Equity in Health

Habitat 3: Jean Pierre Elong Mbassi on the importance of cities in implementing the SDGs
Global Goals UN: Quito 19 October 2016

Jean Pierre Elong Mbassi, Secretary-General of United Cities and Local Governments Africa, speaks about how cities help with implementing the Sustainable Development Goals (SDGs), Paris Agreement and more. He noted that it was a positive move to have had the second world assembly of local and regional governments in Quito in the framework of the UN Habitat 3 conference. This was an accomplishment from Habitat 2 when they were not included. This shows that local authorities are not part of the process, and the next step is to bring them around the table with higher level decision making authorities. He argued that without local authorities there is no way to implement global agendas and that if governments and regional bodies listen to cities, the SDGs, climate agendas, and related agreements will stand a significantly better chance of realisation.

Why are maternal health outcomes worse for migrant women in Masindi, Uganda?
Ayiasi R; Mangwi A; Kiiza A; Orach C: Resilient and responsive health systems (RESYST) blog, Makerere University, School of Public Health, September 2016

Globally, 298,000 women die due to pregnancy related causes each year and half of these occur in Africa. In Uganda, maternal mortality has marginally reduced from 526/100,000 to 435/100,000 livebirths between 2001 and 2011. The presence of a skilled attendant during the entire continuum of care for maternal and new born care has great potential to reduce maternal and new born morbidities and mortality. In 2013, an intervention to mobilize communities in Masindi, Uganda for maternal and new born health was introduced and the results showed marked improvement in utilization of maternal health services such as antenatal care and health facility delivery. However, non-indigenous populations were found to use maternal health services less compared to the indigenous populations. The non-indigenous population are mainly from the West Nile region of Arua and Nebbi. These group of people provide a cheap source of labour for the sugar plantation and sugar factory in Kinyala. This study could not adequately explain why migrants were using maternal health services less. The aim of this study was to gain a deeper understanding of internal migrant’s low access and utilisation of maternal and new born care services in Masindi, Uganda. Key barriers to access were identified as lack of financial resources, social beliefs, neglect by health workers, lack of education and lack of male involvement. There are a number of barriers to access to maternity care among migrant women in Masindi, Uganda. These barriers can be addressed at two levels. At the household level, there should be deliberate efforts to engage with men to support their partners during pregnancy and childbirth for example, by saving money and preparing for transport to the health facility in case of antenatal care and delivery. At the district level, there is need for district local managers together with district health managers to create a dialogue platform in which communication barriers and the mistreatment of migrant women can be addressed in the health sector.

2016: Old Challenges, New Hopes
Independent Accountability Panel, September 2016

The Independent Accountability Panel (IAP) inaugural report '2016: Old Challenges, New Hopes' was launched September 18, 2016 in conjunction with the Partnership for Maternal Newborn and Child Health and Countdown to 2030 and formally submitted to the Secretary-General at the Every Woman Every Child high level reception on the 20th September 2016. The report details how inequalities within and between countries are leaving women, children and adolescents at a disadvantage. It argues that more must be done to give every woman, every adolescent, and every child the opportunity to survive and thrive. In a statement at http://tinyurl.com/hadb8np the O’Neill Institute for National and Global Health Law at Georgetown University Law Center endorsed the report noting "The IAP’s report encompasses remedies as a necessary part of an accountability framework, building on the earlier work of the Commission on Information and Accountability and its accountability framework of monitor, review, and act. The inclusion of remedies rounds out a cycle of accountability that is necessary to realize the right to health and other health-related rights, which must extend beyond the traditional emphasis on monitoring and evaluation. This report is intended to help catalyze the use of national, regional, and global accountability mechanisms – and vitally, to ensure that all people, with special attention to the most marginalized, have the resources and respect that empower their ability to access them".

Pan African Parliament Endorses Ban on Female Genital Mutilation
Latham D: Inter Press Service, August 2016

