It’s a bit a special day for this newsletter as we celebrate the 200th IHP issue. It’s also the end of the year 2012, by all means a productive IHP year. So in spite of the fact that today happens to be the 21st of December, 2012, there’s much to be cheerful about. We celebrate the occasion with a special “Christmas issue” and a number of blog posts by Emerging Voices and IHP editorial staff on the post-MDG framework and health. Check out what they think about UHC, green growth, tracer indicators, the hurried post-MDG process, the importance of governance, neoliberalism, SDGs and much more.
There’s also a reason to be sad, though, today. David Hercot, who started IHP a few years ago, is about to leave us. Find out thereasons why he decided to leave ITM. David will work as a policy broker in Brussels from now on. He wanted to get closer to policy circles – closer to the real action if you want. So this week’s guest editorial – the last editorial of 2012 – is also David’s “farewell” editorial. He cares a lot about this planet, and so do I. So we hope you enjoy his last (somewhat wicked 🙂 ) piece on the climate issue. It’s been a great journey for him at ITM, and we obviously hope in the future he will maintain links with IHP. That shouldn’t be a problem.
The usual global health policy & financing highlights of the week you can find at the bottom of this newsletter. Just in case you think you’ll survive todayJ. See you all next year!
Enjoy your reading.
Kristof Decoster, David Hercot, Ildikó Bokros, Peter Delobelle, Basile Keugoung & Wim Van Damme
Do current post-MDG discussions address the future we seem to be heading for?
By David Hercot & Kristof Decoster (ITM)
The MDGs have no doubt been a unique political window of opportunity to align a large number of actors behind ambitious global public good goals. The world has changed a lot since the early 2000s. Provided our cozy planet is still there tomorrow, we hope that the post-MDG discussion will again seize the opportunity to raise awareness on the challenges of today’s world in the coming months and years.
Despite all its shortcomings, the United Nations are still the most democratic global institution we have. So if the solution for humankind’s current predicament has to come from somewhere else than street riots – although we fully understand the appeal of smashing windows of “Too Big to Fail” banks and corporate headquarters – then New York is probably your safest bet, whether Fox News anchors like it or not. So far, it doesn’t look good, though. Post-MDG discussions like the sustainable development discussions currently underway seem to miss THE health goal of our times. To paraphrase a former US president: it’s about the survival of the human species, stupid! And if global health is not about “survival” of human beings then we didn’t understand anything of it. So we global health people are well placed to say a word or two about the survival of mankind.
Indeed, it is the first time in history that a species is able to cause its own extinction and apparently hell-bent on doing so. We don’t even need aliens or UFOs for destroying our very own habitat. In fact, at this moment, aliens from the planet Zorb are probably looking at us with a mixture of unbelief and horror. The question now is: can our leaders still avoid a catastrophic ecological scenario and will they do so? Don’t count on it. Many scientists have warned repeatedly that the time to act is now and that major shocks are looming just around the corner. For many years, scientists have warned that our economic model of infinite growth is not fit for a world with finite resources. Not that anyone with real power is paying attention. How can we change this?
Perhaps the next time the IPCC publishes a report on climate change, scientists could (a) be surrounded by bodyguards showcasing AK47s – that might impress the Putins of this world (b) or they could spread a very soothing “everything is fine” message. As the world is gradually collapsing around us, the ‘Comical Ali’ effect of such a comforting message might actually have more impact on public opinion than a more traditional ‘alarming’ message. (c) A last option is to screen ‘Mad Max’ or ‘The road’ before every press conference, to focus the minds of the journalists present on the world that is in store if we don’t act now.
Let’s face it, the post-MDGs discussions are a “once in a generation” opportunity to help ensure the survival of mankind. Singing for the climate – a happy pastime in our country – and turning the light off for one hour a year aren’t solutions. They are what they are: awareness raising campaigns. We need more than awareness raising campaigns and in depth-analyses of the impact of climate change on health. We need – asap – bold measures that will address the major challenges of our future as a human species: a warming world, a foreseeable decrease in food productivity and a failing global market mechanism of which the growth addiction is causing huge damage to the entire planet as well as to 99% of the people living on this planet. If the A team still existed, we would call on them right now. No less than a warlike response is needed. In fact, many would say nature is already wreaking havoc upon us. The new MDGs should start from this analysis. And then do something about it.
