This paper highlights gender as a very important factor in determining vulnerability in Disaster Risk Reduction (DRR). The degree of vulnerability to disaster is determined by social variables like gender, age, health status, ethnicity, religion and socio-economic status and understanding these is necessary to identify the underlying causes of disasters and thus try to prevent them. In most countries, women are particularly at risk from disasters. Subsequently, understanding why women are often vulnerable and taking appropriate steps can make a huge difference on impact. The paper looks at DRR in relation to livelihoods. People, especially in developing countries are particularly vulnerable to disasters as they often live in high-risk areas, have lower coping capacities, and have no form of insurance or other safety nets. Furthermore, they are heavily dependent on climate-sensitive primary industries like agriculture and fishing. A disaster can eradicate livelihoods or years of local development efforts in a very short time.
Equity in Health
In 1987, the World Health Organization (WHO) estimated that vitamin A deficiency was endemic in 39 countries based on the ocular manifestations of xerophthalmia or deficient serum (plasma) retinol concentrations. In 1995, WHO updated these estimates and reported that vitamin A deficiency was of public health significance in 60 countries, and was likely to be a problem in an additional 13 countries. The current estimates reflect the time period between 1995 and 2005, and indicate that 45 and 122 countries have vitamin A deficiency of public health significance based on the prevalence of night blindness and biochemical vitamin A deficiency, respectively, in preschool-age children.
The Western Cape provincial government initiated the collaborative Burden of Disease (BOD) Reduction Project to reduce its burden of disease and promote equity in health. This shift in thinking from facilities to a population-based approach to health demonstrates increased awareness about the crucial role of upstream factors on population health. Several lessons may be learnt from the Western Cape experience with mortality surveillance. Identifying health priorities is important, like leading causes of premature mortality such as HIV and AIDS, tuberculosis, homicides and road traffic injuries. Identifying inequities must be done in line with the recommendations of the World Health Organization Commission on Social Determinants of Health to monitor health inequities. Government also needs to start evaluating priority health programmes. Providing accessible information for policy makers is also crucial, as well as advocating for an intersectoral response, such as improving living conditions with the involvement from other sectors such as housing, water and sanitation.
The combination of low levels of malnutrition together with dramatically high rates of mortality encountered in Kenya's Lake Victoria territory is unique for Sub-Saharan Africa. This paper points to a unique interplay of cultural, geographical and political factors in the region that are responsible for causing the described paradox. Moreover, it demonstrates that a salient disease environment is one of the key drivers of the massive under-5 mortality rates in the lake region. This environment is characterised by extremely high malaria prevalence, polluted water sources and high rates of infectious diseases like HIV. It also found that an ethnic specific effect remains even after controlling for mother's age at birth, birth spacing, birth order and HIV-status. Political discrimination seems also to be an important factor. The paper reveals that the HIV status of the mother and children's diarrhoea status explain the largest part in the variation of stunting outcomes between families. Educational attainment of the mother turns out to be the single most important source in explaining mortality differentials between families.
Weather and climate affect the key determinants of human health: air, food and water. They also influence the frequency of heatwaves, floods and storms as well as the transmission of infectious diseases. In addition, policies to mitigate climate change (for example in the energy, transport or urban planning sectors) have a direct and important influence on health, for example through effects on local air pollution, physical activity, or road traffic injuries. In order to guide research in this field, the World Health Organization (WHO) carried out a global consultation. Experts on climate change, health and related disciplines produced background reports covering each of the themes identified by the World Health Assembly Resolution, as well as an additional report on how to support research in this field. This was followed by an online consultation, and a three-day workshop attended by over 70 leading researchers, health practitioners, and representatives of funding bodies and other United Nations (UN) agencies. This report presents the conclusions and recommendations from this process, with the aim of improving the evidence base for policies to protect health from climate change.
According to this book, food production, access to clean water and health in Africa may be affected by climate change. In eastern Africa, rainfall is expected to increase in some parts of the region. In southern Africa, rains will be disrupted, bringing a notable drop in maize production. In contrast, growing seasons may lengthen in parts of Southern Africa, for example Mozambique, owing to a combination of increased temperature and higher rainfall. Yet net revenues from crops could shrink by up to 90% by 2100. There is likely to be a greater number of people living with water stress by 2055 as rainfall becomes more erratic or declines. The previously malaria-free highland areas of Ethiopia, Kenya, Rwanda and Burundi could experience modest incursions of malaria by the 2050s, with conditions for transmission becoming highly suitable by 2080s. Rift Valley fever epidemics could become more frequent and widespread as El Niño events increase. In southern Africa, more areas are likely to become more suitable for malaria, with a southward expansion of the transmission zone into Zimbabwe and South Africa.
The World Health Organization (WHO) says the full impact of the swine flu outbreak in Africa has yet to be seen. The African Region was the last to experience the pandemic amongst the six WHO regions, and concerns are mounting about its potential effect. ‘What is of particular concern to us as Africans is that, although the pandemic has spread to our continent last, we may be more severely affected by it,’ said South African health minister Dr Aaron Motsoaledi. The concern is exacerbated by Africa’s burden of disease. ‘It is well known that this continent has always been worst affected by any outbreak of communicable diseases – whether it is HIV, tuberculosis, malaria, one or more of the haemorrhagic fevers. It is, therefore, essential for all countries within the continent to ensure that we are adequately prepared for all of these, but in the present context prepared to deal with the influenza pandemic’, he added.
Africa’s informal sector is still largely unknown. Some reports have suggested that approximately 60% of those employed in the Southern African Development Community region may be in the informal sector, while others report that up to 20% of all African workers were employed in this sector in 1992. Provision for occupational health and safety (OHS) in the sector is generally scanty, and non-existent in some countries, even if policies exist. This brief recommends that a systematic regional approach is needed to protect the health of workers in the informal sector, including collect basic data on the state of the informal sector, state support for infrastructure in developing the informal sector and insist that health and safety issues form part of business plans that are submitted for funding. Governments must play an active lead role and take responsibility for the provision of health and safety support to this sector, as well as ensure that basic health and safety training for employers and workers is provided.
This article notes that almost 400 million of the world's indigenous people have low standards of health. This poor health is associated with poverty, malnutrition, overcrowding, poor hygiene, environmental contamination, and prevalent infections. The authors argue that this precarious situation is aggravated by inadequate clinical care and health promotion, and poor disease prevention services. As indigenous groups move from traditional to transitional and modern lifestyles, they are rapidly acquiring lifestyle diseases, such as obesity, cardiovascular disease, and type 2 diabetes, and physical, social, and mental disorders linked to misuse of alcohol and of other drugs. To correct these inequities, the authors recommend increased awareness, political commitment, and recognition rather than governmental denial and neglect of these serious and complex problems. Additionally, the authors recommend that indigenous people should be encouraged, trained, and enabled to become increasingly involved in overcoming these challenges.
This second article on the health of indigenous people delves into the underlying causes of health disparities between indigenous and non-indigenous people, providing an indigenous perspective to understanding these inequalities. The authors present a snapshot of the many research publications about indigenous health, with the aim to provide clinicians with a framework to better understand such matters. By applying this lens, placed in context for each patient, the authors argue that more culturally appropriate ways to interact with, to assess, and to treat indigenous peoples shall be promoted. The topics covered in this article include indigenous notions of health and identity; mental health and addictions; urbanisation and environmental stresses; whole health and healing; and reconciliation.