In this paper the author described age- and sex-specific rates of child homicide in South Africa. A cross-sectional mortuary-based study was conducted in a sample of 38 medico-legal laboratories operating in 2009. Child homicide data were collected from mortuary files, autopsy reports and police interviews. Findings showed an estimated 1,018 child homicides occurred in 2009, or 5.5 homicides per 100,000 children under 18 years. The homicide rate was much higher in boys than in girls. Child abuse and neglect had preceded nearly half of all homicides, but three times more often among girls than among boys. In children aged 15 to 17 years, the homicide rate among boys was nearly five times higher than among girls. South Africa’s child homicide rate is more than twice the global estimate. Since a background of child abuse and neglect is common, the authors recommend that parenting skills should be a key part of primary prevention efforts.
Equity in Health
Universal health coverage has been set as a possible umbrella goal for health in the post-2015 development agenda. In this editorial, the authors discuss the relationship between universal coverage and universal access. They argue that addressing the broader social determinants of health will also improve access to health services; differences in access in particular will be ameliorated by reducing poverty and income inequalities. These actions alone, however, will not guarantee that all people obtain the health services they need. Even if the services exist and people have access to them, they might not use them. Universal health coverage cannot be attained unless both health services and financial risk protection systems are accessible, affordable and acceptable. In turn, universal access, although necessary, is not sufficient. Coverage builds on access by ensuring actual receipt of services. Thus, universal health coverage and universal access to health services are complementary ideas. Without universal access, universal health coverage becomes an unreachable goal.
In this paper, the author examines the problems and prospects for including meaningful indicators of equity into the city based regional planning efforts unfolding around the globe. The central focus of the paper is on the challenges that environmental justice (EJ) activists face as they attempt to frame the problem of equity in ways that the general public would see as not only informative, but compelling. After reviewing examples of successful efforts to reframe debates about equity, the author concludes with a discussion of a set of EJ concerns and indicators that have the greatest potential for capturing public attention and commitment despite mounting resistance to the use of redistributive policies in support of sustainability goals.
A United Nations Economic and Social Council (ECOSOC) panel discussion on universal health coverage (UHC) on 3 July 2013 highlighted the importance of science, technology and innovation for achieving UHC, especially in the context of the post-2015 development agenda. Speakers discussed the meaning and scope of UHC as well as the financing and promotion of UHC in various country contexts. World Health Organisation Director General Margaret Chan pointed to political commitment, investment, clear policy goals and tracking mechanisms as necessary conditions for UHC, but also emphasised state ownership in developing and implementing UHC. She argued that each state should develop its own healthcare system according to the needs of its population. She said that no major breakthrough, such as the introduction of vaccines, is possible without innovation; however, innovation has become expensive, at the cost of access for most people. On the matter of social innovation Chan remarked that often innovation is thought of as sophisticated science, but looking forward, the future of healthcare should be people-centred, integrated and based on primary healthcare and prevention.
This report outlines five main goals for the post 2015 agenda: ending poverty by 2030; promote gender quality; improve access to quality education, water and sanitation; promote good governance; and build strong effective institutions. It posits five transformative shifts as crucial for achieving all five goals: leave no one behind; put sustainable development at the core; transform economies for jobs and inclusive growth; build peace and effective, open and accountable institutions for all, and forge a new global partnership. Like the Millennium Development Goals, the report suggests that targets would not be binding, but should be monitored closely. The indicators that track them should be disaggregated to ensure no one is left behind and targets should only be considered ‘achieved’ if they are met for all relevant income and social groups. The Panel recommends that any new goals should be accompanied by an independent and rigorous monitoring system, with regular opportunities to report on progress and shortcomings at a high political level. It also calls for a data revolution for sustainable development, with a new international initiative to improve the quality of statistics and information available to citizens.
In Ghana, the United Nations Development Program (UNDP) estimates that the country is largely on track in achieving the MDG 1. Poverty has reduced from over 50 percent in 1992 to 28.5% in 2006, indicating that the poverty target could be achieved well ahead of time. Similarly, the proportion of people living below the extreme poverty line declined from 36% to 18% over the same period. But the author of this blog argues that these figures do not take into account regional disparities: hunger is still rife in Ghana's three northern regions. A key theme emerging from his own research suggests that policy makers tend to tout the aggregate "success story" and become preoccupied with hitting statistical targets rather than improving the overall welfare of all constituents. This highlights the risks when policy-makers focus too much on targets, implying that complex processes can be over-simplified and priorities skewed when policies aim solely at targets. The author argues that the use of targets can encourage a reductionist approach to complex problems, privilege quantitative indicators at the expense of qualitative ones, distort resource allocation, and undermine professional motivation and responsibility. He concludes that, while Ghana’s progress has been remarkable, much work still needs to be done in the northern regions.
