The objectives of this document were to: build awareness of the ways in which an economic downturn may affect health spending, health services, health-seeking behaviour and health outcomes; make the case for sustaining investments in health; and to identify actions – including monitoring of early warning signs – that can help to mitigate the negative impact of economic downturns. Leaders in health must be prepared to speak out – unequivocally and on the basis of sound evidence – to make the case for health at times of crisis. Country-specific analysis is essential to guide policy and assess the potential impact on different populations and institutions. Counter-cyclical public spending provides a means of reviving economies. Aid will play a key role in providing a boost that many low-income countries cannot finance alone. The challenge is to ensure that spending is genuinely pro-poor and that, where possible, it has a positive impact on health. Primary health care provides an overarching approach to policy at a time of financial crisis. Its continuing relevance lies in its value base – stressing the importance of equity, solidarity and gender; through inclusiveness – and the objective of working towards universal coverage and pooling of risk; through a multisectoral approach to achieving better outcomes; and through utilising the assets of all health actors in the private, voluntary and nongovernment sectors.
Equity in Health
Progress in basic social indicators slowed down last year all over the world. at the present rate it does not allow for the internationally agreed poverty reduction goals to be met by 2015, unless substantial changes occur, according to the 2008 Basic Capabilities Index (BCI), calculated by Social Watch. Out of 176 countries for which a BCI figure can be computed, only 21 register noticeable progress in social indicators relative to 2000. another 55 countries show some progress, but at a slow rate, while 77 countries showed stagnation or decline in social indicators. Information is insufficient to show trends for the remaining 23. As the impact of the food crisis that started in 2006 begins to be registered in the statistics coming in, indicators are likely to deteriorate in the coming months. Contrary to frequent claims that poverty is diminishing in the world, the index computed by Social Watch shows a persistent shortfall in basic needs even in conditions of economic growth.
Théodore MacDonald's latest book, ‘Removing the Barriers to Global Health Equity’, presents an urgent call to bolster international organisations and cooperation in healthcare. Its shocking findings demonstrate how profitable it has become for corporate interests to undermine the UN Universal Declaration of Human Rights, this week celebrating its 60th anniversary. The book indicates steps which can be taken to avert disaster, involving a much higher level of international cooperation than the world has known before. The book provides a meticulously critical analysis of the written record and sharply probing interviews with key figures in UN agencies. It will be officially launched on 21 January.
Overall, child well-being as improved by 34% since 1990, but progress is slow. Leaders must consider how children are doing and how their decisions impact them. Children are doing worse in sub-Saharan Africa than any other region. Africa scores 35 in the Index, reflecting the high level of deprivation in primary schooling, child health and child nutrition. It is also making the slowest progress, improving child well-being by only 20% over 1990-2006. However, progress has been very mixed; some countries in Africa have done incredibly well, while others did spectacularly badly. Countries like Malawi cut child deprivation in half, enrolling more than 90% of primary school children. Some of the poorest children in Africa live in countries suffering from conflict and poor governance, such as Zimbabwe, Somalia and the Democratic Republic of Congo.
In this paper, the author argues that, contrary to popular belief, numerous Poverty Reduction Strategy Papers (PRSPs) and aid programmes do not adequately address the MDGs. The paper analyses the substance of 22 developing countries’ PRSPs and the policy frameworks of 21 bilateral programmes. Major findings of the analysis include noting that economic growth for income poverty reduction and social sector investments (education, health and water) are important priorities in most of the PRSPs, yet decent work, hunger and nutrition, the environment and access to technology tend to be neglected. PRSPs also emphasise governance as an important means of achieving the MDGs, but they focus mostly on economic governance rather than on democratic (participatory and equitable) processes.
This report investigates the cause of a 24% drop in mortality in children under 5 years in Tanzania between 2000 and 2004. It investigated contextual factors that could have affected child mortality, in order to understand the likelihood of meeting the Millennium Development Goal for child survival (MDG 4). The observed reduction coincided with important improvements in Tanzania's health system, including a doubling of public expenditure on health, decentralisation and sector-wide basket funding, and increased coverage of key child-survival interventions, such as integrated management of childhood illness, insecticide-treated nets, vitamin A supplementation, immunisation and exclusive breastfeeding. The authors conclude that Tanzania could attain MDG 4 if this trend in improved child survival were to be sustained through increased investment.
In this open letter, participants of the Conference on the Social Determinants of Health have called on the British Prime Minister to ensure that consideration at the forthcoming G20 meeting onthe financial crisis is not limited to the immediate problems of the banking and financial system. Leaders should extend their review to the key global challenges of ill-health, poverty and climate change, and the anachronistic and undemocratic structure of global governance which underlies the failure of the global community to deal with these issues effectively. The letter calls for reform of the ‘Bretton Woods’ institutions to be fully inclusive of all countries, on an equal basis, and for the institurtions to reflect contemporary standards of democracy, transparency and accountability. It is only through such a system of global governance, placing fairness in health at the heart of the development agenda and genuine equality of influence at the heart of its decision-making, that coherent attention to global health equity is possible.
In her speech, World Health Organization General Secretar Dr Margaret Chan referred to the current global economic crisis and its consequences for the health sector. The health sector had no say when the policies responsible for these crises were made, yet it bears the brunt. The remarks point to the high level of preventable disease and lack of access to health care services, and to massive inequalities in resources for health. For 5.6 billion people in low- and middle-income countries, more than half of all health care expenditure is through out-of-pocket payments. With the costs of health care rising and systems for financial protection in disarray, personal expenditures on health now push more than 100 million people below the poverty line each year. Last week, WHO issued its annual World Health Report which documents a number of failures and shortcomings that have left the health status of different populations, both within and between countries, dangerously out of balance. The WHO Commission on Social Determinants of Health report challenges governments to make equity an explicit policy objective in all government sectors. "Equity in access to health care comes to the fore as a way of holding globalization accountable, of channelling globalization in ways that ensure a more fair distribution of benefits, a more balanced and healthy world".
Civil society organizations and scientists from around the world are calling for 'a new development paradigm' to address the toxic combination of climate change, growing poverty and inequality and poor health. The new report, Global Health Watch 2, says that unfair social and economic policies combined with bad politics are to blame for the poor state of the health of millions of people in the world. The report makes stinging criticisms of key global actors, and calls on governments to stop the Bank from meddling in health politics. Global Health Watch 2 provides examples of civil society mobilization across the world for more equitable health care and more health promotion, although more is needed to bring about significant improvements in health.
This paper analyses the concept of health equity, drawing on ideas of social justice, of rights and values, and of the social and economic determinants which define living conditions and power relations among social groups. It adopts the viewpoint of collective health and outlines the elements which are essential to the understanding of inequity: the role of social, economic, political, cultural and ideological determinants on the equity of health outcomes, access to services and quality of care. It concludes that theoretical/conceptual frameworks must be formally spelled out before we can advance our understanding of health equity. From a collective health perspective, we need to move beyond traditional approaches, a challenge which will enable better understanding of the social dynamics which, when expressed as inequalities in health, constitute social inequity.