Global Health in the Post-2015 Framework
April 7, 2013 in MDG 4 (Child Mortality), MDG 5 (Maternal Health), MDG 6 (Health)
Today is World Health Day, which marks the founding of the World Health Organization (WHO) in 1948. The Millennium Development Goals have tackled health issues in the past, and the post-2015 agenda is shaping up to tackle them in the future.The first set of MDGs contained a number of goals aimed at improving health that can be divided into three categories:
1. Demographic goals: These were concerned with improving the health of certain populations.For example, the health of pregnant women and young children in Goals 4 and 5 (Child Mortality and Maternal Health, respectively).
2. Disease specific goals: The first set of goals focused on “the big three:” HIV/AIDS, malaria and TB. Everything else pertaining to health concerns was put under the blanket term of “other diseases”.
3. Wider determinants of health: This includes things like how being lifted out of extreme poverty will improve your access to food and nutrition, and thus improve your health in general.
Overall, the achievement of these goals has been hit and miss. For example, the roll out of anti-retroviral (ARV) therapy in large parts of the world has reduced the number of people dying from HIV/AIDS. However, many people still cannot access the necessary drugs. Child mortality has reduced in some countries, but is still quite terrible in sub-Saharan Africa. You can read more about these issues here in the UN’s Development Report, and also in the independently produced and very excellent Global Health Watch 3.
However, many people felt this level of specificity focuses programmes and funding on a few specific populations and diseases, to the neglect of many others. This has given rise to specific campaign movements to have other diseases included in the global health agenda, such as the Neglected Tropical Diseases (NTDs), Non-Communicable Diseases (NCDs), and Global Mental Health. Not to mention the extreme need for drugs, hospitals and staff in many places in the world. All of these deserve international recognition and funding.
So how do you tackle a problem like health in the post-2015 framework?
Dividing health down into disease and demographic groups has distorted the funding landscape and left millions of people without access to healthcare . Health is a problem affecting a whole population and encompassing a spectrum of disease. If you try and cherry-pick what health issues to tackle, you will always leave someone out. It is no good being able to get ARVs for HIV and then dying of appendicitis. There are two themes that appear in the current post-2015 discussions:
1. Universal health coverage: At the most basic level, this is the principle that everyone, everywhere should be able to access healthcare when they need it. This is obviously quite complicated and you can click here to find out more from the WHO. This has recently been highlighted by Ban Ki-Moon, the UN secretary General.
2. Prevention, the social determinants of health: Too many people become ill unnecessarily and much more must be done to prevent common diseases. This approach involves tackling the “causes of the causes of ill health.” For instance, the environment in which people are born, grow up, and die significantly impacts their health. This includes things like living conditions, economic development, wealth distribution, education, and more. This approach has been developed and championed by Michael Marmot, and you can read more about it here.
Both strategies need to be adopted in the post-2015 framework. The global health and international development community needs to work together to see how this can be achieved. This may prove difficult due to the vested interests of both the negotiators and the lobbyists, but remains an ethical imperative and one that young people should be advocating for.
Prevention is always better than cure, unless you are already sick.
