IFMSA Delegation to the 5th OWG on Sustainable Development Goals

The IFMSA delegation to the fifth session of the open working group on sustainable development goals, 25-27th November 2013, part of the United Nation Major Group of Children Youth.

Sustainable Development Goals: Realizing the World We Want

The UN Open Working Group (OWG) on Sustainable Development Goals (SDGs) was created to allow for a global conversation around a new development agenda for post-2015. SDGs are based upon the Millennium Development Goals (MDGs) established in 2000 which has guided the development agenda for the past fifteen years. The process of developing SDGs, which started in March 2013, includes a set of eleven multi-stakeholder thematic consultations involving delegates from members’ states, United Nations Groups, and the civil society.

Health in the Development of a Sustainable Development Framework

Health is a “precondition for, an outcome of, and an indicator of all three dimensions of sustainable development”[i] : social, economy and environment. Therefore, it needs to be a crosscutting issue in the post-2015 SDGs. The protection and the promotion of health and wellbeing of all people of all ages can be part of all potential SDGs. Proposed goals and targets should include health-sensitive indicators.

The framework needs to promote action to achieve human development and promotes human health and wellbeing through the following[ii] :

  • Universal, equitable, rights-based, and human security approach
  • Inclusion of existing and future health issues : MDGs priorities, and emerging global health challenges (NCDs, mental health, infectious diseases)
  • Promotion of human rights for all, by ensuring enabling environments for the protection of human rights
  • A focus on the poorest and most vulnerable and marginalized populations: sexual minorities, older people, people with disabilities, NDCs and migrants.
  • Promotion of policies and programs supporting health and development throughout the life course, and ensuring access to services to minimize the social and economic impacts of experiencing a health condition
  • Active and meaningful engagement with nongovernmental organizations and civil society
  • Clear and strong accountability mechanisms, with adequate and sustainable financing


Fifth Session: Health as a Sustainable and Inclusive Economic Issue

“There is a sense of urgency.” “The Social Agenda has to be a strong consensus. Goals must be few, measurable, and easy to communicate.” “We must leave no one behind.” Macharia Kamau opens the fifth working group session. On Monday morning, co-chairs Körösi and Kamau lead the session on sustained and inclusive economic growth, macroeconomic policy questions (including international trade, international system and external debt sustainability), infrastructure development and industrialization.

What is sustainable and inclusive industrialization? It is national economic growth and policies that take under consideration social issues such as public health, food security, gender equity and decent employment, as well as taking environmental issues into consideration.

As a medical student, engaged citizen, and on behalf of the UN Major Group of Children and Youth, I believe that it is essential to promote health in the SDG framework on future and re-negotiated trade and investment agreements. Therefore, international trade agreements must not undermine public health, and should address tobacco control, access to medicine, and technology access. Inclusive economic growth is directly linked to poverty, inequalities, and determinants of health.

I recommend the inclusion of policies that ensure allocation of resources to support the implementation of universal health coverage (UHC) and access. I recommend targets to promote measures to decrease indoor and outdoor air pollution as the use of accessible, active and public transport. I recommend a target to increase national tax revenues and economic capacity through taxation on products that contributes to poor health outcome. Fiscal policy is a powerful tool for encouraging health-promotion behaviours.

Those recommendations were to be discussed with the delegates. One of our goals was to talk to the representatives from member states about health issues. To accomplish this, we were tracking, which means to write what each delegate was saying in short key points. After the sessions, we therefore approached them in one-on-one fashion according to our knowledge and ties to individual countries. Engaging discussion on health issues linked to energy or macroeconomics allowed for inspiring discussions with some delegates as well as for the sharing of our position.

