with chronic conditions that can be prevented, delayed Figure 2.7 or managed. Increasingly, medicine and technology also South-South migration is as common as South-North migration a provide assistive devices that compensate for sensory and motor disabilities. Environmental interventions can ensure →54mln23% that even those with significant losses in capacity can still get where they need to go and do what they need to do In general, health systems will need to find effective strategies to extend health care and respond to the needs of older adults. In order to meet the target on UHC, the specific needs of older adults, often with complex, multiple chronic health conditions, will have to be addressed by health systems. 9 This will also require financial protection 后 against catastrophic health spending to ensure that health interventions produce equitably distributed health gains. All societies also need sustainable models of long-term care and support that allow everyone to maintain lives of dignity and meaning, even in the presence of significant losses in functioning. The number of people requiring long-term care 82 million (35%) South and support is forecast to double by 2030.%9 "Based on migrant stock data, 2013: North: developed regions; South developing regions Migration e live in an era of great human mobility with more people migration affects much larger numbers of people, and on the move today than ever before. The total number of generally takes the form of rural to urban migration in low international migrants is estimated to be 232 million or and middle-income countries 3.2% of the global population for 2013. Half of international a grants who were born in the developing regions(the Conflict and persecution also drive migration and in 2014, global South") moved to the developed regions(the "global the total number of people displaced by war, conflict or North")in 2013( Figure 2.7).20 persecution reached a record high of nearly 60 million globally, an increase of 8. 3 million from the previous year24 While no substitute for development, migration can be ( Figure 2.8. Of these 60 million displaced persons, almost a positive force for development when supported by the 20 million are refugees, 38 million are displaced inside their right set of policies. For example, migration could help own countries and 1.8 million are awaiting the outcome of harmonize the very different economic and demographic claims for asylum. the global number of refugees, asylum conditions across countries as the world moves towards seekers and internally displaced people had ranged between its peak population. At the same time, the emigration of 38 and 43 million for most of the past decade, but started highly skilled workers such as doctors and nurses can have to increase in 2012, due to conflicts in the Central African considerable negative impact Republic, Irag, South Sudan, the Syrian Arab Republic and Ukraine among others Migration could also re-emerge as both a cause and result of conflict within and between countries. Some high In some countries, towards the end of the sdg timeframe income countries are already drastically limiting the rights environmental factors and climate change may play a of refugees to seek asylum. The rise in global mobility, the greater role as a driving force, as they will almost certainly rowing complexity of migratory patterns and their impact have greater adverse impacts in poorer countries of Africa on countries, migrants, families and communities have all and asia contributed to international migration becoming a priority for the international community Many migrants, especially victims of human trafficking, run increased health and mortality risks. For instance, over The factors promoting cross-border migration are likely to 2700 migrant deaths have been recorded in the first half of remain strong or intensify and international migration is set 2015, the majority of these in the mediterranean Region. 25 to grow even faster than it did in the past quarter-century. 23 Migrants often have little or no access to health and social Determinants of migration levels include disparate age services, although they have much greater health risks structures and income inequalities between richer and related to exploitation, dangerous working circumstances poorer countries, easier transportation at lower cost, and substandard living conditions. Eliminating human the presence of migrant networks that link sending and trafficking is a priority task for the global community receiving countries, and improved communications. Internal HEALTH IN 2015: FROM MDGs TO SDGs
