High-Level Dialogue on Health in the Post-2015 Development Agenda concludes in Botswana

IFMSA Interventions at the Global Thematic Consultation on Health in the Post-2015 Development Agenda, delivered by IFMSA President Roopa Dhatt

March 3-5, 2013 in Botswana

Intervention #1—Importance of YP in the Development Agenda, Health in All Policies, and Getting to the Root Cause

Young people are a large population. Health issues (such as mental health, violence, injuries, child marriages, unprotected sex, early pregnancy and childbirth, sexual coercion, HIV) and social issues (such as employment, environment, education) continue to challenge their ability to meaningfully participate in achieving their future. We urge the post MDG framework to increase young people’s analysis, perspective and participation. We also urge the post MDG to consider forgotten voices of marginalized and vulnerable groups regardless of political, religion, social, racial, national, sexual, gender, national, sexual or any discrimination.   Not only are young people the future, but also they will be responsible for sustaining the efforts that are set now. We should engage with young people early on about healthy lifestyles, sexual reproductive health, and career planning and use them as a vehicle for social change, specifically in increasing the shortage in human resources for health.

We also feel that health should be placed in other policy agendas beyond the development agenda and the sustainable development. We urge the creation of more health indicators that are context specific, age-specific, and population specific in evaluating policies.

We encourage the global community to seek and address the root cause of inequity and the determinants that challenge health and well-being, especially in empowering young people early on.

Intervention #2—Political Language and Health in all Policies

1. We need a political language that is universal–understood and useful across sectors, so we can have more meaningful dialogue on setting the development agenda, especially if we are aiming for a more integrated approach.

We have heard a great deal about Human Security as potential framework that is emerging in some other non-health settings. It is a framework that focuses on development, human rights and state security. It is focused on the needs of people, multi-sectorial, integrated, and focused on both protections and empowerment.  It is a tool for both design and evaluation.  We need to consider such frameworks.

2. We need to keep our approach multi-sectorial, focused on sustainable efforts, addressing root determinants of health, bridging gaps, and integrating at the local level.

3. The how still needs to be answered, as we focus on these efforts.                                                       

Intervention #3—Human Resources for Health/Health Workers

 

When we talk about setting the health priorities for post-2015, we have to ask ourselves several questions.

• Who are the targets of these priorities?
• Who will be central to responding to the health priorities? Human resources for health or Human resources for development.
• If these are health workers or similar groups, how do we plan to engage with them and include them in setting in the post-2015 agenda?
• What will be their health literacy?
  • Will this include?
    • Multi-sectorial approach
    • Social Determinant of Health/ Determinants of Well-being
    • Sustainable development
    • Global heath
    • E-Health
    • Addressing the needs of target, marginalized and vulnerable groups
• How do we plan to build their capacities and make sure quality is

 

As a future health care provider, answering these questions are essential to setting the future development agenda and insuring that health priorities that are set are achieved.

 

Intervention #4—Specific Target Groups and An overarching goal on adolescents and young people

 

While we support universality of the goals that are set in the next development agenda, we want to highlight the importance of outreach to specific target group, like marginalized and vulnerable populations, especially adolescents.  While we do support the notion of age-specific, life cycle or other similar groupings for an over arching goal, we want to make sure that specific target groups are emphasized.

 Moreover, we would like to propose to the health community, about considering another additional overarching goal. We have heard in the room these past days a lot of mention of young people and their engagement, involvement, and access to health services, especially sexual reproductive health services. We also have been hearing at the UN level, at the WHO, the Rio+20 and other thematic consultations the importance of investing in young people as an emerging theme.

 

We have been discussing about the future…

The many health issues we discussed are most pertinent to young people, especially adolescents…(topics such as sexual reproductive health, mental health, violence, child brides, even health lifestyles and NCDs apply)

Young People are the future…

So why don’t we put adolescent health on the global development agenda, as an overarching goal?

Such a goal would be universal, sellable, and compelling.

Such a goal appeals to sustainable development (green economies, future generation)

Such a goal has the potential to be multi-sectorial (job employment, education, environment, nutrition)

Social determinants of health are a reality for young people, especially adolescents’ future.

Young people are innovators of social media, new technologies, tools and approaches.

Young people are already in some cases acting as human resources for health. 

Young people are engaging already on claiming their future and investing into it.

