“Global Health Beyond 2015” - Beyond Stockholm:
Young People’s Perspective
We, young health advocates, laud the Swedish Society of Medicine and the entire Swedish global health community for organizing the two-day conference entitled “Global Health Beyond 2015.” The event indeed triggered a massive interest among global health stakeholders in the place of health in the ongoing post-2015 agenda deliberations, in which the Swedish Government plays an important role (1).
Furthermore, we appreciate the effort to include the voice of young health professionals in the discussions, especially through the workshop on the second day, where more than half of the participants hail from the youth sector. The conference provided a unique platform for “intergenerational dialogue” between current global health leaders and emerging young health professionals, and we hope that more meaningful engagements such as this will be replicated across the world and at different levels - from local to international.
The engaging structure of conference programming, which was akin to that of a talk-show, was helpful in making global health a more interesting and palatable subject for a wider group of audience - both those at the location and those who followed the event remotely. A fair blend of old and new ideas emerged through the robust interaction via Twitter with the audience. This open environment was not only conducive to garner several questions which challenged the status quo, but also to elicit fresh suggestions for tackling current and emerging global health challenges.
Having recognized the highlights of the conference, it is fair to present our perspective on key shortcomings of the conference, which we hope we will overcome and not repeat in future global health conferences. Certainly, we recognize that two days are not sufficient to cover all important issues that plague global health today. While we commend the in-depth discussions on crucial topics such as climate change, health inequalities and poverty, non-communicable diseases, maternal and child health, universal health coverage, global governance for health, and the role of youth, other equally-critical global health issues were missed out, such as HIV-AIDS, emerging infections, antibiotic resistance, mental health, the global health workforce crisis, and the socio-political-economic determinants of health. Nonetheless, we see this conference as a starting point for further dialogues which will ensue within the global health community.
In addition, we are concerned about the siloed approach - which previously marked the fields of public and international health - as it continues to still creep into the new global health arena. A recurring theme was the competition between disease-specific movements (ex. non-communicable diseases versus infectious diseases) and population groups (ex. child health versus women’s health). Although we also recognize that limited resources, especially funding, for health could be the persisting reason for such competition for priority, the global health community must attempt to escape this compartmentalized approach, and adopt more holistic, integrated, and comprehensive approaches such as ecological or systems thinking (2), as well as the life course perspective (3). After all, what makes global health a unique and novel arena for collaborative action is its emphasis on the breaking of boundaries - across nations, disciplines, sectors, and interests (4).
Another proposal that was repetitively raised during the conference is the need to involve all disciplines and professions that contribute to health and its determinants for a real global health discussion. The next global health conference should see more lawyers, economists, anthropologists, engineers, environmentalists, activists, etc. actively participating and contributing in the analysis of global health problems and crafting of collective solutions.
Although we understand that this conference is part of Sweden’s self-examination of its role in advancing global health, it would have been more beneficial for the Swedish global health community if there had been greater participation from other voices, especially from low- and middle-income countries. Furthermore, besides representatives from intergovernmental actors and donor agencies, more civil society actors, especially people’s organizations and patient groups, should have been invited. Such healthy mix of top-down and bottom-up actors would have better informed Sweden’s global health priorities in 2015 and beyond.
Finally, we believe that global health discussions should veer away from disease-focused and population-specific debates and instead emphasize on core issues which continue to plague the global health system, such as the global governance of health - “collection of norms, institutions, and processes that collectively shape the health of the world’s population” (5) - which ultimately dictate the course of debates and actions in addressing the world’s health. In addition, Sweden should reflect on its role in perpetuating the current global governance regime and take leadership in its much-needed transformation, especially in this day and age when governments and multilateral organizations, unfortunately, do not want to take responsibility.
“Global Health Beyond 2015” could have also been a perfect opportunity to re-evaluate the philosophy and mission of global health, as well as to re-commit to the principles and values of equity, justice, and solidarity - which have been part of the global health language for long, but unfortunately, we merely pay lip service to until today. Such re-orientation also entails going beyond our conventional approach and beginning to confront the “causes of the causes” of ill global health - referred to by the WHO Commission on Social Determinants of Health as the “toxic combination of poor social policies and programs, unfair economic arrangements, and bad politics” that led to the persistent and widening health inequalities within and across countries today (6).
We, as young health professionals and global health advocates, are committed to continue engaging with the global health community as we rethink our approach, revisit our ideals, and create greater action to improve the state of the world’s health. We pledge to enjoin more fellow young professionals from all disciplines to participate in this global endeavor of transforming the future of global health for the better. Most importantly, we embrace the challenge to close the gap in OUR generation and make health and opportunities for all a reality in the 21st century.
Renzo R. Guinto, MD (Philippines), Nilofer Khan Habibullah (Saudi Arabia), Usman A. Mushtaq (Norway), Waruguru Wanjau (Kenya)
Members of the Youth Commission
Affiliated with The Lancet-University of Oslo Commission on Global Governance for Health
References:
1. Health in the Post-2015 Development Agenda. http://www.worldwewant2015.org/health
2. De Savigny, Don and Taghreed Adam (eds). Systems Thinking for Health Systems Strengthening. Geneva: Alliance for Health Policy and System Research, WHO, 2009.
3. Hertzman, Clyde and Chris Power. “A Life Course Approach to Health and Human Development.” In: Heymann, Jody, et al. Healthier Societies: From Analysis to Action. USA: Oxford University Press, 2006.
4. Beaglehole, Robert and Ruth Bonita. What is Global Health? Global Health Action 2010, 3: 5142. DOI: 10.3402/gha.v3i0.5142
5. Gostin, Lawrence O.; Emily A. Mok, and Eric A. Friedman. Towards a radical transformation in global governance for health. Michael 2011; 8: 228–239.
6. Commission on Social Determinants of Health. Closing the gap in a generation: health equity through action on the social determinants of health. Geneva: World Health Organization, 2008.