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Imperfect relief: Challenges to the impartiality and identity of humanitarian action
- Marc DuBois, Sean Healy
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- Journal:
- International Review of the Red Cross , First View
- Published online by Cambridge University Press:
- 25 March 2024, pp. 1-30
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One of the four core humanitarian principles, impartiality's substantive ethical and deeply operational nature directs aid agencies to seek and deliver aid on the basis of non-discrimination and in proportion to the needs of crisis-affected people. Designed to operationalize the principle of humanity, impartiality is challenged by a plethora of external factors, such as the instrumentalization of aid, bureaucratic restriction, obstruction by States or non-State armed groups, and insecurity. Less visible and less examined are factors internal to aid agencies or the sector as a whole. Based on a desk review of the literature and the authors’ experience working with Médecins Sans Frontières, this article explores shortcomings in how the humanitarian sector understands and operationalizes impartiality, placing the focus on these internal factors.
Beginning with the definition of impartiality, the article focuses on inadequacies in the practice of impartiality's twin pillars: non-discrimination and proportionality in the delivery of aid. Key conclusions include the necessity of an active rather than passive approach to non-discrimination, and the need for greater commitment to proportionality. In extending this analysis, the article looks more deeply at how aid organizations approach the humanitarian principles, identifying shortcomings in the way that the sector operationalizes, engages with and evaluates those principles. Given the sector's limited inclusion of or accountability towards people in crisis, its exercise of impartiality seems particularly problematic in relation to its power to decide the who and what of aid delivery, and to define the needs which it will consider humanitarian.
The objective of this article is to reset humanitarians’ conceptual and operational understanding of impartiality in order to better reflect and protect humanity in humanitarian praxis, and to help humanitarians navigate the emergent challenges and critical discussions on humanitarian action's position in respect to climate change, triple-nexus programming, or simply a future where staggering levels of urgent needs vastly outstrip humanitarian resources.
Effect of vitamin D supplementation on vitamin D status in pregnant women: findings from the MO-VITD study
- Raghad Alhomaid, Maria Mulhern, Laura Cassidy, Eamon Laird, Martin Healy, Sean Strain, Barbara Livingstone, Michael Parker, Mary McCann
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- Journal:
- Proceedings of the Nutrition Society / Volume 79 / Issue OCE2 / 2020
- Published online by Cambridge University Press:
- 10 June 2020, E99
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Pregnant women who are overweight/obese are particularly vulnerable to vitamin D insufficiency owing to higher physiological requirements and lower status (25(OH)D concentrations) associated with obesity. Achieving adequate maternal vitamin D status with current recommendations (10μg/d) remains controversial.
This study examined supplementation effects (10μg-vs-20μg vitamin D3/d) throughout pregnancy (12 weeks gestation until delivery) on vitamin D status of normal weight, overweight and obese pregnant women and on cord blood, using a double-blind randomised vitamin D intervention study (MO-VITD). 240 pregnant women were recruited throughout the year at antenatal clinics in Northern Ireland (equal numbers of normal weight (18.5–24.9 kg/m2), overweight (25–29.9 kg/m2), and obese (> 30kg/m2)). Non-fasting maternal blood samples were collected at 12, 28 and 34–36 weeks gestation and from the umbilical cord after delivery and analysed for total serum 25(OH)D using LCMS.
A high prevalence of vitamin D insufficiency (25–50nmol/L) was found in the 1st trimester in both treatment groups (41.5% and 48.8%; 10μg vs. 20μg respectively). Maternal 25(OH)D concentrations increased from the 1st to 3rd trimester in both the 10μg/d and 20μg/d groups, with a higher increase in the 20μg group (17.1 ± 24.7 and 28.8 ± 33.3nmol/L, P = 0.002). There was no difference in cord blood 25(OH)D concentrations between treatment groups.
Women who started pregnancy with insufficient 25(OH)D concentrations remained insufficient throughout pregnancy in the 10μg/d group (49.9 ± 28.2nmol/L at trimester 3). In the 20μg/d group, women starting pregnancy as insufficient achieved levels of sufficiency in the 2nd (58.9 ± 30.6nmol/L) and 3rd (64.0 ± 35.9nmol/L) trimesters. Women who started pregnancy with sufficient vitamin D status (25(OH)D > 50nmol/L), maintained levels of sufficiency throughout pregnancy irrespective of treatment group (83.1 ± 24.4 and 96.7 ± 30.7 at trimester 3 in 10μg/d and 20 μg/d groups respectively); findings were similar across all BMI categories.
Obese women who started pregnancy with an insufficient status were found to have deficient cord blood (25(OH)D < 25 nmol/L) in both the 10μg/d and 20μg/d groups (19.4 ± 20.2 vs. 19.5 ± 9.4nmol/L respectively), whilst obese women who started pregnancy with sufficient status (> 50nmol/L) had cord blood concentrations considered insufficient (40.2 ± 18.4 vs. 44.2 ± 15.6nmol/L; 10μg vs. 20μg groups respectively).
Based on our findings of the high prevalence of vitamin D insufficiency in early pregnancy, maternal vitamin D supplementation of 20μg/d is advisable to maintain maternal vitamin D status in pregnant women in Northern Ireland.
