HEALTH FOR ALL
A GLOBAL COMMITMENT
Just because he was fortunate enough to be born in Italy, Marco has the opportunity to live twice as long as his native African peer, Elmano, to study in quality schools, have access to secondary education, eat a greater quantity and variety of foods, and obtain access to appropriate and modern healthcare. We need to be aware of this, to fight against this injustice, and to take advantage of our privileged position to rebalance these inequalities.
EDITED BY ELISABETTA BERTOTTI
DOSSIER: HEALTH FOR ALL
HEALTH IN NUMBERS A NEW GEOGRAPHY OF THE PLANET To observe the world from another perspective, based not on borders of geography but on the confines that circumscribe the phenomena affecting the various countries. Source: www.worldmapper.org
INFANT MORTALITY Infant mortality is defined as the number of deaths within the first year of life. In 2002, there were 7.2 million deaths throughout the world, 24% of which were in India. As we can see from the map, Africa is highly afflicted by infant mortality, with one death per 10 live births in as many as 22 territorial areas. Sierra Leone holds the unflattering distinction of 16.5 infants per 100 live births. These deaths are cause for reflection, particularly considering that most result from diseases which could easily be prevented by vaccination, mosquito nets, improved hygiene and other simple forms of prophylaxis. (Source: www.worldmapper.org)
MATERNAL MORTALITY Each year, over 500,000 women die from complications related to pregnancy and childbirth which could be easily prevented and treated. Of these, 85% are in Asia and sub-Saharian Africa, where there are few measures to protect reproductive health and the number of unassisted births remains high, particularly in rural areas. (Source: The Millennium Development Goals Report, 2006)
II | ĂˆAFRICA DOSSIER | JANUARY 2009 |
DOSSIER: HEALTH FOR ALL
MALARIA Over one million people die from malaria each year, particularly infants, women and children. The African continent is once again the most affected, accounting for 92% of all cases of malaria and 94% of deaths throughout the world in 2003. (Source: www.worldmapper.org)
PREVALENCE OF HIV/AIDS The number of people affected by HIV/AIDS rose between 2003 and 2005 from 36.2 million to 38.6 million, with 2.8 million deaths attributable to the virus in 2005. Most deaths from HIV/AIDS occur in sub-Saharian Africa, where just over 10% of the world population accounts for 64% of all cases of HIVpositivity and 90% of all children aged under 16 years affected by the virus. Twelve million children in sub-Saharian Africa are orphans and approximately 59% of HIV-positive people (13.2 million) are women. (Source: The Millennium Development Report)
DOCTORS AT WORK In 2004 there were 7.7 million doctors at work throughout the world. 50% of them were based in areas with less than one fifth of the world population, while the poorest, most highly populated areas were served by only 2% of all physicians available globally. (Source: www.worldmapper.org)
| JANUARY 2009 | ĂˆAFRICA DOSSIER | III
DOSSIER: HEALTH FOR ALL
THE PROBLEM OF AVOIDABLE AND UNJUST DIFFERENCES N A GLOBALIZED WORLD,
characterized by an intense exchange of people and goods, national boundaries are no longer obstacles to the spread of health and disease. Irrespective of where we live, therefore, our well-being is highly conditioned by the way in which health issues are addressed internationally. Examples are the spread of emerging and re-emerging infectious diseases, poor, inefficient healthcare systems, natural, food and humanitarian crises, and growing inequalities. All have a major impact on the health of all world populations.
