Decision-making for delivery location and quality of care among slum-dwellers: a qualitative study in Uttar Pradesh, India.

BackgroundIn 2013, the Government of India launched the National Urban Health Mission (NUHM) in order to better address the health needs of urban populations, including the nearly 100 million living in slums. Maternal and neonatal health indicators remain poor in India. The objective of this study is to highlight the experiences of women, their husbands, and mothers-in-law related to maternal health services and delivery experiences.MethodsIn total, we conducted 80 in-depth interviews, including 40 with recent mothers, 20 with their husbands, and 20 with their mothers-in-law. Purposeful sampling was conducted in order to obtain differences across delivery experiences (facility vs. home), followed by their family members.ResultsMajor factors that influence decision-making about where to seek care included household dynamics and joint-decision-making with families, financial barriers, and perceived quality of care. Women perceived that private facilities were higher quality compared to public facilities, but also more expensive. Disrespectful care, bribes in the facility, and payment challenges were common in this population.ConclusionsA number of programmatic and policy recommendations are highlighted from this study. Future endeavors should include a greater focus on health education and public programs, including educating women on how to access programs, who is eligible, and how to obtain public funds. Families need to be educated on their rights and expectations in facilities. Future programs should consider the role of husbands and mothers-in-law in reproductive decision-making and support during deliveries. Triangulating information from multiple sources is important for future research efforts

Achieving a “Grand Convergence” in Global Health by 2035: Rwanda Shows the Way Comment on “Improving the World’s Health Through the Post-2015 Development Agenda: Perspectives From Rwanda”

lobal Health 2035 , the report of The Lancet Commission on Investing in Health, laid out a bold, highly ambitious framework for making rapid progress in improving global public health outcomes. It showed that with the right health investments, the international community could achieve a “grand convergence” in global health—a reduction in avertable infectious, maternal, and child deaths down to universally low levels—within a generation. Rwanda’s success in rapidly reducing such deaths over the last 20 years shows that convergence is feasible. Binagwaho and Scott have argued that 5 lessons from this success are the importance of equity, quality health services, evidence-informed policy, intersectoral collaboration, and effective collaboration between countries and multilateral agencies. This article re-examines these lessons through the lens of the Global Health 2035 report to analyze how the experience in Rwanda might be generalized for other countries to making progress towards achieving a grand convergenc

Mexico’s path towards the Sustainable Development Goal for health: an assessment of the feasibility of reducing premature mortality by 40% by 2030

Background The United Nations Sustainable Development Goal for health (SDG3) poses complex challenges for signatory countries that will require clear roadmaps to set priorities over the next 15 years. Building upon the work of the Commission on Investing in Health and published estimates of feasible global mortality SDG3 targets, we analysed Mexico’s mortality to assess the feasibility of reducing premature (0–69 years) mortality and propose a path to meet SDG3. Methods We developed a baseline scenario applying 2010 age-specifi c and cause-specifi c mortality rates from the Mexican National Institute of Statistics and Geography (INEGI) to the 2030 UN Population Division (UNPD) population projections. In a second scenario, INEGI age-specifi c and cause-specifi c trends in death rates from 2000 to 2014 were projected to 2030 and adjusted to match the UNPD 2030 mortality projections. A third scenario assumed a 40% reduction in premature deaths across all ages and causes. By comparing these scenarios we quantifi ed shortfalls in mortality reductions by age group and cause, and forecasted life expectancy pathways for Mexico to converge to better performing countries. Findings UNPD-projected death rates yield a 25·9% reduction of premature mortality for Mexico. Accelerated reductions in adult mortality are necessary to reach a 40% reduction by 2030. Mortality declines aggregated across all age groups mask uneven gains across health disorders. Injuries, particularly road traffi c accidents and homicides, are the main health challenge for young adults (aged 20–49 years) whereas unabated diabetes mortality is the single most important health concern for older adults (aged 50–69 years). Interpretation Urgent action is now required to control non-communicable diseases and reduce fatal injuries in Mexico, making a 40% reduction in premature mortality by 2030 feasible and putting Mexico back on a track of substantial life expectancy convergence with better performing countries. Our study provides a roadmap for setting national health priorities. Further analysis of the equity implications of following the suggested pathway remains a subject of future research

Salud global 2035: implicaciones para México

En noviembre de 2014, la Secretaría de Salud de México fue sede de una mesa redonda con miembros de la Comisión de The Lancet para la Inversión en Salud (CIS) para analizar el informe de esta misma comisión titulado Salud global 2035 y sus posibles implicaciones para el mejoramiento de la salud pública..

