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Africa: Health for All?
Jan 6, 2004 (040106)
(Reposted from sources cited below)
In mid-December, the World Health Organization (WHO) released its
annual World Health Report, the first under the leadership of
Director-General Jong-wook Lee. Building on its earlier
announcement of a
plan to bring AIDS treatment to 3 million people
by the end of 2005,
the WHO called for a return to the goal of "Health for All" adopted
twenty-five years ago. The report calls for strengthening health
systems across the board to address the widening gap between rich
and poor countries, and it stresses that AIDS treatment will not be
sustainable unless it is linked to the strengthening of primary
The report thus presents a sharp contrast to the U.S. model of
commercialized health care and the bilateral approach stressed by
President Bush's new AIDS initiative. U.S. officials have used the
weaknesses of national health care systems in African and other
developing countries as an argument for a slower pace in funding
for AIDS programs. The WHO reverses that argument, stressing the
need for immediate steps to build additional health care capacity.
This will be a critical test year for both multilateral
institutions and the Bush administration, as well as national
governments, to deliver on their promises to rapidly scale up
treatment for almost 6 million people in need of immediate antiretroviral
This issue of AfricaFocus Bulletin contains excerpts from the WHO's
World Health Report, as well as links to additional recent reports
from late 2003. Another issue of the Bulletin today contains
excerpts from a paper by Brook Baker of Health Gap defending the
WHO's accelerated treatment plan against doubts reportedly raised
by U.S. and pharmaceutical company representatives.
++++++++++++++++++++++end editor's note+++++++++++++++++++++++
World Health Organization
The World Health Report 2003: Shaping the Future
(1) From WHO Press Release 18 December, 2003
Health for all remains the goal
"These global health gaps are unacceptable," said Dr LEE Jong-wook,
Director-General of WHO. "Twenty-five years ago, the Declaration of
Alma-Ata on Primary Health Care challenged the world to embrace the
principles of health for all as the way to overcome gross health
inequalities between and within countries," said Dr Lee.
"The principles defined at that time remain indispensable for a
coherent vision of global health. Turning that vision into reality
calls for clarity both on the possibilities and on the obstacles
that have slowed and in some cases reversed progress towards
meeting the health needs of all people. This means working with
countries especially those most in need not only to confront
health crises, but to construct sustainable and equitable health
The report confirms that HIV/AIDS has cut life expectancy by as
much as 20 years for many millions of people in sub-Saharan Africa.
Every day in the poorest African countries, 5,000 men and women and
1,000 children die from HIV/AIDS.
Today only 5% of all those people living in the developing world
who require antiretroviral treatment for HIV/AIDS actually receive
it: a treatment gap which WHO declared a global health emergency in
"The WHO goal of universal access to HIV/AIDS treatment, with the
concrete target of providing treatment to three million people in
the poorest countries by the year 2005 is a clear demonstration of
how the principle of equitable access can be put into practice,"
said Dr Lee. "Working with our partners, we will show that
investments we make in treating people with AIDS can help to build
up health systems for the benefit of all." ...
The report suggests ways in which international support can counter
some of the main health care systems weaknesses, including critical
shortages of health workers, inadequate health information, a lack
of financial resources and the need for more government leadership
aimed at improving the health of the poorest members of society.
The report calls for rapid increases in training and employment of
health care workforces, and stronger government-community
From the Message from Director-General Jong-wook Lee
Today's global health situation raises urgent questions about
justice. In some parts of the world there is a continued
expectation of longer and more comfortable life, while in many
others there is despair over the failure to control disease
although the means to do so exist. ...
Major disparities also exist in areas such as child mortality. Of
the more than 10 million children under 5 years old who die every
year, almost all are in developing countries. A world marked by
such inequities is in very serious trouble. We have to find ways to
unite our strengths as a global community to shape a healthier
future. This report on the world's health, my first since taking
office, gives some initial indications of how to do it.
A message that runs throughout these pages is that progress in
health, including rapid and sustainable expansion of emergency
treatments, depends on viable national and local health systems.
Scaling up ARV therapy in resource-poor settings has to be done in
such a way as to strengthen health systems based on primary health
care. In most countries, there will be only small and short-lived
advances towards acceptable standards of health without the
development of health care systems which are strong enough to
respond to current challenges. ...
