Stop TB Partnership

Debate: Addressing global health inequities


05 May 2014 - An interesting debate is brewing on the ways to address health inequities. The political origins of health inequity: prospects for change, a publication by The Lancet - University of Oslo Commission on Global Governance for Health - has sparked much debate. This is likely to evolve in the coming months, especially important in the run up to the conversations around post-2015 goals.

Drawing on the WHO’s Commission on the Social Determinants of Health, the Commission set out to chart the impact that other sectors can have on health. With globalisation, the determinants of health lie beyond any single government’s control, the report says. A range of policy areas that affect health were examined in the report, including economic crises and austerity measures, knowledge and intellectual property, foreign investment treaties, food security, transnational corporate activity, irregular migration, and violent conflict.

The report asserts that in the prevailing landscape of global governance, "power asymmetries between actors with conflicting interests shape political determinants of health". The commission identified five dysfunctions of the global governance system - democratic deficit (unequal participation in the global governance process), weak accountability mechanisms (lack of transparency on matters of public interest), institutional stickiness (the entrenchment of power in international institutions which perpetuates status quo), inadequate policy space for health (commitments made in trade and investment agreements that impact larger interests of public health) and missing institutions (lack of effective enforcement mechanisms in non-binding treaties).

The commission calls for redistribution and accountability of political and economic power. "The unfairness in the distribution of health risks and health effects, require global, cross-sectoral policy interventions that reflect the value of human health and welfare," it said.

The report contains two principal recommendations: establishing a UN Multistakeholder Platform on Global Governance for Health and an Independent Scientific Monitoring Panel on Global Social and Political Determinants of Health. Authors of the report want the multistakeholder platform to provide space for diverse stakeholders to frame issues, set agendas and examine decision-making that have an impact on health.

The report describes the tasks of the monitoring panel as one which examines the complex interaction of forces that lead to health outcomes and the varying effectiveness of different global governance arrangements to protect health. It also recommends that international institutions must conduct health equity impact assessments.

While the commission argues for fundamental changes to address health inequities, critics felt that the commission’s proposals shied away from strong structural or transformative recommendations and limited itself to tinkering with ‘governance’. Its suggestions were termed "safe and apolitical".

Critics also felt that the solutions offered by the authors of the report would add to existing rule-making and ‘regime complexity’ without actually redistributing power or redrawing the framework of existing laws, rules and norms. The commission also failed to adequately address trade and investment agreements that have impact on health, commentators said.

To be sure, the expansive and wide-ranging analysis of the report has been received well, but some feel that in trying to address these varying subjects, the commission dominated by health specialists "runs the risk of straying outside its competence". Some experts have suggested hosting a new commission to come up with better recommendations. Read here for a critique of the report.