The association between maternal body weight and vitamin D status in early pregnancy: findings from the MO-VITD study
- Raghad Alhomaid, Maria Mulhern, Laura Cassidy, Eamon Laird, Martin Healy, Sean Strain, Barbara Livingstone, Michael Parker, Mary McCann
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- Journal:
- Proceedings of the Nutrition Society / Volume 79 / Issue OCE2 / 2020
- Published online by Cambridge University Press:
- 10 June 2020, E586
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Maternal BMI has been shown to be inversely correlated with vitamin D status (25-hydroxyvitamin D (25(OH)D) concentrations) during pregnancy. Pregnant women with obesity and with vitamin D deficiency are at risk of many adverse health outcomes in pregnancy.
The aim of this study was to examine differences in maternal vitamin D status across normal weight, overweight and obese pregnant women in early pregnancy.
Data collected at baseline from a double-blind randomised vitamin D intervention study (MO-VITD) were used. Pregnant women without pregnancy complications, aged > 18 years and having a singleton pregnancy were recruited between January 2016 and August 2017 at antenatal clinics in the Western Health and Social Care Trust, Northern Ireland. Non-fasting blood samples were collected at 12 weeks gestation and analysed for total serum 25(OH)D, using liquid chromatography tandem mass spectrometry. Data from 239 pregnant women (80 normal weight, 79 overweight, 80 obese) were included in the current analysis.
The mean ± SD 25(OH)D concentration of all pregnant women at 12 weeks gestation was 52.0 ± 21.6 nmol/L. Women classed as obese or overweight had significantly lower 25(OH)D concentrations compared to women of normal weight (48.8 ± 20.3 vs 49.8 ± 20.4 vs. 57.5 ± 23.1 nmol/L, P = 0.019; obese, overweight, normal weight respectively). A total of 45% of all pregnant women were found to be either vitamin D deficient (25(OH)D < 25nmol/L; 13%) or insufficient (25–50 nmol/L; 32%) in early pregnancy. BMI was significantly negatively correlated with 25(OH)D concentrations (r = -0.168; P = 0.009). Regression analyses showed that BMI (β = -0.165; P = 0.006), season (β = 0.220; P = < 0.0001), supplement use (β = -0.268; P < 0.0001) and a sun holiday within the previous 6 months (β = -0.180; P = 0.010) were significant predictors of 25(OH)D concentrations. In early pregnancy, 62% of pregnant women reported using a supplement containing vitamin D and 38% reported no supplement use. Supplement users had a significantly higher vitamin D status than non-supplement users in all BMI categories but overall, 37% of supplement users were still classified as vitamin D insufficient. Vitamin D status was significantly lower in winter months compared to summer months. In early pregnancy, especially during winter months, pregnant women with obesity, particularly non-supplement users, are at higher risk of low vitamin D status. Based on the lower vitamin D status observed in early pregnancy in obese women, the effect of BMI on vitamin D supplementation throughout pregnancy needs to be examined.
From Concept to Green Paper: Putting Basic Income on the Agenda in Ireland
- Robbert-Jan van der Veen, Loek Groot
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- Book:
- Basic Income on the Agenda
- Published by:
- Amsterdam University Press
- Published online:
- 23 January 2021
- Print publication:
- 01 January 2000, pp 238-246
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Summary
A Recognized Failure?
The Irish social welfare system was designed to operate in a world which is no longer relevant today. This ‘Beveridge’ system can work well when:
– full employment (for men) is the norm
– women's labour force participation is low
– unemployment, when it occurs, is of short duration
– social welfare payments act simply as a transition mechanism to support people – during short-term illness or unemployment
– employment is usually full-time at relatively good pay rates
– jobs are permanent.
These were the basic assumptions which underpinned the social welfare system when it was originally designed. The end result is a complex and inadequate system which is now failing to meet the needs of the people trapped within it. Today, society is less homogenous than heretofore. We experience rapid technology change, increasing selfemployment, atypical work and fluctuating incomes. There is increasing complexity in household responsibilities and relationships.These need to be catered for by our system of taxation and income distribution. However, the existing tax and social welfare systems suffer from many disadvantages, which have been widely recognized, including:
– Unemployment traps: where net income when unemployed is higher or almost as high as net household income in work. Moreover, we have seen, over the past two decades, the ridiculous situation where unemployed people must do nothing and always keep themselves available for non-existent jobs, if they are to receive their social welfare payments. – Poverty traps: where an individual at work receives a pay increase, net household income either declines or rises by only a small amount.
– Its heavy emphasis on conditionality has contributed in large measure to the downgrading of areas of work for which payment is not made or received (e.g. work in the community, in the voluntary sector, in the home, etc.).
– Complexity: where citizens are unsure of the effects on household income of decisions regarding work, marriage, family size, etc.
– Policy inflexibility: it is difficult to modify the existing systems to increase the incomes of the poorest households (who do not have ‘proper’ jobs), without simultaneously decreasing work incentives.
These disadvantages are unintended consequences of the current tax and welfare system. Several changes were introduced over the years with a view to addressing particular difficulties.