In 2020 the United Nations Committee on Economic, Social and Cultural Rights published its 25th General Comment on the right to enjoy the benefits of scientific progress (REBSP). The General Comment describes the normative content of the right, including the obligations of the state and the entitlements of rights holders. It addressed the major gap in the REBSP, which was the lack of internationally-accepted interpretations of what the right entails. This article aims to shed light on the REBSP, and to demonstrate how it can be applied to advance public health. The article argues that the application of the REBSP requires a balancing act between the rights of researchers or scientists and the rights of users of the scientific knowledge they generate. It further argues that, when applied to health, the REBSP has the potential to improve access to better prevention, diagnosis and treatment of diseases, and could draw attention to neglected diseases, which mostly affect developing countries.

CONTEXTE: La recherche en santé peut jouer un rôle essentiel dans le renforcement des systèmes de santé. Cependant, il y a peu de suivi sur les recherches en santé dans les pays africains pour déterminer si la recherche contribue à donner suite aux priorités en matière de santé. OBJECTIF/ LIEU: Revoir la recherche sur la plateforme des services sanitaires dans la province du Western Cape d'Afrique du Sud, approuvée par les autorités sanitaires pour la période allant du mois de janvier 2011 au mois de décembre 2012. MÉTHODES: On a révisé les banques de données des départements sanitaires de la Province et de la ville du Cap. On a aussi analysé la description des instituts de recherche, les lieux de recherche, les thèmes et le montant et la source des financements. RÉSULTATS: Parmi la recherche sanitaire approuvée dans la province, 56% des projets des Services de Santé de District, et 70% de ceux-ci se trouvaient dans la zone métropolitaine. Le financement total des informations budgétaires relatives aux projets était de 29.2 millions d'USD. La recherche portait principalement sur le VIH et la tuberculose; alors qu'il y avait relativement peu d'études sur la nutrition, la santé mentale ou les blessures et peu de recherches sur les systèmes de santé. Le financement de la recherche était dominé par les subventions importantes des bailleurs de fonds étrangers pour la recherche sur le VIH/la tuberculose. Les sources provenant du gouvernement sud-africain s'élevaient à moins de 8% de tous les financements de recherche en santé. CONCLUSION: Il y a un certain décalage dans le financement des bailleurs de fonds pour les priorités locales en matière de santé. Il conviendrait d'insister d'avantage sur les domaines négligés tels que la santé mentale, le traumatisme, la nutrition et les maladies non contagieuses, et aussi de s'investir plus dans la recherche sur les systèmes de santé. A moins que les gouvernements n'augmentent le financement de la recherche et sa valorisation, la recherche dans le domaine de la santé aura un effet limité sur les priorités locales et nationales.

BACKGROUND: Health research can play a critical role in strengthening health systems. However, little monitoring of health research is conducted in African countries to identify whether research contributes to addressing local health priorities. AIM/SETTING: To review the profile of research on the health service platform in the Western Cape province of South Africa which was approved by the health authorities over the period January 2011 to December 2012. METHODS: Databases held by both the Provincial and City of Cape Town health departments were reviewed. Descriptions of research institution, location of research, topic and funding size and source were analysed. RESULTS: Of the health research approved in the province, 56% of projects were located on the District Health Services platform and 70% were based in the Cape Metropolitan area. For projects reporting budgetary information, the total funding was US $29.2 million. The primary focus of research was on HIV and tuberculosis (TB), whilst relatively few studies addressed nutrition, mental health or injury and there was little health systems research. Research funding was dominated by very large grants from foreign funders for HIV and/or TB research. South African government sources comprised less than 8% of all health research funding. CONCLUSION: There is a partial mismatch of donor funding to local health priorities. Greater focus on neglected areas such as mental health, trauma, nutrition and non-communicable disease, as well as greater investment in health systems research, is needed. Unless governments increase funding for research and a culture of research translation is achieved, health research will have limited impact on both local and national priorities.

Evidence from burden of disease and economic costing studies amply indicate that the public health burden from hazardous and harmful use of alcohol in South Africa warrants drastic action. Evidence that banning alcohol advertising is likely to be an effective intervention is reflected in WHO strategy documents on non-communicable diseases and harmful use of alcohol. Studies on young people furthermore support arguments refuting the claim that advertising only influences brand choice. Given the weakness of relying on industry self-regulation, the government is considering legislation to ban alcohol advertising, resulting in heated debate. Tobacco control and studies investigating the effect of alcohol advertising bans on consumption and alcohol-related deaths point to the effectiveness of such action - ideally supplemented by other policy interventions. Arguments against an advertising ban include possible communication sector job losses, but these are likely to have been exaggerated. Banning alcohol advertising will necessitate greater scrutiny of digital media, satellite television and merchandising to reduce the likelihood of subverting the ban.