During the sessions, the question of financial stability was repetitive. It requires transformation at an international level. Unfortunately, we did not hear concrete propositions about how the financial system can be transformed to support sustainable initiatives; therefore, fiscal policies to support countries in their sustainable efforts are necessary. Calls for donors to reaffirm their goals to allocate 0.7 % of the gross domestic product to foreign aid and to allocate funds especially for improving health outcomes according to current epidemiological trends are strongly voiced. [iii]

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Fifth Session: Health as an Energy Issue

The second half of the working group was devote to Energy issue. “Energy is the golden thread that connects economic growth, social equity, and environmental sustainability” Ban Ki-Moon, UN Secretary-General. We believe that the inclusion of indicators to measure the health equity impacts of energy policies can benefit from access to energy. We also support indicators to measure indoor and outdoor air pollution exposure, according to WHO’s assessment of ambient air pollution concentrations[iv]. Some countries talked about the interlinkages between energy and health, as well as interlinkages with many other issues like gender, economy and poverty. Energy, especially renewable energy, is a strong promoter of health.

Sustainable Economy on Health Outcomes
– National Taxation of tobacco or other unhealthy products
– Interdiction of non-therapeutic use of antibiotics in livestock production, as this contributes to increasing resistance in humans
– Support eradication of malaria, AIDS and tuberculosis
– Support to reduce tropical diseases and non-communicable diseases
– Support free-smoke decent job
– Policy to protect sexual and reproductive health and rights of women and adolescent girls

4 million people die per year as a result of exposure to smoke (cook stoves or open fires). 3, 3 million people die each year from exposure to outdoor air pollution. [v]

Those statistics were mentioned not only by UN major groups, but also by delegates from varied continents. Everybody agreed: energy access for all is essential to the achievement of the post-2015 agenda. However, a major question remains unanswered: how do we address energy when access for all and equity is needed as well as a transformation of energy systems to green energy alternatives?

Things we found missing in the discussions

Growth, growth, growth
Although the need for growth is understandable for development, this cannot be the single target of macroeconomic policies. Growth must most importantly be managed in a sustainable manner within planetary boundaries. How about mentioning an economist’s worst nightmare: managed economic compression in regions / economic areas that are highly unsustainable in their practices instead of only managed growth. The closest we came to hearing such bold ideas was through discussions of increased energy efficiency.

Growth is not the direct equivalence of development. Actually, these two terms refer to quite opposite concepts. Growth can be defined by the unique expansion of something such as the economy, and this is not necessarily good. Development on the other hand refers to a constant evolution toward something better.

Youth presence 
MGCY certainly had a strong delegation and there were a few UN interns present as well, but we found low youth participation. We were told by MGCY representatives that youth participation in this session was significantly lower than usual and indeed, the IFMSA delegation represented more than half of the MGCY members present at any single point in time. An important way to ensure intergenerational equity in major UN discussions is by involving youth in official member state delegation; this is something that we would like to see both in future OWG session and in other international forums.

Youth voice to promote health and equity in the post-2015 agenda is essential. Youth must be engaged in this process. Monday afternoon, Professor Jeffrey Sachs, Director of the UN Sustainable Development Solutions Network and Director of The Earth Institute, exclaims that we are running out of time and of safe space, that the work of these SDGs is essential and that it needs to inspire the world, and most important, SDGs post-post 2015 must “Empower the young people”.

Concluding Thoughts

The MDGs were without a doubt historic and monumental, but regardless, were riddled with problems and short-failings. However, the spirit at OWG5 is impressively positive and constructive in this regard. Although the group in general seems to recognize the failings of MDGs, they are regardless looking forward with bold optimism. Lessons learned from the MDGs center around sustainability, multi-dimensional targets and statistical indicators. Conversations, without a doubt, emphasize that although MDGs highlighted social needs in a unified context, these social and humanitarian goals cannot be achieved without the economic development, and consequent public capital, to spend on social avenues. Secondly, the problem of silo-ing in the MDGs occurred by the creation of single-facet goals (ie: one goal for education, one goal for health, etc.). However, this compartmentalization does not reflect reality. Issues are intertwined and networked in complex fashions, which needs to be reflected in new SDGs and their respective targets.

