The author predicts significant adjustments in the global health status quo in the coming year and identifies seven forces that are converging towards what appears to be an inevitable tipping point. Some changes will be gradual, others may appear as sudden shifts. Each of these forces has the potential to make a significant difference in its own right, but as they begin to interact and influence one another, business as usual is an unlikely outcome. Within the health sector the forces include a shift in public health priorities towards maternal and child health, non-communicable diseases, urban health promotion and primary health care renewal, as well as a shift in national health programmes and global public health initiatives from delivering the downstream interventions that constitute traditional health care services towards addressing the social determinants of health. Also included is the increased focus on health system strengthening, and continued growth in domestic health funding, particularly in the middle-income countries that are experiencing economic growth. The author also points to a change in the locus of global health governance, as countries with emerging economies, like Brazil, China, India and South Africa, exert an increasing influence on global health policies and agendas, linking them increasingly to foreign policy priorities. The author predicts other major forces affecting the global health status quo will be the new global financial reality, where international assistance for health will continue to grow, but the new fiscal prudence will bring stringent accountability and demand for aid effectiveness.
Equity in Health
The primary objective of this paper was to review progress towards adoption of contraception among married or cohabiting women in western and eastern Africa between 1991 and 2004 by examining subjective need, approval, access and use. Indicators of attitudes towards and use of contraception were derived from Demographic and Health Surveys and trends were examined for 24 countries that had conducted at least two surveys between 1986 and 2007. In western Africa, the subjective need for contraception remained unchanged; about 46% of married or cohabiting women reported a desire to stop and/or postpone childbearing for at least two years. The percentage of women who approved of contraception rose from 32 to 39 and the percentage with access to contraceptive methods rose from 8 to 29. The proportion of women who were using a modern method when interviewed increased from 7 to 15% (equivalent to an average annual increase of 0.6 percentage points). In eastern African countries, trends were much more favourable, with contraceptive use showing an average annual increase of 1.4 percentage points (from 16% in 1986 to 33% in 2007).
This paper reports on the prevalence of latent tuberculosis infection (LTBI) and risk factors for a positive tuberculin skin test (TST) among gold miners in South African gold mines. Among 429 participants, the estimated prevalence of LTBI was 89%; 45.5% of HIV-positive participants had a zero TST response compared to respectively 13% and 13.5% in the HIV-negative and status unknown participants. In participants with TST > 0, there was no significant difference between size of response by HIV status. Factors independently associated with a TST < 10 mm were positive HIV status and not working underground. The authors conclude that the prevalence of LTBI is very high in gold miners in South Africa. HIV-infected individuals are more likely to have a negative TST, but HIV infection does not affect the size of TST response.
With four years to go, Tanzania still lags behind other East African countries towards the realisation of the Millennium Development Goals (MDGs), according to this article, only surpassing war-torn Burundi. The minister for Health and Social Welfare, Dr Haji Mponda, admitted that he was aware of the problem and expressed the government’s willingness to ensure that some of the targets are fully realised by 2015. He highlighted the achievements made by the government, specifically in 2007, when the rate of HIV prevalence dropped from 7% to 5% and that of 2004 to 2005, when the number of maternal deaths went down from 98 to 51 out of every 1,000 deaths. The report comes exactly 10 years since the UN's adoption of the goals and twenty years since the recording of most baseline data surface. Despite an extraordinary public campaign to mobilize support for the MDGs, there has been surprisingly little effort to track, record, and disseminate information regarding progress toward the goals at the country level, the authors of the report argued. Reacting to Tanzania’s poor performance, the head of Twaweza, an information advocacy organization, expressed concern that Tanzania still lagged behind its peer East African neighbours. He challenged the government to review each of the eight MDGs by involving stakeholders in health, poverty reduction, environment and other sectors that are related to the MDGs. He also called for independent evaluation bodies of these strategies, with stakeholders involved and not just the government officials and added reports ought to be made available in the public domain, so that citizens know where the country is headed.
