Showing posts from category foreign policy.
-
Visualizing Complex Vulnerability in Africa: The CCAPS Climate-Conflict Mapping Tool
›“Every crisis is complex, and the Sahel is no exception,” wrote USAID Assistant Administrator Nancy Lindborg in a recent Huffington Post article that called for “smarter programming and a coordivenated response” to chronic crises. “A regional drought has been overlaid with instability stemming from the coup in Mali and conflict in the northern part of that country where armed militant groups have forced the suspension of critical relief operations” and led to refugee movement into neighboring countries simultaneously challenged by drought and crop infestation. Understanding the complexity of this type of crisis, let alone visualizing the multiple factors that come into play, is a growing challenge for policymakers and analysts.
Enter version 2.0 of a mapping tool created by the Climate Change and African Political Stability Program (CCAPS) housed in the Robert S. Strauss Center for International Security and Law, based at the University of Texas, Austin.
In collaboration with the College of William and Mary, Trinity College, and the University of North Texas, and with funding by the U.S. Department of Defense’s Minerva Initiative, CCAPS originally launched the mapping tool in March of this year. The map is powered by mapping and data tools from Esri and allows users to view any combination of datasets on international development projects, national governance indicators, incidences of conflict, and climate vulnerability data.
With an intuitive interface and compelling visuals, the mapping tool is a valuable resource for policy analysts and researchers to assess the complex interactions that take place among these environmental, political, and social factors. Advanced filters allow the user to identify a subset of conflicts and aid projects and there are nine base map styles from which to choose.The mapping tool is anything but static. The team is constantly working to refine and enhance it through the inclusion of additional indicators and improvement of the interface. The updated version now includes CCAP’s new Social Conflict in Africa Database, which tracks a broad range of social and political unrest, and their partners’ real-time conflict dataset, the Armed Conflict Location and Event Dataset (ACLED), which tracks real-time conflict data. Impressively, the ACLED data will be updated weekly.
I asked CCAPS program manager Ashley Moran to clarify how the governance indicators work in the model. She explained:The national governance indicators are included in one of four baskets that make up the climate vulnerability model…and represent four potential sources of vulnerability: physical exposure to climate-related hazards, population density, household and community resilience, and governance and political violence. They used the term “basket” since most include several indicators that reflect the full dimensions of that source of vulnerability. The fourth basket includes five national governance indicators and one indicator of political violence.
Moran also shared plans to add more detailed national governance data to the map:We are developing a mapping tool specifically for the climate vulnerability model, which will allow users to see the component parts of the model. It will allow users to re-weight the baskets (e.g. if a user thought governance should have more weight within the model since the government response to climate hazards is key), and it will also allow users to examine an area’s vulnerability to just one or two baskets of the user’s particular interest (instead of all four baskets combined as the tool does now). When we launch this, a user will essentially be able to see the vulnerability model disaggregated into its component parts, so they’ll be able to map just the governance data in the model, if they want.
In the coming months, the CCAPS team will add more detailed historical and projected data on climate vulnerability, data on disaster response capacity, as well as international aid projects coded for climate relevance.
Each of these datasets on their own are a wealth of vital information, but understanding how they intersect and the potential impact of their interactions is crucial to improving our understanding of them individually and collectively and creating responses that are timely and long-lasting.
If you’re in the San Diego area next week, check out Ashley Moran’s presentation of the mapping tool at the Esri International User Conference and the Worldwide Human Geography Data Working Group.
Sources: The Climate Change and African Political Stability Program, The Huffington Post.
Image Credit: CCAPS -
World Population Day 2012: Looking Beyond Reproductive Health
›How should the seven billion or so of us on Earth mark World Population Day? Today, major global players are focusing on increasing access to family planning around the world. But there are other important aspects to population that also deserve our sustained attention.
The links between demography and development have come into the limelight over the last few months, first as advocates decried the last minute removal of reproductive rights language from the Rio+20 outcome document and now as the Bill and Melinda Gates Foundation prepares a massive funding push for reproductive health (starting today, not coincidentally).
