Entrenched poor health and health inequity are important public health problems. Conventionally, solutions to such problems originate from the health care sector, a conception reinforced by the dominant biomedical imagination of health. By contrast, attention to the social determinants of health has recently been given new force in the fight against health inequity. The health care sector is a vital determinant of health in itself and a key resource in improving health in an equitable manner. Actors in the health care sector must recognise and reverse the sector's propensity to generate health inequity. The sector must also strengthen its role in working with other sectors of government to act collectively on the deep-rooted causes of poor and inequitable health.
Equity in Health
At least 100 people have died of cholera in parts of eastern Democratic Republic of Congo (DRC) since January. South Kivu Province is the worst affected, with at least 75 people dead and 6,392 infected. The South Kivu governor, Louis Leonce Muderwa, said the 10 worst-affected health zones in the province included Fizi in the region of Baraka, Nundu, Uvira, Kadutu, Ibanda, Bunyakiri, Katana, Minova, Nyantende and Kabare zones. Two deaths have been reported in Kadutu and one each in Ibanda and Katana. Muderwa declared a cholera epidemic there on 14 September. In neighbouring North Kivu Province, 48 deaths had been recorded and 4,609 people infected by 13 September. Other eastern regions have also recorded cases, with Katanga listing 199 new cases and two deaths. The North Kivu provincial medical inspector, Dominique Bahago, blamed the cholera outbreaks on poor hygiene. ‘The majority of the population's supply of cooking and drinking water is from Lake Kivu where all kinds of waste is dumped; cholera is endemic in that zone,’ said Bahago.
This study investigated the association between precipitation patterns and cholera outbreaks and the preventative roles of drainage networks against outbreaks in Lusaka, Zambia. Data was collected on 6,542 registered cholera patients in the 2003–2004 outbreak season and on 6,045 cholera patients in the 2005–2006 season. Correlations between monthly cholera incidences and amount of precipitation were examined. The distribution pattern of the disease was analysed by a kriging spatial analysis method. The association between drainage networks and cholera cases was analyzed with regression analysis. The study found that increased precipitation was associated with the occurrence of cholera outbreaks, and insufficient drainage networks were statistically associated with cholera incidences. Insufficient coverage of drainage networks elevated the risk of cholera outbreaks. Integrated development is required to upgrade high-risk areas with sufficient infrastructure for a long-term cholera prevention strategy.
Increasingly it is evident that women are affected by blindness and visual impairment to a much greater degree than men. In 1980 a systematic review of global population-based blindness surveys carried out showed that blindness is about 40% more common in women compared to men. This short article explores the gender dimensions of vision loss. The document considers the different risk factors faced by men and women including social and cultural differences and biological. Issues concerning the limited access women have to services are examined and the implications of women usually having a longer life expectancy. Cataract and trachoma are considered in addition to childhood blindness and briefly glaucoma and diabetic retinopathy. The authors emphasis the importance of understanding these problems at community, country, and global level. Reports should be provided which are disaggregated by sex.
This report gives an overview and analysis of the prevalence and impact of Alzheimer's disease, based on a systematic review identifying studies in 21 global burden of disease (GBD) world regions. The authors estimate 35.6 million people with dementia in 2010, with the numbers nearly doubling every 20 years, to 65.7 million in 2030 and 115.4 million in 2050. In low- and middle-income countries, especially, there is a general lack of awareness of Alzheimer’s and other dementias as medical conditions. They are perceived as a normal part of ageing. This general lack of awareness has important consequences, such as a lack of training on dementia recognition and management at any level of the health service. The authors recommend that the World Health Organization (WHO) should declare dementia a world health priority. Low- and medium-income countries should create dementia strategies based first on enhancing primary healthcare and other community services. Collaborations should be created between governments, people with dementia, their carers and their Alzheimer associations, and other relevant non-governmental organisations and professional healthcare bodies.
A new species of mosquito has been discovered by South African researchers that might be a malaria vector. The authors of the report note that ‘understanding the vectors is absolutely key; if we don't do anything about mosquitoes, we will never do anything about malaria.’ The previously unknown species was discovered during field studies in and around rural villages in northern Malawi near the town of Karonga, on the western shore of Lake Malawi. The new species is related to the major African malarial vector, Anopheles funestus, but the ‘jury is still out on ... whether it carries [the] malaria [parasite]," Coetzee, one of the authors, said. The Anopheles funestus Giles group of mosquitoes has nine known African species, and ‘although the members of the Anopheles funestus group may be similar in morphology [its form and structure], their efficiencies as malaria vectors vary greatly,’ the report said. Coetzee said it was important to ascertain whether Anopheles funestus Giles was a malaria vector or not, but this could only be determined after further research.
Fifteen years after liberation from apartheid, South Africans are facing new challenges for which the highest calibre of leadership, vision, and commitment is needed. The effect of the unprecedented HIV and AIDS epidemic has been immense. Substantial increases in mortality and morbidity are threatening to overwhelm the health system and undermine the potential of South Africa to attain the Millennium Development Goals (MDGs). This paper has identified several examples of leadership and innovation that point towards a different future scenario. It discusses the type of vision, leadership and priority actions needed to achieve such a change. There is still time to change the health trajectory of the country, and even meet the MDGs. The new South African Government, installed in April 2009, has the mandate and potential to address the public health emergencies facing the country – will they do so or will another opportunity and many more lives be lost?
This paper highlights gender as a very important factor in determining vulnerability in Disaster Risk Reduction (DRR). The degree of vulnerability to disaster is determined by social variables like gender, age, health status, ethnicity, religion and socio-economic status and understanding these is necessary to identify the underlying causes of disasters and thus try to prevent them. In most countries, women are particularly at risk from disasters. Subsequently, understanding why women are often vulnerable and taking appropriate steps can make a huge difference on impact. The paper looks at DRR in relation to livelihoods. People, especially in developing countries are particularly vulnerable to disasters as they often live in high-risk areas, have lower coping capacities, and have no form of insurance or other safety nets. Furthermore, they are heavily dependent on climate-sensitive primary industries like agriculture and fishing. A disaster can eradicate livelihoods or years of local development efforts in a very short time.
In 1987, the World Health Organization (WHO) estimated that vitamin A deficiency was endemic in 39 countries based on the ocular manifestations of xerophthalmia or deficient serum (plasma) retinol concentrations. In 1995, WHO updated these estimates and reported that vitamin A deficiency was of public health significance in 60 countries, and was likely to be a problem in an additional 13 countries. The current estimates reflect the time period between 1995 and 2005, and indicate that 45 and 122 countries have vitamin A deficiency of public health significance based on the prevalence of night blindness and biochemical vitamin A deficiency, respectively, in preschool-age children.
The Western Cape provincial government initiated the collaborative Burden of Disease (BOD) Reduction Project to reduce its burden of disease and promote equity in health. This shift in thinking from facilities to a population-based approach to health demonstrates increased awareness about the crucial role of upstream factors on population health. Several lessons may be learnt from the Western Cape experience with mortality surveillance. Identifying health priorities is important, like leading causes of premature mortality such as HIV and AIDS, tuberculosis, homicides and road traffic injuries. Identifying inequities must be done in line with the recommendations of the World Health Organization Commission on Social Determinants of Health to monitor health inequities. Government also needs to start evaluating priority health programmes. Providing accessible information for policy makers is also crucial, as well as advocating for an intersectoral response, such as improving living conditions with the involvement from other sectors such as housing, water and sanitation.