When the world experiences a health emergency, the political energy in the global system increases, and an opportunity for major change is created.
The Ebola crisis in West Africa has given rise to such an increase in energy. Many distinguished experts have already examined or are in the process of examining the response to Ebola. Countries are understandably looking forward to the positive action that should flow from all these words.
But we have been here before. The International Health Regulations (IHR) review committee set up in the wake of the 2009 influenza pandemic concluded that ‘the world is ill-prepared to respond to a severe pandemic or to any similarly global, sustained and threatening public-health emergency’. And yet, we are still searching for the political and organizational traction to make a real difference. Furthermore, whatever happens to improve our management of infectious disease outbreaks, no matter how important they are, we must resist the temptation to focus solely on them and ignore the wider requirements of a system aiming to be fit for the post-2015 era. We have to deal with health in the broadest sense, and many of the drivers are outside the health sector, including those for example in the financial, education, energy and environment sectors. We must also take into account demographic shifts, along with economic and political developments.
The importance of the SDGs
In this sense, the UN Sustainable Development Summit last weekend was very timely. World leaders have now adopted the new Sustainable Development Goals (SDGs) − 17 goals with 169 associated targets − reflecting the complex needs of a world facing extreme poverty, inequality and injustice and the ever-present threat of climate change.
Goal number three explicitly relates to health: ‘to ensure healthy lives and promote well-being for all at all ages’. It includes targets for achieving universal health coverage and access to quality health care; reducing newborn, child and maternal mortality; ensuring universal access to sexual and reproductive health-care services; fighting communicable diseases and epidemics; and preventing and treating non-communicable diseases.
The whole SDG process has reinforced how critical it is to have the engagement of all sectors and disciplines, an approach that has been noticeably lacking in many areas of global public health.
The need for stronger leadership and stewardship and for top-quality governance in global health is obvious, and some possible reform options to address this need are beginning to emerge. A proposal put forward at Chatham House involves the creation of a new United Nations health organization, along the lines of UNAIDS but covering the whole of global health.
In essence, this could have a modernized World Health Organization at its centre, and would work across sectors, bringing together those UN agencies with health-related mandates to provide more coherence and integration. The governing body of such an organization must of course include non-state actors, with strong civil society involvement. Another, perhaps less radical, option sees the creation of a UN Health Commission – a global forum for multi-sectoral engagement, reporting directly to the UN Secretary General. This said, the detail remains to be developed, and as usual ‘the devil is in the detail’.
Unfortunately, it remains the case that much of the international debate has so far focused on the diagnosis of the problems. With the rare alignment of the political energy from a major health emergency and the agreement of the ‘2030 Agenda for Sustainable Development’, we now have a golden opportunity to find the cure. Our priority must be to encourage and facilitate the new dialogue for change − how do we actually build the global health system that can deliver on the aspiration of the SDGs?
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