SciCombinator

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Concept: Poverty reduction

174

Debate over the measurement of global poverty in low- and middle-income countries continues unabated. There is considerable controversy surrounding the ‘dollar a day’ measure used to monitor progress against the Millennium Development Goals. This article shines fresh light on the debate with new empirical analyses of poverty (including child poverty), inequality and deprivation levels in the Pacific island state of Vanuatu. The study focuses not only on economic and monetary metrics and measures, but also the measures of deprivation derived from sociology in relation to shelter, sanitation, water, information, nutrition, health and education. Until recently, there had been few, if any, attempts to study poverty and deprivation disparities among children in this part of the world. Different measures yield strikingly different estimates of poverty. The article, therefore, attempts to situate the study findings in the broader international context of poverty measurement and discusses their implications for future research and the post-2015 development agenda.

Concepts: Poverty, Pacific Ocean, World Bank, Sanitation, Millennium Development Goals, Poverty reduction, Pacific Islands, Extreme poverty

174

BACKGROUND: Inequity in access to and use of child and maternal health interventions is impeding progress towards the maternal and child health Millennium Development Goals. This study explores the potential health gains and equity impact if a set of priority interventions for mothers and under fives were scaled up to reach national universal coverage targets for MDGs in Tanzania. METHODS: We used the Lives Saved Tool (LiST) to estimate potential reductions in maternal and child mortality and the number of lives saved across wealth quintiles and between rural and urban settings. High impact maternal and child health interventions were modelled for a five-year scale up, by linking intervention coverage, effectiveness and cause of mortality using data from Tanzania. Concentration curves were drawn and the concentration index estimated to measure the equity impact of the scale up. RESULTS: In the poorest population quintiles in Tanzania, the lives of more than twice as many mothers and under-fives were likely to be saved, compared to the richest quintile. Scaling up coverage to equal levels across quintiles would reduce inequality in maternal and child mortality from a pro rich concentration index of -0.11 (maternal) and -0.12 (children) to a more equitable concentration index of -0,03 and -0.03 respectively. In rural areas, there would likely be an eight times greater reduction in maternal deaths than in urban areas and a five times greater reduction in child deaths than in urban areas. CONCLUSIONS: Scaling up priority maternal and child health interventions to equal levels would potentially save far more lives in the poorest populations, and would accelerate equitable progress towards maternal and child health MDGs.

Concepts: Demography, Population, Maternal death, United Nations, Millennium Development Goals, Child mortality, Maternal health, Poverty reduction

163

As the deadline for the millennium development goals approaches, it has become clear that the goals linked to maternal and newborn health are the least likely to be achieved by 2015. It is therefore critical to ensure that all possible data, tools and methods are fully exploited to help address this gap. Among the methods that are under-used, mapping has always represented a powerful way to ‘tell the story’ of a health problem in an easily understood way. In addition to this, the advanced analytical methods and models now being embedded into Geographic Information Systems allow a more in-depth analysis of the causes behind adverse maternal and newborn health (MNH) outcomes. This paper examines the current state of the art in mapping the geography of MNH as a starting point to unleashing the potential of these under-used approaches. Using a rapid literature review and the description of the work currently in progress, this paper allows the identification of methods in use and describes a framework for methodological approaches to inform improved decision-making. The paper is aimed at health metrics and geography of health specialists, the MNH community, as well as policy-makers in developing countries and international donor agencies.

Concepts: Geographic information system, Map, World Bank, Maternal death, United Nations, Millennium Development Goals, Maternal health, Poverty reduction

33

Globally, the status of women’s health falls short of its potential. In addition to the deleterious ethical and human rights implications of this deficit, the negative economic impact may also be consequential, but these mechanisms are poorly understood. Building on the literature that highlights health as a driver of economic growth and poverty alleviation, we aim to systematically investigate the broader economic benefits of investing in women’s health.

Concepts: Africa, Poverty, Economics, Investment, World Bank, Economic development, Poverty reduction, Extreme poverty

31

Beyond their impact on health, vaccines can lead to large economic benefits. While most economic evaluations of vaccines have focused on the health impact of vaccines at a national scale, it is critical to understand how their impact is distributed along population subgroups.

