Dehydration caused by severe diarrhoea is a key cause of infant deaths in Zambia, a country with one of the highest child morality rates in the world, according to a new report by Zambia’s health department. This will not change until government makes a major effort to improve access to clean water and sanitation throughout the country, health experts say. Diarrhoea accounts for one fifth of all deaths among children under five. The symptom makes children more susceptible to other illnesses, such as malnutrition and respiratory infections, which are also among the leading causes of child mortality in Zambia. Diarrhoea can easily be avoided or reduced by improved sanitation. But sanitation remains a major problem in Zambia. According to the Lusaka-based Central Statistical Office (CSO), less than 60% of the population have access to adequate sanitation and safe water.
Poverty and health
A new film from the African Biodiversity Network (ABN) and the Gaia Foundation, narrated by actor Jeremy Irons, addresses pervasive myths about agriculture, development and Africa’s ability to feed herself. Africa is under growing pressure to turn to hybrid seeds, fertilisers, pesticides and genetically modified organisms in an effort to scale up agricultural production. In April 2012, President Obama of the United States launched the New Alliance for Food Security and Nutrition, which will see the combined forces of agribusiness giants Monsanto, Syngenta, Cargill, DuPont and Yara investing US$3 billion into creating new markets in Africa, amidst claims that this will solve hunger and malnutrition. In the process, the enormous wealth and diversity of locally adapted seeds and farmer knowledge is ignored, undermined and eroded by policy makers. ‘Seeds of Freedom’ shows how powerful corporate interests are destroying the biological diversity of the world’s crops. As the global food supply becomes dependent on just a few seed varieties, owned by a handful of corporations, global food insecurity is set to deepen.
The food crisis in the Horn of Africa is affecting people in informal urban settlements, but they remain largely overlooked by the aid community, according to IRIN. IN Kenya, emergency relief efforts are focused on the arid north, yet over the past five months, Concern Worldwide has recorded a 62% increase in cases of severe acute malnutrition (SAM) at clinics it supports in Nairobi slum areas, while estimating that the need is much greater. The UN Children's Fund (UNICEF) concurred that the food crisis is probably affecting people in urban areas more than in the north. Part of the reason malnutrition in urban slums is paid relatively scant attention is that it rarely reaches the emergency level of 15% global acute malnutrition (GAM) rate, at which point government is obliged to take action. In Turkana in the north, 15% GAM would translate to 13,000 children. But in Nairobi district, 13,000 malnourished children would reflect just a 3.45% GAM rate. Currently, the estimated GAM rate is 2.3% in Nairobi's slums.
A resolution at the 63rd World Health Assembly states that food-borne diseases continue to represent a serious threat to the health of millions of people in the world, particularly those in developing countries with poor nutritional status. It refers to the links between food safety, nutrition and food security, and acknowledges the instrumental role of food safety in eradicating hunger and malnutrition, in particular in low-income and food-deficit countries, while also acknowledging increasing evidence that many communicable diseases are transmitted through food, a risk that is increased by the growing global trade in food. It calls for closer collaboration between the health sector and other sectors, and increased action on food safety at international and national levels, across the full length of the food-production chain, to reduce significantly the incidence of food-borne disease.
Informal settlement upgrading is widely recognised for enhancing shelter and promoting economic development, yet its potential to improve health equity is usually overlooked. Slum upgrading is the process of delivering place-based environmental and social improvements to the urban poor, including land tenure, housing, infrastructure, employment, health services and political and social inclusion. The processes and products of slum upgrading can address multiple environmental determinants of health. This paper reviewed urban slum upgrading evaluations from cities across Asia, Africa and Latin America and found that few captured the multiple health benefits of upgrading. With the Sustainable Development Goals focused on improving well-being for billions of city-dwellers, slum upgrading should be viewed as a key strategy to promote health, equitable development and reduce climate change vulnerabilities. The authors conclude with suggestions for how slum upgrading might more explicitly capture its health benefits, such as through the use of health impact assessment and adopting an urban health in all policies framework. Urban slum upgrading must be more explicitly designed, implemented and evaluated to capture its multiple global environmental health benefits.
The key message of this report is that without better understanding the determinants of smallholders’ participation in agricultural markets, and formulating appropriate measures to facilitate improved participation, initiatives seeking to promote the adoption of productivity enhancing technology by smallholder producers are likely to have limited success. Smallholders’ participation in markets is crucially important for improved food security and poverty reduction. Attempts to improve smallholder productivity will have limited success if smallholder linkages to markets are not strengthened simultaneously. Limited smallholder participation in markets is not necessarily a result of a lack of commercial orientation per se, but the result of constrained choice in a risky environment. Smallholders are very heterogeneous, facing different types of constraints and opportunities, and will react differently to new market opportunities. Public policy interventions are generally needed to foster smallholder market integration, the authors argue. These interventions need to be prioritised and sequenced according to evidence-based diagnosis of the constraints faced by different categories of smallholders. Evidence-based policy-making could help minimise the risks of policy failure.
The thirteen case studies contained in this publication – including studies from Tanzania and South Africa - were commissioned by the research node of the Knowledge Network on Priority Public Health Conditions (PPHC-KN), a WHO-based interdepartmental working group associated with the WHO Commission on Social Determinants of Health. The publication is a joint product of the Department of Ethics, Equity, Trade and Human Rights (ETH), Special Programme for Research and Training in Tropical Diseases (TDR), Special Programme of Research, Development and Research Training in Human Reproduction (HRP), and Alliance for Health Policy and Systems Research (AHPSR). The case studies describe a wealth of experiences with implementing public health programmes that intend to address social determinants and to have a great impact on health equity. They also document the real-life challenges in implementing such programmes, including the challenges in scaling up, managing policy changes, managing intersectoral processes, adjusting design and ensuring sustainability.
Uganda’s Indigenous Batwa people are among the most vulnerable populations in the world and have limited access to key social determinants of health, including health care, education, clean water, employment and adequate clothing, food, and security. The Batwa people were evicted from their native forests following an environmental policy enacted in 1991 and are now considered conservation refugees undergoing a drastic transition from forest dwellers to agriculturalists. The shift has negatively affected people’s health. The report argues that coordinated action among public and private sectors is required to improve Batwa health through the enforcement of their rights and increased participation in policies and programs affecting their well-being.
Globally, research on social determinants of health has built a considerable knowledge base over the last decade. Still, not much of this research has been carried out in the extremely poor areas of the world, like for instance Africa south of the Sahara. In very poor ruralities, classic indicators of socioeconomic status are not well suited. Few people have any education, monetary income is not a good measure of material standing and people cannot be classified by occupation as they make their livelihood from a variety of activities. For efforts towards health equity to benefit the poorest of the poor, more suitable indicators of social health determinants must be identified. Health research might benefit from knowledge developed in neighbouring fields like development research, anthropology and sociology.
Even in the most affluent countries, people who are less well off have substantially shorter life expectancies and more illnesses than the rich. Not only are these differences in health an important social injustice, they have also drawn scientific attention to some of the most powerful determinants of health standards in modern societies. They have led in particular to a growing understanding of the remarkable sensitivity of health to the social environment and to what have become known as the social determinants of health. This publication outlines the most important parts of this new knowledge as it relates to areas of public policy.