It is common to hear officials from countries and international agencies talk about the multiple challenges that impede intersectoral work for health. The concern is valid: while ministries of health and related institutions are organized and funded to improve the “health” of the population, other ministries do not have such a mandate. In most cases, this has led to a certain paralysis characterized by lofty aspirations in the health sector about the potential benefits of intersectoral action, but with little collaboration and action involving other sectors.
On June 5, World Bank Vice President for Sustainable Development Rachel Kyte will host a live online chat about Rio +20 and sustainable development at live.worldbank.org. Submit questions now, and then join Rachel Kyte and economist Marianne Fay on June 5 at 14:00 GMT/10 a.m. EDT.
Rio +20 is coming up in a few weeks. Some 75,000 leaders, advocates, scientists and other experts are expected in person, and tens of thousands more will be watching online to see how the world can advance sustainable development.
Many of us have been advocating for greener, more inclusive growth since before the first Earth Summit at Rio 20 years ago. We’ve seen economic growth lift 660 million people out of poverty, but we’ve also seen growth patterns run roughshod over the environment, diminishing the capacity of the planet’s natural resources to meet the needs of future generations.
The growing global population needs world leaders to do more than just check in at the UN Conference on Sustainable Development, Rio+20 – it needs them to move the needle now toward truly sustainable development practices.
- South Africa
- The World Region
- South Asia
- Middle East and North Africa
- Latin America & Caribbean
- Europe and Central Asia
- East Asia and Pacific
- Urban Development
- Labor and Social Protection
- Social Development
- Science and Technology Development
- Public Sector and Governance
- Private Sector Development
- Macroeconomics and Economic Growth
- Financial Sector
- Communities and Human Settlements
- Agriculture and Rural Development
- Sustainable Development
- Natural Capital Accounting
We’ve all seen what happens when natural capital is undervalued. Oceans that billions of people rely on for food and income get overfished and become dumping grounds for chemicals and waste. Mangroves that protect shorelines from storms are replaced with resorts.
Many countries are looking beyond GDP to help them address the challenges undervaluing natural capital has created. What they need is a measure of a country’s wealth that includes all of its capital — produced, social, human, and natural capital.
In Botswana at the Summit for Sustainability in Africa this afternoon, 10 African countries endorsed the need to move toward factoring natural capital into systems of national accounting. By Rio +20, the upcoming UN Conference on Sustainable Development, we hope to see 50 countries and 50 private corporations join this effort.
The scaling up of voluntary medical male circumcision, particularly in high HIV prevalence settings, is a highly cost-effective intervention to fight the epidemic—randomized controlled trials have found a 60% protective effect against HIV for men who became circumcised.
But, the supply of this medical service is just one part of the picture. Without active involvement from individuals and communities to deal with social and cultural factors that influence service acceptability, the demand for this common surgical procedure will be low.
Indeed, on a recent visit to Botswana, a country with high HIV prevalence and low levels of male circumcision, my World Bank colleagues and I had a good discussion with the National HIV/AIDS Commission about ways to address the low uptake of voluntary, safe male circumcision services in spite of a well-funded program by the government. It was obvious to all that if the demand for, and uptake of, this service were not strengthened through creative mechanisms that foster acceptance, ownership, and active participation of individuals and community organizations, the program would not help control the spread of HIV through increased funding of facilities, equipment, and staff alone.
So, what do we need to do to ensure that need, demand, utilization, and supply of services are fully aligned to improve health conditions?
The scientific evidence is overwhelming. As Robert Beaglehole and colleagues at the World Health Organization (WHO) pointed out years ago, tobacco is the only consumer product that eventually kills half of its regular users if they follow its manufacturers’ recommendations.
Given this dire reality, it is clear that Africa is now at a crossroads. On one hand, the countries in this region have become an attractive and under-tapped market as tougher regulations, high taxes, and greater consumer awareness of the dangers of smoking in developed countries are “closing the door” to tobacco imports and leading to significant drops in consumption. And on the other hand, cigarettes are becoming increasingly affordable as incomes rise in several African countries due to the rapid economic growth of recent years. Indeed, African countries are experiencing the highest increase in the rate of tobacco use amongst developing countries--the number of smokers in sub-Saharan Africa is projected to increase 148 percent by 2030, to 208 million smokers or one-fifth of the total population.
This year, on World Malaria Day, April 25, the global health community has reason to celebrate. Indeed, thanks to substantial investments from partners and countries over the last decade, the scorecard on malaria reports good news: a reduction of more than 50% in confirmed malaria cases or malaria admissions and deaths in recent years in at least 11 countries south of the Sahara, and in 32 endemic countries outside of Africa. Overall, the number of deaths due to malaria is estimated to have decreased from 985,000 in 2000 to 655,000 in 2010.
The fact that an estimated 1.1 million African children were saved from the deadly grip of malaria over the last decade is an extraordinary achievement. By the end of 2010, a total of 289 million insecticide-treated nets were delivered to sub-Saharan Africa, enough to cover 76% of the 765 million persons at risk.
Over the past 5 years, four countries were certified as having eliminated malaria: Morocco, Turkmenistan, the UAE and Armenia. In southern Africa, health ministers of eight countries -- Botswana, Namibia, South Africa, Swaziland, Angola, Mozambique, Zambia, Zimbabwe--have developed a regional strategy to progress towards E8 malaria elimination status.
We’re entering a phase where AIDS is moving from emergency crisis financing to sustainable development financing—which is a major challenge, but one that we’re continuing to tackle, with the goal of stronger national ownership and responsibility.
One of the Bank’s international mandates is to support countries to develop better national health plans and budgets. Today, the Bank released an important study, The Fiscal Dimension of HIV/AIDS in Botswana, South Africa, Swaziland, and Uganda, which is a part of this mandate. The study helps countries do the long-range planning that we so desperately need in HIV programs.
The Bank has a long-established partnership with ministries of finance and planning, and we understand country systems. We stand ready to help countries integrate HIV into their programs and plan for it in a sustainable way.
We’ve seen extraordinary progress in AIDS. Today, we have more antiretroviral drugs to treat HIV than every other virus in history combined. We’ve reduced treatment costs from tens of thousands of dollars to as little as $100. And we’ve expanded our understanding of effective HIV prevention, including the role of male circumcision and the important role that treatment can play in prevention under the right circumstances.
Many of us involved in HIV remember the days when 70% of beds in health facilities in Africa were occupied by people with AIDS. Our successes in treatment and prevention have removed this specter and have allowed health systems to focus on other important health priorities.
Recently, my colleague Cara Santos Pianesi flagged an op-ed she thought might interest me. The aptly-titled op-ed, Resource wealth need no longer be a curse was written by Mats Berdal and Nader Mousavizadeh and published in the FT on March 25th.