 

Discussion Points on Round Table during the meeting

 

GOAL: Universal Health Coverage

• The goal as is comprehendible, sellable, and universal.
•  The message should be more universal health access versus universal health coverage.
• We should make sure that such a goal, also has a specific mention for target groups, especially vulnerable and marginalized groups like migrant, rural, indigenous, young people.
• We should take the time to incorporate more sustainable development concepts in the goal, including sustainable practices.
• The goal should prepare health systems for a dynamic environment and not only the health issues of now, but for the future.
• Human resources for health (health workers) are an essential aspect of achieving this goal, so greater emphasis should be placed on targets for this workforce in the development agenda.
• When we talk about prevention, we should talk about health literacy and what competencies are we aiming for in UHC.
• There also needs to be emphasis on quality and therefore, quality indicators created, no only indicators on service coverage and protection.

 

 

 

GOAL: Maximizing Health Life Expectancy

• The goal is hard to understand and is not very sellable, but universal.
• We recommended changing the language to promoting a more understandable message and one beyond health, as a larger over arching goal (either well-being, healthy planet, maximizing human potential).

• We recommended age-specific targets, but making sure that there is a special mention of target groups, especially adolescents, marginalized and vulnerable populations.
• We should avoid in this setting creating silos and emphasize the multi-sectorial possibilities with other sectors such as education, green economies, environment, and nutrition.
• Additionally, there is potential to make this a larger goal.
• The possibility exists to keep the healthy life expectancy as an indicator.
• We should also integrate more sustainable development concepts and language into this goal—include education, green economies and the environment.

Written by Roopa Dhatt, IFMSA President 2012/13

[Day 4] 28th Pan American Sanitary Conference: A binding research and development treaty to improve access to medicines – Feasible?

Day 4 at the 28^th Pan American Sanitary Conference was welcomed by clear blue skies and sunshine as opposed to the clouds and day experienced the day prior.  Perhaps, this was a symbol of hope as PAHO moves into a new period with the election of the new Regional Director, Dr. Carissa Etienne yesterday. There is hope that the results of this meeting will not only be on paper, but will also become a reality in our region – the Americas.

During the morning plenary session, one of the more controversial resolutions that was tabled the day prior would be discussed amongst member states and civil society. At the World Health Assembly earlier in May, a report entitled Research and Development to Meet Health Needs in Developing Countries: Strengthening Global Financing and Coordination by the Consultative Expert Working Group (CEWG) on Research and Development. The report comes at a pivotal time when not only is the global economy unable to affordable the rising costs of medicines and treatments but also a time where there is a dearth of new medical products especially for those of neglected disease populations.

The report in its recommendations strives to align the incentives of industry in creating medical products for the purpose of profit with that of public health needs to allow for affordable access for patients. Additionally, the CEWG calls for member states to sign onto a binding treaty recommending a 0.01% of the GDP contribution towards a R&D fund. Many member states were adamantly against this proposal – most notably the first speaker, the United States stating that the first goal should not be asking for a dollar amount from countries in trying to overcome the R&D crisis, but rather focusing on implementing new models for innovation. Ironically, however, the United States did acknowledge that they contribute much more than 0.01% of their GDP towards R&D. Other countries voiced similar concerns including France as an observer state. There were a few countries however who voiced support for the recommendation of a binding treaty including Argentina, Colombia and Suriname.

Following member-states, Médecins Sans Frontières (MSF) and IFMSA as representatives from civil society were permitted to read their interventions. To read MSF’s statement, go here: ow.ly/dTnbF. Reshma Ramachandran of the IFMSA delegation read aloud IFMSA’s intervention as follows:

The International Federation of Medical Students’ Associations (IFMSA) welcomes the CEWG report on financing and coordination for R&D. Traditionally, the strengthening of intellectual property rights has been used as a primary method to spur innovation. This incentive, however, has not always proven fruitful especially for treatments not taken chronically such as vaccines and antibiotics – pharmaceutical classes that have seen a decline in R&D investment. In fact, in the Americas, case documentation has shown a rise in “superbugs” leading to patient deaths due to the lack of new antibiotics in the pipeline.

With such low investment in essential medicines due to failed R&D incentives, millions of our patients will continue to be neglected. Additionally, stricter intellectual property rights have led to the emergence of pharmaceutical monopolies and higher treatment costs, further burdening member states under economic strain. We, as future physicians, support the CEWG report in its mission to “align better commercial incentives and actions by the public sector with health needs, while also seeking to minimize costs.”

Representing over 1.3 million medical students worldwide, IFMSA respectfully urges member states to begin formal negotiations towards implementation of the CEWG report proposals. As healthcare providers, we wish to provide the best, most-evidence based treatments possible to our patients. This report provides a rare opportunity to merge the need for increased biomedical innovation with our professional responsibilities to our patients through coordinated public investment.

