With all the hype and fanfare on the advances in global health (erroneously or not) attributed to the Millennium Development Goals era and the positive spin placed on the new, highly ambitious, all-encompassing, development agenda known as the Sustainable Development Goals (SDGs), people could be forgiven for thinking that for the most part, the world’s health problems were solved.
But sadly this is not the case.
MSF can vouch for the lack of adequate health services in, at present, the 63 countries where it has teams working. Among these populations and others like them, there is probably little knowledge and unlikely to be any celebration when the SDGs are adopted by a special UN summit in New York City this coming weekend.
Serious Risks to Global Health
In the past 15 years, the world saw real change and significant health gains in many countries, particularly for people living with HIV/AIDS, tuberculosis and malaria, resulting from well-targeted, people-centred, innovative and properly funded health care programs. It also saw the greatest number of displaced people since the Second World War. In some cases, countries that had health care and populations that had access are now left without health structures.
As medical staff have become targeted as weapons of war, populations have been deprived of some of the most basic medical services. The world has also witnessed serious threats to global health, such as the progressive increase in antibiotic resistance — which risks undoing many of the advances seen in population health today — or the explosion of Ebola in West Africa, to which the world had no treatment response, resulting in thousands of deaths and an epidemic that is still ongoing. There are also populations that, due to government inability, inefficiency or just plain exclusion, have failed to gain access to adequate health care or medicines and whose needs remain critical and immediate.
The SDGs, which will be rolled out in 2016 over the following 15 years worldwide (at least on paper), do include one health goal and a number of targets linked to key diseases, nutrition and other social determinants of health. However with so many other priorities within the SDGs (climate change, peace and security, water, and many more), something has to give. Recent trends and postulating by key international donors indicate a push back to the paradigm of the 1980s, when the major concern about health was associated with how much it cost, and not the cost of suffering to people with little if any access to quality health services. The world remains very much a mixture of those that have and those that have not, and a new development agenda, regardless of how well intentioned, will do little to change this if it is not translated into concrete action with sufficient funding.
Decrease in Healthcare Funding
Recent trends in international aid come in stark contradiction to intentions, with a progressive decrease in concessional funding to health care. The emphasis on countries doing more for themselves and aid being increasingly used as a “catalyst” to drive economic growth does not bode well for global health. Fragile health gains cannot be maintained and ambitious targets cannot be reached if health does not drive policy.
Countries such as the Democratic Republic of Congo (DRC), with overwhelming needs in many social sectors — but where less than 17 per cent of HIV patients receive treatment — should not be obliged to make impossible choices, and their population should not have to pay fees in order to seek care that they often can’t afford. In Kinshasa, the capital of DRC, people have to go through such a long, painful and costly search for HIV diagnosis and care that by the time they present at the hospital, they are at a very advanced stage in the disease. One in four patients hospitalized at the MSF-supported hospital Kabinda die, paying the price of not accessing antiretroviral treatment soon enough. This is unacceptable, and throws us back 20 years in time.
People in countries moving up the income ladder do not automatically gain access to functioning health systems once their countries are classified as middle income economies, especially if one realizes that middle-income countries are home to over 70 per cent of the world’s poor and sick, including the largest part of disease burdens for HIV/AIDS, tuberculosis, malaria and non-communicable diseases.
Healthy Populations, Not Profits
People marginalized due to conflict and instability or social exclusion exist today and will still exist tomorrow. Regardless of where they live or their economic situations, people deserve access to existing medicines and treatments, as well as to newer ones. More research and development, especially on behalf of developing countries, is required and should be aimed at supporting healthy populations, not only healthy profits. MSF doctors were powerless, and without any new tools, to treat the more than 10,000 people admitted to MSF Ebola Treatment Centres across West Africa last year, four decades after the first outbreak of the disease and over a year after the current outbreak began.
Doctors, while relieved to have new drugs to treat drug-resistant-tuberculosis (DR-TB), realize that these new combinations will still not provide patients with the outcomes they deserve, and in many countries the drugs remain unaffordable or unavailable. The basic and essential package of vaccines for immunizing women and children is now 68 times more expensive than it was in 2001 —and even at the lowest available global prices, it is still not accessible to many countries, or to humanitarian organizations such as MSF.
If the SDG slogan of “Leave no one behind” and the goal of achieving universal health coverage are to be more than wishful thinking, this new development agenda needs to bring with it immediate actions and a shift in current approaches to ensure that health remains a priority, and is not reduced to a commodity.
By Dr. Mit Philips. Photo by Phil Moore © MSF, 2014.
via MSF Canada.
