Equity in Health

Managing the health effects of climate change
Costello A, Abbas M, Allen A, Ball S, Bell S, Bellamy R, Friel S, Groce N, Johnson A, Kett M, Lee M, Levy C, Maslin M, McCoy D, McGuire B, Montgomery H, Napier D, Pagel C, Patel J, de Oliveira JAP, Redclift N, Rees H, Rogger D, Scott J, Stephenson J, Twig

Effects of climate change on health will affect most populations in the next decades and put the lives and wellbeing of billions of people at increased risk. During this century, earth's average surface temperature rises are likely to exceed the safe threshold of 2°C above preindustrial average temperature. Rises will be greater at higher latitudes, with medium-risk scenarios predicting 2–3°C rises by 2090 and 4–5°C rises in northern Canada, Greenland, and Siberia. This report outlines the major threats – both direct and indirect – to global health from climate change through changing patterns of disease, water and food insecurity, vulnerable shelter and human settlements, extreme climatic events, and population growth and migration.

Mango tree investigators fight sleeping sickness

Thousands of people in Sub Saharan Africa are dying and being damaged by a disease thought banished 30 years ago. Now in the war-scarred lands of the Democratic Republic of Congo, health workers are fighting back and hoping the outbreak of peace in the human war will let them do more.

Many countries not on target to reach millennium goals

Senior WHO and World Bank officials have warned donor countries and developing countries that many poor nations are behind in meeting the millennium development goals (MDGs) by the target date of 2015, and stressed that more resources and good policies and programmes are needed. The health-related goals include: halving maternal and child mortality rates by 2015; halving the proportion of people who suffer hunger; combating HIV/AIDS and other infectious diseases; and enhancing access to safe drinking water and essential drugs. A recent study by the World Bank concluded that so far no sub-Saharan African country is on target to reach the MDGs.

Mapping out a treatment programme in malawi

The World Health Organisation (WHO) presented a challenge to African countries last year by setting a target of three million HIV-positive Africans to be on antiretroviral (ARV) HIV/AIDS therapy by 2005. Almost a year later, a workshop on scaling up access to care and treatment for people living with HIV/AIDS (PWAs) in 17 East and Southern African countries has been held to assist them in reaching that goal. HIV/AIDS programme managers and health officials from the 17 countries emerged with country-specific "road maps" to guide them in expanding their treatment programmes.

Mapping under-5 and neonatal mortality in Africa, 2000–15: a baseline analysis for the Sustainable Development Goals
Golding N; Burstein R; Longbottom J; et al: The Lancet 390(10108)2171-2182, 2017

This study aimed to generate high-resolution estimates of under-5 and neonatal all-cause mortality across 46 countries in Africa. The authors assembled 235 geographically resolved household survey and census data sources on child deaths to produce estimates of under-5 and neonatal mortality at a resolution of 5 × 5 km grid cells across 46 African countries for 2000, 2005, 2010, and 2015. Amid improving child survival in Africa, there was substantial heterogeneity in absolute levels of under-5 and neonatal mortality in 2015, as well as the annualised rates of decline achieved from 2000 to 2015. Subnational areas in countries such as Botswana, Rwanda, and Ethiopia recorded some of the largest decreases in child mortality rates since 2000, positioning them well to achieve SDG targets by 2030 or earlier. Yet these places were the exception for Africa, since many areas, particularly in central and western Africa, must reduce under-5 mortality rates by at least 8.8% per year, between 2015 and 2030, to achieve the SDG 3.2 target for under-5 mortality by 2030. In the absence of unprecedented political commitment, financial support, and medical advances, the viability of SDG 3.2 achievement in Africa is argued to be precarious at best.

massive population drop in southern africa

The population of HIV/Aids-ravaged southern Africa is expected to decline by 22% by 2050, according to a recent study. The latest world population data sheet of the United States-based Population Reference Bureau estimates South Africa's population will drop from 44 million this year to 35.1 million in 2025, and to 32.5 million in 2050 - a 26% decline.

massive population drop in southern africa

The population of HIV/Aids-ravaged southern Africa is expected to decline by 22% by 2050, according to a recent study. The latest world population data sheet of the United States-based Population Reference Bureau estimates South Africa's population will drop from 44 million this year to 35.1 million in 2025, and to 32.5 million in 2050 - a 26% decline.

Maternal deaths decline sharply across the globe
Grady D: New York Times, 13 April 2010

For the first time in decades, researchers are reporting a significant drop worldwide in the number of women dying each year from pregnancy and childbirth, to about 342,900 in 2008 from 526,300 in 1980. The findings, published in the medical journal The Lancet, challenge the prevailing view of maternal mortality as an intractable problem that has defied every effort to solve it. 'The overall message, for the first time in a generation, is one of persistent and welcome progress,' the journal’s editor, Dr Richard Horton, wrote. The study cited a number of reasons for the improvement: lower pregnancy rates in some countries; higher income, which improves nutrition and access to health care; more education for women; and the increasing availability of 'skilled attendants' – people with some medical training – to help women give birth. Improvements in large countries like India and China helped to drive down the overall death rates.

Maternal deaths disproportionately high in developing countries

New findings on maternal mortality by WHO, UNICEF and UNFPA show that a woman living in sub-Saharan Africa has a 1 in 16 chance of dying in pregnancy or childbirth. This compares with a 1 in 2,800 risk for a woman from a developed region. These findings are contained in a new global report on maternal mortality just released online by the three agencies.

Maternal deaths due to HIV not declining despite PMTCT successes in South Africa
Alcorn K: Aidsmap, 6 March 2014

Improvements in prevention of mother-to-child transmission of HIV (PMTCT) in South Africa are not translating into a reduction in maternal deaths due to HIV infection, according to a 15-year review of a large district referral hospital in Johannesburg, the 21st Conference on Retroviruses and Opportunistic Infections (CROI) heard on Wednesday in Boston. In particular, the audit found that there has been no change in the proportion of maternal deaths caused by HIV since 2007, and over three-quarters of women with HIV who died had never started antiretroviral therapy.The South African review, presented by Coceka Mnyani of University of Witwatersrand, looked at the records of Chris Hani Baragwanath hospital, which serves an urban and periurban population of approximately 2 million people in Johannesburg. The hospital delivered between 17,000 and 23,500 babies a year between 1997 and 2012. HIV prevalence in the maternal population served by the hospital is extremely high: approximately 23% of women who give birth at the hospital were found to be HIV positive in 2012, compared with 30.7% in 2004, the peak year for HIV prevalence among pregnant women giving birth at the hospital.

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