Alcohol is the third leading contributor to death and disability in South Africa, where SABMiller is the major supplier of malt beer, the most popular beverage consumed. The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) has recently included SABMiller as a recipient of funding for an education intervention aimed at minimizing alcohol-related harm, including HIV prevention, among men in drinking establishments. Global Fund support for this initiative is cause for concern. It is debatable whether these men are the best target group for the intervention, whether a drinking establishment is the best location, and whether the educational intervention itself is effective. Our experience is that the liquor industry is inclined to support alcohol interventions that will not affect drinking rates at a population level. These interventions allow the industry to simultaneously fulfil social and legal obligations to address the harmful use of alcohol while ensuring that sales and profits are maintained. Providing funding for a highly profitable industry that could afford to fund its own interventions also reduces the funds available for less well-resourced organizations. Do we take it that the problem of "corporate capture" has now spread to one of the largest health funders in the world?

El alcohol es la tercera causa de muerte y discapacidad en Sudáfrica, donde SABMiller es el principal proveedor de cerveza de malta, la bebida más popular. El Fondo Mundial de lucha contra el SIDA, la tuberculosis y la malaria (Fondo Mundial) ha incluido hace poco a SABMiller como receptor de fondos para una intervención de carácter educativo con el objetivo de minimizar los daños relacionados con el alcohol, incluida la prevención del SIDA, entre hombres en bares. El apoyo del Fondo Mundial a esta iniciativa es motivo de preocupación. Es discutible si esas personas son el mejor grupo objetivo para la intervención, si un bar es el lugar más adecuado y si la intervención educativa en sí es efectiva. Nuestra experiencia nos dice que la industria del alcohol tiende a apoyar intervenciones sobre bebidas alcohólicas que no afectan a las tasas de consumo a nivel de la población. Dichas intervenciones permiten a la industria cumplir con las obligaciones sociales y legales para abordar el consumo perjudicial del alcohol al tiempo que se aseguran las ventas y los beneficios. Proporcionar fondos a una industria con grandes beneficios que podría financiarse sus propias intervenciones reduce también la cantidad de fondos disponibles para organizaciones con menos recursos. ¿Tendremos que asumir que el problema de «captación empresarial» se ha propagado a uno de los mayores financiadores en el ámbito de la salud del mundo?

L'alcool est la troisième cause de décès et et d'invalidité en Afrique du Sud, pays dans lequel SABMiller est le principal fournisseur de bière de malt, la boisson la plus consommée dans le pays. Le Fonds mondial de lutte contre le SIDA, la tuberculose et le paludisme (Fonds mondial) a récemment ajouté la société SABMiller à la liste des bénéficiaires du financement d'une intervention pédagogique visant à réduire les dommages liés à l'alcool, notamment la prévention du VIH, chez les hommes fréquentant les bars. Le soutien de cette initiative par le Fonds mondial est préoccupant. On est en droit de se demander si ces hommes sont le meilleur groupe cible pour l'intervention, si un bar est le meilleur endroit et si l'intervention pédagogique elle-même est efficace. L'expérience dont nous disposons montre que l'industrie des boissons alcoolisées est disposée à soutenir des interventions liées à l'alcool tant qu'elles sont sans incidence sur les taux de consommation d'alcool au niveau de la population. Ces interventions permettent à cette industrie de remplir ses obligations sociales et légales en matière de consommation nocive d'alcool, tout en s'assurant que ses ventes et ses bénéfices n'en sont pas affectés. Offrir un financement à une industrie hautement rentable et capable de financer ses propres interventions réduit en outre les fonds disponibles aux organisations moins bien nanties. Devons-nous en déduire que le problème de la «capture d'entreprise» s'étend désormais à l'un des plus grands bailleurs de fonds mondiaux dans le domaine de la santé?

Current maternal alcohol consumption, especially binge drinking, is strongly associated with childhood behavioural and/or developmental disorders (BDDs) in a population attending tertiary hospital ambulatory services. BDDs were also associated with maternal alcohol use 6 months before pregnancy. An association with BDDs could not be conclusively demonstrated for drinking during pregnancy, but this may have been influenced by underreporting and reduced study power due to misclassification of exposure. We cannot rule out the a priori suspicion that some mild BDDs in children in the Western Cape could be undiagnosed fetal alcohol spectrum disorder. Nonetheless, the study highlighted the important impact of current maternal alcohol use on behaviour and development of children. Future research on the impact of maternal alcohol use on childhood development should include examination of environmental and social factors contributing to this increased risk. Upstream interventions aimed at reducing alcohol-related harms may also contribute to reducing the burden of BDDs.