with chronic conditions that can be prevented, delayed or managed. Increasingly, medicine and technology also provide assistive devices that compensate for sensory and motor disabilities. Environmental interventions can ensure that even those with significant losses in capacity can still get where they need to go and do what they need to do. In general, health systems will need to find effective strategies to extend health care and respond to the needs of older adults. In order to meet the target on UHC, the specific needs of older adults, often with complex, multiple chronic health conditions, will have to be addressed by health systems.18,19 This will also require financial protection against catastrophic health spending to ensure that health interventions produce equitably distributed health gains. All societies also need sustainable models of long-term care and support that allow everyone to maintain lives of dignity and meaning, even in the presence of significant losses in functioning. The number of people requiring long-term care and support is forecast to double by 2030.9 Migration We live in an era of great human mobility, with more people on the move today than ever before. The total number of international migrants is estimated to be 232 million or 3.2% of the global population for 2013. Half of international migrants who were born in the developing regions (the “global South”) moved to the developed regions (the “global North”) in 2013 (Figure 2.7).20 While no substitute for development, migration can be a positive force for development when supported by the right set of policies. For example, migration could help harmonize the very different economic and demographic conditions across countries as the world moves towards its peak population. At the same time, the emigration of highly skilled workers such as doctors and nurses can have considerable negative impact.21 Migration could also re-emerge as both a cause and result of conflict within and between countries. Some highincome countries are already drastically limiting the rights of refugees to seek asylum. The rise in global mobility, the growing complexity of migratory patterns and their impact on countries, migrants, families and communities have all contributed to international migration becoming a priority for the international community. The factors promoting cross-border migration are likely to remain strong or intensify and international migration is set to grow even faster than it did in the past quarter-century.23 Determinants of migration levels include disparate age structures and income inequalities between richer and poorer countries, easier transportation at lower cost, the presence of migrant networks that link sending and receiving countries, and improved communications. Internal migration affects much larger numbers of people, and generally takes the form of rural to urban migration in lowand middle-income countries. Conflict and persecution also drive migration and, in 2014, the total number of people displaced by war, conflict or persecution reached a record high of nearly 60 million globally, an increase of 8.3 million from the previous year24 (Figure 2.8). Of these 60 million displaced persons, almost 20 million are refugees, 38 million are displaced inside their own countries and 1.8 million are awaiting the outcome of claims for asylum. The global number of refugees, asylum seekers and internally displaced people had ranged between 38 and 43 million for most of the past decade, but started to increase in 2012, due to conflicts in the Central African Republic, Iraq, South Sudan, the Syrian Arab Republic and Ukraine among others. In some countries, towards the end of the SDG timeframe, environmental factors and climate change may play a greater role as a driving force, as they will almost certainly have greater adverse impacts in poorer countries of Africa and Asia. Many migrants, especially victims of human trafficking, run increased health and mortality risks. For instance, over 2700 migrant deaths have been recorded in the first half of 2015, the majority of these in the Mediterranean Region.25 Migrants often have little or no access to health and social services, although they have much greater health risks related to exploitation, dangerous working circumstances and substandard living conditions. Eliminating human trafficking is a priority task for the global community. Figure 2.7 South–South migration is as common as South–North migrationa,20,22 a Based on migrant stock data, 2013; North: developed regions; South: developing regions 82 million (35%) 82 million (35 %) 54 million (23%) 14 million (6%) 22 HEALTH IN 2015: FROM MDGs TO SDGs
he recent influx of refugees into Europe is a vivid reminder future in urban areas. this is still due in greater part to cities for all countries of the importance of preparedness. All natural growth, where fertility outpaces replacement countries will need to have measures in place to minimize but is also explained by migration. more than 1 billion people the potential adverse health consequences of migration, on the planet are or were migrants, the majority of which including protective laws and policies and health services settle in urban areas. 31 in refugee settings. Health issues associated with migration present key public health challenges faced by governments Figure 2.9 and societies, as was reflected in a resolution on the health Trends in urban and rural population of the world, 1950-20502 of migrants that was endorsed by the Sixty-first World 圆 Rural Health Assembly in May 2008. 