CRICOS Provider No 00025B uq.edu.au The challenges for global governance for health and universal health coverage under the sustainable development goals. Peter Hill, Claire Brolan School of Public Health European Congress on Tropical Medicine and International Health 10 September 2015

CRICOS Provider No 00025B uq.edu.au EMERGING GLOBAL DISCOURSES 1990 dissolution of the Soviet Bloc saw a shift in global geopolitics Exponential growth in transportation, communication, digital technologies and computerization Opening of markets, rise of transnational corporations Diversification of power—increasing public role for the private sector, recognition of civil society, erosion of the nation state Globalization impacting on global economy, governance, culture This has enabled a re-imagining of global institutions with impacts on -Global Security -Economic and Social Development -Sustainable Development: 1992 Rio Conference And raised expectations (and apprehension) for the New Millennium

CRICOS Provider No 00025B uq.edu.au WITH GLOBAL IMPACTS ON HEALTH These global changes—together with falling confidence in UN agencies, including WHO saw emergent new Players: 1987 Merck Mectizan Donation Program 1993 World Development Report: Investing in Health saw World Bank re-define health in economic terms 1994 Trade-Related Aspects of Intellectual Property Rights makes the World Trade Organization a key health player 1996 UNAIDS created from the WHO Global Program on HIV/AIDS, recognizing the need for a multi-sectoral approach Global Public Private Partnerships, encouraged by Gro Harlem-Brundtland as part of WHO reforms –Product based PPPs –Product development PPPs –Issues based PPPs And a focus on health in the Millennium Declaration

CRICOS Provider No 00025B uq.edu.au THE MDGS: RESTRUCTURING GLOBAL GOVERNANCE FOR HEALTH Health dominates, but accountability at whole-of-government level locally; and networked governance globally.

CRICOS Provider No 00025B uq.edu.au 2000+: THE “DECONSTRUCTION” OF GLOBAL GOVERNANCE FOR HEALTH The expansion of Global Public Private Partnerships: 1998 Roll Back Malaria Global Partnership (RBM) 1999 Medicines for Malaria Venture (MMV) 2000 Stop TB Partnership 2001 Global Alliance for Vaccines and Immunization (GAVI) 2002 the Global Fund to fight AIDS TB & Malaria (GFATM) 2003 Drugs for Neglected Diseases initiative (DNDi) The rise of global philanthropy—Bill and Melinda Gates et al nd High-level Forum on Aid Effectiveness: Paris Principles 2005 WHA resolution: Sustainable Health Financing, Universal Coverage and Social Health Insurance 2005 incorporation of MDG metrics as indicators for World Bank/IMF Poverty Reduction Strategy Papers th High-level Forum on Aid Effectiveness Busan redefines Development Effectiveness

CRICOS Provider No 00025B uq.edu.au POST-2015 DEVELOPMENT AGENDA: THE UN TAKES CONTROL In 2012, UN General-Secretary Ban Ki-moon called for a comprehensive consultative process on the post-2015 development agenda Web-based consultation on the “World We Want” 11 Thematic consultations, including one health 88+ country consultations Mid-2013, three critical documents for health released: Health in the Post-2015 Agenda: Report of the Global Thematic Consultation on Health Report of the High-Level Panel of Eminent Persons on the Post-2015 Development Agenda Rio 20+ Conference on Sustainable Development Outcome Document

CRICOS Provider No 00025B uq.edu.au WHO FRAMES UHC AS THE GLOBAL HEALTH GOAL “I regard universal health coverage as the single most powerful concept that public health has to offer. It is inclusive. It unifies services and delivers them in a comprehensive and integrated way, based on primary health care.” Margaret Chan UNGA Resolution A/67/L.36: “Global support for universal health coverage is gathering momentum, with the unanimous adoption of a resolution in the United Nations General Assembly”. World Health Report 2010: Health systems financing: the path to universal coverage World Health Report 2013: Research for Universal Health Coverage

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CRICOS Provider No 00025B uq.edu.au BUT IN THE 2013 REPORT OF THE THEMATIC CONSULTATION ON HEALTH… “Maximising healthy lives” the health goal UHC a sub-goal, enabling that achievement But epidemic disease response?

