The organisation of political power within and between nations and citizens if failing miserably to protect the public's health. Not that you didn't suspect it. But this time there is corroboration, and it comes in the form of findings of a new Commission from The Lancet and the University of Oslo.
These power asymmetries, together with the piecemeal way that global decisionmaking has developed since World War II, are having a disastrous effect on human health, say the report's authors. The fact that people's life chances differ so sharply from one community to another is not imply a problem of poverty — it is one of socioeconomic inequality. Poor countries and populations that are already disadvantaged are suffering the most.
The Lancet-University of Oslo Commission included 18 leaders in research and policy-making from diverse fields, including health, finance, development, environment, human rights, and foreign policy. The team included one expert from India: Jashodhara Dasgupta, coordinator of Lucknow-based Sahayog, an NGO working with women's health and gender equality using human rights frameworks.
The commission gathered evidence over two years to examine how human health is affected by the current system of global decision-making. The findings add to the growing public discontent with an unjust global economic system that favours a very small elite with great wealth at the price of environmental and social degradation that negatively affects health equity.
The study has identified seven areas where political and economic injustices especially affect population health—the global financial crisis and resultant policies of austerity; knowledge and intellectual property; investment treaties; food security; transnational corporations; migration; and armed violence.
For example, global food production is enough to cover 120 per cent of global dietary needs — there is more than enough food to meet global demand. However, the availability of food is not spread evenly. Food security, the team concluded, is a political choice, and political corporate interests are preventing the equitable distribution of food sources worldwide by prioritising wealth over health. This inequity not only affects the millions who experience undernutrition and food scarcity, but also the ever-increasing numbers of people in countries of all incomes who experience ill-health and premature death from overnutrition and obesity.
The commission concluded that existing mechanisms of global governance are unfit for purpose — they are too fragmented and ineffective to deliver better health for the majority of people in the world. As the international community negotiates a post-2015 global development agenda, the commission argued that the current system of global governance for health should be reformed.
The commission’s chair, Ole Petter Ottersen of the University of Oslo, Norway), remarked, “Health inequities are morally unacceptable and exacerbated by the current system of global governance that places wealth creation over human health. Health equity is a precondition, outcome and indicator of a sustainable society and should be adopted as a universal value of a nation’s success alongside economic growth. This should be a shared social and political objective for all.”
What's wrong with the health system
- Democratic deficit: Insufficient participation and representation of certain actors, such as civil society or health experts, in decision-making processes to enable meaningful public engagement
- Weak accountability mechanisms: Insufficient means at the global level ‘to constrain power and make it responsive to the people that it affects, especially people who tend otherwise to be marginalized and silenced’.
- Institutional ‘stickiness’: Current inflexible norms, rules and decision-making procedures that are difficult to reform, thereby reinforcing inequities when the status quo is harmful for health and/or maintains entrenched interests.
- Inadequate policy space: Inadequate means to protect health at both global and national levels, in global policy-making arenas outside the health sector, such that health may be subordinated to other objectives, such as economic or security goals.
- Missing institutions: The total or near absence of international institutions (eg treaties, funds, courts, and softer forms of regulation such as norms and guidelines) to protect and promote health.
The way out
- Formation of a UN multi-stakeholder platform on global governance for health. This can examine and debate policies that have an impact on health and propose solutions.
- Formation of an independent scientific monitoring panel on the global, social and political determinants of health.
- Strengthen existing mechanisms to protect health and build commitment to global solidarity and shared responsibility.
