The greatest share of health problems is attributable to the social conditions in which people live and work, referred to as the social determinants of health (SDH). Good medical care is vital to the well-being of populations, but improved clinical care is not enough to meet today's major health challenges and overcome health inequities. Without action on social determinants, those countries in greatest need will neither meet the health-related Millennium Development Goals nor achieve global targets for reducing chronic diseases. The article discusses the conceptual and operational challenges thus faced by the commission.
Equity in Health
The Commission on Social Determinants of Health: Tackling the social roots of health inequities
PLoS Medicine 3(6), June 2006: Irwin A, Valentine N, Brown C, Loewenson R; Solar O, Brown H, Koller T, Vega J
THE COST OF HIV PREVENTION AND TREATMENT INTERVENTIONS IN SOUTH AFRICA
What would be the cost of introducing AIDS-related prevention and treatment programmes in South Africa? This paper, produced by the Centre for Social Science Research (CSSR) at the University of Cape Town, attempts to answer this question by combining detailed information about the costs of implementing several interventions with demographic projections of their impact. Information about prices, wages and other cost components is drawn from a range of primary and secondary sources.
The COVID-19 pandemic and health inequalities
Bambra C; Riordan R; Ford J: et al: Epidemiology & Community Health, doi: 10.1136/jech-2020-214401, 2020
This essay examines the implications of the COVID-19 pandemic for health inequalities. It outlines historical and contemporary evidence of inequalities in pandemics—drawing on international research into the Spanish influenza pandemic of 1918, the H1N1 outbreak of 2009 and the emerging international estimates of socio-economic, ethnic and geographical inequalities in COVID-19 infection and mortality rates. It then examines how these inequalities in COVID-19 are related to existing inequalities in chronic diseases and the social determinants of health, arguing that this is a syndemic pandemic. The authors explore the potential consequences for health inequalities of the lockdown measures implemented internationally as a response to the COVID-19 pandemic, focusing on the likely unequal impacts of the economic crisis. The essay concludes by reflecting on the longer-term public health policy responses needed to ensure that the COVID-19 pandemic does not increase health inequalities for future generations.
The DA presents its own HIV/AIDS policy
The Democratic Alliance (DA) has set out steps it intends to take around HIV/AIDS that may have far-reaching implications for people living with HIV/AIDS, in its policy document released on Wednesday. Government’s approach has been simplistic and heavy-handed, the DA says. Although the DA accepts the health department's stance that it cannot supply antiretrovirals to all infected citizens, it says that there must be no compromise on providing antiretroviral drugs to pregnant mothers and rape survivors.
The Debate: Why is equity in health care crucial for the well being of children?
Victora C, Vega J, Chopra M: Research Watch - the web TV/magazine of the UNICEF Office of Research - 2012
All too often what has been counted falls back into a traditional paradigm of economic inequity – measuring poorest and richest quintiles – not for lack of interest but for lack of agreement on an appropriate measure, let alone what priority measures should be. While we all recognize the need to go further, tested and validated measures bringing attention to geographic, ethnic, age and gender disparities are few, let alone those which truly measure inequities and inequalities in health and the related availability, accessibility, acceptability and quality of services as mandated under the right to health. But this panel argues that this must be the goal, with important implications for the health and well-being of children. Christopher Garimoi Orach from Makerere University School of Public Health, Kampala, gives an insight into research on the unmet needs of new and expectant mothers in displaced populations in Uganda, and Gavin Mooney from the University of Cape Town discusses research on the impact of health care payments on families, and in particular on the well-being of children.
The developing world in The New England Journal of Medicine
Lown BB, Banerjee AA: Globalization and Health 2006, 2:3
Rampant disease in poor countries impedes development and contributes to growing North-South disparities; however, leading international medical journals underreport on health research priorities for developing countries. The medical information gap between rich and poor countries as judged by publications in the NEJM appears to be larger than the gap in the funding for research. Under-representation of developing world health issues in the medical literature is a global phenomenon. International medical journals cannot rectify global inequities, but they have an important role in educating their constituencies about the global divide.