FIRST, public investments of innovative approaches to global health research such as those detailed in the report have led to great progress in overcoming current market failures. The CEWG proposals are already in place in the Americas. For example, the NIH National Center for Advancing Translation Sciences (NCATS) assists firms with their pre-clinical efforts in order to meet FDA requirements for investigational new drug applications so that drugs can reach first in-human clinical trials. Smaller companies and academic centers particularly benefit from this, garnering additional contributors to innovation. We therefore believe member-states should begin implementation of such successful models as outlined in CEWG report.

SECOND, many institutions and governments have already adopted Open Knowledge R&D mechanisms as recommended by the CEWG. In May of this year, Argentina passed a law making all government-funded research freely available in an online repository. NIH in the United States through its Public Access Policy ensures that NIH-funded research is available for free online within one year of publication. Such commitments to open access not only benefit patients and providers but also allows for the free flow of information to hasten innovation.

THIRD, several countries in the Americas are currently involved in secret negotiations for the Trans-Pacific Partnership (TPP) Agreement. Leaked TPP text includes provisions that will severely limit access to research and affordable medicines through extended data exclusivity and patent periods as well as low standards for patentability allowing essentially copies of older medications to receive patents. We are concerned that the CEWG proposals will be undermined by adoption of such TPP provisions especially in those member-states in the partnership.

FINALLY, we believe it is necessary that member-states adopt the CEWG’s recommendation regarding financing by contributing 0.01% of their GDP. Such commitment to R&D requires secure financing and this can only be achieved through funding commitments, not voluntary contributions.  One model mentioned earlier, the Global Fund, has in fact suffered from a lack of accountability from voluntary national contributors leading to the lack of funding of new proposals in 2011 and an uncertain future. We urge member-states to make such a commitment through a binding convention in order to ensure the success of such proposals detailed in the report.

We again ask member states to begin negotiations to implement the report’s recommendations as there is a dire need for novel, life saving treatments for our patients, especially those of neglected disease populations

The intervention was well received by member-states as well as those in PAHO who drafted the CEWG, sparking interesting discussion between IFMSA members and others about the real possibility of a binding treaty. From IFMSA’s point of view, without such a binding treaty, there will be no accountability or hope that the recommendations will be adopted by member states. In November, discussion will continue regarding the CEWG report and its implementation. IFMSA hopes to be present there as well to offer its support and suggestions along with the rest of civil society.

During the lunch break, the IFMSA delegation attended the Second Information Session on the Global Fund. The overall objective of this meeting was “Improved positioning of the region of Latin America and the Caribbean in the Global Fund’s governance and operational structures”. The meeting was geared towards:

• Reviewing recent changes on the funding modalities for the Caribbean and Latin America region
• Exploring possible collaborations to increase the ability of the member states and the region to best address issues relating to Malaria, AIDS and Tuberculosis.

What is the Global Fund?

Malaria, TB and AIDS affect many persons worldwide and not only are these diseases devastating, but more importantly, they are preventable. The Global Fund dedicates financial support to about 150 countries to aid in the prevention and treatment of these diseases. This is especially important within the Caribbean and Latin America region where there are many developing countries that without these resources would have found it impossible to tackle these maladies.

One area of policy change of the Global Fund is that countries will now be placed in bands based on the earnings of the countries. The focus of the Fund will then be directed on those countries that experience the highest disease burden and have the greatest difficulty in funding interventions. It is purported that this change will ensure that there will be decreased morbidity and mortality from these diseases. The member states however questioned the use of the World Bank’s Income Classification in determining the economical status of each country. This classification uses the gross national income (GNI) per capita. It does not take into consideration debt or spending requirements of the countries.

Some countries within this region, however, thought this would present more harm than good for their nations. Jamaica, for example was listed as one of the countries that would have a cut in the funds that would normally be received. The Minister of Health, however, pointed out that as it relates to AIDS, this would have negative impacts for the island as the Ministry would now have great difficulty in funding wages for persons who were trained and now employed by the Ministry to head prevention and information campaigns in the move to eradicate HIV/AIDS.  The Minister suggested that when changes are to be made in funding policies, more time should be given to enable countries to better transition so that their achievements may be maintained or improved. Another issue with the changes was whether it would be taken into consideration those countries that have formed economical collaborations because they are unable to face to global market individually.

The meeting also reviewed the targets of the region for 2012-2013:

• Promote treatment optimization in at least 5-7 countries
• Accelerate Mother to Child transmission in at least 3-5 countries

Reshma Ramachandran (AMSA-USA) and Sachalee Campbell (JAMSA)

28th Pan American Sanitary Conference: [Day 2] “Health in the Americas”

A fresh and cloudy morning welcomed us as we headed to 525 Twenty-third Street. Walking was the best morning energizer to positively start our second day of work at the 28^th Pan American Sanitary Conference in Washington D.C. A promising day to actively participate and speak out for our Federation with the intervention regarding the NDC’s regional strategic plan.

