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Workshop
on Stakeholder Citizenship and the Health Sector
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Health
Implementation
Conference
Stakeholder
Action For Our Common Future
Health
Issue
Paper v23,
March
April 2002
Preamble
Healthy
individuals and communities are at the core of sustainable development.
Health
is a human right, as universally agreed in the UN Human Rights Declaration and
Covenant on Economic Social and Cultural Development, and is central
to social and economic development. Our ability to eliminate the economic,
environmental and social barriers to good health will determine the
quality of our future on Earth.
Without health, the innate potential of each person to contribute to
their family’s and community’s well-being is lost, with grave
consequences for our collective future. By "health"
we do not simply mean the absence of disease or infirmity, or the
alleviation of suffering. WHO's definition, "complete physical,
mental and social well-being” is the goal that we believe every society
should embrace.
Poverty, underdevelopment, illiteracy and lack of gender equity contribute to
the spread of disease (particularly HIV/AIDS), which has reversed health and development
gains of the past decade. Improvements to health should be regarded on
the basis of their potential contribution to human capital, the building block
of the future.
1. Framework for the Implementation Conference (IC) process
The
IC process is designed to facilitate joint stakeholder action in order to
contribute to the implementation of recent international agreements and
convention outcomes, such as: Agenda
21, Chapter 6 (Rio 1992); International
Conference on Population and Development (Cairo, 1994) and its 5
year review (New York, 1999); Fourth
World Conference on Women (Beijing 1995); Commission
on the Status of Women 43rd Session (New York, 1999); Regional
environmental meetings such as the Third
European Ministerial Conference on Environment and Health (London, 1999);
the United Nations General
Assembly’s 24th Special Session on Social Development (Geneva
2000), the Millennium
Declaration, the Stockholm
Convention on POPs and
the 26th Special
Session on HIV/AIDS (New York, 2001).
The
principal goal of the IC is to deliver measurable joint collaborative action
plans that contribute to poverty eradication; social inclusion and
empowerment; good governance; and gender equity. While this paper is entitled
‘Health’, linkages with the work undertaken by the energy, freshwater and
food security groups will be established where relevant.
The
IC process also aims to influence the intergovernmental process towards the
Johannesburg Summit (WSSD). A
two-pronged approach is proposed, aiming to impact the ‘Type 1’ (state
ratified objectives) and ‘Type 2’ (stakeholder partnership objectives)
summit outcome documents and enhance their inter-linkages.
Hence, the group may choose to develop joint statements and lobbying
strategies as well as develop joint implementation action plans, but the
opportunity to influence the formal text (Type 1) is likely to end in Bali.
2.
History of the IC process on Health so far
·
Issue Paper v1 available
Jan 2002.
·
Workshop on Stakeholder
Citizenship and the Health Sector, New York, 2-3 February 2002
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Issue Advisory Group (IAG)
selected, Issue Paper v2 distributed and initial one-to-one discussions held
·
IAG dinner
3rd April 2002: outcome reported to group. Conference call
planned for 29th April.
·
Issue Paper v3 distributed
for discussion, conference call to agree core areas (see bold text below).
3.
Planned activities between now and the IC event
IAG
develops working groups (advisers, contributors, participants) for
collaborative action plans.
Working
groups extend interested participants and programmes as appropriate; IAG
offers advice and networks.
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Finalise
requirements of venue and needs and working group agendas for IC. Ensure
finance for implementation of action plans beyond IC.
Other
possible activities: host relevant online debates (Open University have
offered to host/promote) with IAG as key contributors.
4.
Possible focus areas and possible joint stakeholder action
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Possible focus
areas
as
identified in international agreements
Questions:
·
Which of the following focus areas are priorities for effective
joint stakeholder action?
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Which are
missing?
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Possible
action towards governments and official WSSD process (Type
1)
Questions:
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Are there specific agreements / commitments / targets missing
from the intergovernmental agreements at the WSSD?
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Who should do what to achieve such inclusions?
NB
Lobbying for Type 1 outcomes will need to be completed by Bali PrepCom
(end May)
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Possible joint stakeholder
action towards implementation (Type
2)
Questions:
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Which of these ideas should be developed further into IC
outcomes?
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Should any of
these actions be particularly focused on Africa in order to contribute
to the implementation of specific programmes for Africa being developed
for the Johannesburg Summit?
·
Which existing
programmes & experiences should be brought into the IC to broaden
their scope and impact?
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What is the
appropriate workgroup size and composition for each idea?
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Possible IAG
champions and necessary stakeholders (groups/organisations/ individuals)
Questions:
·
Who should be included to achieve tangible outcomes?
