According to this study, three circumstances make the present moment unique for global health. First, health has been increasingly recognised as a key element of sustainable economic development, global security, effective governance and human rights promotion. Second, due to the growing perceived importance of health, unprecedented – albeit still insufficient – sums of funds are flowing into this sector. Third, there is a burst of new initiatives coming forth to strengthen national health systems as the core of the global health system and a fundamental strategy to achieve the health-related Millennium Development Goals. In order to realise the opportunities offered by the conjunction of these unique circumstances, it is essential to have a clear conception of national health systems that may guide further progress in global health. To that effect, the first part of this document examines some common misconceptions about health systems. Part two explains a framework to better understand this complex field. Finally, a list of suggestions is offered on how to improve national health system performance and what role global actors can play.
Equity in Health
The first edition of Global Health Watch (GHW) was launched last year, and the Global Health Watch 2007/8 will be published late in 2007 or early 2008. The full edition of GHW and a shorter advocacy document Global Health Action can be downloaded from the GHW website. People's Health Movement (PHM) would like to ensure that indigenous health issues are highlighted in relation to all the areas that will be covered in the second edition of Global Health Watch, and request your assistance and input in this regard. They would like to provide chapter co-ordinating authors with information on indigenous health issues that can be integrated within the various chapters.
The aim of the research was to assess current and historical surveillance of the pneumoconioses in former miners, in particular silicosis, silico-tuberculosis and tuberculosis, and to assess the functioning of the Occupational Diseases in Mines and Works Act (ODMWA) surveillance and compensation system, which is a responsibility of the Department of Health. The research also aimed to assess the impact of the burden of lung disease and disability on the public health system and on the labour-sending communities from which the miners come and to which they return. The main objective was thus to investigate health systems surveillance of the pneumoconioses in former underground gold miners, and to assess diagnostic and compensation systems under the legal framework of the Occupational Diseases in Mines and Works Act 78 of 1973 as Amended (ODMWA). The main finding was that this is a historically neglected subject, under-researched and undocumented.
Government attempts over the past five years to get private medical schemes to take care of more South Africans have failed as high costs have generally precluded those earning less than R5 000 from joining private schemes. Medical inflation has outpaced overall inflation by around 5% every year, and this has virtually nullified regulations introduced from January 1999 aimed at opening up the private sector.
On 13 May 2010, the United Nations (UN) General Assembly passed resolution 265, ‘Prevention and control of non-communicable diseases’, which called for Heads of State to address NCDs in a high-level plenary meeting scheduled for September 2011. Out of this meeting, and its associated outcome document, will come a series of programmatic steps by all UN members. This editorial analyses the UN resolution and describes the kinds of outcomes that are possible and needed to make chronic non-communicable diseases (NCDs) a global priority among international leaders and to generate global interest and a social movement to ensure commitment by Heads of State. The authors argue that the attention of Heads of State and Government must be secured to promote their participation in the meeting in September 2011. Second, while Member States will decide on the final outcomes of the meeting, international development agencies, the World Bank, UN Agencies, civil society, and the private sector must provide support through a consultative process towards the outcome document. Third, stakeholders must be rallied around a common vision and road map to operationalise a global response to NCDs during the decades to come.
The most widely cited definition of health inequity is: ‘Health inequalities that are avoidable, unnecessary, and unfair are unjust.’ This paper argues that this definition is useful but in need of further clarification because it is not linked to broader theories of justice. It proposes an alternative, pluralist notion of fair distribution of health that is compatible with several theories of distributive justice, based on the principle of equality, which states that every person or group should have equal health except when health equality is only possible by making someone less healthy, or if there are technological limitations on further health improvement. In short, health inequalities that are amenable to positive human intervention are unfair. This principle is offset by the principle of fair trade-offs, which states that weak equality of health is morally objectionable if, and only if, further reduction of weak inequality leads to unacceptable sacrifices of average or overall health of the population, or if further reduction in weak health inequality would result in unacceptable sacrifices of other important goods, such as education, employment and social security.
The authors of this paper propose a pluralist notion of fair distribution of health that is compatible with several theories of distributive justice. It consists of the weak principle of health equality and the principle of fair trade-offs. The weak principle of health equality offers an alternative definition of health equity to those proposed in the past. It maintains the all-encompassing nature of the popular Whitehead/Dahlgren definition of health equity, and at the same time offers a richer philosophical foundation. This principle states that every person or group should have equal health except when: health equality is only possible by making someone less healthy, or there are technological limitations on further health improvement. In short, health inequalities that are amenable to positive human intervention are unfair. The principle of fair trade-offs states that weak equality of health is morally objectionable if and only if: further reduction of weak inequality leads to unacceptable sacrifices of average or overall health of the population, or further reduction in weak health inequality would result in unacceptable sacrifices of other important goods, such as education, employment, and social security.
This study in South Africa investigated the association between multi-morbidity and disability among older adults; and whether hypertension (both diagnosed and undiagnosed) mediates this relationship. The authors consider whether the impact of the multi-morbidity on disability varies by socio-demographic characteristics. Data were drawn from Wave 1 (2007-08) of the South African Study on Global Ageing and Adult Health. Disability was measured using the 12-item World Health Organisation Disability Assessment Schedule (WHODAS) 2.0. Nearly half of the respondents had a hypertensive blood pressure when measured during the interview, but had not been previously diagnosed. A further third self-reported they had been told by a health professional they had hypertension. The logistic regression showed in comparison to those with no chronic conditions, those with one or two or more had significantly higher odds of severe disability. Hypertension was insignificant and did not change the direction or size of the effect of the multi-morbidity measure substantially. The interactions between number of chronic conditions with wealth were significant. The diagnosis of multiple chronic conditions, can be used to identify those most at risk of severe disability and to prioritise limited resources for such individuals for preventative, rehabilitative and palliative care.
This paper documents the impact of the AIDS crisis on non-AIDS related health services in 14 sub-Saharan African countries. The authors, using multiple waves of Demographic and Health Surveys (DHS) for each country, examined antenatal care, birth deliveries, and rates of immunisation for children born between 1988 and 2005. They found deterioration in nearly all of the above dimensions of health care over this period. Using data collected on HIV prevalence in the most recent DHS survey for each country, they noted that erosion of health services is highly correlated with increases in AIDS prevalence. Consequently, regions of countries that have light AIDS burdens have witnessed small or no declines in health care, using the measures noted above, while those regions currently shouldering the heaviest burdens have seen the largest erosion in treatment for pregnant women and children. Finally, the authors estimate that the beginning of the divergence in health services between high- and low-HIV regions took place in the mid-1990s.
A report by a correspondent of Af-Aids Forum from the third African Development Forum in Addis Ababa, Maaaarch 3-8, 2002
"The HIV/AIDS pandemic is a survival issue not just for tens of millions of Africans, but also for some of our nations themselves... The HIV/AIDS pandemic will test those survival skills to the limit, but I have no doubt that Africa will overcome this pandemic, hopefully sooner rather than later." - Abdul Mohammed, Keynote Presentation.