Equity is emerging as an urgent policy priority in health sector reforms in many African countries. This report presents the findings of a study on “Mainstreaming health equity into the development agenda in Africa”. The widely reported fact that health outcomes in Africa are generally poor obscures the existence of a steep gradient in health outcomes between rural and urban areas, between better-off households and the less better-off. These differences in outcome are due in part to inequities in health. There is strong evidence that the poor health outcomes reported for most African countries are attributable to inequities in health. Reducing inequities in health is therefore argued to be integral to success in reaching the targets of the three health-related MDGs and the other MDGs where health is an important component.
Equity in Health
The aim of this study was to assess if a positive gradient in smoking can also be observed in low and middle income countries in other regions of the world. The authors used data of the World Health Survey from 49 countries and a total of 233,917 respondents. Multilevel logistic regression was used to model associations between individual level smoking and both individual level and country level determinants. the results were stratified by education, occupation, sex and generation (younger vs. older than 45). Countries were grouped based on GDP and region. In Sub-Saharan Africa and Latin America no clear gradient was observed: inequalities were relatively small. Among men, no positive gradients were observed, and the strongest negative gradients were seen in South-East Asia and East Asia.
Despite large gains in health over the past few decades, the distribution of health risks worldwide remains extremely and unacceptably uneven. The Lancet—University of Oslo Commission on Global Governance for Health reports that with globalisation, health inequity increasingly results from transnational activities that involve actors with different interests and degrees of power: states, transnational corporations, civil society, and others. The norms, policies, and practices that arise from global political interaction across all sectors that affect health are termed global political determinants of health. The Commission argues that global political determinants that unfavourably affect the health of some groups of people relative to others are unfair, and that at least some harms could be avoided by improving how global governance works. This report examines power disparities and dynamics across a range of policy areas that affect health and that require improved global governance: economic crises and austerity measures, knowledge and intellectual property, foreign investment treaties, food security, transnational corporate activity, irregular migration, and violent conflict. The Commission calls for stronger cross-sectoral global action for health, for strengthened use of human rights instruments for health, and new frameworks for international financing that go beyond traditional development assistance such as for research and social protection.
This paper explores the effect of risk and socioeconomic factors on maternal mortality at the community level in Madagascar using a unique, nationwide panel of communes (i.e., counties). Previous work in this area uses individual or cross-country data to study maternal mortality, however, studying maternal mortality at the community level is imperative because this is the level at which most policy is implemented. The results show that longer travel time from the community to the hospital leads to a high level of maternal mortality. The findings suggest that improvement to transportation systems and access to hospitals with surgery rooms are needed to deal with obstetric complications and reduce maternal mortality.
The Millennium Development Goals have centred on social outcomes, primarily in the fields of poverty, health and education. The goal of halving extreme poverty globally has already been met, albeit in large part thanks to the remarkable performance over three decades of the Chinese economy. Greater ambition is expected for a post-2015 agenda, with the eradication of extreme poverty a possible new goal. However, this goal is very unlikely to be reached by 2030 if business as usual is the order of the day. Paradoxically, this partly reflects the lack of ambition in the conventional poverty line of $1.25 per day, which is by any standard extremely low. However UNCTAD also argue that it is also because poverty eradication, even at this level of ambition, will not happen without addressing the more challenging issue of global inequality.UNCTAD argue that there is an emerging consensus that existing levels of inequality are not only morally unacceptable, but also economically and politically damaging. Moving beyond the Millennium Development Goals, inequality should therefore become a prominent part of the post-2015 development narrative.
The linkage between the socio-economic inequality and HIV outcomes was analysed using data from a population-based household survey that employed multistage-stratified sampling, to help refocus attention on how HIV is linked to inequalities. A socio-economic index (SEI) score, derived using multiple correspondence analysis of measures of ownership of durable assets, was used to generate three SEI groups: Low (poorest), Middle, and Upper (no so poor). Distribution of HIV outcomes (i.e. HIV prevalence, access to HIV/AIDS information, level of stigma towards HIV/AIDS, perceived HIV risk and sexual behaviour) across the SEI groups, and other background characteristics was assessed using weighted data. Univariate and multivariate logistic regression was used to assess the covariates of the HIV outcomes across the socio-economic groups. More women than men were found in the poor SEI. HIV prevalence was highest among the poor and declined as SEI increased. Individuals in the upper SEI reported higher frequency of HIV testing compared to the low SEI. Only 21% of those in poor SEI had good access to HIV/AIDS information compared to 80% in the upper SEI. A higher percentage of the poor had a stigmatizing attitude towards HIV/AIDS and personal HIV risk perception compared to those in the upper SEI. Our findings underline the disproportionate burden of HIV disease and HIV fear among the poor and vulnerable in South Africa, who are further disadvantaged by lack of access to HIV information and HIV and AIDS services.
