Canadian priorities for post-2015 development agenda
http://www.international.gc.ca/developmentdeveloppement/priorities-priorites/mdgomd_consultations.aspx?lang=eng
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http://www.ualberta.ca/~tkeating/ELLA2.pptx
“everyone has the right to a standard of living
adequate for… health and wellbeing of himself and his
family, including food, clothing, housing, medical care
and the right to security in the event of…sickness,
disability…Motherhood and childhood are entitled to
special care and assistance. (UN Declaration of
Human Rights, 1948, Article 25, paragraphs 1 and 2)
“ ‘health security ’ at its simplest level, can be illustrated by reference to
premature and unnecessary loss of life which can be avoided by
provision of and access to health care – implying state responsibility
for empowering people through national and international
mechanisms to protect themselves from poor health at the local level.”
Increased interest in the relationship between health, human security
and human development by the international community and
governments is rooted in the need to protect people from the risks and
insecurities brought about by health deficiencies and hazards, often due
to particular circumstances of underdevelopment and poverty and
conflict.
At Least 30% of Human Deaths are due to poverty-related causes, cheaply
preventable through safe drinking water, better sanitation, more adequate
nutrition, vaccines or other medicines.
diarrhea and malnutrition
perinatal and maternal conditions
childhood diseases
tuberculosis, meningitis, hepatitis,
malaria and other tropical diseases,
respiratory infections- mainly pneumonia,
HIV/AIDS, sexually transmitted diseases
(WHO: World Health Organization, Global Burden of Disease: 2004 Update, Geneva 2008, Table A1, pp. 54-59)
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Linkages
Human causes of health insecurity:
investment/private vs. public
policy
conflicts
antibiotic resistance
food borne diseases - ecoli; BSE
bioterrorism
“the burden of disease in low-income countries is further
compounded by a litany of chronic, non communicable ailments
striking around the globe, notably diabetes, heart disease, and
cancer.”
2001 United Nations Security Council resolution identified HIV/AIDS as a
security threat, a position reiterated in the
served to raise the profile of the health crisis that was the HIV/AIDS
epidemic and to elevate it to a security concern, and a human security concern in
the broader sense
The 2001 UN Security Council resolution placed responsibility for health and
human security squarely with national governments, but a subsequent General
Assembly declaration dispersed this responsibility among non-state actors as
well.
these represented a shift from a health system-wide approach to
a problem-focused, specific disease-oriented one;
second, they ushered in the establishment of cross-sectoral and
broad based partnerships (public– private, philanthropy, and civil
society) in the planning, coordination, and governance of global
health;
third, they saw the emergence of demand-driven funding and
exploitation of market dynamics to stimulate investment in
research and production capacity for drugs and other medical
products; and
fourth, they emphasized results and evidence-based outcomes as
a basis for allocation of global health resources.
Between 1990 and 2010, global health funding grew exponentially, from
approximately $5.6 billion to over $28 billion (IHME, 2012 )
Increased activity in the health arena has resulted in:
over 40 bilateral donors,
25 UN agencies,
20 global and regional funds, and
90+ global initiatives that target health issues
this has led to overlapping mandates and competition for limited (and in
many cases dwindling) resources’ and seeking to influence the content
and execution of the global health and human security agenda
(Council on Foreign Relations, 2013 ).
Global Fund to Fight AIDS, Tuberculosis, and Malaria (Global
Fund) which was established in 2002 as a financing mechanism
with the support of the G7, specifically to combat those three
diseases;
US President’ s Emergency Plan for AIDS Relief (PEPFAR)
established in January 2003 at the behest of then US President
George W. Bush, initially committed US$15 billion3 (renewed in
2008 at US$48 billion (H.R. 5501, 2008 )) expressly to combat
HIV/AIDS in select low-income countries; and
Global Alliance for Vaccines and Immunization (GAVI),
launched in 2000 with an initial $750 million grant from the Bill
and Melinda Gates Foundation.”
Millennium Development Goals:
Globally, the number of deaths of children under 5 years of age fell
from 12.6 million in 1990 to 6.6 million in 2012.
In developing countries, the percentage of underweight children under
5 years old dropped from 25% in 1990 to 15% in 2012.
While the proportion of births attended by a skilled health worker has
increased globally, fewer than 50% of births are attended in the WHO
African Region.
Globally, new HIV infections declined by 33% between 2001 and
2012.
Existing cases of tuberculosis are declining, along with deaths among
HIV-negative tuberculosis cases.
Worldwide, Africa accounts for 9 out of every 10 child deaths due to malaria,
for 9 out of every 10 child deaths due toAIDS, and for half of the world’s child
deaths due to diarrhoeal disease and pneumonia.
In low-income countries, the leading cause of death is pneumonia, followed
by heart disease, diarrhoea, HIV/AIDS and stroke. In developed or highincome countries, the list is topped by heart disease, followed by stroke, lung
cancer, pneumonia and asthma or bronchitis.
Men between the ages of 15 and 60 years have much higher risks of dying
than women in the same age category in every region of the world. This is
mainly because of injuries, including violence and conflict, and higher levels
of heart disease. The difference is most pronounced in Latin America, the
Caribbean, the Middle East and Eastern Europe.
