The United Nations (UN) has named the 26 members of its new High-level Panel to advise on the global development agenda beyond 2015, the target date for the Millennium Development Goals (MDGs). Three co-chairs have been appointed, including President Ellen Johnson Sirleaf of Liberia. The Panel is expected to prepare its development vision to present to UN Member States in 2013, with sustainable development and eradicating poverty at its core. The Panel is part of the Secretary-General’s post-2015 initiative mandated by the 2010 MDG Summit. It intends to take an open, inclusive approach, with consultations involving civil society, the private sector, academia and research institutions from all regions, in addition to the UN system, to advance the development agenda beyond 2015. The work of the Panel will reflect new development challenges while also drawing on experience gained in implementing the MDGs, both in terms of results achieved and areas for improvement.
Equity in Health
he Africa Progress Report 2012 is the Africa Progress Panel’s flagship publication. Its purpose is to provide an overview of the progress Africa has made over the previous year. The report draws on the best research and analysis available on Africa and compiles it in a refreshing and provocative manner. Through the report, the Panel recommends a series of policy choices and actions for African policy makers who have primary responsibility for Africa’s progress, as well as vested international partners and civil society organisations. The report warns that Africa’s strong economic growth trajectory – which will see the region increase the pace of growth well beyond 5 per cent over the next two years – is at risk because of rising inequality and the marginalisation of whole sections of society. The report calls for a “relentless focus” by policymakers on jobs, justice and equity to ensure sustainable, shared growth that benefits all Africans. Failure to generate equitable growth could result in “a demographic disaster marked by rising levels of youth unemployment, social dislocation and hunger.” Africa’s governments and development partners must urgently draw up plans for a big push towards the 2015 Millennium Development Goals, the report says.
According to this report, steady economic growth and improvements in poverty reduction on the continent are reported to have had a positive impact on MDG progress, with sustained progress toward several MDGs. Africa is on track to achieve the targets of: universal primary education; gender parity at all levels of education; lower HIV/AIDS prevalence among 15-24 year olds; increased proportion of the population with access to antiretroviral drugs; and increased proportion of seats held by women in national parliament by 2015. However, the report acknowledges that more needs to be done to address inequalities, including between women and men. It highlights the need to address the sub-standard quality and unequal distribution of social services between rural and urban areas. It suggests active steps to ensure that economic growth translates into new and adequate employment opportunities for Africa’s youthful and rapidly growing population, and supports social protection systems. The report urges policymakers to put greater emphasis on improving the quality of social services and ensuring that investments yield improved outcomes for the poor for MDG progress.
The World Federation of Public Health Associations honooured the author with the Leavell Lectureship Award and this paper is the speech given by the awardee on “Health Equity, from the African Perspective” at the Congress. He raises that addressing equity calls for African countries to break the vicious cycle of poverty and ill-health; to urgently address the water, sanitation and hygiene crisis; to mobilize adequate budget allocation to the health sector and provide social protection for poor people; to strengthen the capacity of health systems to provide effective and equitable quality health care services; to stabilise health personnel; to generate evidence and build transparency and accountability in the use of domestic and externally generated resources allocated for health. All these issues he noted need to be backed by political commitment to make health equity a priority.
Noncommunicable diseases are an increasing health concern worldwide, but particularly in low- and middle-income countries. This study quantified and compared education- and wealth-based inequalities in the prevalence of five noncommunicable diseases (angina, arthritis, asthma, depression and diabetes) and comorbidity in low- and middle-income country groups, using 2002-04 World Health Survey data from 41 low- and middle-income countries. Wealth and education inequalities were more pronounced in the low-income country group than the middle-income country group. Both wealth and education were inversely associated with angina, arthritis, asthma, depression and comorbidity prevalence, with strongest inequalities reported for angina, asthma and comorbidity. Diabetes prevalence was positively associated with wealth and, to a lesser extent, education. Adjustments for confounding variables tended to decrease the magnitude of the inequality.