“Multiple crises – food, fuel, and financial – have caused significant suffering and served as a wake-up call about the need to pay far more attention to the building blocks of sustainable development,” UN Secretary-General Ban Ki-moon says in an address for today. “Reproductive health is an indispensable part of the sustainable development equation.”
The sustainable development connection is fairly obvious. Environmental destruction in some of the most biodiversity-rich parts of the world has complex but significant population drivers, as Wilson Center consultant Laurie Mazur explains:Human impact on the environment is mediated by a host of factors, including culture, technology, institutions, and market forces. And inequitable socioeconomic systems mean that some human beings have far greater impact than others.
“Often, the value of biodiversity becomes apparent only when it is lost,” Mazur continues. “For example, with the global decline of honeybee populations, growers can now calculate the monetary value of pollination services that were once provided for free by nature. ‘Bee pollination is worth $190 billion,’ said Pavan Sukhdev, a Yale environmental economist, in an interview with Bloomberg. ‘But when did a bee ever send you an invoice?’”
But some generalizations can be made. We live on a planet dominated and transformed by human activity. As we have become more numerous, we have also become more adept at altering ecosystems for human use, replacing species-rich natural landscapes with simpler monocultures.
In other areas, population drivers threaten more basic scarcities: food and water, which in turn impede development and cost human lives. Some of the most successful efforts to address these relationships have combined women’s empowerment, family planning, and basic health interventions with site-based conservation and livelihood efforts.
But besides reproductive rights, there are other important aspects of population that deserve attention on this day.
The demographic dividend – a concept that marries population dynamics and development economics – requires more than just fertility decline to take effect in countries. Economic and social policies that prepare and enable young people to enter the workforce are just as important.
And the Arab Spring helps illustrate the complex relationship between population and democracy. “Among the five countries where revolt took root, those with the earliest success in ousting autocratic leaders also had the most mature age structures and the least youthful populations,” writes Wilson Center consultant and demographer Elizabeth Leahy Madsen. The work of fellow Wilson Center consulting demographer Richard Cincotta shows that countries with very young age structures are prone both to higher incidence of civil conflict and undemocratic governance. What happens next in Egypt, Libya, Yemen, and Syria will further test the connection between youth and democracy.
In South Asia, Madsen finds that as Afghanistan and Pakistan’s political circumstances have become more entwined, their demographic paths are more closely parallel than expected. “For Afghanistan, given its myriad socioeconomic, political, cultural, and geographic challenges, this is good news. But for Pakistan, where efforts to meet family planning needs have fallen short of capacity, it is not,” she writes in the first issue of the newly re-launched ECSP Report, “Afghanistan, Against the Odds: A Demographic Surprise.”
In more developed countries, population aging is a concern. At the Wilson Center last year, economists Andrew Mason and Ronald Lee explained the challenges that those on the other side of the “demographic divide” will face in the near future. From 2010 to 2015, 85 countries are projected to witness the largest absolute increase in history of their populations aged 60 and over, straining public welfare systems and reducing labor forces. It’s not the “catastrophe” that it has been portrayed to be in the media, they said, but like many demographic issues, it is a challenge that will require planning for.
These connections demonstrate the wide importance of population dynamics to understanding how the world works today. Demography is the study of us – all seven billion of us. Demography affects – and is affected by – economics, political stability, health, the environment, food security, foreign policy, development, and conflict. Let’s not overlook that breadth on this World Population Day 2012.
