In response to the Rio Political Declaration at the World Conference on Social Determinants of Health held from 19-21 October in Rio de Janeiro, Brazil the International Federation of Medical Students’ Associations (IFMSA) delegation raised issues that the Declaration failed to address. In their statement, they recognise the Rio Declaration as a major step in the quest for global health equity, but point to its failure to explicitly indicate how the unfair distribution of power, resources and wealth will be addressed, especially by United Nations (UN) Member States, arguing that leaders have missed an opportunity to make a strong statement on this. IFMSA believes that democracy is the key instrument in fixing the existing imbalances in power and in ultimately reducing health inequities, but the Declaration does not emphasise the value of democracy in all processes – from decision-making to evaluation – and at all levels – from community to global level. IFMSA also notes that the Declaration fails to specifically define the role of the private sector in reducing health inequities and does not clearly draw the lines governing engagement between government and the private sector, nor does it demand that global economic governance institutions, such as the International Monetary Fund, the World Trade Organisation and the World Bank, adhere to the same standards of transparency, accountability and democracy as those urged of UN Member States. In addition, the Declaration is silent about how tackling health inequities will be financed, making no mention of innovative financing schemes such as progressive taxation on capital gains or extremely-high earners, a financial transactions tax or the prevention of tax evasion. Although the Declaration recognises the importance of engaging with civil society, it does not advocate for the creation of spaces for dynamic dialogue that will enable civil society to be heard, reflecting the fact that civil society was excluded from the official process of developing the Declaration. Finally, IMFSA notes that the Declaration does not explicitly mention the inclusion of young people and youth organisations in the movement for action on social determinants of health.
Values, Policies and Rights
Botswana should decriminalise homosexuality and prostitution to prevent the spread of HIV, says ex-President Festus Mogae. Mogae, who heads the Botswana government-backed Aids Council, said it was difficult to promote safe sex when the two practices were illegal. He also called for condoms to be distributed in prisons. His views are controversial as many conservative Batswana frown upon homosexuality and prostitution. Yet Botswana has one of the highest HIV rates in the world - 17% of the population is HIV positive. Mogae asserted that homosexuals were Botswana citizens and entitled to the same rights as heterosexual citizens. He said the government's failure to give prisoners' condoms was worsening the HIV and AIDS pandemic. However, a government spokesman on HIV and AIDS said that homosexuality and prostitution would remain illlegal until the government concluded wide-ranging consultations to see whether there was a need to change the law.
In this declaration by health civil society organisations from around the world, Peoples Health Movement insist that real power be trabsferred to communities to deal with the social determinants of health. A call is made for United Nations Member States and the World Health Organisation to take action around ten key areas affecting the social determinants of health. 1. Implement equity-based social protection systems and maintain and develop effective publicly provided and publicly financed health systems that address the social, economic, environmental and behavioural determinants of health with a particular focus on reducing health inequities. 2. Use progressive taxation, wealth taxes and the elimination of tax evasion to finance action on the social determinants of health. 3. Recognise explicitly the clout of finance capital, its dominance of the global economy, and the origins and consequences of its periodic collapses. 4. Implement appropriate international tax mechanisms to control global speculation and eliminate tax havens. 5. Use health impact assessments to document the ways in which unregulated and unaccountable transnational corporations and financial institutions constitute barriers to Health for All. 6. Recognise explicitly the ways in which the current structures of global trade regulation shape health inequalities and deny the right to health. 7. Reconceptualise aid for health from high-income countries as an international obligation and reparation legitimately owed to developing countries under basic human rights principles. 8. Enhance democratic and transparent decision-making and accountability at all levels of governance. 9. Develop and adopt a code of conduct in relation to the management of institutional conflicts of interest in global health decision making. 10. Establish, promote and resource participatory- and action-oriented monitoring systems that provide disaggregated data on a range of social stratifiers as they relate to health outcomes.
This article reports that Somali women and girls living in Ethiopian and Kenyan refugee camps are facing major health problems as camps lack security and basic services like latrines, accompanied by a fourfold increase in reports of sexual violence since May 2011. The real numbers are likely much higher, the Women’s Refugee Commission (WRC) notes, because many women and girls fail to report attacks for fear of their safety, because they don't want to be ostracised or because they don't trust that their rapists will ever be caught or prosecuted. Some of those living in the camps also face violence from their partners, and some are being forced into early marriage or survival sex, because they have no other way to support themselves. WRC argues that immediate action will more effectively protect women and girls than trying to fix problems after they have become entrenched. WRC recommendations include not only ensuring that women and girls have safe access to basic necessities, such as food, cooking fuel, potable water, sanitation and shelter, but that they are protected from sexual violence and that health care, particularly reproductive health care, is provided, using the updated Minimum Initial Service Package for reproductive health as a basis. WRC calls on the international community to rapidly scale up efforts initiated by humanitarian agencies in the region.
