The UN working group charged with outlining a proposed set of sustainable development goals (SDGs) adopted an outcome document on Saturday. The recommended goals will now be sent to the UN General Assembly for consideration as part of the discussions around the post-2015 development agenda. The final 23-page document maintains the 17 goals outlined in a revised “zero draft” – released by the working group’s co-chairs in early July to serve as a basis for this final meeting – with 169 targets. Sixty-two of these can be classed as “means of implementation,” (MoI) or the methods to achieve each goal. During the closing plenary on Saturday morning, the working group co-chairs said that while they were happy with their efforts in steering participants towards an outcome document, they recognised the final product was not flawless. Another year of discussion is likely as the UN General Assembly reflects upon the proposed goals. The document does not yet contain indicators for measuring progress towards each goal and target, which was part of the working group’s original mandate. The eventual addition of indicators at a later stage may prove a useful opportunity to clarify some of the proposed targets and further work will likely be undertaken in this area.
Equity in Health
The 2014 Human Development Report— Sustaining Progress: Reducing Vulnerabilities and Building Resilience—looks at two concepts which are both interconnected and immensely important to securing human development progress. As successive Human Development Reports (HDRs) have shown, most people in most countries have been doing steadily better in human development. Advances in technology, education and incomes hold ever-greater promise for longer, healthier, more secure lives. But there is also a widespread sense of precariousness in the world today—in livelihoods, in personal security, in the environment and in global politics. High achievements on critical aspects of human development, such as health and nutrition, can quickly be undermined by a natural disaster or economic slump. Theft and assault can leave people physically and psychologically impoverished. Corruption and unresponsive state institutions can leave those in need of assistance without recourse. Based on analysis of the available evidence, the Report makes a number of important recommendations for achieving a world which addresses vulnerabilities and builds resilience to future shocks. It calls for universal access to basic social services, especially health and education; stronger social protection, including unemployment insurance and pensions; and a commitment to full employment, recognizing that the value of employment extends far beyond the income it generates. It examines the importance of responsive and fair institutions and increased social cohesion for building community-level resilience and for reducing the potential for conflict to break out.
With many MDG targets already met on reducing poverty, increasing access to improved drinking water sources, improving the lives of slum dwellers and achieving gender parity in primary school, The Millennium Development Goals Report 2014, says many more targets are within reach by their 2015 target date. If trends continue, the world will surpass MDG targets on malaria, tuberculosis and access to HIV treatment, and the hunger target looks within reach. Other targets, such as access to technologies, reduction of average tariffs, debt relief, and growing political participation by women, show great progress. The MDG report is based on comprehensive official statistics and provides the most up-to-date summary of all Goals and their targets at global and regional levels, with additional national statistics available online. Results show that concentrated efforts to achieve MDG targets by national governments, the international community, civil society and the private sector are working to lift people out of extreme poverty and improve their futures. It notes that much greater effort and investment will be needed to alter inadequate sanitation facilities. High dropout rates remain a barrier to universal primary education. Despite considerable advancements in recent years, the report says reliable statistics for monitoring development remain inadequate in many countries, but better statistical reporting on the MDGs has led to real results.
Africa is a rich continent. Some of those riches – especially oil, gas and minerals – have driven rapid economic growth over the past decade. The ultimate measure of progress, however, is the wellbeing of people – and Africa’s recent growth has not done nearly as much as it should to reduce poverty and hunger, or improve health and education. To sustain growth that improves the lives of all Africans, the continent needs an economic transformation that taps into Africa’s other riches: its fertile land, its extensive fisheries and forests, and the energy and ingenuity of its people. The Africa Progress Report 2014 describes what such a transformation would look like, and how Africa can get there. Agriculture must be at the heart that transformation. Most Africans, including the vast majority of Africa’s poor, continue to live and work in rural areas, principally as smallholder farmers. In the absence of a flourishing agricultural sector, the majority of Africans will be cut adrift from the rising tide of prosperity. To achieve such a transformation, Africa will need to overcome three major obstacles: a lack of access to formal financial services, the weakness of the continent’s infrastructure and the lack of funds for public investment.
The Africa Progress Report 2014 describes how African governments and their international partners can cooperate to remove those obstacles – and enable all Africans to benefit from their continent’s extraordinary wealth.
With the increasing trend in refugee urbanisation, growing numbers of refugees are diagnosed with chronic non-communicable diseases (NCDs). This study reviewed the literature to determine the prevalence and distribution of chronic NCDs among urban refugees living in developing countries, to report refugee access to health care for NCDs and to compare the prevalence of NCDs among urban refugees with the prevalence in their home countries. Major search engines and refugee agency websites were systematically searched between June and July 2012 for articles and reports on NCD prevalence among urban refugees. Most studies were conducted in the Middle East and indicated a high prevalence of NCDs among urban refugees in this region, but in general, the prevalence varied by refugees’ region or country of origin. Hypertension, musculoskeletal disease, diabetes and chronic respiratory disease were the major diseases observed. In general, most urban refugees in developing countries have adequate access to primary health care services. Further investigations are needed to document the burden of NCDs among urban refugees and to identify their need for health care in developing countries.
