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- UN Economic & Social Council - ECOSOC
High Level
Segment on Global Public Health - July 2009
Draft
Ministerial Declaration of UN ECOSOC
High Level
Session on Global Public Health
Multiple Gender Dimensions
Civil Society Development Forum (
2 – 4 July 2009
Threats to the Health and Sustainable Development of Nations
Civil Society Proposals on Global Public Health in the Context of the Global Economic Crisis
1. We, representatives of member organizations of the
Conference of Non-Governmental Organizations in Consultative Relationship with
the United Nations (
2. We gathered at a time when the worldwide food, energy
and environmental crises were reinforced by the devastating effects of the
financial and economic crises. The combination of these crises is threatening
the socio-economic roots and stability of the Global North and inflicts even
greater burdens, with debilitating effects, on the Global South, cancelling
momentary socio-economic gains achieved over the last three to five years.
3. Now, more than ever, UN Member States must reaffirm their commitment to
fulfil the promises they made with regard to Official Development Assistance, and
for member states and the international financial institutions to take into
account the conclusions and recommendations of the United Nations Conference on
the World Financial and Economic Crisis and Its Impact on Development held in
June 2009 in New York. These recommendations overwhelmingly call on all States
and international financial institutions to ensure adherence to the social and
economic rights of the most vulnerable, especially their right to health.
4. Attaining the Millennium Development Goals (MDGs) by
2015 is in greater jeopardy ever since their promulgation by the leaders of the
world nine years ago. The combined threats of the failure to achieve the MDGs,
which are cross-sectoral goals, the current paralysis in foreign assistance policies,
and the misallocation of national budgets to favour non-productive and military
activities are likely to harm the delicate interrelationship between the
pursuit of human rights and poverty eradication, global public health and
development, and gender equality and the empowerment of women. These are
threats to the good intentions to address the social determinants of health.
5. In
six workshops, CSDF 2009 delved deeply into its overarching theme of “Threats
to the Health and Sustainable Development of Nations.” Three keynote themes
were also explored: (i) the social determinants of health;
(ii) impacts of the global economic crisis on health; and
(iii) threats to the achievement of the MDGs, especially those relating to
global public health. Following are the major points arising out of those
workshops, including a special report from the youth participants who attended
these workshops:
Responding to
Health Inequities at Local and International Levels
6. Governments
are increasingly aware of the value of competent civil society input for their
policy deliberations and decision-making. In the public health field, the input
of numerous international and national advocacy, scientific and community-based
civil society organizations can enhance government policies. We call on
governments and parliaments to take full advantage of these competencies.
Meeting the full range of health needs requires partnership: civil society is
ready and able to contribute constructively.
7. The
conversion of international agreements into national legislation and practical
implementation mechanisms frequently reveals inadequacies. Civil society calls
on governments to fulfil their obligations as the credibility of government
institutions in this adoption process is at stake. A review of the
internationally agreed development goals and commitments, including the MDGs
relating to public health, is of key importance.
8. It
is critical for governments to adopt a human rights-based approach to health,
which would contribute towards attaining the MDGs. The starting point for
applying a rights-based approach is to redefine health beyond it being a mere
state but rather recognize it as a potential that allows people to deal with
challenges of life.
Dealing with the
Shortage of Health Care Workers
9. Policies
need to be designed to reduce the brain drain of health care workers and to
achieve their equitable distribution compatible with community needs. Education
and training must encompass all levels of health care personnel, including
local and grassroots. Decent wages and working conditions are key to ensuring
retention and a rationalized migration policy in both sending and receiving
countries.
10. We stress the importance of a
holistic approach to health and capacity building. The inclusion of indigenous
medical specialists and traditional healers is essential for comprehensive
health care delivery. Oppression and discrimination of that expertise are
directly linked to poor health services and endanger the availability of health
care at the local level.
11. We emphasize the importance, as
does WHO, of defining health as encompassing mental, physical and social
well-being. Depression is projected to be the greatest risk factor in terms of global disease burden, surpassing all
physical illnesses combined by 2030. Women are already at greater risk for
depression worldwide. Yet, mental health is missing from the global public
health agenda.
Addressing the increase in non-communicable and chronic diseases
12. The
increasing trend of non-communicable and chronic diseases is leading to a shift
away from infectious communicable diseases in the overall global disease
burden. The former diseases tend to be under-diagnosed, especially among the
poorest, the most vulnerable and the ageing, thus endangering timely treatment
among large population groups, often in an environment of inadequate health
system infrastructure. The growing incidence of these diseases results in a reduction
in the quality and length of life and in excessive actual costs and social
opportunity costs. It is incumbent on governments to issue health-related
regulations to meet and promote public health interests outside of industry’s
profit maximization strategies and to develop constructive public-private
health policy partnerships.
