Lack of access to health care is a persistent condition for most African indigents, to which the common technical approach of targeting initiatives is an insufficient antidote. To overcome the standstill, an integrated technical and political approach is needed. Such policy shift is dependent on political support, and on alignment of international and national actors. The authors explore if the analytical framework of social exclusion can contribute to the latter. The authors produce a critical and evaluative account of the literature on three themes: social exclusion, development policy, and indigence in Africa–and their interface. First, the authors trace the concept of social exclusion as it evolved over time and space in policy circles. They then discuss the relevance of a social exclusion perspective in developing countries. Finally, this perspective is applied to Africa, its indigents, and their lack of access to health care. The concept of social exclusion as an underlying process of structural inequalities has needed two decades to find acceptance in international policy circles. Initial scepticism about the relevance of the concept in developing countries is now giving way to recognition of its universality. For a variety of reasons however, the uptake of a social exclusion perspective in Africa has been limited. Nevertheless, social exclusion as a driver of poverty and inequity in Africa is evident, and manifestly so in the case of the African indigents. The concept of social exclusion provides a useful framework for improved understanding of origins and persistence of the access problem that African indigents face, and for generating political space for an integrated approach.
Poverty and health
In October, the Global AgeWatch Index issued a report on the quality of life of older people in 91 nations. The report included several factors such as income security, health and well-being, employment and education. African nations did not fare well. South Africa was the highest ranked African nation at number 65 while Ghana, Morocco, Nigeria, Malawi, Rwanda and Tanzania came in at numbers 69, 81, 85, 86, 87 and 90 respectively. Other African nations were not included in the report because there was not sufficient data. With South Africa leading the pack in elderly well-being, it helps to decipher the various ways it deals with its senior citizens.
The intake of added sugar appears to be increasing steadily across the South African population. Children typically consume approximately 40-60 g/day, possibly rising to as much as 100 g/day in adolescents. This represents roughly 5-10% of dietary energy, but could be as much as 20% in many individuals. This paper briefly reviews current knowledge on the relationship between sugar intake and health. There is strong evidence that sugar makes a major contribution to the development of dental caries. The intake of sugar displaces foods that are rich in micronutrients. Therefore, diets that are rich in sugar may be poorer in micronutrients. Over the past decade, a considerable body of solid evidence has appeared, particularly from large prospective studies, that strongly indicates that dietary sugar increases the risk of the development of obesity and type 2 diabetes, and probably cardiovascular disease too. These findings point to an especially strong causal relationship for the consumption of sugar-sweetened beverages (SSBs). The authors propose that an intake of added sugar of 10% of dietary energy is an acceptable upper limit. However, an intake of < 6% energy is preferable, especially in those at risk of the harmful effects of sugar, e.g. people who are overweight, have prediabetes, or who do not habitually consume fluoride (from drinking fluoridated water or using fluoridated toothpaste). This translates to a maximum intake of one serving (approximately 355 ml) of SSBs per day, if no other foods with added sugar are eaten. Beverages with added sugar should not be given to infants or to young children, especially in a feeding bottle. The current food-based dietary guideline is: “Use foods and drinks containing sugar sparingly, and not between meals”. This should remain unchanged. An excessive intake of sugar should be seen as a public health challenge that requires many approaches to be managed, including new policies and appropriate dietary advice.
As care and antiretroviral treatment (ART) for people living with HIV become widely available, the number of people accessing these resources also increases. Despite this exceptional progress, the estimated coverage in low- and middle-income countries is still less than half of all people who need treatment. In addition, treatment discontinuation and non-adherence are still concerns for ART programs. This study assessed the costs of a program providing food assistance to patients with HIV in Sofala province, Mozambique, in 2009. The authors performed a retrospective analysis of the costs of providing food assistance, based on financial and economic costs. The food distribution program was found to carry significant costs at $288 per patient over 3 months. To assess whether it provides value for money, the study results should be interpreted in conjunction with the program’s impact, and in comparison with other programs that aim to improve adherence to ART. The authors' costing analysis also revealed important management information, indicating that the program incurred relatively large overhead costs.
