Towards global health equity: opportunities and threats

O n 29 August, 2011, I had the honour and pleasure to witness and facilitate the creation of the African Federation of Public Health Associations. It was a landmark event attended by all Ministers of Health of the African region, during which we committed to work together to support Governments and communities to address the public health challenges that we face at regional and country levels. Therefore, organizing the 13th World Congress on Public Health in Africa demonstrates the confidence that the World Federation of Public Health Associations places in the young African federation. I am assured that deliberations during the next 5 days will provide new insights and creative solutions to public health issues being faced by the world and the African continent in particular. The health of the population depends both on the provision of health care for the sick and the efforts organized by society to protect, promote and restore people’s health. Since the dawning of civilization, humankind has made remarkable progress in advancing public health and improving people’s health, but in many ways, we are facing intractable and emerging health problems. During the last 100 years, the application of scientific and technological breakthroughs in health has brought accelerated progress in control of communicable diseases in industrialized countries, but the fundamental success factors rested upon social and economic development that improved environment, housing, food, nutrition, education, water supply, hygiene and sanitation, and other key health determinants. To date, developing countries, particularly in subSaharan Africa, are facing a double burden of communicable and non-communicable diseases, high infant and maternal mortality and recurring epidemics. This is further aggravated by the prevailing weak health systems, poverty and weak economic performance that pose serious challenges to health and development. If we compare the key health indicators in the world, for example those related to the Millennium Development Goals, we are struck by the uneven distribution of health across countries, within countries, and between population sub-groups, e.g. rich and poor, men and women. There are differences between rural and urban areas in coverage of key health services, such as, skilled attendance at birth, immunization, and diagnosis and treatment of common diseases. These inequities can be avoided through adoption and implementation of relevant health and development policies that seek to minimize variation of health indicators associated with socio-economic status. Available evidence shows a strong and positive correlation between health and wealth! That is why I think that the theme of the 13th Congress on Public Health Towards Global Health Equity: Opportunities and Threats is very topical and appropriate. Public Health as a discipline is at the crossroads. There are major changes due in part to globalization, political and economic reforms, demographic and epidemiological changes, new technologies, open access to information and communication, and relatively high literacy rates among the population. These changes have brought both positive and negative effects in the way we perceive and manage health systems. Therefore, decision makers, managers, health professionals, and other relevant stakeholders should be prepared to address a broad and ever-increasing public health agenda, with new problems being assigned over time. Over the last 30 years, life expectancy has increased globally. According to the World Health Statistics 2011, the average life expectancy at birth was 68 years in 2009, ranging from 54 in the African Region to 76 years in the region of the Americas (1). More than a billion of the world’s poorest people are not benefiting from major advances in health care (2), and several countries particularly in sub-Saharan Africa have seen a decline in life expectancy due in part to the HIV/AIDS epidemic. According to the WHO Global Burden of Disease, about 59 million people died in 2008, globally (3). Almost 18.6% of those deaths occurred in the African Region which shares about 12.1% of the world’s population. Communicable diseases represent 63% of total deaths in the African Region. HIV/AIDS, diarrheal diseases, malaria, tuberculosis, and childhood diseases cause 88% of those deaths. HIV/AIDS alone, accounts for 38.5% of deaths from communicable diseases and 15.6% of all deaths in the Region (3). Nevertheless, all these diseases are preventable! Globally, the proportion of children under 5 years of age who were underweight declined from 25% in 1990 to