The era of the Convention on the Rights of the Child has seen marked advances in child survival and development, expanded and consolidated efforts to protect children, and a growing recognition of the importance of empowering children to participate in their own development and protection. One of the most outstanding achievements in child survival and development has been the reduction in the annual number of under-five deaths, from 12.5 million in 1990 to less than 9 million in 2008. In particular, immunisation against major preventable diseases has been a life-saving intervention for millions of children in all regions of the world. However, Africa and Asia present the largest global challenges for child rights to survival, development and protection, with the regions of sub-Saharan Africa and south Asia well behind other regions on most indicators. Their progress in primary health care, education, and protection will be pivotal to accelerated progress on child rights and towards internationally agreed development goals for children.
Equity in Health
The purpose of this paper is to explore the socio-cultural context of cardiovascular disease (CVD) risk prevention and treatment in sub-Saharan Africa (SSA). It discusses risk factors specific to the SSA context, including poverty, urbanisation, developing healthcare systems, traditional healing, lifestyle and socio-cultural factors. It found that the epidemic of CVD in SSA is driven by multiple factors working collectively. Lifestyle factors such as diet, exercise and smoking contribute to the increasing rates of CVD in SSA. Some lifestyle factors are considered gendered in that some are salient for women and others for men. For instance, obesity is a predominant risk factor for women compared to men, but smoking still remains mostly a risk factor for men. Additionally, structural and system level issues such as lack of infrastructure for healthcare, urbanisation, poverty and lack of government programmes also drive this epidemic and hampers proper prevention, surveillance and treatment efforts.
In the current climate change debate, the perspective of the developing countries that will be worst affected has been almost completely ignored by the scientific literature. This deficit is addressed by this paper, which analyses the first 40 National Adaptation Programmes of Action reports submitted by governments of least-developed countries to the Global Environment Facility for funding. Of these documents, 93% identified at least one of three ways in which demographic trends interact with the effects of climate change: faster degradation of the sources of natural resources; increased demand for scarce resources; and heightened human vulnerability to extreme weather events. These findings suggest that voluntary access to family planning services should be made more available to poor communities in least-developed countries. The paper concludes by calling for increased support for rights-based family planning services, including those integrated with HIV and AIDS services, as an important complementary measure to climate change adaptation programmes in developing countries.
This is one of the session reports from Forum 2009, convened by the Global Forum for Health Research on 17–20 November 2009. The issue was finding synergies in policy between environmental health and equity agendas. Climate change has had a negative effect on health equity since it affects the most vulnerable populations. However, climate adaptation policies can sometimes make the situation even worse. For example, biofuels policies were intended to reduce the reliance on fossil fuels. In the past few years though, farmers have abandoned crop production in favour of growing biofuel crops, exacerbating the food crisis. Understanding the geographical components of the link between climate change and health is crucial. Data from geographical information systems (GIS) should be integrated with health information systems to provide a cohesive look at changes in disease spread, for example. Health researchers who study the effects of climate change cannot be content with just understanding the changing epidemiology of disease – they need to stay familiar with the latest technologies of monitoring climate change.
Five leading risk factors identified in this report (childhood underweight, unsafe sex, alcohol use, unsafe water and sanitation, and high blood pressure) are responsible for one quarter of all deaths in the world, and one fifth of all DALYs. Reducing exposure to these risk factors would increase global life expectancy by nearly five years. Eight risk factors (alcohol use, tobacco use, high blood pressure, high body mass index, high cholesterol, high blood glucose, low fruit and vegetable intake, and physical inactivity) account for 61% of cardiovascular deaths. Combined, these same risk factors account for over three quarters of ischaemic heart disease, the leading cause of death worldwide. Reducing exposure to these eight risk factors would increase global life expectancy by almost five years. Low- and middle-income countries now face a double burden of increasing chronic, non-communicable conditions, as well as the communicable diseases that traditionally affect the poor. Understanding the role of these risk factors is important for developing clear and effective strategies for improving global health.
Despite considerable progress in the past decades, societies continue to fail to meet the health care needs of women at key moments of their lives, particularly in their adolescent years and in older age. These are the key findings of this report. The World Health Organization (WHO) calls for urgent action both within the health sector and beyond to improve the health and lives of girls and women around the world, from birth to older age. The report provides the latest and most comprehensive evidence available to date on women's specific needs and health challenges over their entire life-course. It includes the latest global and regional figures on the health and leading causes of death in women from birth, through childhood, adolescence and adulthood, to older age.
This report focuses on two key aspects of disaster risk reduction: early warning and early action. Advances in science and technology, in forecasting techniques and the dissemination of information are major contributors to reducing mortality. However, the development of a more people-centred approach is also essential. The report gives a more comprehensive explanation about the different interventions in disaster management and risk reduction such as: an introduction to early warning systems for different hazards and early action; emphasising the link between early warnings and early actions; taking a people-centred approach by finding out how individuals and communities can understand the threats to their own survival and well-being, share that awareness with others and take actions to avoid or reduce disaster; and, in terms of food insecurity, knowing what actions should follow the early warning. A system of data collection to monitor peoples' access to food, in order to provide timely notice when a food crisis threatens and thus to elicit an appropriate response should be developed in order to mitigate the occurrence of the disaster.
Africa will fail to achieve most UN Millennium Development Goals unless countries adopt effective family planning programmes and control rapid population growth, said Khama Rogo, World Bank senior adviser, speaking at a three-day international conference on family planning, organised by the Gates Foundation and Johns Hopkins and Makerere universities and held (from 16–18 November) in the Ugandan capital, Kampala. More than 1,000 policy-makers, researchers, academics and health professionals from 59 countries attended the event. Various speakers warned that the rate of Africa's population increase was too rapid, with women in some countries having on average seven children each. ‘Family planning improves maternal health, thereby increasing women's productivity and reducing dependency at both family and national levels,’ said Chisale Mhango, director of reproductive health at Malawi's Health Ministry. ‘Fewer children means manageable education targets; more children means that parents will mainly educate sons, which promotes gender inequality,’ he added. ‘The fewer the children the better the care, the more the food, the lower the child mortality and there will be savings for health provision.’
Concepts of fair distribution of health, such as equity of access to medical care, may not be sufficient to equalise health outcomes but, nevertheless, they may be more practical and effective in advancing health equity in developing countries. This study used a framework for relating health equity goals to development strategies allowing progressive redistribution of primary health care resources towards the more deprived communities is formulated. The framework is applied to the development of primary health care in post-independence Namibia. In Namibia health equity has been advanced through the progressive application of health equity goals of equal distribution of primary care resources per head, equality of access for equal met need and equality of utilisation for equal need. For practical and efficiency reasons it is unlikely that health equity would have been advanced further or more effectively by attempting to implement the goal of equality of health status. The goal of equality of health status may not be appropriate in many developing country situations; instead, a stepwise approach based on progressive redistribution of medical services and resources may be better.
This report presents a picture that is slightly at variance with many other reports on Africa’s progress towards the targets of the Millennium Development Goals (MDGs). It shows that progress is being made in a number of areas such as primary enrolment, gender parity in primary education, malaria deaths and representation of women in parliaments. There has also been a reinforcement of state capacity to deliver growth in many countries. If this rate of progress continues, the continent will be on course to meet a significant number of the MDGs by the target date (2015), but not all. A critical area for progress is the health-related MDGs, where progress is slowest. Interventions to accelerate progress on the health MDGs will yield significant dividend. In sum, the preconditions for accelerating progress to meet the targets of the MDGs are now largely in place, albeit constrained by inadequate resource flows and capacity in some critical areas like health capacity.