Health and environment ministers in Africa have resolved to build a strategic alliance to reduce environmental threats to human health and well-being.

Following the conclusion of an historic gathering in Gabon, the ministers signed and adopted the Libreville Declaration which commits governments to take measures to stimulate the necessary policy, institutional and investment changes that should be effected to optimize synergies between health, environment and other relevant sectors.

“The signing of this landmark declaration," said Dr Luis G. Sambo, Regional Director of WHO Regional Office for Africa, "is the first step towards saving the lives of millions of people from the harmful effects of changes in the environment. We will work together to promote strategic alliances between health and environment. I am delighted that we have managed to secure political commitment to catalyse institutional changes needed to improve the health and well-being of communities in the region.”

After deliberations on a range of issues, delegates were convinced that the root causes of global environmental degradation are embedded in social and economic problems such as pervasive poverty, unsustainable production and consumption patterns, inequity of distribution of wealth and the debt burden. These result in malaria, tuberculosis, cholera, typhoid, dracunculiasis, helminthiasis, schizosomiasis, asthma, bronchitis and heart diseases that are taking their toll on millions of people living in the region.

"The Libreville Declaration is a milestone for Africa. Nowhere is the human health impact of environmental threats more urgent," said Dr Maria Neira, WHO's Director for Department of Public Health and Environment. “The challenge now is to ensure Africa moves onto the global environmental health agenda."

Delegates highlighted the need to address health, environment and economic development issues in an interrelated manner to generate new synergies in poverty reduction and social equity. Ministers expressed their willingness to actively seek partnerships with civil society, including the private sector, and to seek their expertise in effecting change to improve environmental conditions in Africa.
Angélique Ngoma, Minister of Health and Public Hygiene of Gabon, said, "This conference will go down in the annals of Africa as the first to generate a synergy of political action and complementariness between health and environment for sustainable development."

The declaration urges Member States, among other things, to:

1. update their national, sub-regional and regional frameworks in order to address more effectively the interlinkages between health and environment through integration of these links in policies, strategies and national development plans;
2. ensure integration of the agreed objectives in the areas of health and environment in national poverty reduction strategies;
3. implement priority intersectoral programmes at all levels in health and environment, aimed at accelerating the achievement of the Millennium Development Goals;
4. build national and regional capacities to address the linkages between environment and health through the establishment and strengthening of health and environment institutions.

Expressing his appreciation at the outcomes of this landmark inter-ministerial conference, UNEP's Regional Director for Africa , Mounkaila Goumandakoye said: “For too long both health and environment have sought to cope with the downstream consequences of policies regarding environment, health and economic development that have been designed in parallel, not in concert. In valuing the inextricable links between human health and the sustainability of ecosystems along with the goods and services they provide, this historic conference in Africa reasserts that the work of the environment sector is an issue of human well-being and that together health and environment in acting proactively are critical development partners in the achievement of global and national development objectives.”

The four-day event held in Libreville, Gabon, was attended by hundreds of delegates, including health ministers, environment ministers, high-level experts, academics, policy-makers, bilateral and multilateral institutions and NGOs.

WHO

A child born in a Glasgow, Scotland suburb can expect a life 28 years shorter than another living only 13 kilometres away. A girl in Lesotho is likely to live 42 years less than another in Japan. In Sweden, the risk of a woman dying during pregnancy and childbirth is 1 in 17 400; in Afghanistan, the odds are 1 in 8. Biology does not explain any of this. Instead, the differences between - and within - countries result from the social environment where people are born, live, grow, work and age.