As global health experts we obviously support the right to health of all 8 billion citizens that will live on earth by 2030. But we should also think about the generations after them and frame the challenges of our time the way they are: as a fight for the survival of human kind, a fight to turn the earth into a place where humans can live in peace with themselves, their neighbors and the entire earth, a home that Deepak Chopra, Eckhart Tolle, Kumi Naidoo, Oprah Winfrey ànd Michael Moore can be proud of. We need to reduce the footprint of human kind on earth. We need to actively manage the impact of an overcrowded and over-industrialized planet on the earth ecosystem. Luckily, as Gill and Stott have put it, “overall, what is good for tackling climate change is good for health”.
There aren’t many “high impact interventions” global health experts can promote that directly affect our chances to survive as a species in the long term. Still, we should embrace them. In parallel, we should adapt health systems to a changing world.
We see two global health priorities that can more directly help mitigate the impact of human beings on the planet: Firstly, we need to do everything we can to provide those who want it with the right and the means to use birth spacing measures including policies that are friendly to households willing to limit their size. This will directly affect global population growth. Let’s hope Melinda Gates can push decision makers to open their pockets a bit more. As for the ones who think they’re only fully human if they raise a whole football team of kids, we have been told castration works well.
Secondly, we have to push the richest one or two billion of people to adopt a diet that is both healthier and less demanding in terms of planetary resources. In both richer and emerging economies, many people are consuming excessive amounts of meat and processed food high in saturated fat. On the other end of the economic spectrum, almost a billion people are starving because they just can’t afford food. To do something about this, we will need something more than daily op-eds by Jeffrey Sachs. Some real men seem required here to get the job done. Would be great if George Bush and Al Gore could team up and take up this cause as their ultimate contribution to global health. Only then we can rest assured that no prisoners will be taken and the mission accomplished.
Now, if we manage to survive today’s “end of the world” party, you bet the world will still face some deeply disturbing changes in the medium and long term. To prepare and adapt health systems to a changing planet, we see two priorities. Firstly, we should strive for more equitable health systems that ensure fair access to the services people need. We are not the first ones to advocate for equitable health services, but it is more than likely that in a context of runaway climate change, the need for rationing will only become more urgent and the challenge to do so in an equitable way more daunting. This will no doubt require a lot of diplomatic skills. A schmoozer like Bill Clinton could come in handy here. Secondly, as we can expect more and more climate chaos and extreme weather events in the coming decades, when the world will increasingly resemble a “hell on earth”, health policy makers and researchers should as soon as possible include “emergency preparedness” in their thinking and policy plans, to boost resilience of their countries’ citizens. Humankind needs to become far more resilient – if we have to go down, let us at least do it in slow motion and with dignity, like Willem Dafoe in Platoon.
Not all these priorities need to become post MDG goals and not all these bigshots need to be hired. But if we do have to formulate one overall health goal for the post-MDG framework, it would have to be this one, as it captures the great challenge of our time: Current and future citizens of this world have the right to live a healthy life in a healthy world.
And now, bring on the aliens!
DH & KD
Emerging Voices on post-MDGs and health
1. Rakhal Gaitonde & Natalie Eggermont – Measuring development…..what, how and who? Reflections on a global process in a hurry
As the world rushes towards finalizing the contours of the post-MDG scenario, Rakhal and Natalie are concerned about whether there is enough clarity on what we are hoping to achieve, how we are going to measure our achievements and whether these processes and indicators are really relevant to local communities who hardly have a voice in these processes. They call for more time, more reflection, more democratization and a drive for relevance to local communities rather than a politically convenient set of indicators that will have neither efficacy nor meaning.
2. Mridula Shankar & Radhika Arora – Universal Health Coverage: Is India Up For The Challenge?
Universal Health Coverage currently stands as the front-runner for the Health goal in the post MDG development agenda. India is at the crossroads. Are we going to prioritize health for all, Mridula and Radhika wonder.
3. Daniel Henao – A new identity for a new world: The Latin-American experience
Daniel Henao draws two vital lessons from the last decades in Latin-America, lessons that need to be incorporated in the post-MDG framework in his opinion.
