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CSU 94/2010: FIVE ON MDGs

Sunday, 26th of September 2010 Print
CSU 94/2010:  FIVE ON MDGs
From the MDG summit, 20-22 June, UN headquarters:
UNITED NATIONS — Secretary General Ban Ki-moon plans to end a development summit meeting of world leaders on Wednesday by announcing a huge increase in aid to improve the health of women and children, but independent specialists said they were skeptical about the amount of actual new money committed, given the global economic crisis.

A ward in a state-run Manila maternity hospital. Infant mortality is one of the main concerns of a United Nations campaign.

Governments and private aid organizations committed to spending more than $40 billion toward that goal, Robert Orr, the assistant secretary general leading the effort, said Tuesday, and pledges were still flowing in.

The two lagging areas among the 15-year development goals that United Nations member states agreed to in 2000 are efforts to drastically cut the deaths of both young children and mothers in childbirth. The baseline to measure improvement is 1990.

Having money specifically directed at those two issues should help counteract “the hard stuff that has been the most resistant to change,” Mr. Orr said.

The eight Millennium Development Goals, or M.D.G.’s in the United Nations’ alphabet soup, included cutting by two-thirds the number of children who die before age 5 and reducing maternal mortality by three-quarters by 2015.

Infant mortality has dropped to about 8.1 million annually from more than 12 million in 1990, while maternal mortality is down to about 350,000 from more than 500,000 — improvements, but still short of the goals.

And the latest money committed will still not allow the world to meet the goals.

United Nations officials said they hoped that the bulk of the $40 billion would go to the poorest 49 countries, those least able to afford money from their own budgets. But those countries alone need a projected $88 billion over the next five years to meet the goals.

Mr. Ban’s announcement is also expected to include an ambitious commitment by the poorest countries to add nearly $26 billion to their health budgets.

Aid groups remain skeptical that the traditional donors among Western nations will really increase their giving at a time when they are slashing budgets. In addition, experts say, any announced increases, like France and Norway pledging to increase by 20 percent previous commitments to the Global Fund to Fight AIDS, Tuberculosis and Malaria, still fall short of the need.

“It has to be more than announcing amounts at a summit, it is about going home and putting that money in national budgets,” said Emma Seery, a development specialist at Oxfam International, a global antipoverty organization. “I am not seeing where the money is coming from.”

The American ambassador, Susan E. Rice, said that no new American money would be committed beyond the $63 billion the United States set aside for global health aid through 2014, the bulk of it to combat AIDS.

At the development meeting on Tuesday, Chancellor Angela Merkel of Germany said that her country would not cut its aid budget, but she did not announce any increase.

“The primary responsibility for development lies with the governments of the developing countries,” she said. “Development aid cannot continue indefinitely.”  -- New York Times


See the discussion in the New York Times,
The BBC homepage has a descriptive article at http://www.bbc.co.uk/news/world-11380539
The UN homepage features discussions in all six official languages. See, for example, the French language version at http://www.un.org/fr/millenniumgoals/
See especially the graphs on pages 9 through 19. While the developed countries have been slow to honor their commitments from the Gleneagles Summit, official development assistance to most countries has been on the rise over the last decade. However, aid is 'jerky.' Most assistance is of short duration, and can rise and fall in ways which make it difficult for recipients to do rational medium term planning.


Drivers of Inequality in Millennium Development Goal Progress:

A Statistical Analysis

David Stuckler,1,2* Sanjay Basu,3,4 and Martin McKee2,5

1Oxford University, Department of Sociology, Oxford, United Kingdom

2London School of Hygiene & Tropical Medicine, Department of Public Health and Policy, London, United Kingdom

3Department of Medicine, University of California San Francisco, San Francisco, California, United States of America

4Division of General Internal Medicine, San Francisco General Hospital, San Francisco, California, United States of America

5European Observatory on Health Systems and Policies, Brussels, Belgium

Simon Hales, Academic Editor

University of Otago, New Zealand

* E-mail: David.stuckler@chch.ox.ac.uk

ICMJE criteria for authorship read and met: DS SB MM. Agree with the manuscript's results and conclusions: DS SB MM. Designed the experiments/the study: DS SB MM. Analyzed the data: DS SB. Collected data/did experiments for the study: DS SB. Wrote the first draft of the paper: DS SB. Contributed to the writing of the paper: DS SB MM. Contributed to interpretation of data: MM.

Received August 19, 2009; Accepted January 27, 2010.

·        Abstract


Many low- and middle-income countries are not on track to reach the public health targets set out in the Millennium Development Goals (MDGs). We evaluated whether differential progress towards health MDGs was associated with economic development, public health funding (both overall and as percentage of available domestic funds), or health system infrastructure. We also examined the impact of joint epidemics of HIV/AIDS and noncommunicable diseases (NCDs), which may limit the ability of households to address child mortality and increase risks of infectious diseases.