Although this has been discussed at the OWG5, our lobbying efforts have noticed some resilience in taking a fully integrative approach. As soon as health seems to be mentioned, economy-focussed ears and minds close up. This is the goal of our lobbying efforts this week: to try and persuade delegates that health is a multi-dimensional goal, and is necessary but not sufficient for sustainable economic development. New indicators that measure human well-being and health must be used to evaluate economic progress in the future. Although the final outcomes of our advocacy efforts will not be seen for years to come, it has been monumental to be part of these constructively critical conversations that will set a new development precedent for history.

Jennifer Walker, Mathieu Hains, Stéphanie Lanthier-Labonté, Yassen Tcholakov
IFMSA Delegation to the 5th UN OWG on SDGs

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[i] UN. The Future We Want. June 2012. http://www.un.org/ga/search/view_doc.asp?symbol=A/RES/66/288&Lang=E. Accessed 18 November 2013.

[ii] UNDESA UN, Mr. Nikhil Seth. The Health PerspectiveFifth Session of the Open Working Group on Sustainable Development Goals (OWG 5).  http://sustainabledevelopment.un.org/index.php?page=view&type=9500&menu=[%menu_nr%]&nr=1459. Accessed 21 November 2013.

[iii] UNDESA UN, Mr. Nikhil Seth. The Health PerspectiveFifth Session of the Open Working Group on Sustainable Development Goals (OWG 5).  http://sustainabledevelopment.un.org/index.php?page=view&type=9500&menu=[%menu_nr%]&nr=1459. Accessed 21 November 2013.

[iv] WHO. Health indicators for sustainable development: Energy: http://www.who.int/hia/green_economy/indicators_energy2.pdf Accessed 21 November 2013.

[v] WHO. Health in the green economy: Household energy in developing countrieshttp://www.who.int/hia/hgebrief_henergy.pdf Accessed 21 November 2013.

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Where is health in Sustainable Development? Views from the Coordinator of IFMSA’s Think Global Initiative at the Rio+20 2nd Intersessional

‘Your here with who?’ (accompanied by a puzzled look) this was the response I got from the person sitting next to me, early one cold Wednesday morning in NYC, whilst waiting for a training to start on how civil society can engage with the Rio+20 process. As I explained to him who I was and why I was there he seemed to brighten up, but I think was still a little confused as to why medical students were in attendance at this meeting and secondly why they would have the slightest bit of interest in Rio+20. This seemed to exemplify the reaction I got from a few people at this meeting but as I grew more confident in what exactly I was doing there it seemed that people were starting to switch on to why health was important to this process and what we in the health community could bring to it.

So to begin with I though I would start by introducing what the Rio+20 summit is, it is the UN conference on Sustainable development and is called Rio+20 because it is 20 years after the original Earth Summit in 1992. Back then the whole conference was about environment, and now it is about all three pillars of sustainable development: economic, social and environment. The main outcome of this conference that people have been talking about for months now is a roadmap to a green economy, though there does seem to be little consensus to what a green economy actually is.

Back to the Intersessional, it was a two day event at UN HQ in NYC last week with a training day for stakeholders the day before. The aim of the Intersessional was to decide the format of the zero draft which is currently being compiled. The zero draft is a text which is most likely going to be about 18 pages long and condense down the 30,000 pages of text from over 600 stakeholders (governments and civil society groups) of which the IFMSA is one of them see this link . The Zero draft is due to be released next month on the 22nd January and will be published on the Rio+20 website.

For the few days I was in New York I had embedded myself within the Major Group for Children and Youth (MGCY), the resolution from the UN GA creating the summit allowed for a great deal of civil society participation organised around 7 major groups. This group were an interesting mix of both young people and organisations working with young people e.g. UNICEF, though it must be noted that they mostly had a strictly environmental focus. Since the IFMSA and health community in general are coming to this rather late in the process it was best for us to work through them for the time being.