26 Many migrants do not 7 have access to health care and longer-term migrants may also face difficulties in getting legal identity and citizenship It will be important to ensure that UHC is interpreted as 5 relating to all de facto residents, not just citizens number of people displaced by conflict, 2005-201424 19501960197019801990200020102020203020402050 Urbanization is occurring across all world regions. Africa and Asia, where urbanization is just below 50%, are projected to experience the most rapid urbanization in coming years The number of cities with a population of 1 million or more increased from 270 to 501 during the MDg period, and is 2005200620072008200920102011201220132014 projected to increase to 662 by 2030. The number of mega cities of more than 10 million people will increase from 29 The SDGs include several targets relating to migration in 2015 to 41 in 2030, and more than half of these cities generally(8.1, 10.7, 10.c)as well as one(3. c) explicitly will be in Asia. 29 relating to the health worker "brain drain" from low- and middle-income countries to high-income countries, a Urbanization has been accompanied by an increase in urban phenomenon that has increased with globalization. The slums. Slums are characterized by overcrowding, po 2010 WHO Global Code of Practice on the International access to safe drinking-water or sanitation, poor housing Recruitment of Health Personnel/ highlighted these issues, conditions and lack of secure tenure. In 2000, the number drawing attention, in particular, to the problem of richer of slum dwellers in developing countries was estimated to countries recruiting from poorer nations that are struggling be 767 million; by 2010 it rose to an estimated 828 million with health worker shortages. The Code was voluntarily and by 2020 is projected to reach 889 million. more thar adopted in 2010 by all of the then 193 WHO Member 60% of sub-Saharan Africas urban inhabitants and more States, but thus far implementation has been disappointing. than 30% of urban populations of Southern Asia and South Greater collaboration among state and non-state actors is East Asia live in slums.32 needed to raise awareness of the code and reinforce its relevance as a potent framework for policy dialogue on Urban health inequalities are a growing concern. 3.4For ways to address the health workforce crisis. 28 The Code example Figure 2.10 shows that in urban areas of selected links directly with SDG Target 3.c. 46 countries, children in the poorest quintile were more than twice as likely to not survive till their fifth birthday Urbanization compared to children in the richest quintile In only one country was the national MDG target for reducing under Since the MDgs were adopted in 2000, urban areas have five mortality achieved for children in the poorest wealth grown by more than 1 billion new inhabitants. The urban quintile proportion of the global population increased from 43% in 1990 to 54% in 2015, and it is projected that by the time the about half of urban dwellers live in smaller cities of less than SDG draw to a close in 2030, 60% of the worlds population half a million. It is in these cities that most urban growth will will live in urban areas. The world s rural population is occur as they expand along highways and coalesce around expected to reach its peak in a few years and will gradually crossroads and coastlines, often without formal sector job decline to 3. 2 billion by 2050(Figure 2.9).29 This leaves growth and without adequate services virtually all of global population growth in the projectable ECONOMIC, SOCIAL AND ENVIRONMENTAL CONTEXT OF HEALTH
The recent influx of refugees into Europe is a vivid reminder for all countries of the importance of preparedness. All countries will need to have measures in place to minimize the potential adverse health consequences of migration, including protective laws and policies and health services in refugee settings. Health issues associated with migration present key public health challenges faced by governments and societies, as was reflected in a resolution on the health of migrants that was endorsed by the Sixty-first World Health Assembly in May 2008.26 Many migrants do not have access to health care and longer-term migrants may also face difficulties in getting legal identity and citizenship. It will be important to ensure that UHC is interpreted as relating to all de facto residents, not just citizens. Figure 2.8 Trends in number of people displaced by conflict, 2005–201424 2005 People (millions) 60 30 20 10 2006 2007 2008 2009 2014 50 40 0 2010 2011 2012 2013 The SDGs include several targets relating to migration generally (8.1, 10.7, 10.c) as well as one (3.c) explicitly relating to the health worker “brain drain” from low- and middle-income countries to high-income countries, a phenomenon that has increased with globalization. The 2010 WHO Global Code of Practice on the International Recruitment of Health Personnel27 highlighted these issues, drawing attention, in particular, to the problem of richer countries recruiting from poorer nations that are struggling with health worker shortages. The Code was voluntarily adopted in 2010 by all of the then 193 