Methods and Findings

We calculated each country's distance from its MDG goals for HIV/AIDS, tuberculosis, and infant and child mortality targets for the year 2005 using the United Nations MDG database for 227 countries from 1990 to the present. We studied the association of economic development (gross domestic product [GDP] per capita in purchasing-power-parity), the relative priority placed on health (health spending as a percentage of GDP), real health spending (health system expenditures in purchasing-power-parity), HIV/AIDS burden (prevalence rates among ages 15–49 y), and NCD burden (age-standardised chronic disease mortality rates), with measures of distance from attainment of health MDGs. To avoid spurious correlations that may exist simply because countries with high disease burdens would be expected to have low MDG progress, and to adjust for potential confounding arising from differences in countries' initial disease burdens, we analysed the variations in rates of change in MDG progress versus expected rates for each country. While economic development, health priority, health spending, and health infrastructure did not explain more than one-fifth of the differences in progress to health MDGs among countries, burdens of HIV and NCDs explained more than half of between-country inequalities in child mortality progress (R2-infant mortality = 0.57, R2-under 5 mortality = 0.54). HIV/AIDS and NCD burdens were also the strongest correlates of unequal progress towards tuberculosis goals (R2 = 0.57), with NCDs having an effect independent of HIV/AIDS, consistent with micro-level studies of the influence of tobacco and diabetes on tuberculosis risks. Even after correcting for health system variables, initial child mortality, and tuberculosis diseases, we found that lower burdens of HIV/AIDS and NCDs were associated with much greater progress towards attainment of child mortality and tuberculosis MDGs than were gains in GDP. An estimated 1% lower HIV prevalence or 10% lower mortality rate from NCDs would have a similar impact on progress towards the tuberculosis MDG as an 80% or greater rise in GDP, corresponding to at least a decade of economic growth in low-income countries.


Unequal progress in health MDGs in low-income countries appears significantly related to burdens of HIV and NCDs in a population, after correcting for potentially confounding socioeconomic, disease burden, political, and health system variables. The common separation between NCDs, child mortality, and infectious syndromes among development programs may obscure interrelationships of illness affecting those living in poor households—whether economic (e.g., as money spent on tobacco is lost from child health expenditures) or biological (e.g., as diabetes or HIV enhance the risk of tuberculosis).

Please see later in the article for the Editors' Summary

·        Editors' Summary


In 2000, 189 countries adopted the United Nations (UN) Millennium Declaration, which commits the world to the eradication of extreme poverty by 2015. The Declaration lists eight Millennium Development Goals (MDGs), 21 quantifiable targets, and 60 indicators of progress. So, for example, MDG 4 aims to reduce child mortality (deaths). The target for this goal is to reduce the number of children who die each year before they are five years old (the under-five mortality rate) to two-thirds of its 1990 value by 2015. Indicators of progress toward this goal include the under-five mortality rate and the infant mortality rate. Because poverty and ill health are inextricably linked—ill health limits the ability of individuals and nations to improve their economic status, and poverty contributes to the development of many illnesses—two other MDGs also tackle public health issues. MDG 5 sets a target of reducing maternal mortality by three-quarters of its 1990 level by 2015. MDG 6 aims to halt and begin to reverse the spread of HIV/AIDS, malaria, and other major diseases such as tuberculosis by 2015.


Why Was This Study Done?

Although progress has been made toward achieving the MDGs, few if any of the targets are likely to be met by 2015. Worryingly, low-income countries are falling furthest behind their MDG targets. For example, although child mortality has been declining globally, in many poor countries there has been little or no progress. What is the explanation for this and other inequalities in progress toward the health MDGs? Some countries may simply lack the financial resources needed to combat epidemics or may allocate only a low proportion of their gross domestic product (GDP) to health. Alternatively, money allocated to health may not always reach the people who need it most because of an inadequate health infrastructure. Finally, coexisting epidemics may be hindering progress toward the MDG health targets. Thus, the spread of HIV/AIDS may be hindering attempts to limit the spread of tuberculosis because HIV infection increases the risk of active tuberculosis, and ongoing epidemics of diabetes and other noncommunicable diseases (NCDs) may be affecting the attainment of health MDGs by diverting scarce resources. In this study, the researchers investigate whether any of these possibilities is driving the inequalities in MDG progress.


What Did the Researchers Do and Find?