CRICOS Provider No 00025B uq.edu.au UN HIGH LEVEL PANEL ON THE POST DEVELOPMENT AGENDA: 2013 The High Level Panel’s 12 “Illustrative” Goals: 1. End Poverty 2. Empower Girls and Women and Achieve Gender Equality 3. Provide Quality Education and Lifelong Learning 4. Ensure Healthy Lives 5. Ensure Food Security and Good Nutrition 6. Achieve Universal Access to Water and Sanitation 7. Secure Sustainable Energy 8. Create Jobs, Sustainable Livelihoods and Equitable Growth 9. Manage Natural Resource Assets Sustainably 10. Ensure Good Governance and Effective Institutions 11. Ensure Stable and Peaceful Societies 12. Create a Global Enabling Environment and Catalyse Long-Term Financing

CRICOS Provider No 00025B uq.edu.au AND THE OPEN WORKING GROUP “ZERO DRAFT” OF THE SDGS

CRICOS Provider No 00025B uq.edu.au SDG HEALTH GOAL 3 AND TARGETS Goal 3: “Ensure healthy lives and promote well-being for all at all Ages”. : 3.1 by 2030 reduce the global maternal mortality ratio to less than 70 per 100,000 live births 3.2 by 2030 end preventable deaths of newborns and under-five children 3.3 by 2030 end the epidemics of AIDS, tuberculosis, malaria, and neglected tropical diseases and combat hepatitis, water-borne diseases, and other communicable diseases 3.4 by 2030 reduce by one-third pre-mature mortality from non- communicable diseases (NCDs) through prevention and treatment, and promote mental health and wellbeing 3.5 strengthen prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol

CRICOS Provider No 00025B uq.edu.au SDG HEALTH GOAL 3 AND TARGETS 3.6 by 2030 halve global deaths and injuries from road traffic accidents 3.7 by 2030 ensure universal access to sexual and reproductive health care services, including for family planning, information and education, and the integration of reproductive health into national strategies & programmes 3.8 achieve universal health coverage (UHC), including financial risk protection, access to quality essential health care services, and access to safe, effective, quality, and affordable essential medicines and vaccines for all 3.9 by 2030 substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water, and soil pollution and contamination

CRICOS Provider No 00025B uq.edu.au SDG HEALTH GOAL 3 AND MEANS OF IMPLEMENTATION 3.a Strengthen the implementation of the World Health Organization Framework Convention on Tobacco Control in all countries, as appropriate 3.b Support the research and development of vaccines and medicines for the communicable and non-communicable diseases that primarily affect developing countries… and, in particular, provide access to medicines for all 3.c Substantially increase health financing and the recruitment, development, training and retention of the health workforce in developing countries, especially in least developed countries and small island developing States 3.d Strengthen the capacity of all countries, in particular developing countries, for early warning, risk reduction and management of national and global health risks

CRICOS Provider No 00025B uq.edu.au WAAGE ET AL. GOVERNING UN SDGS LANCET GLOBAL HEALTH 2015;3:E251-2 Three domains for global development within the global partnership: 1. Natural Environment 2. Infrastructure 3. Wellbeing But governance needs to straddle domains so that wellbeing is not achieved at the expense of the environment

CRICOS Provider No 00025B uq.edu.au GLOBAL GOVERNANCE AND THE SDG HEALTH TARGETS 3.8 Achieve UHC 3.1 Reduce MMR 3.2 End preventable newborn/U5 deaths 3.3 End epidemics: AIDS TB Malaria+ 3.4 Reduce NCDs, mental health 3.7 Universal access to SRH services 3.5 Prevent treat substance abuse 3.6 Halve Road Traffic death/injury 3.9 Reduce deaths/injury from pollution 3a Strengthen FC Tobacco Control 3.b Vaccines and medicine for all 3.c Financing and workforce 3.d Early warning, global health risks The Sectoral The Inter-sectoral The Trans-sectoral

CRICOS Provider No 00025B uq.edu.au OR GLOBAL GOVERNANCE FOR THE SDG HEALTH TARGETS? 3.1 Reduce MMR 3.2 End preventable newborn/U5 deaths 3.3 End epidemics: AIDS TB Malaria Reduce NCDs, mental health 3.7 Universal access to SRH services 3.8 Achieve UHC 3.5 Prevent treat substance abuse 3.6 Halve Road Traffic death/injury 3.9 Reduce deaths/injury from pollution 3a Strengthen FC Tobacco Control 3.b Vaccines and medicine for all 3.c Financing and workforce 3.d Early warning, global health risks The Sectoral The Inter-sectoral The Trans-sectoral

CRICOS Provider No 00025B uq.edu.au BUT GLOBAL GOVERNANCE WITH UNIVERSAL HEALTH COVERAGE? 3.1 Reduce MMR 3.2 End preventable newborn/U5 deaths 3.3 End epidemics: AIDS TB Malaria+ 3.4 Reduce NCDs, mental health 3.7 Universal access to SRH services 3.5 Prevent treat substance abuse 3.6 Halve Road Traffic death/injury 3.9 Reduce deaths/injury from pollution 3.8 Achieve UHC 3.b Vaccines and medicine for all 3.c Financing and workforce 3.d Early warning, global health risks 3a Strengthen FC Tobacco Control The Sectoral The Inter-sectoral The Trans-Sectoral