“Why treat people only to send them back to the conditions that made them sick in the first place?”
These sentiments of medical futility in the face of social dysfunction accompanied the WHO’s 2008 Commission on the Social Determinants of Health final report. The Commission outlined the need not only for governments to provide Universal Access to high-quality and integrated healthcare that we have become accustomed to lobbying for, but to do so within the context of creating communities, schools, homes and work-places that were engineered towards positively influencing health. To a limited extent, they went even further arguing the need to engage even further upstream determinants of health, the social, economic and environmental policies that are indeed the “causes of the causes”.
As we sit as an IFMSA delegation amongst the high-drama of the negotiating rooms here in Rio, it is interesting to note the aforementioned sentiments playing out before us. The Brazilian Government finally bit the bullet and took charge of negotiations two nights ago after a further three days of negotiations during Prepcomm III (although it was actually never officially opened) made little ground with a gargantuan 63% of text from the outcome document still to be agreed upon. The Brazilians released a streamlined document 24 hours later which was a whole 30 pages lighter. The good news is that health is relatively well represented within the text (kudos here goes to Mike K who has been lobbying hard for quite a number of months now!). The more sobering news is that the big “causes of the causes” issues such as fleshing out the detail of the “Green Economy”, processes for the development of “Sustainability Development Goals” (SDGs) and the Institutional Frameworks which will provide governance and oversight for it all have reached stalemate with talks on the verge of collapsing. The text put out by the Brazilians was indeed a good crack at the diplomatic compromise. However, what came with this compromise was a further weakening of the text and a fairly universal condemnation from States at a “reactionary” plenary last night.
The health chapter is all but agreed “Ad ref” (meaning that it is officially closed and can’t be edited any further). There are some great social determinants of health sentiments within the document and a good paragraph on Universal Healthcare. Similarly, NCDs, health financing and health in all policies get a look in. The only real parts to be agreed on are to do with reproductive and sexual health (opposition from a likely source) and a TRIPs para that is unfortunately likely to be booted out in some political horse trading to come when the big wigs role in next Wednesday.
As we direct our gaze upstream there is a common subtext to the failed negotiations waged along a familiar North-South divide. For those that have followed either of the UNCSD or UNFCCC negotiations you will be well aware of the perennial difficulties that the Rio Principle 7 (see Agenda 21 from original 92’ Earth Summit) of “Common but differentiated responsibilities” poses. Essentially the argument goes that commitments (particularly environmental ones) should be titrated to country capacity and resources i.e. low-income countries should be given more leniency than those high-income countries that have been able to economically develop at great cost to our ecosystems. It is no surprise that poor countries (largely represented by the G77) are shuddering at the prospect of having aspirational environmental targets at them by the rich with significant implications for development, especially as the North refuses to put up the financing mechanisms (above and beyond ODA) to assist them.
Things aren’t looking too great right now, but with the arrival of heads of State next week could potentially provide a wildcard moment. Once again, the human development project is at risk of being derailed by sovereign interests when we should be looking to a paradigm of integrated, global social and environmental justice that we can bestow to our great grandchildren.
Dan Yore (@sonofche)
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