In this week’s guest-editorial, Meena Daivadanam, Emerging Voice from India, reflects on the 65th World Health Assembly. Among the numerous discussions, resolutions and other outcomes, three issues caught her attention. As Meena recently published an article in BMC Public Health on pathways to catastrophic health expenditure for acute coronary syndrome in Kerala, it comes as no surprise that the WHA’s focus on NCDs and UHC are among these issues.
Enjoy your reading.
David Hercot,Kristof Decoster, Ildikó Bokros, Basile Keugoung &Wim Van Damme
The 65th World Health Assembly: UHC, NCDs and WHO reform
(By Meena Daivadanam, Emerging Voice from India)
The 65th World Health Assembly has come to a close and Margaret Chan has been re-elected for a second term. While the WHO secretary-general’s keynote address touched on the most important priorities for the next 5 years, she also focused our attention on three crucial issues: Universal Health Coverage, non-communicable diseases and the WHO reforms.
Chan projected the WHO as the embodiment of fairness in the 21st century and UHC as the ultimate expression of the same. According to her, it is the “single most powerful concept that public health has to offer” and “the anchor for the work of WHO as we move forward”. Powerful words indeed! We hope that the 2nd global symposium later this year will add further impetus to this growing momentum.
The 65th WHA also well and truly brought the issue of NCDs to the forefront. One of the major steps consisted in setting a target for reduction of premature mortality from NCDs by 2025. The resolution emphasized the importance of a multi-sectoral approach to tackle the four risk factors that the UN special summit in September 2011 resolved to focus on: tobacco use, unhealthy diet, physical inactivity and unhealthy use of alcohol. So, we are likely to see an explosion of funding, research and advocacy activities related to NCDs, much more so than we have seen in the past – at least in a number of countries.
Finally, the matter of WHO reforms. A crucial issue if WHO is to successfully face today’s challenges and strengthen its position as the ultimate global technical and scientific advisory body and coordinating authority for health. Chan identified the crux of the problem: “The future of funding for international health development is uncertain” and “If we let down our guard, slacken our efforts, problems that are so close to being brought under control will come roaring back”. She also committed herself to transparency and accountability, two key watchwords in this process; and affirmed her commitment to these by holding herself accountable for the 22 commitments in her first election manifesto. We look forward to her “report card assessing how well WHO performed, under my leadership, in delivering on each of these promises” in June, before she officially completes her first term.
On this promising note, let me sign off with the hope that actions will speak louder than words before the next five years are through.
World Health Assembly (continued)
1. BMJ (news) – World leaders agree to cut deaths from non-communicable diseases by a quarter by 2025
Health ministers and senior officials from 194 countries have agreed to cut the number of premature deaths from the four most prevalent NCDs by a quarter by 2025.
2. BMJ (news) – Plan to stimulate research in developing countries is put on hold
Health officials have failed to come to an agreement on a binding convention on stimulating R&D focusing on the health problems of developing countries. There was strong opposition from a number of developed countries, including the US. Scidev.net has an article on what might happen in the coming months. Proposals for new mechanisms to improve the funding and coordination of health research for the developing world, potentially including a binding international convention, will be formally discussed over the next year.
For an overview of some of the other resolutions and decisions taken at the WHA, see KFF and the WHO webpage on the WHA. As Tom Paulson reported, one of the decisions taken concerned the global vaccine action plan.
As for yet another view on how the WHO should reinvent itself, see Thomas Bollyky’s stance (CFR).
3. Lancet – Offline: Discarding the shroud of defeatism
Offline shows a combative Richard Horton this week. He refuses to accept today’s austerity “money is tight” wisdom, or the fact that today’s language of international health is all about self-reliance and frugality.
World No Tobacco Day
4. Chatham House – Lessons for World No Tobacco day
On World No Tobacco Day (31 May), WHO called on national leaders to be extra vigilant against the increasingly aggressive attacks by the tobacco industry. In this nice blog post, Kelley Lee draws some lessons from the anti-tobacco fight, and emphasizes the importance of ‘framing’. Lessons that seem valid for other global health fights too, we reckon.
5. BMJ (Comment) – The drug industry is a barrier to diabetes care in poor countries
John S. Yudkin;
In another NCD related publication, Yudkin argues that the approaches to management of diabetes that are so heavily advocated by the research based drug industry are not just irrelevant to diabetes care in LICs, but are actually counterproductive.
