This paper reviews the Millennium Development Goals (MDGs) process, drawing some recommendations to feed into the debate concerning what will take their place in 2015 when the process comes to an end. The authors note that creating the MDGs was a process that was led by rich countries, with comparatively little involvement of the lower- and middle-income countries. Likewise, the merging of the international development goals (IDGs) and MDGs was undertaken mainly between rich countries and the United Nations. In this sense, the author indicates that rich countries needed ambitious goals for their image and legitimacy, while developing countries were more interested in national goals. The paper found some clear progress in meeting the MDGs, notably the reduction of extreme poverty and also an improvement in primary school enrolments, and similarly, the paper predicts that the target of halting and reversing the spread of HIV is likely to be met. However, several areas have shown only weak improvements and even the successes are qualified. Progress has been highly geographically uneven, with global progress masking regional slippage, and regional progress masking deterioration in individual countries. The paper concludes that the opportunity created by the Millennium Movement to mobilise countries and people against poverty has been lost. The MDGs have made a difference but they have not transformed the process of international co-operation in the ways that their proponents had initially hoped.
Equity in Health
In this interview, Dr Colin Summerhayes, president of the Society for Underwater Technology, talks about how the world’s climate is changing and the expected consequences on health. He predicts that, as the rise in temperatures as a result of global warming will be quite slow over the next 30 years, we should not expect an instant change in health factors. He refers to the change as a ‘creeping catastrophe’. As well as increased morbidity and mortality from extreme weather events, such as heatwaves, droughts and floods, Summerhayes anticipates that climate change is likely to increase the burden of malnutrition, diarrhoea and infectious diseases. There is also likely to be a rising frequency of cardio-respiratory diseases because of changes in air quality and in distribution of some disease vectors. All of this could impose a substantial burden on health services. He notes that some scientists now believe there will be both contractions and expansions in the occurrence of malaria, with changes in transmission seasons.
Expressing concern at the relatively slow progress in attaining the Millennium Development Goals, particularly in sub-Saharan Africa, the World Health Assembly in this resolution reaffirms the commitments by developed countries to a target of 0.7% of gross national income on official development assistance by 2015, with an interim goal of 0.56% of gross national income for official development assistance by 2010. It urges United Nations member states to strengthen their health systems so that they deliver equitable health outcomes and achieve Millennium Development Goals 4, 5 and 6. It urges for policy review in areas that are limiting progress, including on the recruitment, training and retention of health workers, particularly in sub-Saharan Africa. Governments should reaffirm the values and principles of primary health care, including equity, social justice and community participation, as the basis for strengthening health systems. Health equity should be taken into account in all national policies that address the social determinants of health, and governments should consider developing and strengthening universal comprehensive social protection policies, including health promotion, disease prevention and health care, and further commit themselves to increased investment in financial and human resources.
Despite the establishment of a 'health inequities knowledge base', the precise roles for municipal governments in reducing health inequities at the local level remain poorly defined. The objective of this study was to monitor thematic trends in this knowledge base over time, and to track scholarly prescriptions for municipal government intervention on local health inequities. Of the total of 1,004 journal abstracts pertaining to health inequities that were analysed, the overall quantity of abstracts increased considerably over the 20 year timeframe. 'Healthy lifestyles' and 'healthcare' were the most commonly emphasised themes, but only 17% of the abstracts articulated prescriptions for municipal government interventions on local health inequities. This study has demonstrated a pervasiveness of 'behavioural' and 'biomedical' perspectives, and a lack of consideration afforded to the roles and responsibilities of municipal governments, among the health inequities scholarly community. Thus, despite considerable research activity over the past two decades, the 'health inequities knowledge base' inadequately reflects the complex aetiology of, and solutions to, population health inequities.
For this survey, school learners completed a self-administered questionnaire, in addition to having their height and weight measures taken, in 2008. The overall response rate was 71.6%. In summary, there were considerable variations across age, gender, grade, race and province for each of the risk behaviours. With regard to behaviours related to infectious diseases, 38% of learners had reported ever having had sex, with 13% of them reporting their age of initiation of sexual activity as being under 14 years old, while 63% always washed their hands before eating and 70% always washed their hands after going to the toilet. High levels of violence were indicated by the 15% of learners reported carrying weapons and 36% who reported they had been bullied in the month prior to the survey. Learners reported alcohol consumption was 50% for ever having drunk alcohol and 35% for having drunk alcohol in the past month, and 29% for having engaged in binge drinking in the month prior to the survey. The study makes specific recommendations to address the clusters of behaviours covered in this survey, based on the concept of intersectoral intervention development or solutions to limit the behaviours that place young people at risk for premature morbidity and mortality.
