VI on Well-being

 

Among many inequalities, such as economic, educational, and power, health inequality is a problem that is felt globally. Health inequalities can be defined as differences in health status or in the distribution of health determinants between different population groups (WHO definition) depending on various factors such as level of education, occupation, household wealth or income, geographical location, ethnicity and gender, i.e. the factors that govern the well-being.

Therefore, “Well-being” means that, resources for health are evenly distributed and essential healthcare is accessible to everyone, at any given time, may be at home, in schools, as well as at the workplace, in one or more of the medical systems (allopathic, homeopathic and indigenous) one desires, so that every individual is able to lead a socially and economically productive life, in the country, i.e. the well-being of every individual is ensured (WHO, 1981).

Well-being of All implies not only finding solutions for lack of doctors, hospital beds, drugs, equipment and vaccines, but also the elimination of malnutrition, ignorance, contaminated food and drinking water, unhygienic housing. Well-being is thus a holistic concept calling for efforts in agriculture, industry, education, housing, and communications, just as much as in medicine and public health.

Present status

In the past, when infectious disease was the predominant cause of illness and death, health was defined in terms of the absence of disease. By the mid-1900s, however, the incidence of many of these infections was reduced, and health had come to mean more than simply not being ill. It was now defined as a state of complete physical, mental and social well-being.

In the 19th century, most important discoveries were made in medicine and public health that had a huge impact on global health. The Broad Street cholera outbreak that took place in 1854 was the basis for the development of modern epidemiology. The parasite responsible for malaria and the bacterium responsible for tuberculosis were identified in 1880 and 1882, respectively. In the 20th century the development of preventive and curative treatments for many diseases, such as the BCG vaccine and penicillin and the eradication of smallpox in 1977, raised hope that diseases could be eradicated.

Important steps were taken towards global cooperation in health with the formation of the United Nations (UN) and the World Bank Group in 1945, after WWII. In 1948, the member states of the newly formed United Nations gathered together to create the World Health Organization (WHO). A cholera epidemic that took 20,000 lives in Egypt in 1947 and 1948 helped spur the international community to action (History of WHO). In 1977, the WHO adopted a 20 year programme “Health for All”, with the intention of making health services and commodities available to everyone by the year 2000.

However, the World Health Organization's effort "Health for All by the Year 2000" failed to reach its goals because it did not distinctly separate itself from the global "business with disease", as it focused on administrative healthcare changes, instead of taking advantage of global advances in medicine (Rath, 2002). At a United Nations Summit in 2000, member nations declared eight Millennium Development Goals (MDGs) reflecting major challenges facing human development globally, to be achieved by 2015.

Three of the eight MDGs focus explicitly on health, while others address broad social conditions. Across all goals, there are 18 targets, supported by 48 health indicators. The declaration has been matched by unprecedented global investment by donor and recipient countries. The UN report released on July 2, 2012 reveals that several MDG targets have been met ahead of the 2015 time-line, there is progress on others, and some e.g., goal 5, are seriously lagging.

More than a decade after world leaders adopted the Millennium Development Goals (MDGs) and associated targets substantial progress has been made in reducing child and maternal mortality, improving nutrition, and reducing morbidity and mortality due to HIV infection, tuberculosis and malaria (WHO, 2013).

When South East Asia Region (SEAR) Scenario is considered as a whole, the following issues have been identified as per the 2012 WHO report:

  • To tackle Non-Communicable Diseases (NCDs) in the region, there is no developed health care system. This leads to the worsening of NCDs epidemic.
  • Health workers particularly concentrate in urban areas, which lead to unequal distribution of healthcare workforce. Mostly health personnel are working at the institutional level.
  • Insufficient attention by the workforce, inadequate training to handle NCD services at the primary care, unavailability of essential drugs are also major reasons for under developed health system.
  • Health care personnel in every category are understaffed, with a regional average of five physicians and 13 nurses/midwives per 10000 persons, but the global average is 14 and 30 respectively.
  • The health infrastructure is also poor, where the number of hospital beds and the number of health centres are inversely proportional.
  • Health expenditure ratios indicate a large variation among member countries. There is a slight improvement shown in pocket expenditure and general government expenditures on health.
  • In most of the member countries an inadequate healthcare infrastructure was seen and also value of the public health unrecognized.

However, Sri Lanka stands out when compared with its member countries of the region, having many of the indicators at satisfactory level, such as 74 years of life expectancy at birth in 2011, which is well above the rest of the South Asian countries (WHO, 2012).

Nevertheless, prevalence of child malnutrition in the country in 2009 was 21.6% and under-five mortality rate (per 1000 live births) was 10 in 2012 indicating there is a great need of improvement in the health sector.

As such, COSTI proposes to consider the following 2020 National targets for VI on Well-being, based on Government projections;
  1. 1. Maternal mortality reduced to 0.2 per 1000 live births
  2. 2. Infant Mortality Rate reduced to 8 per 1000 live births
  3. 3. Under five mortality rate reduced to 6 per 1000 live births
  4. 4. Reduce under 5 malnutrition rate from 25% to 12-15%
  5. 5. Increase life expectancy to 80 yrs and 86 yrs for males and females respectively
  6. 6. Reduce NCD mortality by 25%
  7. 7. Replace 15% of pharmaceutical imports through local production
  8. 8. Local manufacture of medical equipment - Infant Incubators, Phototherapy units, Infant warmers, Baby resuscitators, Haemodialysis machines
  9. 9. Clinical Trials as 1 Bn US $ Industry

The following Clusters have been identified as means of achieving the objectives outlined.
  1. 1. Non Communicable Diseases (NCDs)
  2. 2. Communicable Diseases
  3. 3. Demographic Health
  4. 4. Health Promotion
  5. 5. Equitable Health Care
  6. 6. Futuristic Medicine
  7. 7. Indigenous Medicine
  8. 8. Medical industries

In this context, the Coordinating Secretariat for Science Technology and Innovation (COSTI) expects to coordinate its Virtual Institute on Well-being, with the expectation of improving the well-being of every individual in the country.

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