The United Nations predicts that the world's urban population will almost double from 3.3 billion in 2007 to 6.3 billion in 2050. Most of this increase will be in developing countries. Exponential urban growth is having a profound effect on global health. Because of international travel and migration, cities are becoming important hubs for the transmission of infectious diseases, as shown by recent pandemics. Physicians in urban environments in developing and developed countries need to be aware of the changes in infectious diseases associated with urbanization, the authors of this review argue. Furthermore, health should be a major consideration in town planning to ensure urbanisation works to reduce the burden of infectious diseases in the future.
Whether or not health inequalities are unjust, as well as how to address them, depends on how they are caused, the author of this paper argues. He reviews a range of health inequalities in different countries and internationally, between genders, class, income and racial groups and between countries, tentatively identifying pathways of causality in each case, and making judgments about whether or not each inequality is unjust. He asserts that health inequalities that arise due to medical innovation are among the most benign, while those that arise due to inequalities in early life are more significant, pointing to the importance of parental and child circumstances. Society judges racial inequalities in health as unjust, adding to injustices in other domains. While the inequalities in health between rich and poor countries are wide, the author asserts that they are not perceived as just nor unjust, nor are they easily addressed.
The Global Tuberculosis Control Report is compiled annually by the World Health Organization, and this edition documents the success and challenges in tuberculosis (TB) treatment worldwide during 2009/2010. Some successes are highlighted, such as a 35% drop in the TB death rate since 1990, with a slow decline in TB incidence. It indicates that the world is on track to reach the Millennium Development Goal for TB incidence, and the Stop TB Partnership 2015 target for TB mortality. There has also been major progress in improving access to diagnosis and treatment, and also in the scale up of TB/HIV intervention and strengthening of laboratory services. However, major challenges still exist. In 2009, 1.7 million died from TB, and although incidence levels are falling, they are falling too slowly, the report has revealed. It predicts that, under the current rate of decline, TB will not be eliminated within the next generation. Also, the response to multi-drug resistant TB is still insufficient and more efforts are needed to scale up and strengthen programmes, especially with 440,000 new cases emerging each year. Less than 5% of those cases are being properly treated, the report notes.
According to this article, women's health is closely linked to a nation's level of development, with the leading causes of death in women in resource-poor nations attributable to preventable causes. Unlike many health problems in rich nations, the cure relies not only on the discovery of new medications or technology but also getting basic services to the people who need them most and addressing underlying injustice. In order to do this, the article argues that political will and financial resources must be dedicated to developing and evaluating a scaleable approach to strengthen health systems, support community-based programmes, and promote widespread campaigns to address gender inequality, including promoting girls' education. The Millennium Development Goals (MDGs) have highlighted the importance of addressing maternal health and promoting gender equality for the overall development strategy of a nation. The authors of this article urge stakeholders to capitalise on the momentum created by this and other international campaigns and continue to advocate for comprehensive strategies to improve global women's health.
This article reviews the debates at the United Nation’s Millennium Development Goal Summit, held from 20-22 September 2010. Rather than bringing a convincing message about a turning point for the future, the article argues that the Summit highlights missed opportunities in acting on what has already been agreed to. Barriers to moving forward are hardly mentioned and strategies to overcome them remain largely vague. The outcome of the High Level Meeting can therefore be seen as mixed and fragile as the uneven successes and progress documented in the UN Secretary General’s report to the meeting. On the positive side, the negotiated outcome document combines a return to basics. In promoting public health for all, it brings back the integrated primary health care approach, the social justice and rights imperatives, and participation of civil society as in the Alma Ata Declaration, together with conditional cash transfer, new technology and innovative finance.
The Global strategy for women’s and children’s health sets out the key areas where action is urgently required to enhance health financing, strengthen policy and improve service delivery. It argues that investing in women’s and children’s health reduces poverty, stimulates economic productivity and growth, is cost-effective and helps women and children realise their human rights. The report makes a number of recommendations. First, it urges governments and the global community to support country-led health plans, emphasising life-saving interventions and ensuring that women and their children can access prevention, treatment and care when and where they need it. The report also advocates for stronger health systems, with sufficient skilled health workers at their core and innovative approaches to financing, product development and the efficient delivery of health services. The over-reaching aim of the report is to help reach the goal of saving the lives of 16 million women and children by 2015.