Twenty-five years ago, the Declaration of Alma-Ata challenged the
world to embrace the principles of primary health care as the way
to overcome gross health inequalities between and within countries.
"Health for all" became the slogan for a movement. It was not just
an ideal but an organizing principle: everybody needs and is
entitled to the highest possible standard of health. The principles
defined at that time remain indispensable for a coherent vision of
global health. Turning that vision into reality calls for clarity
both on the possibilities and on the obstacles that have slowed and
in some cases reversed progress towards meeting the health needs of
all people. This entails working with countries especially those
most in need not only to confront health crises, but to construct
sustainable and equitable health systems.
I urge the global health community to set its sights on bold
objectives. All countries of the world have pledged to reach the
Millennium Development Goals set at the United Nations Summit in
2000. These include ambitious targets for nutrition, maternal and
child health, infectious disease control, and access to essential
medicines. With this support we have a real opportunity now to make
progress that will mean longer, healthier lives for millions of
people, turn despair into realistic hope, and lay the foundations
for improved health for generations to come. ...
From Overview chapter
Global health is a study in contrasts. While a baby girl born in
Japan today can expect to live for about 85 years, a girl born at
the same moment in Sierra Leone has a life expectancy of 36 years.
The Japanese child will receive vaccinations, adequate nutrition
and good schooling. If she becomes a mother she will benefit from
high-quality maternity care. Growing older, she may eventually
develop chronic diseases, but excellent treatment and
rehabilitation services will be available; she can expect to
receive, on average, medications worth about US$ 550 per year and
much more if needed.
Meanwhile, the girl in Sierra Leone has little chance of receiving
immunizations and a high probability of being underweight
throughout childhood. She will probably marry in adolescence and go
on to give birth to six or more children without the assistance of
a trained birth attendant. One or more of her babies will die in
infancy, and she herself will be at high risk of death in
childbirth. If she falls ill, she can expect, on average, medicines
worth about US$ 3 per year. If she survives middle age she, too,
will develop chronic diseases but, without access to adequate
treatment, she will die prematurely.
These contrasting stories reveal much about what medicine and
public health can achieve, and about unmet needs in a world of vast
and growing health inequalities. The World Health Report 2003
affirms that the key task of the global health community is to
close the gap between such contrasting lives. ...
A key message of this report is that real progress in health
depends vitally on stronger health systems based on primary health
care. In most countries, there will be only limited advances
towards the United Nations Millennium Development Goals and other
national health priorities without the development of health care
systems that respond to the complexity of current health
challenges. Systems should integrate health promotion and disease
prevention on the one hand and treatment for acute illness and
chronic care on the other. This should be done across all levels of
the health care system, with the aim of delivering quality services
equitably and efficiently to the whole population. The lessons from
SARS and poliomyelitis eradication programmes shape strategies for
an urgent health system response to HIV/AIDS; in turn, scaling up
the attack on HIV/AIDS will do much to strengthen health care
This report argues that the key to success is health systems
strengthening, centred on the strategies and principles of primary
health care, constructing responses that support integrated,
long-term health systems development on behalf of the entire
population. This requires both effective use of existing knowledge
and technologies and innovation to create new health tools, along
with appropriate structures and strategies to apply them. Success
will demand new forms of cooperation between international health
agencies, national health leaders, health workers and communities,
and other relevant sectors.
From Chapter 1: Global Health: today's challenges
Reviewing the latest global health trends, this chapter finds
disturbing evidence of widening gaps in health worldwide. In 2002,
while life expectancy at birth reached 78 years for women in
developed countries, it fell back to less than 46 years for men in
sub-Saharan Africa, largely because of the HIV/AIDS epidemic. For
millions of children today, particularly in Africa, the biggest
health challenge is to survive until their fifth birthday, and
their chances of doing so are less than they were a decade ago.
This is a result of the continuing impact of communicable diseases.
However, a global increase in noncommunicable diseases is
simultaneously occurring, adding to the daunting challenges already
facing many developing countries.
Although this report is global in scope, the findings irresistibly
draw the main focus to the increasingly fragile health of
sub-Saharan Africa. It is here, where scores of millions of people
scrape a living from the dust of poverty, that the price of being
poor can be most starkly seen. Almost an entire continent is being
Overall, 35% of Africa's children are at higher risk of death than
they were 10 years ago. Every hour, more than 500 African mothers
lose a small child. In 2002, more than four million African
children died. Those who do make it past childhood are confronted
with adult death rates that exceed those of 30 years ago. Life
expectancy, always shorter here than almost anywhere else, is
shrinking. In some African countries, it has been cut by 20 years
and life expectancy for men is less than 46 years.
