This report includes data on testing for extensively drug-resistant tuberculosis (XDR-TB) from 46 countries that have reported continuous surveillance or representative surveys of second-line drug resistance among multidrug-resistant tuberculosis (MDR-TB) cases. Combining data from these countries, 5.4% of MDR-TB cases were found to have XDR-TB. Eight countries reported XDR-TB in more than 10% of MDR-TB cases. To date, a cumulative total of 58 countries have confirmed at least one case of XDR-TB. According to the Stop TB Partnership’s Global Plan to Stop TB, 2006–2015, 1.3 million MDR-TB cases will need to be treated in the 27 high-burden countries between 2010 and 2015 at an estimated total cost of US$ 16.2 billion. The current level of funding in 2010 – including grants and other loans – in these countries is US$ 0.4 billion. Mobilisation of both national and international resources is urgently required to meet the current and future need. The funding required in 2015 is predicted to be 16 times higher than the funding that is available in 2010.
Equity in Health
As pandemic (H1N1) influenza spreads around the globe, it strikes school-age children more often than adults. Although there is some evidence of pre-existing immunity among older adults, this alone may not explain the significant gap in age-specific infection rates. Based on a retrospective analysis of pandemic strains of influenza from the last century, this study shows that school-age children typically experience the highest attack rates in primarily naive populations, with the burden shifting to adults during the subsequent season. Using a parsimonious network-based mathematical model, which incorporates the changing distribution of contacts in the susceptible population, it demonstrates that new pandemic strains of influenza are expected to shift the epidemiological landscape in exactly this way. The analysis here provides a simple demographic explanation for the age bias observed for H1N1/09 attack rates, and suggests that this bias may shift in the future. These results have significant implications for the allocation of public health resources for H1N1/09 and future influenza pandemics.
According to this report, the past four decades have, by and large, been a time of substantial progress in human development for the world as a whole. The world’s average Human Development Index (HDI) grew by 29% in this period. Only one of the 111 countries in the dataset saw a decline in its HDI since 1970 – Zambia. Strikingly, the improvements in the HDI come from improvements in education and health. But the author warns that one cannot assume that free-market globalisation has brought these benefits to people in the developing world. Instead, he points to current evidence that shows that the massive increases in education and health achieved over the past 40 years had little if anything to do with globalisation but rather with the decision by states to expand their educational and health systems, coupled by initiatives of the international community to enable access to vaccines and antibiotics. He refers to research that shows that the correlation between economic growth and changes in the non-income components of human development is nearly zero. These results, he suggests, indicate that the oft-repeated dictum that economic growth is a necessary condition for increasing human development is simply not true.
Improving maternal health and reducing newborn deaths is a complex undertaking because, among other things, it involves strengthening health systems, scaling up programmes to reach remote rural areas and marginalised populations, and ensuring that appropriate resources are committed to what some consider a ‘woman’s issue.’ WHO, UNFPA, UNICEF and the World Bank, known as the ‘Health 4’ or ‘H4’, are supporting countries with the highest maternal mortality, starting with six countries that include the Democratic Republic of Congo. In these countries they are supporting strengthening health systems to reduce maternal mortality by 75% and achieve universal access to reproductive health. The four agencies are seeking to enhance collaboration to not only get more money for health, but also more health for the money, by harmonising and working jointly.
Canada has announced that it will make maternal and child health a priority when it hosts the G8 summit in June 2010. Canadian Prime Minister, Stephen Harper, said in a statement that his country would champion a major initiative to improve the health of women and children in the world’s poorest regions. He said that members of the G8 could make a difference in maternal and child health and that Canada would be making this the top priority in June. The Prime Minister suggested that the solutions are within reach for the international community and include better nutrition, clean water, inoculations and training of health workers. With only five years left to achieve the internationally agreed Millennium Development Goals (MDGs), successes have been achieved but much more needs to be done, particularly with MDG 5, which targets maternal health and lags furthest behind of all the eight MDG targets.
