This report presents progress made since the last report in 2007, discusses how far the continent still needs to travel, at what speed, and what needs to be done further. It is an abridged version of a much more comprehensive joint Economic Commission for Africa (ECA), African Union Commission (AUC), and African Development Bank (AfDB) report to the July 2008 African Union Summit. The conditions for accelerating growth and development to meet the targets of the Millennium Development Goals (MDGs) are largely in place. Since the last report, the number of African countries with MDGs-consistent poverty reduction strategies or national development plans has risen to about 41. Growth, fueled in large measure by appropriate policy reforms, favourable primary product prices and a marked improvement in peace and security, notably in the west and south central regions remains strong. In 2007, for example, more than 25 African countries achieved a real GDP growth rate of 5% or above while another 14 grew at between 3 and 5%. However, the continent’s average annual growth rate of approximately 5.8% still remains significantly lower than the 7% annual growth rate required to reduce poverty by half by 2015. This growth is increasingly coming under threat from new developments. Rising food and oil prices, as well as climate change, pose significant risks to the preservation and acceleration of growth and to progress towards the targets of the MDGs in the region.
Equity in Health
After a century of failed tuberculosis (TB) control strategies on South Africa’s mines, and three major but ineffective enquiries and commissions, a government-led ‘TB in Mines Task Team’ is being set up to address the deepening HIV-driven crisis. The HIV-fuelled TB epidemic, compounded by rising drug resistance, is now estimated at 3,500 per 100,000 mine workers, with 40% of all autopsies on men who die working on the mines revealing they had TB. Worker migration from rural areas throughout southern Africa to Gauteng and surrounding industrial areas to work in the mining, building and other dominant sectors is a major driver of the rampant TB epidemic. National TB prevalence has increased nearly threefold in the past decade. South Africa was among the 10 worst performing countries on TB control, and Statistics SA had found that, for every 100 deaths in 2006, 13 were from TB, making it the leading cause of death. Less than 1% of all HIV-infected individuals in this country were accessing proven safe and effective Isoniazid Preventative TB Therapy.
Global life expectancy could be increased by nearly five years by addressing five factors affecting health – childhood underweight, unsafe sex, alcohol use, lack of safe water, sanitation and hygiene, and high blood pressure, according to this report. These are responsible for one-quarter of the 60 million deaths estimated to occur annually. The report describes 24 factors affecting health, which are a mix of environmental, behavioural and physiological factors, such as air pollution, tobacco use and poor nutrition. More than a third of the global child deaths can be attributed to a few nutritional risk factors such as childhood underweight, inadequate breastfeeding and zinc deficiency. Eight risk factors alone account for over 75% of cases of coronary heart disease, the leading cause of death worldwide. These are alcohol consumption, high blood glucose, tobacco use, high blood pressure, high body mass index, high cholesterol, low fruit and vegetable intake and physical inactivity. Most of these deaths occur in developing countries.
Sub-Saharan Africa is off-track to achieve the Millennium Development Goals (MDGs) for maternal and child health by 2015. Each year 265,000 mothers die due to complications of pregnancy and childbirth, 1,243,000 babies die before they reach one month of age and a further 3,157,000 children die before their fifth birthday. Nevertheless, there is clear evidence demonstrating that progress can be achieved even in low-income countries. This evidence, together with the unprecedented new investments in maternal and child health from continental leaders and increasingly from development partners, offers new hope for the future. Improving health systems and promoting high impact interventions are crucial and require partnerships between scientists, health care providers with government, development partners, policy makers, civil society and communities. Four key actions include: further investment and tracking of resources; equitable implementation of programmes; innovation in research; and using evidence as a basis for health policy and resource allocation.
The most widely cited definition of health inequity is: ‘Health inequalities that are avoidable, unnecessary, and unfair are unjust.’ This paper argues that this definition is useful but in need of further clarification because it is not linked to broader theories of justice. It proposes an alternative, pluralist notion of fair distribution of health that is compatible with several theories of distributive justice, based on the principle of equality, which states that every person or group should have equal health except when health equality is only possible by making someone less healthy, or if there are technological limitations on further health improvement. In short, health inequalities that are amenable to positive human intervention are unfair. This principle is offset by the principle of fair trade-offs, which states that weak equality of health is morally objectionable if, and only if, further reduction of weak inequality leads to unacceptable sacrifices of average or overall health of the population, or if further reduction in weak health inequality would result in unacceptable sacrifices of other important goods, such as education, employment and social security.
