Down To Earth highlights the world’s performance on health-related development goals, where our successes lie and where efforts are still a work-in-progress
While WHS lists some landmark accomplishments reported in the 15 years since the beginning of the global programme, the overall results have been a mixed bag with great variations between regions and countries. The health-related goals of the MDGs have focused on hunger, child and maternal mortality, reproductive health, major communicable diseases and access to safe drinking water and basic sanitation.
Fewer underweight children, but target missed
Member nations had committed to halving the number of underweight children under the age of five. There has been significant progress in achieving this target, although the target itself has remained out of reach.
The report states that globally, there has been a reduction of 40 per cent in cases of under-nutrition among children. WHO regional offices of the Americas, Europe and the western Pacific region have registered declines that even exceed the set target.
The Lancet, in its 2013 report on maternal and child nutrition, states that under-nutrition is the main cause for 45 per cent of all deaths of children under five years of age.
The proportion of underweight children in developing countries has declined by 11 per cent, from 28 per cent to 17 per cent, between 1990 and 2013. In absolute terms, South East Asia has seen the biggest reduction in child under-nourishment. The proportion of underweight children globally has dropped 10 per cent during the same period.
The report, however, does not provide figures for overall undernourishment across age groups. According to the Food and Agriculture Organization’s (FAO) State of Food Insecurity report, 805 million people are suffering from chronic under-nourishment. Of these, more than 790 million people live in developing regions.
Africa lags behind in reduction of child mortality
Child mortality under the age of five years has seen a 49 per cent decline from 90 deaths per 1,000 live births to 46 deaths per 1,000 live births. This is a sharp reduction, but it still falls short of the 67 per cent reduction target set in 2000.
Moreover, only about a third of the nations has met or is on track to meeting the targets by 2015. About 83 per cent of countries in the African region, 77 per cent in the Americas, 62 per cent in the eastern Mediterranean region and 89 per cent of the countries in the western Pacific region are either halfway or less than halfway from achieving their targets.
It is also interesting to note that though neo-natal deaths (within 28 days of childbirth) have declined 39 per cent from 4.7 million in 1990 to 2.8 million in 2013, the proportion of neo-natal deaths to total deaths of children under the age of five has increased from 37 per cent to 44 per cent between 1990 and 2013.
Statistics from the African region reflect the poorest performance in terms of reduction of child mortality with 14 nations registering little, zero or negative reductions.
The southern Asian region, by comparison, has done much better with five of the 11 nations exceeding the target of reduction in child mortality and all nations showing significant progress towards the goal. India has reduced child mortality by 58 per cent.
India makes a significant leap in reducing maternal mortality
Maternal mortality fell 45 per cent between 1990 and 2013, much lower than the 75 per cent target set as part of the MDGs. In absolute terms, maternal mortality has dropped from 523,000 deaths in 1990 to 289,000 deaths in 2013.
India registered a 66 per cent reduction in maternal mortality, higher than both the global average of 45 per cent and the South East Asian average of around 61 per cent.
The global decline in maternal mortality is far from uniform across countries. Of the 89 countries demarcated as “critical” in terms of maternal mortality, 13 registered a decline of under two per cent in the number of deaths.
HIV numbers fall, but malaria and TB still plague developing countries
There is some cause for cheer in the international struggle to curb the spread of HIV. According to the World Health Statistics report, the aim of halting and reversing its spread has been met. Globally, 1.3 million fewer new cases of HIV were reported from 2001 to 2013.
Access to HIV treatment has seen a sharp rise since the beginning of the programme in 2003. Globally, 12.9 million people have access to treatment. It is noteworthy that of the 11.7 million with access to treatment in developing nations, 9 million are from sub-Saharan Africa.
The increase in access to treatment has resulted in a fall in HIV-related mortality from 2.4 million deaths in 2005 to 1.5 million deaths in 2013.
But the number of people affected by HIV increased from 31.5 million to 35 million between 2003 and 2013. Of these, 25 million cases are in the sub-Saharan African region alone.
The MDGs had identified malaria and tuberculosis (TB) as leading causes of death in developing regions and set a target of halting and reversing their rates of incidence. According to WHS, 3.2 billion people around the world are at risk of contracting malaria of which 1.2 billion people have been classified as being at high risk.
The population at risk of contracting malaria has increased by 32.5 per cent globally and by 43 per cent in Africa. At the same time, the incidence among at risk population has decreased globally and in Africa by 30 per cent and 34 per cent respectively.
Incidence of malaria has declined 12.77 per cent as number of new cases has dropped from 227 million in 2000 to 198 million in 2013. In 2013, there were 584,000 deaths due to malaria, 90 per cent of which were in Africa.
Tuberculosis has seen an overall decrease in incidence, prevalence as well as mortality across all regions in the world. India saw a decline in mortality due to TB from 39 deaths per 100,000 (HIV negative) people in 2000 to 19 deaths per 100,000 people in 2013. But India also reported the highest number of TB cases—over 1.24 million—in 2013.
Water and sanitation performance is cause for concern
The MDGs had resolved to reduce by half the proportion of population without sustainable access to safe drinking water and basic sanitation. Despite the achievement of the goal on a global level, 45 nations are still not on track to meeting this target. WHS states that 748 million people still lack access to safe drinking water.
The report concedes that “wide disparities continue to exist, not only between different regions of the world but also between urban and rural areas and between different socioeconomic groups within countries”.
In terms of sanitation, numbers convey a bleak scenario globally. WHS states that globally, about 1 billion people or 14 per cent of the world’s population have no access to toilets, latrines or any other form of sanitation facility, posing great risks to health and environment.
Progress in the African region has been the slowest with only seven of the 47 countries that participated in the WHS from the region registering positive change. Algeria (55 per cent) is the only African nation to have recorded a reduction in proportion of population with access to improved sanitation above the target of 50 per cent.
India has performed poorly in this regard with a reduction of merely 22 per cent compared with a South East Asian average of 47.7 per cent. Maldives leads the region in this category with a reduction of 97 per cent followed by Sri Lanka with 75 per cent.
(WHS 2015 report has considered different base years for different categories, depending on the availability of data from countries.)