WHO Member States, but thus far implementation has been disappointing. Greater collaboration among state and non-state actors is needed to raise awareness of the Code and reinforce its relevance as a potent framework for policy dialogue on ways to address the health workforce crisis.28 The Code links directly with SDG Target 3.c. Urbanization Since the MDGs were adopted in 2000, urban areas have grown by more than 1 billion new inhabitants. The urban proportion of the global population increased from 43% in 1990 to 54% in 2015, and it is projected that by the time the SDG draw to a close in 2030, 60% of the world’s population will live in urban areas. The world’s rural population is expected to reach its peak in a few years and will gradually decline to 3.2 billion by 2050 (Figure 2.9).29 This leaves virtually all of global population growth in the projectable future in urban areas. This is still due in greater part to cities’ natural growth, where fertility outpaces replacement level,30 but is also explained by migration. More than 1 billion people on the planet are, or were migrants, the majority of which settle in urban areas.31 Figure 2.9 Trends in urban and rural population of the world, 1950–205029 1950 Population (billions) 6 3 2 1 1960 1970 1980 1990 2050 5 4 2000 2010 2020 2030 7 2040 Rural Urban 0 Urbanization is occurring across all world regions. Africa and Asia, where urbanization is just below 50%, are projected to experience the most rapid urbanization in coming years. The number of cities with a population of 1 million or more increased from 270 to 501 during the MDG period, and is projected to increase to 662 by 2030. The number of mega cities of more than 10 million people will increase from 29 in 2015 to 41 in 2030, and more than half of these cities will be in Asia.29 Urbanization has been accompanied by an increase in urban slums. Slums are characterized by overcrowding, poor access to safe drinking-water or sanitation, poor housing conditions and lack of secure tenure. In 2000, the number of slum dwellers in developing countries was estimated to be 767 million; by 2010 it rose to an estimated 828 million, and by 2020 is projected to reach 889 million. More than 60% of sub-Saharan Africa’s urban inhabitants and more than 30% of urban populations of Southern Asia and SouthEast Asia live in slums.32 Urban health inequalities are a growing concern.33,34 For example, Figure 2.10 shows that in urban areas of selected 46 countries, children in the poorest quintile were more than twice as likely to not survive till their fifth birthday compared to children in the richest quintile. In only one country was the national MDG target for reducing underfive mortality achieved for children in the poorest wealth quintile. About half of urban dwellers live in smaller cities of less than half a million. It is in these cities that most urban growth will occur as they expand along highways and coalesce around crossroads and coastlines, often without formal sector job growth and without adequate services. ECONOMIC, SOCIAL AND ENVIRONMENTAL CONTEXT OF HEALTH 23
Figure 2.10 ty in under-five mortality between richest and poorest 20% of households in urban areas 5 Absolute inequality between urban poorest and richest 20% MDG target Nigeria Sierra Leone Malawi Liberia Zambia Democratic Republic of Congo Swaziland United Republic of Tanzania Rwanda Timar-Leste Bangladesh India Madagascar BolIvia(Plurinational State of), Namibia Cambodia Dominican Republic Maldives Jordan Philippines Armenia Ukraine Republic of Moldova Albania Inequality in under-five mortality rate per 1000 live births(urban areas The provision of health services for the urban poor is a rapid unplanned urbanization may also increase the risks critical part of the SDG health targets, including UHC, of infectious disease transmission, promote adverse trends and of SDG Target 11. 1: " By 2030, ensure access for all to in Ncd risk factors such as obesity and increase the risks adequate, safe and affordable housing and basic services of road injury and violence, and exacerbate environmental and upgrade slums". Urbanization brings opportunities for degradation with impacts on health such as air pollution, health, through the concentration of people, resources and poor water quality, and unavailable sanitation. Therefore, services, which results in better access to health services special attention will need to be given to better monitoring and more scope for public health interventions. However, of the health situation of the urban poor, and to establishing HEALTH IN 2015: FROM MDGs TO SDGs
