The World Health Organization has just published the World Health Statistics 2013. It shows that the world has made dramatic progress in improving health in the poorest countries and narrowing the gaps between countries with the best and worst health status in the past two decades. In particular it highlights how efforts to meet the Millennium Development Goals (MDGs) have reduced health gaps between the most-advantaged and least-advantaged countries.
Progress towards Millennium Development Goals measured
As the 2015 deadline for the Millennium Development Goals (MDGs) approaches, the World Health Statistics shows the considerable progress made in reducing child and maternal deaths, improving nutrition and reducing deaths and illness from HIV infection, tuberculosis and malaria. It compares progress made by countries with the best health status and those with least-favourable health status at the MDG baseline year of 1990 and again two decades later.
As stated by Dr Margaret Chan, Director-General of WHO, “Intensive efforts to achieve the MDGs have clearly improved health for people all over the world. But with less than 1000 days to go to reach the MDG deadline, it is timely to ask if these efforts have made a difference in reducing the unacceptable inequities between the richest and poorest countries.”
Impressive health progress for countries in lowest health status category
In relation to MDG 4 — Reduce child mortality, it shows that, in absolute terms, countries in the lowest 25% category of health status have made impressive health progress. For example, the absolute gap in child mortality between the top and bottom countries was reduced from 171 deaths per 1000 live births in 1990 to 107 deaths per 1000 live births in 2011. Some countries that were among those with the world’s highest child mortality rates in 1990 – including Bangladesh, Bhutan, Lao People’s Democratic Republic, Madagascar, Nepal, Rwanda, Senegal and Timor-Leste – have improved child survival to such an extent that they no longer belong to that group.
However, despite the fact that 27 countries have reached the MDG target already, the current rates of progress will not be sufficient to reach the global target of a two-thirds reduction in 1990 levels of child mortality by 2015.
On MDG 5 — Improve maternal health the report notes that in 1990, countries with the highest rates of women dying in pregnancy and childbirth had on average 915 more maternal deaths per 100 000 live births than countries with the lowest rates. By 2010, this gap had narrowed to 512 maternal deaths per 100 000 live births. Unfortunately the global rate of decline (of 3%) will need to double to achieve the MDG target of reducing maternal mortality ratio by three quarters. It also points out that babies born to adolescent mothers account for approximately 11% of all births worldwide, with 95% of such births occurring in developing countries.
On Millennium Development Goal 6 – Combat HIV/AIDS, malaria and other diseases, it reports that the gap between countries with the highest and lowest rates of new HIV infections narrowed from 360 to 261 people per 100 000 population between 1990 and 2011. While new HIV infections increased six-fold for countries with the lowest rates, the group of countries with the highest rates have cut new HIV infections by 27%.
World Health Statistics 2013, pages 14 -15
“A substantial reduction in maternal deaths has previously been noted – from 543 000 deaths in 1990 to an estimated 287 000 by 2010, with a global rate of decline in the maternal mortality ratio of 3.1% per annum over the same period. Nevertheless, this rate of decline would now need to double in order to achieve the MDG target of reducing the maternal mortality ratio by three quarters between 1990 and 2015. All six WHO regions have seen a decline in the maternal mortality ratio, but at different rates (Figure 2). The WHO African Region remains the region with the highest maternal mortality ratio. Approximately one quarter of countries with the highest maternal mortality ratio in 1990 (100 or more maternal deaths per 100 000 live births) have made insufficient progress or none.
“In order to reduce maternal deaths, women need access to good-quality reproductive health services. In 2010, 63% of women aged 15–49 years who were married or in a consensual union were using some form of contraception. Although the proportion of women receiving antenatal care at least once during pregnancy was about 81% over the period 2005–2012, the figure dropped to around 55% for the recommended minimum of four visits or more. The proportion of births attended by skilled personnel – crucial for reducing perinatal, neonatal and maternal deaths – was above 90% in three of the six WHO regions for the period 2005–2012. However, in the WHO African Region coverage remains at under 50%.
“About 16 million adolescent girls between 15 years and 19 years of age give birth each year. Babies born to adolescent mothers account for approximately 11% of all births worldwide – with 95% of such births occurring in developing countries. In low- and middle-income countries, complications from pregnancy and childbirth are a leading cause of death among adolescent girls in this age group, and in 2008 there were an estimated three million unsafe abortions carried out on such girls. The adverse effects of adolescent childbearing also extend to the health of the infants. Perinatal deaths are 50% higher among babies born to mothers under 20 years of age than among those born to mothers aged 20–29 years. The neonates of adolescent mothers are also more likely to have a low birth weight, which may result in a higher rate of long-term health risks.”