A group of senior officials from China, Africa and from international organisations involved in health assistance in Africa met in Beijing on 4-5 December 2009 to review China’s health assistance to Africa and to discuss opportunities for international cooperation in achieving the health-related Millennium Development Goals in Africa. The International Roundtable on China-Africa Health Collaboration was part of an ongoing effort by Government of China to develop a new strategy for health assistance to Africa as part of its overall South-South collaboration. A key message, emphasised by representatives of international organisations, African officials, and Chinese officials alike, is the importance of strong country ownership, on the one hand, and benefits of working through partnership, on the other. Dr. Tedros Adhanom Ghebreyesus, Ethiopian Minister of Health and Chair of the Global Fund to Fight AID Tuberculosis and Malaria, described his country’s experience in working under the framework of the International Health Partnership, with its reliance on supporting Ethiopia’s national health development plan. He noted that ‘it is through ownership that you can generate commitment, and with commitment begin to see results’. He also noted an African proverb, which was quoted by Chinese Premier Wen Jiaobao in his speech at the recent Forum on China Africa Cooperation, and which says ‘If you want to go quickly, go alone. If you want to go far, go together’.
Equity in Health
According to South Centre, the Copenhagen Accord has five important implications and effects. First, it lays the foundation for weakening the Kyoto Protocol as the multilateral treaty instrument for developed countries’ binding emission reduction commitments. Second, it creates the potential for changing the balance of obligations under the United Nations Framework Convention on Climate Change (UNFCCC) by laying the basis for a new set of obligations for developing countries. Third, it re-interprets the commitments of developed countries to provide or mobilise climate financing to support developing countries’ climate change-related mitigation and adaptation actions in ways that are conditional and highly ambiguous. Fourth, it creates a parallel framework of climate change-related ‘commitments’ and actions, thereby laying the foundation for a shift away from the UNFCCC per se as the primary multilateral treaty instrument for global long-term cooperative action on climate change. Fifth, it recognises the science relating to a two degree centrigrade global temperature increase but does not elaborate on how this would be achieved. It also talks about equity but does not define clearly how equity considerations are to be addressed, what it means, and the modalities for achieving equity.
The Copenhagen Accord presented after the climate summit is only three pages in length. According to the author of this article, what is left out is probably more important than what it contains. The Accord does not mention any figures of the emission reduction that the developed countries are to undertake after 2012, either as an aggregate target or as individual country targets. The author believes this failure at attaining reduction commitments is the biggest failure of the document and of the whole Conference. It marks the failure of leadership of the developed countries, which are responsible for most of the greenhouse gases retained in the atmosphere, to commit to an ambitious emissions target. While developing countries have demanded that the aggregate target should be over 40% reduction by 2020 compared to 1990 levels, the national pledges to date by developed countries amount to only 13–19% in aggregate. Perhaps this very low ambition level is the reason that the Accord remains silent on this issue, except to state a deadline of 31 January 2010 for countries to provide their targets. The author doubts this deadline will be met given the reluctance to be explicit on this in the last four years.
Effects of climate change on health will impact on most populations in the coming decades and put the lives and well-being of billions of people at increased risk, according to this report. The Intergovernmental Panel on Climate Change (IPCC) states that ‘climate change is projected to increase threats to human health’. Climate change can affect human health directly (such as impacts of thermal stress, death/injury in floods and storms) and indirectly through changes in the ranges of disease vectors (such as mosquitoes), water-borne pathogens, water quality, air quality, and food availability and quality. The report also states that social impacts will vary dependent on age, socioeconomic class, occupations and gender, and the world’s poorest people will be most affected. The risks to health from climate change arise from: direct stresses (such as heatwaves, weather disasters and workplace dehydration); ecological disturbance (such as altered infectious disease patterns); disruptions of ecosystems on which humanity depends (for example, health consequences of reduced food yields); and population displacement and conflict over depleted resources (for example, water, fertile land, fisheries).
In this interview, Dr Brawley discusses the challenges particular to Africa in relation to cancer and debunks some of the myths around cancer. He believes Africa is addressing the cancer pandemic, but more focus is needed to bring politicians and non-government organisations into the fold to address cancer in Africa. Cervical cancer is highly treatable in many areas of the world and abilities to prevent, detect and treat it need to reach African more widely. Smoking, which is not very common in Africa but is growing, needs to be stopped to prevent an epidemic of lung cancer. With regard to the role tobacco control plays in cancer control in Africa, he noted that the Africa Tobacco Control Regional Initiative, the Africa Tobacco Control Alliance, and the Framework Convention Alliance have already been instrumental in helping to establish an agenda for cancer control in Africa. With tobacco companies looking at Africa as an area of market growth there is need to combat what could be an epidemic of lung cancer, cardiac and other diseases.
