This volume examines the foundations of health equity. With contributions from philosophers, anthropologists, economists, and public-health specialists, it centers on five major themes: what is health equity?; health equity and its relation to social justice; health inequalities and responsibilities for health; ethical issues in health evaluation and prioritization; and anthropological perspectives on health equity.
Equity in Health
Public Health, Ethics, and Equity
Sudhir Anand, Fabienne Peter, and Amartya Sen (eds.)
Putting equity in health back onto the social policy agenda: experience from South Africa
Over the past decade, international health policy debates have been dominated by efficiency considerations. There has been a recent resurgence of interest in health equity, including consideration of the notions of vertical equity and procedural justice. This paper explores the possible application of these notions within the context of South Africa, a country in which inequities in income and social service distribution between ‘racial’ groups were systematically promoted and entrenched during four decades of minority rule, guided by apartheid and related policies. The South African experience since 1994 provides useful insights into factors which may facilitate or constrain health equity progress. In particular, the constitutional entitlement to health and civil society action to maintain health equity’s place on the social policy agenda are seen as important facilitating factors. This paper concludes that health equity goals are critically dependent on the central involvement of the disadvantaged in decision-making about who should receive priority, what services should be delivered and how equity-promoting initiatives should be implemented.
Putting women at the centre of water supply, sanitation and hygiene
Gender and Economic Reforms in Africa Programme, May 2006
This is a report from the Water Supply and Sanitation Collaborative Council and the Water Engineering and Development Centre. According to the report it is crucial to put women at the centre of water supply, sanitation and hygiene activities. Taking women's needs and preferences into account has resulted in a decrease in drop-out rates from school of young women, reductions in child mortality and maternal morbidity, and improved health for women and girls.
QUESTIONS PROMPT REVIEW OF DIRTY NEEDLES' ROLE IN AFRICAN HIV INFECTIONS
Questions about what percentage of Africa's HIV infections are caused by dirty needles has prompted U.S. Health and Human Services Secretary Tommy Thompson -- who is also the chairman of the Global Fund to Fight AIDS, Tuberculosis and Malaria -- to order a review of all research linking HIV/AIDS and medical injections, Associated Press has reported. The review could affect how funding from the $15 billion U.S. initiative to fight HIV/AIDS in Africa and the Caribbean is distributed, AP reported.
Radical or reminiscent? How to improve the current systems-approach to global health
Stuckler D and Basu S: 6 May 2009
Recent claims have been made that system-wide approaches, and primary health care for all, are universally agreed-upon goals. So why haven’t these goals been fulfilled? Certainly much of the problem has been lack of real commitment to a comprehensive approach to reducing health risks and improving primary care. The prevailing neoliberal economic model of development, the so-called 'Washington Consensus', which -emphasised liberalisation, privatisation and fiscal austerity, displaced ‘Primary Health Care for All’ with ‘Primary Health Care for Some’.
Reducing child mortality: A moral and environmental imperative
Rosling H: Gapminder, 20 September 2010
This presentation by Hans Rosling of Gapminder was presented on 20 September 2010 at an event reflecting on the progress made against the Millennium Development Goals, hosted by the Bill & Melinda Gates Foundation TEDxChange. Using United Nations data on child mortality, he pointed out the reduction in child mortality at an accelerating speed by African countries like Kenya, after poor performance in the 1990s. In this video of his lecture, he says that the time has come to ‘stop talking about sub-Saharan Africa as one place’, as statistics vary so widely between countries on the continent. He also questions the definitions of ‘developed’ and ‘developing’ countries, arguing that the distinction is no longer strictly valid given that countries with lower incomes have better performance on child mortality than others with higher incomes.
Reducing health inequities in a generation: A dream or reality?
Shankar P and Kumar R: Bulletin of the World Health Organisation, 2009
Estimates suggest that achievement of the Millennium Development Goal targets would require Kenya, Lesotho and Zambia to spend more than 40% of their gross domestic product on health by 2015. This can only be achieved if donor countries honour their commitment to developmental assistance. But, by 2010, the G8 countries will have only delivered US$3 billion of the US$21.8 billion committed in 2005 for Africa. the authors assert that it is difficult to convince politicians and bureaucrats about the long-term benefits of social interventions when they are focused on biomedical interventions that impact their status in the short term. Africa. It is difficult to attribute causation to social interventions for long-term outcomes. It is also difficult to conduct randomized controlled trials of social interventions designed to reduce inequities, generalize findings from one research context to another, or generate evidence for the cost-effectiveness of the social interventions. Given the scarcity of resources, such evidence is sorely needed.
Reducing neonatal deaths in South Africa: Are we there yet, and what can be done?
Velaphi S and Rhoda N: South African Journal of Child Health 6(3): 67-71, 2012
South Africa is one of the countries in which neonatal mortality has remained the same or increased over the last 20 years. The major causes of neonatal deaths are related to prematurity and intrapartum hypoxia. In this paper, the authors discuss a number of interventions that have been shown to reduce neonatal deaths and, if implemented on a wider scale, could reduce neonatal deaths significantly. These interventions include providing basic and comprehensive emergency obstetric care, use of antenatal steroids for women in preterm labour, training in immediate care of the newborn and neonatal resuscitation, and post-resuscitation management and ongoing neonatal care (e.g. CPAP), especially to babies who are born preterm.
Reducing the silent burden of impaired mental health
Jané-Llopis E, Anderson P, Stewart-Brown S, Weare K, Wahlbeck K, McDaid D, Cooper C and Litchfield P: Journal of Health Communication 16(Suppl 2): 59-74, 14 September 2011
Mental and behavioural disorders account for about one third of the world’s disability caused by all ill health among adults, with unipolar depressive disorders set to be the world’s number one cause of ill health and premature death in 2030, affecting high- and low-income countries. There is a range of evidence-based cost-effective interventions that can be implemented in parenting, at schools, at the workplace, and in older age that can promote health and well-being, reduce mental disorders, lead to improved productivity, and increase resilience to cope with many of the stressors in the world. These facts need to be better communicated to policymakers to ensure that the silent burden of impaired mental health is adequately heard and reduced.
REFRAMING HIV AND AIDS
Last month the World Health Organisation declared the HIV/AIDS epidemic a global health emergency. Should governments go one step further and treat it as a disaster? Over the past 20 years, the public health community has learnt a tremendous amount about the HIV/AIDS epidemic. Yet, despite widespread discussion about the epidemic and some measurable progress, the overall response has been insufficient: globally 42 million people are already infected with HIV, prevalence continues to rise, and less than 5% of those affected have access to lifesaving medicines, according to the British Medical Journal.