Researchers in this study systematically collected all available data for malaria mortality for the period 1980–2010, correcting for misclassification bias. They found that global malaria deaths increased from 995,000 in 1980 to a peak of 1,817,000 in 2004, decreasing to 1,238,000 in 2010. In Africa, malaria deaths increased from 493,000 in 1980 to 1,613,000 in 2004, decreasing by about 30% to 1,133,000 in 2010. The researchers estimated more deaths in individuals aged 5 years or older than has been estimated in previous studies: 435,000 deaths in Africa and 89,000 deaths outside of Africa in 2010. In conclusion, the researchers assert that the malaria mortality burden is larger than previously estimated, especially in adults. There has been a rapid decrease in malaria mortality in Africa because of the scaling up of control activities supported by international funders. They argue that external funder support needs to be increased if malaria elimination and eradication and broader health and development goals are to be met.
Equity in Health
While attention has focused on the rapid pace of urbanisation as the sole or major factor explaining the proliferation of informal settlements in developing countries, this paper argues that there are other factors that may have an effect. The paper accounts for differences in the prevalence of informal settlements among developing countries using data drawn from the recent global assessment undertaken by the United Nations Human Settlements Programme. The empirical analysis identifies substantial inter-country variations in the incidence of these settlements both within and across the regions of Africa, Asia as well as, Latin America and the Caribbean. Further analysis indicates that higher GDP per capita, greater financial depth and increased investment in infrastructure reduces the incidence of slums. Conversely, external debt burden, inequality in the distribution of income, rapid urban growth and the exclusionary nature of the regulatory framework governing the provision planned residential land directly contribute to the prevalence of informal settlements.
This study aimed to examine the longitudinal contributions of four political and socioeconomic factors to the increase in life expectancy in less developed countries (LDCs) between 1970 and 2004. Researchers collected 35 years of annual data for 119 LDCs on life expectancy at birth and on four key socioeconomic indicators: economy, educational environment, nutritional status and political regime. Results showed that the LDCs' increases in life expectancy over time were associated with all four factors. Political regime had the least influence on increased life expectancy in initial years but increased over time, while the impact of the other socioeconomic factors was initially stronger and decreased over time. Though authors argue that socioeconomic factors have strong impact on life expectancy, but the long-term impact of democracy should not be underestimated.
A number of key challenges to reproductive health in Namibia are identified: high fertility, especially among the poorest people and adolescents; an unmet need for contraception at 21%; women not using modern contraceptives because of health concerns or fear of side effects; and an increase in HIV among adults aged 15–49 years from 4% in 1992 to 20% in 2006. Knowledge of HIV prevention methods was found to be high. Key actions to improve reproductive health outcomes in Namibia were identified in this report as strengthening gender equality; reducing high fertility; highlighting the effectiveness of modern contraceptive methods and properly educating women on the health risks and benefits of such methods; and reducing maternal mortality and the prevalence of STIs/HIV/AIDS.
There are limited means to monitor the occurrence of cancer in developing countries and planning for prevention relies largely on estimates. This paper summarises priorities in cancer prevention in developing countries and the underlying evidence base, and addresses some of the challenges. The author concludes that cancer control calls for interventions that are kept logistically simple, integrated within systems and gradually building the infrastructure to bring care to the population at large. Given serious budgetary constraints, cancer control programmes need to maximise the efficacy of their investments. Of all possible interventions to reduce the cancer burden, the author argues that comprehensive programmes to prevent tobacco smoking are the most cost-effective, so that tobacco prevention should be a priority. Immunisation of infants against hepatitis B virus (HBV) is probably the second most cost-effective option in regions where the infection is still endemic. The author further argues that the uncontrolled use of carcinogens in industrial processes need to be addressed any cancer control programmes.
In 2011, there was important progress in a number of areas, according to the World Helath Organisation, with reports on AIDS, tuberculosis and malaria all indicating fewer deaths – and fewer new infections. The UN General Assembly met to agree a global agenda for noncommunicable diseases – only the second time (after HIV/AIDS) that a health-related theme was selected as the topic for a UN high-level meeting. Natural disasters and conflict took their toll. The year was marked by the earthquake, tsunami and nuclear power plant damage in Japan. Conflicts disrupted health services and added to health demands in a number of countries, notably in Libya, where WHO contributed to the health response, providing expertise and supplies. 2011 also continued to be marked by the world's financial crisis. This photo feature presents a selection of some of the major health issues in 2011.
Despite successes in global health to combat specific diseases, progress remains slow particularly in sub-Saharan Africa. In this paper, researchers discuss two challenges in the global health landscape currently: the changes in global health governance and the recurrent pendulum swing between horizontal (health systems focused) to vertical (single-disease focused) programming by external funders and agencies. Using Ethiopia as a case study, their analysis highlights leadership actions that promoted both vertical and horizontal objectives. These included: clarity and country ownership of purpose, authentic engagement with diverse partners, appropriately focused objectives, and the leveraging of management to mediate policy decisions and front-line action. The authors conclude that effective leadership in global health can reconcile vertical and horizontal objectives.
This report presents the findings of a study on “Mainstreaming health equity into the development agenda in Africa”. A steep gradient in health outcomes between rural and urban areas, between better-off households and the less better-off are due in part to inequities in health. Reducing inequities in health is integral to success in reaching the targets of the three health-related MDGs and the other MDGs where health is an important component. The Report shows that policy makes a difference and that success requires that health equity is clearly mainstreamed in the national development plan because it provides the overall strategic direction to ensuring that development is more inclusive; it can infuse the multi-sectoral linkages required in addressing health inequities; and can strengthen the case for increased resources to health. In only a few countries are there identified health equity-focused strategies to
be implemented. Most of the plans outline strategies that are aimed at universal coverage of health services and take the goal of equity as given.
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. However, these studies are based on selected disease conditions and only consider a single point in time. Trend analyses have yet to be produced. 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. This 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. The current burden and distribution of ill-health indicates how critical it is for the South African health system to strive for access to and use of health services that is in line with need for such care. Concerted government efforts, within both the health sector and other social and economic sectors are therefore needed to address the significant health inequalities in South Africa.
All too often what has been counted falls back into a traditional paradigm of economic inequity – measuring poorest and richest quintiles – not for lack of interest but for lack of agreement on an appropriate measure, let alone what priority measures should be. While we all recognize the need to go further, tested and validated measures bringing attention to geographic, ethnic, age and gender disparities are few, let alone those which truly measure inequities and inequalities in health and the related availability, accessibility, acceptability and quality of services as mandated under the right to health. But this panel argues that this must be the goal, with important implications for the health and well-being of children. Christopher Garimoi Orach from Makerere University School of Public Health, Kampala, gives an insight into research on the unmet needs of new and expectant mothers in displaced populations in Uganda, and Gavin Mooney from the University of Cape Town discusses research on the impact of health care payments on families, and in particular on the well-being of children.