In that case, why talk of global health? “Because it is a problem that closely affects all of us and to emphasize that we all share the related problems; because we would like to draw attention to the need for collective action; to defend, protect and promote health, which we consider to be a fundamental human right, guaranteed by international legislation, a state on which economic development and the reduction of poverty depends,” responds Serena Foresi, Head of the Supporting Groups Department of Doctors with Africa Cuamm and of the project “Equal opportunities for health: action for development”. She continues, “The Declaration of Human Rights states that, ‘everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services’. Health must increasingly be defined in its widest sense, not merely as the absence of illness or infirmity but as a ‘fundamental human right, a state of physical, mental and social well-being’, to quote the definition drawn up by the World Health Organization. Accordingly, the defence, protection and promotion of health for all carries ethical and moral connotations. To address the challenges and take up opportunities in a globalized world, the concept and approach to health must also become global”. IV | ÈAFRICA DOSSIER | JANUARY 2009 |
“I got sick because I’m poor”. “Well, I got poor because I’m sick”. Source: M. Whitehead, et al, Equity and health sector reforms
Is it a question of justice? “Of course. While each individual has a recognized right to enjoy the highest achievable standard of health and, globally, there has been a general improvement in health conditions, inequalities are also increasing not only among the various nations, particularly across the so-called North-South divide, but also within countries themselves. This can be exemplified by just a few data. Take for instance the 48 years’ difference in life expectancy between the inhabitants of Japan and those of Sierra Leone; the 11 million children under five years of age
who die every year, prevalently in developing countries, often from diseases which can be easily treated and prevented, such as diarrhoea; the fact that 99% of deaths related to child birth occur in developing countries, with a prevalence of 900 deaths per 100,000 live births in Africa versus 3.9 deaths in Europe. Further, the fact that the more wealthy sectors of the population in India and the Philippines have three times greater access to healthcare services than do the more vulnerable sectors; that in England labourers live on average seven years less than professionals; that in Italy the people with higher educational qualifications are twice as likely to receive a kidney transplant than are those with a lower educational level. It takes just a few examples to clearly describe these avoidable and therefore ethically and morally unjust differences”. Poverty and medicine: is there a sort of trap… “Unfortunately, this is the case. There is a strong correlation between poor state of health and poverty. Vulnerable, economically and socially disadvantaged people are in fact more susceptible to disease and have more limited access to healthcare, leading to further regression and intensifying their poverty. The poor often end up having to pay for healthcare, thereby further jeopardizing their long-term survival, considering that medical expenses are often compulsory payments. Families go into debt, are forced to sell their capital (a piece of land or animals), borrow money or waive other essential expenses, as the education of their children,” adds Serena Foresi. “The commitment to change this situation, break the vicious circle, reduce inequalities and meet essential human needs therefore becomes a question of social justice that concerns all of us”.
DOSSIER: HEALTH FOR ALL
TO GIVE EVERYONE THE SAME HEALTH OPPORTUNITIES
have a responsibility and a duty to undertake concrete and bold actions to bring about the changes needed to guarantee each man, woman and child equal access to basic healthcare. The year 2008 marks the thirtieth anniversary of the Declaration of Alma-Ata, the final document produced by the Conference on basic healthcare held in 1978, which confirmed that each individual has a right to the maximum possible standard of health. Moreover, 2008 is the year for assessing progress towards accomplishment of the Millennium Goals. However, there is still a long way to go before the slogan “health for all” really translates into practice. OVERNMENTS AND WORLD LEADERS
This is why we are committed, at various levels, to building awareness and to providing information on global health themes and to increasing the political and institutional support needed to draw up fairer healthcare policies.
THE MILLENNIUM GOALS AND HEALTH
“There is no longer any point in making a distinction between national and international health problems” Source: www.tz.undp.org
Gro Harlem Brundtland (Director, World Health Organization, 1998-2003)
In September 2000, at the UN Millennium Summit, the leaders of 189 rich and poor, industrialized and non industrialized countries committed their nations to an ambitious global partnership aimed at reducing extreme poverty and inequalities through eight Millennium Development Goals (MDGs): MDG 1
Eradicate extreme poverty and hunger
Achieve universal primary education
Promote gender equality and empower women
Reduce child mortality
Improve maternal health
Combat HIV/ AIDS, malaria and other serious infectious diseases
Ensure environmental sustainability
Develop a global partnership for development
Clearly, three of the eight goals are directly associated with health, i.e.: the reduction of two-thirds of mortality in children under five years of age by 2015, the reduction of three-quarters of maternal mortality, and the fight against the spread of HIV/AIDS, malaria and other widespread diseases. Added to these are other, not strictly healthcare goals, but which have a major impact on health, as the reduction in the number of people who suffer from hunger, and improved access to sources of drinking water.
| JANUARY 2009 | ÈAFRICA DOSSIER | V
THE ROLE OF CIVIL SOCIETY Civil society plays a fundamental, active, responsible role in the promotion of the right to health. It may be committed in particular to the dissemination of information on global health themes and health equality, awareness building and education in development. By mobilizing public opinion as a whole, civil society undertakes lobbying and advocacy activities, thereby pressuring policy makers to put healthcare policies that ensure health for all into place and to allocate adequate financial resources.