The provision of health services for the urban poor is a critical part of the SDG health targets, including UHC, and of SDG Target 11.1: “By 2030, ensure access for all to adequate, safe and affordable housing and basic services and upgrade slums”. Urbanization brings opportunities for health, through the concentration of people, resources and services, which results in better access to health services and more scope for public health interventions. However, rapid unplanned urbanization may also increase the risks of infectious disease transmission, promote adverse trends in NCD risk factors such as obesity and increase the risks of road injury and violence, and exacerbate environmental degradation with impacts on health such as air pollution, poor water quality, and unavailable sanitation. Therefore, special attention will need to be given to better monitoring of the health situation of the urban poor, and to establishing Figure 2.10 Socioeconomic inequality in under-five mortality between richest and poorest 20% of households in urban areas35 Absolute inequality between urban poorest and richest 20% MDG target Mali Nigeria Guinea Sierra Leone Niger Malawi Liberia Benin Zambia Democratic Republic of Congo Uganda Swaziland Senegal Ghana Sao Tome and Principe United Republic of Tanzania Congo Pakistan Haiti Ethiopia Lesotho Rwanda Timor-Leste Bangladesh India Madagascar Bolivia (Plurinational State of) Kenya Namibia Cambodia Azerbaijan Dominican Republic Honduras Indonesia Nepal Maldives Jordan Egypt Philippines Armenia Colombia Ukraine Republic of Moldova Albania l 0 l 200 l 20 l 40 l 60 l 80 l 100 l 140 Inequality in under-five mortality rate per 1000 live births (urban areas) l 160 l 120 l 180 24 HEALTH IN 2015: FROM MDGs TO SDGs
and implementing policies and programmes that reduce the outdated. Rather than thinking about poor countries risks of illness and death due to unsafe water and sanitation, perhaps the approach should focus on poor individuals. In violence and injuries, poor housing conditions and air other words, attention to reducing poverty in low-income pollution. Strong health promotion(e. g for HIV and NCDs) countries should be expanded to middle-income countries and affordable health services will be an important part of and concerns for the distribution of poverty internationally any response, and need to be driven by local governments should consider the distribution of poverty within national and communities boundaries. In addition, provision of"traditional"aid in the form of transferring resources could increasingly adapt to today s global context and take the form of supporting the ECONOMIIC DETERMINANTS development of national policies and institutional structures to use available resources well, regardless of the source OF HEALTH AND FINANCING FOR DEVELOPMENT The SDGs reflect this change by emphasizing a much broader approach to poverty reduction strategies to improve not only health, but also to enhance progress across the full The MDGs mobilized the collective efforts of countries range of SDGs relating to health and nutrition, education, and the development community to end extreme poverty, governance, economic reform, marginalized populations, reduce hunger, promote gender equity and improve gender discrimination, and violence and conflict. The first education and health. Despite substantial progress in MDG was to eradicate extreme poverty and hunger, and had reducing the numbers of people living in extreme poverty, three targets, including one on nutrition. In contrast, there many millions of people around the world continue to suffer are several SDG targets that focus directly on eradication from deprivation. Some countries, especially those affected of poverty and hunger, and many other targets that will by conflict and civil strife, remain trapped in a vicious spiral also contribute to poverty reduction and development of underdevelopment, inequity and grinding poverty Moreover, inequality is more central in the sdgs than in the MDGs, especially in SDG 10, which calls for efforts"to The social gradient in health that runs from top to bottom reduce inequality within and among countries". Similarly of the socioeconomic spectrum is a global phenomenon while globalization and trade-related issues were addressed that is seen in low-, middle- and high-income countries. as part of MDG 8, they have a more prominent position in Specific examples of this phenomenon, relating to child the SDGs, reflected in the multiple targets on economic, and maternal health outcomes, are presented in Chapter 4. social and environmental issues (e.g. Target 17.10 on trade and Target 3. b on research and access to essential The world has changed, and no longer consists of a large medicines and vaccines) group of poor countries and a small group of rich ones. Today many low-income countries have"graduated"from the This next section focuses on poverty eradication and income orld Bank Groups low-income classification group to reach inequality globalization and trade, and global financing for niddle-income status In fact, between 2000 and 2013, the health and development number of low-income countries fell from 63 to 34 such that there are now 105 middle-income countries. This group of countries are very diverse and include populous countries such as China and India and many small island states, as well as countries with stable economies and countries in conflict. 36 Moreover, progress for many socioeconomic development targets in relation to health and development vary widely across these countries. This means that extreme poverty is no longer concentrated in poor or fragile states but in richer middle-income countries. While only relatively few countries are the main contributors to levels of extreme poverty(i.e. India, Nigeria, China, Bangladesh and the Democratic Republic of Congo)-poverty also continues to persist among the most disadvantaged within sever high-and middle-income countries. As a result, around three quarters of the worlds absolute poor live in middle-income countries that are today less dependent on(and no longer eligible for)devel externally financed development is becoming rapidly
