IHP news 540 : #UNGA74 frenzy
( 27 September 2019)
The weekly International Health Policies (IHP) newsletter is an initiative of the Health Policy unit at the Institute of Tropical Medicine in Antwerp, Belgium.
Dear Colleagues,
It will probably not come as a surprise that this newsletter issue focuses on New York this week. #UNGA74 featured, among others the long awaited UHC High-Level meeting & climate action summits (both on 23 Sept), the SDG summit (24-25 Sept), the Financing for Developing summit (26 Sept), as well heaps of side events, launches of new initiatives, networks & reports (with a special mention here already for the Global Monitoring report on UHC and the Global Action Plan for Healthy Lives and Well-being for All), and let’s not forget all other publications and analyses in New York’s slipstream. When it comes to the UHC (& health SDG 3) agenda(s), it will certainly not be because of a lack of publications and social media activity on UHC that targets won’t be reached by 2030 :)
It was a heavyweight agenda, and so I won’t add to your ‘catching up’ predicament by coming up with a lengthy intro here. But anyway, what is clear is this. The world is in turmoil, among others because the dominant global economic system (and discourse) have failed too many people (as well as, ominously, the planet) in recent decades. Inconsistencies in the SDG agenda are also becoming clearer by the day, and so in many respects the SDG agenda is thus ‘off track’. It remains to be seen whether the GDSR report (from scientists) will be sufficiently listened to in the vital years ahead, or whether (only) a GAP, as much as it is a step forward, can really help us get ‘back on track’ again in the health SDG era, as dr. Tedros argued - by 2023 (the next milestone) and certainly by 2030.
The good thing is: ideas that were considered hegemonic till recently are shifting fast. Just a few examples from this week, via Twitter: “Powerful Winnie Byanyima: “in the world of so much wealth how is it that billions of people do not have access to health care “ “We should reject economic models that put wealth before health” #UHC.” The tweet related to Byanyima – future boss of UNAIDS - ’s statement at the UN HLM on UHC (I have a hunch she was talking about capitalism). Jeffrey Sachs also cut the crap at the HL meeting on UHC, at some point reading aloud the names of the 15 richest individuals on earth: “Wow! Sachs: "Enough is enough!" 15 billionaires own together 1 trillion dollars net worth. This pays for US50 per capita/ year for basic health . There is more than enough wealth worldwide! Someone should do the math. stop tax havens! stop illicit capital flight. Pay! “ Or see Jason Hickel on Johan Rockström (Stockholm Resilience institute) ‘s recent change of heart: “Something significant has happened. Prof Johan Rockström, one of the world's leading sustainability scientists, has publicly reversed his position on "green growth" and now acknowledges that high-income nations must abandon growth as an objective to avoid ecological collapse.”
But you really don’t have a “rocket scientist” to see a way forward: “capitalism as we know it” has to go, sooner rather than later. What should replace it is less clear, but plenty of people are (frantically) trying to think of a way forward. Whether capitalism can be ‘fixed’ (see for example progressive
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capitalism (Stiglitz) ) or not (Graeber), I don’ t know. I do know, however, that a major overhaul of our current global economic system is immensely important if we want to make real progress on the SDG agenda, including UHC, and keep a chance to still avert climate collapse. The fact that even the Financial Times (of all media) pointed to our collective ‘Marie Antoinette moment’ earlier this week, is telling. In short: incremental reform – read ‘inclusive growth’, ‘sustainable growth’, … just won’t do it. We need transformative change. At all levels.
If we fail, you know which “gentlemen” (it will be mostly men) will rule our world, as it spirals into further destruction. As we already have a fair amount of these proto-fascists around. One of them was celebrated this week at the Goalkeepers event.
Enjoy your reading.
Kristof Decoster
Featured Article
Change is gonna come
Remco van de Pas (ITM)
I was this week in New York, at the United Nations. More specifically I participated in the UN High Level Meeting on Universal Health Coverage as a representative of the Medicus Mundi International Network Health for All! The UHC meeting was part of a series of high-level political meetings taking place before and during the 74th session of the UN General Assembly.
In preparation for the HLM on UHC, I already wrote that I consider the Sustainable Development Goals (SDGs) a kind of “golden straightjacket” and that we need to alter the narrative on health development towards an overall “limits to growth” thinking. In this article, I will mainly reflect on the process, setting and actors present at (and around) UNGA74, specifically related to UHC. After an intensive week of listening to national Presidents and others praising the UHC momentum, rushing between strategic meetings and side events in (too) fancy New York hotels, and ‘Walking the Talk’ in Central Park, I can distill several observations from all this frantic activity.
The true ‘historic moment’ I was part of actually took place before and outside the UN premises. I’m referring here to the Climate strike and march held in downtown Manhattan on Friday 20th of September. Attended by 250.000 people, this was an unprecedented experience. I witnessed (and participated in) a very diverse colorful movement of young people with different backgrounds, ethnicity, sexuality, income, nationality and education. A great amount of middle-aged and elderly people had joined them, showing solidarity with the youngsters. This crowd was angry and enraged about the climate policies and their
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current gridlock in American politics. Helicopters and drones were flying over, monitoring the crowd. The people who spoke, and performances that took place, linked the climate resistance to the legacy of the indigenous rights tradition, anti-slavery and the civil rights movement, the more recent Black Lives Matters and #MeToo fights as well as broader ecological and social justice struggles. This was wonderful to see. It was highly intersectional and socio-political, and demands were very clear: “Our world is burning”. Political, societal and corporate powers neglect to address the issue. We will stop this! Indigenous groups from the Amazon spoke about the fires there, the president of the NY state nurse association stressed that the wounds of the people and the planet need to be healed. Greta Thunberg also spoke. Her appearance and message have near messianic proportions by the way she urges us all to strike and stop the status quo. Remarkably - and I scanned for it - I didn’t see any sign of, or any one speaking about, the SDGs. For the Climate Strikers, these simply don’t matter.
What a difference with the United Nations itself! Here, men wear similar suits and women wear similar skirts and pumps. Uniformity rules. Access to the UN is regulated by status (diplomatic or not) and depends on whether one has been formally invited for the several events or not. The whole thing is relatively inaccessible. As a representative of an NGO network, I could only access the UHC meeting and related side-events. I didn’t have access to the Climate summit, the SDG and Financing for Development meetings. To access the UNGA building, one has to go through (heavy) security. All in all, it’s a sanitized, corporate networking environment where the many stakeholders (NGOs, country delegations, companies, philanthropists) have to be “entrepreneurial” in pushing their issues forward. This leads to many issues being addressed in a rather fragmented way, with people talking in their respective side events to likeminded ‘bubbles’. This (continued) fragmentation is all the more remarkable given that the SDGs aim to be an integrative & holistic framework. The events, including in the UHC and health domain were often of a celebratory and advocacy nature, proclaiming a similar public-private “we’re all moving forward together” approach without giving much space to different perspectives and dialogue.
Then the HLM on UHC itself. The meeting was opened by the leaders from the UN, WHO and World Bank. Dr. Tedros, the WHO DG, spoke about a historical and landmark health agreement. Dr. Gro Harlem Brundlandt, former WHO DG and member of the ‘Elders’ provided a clear reminder that UHC is about public finance, a social contract, and that it should mitigate violation of human rights. She urged countries to stop applying user fees and not to leave health care to the free market. While country leaders and delegates afterwards started to make their statements on how to advance UHC in their countries - I listened to president Sisi of Egypt, Kenyatta of Kenya and Kagame of Rwanda making the first statements - the UHC meeting continued in parallel with two multi-stakeholder panels. The first one, on “Leaving no-one behind”, was surprisingly strong with amongst others development economist Jeffrey Sachs (depicted by a colleague as a ‘converted sinner’) making the case that all we should talk about is money. “UHC is about rich people in rich countries that should allow poor people in poor countries to access essential health care services. If you don’t know where to get the money, do consider the 15 mega-billionaires in the world. They have an accumulated net worth of US1 trillion. Do the math. This should be more than sufficient to provide for essential health services and education in low-income countries”. The second panel session on investments (in the afternoon), was far less
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interesting with every one making the case how UHC and health was such a good investment in human capital and inclusive growth, that health coverage provides such a good return on investment (of 200-900 % in some cases), that innovative blended financing is required, … What this value for money or “innovative” blended finance model exactly entailed, and what the sustainable effects and impact are on the long term, remains vague and general. In the sessions, very few NGOs were allowed to provide their statement. Melinda Gates and the World Economic Forum representative, however, had the floor. A representative from Indonesia came up with the following quote, “UHC avoids getting old before one can become rich”.
Many events on, or related to UHC were organized during the week. WHO released a Global Monitoring report on PHC and the road to UHC. One worrying thing is that globally, the population impoverished by out-of-pocket health spending has been slowly increasing between 2000 and 2015. More than 930 million people spent more than 10% of their household income on health care in 2015. The Global Action Plan for Healthy Lives and Wellbeing for All, supported by the governments of Germany, Ghana and Norway, was also presented. While this should provide for stronger collaboration, financial acceleration and coherence between 12 multilateral health organisations, it remains opaque and general how this will be implemented, and the same goes for the financing behind it – it’s not really clear where this will come from. While sessions with more corporate actors on “investments”, “innovation” and “digitalization” in the health sector were held in fancy hotels, I spent most time in sessions at the Ford, Rockefeller and Open Society foundations where UHC 2030, WHO , academics and NGOs discussed how to move forward. The discussions focused a lot on “national implementation, country structures, monitoring and ensuring accountability”. For me, it was telling that all these meetings took place at the philanthropic foundations. It seems that the more socially oriented drive for the UHC programs is left to charitable actors and a small group of supportive countries.
While writing all this, I have mixed and ambiguous feelings on what all this energy, money and framing of UHC at the highest political level actually will imply for health for all! I need to let it sink in, to find out whether some parts of it could lead to a momentum for universal health finance. I am far from sure whether the “investment” frame, currently in vogue, will close the gap. Rather, I am afraid the gap might get even wider. What, however, sticks very clearly in my mind after this week in New York, are the words of a brave teenager who spoke at the climate action summit: “…How dare you! … … all you can talk about is money and fairytales of eternal economic growth. …. … [but] We will not let you get away with this. Right here, right now is where we draw the line. The world is waking up. And change is coming, whether you like it or not.”
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Highlights of the week
UNGA 2019: Expectations/Focal points ahead of the week?
As mentioned last week, all eyes were on 5 big summits this week (in addition to, obviously, the leaders’ statements).
• See for example a Devex analysis of what their focal points would be during the week – What Devex is watching. Among others, the follow-up on the UHC HL meeting, who will pay for everything (SDGs…), whether Trump would go for ‘America First’ development, …
“It will likely require around $2.4 trillion a year of additional investment to achieve the SDGs by 2030, according to a 2018 report from The Business and Sustainable Development Commission.”
• For the New Humanitarian’s agenda - What we’re watching at the UN General Assembly.
UHC High-Level meeting (23 September)
Health policy Watch - UN Adopts Political Declaration On Health Coverage For All – Financing A Big Challenge https://www.healthpolicy-watch.org/un-adopts-political-declaration-on-health-coverage-for-all- amid-efforts-for-financing/
Excellent coverage of the landmark UHC HL meeting.
“United Nations members [today] (23rd) adopted a high-level political declaration raising the stakes in the global push to ensure everyone in the world has affordable access to health a decade from now.”
“The political declaration is “the most comprehensive agreement ever reached on global health,” UN Secretary General Antonio Guterres told the opening session of today’s High Level Meeting on Universal Health Coverage, being held within the context of the annual UN General Assembly. “This is a significant achievement that will drive progress for the next decade.”
“World Health Organization Director General Tedros Adhanom Ghebreyesus (Dr Tedros) called it a “landmark for global health and development.”
A tweet by Jocalyn Clark:
“Struck by how many delegations are mentioning importance of women & girls in their statements despite stripping of #SRHR from agreed #UHC resolution…” (for more on SRHR & the HL meeting, see below)
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IISD - UN High-Level Meeting Adopts Historic Declaration on Universal Health Coverage
IISD;
Some more coverage of the HL meeting.
• “UN Member States adopted a high-level political declaration to ensure all have access to essential health services without experiencing financial hardship. • “The declaration builds on SDG target 3.8 on universal health coverage and the WHO’s ’triple billion' goals.” • “While welcoming the declaration, Member States expressed concerns regarding the health impacts of climate change, health coverage for migrants and refugees, and language around sexual and reproductive health and rights.”
On SRHR, a very contentious issue as you know, it’s worth flagging two (opposite) positions:
“Sigrid Kaag, Minister for Foreign Trade and Development Cooperation, the Netherlands, presented a joint statement on sexual and reproductive health and rights (SRHR) on behalf of more than 50 countries. The statement argued that SRHR is an integral part of UHC and the SDGs, noting that around 62% of sexual and reproductive health services are financed out-of-pocket by patients, and calling for an investment of nine USD per capita per year to make these essential services available to all. The statement further called for directly involving women, adolescents and marginalized groups in the policy and program design of services to realize universal access to SRHR, and to invest in the needs of women, girls, adolescents and people in the most marginalized situations, who most need such services.”
“Alex Azar, US Secretary of Health and Human Services, highlighted US efforts to provide more Americans with health coverage, including by lowering the cost of prescription drugs and promoting partnerships that include civil society, NGOs, faith- and community-based organizations. He deplored “politicization of the negotiation” of the declaration text, which includes language that has been used, he argued, to promote abortion as healthcare and to give access to sex education that diminishes the protective role of the family in improving health. While joining consensus on the political declaration, he dissociated the US from paragraph 68 of the declaration and its mention, in relation to the Program of Action of the International Conference on Population and Development (ICPD) and the Beijing Platform for Action, of “sexual and reproductive health” and “sexual and reproductive health and reproductive rights.” He stressed that there is no universal right to abortion.”
UN News - Universal coverage race at ‘starting line’, with new momentum: UN health agency https://news.un.org/en/story/2019/09/1047262
I guess that’s another way to frame things : )
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“The race to provide Universal Health Coverage can now get underway, said the World Health Organization (WHO) on Tuesday, as nations take to the “starting line” following the most “comprehensive international health agreement in history”- the landmark pledge to improve global health declared by the UN just 24 hours earlier. In the wake of Monday’s universal health commitments, WHO chief Tedros Adhammom Ghebryesus said the document would serve as “a new milestone in our journey towards a healthier, safer and fairer world”, dovetailing with the launch of the agency’s own pledge to boost healthier living. “World leaders have unified around a shared vision of the world we want”, he said. “…”
Some more analyses of the declaration & statements from constituencies Two analyses of the declaration, from Indian & South African authors, first of all:
The Wire – Why health coverage is not sufficient to build a healthier world
S Nadimpaly et al; https://thewire.in/health/why-health-coverage-is-not-sufficient-to-build-a- healthier-world
Excellent piece. “Moving toward ‘health for all’ requires transformations not only in the area of healthcare but also in a wide range of determinants of health, which a UN declaration on universal health coverage appears to have ignored.”
