Human-induced climate change will have the greatest, and generally earliest, impact on the poorest and most disadvantaged populations, according to this paper. Climate change adaptation is receiving much attention given the inevitability of climate change and its effects, particularly in developing contexts, where the effects of climate change will be experienced most strongly and the response mechanisms are weakest. Financial support towards adaptation activities from various actors including the World Bank, the European Union and the United Nations is increasing substantially. With this new global impetus and funding for adaptation action come challenges such as the importance of developing adaptation activities on a sound understanding of baseline community needs and vulnerabilities, and how these may alter with changes in climate. The global health community is paying heed to the strengthening focus on adaptation, albeit in a slow and unstructured manner. The aim of this paper is to provide an overview of adaptation and its relevance to global health, and highlight the opportunities to improve health and reduce health inequities via the new and additional funding that is available for climate-change adaptation activities.
Equity in Health
Considerable declines in malaria have accompanied increased funding for control since the year 2000, but historical failures to maintain gains against the disease underscore the fragility of these successes. In this study, researchers conducted a systematic review of the literature to identify historical malaria resurgence events. They identified 75 resurgence events in 61 countries, occurring from the 1930s through the 2000s. Almost all resurgence events (91%) were attributed at least in part to the weakening of malaria control programmes for a variety of reasons, of which resource constraints were the most common (57%). Over half of the events (59%) were attributed in part to increases in the intrinsic potential for malaria transmission, while only 32% were attributed to vector or drug resistance. Given that most malaria resurgences have been linked to weakening of control programmes, this study highlights the need to develop practical solutions to the financial and operational threats to effectively sustaining today's successful malaria control programmes.
According to the World Health Organisation (WHO), measuring health can tell us how well development is advancing the three pillars of sustainability, namely social, environmental and economic sustainability. It therefore stands to reason that indicators of healthy development can help identify success stories, barriers and the extent to which benefits of greener economies are equitably distributed. Examples of health-relevant indicators for six Rio+20 themes are presented here: sustainable cities, food, jobs, water, energy and disaster management. WHO has identified three key ways in which health can both contribute to, and benefit from, greener and cleaner development. First, achieving universal health coverage will result in healthier people who can contribute economically and socially. Reducing gender, employment and housing inequities will also improve health. Second, strategies need to be designed specifically to enhance health gains from sustainable development investments and decisions – health gains from development are not automatic. Third, governments and other role players should adopt health indicators to measure progress/achievements in sustainable development.
Malawi is one of two low-income sub-Saharan African countries on track to meet the Millennium Development Goal (MDG 4) for child survival despite high fertility and HIV rates and low health worker density. In this study, researchers examined changes in newborn survival in the decade 2000-2010, and assessed national and external funding, as well as policy and programme changes. Compared with the 1990s, they found that progress towards MDGs 4 and 5 accelerated considerably from 2000 to 2010. They argue that a significant increase in facility births and other health system changes, including increased human resources, likely contributed to the 3.5% annual decline in neonatal mortality rate. The initial entry point for newborn care in Malawi was mainly through facility initiatives, such as Kangaroo Mother Care. This transitioned to an integrated and comprehensive approach at community and facility level through the Community-Based Maternal and Newborn Care package, now being implemented in 17 of 28 districts. Addressing quality gaps, especially for care at birth in facilities, and including newborn interventions in child health programmes, will be critical to the future agenda of newborn survival in Malawi, the paper concludes.
As part of a multi-country analysis, the authors of this paper examined changes for newborn survival in Uganda over the past decade through mortality and health system coverage indicators as well as national and external funding for health, and changes in policies and programmes. Between 2000 and 2010 Uganda’s neonatal mortality rate reduced by 2.2% per year, which is greater than the regional average rate of decline but lower than national reductions in maternal mortality and under-five mortality. Attention and policy change for newborn health is comparatively recent, the authors note. In 2006, a national Newborn Steering Committee was launched, which was given a mandate from the Ministry of Health to advise on newborn survival issues. This multi-disciplinary and inter-agency network of stakeholders has been able to preside over a number of important policy changes at various levels of facility care, education and training, in addition to community-based service delivery through village health teams and changes to essential drugs and commodities. The committee’s comprehensive reach has enabled rapid policy change and increased attention to newborn survival in a relatively short space of time. Translating this favourable policy environment into district-level implementation and high quality services is now the priority.