WHO’s annual statistics report shows that low-income countries have made the greatest progress, with an average increase in life expectancy by 9 years from 1990 to 2012. The top six countries where life expectancy increased the most were Liberia which saw a 20-year increase (from 42 years in 1990 to 62 years in 2012) followed by Ethiopia (from 45 to 64 years), Maldives (58 to 77 years), Cambodia (54 to 72 years), Timor-Leste (50 to 66 years) and Rwanda (48 to 65 years). A boy born in 2012 in a high-income country can expect to live to the age of around 76 – 16 years longer than a boy born in a low-income country (age 60). For girls, the difference is even wider; a gap of 19 years separates life expectancy in high-income (82 years) and low-income countries (63 years). Wherever they live in the world, women live longer than men. The gap between male and female life expectancy is greater in high-income countries where women live around six years longer than men. In low-income countries, the difference is around three years. World Health Statistics is the definitive source of information on the health of the world’s people. It contains data from 194 countries on a range of mortality, disease and health system indicators including life expectancy, illnesses and deaths from key diseases, health services and treatments, financial investment in health, as well as risk factors and behaviours that affect health.
Action on the social determinants of health is considered a necessary approach to improving health equity. Most of the social determinants of health lie outside the sphere of the health sector and thus collaboration with governmental and non-governmental sectors outside of health are required to develop policies and programs to improve health equity. Case studies of intersectoral action are available, however there is limited information about the impact of intersectoral action on the social determinants of health and health equity. Search and retrieval of literature published between 2001 and 2011 was conducted in 6 databases. A staged screening of titles and abstracts, and later full-text, was conducted by two independent reviewers. Reviewers independently assessed the quality of the articles deemed relevant for inclusion. Data were extracted and synthesized in narrative format for all included studies, conducted by one reviewer and checked by another. 17 articles of varied methodological quality met the inclusion criteria. One systematic review investigating partnership interventions found mixed and limited impacts on health outcomes. Primary studies evaluating the impact of upstream and midstream interventions showed mixed effects. Downstream interventions were generally moderately effective in increasing the availability and use of services by marginalized communities. The literature evaluating the impact of intersectoral action on health equity is limited. The included studies identified reveal a moderate to no effect on the social determinants of health. The evidence on the impact of intersectoral action on health equity is even more limited. The lack of evidence should not be interpreted as a lack of effect. Rigorous evaluations of intersectoral action are needed to strengthen the evidence base of this public health practice.
Improvements in prevention of mother-to-child transmission of HIV (PMTCT) in South Africa are not translating into a reduction in maternal deaths due to HIV infection, according to a 15-year review of a large district referral hospital in Johannesburg, the 21st Conference on Retroviruses and Opportunistic Infections (CROI) heard on Wednesday in Boston. In particular, the audit found that there has been no change in the proportion of maternal deaths caused by HIV since 2007, and over three-quarters of women with HIV who died had never started antiretroviral therapy.The South African review, presented by Coceka Mnyani of University of Witwatersrand, looked at the records of Chris Hani Baragwanath hospital, which serves an urban and periurban population of approximately 2 million people in Johannesburg. The hospital delivered between 17,000 and 23,500 babies a year between 1997 and 2012. HIV prevalence in the maternal population served by the hospital is extremely high: approximately 23% of women who give birth at the hospital were found to be HIV positive in 2012, compared with 30.7% in 2004, the peak year for HIV prevalence among pregnant women giving birth at the hospital.
Equity is emerging as an urgent policy priority in health sector reforms in many African countries. This report presents the findings of a study on “Mainstreaming health equity into the development agenda in Africa”. The widely reported fact that health outcomes in Africa are generally poor obscures the existence of a steep gradient in health outcomes between rural and urban areas, between better-off households and the less better-off. These differences in outcome are due in part to inequities in health. There is strong evidence that the poor health outcomes reported for most African countries are attributable to inequities in health. Reducing inequities in health is therefore argued to be integral to success in reaching the targets of the three health-related MDGs and the other MDGs where health is an important component.
The aim of this study was to assess if a positive gradient in smoking can also be observed in low and middle income countries in other regions of the world. The authors used data of the World Health Survey from 49 countries and a total of 233,917 respondents. Multilevel logistic regression was used to model associations between individual level smoking and both individual level and country level determinants. the results were stratified by education, occupation, sex and generation (younger vs. older than 45). Countries were grouped based on GDP and region. In Sub-Saharan Africa and Latin America no clear gradient was observed: inequalities were relatively small. Among men, no positive gradients were observed, and the strongest negative gradients were seen in South-East Asia and East Asia.