All populations will be affected by a changing climate but, according to this article, the initial health risks vary greatly, depending on where and how people live. People living in small island developing states and other coastal regions, megacities, and mountainous and polar regions are all particularly vulnerable in different ways. Health effects are expected to be more severe for elderly people and people with infirmities or pre-existing medical conditions. The groups who are likely to bear most of the resulting disease burden are children and the poor, especially women. The major diseases that are most sensitive to climate change – diarrhoea, vector-borne diseases like malaria, and infections associated with undernutrition – are most serious in children living in poverty. Strengthening of public health services needs to be a central component of adaptation to climate change. The international health community already has a wealth of experience in protecting people from climate-sensitive hazards, and proven, cost-effective health interventions are already available to counter the most urgent of these. Broadening the coverage of available interventions would greatly improve health now. Coupled with forward planning, it would also reduce vulnerability to climate changes as they unfold in the future.
Equity in Health
According to this study, three circumstances make the present moment unique for global health. First, health has been increasingly recognised as a key element of sustainable economic development, global security, effective governance and human rights promotion. Second, due to the growing perceived importance of health, unprecedented – albeit still insufficient – sums of funds are flowing into this sector. Third, there is a burst of new initiatives coming forth to strengthen national health systems as the core of the global health system and a fundamental strategy to achieve the health-related Millennium Development Goals. In order to realise the opportunities offered by the conjunction of these unique circumstances, it is essential to have a clear conception of national health systems that may guide further progress in global health. To that effect, the first part of this document examines some common misconceptions about health systems. Part two explains a framework to better understand this complex field. Finally, a list of suggestions is offered on how to improve national health system performance and what role global actors can play.
By framing human health and wellbeing in the context of an ecosystems approach, this paper recognises that healthy people and healthy environments are inextricably linked. However, in most African countries, there is still inadequate assessment and monitoring of the dynamics of human activities and their impact on local ecosystems and this paper notes that the degradation of ecosystem services constitutes an important barrier to achieving Millennium Development Goals. It urges governments to recognise the links between environment and health, from the perspective of the vital services that ecosystems provide to human health and wellbeing, and to promote integrated policies that value these services. Solutions require political commitment, concerted action and shared responsibility between different government sectors and the civil society. Countries should take steps to mitigate the underlying causes of ecosystem damage, while simultaneously improving human health. Intersectoral collaboration among government departments and the civil society, capacity-building, dissemination of knowledge and good practices, and integrated action for health and the environment are also critical.
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.
The Students and Youths Working on Reproductive Health Action Team (SAYWHAT) hosted 60 students from 30 tertiary institutions during its 4th National Students Conference from the 16th to the 18th of December 2009 under the theme 'Healthy Students for a Prosperous Nation' Through presentations, parallel sessions and group discussions, the conference covered major areas of sexual and reproductive health rights (SRHR) for young people. Among the key issues that came out was the need for a universal curriculum on SRHR for tertiary institutions. The delegates also reiterated that there is a need for clear monitoring and evaluation and coordination of SRHR programs within tertiary institutions. In light of the risk posed by multiple and concurrent partnerships, they called for behavioural change amongst all students and a focus on life skills and livelihoods training to sustain the change. Generally there was a call for commitment among all students, college authorities and SAYWHAT’s membership for more effective responses that addresses the real health challenges in tertiary institutions.
Over the past ten years, frequent outbreaks of emerging and re-emerging infectious diseases and mosquito-borne diseases have occurred in Africa. Electric and electronic waste (e-waste) is also a fast-growing concern. There have been significant radiation incidents reported, and new and more toxic substances (dioxins, furans and heavy metals) are creating environmental and health problems and new occupational risks in Africa. According to this paper, the management of hazardous wastes must focus on environmentally sound treatment and/or long-term storage. It notes that a renewed and stronger commitment to the implementation of the Stockholm Convention on Persistent Organic Pollutants is needed. African governments may wish to consider including the following actions: monitoring of new and emerging environmental threats; reviewing their emergency preparedness plans; developing and implementing awareness-raising campaigns on the most important risks factors; and undertaking community sensitisation and education.
This publication covers a number of areas relevant to indigenous people around the world. Chapter 5 deals specifically with health. It points out that the commitment of United Nations Member States to the Millennium Development Goals (MDGs) is an important step forward in improving the health of millions of people who live in poverty around the world. However, by failing to ground the goals in an approach that upholds indigenous peoples’ individual and collective rights, the MDGs fall short in addressing the health disparities that persist between indigenous peoples and other poor, marginalised groups. By advancing the dominant paradigms of health and development rather than an approach based on individual and collective human rights, the MDGs also promote projects that are potentially detrimental to indigenous peoples, and which violate their rights to their collective land, territories and natural resources. Moreover, because the cultures and worldviews of indigenous peoples are not taken into account in the formulation of the MDGs, the goals do not consider the indigenous concept of health, which extends beyond the physical and mental well-being of an individual to the spiritual balance and well-being of the community as a whole. To improve the health situation of indigenous peoples, this report notes that there must thus be a fundamental shift in the concept of health so that it incorporates the cultures and world views of indigenous peoples as central to the design and management of state health systems.
The authors of this paper propose a pluralist notion of fair distribution of health that is compatible with several theories of distributive justice. It consists of the weak principle of health equality and the principle of fair trade-offs. The weak principle of health equality offers an alternative definition of health equity to those proposed in the past. It maintains the all-encompassing nature of the popular Whitehead/Dahlgren definition of health equity, and at the same time offers a richer philosophical foundation. This principle states that every person or group should have equal health except when: health equality is only possible by making someone less healthy, or there are technological limitations on further health improvement. In short, health inequalities that are amenable to positive human intervention are unfair. The principle of fair trade-offs 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 further reduction in weak health inequality would result in unacceptable sacrifices of other important goods, such as education, employment, and social security.
Unsafe water bodies, poor access to safe drinking water, indoor and outdoor air pollution, unhygienic or unsafe food, poor sanitation, inadequate waste disposal, absent or unsafe vector control, and exposure to chemicals and injuries have been identified as key environmental risks to human health in most countries in Africa. The underlining reasons for this situation include inadequate or flawed policies, weak institutional capacities, shortage of resources and low general awareness of links between the environment and health. This paper suggests that governments re-orient their national policies to foster a greater contribution of environmental management towards public health. Specifically, governments may consider creating national frameworks and mechanisms for inter-sectoral action to adequately address the links between health and the environment, invest in the required infrastructure related to health and environmental services, build from past and current experiences, revitalise expertise in environmental management for health, and increase communication and community education to raise awareness of how individual practices can impact upon human health and the environment.
The methodology of priority setting in health care has reached an advanced stage of development, but it is difficult to integrate public health and social interventions into the traditional cost effectiveness approach. Priority setting tends to be drawn towards cost-benefit rather than cost effectiveness analysis, a much more demanding methodology. Furthermore, analysis of equity requires modelling differential responses by subgroup, again increasing complexity. There has been some work by economists on how society values identical health gains for different population groups. In principle, this research can be used to adjust cost-effectiveness ratios for equity concerns. However, studies so far have been relatively small scale and tentative in their conclusions. Given the methodological challenges, policy makers (including the UK government) have developed a more pragmatic approach towards priority setting, in the form of descriptive health impact assessments. These are likely to be especially helpful when examining cross-departmental initiatives.