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Income inequality and differential mortality: An ominous combination

Patricio V. Marquez's picture

A man smokes in Indonesia. © Curt Carnemark/World Bank

It is safe to argue that the issue of income and wealth inequality is nowadays at the center of political debate across the world. Leading intellectuals such as Thomas Piketty in his seminal work, “Capital in the Twenty-First Century,” and Joseph Stiglitz in “The Price of Inequality” have rigorously analyzed the evolution of this social phenomenon and argued that increased inequality and lack of opportunity are creating divided societies that are endangering the future of nations.

Those working in public health have for years documented and discussed how low and decreasing incomes, decline in standards of living, and lack of or limited access health care and other essential services contribute to inequalities in health, manifested in a widening gap in life expectancy between the rich and the poor.

Taxing tobacco and the new vision for financing development

Patricio V. Marquez's picture

As part of the 2016 World Bank Group-International Monetary Fund Spring Meetings held this past week in Washington, D.C., a fascinating panel discussion, A New Vision for Financing Development, took place on Sunday, April 17. Moderated by Michelle Fleury, BBC's New York business correspondent, it included World Bank Group President Jim Yong KimBill Gates, Justine Greening (UK Secretary of State for International Development), Raghuram Rajan (Governor of the Reserve Bank of India), and Seth Terkper (Minister for Finance and Economic Planning of Ghana).
A construction worker takes a break in Timor-Leste. © Alex Baluyut/World Bank The panel was in consensus about the current challenging economic and social environment facing the world as a whole.  That environment includes low rates of economic growth across the world, drastic reductions in the price of commodities that are impacting negatively low-and middle-income countries, rising inequality, frequent natural disasters and pandemics, increased number of displaced populations and refugees due to conflict and violence spilling across national borders and continents, and the ambitious United Nations 2030 Agenda for Sustainable Development, which includes a set of 17 Sustainable Development Goals (SDGs). A question debated in the panel was, Where will the resources be found to address these challenges? This question is critical under the current scenario if countries are to continue to build on the progress achieved over the last decade and maintain previous gains.

Latin America: Making sure anti-tobacco efforts don’t go up in smoke

Joana Godinho's picture

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Today is No Tobacco Day, a moment in time when we’re supposed to remind ourselves of the many evils smoking brings upon us both as individuals and as member of society.

So when I started drafting this blog I asked myself: why can’t we have a No Tobacco Month, or even better a No Tobacco Lifetime? In other words, why are we not already enjoying a tobacco-free world or a tobacco-free Latin America?

Intersectoral work for health: Mirage or oasis?

Patricio V. Marquez's picture

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.

Circumcision and smoking bans: Can policies nudge people toward healthy behaviors?

Patricio V. Marquez's picture

Walking through river. Mali. Photo: © Curt Carnemark / World Bank

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?

Tobacco Kills: So what to do in Africa?

Patricio V. Marquez's picture

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. 

Photo Credit: By AdamCohn, FlickrGiven 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. 

If You Won't Quit, We'll Make You

Antonio Lambino's picture

Yesterday, I attended a session of the World Bank Institute’s Flagship Course on Health, attended by health specialists from various countries.  An expert panel shared experiences of using communication and persuasion toward bringing about pro health outcomes.  Several success stories were shared on applying behavior change communication in areas such as hygiene and sanitation, nutrition and education, and immunization in Africa and Asia.  Complementary to this focus on individual and social change was a presentation by Patricia Sosa, Esq. on experiences of the Campaign for Tobacco-Free Kids.   The organization advocates for policy change in various countries and the core of their strategy is changing the rules of the game to reduce tobacco use.