This paper considers the question of dietary diversity as a proxy for nutrition insecurity in communities living in the inner city and the urban informal periphery in Johannesburg. It argues that the issue of nutrition insecurity demands urgent and immediate attention by policy makers. A cross-sectional survey was undertaken for households from urban informal and urban formal areas in Johannesburg, South Africa. Foods consumed by the respondents the previous day were used to calculate a Dietary Diversity Score. Respondents from informal settlements consumed mostly cereals and meat/poultry/fish, while respondents in formal settlements consumed a more varied diet. Significantly more respondents living in informal settlements consumed a diet of low diversity versus those in formal settlements. When grouped in quintiles, two-thirds of respondents from informal settlements fell in the lowest two, versus 15% living in formal settlements. Respondents in the informal settlements were more nutritionally vulnerable.
Globally, many human rights NGOs seek to expose the dire situations where children work at a young age, often under exploitative conditions and without adequate compensation. According to the International Labour Organization, child labour occurs most frequently in Sub-Saharan Africa — 28 percent of all 5-14 year-olds are engaged in paid and unpaid work across the continent, compared to 14 percent in Asia and 9 percent for Latin America. The author argues that what’s often missing from these official statistics, however, are routine household work activities that are less visible than those in the industrial sector. These less conspicuous types of labour are varied and, despite the potential for violations to go unseen, can sometimes be part of a healthy childhood. The distinction between ‘child work’ (less harmful work that may have beneficial impacts on a child’s development) and ‘child labour’ (blatantly hazardous forms of work that disrupt the healthy development of a child), can therefore be a helpful one to make.
The United Nations Special Rapporteur on the human right to safe drinking water and sanitation, Catarina de Albuquerque, has warned that the sanitation target set by the UN Millennium Development Goals (MDG) is today the most off-track of all, leaving around one billion people still practicing open defecation on a daily basis, and one-third of the world’s population ‘without access to improved sanitation.’ The human rights expert hailed the UN General Assembly’s decision declaring 19th of November as UN World Toilet Day. “I hope this declaration galvanises national and international action to reach the billions of people who still do not benefit from this basic human right,” the Special Rapporteur said.
By 2023 the number of food-insecure people is likely to increase by nearly 23 percent to 868 million (at a slightly faster rate than projected population growth of 16 percent). Despite improvements over the years, sub-Saharan Africa is projected to remain the most food-insecure region in the world. In the past decade global food aid, including the amount making its way to sub-Saharan Africa, has been on a downward trend. Only 2.5 million tons reached sub-Saharan Africa in 2011, whereas during the decade as a whole it ranged from just under three million tons to just over 5 million tons, according to World Food Programme (WFP) data. In this article IRIN presents views of some of the world’s leading experts on the future of food aid.
The International Convention for the Protection of New Varieties of Plants, known as UPOV 91 is argued by the author to be dangerous to African farmers. It will force farmers to buy patented corporate seeds and agrochemicals from the same corporations. The ETC Group, the Action Group on Erosion, Technology, and Concentration has released the report: ‘Putting the Cartel Before the Horse …and Farm, Seeds, Soil, Peasants, etc. Who Will Control Agricultural Inputs, 2013?’ The report details how the agribusiness giants have gobbled up most of the seed and agrochemical companies and control most of the agriculture in the US and Europe and are now aiming to take over the agriculture of the global south, particularly Africa. Peasant farmers, who feed at least 70 percent of the world’s population – are not tied to the corporate seed chain. The agribusiness giants want to tie them in. They are focusing on ‘education’ which seeks primarily to stop farmers from saving seeds.
This compendium of Population Stabilisation Reports was an outcome of the research work done by different authors from the nine countries namely Bangladesh, India (Bihar), Ghana, Kenya, Mali, Nigeria, Senegal, Uganda and Zimbabwe. The reports focus on the demographic realities that take into consideration the age structure, sex ratios, migrations, population projections as well as adolescent pregnancy, fertility and mortality. The historical, religious, cultural, political, resource and environmental considerations are reviewed in the reports. The underlying principals of poverty eradication, sustainable growth, universal education, with a focus on girls, gender equality and empowerment, food security, access to primary health services and a rights-based approach to sexual and reproductive health, are fundamental to the principals and practices that are prescribed within the framework of the reports. The edited book provides an integrated approach to changing
population stabilisation strategies, including attention to sustainable development and gender equity, with case studies from African countries.