The researchers calculated how far 227 countries were from their MDG targets for HIV, tuberculosis, and infant and child mortality in 2005 using information collected by the UN. They then used statistical methods to study the relationship between this distance and economic development (GDP per person), health spending as a proportion of GDP (health priority), actual health system expenditures, health infrastructure, HIV burden, and NCD burden in each country. Economic development, health priority, health spending, and health infrastructure explained no more than one-fifth of the inequalities in progress toward health MDGs. By contrast, the HIV and NCD burdens explained more than half of inequalities in child mortality progress and were strongly associated with unequal progress toward tuberculosis goals. Furthermore, the researchers calculated that a 1% reduction in the number of people infected with HIV or a 10% reduction in rate of deaths from NCDs in a population would have a similar impact on progress toward the tuberculosis MDG target as a rise in GDP corresponding to at least a decade of growth in low-income countries.


What Do These Findings Mean?

These findings are limited by the quality of the available data on health indicators in low-income countries and, because the researchers used country-wide data, their findings only reveal possible drivers of inequalities in progress toward MDGs in whole countries and may mask drivers of within-country inequalities. Nevertheless, as one of the first attempts to analyze the determinants of global inequalities in progress toward the health MDGs, these findings have important implications for global health policy. Most importantly, the finding that unequal progress is related to the burdens of HIV and NCDs in populations suggests that programs designed to achieve health MDGs must consider all the diseases and factors that can trap households in vicious cycles of illness and poverty, especially since the achievement of feasible reductions in NCDs in low-income countries could greatly enhance progress towards health MDGs.


Additional Information

Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1000241.



This paper from Save the Children Fund looks at progress towards MDG 4 through an equity lens. Summary below; full text is at http://www.reliefweb.int/rw/lib.nsf/db900sid/ASAZ-88FGTQ/$file/SC_Aug2010.pdf?openelement with case studies from India and Bangladesh. 'Egypt is an example of a country which is on-track to meet MDG 4 and has also seen a fall in inequality in child mortality.'


Good reading.




Executive summary


Understanding child survival in developing countries requires looking at the inequalities in children’s mortality, and analysing the factors that contribute to these disparities. Countries with higher rates of under-5 mortality tend to have less inequality in child mortality between the richest and poorest households. In contrast, in countries with lower levels of under-five mortality, child deaths are more concentrated in the bottom wealth group. The share of child deaths accounted for by neonatal mortality also tends to be higher in countries with lower rates of child mortality. The data also shows that progress towards Millennium Development Goal (MDG) 4 in many on-track countries has been accompanied by rising inequality in mortality rates. This suggests that progress has often been achieved through interventions that first reached better-off households.


The analysis in the paper illustrates that the child survival picture – in terms of rate and inequality – varies in the developing world, highlighting the importance of differentiated child survival strategies between middle- and low-income countries. In many countries, reductions in child mortality among poorer households have been smaller than for the higher income groups. Once child mortality is concentrated among lower income groups – as is the case in many middle-income countries – major efforts to reduce child mortality should be equalising, but these require a focus on systematic interventions rather than ‘quick win’ strategies. On the other hand, under-five mortality in low-income countries is usually high not only among the poorest quintile, but in the bottom 40–60% of the population, suggesting the need for more comprehensive strategies to reduce under-five mortality across a broader spectrum of the population.


Neonatal mortality tends to fall more slowly than under-five mortality, since reducing it needs longer-term and relatively more expensive interventions associated with functioning health systems. This indicates that while there are quick wins that can help improve child survival, middle-income countries (and low-income ones that have relatively low child mortality rates) need to focus more on reducing neonatal deaths. This strategy is more important in some geographic regions than others. For example, in south Asia roughly half of child deaths occur in the first four weeks, whereas in sub-Saharan Africa neonatal deaths account for about a quarter of the total.


The case studies of India and Bangladesh illustrate that economic growth is not a sufficient precondition to reduce child mortality. A low-income country like Bangladesh, by providing wide coverage of the relevant health interventions, improved child survival significantly. While wealth is an important dimension of inequalities in under-five deaths, unequal child survival outcomes are present across other socio-economic factors, including gender, caste and religion. Reducing unequal child survival outcomes requires addressing socio-economic factors that become a source of inequality and paying special attention to groups that have traditionally been excluded. The case of India illustrates how, in a big and diverse country, national averages hardly begin to tell the story of child survival. It serves to reinforce the need for differentiated policies across states, with a focus on the poorest and disadvantaged groups, in order to reduce under-five mortality more equitably.


