In Ghana, the United Nations Development Program (UNDP) estimates that the country is largely on track in achieving the MDG 1. Poverty has reduced from over 50 percent in 1992 to 28.5% in 2006, indicating that the poverty target could be achieved well ahead of time. Similarly, the proportion of people living below the extreme poverty line declined from 36% to 18% over the same period. But the author of this blog argues that these figures do not take into account regional disparities: hunger is still rife in Ghana's three northern regions. A key theme emerging from his own research suggests that policy makers tend to tout the aggregate "success story" and become preoccupied with hitting statistical targets rather than improving the overall welfare of all constituents. This highlights the risks when policy-makers focus too much on targets, implying that complex processes can be over-simplified and priorities skewed when policies aim solely at targets. The author argues that the use of targets can encourage a reductionist approach to complex problems, privilege quantitative indicators at the expense of qualitative ones, distort resource allocation, and undermine professional motivation and responsibility. He concludes that, while Ghana’s progress has been remarkable, much work still needs to be done in the northern regions.
Equity in Health
During her opening address at the 8th Global Conference on Health Promotion in Helsinki, Finland on 10 June, WHO Director-General Dr. Margaret Chan stated that inequalities, between and within countries, in income levels, opportunities, and health outcomes, are now greater than at any time in recent decades. The rise of non-communicable diseases threatens to widen these gaps even further. she noted that public health must contend with Big Tobacco, Big Food, Big Soda, and Big Alcohol. All of these industries fear regulation, and protect themselves by using the same tactics. For WHO, formulation of health policies must be protected from distortion by commercial or vested interests. She referred to the Finnish government as an example to follow, as it has been a leading proponent of the need for all sectors of government to consider the health impact of their policies. Finland put the health-in-all-policies approach under the spotlight during its presidency of the European Union in 2006. Such an approach makes perfect sense, she argued. The determinants of health are exceptionally broad. Policies made in other sectors can have a profound, and often adverse, effect on health. The globalisation of unhealthy lifestyles is by no means just a technical issue for public health. It is a political, trade and foreign affairs issue.
In this blog, the author comments on the May 2013 report by the United Nations High Level Panel (HLP), which is included in this newsletter. He expresses disappointment that universal health coverage (UHC) is not one of the twelve goals outlined in the report, despite overwhelming global consensus for UHC. Whilst the panel acknowledged that universal access to basic healthcare services is required to achieve desired outcomes, the author argues that without setting a target to ensure this is realised different actors will continue operating in silos and vertical interventions that can undermine the national health system. Instead the panel proposes ‘ensuring healthy lives’ as goal four. The author considers this as vague and it appears as a call to business as usual. It lacks the enthusiasm inherent in UHC. And, in many parts of the world that are in dire need of health, especially in Africa, the fourth goal resonates as maintaining status quo. Although UHC is not an end in itself, it is a means to ensure equitable access to quality health services and can guarantee the protection of the right to health and better health outcomes. The author argues that this oversight is a challenge to UHC advocates, who should represent UHC in a more ambitious way drawing lessons from proponents of gender equality. He calls on advocates to promote UHC as the appropriate overarching post 2015 health goal, using the forum of the UN Sustainable Development Goals Open Working Group.
A major outcome of the United Conference for Sustainable Development, better known as Rio+20, held in Rio de Janeiro in June 2012, was the decision to establish a universal, intergovernmental high-level political forum (HLPF) on sustainable development. In this article, the author argues that argued that the proposed HLPF needs to truly be a forum on sustainable development, both in their work on the next set of global development goals and in their broader mandate, rather than a forum on environmental sustainability. The forum will need to make particular effort to engage on economic and social issues so that each of the three pillars of sustainable development is comprehensively addressed. The HLPF must also connect with human rights and peace and security communities to ensure support and legitimacy. The author advocates that the post-2015 development goals be structured as global goals, with national targets. This would make the goals actionable and relevant in different country contexts, and ideally, allow for the goals to be linked more directly to domestic policy priorities.
The Integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD) proposes a cohesive approach to ending preventable pneumonia and diarrhoea deaths. It brings together critical services and interventions to create healthy environments, promotes practices known to protect children from disease and ensures that every child has access to proven and appropriate preventive and treatment measures. The solutions to tackling pneumonia and diarrhoea do not require major advances in technology. Proven interventions exist. Children are dying because services are provided piece- meal and those most at risk are not being reached. Use of effective interventions remains too low; for instance, only 39% of infants less than 6 months are exclusively breastfed while only 60% of children with suspected pneumonia access appropriate care. Moreover, children are not receiving life-saving treatment; only 31% of children with suspected pneumonia receive antibiotics and only 35% of children with diarrhoea receive oral rehydration therapy WHO recommends: exclusive breastfeeding for six months and continued breastfeeding with appropriate complementary feeding; use of vaccines; use of simple, standardised guidelines; use of oral rehydration salts; and proper water, sanitation and hygiene interventions.
