The Sustainable Development Goals (SDGs) identify achieving universal health coverage (UHC) as one component of the omnibus health goal, “to ensure healthy lives and promote well-being for all at all ages.” The components of UHC specified in goal 3.8 of the SDGs reflect World Health Organisation’s policy documents and include financial risk protection, access to quality essential health-care services, and access to safe, effective, quality and affordable essential medicines and vaccines for all. On the positive side, UHC can be considered to be an expression of the right to health. Indeed, several health and human rights advocates had earlier proposed replacing the various health-related goals in the MDGs with the single overarching health goal of UHC in the SDGs, provided that it specify that international assistance is essential, not optional, for countries otherwise unable to pursue UHC. Significant progress toward UHC, consistent with the requirements of the right to health, would have the potential of enabling the one billion people currently estimated to not have access to the health services they need each year to obtain them. The author argues, however, that not all potential paths to a universal health system are consistent with human rights requirements, even ones that result in some expansion of health coverage. For that reason it is important that health and human rights advocates and scholars identify the essential features of UHC and policies for advancing toward this goal from a human rights perspective.
Values, Policies and Rights
In Part 1 of this three-part study, the authors undertook a multi-method study in three phases – a survey, interviews and case descriptions that drew on site visits – and in each of the second and third phases they focused on a purposive sample of those involved in the previous phase. Seven recommendations emerged for those involved in establishing or leading organisations that support the use of research evidence in developing health policy: collaborate with other organisations; establish strong links with policymakers and involve stakeholders in the work; be independent and manage conflicts of interest among those involved in the work; build capacity among those working in the organisation; use good methods and be transparent in the work; start small, have a clear audience and scope, and address important questions; and be attentive to implementation considerations, even if implementation is not a remit.
In Part 2, the authors drew on many people and organisations around the world, including their project reference group, to generate a list of organisations to survey. They sent the questionnaire by email to 176 organisations and followed up periodically with non-responders by email and telephone. They received completed questionnaires from 152 (86%) organisations. More than one-half of the organisations (and particularly HTA agencies) reported that examples from other countries were helpful in establishing their organisation. The findings confirm that the principles of evidence-based medicine dominate current guideline programmes and underline the importance of collaborating with other organisations. The survey also provides a description of the history, structure, processes, outputs, and perceived strengths and weaknesses of existing organisations from which those establishing or leading similar organisations can draw.
In Part 3, the authors purposively sampled organisations from among those who completed a questionnaire in the first phase of the study, developed and piloted a semi-structured interview guide, and conducted the interviews by telephone, audio-taped them, and took notes simultaneously. They interviewed the director (or his or her nominee) in 25 organisations, of which 12 were GSUs. Using rigorous methods that are systematic and transparent (sometimes shortened to 'being evidence-based') was the most commonly cited strength among all organisations. GSUs more consistently described their close links with policymakers as a strength, whereas organisations producing CPGs, HTAs, or both had conflicting viewpoints about such close links. With few exceptions, all types of organisations tended to focus largely on weaknesses in implementation, rather than strengths.
Twenty-four ex-miners are seeking compensation from Anglo-American after contracting silicosis, an incurable and fatal lung disease. In court papers, the 24 men allege that they contracted silicosis while in the employ of Anglo-American South Africa Ltd. The case is the first of its kind in South Africa. One of Britain’s leading personal injury and human rights law firms, Leigh Day & Co, is consulting for the Legal Resources Centre (LRC), which is representing the plaintiffs. ‘The litigation has two objectives. First, to compensate miners who contracted silicosis on the gold mines, and secondly, to deal with the problem of ex-miners whose health continues to be at risk of bouts of Tuberculosis,’ said Richard Meeran, a lawyer from Leigh Day & Co.
This study examines determinants of gender attitudes among some of the poorest and most vulnerable adolescents in Tanzania using an ecological model. Data come from baseline interviews with 2458 males and females aged 14–19 years conducted within a larger impact evaluation. Secondary school attendance was associated with more equitable gender attitudes. Females had less equitable gender attitudes than males in the sample. Having had sexual intercourse was associated with more gender equitable attitudes among females, but the reverse was true among males. Addressing gender inequity requires understanding gender socialisation at the level of social interactions. The finding that females had more inequitable gender attitudes than males in the study is argued by the authors to suggest that more emphasis be given to highlighting the rights of women with female adolescents.
In this article, the author takes a rights-based view of the current crisis of restricted access to the results of scientific and medical research. Such research is conducted in the interests of the public, and yet the results are largely kept out of the public domain by traditional corporate publishers who own them, subject them to extremely tight copyright restrictions and sell them in a market worth about US$5 billion annually. The results of biomedical research have unfortunately been privatised, monopolised, and concentrated in the hands of a tiny number of multinational corporations.
The overarching legal framework for minerals across Africa is public ownership. Citizens should be the collective beneficial owners of the mineral resources that are managed on their behalf by the state as a trustee. Graham asserts, however, that the reality in Africa is different. The collective ownership of minerals and the trustee role of the state has been compromised. Mining activists have tended to focus on accountability and transparency in relation to the regimes of mineral exploitation that governments have adopted. Graham asserts that there is a more fundamental accountability question in how the choices being made advance the inter- generational interests of citizens. Graham identifies that the citizen should at the very least not be made worse off by the development of assets of which he/she is part owner. He argues that there should be a stronger accountability framework where a minerals and development policy provides for inter-generational benefit, with linkages to development. There is a need to retreat from a 'first come first served' approach to awarding mining contracts, to collect more geological information to inform award of concessions and reform revenue law to be sensitive to mining price cycles so revenue collection can be optimised.
This study assessed gender-equitable norms and their determinants among church-going young men in Kinshasa, the Democratic Republic of Congo. A cross-sectional study was carried out among 289 church-going young men, aged 18–24 years, residing in three disadvantaged communes of Kinshasa. The findings provide evidence of attitudes and beliefs that act as barriers to gender equality. For instance, the majority of church-going young men agreed that a man is the only decision maker in the home and about half of the respondents supported the statement “There are times a woman deserves to be beaten”. Similarly, around half of the participants agreed with the idea of men’s uncontrollable sex drive and men’s toughness. Close to half of the participants agreed that it is women’s responsibility to prevent pregnancy. These attitudes co-existed with a few gender-equitable norms as 82% agreed on the importance of joint decisions concerning family planning. An association between education, certain places of residence, being single or separated, and supportive attitudes towards gender equality was found. The study findings indicated that a high proportion of church-going young men do not endorse gender equitable norms. The authors argue that churches and schools urgently need comprehensive gender equality and masculinity policies and programmes to influence young men’s attitudes and behaviours.
Gaps in child mortality between rich and poor are unacceptably wide and growing. Poorer children face disadvantages at every step from exposure and resistance to infectious disease, through care-seeking, and to effective treatment. How can policy-makers close these gaps? An international team of researchers explore the options of targeting and universal coverage.