The growing global burden of non-communicable diseases (NCDs) is now killing 36 million people each year and needs urgent and comprehensive action, according to this article. The authors provide an overview of key critical issues that need to be resolved to ensure that recent political commitments are translated into practical action. These include categorising and prioritising NCDs in order to inform external funding commitments and priorities for intervention, and finding the right balance between the relative importance of treatment and prevention to ensure that responses cover those at risk in addition to those who are already sick. Governments should also define the appropriate health systems response to address the needs of patients with diseases characterised by long duration and often slow progression, and address research needs, in particular translational research in the delivery of care, as well as ensure sustained funding to support the global NCD response.
This paper assesses the patterns and levels of physical intimate partner violence (PIPV) against women and its association with problem drinking of their sexual partners in a nationwide survey in Uganda. The data came from the women's dataset in the Uganda Demographic and Health Survey of 2006. Results show that 48% of the women had experienced PIPV while 49.5% reported that their partners got drunk at least sometimes. The prevalence of both PIPV and problem drinking significantly varied by age group, education level, wealth status, and region and to a less extent by occupation, type of residence, education level and occupation of the partner. Women with a higher wealth status or education level were less likely to experience violence. Women whose partners got drunk often were six times more likely to report violence compared to those whose partners never drank alcohol. The authors conclude that problem drinking among male partners is a strong determinant of PIPV among women in Uganda. PIPV prevention measures should address reduction of problem drinking among men. Long-term prevention measures should address empowerment of women including ensuring higher education, employment and increased income.
More than 3,000 delegates from approximately 120 countries assembled at the 13th World Congress on Public Health in Addis Ababa from the 23rd to 27th of April 2012. In this statement, delegates re-affirm their commitment to international agreements enshrining health as a human right. They also pledge to promote innovative research to generate evidence on the social determinants of health and health equity, as well as advocate for: evidence-based policy; making health equity an integral part of policy and development; equitable access to high quality health services; and fair trade in all commodities that affect human health. The Federation further intends to strengthen partnerships and networks to take common action on global public health priorities, share experiences and help build capacity.
The aim of this study was to assess the distribution of health care benefits in the Kenyan health system, compare changes over two time periods and demonstrate the extent to which the distribution meets the principles of universal coverage. Two nationally representative cross-sectional households surveys conducted in 2003 and 2007 were the main sources of data. A comprehensive analysis of the entire health system was conducted including the public sector, private-not-for-profit and private-for-profit sectors. The three sectors recorded similar levels of pro-rich distribution in 2003, but in 2007, the private-not-for-profit sector was pro-poor, public sector benefits showed an equal distribution, while the private-for-profit sector remained pro-rich. Larger pro-rich disparities were recorded for inpatient compared to outpatient benefits at the hospital level, but primary health care services were pro-poor. Benefits were distributed on the basis of ability to pay and not on need for care. In conclusion, the Kenyan health sector is clearly inequitable and benefits are not distributed on the basis of need.
Previous studies have reported large socioeconomic inequalities in mortality from conditions amenable to medical intervention, but it is unclear whether these can be attributed to inequalities in access or quality of health care, or to confounding influences such as inequalities in background risk of diseases. In this study, researchers hypothesised that, as compared to non-amenable causes, inequalities in mortality from amenable causes are more strongly associated with inequalities in health care use and less strongly with inequalities in common risk factors for disease such as smoking. Cause-specific mortality data for people aged 30-74 years were obtained for 14 countries, and were analysed by calculating age-standardised mortality rates and relative risks comparing a lower with a higher educational group. In most countries and for most amenable causes of death substantial inequalities in mortality were observed, but inequalities in mortality from amenable causes did not vary between countries in patterns that are different from those seen for inequalities in non-amenable mortality. As compared to non-amenable causes, inequalities in mortality from amenable causes are not more strongly associated with inequalities in health care use. Inequalities in mortality from amenable causes are also not less strongly associated with common risk factors such as smoking. The authors call for further research to find the causes of socio-economic inequalities in mortality from amenable conditions.