4. Vincent Okungu – Good governance and social solidarity form the basis for equitable health systems
Vincent Okungu emphasizes that the post-MDG debate would best start from the basics: governance and social cohesion. Overall good governance is a cost-saving endeavour and a basis for national unity and equitable health systems.
5. Mosa Moshabela – MDG targets: a double-edged sword for sub-Saharan Africa
Mosa Moshabela reflects on the ‘failure’ of MDG targets in sub-Saharan Africa. He reckons perhaps much of sub-Saharan Africa is not yet ready for the new (post-MDG and SDG) goals, as most countries have only recently gained speed and made substantial MDG progress. So they should not risk the sudden loss of this momentum by introducing a different agenda. Also, prior to further detailed discussions on the new SDGs, the subject of ‘failure or success’ regarding the current MDG targets in the context of sub-Saharan Africa must be addressed, he argues.
6. Godson Eze – Universal health coverage in view: a conversation between two old friends somewhere in Sub-Saharan Africa
Godson made a somewhat different contribution to the post-MDG & health debate than the other EVs. He came up with a fictional conversation between two old friends, elaborating current health debates on UHC. The dialogue takes place between a hypothetical intelligent village Youth leader and his old time friend now living in the larger cities of a developing country. The piece raises lots of questions with some probable answers.
7. Seye Abimbola – What could Nigeria learn from the Chinese health care system?
In the BMJ blog series by EVs, Seye Abimbola reflects on a presentation he attended in Beijing – the presenter showed the huge increase in skilled birth attendance in China in a relatively short term. How did the Chinese pull this off? The answer he got triggered this nice blog post on what Nigeria could learn from the – rather top-down – Chinese health care system. Still, he reckons change will have to come from the bottom in his own country.
IHP editorial staff on post-MDGs and health
8. Wim Van Damme – Universal Health Coverage is in sync with the new geopolitical reality
Wim van Damme argues UHC is a nice goal for a rapidly changing world. The fact that current UHC role models and cheerleaders tend to come from emerging countries is a key asset of the UHC agenda.
9. Kristof Decoster – Universal Health Coverage and green growth are acceptable aims for almost everybody – which is why they are probably not ambitious enough for the 21st century
In this blog post, Kristof Decoster argues that the global health community should attack the consumerist American dream, now shared worldwide. The ultimate goal should be an ecological economy, instead of the now mainstream ‘inclusive green growth’ vision. Instead of a greenish version of the American dream, WHO and others should promote a truly sustainable lifestyle for the masses which respects planetary boundaries. This should be an explicit post-2015 global health goal, in addition to the promotion of UHC.
Health policy & Financing news
10. CGD – Global health in 2012: a year in links
Amanda Glassman et al.
Glassman & colleagues capture some of the global health trends of the year, and link them to some of their posts earlier this year. We think the most worrying global health trend is “declining resources, increasing ambition”.
11. Guardian – Malaria gains at risk, warns World Health Organisation
The remarkable gains made in the treatment of malaria over the past decade are under threat because of insufficient increases in funding over the past two years, according to an annual progress report by the World Health Organisation.
12. CGD – The Office of Global Health Diplomacy: A Christmas Miracle or Lump of Coal?
Amanda Glassman & Jenny Ottenhof;
Ambassador Eric Goosby has been selected to head the US Department of State’s new Office of Global Health Diplomacy. Glassman applauds this appointment, but still has some reservations.
13. CSIS – The US role in Global Polio eradication
The Center for Strategic & International Studies (CSIS) has published a new paper which provides an overview of the global polio eradication effort, emphasizing the U.S. role. The paper aims to explain how the Global Polio Eradication Initiative (GPEI) came to where it is today and discusses plans for moving it forward. It focuses on the important US role.
14. Action for Global Health – Teeth of the Tiger: Strengthening the role of the WHO in global health
The 2012 AFGH conference took place in October this year. The event discussed the current reform process of the WHO as it took place in between the Executive Board meeting of WHO in January 2012 and the World Health Assembly in May 2012. This document gives an overview of the debates, speeches and workshops.