Concepts: Poverty, Tuberculosis, Economic development, Poverty reduction, Extreme poverty

30

To develop effective environmental policies, we must understand the mechanisms through which the policies affect social and environmental outcomes. Unfortunately, empirical evidence about these mechanisms is limited, and little guidance for quantifying them exists. We develop an approach to quantifying the mechanisms through which protected areas affect poverty. We focus on three mechanisms: changes in tourism and recreational services; changes in infrastructure in the form of road networks, health clinics, and schools; and changes in regulating and provisioning ecosystem services and foregone production activities that arise from land-use restrictions. The contributions of ecotourism and other ecosystem services to poverty alleviation in the context of a real environmental program have not yet been empirically estimated. Nearly two-thirds of the poverty reduction associated with the establishment of Costa Rican protected areas is causally attributable to opportunities afforded by tourism. Although protected areas reduced deforestation and increased regrowth, these land cover changes neither reduced nor exacerbated poverty, on average. Protected areas did not, on average, affect our measures of infrastructure and thus did not contribute to poverty reduction through this mechanism. We attribute the remaining poverty reduction to unobserved dimensions of our mechanisms or to other mechanisms. Our study empirically estimates previously unidentified contributions of ecotourism and other ecosystem services to poverty alleviation in the context of a real environmental program. We demonstrate that, with existing data and appropriate empirical methods, conservation scientists and policymakers can begin to elucidate the mechanisms through which ecosystem conservation programs affect human welfare.

Concepts: Biodiversity, Poverty, Empiricism, Empirical, Policy, Empirical research, Poverty reduction, Costa Rica

16

While the Millennium Development Goals (MDGs; 2000-2015) focused primarily on poverty reduction, hunger and infectious diseases, the proposed Sustainable Development Goals (SDGs) and targets pay more attention to nutrition and non-communicable diseases (NCDs). One of the 169 proposed targets of the SDGs is to reduce premature deaths from NCDs by one third; another is to end malnutrition in all its forms. Nutrition-related NCDs (NR-NCDs) stand at the intersection between malnutrition and NCDs. Driven in large part by remarkable transformations of food systems, they are rapidly increasing in most low and middle income countries (LMICs). The transformation to modern food systems began in the period following World War II with policies designed to meet a very different set of nutritional and food needs, and continued with globalization in the 1990s onwards. Another type of food systems transformation will be needed to shift towards a healthier and more sustainable diet - as will meeting many of the other SDGs. The process will be complex but is necessary. Communities concerned with NCDs and with malnutrition need to work more closely together to demand food systems change.

Concepts: Biodiversity, Nutrition, Poverty, United Nations, Millennium Development Goals, Sustainable development, Poverty reduction, Extreme poverty

13

Remarkable financial and political efforts have been focused on the reduction of child mortality during the past few decades. Timely measurements of levels and trends in under-5 mortality are important to assess progress towards the Millennium Development Goal 4 (MDG 4) target of reduction of child mortality by two thirds from 1990 to 2015, and to identify models of success.

Concepts: World Bank, United Nations, Millennium Development Goals, Child mortality, Maternal health, International development, African Development Bank, Poverty reduction

11

The Sustainable Development Goals (SDGs), to be committed to by Heads of State at the upcoming 2015 United Nations General Assembly, have set much higher and more ambitious health-related goals and targets than did the Millennium Development Goals (MDGs). The main challenge among MDG off-track countries is the failure to provide and sustain financial access to quality services by communities, especially the poor. Universal health coverage (UHC), one of the SDG health targets indispensable to achieving an improved level and distribution of health, requires a significant increase in government investment in strengthening primary healthcare - the close-to-client service which can result in equitable access. Given the trend of increased fiscal capacity in most developing countries, aiming at long-term progress toward UHC is feasible, if there is political commitment and if focused, effective policies are in place. Trends in high income countries, including an aging population which increases demand for health workers, continue to trigger international migration of health personnel from low and middle income countries. The inspirational SDGs must be matched with redoubled government efforts to strengthen health delivery systems, produce and retain more and relevant health workers, and progressively realize UHC.

Concepts: Biodiversity, United Nations, Millennium Development Goals, Maternal health, International development, United Nations General Assembly, Sustainable development, Poverty reduction

11

Achievement of Millennium Development Goal (MDG) 4 for child survival requires acceleration of gains in newborn survival, and current trends in improving maternal health will also fall short of reaching MDG 5 without more strategic actions. We present a Maternal Newborn and Child Health (MNCH) strategy for accelerating progress on MDGs 4 and 5, sustaining the gains beyond 2015, and further bringing down maternal and child mortality by two thirds by 2030.

Concepts: Maternal death, United Nations, Millennium Development Goals, Child mortality, Maternal health, International development, African Development Bank, Poverty reduction