Equity in Health

Progress in reproductive, maternal, newborn, and child health (RMNCH) in Kenya has been inconsistent over the past two decades, despite the global push to foster accountability, reduce child mortality, and improve maternal health in an equitable manner. This report provides a comprehensive assessment of RMNCH in Kenya from 1990 to 2015, using data from nationally representative Demographic Health Surveys implemented between 1989 and 2014. The authors estimated time trends for key RMNCH indicators, as defined by Countdown to 2015, at both the national and the sub-national level, explored the determinants of change in intervention coverage during the past decade and modelled the effect of intervention scale up by 2030. After an increase in mortality between 1990 and 2003, there was a reversal in all mortality trends from 2003 onwards, although progress was not substantial enough for Kenya to achieve Millennium Development Goal targets 4 or 5. Between 1990 and 2015, maternal mortality declined at half the rate of under-5 mortality, and changes in neonatal mortality were even slower. National-level trends in intervention coverage have improved, although some geographical inequities remain, especially for counties comprising the northeastern, eastern, and northern Rift Valley regions. Disaggregation of intervention coverage by wealth quintile also revealed wide inequities for several health service interventions, such as skilled birth assistance. Maternal literacy and family size were found to be important drivers of positive change in key interventions across the continuum of care. The analysis highlighted the importance of quality of care around birth for maternal and newborn survival, and for targeting poor households and least educated and rural women, through the scale-up of community-level interventions, to improve equity and accelerate progress.

Deaths of children aged under five years have dropped by 27% globally since 1990, according to the latest WHO estimates. But in WHO’s first progress report on the health-related Millennium Development Goals (MDGs) released today in the World Health Statistics 2009, other results are mixed. An estimated nine million children aged under five years died in 2007, significantly fewer than the 12.5 million estimated to have died in 1990. However, in many African countries and in low-income countries generally, progress has been insufficient to reach the MDG target, which aims for a two-thirds reduction in child mortality by the year 2015. ‘The decline in the death toll of children under five illustrates what can be achieved by strengthening health systems and scaling up interventions,’ said Dr Ties Boerma, Director of WHO’s Department of Health Statistics and Informatics.

Weather and climate affect the key determinants of human health: air, food and water. They also influence the frequency of heatwaves, floods and storms as well as the transmission of infectious diseases. In addition, policies to mitigate climate change (for example in the energy, transport or urban planning sectors) have a direct and important influence on health, for example through effects on local air pollution, physical activity, or road traffic injuries. In order to guide research in this field, the World Health Organization (WHO) carried out a global consultation. Experts on climate change, health and related disciplines produced background reports covering each of the themes identified by the World Health Assembly Resolution, as well as an additional report on how to support research in this field. This was followed by an online consultation, and a three-day workshop attended by over 70 leading researchers, health practitioners, and representatives of funding bodies and other United Nations (UN) agencies. This report presents the conclusions and recommendations from this process, with the aim of improving the evidence base for policies to protect health from climate change.

In this speech, delivered as the Eighth Annual Jeffrey P Koplan Global Leadership in Public Health Lecture in Atlanta, in the United States, Margaret Chan, Director-General of the World Health Organization, has admitted that global governance has failed to embrace equity as an explicit policy objective in the international systems that govern financial markets, economic relations, trade, commerce and foreign affairs. And health has suffered as a result. She criticises the way in which development models have assumed that living conditions and health status would somehow automatically improve as countries modernised, liberalised their trade and experienced rapid economic growth – yet this has not happened. She also points out that international trade agreements will not, by themselves, guarantee food, job or health security, nor access to affordable medicines. Instead, all of these outcomes require deliberate policy decisions. She calls for world leaders to recognise that health concerns can, in some instances, be more important than economic interests and that the net result of all our international policies should be to improve the quality of life for as many of the world’s people as possible. Greater equity in health status should be adopted as an indicator of human progress, she recommends.