These "social determinants of health" have been the focus of a three-year investigation by an eminent group of policy makers, academics, former heads of state and former ministers of health. Together, they comprise the World Health Organization's Commission on the Social Determinants of Health. Today, the Commission presents its findings to the WHO Director-General Dr Margaret Chan.
"(The) toxic combination of bad policies, economics, and politics is, in large measure responsible for the fact that a majority of people in the world do not enjoy the good health that is biologically possible," the Commissioners write in Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health. "Social injustice is killing people on a grand scale."
"Health inequity really is a matter of life and death," said Dr Chan today while welcoming the Report and congratulating the Commission. "But health systems will not naturally gravitate towards equity. Unprecedented leadership is needed that compels all actors, including those beyond the health sector, to examine their impact on health. Primary health care, which integrates health in all of government's policies, is the best framework for doing so."

Sir Michael Marmot, Commission Chair said: “Central to the Commission’s recommendations is creating the conditions for people to be empowered, to have freedom to lead flourishing lives. Nowhere is lack of empowerment more obvious than in the plight of women in many parts of the world. Health suffers as a result. Following our recommendations would dramatically improve the health and life chances of billions of people.”

Inequities within countries

Health inequities – unfair, unjust and avoidable causes of ill health – have long been measured between countries but the Commission documents "health gradients" within countries as well. For example:

• Life expectancy for Indigenous Australian males is shorter by 17 years than all other Australian males.
• Maternal mortality is 3–4 times higher among the poor compared to the rich in Indonesia. The difference in adult mortality between least and most deprived neighbourhoods in the UK is more than 2.5 times.
• Child mortality in the slums of Nairobi is 2.5 times higher than in other parts of the city. A baby born to a Bolivian mother with no education has 10% chance of dying, while one born to a woman with at least secondary education has a 0.4% chance.
• In the United States, 886 202 deaths would have been averted between 1991 and 2000 if mortality rates between white and African Americans were equalized. (This contrasts to 176 633 lives saved in the US by medical advances in the same period.)
• In Uganda the death rate of children under 5 years in the richest fifth of households is 106 per 1000 live births but in the poorest fifth of households in Uganda it is even worse – 192 deaths per 1000 live births – that is nearly a fifth of all babies born alive to the poorest households destined to die before they reach their fifth birthday. Set this against an average death rate for under fives in high income countries of 7 deaths per 1000.
The Commission found evidence that demonstrates in general the poor are worse off than those less deprived, but they also found that the less deprived are in turn worse than those with average incomes, and so on. This slope linking income and health is the social gradient, and is seen everywhere – not just in developing countries, but all countries, including the richest. The slope may be more or less steep in different countries, but the phenomenon is universal.

Wealth is not necessarily a determinant

Economic growth is raising incomes in many countries but increasing national wealth alone does not necessarily increase national health. Without equitable distribution of benefits, national growth can even exacerbate inequities.
While there has been enormous increase in global wealth, technology and living standards in recent years, the key question is how it is used for fair distribution of services and institution-building especially in low-income countries. In 1980, the richest countries with 10% of the population had a gross national income 60 times that of the poorest countries with 10% of the world's population. After 25 years of globalization, this difference increased to 122, reports the Commission. Worse, in the last 15 years, the poorest quintile in many low-income countries have shown a declining share in national consumption.

Wealth alone does not have to determine the health of a nation's population. Some low-income countries such as Cuba, Costa Rica, China, state of Kerala in India and Sri Lanka have achieved levels of good health despite relatively low national incomes. But, the Commission points out, wealth can be wisely used. Nordic countries, for example, have followed policies that encouraged equality of benefits and services, full employment, gender equity and low levels of social exclusion. This, said the Commission, is an outstanding example of what needs to be done everywhere.

Solutions from beyond the health sector

Much of the work to redress health inequities lies beyond the health sector. According to the Commission's report, "Water-borne diseases are not caused by a lack of antibiotics but by dirty water, and by the political, social, and economic forces that fail to make clean water available to all; heart disease is caused not by a lack of coronary care units but by lives people lead, which are shaped by the environments in which they live; obesity is not caused by moral failure on the part of individuals but by the excess availability of high-fat and high-sugar foods." Consequently, the health sector – globally and nationally – needs to focus attention on addressing the root causes of inequities in health.

