Health andDevelopment: the African Context

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• Health and Development the African Context
• ECON 3510
• June 2 and 4, 2009
• Text, Chapter 9
• A. R. M. Ritter

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• Outline
• Some General Features of Health in Africa
  History, Ecology and Epidemiology
• What is Health Definition and Measurement
• Some Health Indicators for Sub-Saharan Africa
• Determinants of Health Levels
• Interrelations between Health Development
• Global Trends and Transitions
• Policies

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1. Some History

• Pre-Colonial Era
• Traditional healing
• Colonial Era
• Formal health systems designed originally to meet
  demands of European communities
• Missionary led broadening of medical attention to
  African population
• Consideration of public health measures when
  necessary to prevent epidemics from hitting the
  European populations
• Minimal development of formal medical system for
  African populations

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• Post-Independence Systems
• Beginning from low bases
• Variation among countries differing emphases on
  public and private delivery, and on market vs.
  governmental emphases
• Rapid expansion of public expenditures on health
• from 0.7 in 1960 t0 2.4in 1990
• Institution Building
• Personnel upgrading
• Problems from rapid expansion and resource
  insufficiencies

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Major Diseases Affecting Africa

• Malaria 270 million infected
• mortality 500,000t0 1,200,000 per year, mainly
  children
• Bilharzia or schistosomiasis
• Measles
• Diarrhea
• Tuberculosis
• Elephantiasis
• River blindness
• Leprosy
• HIV/AIDS

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• Neglected Tropical Diseases
• 1, Hookworm
• 2. Ascariasis
• 3. Trichuriasais
• 4. Elephantitis

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• 5. River Blindness
• 6. Bilarzia/Schistosomiasis
• 7. Trachoma

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Neglected Tropical Diseases (NTDs)
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2. What is Health Definition and Measurement

• A. Definition
• WHO
• A state of complete mental, physical and social
  well-being (not just the absence of disease)

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• Measures
• Mortality
• Infant mortality
• Under 5 mortality
• Maternal mortality
• Morbidity
• Sickness rates
• Disability rates
• Stunting of Children

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• Life Expectancy
• Health Services Coverage
• childhood immunization
• Health System
• doctors nurses per 1,000 people
• hospital beds per 1,000 people
• medical costs as of GDP
• Nutrition measures
• Environmental Risk Factors
• access to water sanitation

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3. Some Health Indicators for Sub-Saharan
Africa I
World Bank, World Development Indicators, 2009
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Some Health Indicators for Sub-Saharan Africa II
World Bank, World Development Indicators, 2009
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Some Health Indicators for Sub-Saharan Africa
III
World Bank, World Development Indicators, 2009
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Life Expectancy
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Denmark
Sierra Leone
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Hans Rosling on HIV New facts and data visuals

• Hans Rosling unveils new data visuals that
  untangle the complex risk factors of one of the
  world's deadliest (and most misunderstood)
  diseases HIV. He argues that preventing
  transmissions -- not drug treatments -- is the
  key to ending the epidemic.
• http//www.ted.com/index.php/talks/hans_rosling_th
  e_truth_about_hiv.html

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4. Determinants of Health Levels

• Nutrition quantity, quality, balance.
  Micro-nutrients
• Thence, good agriculture and/or a strong economy
  to generate food imports
• Reasonable income distribution and poverty levels
• Clean Water
• Sanitation
• Self-Help within the home, especially supportive
  of Children
• Education re health, especially for Mothers
• Medical System
• Personnel
• Institutions hospitals, dispensaries, medical
  schools
• Public health organizations

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5. Health and Development

• Health an obvious central element of human
  well-being
• Included in UNDPs HDI
• Development (higher incomes well-distributed)
  promotes health
• Higher family incomes permit
• Better nutrition more and better food
• Better basic sanitation, water and shelter
• Better access to medicines and self-help medical
  care
• Better treatments (mosquito nettings)
• Higher National Income permits
• Better public health
• Better water sanitation and pollution control
• Better health systems
• Importance of Equity of Income Distribution and
  Poverty Elimination for achieving Health
  objectives

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• Better Health promotes Development
• Good Physical and Mental Health ends in
  themselves
• Healthy people are more productive
• note impacts of AIDS, Malaria, River Blindness
  etc. in Africa
• (Reduce work time, energy on the job, productive
  lives)
• Health and physical mental energy
• Healthy people live longer have longer
  productive lives
• Spend less on treatment and more on other things
• Good Health improves childrens learning
• Good Health increases life-time earnings,
• and therefore life-time savings and investment
• Bad Health promotes personal, family and national
  Impoverishment
• Bad health worsens income disparities
• (the health of the poor is worse than that of the
  better off.)

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• HALE Health Adjusted Life Expectancy
• adjusts life expectancy by the years spent with
  disabilities
• weighted according to severity and duration

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• 6. Global Trends and Transitions
• Life Expectancy
• The Epidemiological Transition
• Age of Pestilence and Famine
• Stage 1, Theory of the Demographic Transition
• Age of Receding Pandemics
• Stages 2 and 3, Theory of D.T.
• Age of Human and Man-Made Diseases
• Re-entry into an Age of Disease???
• Ebola, HIV/AIDS, SARS
• TB malaria etc resistant to anti-biotic
  treatment?

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World Population
Age 4?
Age 2 and 3
Age 1
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www.ldeo.columbia.edu/edu/dees/V1003/imagres/demog
raphic .transition2
Age 4?
Age 3 ?
Age 2
Age 1
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Policies

• International Actions
• halt international contagions
• deal with international scourges such as
  AIDS/HIV, Malaria, TB, and neglected tropical
  diseases
• support health budgets of lower income countries
• Roles for UN, WHO, PAHO,
• Donor Agencies,
• Foundations,
• NGOs

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• 2. National Level Foster an Enabling Environment
• Poverty reduction income increases so that
  people can help themselves more effectively
• Formal education economic opportunity, esp. for
  women
• Use of the media
• 3. National Level
• Nutrition Emphases
• Water sanitation priorities

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• 4. Public Health Programs
• Prevention promoting healthy behaviour
  (smoking, drugs, alcohol.)
• Immunization systems
• Taxes price controls (cigarettes alcohol)
• Integrated reproductive health and early
  childhood care
• Build Institutions at all levels rural
  dispensaries nursing stations a hierarchy of
  facilities, medical schools.
• 5. Focus on equitable coverage, rural/urban,
  gender, regional, covering all income groups
• De-emphasize high-tech specialities
• De-emphasize high-cost high-tech service for the
  elites

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• Some Success Stories
• Expansion of health care in Africa since
  Independence
• General improvements in health indicators in
  Africa
• Global Small-Pox eradication
• 3. Improving Diarrheal Dehydration Death
  Prevention
• Slowing AIDS in Uganda
• But there is still a very long way to go.
• The Future
• grounds for optimism
• And pessimism
• Possible climate change may impact harm health
  directly, and may worsen agriculture