Showing posts from category HIV/AIDS.
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Should AFRICOM Leave Development to the Professionals?
›August 30, 2012 // By Schuyler Null
Since its inception, there’s been a great deal of prognostication about the role and goals of the U.S. military’s newest regional command, AFRICOM. The smallest of the six regional commands, in terms of staff and budget, its objectives have included traditional roles like building local military capacities, confronting transnational threats (terrorism, weapons of mass destruction, small arms, drugs, etc.), and helping to mitigate violent conflicts, but also more development-oriented goals, like fighting HIV/AIDs and malaria, “strengthening democratic principles,” and “fostering the conditions that lead to a peaceful, stable, and economically strong Africa.”
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PRB’s 2012 World Population Data Sheet
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“The most rapid population growth in many ways [occurs in] the countries that can least afford it,” said Carl Haub in a webinar on July 19 to launch the Population Reference Bureau’s (PRB) 50th annual World Population Data Sheet. This year, the report explores aging populations in more developed countries, rapid population growth in less developed countries, and the increased global prevalence of non-communicable diseases in an interactive map, which concisely illustrates global trends. PRB estimates that the world’s population is 7,057,075,000 as of mid-2012; the global population crossed the seven billion threshold in October 2011.
“The most rapid population growth in many ways [occurs in] the countries that can least afford it,” said Carl Haub in a webinar on July 19 to launch the Population Reference Bureau’s (PRB) 50th annual World Population Data Sheet. This year, the report explores aging populations in more developed countries, rapid population growth in less developed countries, and the increased global prevalence of non-communicable diseases in an interactive map, which concisely illustrates global trends. PRB estimates that the world’s population is 7,057,075,000 as of mid-2012; the global population crossed the seven billion threshold in October 2011.
Aging Europe and East Asia
Haub explained that population growth in Europe has been declining since the 1970s and is more or less a “pre-programmed destiny” for these countries. People of child-bearing ages make up a smaller percent of the population in many more developed countries, so unless there is an “enormous increase” in total fertility rates, these populations will continue to decline for the foreseeable future.
Haub noted that these aging populations are unprecedented. In Germany and Italy, for example, 21 percent are over the age of 65; many other European countries have similar figures, as do other developed countries like Japan and South Korea. PRB expects these percentages to increase throughout the next century and for European countries to struggle to support greater numbers of retirees.
Many such states have already found it difficult to raise the retirement age, even though medical advances allow people to work until later ages. PRB projects that in Japan, 42 percent of their population will be over the age of 60 in 2050; if such a large percentage of the population is no longer in the labor force, it will be difficult for to find the resources to support them.
The report shows that the United States, on the other hand, is still experiencing modest population growth. The higher birthrate is in part due to immigration, as recent immigrants to the United States tend to have more children. Haub noted that European states have been reluctant to accept greater numbers of migrants to try to reverse their declining population.
Youthful Developing Countries
While the demographic destiny of aging countries is somewhat determined, the future for less developed countries is more uncertain. Many countries in sub-Saharan Africa, the Middle East, and South Asia have large and growing youth populations, and how many children these “future parents” will have is uncertain. That uncertainty is underscored by the variety of scenarios for future population growth. The UN has four variants – high, medium, low, and constant fertility – which vary considerably in their projections for future populations, and PRB’s global projections for 2050 are some 600 million people more than the commonly-used medium variant UN projection.
Rapid growth in the least developed countries is hardly a new phenomenon, but PRB breaks down the numbers to an impressive degree. The 2012 Data Sheet provides updated net migration rates, projected population as a multiple of today’s, infant mortality rates, rate of natural increase, and other basic statistics. PRB also provides population pyramids from the wealthiest and poorest quintiles of the population of Malawi, as an example of the utility of desegregating data to better allocate resources to the underserved. They found that while birthrates have begun to decline for the wealthiest one-fifth of Malawians, the poorest citizens still have a total fertility rate of over seven children per woman.
Measuring Health Systems
Devastating infectious diseases – malaria, tuberculosis, and HIV/AIDS – have long been entrenched in some of the least developed and most rapidly growing parts of the world. But this year, PRB began to assess health on a broader level by tracking deaths attributed to non-communicable diseases as well. Diseases like cardiovascular disease, diabetes, respiratory illness, and cancer are leading causes of death in developed countries, but they have also increased in prevalence in developing countries at an alarming rate.
