Lancet-University of Oslo Commission on

Global Governance for Health

Main Findings

Rita GiacamanInstitute of Community and Public HealthBirzeit UniversityCommissioner: Lancet UiO Commission

* Power and politics: analysis of power structures and dynamics at the global, not only national levels, to understand the social and political determinants of health (the causes of causes).

* With globalization, health inequity results from transnational activities with actors of different interests and degrees of power.

* Actions of such actors are not necessarily designed to harm health, but can have negative effects creating and increasing health inequities.

* Call for a focus on global political interactions across all sectors affecting health. We call them global political determinants of health.

The Framework

* Global political determinants which negatively affect the health of some groups relative to others are unfair, and can be avoided by improving how global governance works – for health.

* Case analyses show that in the contemporary global governance landscape, power asymmetries between actors with conflicting interests shape the political determinants of health.

* Cases show that market power: i.e. economic power, can shape global rule making, with important effects on health.

The Framework

* The report examines power disparities (differences)

* and dynamics across a range of policy areas that affect health

* and that require improved global governance.

* This includes:

The report

Economic crises and austerity measures – Greece as an example

The Greek crisis is linked to transnational crises beyond the control of the Greek government.

Despite this important factor, under pressure from the EU and foreign investors, Greece took a bailout package, in the form of an austerity packages as the only viable economic recovery path, with adverse health effects.

Evidence demonstrates than when fiscal policies that protect health and social welfare are implemented, economies can recover without adverse health outcomes.

Economic crises and austerity measures – Greece as an example

Instead of cutting spending (as has happened in Greece), government should stimulate the economy during times of crises through increased spending, accepting a temporary increase in public debt that would be counterbalanced by surpluses when the economy became stronger .

What does this mean for Palestine given what we constantly hear about the need to reduce spending on social protection,

especially in the face of continued Israeli colonization and military occupation of Palestinian land?)

Economic crises and austerity measures

Iceland is an example of investment in times of crisis rather than cuts in social sectors, an example of a viable path to recovery.

But the Greek government did not have enough power to deal with the EU etc, with catastrophic results (unemployment, cuts in health service provision etc). Power imbalance…..

How does this relate to the Palestinian power situation? How much weight is given to people’s health in

economic policy making, with interests of lenders against borrowers in economic crises.

What does development means: is it about markets and money to the exclusion of what this does to people and human development??

Economic crises and austerity measures –

Is there adequate accountability for international policy makers for the health effects of their decisions?

This is why, our view as a commission is that:

Social protection is an alternative path to recovery.

That is, austerity measures are an example of how political determinants of health can flow from global governance processes.

Knowledge and intellectual property and foreign investment treaties:

Intellectual property rules have a negative impact on health equity. Examples includes the World Trade Organizations’ Trade-Related Aspects of Intellectual Property Rights (TRIPS).

The objective of TRIPS is to secure benefit to authors, through monopoly, as in drug patents, an incentive for private investment in research.

But the introduction of patents on drugs enable monopoly pricing for these products, raising concern about affordability, especially for poor population.

Knowledge and intellectual property and foreign investment treaties:

Ironically, the right to health includes access to essential drugs. Thus the adverse effect of patent monopolies on prices and availability of drugs has made it difficult for countries to comply with their obligations to respect, protect, and fulfill the right to health.

Do we synthesize medications in Palestine or do we package?

What are the impediments to medication synthesis? How does this relate to TRIPS, and our ability to

maneuver to ensure the right of medications to all at affordable prices?

Knowledge and intellectual property and foreign investment treaties:

Copyright is another issue, the cost of accessing scientific publication.

Restrictions on access to knowledge can and does widen existing knowledge disparities, and restrict access to information that is central to improvement of health.

This also raises the question of knowledge production: who produces knowledge (given access to the literature without which we cannot produce knowledge) and what does this mean for the others, including Palestinians?

Tobacco

Worldwide consumption of tobacco products is increasing despite widely held knowledge of the harm of tobacco use for health.

Tobacco use is falling in high income countries in response to tobacco control policies.

So this prompted the global tobacco industry to seek new customers by shifting marketing efforts to low and middle income countries, where nearly 80% of the world smokers live.

