Mental and behavioural disorders account for about one third of the world’s disability caused by all ill health among adults, with unipolar depressive disorders set to be the world’s number one cause of ill health and premature death in 2030, affecting high- and low-income countries. There is a range of evidence-based cost-effective interventions that can be implemented in parenting, at schools, at the workplace, and in older age that can promote health and well-being, reduce mental disorders, lead to improved productivity, and increase resilience to cope with many of the stressors in the world. These facts need to be better communicated to policymakers to ensure that the silent burden of impaired mental health is adequately heard and reduced.
Equity in Health
Preparations for the United Nations High-level Meeting on Non-communicable Diseases in September 2011 have already begun through regional consultations in all six World Health Organisation (WHO) regions. These consultations have resulted in declarations or outcome documents that identify priorities for action against NCDs and outline the expectations of Member States. Based on the regional consultations, some of these expectations include: a greater commitment from policy-makers to NCD prevention; more effective mechanisms and monitoring of intersectoral action; greater accountability of non-health sectors; and scaling-up of WHO’s Action Plan. Despite repeated external funding commitments such as the Paris Declaration on Aid Effectiveness and the Accra Agenda for Action, NCDs receive less than 3% of development assistance for health even though they cause more than one-third of all premature deaths. Ultimately the outcomes of the high-level meeting will depend on the expressed priorities of Member States, the authors of this article argue. At the very least, they conclude, the meeting should increase awareness of NCDs among policy-makers and achieve higher levels of political commitment.
In this study, researchers assessed whether the global target of halving tuberculosis (TB) mortality between 1990 and 2015 can be achieved and estimated the number of lives saved globally by the DOTS/Stop TB Strategy of the World Health Organisation (WHO). Mortality from TB since 1990 was estimated for 213 countries using established methods endorsed by WHO. The researchers found that TB mortality among HIV-negative (HIV−) people fell by 36% between 1990 and 2009 and they predict it could be halved by 2015. The overall decline (when including HIV-positive people, who comprise 12% of all TB cases) was 19%. Between 1995 and 2009, 49 million TB patients were treated under the DOTS/Stop TB Strategy, saving 4.6–6.3 million lives, with a further 1 million lives that could be saved annually by 2015. The researchers conclude that their findings indicate that the global target of halving TB deaths by 2015 relative to 1990 is possible. Intensified efforts to reduce deaths among HIV+ TB cases are still needed, especially in sub-Saharan Africa.
According to this fact sheet measuring progress towards achieving the health-related Millennium Development Goals, annual global deaths of children under five years of age fell to 8.1 million in 2009 from 12.4 million in 1990. Fewer children are underweight. The percentage of underweight children under five years old is estimated to have dropped from 25% in 1990 to 16% in 2010. More women get skilled help during childbirth. The proportion of births attended by a skilled health worker has increased globally, however, in the WHO Africa and South-East Asia regions fewer than 50% of all births were attended. Fewer people are contracting HIV. New HIV infections have declined by 17% globally from 2001–2009. Tuberculosis treatment is more successful. Existing cases of TB are declining, along with deaths among HIV-negative TB cases. More people have safe drinking-water, but not enough have toilets. The world is on track to achieve the MDG target on access to safe drinking-water but more needs to be done to achieve the sanitation target.
The common starting point of many studies scrutinising the factors underlying health inequalities is that material, cultural-behavioural, and psycho-social factors affect the distribution of health systematically through income, education, occupation, wealth or similar indicators of socioeconomic structure. However, little is known regarding if and to what extent these factors can assert systematic influence on the distribution of health of a population independent of the effects channelled through income, education, or wealth. In their analysis, the authors of this paper suggest that three main factors persistently contribute to variance in health: the capability score, cultural-behavioural variables and to a lower extent, the materialist approach. Of the three, the capability score illustrates the explanatory power of interaction and compound effects as it captures the individual's socioeconomic, social, and psychological resources in relation to his/her exposure to life challenges. Models that take a reductionist perspective and do not allow for the possibility that health inequalities are generated by factors over and above their effect on the variation in health channelled through one of the socioeconomic measures are underspecified and may fail to capture the determinants of health inequalities, the authors conclude.
