The idea of a Framework Convention for Global Health (FCGH), using the treaty-making powers of the World Health Organisation (WHO), has been promoted as an opportunity to advance global health equity and the right to health. The idea has promise, but the authors argue that it needs more thought regarding risks, obstacles, and strategies. The reform of global health governance must be based on a robust analysis of the political economy, drivers of inequality and the denial of the right to health arise. The authors warn against limiting analysis to questions of inter-governmental financial transfers because of the risk of neglecting the underlying structural determinants of health injustice, which would help to legitimise an unjust and unsustainable global economic regime. While a FCGH can alert to areas for global regulation, the authors call for popular mobilisation around the right to health in ways that link to the local priorities of different communities.
Values, Policies and Rights
This issue of the Africa Environment Outlook conveys the following key messages to policy makers and other stakeholders: 1. Environmental and health issues deserve priority consideration in national development. 2. Although indoor air pollution is a profound health problem in Africa, it has been inadequately addressed. 3. Biodiversity provides goods and services such as food and medicinal plants that promote human health in Africa. 4. Climate change and variability severely impact human health owing to individuals’ and communities’ limited coping capacities. 5. Coastal and marine resources are integral to the health of coastal populations and need to be conserved and used sustainably. 6. Access to safe water and adequate sanitation is vital to human health and needs to be scaled up by eliminating impediments such as inadequate infrastructure, pollution of water sources, poor hygiene, retrogressive cultural taboos and gender disparities. 7. Sustainable land management is central to human health because land provides the resource base for the provision of ecosystem services such as food, fibre and medicines. 8. The magnitude of domestic and global uncertainties that decision makers have to grapple with imply that espousing the business as usual model when dealing with environmental problems does not only result in failure to meet internationally set goals and targets, it also undermines human health. 9. Although a number of good policies for addressing environmental challenges that affect human health exist, their implementation has been weak. Making policies more effective requires elimination of barriers to implementation.
In this paper, researchers reviewed how government policies in low and middle income countries (LMICs) outline actions that address salt consumption, fat consumption, fruit and vegetable intake, or physical activity. They carried out a structured content analysis of national nutrition, non-communicable diseases (NCDs), and health policies published between 1 January 2004 and 1 January 2013 by 140 LMIC members of the World Health Organisation (WHO). They found policies to be available in 83% of the countries. NCD strategies were found in 47% of LMICs reviewed, but only a minority proposed actions to promote healthier diets and physical activity. The coverage of policies that specifically targeted at least one of the risk factors reviewed was lower in Africa, Europe, the Americas, and the Eastern Mediterranean compared to the other two WHO regions, South-East Asia and Western Pacific. Of the countries reviewed, only 12% proposed a policy that addressed all four risk factors, and 25% addressed only one of the risk factors reviewed. Strategies targeting the private sector were less frequently encountered than strategies targeting the general public or policy makers. This review indicates the disconnect between the burden of NCDs and national policy responses in LMICs. Policy makers urgently need to develop comprehensive and multi-stakeholder policies to improve dietary quality and physical activity, the authors conclude.
In the era of the persisting global north-south health divide, regional integration organisations have emerged as significant legal and diplomatic spaces to advance health goals. In this context, African regionalism is evolving as important frameworks for promoting health diplomacy. This evolving regional health diplomacy is contributing to the reinforcement of social goals of new regionalism in Africa and shaping the drivers of health policy at the global, regional and domestic levels. With reference to case studies of African regional and sub-regional integration organisations, the author of this paper examines the drivers, nature and limits of their practice of health diplomacy. He also analyses the nature of engagement of African regional groupings with select international health regimes. The author identifies the strengths and limits of regionalism for health diplomacy that also advances the protection of public health. The paper concludes with options to foster health diplomacy and its implications for the advancement of health at the domestic, regional and global levels.
