to Tanzania, crossing indigenous lands and sensitive ecosystems. Mugisha narrated how his family of 9 was forcibly displaced by a sub-contractor of Total, to make way for the EACOP pipeline. When he testified against Total in France, he was arrested on his return to Uganda and subsequently taken to court, but the judges ruled in favor of Total. They wrote several times to Total and the Uganda Human Rights commission on the extraction’s impact on their families, and didn’t receive any response. The Ugandan government’s issuance of Land Acquisition Notices in 2019 led to c.14,000 households being displaced, and we heard how this has also led to significant impoverishment, including a ‘proliferation of famine, poverty and family breakage3’.

Shell: Niger Delta and South Africa 

We heard from Onwuli Stanley Nneji, a member of the Umuechem community in the Niger Delta, regarding Shell’s long-standing extractive activities in the Niger Delta – dating back to 1957. He told the shocking story of how, after decades of seeing very little done for their communities despite the ongoing extraction, when they demanded in the 1980s that Shell do more for communities such as Umuechem, they faced first ‘lies’ and violent repression.

In Mr. Nneji’s words: ‘All through this time (1957 to 1981), there was nothing to show for Shell’s existence. So around 81 or 82, we started calling on Shell to discuss the community’s affairs. Because both Shell and the government paid no attention to Umuechem community. Each time we go to Shell – about 3 or 4 times a year – they feed us a basket full of lies … They make you promises they can never dream to fulfil. … We were calling on them until 1989, when we saw that there is nothing we can do to bring the attention of Shell. In 1989 … we started making contact with people who knew better than us, because Umuechem community at that time had no voice. We found out there was nothing we could do other than to hold Shell down, and we held a protest. Because of that protest they called us – me – many different names. We were asking their public and government affairs manager to come and see Umeachem for himself, so that he will know where they are extracting their oil from. Their response was to send three truckloads of mobile policemen, armed to the teeth, to come and shoot down Umuechem community. They were shooting at will.” He also described how they worked to ensure that the massacre was covered in the international media, including the New York Times.

Ibegwera Precious talked about the devastating health and wider impacts of the repeated flooding that the Niger Delta has been experiencing due to climate disruption, which she described have now been occurring each year since 2012. She told us that a particularly devastating flood in 2022 killed over 600 people and displaced more than 1 million people:

‘Flooding is the impact of climate change that we feel most in the Niger Delta… it causes loss of life, loss of property, damage to the schools, children falling behind as they have to stay at home from school every 3 months. … That’s how it has been until 2022 when we had the greatest flood which almost wiped us away. … The Niger Delta was the worst hit – houses submerged so you couldn’t even see the roofs, hospitals, schools, roads submerged. … Families and children on the road in their tents for almost four months. Those whose community was totally submerged … were taken to unprepared IDP (internally displaced person) camps. (They were) not well kept, not hygienic. People were dumped … no good water to drink because all the water was polluted. No food for people to eat, no good medical attention, no government attention. … 400 people all using the same toilet. You see children falling ill every day because of the conditions… In that same condition pregnant women were giving birth. … Government people they just dumped us there and they left us to suffer.” 

“The worst part is our crops got destroyed and most of us had paid for them with government loans. So now… we are also in debt. Our livelihood, everything got destroyed. The flood has come and gone, but the impacts are still there. … Poverty is on the increase. If you are able to see a meal in a day, you are lucky. Even after the flood, every day lives are lost because of hunger and starvation. And we are sure the flood is coming again. It did not used to be like this before the oil companies came.”

This situation illustrates the ‘double jeopardy’ that Ken Henshaw (We The People Nigeria) had described – not only are the people of the Niger Delta facing the direct harms of their water sources being polluted and their ecosystems damaged by oil extraction, and the potential health impacts of ongoing gas flaring around them, but they are now also facing climate impacts (like unprecedented flooding) that are largely driven by fossil fuel companies’ activities.