South Africa is increasingly focused on reducing maternal mortality and documenting variation in access to maternal health services across one of is argued to assist in re-direction of resources. Analysis draws on a population-based household survey that used multistage-stratified sampling. Women, who in the past two years were pregnant (1113) or had a child (1304), completed questionnaires and HIV testing. Distribution of access to maternal health services and health status across socio-economic, education and other population groups was assessed using weighted data. Poorest women had near universal antenatal care coverage (ANC), but only 40% attended before 20 weeks gestation; higher in the wealthiest quartile. Women in rural-formal areas had lowest ANC coverage, completion of four ANC visits and share offered HIV testing. Testing levels were highest among the poorest quartile, but 10% of women above 40 or with low education had never tested. Skilled birth attendant coverage was lowest in the poorest quartile and rural formal areas. Around two thirds of the wealthiest quartile, of white and of formally-employed women had a doctor at childbirth, 11-fold higher than the poorest quartile. Self-reported health status declined considerably with each drop in quartile, education level or age group.
Action on the social determinants of health is considered a necessary approach to improving health equity. Case studies of intersectoral action are available, however there is limited information about the impact of intersectoral action on the social determinants of health and health equity. Search and retrieval of literature published between 2001 and 2011 was conducted in 6 databases. 17 articles of varied methodological quality met the inclusion criteria. One systematic review investigating partnership interventions found mixed and limited impacts on health outcomes. Primary studies evaluating the impact of upstream and midstream interventions showed mixed effects. Downstream interventions were generally moderately effective in increasing the availability and use of services by marginalized communities. The literature evaluating the impact of intersectoral action on health equity is limited. The included studies identified reveal a moderate to no effect on the social determinants of health. The evidence on the impact of intersectoral action on health equity is even more limited. The lack of evidence should not be interpreted as a lack of effect. Rigorous evaluations of intersectoral action are needed to strengthen the evidence base of this public health practice.
This paper offers two unique contributions to existing global and regional frameworks on multisectoral action on NCDs and their social determinants. The first is a typology of multisectoral action that highlights three general categories of possible action outside the health sector: expanding delivery platforms; NCD-specific actions on social determinants; and NCD-sensitive actions on social determinants. This paper’s second contribution is a framework that outlines more specific areas and opportunities for actors outside the health sector to take action on the social determinants of NCDs. The framework has two parts. The first describes opportunities for NCD-specific and NCD-sensitive actions across the policy and programme lifecycle. The second part describes opportunities to create an enabling environment that promotes multisectoral action. Actors outside the health sector are uniquely positioned to help build political will, enabling legal frameworks, enforcement mechanisms and effective governance structures that are multisectoral and participatory – all anchored in a human rights-based approach.
The East African community (EAC) partner states have been urged to re-focus monitoring and achieving of the Millennium Development Goals (MDGS) as the set deadline 2015 draws near. According to Tanzanian vice-president Dr. Mohammed Gharib Bilal, there is need for constant monitoring of MDGs by EAC partner states especially THE ‘shelter for all’ goal as an important agenda in social - economic development. Gharib addressed a two-day East African Legislative Assembly (EALA) conference on MDGs in Arusha Tanzania. He told the conference that Tanzania had taken measures aimed at addressing the challenges of unplanned settlement and slums in the urban population and was undertaking a study with the United Nations-Habitat. Legislators must re-focus their oversight activities in the development agenda, he argued: they should not only be critical of their governments but must stress what has been achieved, where the failures are and the reasons whether they resulted from inadequate resources or misplaced priorities.