Despite progressive health policy, disease burdens in South Africa remain patterned by deeply entrenched social inequalities. The authors suggest that accounting for the relationships between context, health and risk can provide important information for equitable service delivery. This research used a participatory research process with communities in a low income setting in the Agincourt health and socio–demographic surveillance site (HDSS) in rural north–east South Africa. Three village–based discussion groups were convened and consulted about conditions to examine, one of which was under–5 mortality. A series of discussions followed in which routine HDSS data were presented and participants’ subjective perspectives were elicited and systematized into collective forms of knowledge using ranking, diagramming and participatory photography. The process concluded with a priority setting exercise. Visual and narrative data were thematically analysed to complement the participants’ analysis. Participants identified a range of social and structural root causes of under–5 mortality: poverty, unemployment, inadequate housing, unsafe environments and shortages of clean water. Despite these constraints, single mothers were often viewed as negligent. A series of mid–level contributory factors in clinics were also identified: overcrowding, poor staffing, delays in treatment and shortages of medications. However, blame and negativity were directed toward clinic nurses in spite of the systems constraints identified. Actions to address these issues were prioritized as: expanding clinics, improving accountability and responsiveness of health workers, improving employment, providing clean water, and expanding community engagement for health promotion.
Equity in Health
A new effort to assess the quality of HIV medicines could make treatment services more accessible to poor countries. The World Health Organization (WHO) has evaluated several HIV-related medicines and has published the first list of products which were found to meet WHO recommended standards. This initial phase of the project includes forty products from eight branded and generic manufacturers. Managed by WHO, the initiative counts on the expertise of UNICEF and the UNAIDS Secretariat, and is supported by the UN Population Fund (UNFPA) and the World Bank.
The Innov8 approach is a resource that supports the operationalisation of the Sustainable Development Goal (SDGs) commitment to “leave no one behind”. Innov8 is an 8-step analytic process undertaken by a multidisciplinary review team. It results in recommendations to improve programme performance through concrete action to address health inequities, support gender equality and the progressive realisation of universal health coverage and the right to health, and address critical social determinants of health. The Innov8 Technical Handbook is a user-friendly resource that includes background readings, country examples and analytical activities to support a programmatic review process. The Technical Handbook will be complemented by the release of a wider set of materials currently under development by WHO as part of the Innov8 resource package.
The aims of this study were to assess international shortfall inequalities in life expectancy among women and men and to quantify how much specific geographic regions and country income groups contribute to them. Researchers used estimates of life expectancy at birth by sex for the 12 five-year periods between 1950–1955 and 2005–2010. Data for life expectancy at birth by sex were available for 179 of the 193 Member States of the World Health Organization (WHO) (as of 2010). Results indicated large shortfall inequalities in life expectancy among women in low-income countries. Additionally, there were large differences between shortfall inequalities of women and men in low-income countries. The authors call for urgent action is necessary to reduce these inequities. Although they acknowledge that behaviour change policies and programmes focusing on the individual are important in improving the health of women, action at economic, social, cultural and environmental levels is equally vital. Broader strategies such as poverty reduction, increased labour force participation, increased literacy, training and education, improvements in the provision of and access to health services (including reproductive health care), and increased opportunities for participation in economic, social and political activities will contribute to progress in women’s health.
More than at any previous time in history, global public health security depends on international cooperation and the willingness of all countries to act effectively in tackling new and emerging threats. That is the clear message of this year's World health report entitled A safer future: global public health security in the 21st century, which concludes with six key recommendations to secure the highest level of global public health security.
Action on the social determinants of health is considered a necessary approach to improving health equity. Case studies of intersectoral action are available, however there is limited information about the impact of intersectoral action on the social determinants of health and health equity. Search and retrieval of literature published between 2001 and 2011 was conducted in 6 databases. 17 articles of varied methodological quality met the inclusion criteria. One systematic review investigating partnership interventions found mixed and limited impacts on health outcomes. Primary studies evaluating the impact of upstream and midstream interventions showed mixed effects. Downstream interventions were generally moderately effective in increasing the availability and use of services by marginalized communities. The literature evaluating the impact of intersectoral action on health equity is limited. The included studies identified reveal a moderate to no effect on the social determinants of health. The evidence on the impact of intersectoral action on health equity is even more limited. The lack of evidence should not be interpreted as a lack of effect. Rigorous evaluations of intersectoral action are needed to strengthen the evidence base of this public health practice.
