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.
Equity in Health
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.
Significant progress towards reducing child and maternal mortality is being made, but to meet the Millennium Development Goals (MDGs) 4, 5 and 6, strategies aimed at reaching the world’s most inaccessible, marginalised and vulnerable populations will be required, according to Ethiopia’s Minister of Health and the heads of four leading global health organisations – the GAVI Alliance, UNAIDS, the Global Fund to Fight AIDS, TB and Malaria and UNICEF. Many countries are committed to achieving the MDGs but rely largely on donor support for its national health plan to continue its progress. Increased funding has seen improved immunisation rates, more programmes against malaria (by providing insecticide-treated bed nets) and the expansion of anti-retroviral access to two million in sub-Saharan Africa have contributed to an improving health picture for the continent, with reductions in mortality and morbidity rates.
Why a renewal of primary health care (PHC), and why now, more than ever? Globalization is putting the social cohesion of many countries under stress, and health systems are clearly not performing as well as they could and should. People are increasingly impatient with the inability of health services to deliver. Few would disagree that health systems need to respond better – and faster – to the challenges of a changing world. PHC can do that.
This report is based on a master set of data that has been compiled by an inter-agency and expert group on Millennium Development Goal (MDG) indicators, led by the Department of Economic and Social Affairs of the United Nations Secretariat, in response to the wishes of the General Assembly for periodic assessment of progress towards the MDGs. The group consists of representatives of the international organisations whose activities include the preparation of one or more of the series of statistical indicators that were identified as appropriate for monitoring progress towards the MDGs. This report summarises progress towards the Goals in each of the regions. However, any such synthesis inevitably masks the range and variety of development experiences in individual countries since the goals were adopted.
In its report, the Commission calls for increased public finance for programmes and policies to support the social determinants of health, including child development, education, improved living and working conditions and health care, recognising the failure of markets to supply vital goods and services equitably. It also calls for progressive taxation at the national level, a major increase in aid, improved aid quality and greater debt cancellation. It sees an urgent need for a global economic system that supports renewed government leadership to balance public and private sector interests, and identifies quantifying the impact of supra-national political, economic, and social systems on health and health inequities within and between countries as an important research need. Stronger global management of integrated economic activity and social development is needed as a more coherent way to ensure fairer distribution of globalisation's costs and benefits. The entrenched interests of some social groups and countries are seen as ‘barriers to common global flourishing’, and transnational companies should become accountable to the public good, not just to private profit.
This World Health Organisation report takes a broad look at inequality and health. The report issues a call to arms, stressing the need to tackle the inequitable distribution of power, money and resources through better governance, transparency, support for civil society and more equitable economic policies. Some claim the report offers a way out of the ‘sterile debate’ about whether poor health causes poverty, or vice versa. Critics point out that it downplays the link between income (as opposed to inequality) and health. One example of the correlation between money and health is from South Africa, where the health of older people improved after receiving pensions at the age of 65. But whether people are well or sick also depends on factors and policies that lie far beyond the remit of any health minister. For example, the Health Ministry may try to encourage handwashing, but it is unlikely to happen unless there is running water - which is beyond the Ministry’s control.