Daily Maverick – US hijacks the world’s first declaration on Universal Healthcare
J van Dyk; https://www.dailymaverick.co.za/article/2019-09-20-us-hijacks-the-worlds-first-un- declaration-on-universal-healthcare/
“The world’s first United Nations declaration on universal health coverage (UHC) will not include any mention of sexual and reproductive health rights — and activists say US President Donald Trump’s administration is largely to blame. Meanwhile, South African experts say other controversies around the document — including who has a seat at the table — mirror fights about the country’s own UHC financing model, the National Health Insurance (NHI).”
UHC 2030 -The UHC2030 Private Sector Constituency has launched its statement on ‘Private Sector contributions towards universal health coverage'. https://www.uhc2030.org/news-events/uhc2030-news/uhc2030-private-sector-constituency- launches-statement-on-uhc-555298/
“It is essential to reframe public and private sector engagement as a partnership for shared outcomes. This statement provides a helpful basis for dialogue to promote shared UHC goals,” said Peter Salama, Executive Director UHC/Life Course at the World Health Organization.
The statement outlines seven ways in which the private sector can contribute to UHC.
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UHC Global Monitoring report 2019
WHO - Countries must invest at least 1% more of GDP on primary health care to eliminate glaring coverage gaps https://www.who.int/news-room/detail/22-09-2019-countries-must-invest-at-least-1-more-of-gdp- on-primary-health-care-to-eliminate-glaring-coverage-gaps
This tough report was released just before the UN HL Meeting on UHC.
“Countries must increase spending on primary healthcare by at least 1% of their gross domestic product (GDP) if the world is to close glaring coverage gaps and meet health targets agreed in 2015, says a new report from the World Health Organization and partners on the eve of a UN General Assembly high-level meeting on Universal Health Coverage. They must also intensify efforts to expand services countrywide. The world will need to double health coverage between now and 2030, according to the Universal Health Coverage Monitoring Report. It warns that if current trends continue, up to 5 billion people will still be unable to access health care in 2030 – the deadline world leaders have set for achieving universal health coverage. Most of those people are poor and already disadvantaged….” The Universal Health Coverage Global Monitoring Report 2019 has been prepared by the World Health Organization, with contributions from the World Bank, the Organisation for Economic Co-operation and Development, the United Nations Population Fund, and UNICEF.”
Executive summary - https://www.who.int/docs/default-source/documents/2019-uhc-report- executive-summary ( full report: here )
For some great coverage, see HPW - Progress On Universal Health Coverage Lagging: WHO Report Released Ahead Of High Level UHC Meeting (must-read) (or UN News - With 5 billion set to miss out on health care, UN holds landmark summit to boost coverage ).
Or see the 20 pointed tweets from Agnès Soucat, summarizing the main messages from report.
First one: “New @WHO ! Global Monitoring Report on #UHC released for #HLMUHC shows service coverage is improving but catastrophic health spending is not. Gender and equity related challenges must be addressed. #PHC is the route to #UHC”
Excerpts from the HPW coverage:
“Despite advances in Universal Health Coverage (UHC), as many as 5 billion people would be left without full access to healthcare in 2030 at the present rate of progress, according to a new report led by the World Health Organization. And financial protections that shield families from catastrophic health expenses have been eroded in some countries, says the report, released just ahead of Monday’s High Level Meeting on UHC here at UN Headquarters. “
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“…Primary health care is another key focus of the report’s findings. “Investing an additional US$ 200 billion a year on scaling up primary health care across low and middle-income countries would potentially save 60 million lives, increase average life expectancy by 3.7 years by 2030, and contribute significantly to socio-economic development,” WHO said in a press release. “It would represent a 5% increase on the US$ 7.5 trillion already spent on health globally each year.””
“The 163-page report filled with the latest-available data and analysis shows an increase in the “UHC service coverage index” (SCI) measuring progress on SDG indicator 3.8.1 (financial protection and coverage of essential health services). The SCI rose from a global average of 45 (of 100) in 2000 to 66 in 2017, and all regions and income groups recorded gains, according to the report. According to the report, “Progress has been greatest in lower income countries, mainly driven by interventions for infectious diseases and, to less extent, for reproductive, maternal, new-born and child health services. But the poorest countries and those affected by conflict generally lag far behind.” But the pace of progress on UHC has slowed since 2010. … … “The good news is that all around the world, across all income groups, health service coverage is improving, has improved in this time period. Unfortunately, the rate of progress is declining, in relation to issues such as non-communicable diseases, limitations in health systems, and the fact that the group of lower income countries are falling tragically behind,” Peter Salama, WHO’s executive director of Universal Health Coverage & Life Course told reporters. … “In many ways, we may have reached the natural limit of our previous global health model,” he said. “We see what is left in terms of coverage are some of the hardest countries – fragile states in particular – the poorest and most vulnerable, and also some of the hardest to reach people within countries: the rural poor, the peri-urban poor, for example,” he added. … … “On financial hardship, on one hand the world is getting richer, and overall poverty rates are declining, he said. But poverty related to health care expenditure is actually increasing. …. “
UHC 2030 Civil society Engagement mechanism: Commentary on GMR https://www.uhc2030.org/fileadmin/uploads/uhc2030/Documents/Key_Issues/UHC2030_civil_socie ty_engagement/CSEM_GMR_Commentary_Executive_Summary_2019_EN_WEB.pdf
Must-read (and only 5 pages!!!).
Launch of Global Action Plan (GAP) -“Stronger Collaboration, Better Health: Global Action Plan for Healthy Lives and Well- being for All” (24 September)
WHO - Multilateral agencies launch a joint plan to boost global health goals https://www.who.int/news-room/detail/24-09-2019-multilateral-agencies-launch-a-joint-plan-to- boost-global-health-goals
On Tuesday, “…at the United Nations General Assembly, 12 multilateral agencies launched a joint plan to better support countries over the next 10 years to accelerate progress towards the health- related SDGs. Developed over 18 months, Stronger Collaboration, Better Health: Global Action Plan
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for Healthy Lives and Well-being for All outlines how a dozen multilateral health, development and humanitarian agencies will collaborate to be more efficient and provide more streamlined support to countries to deliver universal health coverage and achieve the health-related SDG targets. Together, the 12 agencies contribute nearly one-third of all development assistance to health. Under the Global Action Plan, the agencies commit to strengthening their collaboration to: (1) Engage with countries better to identify priorities, plan and implement together; (2) Accelerate progress in countries through joint actions under 7 accelerator themes, which represent common challenges for many countries and where the agencies’ mandates, expertise and resources offer solutions, namely: 1) Primary health care 2) Sustainable health financing 3) Community and civil society engagement 4) Determinants of health 5) Innovative programming in fragile and vulnerable settings and for disease outbreak responses 6) Research and development, innovation and access, and 7) Data and digital health. They will also work together to advance gender equality and support the delivery of global public goods; (3) Align by harmonizing their operational and financial strategies and policies in support of countries to increase efficiency and reduce the burden on countries; and (4) Account, by reviewing progress and learning together to enhance shared accountability…”
For the GAP, see Global Action Plan
Coverage in HPW - 12 Agencies Launch Global Action Plan To Speed Work On 2030 SDG Health Goals
“…The plan launching today is designed to get us back on track,” said WHO Director General Dr Tedros Adhanom Ghebreyesus. All of the partners have unique strengths and a shared commitment, he said, but added, “It’s all about country focus, country priorities.”
The HPW coverage also includes quotes from the official launch, including from Angela Merkel.
Other UHC (& health financing) related reads from this week
P4H – Financing Universal Health coverage dos and donts https://p4h.world/en/news/financing-universal-health-coverage-dos-and-donts
“WHO is currently developing a guidance note to strengthen an understanding of the central issues which matter in health financing for universal health coverage (UHC). Speaking directly to decision- makers and those advising them, the guide synthesizes lessons learned from reform experiences globally in a question-and-answer format. The lessons do not constitute a specific blueprint or cookbook: countries differ, and every health financing reform must be homegrown and adapt to local history and current context. The lessons are rather principles or signposts— to point in the direction of effective reforms, and to support periodic assessments of progress.”
To access it, click on document. (Biased as we are, we particularly enjoyed the section on PBF)
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Updated WHO country expenditure profiles https://apps.who.int/nha/database/DocumentationCentre/Index/en
Check out how your country is doing.
Health Systems & Reform (Editorial) - Financing Common Goods for Health: Fundamental for Health, the Foundation for UHC
Agnès Soucat; https://www.tandfonline.com/doi/full/10.1080/23288604.2019.1671125
Introduction to a special issue, launched in New York this week. With an overview of the contributions in the special issue.
“This special issue of Health Systems & Reform, sponsored by the World Health Organization (WHO), presents a comprehensive argument that “common goods for health” are a priority for action on the road to Universal Health Coverage (UHC). Its publication is juxtaposed with the September 2019 United Nations General Assembly High Level Meeting on UHC, an event that represents the global community’s commitment to UHC. This special issue proposes a key approach to moving the UHC agenda forward: financing the common goods that form the foundation of health globally.”
FT Health (special report) – The future of African health care https://www.ft.com/reports/future-african-healthcare
“Healthcare systems across Africa are underfunded and understaffed. But clinicians and politicians are campaigning to secure more funds, improve medical training, widen access to vaccines, tackle counterfeit drugs and develop more affordable medicines.”
Much of this special report is gated, unfortunately.
But do check out this Op-ED History shows health is the foundation of African prosperity (by dr. Tedros & Paul Kagame). #buddies
Or FT health – Health care in Africa weighs funding options “Private sector can help overstretched facilities but experts warn of vested interests.”
BMJ Collection on UHC – some new additions https://www.bmj.com/universal-health-coverage
As a reminder on this collection:
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“The BMJ in partnership with The Harvard Global Health Institute has launched a collection of articles exploring how to achieve effective universal health coverage (UHC). The collection highlights the importance of quality in UHC, potential finance models, how best to incentivise stakeholders, and some of the barriers to true UHC.”
With four new reads:
BMJ - Climate change threatens the achievement of effective universal healthcare
Renee Salas and Ashish Jha; https://www.bmj.com/content/366/bmj.l5302
Must-read!!!
“Minimising the health harms of climate change and optimising universal health coverage will only be achieved through an integrated agenda and aligned solutions, say Renee Salas and Ashish Jha.”
BMJ - Achieving universal health coverage for mental disorders
Vikram Patel and Shekhar Saxena; https://www.bmj.com/content/366/bmj.l4516
“Vikram Patel and Shekhar Saxena discuss strategies for integrating mental disorders, and other chronic conditions, into primary healthcare to achieve universal health coverage”
Check out also the 2 other new articles in the collection, Overcoming distrust to deliver universal health coverage: lessons from Ebola and Motivating provision of high quality care: it is not all about the money
FT Health (Special report) - Universal Healthcare https://www.ft.com/reports/universal-healthcare
“World leaders have committed to introduce universal health coverage by 2030 as part of the UN’s Sustainable Development Goals but, as our three-part report explores, there is a still a long way to go.”
Do check out for example “Why the WHO needs a chief economist”
“Health and the economy must be seen as interdependent, say Alan Donnelly and Ilona Kickbusch.” (PS: Alan Donnelly is chair of the G20 Health and Development Partnership )
CGD made a similar case a while ago. Now it’s just waiting for somebody to specify only “ecological economists” fit the criteria : )
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FT Health Op-Ed – How to get adequate and sustainable finance for health in Africa
P Sands (GF), M Pate (GFF) & S Berkley (GAVI); https://www.ft.com/content/91c8a62b-9b3e-308a- bd23-e24803837327
One of the must-reads of the week. “Political leadership and rigorous execution are vital.”
Excerpts:
“There remains a yawning gap between the aspiration of the third Sustainable Development Goal (SDG3) to deliver health and wellbeing for all, and the reality, particularly in Africa. Innovation, better implementation and renewed political commitment can close part of that gap. But we also need more money. … “ “…The World Health Organisation estimates suggest at least $105 per person per year is required to deliver a basic package of health services. But in 2016, average per person spend in low income countries, most of which are in Africa, was less than $40.”
Furthermore, too much of the money comes from the wrong sources. In 26 of Africa’s 55 countries, over 20 per cent of healthcare spending comes from external development partners, including the Global Fund, Gavi, the World Bank and the Global Financing Facility. While such assistance plays a crucial role in improving the health of the poorest and most vulnerable, it is not a long-term solution.
To deliver truly universal health coverage, leaving no one behind, will require a massive step up in health financing by African governments. … … At the moment, only two of Africa’s 55 countries meet the Abuja Declaration’s target of committing 15 per cent of fiscal spending to health. Solving the problem of how to finance health will require a combination of brave political leadership and rigorous technical execution. … … The challenge of sustainable health financing can be broken down into four components: first, ensuring the government has enough fiscal resources; second, devoting enough of these resources to health; third, ensuring the money invested in health is allocated to the right priorities; and finally, spending the money efficiently. In most African countries there is significant room to improve on all these dimensions… external support is not the long-term answer. …”
The three authors also dwell on the Sustainable Finance Accelerator, a key component of the new GAP.
“So we are working together, with partners like the WHO and the IMF, to support countries as they wrestle with the undeniably difficult challenges of implementing adequate and sustainable financing solutions for their health systems. Through the Sustainable Finance Accelerator, a key component of the Global Action Plan for health and wellbeing for all, launched this week during the UN General Assembly meetings in New York, we are committed to coordinating our efforts even more closely, whether in supporting national health financing dialogues, providing technical assistance on the design and implementation of financing mechanisms, or combining resources in innovative ways to support countries as they tackle specific health challenges….”
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Blogs on UHC - Medium ‘Voices of the Universal Health Coverage Coalition’ and other blogs https://medium.com/health-for-all
We recommend, among others, the following blogs from this series on Medium:
Medium (blog) – The Universal Health Coverage Divide
Remco van de Pas; https://medium.com/health-for-all/the-universal-health-coverage-divide- 87dd89256ca9
Blog slightly inspired by Jason Hickel’s book, ‘The Divide’.
Medium (blog) - Post-UHC High-Level Meeting, Advocates Must Push for Clear Milestones and Accountability for Health for All’s Many Components Vince Blaser and Carol Bales; https://medium.com/health-for-all/post-uhc-high-level-meeting- advocates-must-push-for-clear-milestones-and-accountability-for-a404dfe67a83
“As policymakers, advocates, and other global health stakeholders have descended on New York and the United Nations this week, two words seem to sum up the conversations around universal health coverage (UHC): “Now what?”
“With the new commitment made on Monday 23rd September, at the UN, and the how it will be done still pretty fuzzy, the “now what?” question takes on outsize importance... While the Political Declaration does mention the need to address many of the components necessary to achieving UHC, the direct policy and financial commitments needed to meaningfully address those components are lacking.” …. “Now what?” Now comes the hard work. Advocates must go back home and push for data, milestones, and targets.”
PS: civil society also held strategic meetings in New York to think pro-actively about the follow-up, after this landmark declaration.
