In this speech, delivered as the Eighth Annual Jeffrey P Koplan Global Leadership in Public Health Lecture in Atlanta, in the United States, Margaret Chan, Director-General of the World Health Organization, has admitted that global governance has failed to embrace equity as an explicit policy objective in the international systems that govern financial markets, economic relations, trade, commerce and foreign affairs. And health has suffered as a result. She criticises the way in which development models have assumed that living conditions and health status would somehow automatically improve as countries modernised, liberalised their trade and experienced rapid economic growth – yet this has not happened. She also points out that international trade agreements will not, by themselves, guarantee food, job or health security, nor access to affordable medicines. Instead, all of these outcomes require deliberate policy decisions. She calls for world leaders to recognise that health concerns can, in some instances, be more important than economic interests and that the net result of all our international policies should be to improve the quality of life for as many of the world’s people as possible. Greater equity in health status should be adopted as an indicator of human progress, she recommends.
Equity in Health
There is a strong consensus that Africa faces significant challenges in chronic disease research, practice and policy. This editorial reviews eight original papers submitted to a Globalization and Health special issue themed: 'Africa's chronic disease burden: Local and global perspectives'. The papers offer new empirical evidence and comprehensive reviews on, among others, diabetes in Tanzania, and HIV and AIDS care-giving among children in Kenya. Regional and international reviews are offered on cardiovascular risk in Africa, comorbidity between infectious and chronic diseases and cardiovascular disease, diabetes and established risk factors among populations of sub-Saharan African descent in Europe. The editorial discusses insights from these papers within the contexts of medical, psychological, community and policy dimensions of chronic disease. It argues that there is an urgent need for primary and secondary interventions and for African health policymakers and governments to prioritise the development and implementation of chronic disease policies. Two gaps need critical attention. The first gap concerns the need for multidisciplinary models of research to properly inform the design of interventions. The second gap concerns understanding the processes and political economies of policy making in sub-Saharan Africa. The editorial concludes that the economic impact of chronic diseases for families, health systems and governments and the relationships between national policy making and international economic and political pressures have a huge impact on the risk of chronic diseases and the ability of countries to respond to them.
A new report by Zimbabwe's National AIDS Council (NAC), showing a dramatic rise in sexually transmitted infections (STIs) among people aged 15 to 24 in the capital, Harare, has health experts worried that the country's success so far in reducing HIV could be reversed. STIs heighten vulnerability to HIV infection, and this age group is one of the most affected. According to the NAC report, more than 24,000 people were treated for STIs in 2009, compared to 8,500 cases recorded in 2008. During this time almost 900,000 male condoms and over 155,000 female condoms were distributed in Harare. Itai Rusike, executive director of the Community Working Group on Health (CWGH), a network of civic groups that promote health awareness, blamed the rise in STIs on a too-narrow focus on HIV and AIDS treatment, at the cost of prevention interventions, especially for young people.
This report presents the preliminary findings of a study undertaken in six pilot countries – Uganda, Rwanda, Kenya, Tanzania, Burundi and DR Congo. The objectives of the study were to provide a detailed assessment of food security-related initiatives, plans and strategies and also to describe the status of food security in the six countries. Based on the experiences and lessons learnt thereof, the study proposed ways of enhancing synergies and coherence between the identified food security initiatives of the regional economic communities (RECs), inter-governmental organisations (IGOs) and individual member states within Eastern Africa, to strengthen regional and country-specific partnerships in the development of a regional food security programme for Eastern Africa.
This report, which is issued pursuant to General Assembly resolution 64/184, presents information on progress made in achieving the Millennium Development Goals through a comprehensive review of successes, best practices and lessons learned, obstacles and gaps, and challenges and opportunities, leading to concrete strategies for action. It consists of four main sections. The introduction examines the importance of the Millennium Declaration and how it drives the United Nations development agenda. The second section reviews progress on achieving the Millennium Development Goals, presenting both shortfalls and successes in the global effort and outlines emerging issues. The third section sums up lessons learned to shape new efforts for accelerating progress to meet the Goals and identifies key success factors. The fourth and final section lists specific recommendations for action. The report calls for a new pact to accelerate progress in achieving the Goals in the coming years among all stakeholders, in a commitment towards equitable and sustainable development for all.
