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.
Equity in Health
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.
Despite large gains in health over the past few decades, the distribution of health risks worldwide remains extremely and unacceptably uneven. The Lancet—University of Oslo Commission on Global Governance for Health reports that with globalisation, health inequity increasingly results from transnational activities that involve actors with different interests and degrees of power: states, transnational corporations, civil society, and others. The norms, policies, and practices that arise from global political interaction across all sectors that affect health are termed global political determinants of health. The Commission argues that global political determinants that unfavourably affect the health of some groups of people relative to others are unfair, and that at least some harms could be avoided by improving how global governance works. This report examines power disparities and dynamics across a range of policy areas that affect health and that require improved global governance: economic crises and austerity measures, knowledge and intellectual property, foreign investment treaties, food security, transnational corporate activity, irregular migration, and violent conflict. The Commission calls for stronger cross-sectoral global action for health, for strengthened use of human rights instruments for health, and new frameworks for international financing that go beyond traditional development assistance such as for research and social protection.
This paper explores the effect of risk and socioeconomic factors on maternal mortality at the community level in Madagascar using a unique, nationwide panel of communes (i.e., counties). Previous work in this area uses individual or cross-country data to study maternal mortality, however, studying maternal mortality at the community level is imperative because this is the level at which most policy is implemented. The results show that longer travel time from the community to the hospital leads to a high level of maternal mortality. The findings suggest that improvement to transportation systems and access to hospitals with surgery rooms are needed to deal with obstetric complications and reduce maternal mortality.
The Millennium Development Goals have centred on social outcomes, primarily in the fields of poverty, health and education. The goal of halving extreme poverty globally has already been met, albeit in large part thanks to the remarkable performance over three decades of the Chinese economy. Greater ambition is expected for a post-2015 agenda, with the eradication of extreme poverty a possible new goal. However, this goal is very unlikely to be reached by 2030 if business as usual is the order of the day. Paradoxically, this partly reflects the lack of ambition in the conventional poverty line of $1.25 per day, which is by any standard extremely low. However UNCTAD also argue that it is also because poverty eradication, even at this level of ambition, will not happen without addressing the more challenging issue of global inequality.UNCTAD argue that there is an emerging consensus that existing levels of inequality are not only morally unacceptable, but also economically and politically damaging. Moving beyond the Millennium Development Goals, inequality should therefore become a prominent part of the post-2015 development narrative.