Deaths in developing countries
Two out of three deaths among children and young adults
in Africa and South-East Asia are due to seven causes
(ages 0-44)

 

A massive effort for better health among the poor

Global health has moved higher up the political agenda today as governments become increasingly aware that health is key to poverty reduction and development. Leaders of the G8 industrialized nations have recently added their voice to increasing global concern at the impact of infectious diseases in developing countries - endorsing the 10-year targets for reductions in the disease burden of HIV/AIDS, TB, and malaria which have been established by heads of state. The G8 leaders, meeting in Okinawa, Japan, in July 2000, committed themselves to making it possible to meet the 2010 health targets: to halve TB deaths and the prevalence of the disease; to halve the burden of disease associated with malaria; and to achieve a 25% reduction in the number of HIV/AIDS-infected young people.

Since then, the European Commission has adopted a new policy framework on accelerated action against HIV/AIDS, malaria, and TB, in the context of poverty reduction. Meanwhile, the United States Government has warned of the global security threat posed by infectious diseases --which risk exacerbating social and political instability in key countries and regions.

Over the past year, UN agencies (including WHO, UNAIDS, UNICEF, UNFPA, UNESCO), the World Bank, national governments, and a broad range of development partners have examined how the year 2010 health targets can be met. And in December 2000, the G8 leaders meet again in Okinawa, to deliver agreement on a new strategy to meet these targets. A broad range of new partnerships are needed to create a powerful social and political movement worldwide, based on informal coalitions of partners from both the public and private sectors, NGOs, and other development partners, to scale up the use of current interventions for disease control, help accelerate the development of new tools, and push for reductions in the price of urgently needed drugs and vaccines. The initiatives are intended to help reduce poverty through efforts to reduce the excessive burden of illness and premature deaths among the poor.

The boundaries of health service provision need to be extended --engaging public and private sector partners in efforts to reach the millions of people with no access to the health services or commodities they need. A quantum leap forward is needed, not only in scale but in the level of funding required and in the use of innovative ways of delivering health care.

National governments will be at the centre of these efforts, which are intended to strengthen --not undermine- existing health service provision. If the massive effort is to be sustainable it will require concerted efforts to strengthen the capacity of national health systems --not only to effectively deliver essential commodities and services but also to set priorities in response to health needs, to ensure equity in the provision of goods and services, and to work in partnership with other sectors, while ensuring effective stewardship of health care.

In addition, efforts will be needed to increase people's control over their own health --through ensuring that people are aware of and seek access to available health interventions and services. Above all, the new partnerships will build on the experience of what works best-- drawing on the experience of the success stories featured here.

New donors need to be attracted and a major increase in the current low level of development assistance for health needs to be mobilized. The emerging political commitment to address poverty and ill-health provides a unique window of opportunity for global action to reduce the burden of disease and help lift the poorest people out of poverty.

The challenge ahead is to:

  • target the health conditions that have the greatest impact on the well-being of the poor (including HIV/AIDS, malaria, TB, childhood infections, and reproductive health conditions)
  • work through existing partnerships (such as the International Partnership Against AIDS in Africa, Stop TB, Roll Back Malaria, and Making Pregnancy Safer) to identify the most effective health strategies for different settings, based on the best available evidence
  • reduce barriers to implementing strategies and ensure wider access to key interventions, in ways that involve poor populations
  • establish new mechanisms within countries to make use of the most effective channels to ensure that the poor have access to life-saving interventions
  • establish independent systems to monitor progress and impact
  • encourage government stewardship and strengthen health and other systems to improve service delivery
  • make use of poverty reduction strategies and sector-wide approaches
  • work through partnerships with civil society and the private sector
  • strengthen local and national capacity
  • encourage intensified efforts to research and develop new diagnostics, medicines, and vaccines, and better public health approaches
  • review the interaction between international trade practices and public health
  • develop new relationships with the pharmaceutical industry (including the possibility of ÒtieredÓ pricing for different markets)
  • increase political action to ensure that globalization benefits the poor.

ABBREVIATIONS
AIDS: Acquired Immunodeficiency Syndrome
AMREF: African Medical Research Foundation
ARI: Acute Respiratory Infections
DFID: Department for International Development (UK)|
DOTS: Directly Observed Treatment Short-course
EPI: Expanded Programme on Immunization
GDP: Gross Domestic Product
HIV: Human Immunodeficiency Virus
IFRC: International Federation of Red Cross and Red Crescent Societies
IMCI: Integrated Management of Childhood Illness
NGO: Non Governmental Organization
ORT: Oral Rehydration Therapy
PHC: Primary Health Care
RBM: Roll Back Malaria
STI: Sexually Transmitted Infections
TB: Tuberculosis
UN: United Nations
UNESCO: United Nations Educational, Scientific and Cultural Organization
UNICEF: United Nations ChildrenÕs Fund
WB: World Bank
WHO: World Health Organization

Project Manager Agnes Leotsakos
Writer and Editor Sheila Davey
Editorial Advisors Kraig Klaudt, Elil Renganathan, David Heymann
Technical Input WHO Programme on Communicable Diseases, Family and Community Health,
Health Technology and Pharmaceuticals, Evidence and Information for Policy, UNICEF, UNAIDS
Art, Design and Publication Consultant Fokion Kopanaris
Photographs WHO, V&B/Polio, TDR, and UNAIDS Photo Libraries, Jad Davenport, Gary Hampton, Heidi Larson, Michael Midgley, Julie Graber.

© 2000 Communicable Diseases/ World Health Organization

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