The agenda started with the PAHO program and budget 2010-2011, the presentation of the PAHO Budget Policy and continued with the release of the report on “Health in the Americas” (link).

Average life expectancy in Latin America and the Caribbean rose from 29 years in 1900 to 74 years in 2010, and today 98% of children live to see their first birthday, while 100 years ago only 75% did. However, inequalities persist among and within countries, according to the 2012 edition of Health in the Americas. As Dr. Mirta Roses Periago, director of the PAHO, said: “Each country is a mosaic of situations, places, and communities, and every number, every piece of information, and every statistic represents the face, life, health, and hopes of a single, unique individual, each face has a voice, each voice expresses a need, and each need calls for action.”

We therefore welcomed this report which we think represents our best opportunity to advocate for the renewal of the commitment to construct a sustainable and evidence based post MDG agenda.

IFMSA, representing medical students from more than 100 countries worldwide, advocates locally and globally to build a post-MDG agenda where Health Equity For All is built on a shared vision of development across the lifecourse and achieved through:

A)Policy integration,

We acknowledge the effort that has been made towards poverty eradication and development but outline the limited progress made in bringing together the historically independent social, economic and environmental policy at both national and international levels. The macroeconomic approach to solving poverty-related disease is simply insufficient to meet the demand of countries. We need to utilize the current momentum to keep the efforts and achieve cross- sectorial integration.

B)Partnerships,

Recognizing WHO’s considerable increasing work in this area – especially with NGOs, who we believe have a great capacity to positively influence the direction of the Organization. We call for cooperation and collaboration between organizations and countries working towards the same goals to address the unfinished agenda of unnecessary, preventable deaths of mothers, children, and other vulnerable population groups and to continue and renew efforts to sustain achievements in health.

C)Engagement of young people.

Youth comprise nearly 30% of the world’s population. Youth have the greatest at stake in our quest for a sustainable after 2015 agenda.

IFMSA is already working to shape the future health and sustainability agenda; we are agents of change and catalysts of development in our countries. The need for more meaningful opportunities of youth involvement in policy and implementation work is one of our major interests as representatives and voice of medical students worldwide so that together with our governments we can find and implement equitable solutions to improve the health and lives of people worldwide.

The agenda went on with the Strategy and plan of action on noncommunicable diseases. In the context of the epidemiological transition the growing importance of noncommunicable diseases as a cause of mortality is not new. What has changed is the recognition of the enormity of the social and economic consequences of a failure to act on this knowledge. It is evident that sums in the order of US$ 11 billion spent now on cost-effective interventions can prevent over US$ 40 trillion-worth of future damage to the world’s economies. Nevertheless, there remains a significant gap between rhetoric and reality when it comes to concrete action and the allocation of resources.1

Where Sachalee Campbell (IFMSA Jamaica) gave an outstanding intervention (http://psc28.wordpress.com/2012/09/18/civil-society-representatives-support-ncd-strategy/) that highlighted our concern about the proposed strategies. The intervention remarked that :

1. 1.     The NCD crisis is about equity.

Multi-sectoral strategies to reduce the imbalance of social determinants of health must be integrated with efforts to control NCDs as further social inequity will only exacerbate the crisis.

1. 2.     NCDs are a cross-sectoral issue.

NCDs are closely linked to all three pillars of sustainable development – economic growth, social equity, and environmental protection. The WHO and member states have a powerful voice in this debate and can highlight the potential of sustainable development policies to tackle NCDs. We therefore ask if member-states have consider the implications of both bilateral and multi-lateral free trade agreements such as the Trans-Pacific Partnership Agreement that includes multiple countries in the Americas on access to affordable treatments for NCDs and the potential threat to sustainable development policies including access to nutritious food, clean energy, and healthy environments?

1. 3.     Progress should be measured by both health and non-health indicators.

In order to accurately evaluate the effectiveness of integrating sustainable development policies to control NCDs.

1. 4.     Young people should be involved.

Young people in the Americas and worldwide are interested in improving the health statuses of their countries. It is important that we recognize that young people are able to influence development in our region.

We as IFMSA represent medical students from more than one hundred countries – young people who also suffer from NCDs. As the health professionals of tomorrow, we are committed to combating this major health challenge of our generation.

As Zac Ephron (High School Musical) said “We are all in this together”!

Hugs from Washington,

Altagracia Mares