Mostly, death comes in familiar garb. The main causes among
children are depressingly recognizable: the perinatal conditions
closely associated with poverty; diarrhoeal diseases; pneumonia and
other lower respiratory tract conditions; and malaria. Becoming
more familiar by the day, HIV/AIDS, now the world's leading cause
of death in adults aged 15--59 years, is killing almost 5000 men
and women in this age group, and almost 1000 of their children,
every 24 hours in sub-Saharan Africa.
The main components of Africa's tragedy are shared by many of the
poorest people everywhere and include the agonizingly slow progress
towards the Millennium Development Goals of reduced maternal and
child mortality; the HIV/AIDS pandemic; and the double burden of
communicable diseases plus noncommunicable diseases, including the
tobacco epidemic and the avoidable deaths from road traffic
Although approximately 10.5 million children under 5 years of age
still die every year in the world, progress has been made since
1970, when the figure was more than 17 million. These reductions
did not take place uniformly across time and regions, but the
success stories in developing countries demonstrate clearly that
low mortality levels are attainable in those settings. The effects
of such achievements are not to be underestimated. If the whole
world were able to share the current child mortality experience of
Iceland (the lowest in the world in 2002), over 10 million child
deaths could be prevented each year.
Today nearly all child deaths occur in developing countries, almost
half of them in Africa. While some African countries have made
considerable strides in reducing child mortality, the majority of
African children live in countries where the survival gains of the
past have been wiped out, largely as a result of the HIV/AIDS
Across the world, children are at higher risk of dying if they are
poor. The most impressive declines in child mortality have occurred
in developed countries, and in low-mortality developing countries
whose economic situation has improved. In contrast, the declines
observed in countries with higher mortality have occurred at a
slower rate, stagnated or even reversed. Owing to the overall gains
in developing regions, the mortality gap between the developing and
developed world has narrowed since 1970. However, because the
better-off countries in developing regions are improving at a fast
rate, and many of the poorer populations are losing ground, the
disparity between the different developing regions is widening.
The African crisis of child mortality
There are 14 countries in WHO's African Region in which child
mortality has risen since reaching its lowest level in 1990. About
34% of the population under five years of age in sub-Saharan Africa
is now exposed to this disturbing trend. Only two countries outside
Africa observed similar setbacks in the same period -- countries
that experienced armed conflict or economic sanctions. Eight of the
14 countries are in southern Africa, which boasted some of the most
notable gains in child survival during the 1970s and 1980s. Those
promising gains have been wiped out in a mere decade.
The surge of HIV/AIDS is directly responsible for up to 60% of
child deaths in Africa, ...
Other Recent Reports and Statements
Platform endorsed by 200 organizations for evaluating candidates in
2004 U.S. election.
Health Gap, 2003 AIDS Year in Review
14-page summary and analysis of U.S. policy developments in 2003,
prepared by Health Gap for the November 24 March on White House
Journalists against AIDS (JAAIDS) Nigeria,
Special report: Saving the ARV programme
Reports on action by Nigerian AIDS activists to secure continued
supplies of anti-retrovirals, after a threatened interruption due
to funding gaps.
Global Health Council, Reducing Malaria's Burden: Evidence of
Effectiveness for Decision Makers
New 54-page report by Global Health Council, in collaboration with
other organizations, lays out the urgent need for increasing the
global research budget on malaria, as well as for adequate funding
for current treatments known to be effective. In the foreword to
the report, Jeffrey Sachs of Columbia University notes that it is
possible "to reduce the burden of malaria dramatically, through
greatly scaled-up investment in both prevention and treatment."
Kaiser Family Foundation,
Global Funding for HIV/AIDS in Resource Poor Settings
http://www.kff.org [no usable link to report; use search on site to
23-page detailed report on funding, including estimates of funds
dispersed as well as budget commitments, from both multilateral and
University of California, San Francisco,
Country AIDS Policy Analysis Project
Includes detailed country-level reports prepared in 2003 with most
recent data available. The most recent is Uganda, released in
November. Also includes Ethiopia, Malawi, South Africa, Zambia, and
Zimbabwe, as well as Cambodia and India.
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