6. Global Policy – Promising trends in access to medicine
E. Richard Gold & Jean-Frédéric Morin;
This article provides a survey of innovative strategies that aim at maximizing the potential of patents to facilitate the development and delivery of medicines against diseases, the burden of which falls principally on developing country populations.
In a brand new BMJ article, Geoff Watts wonders whether genetically modified plants hold the key to cheaper drugs. (If that doesn’t turn on Bill, what does?)
Meanwhile, trade officials at the U.N. World Intellectual Property Organization (WIPO) failed to make progress on proposals to improve access to generic medicines- again the US seemed to be the main culprit.
Global health & climate change
7. BMJ (Editorial) – People and planet: from vicious cycle to virtuous circle
Reflecting on the recent Royal Society Report ‘People and Planet’, Pencheon argues that overpopulation, poverty, and environmental degradation share common solutions. The report sees three priorities for action. Penchon also lists what role health professionals could take up. “These global challenges and opportunities are happening on our watch. They are the cholera and tobacco of our time.”
8. Globalization and health – Climate change adaptation: Where does global health fit in the agenda?
Kathryn J Bowen and Sharon Friel;
The aim of this paper is to provide an overview of climate adaptation and its relevance to global health, and highlight the opportunities to improve health and reduce health inequities via the new and additional funding that is available for climate change adaptation activities. (yes, WHO, this one is for you)
Health policy & Financing
9. Lancet (Editorial) – What can be learned from China’s health system?
The Lancet publishes a themed issue devoted to China to coincide with the third anniversary of the country’s 2009 health reform plan, and a conference—Preventing NCDs in China: national agenda and local commitments—organised by the Shanghai Jiaotong University School of Medicine. The editorial rightly states: “How to improve universal coverage, reduce costs, and deal with the mounting challenge of NCDs are truly global problems. China’s health-reform process, solutions, and lessons will provide evidence to inform debate and, ultimately, enhance global health-care outcomes.”
Another Lancet editorial dwells on a new Lancet Report ‘Shaping Cities for Health’, which argues against the assumption that urban health outcomes will improve with economic growth and demographic change, and instead highlights the need for urban planning for health needs.
10. Lancet (Comment) – Accelerating the global response to reduce maternal mortality
Tore Godal et al.;
Today (June 1st), Norwegian Foreign Minister Jonas Gahr Støre and US Secretary of State Hilary Rodham Clinton meet at the Global Health in Transition conference in Oslo, Norway. The conference confronts the pressing challenge of global health: how do we develop effective health-care systems led and sustained by countries rather than a fragmented web of donors. As our readers surely know, maternal death and perinatal mortality are “the canary in the coal mine” for assessing the strength of health-care systems. Time to speed up the global response to reduce maternal mortality, the authors argue. They list some of the measures that need to be taken and conditions that need to be fulfilled.
11. IPS – Parliamentarians Seek to Deliver Sexual Rights
In Istanbul, Turkey, lawmakers from 110 countries pledged last week to intensify efforts, individually and collectively, aiming to attain the goals on safeguarding people’s rights to sexual health and freedom to determine their reproductive choices. The goals were set at the International Conference on Population and Development (ICPD), held in 1994 in Cairo. (whether Istanbul was the right location for this sort of event, given Erdogans recent (controversial) policy measures in this area, is another question).
12. Globalization & Health – The International Health Partnership Plus: rhetoric or real change? Results of a self-reported survey in the context of the 4th high level forum on aid effectiveness in Busan
Tim Shorten et al.;
The international community created the International Health Partnership (IHP+), to apply the Paris Declaration to the health sector. This paper presents findings from an independent monitoring process, IHP +Results.
13. JAMA – A Framework Convention on Global Health: – Health for All, Justice for AllA Framework Convention on Global Health
A global coalition of civil society and academics—the Joint Action and Learning Initiative on National and Global Responsibilities for Health (JALI)—has formed an international campaign to advocate for a Framework Convention on Global Health (FCGH). Recently endorsed by Ban Ki Moon, the FCGH would reimagine global governance for health, offering a new post-MDG vision. This JAMA Special Communication (from a few weeks ago) describes the key modalities of an FCGH to illustrate how it would improve health and reduce inequalities.
The JALI manifesto for health Justice and the FCGH is also online now. We encourage you all to sign it.