We also heard a powerful story of resistance – again in the context of the climate disruption that communities are already seeing – from Nonhle Mbuthuma, a spokesperson for Amadiba Crisis Committee. Nonhle lives on the exceptionally biodiverse Wild Coast in South Africa. Shell has been trying to explore a 300km-long stretch of this coast for new offshore oil and gas sites with a seismic survey that according to campaigners would have involved “extremely loud” shock waves into the ocean every 10 seconds, 24 hours a day for five months. 

Nonhle explained that Amadiba Crisis Committee has been fighting Shell’s plans due to their health and food security concerns, as well as the climate impacts they already see:

“We just see that it is quite a big threat for our food and health… because the plan for Shell was to blast the ocean… many fishes will die; and we also know that when they start to drill, there will be quite a lot of oil spills – life is completely dead. … We organised ourselves, all the coastal communities, to make sure it was not only the coastal communities, but also South Africa as a whole. It is a threat to our food security as we are experiencing with the climate crisis right now – changing of seasons, we don’t know when is summer any more – huge floods and also thunderstorms, everything is turned upside down. We cannot allow something that is also going to contribute to the climate crisis that we are already experiencing. That is why we said to Shell – what they are bringing there is not development but it is destruction.”

The verdict:

The Tribunal verdict, delivered by the judges (movement leaders Nnimmo Bassey, Dimah Mahmoud, Kanahus Michael, Jacqui Patterson) is overall located within 6 guiding principles, each described in more depth at the link above. These are: accountability to affected communities;  health, understood in its most expansive sense; land, language and liberation; limitations of international apparatuses; dismantling of hegemonic systems of power; and new practices of world making. 

The Tribunal found Shell “guilty for its activities in the Niger Delta and in South Africa” and Total “guilty for its activities in Mozambique and in Uganda” both to be “extremely harmful to the livelihoods, health, right to shelter, quality of life, right to live in dignity, quality of environment, right to live free of discrimination and oppression, right to clean water, and right to self-determination of the impacted communities”.

They also found “the Governments of the United Kingdom, Netherlands and France guilty for supporting and promoting the egregiously harmful and irresponsible oil and gas investment and extractivism in Sub-Saharan Africa.”  And they found the Governments of Mozambique, South Africa, Uganda, and Nigeria “guilty of being complicit and irresponsible for failing to establish and enforce legislation, regulations, and monitoring and enforcement to protect the rights of (their) people”.

They also make a series of specific demands/recommendations to Shell and Total, including calling for an end to fossil fuel extraction and exploration, and to collusion with and funding of military and paramilitary groups, and deployment of private security forces, as well as for reparative and health justice, repairing the impacts of forced displacement, clean-up and remediation of local territories, and realising the demands of local campaigns, including stopping the EACOP pipeline. The full list of demands, including to other Governments and multilateral institutions, and to movements, can be read here. The Tribunal was also followed by two grassroots actions in London, highlighting the health impacts communities are experiencing and the verdict, at the Africa Energy Summit and Shell’s AGM.

How can you take action?

  • Contact Izzy or Abi to get involved in the FPH sustainability SIG’s fossil fuel proactive advocacy workstream, and help shape public health advocacy and action in relation to some of the issues outlined in this blog.
  • Join the FPH Africa SIG to get involved in and support their work.

FOOTNOTES

1 Catherine Higham. 3/3/2022. Taking companies to court over climate change: who is being targeted? Commentary for LSE Business Review: https://www.lse.ac.uk/granthaminstitute/news/taking-companies-to-court-over-climate-change-who-is-being-targeted/

2 Ole W. Pedersen. 4/4/2023. Climate Change hearings and the ECtHR. EJIL:Talk! Blog of the European Journal of International Law  https://www.ejiltalk.org/climate-change-hearings-and-the-ecthr/

3 https://peopleshealthhearing.org/verdict/

Read Full Post »