Lynn P Freedman, Ronald J Waldman, Helen de Pinho, Meg E Wirth, A Mushtaque R Chowdhury, Allan Rosenfield

Ambitious quantitative goals for reducing mortality and increasing access to health interventions are nothing new to the areas of child, maternal, and reproductive health. They are the standard fare of global declarations and national 5-year plans. They come. They go. What makes he Millennium Development Goals (MDGs) different? ith health firmly embedded in this wider povertyreduction nitiative, which has garnered unprecedented onsensus and support from governments and ultilateral organisations, the global health community as a rare opportunity to break through to new ways of hinking about the obstacles now blocking improvements n the health of women and children and to translate that hinking into bold new steps to meet goals 4 and 5 (table). or the UN Millennium Project Task Force on Child Health and Maternal Health, the potential breakthrough lies in putting health systems at the centre of MDG strategies and in addressing these systems, not only as delivery mechanisms for technical interventions but also as core social institutions—as part of the very fabric of social and civic life. In high-mortality countries today, especially for the poorest populations, health systems are frequently the source of catastrophic costs, humiliating treatment, and deepening social exclusion. But a different way is possible. Health systems can be a vehicle for fulfilling rights, for active citizenship, and for true democratic development—poverty reduction in its fullest sense.

Caren Grown, Geeta Rao Gupta, Rohini Pande

Over the past few decades, great strides have been made in improvement of women’s health status; more than a decade has been added to life expectancy, and fertility rates in both developed and developing countries have declined substantially,1 helping to reduce burdens associated with childbirth and childrearing. Despite this progress, more than half a million women—99% of whom live in the developing world—continue to die every year in pregnancy and childbirth due to entirely preventable reasons. Additionally, amid the HIV/AIDS pandemic, women today face new and worsening health risks: 50% of all adults living with HIV/AIDS worldwide are women, and those age 15–24 years are disproportionately affected.

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Jamie Bartram, Kristen Lewis, Roberto Lenton, Albert Wright

A silent humanitarian crisis kills some 3900 children every day and thwarts progress towards all the Millennium Development Goals (MDGs), especially in Africa and Asia. The root of this unrelenting catastrophe lies in these plain, grim facts: four of every ten people in the world do not have access to even a simple pit latrine; and nearly two in ten have no source of safe drinking water.1 To help end this appalling state of affairs, the MDGs include a specific target (number 10) to cut in half, by 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation.

Attachments:
Download this file (192_PUBL_Lanc_Focusing_on_improved_water_and_sanitation_forhealth.pdf)Focusing on improved water and sanitation for health[Millennium Project]51 kB
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Pedro A Sanchez, M S Swaminathan

worldwide. Various dimensions of malnutrition (eg, underweight, zinc deficiency, iron deficiency, vitamin A deficiency) account for seven of the 13 leading risk factors associated with the global burden of diseases. For both children and adults, malnutrition reduces the body’s natural defences against a vast range of diseases. The death rate from diseases such as lower respiratory infection, malaria, and measles, which account for a large proportion of children’s deaths, are much higher in children who are underweight or have specific nutrient deficiencies than in those who are not. Undernourished people infected with HIV/AIDS develop the full symptoms of the disease more quickly than people who are well fed. Yet one of the earliest side-effects of AIDS is reduced consumption of food in affected households.

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Don J Melnick, Yolanda Kakabadse Navarro, Jeffrey McNeely, Guido Schmidt-Traub, Robin R Sears

Ensuring environmental sustainability is essential to achieving all the Millennium Development Goals. Longterm solutions to problems of drinking-water shortages, hunger, poverty, gender inequality, emerging and reemerging infectious diseases, maternal and childhood health, extreme local weather and global climate changes, and conflicts over natural resources need systematic strategies to achieve environmental sustainability. For this reason, the UN Millennium Project Task Force on Environmental Sustainability has concluded that protection of the environment is an essential prerequisite and component of human health and wellbeing.1 Economic development and good health are not at odds with environmental sustainability: they depend on it.

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J D Sachs, J W McArthur

This year marks a pivotal moment in international efforts to fight extreme poverty. During the United Nations (UN) Millennium Summit in 2000, 147 heads of state gathered and adopted the Millennium Development Goals (MDGs, panel 1) to address extreme poverty in its many dimensions—income poverty, hunger, disease, lack of adequate shelter, and exclusion—while promoting education, gender equality, and environmental sustainability, with quantitative targets set for the year 2015. The UN committed to reviewing progress towards the goals in 2005, recognising that by this time only a decade would be left to fulfil the MDGs.

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Josh Ruxin, Joan E Paluzzi, Paul A Wilson, Yes.im Tozan, Margaret Kruk, Awash Teklehaimanot

With 2015 only a decade away, the poorest countries face enormous hurdles to achieving the Millennium Development Goals (MDGs) for health, let alone the broader goal of health for all their citizens. The MDGs all relate to health to some degree; virtually any intervention that reduces poverty and inequality will also decrease the disproportionate vulnerability to disease and injury borne by impoverished people. The UN Millennium Project established a task force concerned with the sixth goal, to “combat HIV/AIDS, malaria and other diseases” and improving access to essential medicines. Its work emphasises broad health challenges while recognising the specific threats posed by the worsening epidemics of HIV/AIDS, tuberculosis, and malaria, which together caused an estimated 6 million deaths in 2004.

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Elliott D Sclar, Pietro Garau, Gabriella Carolini

“Breathing the air in Bombay (Mumbai) now is the quivalent of smoking two and a half packs of cigarettes day.”
Alfred Knopf

One of the key 21st century challenges in population health is the challenge of improving the global urban condition.2Starting in 2007, and for the first time in human history, the majority of the world’s population will live in urban areas. According to the latest UN projections, by 2030, the world’s urban population will increase by more than two billion, while the rural population will decline by about 20 million. This shift is argely the culmination of a rapid global urbanisation process that has been underway for more than 250 years. Rapid urbanisation first became manifest in the countries undergoing industrialisation in the developed world, and then in Latin America. Today its prime locus is the poorer parts of Asia and Africa. More than 90% of the world’s urban population growth by 2030 will be in less developed regions. Any effort to measurably improve global health outcomes, especially in these regions, will need to address urban reform.

Attachments:
Download this file (187_PUBLIC_LANCET_5_March_2005_The_Lancet_The_21st_century_health_challenge.pdf)The 21st century health challenge of slums and cities [Millennium Project]57 kB
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