ВУЗ: Не указан
Категория: Не указан
Дисциплина: Не указана
Добавлен: 19.10.2020
Просмотров: 1907
Скачиваний: 1
Social Justice, Sustainable Development and Quality of Life
|
79
The trend shows that all the BRICS countries have increased their per capita
expenditure on health. However, the magnitude of the changes tends to vary by
country. Total health care expenditure comprises two categories: general government
and private health expenditure. Inadequate government allocation of financial
resources to health care creates a financial burden for users of the health care system.
The proportion that the Indian government contributes to health care is lowest,
while that of the Russian Federation is the highest (see table 7).
TABLE 7
BRICS general government health expenditure and out-of-pocket expenditure (2011)
(In %)
General government health expenditure as a
proportion of total health expenditure
Out-of-pocket expenditure as a proportion of total
health expenditure
Brazil
45.7
31.3
Russia
59.7
35.4
India
31.0
59.4
China
55.9
34.8
South Africa
47.7
13.8
Sources: World Bank (2013). World Development Indicators.
In all BRICS countries, except South Africa, residents pay significantly out of
pocket for their health care, which implies they have less financial protection than
South African citizens. South African residents spend proportionately less out of
pocket for health care, mainly because the private sector has a large expenditure
for health care relative to a small minority population it serves, most of whom
have medical insurance.
The economic gains experienced by BRICS countries need to be used to
boost health infrastructure, improve access to quality health care and ensure that
medicines are affordable. Almost all BRICS countries have made policy statements
in support of strengthening health systems, but few have matched these statements
with an increase in the government’s allocation to health care. Brazil has introduced
the state-run
Sistema Único de Saúde
(SUS – Unified Health System), which now
covers 90 per cent of the population (Gragnolati et al., 2012). While coverage is
good, the system is inadequately funded (cited in Gomez, 2013).
In India, a policy to provide universal health coverage has been discussed
for some time but not yet been implemented (Bajpai, 2014). Evidence shows
that the Indian government continues to spend far less on health than its BRICS
counterparts. The Chinese Constitution gives Chinese citizens the right to health
care, and 95 per cent of the population have some form of health insurance.
Care needs to be taken to ensure that funds are allocated such that inequity in access
BRICS Long-Term Strategy
80
|
to quality health care is reduced between urban and rural areas. Structural reforms
in China include: basic medical insurance for urban residents, which is financed
by individual payments and government subsidies and has a total reimbursement
rate of up to 85 per cent; and a new type of rural cooperative medical care system
with a total reimbursement rate of up to 70 per cent of the total expense or up
to CNY30,000.
In South Africa, the Constitution mandates the State to progressively realise
the right to health. Consequently the government has announced its intention to
introduce national health insurance over a period of 14 years (Department of Health,
2011). To date, the government has yet to allocate funding for the programme,
save for the implementation of small pilot projects that were rolled out in 2011.
Despite the observation that BRICS countries have progressive policies
supported by legislation on access to essential medicines, out-of-pocket expenditure
for medicines has increased, compounded by shortages in the supply of generic
medicines. For example, Brazil’s Constitution guarantees citizens the right to
access essential medicine, yet it was reported that 40 per cent of the generics were
not available (Bertoldi et al., 2013). When generics were available, they were more
likely to be found in the private than in the public health sector which serves the
majority of the population. Furthermore, about 25.5 per cent of poor people were
reported to be paying for medication out of pocket (ibid.).
As with Brazil, the Russian Federation has a constitutional mandate to provide
free medicines to its citizens (Papovich et al., 2011) but is plagued by shortages
of medicines in poor areas. For example, it was reported that 20 per cent of the
population are not able to access medicines, and only 11 per cent of the population
has free access to state-assisted discounts for medicine (Gomez, 2013). Similar to
Brazil and the Russian Federation, China’s Constitution also guarantees its people
equal access to medicines regardless of socio-economic status.
In contrast, South Africa’s Constitution does not provide guaranteed access to
essential medicines. Instead, the South African government passed legislation aimed
at reducing the cost of medicines, such as parallel importation, compulsory licensing
in line with the Agreement on Trade-Related Aspects of Intellectual Property
(TRIPS), single exit price, Essential Drug List and standard treatment guidelines.
South Africa still has to reform its policies to implement these TRIPS agreements.
Despite challenges related to the allocation of financial resources and
implementation of progressive policies, it is encouraging that in most BRICS
countries health outcomes measured by MDG indicators are showing posi-
tive trends. In all BRICS countries, except South Africa (where there was
an increase), maternal mortality rates per 100,000 live births declined by
more than 50 per cent during the decade up to 2010. According to the data
Social Justice, Sustainable Development and Quality of Life
|
81
reported from 1990 to 2013, there has been a very sharp decrease in India,
where the maternal mortality rate dropped from 560 to 190 per 100,000 live
births (WHO, 2010). With respect to infant mortality rates per 1000 live
births (table 8), South Africa has experienced a decline since 2005. The other
member states each experienced declines of greater than 50 per cent between
1990 and 2012 (WHO, 2010).
TABLE 8
Infant mortality rate (probability of dying between birth and age 1, per 1000 live births)
1990
1995
2000
2005
2010
2013
Brazil
51
40
29
20
15
12
China
50
1
36
32
19
13
10
India
88
78
67
56
46
41
Russian Federation
22
22
20
14
10
9
South Africa
47
46
52
51
35
33
Source: World Health Organization (2013). World Health Statistics, 2013; system for Chinese Maternal and Child Health Surveillance.
Note:
1
1991.