While most countries that experienced significant improvements in child survival saw a rise in inequality in mortality, a few have made progress without increasing inequality in child survival. Egypt is an example of a country which is on-track to meet MDG 4 and has also seen a fall in inequality in child mortality. ‘Outliers’can offer important lessons to countries making efforts to improve child survival.
4) Economic factors related to the Millennium Development Goals: a literature review
Abstracts and references follow. For bilinguals, the Spanish original is at http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892009000800009&lng=en&nrm=iso&tlng=en

Rev Panam Salud Publica vol.26 no.2 Washington Aug. 2009



Factores económicos relacionados con los Objetivos de Desarrollo del Milenio en salud: una revisión bibliográfica


Economic factors related to the Millennium Development Goals: a literature review

 Marco PalmaI; Ildefonso HernándezII; Carlos Álvarez-DardetIII; Diana Gil-GonzálezIII; María T. RuizIII; Manuel MedinaI

IFacultad de Medicina, Universidad Autónoma de Yucatán Salud Pública, Mérida, Yucatán, México. La correspondencia se debe dirigir a Marco Palma, Facultad de Medicina, Universidad Autónoma de Yucatán Salud Pública, Av. Itzaes No. 498, Mérida, Yucatán 97200, México. Correo electrónico: marco_a7@yahoo.com
IIDepartamento de Salud Pública, Historia de la Ciencia y Ginecología, Universidad Miguel Hernández, Alicante, España
IIIObservatorio de Políticas Públicas y Salud, Universidad de Alicante, Área de Medicina Preventiva y Salud Pública, Campus San Vicente de Raspeig, Alicante, España




OBJETIVOS: Sistematizar la información publicada sobre la situación y los avances en el logro de los Objetivos de Desarrollo del Milenio relacionados con la salud (MDGS), así como analizar su asociación con algunos factores económicos y los pronósticos de cumplimiento.

MÉTODOS: Se realizó una búsqueda de los artículos científicos sobre los Objetivos de Desarrollo del Milenio en general publicados entre el 1 de enero de 2000 y el 31 de agosto de 2006 en las bases bibliográficas electrónicas EBSCO, CSA Illumina, ThWHOon Gale, SwetsWise y BIREME. Se seleccionaron los artículos originales en inglés o español que evaluaran la situación de los MDGS o sus avances y se refirieran a factores determinantes. Se analizó la distribución de los factores determinantes de la situación de los MDGS o sus avances, los MDGS referidos, el tipo de evaluación, la relación entre los indicadores económicos y la salud, el lugar estudiado, y la situación y los pronósticos del cumplimiento de los MDGS. Se valoró la calidad de los artículos.

RESULTADOS: Se identificaron 304 artículos originales, de ellos 114 (37,5%) se ocupaban de uno o varios MDGS. Los objetivos relacionados con la mortalidad infantil y materna fueron los más frecuentemente abordados. De los 39 artículos que evaluaban los MDGS y su relación con los factores económicos, en 13 se consideraban factores económicos relacionados con la equidad, la política o la globalización. Los factores económicos y políticos fueron los más frecuentemente asociados con la situación de los MDGS o sus avances.

CONCLUSIONES: Existe una tendencia a utilizar variables económicas vinculadas con las condiciones de la población para analizar la situación de los MDGS y sus avances. Falta información sobre la relación con el gasto gubernamental, el comercio exterior, la ayuda externa y las políticas económicas mundiales. Los pronósticos para lograr los MDGS en los países pobres son desfavorables.

Palabras clave: Objetivos de Desarrollo del Milenio; indicadores económicos; factores socioeconómicos; factores políticos; desarrollo económico.


OBJECTIVES: To systematize all the information published on the status of and progress made toward the Health-related Millennium Development Goals (HMDGs), as well as to understand associations with certain economic factors and the potential for success.

METHODS: A search was conducted for all scientific articles covering the Millennium Development Goals in general, published from 1 January 2000 to 31 August 2006, in the electronic databases of the EBSCO, CSA Illumina, Thomson Gale, SwetsWise, and BIREME. All original articles in English or Spanish that evaluated HMDG status, progress, and determinants were selected. The analysis evaluated the distribution of determinants of HMDG status or progress, the HMDGs referred to, the study type, the relationship between economic indicators and health, the study location, and the status and potential for attaining the HMDGs. The quality of the articles was also rated.

RESULTS: Of the 304 original articles found, 114 (37.5%) covered one or more HMDGs. The most frequently addressed goals were those concerning infant and maternal mortality. Of the 39 articles that evaluated HMDGs and their association with economic variables, 13 dealt with economic factors related to equity, policy, or globalization. Economic and policy factors were most frequently associated with HMDG status or progress.

CONCLUSIONS: There is a definitive trend toward measuring HMDG status and progress according to economic factors that reflect the population's condition. There is an information gap regarding government spending, international commerce, international aid, and global economic policy. The potential for achieving HMDGs in poor countries is low.

Key words: Millennium Development Goals; economic indexes; socioeconomic factors; political factors; economic development.



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