Improving health and reducing mortality are major objectives of development, according to the Millennium Development Goals (MDGs). However, the health-related MDGs focus on the causes of a small share of deaths worldwide and are relevant mainly for low-income countries. Ensuring health improvements on all fronts are therefore crucial.
The 43rd session of the Commission on Population and Development, which takes place from 12-16 April, will focus on “Health, Morbidity, Mortality and Development”. The Commission will look at the significant reduction in mortality that has occurred over in the last five decades and notes that the reduction, and the increase in life expectancy, is associated with a shift in the cause of death from communicable to non-communicable diseases.
A major topic of this year’s Commission will be the link between income and health. Previous reports of the Commission have observed that there is a persistent association between increasing incomes and better health. However, at the country level, health improvements have begun to occur without major changes in income. Such achievements can be repeated by combining an intersectoral approach to disease prevention with measures to strengthen health-care delivery in a sustainable manner, particularly by ensuring that health systems have comprehensive primary health care at their core.
The unprecedented decrease in worldwide mortality is a great human achievement. Some of the factors contributing to this decrease include higher calorie intake made possible by rising agricultural productivity, better hygiene facilitated by improvements in sanitation and access to safe drinking water, the development of insecticides, and the many breakthroughs in medical technology leading to cost-effective public health interventions and effective treatments. All of them have contributed to reduce the incidence of disease at younger ages and prevent death when disease strikes.
Communicable and non-communicable diseases
A major factor in the remarkable increase in longevity has been the control of the spread of communicable diseases and the use of effective medicinal drugs to treat them. This has resulted in a transition in terms of causes of death from being preponderantly communicable diseases to being dominated by non-communicable diseases.
By the 1970s, even in the absence of sustained economic growth, the major infectious and parasitic diseases that had affected humanity for centuries were being successfully controlled or treated. Most communicable diseases are preventable, treatable or curable with low-cost interventions.
However, progress towards achieving a complete eradication of communicable diseases is falling short and the MDGs do not address all those diseases. The key interventions to combat the major communicable diseases include HIV/AIDS, tuberculosis, malaria, neglected tropical diseases, communicable causes of child mortality and maternal conditions.
On the other hand, non-communicable diseases still cause 60 per cent of deaths worldwide and 72 per cent of those in middle-income countries, and their share of the burden of disease is expected to increase in the future. Among them, cardiovascular diseases, cancers, chronic respiratory diseases, diabetes and depression represent the leading threats to human health and development.
Non-communicable diseases pose a major economic and social burden because most are chronic and require long-term treatment. Yet, up to 80 per cent of heart disease, stroke, type 2 diabetes and over a third of cancers could be prevented by eliminating shared risk factors, especially tobacco use, unhealthy diets and physical inactivity.
In addition, advances in biomedical and behavioural management have substantially increased the ability of interventions to prevent and control these diseases, especially when effective treatments, self-management support and regular follow-up are provided. Tobacco use is the single most preventable cause of death in the world since it is a risk factor for all the major non-communicable diseases.
Strategies to strengthen health systems
The Commission’s reports include a number of recommendations, calling for strengthening of health systems, especially the training of health workers. Shortages of health workers are severe in many low-income countries but also exist in high-income countries because of the increasing burden of chronic disease among their ageing populations. There is a need for concerted efforts at both the national and international level to train an adequate supply of health workers, ensuring that training produces the variety of skills needed and that it is oriented to the contexts in which health workers are required.
Devising incentives for health workers to take jobs and remain in underserved areas, especially the rural areas of developing countries, is also necessary. Donor funding can assist Governments of low-income countries to implement national plans on health workforce retention and development. High-income countries should follow responsible recruitment practices in order not to exacerbate the shortage of health workers in low-income countries.
A key strategy is to strengthen health systems to ensure that they can deliver the services that communities require, including not only curative care and the treatment of acute conditions but also preventive care, health promotion and the long-term management of chronic conditions. A comprehensive primary health-care approach offers a flexible framework to achieve these objectives.
To be comprehensive, primary healthcare must integrate individual and population-based care, blending the clinical approach with epidemiology, preventive medicine and health promotion. It should be the basis of a district health system, with capacity to treat most cases and adequate referral support from secondary- and tertiary-care facilities. It should ensure a holistic approach to health maintenance, disease prevention and the management of chronic conditions through interdisciplinary practice and continuity of care.
In conclusion, ensuring health improvements on all fronts, including mortality trends, cause of death, the burden of disease, health and development, the role of primary health care, the need for health workers, prevention and treatment of communicable diseases and maternal conditions, prevention of non-communicable diseases and preventing injuries are, therefore, crucial.
More information on 43rd session of the Commission on Population and Development
