Yoko Akachi Research Fellow Global Health and Development
MDGs to SDGs: the role of health Source: UN
Change in under-5 mortality rate between 1990 and 2015 Source: WHO
Trends in the under-5 mortality rate and number of under-5 deaths Global, regional, and national levels and trends in under-5 mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Inter-agency Group for Child Mortality Estimation http://dx.doi.org/10.1016/S0140-6736(15)00120-8 Lancet 2015, Available online 8 September 2015
Development assistance for health by health focus area, 1990-2014 Source: Sources and Focus of Health Development Assistance, 1990 – 2014 JAMA. 2015;313(23):2359-2368. doi:10.1001/jama.2015.5825
Gaps in achieving the MDG targets • Big picture: Links among development, inequality, and health? • Zooming in: – What interventions contributed to reductions in mortality? – How can the aid for health be used more efficiently? Source: WHO
What key intervention coverage is associated with child mortality? Ghana • 75 DHS surveys 1991-2013 Key intervention coverage by region Ashanti Brong Ahafo Central Eastern • 241 sub-national regions of 24 1 1 1 1 .09 .1 .12 .07 .08 .11 .068 .08 .5 .5 .5 .5 .07 .1 .066 .06 .09 sub-Saharan African countries .06 .064 .08 0 0 0 0 .05 .04 .062 1990 2000 2010 1990 2000 2010 1990 2000 2010 1990 2000 2010 (550,000 children under 5) Greater Accra Northern Upper East Upper West 1 1 .13 1 .12 1 .12 .065 .06 .12 .1 .1 • .5 .055 .5 .11 .5 .5 .08 .08 Bednet coverage, water and .05 .1 .06 .06 .045 .09 .04 0 0 0 0 .04 .04 sanitation infrastructure , 1990 2000 2010 1990 2000 2010 1990 2000 2010 1990 2000 2010 vaccination coverage , Volta Western 1 1 .1 .09 .08 .08 institutional deliveries, modern .07 .5 .5 .06 .06 .04 .05 .04 0 0 .02 contraception usage, antenatal 1990 2000 2010 1990 2000 2010 ea Y r v su r ey w as r t t a s ed care , breastfeeding practices (mean) bednets3 (mean) bontoilet (mean) pipwater (mean) anc • (mean) onlymilk (mean) vaccine Regional fixed effects and country (mean) death time trends Graphs by region Source: DHS
Links among health, income, and poverty • Wealth to health – Increases in income per capita – Improvements in health technology, institutions and infrastructure Economic development could lead to better health of the • population, but the arrow is Health to wealth bidirectional: better health contributes to economic – Microeconomic studies (e.g. development deworming, iron supplements) – Improved health central to poverty reduction • Labor productivity, education, investment, demographic channels
Demographic transition • When looking into development, you have to consider population growth rate and age structure • Countries can experience “demographic dividend” – Demographically driven, time- limited economic boom – e.g. East Asia in 1965-1990 David E. Bloom Science 2011;333:562-569 Published by AAAS
Age structure of (A) East/Southeast Asia and (B) Sub-Saharan Africa 1950 to 2050 David E. Bloom Science 2011;333:562-569 Published by AAAS
Investing in reproductive, maternal, and child health • Childhood health and nutrition can have a substantial impact on both physical and Childhood health strongly cognitive development, and eventual affect the health status and health status and productivity as an adult productivity as an adult • Health investments in children and mothers (fetal growth) most important for human capital • Inter-generational effect (e.g. under nutrition of mothers affecting their children of either sexes) • Investing in health of mothers and And ultimately determines children means investing in the country’s the health and well-being of economy and future the next generation
Measuring health in research • • Indicators of health and well- Sources of health data being: “biological” and – Censuses “economic” standard of living – Population surveys • Health is multi-dimensioned – Civil registration – Mortality versus morbidity – Institution based individual and • Physical measures such as birth service records weight, stunting, wasting, adult – Data collected specifically for height medical/epidemiological studies
Continuing to the next presenters • • Investment case for health to Major global shift of attention heads of state and Ministry of towards NCDs Finance • Measuring health and the • Innovative mechanisms to aid multi-disciplinary nature of health (e.g. results-based research blending financing) epidemiology, medicine, public health and economics • Externality of health -budgeting for health when the benefit goes beyond health
www.wider.unu.edu Helsinki, Finland
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