The era of the Convention on the Rights of the Child has seen marked advances in child survival and development, expanded and consolidated efforts to protect children, and a growing recognition of the importance of empowering children to participate in their own development and protection. One of the most outstanding achievements in child survival and development has been the reduction in the annual number of under-five deaths, from 12.5 million in 1990 to less than 9 million in 2008. In particular, immunisation against major preventable diseases has been a life-saving intervention for millions of children in all regions of the world. However, Africa and Asia present the largest global challenges for child rights to survival, development and protection, with the regions of sub-Saharan Africa and south Asia well behind other regions on most indicators. Their progress in primary health care, education, and protection will be pivotal to accelerated progress on child rights and towards internationally agreed development goals for children.
The purpose of this paper is to explore the socio-cultural context of cardiovascular disease (CVD) risk prevention and treatment in sub-Saharan Africa (SSA). It discusses risk factors specific to the SSA context, including poverty, urbanisation, developing healthcare systems, traditional healing, lifestyle and socio-cultural factors. It found that the epidemic of CVD in SSA is driven by multiple factors working collectively. Lifestyle factors such as diet, exercise and smoking contribute to the increasing rates of CVD in SSA. Some lifestyle factors are considered gendered in that some are salient for women and others for men. For instance, obesity is a predominant risk factor for women compared to men, but smoking still remains mostly a risk factor for men. Additionally, structural and system level issues such as lack of infrastructure for healthcare, urbanisation, poverty and lack of government programmes also drive this epidemic and hampers proper prevention, surveillance and treatment efforts.
In the current climate change debate, the perspective of the developing countries that will be worst affected has been almost completely ignored by the scientific literature. This deficit is addressed by this paper, which analyses the first 40 National Adaptation Programmes of Action reports submitted by governments of least-developed countries to the Global Environment Facility for funding. Of these documents, 93% identified at least one of three ways in which demographic trends interact with the effects of climate change: faster degradation of the sources of natural resources; increased demand for scarce resources; and heightened human vulnerability to extreme weather events. These findings suggest that voluntary access to family planning services should be made more available to poor communities in least-developed countries. The paper concludes by calling for increased support for rights-based family planning services, including those integrated with HIV and AIDS services, as an important complementary measure to climate change adaptation programmes in developing countries.
This is one of the session reports from Forum 2009, convened by the Global Forum for Health Research on 17–20 November 2009. The issue was finding synergies in policy between environmental health and equity agendas. Climate change has had a negative effect on health equity since it affects the most vulnerable populations. However, climate adaptation policies can sometimes make the situation even worse. For example, biofuels policies were intended to reduce the reliance on fossil fuels. In the past few years though, farmers have abandoned crop production in favour of growing biofuel crops, exacerbating the food crisis. Understanding the geographical components of the link between climate change and health is crucial. Data from geographical information systems (GIS) should be integrated with health information systems to provide a cohesive look at changes in disease spread, for example. Health researchers who study the effects of climate change cannot be content with just understanding the changing epidemiology of disease – they need to stay familiar with the latest technologies of monitoring climate change.
Five leading risk factors identified in this report (childhood underweight, unsafe sex, alcohol use, unsafe water and sanitation, and high blood pressure) are responsible for one quarter of all deaths in the world, and one fifth of all DALYs. Reducing exposure to these risk factors would increase global life expectancy by nearly five years. Eight risk factors (alcohol use, tobacco use, high blood pressure, high body mass index, high cholesterol, high blood glucose, low fruit and vegetable intake, and physical inactivity) account for 61% of cardiovascular deaths. Combined, these same risk factors account for over three quarters of ischaemic heart disease, the leading cause of death worldwide. Reducing exposure to these eight risk factors would increase global life expectancy by almost five years. Low- and middle-income countries now face a double burden of increasing chronic, non-communicable conditions, as well as the communicable diseases that traditionally affect the poor. Understanding the role of these risk factors is important for developing clear and effective strategies for improving global health.