“We rely too much on medical interventions as a way of increasing life expectancy” explained Sir Michael. “A more effective way of increasing life expectancy and improving health would be for every government policy and programme to be assessed for its impact on health and health equity; to make health and health equity a marker for government performance.”

Recommendations

Based on this compelling evidence, the Commission makes three overarching recommendations to tackle the "corrosive effects of inequality of life chances":

1. Improve daily living conditions, including the circumstances in which people are born, grow, live, work and age.
2. Tackle the inequitable distribution of power, money and resources – the structural drivers of those conditions – globally, nationally and locally.
3. Measure and understand the problem and assess the impact of action.

Recommendations for daily living

Improving daily living conditions begins at the start of life. The Commission recommends that countries set up an interagency mechanism to ensure effective collaboration and coherent policy between all sectors for early childhood development, and aim to provide early childhood services to all of their young citizens. Investing in early childhood development provides one of the best ways to reduce health inequities. Evidence shows that investment in the education of women pays for itself many times over.

Billions of people live without adequate shelter and clean water. The Commission's report pays particular attention to the increasing numbers of people who live in urban slums, and the impact of urban governance on health. The Commission joins other voices in calling for a renewed effort to ensure water, sanitation and electricity for all, as well as better urban planning to address the epidemic of chronic disease.
Health systems also have an important role to play. While the Commission report shows how the health sector can not reduce health inequities on its own, providing universal coverage and ensuring a focus on equity throughout health systems are important steps.

The report also highlights how over 100 million people are impoverished due to paying for health care – a key contributor to health inequity. The Commission thus calls for health systems to be based on principles of equity, disease prevention and health promotion with universal coverage, based on primary health care.

Distribution of resources

Enacting the recommendations of the Commission to improve daily living conditions will also require tackling the inequitable distribution of resources. This requires far-reaching and systematic action.
The report foregrounds a range of recommendations aimed at ensuring fair financing, corporate social responsibility, gender equity and better governance. These include using health equity as an indicator of government performance and overall social development, the widespread use of health equity impact assessments, ensuring that rich countries honour their commitment to provide 0.7% of their GNP as aid, strengthening legislation to prohibit discrimination by gender and improving the capacity for all groups in society to participate in policy-making with space for civil society to work unencumbered to promote and protect political and social rights. At the global level, the Commission recommends that health equity should be a core development goal and that a social determinants of health framework should be used to monitor progress.

The Commission also highlights how implementing any of the above recommendations requires measurement of the existing problem of health inequity (where in many countries adequate data does not exist) and then monitoring the impact on health equity of the proposed interventions. To do this will require firstly investing in basic vital registration systems which have seen limited progress in the last thirty years. There is also a great need for training of policy-makers, health workers and workers in other sectors to understand the need for and how to act on the social determinants of health.
While more research is needed, enough is known for policy makers to initiate action. The feasibility of action is indicated in the change that is already occurring. Egypt has shown a remarkable drop in child mortality from 235 to 33 per 1000 in 30 years. Greece and Portugal reduced their child mortality from 50 per 1000 births to levels nearly as low as Japan, Sweden, and Iceland. Cuba achieved more than 99% coverage of its child development services in 2000. But trends showing improved health are not foreordained. In fact, without attention health can decline rapidly.

Is this feasible?

The Commission has already inspired and supported action in many parts of the world. Brazil, Canada, Chile, Iran, Kenya, Mozambique, Sri Lanka, Sweden, and the UK have become 'country partners' on the basis of their commitment to make progress on the social determinants of health equity and are already developing policies across governments to tackle them. These examples show that change is possible through political will. There is a long way to go, but the direction is set, say the Commissioners, the path clear.
WHO will now make the report available to Member States which will determine how the health agency is to respond.