13. The
advance of non-communicable and chronic diseases must be stemmed by helping
remove unhealthy life conditions and lifestyles. Conditions such as health
illiteracy, toxic environments, impediments to treatment and care need to be
eradicated. Harmful lifestyles such as inadequate nutrition, drug abuse,
alcoholism, tobacco smoking, and the consumption of other toxic products, and
dependencies need to be abandoned. Multi-sectoral, gender-based, comprehensive
strategies pursued by civil society, including also health professionals,
scientists, faith-based organizations, the private sector and policy-makers,
must be set up for effective global action.
14. Concrete
follow-up action should comprise (i) the inclusion, in the MDGs and UN
agency programmes, of quantifiable action against the spreading of
communicable, non-communicable and chronic diseases; (ii) the creation of
a Global Fund to address such diseases that do not have such funding
mechanisms; (iii) the adjustment of international health regulations to
include a strengthened focus on such diseases and the management of
risk-related factors; (iv) the revision of international trade agreements
and legislation in favour of healthy food and decent labour-related
productivity standards and markets; and (v) political action highlighting
the right to health, including access to quality medicine and health care for
all, the facilitating of the local manufacturing of safe medicine, covering
also the development and production of generics and traditional medicine.
Financing Global Access to Health Including Health
Technologies
15. Good health is an asset and should be preserved. People
should be aware that good health is a right and a responsibility. Emphasizing
prevention in primary health care will help reduce pressure on available
resources, especially government resources which can be allocated to those who
need most such resources. Communities as well as states should create their own
programmes to make their health system more efficient.
16. Ancestral indigenous people’s
medicine must be recognized and respected, and adopt health policies that take
into account the particular realities in each country. The holistic approach of
indigenous medicine complements western medicine and needs to be included when
shaping national health policy and practice. A change of attitude, including an
intercultural approach, should take place to overcome the hegemonic approach of
modern medicine as the only existing answer to health care. Efforts should be
made to shift towards a harmonious coexistence of both modern and ancestral
medicine for the benefit of all peoples.
17. Promotion of innovative
user-oriented information and communications technology (ICT) could support
independent living, especially for elderly and disabled persons. Skills and
infrastructure for low-income countries need to be developed to enable them to
use ICT, such as e-Health and m-Health for medical education and information
systems. Use of ICT will reduce costs and lead to a better and more efficient
health care system.
Ensuring the Right
to Health for Women throughout the Life-Cycle
18. Women’s health, including
reproductive health, must be promoted throughout their lifecycle by providing
gender sensitive medical care. Healthy mothers and healthy babies make for
healthy societies. Continuing and expanding financial and political support for
MDG 5 is critical. We must break out of the scandalous lack of progress on this
goal. Investing in maternal and child health is a precondition for the health
of families, communities and nations and not only the health of half of
humanity.
19. Most
national budget allocations are used to cover curative services and the
recurrent costs of health facilities and services; very few resources are
deployed for prevention, promotion and rehabilitation. The availability and
accessibility of essential health services are often inadequate. This has
resulted in considerable inequalities in health-care provision and access,
especially among women and other vulnerable groups.
20. Donor and recipient countries,
as well as NGOs, must be supported in introducing good governance, efficient
planning, accountability and responsible approaches of communities at regional
and local levels. Scientific research into gender medicine needs to be funded
to provide data for optimal health programmes taking into account differences
between men and women, age groups and ethnicity.
Promoting
Prevention and Treatment of HIV/AIDS
21. Governments and
intergovernmental agencies must broaden the concept of HIV/AIDS prevention and
address the social determinants of health regarding vulnerable populations,
including women and people who live in abject poverty and hunger. Resources for
HIV/AIDS programmes are threatened by the financial crisis which should not be
used as an excuse to stop funding them. Countries need to keep their commitment
and allocate resources to address HIV/AIDS. The Global Fund should be made more
accessible for HIV/AIDS resources and should work towards ensuring that
resources get to the needy. HIV/AIDS programmes and policies should make
scaling up possible at the national level.
22. Governments need to commit
themselves to keep their promise of 0.7% of their GDP, which would help towards
attaining the MDGs. Civil society needs to hold up that issue in ECOSOC’s
debates. Coherence within UN agencies must be encouraged to avoid duplication
of services.
23. National health systems should
be strengthened and measures taken expeditiously to confront the brain drain
phenomenon. Governments should be urged to exercise pressure on pharmaceutical
companies and laboratories to produce diagnostic tools, child-friendly
medicines, and to provide universal access to antiretroviral drugs. The
disbursement of funds for HIV/AIDS programmes at the global level should be
closely monitored.
Youth perspectives
on the CSDF
24. Youth participants asserted
that meaningful participation includes being immersed and knowledgeable about
the issues under discussion they mostly only hear about. The introduction of
new approaches, such as dialogue through existing social structures, is a way
to present information related to the daily experience of young people. These dialogues
can help initiate change in communities.
25. Young people need a voice in
global governance systems but, to do so, it is crucial that they can feel a
sense of purpose and respect. When encouraged to speak with their opinion being
valued, recognizing that “youth speak truth,” they are empowered to talk about
their experiences. They stressed the importance of having even more
youth-sensitive speakers in the future, and moderators skilled in facilitating
discussion.
