This Commission was prompted by sub-Saharan Africa's potential to improve health on its own terms, and largely with its own resources. It promotes evidence-based optimism, with caution. Sub-Saharan countries are noted to face difficult development agendas in the decades to come, but also immense opportunities to be acted upon. A key message of this commission is that the opportunities ahead cannot be unlocked with 'more of the same' approaches and by keeping to the current pace. The commission advocates an approach based on people-centred health systems and inspired by progress, which can be adapted in line with each country's specific needs. A comprehensive approach and system-wide changes are required. Broad partnerships beyond the medical and health community are argued to be essential to move the health agenda forward. Without a serious shift in mindsets across all levels of society, all sectors of government, and all institutions it is seen to be difficult to have meaningful and sustainable change. Young people in Africa are observed to be key to bringing about the transformative changes needed to rapidly accelerate efforts to improve health and health equity across sub-Saharan Africa.
Equity in Health
Malnutrition affects about 30% of children in Africa, caused by low birth weight and post-natal growth faltering. Child malnutrition is a persistent problem. The long term trend shows only slow improvement, and malnutrition rates worsen during droughts, economic crises, conflicts and displacement, and HIV. Without greater attention to nutrition, increased child mortality, morbidity and impaired intellectual development are inevitable. Policies must tackle intermittent crises through emergency programmes and support sustained community-based programmes. Nutrition should be reinstated as a priority programme area alongside HIV, tuberculosis and malaria.
This paper reviews the Millennium Development Goals (MDGs) process, drawing some recommendations to feed into the debate concerning what will take their place in 2015 when the process comes to an end. The authors note that creating the MDGs was a process that was led by rich countries, with comparatively little involvement of the lower- and middle-income countries. Likewise, the merging of the international development goals (IDGs) and MDGs was undertaken mainly between rich countries and the United Nations. In this sense, the author indicates that rich countries needed ambitious goals for their image and legitimacy, while developing countries were more interested in national goals. The paper found some clear progress in meeting the MDGs, notably the reduction of extreme poverty and also an improvement in primary school enrolments, and similarly, the paper predicts that the target of halting and reversing the spread of HIV is likely to be met. However, several areas have shown only weak improvements and even the successes are qualified. Progress has been highly geographically uneven, with global progress masking regional slippage, and regional progress masking deterioration in individual countries. The paper concludes that the opportunity created by the Millennium Movement to mobilise countries and people against poverty has been lost. The MDGs have made a difference but they have not transformed the process of international co-operation in the ways that their proponents had initially hoped.
Despite large gains in health over the past few decades, the distribution of health risks worldwide remains extremely and unacceptably uneven. The Lancet—University of Oslo Commission on Global Governance for Health reports that with globalisation, health inequity increasingly results from transnational activities that involve actors with different interests and degrees of power: states, transnational corporations, civil society, and others. The norms, policies, and practices that arise from global political interaction across all sectors that affect health are termed global political determinants of health. The Commission argues that global political determinants that unfavourably affect the health of some groups of people relative to others are unfair, and that at least some harms could be avoided by improving how global governance works. This report examines power disparities and dynamics across a range of policy areas that affect health and that require improved global governance: economic crises and austerity measures, knowledge and intellectual property, foreign investment treaties, food security, transnational corporate activity, irregular migration, and violent conflict. The Commission calls for stronger cross-sectoral global action for health, for strengthened use of human rights instruments for health, and new frameworks for international financing that go beyond traditional development assistance such as for research and social protection.
Equity, defined primarily as equality of opportunities among people, should be an integral part of a successful poverty reduction strategy anywhere in the developing world, says the World Bank's annual 2006 World Development Report. "Equity is complementary to the pursuit of long-term prosperity," said François Bourguignon, the Bank's Chief Economist and Senior Vice President for Development Economics, who guided the team that produced the report. "Greater equity is doubly good for poverty reduction. It tends to favor sustained overall development, and it delivers increased opportunities to the poorest groups in a society."
Vision impairment is a leading cause of disability, and a barriers to access education and employment, which may force people into poverty. This study determined the prevalence of self-reported vision difficulties as an indicator of vision impairment in economically disadvantaged regions in South Africa, and to examine the relationship between self-reported vision difficulties and socio-economic markers of poverty, namely, income, education and health service needs. A cross-sectional study was conducted in 27 economically disadvantaged districts (74901 respondents) to collect data from households on poverty and health, including vision difficulty. As visual acuity measurements were not conducted, the researchers used the term vision difficulty as an indicator of vision impairment. The prevalence of self-reported vision difficulty was 11.2%. More women (12.7%) compared to men (9.5%) self-reported vision difficulty (p < 0.01). Self-reported vision difficulty was higher (14.2%) for respondents that do not spend any money. A statistically significant relationship was found between the highest level of education and self-reporting of vision difficulty; as completed highest level of education increased, self-reporting of vision difficulty became lower (p < 0.01). A significantly higher prevalence of self-reported vision difficulty was found in respondents who are employed (p < 0.01). The evidence from this study suggests associations between socio-economic factors and vision difficulties that have a two-fold relationship (some factors such as education, and access to eye health services are associated with vision difficulty whilst vision difficulty may trap people in their current poverty or deepen their poverty status).
A new report by UNAIDS released prior to World AIDS Day 2016 reveals concerning trends in new HIV infections among adults. The Prevention gap report shows that while significant progress is being made in stopping new HIV infections among children (new HIV infections have declined by more than 70% among children since 2001 and are continuing to decline), the decline in new HIV infections among adults has stalled. The report shows that HIV prevention urgently needs to be scaled up among this age group. The Prevention gap report shows that an estimated 1.9 million adults have become infected with HIV every year for at least the past five years and that new HIV infections among adults are rising in some regions. New HIV infections among adults declined by only 4% in eastern and southern Africa since 2010. The Prevention gap report gives the clear message that HIV prevention efforts need to be increased in order to stay on the Fast-Track to ending AIDS by 2030. “We are sounding the alarm,” said Michel Sidibé, Executive Director of UNAIDS. “The power of prevention is not being realized. If there is a resurgence in new HIV infections now, the epidemic will become impossible to control. The world needs to take urgent and immediate action to close the prevention gap.”
This World Health Organisation report takes a broad look at inequality and health. The report issues a call to arms, stressing the need to tackle the inequitable distribution of power, money and resources through better governance, transparency, support for civil society and more equitable economic policies. Some claim the report offers a way out of the ‘sterile debate’ about whether poor health causes poverty, or vice versa. Critics point out that it downplays the link between income (as opposed to inequality) and health. One example of the correlation between money and health is from South Africa, where the health of older people improved after receiving pensions at the age of 65. But whether people are well or sick also depends on factors and policies that lie far beyond the remit of any health minister. For example, the Health Ministry may try to encourage handwashing, but it is unlikely to happen unless there is running water - which is beyond the Ministry’s control.
Every day an estimated 1600 women die world-wide as a result of problems during pregnancy or childbirth. Many of these deaths are preventable. But which safe motherhood interventions are the most cost-effective in resource-poor settings?
The report, 'The Promise of Equality: Gender Equity, Reproductive Health and the Millennium Development Goals', explores the degree to which the global community has fulfilled pledges made to the world’s most impoverished and marginalized peoples. It tracks progress, exposes shortfalls and examines the links between poverty, gender equality, human rights, reproductive health, conflict and violence against women and girls. It also examines the relationship between gender discrimination and the scourge of HIV/AIDS.