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Workshop on Stakeholder Citizenship and the Health Sector

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Implementation Conference

Stakeholder Action For Our Common Future



Issue Paper v23, March April 2002




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

·         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.




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


Possible focus areas
as identified in international agreements



·         Which of the following focus areas are priorities for effective joint stakeholder action?

·         Which are missing?





Possible action towards governments and official WSSD process (Type 1)


·         Are there specific agreements / commitments / targets missing from the intergovernmental agreements at the WSSD?

·         Who should do what to achieve such inclusions?

NB Lobbying for Type 1 outcomes will need to be completed by Bali PrepCom (end May)

Possible joint stakeholder action towards implementation (Type 2)



·         Which of these ideas should be developed further into IC outcomes?

·         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?

·         What is the appropriate workgroup size and composition for each idea?

Possible IAG champions and necessary stakeholders (groups/organisations/ individuals)



·         Who should be included to achieve tangible outcomes?



Communicable Diseases


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.



·         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.



·         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?)

·         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?)

·         Engage stakeholders to consider WHO’s latest approach / care recommendations.

·         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




·         IAG:


·         Other: WHO, governments, oil companies (Africa); ILO, Trade Unions, community leaders, physicians




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).








·         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.

·         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)


·         IAG:


·         Other: Roll Back Malaria, GEF, Pan-American Health Organisation, farmers, unions (esp rural), educators, DDT proponents, care providers, health and environment ministries)



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.




·         Identify health/ water overlaps with Freshwater issue; eg hygiene practice, oral rehydration campaign

·         Promote best practice, eg education of women with infants in areas of poor water quality



·         IAG:


·         Other:




Non-communicable diseases



Alarming growth rate of tobacco consumption; rising prevalence rates, especially among children, youth and women


·         Lobby for commitment to Framework Convention on Tobacco Control (FCTC)



·         Support the Tobacco Free Initiative and maintain the momentum towards the FCTC, building on the WHO campaign network around FCTC

·         Support World Bank efforts in developing countries promoting ‘polluter pays’ principle by raising tobacco taxes

·         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?




·         IAG:


·         Other:





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)



·         Promote awareness of diet and nutrition and the known scientific links between diet, obesity and ill health.




·         Promote physical activity, replicate “Move for the World” campaign, tie into Olympics

·         Promote specific campaigns of youth and elderly

·         Develop/support campaign for diabetes sufferers.

·         Extend access to diabetes diagnosis, drugs and care in developing countries

·         Work with FAO/ILO/WHO to develop long-term strategy for significant reduction of meat in human diet

·         Consider interventions: reduce subsidies to agriculture (esp meat), campaign for foods to be taxed based on their nutrient value per calorie



·         IAG:




·         Other:



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.



·         Promote the rapid ratification and implementation of the Rotterdam Convention on PIC and the Stockholm Convention on POPs



·         Work with International POPs Elimination Network (IPEN). Support WIT in helping with Stockholm ratification



·         IAG:


·         Other:



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.



·         Extend existing networks that address the indoor air pollution problem

·         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

·         Toxicity measurement (indoor and out) needed to understand environmental impact on health

·         Add links to smoking awareness campaigns



·         IAG:


·         Other: WHO, Energy companies, educators, NGOs



Lead: Significant improvements made in reducing lead in gasoline (85% of supply is currently lead-free) but significant pockets remain, esp. LDCs and China.



·         Lobby for worldwide commitment to remove lead from fuel, with timetable



·         Extend existing networks that address the lead pollution problem

·         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

·         Explore tax-based approach, identifying to governments the benefits to country of lower health care expense.

·         Toxicity measurement (indoor and out) needed to understand environmental impact on health

·         Facilitate the implementation of the recommendations of the Bangalore International Conference on Lead Poisoning, Prevention and Treatment

·         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



·         IAG:



·         Other: Oil companies, OCTEL (lead additive producer), governments (esp China, Africa), youth, medical profession,





Health care systems


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.



·         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?)





·         IAG:


·         Other: Medics, governments, ILO, trade unions, educators, others?


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



·         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


·         IAG:


·         Other: Physicians, farmers, pharmaceutical companies




Access to health care, healthy environments and healthy living conditions


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.


·         Promote relationship between health, poverty, prosperity and civility.

·         Analyse/ suggest improvements to draft WSSD chair's text

·         Consider lobbying for “Right to Health / Healthy Environment” to be given legal meaning in countries where the law may be upheld.


·         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.

·         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.

·         Establish linkages with Freshwater, Energy, and Food Security issue coordinators


·         IAG:



·         Other:




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.



·         Support recommendations on Macroeconomics and Health re government responsibilities for health care and the need for richer nations to support developing countries.

·         Call on governments to clarify stakeholders’ responsibilities.


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