In this paper, the authors argue that addressing inequality should be central to the post-2015 development framework. They say inequality must be approached on multiple levels: within countries, among nations, and between generations. Tracking inequalities – for example, the progress of the poorest quintile of the population – is important, but to actually reduce inequality, we must reduce the structural inequalities that cause poverty, they add. Their paper highlights some of the many examples of severe inequalities that can be found both among and within countries today. Inequalities are caused by structural barriers, and new as well as old deprivations. A post-2015 development framework must find ways to build on the progress that has already been made and identify policies that can break down some of the barriers faced by the disadvantaged. While the world might be ready to set ambitious targets in areas such as sustainable energy, water, sanitation, and access to knowledge and technology, the authors point out that other areas like migration and trade should also be taken into account. They demand an agenda that pays more attention to social cohesion and social justice, and emphasise that getting the metrics right is critical to improving the reach and effectiveness as of public services.
Equity in Health
This fact sheet outlines trends in key dimensions of socio-economic inequality in the BRICS countries (Brazil, Russia, India, China and South Africa), looking especially at education, gender, health, social expenditure and environmental sustainability. The BRICS countries have growing influence in the global economy, but face challenges in reducing inequality. For instance, growth in the informal jobs sector is associated with deepening inequality, and working women are particularly affected. In South Africa, India and China, rural dwellers are increasingly poorer than their urban counterparts; 50.3% of China’s rural population is excluded from public benefits such as health insurance and higher levels of education. In all the BRICS, girls are disadvantaged in levels of access to education, especially in rural areas. Gaps in women’s and men’s economic participation are high, although the number of women in political leadership in Brazil and South Africa has increased. Regressive taxation systems, dependent on consumption rather than income, and subscription-based social security schemes, mean that the poorest are disproportionately taxed and lack security nets such as health insurance. And with climate change disproportionately impacting poor and vulnerable populations, strategies for ‘green growth’ must also address inequalities in people’s exposure to environmental risks.
This statistical release presents information on mortality and causes of death in South Africa for deaths that occurred in 2010. It also provides information on death occurrences from 1997 to 2009 to show trends in mortality and causes of death. It is based on data collected through the South African civil registration system that is maintained by the Department of Home Affairs. The information on causes of death provided is as recorded on death notification forms completed by medical practitioners and other certifying officials. The results generally showed that mortality continues to decline in the count ry. A total of 543,856 deaths occurred in 2010, which was a 6,2% decline from 579,711 deaths that occurred in 2009. Decreases in the overall number of deaths from the civil registration system have been observed since 2007. The National Population Register, which is maintained by the Department of Home Affairs, also showed annual declines in the number of deaths since 2007. Furthermore, median ages at deaths showed that mortality occurs later in life, which is also an indication of declining mortality. In 2010, the median age at death was estimated at around 48 years, which has increased by about five years since 2004. Tuberculosis maintained its rank as the number one leading cause of death in South Africa (12% of all mortalities).
This report is a synthesis of inputs received during the Global Thematic Consultation on Health, which concluded on 6th March 2013 in Gaborone, Botswana. It highlights lessons learned from the Millennium Development Goals (MDGs), health in the post-2015 agenda, health priorities for 2015-2030, and how to frame the future health agenda in terms of principles, goals, targets and indicators. Participants suggested an overall health development goal: “Maximising health at all stages of life,” and proposed two health sector goals: accelerating progress on the health MDGs and reducing the burden of major non-communicable diseases (NCDs). They also suggested that the post-2015 framework should include more ambitious health targets; emphasise equity; address reproductive health and sexual rights; include differentiated targets and indicators for various life stages; and appreciate the interconnections between health and other goals, while addressing macroeconomic issues that impact on health, inequality and poverty. Further, participants argued that universal health access might be a preferable formulation – and vision – to universal health coverage.
This briefing note offers principles and approaches for integrating economic, social and environmental sustainability and equity in a new post-2015 development agenda. It offers guidance on how development processes can help create a foundation for human wellbeing based on economic progress, equitable prosperity and opportunity, a healthy and productive environment and participatory governance. The Independent Research Forum argues that sustainable development can only be achieved when these dimensions of development are all present and mutually reinforcing. But first, eight shifts will be essential: from ‘development assistance’ to a universal global compact; from top-down to multi-stakeholder decision-making processes; from economic models that increase inequalities and risks to ones that reduce them; from business models based on shareholder value to those based on stakeholder value; from meeting ‘easy’ development targets to tackling systemic barriers to progress; from damage control to investing in resilience; from concepts and testing to scaled up interventions; and from multiple discrete actions to cross-scale coordination.