Medium- Moving Towards UHC: Time to Think about Policies for Provisioning
S Nandi (PHM); https://medium.com/health-for-all/moving-towards-uhc-time-to-think-about- policies-for-provisioning-471bbb11173b
“Universal Health Coverage (UHC) has dominated the global health discourse over the last decade. The political declaration of the upcoming UN High Level Meeting (HLM) on UHC that has emerged out of intensive negotiations between countries and advocacy by civil society, illustrates the global political commitment towards UHC.”
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“A significant omission in the political declaration is the lack of commitment to strengthening delivery of public sector health services, which reflects the dominant discourse on UHC.”
“UHC can gain much by moving away from market-based interpretations to a clear policy towards strengthening publicly-funded and publicly-provided healthcare. The leaders meeting at the UN HLM on UHC and civil society need to commit to such a path for attaining UHC.”
HSG (blog) – Health systems must go beyond sick care for UHC https://www.healthsystemsglobal.org/blog/364/Health-systems-must-go-beyond-sick-care-for- Universal-Health-Coverage.html
By Sara Bennett & Fadi El-Jardali. Anticipating already the topic of next year’s symposium in Dubai, “…there are at least three major ways in which our health systems need to radically transform….”
SRHR
Telegraph - UK announce £600m aid for family planning as US ramps up anti- abortion stance https://www.telegraph.co.uk/global-health/women-and-girls/uk-announce-600m-aid-family- planning-us-ramps-anti-abortion/
“Britain announced a £600 million aid package for women's sexual and reproductive health and rights at the United Nations on Monday 23rd September, in the face of opposition from the United States.”
“The UK is committed to defending and promoting sexual and reproductive health and rights,” Mr Sharma told delegates.”
The Guardian - Letter suggests US is rallying UN member states to oppose abortion
Guardian;
Article published ahead of the HL Meeting on UHC. Which turned out to be true a few days later.
“In the letter signed by the secretary of state Mike Pompeo and health and human services secretary Alex Azar, governments are encouraged to sign a joint statement opposing “harmful” UN policies that promote sexual and reproductive health and rights….”
See NPR – At U.N., Trump Administration Professes 'No International Right To An Abortion'
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(see also above in this newsletter, on the two camps at the UN HL meeting on UHC, on this issue)
“The Trump administration is calling on U.N. member nations to oppose efforts to promote access to abortion internationally, a move immediately criticized by reproductive rights groups seeking greater access to the services globally. At a meeting of the United Nations General Assembly in New York on Monday, U.S. Health and Human Services Secretary Alex Azar spoke on behalf of the U.S. and more than a dozen other countries stating that abortion is not an international human right. "We do not support references to ambiguous terms and expressions such as 'sexual and reproductive health and rights' in U.N. documents, because they can undermine the critical role of the family and promote practices like abortion in circumstances that do not enjoy international consensus and which can be misinterpreted by U.N. agencies," Azar said. The remarks came at a U.N. summit focused largely on climate change and health care. Azar was joined by representatives from countries including Brazil, Poland and Iraq in making the statement, which was signed by a total of 19 countries including the United States.” “
For reactions, see US and 18 countries tell UN there is 'no international right to abortion'; pro- and anti-reproductive rights groups react
“…. 58 countries including Nepal, Croatia and Liberia signed a counter-statement stressing the importance of protecting the full range of sexual and reproductive rights. … “
Washington blade- Trump brings up global initiative to decriminalize homosexuality at U.N.
Washingtonblade;
On a remarkable statement by Trump in his own UNGA address.
“In a surprise move, President Trump included in his speech before the United Nations on Tuesday his administration’s global initiative to decriminalize homosexuality in the more than 70 countries where it remains illegal. “My administration is working with other nations to stop criminalizing of homosexuality,” Trump said. “And we stand in solidarity with LGBT people who live in countries that punish, jail and execute people based upon sexual orientation.” The remarks mark the first time ever outside of Twitter Trump has acknowledged the global initiative, which is being spearheaded by U.S. Ambassador to Germany Richard Grenell, the highest-ranking openly gay person in the Trump administration….”
However, “… David Stacy, government affairs director for the Human Rights Campaign, said in a statement Trump including the administration’s global initiative to decriminalize same-sex relations in his speech pales in comparison to the rest of his record.” “Trump has no credibility to speak about LGBTQ human rights abroad when he has done so much to damage them here at home, from banning trans people from the military to proposing that medical providers can deny care to LGBTQ patients and permitting federal contractors to fire employees for being LGBTQ,” Stacy said.”
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“Jessica Stern, executive director of Outright International, noted Trump’s emphasis on nationalism in his speech and said he can’t have it both ways with a global initiative to decriminalize homosexuality.” “Throwing in a reference to opposing the criminalization of same-sex relations while at the same time stating that the national supersedes the international, and that tradition and culture are sacred, is one more example of President Trump’s hypocrisy,” Stern said.”
Forbes - Bill Gates and Two African Billionaires Say Family Planning is Essential to Africa’s Future Forbes:
" (24th Sept) Bill Gates, the second richest person in the world; Aliko Dangote, the richest man in Africa; and Mohammed 'Mo' Ibrahim, a U.K billionaire born in Sudan, spoke about ways Africa can reach its potential in the coming decades during an event at the Africa Center in Harlem in New York City on Monday. As Africa's population expands, the continent needs to create jobs and keep up with food demand, the billionaires said during a fireside chat at an event called The Future Africa Forum. Ibrahim said there is a controversial topic that can help Africa develop sustainable communities and cities: family planning..."
Gates said it’s important to get the conversation on family planning right, though (as it’s potentially very explosive).
And “the quote of the week” comes from Ibrahim: “…Ibrahim went a step further, explaining that major social problems, like fundamentalism and violence, are byproducts of population growth outpacing job growth. “If you have two kids, you can educate them. But if you have seven to eight kids and no jobs, you have Boko Haram,” said Ibrahim, making a reference to the jihadi terrorist organization in Nigeria, Chad and Cameroon.”
MSF report – Women and girls prevented from having a safe abortion
MSF;
“Unsafe abortions, women at risk, a new report based on data Médecins Sans Frontières (MSF) collected between 2017 and 2018 in Colombia, highlights the multiple barriers women and girls still face when seeking to end their pregnancies. Based on our experience in Colombia, we are calling on the country's health institutions to increase and simplify access to family planning services and ensure that comprehensive safe abortion services are available for women and girls nationwide. Health promotion and prevention services should be reinforced, including the legal rights of women and girls to access safe abortions.”
The report was released on the occasion of International Safe Abortion Day on 28 September.
Lancet – Offline: The false narrative of “tremendous progress”
R Horton; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32208-1/fulltext
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“More women and their children are surviving today than ever before.” This statement from UNICEF last week was indisputably true. Impressively detailed reports from the UN Inter-Agency Group for Child Mortality Estimation and the UN Maternal Mortality Estimation Inter-Agency Group described “tremendous progress…over the past two decades”. …. …. But this rather triumphalist story of success has a more sombre dimension, one that is deliberately silenced by multilateral institutions under persistent populist attack. … … While many countries may justifiably celebrate success in reducing maternal and child mortality, sub-Saharan Africa presents a very different story. Some of the highest rates of child mortality are to be found in Africa. One in 13 children dies before their fifth birthday. The UN does note that “special attention is needed for sub-Saharan Africa” and that it is “urgent to further accelerate progress”. But this conclusion comes with no credible proposals to explain what “special attention” means. Such weak acknowledgment of systemic failure is shameful. …. …. [It’s] Shocking, but not surprising. During the MDG era, attention to maternal and child health was unprecedented. … … But with the advent of the SDGs, this attention ceased. Universal health coverage (UHC) became the fashion du jour. And women's, children's, and adolescents' health mattered only in so far as it served the cause of UHC. The truth is that women and children have been pushed to one side in global health policy making since 2016….”
Run-up to Climate action summit
Global climate actions & strike (20 Sept)
Guardian – Across the globe, millions join biggest climate protest ever https://www.theguardian.com/environment/2019/sep/21/across-the-globe-millions-join-biggest- climate-protest-ever
We bet you noticed this, in your city/country or on tv. Many of you might have even joined!
Youth climate summit (21 September)
UN News - World’s 1.8 billion youth must ‘have a say in the future of the planet’ https://news.un.org/en/story/2019/09/1046882
“It is “crucial” that the world’s 1.8 billion young people have a say in the fight against climate change and ultimately “the future of the planet” according to the UN Youth Envoy.”
See also HPW coverage - Civil Society Takes Charge On Climate Action As Governments Waver
“…Youth leaders from around the world clamored for more action on climate change Saturday at a first-ever United Nation’s Youth Climate Summit – even as the actual government commitments lined up for Monday’s formal meeting with heads of state appeared likely fall far short of making the
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dramatic changes that scientists say would be needed to limit global warming to 1.5° C. … … Against the dark scientific predictions, Saturday’s assembly was a further reflection of how civil society organizations of all stripes – from climate researchers to public health advocates, students and urban leaders– have been mobilizing to seize initiative where governments have so far failed.”
HPW - WHO Launches “Clean Air Coalition”; New Clean Air Fund To Be Announced Tomorrow (22 Sept) https://www.healthpolicy-watch.org/who-launches-clean-air-coalition-new-clean-air-fund-to-be- announced-tomorrow/
“WHO said Sunday that it was launching a “Clean Air Coalition” led by the Governments of Spain and Peru, while a group of philanthropic organizations and foundations were poised to launch a new “Clean Air Fund” at Monday’s Climate Summit to spur investment in reducing sources of air pollution, which also contribute to climate change. Some 29 countries and over 50 subnational entities have pledged to join the coalition committed to achieving healthy air quality by 2030, as part of their Climate Summit pledges, said Spain’s Health Minister María Luisa Carcedo, speaking at a WHO-organized side event on Sunday, the day before the UN Secretary General’s Climate Action Summit brings together heads of state…. The Clean Air Coalition is also being supported by the UN Secretary General’s Office and the Climate and Clean Air Coalition of UN Environment, said WHO’s Director of Public Health and Environment, Maria Neira.”
“As for the new Clean Air Fund being formally launched tomorrow, Executive Director Jane Burston, said that the fund brings together “a group of like-minded philanthropic foundations” which have recognized that tackling air pollution will have “huge benefits for health as well as for climate.” … … Burston said that a report being published by the new fund tomorrow surveyed the funding landscape and found that philanthropic investment in air quality initiatives is disproportionately low in comparison to the burden disease caused by air pollution – which is estimated to kill some 7 million people around the world every year. … … Additionally, the report found that most money is spent only in a few countries – even though WHO estimates that over 90% of people around the world breathe unhealthy air….”
Guardian - Countries must triple climate emissions targets to limit global heating to 2C https://www.theguardian.com/environment/2019/sep/23/countries-must-triple-climate-emissions- targets-to-limit-global-heating-to-2c
“United in Science report ahead of UN summit says climate is changing faster than forecast, and current plans would lead to ‘catastrophic’ global temperature rise.”
“…the report confirmed well-established trends, including that climate changes had accelerated in the past three decades, and particularly in the past 10 years. … … The United in Science report, which is also backed by the United Nations Environment Programme and the Intergovernmental Panel on Climate Change, estimates global emissions are not likely to peak before 2030 on the current trajectory. … … It says policies to reduce emissions must triple to meet the 2C target and
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increase fivefold to keep heating to within 1.5C. A separate report to be released on Monday has found emissions from coal power would need to peak next year and fall to zero by 2040 if the world is to meet the Paris goals.”
Another ominous IPCC report (released a day after the Climate Action Summit), related to oceans, also pointed to accelerating climate change.
See Bloomberg - UN Report Warns Climate Change Is Accelerating Ice Melt (for more on this new IPCC report, see the separate ‘Planetary Health’ section).
UN News - Banks worth $47 trillion adopt new UN-backed climate, sustainability principles https://news.un.org/en/story/2019/09/1046982
“Banks collectively with more than $47 trillion in assets, or a third of the global industry, signed up on Sunday to new United Nations-backed responsible banking principles in a massive boost for climate action and the shift from “brown to green” models of economic growth.”
Al Jazeera - World’s poor get less than 1 cent a day for climate change: Oxfam https://www.aljazeera.com/ajimpact/worlds-poor-1-cent-day-climate-change-oxfam- 190923040238683.html
“A new report by Oxfam showed that the 48 least developed countries in the world are receiving between $2.4bn to $3.4bn a year to cope with disastrous climate events, equivalent to approximately $3 per person annually or less than one cent per person each day….”
Devex – Report warns of the humanitarian cost of climate change
Devex;
“In a worst-case scenario, the price of responding to humanitarian needs as a result of climate- related disasters could climb to $20 billion annually by 2030, according to a report by the International Federation of Red Cross and Red Crescent Societies, up from a maximum of $12 billion currently being spent….”
Climate action summit (23 Sept)
And then the Climate Action summit itself.
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Long awaited - see for example Health sector demands world leaders at UN Climate Summit act on global health crisis , but unfortunately, not exactly “delivering” on Guterres’ hopes & demands… And certainly not along the lines of what Greta Thunberg (and we) would like to see happen.
An overview of some of the news & announcements of pledges, both from a glass half full & half empty perspective:
IISD - 77 Countries, 100+ Cities Commit to Net Zero Carbon Emissions by 2050 at Climate Summit http://sdg.iisd.org/news/77-countries-100-cities-commit-to-net-zero-carbon-emissions-by-2050-at- climate-summit/
For the glass half full picture: “The Climate Action Summit brought together more than 65 Heads of State and Government as well as leaders of sub-national governments and the private sector. Announcements made during the day included commitments by 77 countries, ten regions and over 100 cities to achieve net zero carbon emissions by 2050. An initial report on implementation of plans presented at the Summit is expected to be delivered at COP 25 in Santiago, Chile….”
Guardian - UN secretary general hails 'turning point' in climate crisis fight https://www.theguardian.com/world/2019/sep/23/un-secretary-general-antonio-gutteres-turning- point-climate-crisis
More from the ‘glass half full’ picture, these comments from UN SG Guterres at the start of the Climate Action Day: “The world may have hit a hopeful “turning point” in the struggle to tackle the climate crisis despite escalating greenhouse gas emissions and the recalcitrance of major emitters Brazil and the US, according to the United Nations secretary general. On Sunday, ahead of a key UN climate summit in New York, the World Meteorological Organisation published new data showing 2014-19 to be the warmest five-year period on record. But the UN secretary general, António Guterres, said recent action by some countries and businesses, as well as the stunning rise of the youth climate movement, gave him hope that international goals to avoid catastrophic global heating could be met. “I see a new momentum,” Guterres said. “I believe in these last few months [there has been] a turning point. Six months ago, I must tell you, I was quite pessimistic about everything. I would see no movement, now I see a lot of movement and we need to boost that movement.””
UN News - Actions not words: what was promised at the UN’s landmark climate summit? https://news.un.org/en/story/2019/09/1047112
A good overview of the commitments & new initiatives (by governments, private sector, finance…)
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Devex - UN climate summit a 'stepping stone' for new action, experts say https://www.devex.com/news/un-climate-summit-a-stepping-stone-for-new-action-experts-say- 95686
That’s another way to frame it : ) Looks like we’re gonna “step” all the way till over the cliff.