and implementing policies and programmes that reduce the risks of illness and death due to unsafe water and sanitation, violence and injuries, poor housing conditions and air pollution. Strong health promotion (e.g. for HIV and NCDs) and affordable health services will be an important part of any response, and need to be driven by local governments and communities. ECONOMIC DETERMINANTS OF HEALTH AND FINANCING FOR DEVELOPMENT The MDGs mobilized the collective efforts of countries and the development community to end extreme poverty, reduce hunger, promote gender equity and improve education and health. Despite substantial progress in reducing the numbers of people living in extreme poverty, many millions of people around the world continue to suffer from deprivation. Some countries, especially those affected by conflict and civil strife, remain trapped in a vicious spiral of underdevelopment, inequity and grinding poverty. The social gradient in health that runs from top to bottom of the socioeconomic spectrum is a global phenomenon that is seen in low-, middle- and high-income countries. Specific examples of this phenomenon, relating to child and maternal health outcomes, are presented in Chapter 4. The world has changed, and no longer consists of a large group of poor countries and a small group of rich ones. Today, many low-income countries have “graduated” from the World Bank Group’s low-income classification group to reach middle-income status. In fact, between 2000 and 2013, the number of low-income countries fell from 63 to 34 such that there are now 105 middle-income countries. This group of countries are very diverse and include populous countries such as China and India and many small island states, as well as countries with stable economies and countries in conflict.36 Moreover, progress for many socioeconomic development targets in relation to health and development vary widely across these countries. This means that extreme poverty is no longer concentrated in poor or fragile states but in richer middle-income countries. While only relatively few countries are the main contributors to levels of extreme poverty (i.e. India, Nigeria, China, Bangladesh and the Democratic Republic of Congo) – poverty also continues to persist among the most disadvantaged within several high- and middle-income countries. As a result, around three quarters of the world’s absolute poor live in middle-income countries that are today less dependent on (and no longer eligible for) development assistance.37 As such, an approach to poverty reduction based on externally financed development is becoming rapidly outdated. Rather than thinking about poor countries perhaps the approach should focus on poor individuals. In other words, attention to reducing poverty in low-income countries should be expanded to middle-income countries and concerns for the distribution of poverty internationally should consider the distribution of poverty within national boundaries. In addition, provision of “traditional” aid in the form of transferring resources could increasingly adapt to today’s global context and take the form of supporting the development of national policies and institutional structures to use available resources well, regardless of the source. The SDGs reflect this change by emphasizing a much broader approach to poverty reduction strategies to improve not only health, but also to enhance progress across the full range of SDGs relating to health and nutrition, education, governance, economic reform, marginalized populations, gender discrimination, and violence and conflict. The first MDG was to eradicate extreme poverty and hunger, and had three targets, including one on nutrition. In contrast, there are several SDG targets that focus directly on eradication of poverty and hunger, and many other targets that will also contribute to poverty reduction and development. Moreover, inequality is more central in the SDGs than in the MDGs, especially in SDG 10, which calls for efforts “to reduce inequality within and among countries”. Similarly, while globalization and trade-related issues were addressed as part of MDG 8, they have a more prominent position in the SDGs, reflected in the multiple targets on economic, social and environmental issues (e.g. Target 17.10 on trade and Target 3.b on research and access to essential medicines and vaccines). This next section focuses on poverty eradication and income inequality, globalization and trade, and global financing for health and development. ECONOMIC, SOCIAL AND ENVIRONMENTAL CONTEXT OF HEALTH 25