For more, be sure to read some of our additional resources from the recent archives:- Food Security in a Climate-Altered Future: More Than a Supply Problem
- Taming Hunger in Ethiopia: The Role of Population Dynamics
- Uganda’s Demographic and Health Challenges Put Into Perspective With Newfound Oil
- New Surveys Generate Mixed Demographic Signals for East and Southern Africa
- In Building Resilience for a Changing World, Reproductive Health Is Key
- Demographic Security 101 (video)
- Yemen: Revisiting Demography After the Arab Spring
- Hania Zlotnik Discusses Latest Changes to UN Population Projections (audio)
- Book Review: ‘World Population Policies’
- Tunisia’s Shot at Democracy: What Demographics and Recent History Tell Us
- Joel E. Cohen on Solving the Resource-Population Equation in the Developing World (video)
Photo Credit: UN Day Secretary-General Ban Ki-moon with students in October celebrating the seven billion mark, courtesy of Eskinder Debebe/UN Photo. -
Hania Zlotnik Discusses Changes to Latest UN Population Projections
›Former UN Population Division Director Hania Zlotnik spoke recently at the Wilson Center discussing last year’s highly-publicized UN world population projections and explaining the methodology behind the figures. “The latest projections are very special,” she said, adding that “we think that this methodology is a lot better than what we had before.”
What accounts for such improvement? Zlotnik said it has a lot to do with greater availability of data. “The UN has been…mandated by governments to produce population estimates since the 1950s,” she stated, and they have refined their projections process over the years based on an increasing record of data and identification of some “patterns that can inform the future.”Former UN Population Division Director Hania Zlotnik spoke recently at the Wilson Center discussing last year’s highly-publicized UN world population projections and explaining the methodology behind the figures. “The latest projections are very special,” she said, adding that “we think that this methodology is a lot better than what we had before.”
What accounts for such improvement? Zlotnik said it has a lot to do with greater availability of data. “The UN has been…mandated by governments to produce population estimates since the 1950s,” she stated, and they have refined their projections process over the years based on an increasing record of data and identification of some “patterns that can inform the future.”
The increasingly large dataset accumulated during this process is particularly important because of what Zlotnik called “inertia” in population change. “There’s something called ‘population momentum,’ where the population changes on the basis of how many people have already been accumulated on the planet,” she explained, pointing out that many of the people included in the UN’s population projections for 2050 have already been born.
This inertia helps make population projections fairly accurate, but last year’s projections differed from previous efforts in two significant ways.
First, the UN Population Division provided projections not just to 2050 but also to 2100. These more long-term projections estimated an end-of-century population of more than 10 billion – notably higher than previous reports, which had predicted that population would stabilize mid-century at around nine billion.
Second, the underlying methodology used shifted from a deterministic to a probabilistic approach that, according to Zlotnik, does a better job capturing variability in each country’s fertility rate over the next century. “Essentially,” she explained, “a model was developed for every country that takes into account the past path of fertility change [and] also takes into account changes that have happened in other countries…Then [it] does a simulation for the future for every country, in which 100,000 paths are projected, essentially by throwing dice, and then the central path of those 100,000 is used to project the future.”
Zlotnik cautioned that projecting so far into the future is an inexact – albeit necessary – science: “Of course, as we go further into the future, the numbers are more subject to uncertainty. But [the long-term projections] help us give people a better feeling of how important it is to change trends from here to 2050, so that we ensure that, at the end of the century, the number of people on the planet is sustainable.”
“In order to make sure that the population projections made by the United Nations [are realized],” Zlotnik said, “it’s very important that fertility continues to decline, and especially that fertility decline happens in the countries that still have very high fertility.”
“Fertility decline happens in many ways,” she continued, “but the immediate reason why fertility can be reduced is that more people use modern methods of contraception.” -
Jennifer Dabbs Sciubba, The Huffington Post
Global Threats Exist, But Also Many Global Demographic Opportunities for the United States
›July 3, 2012 // By Wilson Center StaffThe original version of this article, by Jennifer Dabbs Sciubba, appeared on The Huffington Post.
Events like the Arab Spring gave birth to a generation of demographic converts in the national security community. Many are now convinced that demography matters because demographers today can clearly show how youthful population profiles in the developing world could lead to conflicts over the next 20 years – a major concern for policymakers.
Too much focus on demography and conflict, though, means policymakers miss opportunities for cooperation.
