Poverty and health

Tipping The Balance: Policies to shape agricultural investments and markets in favour of small-scale farmers
Vorley B, Cotula L and Chan M: Oxfam, December 2012

Four country case studies undertaken for this report provide examples of innovations in policy design and implementation that have improved the investment climate for smallholders, such as decentralisation of land management responsibilities in Tanzania. Implementation of progressive policies in the face of major power imbalances between beneficiaries and vested interests seeking to maintain the status quo remains a major challenge. There are six inter-related sets of conclusions from the study. 1. Policy is currently biased against smallholders. 2. The investment climates that support smallholder investment and corporate investments in agriculture, while having elements in common, are not the same. 3. Policies must respond to the diversity of rural societies. 4. Policy innovations in inclusive investment do exist and should be copied. 5. Effective implementation is vital. 6. Politics matter: Vested interests undermine socially optimal outcomes, yet without a political analysis there is a risk of assuming that politicians choose policy in a socially optimal way and of constructing a normative analysis that focuses on technical solutions to the challenges of economic liberalisation.

To legislate or not to legislate? A comparison of the UK and South African approaches to the development and implementation of salt reduction programs
Charlton K, Webster J, Kowal P: Nutrients 6(9), 3672-3695, 2014

The World Health Organization promotes salt reduction as a best-buy strategy to reduce chronic diseases, and Member States have agreed to a 30% reduction target in mean population salt intake by 2025. Whilst the UK has made the most progress on salt reduction, South Africa was the first country to pass legislation for salt levels in a range of processed foods. This paper compares the process of developing salt reduction strategies in both countries and highlights lessons for other countries. Like the UK, the benefits of salt reduction were being debated in South Africa long before it became a policy priority. Whilst salt reduction was gaining a higher profile internationally, undoubtedly, local research to produce context-specific, domestic costs and outcome indicators for South Africa was crucial in influencing the decision to legislate. In the UK, strong government leadership and extensive advocacy activities initiated in the early 2000s have helped drive the voluntary uptake of salt targets by the food industry. It is too early to say which strategy will be most effective regarding reductions in population-level blood pressure. Robust monitoring and transparent mechanisms for holding the industry accountable will be key to continued progress in each of the countries.

Tobacco use among people living with HIV: analysis of data from Demographic and Health Surveys from 28 low-income and middle-income countries
Mdege N; Shah S; Ayo-Yusuf O; Hakim J; Siddiqi K: The Lancet Global Health 5(6), e578-e592, 2017

Tobacco use among people living with HIV results in excess morbidity and mortality. However, very little is known about the extent of tobacco use among people living with HIV in low-income and middle-income countries (LMICs). The authors assessed the prevalence of tobacco use among people living with HIV in LMICs. The authors used Demographic and Health Survey data collected between 2003 and 2014 from 28 LMICs where both tobacco use and HIV test data were made publicly available. They estimated the country-specific, regional, and overall prevalence of current tobacco use (smoked, smokeless, and any tobacco use) among 6729 HIV-positive men from 27 LMICs (aged 15–59 years) and 11 495 HIV-positive women from 28 LMICs (aged 15–49 years), and compared them with those in 193 763 HIV-negative men and 222 808 HIV-negative women, respectively. The authors estimated prevalence separately for males and females as a proportion, and the analysis accounted for sampling weights, clustering, and stratification in the sampling design. They computed pooled regional and overall prevalence estimates through meta-analysis with the application of a random-effects model. They computed country, regional, and overall relative prevalence ratios for tobacco smoking, smokeless tobacco use, and any tobacco use separately for males and females to study differences in prevalence rates between HIV-positive and HIV-negative individuals. The overall prevalence among HIV-positive men was 24·4% for tobacco smoking, 3·4% for smokeless tobacco use, and 27·1% for any tobacco use. The authors found a higher prevalence in HIV-positive men of any tobacco use (risk ratio [RR] 1·41 and tobacco smoking than in HIV-negative men (both p<0·0001). The difference in smokeless tobacco use prevalence between HIV-positive and HIV-negative men was not significant. The overall prevalence among HIV-positive women was 1·3% for tobacco smoking, 2·1% for smokeless tobacco use, and 3·6% for any tobacco use. The authors found a higher prevalence in HIV-positive women of any tobacco use, tobacco smoking and smokeless tobacco use than in HIV-negative women. The high prevalence of tobacco use in people living with HIV in LMICs mandates targeted policy, practice, and research action to promote tobacco cessation and to improve the health outcomes in this population.

