More than 3,000 delegates from approximately 120 countries assembled at the 13th World Congress on Public Health in Addis Ababa from the 23rd to 27th of April 2012. In this statement, delegates re-affirm their commitment to international agreements enshrining health as a human right. They also pledge to promote innovative research to generate evidence on the social determinants of health and health equity, as well as advocate for: evidence-based policy; making health equity an integral part of policy and development; equitable access to high quality health services; and fair trade in all commodities that affect human health. The Federation further intends to strengthen partnerships and networks to take common action on global public health priorities, share experiences and help build capacity.
Equity in Health
The aim of this study was to assess the distribution of health care benefits in the Kenyan health system, compare changes over two time periods and demonstrate the extent to which the distribution meets the principles of universal coverage. Two nationally representative cross-sectional households surveys conducted in 2003 and 2007 were the main sources of data. A comprehensive analysis of the entire health system was conducted including the public sector, private-not-for-profit and private-for-profit sectors. The three sectors recorded similar levels of pro-rich distribution in 2003, but in 2007, the private-not-for-profit sector was pro-poor, public sector benefits showed an equal distribution, while the private-for-profit sector remained pro-rich. Larger pro-rich disparities were recorded for inpatient compared to outpatient benefits at the hospital level, but primary health care services were pro-poor. Benefits were distributed on the basis of ability to pay and not on need for care. In conclusion, the Kenyan health sector is clearly inequitable and benefits are not distributed on the basis of need.
Previous studies have reported large socioeconomic inequalities in mortality from conditions amenable to medical intervention, but it is unclear whether these can be attributed to inequalities in access or quality of health care, or to confounding influences such as inequalities in background risk of diseases. In this study, researchers hypothesised that, as compared to non-amenable causes, inequalities in mortality from amenable causes are more strongly associated with inequalities in health care use and less strongly with inequalities in common risk factors for disease such as smoking. Cause-specific mortality data for people aged 30-74 years were obtained for 14 countries, and were analysed by calculating age-standardised mortality rates and relative risks comparing a lower with a higher educational group. In most countries and for most amenable causes of death substantial inequalities in mortality were observed, but inequalities in mortality from amenable causes did not vary between countries in patterns that are different from those seen for inequalities in non-amenable mortality. As compared to non-amenable causes, inequalities in mortality from amenable causes are not more strongly associated with inequalities in health care use. Inequalities in mortality from amenable causes are also not less strongly associated with common risk factors such as smoking. The authors call for further research to find the causes of socio-economic inequalities in mortality from amenable conditions.
The 2011 Update identifies and discusses 159 different health equity activities and 79 sets of recommendations from local, state, national, and international reports. It notes that many of the recommendations focus on a wide range of areas, including early childhood investment, education, lifestyle, housing, transportation, the environment, employment and community and interagency collaboration. This breadth of topics reflects the growth in “Health in All Policies” thinking and analysis among community groups and governments at all levels, calling for each sector to contribute to the quality of the nation's health. The Update recommends actions to increase awareness of health inequities and the social determinants of health, as well as advocacy and leadership for health equity and social justice. A health equity-oriented approach should emphasise community empowerment, increasing collaborative partnerships with all sectors and the need to coordinate and utilise research and outcome evaluations more effectively.
The current over-arching development framework of the MDGs expires in 2015. Any plans for SDGs coming out of Rio+20 must be fully integrated into the global overarching post-2015 development framework, argues Beyond 2015. To develop SDGs and the post-MDG development framework in parallel would be both inefficient and short-sighted, and could lead to a number of negative scenarios. Principles of participation, accountability, equality and non-discrimination must cut across any post-2015 framework to ensure outcomes which are effective, just and sustainable. Principles of Agenda 21 should similarly be embedded throughout. To illustrate this, Beyond 2015 have identified four principles which must be the foundation for any guidance coming out of Rio+20 on a future development framework: holistic, inclusive, equitable and universally applicable. Fundamentally, any global development framework must be based on, and fully ensure, equal enjoyment of all human rights for all people.
More than 3,000 delegates from approximately 120 countries assembled at the 13th World Congress on Public Health in Addis Ababa from the 23rd to 27th of April 2012. In this statement, delegates re-affirm their commitment to international agreements enshrining health as a human right. They also pledge to promote innovative research to generate evidence on the social determinants of health and health equity, as well as advocate for: evidence-based policy; making health equity an integral part of policy and development; equitable access to high quality health services; and fair trade in all commodities that affect human health. The Federation further intends to strengthen partnerships and networks to take common action on global public health priorities, share experiences and help build capacity.
World Health Statistics 2012 is the World Health Organisation’s annual compilation of health-related data for its 194 Member States, and includes a summary of the progress made towards achieving the health-related Millennium Development Goals (MDGs) and associated targets. In this edition it also includes highlight summaries on the topics of non-communicable diseases, universal health coverage and civil registration coverage. The report notes a decrease in child mortality, increased vaccination coverage, while worldwide obesity prevalence almost doubled between 1980 and 2008. In the last 20 years, maternal deaths have been reduced by almost half, but the mortality burden is extremely uneven, and remains high in sub-Saharan Africa, where 500 women out of every 10,000 die in childbirth.
The value of ecosystem services typically goes unaccounted for in business and policy decisions and in market prices, according to this article. For commercial purposes, if ecosystem services are recognised at all, they are perceived as free goods, like clean air and water. The author considers the work of organisations like the United States President’s Council of Advisors on Science and Technology (PCAST), which are working to build recognition of ecosystem services and, importantly, methods to evaluate them. By calculating specific values for these services, policy makers and resource managers may be able to make better-informed decisions that factor important environmental and human health outcomes into the bottom line.
Over the past year, at a range of international conferences, including the Conference on Social Determinants in Rio and COP-17 in Durban, there have been side events introducing work on the link that exists between health and climate change. In the run-up to Rio+20 climate conference in June 2012, the need for a sustainable approach to global health will become even more important, the author of this article argues. It will require a shift in focus away from disease-specific thinking to an approach that more fully considers climate change and environmental degradation as important determinants of health. The author argues that the Istanbul Declaration, which calls on the world community to take bold action jointly against global social inequities and environmental deterioration, is a useful tool to achieve this end. It points to the need to integrate equity within the links made across health, economy and environment, reinforcing similar issues raised at the World Conference on the Social Determinants of Health, held in October 2011.
In the industrialised North, South Africa is seen as an archetypal medical tourism destination, combining a medical (elective) procedure with related travel and tourism activity. Yet this paper shows that the industry is premised on a highly romanticised and stylised image of South Africa, and most medical tourism to South Africa is not from the North: the Global North generated a total of 281,000 medical travellers between 2009 and 2010, while the Global South was the source of over two million. Most patients were middle-class people from East and West Africa, as well as a growing number of patients from South Africa’s neighbouring countries. In some cases, patients go to South Africa for procedures that are not offered in their own countries. In others, patients are referred by doctors and hospitals to South African facilities. But most of the movement is motivated by lack of access to basic healthcare at home. The total annual spend by medical travellers in South Africa amounts to over R1.5 billion (US$191 million). Of this, over 90% is generated by South-South medical travellers from the rest of Africa, powerfully illustrating the overall economic importance of this form of medical travel. In addition, South Africa has entered into bilateral health agreements with eighteen African countries. The authors call for further research on and policy attention for intra-African medical tourism and migration, which is identified as a growing trend.