15. Future health systems – Future Health Markets: A meeting statement from Bellagio
Policy-makers, entrepreneurs, academics and funders convened at the Rockefeller Foundation Bellagio Center from 10th-14th December 2012 to discuss the changing face of health markets, and in particular to consider future trends in such markets. The aim was to promote a greater shared understanding and analysis of health market systems, and to consider how markets can better serve the needs of the poor in low- and middle-income countries (LMICs).
16. Global Health Europe – World Health Summit: Research for Health and Sustainable Development
Samantha Battams & Stephen A. Matlin;
Global Health Europe organized a discussion meeting on “Research for Health and Sustainable Development” at this year’s World Health Summit. The meeting, held on October 23rd, 2012, emphasized that meeting people’s aspirations for health and health equity required a special kind of symbiosis between policy, research and practice. Taking this vision of a unified effort to achieve better health and health equity as a starting point, the Global Health Europe Symposium looked at the policy domain and the domain of research development and innovation, asking about both the nature of policies, frameworks, structures and settings that are needed for effective research and innovation for global health; and the important role of research and innovation in informing policy and action for global health; while bearing in mind the many barriers that exist across the interface between these domains and asking how these can be overcome.
17. CGD – Taliban’s New Weapon: Childhood Vaccination
Amanda Glassman & Charles Kenny;
This week, eight polio vaccination workers in Sindh and Peshawar have been killed in Pakistan during a three day anti-polio drive. Last week in Afghanistan, two polio vaccinators were also killed. Childhood vaccination is increasingly used as a tool of terror.
18. BMC health services – Mapping of multiple criteria for priority setting of health interventions: an aid for decision makers
Noor Tromp et al.;
In rationing decisions in health, many criteria like costs, effectiveness, equity and feasibility concerns play a role. These criteria stem from different disciplines that all aim to inform health care rationing decisions, but a single underlying concept that incorporates all criteria does not yet exist. Therefore, the authors aim to develop a conceptual mapping of criteria, based on the World Health Organization’s Health Systems Performance and Health Systems Building Blocks frameworks. This map can be an aid to decision makers to identify the relevant criteria for priority setting in their specific context.
19. Plos Speaking of Medicine – Estimates from the Global Burden of Disease can become a global public good only if the data are made public
Veitch compares GBD 2010 with the human genome project in terms of transparency and data sharing. She reckons it is critical that GBD moves towards full and open public sharing of original datasets sooner rather than later, as this would bolster the assertions of some in the GBD group that these estimates should not be seen as the definitive outputs of a global consensus on burden of disease, but rather a starting point for scientific discussion and debate.
20. Global Health Policy – No same sex please: We’re African
Harmer comments on the recent outpouring of gay-bashing on the e-forum of Afro-Nets – the African network for health research and development. Recently, Brook Baker posted an appeal on the e-forum for people to sign a petition produced by the Centre for Health Human Rights and Development (CEHURD) asking the UN special rapporteur for health to: “investigate pending legislation in Uganda that would greatly increase criminal liability for engaging in homosexual acts, advocating LGBTI rights, or failing to report known homosexuals. …”. After going through some of the reactions, Harmer wonders how people can be health professionals and hold views that contradict an individual’s human rights.
21. American journal of bioethics – Global Health Justice and Governance
Jennifer Prah Ruger;
While there is a growing body of work on moral issues and global governance in the fields of global justice and international relations, little work has connected principles of global health justice with those of global health governance for a theory of global health. Such a theory would enable analysis and evaluation of the current global health system and ethically and empirically grounds proposals for reforming it to more closely align with moral values. Global health governance has been framed as an issue of national security, human security, human rights and global public goods. The global health governance literature is essentially untethered to a theorized framework to illuminate or evaluate governance. This article ties global health justice and ethics to principles for governing the global health realm, developing a theoretical framework for global and domestic institutions and actors.
22. Laurie Garrett – The end of Aids? I don’t think so!
Although it’s nearly Christmas, Laurie is angry for two reasons – the second one being “The “End of AIDS” myth now pushed by the White House and US government agencies, especially overseas.”
Finally, Ilona Kickbusch and others just published a new book on Global Health Diplomacy. Maybe we can try out some of the GHD skills today when the aliens attack usJ