This presentation by Hans Rosling of Gapminder was presented on 20 September 2010 at an event reflecting on the progress made against the Millennium Development Goals, hosted by the Bill & Melinda Gates Foundation TEDxChange. Using United Nations data on child mortality, he pointed out the reduction in child mortality at an accelerating speed by African countries like Kenya, after poor performance in the 1990s. In this video of his lecture, he says that the time has come to ‘stop talking about sub-Saharan Africa as one place’, as statistics vary so widely between countries on the continent. He also questions the definitions of ‘developed’ and ‘developing’ countries, arguing that the distinction is no longer strictly valid given that countries with lower incomes have better performance on child mortality than others with higher incomes.
Equity in Health
In a globalising world, public health can no longer be confined to national borders, the author of this paper argues. Recent years have seen an increasing movement of patients across international borders. The full extent of this trend is yet unknown, as data is sparse and anecdotal. If this trend continues, experts are convinced that it will have major implications for public health systems around the globe. Despite the growing importance of medical travel, little empirical evidence exists on its impact on public health, especially on health systems. This paper summarises the most recent debates on this topic. It discusses the main forces that drive medical travel and its implications on health systems, in particular the impacts on access to health care, financing and the health workforce. The author offers guidance on how to define medical travel and how to improve data collection. He advocates for more scientific research that will enable countries to harness benefits and limit the potential risks to public health arising from medical travel.
In this paper, the authors review the extensive body of literature regarding health systems research on equity of access as it relates to universal health coverage, identifying the issues addressed, methods used and specific findings. Most of the studies that were reviewed interpreted equitable access as equal utilisation for equal need across socio-economic groups and report that poorer social groups experience less health care than their needs require. However, the authors noted that evidence on the causes and specific barriers to access faced by specific groups is often lacking in the literature. Only a few studies evaluated the impact of specific policies or interventions on equitable access, but they had significant methodological limitations. These findings suggest a need to strengthen policy relevant research, which should go beyond simply reporting inequities in health care utilisation and assess equity in the overall process of access to explain the causes of differential access. The framework devised by the authors is proposed as a useful reference scheme for future research, providing guidance on areas and methodological approaches.
The authors of this study estimated deaths and disability-adjusted life years (DALYs), years lived with disability (YLD) and years of life lost (YLL) attributable to the independent effects of 67 risk factors and clusters of risk factors for 21 regions in 1990 and 2010. They included estimates from published and unpublished literature, and data from the Global Burden of Disease Study 2010. Worldwide, the contribution of different risk factors to disease burden appears to have changed substantially, with a shift away from risks for communicable diseases in children towards those for non-communicable diseases in adults. These changes are related to the ageing population, decreased mortality among children younger than five years, changes in cause-of-death composition, and changes in risk factor exposures. New evidence has led to changes in the magnitude of key risks including unimproved water and sanitation, vitamin A and zinc deficiencies, and ambient particulate matter pollution. The extent to which the epidemiological shift has occurred and what the leading risks currently are varies greatly across regions. In much of sub-Saharan Africa, the leading risks are still those associated with poverty and those that affect children.
In this study, researchers estimated life expectancy and mortality rates for children under five and adults for 187 countries from 1970 to 2010. Findings showed that from 1970 to 2010, global male life expectancy increased from 56.4 years to 67.5 years and global female life expectancy increased from 61.2 years to 73.3 years. Substantial reductions in mortality occurred in eastern and southern sub-Saharan Africa since 2004, coinciding with increased coverage of antiretroviral therapy and preventive measures against malaria. Globally, 52.8 million deaths occurred in 2010, which is about 14% more than occurred in 1990, and 22% more than occurred in 1970. Deaths in children younger than 5 years declined by almost 60% since 1970. Yet substantial heterogeneity exists across age groups, among countries, and over different decades. Greater efforts should be directed to reduce mortality in low-income and middle-income countries, the authors argue. Improvement of civil registration system worldwide is crucial for better tracking of global mortality.
