This literature review highlights the causes, effects and potential mitigation measures of adult obesity in Africa. The major factors that contribute to obesity include over-nutrition, physical inactivity, change of dietary habits, modernisation, consumption of high-fat, high-carbohydrate foods and increased urbanisation. Despite African women tending to be more obese than men, they are less prone to hypertension, heart disease and type 2 diabetes than men before they reach menopause due to their fat deposition being predominantly sub-cutaneous rather than abdominal. The defining metabolic changes in obesity are decreased glucose tolerance, decreased sensitivity to insulin, hyperinsulinemia and reduced life expectancy. The author highlights that obesity is a controllable behavioural disorder, with regular exercise and sensible eating being the best ways to regulate body fat percentage and maintain a healthy body weight. As it is difficult to treat obesity, efforts in Africa should be directed towards prevention in order to keep it in check.
Equity in Health
The corroboration of scientific evidence across disciplines has confirmed that global warming is occurring and that this will have potentially negative consequences for health, such as respiratory diseases from polluted air, the spread of tropical diseases and increased malnutrition due to drought and floods. The author of this paper argues that it is time for public health advocates to draw on their past successes in tackling the health consequences of pollution, and to draw the link between the causes of global warming and pollution. In addition, strategies that link stakeholders and current development goals and provide feedback data from climate change adaptation and mitigation approaches are needed as we move forward to face the health consequences of global warming.
The High-Level Panel of Eminent Persons on the Post-2015 Development Agenda has been tasked by United Nations Secretary-General Ban Ki-Moon to develop a framework for a post-2015 development agenda. This Communiqué reports on the Panel’s third meeting in Monrovia, Liberia from 30 January to 1 February 2013, where members took stock of the progress achieved so far towards the fulfilment of the Panel’s mandate. Members agreed to make every effort to achieve the Millennium Development Goals by 2015, while also framing a single and cohesive post-2015 development agenda that integrates economic growth, social inclusion and environmental protection. Economic growth alone is not sufficient to ensure social justice, equity and sustained prosperity for all people. The global community must pursue economic and social transformation leading to sustained and inclusive economic growth at the local, national and global levels. The protection and empowerment of people is crucial. Achieving structural transformations through a global development agenda will involve: sustainable growth with equity, creating wealth through sustainable and transparent management of natural resources; and partnerships with many actors, unified behind a common agenda.
Placing health at the heart of the post-2015 development agenda will not only save lives and advance economic development, it will also protect environmental sustainability, and advance wellbeing, equity and social justice, according to this report. It makes a number of recommendations. Health goals should be equitable, holistic and people-centred. The post-2015 development agenda should be direct explicit attention to reducing health inequities between and within all countries, especially when considering the needs of the poor, marginalised, and those whom the efforts of the Millennium Development Goals (MDGs) have not reached. The right to health means that governments must generate conditions in which everyone can be as healthy as possible. A hierarchy of goals is needed to capture the increasing complexity of priority health challenges and the reality that efforts to prevent disease and disability and improve health and well-being require policies and actions both within the health sector and across many other sectors. Indicators need to measure impact, coverage of health services and health systems. Some qualitative indicators may be needed to measure quality of life and well-being, while assessing quality of health services may require qualitative as well as quantitative indicators. The MDG targets and indicators as well as those in other internationally agreed agendas should be revised for the post-2015 era and included under the relevant goals.
The commitment toward achieving universal coverage understood as access to quality, individualized healthcare for all, in a human rights framework, has been profiled as the Goal of the Post 2015 Development Agenda on the topic of Health. For this reason, the Pan American Health Organization proposed a consultation of the key social actors in this process and to hear their voices. The present document summarizes the debate and the agreements assumed by the representatives of civil society organizations, municipal authorities or mayors, indigenous authorities, afro descendants, and other civil society representatives.
Societies make decisions and take actions that profoundly impact the distribution of health. Why and how should collective choices be made, and policies implemented, to address health inequalities under conditions of resource scarcity? How should societies conceptualise and measure health disparities, and determine whether they've been adequately addressed? Who is responsible for various aspects of this important social problem? In her book, Jennifer Prah Ruger elucidates principles to guide these decisions, the evidence that should inform them, and the policies necessary to build equitable and efficient health systems world-wide. This book weaves together original insights and disparate constructs to produce a foundational new theory, the health capability paradigm, in which all people should have access to the means to avoid premature death and preventable morbidity. Ruger's theory takes the ongoing debates about the theoretical underpinnings of national health disparities and systems in a new rights-based direction. She shows the limitations of existing approaches (utilitarian, libertarian, Rawlsian, communitarian), and effectively balances a consequentialist focus on health outcomes and costs with a proceduralist respect for individuals' health agency. Through what Ruger calls ‘shared health governance’, her approach emphasises responsibility and choice. It allows broader assessment of injustices, including attributes and conditions affecting individuals' ability to ‘flourish’, as well as societal structures within which resource distribution occurs.
This paper focuses on migration in South Africa, and explores the links between health and the movements of people within the county and across its borders. The authors found that most migrants send remittances to their families back home or provide reciprocal care in times of sickness. Current health system planning within South Africa did not appear to adequately engage with the health of migrants in urban and transition areas. The authors emphasise the importance of engaging with a place-based approach to address the health of those affected by the migration process in South Africa. They argue that South Africa needs to develop, implement and monitor an evidence-based, coordinated, multi-level national response to migration and health, with an emphasis on the role of local government. Planning should address the needs of those who return home to die when they are too sick to work and government should also work towards developing a co-ordinated regional response to migration and health.
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.
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.