One hundred and seventeen African health, social development, gender-based, youth and human rights organisations, as well as trade unions, have signed and submitted a letter to the 15th African Union Summit of Heads of State, which took place from 19-27 July 2010 in Uganda. The letter was featured in the July EQUINET newsletter since which time the large number of civil society organisations have signed on. The letter sent to the chairman of the African Union urged governments to uphold, improve and urgently implement African and global health and social development financing commitments, including the Abuja Commitment to allocate 15% of national budgets to health.
Equity in Health
Letter from 117 African civil society organisations to July 2010 African Union Summit
Africa Public Health Alliance & 15% Plus Campaign: July 2010
Sub-Saharan Africa's mothers, newborns, and children: How many lives could be saved with targeted health interventions?
Friberg IK, Kinney MV, Lawn JE, Kerber KJ, Odubanjo MO et al: PLoS Medicine 7(6), 21 June 2010
According to this paper, sub-Saharan Africa is at a critical point for achieving the Millennium Development Goals for maternal and child survival. It urges for strategic action to be taken now to maximise mortality reduction by 2015. It estimates mortality reduction for 42 sub-Saharan African countries if 90% coverage of maternal, newborn and child health (MNCH) interventions was achieved – nearly four million African women, newborns and children could be saved each year. The study also undertook a detailed analysis of nine African countries that estimated mortality reductions and additional cost for feasible increases in coverage of selected high-impact MNCH interventions considering three differing health system contexts. It revealed that a 20% coverage increase for selected community-based/outreach interventions would save an estimated 486,000 lives and cost an additional US$1.21 per capita. Increasing the quality of current facility births would save 105,000 lives and cost an additional US$0.54 per capita. The study concludes that functioning health systems require both community-based or outreach services and facility-based care. Maximising mortality impact for Africa's mothers, newborns, and children will depend on using local data to prioritise the most effective mix of interventions, while building a stronger health system.
The political economy of the MDGs: Retrospect and prospect for the world’s biggest promise
Hulme D and Scott J: Brooks World Poverty Institute, University of Manchester, Working Paper 110, 2010
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.
Climate change: A creeping catastrophe
Bulletin of the World Health Organization 88: 410–411, June 2010
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.
Sixty-third World Health Assembly resolution on monitoring of the achievement of the health-related Millennium Development Goals
World Health Organization: 21 May 2010
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.
The role of urban municipal governments in reducing health inequities: A meta-narrative mapping analysis
Collins PA and Hayes MV: International Journal for Equity in Health, 25 May 2010
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.
Umthente, uhlaba, usamila: The second South African national youth risk behaviour survey 2008
Medical Research Council: 2010
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.
WHO: Equity, social determinants and public health programmes
World Health Organization: 2010
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.
Women Deliver Conference urges world leaders to reduce maternal and child mortality
Women Deliver: June 2010
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.
Address by WHO Director-General to the Sixty-third World Health Assembly
Chan M: World Health Organization, 18 May 2010
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.