This latest edition of Roll Back Malaria’s (RBM) global progress report indicates that all but four of the 46 African region countries still have ongoing malaria transmission. Four countries in southern Africa (Botswana, Namibia, South Africa and Swaziland) share a common goal of eliminating malaria by 2015. They were joined by their four northern neighbours (Angola, Mozambique, Zambia and Zimbabwe) in 2009, to form the sub-regional malaria elimination initiative known as the Elimination Eight (E8). Another four countries in Africa (Gambia, Rwanda, São Tomé and Principe, and Madagascar) have secured Global Fund grants to prepare for elimination. The long-term cost benefit of elimination still needs to be sufficiently documented, RMB notes, in order to facilitate the required policy and financing commitments. Success is accumulating, however, and the evidence base guiding local, national, regional and global action is growing quickly. Future investment in new malaria control tools and in socio-economic development that will support malaria control and communities broadly will be essential, RBM argues. With strong human capacity, continued investment, evidence-based programming and continued partnership, achieving the ambitious Roll Back Malaria 2015 targets, including elimination in at least eight to ten countries is still possible, the report concludes.
Equity in Health
In the three years since ‘Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health’ was published by the World Health Organisation (WHO), the global financial crisis has deepened and the steps put in place to deal with the crisis have had worse impacts on the poor and relatively disadvantaged, while bad governance nationally and globally persists, and measures to mitigate climate change have served to increase health inequity. Despite the dissenters who claim that social determinants are not the concern of WHO, specialists across WHO used evidence-based research to show that action on social determinants of health was fundamental to disease control programmes. The author of this article suggests that the global community can still make great progress towards closing the health gap by improving the social determinants of health and by ensuring equity for every child from the start, as well as ensuring healthier environments, fair employment and decent work, social protection across the life course and universal health care. But to make progress, the global community must also deal with inequity in power, money and resources – the social injustice that is killing on a grand scale.
In this editorial, the author argues that a comprehensive response to Non Communicable Diseases (NCDs) not only calls for systemic changes in our physical and social environments. It also demands that we focus on equitable and universal access to prevention, diagnosis, and treatment, as well as on improving the quality of life of those living with NCDs. The interconnections between policies in agriculture, education, environment, transportation, labor, trade, finance, and health run deep and their contribution to NCDs is as yet underappreciated. Thus, the response to NCDs requires an intersectoral approach – which includes civil society - that embeds health in policies across the board. Stakeholders need to educate and focus public interest, as well as that of government and industry, on the positive value of health and well-being. This will require a social movement and maximising the use of social media to generate more consumer demand for healthier products and healthier environments.
The global obesity epidemic has been escalating for four decades, yet sustained prevention efforts have barely begun. Forecasts suggest that high rates of obesity will affect future population health and economics. The authors of this study identify several cost-effective policies that governments should prioritise for implementation. Systems science provides a framework for organising the complexity of forces driving the obesity epidemic and has important implications for policy makers. Many parties (such as governments, international organisations, the private sector, and civil society) need to contribute complementary actions in a coordinated approach. Priority actions include policies to improve the food and built environments, cross-cutting actions (such as leadership, healthy public policies, and monitoring), and much greater funding for prevention programmes. Increased investment in population obesity monitoring would improve the accuracy of forecasts and evaluations. The integration of actions within existing systems into both health and non-health sectors (trade, agriculture, transport, urban planning, and development) can greatly increase the influence and sustainability of policies. The authors call for a sustained worldwide effort to monitor, prevent, and control obesity.
Rather than call for a new ‘mega-fund’ for NCDs, the author of this article argues that we need to use the growing focus on NCDS to build a global social movement for Universal Health Coverage (UHC) to address all health needs according to national and local epidemiology and priorities. The UHC movement calls on nations to reform their health plans and financing structures toward access to essential diagnostics, prevention, and treatment for all. Strong equitable health systems are the tipping point for universal health coverage. As demographics change and people with communicable diseases live long enough to develop chronic diseases, a responsive, performance-driven, integrated health systems approach will have the greatest health impact. A strong health system grounded in UHC, working to address NCDs must: be coordinated and integrated to reach people who may otherwise go undetected; deliver integrated care and include all players in the health system; have strong information systems and an educated health workforce; and support local private sector health providers.
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.
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.