In this paper, the authors argue that addressing inequality should be central to the post-2015 development framework. They say inequality must be approached on multiple levels: within countries, among nations, and between generations. Tracking inequalities – for example, the progress of the poorest quintile of the population – is important, but to actually reduce inequality, we must reduce the structural inequalities that cause poverty, they add. Their paper highlights some of the many examples of severe inequalities that can be found both among and within countries today. Inequalities are caused by structural barriers, and new as well as old deprivations. A post-2015 development framework must find ways to build on the progress that has already been made and identify policies that can break down some of the barriers faced by the disadvantaged. While the world might be ready to set ambitious targets in areas such as sustainable energy, water, sanitation, and access to knowledge and technology, the authors point out that other areas like migration and trade should also be taken into account. They demand an agenda that pays more attention to social cohesion and social justice, and emphasise that getting the metrics right is critical to improving the reach and effectiveness as of public services.
This fact sheet outlines trends in key dimensions of socio-economic inequality in the BRICS countries (Brazil, Russia, India, China and South Africa), looking especially at education, gender, health, social expenditure and environmental sustainability. The BRICS countries have growing influence in the global economy, but face challenges in reducing inequality. For instance, growth in the informal jobs sector is associated with deepening inequality, and working women are particularly affected. In South Africa, India and China, rural dwellers are increasingly poorer than their urban counterparts; 50.3% of China’s rural population is excluded from public benefits such as health insurance and higher levels of education. In all the BRICS, girls are disadvantaged in levels of access to education, especially in rural areas. Gaps in women’s and men’s economic participation are high, although the number of women in political leadership in Brazil and South Africa has increased. Regressive taxation systems, dependent on consumption rather than income, and subscription-based social security schemes, mean that the poorest are disproportionately taxed and lack security nets such as health insurance. And with climate change disproportionately impacting poor and vulnerable populations, strategies for ‘green growth’ must also address inequalities in people’s exposure to environmental risks.
This statistical release presents information on mortality and causes of death in South Africa for deaths that occurred in 2010. It also provides information on death occurrences from 1997 to 2009 to show trends in mortality and causes of death. It is based on data collected through the South African civil registration system that is maintained by the Department of Home Affairs. The information on causes of death provided is as recorded on death notification forms completed by medical practitioners and other certifying officials. The results generally showed that mortality continues to decline in the count ry. A total of 543,856 deaths occurred in 2010, which was a 6,2% decline from 579,711 deaths that occurred in 2009. Decreases in the overall number of deaths from the civil registration system have been observed since 2007. The National Population Register, which is maintained by the Department of Home Affairs, also showed annual declines in the number of deaths since 2007. Furthermore, median ages at deaths showed that mortality occurs later in life, which is also an indication of declining mortality. In 2010, the median age at death was estimated at around 48 years, which has increased by about five years since 2004. Tuberculosis maintained its rank as the number one leading cause of death in South Africa (12% of all mortalities).
This report is a synthesis of inputs received during the Global Thematic Consultation on Health, which concluded on 6th March 2013 in Gaborone, Botswana. It highlights lessons learned from the Millennium Development Goals (MDGs), health in the post-2015 agenda, health priorities for 2015-2030, and how to frame the future health agenda in terms of principles, goals, targets and indicators. Participants suggested an overall health development goal: “Maximising health at all stages of life,” and proposed two health sector goals: accelerating progress on the health MDGs and reducing the burden of major non-communicable diseases (NCDs). They also suggested that the post-2015 framework should include more ambitious health targets; emphasise equity; address reproductive health and sexual rights; include differentiated targets and indicators for various life stages; and appreciate the interconnections between health and other goals, while addressing macroeconomic issues that impact on health, inequality and poverty. Further, participants argued that universal health access might be a preferable formulation – and vision – to universal health coverage.
This briefing note offers principles and approaches for integrating economic, social and environmental sustainability and equity in a new post-2015 development agenda. It offers guidance on how development processes can help create a foundation for human wellbeing based on economic progress, equitable prosperity and opportunity, a healthy and productive environment and participatory governance. The Independent Research Forum argues that sustainable development can only be achieved when these dimensions of development are all present and mutually reinforcing. But first, eight shifts will be essential: from ‘development assistance’ to a universal global compact; from top-down to multi-stakeholder decision-making processes; from economic models that increase inequalities and risks to ones that reduce them; from business models based on shareholder value to those based on stakeholder value; from meeting ‘easy’ development targets to tackling systemic barriers to progress; from damage control to investing in resilience; from concepts and testing to scaled up interventions; and from multiple discrete actions to cross-scale coordination.