After years of wrangling and debates among African leaders, the movement to end female genital mutilation (FGM) is gaining real momentum, with a new action plan signed in August by the Pan African Parliament (PAP) representatives and the U.N. Population Fund (UNFPA) to end FGM as well as underage marriage. The UNFPA has already trained over 100,000 health workers to deal specifically with aiding victims of FGM, while tens of thousands of traditional leaders have also signed pledges against the practice. In some African countries, girls as young as eleven and twelve are forced to marry much older men, leading to an increase in serious health problems, including cervical cancer and a host of social problems. UNFPA East and Southern Africa Deputy Regional Director Justine Coulson said if the current trend continues, the number of girls under 15 who had babies would rise by a million – from two to three million. There are believed to be at least seven million child brides in Southern Africa alone. While underage marriage and childbirth is a major health risk, the Pan African Parliament UNFPA workshop also heard how FGM had led to an increased likelihood girls and women would be exposed to sexually transmitted diseases such as HIV/AIDS. Globally, an estimated 200 million girls and women alive today have undergone some form of FGM. In Africa, FGM is practiced in at least 26 of 43 African countries, with prevalence rates ranging from 98 percent in Somalia to 5 percent in Zaire. The buy-in of African political leadership is argued to be crucial if this latest move is to succeed, with up to 140 million women and girls in sub-Saharan Africa who’ve been forced to submit to FGM. The aim is to influence people on the ground as well as effect legislation banning the practice. There are no health benefits in the process and it can cause severe bleeding, problems urinating, cysts, infections and a host of childbirth complications. The PAP also agreed to work with the UNFPA in seeking to overturn the practice of marrying off children under the age of sixteen. In June 2016, the UNFPA worked with Southern African Development Community Parliamentary Forum representatives at a meeting in Swaziland which voted through a Model Law on eradicating child marriage.

Report of the Reflection Group on the 2030 Agenda for Sustainable Development
Social Watch; Global Policy Forum; Development Alternatives with Women for a New Era; Third World Network; Arab NGO Network for Development; Friedrich-Ebert-Stiftung, 2016

Independent monitoring and review of the implementation of the 2030 Agenda and its structural obstacles and challenges are key factors for the success of the SDGs. For this reason, the Reflection Group on the 2030 Agenda for Sustainable Development together with other civil society organisations and networks has produced the first annual Spotlight Report assessing the implementation of the 2030 Agenda and the structural obstacles in its realisation. The report puts a spotlight on the fulfilment of the 17 goals, with a particular focus on inequalities, responsibility of the rich and powerful, means of implementation and systemic issues. It raises the main obstacles to achieving the SDGs and explores transnational spill over effects that influence or even undermine the implementation of the goals. It comments on whether the current policy approaches, as reflected in the 2030 Agenda, are an adequate response to the challenges and obstacles or are part of the problem and discusses necessary policy changes.

Understanding Ebola: the 2014 epidemic
Kaner J; Schaak S: Globalization and Health 12(53), 2016, doi: 10.1186/s12992-016-0194-4

Near the end of 2013, an outbreak of Zaire ebolavirus (EBOV) began in Guinea, subsequently spreading to neighbouring Liberia and Sierra Leone. As this epidemic grew, important public health questions emerged about how and why this outbreak was so different from previous episodes. This review provides a synthetic synopsis of the 2014–15 outbreak, with the aim of understanding its unprecedented spread. The authors present a summary of the history of previous epidemics, describe the structure and genetics of the ebolavirus, and review our current understanding of viral vectors and the latest treatment practices. They conclude with an analysis of the public health challenges epidemic responders faced and some of the lessons that could be applied to future outbreaks of Ebola or other viruses.

Africa’s demographic future: why Africa should take the lead
Sankoh O: The Lancet Global Health 4(8), pp.e522-e522, 2016

In 2010, the UN’s Population Division predicted that the African continent, the population of which is now 1·2 billion, will have 3·5 billion people by the year 2100. By 2015, the projection for the year 2100 had risen to 4·4 billion. In many ways this is good news for Africa—the population increase reflects impressive progress in reducing mortality, especially child mortality, and improving life expectancy. But the response to the news in developed countries has been of concern, often turning into panic. John Bongaarts, vice president of the Population Council, warned that “Most of these people are going to end up in slums. That’s not good news.” Mertule Mariam said: “Alarmingly, population growth in Africa is not slowing as quickly as demographers had expected...the number of Africans seeking a better life in Europe and other richer places is likely to increase several times over”. These reactions have revived discussions in developed countries on what should be done to alleviate the apparent crisis. Policy prescriptions in developed countries focus on family planning services and education of girls. The author argues that these recommendations might be sensible, but if Africans do not take the lead in framing the population discourse, their motivations and needs could be overlooked. New policies must consider African development. An African-led response to population change might begin with efforts to establish the size of the population Africa wants, in the context of broader developmental ambitions. Rather than being dictated by fears in developed countries of mass emigration, conflict, and environmental destruction, such a strategy would be based on the needs of African people. As well as national objectives, a continent-wide perspective on population goals led by the African Union, might be useful. Just as many of the drivers of population change are pan-national (eg, armed conflict, environmental damage, or economic pressures), so are some of its results. In consultation with their people, African Governments will no doubt propose further population policies that are closely tailored to the needs of their societies. What is important, the author poses, is that these objectives and policies are established by Africans.

