The new Global AIDS Strategy (2021–2026) uses an inequalities lens to identify, reduce and end inequalities that represent barriers to people living with and affected by HIV, countries and communities from ending AIDS. The Strategy outlines a comprehensive framework for transformative actions to confront these inequalities and to respect, protect human rights in the HIV response. It puts people at the centre to ensure that they benefit from optimal standards in service planning and delivery, to remove social and structural barriers that prevent people from accessing HIV services, to empower communities to lead the way, to strengthen and adapt systems so they work for the people who are most acutely affected by inequalities, and to fully mobilize the resources needed to end AIDS.
Equity in Health
The Treatment Action Campaign and the South African Medical Association (SAMA) have filed court papers against the Minister of Health, the Medicines Control Council (MCC), the Western Cape MEC for Health, as well as pharmaceutical proprietor Matthias Rath and several of his employees and associates, including AIDS denialists Anthony Brink, David Rasnick and Sam Mhlongo (Professor of Family Medicine, MEDUNSA). This briefing explains why.
The Integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD) proposes a cohesive approach to ending preventable pneumonia and diarrhoea deaths. It brings together critical services and interventions to create healthy environments, promotes practices known to protect children from disease and ensures that every child has access to proven and appropriate preventive and treatment measures. The solutions to tackling pneumonia and diarrhoea do not require major advances in technology. Proven interventions exist. Children are dying because services are provided piece- meal and those most at risk are not being reached. Use of effective interventions remains too low; for instance, only 39% of infants less than 6 months are exclusively breastfed while only 60% of children with suspected pneumonia access appropriate care. Moreover, children are not receiving life-saving treatment; only 31% of children with suspected pneumonia receive antibiotics and only 35% of children with diarrhoea receive oral rehydration therapy WHO recommends: exclusive breastfeeding for six months and continued breastfeeding with appropriate complementary feeding; use of vaccines; use of simple, standardised guidelines; use of oral rehydration salts; and proper water, sanitation and hygiene interventions.
This paper explores the features and drivers of frameworks for healthy societies that had wide or sustained policy influence post-1978, globally and in selected southern regions, in India, Latin America and East and Southern Africa. The authors implemented a thematic analysis of 150 online documents and reviewed the findings with expertise from the regions covered. Globally, comprehensive primary healthcare, whole-of-government and rights-based approaches have focused on social determinants and social agency to improve health as a basis for development. Biomedical, selective and disease-focused technology-driven approaches have, however, generally dominated, positioning health improvements as subsequent to macroeconomic growth. Historical approaches in the three southern regions that integrated reciprocity and harmony with nature were suppressed by biomedical models during colonialism and by postcolonial neoliberal economic reforms. With widening differences between biosecurity approaches on the one hand and holistic, ecological approaches on the other, economic, the context in the 2000s of ecological, pandemic crises and social inequality is argued to imply that which ideas dominate will be critical for health futures. The authors point to what this implies for building approaches to healthy societies, including for a more equitable circulation of ideas between regions in framing global ideas.
Indigenous people remain on the margins of society in high, middle and low-income countries, and bear a disproportionate burden of poverty, disease, and mortality compared to the general population. These inequalities have persisted, and in some countries have even worsened, despite the overall improvements in health indicators. The social determinants of health framework has enriched the understanding of the complex conditions that give rise to inequalities in indigenous health, including the structural and socio-political factors, and the intersecting conditions of poverty, social and political exclusion, discrimination and land loss that shape indigenous people’s health. The authors report in this paper the conditions of marginalisation that impact indigenous health from their work in Guatemala and argue for a citizen-led initiative for state accountability for the right to health in rural indigenous municipalities. The authors argue that the challenge of engaging with the conditions underlying inequalities and promoting transformational change means that equity-oriented research and practice in the field of indigenous health requires: engaging power, context-adapted strategies to improve service delivery, and mobilising networks of collective action.
WHO presents country data on the burden of disease preventable through healthier environments. These estimates provide the stepping stone for informed policy making in disease prevention. The country profiles provide an overview of summary information on selected parameters that describe the environmental health situation of a country, as well as a preliminary estimate of health impacts caused by environmental risks.
Inadequate drinking water and sanitation, indoor air pollution, and accidents, injuries and poisonings, are a few of the causes of the 3 million deaths per year of children under five due to environmental hazards. WHO is addressing environmental hazards which specifically affect children at the International Conference on Environmental Threats to the Health of Children. This opens today in Bangkok. WHO is also monitoring these issues through the Task Force for the Protection of Children’s Environmental Health.
The global HIV/AIDS pandemic could cause gross national product in some hard-hit countries to shrink by 40% over the next 20 years, according to a report launched yesterday in New York by the UN Development Program. That development setback would jeopardize goals set at last year's UN Millennium Summit, including halving poverty by 2015.
This short paper outlines the perspectives and motivations for the work of the Regional Network for Equity in Health in Eastern and Southern Africa (EQUINET). It presents key areas of work on health equity being implemented to strengthen the state and public sector in health; organised around the active participation and involvement of communities. This includes work on strengthening people's power for health, on increased fair financing, on retaining health workers and challenging trade policies that encroach on health. Such work faces challenges that can be met through increased regional networking to exchange experience, information and expertise, particularly given the demand for learning by doing.
Most countries do not have universal health insurance and for most people living in countries without universal access, particularly the poor, illness is a substantial financial burden, and indeed often a crippling burden. Paradoxically, a far greater proportion of out-of-pocket spending occurs in those countries least able to afford it. Inevitably, health care, far from being a basic human right, is simply beyond the reach of many. These problems are magnified in lower- and middle-income countries. For example, in Tanzania a 1997 scheme to implement evidence based health plans at an estimated cost of US$2 per capita was limited by inadequacy of infrastructure and capacity. These difficulties are particularly evident where there is increased spending on vertical programmes in areas of limited capacity and infrastructure, limiting resources available to the system as a whole. In light of this, this article highlights some key questions for tackling equity in health, including: 1) What do we mean by equity? Which aspect has primacy -dollars spent or health status or health outcomes? 2) How do we determine what is a reasonable amount to spend (or invest)? How can this best be contextualised and harmonised with other government priorities? 3) Would there be more equitable access to health services if governance and decision-making were more open to input by community stakeholders? 4) Given the resource and other infrastructure constraints, particularly in poorer countries, what are the most appropriate health care delivery models for a country to adopt?