26. Many youth are faced with inadequate
health care services and feel that the health care system needs to be taken
beyond a monetary world. For youth, a new service-based health system should be
seen as a social duty and a new global ethic. The idea of “design for all”
services should encompass the development of a truly generally accessible
global health network. Accessibility denotes prior access to the system, but
what about those who have no access?
Cross-cutting
themes and other issues
27. Civil society advocacy for the
MDGs must redound to the betterment of life and living conditions of people
around the world, especially the extremely poor and the hungry who are also the
most deprived, oppressed and marginalized. In the economic downturn, we must
not renege on ensuring their health and in turn the health of the entire human
community. A review of internationally agreed development goals is a review of
humanity’s commitments to life-giving and life-enhancing activities, and a
review to combat those that deal with and peddle violence and death.
28. CSDF continues to reaffirm the
intersections and interdependence between human rights, peace and security, and
sustainable development. These very values undergird, enhance and sustain a
healthy human life, planet and the whole ecological system. The human right to
health is equally the human right to a healthy and sustainable ecological
system. The health of human beings and the planet are inherently intertwined.
The health of women is also greatly affected by, and particularly vulnerable to,
environmental changes. Sustenance is an essential element of health. Food must
be ensured for all. Without food, health goals are meaningless. Profit
structures, including especially those affecting the food production and
distribution chain, must favour and ensure availability of safe, healthy and
affordable food for all.
29. WHO defines health as “a state
of complete physical, mental, and social well-being and not merely the absence
of disease or infirmity.” But it must be more. The starting point for a human
rights-based approach to health is to redefine health beyond being a mere state
but rather recognize it as a potential allowing people to deal with challenges
to their bodies and the social determinants of their health. It is a potential
for becoming fully human and humane. Focus on prevention, cure and care and for
healing and wholeness, require us to demand that health care, to be viable and
sustainable, must be affordable, acceptable, accessible, and adaptable. It must
be a health system that is socially responsive, policy-based,
contextually-appropriate, and gender-sensitive. Primary health care should in
itself be comprehensive.
30. The use and abuse of alcohol is
a global problem that spans both physical and mental health. It is
multi-faceted with issues varying across cultures. The benefits connected with
the production, sale and use of alcoholic beverages come at an enormous cost to
society. Acute and chronic disease and psycho-social problems are integrally
linked. Physical toxicity, intoxication, and dependence explain alcohol’s
ability to cause medical, psychological, and social harm. Like WHO, NGOs must
be mobilized to promote alcohol policies which safeguard from the negative
consequences of alcohol abuse. NGO alliances must be enjoined to own the
problem of alcohol addiction and help monitor alcohol marketing. NGOs must help
foster political will to reduce the global burden of disease caused by alcohol.
31. Global public health is a
challenge to socio-economic policies. Health is not primarily an economic
outlay but the foundation for productivity and the enjoyment of human rights
and dignity. Public health cannot be a mere consumer good for it is a
fundamental building block of society. The right to and equal access to health
care implies a just and equitable health for vulnerable populations. Thus,
society needs to ensure that public policies consider the implications of
social and economic conditions--determinants that either increase or decrease
the risk and vulnerability of specific populations.
32. Health financing by governments
should go beyond financing health care systems but include investing in the
preconditions of health, including freedom, education and economic welfare. In
so doing, financing health should not be seen as an economic burden but an
investment in people contributing to sustainable development and being a major
contributor to gross national product. Health systems function properly with several key elements, such as
adequate numbers of skilled health workers, basic infrastructure and equipment,
essential medicines and supplies and health financing systems. They underscore
the importance of establishing effective health information systems.
33. Empowering youth is an
investment today as well as in future for their meaningful participation in
decision-making for themselves and of society.
Increased funding and research must be allocated to attend to the health
of young people. Greater attention must be given to the high disease burden of
the above sectors, including the high prevalence of depression and suicide
rates among the youth. Health strategies must guarantee accessibility to health
services for the youth. Promoting youth participation in decision-making is a
key element in ensuring the provision of youth-friendly health services,
including opportunities for employment and decent wage, and thus a healthy and
productive youth population.
34. A national eHealth legislative framework should
provide the basis for protecting data, users and citizens from misuse. Health
information for citizens involves access to information for health promotion,
health education, health literacy and awareness. These require consideration of
legal and ethical aspects such as the quality and credibility of information,
whether or not it is evidence-based, the source, conflicts of interest, and
consent. Access to information across organizational and geographic boundaries
should not limit access to health data and information, and must be managed
through agreed protocols for data protection, privacy and authenticity.
35. E-health is
an emerging field in the intersection of medical informatics, public health and
business, referring to health services and information delivered or enhanced
through the Internet and related technologies. In a broader sense, it is more
than a technical development, it is a way of and a commitment for networked and
global thinking, to improve health care locally, regionally, and worldwide by
using information and communication technology.
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