Last Friday the much awaited report of the UN High Level Panel on Post 2015 was launched. This report was supposed to set out advice for the UN Secretary General ‘on a bold and at the same time practical development agenda beyond 2015’. Such an ambitious report was always going to spark controversy; we do not envy Dr Homi Kharas (the reports’ lead author) who had to reconcile the interests of the 32 panelists alongside those of the three co-chairs. The report sets out what is call an illustrative framework of goals and targets which aim to eradicate extreme poverty.
Before we go into what there is to like and not like about the report we thought we would provide a quick refresher on the process this far. In July last year Ban Ki Moon announced the creation of a High Level Panel to examine the lessons of the MDGs and set out a framework for a new set of goals. The panel met a number of times in New York as well as meetings in London and Monrovia focussing on poverty at the household and national levels; with a meeting in Bali focussing on thematic priorities, means of implementation and global partnerships. Each of these meetings produced a communiqué of how the panel saw the report shaping up so far. At each meeting there was civil society outreach and IFMSA took part in both the London and Bali meetings (you can read an intervention from Bali here).
So what is actually in the report?
The report was always going to be principles based, therefore on a lot of things there are a lack of detailed proposals. The fact it wishes to eradicate extreme poverty by 2030 in the context of Sustainable Development is definitely a positive sign. There were some real fears that it would not pay enough attention to the environment. The messages that came out Rio+20 with regards to Sustainable Development were definitely listened to by the panel, there is even reference to phasing out fossil fuel subsidies. That being said there is still a lack of focus on planetary boundaries and sustained economic growth is given primacy in the report.
The focus on it being data driven and based on disaggregated is also clearly a positive step. Big data needs to drive the future of global development. But there is no clear strategy for obtaining this data, also as we will see some of the goals are not clearly orientated towards setting up adequate surveillance systems.
The thematic priority areas definitively have some positive steps, there is a much greater focus on environment than there was with the MDGs. There is also an explicit target on the global climate. So in terms of items to work with as a civil society organisations there is quite a bit here. One glaring omission in terms of thematic priorities is a lack of a specific goal on inequality or inclusion of this within a goal on poverty. Social inequality has a huge impact on health and rising wealth differentials are deeply concerning. Whilst a focus on disaggregated data goes someway to addressing this it is not in itself enough and countries should focus on efforts to make their GINI co-effecients more favourable.
This is probably the weakest area of the report compared to other areas. Where on earth is Universal Health Coverage? This clearly is a strong component of what was in the Botswana. This section strikes me as the MDGs all over again with NCDs tacked on at the end. The focus purely on outcome targets leads to a re-verticalisation of health, we are missing things such as mental health and other key issues. This is instead of a focus on health systems strengthening and primary care. The lack of a coherent health care system means it will be difficult to gather data on progress towards these goals at all, let alone the disaggregated data we need.
For those in the Sexual and Reproductive health rights community they will probably be happy with a lot of the report, there is also a strong goal on gender equality including things such as ending child marriage. This was never really an issue with the High-Level Panel as these goals always enjoyed a lot of support from the UN Secretary General and all three of the co-chairs, though not by many member states. To really push these goals in the political processes, this community will need to join up with the rest of the health community and act less in isolation. Access to comprehensive sexuality education and contraception are critical to development, but they must be integrated into universally accessible health systems as a whole to avoid slipping back into the MDG trap of siloization.
Means of Implementation
Fortunately this out dated bit on UN Jargon has been dropped from the report, that was a concession to civil society, as during the Bali meeting many people were confused by what it actually means. For those less familiar with the jargon this is the nitty gritty stuff such as how we pay for all this, what role with tech transfer have and how will trade be regulated. Whilst the focus on tax evasion and fossil fuel subsidies is a good start, there is no real focus on new sources of revenue. The report does call for a global conference on financing for sustainable development, in fact there was already a mandate from Rio+20. Clearly there is more work to be done here and the health community have a key role in articulating the impact of these issues on health.
What impact will it have?
This is hard to say with any certainty, and to a certain extent is down to civil society picking up the report and using the parts they like. A number of member states have hinted that they are not keen on the report. Many of those who are not happy with it are annoyed due to the process as much as anything else. The report was developed by a panel of experts, it was not driven by member states, as opposed to the SDG OWG, so it is up to countries to take it or leave it. What is clear is that any future set of goals will have to be owned by countries not just the UN secretariat.
What is next?
The future of post 2015 is hard to say with any 100% certainty, the corridors in the UN are all talking about the Sustainable Development goal open working group. Their next meeting is partially focused on health and IFMSA will be there in force, ready to respond as this process unfolds. This is a chance to put UHC back on the table and educate negotiators about the broad cross cutting nature of health, rather than it just being a number of health related outcome targets focussed primarily on mortality.
We would love to hear your opinions and comments on the HLP report, what do you like and not like. Please share your opinions below or tweet them to #IFMSAHLP.