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.
Equity in Health
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.
Diarrhoea is a leading cause of morbidity and mortality globally; yet the overall burden of diarrhoea in terms of duration and severity has not been quantified. This study aims to fill that research gap. The authors estimated that, globally, among children under-five, 64.8% of diarrhoeal episodes are mild, 34.7% are moderate, and 0.5% are severe. On average, mild episodes last 4.3 days, and severe episodes last 8.4 days and cause dehydration in 84.6% of cases. Among older children and adults, 95% of episodes are mild; 4.95% are moderate; and 0.05% are severe. Among individuals ≥16 yrs, severe episodes typically last 2.6 days and cause dehydration in 92.8% of cases. Moderate and severe episodes constitute a substantial portion of the total envelope of diarrhoea among children under-five (35.2%; about 588 million episodes). Among older children and adults, moderate and severe episodes account for a much smaller proportion of the total envelope of diarrhoea (5%), but the absolute number of such episodes is noteworthy (about 21.5 million episodes among individuals ≥16 yrs). Hence, the global burden of diarrhoea consists of significant morbidity, extending beyond episodes progressing to death.
The fourth edition of the World Water Development Report, ‘Managing Water under Uncertainty and Risk’ is a comprehensive review of the world's freshwater resources and seeks to demonstrate, among other messages, that water underpins all aspects of development, and that a coordinated approach to managing and allocating water is critical. The report underlines that in order to meet multiple goals water needs to be an intrinsic element in decision-making across the whole development spectrum. It aims to encourage all stakeholders both in and out of the ‘water box’ - water managers, leaders in government, civil society and businesses – to engage early in decision making processes to improve the quality and acceptance of decisions and the probability of successful implementation. It highlights that more responsible action by all water users has enormous potential to lead to better outcomes - but requires political, social, economic and technical responses at all levels of government, businesses and communities, from local to international.
A cholera epidemic has spread to nine out of 11 provinces in the Democratic Republic of the Congo, according to the United Nations. The UN said the spread was "worrisome" as the epidemic had so far killed 644 people and infected 26,000 since January 2011. Lack of access to potable water remains the single most important cause of the recurrent cholera outbreaks, according to the United Nations Office for the Co-ordination of Humanitarian Affairs (UN OCHA). UN OCHA cited the example of the north-eastern city of Bunia, where over a third of the residents - more than 100,000 people - have been cut off from drinking water since the start of 2012. In neighbouring Republic of Congo, an official announced that there have been more than 340 cholera cases reported in recent months, and several people have died from the water-borne disease.
The Istanbul Declaration was adopted by consensus at the conclusion of the two-day Global Human Development Forum, a gathering of more than 200 leading development experts, civil society activists, government ministers, private sector representatives and UN officials from all regions of the world. The Declaration stresses the need for global and national development strategies to put “strong emphasis on social inclusion, social protection, and equity, in recognition of the fact that economic development has too often gone hand in hand with environmental degradation and increased inequality.” Achieving those goals will require better-coordinated “mobilization of global capital and local resources,” good governance on the local and global level, and full empowerment of women “through access to education, health care, basic services and their participation in the labour force.” The declaration calls for a post 2015 MDG framework that addresses all three dimensions of sustainable development (social, economic and environmental), and their interconnections.
The theme of the Prince Mahidol Award Conference – held in Bangkok, Thailand on on 24-28 January 2012 – was “Moving towards universal health coverage: health financing matters”. At the close of the meeting, a 10-point declaration recognised universal health coverage (UHC) as fundamental to the right to health, and marked the commitment by more than 800 delegates to translate the rhetoric of UHC into better, more equitable health outcomes. Similar endorsements of UHC have been made before, including at the World Health Assembly in 2011. What makes the Bangkok Statement any more likely to hasten and widen the implementation of UHC? One answer may be the power of the Prince Mahidol Award Conference and its sponsors to draw global health enthusiasts from a wide variety of disciplines and health systems. Delegates from 68 countries included external funders and recipients of aid, managers and front-line health workers, ministers, economists, and consumers. From these many perspectives came the realisation that whether one seeks to provide access to health care for the one billion people who lack it, or to protect the 100 million people who end up in poverty every year as a result of medical costs, or to accelerate progress towards the Millennium Development Goals: UHC provides a common mechanism – and common cause.
Despite a high disease burden, mental illness has thus far not achieved commensurate visibility, policy attention, or funding, the authors of this study note. They found that, while significant progress has been made in terms of prioritising mental health globally, debates around the definition of mental illness, and the continued impact of stigma, remain. The authors make five recommendations to increase the visibility and policy priority of mental health as a global issue. 1. Greater community cohesion and international governance structures need to be developed to contribute to a more unified voice regarding global mental health. 2. A common framework of integrated innovation is needed to ensure that global mental health speaks in the language of national and international policy makers. 3. For global mental health to gain significant attention, a coherent evidence base for scalable interventions that can be shown to have an impact at the structural level - on economic development and human well-being - is central. 4. A social justice and human rights approach is important. 5. Current innovative strategies for addressing stigma need to be evaluated and expanded.
Development progress in the world's poorest countries could be halted or even reversed by mid-century unless bold steps are taken now to slow climate change, prevent further environmental damage, and reduce deep inequalities within and among nations, according to projections in the 2011 Human Development Report. In the report the United Nations Development Programme (UNDP) argues that environmental sustainability can be most fairly and effectively achieved by addressing health, education, income and gender disparities together with global action on energy production and ecosystem protection.
The deadline for meeting the Millennium Development Goals (MDGs) is quickly approaching. While progress has been made on a number of the goals, it is already clear that many targets will not be reached. Policy makers have been reluctant to start discussions of what comes after the 2015 deadline, fearing that negotiating a new framework would detract from efforts to meet the Millennium Development Goals (MDGs). While there seems to be broad support for a post- 2015 framework, there is not yet agreement on what this could look like. The United Nations and the World Health Organisation have started discussions on the issue, and it appears that sustainable development goals may be the way forward. In a survey of developing countries by the Institute of Development Studies, respondents overwhelmingly agreed that although the MDG framework has shortcomings, it is desirable to have an internationally agreed framework in place. Eighty percent of the respondents agreed that the post- 2015 arrangement should be target based, in part because it allows monitoring of progress.