Prioritising research to attain SDG Goal 3: Health

Professor Thorkild Tylleskär, CISMAC, CIH, University of Bergen OK

According to Tylleskär, there have been some improvements in the average levels of maternal mortality world-wide – enough that the topic is no longer being discussed as “high priority”. However, he stresses, this average value does not reflect the unacceptably high levels that remain in Low Income Countries (LIC). Thankfully, he points out that the issues is still included in the Economist’s recent list of “169 Commandments”.

In many LIC, Tylleskär says, a woman’s inherent value still lies in her ability to produce children. He showed a short film to underline the challenges that remain to be addressed. “Why did Mrs X die?” is produced by the WHO and addresses how maternal mortality is connected to the unjust situation of women in low income societies.

See a video summary of his talk.

View “Why did Mrs X die?”: (2 versions, full and shortened)

• Shortened version (~6 min)
• Full version (~15 min)  

Professor Halvor Sommerfelt, CISMAC, CIH, University of Bergen

Sommerfelt underlined that the first 28-days – the neonatal period – are the most challenging for survival. In many Low Income Countries (LIC) neonatal mortality is 30-50 per 1000 live births. In addition, he stresses, this figure does not include stillbirths.

Sommerfelt is the Director of a Centre of Excellence (CISMAC) that is engaged in a number of very large intervention trials aiming to reduce the risk of death in mothers and newborns as well as equitably promoting the growth and development of children. Many of the mother and newborn deaths are preventable and do not require advanced technological solutions, or state-of-the-art facilities. Significantly improving maternal and neonatal health does not require large investments, but will provide significant returns in terms of less suffering and enhanced human capital.

See a video summary of his talk.

Professor Tehmina Mustafa, CIH, Haukeland University Hospital, University of Bergen

Mustafa began by pointing out that the UN Millennium Development Goals, which preceded the SDGs (Goal 6: COMBAT HIV/AIDS, MALARIA AND OTHER DISEASES), had only highlighted a few global communicable diseases. The SDGs continue to address the challenges of communicable disease epidemics, but have a widened focus to include a number of other important diseases. Also diseases that are not only pathogen caused.

Mustafa underlined that communicable disease epidemics highlight other global issues such as social injustice and social inequality. The years of life lost to these diseases is much higher in “hot-spots”, generally located in low- and middle-income countries.

According to Mustafa, the approaches included in the SDGs are more integrated than those of the MDGs and will be better able to lead to research directions that will help to alleviate the health and economic implications of communicable disease outbreaks.

See a video summary of her talk.

Professor Ingunn Maria S. Engebretsen, CIH, University of Bergen

Engebretsen explains that the Goal is ambitious, embracing everything that is “non-communicable”, it means everything that is not infectious. Her own research interests include diseases relating to nutrition and mental health. She noted that malnutrition, in particular, is a common factor for many poor health conditions.

Engebretsen highlighted a number of established theories (Forsdahl, Barker, Brenner) and newer theories linking genetics, epigenetics, environment and health, to argue that a lifestyle approach is needed to best tackle non-communicable diseases. She also mentioned how many of these diseases have significant socio-economic effects on society and many impact the health of future generations.

Finally, Engebretsen presented information about the importance of mental health, highlighting that this is a significant factor in disability-adjusted life years (DALYs) for young people (aged 15-24).

See a video summary of her talk.

Associate Professor Lars Thore Fadnes, Department of Global Public Health and Primary Care, University of Bergen

Lars Thore Fadnes explained that globally, disability-adjusted life years (DALYs) relating to substance abuse show that this is a significant factor reducing the lives of young people (ages 15-35). Perhaps because of the stigma and negative connotations, Fadnes feels that this area tends to be down-prioritised compared to other health issues. However, Fadnes argues that interventions are available for substance abuse and that it is both preventable and treatable, making it a good focus for an attainable SDG. He would like to see efforts increased in this area to reduce its global burden.

See a video summary of his talk.

Dr. Sven Young, University of Malawi, Haukeland University Hospital, CIH

Sven Young is part of a Norwegian Programme for Capacity Building in Higher Education and Research for Development (NORHED) project to educate surgeons in Malawi at Kamuzu Central Hospital in Lilongwe, Malawi. He has been very active in both educating Malawian surgeons and in building collaborations that will help to better equip and modernize Kamuzu Central Hospital.

In 2015 the global average for traffic deaths was 18 per 100 000 people. In Malawi, it is nearly double that, 35 per 100 000. Young says that low- and middle-income countries (LMIC) account for 90% of the global total of traffic fatalities, with only 50% of the global total number of vehicles. But, he underlines, accidents that end up with deaths are just the tip of the iceberg – 20 times more result in injuries, many of which permanently disable the victim, with the inherent catastrophic economic effects for the person and their families.

Action is needed. Long-term goals and actions need to be undertaken. Young says that he hopes that the “2020” on the target indicator is a typo for 2030, and calls on high-income countries for commitments to help reduce the impact of traffic accidents on LMIC countries.

See a video of his talk.

PhD candidate Andrea Melberg, CIH, University of Bergen OK

Melberg underlined that the things that the indicators for reproductive health are measuring are difficult to quantify. For example, the proportion of women with access to the family planning resources they need depends very much on a given woman’s status – married vs unmarried etc. She also highlighted that the process of defining indicators often impacts social processes, which then can become political issues, in turn generating social pressures.

Melberg stresses that concrete quantifiable data is lacking in this area, and measurements are not standardized. She concluded by mentioning the “elephant in the room – abortion”. Abortion is a significant cause of maternal deaths, but data is difficult to collect. She highlights the need to work towards gender equality and women’s health and rights.

See a video summary of her talk.

Professor Bjarne Robberstad, CIH, CISMAC, University of Bergen OK

Robberstad began his presentation by stating that “universal” is a big word! Universality must be considered along several dimensions.

Robberstad used a visual model to explain the interaction between competing factors. He suggests that a box, or the WHO “cube”, is a useful framework for considering universal coverage. Population, or who is covered, is one dimension. Financing, or cost sharing, is a second dimension. The third dimension is which services are included – which are most essential?

The next step is to consider the size of the box. The largest box would represent a hypothetical situation, where everything is possible and covered for everyone. Boxes of smaller sizes represent the compromises that are necessary to design for the actual coverage possible within given budget constraints.

This is priority setting – the challenges of trade-offs and compromises in health-care service plans.

See a video summary of his talk.

Professor Magne Bråtveit, Occupational and Environmental Health, and Professor Bente E. Moen, CIH, University of Bergen

London’s lethal fog of 1952 was a result of coal burning and temperature inversions. It brought the issue of air pollution to public attention. It resulted in 12 000 deaths and 150 000 hospitalisations. As a result, Britain passed the Clean Air Act of 1956. Health complications due to air pollution make it among the 10 leading factors for death in most countries. It is responsible for about 1 in every 9 deaths around the world every year. It is listed as number 6 in the 10 leading risk factors posted by the Global Burden of Disease.

Air pollutions is due to chemicals, gases, particles or biological material in the atmosphere that lead to discomfort and undesirable health effects such as airway diseases, cancer, and cardiovascular diseases, all of which can lead to death.

See a video summary of her talk.