Poverty eradication and income inequality around the world, and there is clear evidence that people with lower income have worse health outcomes across a The world attained the MDG target to cut the 1990 broad range of indicators 46.4/ In developed and developing poverty rate in half by 2015-in 2010, and the target was countries alike, the poorest half of the population often met in all regions, except sub-Saharan Africa In 2015, controls less than one tenth of the country's wealth 48 836 million people globally live on less than USS 1.25 per Failure to address income inequality is likely to reduce the day, compared with 1.9 billion in 1990. In the developing sustainability of economic growth, weaken social cohesion world, 14% of the population live on less than USS 1.25 and security and increase risk of conflict per day in 2015, down from 47% in 1990. Progress has been harder won at higher poverty lines, such as US$ 2 MDG Target 1.C, which called for a halving of the proportion per day The worlds most populous countries, China and of people who suffer from hunger was almost achieved, India, have played a central role in the global reduction of with a reduction from 23. 3% in 1990-1992 to 12.9% in poverty(although India still has 30% of the world' s extreme 2014-2016(projected). 3 This occurred despite major poor: Figure 2. 11) and most of that reduction is related to global challenges such as natural disasters and adverse growth in labour-intensive sectors of the economy. Direct weather events, volatile commodity prices, higher food income transfers to the poor, remittances and changes and energy prices, rising unemployment and economic in demographic patterns have contributed much less. 39 recessions in the late 1990s and in 2008-2009. There Despite positive trends, about one in seven people in has also been significant progress on the child nutrition developing regions still lives on less than US$ 1.25 per day. indicators (underweight and stunting in children under In sub-Saharan Africa, more than 40% of the population still five years), an issue that is presented in Chapter 4. The lives in extreme poverty in 2015.38 Middle-income countries current trends and projections indicate the importance of are home to 73% of the world s poor people. 40 continued targeting of programmes for the poor, whether directed at the poorest countries, poorest regions or poorest populations within col Progress needs to be Top 10 countries with largest share of the global extreme poor, 2011 based on disaggregated health and nutrition indicators The 2001 report of the Commission on Macroeconomics and Health made a valuable contribution to global and test of the w country dialogues regarding the economic benefits of better health and the costs of achieving it, 49 showing, among United Republic of other things, the large economic returns to be derived from investing in health. It is estimated that reductions in mortality account for about 11% of recent economic growth in low- and middle-income countries as measured by their national income accounts. 50 Subsequently the 2008 report of the Commission on Social Determinants of Health complemented this message by adding to evidence on the health returns, in particular in relation to reducing health inequalities from optimizing policies in other sectors. 5 A common theme related to optimizing policies in other Democratic Republic sectors was to address inequalities in power, money nd of the thre a people living on less than USS 1.25 per day recommendations. It is estimated that health gains from policies in other sectors have been considerable. Of Poor people become"trapped"in poverty for a number of improvements in child under-five mortality rates between reasons, including the inability to access credit or own land, 1990 and 2010, 50% were attributed to non-health sector governance failures, and because low levels of education, investments. 2 Also, reducing inequalities in NCDs requires skills or health hinder their ability to seize opportunities substantial non-health sector investments, especially for arising from a general expansion of economic activity. The cardiovascular diseases and lung cancer. 3 Policies and poor also tend to be more vulnerable to economic"shocks" programmes addressing income inequalities, such as cash mainly due to health events as well as weather-related transfers and active labour policies, have demonstrated natural disasters and broad economic crises- that push benefits for health and the economy 54 households below the poverty line and keep them there hile globalization is associated with increasing average Ensuring that investing in health is perceived as a necessary comes in many countries, there is concern that it is also and effective way to combat poverty and ensure economic causing widening income inequality between and within progress requires an ongoing dialogue between health and countries. 43 44, 45 Income inequality affects all countries finance executive bodies. One way to open and maintain HEALTH IN 2015: FROM MDGs TO SDGs
