More than 3,000 delegates from approximately 120 countries assembled at the 13th World Congress on Public Health in Addis Ababa from the 23rd to 27th of April 2012. In this statement, delegates re-affirm their commitment to international agreements enshrining health as a human right. They also pledge to promote innovative research to generate evidence on the social determinants of health and health equity, as well as advocate for: evidence-based policy; making health equity an integral part of policy and development; equitable access to high quality health services; and fair trade in all commodities that affect human health. The Federation further intends to strengthen partnerships and networks to take common action on global public health priorities, share experiences and help build capacity.
Equity in Health
The theme of the Prince Mahidol Award Conference – held in Bangkok, Thailand on on 24-28 January 2012 – was “Moving towards universal health coverage: health financing matters”. At the close of the meeting, a 10-point declaration recognised universal health coverage (UHC) as fundamental to the right to health, and marked the commitment by more than 800 delegates to translate the rhetoric of UHC into better, more equitable health outcomes. Similar endorsements of UHC have been made before, including at the World Health Assembly in 2011. What makes the Bangkok Statement any more likely to hasten and widen the implementation of UHC? One answer may be the power of the Prince Mahidol Award Conference and its sponsors to draw global health enthusiasts from a wide variety of disciplines and health systems. Delegates from 68 countries included external funders and recipients of aid, managers and front-line health workers, ministers, economists, and consumers. From these many perspectives came the realisation that whether one seeks to provide access to health care for the one billion people who lack it, or to protect the 100 million people who end up in poverty every year as a result of medical costs, or to accelerate progress towards the Millennium Development Goals: UHC provides a common mechanism – and common cause.
In this paper, the authors investigate the cross-country determinants of health improvements and describe the implications for development policy. The authors argue that making improvements to health need not be expensive. Even very low income countries can make great strides with good technologies and good delivery, but the authors warn that this may take time. They argue that two major factors underlie improved global health outcomes: first,the discovery of cheap technologies that can dramatically improve outcomes; and second, the adoption of these technologies, thanks to the spread of knowledge. Other factors have played a role. Increased income not only allows for improved nutrition, but also helps to improve access to more complex preventative technologies. Institutional development is a second key to the spread of such complex technologies. Nonetheless, evidence of dramatic health improvements even in environments of weak institutions and stagnant incomes suggests that the role of institutional factors may be secondary.
Road traffic injuries are among the leading causes of death and life-long disability globally. The World Health Organization (WHO) reports road traffic injuries as the leading cause of death among young people aged 15–29 years globally and are among the top three causes of mortality among people aged 15–44 years. In Africa, the number of road traffic injuries and deaths have been increasing over the last three decades. According to the 2015 Global status report on road safety, the WHO African Region had the highest rate of fatalities from road traffic injuries worldwide at 26.6 per 100 000 population for the year 2013. In 2013, over 85% of all deaths and 90% of disability adjusted life years (DALYs) lost from road traffic injuries occurred in low- and middle-income countries, which have only 47% of the world’s registered vehicles. The increased burden from road traffic injuries and deaths is partly due to economic development, which has led to an increased number of vehicles on the road. Given that air and rail transport are either expensive or unavailable in many African countries, the only widely available and affordable means of mobility in the region is road transport. However, the road infrastructure has not improved to the same level to accommodate the increased number of commuters and ensure their safety and as such many people are exposed daily to an unsafe road environment. The 2009 Global status report on road safety presented the first regional estimate of a road traffic death rate, which was used to statistically address the under-reporting of road traffic deaths by countries with an unreliable death registration system. In the 2009 report, Africa had the highest estimated fatality rate at 32.2 per 100 000 population, in contrast to the reported fatality rate of 7.2 per 100 000 population. The low reported death rate is said to reflect missing data due to non-availability of road traffic data systems. This has a direct impact on health planning including emergency care and other responses by government agencies.
