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Debate on Post-2015 Agenda Tops Global Health Issues of 2013

December 20, 2013

By David J. Olson

Undoubtedly, the biggest global health story as we approach the end of 2013 is the debate on the post-2015 agenda; that is, the framework that will replace the Millennium Development Goals (MDGs) which expire in 2015. Arguably the second biggest story is the financing of global development, including health.

The latter will determine how global health fares in the next few months and years. But the former could well determine its fate for the next few decades. And this discussion leads us directly to some of the other key global health issues of late 2013.

Where are we with post-2015?

Last year, UN Secretary General Ban Ki-moon named British Prime Minister David Cameron, Liberian President Ellen Johnson Sirleaf and Indonesian President Susilo Bambang Yudhoyono to co-chair a high-level panel (HLP) to come up with a new vision of development. The HLP met for the first time last September at the UN General Assembly. Since then the HLP has met in Liberia and Indonesia, and there has been a whole series of meetings and consultations by the UN, governments and civil society on all issues related to global development, including one on health in Botswana in 2013. http://www.theguardian.com/global-development/interactive/2013/mar/26/future-of-development-timeline

In May, the HLP released their report http://www.post2015hlp.org/wp-content/uploads/2013/05/UN-Report.pdf on its vision and priorities for post-2015 development, which called for an end to extreme poverty by 2030 and a universal agenda driven by “five big, transformative shifts”: Leave no one behind; put sustainable development at the core; transform economies for jobs and inclusive growth; build peace and effective, open and accountable institutions for all; and forge a new global partnership.

In July, the World Health Organisation (WHO), in its own report on the place of health in the post-2015 agenda, http://apps.who.int/iris/bitstream/10665/85535/1/9789241505963_eng.pdf criticized the HLP report, saying it was “not as transformational, ambitious or coherent as one might have hoped, and that the interconnectedness of today’s global challenges is not well reflected in the HLP’s framework.” It says: “Health needs to be prominently positioned in the post-2015 development framework – this is not yet ensured.”

WHO also said the framing of health is “narrow, focusing on communicable diseases, child and maternal health without adequately addressing the changing global burden of disease.”

On Sept 25, at the opening of the U.N. General Assembly, world leaders agreed “to take bolder action against extreme poverty, hunger and disease,” according to the U.N. News Centre http://www.un.org/ and called for a summit in September 2015 to adopt the next set of anti-poverty goals. Ban presented a report outlining his vision of post-2015 development, calling for a “new and responsive sustainable development framework that meets the needs of both people and the planet.”

Global health financing

Overall, overseas development assistance fell by 4% in real terms in 2012, according to The Guardian http://www.theguardian.com/global-development/2013/apr/03/aid-rich-countries-falls-oecd However, this was not the case with global health funding. “Despite dire predictions in the wake of the economic crisis, donations to health projects in developing countries appear to be holding steady, according to the Institute for Health Metrics and Evaluation at the University of Washington. http://www.healthmetricsandevaluation.org/news-events/news-release/has-golden-age-global-health-funding-come-end And that appeared to be the case in the U.S. as well, with the Obama Administration and the legislative branch finding a rare consensus on global health at least until the current budget impasse. http://www.cgdev.org/blog/global-health-fares-relatively-well-fy14-state-and-foreign-ops-appropriations

That leads to three of the next big global health issues – communicable diseases (AIDS and polio) and non-communicable diseases (NCDs):

The rise of non-communicable diseases (NCDs)

When WHO talks about “the changing global burden of disease,” they are really talking about the rise of NCDs on the global stage. http://www.healthmetricsandevaluation.org/gbd/news-events/news-release/massive-shifts-reshape-health-landscape-worldwid September marked the second anniversary of the U.N. High Level Meeting on NCDs, where the world formally acknowledged the need for urgent action on these under-recognized diseases. Thanks to the 2011 meeting, NCDs are finally getting some respect: In May, the health ministers of 194 WHO member states adopted the Global Action Plan for Prevention and Control of NCDs 2013-2020, http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2813%2961457-9/fulltext the first specific and measurable global targets and a monitoring framework. A coalition of researchers are calling for a “global fund” for cancer, which they say kills more than AIDS, malaria and tuberculosis combined. http://www.businessweek.com/news/2013-09-30/global-cancer-fund-needed-to-fight-surging-cases-in-poor-nations And a recent article in The Guardian http://www.theguardian.com/global-development/2013/aug/05/road-deaths-cancer-diabetes-africa suggested that the NCDs of cancer and diabetes along with road traffic deaths constituted “hidden epidemics” in Africa. In fact, a World Bank report predicted that road deaths will rise by 80% by 2020, making them the biggest killer of children by 2015, outstripping AIDS and malaria.

A resurgence of polio

Early this year, there was optimism that polio was on the verge of eradication with only 223 cases worldwide. However, dreams of eradication have been dashed by an outbreak of polio in Somalia, Kenya, Ethiopia and Pakistan. http://www.washingtonpost.com/opinions/a-setback-on-polio-in-east-africa/ In October, the U.N. announced that they fear a polio epidemic in Syria http://www.nytimes.com/2013/10/26/world/middleeast/syria-polio-epidemic.html and in November, the first cases of wild polio virus since 2009 appeared in Cameroon. http://www.who.int/csr/don/2013_11_21/ But if we can overcome this last challenge, it will be one of the landmark scientific achievements of all time. http://www.washingtonpost.com/opinions/michael-gerson-polio-is-a-killer-on-the-run/

Family planning picks up steam

Family Planning 2020, http://www.familyplanning2020.org/ a global partnership set up to follow through on the promises of the London Family Summit in 2012, says that FP2020 commitments are starting to kick in. According to Valerie DeFillipo, Director of FP2020, donors are starting to release the funds they committed to at the London Summit. However, I wonder why even though FP2020 says that 70+ new commitments to family planning have been made since the London Summit, the total amount raised in new funding remains at $2.6 billion, the same figure that was announced at the end of the summit in July 2012. The International Family Planning Conference that took place in Ethiopia in November http://www.fpconference2013.org/ raised a lot of expectations and saw the launch of the first Family Planning Progress Report. http://www.familyplanning2020.org/progress What happens in 2014 will give a good sense of whether we will be able to reach the 2020 goals on schedule.

Continued progress against AIDS, with a caveat

Since last year, more and more organizations are using the phrase “AIDS-free generation” in the title of their reports and blogs. And they’re doing it not necessarily to describe something in the distant future, but in the next 5-10 years. On World AIDS 2012, UNAIDS announced that 25 countries had reduced new HIV infections for 50% or more. In May this year, UNAIDS reported that, in Africa, the number of new infections has fallen by 32% from 2001 to 2011. http://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2013/may/ But this genuine hope is accompanied by the harsh reality that this will not happen unless we do a better job of reaching four populations at high risk: people involved in commercial sex, people who inject drugs, men who have sex with men and transgender people.


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