Migrant health is a critical public health issue, and in many countries attention to this topic has focused on the link between migration and communicable diseases, including tuberculosis (TB). This paper traces a commonly used migration route from sub-Saharan Africa to Europe, identifying situations at each stage in which human rights and ethical values might be affected in relation to TB care. The authors highlight three strands of discussion in the ethics and justice literature in an effort to develop more comprehensive ethics of migrant health. These strands include theories of global justice and global health ethics, the creation of ‘firewalls' to separate enforcement of immigration law from protection of human rights, and the importance of non-stigmatization to health justice.
Poverty and health
The United Nations Food and Agriculture Organization (FAO) has launched a major online drive to spur action to eliminate hunger and highlight the fact that one in six people worldwide go hungry everyday. Through its '1 billionhungry project' people can voice their opinions about world hunger by adding their names to an online petition. The campaign uses a yellow whistle as an icon encouraging people to blow the whistle against this global scourge. Events in support of the petition launch are organised through FAO offices around the world. International athletes, football players and recording artists will add their voices to the campaign. Civil society organisations, including the World Association of Girl Guides and Girl Scouts, will also promote the campaign through their own networks.
The author of this paper identifies two main concerns with regard to biofuel policies: one involves the likely consequences of biofuels for greenhouse gas emissions because of the ploughing up of forests and grasslands and their release of carbon, while the other involves the consequences for hunger and poverty. What is not broadly understood is that the two consequences closely and inversely relate: the less farmers plough up forest and grassland, the greater the impacts on hunger; but the lower the impacts on hunger, the more farmers emit greenhouse gases from land use change. Much of the uncertainty about the consequences of biofuels relate to how much of which undesirable response the world will get. When biofuels divert crops from food there are three basic alternative responses: (1) the crops are not replaced; (2) crops are replaced by land use change; and (3) crops are replaced by boosting production on existing agricultural land. The author argues that the evidence indicates that biofuels are fuelling hunger, land grabs and climate change.
The objective of this paper was to investigate the relationships between the prevalence of HIV infection and underlying structural factors of poverty and wealth in several African countries. A retrospective ecological comparison and trend analysis was conducted by reviewing data from demographic and health surveys, AIDS indicator surveys and national sero-behavioural surveys in twelve sub-Saharan African countries with different estimated national incomes. The relationship between the prevalence of HIV infection and household wealth quintile did not show consistent trends in all countries. In particular, rates of HIV infection in higher-income countries did not increase with wealth. The Tanzanian data illustrated that the relationship between wealth and HIV infection can change over time in a given setting, with declining prevalence in wealthy groups occurring simultaneously with increasing prevalence in poorer women. In conclusion, both wealth and poverty can lead to potentially risky or protective behaviours. To develop better-targeted HIV prevention interventions, the paper urges the HIV community to recognise the multiple ways in which underlying structural factors can manifest themselves as risk in different settings and at different times. Context-specific risks should be the targets of HIV prevention initiatives tailored to local factors.
The agricultural sector has been seriously affected by the HIV/AIDS crisis. In parts of eastern and southern Africa, HIV prevalence rates exceed 15 percent. The disease has contributed to a loss of assets, loss of land, and, in some cases, labour shortages. As a result, crop production has declined for many farm households and rural inequality appears to have increased. Agricultural policies need to take account of these changes. Agricultural growth built on policies sensitive to the impacts of HIV/AIDS is essential if poverty caused by the disease is to be reduced.
This paper examines the South African government’s mandate to halve unemployment and poverty by 2014, noting the growing evidence of the unlikelihood of this happening. The paper found that disagreements among academics on the severity of poverty can be traced to the failure by Statistics South Africa to conduct adequate surveys on poverty, while unemployment rates have undermined the progress of poverty-elevation made since 2006. It estimates that, in 2014, there will still be between three and five million unemployed lacking any kind of income protection. The impact of AIDS on mortality also means that the number of poor has been significantly reducing, also impacting on unemployment rates. The paper attempts to explain the reasons behind the offhand rejection of the 'Basic Income Grant' (BIG) by government, concluding that the political bargains were behind scrapping the proposal of BIG.
Urban farming in the Democratic Republic of Congo (DRC) is providing a livelihood for thousands of city dwellers, with vegetables bringing in good money for small growers and helping to alleviate high levels of malnutrition, according to this article. The Food and Agricultural Organisation (FAO) has noted that the demand for vegetables and the high prices they command in DRC cities has pushed many jobless residents into becoming small-scale growers. Most of the green spaces along the roadsides of the capital, Kinshasa, have been transformed into small farms. City farmers now grow 122% more produce than they did five years ago, according to the FAO, which is supporting gardeners in five main DRC cities with a US$10.4 million urban horticulture project. Although the project has contributed to improving nutrition in urban areas, the project manager cautions that there is still a lot of work to be done and malnutrition levels remain high: 24% of children in the DRC under five are underweight, 43% are stunted, and 9% are wasted.
The new international food security agenda focuses almost exclusively on raising food production by small rural farmers (something that has preoccupied rural development ‘experts’ for decades without success). The authors of this paper argue that there is a very real danger that this approach will be transferred uncritically to urban areas in the form of technical inputs for poor urban households to grow more food for themselves and for market. There is already an emerging focus on the “technical” aspects of urban farming and how these can be supported and enhanced through strategic interventions such as the promotion and adoption of innovative and appropriate urban farming technologies. However, as elsewhere, such technocratic ‘solutions’ are likely to fail if they do not first examine why so few poor households in southern Africa currently grow any of their own food. Agriculture is rarely recognised as a legitimate land use activity in urban plans or municipal designs. For urban farmers, this means that land is scarce and they often ruffle the feathers of officials and police by establishing their farming activities wherever they can, and urban farmers are often harassed by municipal authorities. The authors conclude that comprehensive, systematic research into the links between urban agriculture, food security and health/nutrition could go a long way to easing such institutional and political obstacles so that city farming can meet its full potential in Southern Africa.
This bulletin provides a sketch of urban health in developing countries, documenting the intra-urban differences in health for a number of countries and showing how the risks facing the urban poor compare with those facing rural villagers. It notes that, to better understand urban health in developing countries, the situations of the urban poor and near-poor must be distinguished from those of other city residents. Even among the urban poor, some live in communities of concentrated disadvantage (slums) where they are subjected to a daily barrage of health threats. The author recommends geographic targeting as an effective health strategy for reaching slum dwellers, though other approaches should be devised to meet the needs of the poor who live outside slums. Public health agencies need to work in tandem with other government agencies, and public health programmes should draw on the social capital that is embodied in the associations of the urban poor.
Even if, in terms of income, there are still today a higher number of poor people in the countryside than in Kenya’s cities, poor urban-dwellers face an alarming (and growing) range of vulnerabilities. Oxfam GB Kenya’s report highlights the mutually reinforcing dimensions of vulnerability in Nairobi’s slums. It launched a new Urban Programme Strategy in 2009 that aims to build on the organisation’s strategic comparative advantages, bringing its experience elsewhere into the urban sector in Kenya. These advantages include: coordinating partnerships with key stakeholders, bringing Oxfam GB’s experience in peace and conflict transformation in other parts of rural Kenya into the urban arena; capitalising on its international status in terms of resource mobilisation; and utilising its expertise on water, sanitation and food security to support local organisations in delivering basic urban services. The strategy will be implemented on a phased basis over a fifteen-year period, and will focus on three strategic priority areas: urban governance, sustainable livelihoods, and disaster preparedness and risk reduction.