This book analyses the impact of social determinants on specific health conditions. It presents promising interventions to improve health equity for: alcohol-related disorders, cardiovascular diseases, child health and nutrition, diabetes, food safety, maternal health, mental health, neglected tropical diseases, oral health, pregnancy outcomes, tobacco and health, tuberculosis, and violence and injuries. Individual chapters represent the major public health programmes at WHO, reflecting the premise that health programmes must lead the way by demonstrating the relevance, feasibility and value of addressing social determinants. Each chapter is organised according to a common framework that allows a fresh but structured look at common, high burden public health problems. Levels in this framework range from the overall structure of society, to differential exposure to risks and disparate vulnerability within populations, to individual differences in health care outcomes and their social and economic consequences. Throughout the volume, an effort is made to identify entry-points, within existing health programmes, for interventions that address the upstream causes of ill-health. Possible sources of resistance or opposition to change are also consistently identified.
About 3,500 advocates, policymakers, development leaders, health care professionals, youth advocates, celebrities and media personnel from 140 countries attended the 2010 Women Deliver Conference, held from 7–9 June in Washington, DC, United States. The conference challenged the international community to dramatically reduce maternal and child mortality by committing US$12 billion in aid. Three messages emerged from the conference. First, maternal and newborn mortality rates are dropping, but the work is far from done. Second, investing in girls and women is not only the right thing to do, but it makes economic sense. Third, although solutions exist to achieve Millennium Development Goal 5, which aims to reduce maternal and infant mortality, what is lacking are the requisite political will and the equitable allocation of resources.
In her address at the 2010 World Health Assembly, Margaret Chan charted the successes and failures of public health over the past year. She underlined the importance of equity and social justice, which are central to the Millennium Declaration and its goals, as well as the primary health care approach. Principles such as universal access to services, multisectoral action and community participation form a solid basis for strengthening health systems. However, efforts to reduce maternal and newborn deaths have shown the slowest progress of all the Millennium Development Goals (MDGs) in all regions, largely, as she pointed out, because reducing these deaths depends absolutely on a well-functioning health system. She informed participants that, in preparation for the September United Nations Summit on the Millennium Development Goals, the Secretary-General’s office is finalising a joint action plan to accelerate progress in reaching the health-related MDGs, with a special focus on maternal and child health. She urges all participants to maintain a focus on building strong health systems and improving regulatory capacity. Acknowledging that WHO has not met its goals in the past, she re-iterated the organisation's commitment to improving fundamental capacities to help reach international commitments, increase efficiency and fairness, improve health outcomes in sustainable ways and move countries towards greater self-reliance.
Honorary Chair and Patron of the Africa Public Health Alliance and 15% Plus Campaign, Desmond Tutu, has called on African Heads of State and Ministers of Health and Finance to work urgently towards meeting their Abuja commitments before the 2011 High Level Progressive Review of Africa's commitment to health financing. He pointed out that, in the past nine years, only six out of 53 African Union member states have met their 2001 Abuja commitment to pledge 15% of their budgets to health. He attributed shortfalls on meeting health Millennium Development Goals (MDGs)to a combination of low per-capita investment in health and low investment in social determinants of health, such as clean water, improved sanitation, poor nutrition and gender equity in health, as well as a lack of pharmaceutical capacity and access to medicines. He urged the education and labour sectors to train and retain the necessary numbers of health workers, and double per capita investment in health.
This statement was made after a meeting of Commonwealth Health Ministers (CHMM), which was held on 16 May 2010 in Geneva, Switzerland. The theme of the meeting was 'The Commonwealth and the Health MDGs by 2015'. The Meeting noted that only 5% of Commonwealth developing countries have met Millennium Development Goal (MDG) 4 targets or are on track to do so. At least 19 countries have high maternal mortality rates, and only 36% of developing Commonwealth countries have achieved or are on track to achieve the targets for births attended by skilled staff. The Meeting also noted the major challenges facing the world, and Commonwealth countries in particular, if the MDGs are to be met. Ministers were optimistic that many of the 2015 MDG targets could be met by Commonwealth countries. They, however, noted that this would require greater technical co-operation; attention to enabling environments, including legal frameworks, and where appropriate free healthcare to mothers and children; and an integration of preventative and curative services in the context of strengthening health systems through primary healthcare. Ministers called on the global community, especially the G8 and G20, to support maternal and newborn health programmes, and to meet MDGs 4 and 5. While acknowledging the tremendous achievements in access to anti-retroviral treatment, the Ministers noted that two thirds of those needing treatment did not receive it. Ministers pledged support for the greater alignment of non-communicable disease issues with the MDGs.