The Words of the Ladouce Family
Alberto Palloni, professor of demography
Geneva, Switzerland -- Two thematic debates marked the end of the 2009 UN Economic and Social Council Annual Ministerial Review in Geneva on July 9.
The first debate X-rayed the current social situation of the planet, showing the prospects for the future. A special focus of this X-ray was to explore the most vulnerable areas, where the suffering is already strong, or which may start to ache in the near future. This debate was entitled “Social trends and emerging challenges and their impact on public health: Renewing our commitment to the vulnerable in a time of crisis.”
What is the effective treatment? The second debate was entitled “Trends in aid and aid effectiveness in the health sector.”
Anna Kajumulo Tibaijuka, Under-Secretary-General of the United Nations and Executive Director of the United Nations Human Settlements Programme If mankind was a single body, what would an X-ray reveal about its present and future condition? The answer coming from sociology is that half of mankind now lives in towns.
More and more people will live in urban areas. By 2050, all regions of the world will be predominantly urban, even on the African continent. This is what Mrs. Anna Kajumulo Tibaijuka said first. She was moderating the debate in her position of Under-Secretary-General of the United Nations and Executive Director of the United Nations Human Settlements Programme (UN-HABITAT).
What will be the impact of this growing urbanization on public health? While urban residents have, on average, better access than rural residents to health services, urban populations are very diverse socially and economically. “This has consequences on the cultural-social fabric, Mrs. Tibaijuka said. New safety nets are needed.
The old ones are obsolete. The biggest challenge is in cities. UN-HABITAT is working with different partners to face these challenges in main cities and also in secondary towns. When you focus on main towns and secondary towns, you also have to invest in the infrastructures, the ways of communications in the countries” she explained.
What about demography, then? Dr Alberto Palloni, a professor of demography, gave an overview of the situation. Mankind is aging, and the median age will rise from its current 28 years to 38 years by 2050.
By this time, there will be more people over 60 than under 15. What are the consequences for public health? There will be a shift from a predominance of infectious diseases to non-communicable diseases, particularly chronic ones (diabetes, cancer and so on).
Here, proper choices need to be made. While caring for the elderly, we also need to invest massively in today’s young people, who will be the elderly of tomorrow. Although the onset of many non-communicable diseases happen later in life, the precursors of their development include habits of consumption and lifestyle that start much earlier.
A focus on adolescence is therefore crucial, in order to influence their dietary habits and exposure to substance abuse and risky behaviors.
Of special concern is HIV/AIDS. Concerning the elderly who live in Latin America, a population that Dr. Palloni has been studying thoroughly, he mentioned that the disintegration of the traditional family raises major concerns about the care of the elderly.
This ageing and urbanized humanity is also moving a lot. The x-ray of our planet shows a very mobile mankind. The immigration fluxes, as always, have important repercussions on health.
Dr Manuel Carballo is an epidemiologist and is currently Executive Director of the International Centre for Migration and Health Dr. Manuel Carballo, an epidemiologist, is Executive Director of the International Centre for Migration and Health and Professor of Clinical Public Health at the Mailman School of Public Health at Columbia University in New York. Why do people migrate, and what for?
Dr. Carballo reminded us that poverty and war are the two factors pushing people to migrate. He added that the media is now a key player in migration trends. In a globalized world, the media create a global culture.
The poor people are constantly receiving snapshots of the El Dorados here and there. Dreaming of a better life elsewhere, they risk their lives to leave their hometown. However, Dr. Carballo insisted that there is also a demand for immigrants. “Developed nations are thirsty for new blood.
Fertility has dropped. In European nations, they will not be able to replenish the population. Newcomers will be needed for pension schemes among other things.”
This creates a vicious circle where an aging population in the North attracts qualified health workers from the South, who will not be present to care for their own people, thus creating more frustration about life.
How many people migrate? Estimates range from 350 millions officially to over a billion, Dr. Carballo said, adding that we should take into consideration daily border crossings as well as huge domestic migrations in countries such as China.
Where do they mostly migrate from? Africa and Central Asia are now the main sources of migrations.
What are the implications of migrations on public health? Recent pandemics have shown that migrations in a globalized world can easily propagate health hazards. “Infectious diseases are always spread by migrations,” Dr. Caraballo said. He presented alarming statistics showing that the greatest health hazards are for immigrants on the way to their new destination and once they arrive.
Changes in dietary habits and lifestyles cause serious non-communicable diseases among people who, on the average, are far more resilient. Contrary to what people may think, immigrants are rarely weak people, but rather strong individuals and survivors. However, the health of immigrants can be harmed if they do not maintain their good habits.
Dr. Carballo wanted to offer a balanced picture of migration. The generally negative image is that “migrants just come and take” in their host countries. Dr. Carballo spoke of the paradox of nations “in need of migrants, but who don’t like migrants” and warned against a demonization of immigration.
He insisted that migrants contribute to the spread of health literacy worldwide by educating people in their hometown about health. Moreover, the remittances sent home amount to 386 billion USD. Much of this money serves as some form of social security for people in their hometown. In this sense, migration is part of global development.
In conclusion, Dr. Carballo urged the international community to stop being blind. The x-ray of international migrations reveals an absence of global thinking and little international planning. It is time to study the phenomenon and take appropriate measures.
However, a general X-ray and general statistics are not enough to help us understand the future of public health. We have to put ourselves in the shoes of the most vulnerable. Mr. Assane Diop tried to do that. He is the Executive Director responsible for the Social Protection Sector in the International Labour Organization.
