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Asia Pacific should reduce inequalities in access to care for the most marginalised groups

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Access to healthcare has improved in the Asia Pacific region over the past decade but women in low-income households in rural areas still have difficulty accessing care due to distance and financial reasons, according to a new OECD report.

Health at a Glance Asia/Pacific 2018 – Measuring Progress Towards Universal Health Coverage says that in Cambodia, Nepal, the Philippines and the Solomon Islands, more than three women in four with the lowest household income reported difficulties in accessing healthcare due to financial reasons. In Nepal, Pakistan and the Solomon Islands, about two women in three from worst-off households reported having unmet care needs due to distance.

The report reveals that life expectancy has increased by almost six years since 2000 to reach 70 years across lower-middle and low-income Asia Pacific countries, but maternal mortality is still twice the Sustainable Development Goal target in these countries.

The report also tells that the infant mortality rate has fallen dramatically across the lower-middle and low-income Asia Pacific countries since 2000, with many countries experiencing declines of greater than 50%. But at an average of 30 deaths per 1 000 live births, infant mortality rate in these countries is still eight times that of the high income Asia Pacific countries and OECD average, and two and a half times the SDG target of 12 deaths per 1 000 live births.

Many countries in the region face a double burden of disease, as they still struggle to reduce maternal and child deaths at a time when the prevalence of chronic conditions and unhealthy lifestyle is growing. More than one third of adults are overweight in Asia Pacific, and one in ten persons is obese, according to the report. Among children, 5% of under age 5 and more than 20% of adolescents are overweight. Between 2010 and 2016, obesity rates increased by 33% among adults and 58% among adolescents.

Other findings of Health at a Glance Asia/Pacific 2018 include:

Between 2000 and 2015, the average maternal mortality rate across lower-middle and low-income Asia Pacific countries was cut by more than half, but is still high at 140 deaths per 100 000 live births, twice the SDG target of 70 deaths per 100 000 live births.

In high-income Asia Pacific countries, the share of the population aged over 65 years is expected to double, to reach an average of 27.6% in 2050, whereas the share of population aged over 80 years is expected to triple to reach 10.2%. In upper-middle income and lower-middle low-income Asia Pacific countries, the share of population over 65 and over 80 will be two and a half and four times the current share, and reach 23.9% and 14.5% (over 65) and 7.9% and 3.5% (over 80) respectively.

Lower-middle and low-income Asia Pacific countries spend just under USD 200 per person per year on health, against USD 670 and USD 3 450 in upper-middle income and high-income countries respectively. This amounts to over 4.3% of gross domestic product, on average, in middle- and low-income countries, compared to over 7.3% in high-income countries in 2015. Spending in high-income countries increased by 0.8 percentage points from 2010-2015, twice the increase reported by middle- and low-income countries at 0.4 percentage points.

On average, household out-of-pocket expenditure accounted for 48.2% of total health expenditure in lower-middle and low-income Asia Pacific countries in 2015, an increase of one percentage point from 2010. Spending on pharmaceuticals accounted for almost one third of all health expenditure across these countries in 2015.

Disparities in the use of essential services based on income and education remain large. For example, the divide in access to antenatal care between women in low-income and high-income households remains quite large in Bangladesh, Lao PDR and Pakistan, and in Indonesia, Lao PDR and the Philippines inequalities in the proportion of children with immunisation coverage whose mother has high education compared to no education are large with a difference of more than 50%.

Health at a Glance Asia/Pacific 2018, a joint publication of the OECD with the World Health Organisation, presents key indicators on health status, determinants of health, healthcare resources and utilisation, health expenditure and financing, and quality of care for 27 Asia/Pacific countries and territories. This report offers a comprehensive and user-friendly framework to help policy makers make further progress towards improving coverage, access and financial protection of population across the Asia Pacific region.