This report includes data on testing for extensively drug-resistant tuberculosis (XDR-TB) from 46 countries that have reported continuous surveillance or representative surveys of second-line drug resistance among multidrug-resistant tuberculosis (MDR-TB) cases. Combining data from these countries, 5.4% of MDR-TB cases were found to have XDR-TB. Eight countries reported XDR-TB in more than 10% of MDR-TB cases. To date, a cumulative total of 58 countries have confirmed at least one case of XDR-TB. According to the Stop TB Partnership’s Global Plan to Stop TB, 2006–2015, 1.3 million MDR-TB cases will need to be treated in the 27 high-burden countries between 2010 and 2015 at an estimated total cost of US$ 16.2 billion. The current level of funding in 2010 – including grants and other loans – in these countries is US$ 0.4 billion. Mobilisation of both national and international resources is urgently required to meet the current and future need. The funding required in 2015 is predicted to be 16 times higher than the funding that is available in 2010.
As pandemic (H1N1) influenza spreads around the globe, it strikes school-age children more often than adults. Although there is some evidence of pre-existing immunity among older adults, this alone may not explain the significant gap in age-specific infection rates. Based on a retrospective analysis of pandemic strains of influenza from the last century, this study shows that school-age children typically experience the highest attack rates in primarily naive populations, with the burden shifting to adults during the subsequent season. Using a parsimonious network-based mathematical model, which incorporates the changing distribution of contacts in the susceptible population, it demonstrates that new pandemic strains of influenza are expected to shift the epidemiological landscape in exactly this way. The analysis here provides a simple demographic explanation for the age bias observed for H1N1/09 attack rates, and suggests that this bias may shift in the future. These results have significant implications for the allocation of public health resources for H1N1/09 and future influenza pandemics.
According to this report, the past four decades have, by and large, been a time of substantial progress in human development for the world as a whole. The world’s average Human Development Index (HDI) grew by 29% in this period. Only one of the 111 countries in the dataset saw a decline in its HDI since 1970 – Zambia. Strikingly, the improvements in the HDI come from improvements in education and health. But the author warns that one cannot assume that free-market globalisation has brought these benefits to people in the developing world. Instead, he points to current evidence that shows that the massive increases in education and health achieved over the past 40 years had little if anything to do with globalisation but rather with the decision by states to expand their educational and health systems, coupled by initiatives of the international community to enable access to vaccines and antibiotics. He refers to research that shows that the correlation between economic growth and changes in the non-income components of human development is nearly zero. These results, he suggests, indicate that the oft-repeated dictum that economic growth is a necessary condition for increasing human development is simply not true.
Improving maternal health and reducing newborn deaths is a complex undertaking because, among other things, it involves strengthening health systems, scaling up programmes to reach remote rural areas and marginalised populations, and ensuring that appropriate resources are committed to what some consider a ‘woman’s issue.’ WHO, UNFPA, UNICEF and the World Bank, known as the ‘Health 4’ or ‘H4’, are supporting countries with the highest maternal mortality, starting with six countries that include the Democratic Republic of Congo. In these countries they are supporting strengthening health systems to reduce maternal mortality by 75% and achieve universal access to reproductive health. The four agencies are seeking to enhance collaboration to not only get more money for health, but also more health for the money, by harmonising and working jointly.
Canada has announced that it will make maternal and child health a priority when it hosts the G8 summit in June 2010. Canadian Prime Minister, Stephen Harper, said in a statement that his country would champion a major initiative to improve the health of women and children in the world’s poorest regions. He said that members of the G8 could make a difference in maternal and child health and that Canada would be making this the top priority in June. The Prime Minister suggested that the solutions are within reach for the international community and include better nutrition, clean water, inoculations and training of health workers. With only five years left to achieve the internationally agreed Millennium Development Goals (MDGs), successes have been achieved but much more needs to be done, particularly with MDG 5, which targets maternal health and lags furthest behind of all the eight MDG targets.