The Plenaries themselves were slightly tedious, I was involved with tracking for MGCY which consisted of sitting listening to all the speakers and identifying policy positions and sticking them on a google doc then identifying which countries shared the exact same position. Given that most countries said variations of the exact same thing I was ready to kill myself if I ever heard the phrases ‘common but differentiated responsibility’ or ‘short, concise political statement’ and generally talked about the environment. A few exceptions to this were some Latin American countries who did not believe in the private sector, Island states talking about a Blue Economy and the US who wanted a ‘5 page non-binding aspirational political statement’ that the average person on the street could understand with a compendium of voluntary commitments The upside of these sessions each civil society grouping got to submit a position statement, check out the MGCY one which has some mention of health and also the Indigenous Peoples one for being probably the most radical thing I heard in those few days.

The interesting bit of the session was the side events, suddenly from not hearing the world health mentioned at all I started to see the relevance. In particular in sessions around sustainable agriculture, cities and the creation of Sustainable Development goals.  The cities and agriculture all talked about environments to create healthy lives and although I don’t think we could input on the technical stuff I think the health community has a lot to contribute in terms of framing these arguments (reducing the amount of cattle reared etc..). The really interesting session was that by the Colombian government who have proposed creating Sustainable Development Goals to compliment the MDGs with health potentially acting as a key indicator.

To finish up I think I will just say where can the IFMSA fit in and what should our plans be moving forward from this:

– Health currently isn’t being mentioned much so making sure the conference does take into account the social aspect of Sustainable Development.

– Promoting health as a key indicator of well being and as a central part of alternative economic indicators to GDP.

– Acting as a go between for various health groups which we made initial contact with at the intersessional to form an alliance of health groups around Rio.

– Generally encouraging health professionals to be part of the wider civil society mobilisation around Rio.

– Develop a policy statement on Sustainable Development

On January 22nd the Bureau will release the Zero Draft and also the schedule for events running up to Rio as well as what if any civil society participation will be allowed, before then we should have formed a SWG on sustainable development to work together in the run up to Rio.

Thanks for reading this and have a Happy Holidays,

Mike Kalmus Eliasz

(TG Coordinator)

The leading Health Organization in the World is reforming!

You guessed it right! WHO it self is undergoing a major process of reform. This organization is the  only institution capable of providing a balanced platform for global discussion on the future of our health, while taking into account diverse interests and priorities. So what has changed so sudden that it is a need for such a reform?

The answer to the question is quite complex, but yet breaks down one simple fact, we live in a complex and rapid changing world. The growth of big philanthropical entities and global economical crisis is putting WHOs supreme position into a unprecedented challenge. What started as a simple financial issue turned into a full fledged change, touching almost all working areas of WHO.

The three main purposes for the this process is as following:

  • Refocusing core business to address the 21st century health challenges facing countries;
  • Reforming the financing and management of WHO to address health challenges more effectively;
  • Transforming governance to strengthen global health.

The process of reform is Member State-driven, and Director General (DG) Dr. Margret Chan, does not save the ammunition to explain this fact, stating “You are the bosses!”. From the 129th Executive Board (EB) Meeting, it has been published a number of concept papers by the WHO secretariat explaining the reform process in details, thereby it has been an extensive consultation process with the member states which leads us up to the EB Special Session (EBSS) which is taking place right now.

Fundamental questions about WHO’s priorities, its changing role in global health governance, and internal governance and managerial reforms is going to be discussed amongst the EB members (http://www.who.int/governance/eb/eb_members/en/index.html). The decisions made during this special event will lay the foundation for the future of this agency. Its needed for WHO to be more effective and accountable to address the increasingly complex challenges of the health of populations in the 21st century.

Stay tuned, we will update from Geneva as the action unveils!

The IFMSA team to EBSS

Usman, Alex and Lukas