PRB is not the only organization to take note of the change in disease predominance. The World Health Organization has issued guidelines targeting four factors which increase the risk of these illnesses: tobacco use, alcohol abuse, poor diet/obesity, and physical inactivity. The UN also called a special session last September to discuss non-communicable diseases. President of PRB Wendy Baldwin noted that the last such discussion on a health issue was 10 years ago about HIV/AIDS.
Baldwin also pointed out that non-communicable diseases can increase the burden on the health systems of developing countries even more so than in developed states. She reported that in south Asia, for example, people have heart attacks on average six years earlier than people in developed countries, meaning more families lose their primary breadwinners.
The risk factors for these non-communicable diseases are difficult to target, especially with increasing urbanization in developing countries. But in a video accompanying the report, Baldwin mentioned that raising the price of cigarettes is an effective way to reduce tobacco consumption, especially for youth. Some countries have also made progress in increasing physical activity through sports programs and making urban areas safer for pedestrians. “The low and middle income countries have a real opportunity to take really positive steps to confront that rise in non-communicable diseases and to address the risk factors that drive them,” she said.
The Data Sheet Over Time
The World Population Data Sheet has long been a vital resource for those in the population, health, and environment fields and has grown to include far more data than its first iteration in 1962. At first, the sheet had only four indicators: a population estimate for the year, annual rate of increase, crude birth rate, and crude death rate. Over time, PRB began measuring a greater number of key figures like infant mortality and life expectancy at birth. Population projections, a staple of the current version, were not added until 1978, perhaps in response to the inception of the United Nations World Population Projections in 1974.
Over the past five decades, the data sheet has been witness to some major shifts in global population trends. While PRB discourages researchers from comparing past data to current figures because the measures and methods of gathering information have likely changed over time, it is still possible to see the rise of importance in several trends based on the indicators PRB chose to focus on each year. For example, extremely young populations have been found to have profound effects on a country’s stability and prosperity, as have aging populations. The 1966 data sheet was the first to measure the percentage of the population under the age of 15, and it didn’t become a consistent data point until 1977.
The number of people living in cities in the developing world surpassed those in the developed in 1970, according to the UN, and in 1972, PRB began tracking the percentage of populations living in urban areas. HIV/AIDS indicators were added in 2000, as global awareness and a commitment to fighting the disease was rising.
PRB’s demonstrated commitment to continually adding more data and refining existing projections makes the data sheet is a valuable resource to those studying the problems of today and the future. Fifty years on, the amount of information collected is staggering. The data sheet provides a glimpse at not just how many people there are in the world, but also where and how they live.
For more information, take a look at the full data sheet!
Sources: Population Reference Bureau, UN Population Division.
Image Credit: PRB; Video: Noncommunicable Diseases and Youth in Developing Countries. -
Three UN Millennium Development Targets Reached and a Review of the Human Drivers of Climate Change
›“It is plausible that key transitions in human evolutionary history have been driven in large part by climate change,” write Eugene A. Rosa and Thomas Dietz in “Human Drivers of National Greenhouse-Gas Emissions,” a literature review published by Nature Climate Change. “Changes in climate will doubtless be a key force in the future evolution of social systems, including all aspects of social, economic, and political life, while impinging on the health and well-being of the individuals who populate them.” Rosa and Dietz cite numerous studies to argue that nearly every facet of society will be affected by climate change. “The critical point,” they write, “is that population, affluence, technology, and all other drivers act not alone or additively but in a multiplicative fashion.” For example, rapid population growth can lead to an increase in urbanization, which generates “substantial demand for goods and services that can induce emissions in distant places.” They conclude that huge changes must be made in technology and consumption in order to combat the effects of climate change that are being caused by a growing population and an increasingly affluent world.
The United Nations’ 2012 Millennium Development Goals Report, released last month in New York City, announces that three of the eight major human development goals have been reached ahead of their 2015 targets. The Millennium Development Goals, set at a conference in 2000, were established to “uphold the principles of human dignity, equality, and equity at a global level.” The 2012 report indicates that the number of people living in extreme poverty has been halved since 1990; the proportion of people in the world without sustainable access to safe drinking water has also been halved; and more than 200 million slum dwellers have “gained access to either improved water sources, improved sanitation facilities, or durable or less crowded housing.” At the report launch, UN Secretary-General Ban Ki-moon noted that “these results represent a tremendous reduction in human suffering and are a clear validation of the approach embodied in the MDGs, but they are not a reason to relax.” Goals that have yet to be achieved include universal primary education; gender equality; reduced child mortality and improved maternal health; reducing rates of diseases such as HIV and malaria; and creating a global partnership for development.