Human-induced climate change will have the greatest, and generally earliest, impact on the poorest and most disadvantaged populations, according to this paper. Climate change adaptation is receiving much attention given the inevitability of climate change and its effects, particularly in developing contexts, where the effects of climate change will be experienced most strongly and the response mechanisms are weakest. Financial support towards adaptation activities from various actors including the World Bank, the European Union and the United Nations is increasing substantially. With this new global impetus and funding for adaptation action come challenges such as the importance of developing adaptation activities on a sound understanding of baseline community needs and vulnerabilities, and how these may alter with changes in climate. The global health community is paying heed to the strengthening focus on adaptation, albeit in a slow and unstructured manner. The aim of this paper is to provide an overview of adaptation and its relevance to global health, and highlight the opportunities to improve health and reduce health inequities via the new and additional funding that is available for climate-change adaptation activities.
Considerable declines in malaria have accompanied increased funding for control since the year 2000, but historical failures to maintain gains against the disease underscore the fragility of these successes. In this study, researchers conducted a systematic review of the literature to identify historical malaria resurgence events. They identified 75 resurgence events in 61 countries, occurring from the 1930s through the 2000s. Almost all resurgence events (91%) were attributed at least in part to the weakening of malaria control programmes for a variety of reasons, of which resource constraints were the most common (57%). Over half of the events (59%) were attributed in part to increases in the intrinsic potential for malaria transmission, while only 32% were attributed to vector or drug resistance. Given that most malaria resurgences have been linked to weakening of control programmes, this study highlights the need to develop practical solutions to the financial and operational threats to effectively sustaining today's successful malaria control programmes.
According to the World Health Organisation (WHO), measuring health can tell us how well development is advancing the three pillars of sustainability, namely social, environmental and economic sustainability. It therefore stands to reason that indicators of healthy development can help identify success stories, barriers and the extent to which benefits of greener economies are equitably distributed. Examples of health-relevant indicators for six Rio+20 themes are presented here: sustainable cities, food, jobs, water, energy and disaster management. WHO has identified three key ways in which health can both contribute to, and benefit from, greener and cleaner development. First, achieving universal health coverage will result in healthier people who can contribute economically and socially. Reducing gender, employment and housing inequities will also improve health. Second, strategies need to be designed specifically to enhance health gains from sustainable development investments and decisions – health gains from development are not automatic. Third, governments and other role players should adopt health indicators to measure progress/achievements in sustainable development.
Malawi is one of two low-income sub-Saharan African countries on track to meet the Millennium Development Goal (MDG 4) for child survival despite high fertility and HIV rates and low health worker density. In this study, researchers examined changes in newborn survival in the decade 2000-2010, and assessed national and external funding, as well as policy and programme changes. Compared with the 1990s, they found that progress towards MDGs 4 and 5 accelerated considerably from 2000 to 2010. They argue that a significant increase in facility births and other health system changes, including increased human resources, likely contributed to the 3.5% annual decline in neonatal mortality rate. The initial entry point for newborn care in Malawi was mainly through facility initiatives, such as Kangaroo Mother Care. This transitioned to an integrated and comprehensive approach at community and facility level through the Community-Based Maternal and Newborn Care package, now being implemented in 17 of 28 districts. Addressing quality gaps, especially for care at birth in facilities, and including newborn interventions in child health programmes, will be critical to the future agenda of newborn survival in Malawi, the paper concludes.
As part of a multi-country analysis, the authors of this paper examined changes for newborn survival in Uganda over the past decade through mortality and health system coverage indicators as well as national and external funding for health, and changes in policies and programmes. Between 2000 and 2010 Uganda’s neonatal mortality rate reduced by 2.2% per year, which is greater than the regional average rate of decline but lower than national reductions in maternal mortality and under-five mortality. Attention and policy change for newborn health is comparatively recent, the authors note. In 2006, a national Newborn Steering Committee was launched, which was given a mandate from the Ministry of Health to advise on newborn survival issues. This multi-disciplinary and inter-agency network of stakeholders has been able to preside over a number of important policy changes at various levels of facility care, education and training, in addition to community-based service delivery through village health teams and changes to essential drugs and commodities. The committee’s comprehensive reach has enabled rapid policy change and increased attention to newborn survival in a relatively short space of time. Translating this favourable policy environment into district-level implementation and high quality services is now the priority.