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.
Equity in Health
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.
Occupational health and safety (OHS) provision for public servants is southern Africa is poor. Many factors may contribute to this grave situation. Managers of government departments often lack knowledge of their responsibilities regarding occupational health and safety. Training in health and safety for managers and workers is limited by inadequate budgets, bureaucratic obstacles to procuring the training and lack of available approved trainers. Resources to improve the working conditions in the public sector are scarce. What is needed to ensure the health and safety of the public sector in Southern Africa are adequate policy and legislation, enforcement and monitoring of compliance in public service departments, OSH programmes in public sector workplaces, access to adequate treatment and rehabilitation for those affected by workplace hazards, and adequate social security for those disabled and the survivors of those who die on the job. Even if they are motivated to act against unsafe conditions, many categories of worker are precluded from the right to strike as they are considered providers of ‘essential services’.
The aim of the research was to assess current and historical surveillance of the pneumoconioses in former miners, in particular silicosis, silico-tuberculosis and tuberculosis, and to assess the functioning of the Occupational Diseases in Mines and Works Act (ODMWA) surveillance and compensation system, which is a responsibility of the Department of Health. The research also aimed to assess the impact of the burden of lung disease and disability on the public health system and on the labour-sending communities from which the miners come and to which they return. The main objective was thus to investigate health systems surveillance of the pneumoconioses in former underground gold miners, and to assess diagnostic and compensation systems under the legal framework of the Occupational Diseases in Mines and Works Act 78 of 1973 as Amended (ODMWA). The main finding was that this is a historically neglected subject, under-researched and undocumented.
The Economic and Social Council (ECOSOC) has adopted a number of resolutions, including a resolution urging the Joint United Nations Programme on HIV/AIDS (UNAIDS) and other relevant organisations and bodies of the United Nations system to intensify their support to governments in dealing with HIV and AIDS. It also reaffirmed its commitment to the implementation of the Programme of Action for the Least Developed Countries for the Decade 2001–2010, which calls on the UN Secretary-General to step up appropriate measures for effective and timely implementation of the Programme in coordination with all relevant stakeholders, and submit an analytical and results-oriented annual progress report on the further implementation. The Council also recommended mainstreaming information and communication technologies in the economy as a driver of growth and sustainable development and encouraged all stakeholders to continue engaging in people-centred partnerships as an effective way forward.
The International Federation of Red Cross and Red Crescent Societies (IFRC) has launched a US$ 8 million initiative to help build the disaster resilience of 600,000 people living along the Zambezi river in seven southern African countries. The Zambezi River Basin Initiative (ZRBI) is a response to ‘a dramatic increase in the numbers of floods along the river basin’, according to Farid Abdulkadir, IFRC disaster management coordinator for the southern Africa region. The focus of the ZRBI is on disaster preparedness rather than post emergency relief operations, as in the past. It is a joint programme between the Angolan, Botswana, Malawi, Mozambique, Namibia, Zambia and Zimbabwe Red Cross Societies, combining risk reduction efforts with food security, health, HIV prevention and capacity building activities. The US Agency for International Development (USAID) has already committed US$1 million to the project.
Zimbabwe and Botswana have reported their first suspected cases of swine flu as the H1N1 virus begins to establish a foothold in southern Africa. Neighbouring South Africa has reported 54 laboratory confirmed cases of swine flu so far, 32 of which have been linked to a squash tournament at a university in Johannesburg. No deaths have been reported in the region as yet. Dr Lucille Blumberg, head of epidemiology at South Africa's National Institute for Communicable Diseases, said that most cases of the illness were ‘mild’, and that it was too early to tell whether people living with HIV and AIDS (PLWHAs) would be affected to a greater degree by the flu. Most PLWHAs are in southern Africa, where most countries also have severely stretched health services, and the effects of the virus on their populations remain uncertain. Blumberg said in other parts of the world swine flu had killed healthy people, as well as those suffering from underlying illnesses.
This study set out to assess the effect of educational attainment and other factors on the risk of HIV in pregnant South African women. Repeated cross-sectional surveys were used. Pregnant women, who were attending public antenatal clinics were tested for HIV annually between 2000 and 2005, provided demographic information. Among women aged 15-24 years, HIV risk in those who had completed secondary education was significantly lower than in those who had only primary education – it increased by 8% per annum in those with no secondary education but did not increase those with secondary education. Together with other evidence, this study suggests that higher educational attainment did not protect against HIV in the early stages of the South African HIV/AIDS epidemic. But in recent years, the risk of HIV infection in young South African women with completed secondary education has reduced significantly relative to that in young women with primary education, suggesting that HIV prevention strategies may have been more effective in more educated women.
This paper documents the impact of the AIDS crisis on non-AIDS related health services in 14 sub-Saharan African countries. The authors, using multiple waves of Demographic and Health Surveys (DHS) for each country, examined antenatal care, birth deliveries, and rates of immunisation for children born between 1988 and 2005. They found deterioration in nearly all of the above dimensions of health care over this period. Using data collected on HIV prevalence in the most recent DHS survey for each country, they noted that erosion of health services is highly correlated with increases in AIDS prevalence. Consequently, regions of countries that have light AIDS burdens have witnessed small or no declines in health care, using the measures noted above, while those regions currently shouldering the heaviest burdens have seen the largest erosion in treatment for pregnant women and children. Finally, the authors estimate that the beginning of the divergence in health services between high- and low-HIV regions took place in the mid-1990s.
There is overall consensus that recent decades have seen an increase in inequities in general and in health in particular. Some less-developed countries are showing deteriorating health outcome averages (in some cases due to the HIV/AIDS pandemic), as a result of the widening gap between poor and rich. The epidemiological transition has been quoted as one contributing factor. What is missing is consensus around what the solutions are. There have been justified criticisms that private foundations – the big health spenders – are too technocratic and disease-specific to make an impact. The way forward is argued to need more comprehensive government leadership, acting beyond the health sector, through comprehensive approaches and processes that deal with diseases in an equitable and effective way.