If the South African government wants to alleviate poverty, it should increase the number of people accessing social grants, according to recent submissions by a coalition of non-governmental organisations before the South African Human Rights Commission. The coalition, dubbed the National Working Group on Social Security, pointed out that President Jacob Zuma acknowledged that social grants remain the main effective form of poverty alleviation. However, they noted that no extension of the child support grant to children aged 15 to 18 has been announced, despite the importance of secondary school enrolment. Some people with HIV were alleged to be defaulting on their antiretroviral treatment to retain disability grants, because if they regain their health and their CD4 counts improve, social security stops issuing their HIV and AIDS grant. The Steve Biko Centre for Bioethics has called for a basic income grant and other poverty alleviation programmes that will include sex workers.
Poverty and health
The consequences of malnutrition for the efficacy of anti-retroviral therapy (ART) are poorly understood, and evidence regarding the impact of food supplementation on ART outcomes is still limited. The World Health Organization and World Food Programme have issued guidance on food support in ART programmes: every newly enrolled patient should have a nutritional assessment that includes measurement of weight and body mass index, along with nutritional counselling and monitoring. Promotion of activity that increases ability to maintain and expand food supplies, either through growing crops or trading (`livelihoods`) may be a more appropriate response to malnutrition in people with less-advanced HIV disease, with cash transfers also being used as a means of addressing food insecurity. Households affected by HIV often experience multiple threats to their livelihoods. All nutritional support programmes need realistic strategies to avoid dependency and promote long-term food security.
The return of cholera to Zimbabwe is not a matter of if, but when, said Rian van de Braak, head of mission of the medical non-governmental organisation, Médecins Sans Frontières. ‘The threat is definitely not over. Everyone expects cholera to be back, at the latest with the next rainy season [in September or October], because the root causes of the outbreak [in 2008] have not been addressed adequately yet,’ he said. The first case of the cholera epidemic that swept through Zimbabwe, killing more than 4,000 people and infecting close to 100,000 others, was reported in August 2008 and lasted almost a year until it was officially declared at en end in July 2009. Broken sanitation and water systems, the cause of Africa's worst outbreak of the waterborne disease in 15 years, are unlikely to be repaired in time. ‘Several aid agencies are drilling new boreholes in cholera hotspots, which is an important contribution to safe drinking water. Dealing with those causes before the next rainy season is a race against the clock,’ said van de Braak.
Increasing the accessibility of health services to poor people requires overcoming the well-known obstacles of travel time, convenient hours and trust. These obstacles differ in importance for urban and rural poor people. For example, spatial obstacles to care are less important for urban poor people, but convenient hours matter more. In rural areas, solutions to increased travel time bring tradeoffs between more clinics in more locations and better clinics in fewer places. There are no universal solutions, but there are universal ways of finding them. Tracking the socioeconomic status of clients served is needed to make poor people were more visible in health system data, contributing to an understanding of how poverty interacts with epidemiology in the course of disease, and also how treatment is sought and complied with. This raises the importance of making solid measurements in future research to show where poor people are and what their barriers to health care access are.
Poor rains have heightened food insecurity in Kenya's northwestern region of Turkana, where malnutrition rates in children under five have risen above the emergency threshold, according to humanitarian officials. About 74% of the population (550,000) already depends on food aid, according to the International Rescue Committee (IRC). It said at least half of child deaths in the region were due to malnutrition or had malnutrition as an underlying cause of death. ‘In [the north-central] Samburu district, the percentage of children under-five considered at risk of malnutrition increased to 29.4% from 21.8% in June. In Moyale [in the northeast], the nutrition status of children below five years declined, with the percentage of children rated at risk of malnutrition rising to 35% in June from 30.6% in April.’ The decline was attributed to higher food prices and reduced availability of food, with pneumonia, malaria and diarrhoea as the three main diseases responsible for deaths among under-fives in Turkana.
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.
The number of poor and food-insecure people in developing countries is increasing more quickly in urban areas than in rural areas, and could be dropping off the policy radar, according to new research by the US Department of Agriculture (USDA). By 2030 the majority of people in all developing countries will live in urban areas, and UNFPA estimates that about 60 percent of the urban slum population will be under the age of 18. Sub-Saharan African countries have the world's highest rates of urban growth and highest levels of urban poverty – the slum population in these countries doubled from 1990 to 2005, when it reached 200 million. Health hazards emanating from food in urban areas are a critical concern: buying pre-cooked food from street vendors, close contact between humans and poultry and other domestic animals for slaughter, and generally unhygienic conditions in urban markets can have significant health consequences.
This first edition of the biennial Global Assessment Report on Disaster Risk Reduction (DRR) aims to review and analyse the natural hazards threatening humanity and seeks to provide new evidence on how, where and why disaster risk is increasing globally. It found that economic development increases a country’s exposure at the same time as it decreases its vulnerability, but this trend was more pronounced in low- and middle-income countries with rapidly growing economies. More than two thirds of the mortality and economic losses from internationally reported disasters were related to climate change and natural disasters. The translation of poverty into risk is conditioned by the capacity of urban and local governments to plan and regulate urban development, enable access to safe land and provide protection for poor households. Community- and local-level approaches can increase the relevance, effectiveness and sustainability of DRR across all practice areas, reduce costs and build social capital.
The International Baby Food Action Network, through its campaign called ‘One Million Campaign: Support Women to Breastfeed’, submitted a petition to the President of World Health Assembly, Mr. NS de Silva, which was signed by more than 45,000 people from 161 countries. The petition demanded concrete support systems for breastfeeding women and urged the Assembly to adopt a resolution in 2010 to deal with four key issues: to prepare a specific plan of action on infant feeding, which is budgeted and coordinated in the same way as action plans for immunisation; to ensure the end of promotion of baby milks and foods intended for children under two years old in a time-bound manner, that is, by 2015; to end partnerships in the area of infant and young child feeding and nutrition with commercial sector corporations that present conflicts of interests; and to create support and maternity entitlements for women both in the formal and informal sectors, so that mothers and babies can stay close to each other for six months at least.
On the occasion of the Day of the African Child, 16 June 2009, the Africa Public Health Alliance and 15%+ Campaign called on African governments to end the ‘5 by 5 Tragedy’ by stopping the estimated five million African children under the age of five from dying annually of preventable, manageable or treatable health causes. The campaign blames the existing situation on a failure of government policy on child health and protection in particular, and health development and financing in general. [To] meet the Millennium Development Goal 4 on reversing and ending child mortality, African governments are called on to meet their pledge to allocate 15% of national budgets to health, and significantly increase per capita investment in health. Strategic investment in vaccinations, health systems, human resources for health and social determinants of health, such as clean water, sanitation, food security and nutrition, must also be implemented.