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

In the recent past, Anglican Bishops and Archbishops took time off their Lambeth conference in England to march across London Bridge in a show of solidarity against poverty.

It has been reported that over 500 Anglican Clergy from that conference paraded in full purple regalia to demonstrate against some of the eight most wealthy countries of the world, the Group of 8 (G8), for the latter’s unending failure to fulfill promises of assistance to poor countries. The G8 have in the past offered but not implemented anti-poverty programmes, NEPAD being one of the most recent, for the alleviation of the scourge of poverty in Third World countries more particularly those rated LDC (Least Developed Countries). In this sense the view can be reasonably held that poverty is in reality a humanly imposed spectre: the richer countries over the poor.

The question then arises have the rich countries any responsibility to the poor ones for either their present plight or their future redemption? The answer is in the positive if certain factors are put into consideration.

The poor countries have been offered by the Developed countries panaceas such as NEPAD that never seem to work, which now we should begin to take with several grains of salt.

These poor countries are the countries that were exploited and ravaged inorder to build a wealthier Europe and an affluent United States. These poor countries gave blood, sweat and tears for the development of the West especially during its industrial revolution. These are the countries whose efforts at self-development are continually and systematically undermined, stifled, and de-railed at every turn to keep them where they are and where they ought not to be – in the mire and quagmire of poverty. These countries face imposed disadvantage of commodities, in agricultural subsidies, import restrictions tariff and non-tariff barriers. These countries now have to live with mass poverty, malnutrition disease which in a vicious circle are conditions both debilitating and unfavourable to self-development.

Poverty is confounding, disparaging and stagnating for those who really have suffered its effects. Poverty represses, oppresses, and dehumanizes.

Poverty can be fatal and more wide-spread surely than malaria, HIV and other afflictions into which the rich countries pour immeasurable resources.

What is beneficial to mankind is a world wherein people especially children can grows in health and security, and be in a better position to contribute to nation-building and to the world by extension. For these reasons the London Bridge march should serve as a shining example to all that change is better pursued not through speeches and rhetoric but through positive action.

Mr Lamin Suso, the coordinator for the ICT domain of Global Unification The Gambia, recently left for the US, for a five year studies in ICT.

Mr Suso had served in that capacity for two years. Shortly before leaving, he told Youth Matters that he was looking forward to returning home  at the end of his studies. Meanwhile, Mr Sutura Sowe is stepping in the shoe of Mr Suso, as acting cordinator.

In a separate development, Global Unification, which is on the verge of increasing its scope in support of more local communities in rural areas of the Gambia, is looking for interested volunteers, both local and international, to work with it.

If you are interested in community development, poverty alleviation, supporting people at the grassroots, or simply wanting to get the experience of working with local people in Africa, this is an opportunity for you. As a development and research oriented organization, GU deals mainly on

1. Children welfare issues
2. Information Communication technology
3. Gender or Women welfare issues
4. Lobbying and Campaigning in various fields,
5. Education or youth activities, among others
To participates, simply send your curriculum Vitae and cover letter on why you want to volunteer with us to them gambia@globalunification.com

The ability to reach its fiscal targets has endeared the country to world creditors.

In December of 2007, the International Monetary fund (IMF) granted The Gambia a milestone debt relief package worth $140 million. In a statement at time, the IMF said that the country had made sufficient progress in strengthening tools to boost growth and combat poverty, and had reached a “completion point” under the heavily indebted Poor Countries (HIPC) Initiative.

In January of 2008, the Parish club followed Suit. The club of creditors, representing 19 of the world’s richest countries reached a deal with the Gambian government to cancel $11.

Million of the country’s total $40 million debt. The real icing on the cake came, however, in March when the IMF announced that The Gambia had met the requirements for full debt relief, and that the country was well placed to consolidate and deepen its poverty reduction strategy while maintaining strong gross domestic product (GDP) growth.

The fact of the matter is that the Gambian economy has proved remarkably resilient over the past three years, backed by strong monetary policy from the central bank and growing macroeconomic stability. The economy grew at an average 6.4% between 2003 and 2006, and was estimated at 7% last year, buoyed by an 11.3% increase in the service sector’s valued-added production.