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Financial Services Study Reveals Emerging Tech-driven Systemic Risks

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Accelerated technology adoption in the financial services sector is creating new systemic risks to the global financial system, according to a new report. Beneath the Surface: Technology-driven systemic risks and the continued need for innovation is the first publication in the World Economic Forum’s two-part Technology, Innovation and Systemic Risk research initiative.

Prepared in collaboration with Deloitte, the report explores the relationship between increased technology adoption and the potential shock of cascading risk factors – for example, the domino effect that can result when hackers, disasters or geopolitics expose interconnected financial systems to a growing array of known and unknown vulnerabilities. The research additionally examines actions that can address identified risks, including the role that technology itself can play in mitigation approaches.

“This comprehensive study aims to establish a sector-wide understanding of technology-driven risks, and deliver insights for all stakeholders,” said Drew Propson, Head of Technology and Innovation in Financial Services, World Economic Forum. “Not only is it essential that we have full awareness of what these risks are and how they are building upon one another, but equally important is true collective action around solutions. The need for continuing innovation, and for multiple financial sector entities to increase collaborative efforts, couldn’t be more critical as we work toward risk mitigation.”

Key takeaways

Over the past year, approximately 200 financial services and technology experts engaged in a series of global workshops and interviews, insights from which formed the basis of the report findings. Research outcomes reinforce the need for leaders within the financial services ecosystem to have a solid understanding of today’s risk environment, and for them to embrace experimentation with new mitigation applications that hold the potential to enhance current efforts.

Problems highlighted in the report include lagging cyber defence mechanisms, increasing business disruptions, talent scarcity, climate change imperatives and rising geopolitical tensions. The data emphasizes that virtually any entity within the interconnected financial services ecosystem, large or small, can cause or be caught by the impact of network disruptions.

Digital interconnectedness. As the number of interlinkages between service providers grows, private and public sector leaders should remain conscious of their external relationships. Broader vendor networks with third, fourth and fifth parties can be monitored through new forms of technology while reducing over-reliance on a single vendor’s shared capabilities. However, while new monitoring capabilities can be enabled by as-a-service providers, leaders must be aware of the trade-off of adding to ecosystem dependencies that create another source of operational risk.

Regulatory alignment. Certain entities within the financial services ecosystem are not currently under the purview of financial services supervision and regulation. Tackling systemic risks outside financial networks remains in the formative stage and concerns of non-bank systemic importance grow as operational failures or cascading cyber attacks on vendors become harder to trace across the ecosystem. This is especially the case as the traditional determinant of an entity’s systemic importance is primarily based on its size of book, or total assets, which is becoming less relevant than its size of network, or total digital interconnections. Public sector players need to examine the range of emerging activities to ensure a consistent taxonomy and adequate regulatory coverage that appropriately defines the scope of oversight across these activities.

New incentives for multilateralism. While many emerging use cases of systemic risk mitigation are being developed in collaboration, there is no industry-wide vision of the future across most jurisdictions. And while the potential for technology to enhance risk mitigation is undeniable, addressing systemic risk must start with the basics. Without a common understanding in the form of frameworks, principles and standards, fragmented efforts and siloed information make global prevention of systemic risk difficult.

Closing the gaps

The report cites examples and important lessons to be learned from recent events such as the SolarWinds breach, where a digital supply chain attack compromised almost 20,000 interconnected companies including major financial institutions and IT vendors. The proliferation of such contagious, backdoor breaches is forcing a reassessment of systemic risk management strategies and the implementation of unified standards. Ideally, future gaps can be identified before destructive events occur. The ability to take collaborative action to close such gaps is equally essential.

“Among the numerous actions that our industry must take, there are two areas of immediate concern to us,” said Rob Galaski, Vice-Chair and Deputy Global Leader, Financial Services, Deloitte. “First, we must move toward safe sharing of risk-based data across institutions and jurisdictions. A global network will always be able to detect and neutralize threats more effectively than individual actors. Our second concern speaks to the modernization of regulatory frameworks. For example, ‘systemically important institutions’ are currently defined by traditional measures of balance sheet size and a dated notion of what constitutes a ‘financial institution.’ As our report points out, new measures such as size of network should also be considered when determining systemic significance.”