“The world’s largest emitters did not answer U.N. Secretary-General António Guterres’ call for “concrete” commitments on climate change during the U.N. Climate Action Summit. But some companies, foundations, and other players made it clear this week that they are ready to move forward on climate adaptation and mitigation plans, according to experts on climate change and food security. … … “The meeting was a stepping stone, but definitely not the end and there needs to be a lot of work to increase the momentum at government level,” said Yamide Dagnet, senior associate at the World Resources Institute’s International Climate Action Initiative….”
…The Bill & Melinda Gates Foundation and several other funders announced on Monday they would give $790 million to support resilience of over 300 million small-scale food producers…. “ (as part of the Global Adaptation Initiative)
“New contributions to the U.N. Green Climate Fund were also announced during the summit, replenishing the fund to more than $7.3 billion, ahead of its pledging conference in October….”
HPW - Climate Summit Garners Modest Commitments On Clean Air, Foods, Oceans & Coal Phase-Out https://www.healthpolicy-watch.org/climate-summit-garners-modest-commitments-on-clean-air- foods-oceans-coal-phase-out/
Over to the distinctly “glass half empty” take then. Excellent coverage (must-read).
“Monday’s long-awaited United Nations Climate Summit produced no dramatic surprises, but a long list of modest commitments offered a glimmer of a way forward. Government leaders, CEOs, and heads of major philanthropies announced a string of new initiatives to clean up the air, restore oceans, advance more sustainable food systems, phase out coal, plant forests, protect small island states, and better align trade rules with climate goals. Leaders of the planet’s two most polluting nations, China and the United States, were absent from the summit stage – although US President Donald Trump, who has said he would withdraw from the Paris Climate Agreement, made a brief, unannounced appearance in the audience during the morning’s remarks by India’s Prime Minister Narendra Modi, before heading to a meeting on religious freedom. Chinese president President Xi Jinping sent a representative who recited an impressive litany of Chinese innovations in areas such as renewable energy and e-transport, but stepped gingerly around the debate over controversial new projects such as China’s massive Belt and Road project through Asia, which critics say could stimulate new sources of climate emissions…. ”
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“…At the summit’s end, reactions were mixed about the range of individual commitments countries made:
ActionAid’s global lead on climate change, Harjeet Singh, had strong words about the outcome. “This summit was supposed to be a turning point. But we have seen an exceptional lack of commitment from the biggest and richest polluting countries that continue to take trivial measures toward solving a life-or-death crisis. At this late stage when the window of opportunity is shrinking, we need leaders to show courage, not cowardice.”
“Incoming UNAIDS chief Winnie Byanyima called the summit “largely disappointing,” saying the set of outcomes “raises the stakes even higher for the upcoming COP25 and 2020, when leaders have another chance to lead or let down, once again.”…
See also Climate change news - The UN asked for climate plans. Major economies failed to answer
“Delivering on a goal of net zero emissions is a ‘daunting’, ‘civilisational’ task, which a summit on Monday showed leaders do not have plans to meet.”
Or Reuters - Climate summit pledges fall short, as big emitters skip 'honest appraisal'.
Gizmodo – It’s kids vs the world in a landmark new climate lawsuit https://earther.gizmodo.com/its-kids-vs-the-world-in-a-landmark-new-climate-lawsui-1838343565
“On Monday, Greta Thunberg and 15 other young people filed a potentially world-changing lawsuit. … … They announced that they’re suing five of the world’s major carbon polluters on the grounds that the countries are violating their rights as children. If the suit is successful, the United Nations would classify the climate crisis as a children’s rights crisis. And more importantly, it would compel Argentina, Brazil, France, Germany, and Turkey—the five countries named in the suit—to work with other nations to forge binding emissions’ reduction targets, a sharp change from current international efforts that have so far basically rearranged the deck chairs on the Titanic….”
The countries are (unlike US, China, …) countries that have ratified UN Convention on the Rights of the Child.
PS: “Jupiter“ wasn’t very pleased, it appears : )
SDG summit (24-25 September)
As you recall, this was the first major HL ‘SDG stocktaking’ since the start of the SDGs. The watchword: time for a ‘decade of action’. This was supposed to be ‘the Summit that launched a decade of accelerated delivery and action’….
IISD reporting – SDG Summit
For a 6-page overview of the whole SDG summit, see IISD
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“The Sustainable Development Goals (SDGs) Summit, which is also the first session of the UN High- level Political Forum on Sustainable Development (HLPF) to convene under the auspices of the UN General Assembly (UNGA) since the adoption of the 2030 Agenda, convened at UN Headquarters in New York on 24 and 25 September. The Summit reviewed progress in the implementation of the 2030 Agenda and its 17 SDGs, with just over a decade left to the target date of 2030. The Summit featured six “leaders dialogues” on: megatrends impacting the achievement of the SDGs; accelerating the achievement of the SDGs: critical entry points; measures to leverage progress across the SDGs; localizing the SDGs; partnerships for sustainable development; and the 2020-2030 vision. The Summit also featured the launch of the 2019 Global Sustainable Development Report (2019 GSDR). A political declaration was adopted during the opening segment of the Summit.”
Check out in particular the (ominous) conclusion.
Excerpts:
“The message from the GSDR scientists could not be stronger: we seem to find it easier to imagine the end of humanity, observed the GSDR Co-Chair, than changing our systems. Youth leaders were scathing in their final assessment: “Leaders of the world, you made a bold commitment in 2015. But you are failing. We need a dramatic change of course in 2020. This is make or break for the planet…”
Political declaration SDG summit https://undocs.org/en/A/HLPF/2019/l.1
6-pager. Worth to have a look.
On the adaptation of the declaration: “…United Nations Member States have pledged to accelerate common efforts to achieve the Sustainable Development Goals (SDGs) by 2030 … . In a political declaration adopted by United Nations Member States at the summit on the Sustainable Development Goals, held on 24 and 25 September, United Nations Member States confirmed that the goals remain in reach if countries embrace transformation and accelerate implementation….”
Some other coverage of the SDG summit
UN News - UN chief calls for ‘a fair globalization’ with first-ever Global Goals Summit
Thomson Reuters - UN head urges a 'decade of action' to address world crises
UN News - UN News - ‘We must step up our efforts - now’, Guterres declares
And angle to look at the SDG challenge (via Global Policy Watch) - It is not possible to implement the 2030 Agenda and the Sustainable Development Goals without quality public services
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Financing for Development Summit (26 Sept)
UN News - Time to pay up: UN summit to push for development finance breakthrough https://news.un.org/en/story/2019/09/1047242
This article looked ahead to this summit, the first High-level Dialogue on Financing for Development since the adoption of the ground-breaking Addis Ababa Action Agenda in 2015.
“…The UN estimates that achieving the SDGs could generate some $12 trillion of value across the global economy, and create 380 million new jobs by 2030. But realizing this objective will take annual investments, across all sectors, of $5-7 trillion: currently, investment levels are falling far below that level….”
Via a Devex newsletter, looking ahead to the meeting: “Four years after Addis, immense funding gaps persist and solutions will need to come from a variety of actors.
“1. SDG investment strategies are rare. Earlier this year at a precursor meeting — the Financing for Development Forum — the clear message was that not enough was being done, particularly on domestic resource mobilization. The majority of countries don't have an SDG investment strategy. An event today will aim to jumpstart progress on that front by focusing on integrated national financing frameworks and how the U.N. can help governments develop their own strategies.
2. Tackling thorny issues. The day’s agenda also includes tackling illicit financial flows, corporations paying their fair share, and addressing the growing debt burden in some countries. Civil society groups in particular have been vocal in their concerns about global financial governance. …”
Global Policy Watch - Major action must be taken to access ‘hidden’ finance to fulfil SDGs https://www.globalpolicywatch.org/blog/2019/09/26/hidden-finance-to-fulfil-sdgs/
“Civil society groups call for urgent reforms to combat illicit financial flows, abolish tax havens, introduce a global wealth tax and an intergovernmental body on tax cooperation.”
With the view from Kate Donald from the Center for Economic and Social Rights and Jens Martens from the Global Policy Forum. They rightly point out that there’s a growing accumulation of private wealth while governments become poorer.
“… Donald and Martens suggest the following measures: institute a serious crack-down against illicit financial flows, including through mandatory country-by-country reporting for transnational corporations, effective measures against the manipulation of transfer pricing and taking action against tax havens; move decisively towards the introduction of a Global Asset Register to record
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ownership of equity, bonds and other financial and non-financial assets; introduce a globally coordinated wealth tax, along the lines suggested by economist Thomas Piketty, such as a 1% tax on wealth of $1–5 million, and 2% tax above $5 million; establishing an intergovernmental body on tax cooperation under UN auspices in which all countries participate equally.”
Devex (blog) – Opinion: Time to get serious about financing the SDGs M Ahmed (CGD CEO); https://www.devex.com/news/opinion-time-to-get-serious-about-financing- the-sdgs-95699
“Four years after adopting the Addis Ababa Action Agenda on financing for development, world leaders will meet at the United Nations Thursday to review progress toward meeting the 2030 Sustainable Development Goals. Part of this review will check if the world is on track to mobilize the necessary funding to achieve the SDGs. The short answer is: we are not. “Billions to trillions” remains an aspiration rather than a reflection of the current development financing trajectory. …”
“To fix the problem, it is first important to accept two realities: First, expectations of leveraging private finance have proved too optimistic. … … Second, the push to raise domestic resources risks worsening inequalities. The International Monetary Fund estimates that in order to meet the SDGs, LICs will need to increase their tax-to-GDP ratio by five percentage points by 2030. But a headlong rush to raise tax revenues in poor countries is likely to worsen inequality because their collection structures are much more skewed toward indirect taxes on consumption rather than direct taxes on income and assets….”
CGD (blog) – Financing Development: A “Common but Differentiated” Path to 0.7%
Ian Mitchell et al; https://www.cgdev.org/blog/financing-development-common-differentiated- path-07#.XYuj7V6dM98.twitter
“Ministers are gathering at the UN this week to discuss the financing needs to meet the Global Goals—with the challenge that resources will clearly fall short, not least because most high-income countries are still failing to meet their financial commitments. We reviewed the pathways taken by the countries that agreed to the UN 0.7 percent target on overseas development assistance as a share of national income, and find that—perhaps unsurprisingly—aid as a share of the economy rises with per capita income. This “pathway” could form the basis of “common but differentiated responsibilities” for emerging economies who don’t fall under the UN target but who are reaching income-levels consistent with providing aid. If high-income countries were also willing to increase their actual contribution, this pathway could even be the basis of a new deal to increase overall international finances, and deliver the extra $100 billion of aid per year that estimates suggest would be necessary to eradicate extreme poverty….”
“…In sum, if emerging economies contributed development assistance in line with the historical pattern of higher income economies, this would be a substantial new resource to move the world towards the Sustainable Development Goals. If upper-middle income countries provided 0.15 percent (in line with historic contributions for countries with their average per capita income of $18,745), this would equate to $36 billion, much of it new. If high-income countries also lifted their average contribution a similar amount—from 0.31 percent to, say, 0.45 percent—this would add $75
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billion, or up to $111 billion in total – and be broadly in line with the estimate of ending extreme poverty above….”
Paper - ODA, The next 50 years: A proposal for a new universal development – commitment Jonathan Glennie et al; Via Research gate;
Some great background reading. Even if politically not very feasible for the time being.
“Most Organization for Economic Development (OECD) countries have accepted, in principle if not in practice, the fifty-year-old commitment of contributing 0.7 per cent of their annual gross national income to the provision of concessional resources to support the development of countries in the Global South. This paper asks a seemingly simple question: what if all countries made a universal development commitment, meaning a scaled contribution? Hence, our intention here is to present a proposal for a new, universal financial commitment to development. As such, this paper does the following: (i) it sets out how a new era is emerging of fewer very poor countries and higher development ambitions; (ii) it provides a general proposal for a new way to raise and govern international public funds; and (iii) it discusses the possible size of contributions and what the money would be for, as well as the evolution in global governance and democracy that a new deal would inevitably entail. We conclude with a set of questions that the proposal raises. We do not naively think that this idea would be politically easy to implement. Our aim here is to contribute to the discussion on the future of development finance and global governance.”
Other global health related news from New York
Guardian - New global 'scorecard' to map extent of mental illness crisis https://www.theguardian.com/society/2019/sep/25/new-global-scorecard-to-map-extent-of- mental-illness-crisis
“A global initiative to measure the extent of mental illness around the world and identify some of the most effective treatments [was] unveiled in New York on Wednesday. The Countdown Global Mental Health 2030 project is aimed at improving the sketchy data for illnesses like depression and anxiety, and establishing proper metrics so that countries can be compared with one another. A scorecard will be produced every two years, so that the best performing countries can be held up as examples to the rest. The broad aim is to pinpoint successes and failures in treatment and encourage states – and donors – to invest in what works best to deal with illnesses that afflict hundreds of millions of people. …”
The countdown metric was unveiled at the “Goalkeepers” summit on the sidelines of the UN general assembly.
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Stat - A new global initiative aims to use AI to improve public health in the developing world https://www.statnews.com/2019/09/25/rockefeller-foundation-initiative-ai-improve-public-health- developing-world/
“… a group of humanitarian organizations is taking on an even steeper challenge: using data collected in developing countries to improve public health overseas. The Precision Public Health initiative, led by the Rockefeller Foundation and unveiled Wednesday on the sidelines of the United Nations General Assembly, hopes to deliver cutting-edge tech to parts of the world that have been slow to benefit from it. The idea is that AI and data science could provide health workers important insights they might not otherwise have — say, a suggestion, delivered via a tablet notification, about which houses to visit to check on mothers and children in need of care. Initially, the initiative will be funded with $100 million. The Rockefeller Foundation will contribute $60 million, UNICEF will chip in $15 million, and the remaining $30 million will come from the initiative’s other partners — the World Health Organization, the Global Fund, the World Bank Group-backed Global Financing Facility, and the public-private partnership known as Gavi, the Vaccine Alliance. The initiative will launch in India and Uganda, where backers hope to introduce tech-powered tools to prevent the deaths of mothers and children. It will expand by 2030 to eight additional countries, which have yet to be announced. The initiative’s ambitious goal: to prevent 6 million deaths in those countries within the decade….”
See also Devex - $100M health initiative aims to democratize data science
“On Wednesday, the Rockefeller Foundation announced a new effort to prevent 6 million maternal and child deaths in 10 countries by 2030. Launched on the sidelines of the United Nations General Assembly, and on the heels of the U.N. High-Level Meeting on Universal Health Coverage, the $100 million Precision Public Health initiative aims to ensure that frontline health workers have access to data science tools such as predictive analytics, artificial intelligence, and machine learning….”