We are used to thinking of the wealthy and stable “Global North” and the poor and tumultuous “Global South,” but a demographic divide within the developing world is emerging, a third category of states that are growing older, more urban, more prosperous, more peaceful, and active in international affairs. These states – particularly India, Brazil, and South Africa – represent opportunities for building U.S. and world security.
Even as it maintains its longstanding relationships in Europe and elsewhere in the developed world, the U.S. should be more assertive in seeking partnerships with India as both a counterbalance to China and as a global security partner in addressing piracy and terrorism and in distributing international aid.
Continue reading on The Huffington Post.
Photo Credit: Tahrir 2011, courtesy of flickr user Denis Bocquet. -
What Are the Most Important Factors in the Failed States Index?
›Last week, the Fund for Peace issued its eighth annual Failed States Index (FSI). The index gives 177 countries a score between 1.0 and 10.0 for 12 indicators, ranging from the legitimacy of the state and the security apparatus to demographic pressure and uneven development (high being bad, low being good – see full descriptions of the indicators here). But which of these indicators has the biggest impact? We did a quick analysis of the Failed States Indexes published from 2006 to 2012 to show which of the indicators correlate most with a high score. (We skipped 2005 since the roster of analyzed countries was significantly smaller.)
-
Nancy Lindborg, The Huffington Post
For Yemen’s Future, Global Humanitarian Response Is Vital
›June 12, 2012 // By Wilson Center StaffThe original version of this article, by Nancy Lindborg, appeared on The Huffington Post.
This weekend in Sana’a, I had dinner with a group of young men and women activists who are on the forefront of Yemen’s historic struggle for a better future. They turned out for change with great courage last year, and at dinner, with great eloquence they outlined for me the many challenges facing Yemen during this critical transition period: conflict in the north and south, weak government institutions, cultural barriers to greater women’s participation, an upended economy, and one of the world’s highest birthrates. And, as one man noted, it is difficult to engage the 70 percent of Yemeni people who live in rural areas in dialogue about the future when they are struggling just to find the basics of life: food, health, water.
His comment makes plain the rising, complex humanitarian crisis facing Yemen. At a time of historic political transition, nearly half of Yemen’s population is without enough to eat, and nearly one million children under the age of five are malnourished, putting them at greater risk of illness and disease. One in 10 Yemeni children do not live to the age of five. One in 10. This is a staggering and often untold part of the Yemen story: a story of chronic nationwide poverty that has deepened into crisis under the strain of continuing conflict and instability.
Unfortunately, in communities used to living on the edge, serious malnutrition is often not even recognized in children until they are so acutely ill that they need hospitalization.
Continue reading on The Huffington Post.
Nancy Lindborg is the assistant administrator of the Bureau for Democracy, Conflict, and Humanitarian Assistance at the U.S. Agency for International Development.
Sources: U.S. Department of State.
Photo Credit: Informal settlements near the Haddjah governorate, courtesy of E.U. Humanitarian Aid and Civil Protection. -
The Year Ahead in Political Demography: Top Issues to Watch
›June 8, 2012 // By Elizabeth Leahy Madsen2011 and the first half of 2012 have been a remarkable period for political demography, with theories about the relationships between age structure and governance validated in real time by the events of the Arab Spring. Although such game-changers are rarely predictable, the year ahead promises to be eventful as well, with new demographic research and major policy initiatives on the horizon. Below are brief assessments of some of the top issues to watch between now and next summer.
1. The Evolving Story of the Arab Spring
The Arab Spring was anticipated by few observers, but for a handful of political demographers it was a watershed of sorts. As readers of this blog know, political demography research shows that countries with very young age structures are prone both to higher incidence of civil conflict and – most relevant to the outcomes of the Arab Spring – to undemocratic governance. This nuance escaped many observers of the region’s drama. Violence and conflict erupted not from raging citizens in the streets but from military and militia forces unleashed by autocrats unwilling to cede their grip on power. Young people, and their fellow protestors of all ages, were acting as a force for positive change in their demonstrations against corrupt and unrepresentative leadership. The difference in outcomes across the region, according to Richard Cincotta, can be attributed to the fact that as age structures mature, elites become less willing to trade their political freedoms to autocratic leaders in exchange for the promise of security and stability.