Toward Food and Nutrition Security in Africa
International Food Policy Research Institute, January 2007

Several major initiatives in the past few years have brought renewed attention and commitment to economic development and food and nutrition security in Africa. The recent economic recovery and the new commitment to change among African leaders and development partners indicate for the first time after decades that Africa is poised to achieve real progress toward food and nutrition security. Sustaining and accelerating growth to reach the poverty reduction and nutrition Millennium Development Goals will require clear strategies to guide future policy and investment decisions. Furthermore, these goals seek to only halve the number of poor and malnourished in the next 10 years, something a number of African countries will fail to do. Progress toward food and nutrition security in Africa, therefore, calls for more than growth and requires a greater focus on human welfare improvement supported by adequate investments in health and nutrition safety nets to protect vulnerable segments of the population.

Towards food sovereignty: Reclaiming autonomous food systems
Pimbert M: 2008

Pimbert’s book covers a range of topics related to food sovereignty. He looks at local food systems, livelihoods and environments, and the ecological basis of food systems before explaining how the current multiple crises in food, agriculture and environment arose, in terms of the social and environmental costs of modern food systems. The book concludes with the author’s vision of a way forward: He presents food sovereignty as an alternative paradigm for food and agriculture and discusses how to promote national policies and legislation and global multilateralism and policies that promote food sovereignty.

Towards the Human City
Collaborative Media Advocacy Platform: Port Harcourt, Nigeria

The Human City Project is a community-driven media, architecture, urban planning and human rights movement in Port Harcourt, Nigeria. It is a collaboration between local and international community organisers, filmmakers, broadcasters, urban planners, architects, designers, university researchers and ordinary people from across Port Harcourt’s informal settlements. Those involved share skills and technologies for communities to record their experiences, tell their stories and change their lives. They are moved by the conviction that democratic design principles can make cities more creative and just. Based on community mapping of needs and priorities, a community radio station was started – Chicoco Radio – formally owned by Chicoco Community Media Initiative, an incorporated board of trustees drawn from communities across the city. With a campaign of 'the people live here' communities in the informal settlements in Port Harcourt have resisted eviction, and are carrying out activities to map and make visible their conditions and needs, develop their voice and capacity to participate meaningfully in the shaping of their city, including to change the way the city is imagined and inhabited on principles of social justice and equity. With the means to tell their stories on film, on air and in court, charting their reality on maps and describing their visions in urban action plans, these communities are changing their lives and shaping their city.

Transport, (im)mobility and spatial poverty traps: issues for rural women and girl children in sub-Saharan Africa
Porter G: Overseas Development Institute, London, 2007

This paper produced for a conference at the Overseas Development Institute (ODI) reflects on the experiences of women and girls with poor accessibility to services and markets, and inadequate transport in rural sub-Saharan Africa. It uses examples from field research to look at the impact of these factors on girl’s education before going to examine access to health services.

Treating diseases of poverty: Creating markets for advance drug purchasing
id21 Health, May 2006: Towse A, Kettler H

While new drugs and vaccines are needed to treat diseases of poverty, not enough is being invested in developing these products because of the lack of a demand or market for them. Advance price or purchase commitments potentially offer a solution, yet a number of structure and design issues first need to be resolved.

Trends in prevalence and correlates of intimate partner violence against women in Zimbabwe, 2005–2015
Mukamana J; Machakanja P; Adjei N: BMC International Health and Human Rights 20 (2),1-11, 2020

Intimate partner violence (IPV) is a widespread problem affecting all cultures and socioeconomic groups. This study explored the trends in prevalence and risk factors associated with IPV among Zimbabwean women of reproductive age (15–49 years) from 2005 to 2015, analysing data from the 2005/2006, 2010/2011 and 2015 Zimbabwe Demographic and Health Surveys. The prevalence of Intimate partner violence was found to have decreased from 45% in 2005 to 41% in 2010, and then increased to 43% in 2015. Some of the risk factors associated with Intimate partner violence were younger age, low economic status, cohabitation and rural residence. Educational attainment of women was not significantly associated with Intimate partner violence. The findings indicate that women of reproductive age are at high and increasing risk of physical and emotional violence. The authors argue that there is a need for an integrated policy approach to address the rise of IPV related physical and emotional violence against women in Zimbabwe.

Tuberculosis crisis looming in Swaziland
Phakathi M: IPS News, 23 April 2009

The Swazi government's slow response to a fast-growing tuberculosis epidemic has eroded the possibility of controlling it, says the National TB Control Programme manager. There has been a nearly ten-fold increase in the last 20 years from about 1,000 TB cases per year in 1987 to over 9,600 cases in 2007, exacerbated by the world's highest HIV prevalence rate – 80% of the TB cases are also co-infected with HIV. The country is falling short of meeting the World Health Organisation's TB treatment rate of 85% with a treatment success rate of 42%. The report points to higher rates of default on treatment when patients feel the TB treatment takes long, when they are also taking antiretroviral drugs and when they take drugs on an empty stomach.

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