Thus the health consequences of smoking are disproportionately born by the most disadvantages groups in society.

TOBACCO

Howe is this played out in Palestine? Marketing? Advertizing? Powers that be complicit in money making at the expense of ill health? Sales of tobacco to minors? Policies and controls?

That is, while the Palestinian Authority must address this problem urgently,

this is also a global governance issue, where the tobacco industry needs to be addressed by global policymakers, not only local ones.

This is another example where public health is subordinated to private wealth making, in southern countries and in Palestine as well.

“Armed violence”, which, in the Palestinian case, is Israeli military occupation and colonization of Palestinian land

We Palestinians have been enduring what is called the New Wars. The new wars affect civilians, ordinary people which are often targeted, and not only the destruction of health services, and infrastructure necessary to support civilian life and function; and where wars and conflicts create the problems of refugees and displaced people.

Indeed the 2002 invasions of the West Bank towns and the 2008-2009 winter war waged by Israel on the Gaza strip are examples.

What did the world do other than watch what is happening, and then move in with humanitarian emergency aid after the fact?

Why did the world not intervene to stop the onslaughts?

“Armed violence”, which, in the Palestinian case, is Israeli military occupation and colonization of Palestinian land

Where are the responsible political and security

institutions responsible for implementing the

Geneva Conventions and other UN charters?

Why did they not act?

Or not act effectively?

How are they addressing grave and protracted

violations of human rights of Palestinians?

How is this related to power disparities?

Key messages

The report entails a shared conviction that the present system of global governance fails to adequately protect public health.

This failure strikes the most vulnerable, marginalized and poorest population, leaving them with the heaviest health risks and disease. This is not about poverty but about socio-economic inequality, and power asymmetry.

The unacceptable health inequities within and between countries cannot be addressed within the health sector, by technical measures, or at the national level alone, but require global political solutions.

Norms, policies and practices that arise from transnational interactions should be understood as political determinants of health that cause and maintain health inequities.

Key messages

Power asymmetry and global social norms limit and constrain action on health inequity, reinforced by systemic global governance dysfunctions and require action across all policy arenas.

Independent monitoring of progress ineeded to redress health inequities, and in countering the global political forces that are detrimental to health.

State and non-state stakeholders across global policy arenas must be better connected for transparent policy dialogue in decision-making processes that affect health.

Global governance for health must be rooted in commitment to global solidarity and shared responsibility

Sustainable and healthy development requires a global economic and political system that serves a global community of health people on a healthy planet.

How do we translate these statements to the Palestinian context Given ongoing colonization and Israeli military

occupation? Given the power asymmetry between Palestinians and

Israel? Given the Israeli control of the Palestinian economy,

and land, water sources, other sources, air space, waters… and lives?

Given the chronic violations of human rights? What is global solidarity about in the Palestinian

context, with US support of Israeli intransigence? What is the role of Europe? The EU?

Conclusion

The Commission suggests: A UN multi-stakeholder platform on Global

Governance for Health. Policies, regulations and actions with major implication

for health are now compartmentalized. To enable global policies for health, a multi-stakeholder

platform should be considered, engaging governments, inter-governmental organizations, and non- state actors including civil society, academics, and business.

The Platform should derive its legitimacy from the UN and serve as a policy forum with space for diverse stakeholders to frame issues, set agendas, examine and debate policies with effect on health, and identify barriers and propose solution for concrete policy processes.

Conclusion

An independent scientific monitoring panel on global social and political determinants of health.

Such a panel would be grounded in a network of academic institutions and centers of excellence across all the world region.

The Panel will deploy the best minds to investigate complex interaction of forces that lead to health outcomes, risk factors for adverse health outcomes, and effectiveness of different global governance arrangements enabling and protecting health.

Conclusion

Need to generate data to complement existing information, not only on biomedical outcomes and health systems, but also a political analysis of the social and political determinants of health ( the causes of causes).

Recognize diverse types and sources of knowledge, and work on building research capacity among people whose health is most directly affected by the global social and political determinants of health.

We need to strengthen (in the case of Palestine, implement to begin with) existing sanctions, and weak accountability. Courts?