Ensuring healthy lives after 2015

June 2013 The Lancet; It isn’t perfect, but it is a passionate, rigorous, and radical statement about the scale of our common predicaments and the need to initiate an inflection point in the trajectory of nations. The heads of state of Indonesia (Susilo Bambang Yudhoyono), Liberia (Ellen Johnson Sirleaf), and the UK (David Cameron) chaired the High Level Panel of Eminent Persons on the Post-2015 Development Agenda. Their report, A New Global Partnership: Eradicate Poverty and Transform Economies Through Sustainable Development, was published last week. Their vision is progressive, inclusive, and internationalist.

The Panel’s timeframe is 2015–30, and its two big ideas are ending poverty and promoting sustainable development. One can discern a set of six principles underpinning its argument. First, universalism. The coming era of human development is about all of us, not just some of us. It is about a universal set of human rights. It is about equity. It is about embracing the additional billion people who will share our planet by 2030. Second, sustainability. The Panel’s understanding of sustainability goes beyond the weak idea that the world simply needs to add “environment” to its prescriptions for development. Sustainability means “structural changes in the world economy”. It means addressing unsustainable human production and consumption patterns. It means addressing climate change. Third, peace. The Panel criticises the MDGs for ignoring conflict and violence. Peace is an essential ingredient of development. The inclusion of peace as a principle sensibly unites foreign and development polices. Fourth, girls and women. Most people living in extreme poverty are female. Women and girls face violence, exploitation, and exclusion from health services, education, economic opportunity, and political participation. Fifth, multilateralism. The Panel calls for a “new era for multilateralism and international cooperation”. And finally, accountability. The Panel seeks a data revolution. This revolution means investing in stronger national statistical systems, creating a “single locus of accountability” and “one review” mechanism that should be UN-led every 1–2 years.

The product of this analysis is a set of 12 goals and 54 targets. There were disagreements and there are gaps in the detail (eg, “Decrease the maternal mortality ratio to no more than × per 100 000”). But here they are: end poverty, empower girls and women, provide quality education and lifelong learning, ensure healthy lives, ensure food security and good nutrition, achieve universal access to water and sanitation, secure sustainable energy, create jobs, manage natural resource assets sustainably, ensure good governance, ensure stable and peaceful societies, and create a global enabling environment, including long-term finance. 16 targets have an explicitly health dimension. The health goal—ensuring healthy lives—has five targets: ending preventable under-5 mortality, increasing vaccination coverage, reducing maternal mortality, providing universal access to sexual and reproductive health services and rights, and diminishing the burden of AIDS, tuberculosis, malaria, neglected tropical diseases, and priority non-communicable diseases. The Panel focused on health outcomes, not the means to those outcomes. But it did single out Universal Health Coverage—access to a broad range of affordable, quality essential health services—as a further objective. There is an interesting line about creating “goal specific global partnerships”, suggesting an opportunity for better integration and coordination. Disappointments? The commitment to NCDs is weak (the Panel framed chronic diseases as a high-income country issue, which is wrong). By not making Universal Health Coverage a target, it will inevitably be deprioritised. The commitment to civil registration and vital statistics systems—”Provide free and universal legal identity, such as birth registrations”—is insufficient to meet the hope of a “data revolution”. And the notion of “mutual accountability” is too soft. Only independent accountability can monitor, review, and remedy the problems and obstacles ahead. But these criticisms should not detract from the overall success of the High Level Panel’s work. The Panel calls for a global summit in 2015 to bring together parallel processes on post-2015 goals and financing. The target date is Jan 1, 2016. We have 30 months to get this right.

 

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