A group of senior officials from China, Africa and from international organisations involved in health assistance in Africa met in Beijing on 4-5 December 2009 to review China’s health assistance to Africa and to discuss opportunities for international cooperation in achieving the health-related Millennium Development Goals in Africa. The International Roundtable on China-Africa Health Collaboration was part of an ongoing effort by Government of China to develop a new strategy for health assistance to Africa as part of its overall South-South collaboration. A key message, emphasised by representatives of international organisations, African officials, and Chinese officials alike, is the importance of strong country ownership, on the one hand, and benefits of working through partnership, on the other. Dr. Tedros Adhanom Ghebreyesus, Ethiopian Minister of Health and Chair of the Global Fund to Fight AID Tuberculosis and Malaria, described his country’s experience in working under the framework of the International Health Partnership, with its reliance on supporting Ethiopia’s national health development plan. He noted that ‘it is through ownership that you can generate commitment, and with commitment begin to see results’. He also noted an African proverb, which was quoted by Chinese Premier Wen Jiaobao in his speech at the recent Forum on China Africa Cooperation, and which says ‘If you want to go quickly, go alone. If you want to go far, go together’.
According to South Centre, the Copenhagen Accord has five important implications and effects. First, it lays the foundation for weakening the Kyoto Protocol as the multilateral treaty instrument for developed countries’ binding emission reduction commitments. Second, it creates the potential for changing the balance of obligations under the United Nations Framework Convention on Climate Change (UNFCCC) by laying the basis for a new set of obligations for developing countries. Third, it re-interprets the commitments of developed countries to provide or mobilise climate financing to support developing countries’ climate change-related mitigation and adaptation actions in ways that are conditional and highly ambiguous. Fourth, it creates a parallel framework of climate change-related ‘commitments’ and actions, thereby laying the foundation for a shift away from the UNFCCC per se as the primary multilateral treaty instrument for global long-term cooperative action on climate change. Fifth, it recognises the science relating to a two degree centrigrade global temperature increase but does not elaborate on how this would be achieved. It also talks about equity but does not define clearly how equity considerations are to be addressed, what it means, and the modalities for achieving equity.
The Copenhagen Accord presented after the climate summit is only three pages in length. According to the author of this article, what is left out is probably more important than what it contains. The Accord does not mention any figures of the emission reduction that the developed countries are to undertake after 2012, either as an aggregate target or as individual country targets. The author believes this failure at attaining reduction commitments is the biggest failure of the document and of the whole Conference. It marks the failure of leadership of the developed countries, which are responsible for most of the greenhouse gases retained in the atmosphere, to commit to an ambitious emissions target. While developing countries have demanded that the aggregate target should be over 40% reduction by 2020 compared to 1990 levels, the national pledges to date by developed countries amount to only 13–19% in aggregate. Perhaps this very low ambition level is the reason that the Accord remains silent on this issue, except to state a deadline of 31 January 2010 for countries to provide their targets. The author doubts this deadline will be met given the reluctance to be explicit on this in the last four years.
Effects of climate change on health will impact on most populations in the coming decades and put the lives and well-being of billions of people at increased risk, according to this report. The Intergovernmental Panel on Climate Change (IPCC) states that ‘climate change is projected to increase threats to human health’. Climate change can affect human health directly (such as impacts of thermal stress, death/injury in floods and storms) and indirectly through changes in the ranges of disease vectors (such as mosquitoes), water-borne pathogens, water quality, air quality, and food availability and quality. The report also states that social impacts will vary dependent on age, socioeconomic class, occupations and gender, and the world’s poorest people will be most affected. The risks to health from climate change arise from: direct stresses (such as heatwaves, weather disasters and workplace dehydration); ecological disturbance (such as altered infectious disease patterns); disruptions of ecosystems on which humanity depends (for example, health consequences of reduced food yields); and population displacement and conflict over depleted resources (for example, water, fertile land, fisheries).
In this interview, Dr Brawley discusses the challenges particular to Africa in relation to cancer and debunks some of the myths around cancer. He believes Africa is addressing the cancer pandemic, but more focus is needed to bring politicians and non-government organisations into the fold to address cancer in Africa. Cervical cancer is highly treatable in many areas of the world and abilities to prevent, detect and treat it need to reach African more widely. Smoking, which is not very common in Africa but is growing, needs to be stopped to prevent an epidemic of lung cancer. With regard to the role tobacco control plays in cancer control in Africa, he noted that the Africa Tobacco Control Regional Initiative, the Africa Tobacco Control Alliance, and the Framework Convention Alliance have already been instrumental in helping to establish an agenda for cancer control in Africa. With tobacco companies looking at Africa as an area of market growth there is need to combat what could be an epidemic of lung cancer, cardiac and other diseases.