The report concludes with encouragement for a collaborative new risk agenda. It highlights core questions that public and private sector leaders can consider as they assess their organizations’ capabilities and resilience against systemic risks of the present and future.

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Global Wealth Has Grown, But at the Expense of Future Prosperity

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Global wealth has grown overall—but at the expense of future prosperity and by exacerbating inequalities, according to the World Bank’s new Changing Wealth of Nations report released today.

Countries that are depleting their resources in favor of short-term gains are putting their economies on an unsustainable development path. While indicators such as Gross Domestic Product (GDP) are traditionally used to measure economic growth, the report argues for the importance of considering natural, human, and produced capital to understand whether growth is sustainable.

The Changing Wealth of Nations 2021 tracks the wealth of 146 countries between 1995 and 2018, by measuring the economic value of renewable natural capital (such as forests, cropland, and ocean resources), nonrenewable natural capital (such as minerals and fossil fuels), human capital (earnings over a person’s lifetime), produced capital (such as buildings and infrastructure), and net foreign assets. The report accounts for blue natural capital—in the form of mangroves and ocean fisheries—for the first time.

“A deeper and more nuanced understanding of the sustainability of wealth is crucial to a green, resilient, and inclusive future,” said World Bank Managing Director for Development Policy and Partnerships, Mari Pangestu. “It is essential that renewable natural capital and human capital are given the same importance as more traditional sources of economic growth, so that policymakers take steps to enable long-term prosperity.”

According to the report, global wealth grew significantly between 1995 and 2018, and middle-income countries are catching up to high-income countries. However, growing prosperity has been accompanied by unsustainable management of some natural assets. Low- and middle-income countries saw their forest wealth per capita decline 8% from 1995 to 2018, reflecting significant deforestation. Meanwhile, the value of global marine fish stocks collapsed by 83% due to poor management and overfishing over the same period. The projected impacts of climate change may exacerbate these trends.

In addition, mispricing of assets like carbon-emitting fossil fuels can lead to overvaluation and over-consumption. Development can be put on a more sustainable path by taking a comprehensive view of wealth and putting in place policy measures including carbon pricing to better value and nurture assets such as forests, mangroves, and human capital.

Global wealth inequality is growing, the report indicates. Low-income countries’ share of global wealth has changed little from 1995 to 2018, remaining below 1% of the world’s wealth, despite having around 8% of the world’s population. Over one-third of low-income countries saw declining wealth per capita. Countries with declining wealth tend also to be degrading their base of renewable natural assets. For low-income countries, appropriately managing renewable natural capital, which accounts for 23% of their wealth, remains crucial.

Globally, the share of total wealth in renewable natural capital (forests, cropland, and ocean resources) is decreasing and being further threatened by climate change. At the same time, renewable natural capital is becoming more valuable as it provides crucial ecosystem services. For example, the value of mangroves for coastal flood protection has grown more than 2.5 times since 1995 to over $547 billion in 2018. The value of protected areas per square kilometer has also rapidly increased.

“The Changing Wealth of Nations provides the data and analysis to help governments get prices and policies right for sustainable development,” said World Bank Global Director for Environment, Natural Resources, and the Blue Economy, Karin Kemper. “By ignoring polluting and climate warming impacts, fossil fuel assets have historically been overvalued, while assets that contribute to climate mitigation, like forests, are undervalued.”

The report shows that human capital, measured as the population’s expected lifetime earnings, is the largest source of worldwide wealth, comprising 64% of total global wealth in 2018. Middle-income countries increased their investment in human capital and in turn saw significant increases in their share of global human capital wealth.

