PERSPECTIVES
On the Road to Health Equality
Investing in Women and the People of Africa
MARGARET CHAN currently serves as the Director-General of the World
Health Organization (WHO). Chan was previously Hong Kong’s Director of
Health (1994–2003) and WHO Assistant Director-General for Communicable Diseases (2003–2006).
U
pon taking office as Director-General of
the World Health Organization (WHO)
in 2007, I said that I wanted to be judged
by the WHO’s impact on the health of two
populations: women and the people of Africa.
We, the WHO, are of course concerned with everyone’s
health, but within the broad compass of global health
these two large groups of people have been at a particular
disadvantage. For reasons of history, geography, climate,
and ecology, the people of sub-Saharan Africa (“Africa” from
here on) bear the greatest burden of ill health and disease. In
many societies around the world, women are still denied the
same opportunities as men to participate in decisions that
affect their health and the health of their families. For many
African women, the two kinds of disadvantages coincide. I
therefore concluded in 2007 that supporting women and
the people of Africa would be two powerful ways of working
towards greater health equality worldwide.
Seven years later, it is clear that there have been substantial improvements in the health of these overlapping
populations, but the gains that have been made are nowhere
near enough. In Africa, maternal and infant mortality were
cut by more than 40 percent between 1990 and 2012, falling, respectively, to 480 per 100,000 live births and 63 per
10
1,000 live births. However, the rates of decline in these key
indicators have been slower than in other WHO regions of
the world; consequently, the levels observed in 2012 were
still higher than for any other region.
Over the same period in Africa, the drop in neonatal
mortality, which is closely linked to the health of mothers and
young children, was even smaller (just 29 percent). Therefore, while these indicators of maternal and child mortality
are moving in the right direction—downwards—they show
that the health of African women and infants is falling behind
that of individuals in other regions.
An important underlying reason for these persistently
high death rates is that mothers and children in Africa still
have relatively poor access to essential health services. Considering some of the services that are important for families,
WHO statistics show that Africa has, by standard measures,
the greatest unmet need for family planning, the lowest
use of contraceptives, and the lowest percentage of births
attended by skilled health workers. Falling ill is costly. To
pick just one example, only one in five people in the world
enjoy a form of social security that covers for wages lost due
to illness; but in Africa the proportion is less than 1 in 10
according to the World Health Report 2010. The challenge
for most national governments, but especially those in Africa,
H A R V A R D I N T E R N A T I O N A L R E V I E W • Summer 2014
Photo Courtesy Reuters