For Africa, there is the urgent and desperate need for a radically different approach to understanding and tackling regional challenges post-2015, argues the author of this article. Africa’s greatest challenge is creativity, and innovation founded on indigenous knowledge and indigenous resources. The continent needs homegrown, creative solutions and breakthroughs in governance, science and technology, economic policies, curriculum, health and wellness, and just about any area of human existence covered and not covered by the Millennium Development Goals (MDGs). What is absent in Africa are ideas rooted in Africa’s indigenous material and non-material resources, ranging from mineral, environmental, herbal and ecological resources to agricultural practices, social organisation, political processes, medical knowledge, and numerous others. Africa’s own knowledge systems and ideas are the most valid, inexpensive and rely on easily accessible resources that will bring about advancement for the continent, the author argues. The formulators of the numerous development plans superimposed on Africa have had little or no regard for the continent’s indigenous knowledge, and because of that Africans themselves hold their knowledge and abilities in contempt.
This report brings together a series of policy briefs and is aimed at policy-makers and others interested to improve health equity by acting within the health system and on broader governmental policy. The report provides an update and overview of the vast amount of evidence produced during the Commission on Social Determinants of Health and identifies policy options to implement the main recommendations of the Commission. It draws from the extensive work of the nine global knowledge networks set up by WHO to generate evidence for the Commission. It first considers the essential role of the health sector in reducing inequities in five areas: working towards universal coverage; public health programmes; measuring inequities in health; facilitating mobilisation of people and groups; and intersectoral action. Second, it discusses how the health sector can work with other sectors that are also vital to this task in seven additional areas: early child development; urban settings; globalisation; employment and working conditions; policy and attitudes towards women; inclusive policies; and engaging civil society. The report ends by outlining a methodology to put together a national action plan addressing these issues, in light of the different starting points and priorities found in each country.
The purpose of this report is to present a summary of the main themes and messages that have emerged from the Global Consultation on Health and to make recommendations to inform the deliberations of the High-Level Panel of Eminent Persons and the UN Secretary-General’s report to the General Assembly in May 2013. The report describes the consultation process, detailing the processes that were used to reach out to different constituencies, explains why health should be at the centre of the post-2015 development agenda and summarises the inputs about the successes and shortcomings of the MDGs, many of which were unintended and only became apparent with the benefit of hindsight. It then presents guiding principles for the post-2015 development agenda and the various options for health goals and indicators that were put forward during the consultation and gives recommendations on how to frame the future agenda for health. The contributors to this consultation are looking in the same general direction: all agree that the new development agenda needs strong and visible health goals supported by measurable indicators. The report concludes by suggesting concrete actions that could be taken between now and 2015 by those advocating for health to feature prominently in the next development agenda.
The aim of this study was to develop a model for identifying areas at high risk for sporadic measles outbreaks based on an analysis of factors associated with a national outbreak in South Africa between 2009 and 2011. Data on cases occurring before and during the national outbreak were obtained from the South African measles surveillance programme, and data on measles immunisation and population size, from the District Health Information System. Model projections were used to identify emerging high-risk areas in 2012. A clear spatial pattern of high-risk areas was noted, with many interconnected (i.e. neighbouring) areas. An increased risk of measles outbreak was significantly associated with both the preceding build-up of a susceptible population and population density. The risk was also elevated when more than 20% of infants in a populous area had missed a first vaccine dose. The model was able to identify areas at high risk of experiencing a measles outbreak in 2012 and where additional preventive measures could be undertaken. In conclusion, the South African measles outbreak was associated with the build-up of a susceptible population (owing to poor vaccine coverage), high prevalence of HIV infection and high population density. The predictive model developed could be applied to other settings susceptible to sporadic outbreaks of measles and other vaccine-preventable diseases.
This Mapping Report presents an overview of the social determinants of health (SDH) landscape in Tanzania. It specifically looks at SDH's conceptualisation and role in addressing health inequalities, SHD-related policies, research trends, priorities and capacity needs. The report is based on a desk review of available SDH-related research from 2005 onwards, complemented with in-depth interviews with 34 individuals from a cross-section of institutions. Results showed that conceptualisation of SDH varied, but most interviewees linked it to inequities or inequalities. A number of organisations in the country are working towards achieving health equity, some involved in research and others in disseminating information. Nationally there is no SDH-specific research and/or policy portfolio. While there are no policies, programmes or legislation related to SDH, reducing inequities is central to Tanzania’s Vision 2025 and the National Strategy for Growth and Reduction of Poverty. Interviewees suggested strengthening Tanzania’s health system by establishing an SDH consortium to manage and consolidate various aspects of SDH research.