Non-communicable diseases (NCDs), principally heart disease, stroke, cancer, diabetes and chronic respiratory diseases, are a global crisis and require a global response, according to the authors of this report. Yet, despite the threat to human development, and the availability of affordable, cost-effective and feasible interventions, most countries, development agencies and foundations are neglecting the crisis. The authors call on the United Nations, which will gather for its High-Level Meeting on NCDs in September 2011, to launch a coordinated global response to NCDs that is commensurate with their health and economic burdens. The report aims to answer four questions: is there really a global crisis of NCDs? How is NCD a development issue? Are affordable and cost-effective interventions available? And do we really need high-level leadership and accountability? Action against NCDs will support other global health and development priorities, the authors argue, concluding that long-term success will require inspired and committed national and international leadership.
This is the first-ever World Report on Disability (WRD) and it comes at a critical time, now that 150 countries have signed the UN Convention on the Rights of Persons with Disabilities (CRPD). One billion people in the world are experiencing disability – one in seven of the world’s population – and the numbers are rising. The report provides strong evidence of the need to equalise rights and opportunities for persons with disabilities in all aspects of life. The authors highlight the barriers and hardships faced by persons with disabilities, especially in low- and middle-income countries, such as increased unemployment (one in two men and four in five women with disabilities are unemployed globally), increased poverty (higher rates of food insecurity, poor housing, lack of access to safe water and sanitation, and inadequate access to health care), poor educational attainment, poor health outcomes and a higher risk of exposure to violence.
In this paper, the authors provide a comprehensive and up-to-date review of the epidemiological trends and public health implications of diabetes in Sub-Saharan Africa They conducted a systematic literature review of papers published on diabetes in Sub-Saharan Africa from 1999-March 2011, providing data on diabetes prevalence, outcomes (chronic complications, infections, and mortality), access to diagnosis and care and economic impact. Type 2 diabetes was found to account for well over 90% of diabetes in Sub-Saharan Africa, and population prevalence proportions ranged from 1% in rural Uganda to 12% in urban Kenya. Reported type 1 diabetes prevalence was low and ranged from 4 per 100,000 in Mozambique to 12 per 100,000 in Zambia. Gestational diabetes prevalence varied from 0% in Tanzania to 9% in Ethiopia. Screening studies identified high proportions (>40%) with previously undiagnosed diabetes, and low levels of adequate glucose control among previously diagnosed diabetics. Barriers to accessing diagnosis and treatment included a lack of diagnostic tools and glucose monitoring equipment and high cost of diabetes treatment. The total annual cost of diabetes in the region was estimated at US$67.03 billion, or US$8836 per diabetic patient. The authors argue that significant interactions between diabetes and important infectious diseases like HIV highlight the need and opportunity for health planners to develop integrated responses to communicable and non-communicable diseases.
Cervical cancer is the second most common cancer among women in Africa, according to David Kerr, president of the European Society of Medical Oncology, yet there is a profound lack of reproductive health information for women and delayed access to treatment in rural areas in Africa. He notes that, in many parts of the continent, cancer is stigmatised as a death sentence, and he calls for a long-term strategy for vaccination, screening, treatment and awareness building. Although cancer is slowly receiving attention in Africa, the article notes that other diseases such as AIDS still absorb much of the health funding. The author also argues that many of the strategies aimed at preventing HIV could also help prevent the spread of the human papillomavirus too, which may play a role in the development of cancer. New research tackling AIDS and cancer simultaneously has shown that the anti-retroviral, lopanivir, can kill cells infected by HPV, while leaving healthy cells relatively unharmed. This might prove a useful way to prevent cervical cancer. Also, the drug could be used after a HPV infection, whereas vaccination is only effective prior to it – and is currently more expensive.
This report contains the twelfth annual Mothers’ Index, which documents conditions for mothers and children in 164 countries – 43 developed nations and 121 in the developing world – and shows where mothers fare best and where they face the greatest hardships. All countries for which sufficient data are available are included in the Index. Some countries from the east, central and southern African region fared poorly in the Index, notably the Democratic Republic of Congo (DRC), which was ranked 37th out of 42 least-developed countries (LDCs). The Central African Republic and Angola also performed poorly, positioned at 33 and 30 respectively. Rwanda, Lesotho, Malawi and Uganda were ranked highest among LDCs, surpassed only by the Maldives in the first place. South Africa’s performance was mediocre, as it was ranked at 19 out of 38 less-developed countries, far behind Cuba, which was ranked first.