How many times have you, or a family member, visited a doctor during the last five years? Well, according to the World Health Organization 1 billion people have never had that chance.
How many times have you, or a family member, visited a doctor during the last five years? Well, according to the World Health Organization 1 billion people have never had that chance.
That’s right, one out of every seven people in the world has never received basic healthcare. Imagine one out of every seven people you know getting sick and being unable to access treatment, as a result their health deteriorates, they lose their job, they can’t afford to eat well or pay the rent, and eventually… well I think you get the picture.
This week is UN week, and hundreds of global leaders, non-governmental organisations and activists are gathered in New York hotly debating what will replace the Millennium Development Goals (MDGs) when they expire in 2015. I am particularly interested in the issue of health and have attended a couple of events at the Rockefeller Foundation, where politicians, physicians, journalists and civil society activists gathered with a main focus on human rights and the need to achieve universal health coverage (UHC).
Healthcare as a human right
UHC is defined by the World Health Organisation as “ensuring all people obtain the health services they need, of good quality, without suffering financial hardship when paying for them”.
Access to healthcare is a basic human right. But currently 100 million people fall into poverty trying to access needed care.
At this point the saying ‘which comes first; the chicken or the egg?’ comes to mind. Should we start with education? Should go for food security? But we cannot leave HIV and AIDS out of the agenda. Children are out there, failing to thrive and achieve healthy lives because of a multitude of issues. We need to ensure the new sustainable development goals, which are currently being shaped to replace the MDGs, are linked. They must include shared targets to acknowledge that all sectors of development are interlinked, for example progress on HIV is dependent on education, poverty reduction, gender equality and other sectors.
The ‘chicken and egg’ of development
If women can plan their pregnancies, deliver safely, get vaccines and access basic healthcare, raise their children with enough food, safe water and sanitation, and education, such a different and more equitable world can be achieved.
So back to the chicken and the egg – as an infectious diseases physician I would put my eggs in the basket of ensuring healthy lives, I believe this could be the main entrance to a more equitable and sustainable future.
Next we have to consider who has the key to the main entrance. Well it looks like a lock that requires several keys – from governments and global leaders to the UN, NGOs, business and civil society – everyone has a key and we must co-ordinate if we want the gate unlocked. This also means – using Melinda Gates phrase, speaking during this UN week – all stakeholders need to put on their kakhi pants and spend more time in the field engaging with the people most affected by the issues at stake, from poverty and climate change to access to healthcare and education, and so on.
Building on the Millennium Development Goals
In 2000, leaders of 189 nations signed the Millennium Declaration, and much has been achieved; mortality rates for mothers and children under five years have decreased by 47 per cent and 41 per cent respectively between 2000 and 2010. But it seems that by the time the MDGs expire we will have fallen short of most of the goals.
This week I’ve already written about the world I want to see by 2030. From now until September 2015 when the new sustainable development goals will be launched, lobbying from activists from different sectors will continue to intensify as we all try to ensure the cause we are most passionate about will be high in the new framework. But however that looks we cannot wait for another 15 years before achieving the unfinished business of the MDGs.
Health is a major cross-over issue, it is not only an essential part of individual wellbeing, but it has consequences on families, communities and nations’ economies.
The alternative to universal health coverage
Currently there are two schools of thought for the new health goal – firstly universal health coverage (UHC) as advocated by the World Health Organisation, World Bank, a number of UN member states and civil society organisations.
The alternative approach as put forward by the UN Secretary General’s High Level Panel advocates for an outcome-focused goal as ‘ensure healthy lives’. A number of rights-based organisations, such as the International HIV/AIDS Alliance, are calling for this approach believing it will better address all factors affecting healthy lives, critically including structural drivers of inequalities.
There is a risk that if countries adopt the UHC approach they will focus on the most easy to reach populations. This could allow them to show success through their statistics, but likely would brush under the carpet the most marginalized key populations, including men who have sex with men, sex workers, drug users, rural and uneducated women and girls, and transgenders.
Tackling criminalization and right to health
Criminalization of homosexuals and lack of political will to change this issue is a major barrier blocking access to HIV prevention and treatment in more than 70 countries. These contexts make it dangerous for marginalized civil society members to come out and demand their right to health.
According to a WHO report, HIV services are most lacking for incarcerated people. Very few countries provide antiretrovirals in prisons and lack of political will in many countries blocks comprehensive services for people who inject drugs and sex workers.
At an event organized this week by Action for Global Health and the Global Health Council, Joan Awunyo Akaba, executive director of Future Generations International, Ghana, said: “Community leaders, civil society and NGOs need to be more vigilant in their role as watch dogs, to ensure government accountability and transparency, and to ensure all voices are heard.”
Sustainable development can only be achieved if inequalities and marginalization are dropped to zero. Those left behind are not a random selection. Systematically key populations are missing out as the rest of the world makes progress. This is unacceptable and an outrageous human rights violation.
If we are truly to ensure no one is left behind, now is the time to get the message across: we must reduce the discrimination of all marginalized groups and ensure their meaningful participation in the development and implementation of health strategies.
Read more about HIV and the post 2015 development agenda
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