The authors of this paper, drawing also on experience in primary health care in Zimbabwe, developed a "healthy, feasible and sustainable (HFS)" model utilising trends in readily available data from 1960s onwards in detailed tables, figures and maps and identifying specific countries which fit the criteria of the model. They also identify countries and population subgroups affected by inequity, with practical insights to eliminate global health inequities. They quantify the cost of bridging the global health equity gap, and outline mechanisms to finance the necessary interventions through a binding global redistribution system. This is compared with what is considered to be an outdated, arbitrary and inefficient international cooperation model. The approach considers global levels of poverty and excessive global accumulation, which abuses natural resources in such a way as to deprive current and future generations from the access they deserve, making reference to the concept of inter-generational equity. The online book discusses the difference between equity and equality, the global burden of health equity, the minimum income threshold for dignity, the maximum threshold of income above which excessive accumulation or hoarding occurs, and how resource hoarding is directly linked to the burden of health equity; while also proposing a holistic health index, including healthy life expectancy by gender, the happiness index, and life-years lost of others due to the hoarding effect and to exhausting effect. The methodology provides tools to defend the right to health for all by supporting the development of binding instruments linked to concrete health standards attainable through a financially sustainable mechanism.
Equity in Health
This brief summarizes key findings from the UNRISD research project Towards Universal Social Security in Emerging Economies. The project analysed the efforts of selected emerging economies to move towards universal provision of health care. The brief provides a comparative analysis of the political, economic and social drivers of, and constraints on, the extension of health care service for all and draws out the implications for poverty reduction, equity, growth and democracy. The brief identifies the following factors enabling universalisation: facilitating an empowered civil society, working together with government; political will, institutional capacity and political support for reform to create fiscal space for universal health care; democratic mechanisms to build consensus between different interest groups and maintain reform momentum; strategies to reduce resistance in and from the private sector; comprehensive and coherent national framework for health care, with mechanisms to ensure vertical coherence of policies between different levels of government; and tax- financed health care systems. An overarching finding emerges from the successful cases of the universalisation of health care observed in this UNRISD research: they all adopted integrated approaches that can promote synergies between health and non- health sectors; equally the contestation and consensus that reforms for universal health care entailed were not limited to the health sector alone. Health is interconnected with other areas of social, economic and environmental well- being, so the expansion of health care systems must happen alongside efforts to address the determinants of health that lie beyond the health sector.
A five-day regional health meeting in Johannesburg, South Africa, last month saw African health ministers pledging to give greater attention to women's health and scale up their HIV/AIDS, malaria and tuberculosis (TB) programmes. The World Health Organisation (WHO) regional committee session urged governments to develop "appropriate policies and legislation to create a supportive environment for scaling up interventions" for the three epidemics, a WHO statement said.
This report is a synthesis of inputs received during the Global Thematic Consultation on Health, which concluded on 6th March 2013 in Gaborone, Botswana. It highlights lessons learned from the Millennium Development Goals (MDGs), health in the post-2015 agenda, health priorities for 2015-2030, and how to frame the future health agenda in terms of principles, goals, targets and indicators. Participants suggested an overall health development goal: “Maximising health at all stages of life,” and proposed two health sector goals: accelerating progress on the health MDGs and reducing the burden of major non-communicable diseases (NCDs). They also suggested that the post-2015 framework should include more ambitious health targets; emphasise equity; address reproductive health and sexual rights; include differentiated targets and indicators for various life stages; and appreciate the interconnections between health and other goals, while addressing macroeconomic issues that impact on health, inequality and poverty. Further, participants argued that universal health access might be a preferable formulation – and vision – to universal health coverage.
Placing health at the heart of the post-2015 development agenda will not only save lives and advance economic development, it will also protect environmental sustainability, and advance wellbeing, equity and social justice, according to this report. It makes a number of recommendations. Health goals should be equitable, holistic and people-centred. The post-2015 development agenda should be direct explicit attention to reducing health inequities between and within all countries, especially when considering the needs of the poor, marginalised, and those whom the efforts of the Millennium Development Goals (MDGs) have not reached. The right to health means that governments must generate conditions in which everyone can be as healthy as possible. A hierarchy of goals is needed to capture the increasing complexity of priority health challenges and the reality that efforts to prevent disease and disability and improve health and well-being require policies and actions both within the health sector and across many other sectors. Indicators need to measure impact, coverage of health services and health systems. Some qualitative indicators may be needed to measure quality of life and well-being, while assessing quality of health services may require qualitative as well as quantitative indicators. The MDG targets and indicators as well as those in other internationally agreed agendas should be revised for the post-2015 era and included under the relevant goals.
The purpose of this report is to present a summary of the main themes and messages that have emerged from the Global Consultation on Health and to make recommendations to inform the deliberations of the High-Level Panel of Eminent Persons and the UN Secretary-General’s report to the General Assembly in May 2013. The report describes the consultation process, detailing the processes that were used to reach out to different constituencies, explains why health should be at the centre of the post-2015 development agenda and summarises the inputs about the successes and shortcomings of the MDGs, many of which were unintended and only became apparent with the benefit of hindsight. It then presents guiding principles for the post-2015 development agenda and the various options for health goals and indicators that were put forward during the consultation and gives recommendations on how to frame the future agenda for health. The contributors to this consultation are looking in the same general direction: all agree that the new development agenda needs strong and visible health goals supported by measurable indicators. The report concludes by suggesting concrete actions that could be taken between now and 2015 by those advocating for health to feature prominently in the next development agenda.
How successful is South Africa at providing decent healthcare for all its citizens? Is the gap in healthcare between the poorest members of society and the richest getting narrower? The Universities of Cape Town and Witwatersrand, South Africa, looked at South Africa’s efforts to ensure all sections of the population have proper access to health services. A right to good health services is enshrined in the country’s constitution and has played an important part in ensuring the health service remains a priority. Nevertheless the study found certain problems have arisen in the drive to create an equitable health system.
According to this paper, Zambia’s Millennium Development Goal (MDG) progress reports of 2003 and 2005 show that it is unlikely that Zambia will achieve even half of its MDG goals, despite laudable political commitment and some advances made towards achieving universal primary education, gender equality, improvement of child health and management of the HIV and AIDS epidemic. The authors of this paper argue that Zambia’s health systems have been weakened by a high disease burden and high mortality rates, natural and man-made environmental threats and some negative effects of globalisation such as major external debt, low world prices for commodities and the human resource ‘brain drain’. They urge for the government to put its political promises into action, and offer some tried-and-tested strategies and ‘quick wins’ that have been proven to produce high positive impact in the short term.
Ministers of Health of the Southern Africa sub region have committed themselves to working with other sub regions on the continent to integrate sexual reproductive health and rights (SRHH) goals and targets into the New Partnership for Africa's Development (NEPAD) framework. They also reaffirmed their commitment to taking the necessary action to speed up the development of relevant policies and to secure the resources for implementation.
This paper discusses a set of complex, inter-connecting issues related to the moral imperative to increase access to HIV care and treatment in southern Africa, with a particular focus on antiretroviral therapy (ART). It is argued in the paper that an equity-oriented approach is necessary not only from a moral and humanitarian perspective but also for public health reasons. Unless attention is paid to the redistribution of available resources and to the relative and absolute levels of disempowerment amongst individuals, communities and countries, we run the risk of failing to achieve the Millennium Development Goals and the targets that have been set for increasing access to ART.