He was originally a teacher in Senegal. “I was born in Dakar, the capital city of Senegal, but spent all my childhood and my early career in rural areas.” he said. “I know very well what health means for people in rural areas. As a minister of health in my country, I gave a report to the World Bank.
First, we need to bring the health facilities as close as possible to people, geographically speaking. Can you imagine, for instance, the ordeal of a woman with a complicated pregnancy who has to walk sometimes 10 miles to find a health center?
If she is more lucky, she may find a cart or a donkey. However, the geographical access still means nothing when people cannot pay. Thus, financial access is the next battle.'
“As the minister of labour in Senegal," Diop continued, "I could see our powerlessness. We do have some social security in Senegal, but what does it mean when 97 percent of the population lives in the informal sector?
More than 1 billion people in the world cannot afford health expenditures. The United Nations has agreed to study this serious issue, and there is now a partnership between the World Health Organization and the International Labor Organization; the International Monetary Fund is also involved.”
Of course, remittances sent home by migrants can be one source of the solution, but the crisis is going to hit them hard too. “In Africa, 30 USD per person goes to health care each year, a hundred times more than the average in the developed world," Diop added. "They can’t afford these 30 dollars, which often come from remittances. Seventy percent of the money earned by migrants is for health care. Please, try to understand these issues by putting yourself in the situation of these people.
Moreover, there is a severe shortage of health care workers. We need 400,000 more, worldwide. Twenty-three percent of African medical doctors are now working in affluent countries, not in Africa. As a conclusion, I urge all of is to think differently and to act differently. We need a cohesive and integrated approach.”
Mrs Marcia Metcalfe, global manager for Freedom from Hunger’s Microfinance and Health Protection Initiative Part of the answer to the issues raised by Mr. Diop is remittances, but microfinance development projects also work. Mrs. Marcia Metcalfe is the global manager for Freedom from Hunger’s Microfinance and Health Protection Initiative.
She offered an overview of microfinance projects, which currently cover 34 million households worldwide, representing about 130 million people. In the past few years, microfinance has been widely heralded as a successful contributor to the alleviation of poverty and a valuable tool for achieving the Millennium Development Goals, and with good reason.
Scores of studies have shown the positive impact that microfinance can have on the lives of poor people. A World Bank study of three microfinance institutions in Bangladesh, for example, found that 40 percent of the entire reduction of rural poverty over 14 years was directly attributable to microfinance.
What is the impact on health? Equipped with more income and decision-making authority, microfinance clients have choices -- often for the first time in their lives. As a result, coupling microfinance with behavior-change education can be especially powerful. The combination of greater knowledge of sound health practices and the increased income to act on that knowledge leads to dynamic, positive change.
Additionally, microfinance can help creating safety nets for the poor. According to a World Bank report, linkages between microfinance institutions and health microinsurance schemes in Rwanda have increased opportunities for scheme members to access credit for income-generating activities.
Needless to say, microfiance alone will not save the world, Mrs. Metcalfe admitted. But just as we need an x-ray of the whole body and a global treatment, we also need micro-therapies.
Mankind as a whole is a frail body; a chronic crisis existed before it was aggravated by the financial crisis. What will be the impact of this crisis on the most vulnerable parts of this frail body? Mr. Richard Newfarmer, the World Bank’s Special Representative to the United Nations and World Trade Organization, gave an overview of the economic crisis.
“In September 2008, a substantial financial panic spread from the USA to Europe and to the global economy,” he said. “The contraction caused people to modify their consumption behaviors, and this had an impact on trade. Moreover, the costs of borrowing have skyrocketed and funds have dried up. This is leading to a global recession for the first time in 70 years.”
According to Newfarmer, East Asia is less affected, as well as South Asia, with an average growth of 5 percent. However, after a cogent remark of the delegation of Saint Lucia, Mr. Newfarmer had to admit that global figures can be misleading; China and India will have a 7 percent growth, but small neighboring countries can be in a very difficult situation, he had to admit. The most devastating effects will be in Latin America, Europe, and Central Asia.
What about a possible recovery? It could start this year or next year, Newfamer said, but strength and duration is uncertain. The situation may be similar to Japan in the 1990s.
He admitted that there are signs of green shoots, and that recession is bottoming out, led by developing countries. “There is some uptake in the industry, but it is too early to be certain,” he warned, echoing Pascal Lamy from the World Trade Organization.
What about the impact on health, then? Low-income countries are at risk especially because they have low reserves and few commodities to sell. Two hundred million people will remain in poverty in Africa and Central Asia. Unemployment will rise. Infant mortality will climb. More seriously, the crisis represents a risk for the long-term agenda. The same countries that were most affected by the recession are also affected by climate change. There is a risk of more migration. Development assistance may diminish when it is needed more than ever.
However, Newfarmer suggested that the collective body of nations is not passively waiting for a recovery. More than before, there is multilateral reaction and coordination in an effort to diminish trade barriers and protectionism. “It is not a time for complacency; we have to work very hard and move very fast,” he concluded.
In a brief reply to his speech Anna Tibaijuka said that the root cause of the financial crisis had not been addressed by Newfarmer. “What is this recession all about?” she asked. "The developed world failed to provide proper housing for lower-income people, the system of mortgages failed, and this led to bankruptcy.” Newfarmer nodded affirmatively.
The most optimistic approach was presented by Mrs. Carissa Etienne from Dominica. She is the Assistant Director-General for Health Systems and Services at the World Health Organization. After sketching a dramatic picture of the global situation, she said, “We must anticipate risk, and we have to invest much more seriously than before in prevention. I know very well that recessions do end, and this crisis will one day be behind us. But we should anticipate and prepare the basic reforms which will guarantee future growth with better equity.”