Building a tuberculosis-free world: The Lancet Commission on tuberculosis

___Key messages___ The Commission recommends five priority investments to achieve a tuberculosis-free world within a generation. These investments are designed to fulfil the mandate of the UN High Level Meeting on tuberculosis. In addition, they answer

Advancing a Social Determinants Approach to Climate Change and Health

Climate change is a global crisis harming the health of communities around the world. We have known about the causes and risks of climate change since at least the 1960s, and about the health harms of climate change since the 1990s. Yet our collective inability to envision and enact alternative energy and economic systems has locked in a level of global temperature rise with devastating consequences. At current levels of warming, communities around the world are already experiencing a wide range of harmful impacts to mental and physical health and wellbeing; impacts which will grow as climate change continues unabated. As a result of systemic forms of social injustice – including those of economics, race, and gender – climate change is deepening health inequities within and between countries. Gaps in the literature hinder our ability to comprehend and effectively communicate the scale of the challenge, to identify and implement effective programs and policies to protect health in the face of climate change, and to overcome deeply entrenched political barriers to action. In this dissertation, I focus on one gap in particular: the paucity of research at the global level exploring the intersection of climate change and the social determinants of health. Using Nancy Krieger’s Ecosocial Theory of Disease Distribution as a conceptual guide, I develop three empirical case studies, each of which focuses on a distinct pathway though which climate change and the social determinants of health intersect to drive adverse health outcomes. Chapter One offers a brief overview of the current state of climate change and health and describes how a social determinants approach can respond to existing research gaps. Chapter Two utilizes a historical case study to document the engagement of the fossil fuel industry in the science of climate change and health, newly emergent in the 1990s. It identifies how the industry sought to influence the public health narrative on climate change and opens a critical new area of research for understanding and navigating political barriers to climate action. Chapter Three quantitatively assesses the relationship between drought – an environmental phenomenon becoming increasingly common and severe because of climate change – and women’s empowerment – a social determinant of women’s and children’s health. Drawing on analysis of household surveys in twenty-four countries in sub-Saharan Africa, this paper finds that drought is associated with small but significant decline in women’s empowerment, thus expanding a currently understudied area in the literature on climate change and women’s health. Chapter Four presents qualitative analysis of how climate change impacts mental health in a uniquely vulnerable population of smallholder farmers living with HIV in western Kenya. This chapter finds that mental health is predominantly mediated by profound changes in economic and social systems, and thus proposes a new conceptual framework for understanding the social determinants pathways through which climate change shapes emotional health. Finally, Chapter Five draws conclusions from these three studies, proposing directions for future research, and highlighting how a social determinants approach to global health sciences research on climate change can inform more effective community and policy interventions to reduce climate change’s health harms

Achieving a “Grand Convergence” in Global Health by 2035: Rwanda Shows the Way; Comment on “Improving the World’s Health Through the Post-2015 Development Agenda: Perspectives From Rwanda”

Global Health 2035, the report of The Lancet Commission on Investing in Health, laid out a bold, highly ambitious framework for making rapid progress in improving global public health outcomes. It showed that with the right health investments, the international community could achieve a “grand convergence” in global health—a reduction in avertable infectious, maternal, and child deaths down to universally low levels—within a generation. Rwanda’s success in rapidly reducing such deaths over the last 20 years shows that convergence is feasible. Binagwaho and Scott have argued that 5 lessons from this success are the importance of equity, quality health services, evidence-informed policy, intersectoral collaboration, and effective collaboration between countries and multilateral agencies. This article re-examines these lessons through the lens of the Global Health 2035 report to analyze how the experience in Rwanda might be generalized for other countries to making progress towards achieving a grand convergence