Transcript SUSTAINABLE DEVELOPMENT DEFINITION - EcoHealth-Live

ECOHEALTH
Sustaining Ecosystems. Supporting Health
4th Biennial Conference of International Association for Ecology and Health
15–18 October 2012, Kunming, P.R. China
Health and Sustainability Challenges of
the 21st Century
Jacobo Finkelman
“Health is a state of complete physical, mental and social well-being and not
merely the absence of disease or infirmity”. WHO, 1946
health: increasingly complex and dynamic
Epidemiological
Demographic
changes
Environmental
Social
determinants
Technological
innovations
development
health
ethical
cultural
political
Biomedical
Health care
A new paradigm integrating health in sustainable
development
Health is a precondition for and an outcome, as well as an indicator of all three
dimensions of sustainable development. (Future We Want, 2012)
Social
Health
Economic
Environmental
4 Decades of UN Summits and High Level Meetings
Stockholm,1972
Alma Ata, 1978
Ottawa ,1986
Brundtland
Report ,1987
ECO
1992
Human Rights, 1993
Population ,1994
Women,1995
Social Develop 1995
COP 1 CC, 1995
Habitat II , 1996
Food,1996
MDG
2000
Monterrey, 2002
Millennium II,
2005
Millennium III,
2010
Johannesburg,
2010
RIO+2
0
2012
2015
UN CONFERENCE ON ENVIRONMENT AND DEVELOPMENT. RIO, 1992
INTERNATIONAL TREATIES
•UN Framework Convention on Climate Change (UNFCCC)
•UN Convention on Biological Diversity (UNCBD)
•UN Convention to Combat Desertification (UNCCD)
AGENDA 21
ROAD MAP
40 CHAPTERS
CH. 6 HEALTH
No Targets,
indicators and
operational
definitions
RIO DECLARATION ON ENVIRONMENT AND DEVELOPMENT
PRINCIPLE 1
“Human beings are at the centre of concerns for sustainable development. They
are entitled to a healthy and productive life in harmony with nature”
UN CONFERENCE ON SUSTAINABLE DEVELOPMENT, RIO 2012
Rio + 20
CENTRAL THEMES
(a) economy in the context of sustainable development and poverty eradication
(b) Institutional framework for sustainable development
THE FUTURE WE WANT (six sections, 283 paragraphs)
MAIN OUTCOMES
•Renewed commitment to sustainable
development
•Eradicating poverty is the greatest
global challenge
•Promoting sustainable production
and consumption. Green economy
•Reversing global environmental
changes
•Commitment with MDG and SDG
•Democracy and governance
•Intensive participation of civil society.
~ 3000 non – official paralel events
•Health better positioned as initially
expected
MAIN SHORTCOMINGS
•Green economy severely questioned
by social movements
•No major break troughs on
institutional governance
•Lack of goals, targets and indicators
•Lack of financial commitments
Major heath issues addressed at ECO 92 and Rio + 20
ECO 92
RIO + 20
Paragraphs 138-146
Ch 6. Protecting and Promoting Human
Health
a) Meeting primary health care
needs, particularly in rural areas;
b) Control of communicable
diseases;
c) Protecting vulnerable groups;
d) Meeting the urban health
challenge;
e) Reducing health risks from
environmental pollution and
hazards
a)
b)
c)
d)
e)
f)
g)
h)
i)
Universal and equitable health
coverage
HIV and AIDS, malaria, tuberculosis,
influenza, NTDs and polio
NCD: cancers, CV, CRD and diabetes
Health effects of air, water and
chemical pollution
TRIPS. Public health rights
Strengthen health systems. Financing,
retention of work force
Population trends and projections in
development strategies and policies
Sexual and reproductive health
Reduce maternal and child mortality
Millennium Declaration 2000
PRINCIPLES
a) Development and poverty eradication b) Peace and security
c) environmental conservation d) democracy and human rights
MDG
8 GOALS, 18 TARGETS AND 48 INDICATORS
GOAL 1: eradícate extreme poverty & hunger
GOAL 2: achieve universal primary education
GOAL 3: promote gender equality and empower women
GOAL 4: reduce child mortality
GOAL 5: improve maternal health
GOAL 6: combat HIV/AIDS, malaria and other diseases
GOAL 7: ensure environmental sustainability
GOAL 8: develop a global partnership for development
Three years to the deadline.