Although the long-lasting effects of the COVID-19 pandemic are still unknown, low-income countries are likely to experience the most severe impacts, with a projected loss of 14% of total human capital. Human capital is additionally constrained by gender gaps across all regions and income groups, with little improvement since 1995. Air quality also has serious consequences for both human capital and climate change, and accounts for over 6 million premature deaths annually.

Nonrenewable natural capital wealth (minerals, fossil fuels) has declined since 2014, mainly due to falling commodity prices. The reportlooks at the projected impacts of a low-carbon transition and border carbon adjustment taxes on fossil fuel wealth and provides recommendations for managing the economic risks posed for resource-dependent countries. Countries that are heavily dependent on fossil fuel wealth were found to have lower shares of wealth from human capital, despite their high income levels, with human capital only comprising 34% of their wealth.

The report outlines several priorities for policymakers to diversify and rebalance their national portfolios to be more resilient and sustainable. It recommends actively investing in public goods like education, health, and nature, to prevent unsustainable depletion, and manage future risks. Recommendations also include policy and pricing measures that help reflect the social value of assets and to steer private investment toward better outcomes for all. This may include, for example, actions like repurposing fisheries subsidies, and taking action to price carbon and promote renewable energy assets.

Regional trends

In Sub-Saharan Africa, wealth per capita has increased over the past two decades, but at a lower rate than other regions. 11 countries in Sub-Saharan Africa saw stagnating or even declining wealth per capita between 1995 and 2018 as population growth outpaced net growth in asset values. Human capital in Sub-Saharan Africa has increased more rapidly than any other asset. However, this growth has been unequal, and the female share of human capital is only about one third of the total. Wealth in natural capital has been declining, and many countries in the region have a high dependence on nonrenewable natural resource revenues, especially from fossil fuels.

As of 2018, the East Asia and the Pacific region has the largest share of wealth in the world, with an 188% increase since 1995. Human capital makes up over half of the region’s wealth, however, only about one third of human capital was attributed to women. Natural capital comes in at 4% of regional wealth, with renewable natural capital declining, led by the drop in marine fisheries. Cropland wealth is projected to be especially hard hit by climate change in East Asia and Pacific countries.

In South Asia,total wealth has grown since 1995, but due to population growth in the same time period, per capita wealth remains among the lowest in the world. Human capital makes up over half of the region’s wealth, but is extremely unbalanced, with over 80% attributed to men, with little change in the past two decades. If gender parity was achieved in South Asia, this could increase human capital nationally by roughly 42 percentage points. As a region, South Asia is also most severely affected by the estimated loss of human capital due to air pollution. Renewable natural capital, particularly cropland, is vital for South Asia, and the value of its blue natural capital also grew over the past two decades.

Wealth in Europe and Central Asia, which includes Western Europe for the purpose of this report, has increased 45% since 1995. Wealth per capita has grown slowly compared with many other regions. Human capital accounts for over half of the region’s wealth, with consistent growth compared to other assets. Non-timber forest resources are becoming the main renewable natural capital asset in Europe and Central Asia, due to the value of ecosystem services they provide, while the value of marine fisheries assets has significantly dropped.

Although total wealth has nearly doubled in Latin America and the Caribbean over the past two decades, there are significant contrasts in the trends of wealth per capita. Some countries have more than doubled their wealth since 1995, while in several Caribbean countries, total wealth per capita has declined. Over time, wealth in nonrenewable natural capital has begun to decline, due to price volatility, but renewable wealth is increasing. Wealth in protected areas has more than doubled, despite the fact that land area of forests has declined. Female labor force participation is higher than in any other region, but Latin America and the Caribbean has still not reached gender parity in its human capital.

