On 2-3 March 2011, Partners in Health, Harvard University and other organisations met to discuss the non-communicable diseases (NCDs) of the world’s poorest billion people. The Conference was held in Boston, United States, and attended by a wide range of government, civil society and academic organisations who have advocated for the inclusion of NCDs as a priority on the global health agenda. This Statement allies itself with a number of World Health Organisation (WHO) and United Nations (UN) agreements and resolutions, such as the WHO’s Framework Convention on Tobacco Control and its Global Strategy on NCDs and the UN Resolution ‘Keeping the Promise: United to Achieve the Millennium Development Goals’. The Statement calls on all UN member state Heads of Government and Heads of State to take urgent action to address NCDs amongst the world’s billion poorest people by: leading at global and national levels for NCDs; strengthening health systems and NCD prevention, treatment and care; strengthening research and data systems; and addressing poverty, vulnerability and discrimination.
Poverty and health
South Africa's high child mortality rates have forced the government to rethink its policy on infant feeding and move to discontinue the free provision of formula milk at hospitals and clinics, as well as promote an exclusive breastfeeding strategy for all mothers, including those living with HIV. Minister of Health Aaron Motsoaledi made the announcement on 23 August 2011 after a two-day national consultation on breastfeeding, where participants unanimously recommended the changes. Until now, the country's health system has not supported the practice of breastfeeding and mothers are often discharged as soon as six hours after birth, with no or little counselling on infant feeding, the Minister of Health acknowledged. Formula milk manufacturers and distributors have also promoted their products aggressively, because of the absence of legislation to regulate the marketing of formula milk, according to UNICEF. In December 2009, the UN World Health Organisation (WHO) issued guidelines recommending that infants born to HIV-positive women be exclusively breastfed for the first six months, but South Africa's programme to prevent mother to child HIV transmission has continued to provide free formula to HIV-positive mothers. Representatives of WHO in South Africa are calling on government to implement the guidelines.
The food crisis in the Horn of Africa is affecting people in informal urban settlements, but they remain largely overlooked by the aid community, according to IRIN. IN Kenya, emergency relief efforts are focused on the arid north, yet over the past five months, Concern Worldwide has recorded a 62% increase in cases of severe acute malnutrition (SAM) at clinics it supports in Nairobi slum areas, while estimating that the need is much greater. The UN Children's Fund (UNICEF) concurred that the food crisis is probably affecting people in urban areas more than in the north. Part of the reason malnutrition in urban slums is paid relatively scant attention is that it rarely reaches the emergency level of 15% global acute malnutrition (GAM) rate, at which point government is obliged to take action. In Turkana in the north, 15% GAM would translate to 13,000 children. But in Nairobi district, 13,000 malnourished children would reflect just a 3.45% GAM rate. Currently, the estimated GAM rate is 2.3% in Nairobi's slums.
Arguments about the most effective and equitable approach to distributing insecticide-treated nets (ITNs) centre around whether to provide ITNs free of charge or continue with existing social marketing strategies. In this study, researchers in Tanzania examined the equity implications of ownership and use of ITNs in households from different socioeconomic quintiles in a district with free ITNs (Mpanda) and a district without free ITN distribution (Kisarawe). They found that ownership of ITNs increased from 29% in the 2007/08 national survey to 90% after the roll out of free ITNs in Mpanda, and use increased from 13% to 77%. Inequality was considerably lower in Mpanda. In Kisarawe, ownership of ITNs increased from 48% in the 2007/08 national survey to 53%, with marked inequality. The results suggest that inequality in ownership and use of ITNs may be addressed through the provision of free ITNs to all.
Exclusive breastfeeding (EBF) is reported to be a life-saving intervention in low-income settings. In this study, researchers evaluated the effectiveness of breastfeeding counselling by peer counsellors in Africa. Twenty-four communities in Burkina Faso, 24 in Uganda and 34 in South Africa were included in the study. Of the 2,579 mother-infant pairs assigned to the intervention or control clusters in the three countries, EBF prevalences were recorded along with prevalence of diarrhea. The researchers found that, although it does not affect diarrhoea prevalence, low-intensity individual breastfeeding peer counselling is an achievable target and they urge governments in low-income countries in sub-Saharan Africa to scale up EBF counseling to increase the prevalence of EBF.
