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In the 1990's, two important documents
in global health emerged. The first one is the Global Burden of
Disease study that was released in the 1990.
This is the first every comprehensive global and regional assessment of
mortality and morbidity from major diseases, injuries, and risk factors.
This is an important document because it helped
shape global health prioritization in the years to come.
It was updated twice, first in 2004 and most recently
in 2010.
The other document was released in 1993 by the World Bank.
It is the first world development report focused on health matters.
Entitled investing in health, this report signalled World Bank's commitment
to addressing global health issues. This document examined the inter-play
between human health, health policy and economic development.
It contain many policy prescription. But one of the,
the, the suggestions,recommondations, was the use
of the Disability-Adjusted Life Year, or DALY, as new metric for
morbidity and mortality. Again, this DALY, among other
metrics will be discussed in a future session in this course.
The impact of the World Development Report 1993, as well as the different structural
adjustment programs that were imposed by the World Bank on many countries was huge.
There were a cuts in public funding for
health, privatization of health care services, promotion of private
health insurance, introduction of user fee's, and
rising cost in health care services overall.
The following year in 1994, in Cairo, there
was held the International Conference on Population on Development.
This is also a very important conference, because it recognized the importance of
addressing reproductive health and rights as well as the role of women
and gender equality as
corner stones of population and development programs.
This conference has been the basis of many
efforts by different UN agencies, such as the UN
population fund, and many countries that have been supporting
efforts in reproductive health and gender and women empowerment.
Another important milestone
in the 1990s is the emergence of the World Trade organization in 1995.
The WTO is the successor to the general agreement on tariffs and trade,
which is the mechanism that has governed international trade for many decades.
But WTO expanded their reach of global trade to include internationally
traded services such as Health Care and Health Work Force.
And also intellectual property, and of course, this made a
huge impact on access to medicines, especially in the developing world.
With all the developments in the 1990s, and with the
fact that the vision of health for all was never achieved in the year 2000.
Civil Society organizations decided to come up with a
collective response and gathered in Bangladesh at the first People's Health
Assembly which led to the founding of the Peoples Health
Movement and the drafting of the People's Charter for Health.
This charter lay down a comprehensive analysis
of the political economy of health
and at the same time listed key recommendations and demands for
economic transformation, the protection of the environment, the provision of
publicly funded health care services among all others.
On the other hand, inside the holes of the
United Nations,governments were negotiating what we now call the
Millennium Development Goals. These goals are meant to
be achieved by countries, by the year 2015, in a 15 year period.
And while all the eight goals are related to health,
three are specifically addressing health issues, such
as the reduction of child mortality, the improving of
maternal health, and the combating of HIV/AIDS, malaria, and other diseases.
These goals have shaped national policies as well as programs of UN agencies.
And now we are in the process of reviewing the gains as
well as the lessons that we can learn for the future development agenda.
After the crafting
of the Millennium Development Goals, the United Nations was
in 2001 called for a meeting to discuss HIV/AIDS.
It is important to remember that HIV/AIDS is the first
health issue to be discussed by the United Nations General Assembly.
The summit laid down firm commitments on a wide range of issues,
including the prevention and treatment of HIV/AIDS, as well as addressing the needs
of vulnerable groups that are often afflicted by HIV/AIDS and
who, and who also suffer the stigma associated with the disease.
[INAUDIBLE].
In addition, in 2001, WHO, under the leadership of then Director General,
Dr Gro Harlem Brundtland, created the commission on macroeconomics and health.
This commission emphasized that health
is a creator and prerequisite of development.
It also recommended the extension of coverage of health services,
as well as of a small number of critical interventions to the world's poor.
And these interventions are actually proven to
have the potential to save millions of lives.
Since the release of the report of the commission
there has been so many developments,
especially in the financing of such interventions,
for example, the G8 played a more prominent role in global health from
creating the global fund to fight AIDS, tuberculosis and malaria in 2001
to making pledges on a wide range,
such as health system strengthening.
Moreover, the Bill and
Melinda Gates Foundation became a key global health player, and a source
of Global health funding. For example it stimulated the creation of
the Global Alliance for Vaccines and Immunization (GAVI).
Since then more Global health initiatives and partnerships from the
governance, the private sector foundations and civil society
along side governments.
Despite the growing attention and increased
flow of financing and resources for global
health, health inequalities remain a huge
problem between countries and within countries.
Therefore in 2008, the World Health Organization released the
report of the Commission on Social Determinants of Health.
And the commission attempted to answer the basic question,
what good does it do to treat people's illnesses
only to send them back to the conditions that made them sick?
Social determinants of health pertain to the conditions in which people are born,
grow, live, work and age. And the report clearly stated that
an equal distribution of health damaging experiences,
is not in any sense a natural phenomenon
but the result of the toxic combination of poor social policies and programs,
unfair economic arrangements, and bad politics.
Therefore, the Commission crafted three
over-arching recommendations to address this problem.
First, through improving
daily living conditions such as sanitation and housing.
The second is to tackle the
inequitable, distribution of power, money, and resources
through reforms in international financing institutions and in global trade.
And the third one pertains to measuring and understanding
the problem in assessing the impact of actions.
how we can enhance monitoring
progress in acting on the social determinants of health.
Also, in 2008, the Director General of
the World Health Organization, Dr Margaret Chan, made a call to return
to Alma-Ata. This is in part of the 30th anniversary
celebration of the Alma-Ata declaration. And during this
year WHO released a world health report
entitled, primary health care now more than ever
which laid down reform, priority areas in
delivery, in leadership of health care systems, in financing
to achieve universal health coverage and addressing public
policies that impact on health systems and health outcomes.
This was supported by the development of a frame work for health
system, the so called six building blocks of a health care system.
Which included governance, human resources for a health, health information systems,
service delivery, health financing and medicine technologies and devices.
This is a very important framework for action,
for governments, for civil society and any actor
that wants to contribute to strenghtening of health systems worldwide.
In 2010 WHO again released an important report,
this time focusing on health financing, and this serve as the basis
of our reform of priorities toward achievement of universal
health coverage that is now growing momentum, in fact, nearly a 100
countries are now racing towards the finish line of universal health coverage
in order to ensure that their people, the populations have access to
essential healthcare without the risk of
impoverishment due to catastrophic, health spending.
Even the Director General herself emphasized
during the 65th World Health Assembly in 2012
that universal health coverage is the ultimate expression of fairness.
And universal coverage is the single most powerful concept
that public health has to offer.
Universal health coverage is now gaining traction
even in the ongoing discussions on the post 2015th agenda.
We know that the millennium development goals are nearing their end and therefore, the world,
the United Nations, the Global community is discussing what's next after
2015 and universal coverage is about definitely at the center of the table
of, global discussion.
And I would like to encourage you by closing with a quotation, by a German
philosopher named Arthur Schopenhauer, he said that, health is not everything.
But without health everything is nothing.
Thank you very much and I look forward to working with you in the future, Bye bye.
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