Keenan Dillard is a cadet at the United States Military Academy at West Point and an intern with the Woodrow Wilson Center’s Environmental Change and Security Program. -
Lawrence K. Altman, The New York Times
A World Without AIDS, Still Worlds Away
›August 6, 2012 // By Wilson Center Staff
The original version of this article, by Lawrence K. Altman, appeared on The New York Times.
Is the world on the verge of ending the AIDS epidemic and creating an AIDS-free generation, even though a cure and a vaccine are still distant hopes?Yes, roared enthusiasts among the nearly 24,000 participants at the 19th International AIDS Conference here last week. Their hopes are based on the extraordinary scientific gains made since the conference was last held in the United States, 22 years ago, when an AIDS diagnosis was a sure death sentence.
Among those gains: antiretroviral drug combinations for women to prevent infection of their newborns; drugs to treat and prevent infection with HIV, the virus that causes AIDS, among adults; and evidence that voluntary male circumcision can reduce the risk of female-to-male transmission by 50 to 60 percent.
Today, HIV has become a chronic disease that, if treated appropriately, can be held at bay in a newly infected young adult for decades — if the patient adheres to the rigid daily drug regimen.
Continue reading on The New York Times.
Lawrence K. Altman is a senior scholar for the Woodrow Wilson Center’s United States Studies Program.
Photo Credit: “Secretary of State Hilary Rodham Clinton speaks at the International AIDS Conference,” courtesy of Roxana Bravo/World Bank. -
Adenike Esiet: Building Support for Improving Adolescent Sexual and Reproductive Health in Nigeria
›“In Nigeria, young people under the age of 25 are driving the HIV epidemic…and that’s been the opening place for people to begin to say, ‘let’s address the issues of young people’s sexual and reproductive health,’” said Adenike Esiet, executive director of Action Health Incorporated in Lagos, during an interview with ECSP.
On any number of health indicators, girls suffer disproportionately. “For every one boy in the age bracket of 10 to 24 who is HIV positive, there are three girls who are HIV positive,” Esiet said. “Over 60 percent of cases of complications from unsafe abortion reported in Nigerian hospitals are amongst adolescent girls. In fact in literature, 10-15 years ago, this was described as ‘a schoolgirl’s problem’…and it’s still an ongoing problem.” She added: “And for girls too, the issue of sexual violence is huge. It goes largely unreported but it’s occurring at epidemic levels.”
Esiet spoke on an adolescent health panel during the April 25 “Nigeria Beyond the Headlines” event at the Wilson Center. Progress is slow on these issues, in large part because “there’s a whole lot of silence about acknowledging young people’s sexuality,” she said.
Adults “want to believe [adolescents] shouldn’t be sexually active.” But turning a blind eye to adolescent sexuality can mean that efforts “to provide access to education or services is hugely resisted by practitioners who should be doing this.”
Action Health works to fill the gap that emerges. “Our work covers advocacy, community outreach, and service provision for young people,” said Esiet.
“Our primary entry road in to work with young people is creating access to sexuality education and youth friendly services. And in the course of trying to do that, we have to do a whole lot of advocacy with government and also with ministries or education and ministries of health and youth development.”
The group has worked with government officials and agencies to establish a nationwide HIV education curriculum and paired with local healthcare providers to increase access to “youth-friendly” sexual and reproductive health services. Funding shortages and insufficient resources have hampered the curriculum’s success, though, and the pervasive attitude against youth sexuality has limited the reach of services, she said. Ultimately, “there are a whole range of issues that truly need to be addressed” for outreach efforts to be successful.
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Uganda’s Demographic and Health Challenges Put Into Perspective With Newfound Oil Discoveries [Part One]
›April 26, 2012 // By Kate Diamond
Uganda’s population is the second youngest in the world, with half of the country younger than 15.7 years old (just older than Niger’s median age of 15.5 years). In the past 10 years, the country – about half the size of France in land area – has added 10 million people, growing from 24 to 34 million. That growth, paired with other factors like poor governance and long-standing insecurity, has made providing basic services a difficult task for a government that is one of Africa’s most aid-dependent.
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Jeanne Nyirakamana, PHE Champion
Reaching Rural Rwandans With Integrated Health and Livelihood Messages
›This PHE Champion profile was produced by the BALANCED Project.
Rwanda is one of the most densely populated countries on the planet, with more than 11 million people in one of Africa’s smallest countries, most of whom depend on the land as subsistence farmers. The country has diverse mountain, lake, and savannah landscapes, and the Virunga Mountain chain in the northwest part of the country is home to one-third of the world’s threatened mountain gorilla population. At the same time, the population throughout the country suffers from high rates of unmet need for contraception, and three percent of the adult population lives with HIV/AIDS. In a land under such intense pressure on natural resources, rural livelihood initiatives are critical to ensuring people have options for meeting their daily health and well-being needs.
