The number of abortions among women older than 18 has increased steadily over the past two years in the Western Cape Province, according to South African Health MEC Theuns Botha. Responding recently in the legislature on the impact that illegal abortions have on public health care facilities, Botha said such abortions continued to take place, despite the legal service that was offered at more than 30 health care centres in the province. While health care facilities had treated a number of women with complications arising from illegal abortions, Botha said it was difficult to say how many cases there had been as those known to the department were only of women who volunteered the information during treatment. According to the latest figures from the National Health Department, between 1997 – when legal termination of pregnancy was introduced – and last year, about 702,354 abortions were performed at public health care facilities nationwide. About 528,000 of these involved teenagers. Health Minister Aaron Motsoaledi expressed concern about the number of teenagers who were having abortions, arguing this was proof that young people were engaging in unprotected sex and risking HIV infection. A spokesperson from Marie Stopes – a non-profit organisation offering reproductive health services – called on parents and teachers to talk openly about contraception, saying that research showed that most pregnant teenagers are in poor communities where educational and financial opportunities are limited. Women need to be made aware that abortion is not a form of contraception, she said.
Values, Policies and Rights
The Rio Declaration is the outcome document of the World Conference on Social Determinants of Health, held from 19-21 October 2011 in Rio de Janeiro, Brazil. In the Rio Declaration, heads of government, ministers and government representatives reaffirm their commitment to take action on social determinants of health to create vibrant, inclusive, equitable, economically productive and healthy societies, and to overcome national, regional and global challenges to sustainable development. They recognise that the current global economic and financial crisis urgently requires the adoption of actions to reduce increasing health inequities and prevent worsening of living conditions and the deterioration of universal health care and social protection systems. They offer specific actions under the following common objectives: to adopt better governance for health and development; to promote participation in policy-making and implementation; to further reorient the health sector towards reducing health inequities; to strengthen global governance and collaboration; and to monitor progress and increase accountability. In the declaration, signatories call upon the World Health Organisation, United Nations agencies and other international organisations to advocate for, co-ordinate and collaborate in the implementation of these objectives.
According to this statement by Latin American social medicine and civil society organisations at the World Conference on Social Determinants of Health, the fundamental cause of the inequalities within and between nations is the neoliberal economy, infused with an exclusively speculative desire for unlimited profit. Capitalism grabs profits and socialises losses, they argue, resorting to new and crueler neoliberal measures that further reduce the fundamental social rights of people. There are abundant resources for all of us on the earth, but the ‘logic’ of the market prevents people from obtaining what they need. In the area of public health, neoliberalism translates into the commercialisation of life, legal protections for intellectual property for the benefit of the medical industrial complex, control of the media in order to create ‘need’ through shock, damage to public health systems, manipulation of civil society, multiple forms of violence and other strategies to colonise the ‘collective thought’. The current dominant societal model, using the lifestyle of affluent Americans as a basis, they argue is not sustainable. The statement concludes with a call for the establishment of global alliances between progressive governments and social movements, and meaningful social participation, as well as support for the creation and consolidation of health systems and social security systems that are universal, free, integral, and public, with coverage for all people for all services.
This study explores and describes the views of drivers and conductors on the causes of workplace violence (WPV) and ways of preventing it in the road passenger transport sector in Maputo, Mozambique. The design was qualitative. Participants were purposefully selected from among transport workers identified as victims of WPV in an earlier quantitative study, and 32 transport professionals were interviewed. The triggers and causes of violence included fare evasion, disputes over revenue owing to owners, alcohol abuse, overcrowded vehicles, and unfair competition for passengers. Failures to meet passenger expectations, e.g. by-passing parts of a bus route or missing stops, were also important. There was disrespect on the part of transport workers, e.g. being rude to passengers and jumping of queues at taxi ranks, and there were also robberies. Proposals for prevention included: training for workers on conflict resolution, and for employers on passenger-transport administration; and promoting learning among passengers and workers on how to behave when travelling collectively. Regarding control and supervision, participants expressed the need for the recording of mileage and for the sanctioning of workers who transgress queuing rules at taxi ranks. They also requested that police or supervisors should prevent drunken passengers from getting into vehicles, and said drivers should refuse to go to dangerous, secluded neighbourhoods. Finally, participants called for an institution to judge alleged cases of employees not handing over demanded revenues to their employer.
In response to the Rio Political Declaration at the World Conference on Social Determinants of Health held from 19-21 October in Rio de Janeiro, Brazil the International Federation of Medical Students’ Associations (IFMSA) delegation raised issues that the Declaration failed to address. In their statement, they recognise the Rio Declaration as a major step in the quest for global health equity, but point to its failure to explicitly indicate how the unfair distribution of power, resources and wealth will be addressed, especially by United Nations (UN) Member States, arguing that leaders have missed an opportunity to make a strong statement on this. IFMSA believes that democracy is the key instrument in fixing the existing imbalances in power and in ultimately reducing health inequities, but the Declaration does not emphasise the value of democracy in all processes – from decision-making to evaluation – and at all levels – from community to global level. IFMSA also notes that the Declaration fails to specifically define the role of the private sector in reducing health inequities and does not clearly draw the lines governing engagement between government and the private sector, nor does it demand that global economic governance institutions, such as the International Monetary Fund, the World Trade Organisation and the World Bank, adhere to the same standards of transparency, accountability and democracy as those urged of UN Member States. In addition, the Declaration is silent about how tackling health inequities will be financed, making no mention of innovative financing schemes such as progressive taxation on capital gains or extremely-high earners, a financial transactions tax or the prevention of tax evasion. Although the Declaration recognises the importance of engaging with civil society, it does not advocate for the creation of spaces for dynamic dialogue that will enable civil society to be heard, reflecting the fact that civil society was excluded from the official process of developing the Declaration. Finally, IMFSA notes that the Declaration does not explicitly mention the inclusion of young people and youth organisations in the movement for action on social determinants of health.