14. Global Health Governance – 25 by 25: The New 3 by 5? – Derek Yach, Larry Gostin & Devi Sridhar
Derek Yach, Larry Gostin & Devi Sridhar;
The authors of this blog post argue that a new approach is needed if the ‘25 by 25’ target is to have a chance at being realized. This will require deeply committed public-private partnerships, the use of IT, low cost and effective diagnostics and poly-therapies. And beyond the health sector, it will no doubt require buy-in from ministries of finance, trade, customs and transportation.
15. Foreign Policy – Losing Polio
Laurie Garrett explores whether the CIA ruined the world’s chance to eradicate polio.
You find another nice article on polio (“Why polio just became a global health crisis and a global governance crisis”) in the Atlantic.
16. WHO Bulletin (new issue)
The new WHO Bulletin features two interesting editorials this month – one titled “Getting research into practice: primary care management of NCDs in LMICs”, the other one arguing for increased use of ‘social autopsy’ to improve maternal, neonatal and child health programmes in LICs.
Some other bits of global health news:
- This week, Bill Gates had a few high level meetings in Asia, among others with the Chief Minister of Uttar Pradesh, and with (probably) the next Chinese president, Xi Jinping.
- In the new GFO issue, there’s a news article on the relatively low ranking of the Global Fund in an Australian multilateral aid evaluation.
- Today’s Economist issue features an article on the HIV business in North and South.
- Finally, Plos neglected diseases warns us that Chagas might turn out to be ‘the new HIV/AIDS of the Americas’. (as we came across another article (on the fact that Chagas is now also endemic in Texas), perhaps it’s time for another Dubya global health initiative?)
17. Globalization and health – What are the barriers to scaling up health interventions in low and middle income countries? A qualitative study of academic leaders in implementation science
Gavin M. Yamey;
This study aimed to explore the barriers that have impeded the scale-up of evidence-based health tools and interventions in LMICs, and lay out an “implementation research agenda”–a series of key research questions that need to be addressed in order to help overcome such barriers.
Plos Medicine started a series on Global Mental Health Practice.
Development & Aid
18. ODI Background note – What if three quarters of the world’s poor live (and have always lived) in Low Aid Countries?
Some of the key findings: (1) a large majority of poor people (around three quarters) live in Very Low Aid or Low Aid Countries (VLACs and LACs) and have done for at least two decades. (2) 7 out of 10 of the world’s poorest countries have seen aid levels fall as a proportion of GNI. (3) More poor people, not fewer, now live in countries more dependent on aid. (4) About three quarters of the world’s poorest live in countries that receive less than 2% of their annual income in aid. Glennie also summarizes some of the key messages in this Guardian article.
Another ODI working paper zooms in on the impact of the EU debt crisis on developing countries.
A few reads on Rio+20 that you might want to glance at:
* a Guardian article on the danger of monetising nature
* switching to a green economy can create plenty (millions) of jobs, according to a new UNEP report.
- To make up for last week’s negative verdict on Cameron (for the UN High Level Panel on Development) in the IHP newsletter, this week we provide the opposite stance – i.e. why David “chillaxing” Cameron might actually be the right man for the job, and why next year even presents a golden opportunity, as he will also chair the G8 in 2013 (article by Jamie Drummond, in the Guardian). Cameron is definitely in ‘development mode’ now, he also announced to organize a ‘Hunger summit’ during the Olympics, for example.
- Claire Melamed reports on preliminary post-2015 discussions she had in China. An eyeopener, apparently, and not just because it was her first time in China.
Other D&A stuff
- Guy Rider is the new ILO boss.
- Jayathi Ghosh sees seven common threads in the emerging ‘New left’ (in the Guardian), with an ecological focus being one of them.
- Simon Maxwell reviewed a new World Bank Policy paper on inclusive green growth.
- In the ongoing discussion on the recently much improved child mortality figures in many African countries, Jeffrey Sachs contributes: “(health) Aid works.”
- A CGD blog post by Nancy Birdsall & Christian Meyer explores economists’ search for the middle class in the developing world.
- An IPS article reflects on the findings of a new Eurodad report – “While governments and international institutions are focusing on a stronger role for the private sector in development aid, a new report by the European Network on Debt and Development (Eurodad) released yesterday suggests there is good reason to doubt this approach.” Guess what: the study found that most of the recent development investments went to tax havens and private companies from rich countries, while half of total private investments went directly into the financial sector.
- Finally, Darth Vader thinks the time to do business in Africa is now – check out this new Goldman Sachs report (you find the link at the bottom of the All Africa.com article).