Equity in Health

This publication presents in numerical and graphical formats the best data available for key health indicators in the 46 countries of the World Health Organisation’s African Region. It describes the health status and trends in the countries of the African Region, the various components of their health systems, coverage and access levels for specific programmes and services, and the key determinants of health in the region, and the progress made on reaching the United Nations’ Millennium Development Goals (MDGs). A major finding is improvement in progress towards reaching the MDGs – however, most improvements have been small and it does not appear that the continent will meet all the health-related MDGs set for 2015, notably those for child and maternal mortality, which remain very high. Communicable diseases make up the largest part of the disease burden (42.4% of disability-adjusted life years) versus only 15.9% for non-communicable diseases in second place (data from 2004). Utilisation of health services is low for antenatal care (44%) and contraceptive prevalence is a mere 24%, but immunisation coverage for children improved to 72%.

Improvements in secondary and tertiary hospital capacity should not come at the expense of basic care for the poor, the Health Systems Trust (HST) says. The Durban based NGO was responding to a speech by Minister of Health Manto Tshabalala-Msimang, in which she said R2 billion would be spent on upgrading and revitalising hospital facilities next year, including the building of 18 new facilities. The minister also said inequities in the funding allocated to primary healthcare in different provinces would have to be addressed, with some provinces allocating R50 per person each year, and others R300. But Antoinette Ntuli, HST information dissemination and equity director, urged her to ensure resources and initiatives are "fast-tracked in poor, rural areas".

This report card on South African children and youth shows that there has been little or no improvement in the areas of tobacco use, nutrition, physical activity and obesity over the last three years. It draws on more than 95 published, peer-reviewed studies or reports, which cumulatively show a decline in physical activity levels, with only 42% of youth having participated in sufficient vigorous physical activity to be considered health-enhancing. Less than one-third of youth surveyed participated in moderate activity and nearly 42% did little or no physical activity. There was an increase in overweight and obese children to 20% and 5% respectively. Nearly 30% of teens consumed fast food two to three times a week, while researchers found that healthy foods in rural settings cost almost twice as much as the unhealthy equivalent, further fuelling unhealthy eating habits. Almost 30% of adolescents say they have ever smoked, while 21% admit to being smokers currently (which is double that of global prevalence estimates). Most smokers start before the age of 19, with 6.8% starting under the age of 10. These trends may give rise to serious non-communicable and preventable diseases such as heart disease, diabetes, lung disease and certain cancers, which are responsible for over half of adult deaths worldwide, according to the report.

Non-communicable diseases (NCDs) represent a significant threat to human health and well-being, and carry significant implications for economic development and health care and other costs for governments and business, families and individuals. Risks for many of the major NCDs are associated with the production, marketing and consumption of commercially produced food and drink, particularly those containing sugar, salt and transfats (in ultra-processed products), alcohol and tobacco. The problems inherent in primary prevention of NCDs have received relatively little attention from international organisations, national governments and civil society, especially when compared to the attention paid to provision of medical treatment and long-term clinical management. Low political priority may be due in part to the complexity inherent in implementing feasible and acceptable interventions, such as increased taxation or regulation of access, particularly given the need to coordinate action beyond the health sector, and the fact that this brings public health into conflict with the interests of profit-driven food, beverage, alcohol and tobacco industries. The authors use a conceptual framework to review three models of governance of NCD risk: self-regulation by industry; hybrid models of public-private engagement; and public sector regulation. The authors analysed the challenges inherent in each model, and review what was known (or not) about their impact on NCD outcomes. While piecemeal efforts have been established, the authors argued that mechanisms to control the commercial determinants of NCDs are inadequate and efforts at remedial action too limited. The authors set out an agenda to strengthen each of the three governance models, with reforms that will be needed to the global health architecture to consolidate the collective power of diverse stakeholders, its authority to develop and enforce clear measures to address risks, as well as establish monitoring and rights-based accountability systems across all actors to drive measurable, equitable and sustainable progress in reducing the global burden of NCDs.