Botaswana’s Minister of Health, John Seakgosing, has announced that Botswana has significantly reduced its burden of malaria from 77,555 unconfirmed cases in 2000 to 12,196 cases in 2010. Malaria deaths have decreased from 35 to seven over the same period. He said this success is due to the country's distribution programme of long lasting mosquito nets and indoor spraying in malaria-prevalent areas. The rolling out of artemisin-based combination treatment (ACT) in 2007 also contributed to the reduction of malaria cases and deaths. Moving towards the total elimination of the disease, Botswana has drafted malaria case based surveillance guidelines. According to the Minister, all malaria cases from disease-free areas will be notified, investigated and all contacts of the case will be screened. The country is committed to ensure an increase in diagnostics and ACT coverage to reach 100% of all malaria cases.
Equity in Health
This publication presents in numerical and graphical formats the best data available for key health indicators in the 46 countries of the World Health Organisation’s African Region. It describes the health status and trends in the countries of the African Region, the various components of their health systems, coverage and access levels for specific programmes and services, and the key determinants of health in the region, and the progress made on reaching the United Nations’ Millennium Development Goals (MDGs). A major finding is improvement in progress towards reaching the MDGs – however, most improvements have been small and it does not appear that the continent will meet all the health-related MDGs set for 2015, notably those for child and maternal mortality, which remain very high. Communicable diseases make up the largest part of the disease burden (42.4% of disability-adjusted life years) versus only 15.9% for non-communicable diseases in second place (data from 2004). Utilisation of health services is low for antenatal care (44%) and contraceptive prevalence is a mere 24%, but immunisation coverage for children improved to 72%.
On 16 September 2011, the United Nations (UN) General Assembly unanimously adopted a political declaration at the end of its High-Level Summit on Non-communicable Diseases (NCDs), the response to which has been largely positive. But the authors of this article argue that the declaration missed a number of opportunities to effect real change in the fight against NCDs. They note that the declaration did not establish a special funding mechanism devoted to improving access to treatment of NCDs globally, nor did it commit donors and international organisations to invest more resources in that area, as was requested by developing country members of the Group of 77. Also, the final document did not include a reference to the Doha declaration on TRIPs and Public Health adopted in 2001, which re-affirmed the right of governments to adopt measures to protect health, despite this issue being emphasised during the process by the G77. Likewise, the declaration does not include new specific targets in reducing NCDs or concrete measures to be undertaken by governments, thanks largely to the United States, the European Union, and Canada, which generally opposed mandatory targets. The influence of the private sector was also clearly felt in this regard, as, in various side-meetings during the Summit, private sector companies argued for a voluntary rather than a regulatory approach for industry practices. Next steps include the development of targets and of a monitoring framework by the World Health Organisation by 2012. So far, the 68th session of the UN General Assembly in 2014 does not appear to include any discussion of NCDs.
Inequalities in health have received considerable attention from health scientists and economists. In South Africa, inequalities exist in socio-economic status (SES) and in access to basic social services and are exacerbated by inequalities in health. While health systems, together with the wider social determinants of health, are relevant in seeking to improve health status and health inequalities, those that need good quality health care too seldom get it. Studies on the burden of ill-health in South Africa have shown consistently that, relative to the wealthy, the poor suffer more from more disease and violence. This paper specifically investigates socio-economic related health inequality in South Africa and seeks to understand how the burden of self-reported illness and disability is distributed and whether this has changed since the early 2000s. The study demonstrates the existence of socio-economic gradients in self-reported ill-health in South Africa. The burden of the major categories of ill-health and disability is greater among lower than higher socio-economic groups. Even non-communicable diseases, which are frequently seen as diseases of affluence, are increasingly being reported by lower socio-economic groups. For instance, the concentration index of flu (and diabetes) declined from about 0.17 (0.10) in 2002 to 0.05 (0.01) in 2008.
Globally, 12% of women smoke, 22% in developed and 9% in developing countries, according to this article. While smoking has peaked in men and begun a slow decline, it is predicted that by 2025, 20% of women worldwide will be smokers, with so many younger women taking up the habit. Tobacco transnationals minimise the dangers of smoking in powerful advertising that goes round the globe, while health agencies and institutions strive to counter these media messages on shoestring budgets - an astounding asymmetry that endangers the health of millions, the author notes. The author argues that we have to go beyond banning tobacco advertising and ‘demarket’ smoking and counter the positive images that permeate our culture with more sophisticated presentations of the threat to health. Stakeholders also need to create more barriers to tobacco access - in addition to those already banning sales to youngsters and raising cigarette prices - aligning education and legislation for greater effect. And finally, policy makers need to understand more fully the forces that influence people - particularly young women - to start smoking. It is not enough to simply warn people of the dangers of smoking, the article concludes – stronger measures are needed.