Launch of UHC Legal solutions Network (25 Sept) Cfr a few tweets:
“UHC Legal Solutions Network was launched today with @UNAIDS @UNDP @ASteiner @WHO and Georgetown University will play vital role in access to @UHC2030 on non discriminatory basis.
The Legal Solutions for #UHCHLM Network is based on the @Lancet Commission on Legal Determinants of Health. Law is vital to affordable, accessible, equitable #UHC. We will support law reform based on #HumanRights”
NCD Alliance - Governments should fight air pollution from fossil fuels like they fight tobacco: new report https://ncdalliance.org/news-events/news/governments-should-fight-air-pollution-from-fossil-fuels- like-they-fight-tobacco-new-report
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“A new report launched today has challenged decision-makers, policy-makers and political leaders to tackle fossil fuel production and consumption as a health control issue, in the same way that smoking has been reduced and regulated. The report, Burning Problems, Inspiring Solutions: Sharing Lessons on Action Against Tobacco and Fossil Fuels, co-authored by the International Institute for Sustainable Development (IISD(link is external)) and the Noncommunicable Diseases Alliance (NCD Alliance), was released today on the sidelines of the United Nations (UN) Climate Summit and UN High-Level Meeting on Universal Health Coverage taking place this week in New York….”
Vital Strategies/NCD Alliance brief: Fueling an Unhealthy Future Fueling an Unhealthy Future
“Nations will more quickly transition to clean energy if they redirect government funds away from subsidizing unhealthy commodities–in particular fossil fuels. Such action would reduce air pollution and greenhouse gas emissions, thereby mitigating climate change and saving lives. This brief, coauthored by Vital Strategies and NCD Alliance, calls on countries to reexamine current economic incentives to industries that harm health as an essential step towards creating coherent policies that sustain growth, support clean energy expansion and prevent noncommunicable diseases (NCDs).”
See some great coverage in HPW - Fueling An Unhealthy Future – Report Sheds New Light On Health Costs of Fossil Fuel Subsidies
“Globally, governments are spending nearly $US 300 billion in price supports and other pre-tax subsidies for fossil fuels – which are costing national governments a whopping US$ $2.7 trillion in health costs from air pollution-related mortality, disease and lost productivity—not to mention fueling climate change…..”
… In low- and lower-middle income countries such as India, China and Russia – the health costs attributable to fossil fuel subsidies also are more than five times the entire national government health expenditure…. “
“Mainstream global health leaders are beginning to express strong backing for so-called “health taxes” on sugary drinks, tobacco and alcohol – which civil society groups such as the NCD Alliance and Vital Strategies have championed for a number of years already as effective strategies in shaping consumer demands and preventing NCDs. … … WHO’s leadership is also getting on the alcohol- tobacco-sugary drinks bandwagon … … However, none of the big agency heads have spoken out in the same way about fuel subsidies. For health advocates, confronting the ways in which fossil fuel subsidies are also fueling deaths and disease is still a relatively new, and edgy topic – which has generally been regarded as a topic of the climate sector….”
HPW – Universal Health Coverage Requires More Policy-Relevant Research https://www.healthpolicy-watch.org/universal-health-coverage-requires-more-policy-relevant- research/
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“Evidence-based decision-making and tapping into local potential are keys to achieving the goals set in the Universal Health Coverage (UHC) declaration, said a panel convened today on the sidelines of the 74th United Nations General Assembly. The Government of Georgia, which co-hosted the panel, helped lead key intergovernmental meetings during drafting of the landmark UHC declaration adopted on Monday….” With quotes from Stefan Peterson & Sara Bennett, among others.
UNAIDS welcomes announcement of significant price reduction in the cost of life- saving insulin for low- and middle-income countries https://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2019/septem ber/20190925_insulin
“UNAIDS welcomes the announcement by Biocon Biologics, a biotech company, to offer recombinant human insulin (rh-insulin) at US$ 0.10 per day (for the average 40 units of insulin that is required per patient per day) to low- and middle-income countries, a reduction of 50% from current prices. This announcement was made at an event hosted by UNAIDS to promote innovation in access to health care….”
And a quick link:
PMNCH - New commitments galvanized in support of Every Woman Every Child to help advance the UHC agenda.
World Contraception Day (September 26)
“World Contraception Day takes place on September 26th every year. The day’s mission is to improve awareness of all contraceptive methods available and enable young people to make informed choices on their sexual and reproductive health.”
Quick link: 10 things you should know on World Contraception Day (S Etzo – Plan International)
Global inequality
Guardian - Turning the tables: global poverty conference to be held in a slum https://www.theguardian.com/global-development/2019/sep/25/global-poverty-conference-to-be- held-in-slum?CMP=twt_a-global-development_b-gdndevelopment
“Inaugural World Poverty Forum – dubbed ‘Davos with the poor’ – to take place in Kenya’s Kibera to ensure voices of poorest are heard.” Not quite sure whether this is a good idea or not.
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Vox – Bernie Sanders’s wealth tax proposal, explained https://www.vox.com/policy-and-politics/2019/9/24/20880941/bernie-sanders-wealth-tax-warren- 2020
But this is definitely long overdue. “Sanders’s proposal is estimated to raise $1.6 trillion more in revenue than Warren’s plan over 10 years.”
Whoever makes it of these two, in the end, I don’t mind, as they would both change the American & global momentum for the better. And would also affect (global health) philanthropy in the process.
Quick link :
Blog by Winnie Byanyima - A small group of world leaders are standing together against inequality
“… a group of progressive leaders of countries both rich and poor have come together in common cause to tackle extreme inequality and exclusion. Each is trying to tackle inequality in their countries….” Few, true, but it’s a start.
Digital transformation & AI
Above we already flagged a new Rockefeller health (data science) initiative, launched this week in NY.
Lancet - Governing health futures 2030: growing up in a digital world—a joint The Lancet and Financial Times Commission https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32181-6/fulltext
“Our understanding of health and health systems design has been influenced by the rapid technological innovations of the digital era. But governance models have not followed at the same pace. With new challenges facing the health sector, including new digital health stakeholders with variable mindsets and governance models, there are growing calls for international coordination and coherency. To help fill the space, a new joint The Lancet and Financial Times Commission focused on the convergence of digital health, artificial intelligence (AI), and universal health coverage (UHC) has been established to run from October, 2019, to December, 2021. The Governing Health Futures 2030: Growing up in a Digital World Commission will convene a group of independent commissioners from diverse sectors and geographical locations to ensure a broad input of voices in moving forward the digital health agenda…”
… The Commission will be launched in Berlin, Germany, on Oct 30, 2019, and the first meeting will take place on Oct 31. …”
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FT – Drones deployed in Africa’s ‘leapfrog’ vaccine drive https://www.ft.com/content/c252a4a2-c8c2-11e9-af46-b09e8bfe60c0
(gated) “21st century is helping close gaps in curing disease.”
And a quick link:
Guardian - AI equal with human experts in medical diagnosis, study finds
“… However, experts have warned the latest findings are based on a small number of studies, since the field is littered with poor-quality research….”
Ebola DRC – “On decline, but risk of international spread still high” (dr. Tedros)
HPW - Ebola On Decline; Vigilance Still Needed, Says WHO Director General https://www.healthpolicy-watch.org/ebola-on-decline-vigilance-still-needed-says-who-director- general/
“The Ebola outbreak in the Democratic Republic of Congo appears to be finally “on the decline”, World Health Organization Director General Tedros Adhanom Ghebreyesus told reporters Wednesday. Dr Tedros spoke after a meeting at UN Headquarters with new DRC Minister of Health Etembi Longodo and Alex Azar, US Secretary of Health and Human Services, which coincided with the launch of a new US $66 million regional Ebola preparedness plan for the second half of 2019….”
See also UN News - Signs DR Congo Ebola outbreak finally ‘on the retreat’ but risk of international spread, ‘still high’
PS: on the MSF criticism on WHO’s vaccination strategy (from earlier this week, see below), Tedros said this: “… Responding to criticism reportedly levelled at the WHO vaccination strategy by partner NGO in the DRC, Médecins Sans Frontières (MSF), that it had been too limited and selective in scope so far, Mr. Tedros told reporters that “we learn almost every day, and adjust our response accordingly”, adding that “be it on use of vaccines, on other strategies that we follow, we try and learn every day, and recalibrate our response on a regular basis.” …”
Some more info on this regional preparedness plan (costed at $66 million):
“To assist the DRC’s nine neighbours with advancing critical preparedness measures, the United Nations has developed this Regional Ebola Preparedness: Overview of Needs and Requirements July - December 2019. The Regional Overview serves as a complement to the Integrated Strategy to Respond to Ebola Virus: Ituri and North Kivu Provinces for the DRC, covering the same period.
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Together, the two documents present the full scope of actions and funding required to respond to the current Ebola outbreak in the DRC, to prevent it from spreading further, and to drive the response towards zero cases. The nine countries included in this Regional Overview are categorized into two groups, based on risk level: • Priority 1 (based on proximity to areas where cases have been reported and large-scale movement of goods and people across borders): Burundi, Rwanda, South Sudan and Uganda. • Priority 2 (all other countries neighbouring the DRC): Angola, Central African Republic. Republic of Congo (RoC), Tanzania and Zambia. …”
Devex - MSF, WHO lock horns over Ebola vaccine deployment
Devex - https://www.devex.com/news/msf-who-lock-horns-over-ebola-vaccine-deployment-95670
Caused quite some commotion earlier this week. “MSF says WHO is restricting access to Ebola vaccines in DRC. But WHO says it is following protocol.”
For the MSF statement, see “Independent Ebola vaccination committee is needed to overcome lack of WHO transparency”.
See also Nature News - Aid group says Ebola vaccine is not reaching enough people
Guardian - Alarm over cases of disease with Ebola-like symptoms in Tanzania https://www.theguardian.com/global-development/2019/sep/23/alarm-over-cases-of-disease-with- ebola-like-symptoms-in-tanzania
And this caused even bigger uproar over the weekend. “Several unexplained cases of a disease with Ebola-like symptoms in Tanzania have prompted an extraordinary statement from the World Health Organization questioning the response of the country’s health authorities. WHO warned that lack of information over the cases, including clinical data, possible contacts and potential laboratory tests performed for differential diagnosis of the patients had not been communicated, leaving it unable to assess the potential risk.”…”
See also Stat News - WHO signals alarm over possible unreported Ebola cases in Tanzania
In an update (Reuters), Tanzania summoned the World Health Organization representative in the country over the Ebola complaint. “Tanzania on Tuesday summoned the World Health Organization’s local representative over its assertion that the government refused to share information on suspected Ebola cases, signalling displeasure at the agency’s rare public rebuke.”
WHO - Second Ebola vaccine to complement “ring vaccination” given green light in DRC https://www.who.int/news-room/detail/23-09-2019-second-ebola-vaccine-to-complement-ring- vaccination-given-green-light-in-drc
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“The health authorities in the Democratic Republic of the Congo (DRC) have announced plans to introduce a second experimental Ebola vaccine, manufactured by Johnson & Johnson, from mid- October. This vaccine, which is given as a 2-dose course, 56 days apart, will be provided under approved protocols to targeted at-risk populations in areas that do not have active Ebola transmission as an additional tool to extend protection against the virus….”
Other Ebola-related links
CIDRAP - WHO: Multiple DRC Ebola hot spots 'grave concern'
Global Health Security
Foreign Policy -The World Knows an Apocalyptic Pandemic Is Coming
L Garrett; https://foreignpolicy.com/2019/09/20/the-world-knows-an-apocalyptic-pandemic-is- coming/
“But nobody is interested in doing anything about it”. Laurie Garrett in great shape, reflecting on last week’s GPMB (Global Preparedness Monitoring Board ) report.
“… With no intention of degrading the GPMB’s effort, I must sadly say that this core message has been shouted from the rafters many times before, with little discernable impact on tone-deaf political leaders, financial enterprises, or multinational institutions. There’s no reason to think this time will be any different. It’s hard to know what, shy of a genuinely devastating pandemic of killer influenza or some currently unknown microbe, will motivate global leaders to take microscopic threats seriously.”
Global Fund replenishment update
With the Replenishment meeting in Lyon coming up in just a few weeks, GF replenishment advocacy and preparations are going into even higher gear.
In his UN speech, Emmanuel Macron called on donor countries to help meet the $14 billion goal.
Spain also pledged $100 million this week. (via its prime minister, in his UNGA speech). “The pledge marks the return of Spain as a donor”.
The latest issue of the Global Fund Observer also has a number of must-read articles related to the Replenishment:
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GFO - Five G7 countries have increased their pledges for 2020-2022 compared to last Replenishment, with United States and France still to announce http://www.aidspan.org/node/5060
“As the Global Fund approaches the replenishment of funds for the next implementation period, 2020 to 2022, some of its traditional major donors have already announced their pledges. The G7 countries – the world’s most advanced economies in the world including Canada, France, Germany, Italy, Japan, the United Kingdom (UK) and the United States - are the Global Fund’s largest donors, and their contributions account for approximately 79% of all the funds raised by the Global Fund since its inception. So far, five of the seven G7 countries: Canada, Germany, Italy, Japan and the United Kingdom (UK), all have announced their pledges which have increased by about 15% relative to the last replenishment. (The US is expected to announce its pledge formally in Lyon, but on 19 September the Senate posted its bill approving a 15.6% increase in its contribution to the Global Fund.) … … “…This article focuses on the G7 countries’ contributions to the Global Fund, highlighting the trends in the contributions of this group of countries since 2001. Data used for this analysis comes from the Global Fund website….”
GFO - Will the private sector step up (enough) for the Global Fund’s Sixth Replenishment? http://www.aidspan.org/node/5058
“John Fairhurst, Head of Private Sector Engagement at the GF talks about the sector’s financial and strategic roles.”
“At this year’s annual World Economic Forum meeting in Davos in January, … Global Fund Executive Director Peter Sands issued a challenge to the private sector, to contribute at least $1 billion to the overall Sixth Replenishment target of at least $14 billion for the Global Fund’s next funding cycle. The language setting out the challenge is careful: The actual wording on the Global Fund website reads: “Of the at least $14 billion, the Global Fund is calling on the private sector to mobilize at least $1 billion to step up the fight”. Though the Global Fund will in fact count only financial contributions in reaching the $1 billion, the difference between “mobilize” and “contribute” (or “invest” or “give” or “pay”) is immense – and highlights the distinction, unique to this sector’s role in the Global Fund partnership, between financial and non-financial contributions. The Global Fund’s private sector resource mobilization includes direct funding as well as “innovation, expertise and advocacy”. John Fairhurst, Head of Private Sector Engagement at the Fund, spoke with the GFO to discuss private sector pledges for the Sixth Replenishment. Fairhurst said he expects that most announcements from the private sector will occur at the pledging conference on October 10, including that of the Gates Foundation, and Product (RED)….”
For the ones among you who read French, have a look at Transversal.