The Secretary-General’s High-Level Panel of Eminent Persons on the Post-2015 Development Agenda delivered its report on 30 May 2013 (included in this newsletter). In this statement, CESR welcomes the Panel’s clear affirmation that the framework to replace the Millennium Development Goals in 2015 should be grounded in respect for universal human rights. However, the fragmented and inconsistent incorporation of human rights in its proposals, coupled with the prominence given to an outdated vision of market/business-led development, prevents the report from meeting its own stated aim of proposing a truly “transformative shift”. For the new framework of goals, targets and indicators to meet the human rights litmus test, it must fully reflect the fundamental human rights principles of universality, indivisibility, equality, participation, transparency and accountability. It must also reinforce the duty of states to guarantee at least minimum essential floors of rights enjoyment, to use the maximum of their available resources to realise rights progressively for all, and to engage in international cooperation for this purpose. Human rights advocates have been particularly insistent that, alongside the environmental, economic, and social dimensions, a fourth pillar of sustainable development - accountable governance - is fundamental to putting in place the right institutions and effective incentives to translate international political commitments into lived realities. The report is also particularly weak in addressing corporate accountability.
This paper reports on an analysis of 11 African Union (AU) policy documents to ascertain the frequency and the extent of mention of 13 core concepts in relation to 12 vulnerable groups, with a specific focus on people with disabilities. The researchers applied the EquiFrame analytical framework to the 11 AU policy documents. The 11 documents were analysed in terms of how many times a core concept was mentioned and the extent of information on how the core concept should be addressed at the implementation level. The analysis of regional AU policies highlighted the broad nature of the reference made to vulnerable groups, with a lack of detailed specifications of different needs of different groups. This is confirmed in the highest vulnerable group mention being for ‘universal’. The reading of the documents suggests that vulnerable groups are homogeneous in their needs, which is not the case. There is a lack of recognition of different needs of different vulnerable groups in accessing health care. The authors conclude that the need for more information and knowledge on the needs of all vulnerable groups is evident. The current lack of mention and of any detail on how to address needs of vulnerable groups will significantly impair the access to equitable health care for all.
Attention to women’s and children’s health is increasing in AU policy making, according to this report. The AU has provided a platform for leaders to debate issues of women’s and children’s health and to make commitments to their improvement. In an environment where different priorities compete for funding, women and children's health could be given greater profile by providing evidence of their contribution to overall development. Improving the health of women and children requires a cross sectoral approach and evidence on collective impact.
Delivering health services to vulnerable populations is a significant challenge in many countries. Groups vulnerable to social, economic, and environmental challenges may not be considered or may be impacted adversely by the health policies that guide such services. In this study, the authors report on the application of EquiFrame, a policy analysis framework, to ten Namibian health policies, representing the top ten health conditions in Namibia identified by the World Health Organisation. Health policies were assessed with respect to their commitment to 21 Core Concepts of human rights and their inclusion of 12 Vulnerable Groups. Substantial variation was identified in the extent to which Core Concepts of human rights and Vulnerable Groups are explicitly mentioned and addressed in these health policies. Four health policies received an Overall Summary Ranking of High quality; three policies were scored as having Moderate quality; while three were assessed to be of Low quality. Health service provision that is equitable, universal, and accessible is instigated by policy content of the same. EquiFrame may provide a tool for health policy appraisal, revision, and development.
Refugees and asylum seekers face a host of challenges when crossing borders, but the obstacles are particularly pronounced for lesbian, gay, bisexual, transgender, or intersex (LGBTI) persons, according to this article. LGBTI asylum seekers and refugees face a range of threats, risks and vulnerabilities throughout the displacement cycle, said the UN Refugee Agency (UNHCR). In situations of upheaval or conflict, sexual and gender minorities have become targets for scapegoating or “moral cleansing” campaigns, compounding the inherent vulnerability created by unrest. Activists say that security in refugee camps is complicated and contingent on numerous, unpredictable factors, which are exacerbated for LGBTI persons. Sexual abuse is common, but often goes unreported because the right questions are not being asked, and because survivors of sexual violence are reluctant to report events that will “out” them to legal authorities. This discrimination impacts negatively on LGBTI’s ability to access basic health services for fear of exposure and discrimination.
With over-consumption of alcohol on the rise, governments are struggling to find suitable legislation to control the marketing of alcohol. The increase in the market for branded alcohol in Africa has been attributed to demographic shifts, including the growth of the middle-class and an increase in self-dependent women. Both law and education are needed to avert the risk of alcohol related disease, injury and death, for both illegally produced local liquor and the big brands of beverage giants. Among the major concerns are the impact of prolific advertising campaigns on young people, particularly in new markets where attitudes. Unethical advertising is also a major concern, with companies suggesting alcohol consumption is a timeless part of African culture, or could lead to a better life and or even sporting achievements.