When considered with this important distinction in mind, the initial events following the uprising in Tunisia that quickly spread across the region played out in a neatly linear fashion. Among the five countries where revolt took root, those with the earliest success in ousting autocratic leaders also had the most mature age structures and the least youthful populations.
In Tunisia, with a median population age of 29, one month passed between a fruit seller’s self-immolation and Zine El Abedine Ben Ali’s flight to exile. In Egypt and Libya, where median age is close to 25 years (identified by Cincotta as a threshold when countries are at least 50 percent likely to be democratic), Hosni Mubarak and Moammar Gaddafi took three weeks and eight months, respectively, to lose their titles. Ali Abdullah Saleh in Yemen (median age 17), took one year to be convinced to formally resign, while in Syria (median age 21), the 15-month uprising continues to be brutally repressed by Bashar Assad’s forces.
Of course, overthrowing a dictator, while inspiring and liberating to those whose rights have been repressed, is only the first step in achieving democracy. In the coming year, the countries that have already taken steps toward solidifying regime change will face continued tests as internal tensions surface. Even in Tunisia, recent clashes signal that political divisions and economic uncertainty have not been resolved. With potentially divisive elections ahead in Egypt and Libya, a holdover from the Saleh regime leading Yemen, and Syria’s fate unknown, the coming year should offer political demographers further evidence of the soundness of the age structure and democracy thesis.
2. New Commitments to Family Planning
Reproductive health and demography go hand-in-hand, and two milestones for family planning advocates are fast approaching: the 20th anniversary of the 1994 International Conference on Population and Development in Cairo, and the 2015 endpoint of the Millennium Development Goals.
These historic commitments by governments will be joined by a major initiative to generate new funding and political will this summer at an international family planning summit in London on July 11. The summit will be co-hosted by the Bill and Melinda Gates Foundation (Melinda made an impassioned TEDxChange speech in support of the issue in April), and the UK’s Department for International Development, for whom family planning is a priority in efforts to reduce maternal and child mortality.
Details of the summit have yet to be finalized and publicly released, but financial commitments from donors and developing countries are anticipated toward meeting a new and ambitious goal of generating $4 billion to fund contraceptives for 120 million women in developing countries by 2020. Assuming these are new users, rather than those who would be expected by projecting recent growth in contraceptive use forward, this would represent more than half of the estimated 215 million women with an unmet need for family planning.
Why does new family planning funding matter for political demography? Rates of contraceptive use are lowest and fertility highest in countries with youthful age structures. Such population dynamics exacerbate the challenges governments face in providing education, health, and basic infrastructure services, as well as supporting an economic climate conducive to industry diversification and job creation. In turn, the likelihood of civil conflict and undemocratic governance is higher in such countries.
While policies that recognize the benefits of family planning may be solid, funding and implementation often fall woefully short. In the least developed countries, less than one-third of reproductive-age women are using any contraception, and the rate has grown by just 0.4 percentage points annually over the past decade. Meanwhile, funding from all sources is less than half the amount required to meet unmet need. If the July summit motivates a new groundswell of financial support, 2012 could incite major strides toward improvements in individual health and well-being as well as demographic momentum in the remaining high-fertility countries.
3. Demographic Diversity in Sub-Saharan Africa
The current era of global demographic diversity has been distinguished by both record-low fertility rates in parts of Europe and eastern Asia and persistently high fertility across most of western, central, and eastern Africa. More than one-quarter of women in sub-Saharan Africa would like to postpone or avoid pregnancy, but are not using contraception, demonstrating a large unmet need for family planning.