The famine spreading across the Horn of Africa is not principally the result of drought, but due to political and social circumstances that urgently need to be addressed, the author of this article argues. Global media reports attribute the main cause for the famine to successive seasons of failed rains, yet the author notes here that there has been only one failed rainy season in the Horn so far. The primary cause of the famine is war, the author argues, which has disrupted farmers in Somalia from their normal routines. In the past, a single rainy season failure was easily augmented by relying on stored food from surplus harvests, or from importing food from further south, but violence and fighting has kept farmers from their fields, even if the rains are good, as they were this year. And while there is surplus food, it isn’t getting to the famine area due to lack of infrastructure and local disruption of services. Tanzania, which has had a bumper harvest so far this year, has also banned agricultural sales to the north, for fear it will deplete its own surpluses.
In this paper, the authors investigated the relationship between maternal depression and child growth in developing countries through a systematic literature review and meta-analysis. Seventeen studies were included, with a total of 13,923 mother-and-child pairs from 11 countries. The authors found that children of mothers with depression or depressive symptoms were more likely to be underweight or stunted. The selected studies indicated that if the infant population were entirely unexposed to maternal depressive symptoms, 23% to 29% fewer children would be underweight or stunted. The authors call for rigorous prospective studies to identify mechanisms and causes. Early identification, treatment and prevention of maternal depression may help reduce child stunting and underweight in developing countries.
East Africa is experiencing a severe food crisis, with at least 10 million people affected in Djibouti, Ethiopia, Kenya, Somalia and Uganda, says the UN Office for the Coordination of Humanitarian Affairs (OCHA). And according to the Mubarak Relief and Development Organisation (MURDO), a local NGO working in the Lower Shebelle region of Somalia, the international community is not helping. The recent March to May "long rains" in Kenya were poor for the second or third successive season in most rangelands and cropping lowlands, with many of these areas receiving 10-50% of normal rains. The consequences include declining water and pasture, and high levels of livestock death. In the predominantly pastoralist north, a low milk supply has contributed to malnutrition levels soaring above 35%. Nationally, at least 3.2 million people are currently food insecure, and even in Kenya's coastal region, thousands are food insecure, says the Kenya Red Cross Society.
According to this report by Oxfam, the global food system works only for the few but not for most of the world’s population. It leaves billions of consumers lacking sufficient power and knowledge about what they buy and eat and the majority of small food producers disempowered and unable to fulfill their productive potential. The failure of the system flows from failures of government – failures to regulate, correct, protect, resist and invest – which mean that companies, interest groups, and elites are able to plunder resources and to redirect flows of finance, knowledge, and food. Oxfam highlights the need to address the inequities which plague the food system. They argue that global agriculture produces more food than the world’s population needs, much of which is thrown away. Hunger and poverty are concentrated in rural areas, with smallholder food producers routinely deprived of the resources they need to thrive, like water, technology, investment and credit. Large areas of land in Africa and elsewhere are being sold off to foreign investors at rock bottom prices, in deals that offer little to local communities. The report presents new research forecasting price rises for staple grains in the range of 120–180% within the next two decades, as resource pressures mount and climate change takes hold.
Oxfam has launched a global campaign, GROW, to combat global hunger. Jeremy Hobbs, Executive Director of Oxfam, said that global agriculture is capable of feeding all of humanity yet one in seven go hungry. The GROW campaign will expose the governments whose failed policies are propping up the broken food system and the clique of 300–500 powerful companies who benefit from and lobby hard to maintain it. For example, four global companies control the movement of most of the world’s food. Three companies – Archer Daniels Midland, Bunge and Cargill – control an estimated 90% of the world’s grain trade. Their activities help drive up volatile food prices and they profit from them. In the first quarter of 2008, at the height of a global food price crisis, Cargill’s profits were up 86% and the company is now heading for its most profitable year yet on the back of further disruptions to global food supplies. Oxfam is calling on governments - especially the G20 - to lead the transformation to a fairer more sustainable food system by investing in agriculture, valuing the world’s natural resources, managing the food system better and delivering equality for women who produce much of the world's food. It is calling on the private sector to shift to a business model where profit does not come at the expense of poor producers, consumers and the environment.