This paper reviews theories and empirical findings on inequality and finds evidence for a liberal shift in international development. While the reduction of absolute poverty has become the centre of attention in international development any concern for inequalities and relative poverty has been excluded and(re)distribution of incomes has disappeared from the agenda. However, there are numerous economic and political reasons for which inequality should be seen as a more important and urgent problem, including the violation of social and economic rights due to inequality. These factors combined with the emergence of a global civil society and the dwindling legitimacy of the Bretton Woods institutions may open up a window of opportunity for putting inequality back at the heart of a UN led development cooperation. Authors argue that a 'Global Fund' for globalisation and/or development could play an important role in spreading the concept of world public finances, in proposing global taxes and in organising global redistribution, based on the idea of a global welfare state.
Equity in Health
Tuberculosis (TB) is a major cause of illness and death worldwide, especially in Asia and Africa. Globally, 9.2 million new cases and 1.7 million deaths from TB occurred in 2006, of which 0.7 million cases and 0.2 million deaths were in HIV-positive people. Population growth has boosted these numbers compared with those reported by the World Health Organization (WHO) for previous years. More positively, and reinforcing a finding first reported in 2007, the number of new cases per capita appears to have been falling globally since 2003, and in all six WHO regions except the European Region where rates are approximately stable. If this trend is sustained, Millennium Development Goal 6, to have halted and begun to reverse the incidence of TB, will be achieved well before the target date of 2015. Four regions are also on track to halve prevalence and death rates by 2015 compared with 1990 levels, in line with targets set by the Stop TB Partnership. Africa and Europe are not on track to reach these targets, following large increases in the incidence of TB during the 1990s. At current rates of progress these regions will prevent the targets being achieved globally.
This paper sets out an initiative by African Development Bank, UNAIDS, UNFPA, UNICEF, WHO and the World Bank that aims to tackle barriers to scaling up health in Africa. The ‘Harmonisation for Health in Africa’ initiative HHA is a regional mechanism through which collaborating partners agree to focus on providing support to the countries in the African region for reaching health MDGs. The HHA initiative aims to: support countries to identify, plan and address health systems constraints to improve health related outcomes; develop national capacity through training, planning, costing and budgeting, harmonisation and stimulating peer exchange; promote the generation and dissemination of knowledge, guidance and tools for specific technical areas including strengthening health service delivery and monitoring health systems performance; support countries to leverage predictable and sustained resources for the health sector; ensure accountability and assist in monitoring performance, of national health systems, aid effectiveness and the performance of the International Health Partnership; and enhance coordination to support nationally owned plans and implementation process, helping countries to address the country level bottlenecks arising from constraints within international agencies.
The latest global maternal death statistics indicate that of the 536,000 women that died in 2005 of childbirth related complications, about half or 261,000 were African women. The recently released 2005 figures also indicate that Africa is the only region where maternal deaths have increased since 1990 up from 205,000. Maternal deaths dropped in every other continent over the same period. In Europe from 4,800 to 2,900, and in the America’s from 21,000 to 16,000. The prevalent maternal death risk also reflects a much bleaker picture of overall reproductive health in Africa. The Africa Public Health Rights Alliance “15% Now!” Campaign has developed a scorecard based on the 2005 figures and available comparable global health financing and health systems data. The scorecard shows that in the bottom 10 countries globally - all of which are African except Afghanistan, maternal death risk is between 1 in 7 (Niger) and 1 in 15 (Mali). In the top 10 the risk is between 1 in 47,600 (Ireland) and 1 in 13,800 (Switzerland). Possibly every family in the bottom 10 countries will suffer 1 maternal death. Overall 1 in 23 African women have a lifetime risk of maternal death compared with 1 in 2,300 in Europe.
World Health Day, on 7 April, marks the founding of the World Health Organization and is an opportunity to draw worldwide attention to a subject of major importance to global health each year. In 2008, World Health Day focuses on the need to protect health from the adverse effects of climate change. The theme “protecting health from climate change” puts health at the centre of the global dialogue about climate change. WHO selected this theme in recognition that climate change is posing ever growing threats to global public health security. Through increased collaboration, the global community will be better prepared to cope with climate-related health challenges worldwide. Examples of such collaborative actions are: strengthening surveillance and control of infectious diseases, ensuring safer use of diminishing water supplies, and coordinating health action in emergencies.
The State of the World's Children 2008 provides a wide-ranging assessment of the current state of child survival and primary health care for mothers, newborns and children. The report argues that these issues serve as sensitive barometers of a country's development and wellbeing and as evidence of its priorities and values, and states that investing in the health of children and their mothers is a human rights imperative and one of the surest ways for a country to set its course towards a better future. The report identifies six pivotal actions at the macro level that urgently require unified engagement to intensify efforts for maternal, newborn and child survival and fulfil the right of women and children to health and well-being.
The Knowledge Networks of the Commission in different regions have completed their reports. These reports will inform the Commission's interim statement to be published later this year for broader consultation. They are available on the Commission website and cover areas of Early childhood development; Globalisation; Health Systems; Employment; Women and Gender equity; Urban Settings and Measurement and Evidence.
Over 200 million children under five years old in developing countries do not reach their development potential. Whilst risks such as stunting, iodine-deficiency, anaemia and inadequate cognitive stimulation are known, evidence suggests that maternal depression, exposure to violence, environmental contamination and malaria are further potential risk factors. The researchers identify factors that are consistently associated with effective programmes and identify a need to establish globally accepted monitoring indicators for child development and for more evaluation. Despite the evidence that comprehensive early development programmes are effective in increasing disadvantaged children’s chances of success, government investment remains low. At the current rate of progress, the disparity between rich and poor countries in pre-school attendance will increase.
Launched on 6 December 2007, 'make medicines child size' is a global campaign spearheaded by WHO to raise awareness and accelerate action to address the need for improved availability and access to safe child specific medicines for all children under 15. To achieve this goal, more research is needed, more medicines need to be developed, and improved access measures are essential. At present, many medicines are not developed for children or available in suitable dosages or formats; and when they are they are not reaching the children who need them most. The 'make medicines child size' campaign is an effort to change that reality.
This article synthesises what is known on equity and tuberculosis (TB) in Malawi and highlights areas for further action and advocacy. Based on a range of published and unpublished reports and analysis of routine data on access to TB services, the authors find that TB cases have increased rapidly from 5,334 in 1985 to 28,000 in 2006. This increase has been attributed to HIV/AIDS; 77 per cent of TB patients are HIV positive. Poor people’s ability to access TB diagnosis services is reduced by the need for repeated visits, long queues and delays in sending results. The costs of seeking care for these people can be up to 240 per cent of monthly income. The paper concludes that the government’s policies to address TB, which are being delivered through the Sector Wide Approach, provide a good opportunity to enhance equity and pro-poor health services. The major challenge is to increase case detection especially amongst poor people. In addition, the Programme needs a prevalence survey which will enable equity monitoring and the development of responsive interventions to promote service access to people with undiagnosed TB.