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  • The median standardised inclusion score

    2019-06-20

    The median standardised inclusion score for the 70 countries reviewed was 1·53 (IQR 0·63–2·09), corresponding to a reasonable level of inclusion. Countries showing best practice (score of 4) were Moldova, Ghana, Serbia, and the Dominican Republic. 20 countries (29%) showed strong inclusion, 25 countries (36%) had a reasonable level of inclusion, and 15 countries (21%) showed limited inclusion. Ten countries scored for having no evidence of consultations (or of reports, in three cases), effectively excluding their marginalised people from the global process (, ). The best performers for external inclusion used a priori strategies such as literature reviews or indices to identify additional marginalised groups beyond those suggested by the UNDG, such as undocumented Coenzyme Q10 workers and children living on the street. High performers sensitised marginalised groups using mass media campaigns and consulted them in their communities with civil society organisations (CSO). Poor performers generally held large conferences in the capital city and invited CSO representatives rather than the marginalised people themselves, or used randomised national samples instead of targeted efforts with under-represented communities. These consultations had low attendance, especially by marginalised groups.
    As the World Bank reflects on its annual autumn meetings with the International Monetary Fund (Oct 10–12, 2014), it might want to include lessons to be learned from the groundbreaking public disclosure of Google and other global technology companies about their racial inequalities in staffing. With reportedly only four African Americans employed out of more than 1000 staff of professional grade (levels 25+) working for the World Bank, and with the institution refusing to divulge its Coenzyme Q10 data, perhaps it can learn from Silicon Valley. Taking their lead from Google, companies such as Apple, Twitter, Yahoo, Facebook, and LinkedIn embraced transparency and reported their racial and gender diversity online in summer, 2014. Under US law, major employers are only required to report their data to the Equal Employment Opportunity Commission; they are not obliged to make them public. These companies took the view that, no matter how bad the inequality, full disclosure is an important first step to close the diversity gap. Over the years, the World Bank has launched a range of measures aimed at improving racial diversity such as the racial equality programme in 1998, an office of diversity programmes in 2001, the diversity and inclusion leadership awards in 2003, a newsletter, and, in 2009, a code of conduct. What the Bank has not done is take the needed first step and become transparent. As Google\'s blog concluded about racial inequalities “it\'s hard to address these kinds of challenges if you\'re not prepared to discuss them openly, and with the facts.” Inequalities at the World Bank are not intractable. For example, when Robert Zoellick became president, he was stunned at the glass ceiling for women. He promised change, and half of the senior managers were women within 5 years. Jim Yong Kim (the current president) has also dealt effectively with inequalities associated with gender and sexual orientation.
    At least 15 children have died after being vaccinated against measles in northern Syria, owing to accidental injection of atracurium. The seriousness of this particular event is compounded by the fact that the deaths were associated with vaccination in a population in the midst of civil war whose trust in western medicine is already fragile. It was an accident waiting to happen. 5 years ago a problem was reported with the packaging of atracurium, a deadly muscle relaxant used in surgery. “In a pediatric ICU, a respiratory therapist obtained what he thought was a sterile water vial to prepare a nebulizer treatment. As he was piercing the stopper, he fortunately noticed that he had accidentally grabbed a vial of atracurium that someone had inadvertently returned to a respiratory box in the refrigerator. The atracurium and sterile water vials both had similar purple color accents.”