Poverty eradication and income inequality The world attained the MDG target – to cut the 1990 poverty rate in half by 2015 – in 2010, and the target was met in all regions, except sub-Saharan Africa. In 2015, 836 million people globally live on less than US$ 1.25 per day, compared with 1.9 billion in 1990. In the developing world, 14% of the population live on less than US$ 1.25 per day in 2015, down from 47% in 1990.38 Progress has been harder won at higher poverty lines, such as US$ 2 per day. The world’s most populous countries, China and India, have played a central role in the global reduction of poverty (although India still has 30% of the world’s extreme poor; Figure 2.11) and most of that reduction is related to growth in labour-intensive sectors of the economy. Direct income transfers to the poor, remittances and changes in demographic patterns have contributed much less.39 Despite positive trends, about one in seven people in developing regions still lives on less than US$ 1.25 per day. In sub-Saharan Africa, more than 40% of the population still lives in extreme poverty in 2015.38 Middle-income countries are home to 73% of the world’s poor people.40 Figure 2.11 Top 10 countries with largest share of the global extreme poor,a 201141 India 30% Nigeria 10% China 8% Democratic Republic of the Congo 5% Rest of the world 28% Bangladesh 6% Indonesia 4% United Republic of Tanzania 2% Madagascar 2% Ethiopia 3% Pakistan 2% a People living on less than US$ 1.25 per day. Poor people become “trapped” in poverty for a number of reasons, including the inability to access credit or own land, governance failures, and because low levels of education, skills or health hinder their ability to seize opportunities arising from a general expansion of economic activity. The poor also tend to be more vulnerable to economic “shocks” – mainly due to health events as well as weather-related natural disasters and broad economic crises – that push households below the poverty line and keep them there.42 While globalization is associated with increasing average incomes in many countries, there is concern that it is also causing widening income inequality between and within countries.43,44,45 Income inequality affects all countries around the world, and there is clear evidence that people with lower income have worse health outcomes across a broad range of indicators.46,47 In developed and developing countries alike, the poorest half of the population often controls less than one tenth of the country’s wealth.48 Failure to address income inequality is likely to reduce the sustainability of economic growth, weaken social cohesion and security, and increase risk of conflict. MDG Target 1.C, which called for a halving of the proportion of people who suffer from hunger was almost achieved, with a reduction from 23.3% in 1990–1992 to 12.9% in 2014–2016 (projected).38 This occurred despite major global challenges such as natural disasters and adverse weather events, volatile commodity prices, higher food and energy prices, rising unemployment and economic recessions in the late 1990s and in 2008–2009. There has also been significant progress on the child nutrition indicators (underweight and stunting in children under five years), an issue that is presented in Chapter 4. The current trends and projections indicate the importance of continued targeting of programmes for the poor, whether directed at the poorest countries, poorest regions or poorest populations within countries. Progress needs to be measured based on disaggregated health and nutrition indicators. The 2001 report of the Commission on Macroeconomics and Health made a valuable contribution to global and country dialogues regarding the economic benefits of better health and the costs of achieving it,49 showing, among other things, the large economic returns to be derived from investing in health. It is estimated that reductions in mortality account for about 11% of recent economic growth in low- and middle-income countries as measured by their national income accounts.50 Subsequently, the 2008 report of the Commission on Social Determinants of Health complemented this message, by adding to evidence on the health returns, in particular in relation to reducing health inequalities from optimizing policies in other sectors.51 A common theme related to optimizing policies in other sectors was to address inequalities in power, money and resources, which was one of the three overarching recommendations. It is estimated that health gains from policies in other sectors have been considerable. Of improvements in child under-five mortality rates between 1990 and 2010, 50% were attributed to non-health sector investments.52 Also, reducing inequalities in NCDs requires substantial non-health sector investments, especially for cardiovascular diseases and lung cancer.53 Policies and programmes addressing income inequalities, such as cash transfers and active labour policies, have demonstrated benefits for health and the economy.54 Ensuring that investing in health is perceived as a necessary and effective way to combat poverty and ensure economic progress requires an ongoing dialogue between health and finance executive bodies. One way to open and maintain 26 HEALTH IN 2015: FROM MDGs TO SDGs