The U.S. government-funded Demographic and Health Survey (DHS) program is the largest single source for detailed data on health status and behavior in high-fertility developing countries, and in turn informs estimates and projections of demographic trends. Recently, DHS reports have been released showing that contraceptive use over the past five years is growing much faster than the regional average in Ethiopia, Malawi, and Rwanda. In turn, fertility rates have dropped, ranging from a relatively modest 0.3 children per woman in Malawi and an unprecedented 1.5 children per woman in Rwanda.
These findings suggest that the pattern of demographic stagnation in sub-Saharan Africa may be shifting, perhaps due to governments’ and donors’ investments in family planning. However, newer survey results for Mozambique, Uganda, and Zimbabwe present a more mixed picture, with modest gains in contraceptive use in Uganda, offset by declines in the other two countries.Click here for the interactive version (non-Internet Explorer users only).
Additional recent survey results show that use of modern contraceptive methods has barely increased in Senegal (from 10 percent in 2005 to 12 percent in 2010-11). And while modern contraceptive use increased in the Republic of Congo from 13 percent in 2005 to 20 percent currently, fertility also rose slightly, from 4.8 to 5.1 children per woman.
Approximately 10 countries in sub-Saharan Africa are slated for DHS fieldwork this year, including one of the continent’s giants, the Democratic Republic of the Congo, and several of the highest-fertility countries in the region. (Outside of sub-Saharan Africa, the demographic heavyweights in this year’s group of DHS reports are Bangladesh, Indonesia, and Pakistan.)
The upcoming surveys will provide greater clarity about whether the promising signs of family planning adoption and the potential for progress through the demographic transition in Ethiopia, Malawi, and Rwanda are initiating widespread change across the continent, or whether the need for commitments such as those generated by the London summit is even stronger.
4. New Population Projections
DHS reports are critical inputs for the world’s most comprehensive and readily accessible set of demographic data, the UN Population Division’s World Population Prospects. This database is fully updated and revised biannually, in large part due to the steady stream of newly available estimates from the DHS and related sources, such as national censuses. The next revision of World Population Prospects, based on estimates for mid-year 2012, is expected to be published in spring 2013.
The previous revision of World Population Prospects was notable for its methodological overhaul. In addition to extending the projections until 2100, the Population Division shifted to a probabilistic technique (as opposed to assuming convergence at a single fertility rate of 1.85 children per woman) that generates 100,000 possible fertility trajectories for each country and selects the median as the medium fertility variant, commonly cited as the most likely projection. Still, the basic parameters remain the same: With fertility rates the strongest driver of population projections, low, medium, and high fertility variants are constructed around the assumption that countries will converge towards replacement level fertility, around 2.1 children per woman.
In some cases, this results in projections that are vastly at odds with recent trends. For example, in Japan, fertility has fallen by 38 percent, from replacement level in the early 1970s to 1.3 children per woman in 2010, but the UN projects it to immediately reverse course and begin rising to 1.8 by mid-century. If the projection holds, Japan’s population will decline relatively modestly, from 127 million to 109 million. But if fertility stays constant at current levels, the population will fall below 100 million. For low-fertility countries like Japan, all UN scenarios assume constant or rebounding fertility rates, even though continued decline may be a plausible outcome in some cases.
When next year’s projections are released, a cluster of media articles will report the projected world population for 2050. In last year’s revision, the medium fertility variant resulted in a projection of 9.3 billion, an increase from the 9.1 billion projected two years earlier based on higher projected fertility in the future. Such reports often overlook the range of population totals possible depending on fertility paths: If the global fertility rate varies by 0.5 children per woman in either direction, the total population could be more than one billion higher or lower in 2050, with an even wider range possible by 2100.
Most of the projected growth in world population, and its potential range, will be driven by the high-fertility countries concentrated in sub-Saharan Africa. Population projections for these countries vary tremendously based on fertility scenarios informed by the recent DHS results described above.
