Health and society
Women, children and other marginalised groups are particularly susceptible, with millions dying from preventable causes every year.
Medicine in the Western world has increasingly focused on the treatment of sickness at the individual level but the new millennium has shifted the gaze towards public health and considering death and disease at a population level.
This is of particular relevance for poorer countries, but even the West cannot escape its own emerging public health crises resulting from obesity, tobacco and alcohol consumption.
Public health challenges
Many of the fundamental issues impacting the health of the poor are not new – poor nutrition, poverty, lack of clean water and sanitation facilities, limited education and overcrowding.
We continue to see substantial inequalities in health outcomes between the richest and the poorest countries. Within countries social gradients in health vary between the richest and the poorest in society. Women and children continue to be disproportionately affected by disease and ill-health.
The world, however, also faces new public health challenges – chronic diseases associated with smoking, alcohol and obesity and traditionally classified as «western» health problem, are on the increase in low and middle income countries.
We see rising levels of mental ill-health that cannot be ignored. New diseases have emerged such as HIV/AIDS and, more recently, SARS, highlighting the need for global cooperation to tackle and limit their spread.
The role of prevention
Preventing ill-health is generally considered to be less resource intensive than treating ill-health. When we consider that many of the diseases associated with poverty could be prevented through relatively simple measures such as hygiene, better nutrition, education, behaviour change and vaccination, the challenge is not what to do, but how to do it.
Vaccination is an extremely cost-effective means of saving lives and yet as many as 24.1 million babies are not vaccinated against common diseases. (WHO 2008/GAVI website). As a result, vaccine-preventable diseases are estimated to cause more than 2 million deaths every year (REF). Norway gives considerable financial support to the GAVI alliance in the fight against vaccine preventable diseases.
The global food and financial crises disproportionately impact the poor – food is more expensive and the opportunities to earn money to pay for basic staples are more limited. Adequate nutrition during the first years of life is crucial for child development and better health; encouraging women to breastfeed can improve health outcomes for young children (REF), but that is also dependent on the the mother getting enough to eat.
Basic education is something else we take for granted in the West. Research points to a link between education and health (REF) – especially for women and young girls whose level of education can directly influence the health of their children. Norway currently supports the UN Girl’s Education Initiative which supports governments working towards improving the quality and availability of girls’ education. In addition society in general may benefit if these women go on to become health workers.
There has been a great deal of focus on the role of the social determinants of health – these are the social, political and economic forces that can, in part, explain the considerable inequalities in health that exist today.
The Commission on Social Determinants for Health was established by WHO in order to support countries and global health partners to address the social factors leading to ill health and inequities.
The final report of the Commission had three main messages:
- To improve daily living conditions – especially in early life and for women.
- To aim for more equitable redistribution of money, power and resources, reflecting the way society is organized. This requires strong governments and better governance.
- To measure and understand the problems that result in inequities. We can use this "evidence" to effect informed policy changes that themselves should be studied further to see if they had the intended effect and why.
The challenges ahead
The Millennium Development Goals focus on reducing death and disease amongst specific groups (MDG 4&5) and from specific illnesses (MDG 6) but also look at many of the social determinants of health (MDGs 1, 2, 3 & 4). The MDGs have an implicit aim to strengthening health systems in poorer countries and an explicit focus on reducing economic and trade barriers that hinder them from providing good healthcare to their populations (MDG 8).
As the 2015 target date for achieving the goals approaches – there are many countries who are not on track to meet them. The challenge is to strengthen public health systems to meet the needs of a globalised world, in particular those countries disproportionately affected by disease, death, poverty, natural disasters or conflict. This is our challenge.