The 2011 Update identifies and discusses 159 different health equity activities and 79 sets of recommendations from local, state, national, and international reports. It notes that many of the recommendations focus on a wide range of areas, including early childhood investment, education, lifestyle, housing, transportation, the environment, employment and community and interagency collaboration. This breadth of topics reflects the growth in “Health in All Policies” thinking and analysis among community groups and governments at all levels, calling for each sector to contribute to the quality of the nation's health. The Update recommends actions to increase awareness of health inequities and the social determinants of health, as well as advocacy and leadership for health equity and social justice. A health equity-oriented approach should emphasise community empowerment, increasing collaborative partnerships with all sectors and the need to coordinate and utilise research and outcome evaluations more effectively.
Equity in Health
The current over-arching development framework of the MDGs expires in 2015. Any plans for SDGs coming out of Rio+20 must be fully integrated into the global overarching post-2015 development framework, argues Beyond 2015. To develop SDGs and the post-MDG development framework in parallel would be both inefficient and short-sighted, and could lead to a number of negative scenarios. Principles of participation, accountability, equality and non-discrimination must cut across any post-2015 framework to ensure outcomes which are effective, just and sustainable. Principles of Agenda 21 should similarly be embedded throughout. To illustrate this, Beyond 2015 have identified four principles which must be the foundation for any guidance coming out of Rio+20 on a future development framework: holistic, inclusive, equitable and universally applicable. Fundamentally, any global development framework must be based on, and fully ensure, equal enjoyment of all human rights for all people.
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.
World Health Statistics 2012 is the World Health Organisation’s annual compilation of health-related data for its 194 Member States, and includes a summary of the progress made towards achieving the health-related Millennium Development Goals (MDGs) and associated targets. In this edition it also includes highlight summaries on the topics of non-communicable diseases, universal health coverage and civil registration coverage. The report notes a decrease in child mortality, increased vaccination coverage, while worldwide obesity prevalence almost doubled between 1980 and 2008. In the last 20 years, maternal deaths have been reduced by almost half, but the mortality burden is extremely uneven, and remains high in sub-Saharan Africa, where 500 women out of every 10,000 die in childbirth.
The value of ecosystem services typically goes unaccounted for in business and policy decisions and in market prices, according to this article. For commercial purposes, if ecosystem services are recognised at all, they are perceived as free goods, like clean air and water. The author considers the work of organisations like the United States President’s Council of Advisors on Science and Technology (PCAST), which are working to build recognition of ecosystem services and, importantly, methods to evaluate them. By calculating specific values for these services, policy makers and resource managers may be able to make better-informed decisions that factor important environmental and human health outcomes into the bottom line.
Over the past year, at a range of international conferences, including the Conference on Social Determinants in Rio and COP-17 in Durban, there have been side events introducing work on the link that exists between health and climate change. In the run-up to Rio+20 climate conference in June 2012, the need for a sustainable approach to global health will become even more important, the author of this article argues. It will require a shift in focus away from disease-specific thinking to an approach that more fully considers climate change and environmental degradation as important determinants of health. The author argues that the Istanbul Declaration, which calls on the world community to take bold action jointly against global social inequities and environmental deterioration, is a useful tool to achieve this end. It points to the need to integrate equity within the links made across health, economy and environment, reinforcing similar issues raised at the World Conference on the Social Determinants of Health, held in October 2011.
In the industrialised North, South Africa is seen as an archetypal medical tourism destination, combining a medical (elective) procedure with related travel and tourism activity. Yet this paper shows that the industry is premised on a highly romanticised and stylised image of South Africa, and most medical tourism to South Africa is not from the North: the Global North generated a total of 281,000 medical travellers between 2009 and 2010, while the Global South was the source of over two million. Most patients were middle-class people from East and West Africa, as well as a growing number of patients from South Africa’s neighbouring countries. In some cases, patients go to South Africa for procedures that are not offered in their own countries. In others, patients are referred by doctors and hospitals to South African facilities. But most of the movement is motivated by lack of access to basic healthcare at home. The total annual spend by medical travellers in South Africa amounts to over R1.5 billion (US$191 million). Of this, over 90% is generated by South-South medical travellers from the rest of Africa, powerfully illustrating the overall economic importance of this form of medical travel. In addition, South Africa has entered into bilateral health agreements with eighteen African countries. The authors call for further research on and policy attention for intra-African medical tourism and migration, which is identified as a growing trend.
Diarrhoea is a leading cause of morbidity and mortality globally; yet the overall burden of diarrhoea in terms of duration and severity has not been quantified. This study aims to fill that research gap. The authors estimated that, globally, among children under-five, 64.8% of diarrhoeal episodes are mild, 34.7% are moderate, and 0.5% are severe. On average, mild episodes last 4.3 days, and severe episodes last 8.4 days and cause dehydration in 84.6% of cases. Among older children and adults, 95% of episodes are mild; 4.95% are moderate; and 0.05% are severe. Among individuals ≥16 yrs, severe episodes typically last 2.6 days and cause dehydration in 92.8% of cases. Moderate and severe episodes constitute a substantial portion of the total envelope of diarrhoea among children under-five (35.2%; about 588 million episodes). Among older children and adults, moderate and severe episodes account for a much smaller proportion of the total envelope of diarrhoea (5%), but the absolute number of such episodes is noteworthy (about 21.5 million episodes among individuals ≥16 yrs). Hence, the global burden of diarrhoea consists of significant morbidity, extending beyond episodes progressing to death.
The fourth edition of the World Water Development Report, ‘Managing Water under Uncertainty and Risk’ is a comprehensive review of the world's freshwater resources and seeks to demonstrate, among other messages, that water underpins all aspects of development, and that a coordinated approach to managing and allocating water is critical. The report underlines that in order to meet multiple goals water needs to be an intrinsic element in decision-making across the whole development spectrum. It aims to encourage all stakeholders both in and out of the ‘water box’ - water managers, leaders in government, civil society and businesses – to engage early in decision making processes to improve the quality and acceptance of decisions and the probability of successful implementation. It highlights that more responsible action by all water users has enormous potential to lead to better outcomes - but requires political, social, economic and technical responses at all levels of government, businesses and communities, from local to international.
A cholera epidemic has spread to nine out of 11 provinces in the Democratic Republic of the Congo, according to the United Nations. The UN said the spread was "worrisome" as the epidemic had so far killed 644 people and infected 26,000 since January 2011. Lack of access to potable water remains the single most important cause of the recurrent cholera outbreaks, according to the United Nations Office for the Co-ordination of Humanitarian Affairs (UN OCHA). UN OCHA cited the example of the north-eastern city of Bunia, where over a third of the residents - more than 100,000 people - have been cut off from drinking water since the start of 2012. In neighbouring Republic of Congo, an official announced that there have been more than 340 cholera cases reported in recent months, and several people have died from the water-borne disease.