In the Global Burden of Diseases, Injuries, and Risk Factors Study 2010, researchers aimed to estimate annual deaths for the world and 21 regions between 1980 and 2010 for 235 causes, separately by age and sex. They collected data on causes of death for 187 countries from 1980 to 2010 from vital registration, verbal autopsy, mortality surveillance, censuses, surveys, hospitals, police records, and mortuaries. Findings revealed a broad shift from communicable, maternal, neonatal, and nutritional causes towards non-communicable diseases, which appears to be driven by population growth, increased average age of the world's population, and largely decreasing age-specific, sex-specific, and cause-specific death rates. Nevertheless, communicable, maternal, neonatal, and nutritional causes remain the dominant causes of years of life lost due to premature mortality (YLLs) in sub-Saharan Africa. Overlaid on this general pattern of the epidemiological transition, marked regional variation exists in many causes, such as interpersonal violence, suicide, liver cancer, diabetes, cirrhosis, Chagas disease, African trypanosomiasis, melanoma, and others. Regional heterogeneity highlights the importance of sound epidemiological assessments of the causes of death on a regular basis.
The changes that have taken place, and continue to take place, in South Africa’s post-1994 health sphere are often difficult to comprehend for both those inside and outside the country’s health care system. This book presents a coherent “big picture” of health and health care in South Africa. The contributing authors chart the evolving health system, along with the ensuing changes and challenges, and contextualise these developments historically and globally, as well as critically assess them. Contents include the following: national health care systems: trends, changes and reforms; the changing biophysical environment: impact on health and health conditions; HIV, AIDS and tuberculosis: trends, challenges and responses; health care expenditure: using resources efficiently and equitably; revitalisation and re-engineering of primary health care; hospitals and hospital reform; complementary and alternative medicine and traditional health care; and medical ethics and human rights. The book is aimed at researchers and lecturers, as well as senior and postgraduate students in the health and health-related professions, the social sciences, and health planning, policy and management-related disciplines.
In the Global Burden of Disease (GBD) studies done in 1990 and 2000, 289 diseases and injuries were identified as causing disability. The authors of this study undertook a systematic global analysis of these diseases and injuries to calculate and interpret years lived with disability (YLDs). They found that, in 2010, there were 777 million years lived with disability (YLDs) from all causes, up from 583 million in 1990. The main contributors to global YLDs were mental and behavioural disorders, musculoskeletal disorders, and diabetes or endocrine diseases. Neglected tropical diseases, HIV and AIDS, tuberculosis, malaria and anaemia were important causes of YLDs in sub-Saharan Africa. Overall, rates of YLDs per 100,000 people have remained largely constant over time but rise steadily with age. Population growth and ageing have increased YLD numbers and crude rates over the past two decades. Health systems urgently need to address the needs of the rising numbers of individuals with a range of disorders that largely cause disability but not mortality, the authors argue. Quantification of the burden of non-fatal health outcomes will be crucial to understand how well health systems are responding to these challenges.
Research has shown that if prospective parents lose weight and reduce weight gain during pregnancy, this may lower the risk of their unborn children from developing non-communicable diseases in later life. Interventions have been launched in low- and middle-income countries (LMICs) to get these adults to lose weight, yet they have limited impact. As an alternative, the authors of this paper argue that the most promising strategy to improve prospective parents' body composition and lifestyle is the promotion of health literacy in adolescents. Multiple but integrated forms of community-based interventions that focus on nutrition, physical activity, family planning, breastfeeding and infant feeding practices are needed. They need to address the wider social economic context in which adolescents live and to be linked with existing public health programmes in sexual and reproductive health and maternal and child health initiatives. Addressing the promotion of such health literacy in parents-to-be in LMICs requires a wider social perspective. A range of multisectoral agencies will have to work together and could be linked to issues of women's empowerment, reproductive health, communicable disease prevention and Millennium Development Goals 4 and 5 (maternal and child health).
This paper offers an overview of calculations of global inequality, recently and over the long-run as well as main controversies and political and philosophical implications of the findings. The author focuses in particular on the winners and losers of the most recent episode of globalisation, from 1988 to 2008. He suggests that the period might have witnessed the first decline in global inequality between world citizens since the Industrial Revolution. The decline however can be sustained only if countries’ mean incomes continue to converge (as they have been doing during the past ten years) and if internal (within-country) inequalities, which are already high, are kept in check. Mean-income convergence would also reduce the huge “citizenship premium” that is enjoyed today by the citizens of rich countries.