During her opening address at the 8th Global Conference on Health Promotion in Helsinki, Finland on 10 June, WHO Director-General Dr. Margaret Chan stated that inequalities, between and within countries, in income levels, opportunities, and health outcomes, are now greater than at any time in recent decades. The rise of non-communicable diseases threatens to widen these gaps even further. she noted that public health must contend with Big Tobacco, Big Food, Big Soda, and Big Alcohol. All of these industries fear regulation, and protect themselves by using the same tactics. For WHO, formulation of health policies must be protected from distortion by commercial or vested interests. She referred to the Finnish government as an example to follow, as it has been a leading proponent of the need for all sectors of government to consider the health impact of their policies. Finland put the health-in-all-policies approach under the spotlight during its presidency of the European Union in 2006. Such an approach makes perfect sense, she argued. The determinants of health are exceptionally broad. Policies made in other sectors can have a profound, and often adverse, effect on health. The globalisation of unhealthy lifestyles is by no means just a technical issue for public health. It is a political, trade and foreign affairs issue.
In this blog, the author comments on the May 2013 report by the United Nations High Level Panel (HLP), which is included in this newsletter. He expresses disappointment that universal health coverage (UHC) is not one of the twelve goals outlined in the report, despite overwhelming global consensus for UHC. Whilst the panel acknowledged that universal access to basic healthcare services is required to achieve desired outcomes, the author argues that without setting a target to ensure this is realised different actors will continue operating in silos and vertical interventions that can undermine the national health system. Instead the panel proposes ‘ensuring healthy lives’ as goal four. The author considers this as vague and it appears as a call to business as usual. It lacks the enthusiasm inherent in UHC. And, in many parts of the world that are in dire need of health, especially in Africa, the fourth goal resonates as maintaining status quo. Although UHC is not an end in itself, it is a means to ensure equitable access to quality health services and can guarantee the protection of the right to health and better health outcomes. The author argues that this oversight is a challenge to UHC advocates, who should represent UHC in a more ambitious way drawing lessons from proponents of gender equality. He calls on advocates to promote UHC as the appropriate overarching post 2015 health goal, using the forum of the UN Sustainable Development Goals Open Working Group.
A major outcome of the United Conference for Sustainable Development, better known as Rio+20, held in Rio de Janeiro in June 2012, was the decision to establish a universal, intergovernmental high-level political forum (HLPF) on sustainable development. In this article, the author argues that argued that the proposed HLPF needs to truly be a forum on sustainable development, both in their work on the next set of global development goals and in their broader mandate, rather than a forum on environmental sustainability. The forum will need to make particular effort to engage on economic and social issues so that each of the three pillars of sustainable development is comprehensively addressed. The HLPF must also connect with human rights and peace and security communities to ensure support and legitimacy. The author advocates that the post-2015 development goals be structured as global goals, with national targets. This would make the goals actionable and relevant in different country contexts, and ideally, allow for the goals to be linked more directly to domestic policy priorities.
The Integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD) proposes a cohesive approach to ending preventable pneumonia and diarrhoea deaths. It brings together critical services and interventions to create healthy environments, promotes practices known to protect children from disease and ensures that every child has access to proven and appropriate preventive and treatment measures. The solutions to tackling pneumonia and diarrhoea do not require major advances in technology. Proven interventions exist. Children are dying because services are provided piece- meal and those most at risk are not being reached. Use of effective interventions remains too low; for instance, only 39% of infants less than 6 months are exclusively breastfed while only 60% of children with suspected pneumonia access appropriate care. Moreover, children are not receiving life-saving treatment; only 31% of children with suspected pneumonia receive antibiotics and only 35% of children with diarrhoea receive oral rehydration therapy WHO recommends: exclusive breastfeeding for six months and continued breastfeeding with appropriate complementary feeding; use of vaccines; use of simple, standardised guidelines; use of oral rehydration salts; and proper water, sanitation and hygiene interventions.