By Lilly Smines (@LillySmines)
“The WHO Constitution enshrines the highest attainable standard of health as a fundamental right of every human being.” – World Health Organization
Whilst approaching the debated year 2015, we are embarking upon the final period of the Millenium Development Goals (MDGs), which is the first globally organized development plan in history. Initially judged as being idealistic and unrealistic, it has since shown to generate great improvements in human health worldwide. A UN progress report from 2014 shows that total hunger in the world has been halved, and that between 2000 and 2012 an estimated 3.3 million deaths from malaria were averted. 90% of these cases were in children in sub-Saharan Africa. Access to an improved drinking water source reached 2.3 billion people.
Still some way to go…
Despite the progress made, there is still great room for advancement. The target of halving the proportion of people without access to an improved drinking water source was astoundingly achieved five years ahead of schedule, the goal on sanitation on the other hand is still lagging behind with 2.5 billion people not using an improved sanitation facility and 1 billion people still resorting to open defecation. Only 8% of the 2.3 billion people, who have gained access to improved sanitation, were from sub-Saharan Africa. Maternal death is another issue that should raise attention, as nearly 300.000 women die every year due to complications related to pregnancy and childbirth. Child mortality has been almost halved, but can be improved significantly. Most causes for maternal and under-five deaths are preventable!
Progress has not occurred evenly- great regional variations have occurred in the process of reaching some or all goals. Political instability is one factor here. A more holistic approach in reaching the goals is therefore necessary with political, socioeconomic, natural resource constraint and climatic considerations taken into account. One central criticism of the MDGs has also been the lack of inclusion of equity and human rights in the goals. Although agreeing on the importance of addressing inequality and inequity, missing or unclear definitions and frameworks made it challenging and nearly impossible to implement.
So, how do we then measure gaps based on gender, ethnicity, socioeconomic status or geographical location, rather than only focusing on economic equity? And with regard to the right to health, how do we actually go about measuring availability, accessibility, acceptability and quality of services as defined by the WHO?
Some improvements have been made, as these topics have received more attention. The UN officially states that all UN agencies must apply a human rights based approach (HRBA), but due to the same reasons mentioned above, the implementation practices have not always been easy or efficient, although it has improved drastically after various evaluations. Many other organizations also use this approach to varying degrees in ensuring that human rights are considered in policy and in all aspects of their work, thus also focusing on potentially excluded groups. More research and results of the HRBA are needed to prove to policy makers and governments that there are benefits of such an approach. One such example is a WHO report that concludes “(…) applying human rights to women’s and children’s health policies, programmes and other interventions not only helps governments comply with their binding national and international obligations, but also contributes to improving the health of women and children.”
The post 2015 development agenda
So, why should human rights and equity be central parts of the post 2015 development agenda?
Human rights and equity need to be stressed in all countries. A recent study shows how the gap between the rich and poor in most OECD countries has never been higher than the past 30 years, and there is a tendency of less social mobility. Strong correlations have been shown between economic inequalities and shorter life expectancy and ill health within and compared with other high-income countries, rather than economic growth and GDP per capita.
Human rights are essential to health and must be included in the Sustainable Development Goals (SDGs), finalized in September 2015, and not only as part of the discourse to then be lost in translation when writing the agenda. We need to be more specific in how to measure and operationalize human rights in the SDGs and emphasize progress monitoring and evaluation, by including mechanisms such as accountability, participation, and empowerment.
Eye on Global Health 