A new national HIV and AIDS strategic plan for Uganda is due to be finalised before the year's end, and gay rights activists are reported in this article to be urging its authors to break with tradition and, for the first time, provide for programming for men who have sex with men (MSM). A draft version of the new strategic plan distributed to civil society organisations mentioned the MSM community by name under an introductory section outlining groups that have prevalence rates above the national average, but the strategy concluded that MSM did not play ‘a big role’ in the transmission of HIV in Uganda and did not warrant a high rank among prevention activities. The draft strategy did recommend that more research be done within communities of MSM and injecting drug users to determine whether the groups were at risk of an upsurge in new infections. However, James Kigozi, spokesman for the Uganda AIDS Commission, said that because homosexual activity was illegal in Uganda, programming for MSM was unlikely to make it into the final version on the plan.
Alcohol, like mental health, is a neglected topic in public health discussions. However, the authors argue that there is sufficient evidence for it to be defined as a priority public health concern. Although only half the world’s population drinks alcohol, it is the world’s third leading cause of ill health and premature death, after low birth weight and unsafe sex, and the world’s greatest cause of ill health and premature death among individuals between 25 and 59 years of age. This paper outlines current global experiences with alcohol policies and suggests how to better communicate evidence-based policy responses to alcohol-related harm using narratives. The text summarizes six incentives for a healthier relationship with alcohol in contemporary society. These include price and availability changes, marketing regulations, changes in the format of drinking places and on the product itself, and actions designed to nudge people at the time of their purchasing decisions. Communicating alcohol narratives to policymakers more successfully will likely require emphasis on the reduction of heavy drinking occasions and the protection of others from someone else’s problematic drinking.
The health of prisoners is among the poorest of any population group and the apparent inequalities pose both a challenge and an opportunity for country health systems. The high rates of imprisonment in many countries, the resulting overcrowding, characteristics of prison populations and the disproportionate prevalence of health problems in prison should make prison health a matter of public health importance, the authors of this paper argue. Women prisoners constitute a minority within all prison systems and their special health needs are frequently neglected. The urgent need to review current services is clear from research, expert opinion and experience from countries worldwide. Current provision of health care to imprisoned women fails to meet their needs and is, in too many cases, far short of what is required by human rights and international recommendations. National governments, policy-makers and prison management need to address gender insensitivity and social injustice in prisons. There are immediate steps which could be taken to deal with public health neglect, abuses of human rights and failures in gender sensitivity.
In preparation for the United Nations (UN) High-Level meeting on non-communicable diseases (NCDs) in New York from September 19-20, 2011, the UN released an Outcome Document, called the ‘Zero Draft’, which affirmed the UN’s commitment to combat non-communicable diseases (NCDs). Civil society has voiced concern over the Zero Draft though, saying their input at the 16 June 2011 Informal Interactive Hearing on NCDs was not taken into account. Concerns include the lack of concrete targets and goals, the lack of specific mechanisms for resource mobilisation, and the lack of substantial follow-up to the meeting within the draft document. The role of the private sector in preventing NCDs is also another point of contention, and particularly the role of regulatory approaches, vs the adoption of the voluntary guidelines and targets favoured by the food and beverage industry representatives.
In 1978, at the Alma‐Ata Conference, ministers from 134 member countries in association with WHO and UNICEF declared ‘Health for All by the Year 2000’ selecting Primary Health Care as the best tool to achieve it. Unfortunately, the health status of third-world populations has not improved, according to the People’s Health Movement (PHM). In this Charter, PHM lays five health principles that may be applied globally. First, the attainment of the highest possible level of health and well‐being is a fundamental human right, regardless of a person's colour, ethnic background, religion, gender, age, abilities, sexual orientation or class. Second, the principles of universal, comprehensive Primary Health Care (PHC), envisioned in the 1978 Alma Ata Declaration, should be the basis for formulating policies related to health. Now more than ever an equitable, participatory and intersectoral approach to health and health care is needed. Third, Governments have a fundamental responsibility to ensure universal access to quality health care, education and other social services according to people’s needs, not according to their ability to pay. Fourth, the participation of people and people's organisations is essential to the formulation, implementation and evaluation of all health and social policies and programmes. Finally, health is primarily determined by the political, economic, social and physical environment and should, along with equity and sustainable development, be a top priority in local, national and international policy‐making.
The United Nations General Assembly adopted by consensus the resolution titled "Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases" (document A/66/L.1). The declaration calls for the development of multisectoral public policies that create equitable health-promoting environments that empower individuals, families and communities to make healthy choices and lead healthy lives. It commits governments to accelerate implementation of the WHO Framework Convention on Tobacco Control (FCTC) and encourages countries, which have not yet done so, to consider acceding to the FCTC. In addition to price and tax measures to reduce tobacco consumption, governments committed to steps that include curbing the extensive marketing to children of foods and beverages that are high in saturated fats, trans-fatty acids, sugars, or salt. Other measures seek to cut the harmful consumption of alcohol, promote overall healthy diets and increase physical activity. It calls for countries to promote, establish or strengthen by 2013, and to implement multisectoral national policies and plans for the prevention and control of NCDs, taking into account, as appropriate, the 2008-2013 WHO Action Plan for the Global Strategy for the Prevention and Control of NCDs.