Botswana should decriminalise homosexuality and prostitution to prevent the spread of HIV, says ex-President Festus Mogae. Mogae, who heads the Botswana government-backed Aids Council, said it was difficult to promote safe sex when the two practices were illegal. He also called for condoms to be distributed in prisons. His views are controversial as many conservative Batswana frown upon homosexuality and prostitution. Yet Botswana has one of the highest HIV rates in the world - 17% of the population is HIV positive. Mogae asserted that homosexuals were Botswana citizens and entitled to the same rights as heterosexual citizens. He said the government's failure to give prisoners' condoms was worsening the HIV and AIDS pandemic. However, a government spokesman on HIV and AIDS said that homosexuality and prostitution would remain illlegal until the government concluded wide-ranging consultations to see whether there was a need to change the law.
In this declaration by health civil society organisations from around the world, Peoples Health Movement insist that real power be trabsferred to communities to deal with the social determinants of health. A call is made for United Nations Member States and the World Health Organisation to take action around ten key areas affecting the social determinants of health. 1. Implement equity-based social protection systems and maintain and develop effective publicly provided and publicly financed health systems that address the social, economic, environmental and behavioural determinants of health with a particular focus on reducing health inequities. 2. Use progressive taxation, wealth taxes and the elimination of tax evasion to finance action on the social determinants of health. 3. Recognise explicitly the clout of finance capital, its dominance of the global economy, and the origins and consequences of its periodic collapses. 4. Implement appropriate international tax mechanisms to control global speculation and eliminate tax havens. 5. Use health impact assessments to document the ways in which unregulated and unaccountable transnational corporations and financial institutions constitute barriers to Health for All. 6. Recognise explicitly the ways in which the current structures of global trade regulation shape health inequalities and deny the right to health. 7. Reconceptualise aid for health from high-income countries as an international obligation and reparation legitimately owed to developing countries under basic human rights principles. 8. Enhance democratic and transparent decision-making and accountability at all levels of governance. 9. Develop and adopt a code of conduct in relation to the management of institutional conflicts of interest in global health decision making. 10. Establish, promote and resource participatory- and action-oriented monitoring systems that provide disaggregated data on a range of social stratifiers as they relate to health outcomes.
This article reports that Somali women and girls living in Ethiopian and Kenyan refugee camps are facing major health problems as camps lack security and basic services like latrines, accompanied by a fourfold increase in reports of sexual violence since May 2011. The real numbers are likely much higher, the Women’s Refugee Commission (WRC) notes, because many women and girls fail to report attacks for fear of their safety, because they don't want to be ostracised or because they don't trust that their rapists will ever be caught or prosecuted. Some of those living in the camps also face violence from their partners, and some are being forced into early marriage or survival sex, because they have no other way to support themselves. WRC argues that immediate action will more effectively protect women and girls than trying to fix problems after they have become entrenched. WRC recommendations include not only ensuring that women and girls have safe access to basic necessities, such as food, cooking fuel, potable water, sanitation and shelter, but that they are protected from sexual violence and that health care, particularly reproductive health care, is provided, using the updated Minimum Initial Service Package for reproductive health as a basis. WRC calls on the international community to rapidly scale up efforts initiated by humanitarian agencies in the region.
A new national HIV and AIDS strategic plan for Uganda is due to be finalised before the year's end, and gay rights activists are reported in this article to be urging its authors to break with tradition and, for the first time, provide for programming for men who have sex with men (MSM). A draft version of the new strategic plan distributed to civil society organisations mentioned the MSM community by name under an introductory section outlining groups that have prevalence rates above the national average, but the strategy concluded that MSM did not play ‘a big role’ in the transmission of HIV in Uganda and did not warrant a high rank among prevention activities. The draft strategy did recommend that more research be done within communities of MSM and injecting drug users to determine whether the groups were at risk of an upsurge in new infections. However, James Kigozi, spokesman for the Uganda AIDS Commission, said that because homosexual activity was illegal in Uganda, programming for MSM was unlikely to make it into the final version on the plan.
Alcohol, like mental health, is a neglected topic in public health discussions. However, the authors argue that there is sufficient evidence for it to be defined as a priority public health concern. Although only half the world’s population drinks alcohol, it is the world’s third leading cause of ill health and premature death, after low birth weight and unsafe sex, and the world’s greatest cause of ill health and premature death among individuals between 25 and 59 years of age. This paper outlines current global experiences with alcohol policies and suggests how to better communicate evidence-based policy responses to alcohol-related harm using narratives. The text summarizes six incentives for a healthier relationship with alcohol in contemporary society. These include price and availability changes, marketing regulations, changes in the format of drinking places and on the product itself, and actions designed to nudge people at the time of their purchasing decisions. Communicating alcohol narratives to policymakers more successfully will likely require emphasis on the reduction of heavy drinking occasions and the protection of others from someone else’s problematic drinking.