UN sources
People living in extreme poverty (less than $1.25/day) fell from 47 to 24% (1990 - 2008) a
reduction from over 2 billion to 1.4 billion individuals. Yet, 15.5% of the world population
is undernourished. (2006- 2008)
Access to safe drinking water raised from 76 to 89% (1990 – 2010) Over two billion
people gained access to improved drinking water. Great disparity between urban and
rural.
Half of the population in developing regions—2.5 billion—still lacks access to improved
sanitation facilities. By 2015, the world will have reached only 67% coverage, well short of
the 75% needed to achieve the MDG target.
Urban residents in slums declined from 39 to 33% by 2012. Yet, in absolute numbers the
slum population grew from 650 to 863 million (1990 – 2010)
Enrolment rates of children of primary school age increased and drop-out school rates
decli8ned. Parity in primary education between girls and boys grew from 91 to 97 (1990 2010)
Three years to the deadline
UN sources
Child survival progress is gaining momentum. The number of under-five deaths
worldwide fell from more than 12.0 to 7.6 million (1990 – 2010)
Despite some improvements decreases in maternal mortality are far from the
2015 target. Since 2000, reductions in adolescent childbearing and expansion of
contraceptive use have continued at a slower pace
Access to treatment for people living with HIV increased. 6.5 million were under
antiretroviral therapy (2010). The target of universal access, has not been reached.
The world is on track to achieve the target of halting and reversing the spread of
tuberculosis
Global malaria deaths have declined
The estimated incidence has decreased globally by 17% since 2000 and, mortality
rates have decreased by 25%.
Health MDGs gained traction for a number of reasons.
• Encapsulated some of the most serious challenges affecting child and
maternal mortality, infectious diseases including HIV/AIDS, malaria and
tuberculosis.
• Financial and technical support (Global Fund, GAVI, RBM)
• Built upon decades of development efforts expressed through global and
regional conferences
• Simple format of concise goals, targets and indicators with defined time
lines intuitively attractive and readily understandable.
Lessons learnt from the health-related MDGS
• A top down, technocratic approach to the selection of goals, targets and
indicators. From global to national: a difficult translation
• Limited organized framework for health and development
• Reductionist
approach between the goals, targets and indicators.
• Relevant issues were left out
• Lack of clarity in definitions and limited attention to its feasibility
• Variability in the formulation of the targets.
•Lack of attention to disaggregated monitoring process. Uneven distribution of
benefits
International financial assistance
2000 - 2010
SUSTAINABLE DEVELOPMENT
“development that meets their present needs without compromising the ability of
future generations to meet their own” Our Common Future, 1987
Sustainable
development
Shared values:
Solidarity, equity, dignity and respect for nature
Integrated framework post 2015
Universal access to quality care
Spending on health: A global overview
WHO, 2012
Spending on health: A global overview
WHO, 2012
Universal Health Coverage
“Is a system in which everyone can get the health services they need without
incurring in financial hardship”
WHO, 2005
Health care
Public health
Market
HEALTH CARE “The prevention, treatment, and management of illness
and the preservation of mental and physical well-being through the
services offered by the medical and allied health professions”. Medical
Dictionary, 2007
• Disease oriented( past individual exposures and biological/genetic
disorders)
• Traditional preventive programs (proximal)
• Services are segmented and fragmented
•Hospital driven. Week PHC
• Offer and demand unbalances
•Ill prepared to address demographic, epidemiological, technological,
economic, cultural, information and political changes
PUBLIC HEALTH “is the science and art of preventing disease, prolonging life,
and promoting physical health and efficiency through organized community
efforts” Charles Winslow, 1920
• future oriented. Public good
• collective or social actions (proximal and structural)
• strong ethical and human rights foundations
• shared responsibility (governments, communities, families, and individuals )
• Ill prepared to address demographic, epidemiological, technological,
economic, cultural, information and political changes
Social determinants of health
The social determinants of health are the conditions in which people are born,
grow, live, work and age, including the health system. These circumstances are
shaped by the distribution of money, power and resources at global, national
and local levels. The social determinants of health are mostly responsible for
health inequities - the unfair and avoidable differences in health status seen
within and between countries. WHO Commission on Social Determinants of Health. 2008
Key commonalities between PHC and the SDH paradigms
•Central focus on health equity.
•Relevant in all countries and contexts, regardless of income level.
•Health is more than the absence of disease.
•Key role for health sector.
•Promotion of multisectoral action and consideration of health in all policies.