WHO

The first inter–ministrial conference on health and environment in Africa will be held in Libreville, Gabon, from the 26th – 29th  of August 2008 under the slogan “ Health security through healthy environment”.

The conference jointly organsined by the World Health Organization (WHO) and United Nations Environment Programme (UNEP) is expected to attract hundreds of delegates including health ministers, ministers of environment, high –level experts, academics, policy makers, bilateral and multilateral institutions and NGO’s

The conference, the first of its kind in Africa, aims to secure political commitment for catalyzing an integrated approach to policy and obtaining the institutional and investment changes required to reduce environmental threats to health.

Dr Luis Sambo, WHO Regional Director for Africa, said African countries share common ecosystem and the impact of the environment on health transcends national borders. For this reason accelerated efforts are required to deal with the outbreak of diseases caused by environmental health risks and climate change.

According to him, the conference is a step towards future collaborative efforts between the WHO and UNEP and ministries of health and environment to implement integrated activities that promote health and sustainable development.

Angela Cropper, deputy director UNEP, said evidence that ecosystems, species and the quality of the environment relate to human health has been increasing, there is however a lag in concerted policy and action to address this relationship.

The Department of state for Health and Social Welfare, in collaboration with Action Aid The Gambia, CRS, HEPDO, NSGA, CADO, ADOWAD and the Regional Health Teams will embark on mass bednet dipping on Monday.

Speaking in a brief interview with The Point yesterday, Balla Kandeh, Senior program officer National Malaria Control Program said the countrywide mass bednet dipping will commence from the 25th to the 29th of this month. Teams will be deployed to all the towns and villages in the country to carried the exercise.

He stated that at the moment all the Region Health Teams have done their micro planning for the campaign.

He added that before the commencement of the campaign all the dippers will be trained. In conclusion he said that bed net dipping is among the strategies proposed to eradicate malaria.

As part of continued support to The Gambia’s health sector, the government of Taiwan on Wednesday donated $300,000.00 to the Department of State for Health and Social welfare. The money is the second payment of Taiwan’s annual grant of $600,000.00 to Gambia’s health sector.

Th cheque was presented to the Secretary of State for Health and Social Welfare at a ceremony held at his office in Banjul.

Presenting the money on behalf of his government, His Excellency Richard Shih, Ambassador of the Republic of China on Taiwan, expressed his pleasure in delivering the cheque. He described health as very important, hence the need to support the sector.

For his part, Dr Malick Njai, Secretary of State for Health and Social Welfare, thanked the Taiwanese government for being supportive to the country’s health sector. He revealed that through the grants, the health sector has been able to provide doctors and medical technicians all over the country. “It has always a pleasure working with the Republic of China on Taiwan,” he said.

The National Malaria Control programme, in collaboration with the regional Health team in Western Region, will today embark on a six-day DDT house spraying exercise in Foni. Speaking in an exclusive interview with Health Matters, Balla Kandeh, senior program officer National Malaria Control Programme, said over 300 spraymen have been trained recently to embark on this exercise.

He stated that the pilot project is aimed at indoor residual spraying  as an additional  strategy designed for  operation  Eradicate  Malaria Initiative which  was launched early this year by the vice-president.

Mr Kandeh noted that malaria is one of the world’s most serious tropical diseases and imposes significant economic costs on the poorest nations around the world, including The Gambia. He added that the historical successes in controlling malaria are due in  large part to the use of DDT  in malaria vector  control.

According to reports, there has been a sharp rise in  malaria cases in sub- Saharan African countries due to factors such as high rainfall, increased migration and reduction in the use of DDT in vector control.

According to him, the World Health Organisation report indoor residual spraying (IRS)is a major intervention  for malaria  control.

He has assured the general public that the spray is safe and called them on them to co-operate with spray operators.

He has also disclosed that a similar exercise would be carried out in the Greater Banjul Area.

Mr Kandeh pointed out that the Government of The Gambia with partners are doing their level best to eradicate malaria in the country.