And a quick link: (Eastafrican) - Kenya, Uganda $6.5m pledge to the Global Fund
“Kenya and Uganda are among 11 countries to pledge $32 million to the Global Fund ahead of its annual fundraising scheduled for October in France. In its 2019 report, Global Fund—an international financing organisation that fundraises and disburses money for controlling and treating
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HIV and Aids, Tuberculosis and malaria—Kenya has pledged $5 million, coming behind Nigeria which offered $10 million, and tied with South Africa, which promised to give $5 million as well. In East Africa, Uganda is the only other contributor – pledging $1.5 million. The other African countries offering to contribute are Zambia ($3 million), Benin ($2 million) and Namibia ($1.5 million. The rest—Zimbabwe, Cote D’Ivoire, Togo, Senegal—have each pledged $1 million….”
• For other GF related news: Technical Evaluation Reference Group Thematic Review: Resilient and Sustainable Systems for Health
“…At the request of the Strategy Committee of the Global Fund’s Board, the Technical Evaluation Reference Group conducted in 2018 the Thematic Review to Assess the Current Approach to Investments in Resilient and Sustainable Systems for Health. In close coordination with the Technical Review Panel, Office of the Inspector General and Secretariat, the Technical Evaluation Reference Group generated evidence on the implementation, successes and challenges related to investments in resilient and sustainable systems for health. The review also provides recommendations addressed to the Global Fund and its country and technical partners…. The report, including Technical Evaluation Reference Group's position paper and a management response from the Global Fund Secretariat, is available for download. “ See here.
EV4GH call for Dubai 2020 is out !
Check it out here: EV 2020 call
Do spread the word in your networks! Deadline: 6 February.
Lancet (9th) theme issue on China
Lancet Editorial - China's health-care reform: an independent evaluation https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32210-X/fulltext
“When The Lancet visited the National Health Commission of China in 2018, Ma Xiaowei, the minister of health, said he would welcome independent assessment of the progress of China's health reforms. Today, The Lancet dedicates the ninth China-themed issue to evaluate progress of China's health- care reform since 2009, which coincides with the fifth Lancet–Chinese Academy of Medical Sciences (CAMS) Health Conference, held in Chengdu on Oct 19–20. … “
This Editorial gives a quick overview of the theme issue, including a Review article (by Winnie Yip et al), a research article and various comments. … … The Lancet has pledged long-term support for China's health-care reform. So a number of other collaborative projects & publications are in the pipeline.
Review article by Yip et al - 10 years of health-care reform in China: progress and gaps in Universal Health Coverage.
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Some papers of the week
Duke (Center for Policy Impact in Global Health) – 2 new papers (on transition strategies of PEPFAR & GAVI) http://centerforpolicyimpact.org/our-work/the-4ds/4ds-donors/
In the ongoing series. “We are publishing a series on how seven major global health funders are approaching transition. These funders are the World Bank; the Global Fund; Gavi, the Vaccine Alliance; the United States government—specifically, the US President’s Emergency Plan for AIDS Relief (PEPFAR) and the US Agency for International Development (USAID); the United Kingdom government; and the Japanese government. Our latest research in this series focuses on two donors, one bilateral (PEPFAR) and one multilateral (Gavi).” … “…These papers are variations on the theme of “transition”—particularly, the transition of middle-income countries away from development assistance for health (DAH). … In a blog on the Center website, Kaci Kennedy McDade et al compare and contrast Gavi’s and PEPFAR’s approaches to reducing their support to their partner countries.”
Excerpt from this blog:
“Gavi has an explicit policy outlining a clear path for countries to transition out of Gavi support. This transition pathway is primarily based on a country’s gross national income per capita (GNI p.c.). The goal in using GNI p.c. thresholds is to support countries based on a country’s ability to pay. As this ability to pay increases, Gavi’s support gradually reduces over a specific time period. PEPFAR behaves a bit differently: it does not have an explicit approach to leaving a country and, in fact, PEPFAR has stated that such graduations are not on the table. However, PEPFAR recognizes that countries are becoming increasingly able to pay for their own HIV programs. And PEPFAR itself has moved from supporting an emergency response (reflected in the name of the initiative) to supporting sustainable, long-term programming. These two realities mean that PEPFAR has begun shifting the type and level of support provided to countries as countries progress through the process of achieving, and ultimately sustaining, HIV epidemic control. While departure from any currently supported country is not imminent, says PEPFAR, PEPFAR is taking steps to sustainably shift responsibility to domestic players….”
Global Health Promotion - Health promotion in the sustainable development goal era https://journals.sagepub.com/doi/full/10.1177/1757975919874708
By Erica di Ruggiero, the new Editor in Chief for Global Health Promotion (GHP).
Scandinavian Journal of Public Health - Relieving the tension between national health equity strategies and global health equity C McNamara; https://journals.sagepub.com/doi/abs/10.1177/1403494819860742?journalCode=sjpc
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“Globally, numerous national strategies have taken aim at reducing health inequities. An ever- present tension characterizing these strategies, however, is their lack of attention to the global political economy. This commentary argues that national policies which target only domestic factors (without engaging with the global political economy) will be limited, both, in their ability to address national levels of health equity and the larger global health inequity problem. Meaningful proposals to reduce health inequities have been made that take into account a global political economy perspective. National health equity strategies could provide the lacking momentum to advance such proposals, but will require united and sustained advocacy by global health and health equity scholars. Ultimately, relieving the tension between national health equity commitments and global health equity concerns could be one of the new approaches needed to improve health equity worldwide.”
Critical Public Health - A critical review of the Lancet Commission on global mental health and sustainable development: Time for a paradigm change
L Cosgrove et al; https://www.tandfonline.com/doi/abs/10.1080/09581596.2019.1667488?journalCode=ccph20
Hard-hitting criticism of the Lancet Commission on global mental health & sustainable development. “In October 2018, the UK government, positioning itself as a global leader in mental health, hosted a Global Ministerial Mental Health Summit. The event was scheduled to coincide with the publication of the Lancet Commission on Global Mental Health and Sustainable Development. Despite claiming a public health and social determinants approach, the report focused on the importance of ‘closing the treatment gap’ through the use of Western diagnostic tools and interventions. In response, coalitions of mental health activists and service-users organized open letters detailing their concerns with the summit and report. Among these concerns were the ways in which recent UK government policies, particularly welfare reform, violated the rights of persons with disabilities; the lack of stakeholder representation and involvement in the report; and the continuation of the colonial legacy in which the ‘North drives the South.’ Expanding on the concerns raised by this coalition of activists and service-users, we argue that a focus on societal (structural) determinants and political economy could open new possibilities for global mental health beyond narrow individualized interventions. Additionally, we suggest that a politically informed societal determinants of health framework is needed in order to move the Global Mental Health Movement in a more emancipatory direction.”
WHO resource: Addressing the political economy of health financing reform https://www.who.int/activities/addressing-the-political-economy-of-health-financing-reform
“…WHO has developed an approach to analyze the political economy of health financing reform to support strategies that supports progress towards UHC. …” Website with all documents, papers, … published in recent months by WHO on this issue.
HP&P - Assessing the field of health policy and systems research using symposium abstract submissions and machine learning techniques
Erlyn Macarayan (EV 2014) et al ; https://academic.oup.com/heapol/advance-article- abstract/doi/10.1093/heapol/czz086/5573246?redirectedFrom=fulltext
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“… Examining recently aggregated data from the Global Symposia on Health Systems Research, a key global fora for HPSR convened by the largest international society—Health Systems Global (HSG)—provides opportunities to enhance existing research on HPSR capacity using novel analytical techniques. This addresses the demand not only to map the field but also to examine potential predictors of acceptance to, and participation at, these global conferences to inform future work and strategies in promoting HPSR. We examined data from the abstracts submitted for two Global Symposia on Health Systems Research in 2016 and 2018 by type of institution, countries, regional groupings and gender. After mapping hotspot areas for HPSR production, we then examined how the corresponding author’s characteristics were associated with being accepted to present at the Global Symposia. Our findings showed that submissions for the Global Symposia increased by 12% from 2016 to 2018. Submissions increased across all participant groups, in particular, the for-profit organizations and research/consultancy firms showing the highest increases, at 58% for both. We also found reduced submissions from high-income countries, whereas submissions from low- and middle-income countries (LMICs), Sub-Saharan Africa and Latin America, increased substantially revealing the inclusivity values of Symposium organizers. Submissions increased to a larger extent among women than men. Being a woman, coming from a high-income country and having multiple abstracts submitted were found to be significant predictors for an abstract to be accepted and presented in the Symposia. ….”
BMJ Analysis – Towards universal health coverage: governance and organisational change in ministries of health
Peter Berman et al; https://gh.bmj.com/content/4/5/e001735
“Countries have implemented a range of reforms in health financing and provision to advance towards universal health coverage (UHC). These reforms often change the role of a ministry of health (MOH) in traditionally unitary national health service systems. An exploratory comparative case study of four upper middle-income and high-income countries provides insights into how these reforms in pursuit of UHC are likely to affect health governance and the organisational functioning of an MOH accustomed to controlling the financing and delivery of healthcare. These reforms often do not result in simple transfers of responsibility from MOH to other actors in the health system. The resulting configuration of responsibilities and organisational changes within a health system is specific to the capacities within the health system and the sociopolitical context. Formal prescriptions that accompany reform proposals often do not fully represent what actually takes place. An MOH may retain considerable influence in financing and delivery even when reforms appear to formally shift those powers to other organisational units. MOHs have limited ability to independently achieve fundamental system restructuring in health systems that are strongly subject to public sector rules and policies. Our comparative study shows that within these constraints, MOHs can drive organisational change through four mechanisms: establishing a high-level interministerial team to provide political commitment and reduce institutional barriers; establishing an MOH ‘change team’ to lead implementation of organisational change; securing key components of systemic change through legislation; and leveraging emerging political change windows of opportunity for the introduction of health reforms.”
Lancet Letter – Tribute to David Sanders from the People's Health Movement Fran Baum et al; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32176- 2/fulltext
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“On behalf of the People's Health Movement, we would like to pay tribute to David Sanders. … … His contribution was summed up by the South African Minister of Health Zweli Mkhize when he said David “was a fierce critic of the impact of neoliberalism on the health of people. He was not only an accomplished researcher, academic and mentor to many but also a leader of social movements, including the Peoples' Health Movement”. What marked out David's life was that he managed to bridge the often-divided worlds of academia and activism. …
Some blogs & mainstream articles of the week
WEF Forum - Our health systems are under pressure. Here are 9 ways to remedy that Helen Clark; https://www.weforum.org/agenda/2019/09/health-systems-technology-funding- fourth-industrial-revolution/
“… In a new report, A Vision for the Future: Transforming Health Systems, issued by the World Economic Forum’s Global Future Council on Health and Healthcare, we explore five potential scenarios for patient experiences around the world, showing what needs to change in the next decade to create well-functioning, resilient health systems that put people first….”
Based on this, Helen Clark comes with nine recommendations to guide policymakers.
Nature - Radical reform and the Green New Deal M Mann; Nature;
“Michael E. Mann examines Naomi Klein’s collection on the proposed US policy aiming to curb climate change.”
“A new book by public intellectual Naomi Klein on the proposed US policy aiming to curb climate change is a provocative and evocative manifesto, says leading climate scientist Michael Mann. In his review, he breaks down some substantial points of disagreement, but nevertheless urges “anyone who cares about the defining threat of our time to read it, and talk about it”.” Excerpt:
“…Deep change is necessary. Klein emphasizes that it will centre on expressions of collective action, such as the global youth climate movement, and the anti-oil-pipeline protests in North Dakota in 2016–17. But Klein goes further. Her thesis is that neoliberalism — the prevailing global policy model, predicated on privatization and free-market capitalism — must be overthrown through mass resistance. She holds that climate change can’t be separated from other pressing social problems, each a symptom of neoliberalism: income inequality, corporate surveillance, misogyny and white supremacy.” That’s where Michael Mann disagrees, mostly for strategic reasons.
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Tweet of the week
Tweet from Peter Wiessner:
“Dr Agnes Soucat, WHO, addresses to need to find common solutions for global problems, that’s why declarations are an accomplishment even if the language is not satisfying.”
Global health events
Coming up: 4th International Conference for Realist Research, Evaluation and Synthesis (Dublin, 24-26 March 2020)
“The 4th International Conference for Realist Research, Evaluation, and Synthesis will take place at Dublin Castle Conference Centre, Dublin, Ireland from 24-26 March 2020 (with workshops and other events preceding and following the conference). Sponsored by the Irish Health Board, the Dublin conference will be the fourth international conference for realist research. This year’s conference theme is “Fostering Innovation in Practice.” Delegates will learn about the current state of realist research, evaluation and synthesis, current innovation and gauge progress since the publication of Ray Pawson’s and Nick Tilley’s seminal “Realistic Evaluation” more than 20 years ago. More information about the conference can be found at www.realist2020.org.”
Global governance of health
Devex - New Google, UN partnership aims to 'turn on the tap' to SDG data
Devex;
“Some of the biggest players in development and the private sector — including the United Nations and World Bank Group, as well as Google and Alibaba Group — launched a new partnership on Wednesday to jumpstart global data work and close the information gap impeding progress on the SDGs. The new initiative, Data For Now, will link Google Earth satellite imagery and mobile phone data with governments that need better understanding of some of the most complex development challenges, such as food insecurity or disease outbreaks….”
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Open Democracy - Is civic space really shrinking, and if so who’s to blame?
David Sogge; https://www.opendemocracy.net/en/transformation/is-civic-space-really-shrinking- and-if-so-whos-to-blame/
“The changing shape of civil society is due to international forces, not just domestic repression.” Well worth a read.
OECD/UNDP - Launch of the Global Hub on the Governance for the SDGs
http://www.oecd.org/gov/pcsd/launchoftheglobalhubonthegovernanceforthesdgs.htm
On Wednesday, this new hub was launched in New York: It’s …a joint OECD-UNDP initiative, which aims to facilitate targeted support to interested countries tackling the specific governance challenges of SDG implementation. It will provide a space to build leadership capacity on critical governance issues, and for national experts and practitioners to interact and learn from each other, in support of the achievement of the 2030 Agenda. The Hub will align with other existing and planned SDG initiatives to leverage the full potential of SDGs 16 and 17 as key enablers of the entire 2030 Agenda….”
Euractiv - Georgieva to be the first IMF chief from an emerging economy https://www.euractiv.com/section/global-europe/news/georgieva-to-be-the-first-imf-chief-from-an- emerging-economy/
Bulgarian economist Kristalina Georgieva [was] confirmed on Wednesday (25 September) as managing director of the International Monetary Fund, which [made] her the first person from an emerging economy to head the global lender.
See IMF - IMF Executive Board Selects Kristalina Georgieva as Managing Director.
Eurodad - We can work it out: 10 civil society principles for sovereign debt resolution
B Ellmers et al; https://eurodad.org/debtworkout
Against a deteriorating debt outlook, “… To stimulate and inform these efforts, Eurodad along with 33 partner CSOs, who together represent more than 1500 individual organisations, have set out 10
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key principles that we see as essential to the functioning of any mechanism that genuinely seeks to overturn the shortcomings of the current ‘non-regime’, and that will ensure a timely approach to orderly, fair, transparent, and durable crisis resolution.”