For the past three years, Jeanne Nyirakamana has served as head of the health program for the Sustaining Partnerships to Enhance Rural Enterprise and Agribusiness Development (SPREAD) Project. Supported by the U.S. Agency for International Development through Texas A&M; University, the SPREAD Project is integrating a dynamic coffee production and quality improvement program in Rwanda with health outreach to improve community well-being. The health component works to improve the lives of coffee farmers and cooperative members by providing them with health information and services related to family planning, maternal and child health, prevention of sexually-transmitted infections (including HIV), and water and sanitation.
Training Peer Educators
Working closely with the coffee program, Nyirakamana’s team has trained more than 540 men, women, and youth peer educators who have reached more than 95,000 coffee farmers with education and services. Key communication messages highlight the links between sound decision-making and health-seeking behaviors, productive farms and agribusinesses, and strong and healthy families.
The program also leverages and supports local health resources through referrals to existing public health services, organization of mobile clinics, and community-based distribution of a socially marketed water purification solution (Sur Eau) and condoms (Prudence). According to Nyirakamana, one of the project’s greatest successes is the increased acceptance of family planning by farmers and their families and the more than 7,500 farmers who have been tested for HIV. In order to draw in as many coffee farmers as possible, many of the health and livelihood activities take place at the stations where the coffee beans are washed, at other buildings used by the coffee farmer cooperative, or during combined community meetings or home visits. At the washing stations, Nyirakamana’s team supports local health center staff to provide voluntary counseling and testing (VCT) and de-worming services while at the same time SPREAD-trained peer educators and coffee/health extension agents disseminate family planning information.
The cooperatives’ buildings have clean water, hand-washing stations, and small kiosks where condoms and Sur Eau are sold. These community health agents work with SPREAD to ensure that the greater community, not just the coffee farmers, has access to health knowledge and services. They learn how to teach the community about a range of health issues and each month they submit reports showing how many people they reached and with what kinds of messages. They are also becoming increasingly engaged in coffee and agribusiness activities. Through the success of their health activities, these agents are seen as vital community resources.
Integrated Results
By implementing this integrated population, health and environment (PHE) approach, the SPREAD Project staff is ensuring the health of the people and environment and success of the agribusiness. “You cannot care for the environment without first caring for the people who live and use that environment, so when you transmit dual messages [agriculture and health] you are able to hit two birds with one stone,” said Nyirakamana.
According to a 2010 evaluation of the project, farmers and their families reported improvements in personal and household hygiene; an increase in understanding and acceptance of family planning; uptake of HIV and VCT services; and use of condoms and other local health services. As well, they noted shifts in gender norms affecting household revenue use, alcohol, and reproductive health. The agribusiness stakeholders value the integrated approach as a means to more holistically meet farmers’ goals of increased incomes and improved lives and livelihoods.
This PHE Champion profile was produced by the BALANCED Project. A PDF version can be downloaded from the PHE Toolkit. PHE Champion profiles highlight people working on the ground to improve health and conservation in areas where biodiversity is critically endangered.
Photo Credit: BALANCED Project. -
Ben Ramalingam, Aid on the Edge of Chaos
The Complexity of Scaling Up
›October 11, 2011 // By Wilson Center StaffThe original version of this article, by Ben Ramalingam, appeared on Aid on the Edge of Chaos.
Despite increased prominence and funding of global health initiatives, attempts to scale up health services in developing countries are failing, with serious implications for achieving the Millennium Development Goals. A new paper argues that a key first step is to get a more realistic understanding of health systems, using the lens of complex adaptive systems.
Much ongoing work in development and humanitarian aid is based on the idea of “scaling up” effective solutions. Healthcare is one of the areas where this idea has played a central role – from the World Health Organization’s Health for All in the 1960s to UNICEF’s child healthcare programs, from rolling out HIV-AIDS, malaria and TB treatments to the package of interventions delivered to achieve the Millennium Development Goal on health.
However, despite the fact there are many cost-effective solutions to health problems faced in developing countries, many agencies are still frustrated in their attempts to deliver them at scale. This may be because of a widespread failure to understand the nature of health systems.
Continue reading on Aid on the Edge of Chaos.
Image Credit: Adapted from Table 1, “Understanding pathways for scaling up health services through the lens of complex adaptive systems,” Health Policy and Planning, Oxford University Press.