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Communicable
Diseases
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HIV/AIDS:
Numerous
HIV/AIDS initiatives, but much remains to be done in Sub-Saharan Africa,
E Europe, Asia and the Caribbean. Focus on Barcelona
World AIDS Conference (7/02) and other regional conferences; they
are expected to emphasise implementation of the UNGASS
AIDS Conference commitments.
Need
for networking / communication tools for stakeholders to exchange best
practice and experience; empower stakeholders to find their own solution
and build capacity organically.
Need
for targeted educational/ behavioural interventions at systemic level:
targeting specific groups: eg men, truckers, health workers.
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Persuade governments to accept the moral responsibility to inform
/ demystify their populace re. the disease, transmission and protection
and to implement proven effective means of tackling existing problems.
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Educate re
HIV/AIDS and provide support systems for sufferers (school, workplace,
community). Add HIV/AIDS to workplace Health and Safety codes. Raise
AIDS profile at World Congress on Occupational Health and Safety,
Vienna, 26-31 May. Targeted, specific interventions for eg truckers and
healthcare workers (others?)
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Identify
community-driven solutions (non-pharmaceutical) and promote exchange,
through ‘model community / programme’ to disseminate best practice
(rural, urban settings?). Replicate at national level through
understanding and sharing successes of eg Uganda (others?)
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Engage stakeholders to consider WHO’s latest approach / care
recommendations.
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Extend awareness/ cultural campaign under World AIDS Campaign
banner (e.g. I care…do you?) using large group facilitation techniques
to mobilise change – e.g. existing programmes in South Africa
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IAG:
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Other: WHO, governments, oil companies (Africa); ILO, Trade
Unions, community leaders, physicians
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Malaria
Effectively
tackling malaria involves multiple stakeholders: education (school/
workplace), housing (house by house monitoring, rapid response with
nets, sprays), ecosystem (water, sanitation) management, farming, as
well as health and environment ministry cooperation).
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Replicate best
practice examples, eg “Regional Programmes of Action and Demonstration
of Sustainable Alternatives to DDT for Malaria Vector Control in Mexico
and Central America” or other local, regional or national programmes
championing community involvement and strategy of reducing DDT. Monitor,
evaluation and improve.
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Add environmental awareness / management into sustainable
education curricula at schools (tie into / extend WHO’s School Health
Programme), extend training network of IUHPE (Health Promotion and
Education)
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IAG:
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Other: Roll Back Malaria, GEF, Pan-American Health Organisation,
farmers, unions (esp rural), educators, DDT proponents, care providers,
health and environment ministries)
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Water
borne diseases
1
billion without access to water; 2.4 billion without access to
sanitation; 1.5 million children die each year from diarrhoea.
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Identify health/
water overlaps with Freshwater issue; eg hygiene practice, oral
rehydration campaign
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Promote best practice, eg education of women with infants in
areas of poor water quality
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IAG:
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Other:
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Non-communicable
diseases
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Smoking:
Alarming
growth rate of tobacco consumption; rising prevalence rates, especially
among children, youth and women
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Lobby for commitment to Framework
Convention on Tobacco Control (FCTC)
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Support the Tobacco Free
Initiative and maintain the momentum towards the FCTC, building on
the WHO campaign network around FCTC
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Support World Bank efforts in developing countries promoting
‘polluter pays’ principle by raising tobacco taxes
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Employ ‘strategy of small wins’ approach: target groups of
women (successful WHO, NGO campaigns in Japan), children (smoking at
home), employees (in workplace), journalists (to expose companies),
other?
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IAG:
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Other:
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Obesity
The
shift in many countries to a more ‘Western’ diet is inefficient and
unhealthy. Average 8kgs of grain needed per kg meat; 40% of world’s
grain supply used in meat production (70% of US) and 60% of fish catch.
1
billion globally are overweight (dramatic increase in rich and poor
countries). Obesity enhances chronic diseases, effectively
‘handicapping’ people and burdening developing countries.
Global
population with diabetes projected to double to 300 million by 2025, 75%
of increase in poor countries (Source: Novo Nordisk)
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Promote awareness of diet and nutrition and the known scientific
links between diet, obesity and ill health.
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Promote physical activity, replicate “Move for the World”
campaign, tie into Olympics
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Promote specific campaigns of youth and elderly
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Develop/support campaign for diabetes sufferers.
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Extend access to diabetes diagnosis, drugs and care in developing
countries
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Work with FAO/ILO/WHO
to develop long-term strategy for significant reduction of meat in human
diet
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Consider interventions: reduce subsidies to agriculture (esp
meat), campaign for foods to be taxed based on their nutrient value per
calorie
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IAG:
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Other:
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POPS/PICS
related diseases:
Many
POPs (Persistent Organic Pollutants) are carcinogenic. Prior Informed
Consent (PIC) relates to the clear labelling and regulation of hazardous
chemicals, to help curb illegal trade.