Lancet Infectious Diseases (Editorial) – Moving towards equitable access to vaccination https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(19)30487-6/fulltext
Strong plea for the GAVI replenishment in 2020 – when the UK hosts the replenishment conference.
Health Affairs (blog) - The Global Community Has Pledged To Achieve Universal Health Coverage: What’s It Going To Take?
M Carter et al ; Health Affairs;
“… The center of gravity for global health is shifting. Decisions made in donor capitals and United Nations agencies remain important, and international NGOs still have a role to play. However, the locus of action has moved to national and local governments, responsive to the needs of their people and simultaneously encouraged and challenged by their civil society. … … CSOs aren’t just important partners in UHC. They’re essential to ensuring that the vision of access, quality and affordability gets translated into reality. In-country CSO advocacy is at the heart of UHC….”
Convergence (report) - The State of Blended Finance 2019
Convergence
New report from Convergence, a blended finance network. Turns out blended finance remains rather slim in comparison to more traditional development finance. With respect to health, that’s even more the case.
Brookings (blog) - Getting specific to leave no one behind
Homi Kharas et al; Brookings;
« …In the sphere of global development cooperation and poverty reduction, governments and official agencies often deploy the rhetoric of LNOB [Leave No One Behind ] but revert to traditional development strategies in their programming. To make LNOB into a practical agenda, this tendency must be confronted. This is why we, together with colleagues at the Japan International Cooperation Agency and other partners, collaborated on a new edited volume, Leave No One Behind: Time for Specifics on the Sustainable Development Goals. «
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You might want to check out chapter 7 (by Krishna Rao et al) in particular - Vulnerable populations and UHC.
KFF – Senate Appropriations Committee Releases Draft FY 2020 State and Foreign Operations (SFOPs) Appropriations Bill
KFF;
Analysis by KFF. “ The Senate Appropriations Committee released the draft FY 2020 State & Foreign Operations (SFOPs) appropriations bill (and accompanying report) on September 18, 2019. The SFOPs bill includes funding for U.S. global health programs at the State Department and the U.S. Agency for International Development (USAID).[i] Funding for these programs, through the Global Health Programs (GHP) account, which represents the bulk of global health assistance, totaled $9.1 billion, an increase of $274 million above the FY 2019 enacted level, $2.8 billion above the President’s FY 2020 request, and $186 million below the House FY 2020 level….”
“… the bill includes $1,560 million as the U.S. contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), an increase of $210 million above the FY19 enacted level ($1,350 million), $602 million above the FY20 Request ($958 million), and matching the FY20 House level. The report accompanying the bill states that the committee “anticipates that the United States will pledge not less than [$1.56 billion] for each of the three fiscal years pertaining to the Global Fund’s Sixth Replenishment . . . [and] does not support the administration’s proposal to amend the longstanding matching rates for U.S. contributions to the Global Fund and expects the United States to continue to match other donor contributions at a rate of $1 for every $2 received from other donors.”
NYT – As Narendra Modi heads to the US, controversy follows him
NYT;
Commotion on the Gates Foundation & its Modi award continued. "As Prime Minister Narendra Modi of India prepares for a big trip to the United States, human rights groups and three Nobel Peace Prize winners have criticized the Bill & Melinda Gates Foundation for its plan to bestow a prestigious award upon Mr. Modi next week during his visit…. ... The Gates Foundation, which focuses on health and anti-poverty programs, is honoring Mr. Modi for his ambitious Clean India campaign, centered on an initiative that has built 100 million new toilets in India over the past five years -- roughly 40 every minute. ... …. The foundation says [it still plans] to present Mr. Modi with the Goalkeepers Global Goals Award at a ceremony in New York on Tuesday. ... … In response to the mounting questions, the Gates Foundation released a statement explaining its decision. 'Globally, sanitation-related diseases kill nearly 500,000 children under the age of 5 every year,' it said. 'Yet despite its importance, sanitation has not received significant attention. A lot of governments are not willing to talk about it, in part because there are not easy solutions'..."
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We did appreciate the comparison with Mussolini & rewarding him for trains running on time (in this hard-hitting Guardian op-ed). Or Dolf & his Autobahns, if you want.
One Gates Foundation staffer quit because of the award for Modi.
PS: in other news from the Goalkeepers event (via Xinhua ), “ …Three new partnerships, called "Accelerators," were announced at the event, namely increasing access to prenatal supplements for women, expanding innovative family planning programs for young couples, and mobilizing critical global support for mental health services.”
BMJ Editorial - Targeted health innovation for global health
J-A Rottingen & J Farrar; https://www.bmj.com/content/366/bmj.l5601
“New WHO database will help tackle health problems in low and middle income countries.”
Editorial related to the WHO Global Observatory on Health Research and Development. “… The WHO Global Observatory on Health Research and Development has now been operating for almost three years and collates information on investment levels, grants, research capacity, clinical trials, publications, patents, and product pipelines. Analyses based on these data indicate relative underinvestment in products relevant to low and middle income countries….”
“…WHO has extended the global observatory to include a directory of agreed health product profiles. The database currently prioritises products in areas with limited incentives for research because of low market demand and includes poverty related neglected diseases, emerging and epidemic infections, products to combat antimicrobial resistance, and products tackling the specific needs of low income and middle income countries….”
“… At the global level, the key agency is WHO. The organization must use its normative role and power to define priorities and investment needs, as well as giving guidance on how to conduct such processes. Other organisations will then be the ones to finance or conduct product development. One example of this model is the decision of the Coalition for Epidemic Preparedness Innovations to use WHO’s priorities and target product profiles to inform its investment decisions. The new directory will help WHO develop this role….”
Washington Post (op-ed)- The Trump administration prepares a new assault on US soft power https://www.washingtonpost.com/
"...The White House has prepared a draft National Security Presidential Memorandum, which I obtained, that would -- if implemented -- completely reshape U.S. foreign aid to become a tool of this administration's agenda and an ineffective one at that. … ... Cutting aid to countries that don't fully
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support U.S. policy is penny-wise, pound-foolish. Problems such as terrorism, global health, and climate change know no borders. …”
However, Trump didn’t mention it in his speech at UNGA, and it’s not clear to what extent the Memorandum was (still) shaped by his former National Security Advisor, John “The Moustache” Bolton.
Project Syndicate - Reconciliation Must Drive Development
Rémy Rioux (CEO of the Agence Française de Développement) ; https://www.project- syndicate.org/commentary/reconciliation-must-drive-development-by-remy-rioux-2019-09
“…We therefore need a guiding concept to define a new basis for collective action. I believe that the idea and method of reconciliation can help. “Reconciliation” is perhaps a simpler and more dynamic way of expressing the collective global objectives reflected in the SDGs. It would amount to a new modus operandi that would help us transcend the simplistic binary division between local and global. … … A reconciliation policy would fully mobilize the resources and stakeholders of all countries – including civil-society organizations, multinational companies, major cities, and development banks – and direct them toward concrete cooperation and reciprocal international aid. This would bring about what I call a “polypolar” world. …”
You gotta be French to come up with this sort of thing.
Thomson Reuters – Political uncertainty poses obstacle to U.N.'s global goals, businesses say http://news.trust.org//item/20190924120446-u4gct/
“Only one in five chief executives thinks business is playing a critical role in the wide-ranging development goals. Business leaders complain of being hampered by political uncertainty and market constraints in efforts to fight poverty, inequality and other ills by 2030, research showed on Tuesday as world leaders met to discuss the United Nations' global goals. Only one in five chief executives thinks business is playing a critical role in the wide-ranging development goals, according to a study by the United Nations Global Compact, a network of businesses, and consulting company Accenture Strategy….”
Quick links:
• NK News - Global Fund board approves $41.7 million grant for North Korea TB-malaria work
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“"The board of the Global Fund, an international aid financing organization, has approved a new $41.7 million grant for work related to tackling tuberculosis and malaria in North Korea, a spokesperson told NK News on Thursday..." “
• Devex - Boehler sails through hearing for top job at new US DFC
• Devex - Exclusive: Gates Foundation's chief strategy officer pulls back the curtain
Interview with Mark Suzman (47 minutes). We hadn’t had a chance to listen to it, but looks very interesting.
• IISD - Assessing the HLPF Four Years On: Enhancing Integration, Linking Processes, and Strengthening Political Leadership
“The HLPF has struggled to encourage countries to “integrate the three dimensions” of sustainable development, even though interlinkages among the 17 SDGs and their targets have been identified. A clear illustration of different tools, approaches, and conceptual frameworks for better understanding interlinkages between the SDGs would make integration more concrete and actionable. One way to enhance political leadership and guidance for sustainable development is to bring more local and regional governments into the VNR [voluntary national review ] process.”
Finally, a tweet on a (debatable) quote from Ilona Kickbush, at the launch of the ‘A World at Risk’ report in NY:
“We cannot accept anymore the distinction between health security and #UniversalHealthCoverage - the “camps” must come together says @IlonaKickbusch #AWorldatRisk #UHC2030 #HealthForAll.”
UHC
Lancet Global Health – Guide posts for investment in primary health care and projected resource needs in 67 low-income and middle-income countries: a modelling study
K Stenberg et al; https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(19)30416- 4/fulltext
“Primary health care (PHC) is a driving force for advancing towards universal health coverage (UHC). PHC-oriented health systems bring enormous benefits but require substantial financial investments. Here, we aim to present measures for PHC investments and project the associated resource needs….” “….Recognising the variation in PHC services among countries, we propose three measures for PHC, with different scope for included interventions and system strengthening. Measure 1 is centred on public health interventions and outpatient care; measure 2 adds general inpatient care; and measure 3 further adds cross-sectoral activities….”
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“The resources required to strengthen PHC vary across countries, depending on demographic trends, disease burden, and health system capacity. The proposed PHC investment guide posts advance discussions around the budgetary implications of strengthening PHC, including relevant system investment needs and achievable health outcomes. Preliminary findings suggest that low- income and lower-middle-income countries would need to at least double current spending on PHC to strengthen their systems and universally provide essential PHC services….”
Lancet Global Health (Comment) – Universal health coverage: an opportunity to address antimicrobial resistance?
E Taylor, G Bloom, P Salama et al; https://www.thelancet.com/journals/langlo/article/PIIS2214- 109X(19)30362-6/fulltext
“On Sept 23, 2019, global leaders will gather at the UN for a high-level meeting on universal health coverage and discuss commitments and action to extend essential health services to over half of the world's population that have no access to them. 3 years ago, leaders met similarly at the UN General Assembly to consider antimicrobial resistance, perhaps the greatest threat to public health of our time. These two major global health priorities are much more closely linked than they might appear at first. If antimicrobial resistance is not controlled, health care will become more difficult, less effective, and more expensive. Conversely, action towards universal health coverage—and a positive response by countries at the meeting to the key asks proposed by the universal health coverage movement—can help expand coverage of measures to prevent and manage infection, including appropriate use of antibiotics. Countries have a great opportunity to both accelerate universal health coverage progress and tackle antimicrobial resistance, with substantial and sustainable gains. … … … The universal health coverage movement is asking countries to invest more and better in health systems. Investing in antimicrobial resistance control is an exceptionally good buy. … … All countries need to do more; for low-income countries, where the needs are great and resilience and resources are lowest, additional development finance is required. More broadly, the universal health coverage movement is calling on political leaders to legislate, invest, and collaborate with all of society to make universal health coverage a reality. Much of what is called for is also crucial for tackling antimicrobial resistance, and strengthening systems for prevention and management of infection will be of mutual benefit for both antimicrobial resistance control and universal health coverage goals.”
Quick link:
• CNBC - Amazon launches Amazon Care, a virtual medical clinic for employees
“Amazon just launched Amazon Care, a virtual primary care clinic with an option for nurses to visit employees in the home. It’s described as a new benefit for employees that offers “the best of both virtual and in-person care.” The company says it’s a pilot for employees in the Seattle area.”
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Planetary health
EC Research & Innovation - ‘I would like people to panic’ – Top scientist unveils equation showing world in climate emergency https://horizon-magazine.eu/article/i-would-people-panic-top-scientist-unveils-equation-showing- world-climate-emergency.html
“A new equation showing that the world is ‘deep in a climate emergency’ was unveiled on 24 September by Professor Hans Joachim Schellnhuber, one of the world’s leading authorities on climate change, who said that people still don’t want to see the truth about the state we’re in.”
“… To make his assessment, Prof. Schellnhuber, founder of the Potsdam Institute for Climate Impact Research, Germany, has devised a formula that defines the level of emergency as risk multiplied by urgency. … … ‘If we go into a runaway climate effect, the damage may be between €100 trillion and the loss of civilisation,’ he said. ‘The probability, I would say, is about 10% that this is going to happen. And when it comes to the urgency of decarbonising society and keeping the forests alive, we need at least 20 years. We have only 30 years left to do this.”
Guardian - Extreme sea level events ‘will hit once a year by 2050’ https://www.theguardian.com/environment/2019/sep/25/extreme-sea-level-events-will-hit-once-a- year-by-2050
Yet another ominous IPCC report came out, pointing to the acceleration of climate change. This one is linked to the oceans.
“Extreme sea level events that used to occur once a century will strike every year on many coasts by 2050, no matter whether climate heating emissions are curbed or not, according to a landmark report by the world’s scientists. The stark assessment of the climate crisis in the world’s oceans and ice caps concludes that many serious impacts are already inevitable, from more intense storms to melting permafrost and dwindling marine life. But far worse impacts will hit without urgent action to cut fossil fuel emissions, including eventual sea level rise of more than 4 metres in the worst case, an outcome that would redraw the map of the world and harm billions of people. The report from the Intergovernmental Panel on Climate Change (IPCC), and approved by its 193 member nations, says that “all people on Earth depend directly or indirectly on the ocean” and ice caps and glaciers to regulate the climate and provide water and oxygen. But it finds unprecedented and dangerous changes being driven by global heating….”
See also Nature - World’s oceans are losing power to stall climate change
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“United Nations report predicts more powerful storms, increased risk of flooding and dwindling fisheries if greenhouse-gas output doesn’t fall.” “The world’s oceans have long helped to stave off climate change by absorbing heat and carbon dioxide from the atmosphere. But that is changing, warn leading researchers in a high-level report from the Intergovernmental Panel on Climate Change (IPCC). The oceans “can’t keep up” with humanity’s greenhouse-gas output, says Ko Barrett, vice- chair of the IPCC and a deputy administrator at the US National Oceanic and Atmospheric Administration. “The consequences for nature and humanity are sweeping and severe.””
Coalition for Urban transitions (report) – Climate emergency: urban opportunity https://urbantransitions.global/wp-content/uploads/2019/09/Climate-Emergency-Urban- Opportunity-report.pdf
For the optimists & can-do people among you. “…This report, a collaborative effort of more than 50 organisations brought together by the Coalition for Urban Transitions, is being launched in September 2019 in advance of the Climate Action Summit and Sustainable Development Goals Summit in New York. The Coalition for Urban Transitions is a global initiative to support national governments in transforming cities to accelerate economic development and tackle dangerous climate change. Collectively, the contributors hope this report will provide the evidence and confidence that governments need to submit more ambitious Nationally Determined Contributions in 2020, and to propel inclusive, zero-carbon cities to the heart of their national development strategies.”