•Emphasize role of empowered communities
market
Debate is focused on:
costs rather then health outcomes
 private/public mix of providers
 profit – human rights
 social inclusion – exclusion
 global – local
 steering process (citizens, state market)
Universal Health
increasingly driven by the expectation that health can be created, managed
and produced
World Health Summit
Berlin, Germany
Oct 21 -24 , 2012
8th Global Conference
on Health Promotion
Helsinki, Finland
10-14 June 2013
World Health Summit
Berlin, Germany Oct 21 -24
Goals
•To engender improvement of health care worldwide by strengthening
the links in place between research, academic medicine and decision
makers across all healthcare sectors, including government and industry.
•To influence, guide and support positive action by policy and decision
makers through the provision of credible and scientifically-based
evidence.
•To maintain an international, multi-sectoral health forum, sustaining
dialogue, creating networks and fostering collaboration as a catalyst for
innovation and measurable health care improvement.
•To promote thought leadership through academic input into the
scientific and global health agenda.
8th Global Conference on Health Promotion
Helsinki, Finland 10-14 June 2013
Conference aims
• exchange of experiences to provide guidance on effective mechanisms for
promoting intersectoral action
•address barriers and build capacity for implementing HiAP
•implement recommendations of the Commission on Social Determinants of
Health through HiAP
•review economic, developmental and social case for investing in HiAP
•health promotion in the renewal and reform of PHC
Governance
• The call for governance innovation is a major
consideration in all international documents
• Reduce fragmentation/overlapping
• Increase coherence, transparency and efficacy
• Not universal consensus on its meaning.
Involves: actors, organizational structures and
practices, in a given context (subnational, national,
regional, global)
Multi and Intersectoriality adds complexity
Science and perceptions are both relevant
Post 2015 SDG Challenges
Issues:
• New narrative, new instruments, old policies?
• Clear set of values (human rights, equity, sustainability)
• Multidimensionality of human well – being
• Interrelated global, national and local problems
• Stronger emphasis on poverty elimination. Empowerment of most
vulnerable
• Unfinished agenda (vertical – comprehensive)
Process:
• Highly competitive.
• Global goals, but countries should adapt targets to national and subnational
contexts through democratic consultations
• Clarity in definitions and measurement
• Realistic time horizons
post-2015 UN development agenda road map
National consultations May 1, 2012 - Jan , 2013.
Thematic events . Nine thematic events on key post-2015
High-level Panel on Post-2015 Jul 1, 2012. Report Feb 1, 2013..
Sustainable Development Solutions Network. Aug, 2012
General Assembly High-level Meeting on MDGs Sep 23, 2013
National consultations, beyond 2015
AFRICA
Angola, Burkina Faso, CAR, DRC,
Ethiopia, Ghana, Kenya, Mali,
Malawi, Mauritius, Mozambique,
Niger, Nigeria, Senegal, South
Africa, Tanzania, Togo, Uganda,
Zambia
ASIA AND PACIFIC
Bangladesh, Bhutan, Cambodia,
China, India, Indonesia, Iran, Lao
PDR, Pakistan, Philippines, PNG,
Samoa, Solomon Islands, TimorLeste, Vietnam
LAC
Bolivia, Brazil, Colombia, Costa
Rica, El Salvador, Guatemala,
Honduras, Peru, Santa Lucia
ARAB STATES
Algeria, Djibouti, Egypt, Jordan,
Morocco, Sudan
EASTERN EUROPE AND CIS
Albania, Armenia, Kazakhstan,
Moldova, Tajikistan, Turkey
thematic events beyond 2015
Health in the Post-2015 Development Agenda
Global conversation . Call for Papers
1.
2.
3.
4.
5.
What are the lessons learnt from the health related MDGs?
What is the priority health agenda for the 15 years after 2015?
How does health fit in the post 2015 development agenda?
What are the best indicators and targets for health?
How can country ownership, commitment, capacity and accountability for
the goals, targets and indicators be enhanced?
6. How can we ensure effective working relations between countries and global
partners in terms of alignment and harmonization with a focus on
development results?
Manuscripts (maximum 3000 words, excluding annexes) should be submitted by
email to [email protected] Oct 5 – Dec 15, 2012. English or French.
Face to face consultations
•II Global Health Systems Research. Beijing, China. Nov 1-2,2012
•WHO consultation, Geneva, mid-December
“The challenge is how to frame an overarching health goal and
target in a way that drives change that is relevant for all
countries; that acknowledges health as a global concern that
appeals to politicians to the public; and is actually mesurable. No
easy task”
UN SYSTEM TASK TEAM ON THE POST 2015 UN DEVELOPMENT AGENDA
http://www.worldwewant2015.org/health