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Promote the rapid ratification and implementation of the Rotterdam
Convention on PIC and the Stockholm
Convention on POPs
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Work with International POPs
Elimination Network (IPEN). Support WIT in helping with Stockholm
ratification
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IAG:
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Other:
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Indoor Air
pollution:
3
billion people rely on biomass fuels and coal-burning for household
energy needs. Indoor air pollution is a major source of illness,
particularly with young children.
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Extend existing networks that address the indoor air pollution
problem
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Share best
practice from other communities in stove building techniques for cooking
and ventilation. Create stakeholder owned models for effective
replication and community level exchange. Explore link with Energy issue
coordinator
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Toxicity measurement (indoor and out) needed to understand
environmental impact on health
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Add links to smoking awareness campaigns
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IAG:
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Other: WHO, Energy companies, educators, NGOs
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Lead:
Significant improvements made in reducing lead in gasoline (85% of
supply is currently lead-free) but significant pockets remain, esp. LDCs
and China.
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Lobby for worldwide commitment to remove lead from fuel, with
timetable
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Extend existing networks that address the lead pollution problem
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Pressure oil companies to upgrade refineries (higher octane fuel
needed in absence of lead additive), even if this means doing so without
government partner commitment
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Explore tax-based approach, identifying to governments the
benefits to country of lower health care expense.
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Toxicity measurement (indoor and out) needed to understand
environmental impact on health
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Facilitate the
implementation of the recommendations of the Bangalore International
Conference on Lead Poisoning, Prevention and Treatment
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Best practice: UNEP workshop in June, Nairobi providing
technical, political and strategic info / support to central African
governments and industry. Support of World Bank and Habitat
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IAG:
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Other: Oil companies, OCTEL (lead additive producer), governments
(esp China, Africa), youth, medical profession,
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Health care
systems
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Medical staff
employment ethics
Medical
staff leave/ are invited to work in regions where they can earn more;
poorer regions suffer double loss of investment in training and trained
staff.
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Establish a
multi stakeholder group (WMA’s ‘International Mobility of
Physicians’ taskforce) to address the ethical and practical problems
involved; recommend potential solution (transfer pricing, taxation,
incentives?)
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IAG:
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Other: Medics, governments, ILO, trade unions, educators, others?
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Abuse of
Antibiotics:
The
abuse of antibiotics in both human disease treatment and livestock is
threatening humanity`s ability to treat diseases in the future
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Multi-stakeholder campaign in support
of the WHO
Global Strategy for Containment of Anti-microbial Resistance to
educate and influence the main groups involved: patients, pharmaceutical
companies, doctors, food producers and farmers
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IAG:
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Other: Physicians, farmers, pharmaceutical companies
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Access
to health care, healthy environments and healthy living conditions
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Non-pharmaceutical
Well-being
requires satiation of basic needs: safe and clean living and working
environment, access to food, clean water, sanitation, education, public
health services and transport facilities. Also important is equity of
information transfer, social reform, infrastructure development and
resource mobilisation.
The
primary causes of premature mortality and high morbidity can be managed
by known and proven measures. The challenge is to make healthcare a
national priority, and to involve existing stakeholders in new, more
effective partnerships for progress.
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Promote relationship between health, poverty, prosperity and
civility.
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Analyse/ suggest improvements to draft
WSSD chair's text
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Consider lobbying for “Right to Health / Healthy Environment”
to be given legal meaning in countries where the law may be upheld.
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Build local
capacity, support empowerment of communities and exchange of communities
for effective exchange and promotion of best practice. Particular
emphasis on health of children.
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Promote
productive labour force through both “carrots” and “sticks”:
extension of health care benefits by employers; empower organized labour
to secure healthcare through collective bargaining.
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Establish linkages with Freshwater, Energy, and Food Security
issue coordinators
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IAG:
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Other:
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Pharmaceutical
95%
of the WHO’s “Model List of Essential Drugs” are available
off-patent; over one third of the world’s population lacks access to
essential (generic) drugs (Source: Novartis study).
High
drug prices reward innovation but restrict access. This is within the TRIPS
mandate, but there is a need for specific action by relevant
stakeholders. Some pharmaceutical companies seek guidance. Tiered
pricing/ distribution has appeared exist for rich/poor countries and
rich/poor people within developed countries; this has governance
implications.
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Support recommendations on Macroeconomics and Health re
government responsibilities for health care and the need for richer
nations to support developing countries.
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Call on governments to clarify stakeholders’ responsibilities.
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