Wealth has increased in the Middle East and North Africa in the past two decades, but to a lesser extent than the regional GDP over the same period. Human capital makes up the lowest share of total wealth in this region, compared to other regions, with a significant gender imbalance. Nonrenewable natural capital makes up a large portion of the region’s wealth and has generated issues for countries facing resources dependence and price volatility. The countries in the region reliant on fossil fuel revenues face unique development challenges in the face of global efforts to shift to low-carbon development. Although cropland remains the main renewable natural asset in the region, per capita cropland wealth has declined over the past two decades. The region will need to preserve and restore its renewable 

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Renewable Energy Jobs Reach 12 Million Globally

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Renewable energy employment worldwide reached 12 million last year, up from 11.5 million in 2019, according to the eighth edition of Renewable Energy and Jobs: Annual Review 2021. The report was released by the International Renewable Energy Agency (IRENA) in collaboration with the International Labour Organization (ILO) at a high-level opening of IRENA’s Collaborative Framework on Just and Inclusive Transitions, co-facilitated by the United States and South Africa.

The report confirms that COVID-19 caused delays and supply chain disruptions, with impacts on jobs varying by country and end use, and among segments of the value chain. While solar and wind jobs continued leading global employment growth in the renewable energies sector, accounting for a total of  4 million and 1.25 million jobs respectively, liquid biofuels employment decreased as demand for transport fuels fell. Off-grid solar lighting sales suffered, but companies were able to limit job losses.

China commanded a 39% share of renewable energy jobs worldwide in 2020, followed by Brazil, India, the United States, and members of the European Union. Many other countries are also creating jobs in renewables. Among them are Viet Nam and Malaysia, key solar PV exporters; Indonesia and Colombia, with large agricultural supply chains for biofuels; and Mexico and the Russian Federation, where wind power is growing. In Sub-Saharan Africa, solar jobs are expanding in diverse countries like Nigeria, Togo, and South Africa.

“Renewable energy’s ability to create jobs and meet climate goals is beyond doubt. With COP26 in front of us, governments must raise their ambition to reach net zero,” says Francesco la Camera, IRENA Director-General. “The only path forward is to increase investments in a just and inclusive transition, reaping the full socioeconomic benefits along the way.”

“The potential for renewable energies to generate decent work is a clear indication that we do not have to choose between environmental sustainability on the one hand, and employment creation on the other. The two can go hand-in-hand,” said ILO Director-General, Guy Ryder.

Recognising that women suffered more from the pandemic because they tend to work in sectors more vulnerable to economic shocks, the report highlights the importance of a just transition and decent jobs for all, ensuring that jobs pay a living wage, workplaces are safe, and rights at work are respected. A just transition requires a workforce that is diverse – with equal chances for women and men, and with career paths open to youth, minorities, and marginalised groups. International Labour Standards and collective bargaining arrangements are crucial in this context.

Fulfilling the renewable energy jobs potential will depend on ambitious policies to drive the energy transition in coming decades. In addition to deployment, enabling, and integrating policies for the sector itself, there is a need to overcome structural barriers in the wider economy and minimise potential misalignments between job losses and gains during the transition.

Indeed, IRENA and ILO’s work finds that more jobs will be gained by the energy transition than lost. An ILO global sustainability scenario to 2030 estimates that the 24-25 million new jobs will far surpass losses of between six and seven million jobs. Some five million of the workers who lose their jobs will be able to find new jobs in the same occupation in another industry. IRENA’sWorld Energy Transition Outlook forecasts that the renewable energy sector could employ 43 million by 2050.

The disruption to cross-border supplies caused by COVID-19 restrictions has highlighted the important role of domestic value chains. Strengthening them will facilitate local job creation and income generation, by leveraging existing and new economic activities. IRENA’s work on leveraging local supply chains offers insights into the types of jobs needed to support the transition by technology, segment of the value chain, educational and occupational requirements.

This will require industrial policies to form viable supply chains; education and training strategies to create a skilled workforce; active labour market measures to provide adequate employment services; retraining and recertification together with social protection to assist workers and communities dependent on fossil fuels; and public investment strategies to support regional economic development and diversification.

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