All populations will be affected by a changing climate but, according to this article, the initial health risks vary greatly, depending on where and how people live. People living in small island developing states and other coastal regions, megacities, and mountainous and polar regions are all particularly vulnerable in different ways. Health effects are expected to be more severe for elderly people and people with infirmities or pre-existing medical conditions. The groups who are likely to bear most of the resulting disease burden are children and the poor, especially women. The major diseases that are most sensitive to climate change – diarrhoea, vector-borne diseases like malaria, and infections associated with undernutrition – are most serious in children living in poverty. Strengthening of public health services needs to be a central component of adaptation to climate change. The international health community already has a wealth of experience in protecting people from climate-sensitive hazards, and proven, cost-effective health interventions are already available to counter the most urgent of these. Broadening the coverage of available interventions would greatly improve health now. Coupled with forward planning, it would also reduce vulnerability to climate changes as they unfold in the future.
According to this study, three circumstances make the present moment unique for global health. First, health has been increasingly recognised as a key element of sustainable economic development, global security, effective governance and human rights promotion. Second, due to the growing perceived importance of health, unprecedented – albeit still insufficient – sums of funds are flowing into this sector. Third, there is a burst of new initiatives coming forth to strengthen national health systems as the core of the global health system and a fundamental strategy to achieve the health-related Millennium Development Goals. In order to realise the opportunities offered by the conjunction of these unique circumstances, it is essential to have a clear conception of national health systems that may guide further progress in global health. To that effect, the first part of this document examines some common misconceptions about health systems. Part two explains a framework to better understand this complex field. Finally, a list of suggestions is offered on how to improve national health system performance and what role global actors can play.
By framing human health and wellbeing in the context of an ecosystems approach, this paper recognises that healthy people and healthy environments are inextricably linked. However, in most African countries, there is still inadequate assessment and monitoring of the dynamics of human activities and their impact on local ecosystems and this paper notes that the degradation of ecosystem services constitutes an important barrier to achieving Millennium Development Goals. It urges governments to recognise the links between environment and health, from the perspective of the vital services that ecosystems provide to human health and wellbeing, and to promote integrated policies that value these services. Solutions require political commitment, concerted action and shared responsibility between different government sectors and the civil society. Countries should take steps to mitigate the underlying causes of ecosystem damage, while simultaneously improving human health. Intersectoral collaboration among government departments and the civil society, capacity-building, dissemination of knowledge and good practices, and integrated action for health and the environment are also critical.
Global life expectancy could be increased by nearly five years by addressing five factors affecting health – childhood underweight, unsafe sex, alcohol use, lack of safe water, sanitation and hygiene, and high blood pressure, according to this report. These are responsible for one-quarter of the 60 million deaths estimated to occur annually. The report describes 24 factors affecting health, which are a mix of environmental, behavioural and physiological factors, such as air pollution, tobacco use and poor nutrition. More than a third of the global child deaths can be attributed to a few nutritional risk factors such as childhood underweight, inadequate breastfeeding and zinc deficiency. Eight risk factors alone account for over 75% of cases of coronary heart disease, the leading cause of death worldwide. These are alcohol consumption, high blood glucose, tobacco use, high blood pressure, high body mass index, high cholesterol, low fruit and vegetable intake and physical inactivity. Most of these deaths occur in developing countries.
The Students and Youths Working on Reproductive Health Action Team (SAYWHAT) hosted 60 students from 30 tertiary institutions during its 4th National Students Conference from the 16th to the 18th of December 2009 under the theme 'Healthy Students for a Prosperous Nation' Through presentations, parallel sessions and group discussions, the conference covered major areas of sexual and reproductive health rights (SRHR) for young people. Among the key issues that came out was the need for a universal curriculum on SRHR for tertiary institutions. The delegates also reiterated that there is a need for clear monitoring and evaluation and coordination of SRHR programs within tertiary institutions. In light of the risk posed by multiple and concurrent partnerships, they called for behavioural change amongst all students and a focus on life skills and livelihoods training to sustain the change. Generally there was a call for commitment among all students, college authorities and SAYWHAT’s membership for more effective responses that addresses the real health challenges in tertiary institutions.