Another crucial health outcome indicator is life expectancy at birth. In all
the BRICS countries, females live longer than males. However, the extent of this
gender disparity in life expectancy varies by country. In 2012, Russian females
lived 12 years longer than their male counterparts, Brazilians 7 years longer, and
Indians, Chinese and South Africans 3 years longer. Brazil, China and India each
displayed increasing life expectancies across genders when comparing data from
1990, 2000 and 2012. The trend is not as clear in the Russian Federation and
South Africa. Russia experienced a decline in life expectancies between 1990 and
2000, while South Africa experienced a decline between 1990 and 2000 and then
stagnation between 2000 and 2012.
South Africa has the lowest life expectancy, due to the high rates of HIV
and AIDS. South Africa is attempting to increase its life expectancy by preventing
new HIV infections and providing treatment to those eligible to receive
antiretroviral therapy (ART). The latest mortality report shows that there was
a decline from 613,128 deaths in 2006 to 505,803 deaths in 2011, resulting
in a life expectancy of 59.1 years for males and 63 years for females (Statistics
South Africa, 2014b).
1.4 Migration, urbanisation and infrastructure
The BRICS countries are facing an increase in migration and urbanisation – a
common trend in many emerging economies of the world. As their economies
develop and industrialisation increases, people migrate to urban areas, seeking
BRICS Long-Term Strategy
82
|
employment and better living conditions. Similarly, as the threats of climate change
increase, people have begun to move from often vulnerable and under-resourced
rural areas to the urban centres. In fact, according to the Population Division of the
UN Department of Economic and Social Affairs, in the next four decades urban
residents will account for 66 per cent of the population in developing countries
(Heilig, 2012).
Migration is a critical issue for all BRICS members, indicating the existence
of a number of common problems and policy goals, even though their migration
challenges vary significantly. At present, migration has acquired a truly world-
wide importance: in 2013, 232 million people worldwide, or about 3 per cent
of the world population, were international migrants (UN Population, 2013).
Peace and security issues related to illegal cross-border migration are dealt with
under Pillar 2.
In terms of internal migration trends, migration to urban areas has increased
significantly in the BRICS countries. Brazil has the largest urban population
(representing 84.6 per cent of its total population), while India has the smallest
(31.3 per cent). With the exception of India, all member states have a larger urban
than rural population. Even so, the rates of urbanisation in India and China are the
highest at 2.4 and 2.7, respectively. In Brazil, the Russian Federation and South
Africa urbanisation rates range from 0.2 to 1.8.
Since urbanisation has been occurring within a relatively compressed time-
frame, many cities have not managed to provide the required infrastructure for
housing, water and sanitation services. In many cases this backlog has led to the
growth of urban inequality, with large segments of the population inhabiting poorly
located and poorly serviced informal settlements (Heilig, 2012).
An added challenge has been that of unequal access to basic infrastructure
and services in urban and rural areas. Despite the critical importance of sanitation
to poverty alleviation, health care, human development and dignity, it has tradi-
tionally been viewed as a lesser developmental priority. This is not only because
in many places sanitation is a taboo subject but also because there are difficulties
with defining what sanitation is and who bears the responsibility for providing it
(the State, individuals or communities).
Having committed to the MDGs, BRICS countries have generally made
significant progress in achieving outcomes relating to water and sanitation.
As illustrated in table 9, India has made the slowest progress in improving sanitation
targets, with access increasing from 25 per cent of the population in 2000 to 34
per cent in 2010 (World Bank, 2014).
Social Justice, Sustainable Development and Quality of Life
|
83
TABLE 9
MDG 7: Ensure environmental stability (2000, 2005 and 2010)
(In % of population with access)
Year
Improved sanitation facilities
Improved water source
2000
2005
2010
2000
2005
2010
Brazil
74
76
79
94
96
98
Russia
72
71
70
95
96
97
India
25
30
34
81
86
92
China
44
55
64
80
87
91
South Africa
75
77
79
86
89
91
Source: World Bank (2014). Millennium Development Goals.
The large urban-rural disparity, especially in sub-Saharan Africa and South
Asia, is the principal reason why the sanitation target of the MDGs will not be
achieved. Even within the BRICS countries, the lack of improved water and sani-
tation facilities is predominantly a rural and poverty-related phenomenon. Rich
households in urban areas are more likely to have piped water on the premises,
or toilets connected to a sewer system, whereas poor households often use com-
munal sources or need to buy their water from vendors, share public facilities or
rely on pit latrines (ibid.).
With regards to improved access to water, all of the BRICS countries have
achieved very high results, with Brazil and the Russian Federation having the highest
rates at 98 per cent and 97 per cent, respectively. In fact, Brazil has achieved the
MDG: the target of halving the proportion of people without access to an improved
drinking water source was achieved in 2010, five years ahead of schedule (ibid.).
In addition, high rates of population growth and urbanisation have meant
that the provision of affordable housing is a universal problem. The most notable
shortages of adequate housing are in developing nations, where housing provision
has failed to keep pace with economic development. Rising income inequalities,
and a tendency for housing costs to rise faster than incomes, have made it difficult
for younger and poorer households to find adequate shelter. It should be noted that
in most of the BRICS countries unequal access to basic services such as housing, water
and sanitation has been a result of past administration and policies. In South Africa
apartheid policies enforced racially segregated urban policies, which determined
different levels of access to housing, sanitation and water.
The Brazilian housing sector has marked a number of achievements since
the turn of the millennium. In particular, the urban and housing sectors gained
leverage with the creation, in 2003, of the Ministry of Cities (UN-Habitat, 2013).
In 2000 a Brazilian constitutional amendment recognised the right to housing.