Further-export base more, efforts to diversify the economy through tourism and re-exports have been successful in broadening the country’s export base, fuelled by rising levels of foreign direct investment (FDI).

“The recent economic growth in The Gambia has been driven by the services sector, mainly in the field of telecommunications, construction, and tourism,” confirms the central bank’s governor, Momodou Bamba Saho. “All these have been driven by significant flows of FDI.

To a certain extent, this is due to the strong macroeconomic stability in The Gambia. The government has implemented significant reforms over the past few years, both in the Central bank and the Department of state for Finance, as well as the other sectors, to make sure that we achieve and maintain this macroeconomic stability.

Our fiscal position was also strengthened significantly. In 2007, for the first in a decade, we had a fiscal surplus. We have been able to restore the confidence of foreign investors in the economy. All these are factors that have contributed to the growth in the economy.”

All this has had a positive effect on the national currency, the Dalasi. In 2007, it appreciated nearly 20% against the U.S. Dollar.

2008 forecasts are fro the Gambia currency to remain stable. Saho comments, “As a result of the appreciate of the dalasi, we are able to keep prices low. That has had a positive impact in terms of inflation,which is still single-digit. If you look at other places around the world, the price of oil and food has gone up significantly. In The Gambia, we have been able to keep prices in check.”

Louya, a 16-year-old boy begging in the Fonde market of Pointe-Noire, Congo's southern port city, said he was an orphan who had lived on the streets since 1997.

"Muké na satu, muké na satu ['I am hungry, I am hungry' in Kituba]," he beseeched passersby.

Like Louya, several other barefoot boys and girls were begging for money or doing odd jobs to pay for food.

The children are part of a growing number living on Congo's streets, say specialists. According to Florent Niama, managing director of the NGO l'Action Sociale, their number is estimated at around 3,000, but the phenomenon "is growing in [Congo's] cities".

And it is not just in Pointe-Noire, where the NGO Samu Social estimates more than 500 live on the streets, or in the capital, Brazzaville. In Dolisie, a city in the southwest, hundreds of children fend for themselves each day.

Analysts attribute the growing phenomenon to deteriorating social conditions within the family, witchcraft and parental negligence. Armed conflicts in the country had also contributed, they add.

According to the UN Children's Fund (UNICEF), Congo has continued to feel the effects of a decade-long brutal civil war that ended in 2003, displaced millions of people and ravaged the economy.

The war left in its wake thousands of children without birth certificates, young girls with babies from unknown fathers, and child soldiers needing demobilisation and reintegration into civil society.

Training programmes

In a bid to respond to the problem of street children, the government has since 2004 launched two programmes. First, it established a centre for the reintegration of vulnerable children, providing food, schooling and training in leatherwork, dressmaking and baking.

Then, with UNICEF, it launched a project to reintegrate them into families in August 2005. The project is being implemented in Brazzaville and Pointe-Noire.

So far, 40 children have been identified and reunited with their families in Brazzaville. Another 22 have gone back to school while 16 are undergoing training. In Pointe-Noire, 37 children have been identified, of whom 17 were reunited with their biological families - but five went back to the streets.

The project, which works with various NGOs, has also trained officials from the government's department of social affairs on the care and reintegration of street children, according to a progress report.
"Our approach consists of providing shelter for children with difficulties to stabilise them before finding an appropriate solution - whether social or family reintegration," Josué Nlemvo Ntelo, coordinator of one of the NGOs, Association Espace Enfant (AEE), told IRIN in Pointe-Noire.

The NGO, which was established in 1997, looks after children in vulnerable situations, and also has an education centre. It shelters 26 children, some from families living in precarious conditions.

Trafficking

Congolese authorities have also had to deal with increasing trafficking of children, mostly for labour.

A report prepared by UNICEF and the Congolese government in 2007 estimated that 200,000 children were affected by trafficking every year across the central and West African region.

Many of these children were orphans or unaccompanied following the civil wars, according to local NGOs. Since 2006, for example, Action Against the Trafficking of West African Children (ALTO) has dealt with almost 100 cases and helped repatriate about 50 in Pointe-Noire.

IRIN