The Ebola epidemic: a transformative moment for global health
Hill SR, Bero L, McColl G, Roughead E: Bulletin of the World Health Organization 93 (1), January 2014
The devastating effects of the current epidemic of Ebola virus disease in western Africa have put the global health response in acute focus. The index case is believed to have been a 2-year-old child in Guéckédou, Guinea, who died in December 2013. By late February 2014, Guinea, Liberia and Sierra Leone were in the midst of a full-blown and complex global health emergency. The response by multilateral and humanitarian organizations has been laudable and – at times – heroic. Much of the worst affected region is recovering from civil conflicts. This region is characterized by weak systems of government and health-care delivery, high rates of illiteracy, poverty and distrust of the government and extreme population mobility across porous, artificial boundaries. A more coordinated, strategic and proactive response is urgently needed.
The effect of educational attainment and other factors on HIV risk in South African women: Results from antenatal surveillance, 2000-2005
Johnson, LF, Dorrington RE, Bradshaw D, du Plessis H and Makubalo L: AIDS Journal 23(12): 1583-1588, 31 July 2009
This study set out to assess the effect of educational attainment and other factors on the risk of HIV in pregnant South African women. Repeated cross-sectional surveys were used. Pregnant women, who were attending public antenatal clinics were tested for HIV annually between 2000 and 2005, provided demographic information. Among women aged 15-24 years, HIV risk in those who had completed secondary education was significantly lower than in those who had only primary education – it increased by 8% per annum in those with no secondary education but did not increase those with secondary education. Together with other evidence, this study suggests that higher educational attainment did not protect against HIV in the early stages of the South African HIV/AIDS epidemic. But in recent years, the risk of HIV infection in young South African women with completed secondary education has reduced significantly relative to that in young women with primary education, suggesting that HIV prevention strategies may have been more effective in more educated women.
The epidemiology of child homicides in South Africa
Mathews S, Abrahams N, Jewkes R, Martin LJ and Lombard C: Bulletin of the World Health Organisation 91(8): 562-568, August 2013
In this paper the author described age- and sex-specific rates of child homicide in South Africa. A cross-sectional mortuary-based study was conducted in a sample of 38 medico-legal laboratories operating in 2009. Child homicide data were collected from mortuary files, autopsy reports and police interviews. Findings showed an estimated 1,018 child homicides occurred in 2009, or 5.5 homicides per 100,000 children under 18 years. The homicide rate was much higher in boys than in girls. Child abuse and neglect had preceded nearly half of all homicides, but three times more often among girls than among boys. In children aged 15 to 17 years, the homicide rate among boys was nearly five times higher than among girls. South Africa’s child homicide rate is more than twice the global estimate. Since a background of child abuse and neglect is common, the authors recommend that parenting skills should be a key part of primary prevention efforts.
The Financial Crisis and Global Health: Report of a High-Level Consultation
World Health Organization, 19 January 2009
The objectives of this document were to: build awareness of the ways in which an economic downturn may affect health spending, health services, health-seeking behaviour and health outcomes; make the case for sustaining investments in health; and to identify actions – including monitoring of early warning signs – that can help to mitigate the negative impact of economic downturns. Leaders in health must be prepared to speak out – unequivocally and on the basis of sound evidence – to make the case for health at times of crisis. Country-specific analysis is essential to guide policy and assess the potential impact on different populations and institutions. Counter-cyclical public spending provides a means of reviving economies. Aid will play a key role in providing a boost that many low-income countries cannot finance alone. The challenge is to ensure that spending is genuinely pro-poor and that, where possible, it has a positive impact on health. Primary health care provides an overarching approach to policy at a time of financial crisis. Its continuing relevance lies in its value base – stressing the importance of equity, solidarity and gender; through inclusiveness – and the objective of working towards universal coverage and pooling of risk; through a multisectoral approach to achieving better outcomes; and through utilising the assets of all health actors in the private, voluntary and nongovernment sectors.