Facing up to the world’s critical health crises
Khor M: Third World Network Info Service on UN Sustainable Development, 2016

The global health situation is facing many critical challenges, and multiple actions must be taken urgently to prevent crises from boiling over. This paper reflects on the 2016 World Health Assembly (WHA) as the world’s prime public health event, attended by 3,500 delegates, including Health Ministers from most of the 194 countries.World Health Organisation director-general Dr Margaret Chan gave an overview of what went right and what is missing in global health. 19,000 fewer children dying every day, a 44% drop in maternal mortality, the 85% cure rate for tuberculosis, and 15 million people living with HIV now receiving therapy, up from just 690,000 in 2000. Chan also described how health has become a globalised problem, with air pollution becoming a transboundary health hazard, and drug-resistant pathogens being spread through travel and food trade. The recent Ebola and Zika outbreaks showed how global health emergencies can quickly develop. The world is not prepared to cope with the dramatic resurgence of emerging and re-emerging infectious diseases. Chan said the global health landscape is being shaped by three slow-motion disasters: climate change, antimicrobial resistance and the rise of chronic non-communicable diseases. The assembly agreed that the WHO set up a new Health Emergencies Programme to enable it to give rapid support to countries and communities to prepare for, face or recover from emergencies caused by health hazards including disease outbreaks, disasters and conflicts. On anti-microbial resistance, many developing countries stressed the importance of funds and technology to help them develop national action plans by 2017. The WHA called on the WHO to develop an implementation plan and urged governments to develop national policies on marketing unhealthy foods to children. Two environment-related health issues were discussed. Air pollution accounts for eight million deaths worldwide annually – 4.3 million due to indoor and 3.7 million to outdoor air pollution. The assembly welcomed a new WHO road map for actions in 2016-19 to tackle the health effects of air pollution. A controversial issue is how the WHO should relate to “non-state actors”. After two years of negotiations, the WHA adopted the Framework of Engagement with Non-State Actors (FENSA), which provides the WHO with policies and procedures on engaging with non-governmental organisations, private sector entities, philanthropic foundations and academic institutions.

The prevalence of self-reported vision difficulty in economically disadvantaged regions of South Africa
Naidoo K; Jaggernath J; Ramson P; Chinanayi F; Zhuwau T; Øverland L: African Journal of Disability 4(1) 2015

Vision impairment is a leading cause of disability, and a barriers to access education and employment, which may force people into poverty. This study determined the prevalence of self-reported vision difficulties as an indicator of vision impairment in economically disadvantaged regions in South Africa, and to examine the relationship between self-reported vision difficulties and socio-economic markers of poverty, namely, income, education and health service needs. A cross-sectional study was conducted in 27 economically disadvantaged districts (74901 respondents) to collect data from households on poverty and health, including vision difficulty. As visual acuity measurements were not conducted, the researchers used the term vision difficulty as an indicator of vision impairment. The prevalence of self-reported vision difficulty was 11.2%. More women (12.7%) compared to men (9.5%) self-reported vision difficulty (p < 0.01). Self-reported vision difficulty was higher (14.2%) for respondents that do not spend any money. A statistically significant relationship was found between the highest level of education and self-reporting of vision difficulty; as completed highest level of education increased, self-reporting of vision difficulty became lower (p < 0.01). A significantly higher prevalence of self-reported vision difficulty was found in respondents who are employed (p < 0.01). The evidence from this study suggests associations between socio-economic factors and vision difficulties that have a two-fold relationship (some factors such as education, and access to eye health services are associated with vision difficulty whilst vision difficulty may trap people in their current poverty or deepen their poverty status).

Physical, emotional and sexual adolescent abuse victimisation in South Africa: prevalence, incidence, perpetrators and locations
Meinck F; Clever L; Boyes M; Loening-Voysey H: Journal of Epidemiology and Community Health, 2016, doi:10.1136/jech-2015-205860

Physical, emotional and sexual abuse of children is a major problem in South Africa, with severe negative outcomes for survivors. This study investigated the prevalence and incidence, perpetrators, and locations of child abuse in South Africa using a multicommunity sample. 3515 children aged 10–17 years (56.6% female) were interviewed from all households in randomly selected census enumeration areas in two South African provinces. Child self-report questionnaires were completed at baseline and at 1-year follow-up (97% retention). Prevalence was 56% for lifetime physical abuse (18% past-year incidence), 36% for lifetime emotional abuse (12% incidence) and 9% for lifetime sexual abuse (5% incidence). 69% of children reported any type of lifetime victimisation and 27% reported lifetime multiple abuse victimisation. Main perpetrators of abuse were reported: for physical abuse, primary caregivers and teachers; for emotional abuse, primary caregivers and relatives; and for sexual abuse, girlfriend/boyfriends or other peers. This is the first study assessing current self-reported child abuse through a large, community-based sample in South Africa. Findings of high rates of physical, emotional and sexual abuse demonstrate the need for targeted and effective interventions to prevent incidence and re-abuse.