THE HEALTHCAR PROFESSIONALSâ€™ ROLE: EFFECTIVE OPINION MAKERS In order to provide the right skills to address the challenges of a globalized world, e.g. to deal with patients from different geographical backgrounds or treat new or re-emerging transmissible diseases, it has become essential to train and update healthcare providers on the subjects of global health. In addition, considering their social and professional role, healthcare professionals may play an important role in spreading information and as opinion makers. In other words, they could act as a pressure group to promote a global approach to health and fairer health policies, thereby becoming activists in promoting the right to health and the elimination of those determinants that prevent this right from being fully realized.
INTERNATIONAL HEALTH COOPERATION International health cooperation may curb inequalities in health by impacting on health determinants and assisting, but not replacing, local healthcare systems to aid their consolidation, at hospital level (in governance, management and clinical practice), in the local community and district facilities, in the family and community, and in terms of human resources. VI | ĂˆAFRICA DOSSIER | JANUARY 2009 |
DOSSIER: HEALTH FOR ALL
THE PROPOSAL BECOMING ADVOCATES OF THE RIGHT TO HEALTH EQUAL OPPORTUNITIES FOR HEALTH: ACTION FOR DEVELOPMENT A COMMITMENT TO THE PROMOTION OF GLOBAL HEALTH WHO ARE WE?
A network of 29 partners and associates representing the medical-healthcare community – including universities, research centres, medical associations and hospital authorities, non governmental organizations and associations – belonging to six European countries (Italy, Germany, Poland, Great Britain, Belgium and Spain).
WHAT IS OUR GOAL?
We operate synergically to mobilize civil society in general and healthcare providers in particular, and to promote a movement for the right to health at global level.
WHO DO WE ADDRESS?
Medical schools, representatives of local healthcare units, hospital authorities and research centres, scientific societies and medical and healthcare associations, representatives of non governmental organizations and associations committed to the promotion of the right to health.
WHAT DO WE DO?
> Training - Mapping of university courses in global and international health and assessment of training needs. - Development of a study course on global health and related training materials - Training of global health trainers. - Setting up of optional undergraduate courses in global health at medical schools. - Training seminars on global health at local medical associations and hospital authorities. - Informative and awareness-building seminars at congresses held by scientific societies. > Awareness building - Training of local promoters and activists. - Organization of events at universities and at community level. > Lobby e advocacy - Organization of an international conference to promote themes central to the project. > Communications - Development of an area dedicated to the project on www.mediciconlafrica.org/globalhealth. - Production of informative and training materials. - Publications.
| JANUARY 2009 | ÈAFRICA DOSSIER | VII
WE ARE CONVINCED THAT HEALTH IS NOT A CONSUMER GOOD, BUT A FUNDAMENTAL HUMAN RIGHT. AS SUCH IT CANNOT BE BOUGHT AND SOLD. SINCE HEALTH IS A RIGHT, ACCESS TO HEALTHCARE SERVICES CANNOT BE A PRIVILEGE. SINCE HEALTH IS A RIGHT, FIGHTING FOR ITS UNIVERSAL RECOGNITION IS A DUTY.
In partnership with:
Italian Global Health Watch (IT)
Department of Medicine and Public Health, University of Bologna (IT)
In association with:
Department of Public Health - University of Florence (IT)
Secretariat of Italian Medical Students SISM (IT)
University of Leeds Nuffield Centre for International Health and Development - University of Leeds (UK)
“Redemptoris Missio” Foundation (PL)
action medeor e.V. (DE)
Institute of Tropical Medicine Prince Leopold of Antwerp (BE); Medicus Mundi Spain (ES); ONSP – National Observatory of Residents in Paediatrics (IT); IPASVI Padua College of Nurses (IT); Medical Association of the Province of Padua (IT); Padua Hospital Authority (IT); Department of Environmental Medicine and Public Health, University of Padua (IT); Department of Public Health and Microbiology, University of Turin (IT); Department of Internal and Specialist Medicine, University of Catania (IT); Department of Experimental and Environmental Medicine and Biotechnologies, University of Milan (IT); IRCCS Burlo Garofolo, Trieste (IT); Doctors with Africa Cuamm Supporting Groups (IT).
VIII | ÈAFRICA DOSSIER | JANUARY 2009 |
This publication has been produced with the assistance of the European Union. The contents of this publication are the sole responsibility of Doctors with Africa Cuamm and can in no way be taken to reflect the views of the European Union.