By Arthur Cheung, BSc, GCGPP; MBBS and BHlthSc (Hons) in progress (University of Queensland); Intern, Department of Public Health and Environment, World Health Organisation; International Director, Healthy Planet International, IFMSA
The next year or two are a crucial time for the global role of health, as the post-2015 development agenda and Sustainable Development Goals (SDGs) are developed. With the deadline for achievement of the MDGs approaching, work has begun in earnest to define the post-2015 development agenda. Having had great prominence in the MDGs, health now competes in a new arena with dominant players including energy and agriculture. The health community must be well informed on the context, both in process and content, and speak with a common message. This will ensure the strongest position for global health in an arena with many voices and little time.
There are three core considerations for health:
- how to sustain gains and protect existing investments in the unfinished business of MDGs;
- how to accommodate the changing global health agenda;
- the need to ensure health is positioned appropriately within the context of Sustainable Development.
With the expectation of just one health goal post-2015, the WHO recently released a discussion paper which outlined these issues before arguing for Universal Health Coverage (UHC) as the most appropriate health goal. UHC provides an integrated approach that will build on rather than undermine existing work on MDGs, accommodate differing country realities, as well realising synergies for poverty reduction through financial risk protection. Margaret Chan has previously called UHC the “single most powerful concept that public health has to offer”.
Of the three dimensions of UHC (population coverage, services coverage, financial protection coverage), service coverage will remain an interesting area. Should we conceive of UHC as a deliverable for the health sector only? Or should we give more attention to preventative interventions and Social Determinants of Health? Does UHC include interventions such as vector-control and water, sanitation and hygiene systems? This would require cross-sectoral work, and whether we possess (or can create) the global governance architecture required is a key challenge (and one for which the Lancet-Uio Commission may be timely). The answer to these questions will inform what targets and indicators are appropriate for a UHC goal.
Regardless of these questions, UHC will be the best method of addressing health as an input into Sustainable Development. But health is also an outcome (perhaps the ultimate objective) of Sustainable Development. As an input and outcome, health indicators are a particularly powerful way of measuring progress in all thematic areas of Sustainable Development.
These indicators will also ensure that interventions in all sectors promote rather than worsen health: the Health in All Policies/Health Impact Assessment approach. The role of health is obvious for thematic areas such as Water and Sanitation, Food security and Nutrition, Climate Change, and Disaster Management. But health should also be a key consideration for other areas. For example, in Energy, an indicator measuring the percentage of households using only modern, low-emissions heating, cooking and lighting technologies that meet emission and safety standards (output indicator), or an indicator measuring the burden of disease attributable to household air pollution (outcome indicator). Indicators for the reliability of energy supply to health facilities are also important. In Jobs, healthy workforces are a precondition for Sustainable Development, and indicators such as the proportion of workplaces that comply with national occupational safety and health standards (output indicator), or measuring occupational disease and injury rates (outcome indicator), merit consideration.
Knowing this, what is the process for developing a new set of (sustainable) development goals?
There are two key intersecting processes: the Post-2015 Development Agenda, mandated by the 2010 MDG Summit; and the post-Rio+20 (SDGs) agenda, mandated by Rio+20. Both mandates include specific directives to work in consultation with the other process, and an informal (and high-level) coordination group exists to ensure this. Both processes will submit reports to the 68th session of the UN General Assembly in 2013.
The key body of the post-2015 agenda is the UN Secretary General’s High Level Panel of Eminent Persons on Post-2015 Development Agenda (HLP). The Panel is expected to report to the Secretary General by May 2013, and is tasked with the vision, shape and key principles for the post-2015 development agenda. The 26 member HLP is co-chaired by the Presidents of Indonesia and Liberia, and the Prime Minister of the United Kingdom.
The key body of the post-Rio+20 agenda is the Intergovernmental Open Working Group on SDGs (OWG). The 30 representatives, from the five UN regions, were to be decided in September 2012, but has been delayed with ongoing deliberations about the exact composition and the meaning of “open”.
Both the HLP and OWG are will have inputs from, and be supported by, the UN system through a dedicated UN Task Team that brings together over 60 UN entities including the WHO. UN Development Group MDG Task Force is therefore running broad consultations to inform both the HLP and OWG. A web platform has been produced for this purpose, jointly developed by the UN and Civil Society. These consultations include over 50 national consultations, and 11 thematic consultations to include input from Member States, civil society, academia, etc. The thematic area consultations include one on health, which is convened by WHO and UNICEF with the support of the national governments of Sweden and Botswana.
To better and directly engage civil society, academic and private sectors, the UN Secretary General has also launched a Sustainable Development Solutions Network, led by Jeff Sachs, which will convene expert thematic groups. These groups include one specifically on UHC, and a number of other health-related groups (all of them!). The Network is expected to inform the HLP.
With the OWG not yet formed, and with consultative mechanisms therefore yet to be decided, the avenues for stakeholder input into OWG (as opposed to the HLP) are currently unclear. In the mean-time, the Major Groups structure for civil society that was utilised for the Rio+20 process have proposed a “multi-stakeholder advisory group (MAG)” to fulfil this purpose.
The world has a great window of opportunity. We must learn our lessons and be coherent in our message. A fragmented set of goals won’t work, and neither will fragmentation of the health community in creating them.