Global health post-2015: the case for universal health equity

April 2013 Global Health Action; Conclusions-The global landscape is changing. Virtually all reporters acknowledge a global context indistinguishable from the one in which the MDGs were formulated. Climate change, the environment, planetary boundaries, globalisation, the global economic crises, urbanisation, industrialisation, migration, the double burden of non-communicable and infectious diseases, conflict, violence, fragility, and ageing populations are a handful of the ever-more globalised issues that programming and monitoring must be capable of responding to. As stated by the UNTT: ‘It is no longer viable to think of solutions in terms of individual sectors’ (26 p. 10).

In addition, and despite the significant achievements of the MDGs, 1.4 billion remain in conditions of extreme poverty, over 900 million are affected by chronic hunger, universal primary completion and mortality goals are unlikely to be met, and the progress that has been achieved is markedly uneven within and between countries (9–12): ‘part of the explanation for this stagnation in progress lies in a failure to reach the most vulnerable populations … these gaps within and between countries demand a much sharper focus on inequities and their consequences for health’ (26 pp. 4–5). Rooted in the progressive realisation of rights and economic development, UHC is a promising concept. Recent evidence is suggestive of substantial gains, although authors point to the need to consider UHC as a diversity approach that addresses structural inequities and democratic accountability (75, 76).

This review concludes that prioritising universal health equity post-2015 may offer instrumental and substantive co-benefits that subscribe to the original terms of the Millennium Declaration, that respond to the limitations observed in current M&E practice, and that enable attention to the root causes of intractable health problems. As the circularity between measurement and policy becomes more explicitly acknowledged, it is clear that these topics must be measured if they are to be addressed. For more authentic renditions of how and why inequities occur and recur in particular settings and for particular groups, analyses that attend to the structural, political, and economic contexts of health production and distribution, to the globalised political ideologies that underpin public policy, and to the manifest implications for population health are required in broader and more integrated analytical frameworks than exist in the mainstream at present.

Finally, because analysis of equity gives rise to issues traditionally beyond the scope of public health research, a shift in the normative analytical paradigm is also necessary. In this sense, 2015 can be viewed as an opportunity to define a new global health orthodoxy that enables more democratic and critical perspectives through reform of global governance and by fostering inclusion and participation. Based on these observations, discussions on critical and collective cross-sector, country-led dialogues as part of an approach characterised by investment at the national level ensuring continuity, predictability and coherence is recommended to attend to the structural contexts of health inequities, to examine mechanisms by which health and risk are conditioned and produced, and to develop regulatory frameworks to protect fundamental rights and freedoms so that those for whom health and development issues are most relevant define the way forward post-2015.


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