The United Nations (UN) High-Level Meeting on Non-communicable Diseases (NCDs) has helped raise awareness about the burden of NCDs, but the authors of this article caution that the real work of preventing and controlling NCDs must begin. They put forward several important steps that must be taken immediately. Governments need to implement the commitments in the Political Declaration that call for acceleration of the Framework Convention on Tobacco Control (FCTC), a global public health treaty focused on reducing the five million deaths per year caused by tobacco use. In addition, national plans to address NCDs need to be developed and NCDs need to be incorporated into the United Nations’ Millennium Development Goals. Clear, effective, and achievable targets to reduce NCDs - developed with input from health experts and civil society - need to be established and monitored by the World Health Organisation. And, importantly, global and national funding needs to be mobilised by governments, the private sector and civil society so that these plans can be effectively implemented, particularly in low- and middle-income countries. Moreover, the global health and development community must commit to greater collaboration across sectors and disease groups. Vertical interventions that target one disease at a time must be folded into comprehensive horizontal health programmes that promote overall health and wellness across the individual’s lifespan.
The World Health Organisation estimates that global warming and trends in rainfall due to human-induced climate change already claim over 150,000 lives annually. Diseases associated with climate change include heart and lung disease due to heat waves, increased spread of infectious diseases, and malnutrition due to crop failures. Sub-Saharan Africa is one of the most vulnerable regions, especially its sprawling cities where the effects of urbanisation aggravate extreme climatic events. More people die from the effects of climate change in Africa than anywhere else. Given the devastating and growing impact of climate change on health, it is ironic that health systems themselves contribute substantially to climate change through their enormous greenhouse gas (GHG) emissions, the authors of this article note. While no data exist for South Africa, estimates from the United Kingdom indicate that the country’s National Health Service contributed 25% of public sector emissions in 2004. The authors emphasise that the parallel policy initiatives of South Africa’s proposed National Health Insurance and ‘Re-engineering Primary Health Care’ initiative could, if thoughtfully implemented, address three crises simultaneously: the health crisis, the employment crisis and the carbon emissions crisis.
In this background paper to the World Conference on the Social Determinants of Health, held in October 2011, the World Health Organisation (WHO) argues that poor progress in the implementation of a social determinants approach reflects in part the inadequacy of governance at the local, national and global levels to address the key problems of the 21st century. WHO proposes a number of priority strategies for action. In terms of governance, WHO argues that governments should build good governance for action on the social determinants of health by implementing collaborative action between sectors (intersectoral action). WHO further recommends that governments should promote participation by: creating the conditions for participation; playing a role as brokers in participation and ensuring representativeness; and facilitating participation by civil society. WHO also considers the role of the health sector in reducing health inequities, arguing that the sector should: execute its role in governance for social determinants; re-orient health care services and public health programmes to reduce inequities; and institutionalise equity into health systems governance. With regard to global action on social determinants, international organisations, non-governmental agencies, bilateral co-operation partners and governments need to align their efforts and priorities for addressing the social determinants of health. Progress also needs to be monitored, as governments should: use measurement and analysis to inform policies and build accountability on social determinants; identify sources, select indicators, collect data, and set targets; move forward despite unavailability of systematic data; and disseminate data on health inequities and social determinants and integrate these data into policy processes.
This latest edition of Roll Back Malaria’s (RBM) global progress report indicates that all but four of the 46 African region countries still have ongoing malaria transmission. Four countries in southern Africa (Botswana, Namibia, South Africa and Swaziland) share a common goal of eliminating malaria by 2015. They were joined by their four northern neighbours (Angola, Mozambique, Zambia and Zimbabwe) in 2009, to form the sub-regional malaria elimination initiative known as the Elimination Eight (E8). Another four countries in Africa (Gambia, Rwanda, São Tomé and Principe, and Madagascar) have secured Global Fund grants to prepare for elimination. The long-term cost benefit of elimination still needs to be sufficiently documented, RMB notes, in order to facilitate the required policy and financing commitments. Success is accumulating, however, and the evidence base guiding local, national, regional and global action is growing quickly. Future investment in new malaria control tools and in socio-economic development that will support malaria control and communities broadly will be essential, RBM argues. With strong human capacity, continued investment, evidence-based programming and continued partnership, achieving the ambitious Roll Back Malaria 2015 targets, including elimination in at least eight to ten countries is still possible, the report concludes.
In the three years since ‘Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health’ was published by the World Health Organisation (WHO), the global financial crisis has deepened and the steps put in place to deal with the crisis have had worse impacts on the poor and relatively disadvantaged, while bad governance nationally and globally persists, and measures to mitigate climate change have served to increase health inequity. Despite the dissenters who claim that social determinants are not the concern of WHO, specialists across WHO used evidence-based research to show that action on social determinants of health was fundamental to disease control programmes. The author of this article suggests that the global community can still make great progress towards closing the health gap by improving the social determinants of health and by ensuring equity for every child from the start, as well as ensuring healthier environments, fair employment and decent work, social protection across the life course and universal health care. But to make progress, the global community must also deal with inequity in power, money and resources – the social injustice that is killing on a grand scale.