Action on the social determinants of health is considered a necessary approach to improving health equity. Most of the social determinants of health lie outside the sphere of the health sector and thus collaboration with governmental and non-governmental sectors outside of health are required to develop policies and programs to improve health equity. Case studies of intersectoral action are available, however there is limited information about the impact of intersectoral action on the social determinants of health and health equity. Search and retrieval of literature published between 2001 and 2011 was conducted in 6 databases. A staged screening of titles and abstracts, and later full-text, was conducted by two independent reviewers. Reviewers independently assessed the quality of the articles deemed relevant for inclusion. Data were extracted and synthesized in narrative format for all included studies, conducted by one reviewer and checked by another. 17 articles of varied methodological quality met the inclusion criteria. One systematic review investigating partnership interventions found mixed and limited impacts on health outcomes. Primary studies evaluating the impact of upstream and midstream interventions showed mixed effects. Downstream interventions were generally moderately effective in increasing the availability and use of services by marginalized communities. The literature evaluating the impact of intersectoral action on health equity is limited. The included studies identified reveal a moderate to no effect on the social determinants of health. The evidence on the impact of intersectoral action on health equity is even more limited. The lack of evidence should not be interpreted as a lack of effect. Rigorous evaluations of intersectoral action are needed to strengthen the evidence base of this public health practice.
In this interview with Archbishop Ndungane, president and founder of African Monitor, he assesses the outcomes of the United Nations Summit on the Millennium Development Goals (MDGs). On the positive side, he welcomes the fact that the outcome document is comprehensive, touching on almost everything that needs to be addressed if MDGs are to be met, with commitments that are measurable and therefore can be tracked. The specific amounts committed by specific stakeholders is also a step in the right direction, according to him. Clause 23 (c) makes specific reference to the promotion of national food security strategies that strengthen support for smallholder farmers and contribute to poverty eradication. This is key to poverty eradication, particularly where without exception, 70% of the population in rural areas depend on agriculture for their livelihood. According to the Archbishop also commendable are the specific focus on maternal and child health, the references to lessons learnt, particularly the issue of supporting community-led strategies; and the commitment to strengthening the statistical capacity to produce reliable and disaggregated data. He also pointed out a number of concerns about the Summit, in the lack of any guarantee that the concrete commitments will go beyond mere ‘lip service’; the lack of clear mechanisms for enforcement; and the repetition of principles that have proved difficult to operationalise without new angles on how they are going to be implemented in reality. Finally, although there are specific commitments, world leaders need to find mechanisms to reinvigorate and stimulate the local energies, initiatives and actions which are people-driven. They should look beyond 2015 and work for sustainable solutions.
In this interview, Dr Brawley discusses the challenges particular to Africa in relation to cancer and debunks some of the myths around cancer. He believes Africa is addressing the cancer pandemic, but more focus is needed to bring politicians and non-government organisations into the fold to address cancer in Africa. Cervical cancer is highly treatable in many areas of the world and abilities to prevent, detect and treat it need to reach African more widely. Smoking, which is not very common in Africa but is growing, needs to be stopped to prevent an epidemic of lung cancer. With regard to the role tobacco control plays in cancer control in Africa, he noted that the Africa Tobacco Control Regional Initiative, the Africa Tobacco Control Alliance, and the Framework Convention Alliance have already been instrumental in helping to establish an agenda for cancer control in Africa. With tobacco companies looking at Africa as an area of market growth there is need to combat what could be an epidemic of lung cancer, cardiac and other diseases.
Many gross health inequalities that exist between and within countries have social factors at the root. This Lancet article introduces the independent Commission on Social Determinants of Health, set up by WHO, and consisting of prominent figures in politics, research, and social action. Within 3 years the Commission aims to understand the societal factors that influence health and use this knowledge to develop policies to improve health. In a comment paper, Lee Jong-wook argues that public health begins with the recognition of the need for favourable social conditions, and that neglect of such factors undermines health efforts.