Thomson Reuters - Africa to seek declaration of global climate emergency at UN summit
Reuters.
Not sure they succeeded. “African countries [plan to] call on the United Nations to declare a global climate emergency, among a set of demands to be presented at a climate summit in New York on Monday organised by the U.N. chief. Backed by African climate change negotiators, the statement is also expected to say that countries' climate action plans should be made legally binding, to ensure the 2015 Paris Agreement goals to limit global warming are met….”
Guardian - Climate change is morally wrong. It is time for a carbon abolition movement
E Beinhocker; https://www.theguardian.com/commentisfree/2019/sep/20/climate-change-morally- wrong-carbon-abolition-movement
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By Eric Beinhocker (professor of public policy practice at the Blavatnik School of Government, University of Oxford, and executive director of the Institute for New Economic Thinking at the Oxford Martin School).
“…The climate movement is finally finding its moral voice. The school strikes, the global climate strike, Extinction Rebellion and growing support for a Green New Deal suggest that, at last, a mass social movement is rising that could tip our politics into action. But to catch fire this campaign needs a clear, simple demand, a rallying cry that everyone can share. “…. by clearly showing the immorality of carbon pollution, we can activate people’s moral emotions and then focus those emotions on a specific action: making it illegal. …
Quick links:
• Guardian - Airlines' CO2 emissions rising up to 70% faster than predicted
“Worldwide CO2 emissions from commercial flights are rising up to 70% faster than predicted by the UN, according to an analysis. Carbon dioxide emitted by airlines increased by 32% from 2013 to 2018, according to a study by the International Council on Clean Transportation….”
• The Conversation - Ghana’s health system isn’t quite ready for climate change realities
By L Hussey.
• Guardian - Indonesian forest fires putting 10 million children at risk, says Unicef
“Millions aged under five are particularly at risk from the slash and burn fires due to undeveloped immune systems.”
Infectious diseases & NTDs
Reuters – Afghanistan's Taliban lifts ban on World Health Organization
Reuters;
“Afghanistan’s Taliban insurgency has lifted a ban on World Health Organization activities in areas the militants control, a spokesman for the Islamist group said, reversing a stance that had been complicating efforts to eradicate polio. The Taliban had in April banned the WHO and International Committee of the Red Cross, citing their “suspicious activities” during vaccination campaigns, which threatened to deepen one of the world’s worst humanitarian crises….”
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Buzzfeed - The Mysterious “Sonic Attacks” In Cuba Might Have Actually Been Caused By Zika Pesticides
Buzzfeed;
“Canadian diplomats with “Havana syndrome” injuries show signs of pesticide poisoning, suggests a new international study, posing an explanation for mysterious long-term neurological ailments striking diplomats from the US and Canada in Cuba. The finding suggests that the Zika virus crisis of 2016 may have inadvertently created the syndrome through excessive fumigation. Fears about the syndrome led to an international diplomatic row, with US diplomat numbers in Havana lowered, and Cuban diplomats expelled from the US in retaliation….”
Lancet Global Health (Comment) - The challenge of ensuring equity in mass deworming programmes
P M Jourdan et al ; https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(19)30392- 4/fulltext
Comment linked to a new study in the Lancet Global Health. “… Nathan Lo and colleagues have estimated the equity of access to such deworming by analysing Demographic and Health Surveys data for over 820 000 children aged 1–4 years across 50 low-income and middle-income countries….”
“The findings suggest that deworming programmes did not consistently provide deworming equitably across geographical locations and wealth classes, indicating that children of wealthier families were more likely to be treated than others. The results also apply to countries that, in line with the WHO goal, have reported more than 75% national coverage….”
Devex - DFID puts £220M into fighting NTDs https://www.devex.com/news/dfid-puts-220m-into-fighting-ntds-95656
See also last week’s IHP news (cfr. announcement at ECTMIH conference). “Health experts have welcomed an “unprecedented” £220 million ($274 million) United Kingdom program for taking an integrated, inclusive, and sustainable approach to tackling some of the worst neglected tropical diseases across 25 countries in Africa and Asia. Funded by the U.K. Department for International Development and announced last week, the program aims to deliver 600 million treatments targeting five NTDs, which are part of a diverse group of communicable diseases affecting more than 1.5 billion people from the poorest and most marginalized communities in the world. … … While DFID has funded NTD programs in the past, the new flagship program — Accelerating Sustainable Control and Elimination of Neglected Tropical Diseases, or ASCEND — marks a significant increase in funding from the donor and also a change in approach….”
“It is the first installment of a larger £360 million NTD commitment made in 2017 and makes DFID the world’s second-largest NTD donor after the United States. Kate Hargreaves, director of product
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development and innovation at Crown Agents, which is implementing ASCEND in Eastern Africa and South Asia, praised the “shift from ‘vertical’ or single-disease projects to encouraging a more integrated, holistic approach to NTD programming.”…”
And a few quick links:
Stat News - A devastating illness rocked Uganda, then disappeared. Disabled children — and a mystery — remain On the ‘nodding syndrome’ that hit Uganda starting two decades ago. “… No new cases have been reported since 2015, according to the Ministry of Health. But the outbreak left behind more than 2,100 children with lifelong disabilities, overwhelming their families and the region’s capacity to care for them. In Uganda, nodding syndrome is seen in 0.7% of children aged 5- 18, but in certain districts the prevalence is as high as 4.6%....”
Stat - What to know about EEE, a mosquito-borne virus on the rise
(by Helen Branswell) “…2019 is turning out to be a big year for Eastern equine encephalitis, generally called EEE — “triple E”…” In the US, that is.
AMR
Axios - U.S. pushes global effort to fight antibiotic resistance at UN meeting
Axios;
“While praising "real progress" in the fight against growing antimicrobial resistance, HHS Secretary Alex Azar challenged individuals and private and public organizations around the world to renew efforts to end the "scourge of AMR" while speaking Monday at the UN General Assembly….”
See also US-led push against antibiotic resistance adds hundreds of global supporters
“Since it was launched last year, the United States' AMR Challenge has gathered nearly 350 commitments from 33 countries to implement specific actions to combat antibiotic resistance. The CDC and HHS led the global initiative, which includes commitments to antibiotic resistance efforts from pharmaceutical and health insurance companies, food animal producers and purchasers, and medical professionals and healthcare systems. More than 55 pharmaceutical and biotech groups committed to developing or increasing access to products that will mitigate drug-resistant infections and nearly half of the commitments focus on improving antibiotic use. Also, nearly 50 percent of the commitments focus on improving infection prevention and control….”
Quick link:
* The Bureau of Investigative Journalism - 'Invisible' pharmacists selling knock-off drugs: the rise of antibiotic resistance in Cambodia
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Based on research from the London School of Hygiene & Tropical Health and University of Health Sciences.
“Quack pharmacists in Cambodia are fuelling the rise of drug resistant bacteria by incorrectly peddling antibiotics, a study has found. For the first time researchers have interviewed Cambodia’s “invisible” drug sellers – those who sell from their own homes, visit customers’ houses or wander around markets or villages….”
NCDs
NCD Child - Children & Non-Communicable Disease: Global Burden Report 2019 http://www.ncdchild.org/news-events/posts/2019/september/children-non-communicable-disease- global-burden-report-2019/
“The Children & Non-Communicable Disease: Global Burden Report 2019 from NCD Child is the first publication summarizing the current prevalence, disability, and mortality of NCDs in children, adolescents, and young people using data from the World Health Organization, Global Burden of Disease (Institute for Health Metrics & Evaluation), and other sources.”
Globalization & Health - Corporations’ use and misuse of evidence to influence health policy: a case study of sugar- sweetened beverage taxation
G J Fooks et al; https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-019- 0495-5
Focus on South-Africa in this article.
The Conversation - An increasing number of countries are banning e-cigarettes – here’s why https://theconversation.com/an-increasing-number-of-countries-are-banning-e-cigarettes-heres- why-123055
This analysis starts with the US situation & the recent ban in India. “…To date, over 20 countries, mostly in South America, the Middle East and South-East Asia, have banned the sale of e-cigarette
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products. Some countries have also banned possession of these products. Thailand has the strictest laws, while countries such as Australia, Canada and Norway have introduced many restrictions…..”
After going some of the evidence so far, and difficulties to research the potential harm of e- cigarettes, the piece concludes: “The evidence to date suggests that vaping is not a safe alternative to smoking tobacco. This, coupled with the worrying trend of young, previous non-smokers being attracted to vaping, raises fears of yet another generation suffering from chronic lung disease….”
World obesity (blog) - Obesity and the SDGs: an opportunity hidden in plain sight
K Cooper; https://www.worldobesity.org/news/blog-obesity-and-the-sdgs-an-opportunity-hidden- in-plain-sight
“To coincide with the SDG Summit at the UN General Assembly, World Obesity’s consultant Katy Cooper highlights the many opportunities to address obesity within the Sustainable Development Goals.” “… This blog highlights seven areas of synergy between obesity and the SDGs; the 13 relevant Goals and accompanying targets are mapped out in Figure 1….”
Quick links:
• Scientific American - A New Theory of Obesity
““Ultraprocessed” foods seem to trigger neural signals that make us want more and more calories, unlike other foods in the Western diet.”
• FT Health - Philip Morris International ends merger talks with Altria
(gated) “Juul chief steps down and company suspends US advertising amid vaping concerns. “
See also Stat News - Juul, e-cigarette maker, to drop ads, won’t lobby against proposed ban on flavored products
And Vox - With its new tobacco industry CEO, has Juul become Big Tobacco?
“Juul wants to help solve smoking. But it keeps cozying up to the tobacco industry.”
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SR/Maternal/Neonatal and child health
International Journal for Equity in Health – Reproductive health and the politics of abortion in Ethiopia, Zambia, and Tanzania https://www.biomedcentral.com/collections/abortionpolitics
New thematic collection.
Access to medicines
Quick links:
• HPW - Over Half of New Cancer Drugs Approved Based On Potentially Biased Evidence, New Study Finds
“Over half of new cancer drug approvals granted by European authorities between 2014-2016 may have been made based on evidence from biased clinical trials, according to a new study published in The BMJ. The study, led by Dr. Christopher Booth, professor of oncology from Queens University Cancer Research Institute, raises serious questions about the quality and strength of evidence used by the European Medicines Agency (EMA) to approve new cancer drugs.”
• New scientist - UK families in buyers club fly to Argentina for cystic fibrosis drugs • Lancet World Report: Congress and President Trump take on high drug prices
Human resources for health
Devex - We need a Marshall Plan to train health care workers around the globe
R Torbay; https://www.devex.com/news/opinion-we-need-a-marshall-plan-to-train-health-care- workers-around-the-globe-95579
By R Torbay (CEO of Project Hope). “…we need governments and donors to commit to a Marshall Plan for training health care workers across the globe. In the same way the Marshall Plan spurred European recovery following World War II, we must see a global health workforce as an investment worth championing.”
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NCD Alliance (Report) - Protecting Populations, Preserving Futures: Optimising the health workforce to combat NCDs and achieve UHC https://ncdalliance.us4.list- manage.com/track/click?u=f8751cb14c745b632f0e2871c&id=cdb7712616&e=7081d2a780
“A new, evidence-based policy report to enable an optimised health workforce was launched by the NCD Alliance today, on the sidelines of the United Nations High-Level Meeting on Universal Health Coverage (UHC) in New York. The report “Protecting Populations, Preserving Futures: Optimising the health workforce to combat NCDs and achieve UHC”, developed thanks to the support of Pfizer Upjohn, explores the optimal level of health workforce for noncommunicable diseases (NCDs) across the continuum of care, presenting existing and novel strategies drawn from best practice case studies….”
Lancet World Report – Cuba's doctors-abroad programme comes under fire https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32214-7/fulltext
“Disapproval of the assistance programme that sends hundreds of Cuban doctors to foreign countries has been building. Lise Alves reports.”
Miscellaneous
Stat News - Before heritable genome editing, we need slow science and dialogue ‘within and across nations’
Stat;
Indeed.
BMJ blog - Satchit Balsari: Will AI help universalize health care?
BMJ blog;
“The successful integration of AI into healthcare services must take different focuses depending on local contexts, says Satchit Balsari.”
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CGD (blog) - Is the New Model IFC a Good Deal for IDA Countries?
Charles Kenny; https://www.cgdev.org/blog/new-model-ifc-good-deal-ida-countries
Blog on Development Finance Institutions (IFC), linked to Kenny’s new policy paper, Marginal, Not Transformational: Development Finance Institutions and the Sustainable Development Goals.
BMJ Global Health - Vaccinology in sub-Saharan Africa
J Moïsi et al; https://gh.bmj.com/content/4/5/e001363
“We undertook a landscape analysis of vaccinology research and training in sub-Saharan Africa in order to identify key gaps and opportunities for capacity development in the field . We conducted interviews with regional and global immunisation experts, reviewed university and research centre websites, searched the scientific literature and analysed donor databases as part of our mapping exercise. We found that (1) few vaccinology training programmes are available in the region; (2) vaccinology research sites are numerous but unevenly distributed across countries and subregions and of widely varying capacity; (3) donor funding favours HIV, tuberculosis and malaria vaccine development over other high-burden diseases; (4) lack of vaccine design, manufacturing and regulatory capacity slows the progress of new vaccines through the research and development pipeline and (5) vaccine implementation research garners limited support. Regional efforts to strengthen African vaccinology expertise should develop advanced vaccinology training programmes, support clinical trial and implementation research sites in geographic areas with limited capacity and conduct multidisciplinary research to help design, license and roll out new vaccines.”
Emerging Voices
• Check out Seye Abimbola’s s contribution to 10th EV anniversary series of micro-blogs
• And Vladimir Gordeev (EV 2014 & currently co-chair of the EV governance team) co- authored this HSG blog related to Europe, As a continent of disparities how can Europe achieve UHC by 2030 ?
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Research
BMJ Global Health – Quantifying changes in global health inequality: the Gini and Slope Inequality Indices applied to the Global Burden of Disease data, 1990–2017
F Steinbeis et al; https://gh.bmj.com/content/4/5/e001500
“The major shifts in the global burden of disease over the past decades are well documented, but how these shifts have affected global inequalities in health remains an underexplored topic. We applied comprehensive inequality measures to data from the Global Burden of Disease (GBD) study….”
“Despite considerable reductions in disease burden in 1990–2017 and absolute health inequality between countries, absolute and relative international health inequality remain high. The limited reduction of relative inequality has been largely due to shifts in disease burden from CMNNs (communicable, maternal, neonatal and nutritional diseases) and injuries to NCDs. If progress in the reduction of health inequalities is to be sustained beyond the global epidemiological transition, the fight against CMNNs and injuries must be joined by increased efforts for NCDs.”
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