For health the global landscape has changed dramatically since the beginning of the twenty first century. At a ‘high level’, the most recent overarching change has been the endorsement in September 2015 at the UN General Assembly of the Sustainable Development Goals to 2030 which replace the Millennium Development Goals and have a strong focus on:
- equity and lifting people out of extreme poverty
- value for money, using research based evidence leading to measurable outcomes and impact
- the intersections between sectors including health, agriculture, climate change, education
Global health equity in this context necessitates a strong focus on effective public health interventions that are based on sound research and evidence of impact. Effective modern public health practice requires both multidisciplinary and multi-sector collaboration.
Looking beyond health there has also been a significant transformation in the global environment with changing trends likely to continue through the first half of this century. These challenges require an innovative institutional response that should be considered in the development of the Alliance:
- Rapid economic growth in emerging economies. “Recipient” countries are assuming greater responsibilities for their essential social infrastructure. This is particularly the case in the Asia-Pacific region. A number of resource-rich low and middle-income countries however, haven’t necessarily invested in social infrastructure including health and education – a key to sustainable economic growth. Downward trends in commodity prices will change the situation further.
- Wealthy countries have experienced major economic crises. Consequently they have become risk adverse in donor funding and expecting traditional recipient countries to significantly increase domestic funding. The donor/recipient divide is increasingly blurred with implications for the relationships between countries. Increased focus on value for money, efficiency, sustainability and evidence base are now central to arrangements.
- Economic growth is transforming global poverty with a significant decline in extreme poverty. Demographically a majority of people classified as living in poverty live in middle-income countries where the benefits of economic growth have been unequally distributed within countries. Women make up a majority of those in extreme poverty and many live in conflict-affected countries.
- There is an emerging global crisis in refugees. The scale of movement of peoples fleeing conflict and social upheaval is unparalleled in human history. This is creating large populations of stateless peoples who lack the protections that safety nets normally afford to citizens of nation states. This crisis presents a challenge to democratic institutions, which by default respond to the interests of voting constituencies.
- Indigenous and tribal minorities constitute 6 per cent of the global population but experience a disproportionate burden of global poverty. The UN Declaration of Indigenous Rights has become a focus for the development of transnational relationships that cut across traditional development relationships. Strengthening global Indigenous networks has the potential to accelerate the development of strategies to tackle in-country inequality.
- The global population is aging and life styles are changing. The share of mortality and morbidity caused by non-communicable diseases (NCDs) is growing and tackling the social determinants of NCDs requires action in non-health sectors, strong political leadership and regional and global collaboration.
At the same time Ebola, Avian Flu and Zika outbreaks have made it clear that, while we can’t predict the next epidemic of an infectious disease, we can say with certainty that it will happen. And the lesson from Ebola is that we need to collaborate and respond swiftly, effectively and immediately, to ensure that an emerging threat doesn’t get out of hand.
- The global political landscape has been transformed. There have been significant challenges to the role of sovereign governments and the emergence of a growing number and diversity of powerful non-state actors. Global capital has been privatized. This brings with it a need to rethink traditional governance structures and move to more fluid political relationships.
The complexity of these challenges is enormous and when climate change is added to the mix it becomes even more daunting. But challenges and change also present opportunities. The way forward is clearly not business as usual. It requires new thinking. As the UN Secretary General said at the conclusion of the debate on the Goals for Sustainable Development, “The 2030 agenda compels us to look beyond national boundaries and short term interests …We can no longer afford to think and work in silos”.
As we move towards the future – the Australian Global Health Alliance has identified several areas of opportunity where we can affect positive change upon these challenges using various methods means at the disposal of our alliance members.
KEY GLOBAL HEALTH CHALLENGES
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