The big global health meeting at the United Nations has come and gone I still can’t quite tell if anything actually happened.
Maybe that’s normal, when it comes to how things get done at the UN.
After all, the Obama Administration has said if the UN were to recognize Palestine as a state, it would be “merely symbolic.” And yet they’re still fighting like hell to keep it from happening.
I came to New York to cover a meeting called the UN High-Level Meeting on Non-Communicable Diseases, which concluded yesterday. This was billed as a historic moment in global health, only the second time the UN has held such a meeting. The last one, in 2001, launched the Global Fund to Fight AIDS, TB and Malaria — a massive, if imperfect, effort that has saved millions of lives.
The aim of this week’s special session on global health at the UN General Assembly meeting is potentially even more significant than it may sound.
On the surface, it was a call to expand the already strained global health agenda to include non-infectious killers like cancer, diabetes and heart disease — the NCDs (or non-communicable diseases). That’s a big deal because it adds a lot to the agenda, given that chronic diseases kill more people (about 36 million per year) than AIDS, TB and malaria combined.
But it may be even bigger than that.
If you dig a little deeper here, this is the big — mostly unspoken — question: Is this move to get chronic disease on the agenda actually a move away from the standard disease-oriented approach to global health — and toward a more “systems” approach?
“That question has never gone away,” said Gro Harlem Brundtland, former Prime Minister of Norway, former Director-General of the World Health Organization and one of the original architects of what became (and remains) the biggest project of the Bill & Melinda Gates Foundation — the Global Alliance for Vaccines and Immunization (GAVI).
Brundtland and Seth Berkley, a former smallpox warrior, AIDS vaccine advocate and now CEO of GAVI, were among the global health illuminati fielding questions yesterday from journalists at the UN Foundation’s offices.
Both celebrated the millions of lives saved by the international community’s support for greatly expanding childhood vaccinations through GAVI and other such initiatives (like the polio campaign). Brundtland noted that the success of GAVI on kids’ vaccines led others to launch the Global Fund — which, in turn, has sparked momentum and progress in other areas of global health.
“It’s been a dramatic change,” said Brundtland.
There has been dramatic progress in many areas. But I asked Brundtland and Berkley about the fact that donations to fighting AIDS worldwide have declined by about 10 percent. Others noted polio, which this week re-appeared in China, seems like a game of whack-a-mole.
I asked them if the global health agenda, in general, isn’t a bit like pushing on a balloon — push here, bulge there. Do we have a coherent game plan?
“GAVI was a sort of systems approach,” said Brundtland. The idea, she said, was to provide incentives to get poor countries to invest in their public health systems — necessary to do vaccination — by providing donor money for immunization.
“And you cannot have a health system without health workers,” Brundtland added. You have to start somewhere when you try to make health improvements, she said, and funding expanded immunizations has the power to stimulate government to invest in many aspects of health systems.
Berkley agreed, noting that there are plenty of moves afoot to try to bring disparate programs — like GAVI and Pepfar (the massive AIDS drug program for Africa started by President George W. Bush) together to share resources and collaborate.
“We’re all looking at how do we connect all of these so we can work together,” said Berkley.
Hmm, sounds like health systems reform to me. Seems odd that nobody wants to call it that, and we are instead focusing on a single category of disease (if not a single disease).
Part of that reluctance, Brundtland said, is that “ideologues” tend to get involved if you use those words, “health systems reform.” Another expert here said the problem is “health systems” is too vague, involving lots of “hand-waving and generalities.”
Outcome of this week’s meetings?
At the end of the UN meeting on NCD’s there was supposed to be an “outcome declaration” offering a precise road map with clear targets and measurable goals. That didn’t happen. And, in fact, I’m having trouble finding the outcomes declaration anywhere on the UN website.
Now, it looks like the outcome is pretty much the same as the opening declaration, which noted:
“… with profound concern that, according to WHO, in 2008, an estimated 36 million of the 57 million global deaths were due to non-communicable diseases, principally cardiovascular diseases, cancers, chronic respiratory diseases and diabetes … (and that) communicable diseases, maternal and perinatal conditions and nutritional deficiencies are currently the most common causes of death in Africa….”
It goes on. You can read it yourself. It’s long and I’m not at all clear what it is suggesting be done. A press release (implying that perhaps some outcome declaration does exist, somewhere) issued at the end of the meeting did mention the importance of systems, primary care and prevention:
The development of primary health-care systems was key, the representative of Japan said, noting that after 50 years of universal health care in the country, it had attained the highest life expectancy in the world. He said it was important to share best practices from that experience, and his country was participating in numerous conferences for that purpose. The representative of Mexico said that the sharing of experiences in all areas of prevention and treatment were critical for the quickest progress possible in fighting non-communicable diseases.