Canadian priorities for post-2015 development agenda

http://www.international.gc.ca/development-developpement/priorities-priorites/mdg-omd_consultations.aspx?lang=eng

• http://www.ualberta.ca/~tkeating/ELLA2.pptx

“everyone has the right to a standard of living adequate for… health and wellbeing of himself and his family, including food, clothing, housing, medical care and the right to security in the event of…sickness, disability…Motherhood and childhood are entitled to special care and assistance. (UN Declaration of Human Rights, 1948, Article 25, paragraphs 1 and 2)

“ ‘health security ’ at its simplest level, can be illustrated by reference to premature and unnecessary loss of life which can be avoided by provision of and access to health care – implying state responsibility for empowering people through national and internationalmechanisms to protect themselves from poor health at the local level.”

Increased interest in the relationship between health, human security and human development by the international community and governments is rooted in the need to protect people from the risks and insecurities brought about by health deficiencies and hazards, often due to particular circumstances of underdevelopment and poverty and conflict.

At Least 30% of Human Deaths are due to poverty-related causes, cheaply preventable through safe drinking water, better sanitation, more adequate nutrition, vaccines or other medicines.

diarrhea and malnutritionperinatal and maternal conditionschildhood diseasestuberculosis, meningitis, hepatitis,malaria and other tropical diseases,respiratory infections- mainly pneumonia,HIV/AIDS, sexually transmitted diseases

(WHO: World Health Organization, Global Burden of Disease: 2004 Update, Geneva 2008, Table A1, pp. 54-59)

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Linkages

Human causes of health insecurity:

investment/private vs. public

policy

conflicts

antibiotic resistance

food borne diseases - ecoli; BSE

bioterrorism

“the burden of disease in low-income countries is further compounded by a litany of chronic, non communicable ailments striking around the globe, notably diabetes, heart disease, and cancer.”

2001 United Nations Security Council resolution identified HIV/AIDS as a security threat, a position reiterated in the

served to raise the profile of the health crisis that was the HIV/AIDSepidemic and to elevate it to a security concern, and a human security concern in the broader sense

The 2001 UN Security Council resolution placed responsibility for health and human security squarely with national governments, but a subsequent General Assembly declaration dispersed this responsibility among non-state actors as well.

these represented a shift from a health system-wide approach to a problem-focused, specific disease-oriented one;

second, they ushered in the establishment of cross-sectoral and broad based partnerships (public– private, philanthropy, and civil society) in the planning, coordination, and governance of global health;

third, they saw the emergence of demand-driven funding andexploitation of market dynamics to stimulate investment in research and production capacity for drugs and other medical products; and

fourth, they emphasized results and evidence-based outcomes as a basis for allocation of global health resources.

Between 1990 and 2010, global health funding grew exponentially, from approximately $5.6 billion to over $28 billion (IHME, 2012 )

Increased activity in the health arena has resulted in:over 40 bilateral donors, 25 UN agencies, 20 global and regional funds, and 90+ global initiatives that target health issues

this has led to overlapping mandates and competition for limited (and in many cases dwindling) resources’ and seeking to influence the content and execution of the global health and human security agenda(Council on Foreign Relations, 2013 ).

Global Fund to Fight AIDS, Tuberculosis, and Malaria (Global Fund) which was established in 2002 as a financing mechanism with the support of the G7, specifically to combat those three diseases;

US President’ s Emergency Plan for AIDS Relief (PEPFAR) established in January 2003 at the behest of then US President George W. Bush, initially committed US$15 billion3 (renewed in 2008 at US$48 billion (H.R. 5501, 2008 )) expressly to combat HIV/AIDS in select low-income countries; and

Global Alliance for Vaccines and Immunization (GAVI), launched in 2000 with an initial $750 million grant from the Bill and Melinda Gates Foundation.”

Millennium Development Goals:

Globally, the number of deaths of children under 5 years of age fellfrom 12.6 million in 1990 to 6.6 million in 2012.

In developing countries, the percentage of underweight children under5 years old dropped from 25% in 1990 to 15% in 2012.

While the proportion of births attended by a skilled health worker hasincreased globally, fewer than 50% of births are attended in the WHOAfrican Region.

Globally, new HIV infections declined by 33% between 2001 and2012.

Existing cases of tuberculosis are declining, along with deaths amongHIV-negative tuberculosis cases.

Worldwide, Africa accounts for 9 out of every 10 child deaths due to malaria, for 9 out of every 10 child deaths due toAIDS, and for half of the world’s child deaths due to diarrhoeal disease and pneumonia.

In low-income countries, the leading cause of death is pneumonia, followed by heart disease, diarrhoea, HIV/AIDS and stroke. In developed or high-income countries, the list is topped by heart disease, followed by stroke, lung cancer, pneumonia and asthma or bronchitis.

Men between the ages of 15 and 60 years have much higher risks of dying than women in the same age category in every region of the world. This is mainly because of injuries, including violence and conflict, and higher levels of heart disease. The difference is most pronounced in Latin America, the Caribbean, the Middle East and Eastern Europe.