Depression is the leading cause of years lost due to disability, the burden
being 50% higher for females than males. In all income strata, alcohol
dependence and problem use is among the 10 leading causes of disability.
“The world has changed dramatically since 1951, when WHO
issued its first set of legally binding regulations aimed at
preventing the international spread of disease. At that time, the
disease situation was relatively stable. Concern focused on only
six “quarantinable” diseases: cholera, plague, relapsing fever,
smallpox, typhus and yellow fever. New diseases were rare, and
miracle drugs had revolutionized the care of many well-known
infections. People travelled internationally by ship, and news
travelled by telegram.”
Margaret CHAN, WHO Director General, A safer future, WHO
2007 World Health Report
Responding to changes
More than 2.5 billion airline passengers annually
Infectious diseases can not only spread faster, but are increasing in
number: since the 1970s, new diseases have been identified at the
unprecedented rate of one or more per year.
More than 1100 epidemic events have been verified by WHO the
last five years
SARs epidemic 2002-3; belated reporting from China; 8273 cases,
775-835 deaths
International Health Regulations (IHR) were revised in May 2005,
and came into force on 15th of June 2007.
It includes all diseases and health events that may constitute a
public health emergency of international concern.
194 States parties to the revised IHR
designed to have the necessary global framework to prevent,
detect, assess and provide a coordinated response to events that
may constitute a public health emergency of international concern
(Article 2 IHR)
The Regulations now cover public health emergency of
international concern whatever their origin or source (Article 1.1),
including:
(1) naturally occurring infectious diseases, whether of known or
unknown etiological origin;
(2) the potential international spread of non-communicable
diseases caused by chemical or radiological agents in products
moving in international commerce; and
(3) suspected intentional or accidental releases of biological,
chemical, or radiological substances.
Ebola crisis
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2 yo Guinean boy contracts virus from fruit bats in December
2013
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disease continues to spread as family members mourn their
loved ones, no sterile precautions taken
•
August 2014, disease spreads to Monrovia
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spreads exponentially
•
WHO issued a public health emergency call in September 2014
•
26,571 cases; 10,995 deaths as of April, 2015
Why Does it Spread?
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traditions
•
suspicion of outside help
•
lack of infrastructure
“Whether it is Ebola or another medical issue, countries
will repeatedly experience outbreaks if solutions focus on
symptoms and not the underlying need for strong local systems.
The Ebola outbreak is the result of a frail health care system. It
is imperative that international aid communities join forces with
local governments, organizations and leaders in order to contain
the virus while being cognizant of the need to also build
stronger, more resilient, health care systems”
- Samuel A. Worthington, President of InterAction
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the involvement of military units in public health interventions are a potential source
of concern.This type of arrangement has been described as ‘dual usage’ for public
health and military purposes (Chen 2004).
some support and encourage this kind of assistance and recommend that it be
accelerated, but there is obviously a potential for conflict of interest (Fidler 2005).
it has also been proposed that ‘since the health services are now in the front line . . .
they could get support from government defence and security budgets’ a
recommendation supported by some within WHO
if accepted this could raise questions about the neutrality and independence of health
care providers
Health care workers
are prized by
conflicting parties
Health care facilities are
targeted for their
resources
Health care workers
overburdened in
response to conflict and
its aftermath
Health care systems and
support facilities lack
resources
much maligned agency;
heavily dependent on leadership;
but also constrained by member governments
provides information and monitors performance;
http://www.who.int/gho/map_gallery/en/
Investment in Health Care Systems:
the world is now short well over four million health-care workers,
aging populations require more medical attention, and are drawing health talent from developing
countries.
20% of practicing physicians in the United States is foreign-trained,
if current trends continue, by 2020 the United States could face a shortage of up to 800,000
nurses and 200,000 doctors
“Unless it and other wealthy nations radically increase salaries and domestic training programs for
physicians and nurses, it is likely that within 15 years the majority of workers staffing their hospitals
will have been born and trained in poor and middle-income countries. As such workers flood to the
West, the developing world will grow even more desperate.” (Garrett, Council on Foreign Relations)
Health care spending country comparisons:
http://www.theguardian.com/news/datablog/2012/jun/30/healthcare-spending-world-country
Distribution of Pharma Research
Diseases accounting for 90% of the global disease burden receive only
10% of all medical research worldwide. Pneumonia, diarrhea, tuberculosis
and malaria, which account for over 20% of the global burden of disease,
receive less than 1% of all public and private funds devoted to health
research. Of the 1556 new drugs approved between 1975 and 2004, only
18 were for tropical diseases and 3 for TB.
WTO trade rules protected pharmaceutical firms through the
adoption of restrictions on copying intellectual property/patent
(TRIPS)
WTO Doha Declaration on TRIPS affirmed its members’ right to
protect public health, but access to affordable pharmaceuticals was
blocked by the requirement that the drug in question only have its
patent removed if the state proved that the disease in question was
of epidemic and emergency proportions
counterfeit drugs have emerged as a very significant problem,
representing more than 10% of seized counterfeit products