There are limited means to monitor the occurrence of cancer in developing countries and planning for prevention relies largely on estimates. This paper summarises priorities in cancer prevention in developing countries and the underlying evidence base, and addresses some of the challenges. The author concludes that cancer control calls for interventions that are kept logistically simple, integrated within systems and gradually building the infrastructure to bring care to the population at large. Given serious budgetary constraints, cancer control programmes need to maximise the efficacy of their investments. Of all possible interventions to reduce the cancer burden, the author argues that comprehensive programmes to prevent tobacco smoking are the most cost-effective, so that tobacco prevention should be a priority. Immunisation of infants against hepatitis B virus (HBV) is probably the second most cost-effective option in regions where the infection is still endemic. The author further argues that the uncontrolled use of carcinogens in industrial processes need to be addressed any cancer control programmes.
Along with millions of others, health workers celebrated South Africa's first democratic elections in 1994 as the first step in rolling back the devastating inequity of an apartheid era health system. At last the health needs of the whole population would be addressed with the advent of representative government and the anticipated “peoples” health system. An impressive array of health policies and plans were designed to reduce inequities and improve the health of all South Africans. Health activists and struggle veterans were in consensus that a single, unified National Health Service based on a comprehensive Primary Health Care approach would be the key to this transformation. Despite one of the most progressive constitutions on the planet and a strong rhetorical commitment to addressing the health needs of the poor, implementation has been slow. The huge effort put into reshaping the “architecture” of the health system has not translated into real health gain for all South Africans. Many of the poorest still find themselves marginalized and neglected, just as they were in pre-democratic South Africa.
What does equity in health and health care mean? Equality? A basic minimum standard of service? A system of entitlements?Global health professionals have struggled with a definition for some time. Dr Rene Loewenson, a Zimbabwean epidemiologist, presents a Southern African view: equity in health implies addressing differences in health status that are unnecessary, avoidable, and unfair, she says. This also means understanding and influencing, not only the way society allocates health resources, but the power relations involved.
Overall, child well-being as improved by 34% since 1990, but progress is slow. Leaders must consider how children are doing and how their decisions impact them. Children are doing worse in sub-Saharan Africa than any other region. Africa scores 35 in the Index, reflecting the high level of deprivation in primary schooling, child health and child nutrition. It is also making the slowest progress, improving child well-being by only 20% over 1990-2006. However, progress has been very mixed; some countries in Africa have done incredibly well, while others did spectacularly badly. Countries like Malawi cut child deprivation in half, enrolling more than 90% of primary school children. Some of the poorest children in Africa live in countries suffering from conflict and poor governance, such as Zimbabwe, Somalia and the Democratic Republic of Congo.
This paper presents a combined historical and contemporary review of the clinical burden of malaria within one of Africa's largest urban settlements, Nairobi, Kenya. The authors conducted a review of historical reported malaria case burdens since 1911 within Nairobi using archived government and city council reports. An audit of 22 randomly selected health facilities within Nairobi was undertaken, including interviews with health workers, and a checklist of commodities and guidelines necessary to diagnose, treat and record malaria. The researchers found that, from the 1930s through to the mid-1960s, malaria incidence declined coincidental with rapid population growth. During this period malaria notification and prevention were a priority for the city council. From 2001-2008 reporting systems for malaria were inadequate to define the extent or distribution of malaria risk within Nairobi. The facilities and health workers included in this study were not universally prepared to treat malaria according to national guidelines or identify foci of risks due to shortages of national first-line drugs, inadequate record keeping and a view among some health workers (17%) that slide negative patients could still have malaria. Combined with historical evidence, there is a strong suggestion that very low risks of locally acquired malaria exist today within Nairobi's city limits and this requires further investigation.
The Commission on Macroeconomics and Health is a collaborative effort led by eighteen of the world’s leading economists and policymakers from academia, governments, and international agencies to assess the place of health in global economic development and offer a new strategy for investing in health for economic development, especially in the world’s poorest countries. The Commission is a crucial part of the World Health Organization’s (WHO) strategy to meet the challenge of assembling and analyzing the evidence linking health status and poverty reduction. In this regard the Commission is a source of advice and analysis for WHO and the broader development community on the relationship between health, economics, and poverty reduction and will communicate its findings to policy makers in national governments and in development agencies. This document provides an overview of the CMH purpose, composition, and activities during the period January 2000 to October 2001.