Equity in Health

This report on progress towards achieving the Millennium Development Goals is mixed. It acknowledges some success but also points to shortcomings. Successes include progress on poverty reduction – with the developing world as a whole remaining on track to achieve the poverty reduction target by 2015 – and improvements in key disease interventions, which have cut child deaths from 12.5 million in 1990 to 8.8 million in 2008. Between 2003 and 2008, the number of people receiving antiretroviral therapy increased tenfold - from 400,000 to 4 million - corresponding to 42% of the 8.8 million people who needed treatment for HIV. However, some challenges remain. The most severe impact of climate change is being felt by vulnerable populations who have contributed least to the problem, gender equality has shown little progress, armed conflict continues to add to the growing number of refugees worldwide and the number of people who are undernourished has continued to grow, as the slow progress in reducing the prevalence of hunger has stalled in some regions. About one in four children under the age of five are underweight, mainly due to lack of adequate and quality food, inadequate water, sanitation and health services, and poor care and feeding practices. An estimated 1.4 billion people were still living in extreme poverty in 2005. Moreover, the effects of the global financial crisis are likely to persist: poverty rates will be slightly higher in 2015 and even beyond, to 2020, than they would have been had the world economy grown steadily at its pre-crisis pace.

Despite significant setbacks after the 2008-2009 economic downturn, exacerbated by the food and energy crisis, the United Nations notes that the world is on track to reach poverty-reduction targets, but also notes that progress has been inequitable. According to the United Nations. The number of deaths of children under the age of five declined from 12.4 million in 1990 to 8.1 million in 2009. The largest absolute drops in malaria deaths were in Africa, where 11 countries have reduced malaria cases and deaths by over 50%. New HIV infections are declining steadily, led by sub-Saharan Africa. Between 1995 and 2009, a total of 41 million tuberculosis patients were successfully treated and up to 6 million lives were saved, due to effective international protocols for the treatment of tuberculosis. In contrast, the report notes that progress has been inequitable: the poorest children have made the slowest progress in terms of improved nutrition, poor women and girls remain severely socially disadvantaged, and advances in sanitation often bypass the poor and those living in rural areas.

This paper aims to identify cross-cutting challenges that have emerged from Millennium development Goal (MDG) implementation so far. The MDGs have had notable success in encouraging global political consensus, providing a focus for advocacy, improving the targeting and flow of aid, and improving the monitoring of development projects. However, they have also encountered a range of common challenges with regard to conceptualisation and execution: gaps that exist in goals, targets with too narrow a focus, a lack of ownership and poor equity outcomes. The paper concludes that future goals should be built on a shared vision of development, and not on the bundling together of a set of independent development targets. Development should be conceptualised as a dynamic process involving sustainable and equitable access to improved wellbeing, which is achieved by expansion of access to services that deliver the different elements of wellbeing.

Ebola is also an epidemic, and the causes and conditions of the epidemic are social, economic, and political rather than natural. Outside of these social and economic conditions, the disease would have been contained or even eliminated long before now. The three countries at the centre of the Ebola epidemic are among the most impoverished in the world. The author argues that the permanent legacy of centuries of uninterrupted plunder is chronic and widespread malnutrition, dirt roads, poor or non-existent sanitation, unreliable or non-existent electric power, and one doctor per 100,000 inhabitants. These are the conditions in which an Ebola outbreak becomes an epidemic. For several months after the existence of Ebola was confirmed in the three countries of West Africa, it did not, the author argues, threaten the extraction of wealth from the region, and the first actions were to withdraw many volunteers including those working in health and to suspend flights. As cases were diagnosed in the USA and Europe, the response is reported to have been isolationist, with media spreading fear and speculation. Aid increased, but with limited personnel, except from Cuba. The author argues that West African health workers and volunteers are the ones who have carried out the socially necessary tasks of caring for patients, collecting and burying bodies, and educating the population in prevention and containment measures, despite inadequate safety equipment, serious threats to their own health, inadequate pay, and despite sometimes being ostracised in their own communities.