In Nigeria, Africa’s most populous country, fertility has fallen over the past 40 years, but by a gradual 15 percent. The UN projects it to drop more than twice as fast, by more than two children per woman (39 percent), in the next four decades. In any scenario, Nigeria is on track for rapid population growth, but the potential range based on fertility outcomes is wide. If fertility declines as projected in the medium variant, the country would grow from 158 million to 390 million. And although unlikely, the constant fertility projection of 504 million Nigerians in 2050 should be kept in mind given the slow pace of fertility decline to date.
Population projections are highly wonky, but their careful production and regular revision are essential for accurate planning of economic and social needs in countries around the world. While governments with dedicated census agencies, such as those in the U.S., Japan, or India, rely on internally-generated estimates, the UN projections serve as the primary indication of population trends in countries with spottier data coverage and have tremendous utility in gauging future needs for infrastructure, housing, health care across the life cycle, education, jobs, and other investments.
By no means is this an exhaustive list of factors that will affect political demography research and policy over the coming year. Other events to watch for include the Rio+20 conference on sustainable development in June, where the priority issues of jobs, energy, infrastructure, and resources will be shaped by demographic trends, and continued attention to prospects for the demographic dividend in Africa. Political demography is inherently cross-disciplinary, and the field’s researchers and practitioners will be engaged on multiple fronts in the year ahead.
Elizabeth Leahy Madsen is a consultant on political demography for the Wilson Center’s Environmental Change and Security Program and senior technical advisor at Futures Group.
Sources: Al Jazeera, Bongaarts (2008), Cincotta (2008), Cincotta (2012), Cincotta and Leahy (2006), Grist, Guttmacher Institute, MEASURE DHS, The New York Times, NPR, Population Reference Bureau, UN Population Division, The Washington Post.
Image Credit: “The Face of a Tyrant,” courtesy of flickr user freestylee (Michael Thompson); video courtesy of TED; chart created by Schuyler Null, data from UN Population Division. -
USAID’s New Global Health Framework and Delivering Equity in Health Interventions
›USAID’s new Global Health Strategic Framework, Better Health for Development, lays out the agency’s major health priorities for the next five years. “Core global health priorities” include reducing maternal mortality, ensuring child survival and nutrition, fostering an “AIDS free generation,” and fighting infectious diseases. Family planning and reproductive health is listed as a key area for bilateral engagement. In particular, the strategy hopes to continue to “graduate” countries from the agency’s family planning program, which since the 1980s has transitioned 21 countries into local ownership of family planning support. The strategy also takes stock of the shifting global health environment, noting the rise of the “BRICS” countries as new donors and the need to strengthen public health systems in developing countries. “Already, private payments account for 50-80 percent of total health spending in Africa and Asia, leading to system inefficiencies, inequitable access, and health costs that prove catastrophic to individuals and families,” the report reads. In order to achieve its priorities within this context, the document sets out a number of strategies, including a focus on program sustainability, the empowerment of women, and integrated approaches to development. Health, it says, “cannot be isolated from other development challenges.”Speaking of health interventions, a team of researchers led by Aluisio Barros of the Federal University of Pelotas, Brazil, recently compared coverage data from more than 50 countries against an index of household wealth to estimate the most and least equitable interventions. The study, “Equity in Maternal, Newborn, and Child Health Interventions in Countdown to 2015: A Retrospective Review of Survey Data From 54 Countries,” published in The Lancet, found that “interventions with similar levels of overall coverage often have very different degrees of inequality.” According to the data, “the most inequitable indicator was skilled birth attendant, followed by four or more antenatal care visits, whereas the most equitable was early initiation of breastfeeding.” For example, though the average for attendance by a skilled birth attendant was 53.6 percent across the entire sample, the wealthiest fifth had an 84.4 percent coverage rate and the poorest stood at 32.3 percent. “Interventions that are usually delivered in fixed health facilities…tend to be the most inequitably distributed,” write the authors, with geographical access, financial barriers, and discrimination appearing as likely obstacles for the poor. The authors conclude that, although “concern about inequalities in maternal and child health in poor countries was conspicuously absent from the global agenda in the past,” the availability of new, intervention-specific data provides a means of targeting equity issues in health delivery more successfully.