Depression is the leading cause of years lost due to disability, the burden being 50% higher for females than males. In all income strata, alcohol dependence and problem use is among the 10 leading causes of disability.

“The world has changed dramatically since 1951, when WHO issued its first set of legally binding regulations aimed at preventing the international spread of disease. At that time, the disease situation was relatively stable. Concern focused on only six “quarantinable” diseases: cholera, plague, relapsing fever, smallpox, typhus and yellow fever. New diseases were rare, and miracle drugs had revolutionized the care of many well-known infections. People travelled internationally by ship, and news travelled by telegram.”

Margaret CHAN, WHO Director General, A safer future, WHO 2007 World Health Report

Responding to changes

More than 2.5 billion airline passengers annually

Infectious diseases can not only spread faster, but are increasing in number: since the 1970s, new diseases have been identified at the unprecedented rate of one or more per year.

More than 1100 epidemic events have been verified by WHO the last five years

SARs epidemic 2002-3; belated reporting from China; 8273 cases, 775-835 deaths

International Health Regulations (IHR) were revised in May 2005, and came into force on 15th of June 2007.

It includes all diseases and health events that may constitute a public health emergency of international concern.

194 States parties to the revised IHR

designed to have the necessary global framework to prevent, detect, assess and provide a coordinated response to events that may constitute a public health emergency of international concern (Article 2 IHR)

The Regulations now cover public health emergency of international concern whatever their origin or source (Article 1.1), including:

(1) naturally occurring infectious diseases, whether of known or unknown etiological origin; (2) the potential international spread of non-communicable diseases caused by chemical or radiological agents in products moving in international commerce; and(3) suspected intentional or accidental releases of biological, chemical, or radiological substances.

Ebola crisis

• 2 yo Guinean boy contracts virus from fruit bats in December 2013

• disease continues to spread as family members mourn their loved ones, no sterile precautions taken

• August 2014, disease spreads to Monrovia

• spreads exponentially

• WHO issued a public health emergency call in September 2014

• 26,571 cases; 10,995 deaths as of April, 2015

Why Does it Spread?

• traditions

• suspicion of outside help

• lack of infrastructure

“Whether it is Ebola or another medical issue, countries will repeatedly experience outbreaks if solutions focus on symptoms and not the underlying need for strong local systems. The Ebola outbreak is the result of a frail health care system. It is imperative that international aid communities join forces with local governments, organizations and leaders in order to contain the virus while being cognizant of the need to also build stronger, more resilient, health care systems”

- Samuel A. Worthington, President of InterAction

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the involvement of military units in public health interventions are a potential source of concern.This type of arrangement has been described as ‘dual usage’ for public health and military purposes (Chen 2004).

some support and encourage this kind of assistance and recommend that it beaccelerated, but there is obviously a potential for conflict of interest (Fidler 2005).

it has also been proposed that ‘since the health services are now in the front line . . . they could get support from government defence and security budgets’ a recommendation supported by some within WHO

if accepted this could raise questions about the neutrality and independence of health care providers

Health care workers are prized by

conflicting parties

Health care facilities are targeted for their

resources

Health care workers overburdened in

response to conflict and its aftermath

Health care systems and support facilities lack

resources

much maligned agency;

heavily dependent on leadership;

but also constrained by member governments

provides information and monitors performance; http://www.who.int/gho/map_gallery/en/

Investment in Health Care Systems:

the world is now short well over four million health-care workers,

aging populations require more medical attention, and are drawing health talent from developing countries.

20% of practicing physicians in the United States is foreign-trained,

if current trends continue, by 2020 the United States could face a shortage of up to 800,000 nurses and 200,000 doctors

“Unless it and other wealthy nations radically increase salaries and domestic training programs for physicians and nurses, it is likely that within 15 years the majority of workers staffing their hospitals will have been born and trained in poor and middle-income countries. As such workers flood to the West, the developing world will grow even more desperate.” (Garrett, Council on Foreign Relations)

Health care spending country comparisons: http://www.theguardian.com/news/datablog/2012/jun/30/healthcare-spending-world-country

Distribution of Pharma Research

Diseases accounting for 90% of the global disease burden receive only 10% of all medical research worldwide. Pneumonia, diarrhea, tuberculosis and malaria, which account for over 20% of the global burden of disease, receive less than 1% of all public and private funds devoted to health research. Of the 1556 new drugs approved between 1975 and 2004, only 18 were for tropical diseases and 3 for TB.

WTO trade rules protected pharmaceutical firms through the adoption of restrictions on copying intellectual property/patent (TRIPS)

WTO Doha Declaration on TRIPS affirmed its members’ right to protect public health, but access to affordable pharmaceuticals was blocked by the requirement that the drug in question only have its patent removed if the state proved that the disease in question was of epidemic and emergency proportions

counterfeit drugs have emerged as a very significant problem, representing more than 10% of seized counterfeit products