OBJECTIVE: To assess and compare the extent of high-risk drinking and factors associated with high-risk drinking in the adult female population of a rural and an urban region in South Africa. DESIGN: Cross-sectional household survey using multistage sampling methods. SETTING: A rural wine farming area of the Western Cape and an urban site in Gauteng. SUBJECTS: Women of reproductive age (18 - 44 years). Outcome measures. The extent of risky alcohol consumption measured using the Alcohol Use Disorders Identification Test (AUDIT) scale which categorises current drinkers into highand low-risk drinkers. RESULTS: Twenty-seven per cent (166/606) and 46% (188/412) of the women interviewed in Gauteng and the Western Cape respectively were current drinkers. In turn, 20% (33/166) of the Gauteng current drinkers and 68% (128/188) of the Western Cape current drinkers were classified as high-risk drinkers. Multivariate analysis indicated that employed people in Gauteng were less likely to be high-risk drinkers (odds ratio (OR) 0.3, 95% confidence interval (CI) 0.1 - 0.8). Living in a household that never/seldom went hungry was inversely associated with risky drinking for both sites (OR 0.3, 95% CI 0.1 - 0.9 for Gauteng and OR 0.2, 95% CI 0.3 - 1.2 for the Western Cape). Current smokers (Western Cape) (OR 7.6, 95% CI 3.1 - 18.9) and respondents with an alcohol problem in one or more family members (both sites) (OR 6.0, 95% CI 2.3 - 15.7 and OR 3.1, 95% CI 1.5 - 6.4) were more likely to be high-risk drinkers. CONCLUSIONS: High-risk drinking by women is a major problem, especially in the Western Cape. Targeted interventions are needed for women with alcohol problems in the family setting, lower socio-economic status, and concurrent substance abuse.

BACKGROUND: As part of a larger dermatological investigation undertaken in 1999 - 2001 involving the Department of Dermatology, Groote Schuur Hospital (Cape Town, South Africa) and Nottingham University (UK), household pesticide use was investigated among Xhosa-speaking families living in three areas in South Africa (a rural area, an urban township and an informal settlement). OBJECTIVES: The aim was to characterise pesticide use patterns and potential exposures through skin absorption, ingestion and inhalation for this group of South African children. METHODS: A standardised questionnaire, which included a section investigating household pesticide use, was administered by four trained fieldworkers to the parents/guardians of the 740 children (25%) aged between 3 and 11 years identified as having atopic dermatitis either by clinical examination or according to the UK criteria (rural N=387, urban N=292, informal N=61). RESULTS: Of the children with atopic dermatitis, 539 (73%) had been exposed to household pesticides. Most childhood exposure (89%) occurred in the informal settlements, followed by 78% in the urban area and 63% in the rural area. CONCLUSIONS: This research highlighted considerable home environment pesticide exposure of South African children in lower socio-economic groups in rural, urban and informal areas. As children are particularly vulnerable to the short- and long-term health effects of pesticide exposure, further indepth investigation is needed to ascertain and document the health effects associated with such exposure in the home.

This article explores the relevance of international human rights law in the response to the HIV/AIDS epidemic at national and international levels. Public health advocates can use arguments based on this body of law to promote responses to HIV/AIDS that reflect sound public health principles and documented best practice. Development assistance is increasingly linked to rights-based approaches, such as participatory processes, and strategic alliances between health professionals, organizations of people living with HIV/AIDS, and affected communities. Legal and human rights advocacy strategies are increasingly productive and necessary.

En este artículo se analiza la pertinencia de la legislación internacional en materia de derechos humanos en la respuesta a la epidemia de VIH y SIDA a nivel nacional e internacional. Los defensores de la salud pública pueden usar argumentos basados en este cuerpo de leyes para promover respuestas contra el VIH y el SIDA que reflejen unos principios sólidos de salud pública y las mejores prácticas documentadas. La asistencia para el desarrollo está cada vez más ligada a enfoques basados en derechos, como los procesos participativos, y a alianzas estratégicas entre los profesionales de la salud, las organizaciones de personas que viven con el VIH y el SIDA y las comunidades afectadas. Las estrategias jurídicas y de defensa de los derechos humanos son cada vez más eficaces y necesarias.

Le présent article pose la question du rôle des règles internationales en matière de droits de l'homme face à l'épidémie de VIH et de SIDA aux niveaux national et international. Les défenseurs de la santé publique peuvent puiser dans cet ensemble de lois les arguments qu'ils utilisent pour promouvoir des interventions destinées à combattre l'infection à VIH et le SIDA qui reflètent de solides principes de santé publique et les meilleures pratiques établies. L'aide au développement est de plus en plus liée à des démarches fondées sur les droits, comme les processus participatifs, et à des alliances stratégiques entre professionnels de santé, organisations et personnes vivant avec le VIH et le SIDA, et communautés affectées. Les stratégies à base juridique, notamment en matière de défense des droits de l'homme, sont de plus en plus développées tout autant que nécessaires.