{"id":31168,"date":"2014-03-05T10:09:57","date_gmt":"2014-03-05T09:09:57","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=31168"},"modified":"2014-03-06T09:25:31","modified_gmt":"2014-03-06T08:25:31","slug":"guddi-vijaya-rani-singh-why-the-political-origins-of-health-inequity-havent-been-tamed-just-yet","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2014\/03\/05\/guddi-vijaya-rani-singh-why-the-political-origins-of-health-inequity-havent-been-tamed-just-yet\/","title":{"rendered":"Guddi Vijaya Rani Singh: Why the political origins of health inequity haven\u2019t been tamed just yet"},"content":{"rendered":"<p><a href=\"https:\/\/blogs.bmj.com\/bmj\/files\/2014\/03\/guddi.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-full wp-image-31170\" alt=\"guddi\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2014\/03\/guddi.jpg\" width=\"119\" height=\"126\" \/><\/a>Last week saw the release of the much vaunted \u201cPolitical origins of health inequity\u201d <a href=\"http:\/\/download.thelancet.com\/pdfs\/journals\/lancet\/PIIS0140673613624071.pdf\">report<\/a> by the Lancet-University of Oslo Commission on Global Governance for Health\u2014an analysis of how policies and factors external to the health sector impact on health inequity, with appropriate recommendations.<\/p>\n<p>The question for the public health community is: does this herald a true transformation in global health governance or merely reproduce its current impotence?<!--more--><\/p>\n<p>The report\u2019s starting point is that given that health outcomes are determined as much by the circumstances in which people live as by their access to quality health services, there is a need to consider what can be done in other sectors that impinge on health. This marks an important shift away from biomedical fixes to global health problems, and as such, the commission promises a great deal.<\/p>\n<p>The report focuses on the \u201cpolitical nature of global health,\u201d reaffirming many of the points established by Michael Marmot, a member of this commission, in his <a href=\"http:\/\/www.who.int\/social_determinants\/final_report\/csdh_finalreport_2008.pdf\">social determinants<\/a> of health approach. The key claim is that globalisation has promoted growth, but exacerbated inequality. The report talks of \u201can unjust global economic system that favours a very small elite with great wealth at the price of environmental and social degradation that negatively affects health equity.\u201d To the extent that\u2014<a href=\"http:\/\/www.theguardian.com\/business\/economics-blog\/2014\/jan\/19\/davos-inequality-world-economic-forum\">until Davos<\/a> at least\u2014inequality was a dirty word at a supranational level, this report helps to make it part of mainstream discourse.<\/p>\n<p>However, despite its length, the report makes some rather glaring omissions. We are told that the commission selected seven focus areas through a \u201cprocess of informed deliberation.&#8221; What exactly informed the deliberation is not clear; how can they explain, for instance, why an obvious candidate such as climate change was neglected? This is an oversight that the <a href=\"http:\/\/www.theguardian.com\/environment\/2014\/feb\/13\/flooding-storms-uk-climate-change-lord-stern\">people of Somerset<\/a> would surely find hard to forgive.<\/p>\n<p>The commission then goes on to offer two principal solutions to address the \u201csystemic dysfunctions that impede the realization of global governance for health.&#8221; The first calls for establishing a UN Multistakeholder Platform. Given that the purpose of such an entity is purportedly to provide \u201cspace for diverse stakeholders to frame issues, set agendas, debate policy proposals that affect health and health equity, and propose solutions for concrete policy processes,\u201d why is the World Health Organization given such a peripheral and <a href=\"http:\/\/www.thelancet.com\/journals\/lancet\/article\/PIIS0140673613624071\/images?imageId=gr1&amp;sectionType=green&amp;hasDownloadImagesLink=true\">miniscule role<\/a>?<\/p>\n<p>Far from bringing forth a revolution, the multistakeholder platform does little more than recreate the existing problem. And therein lies the rub. Global issues demand global solutions, not ones where the health community\u2014represented by the WHO\u2014helplessly wrings its hands at the fringes of a discussion led primarily by non-health and private interests. Why is the finance sector given the same voice as the public health community? The report notes that the finance sector and the trade sector cause ill health; now is not the time to listen to them, now is the time to change them.<\/p>\n<p>Sadly, the commission\u2019s second proposal offers little better. The suggested Independent Scientific Monitoring Panel on Global Social and Political Determinants of Health \u201cwill call for, receive, assess, analyse, debate, and communicate multiple lines of independent evidence\u2014across disciplines\u2014and provide independent and transparent strategic information to the UN and other actors that affect global governance for health.\u201d The similarities with the <a href=\"http:\/\/en.wikipedia.org\/wiki\/Global_warming_controversy#Authority_of_the_IPCC\">controversial<\/a> Intergovernmental Panel on Climate Change is unsettling, and reminds us to ask: Can independence be secured in such a highly contested debate? Given the so-called balance of power in the proposed stakeholder model, who is to say that there won\u2019t be strong influences from business, especially given that commercial interests are so explicitly represented?\u00a0 If so, how effective can this \u201cmonitoring panel\u201d be? And even if this were not to play out, what good is a watchdog nobody trusts?<\/p>\n<p>With the Lancet-University of Oslo Commission on Global Governance for Health we must be careful of applauding merely another glossy report and ask whether it is feasible or practicable to set up new bodies of such complexity, and what they might achieve.<\/p>\n<p>We have now perhaps come to expect anodyne recommendations from these so-called high-level panels. But is this really acceptable at a time when the world is facing the biggest challenges in human history? Economic justice and climate change will be the major determinants of health and wellbeing for decades to come. But this concept is not new. The report itself admits that many scholars have brought attention to the global and political nature of health and health equity. Another meeting of global health glitterati, convened at great expense, merely to come to the same conclusion that many in the global health community have known for years is disappointing.<\/p>\n<p>It would have made more sense for the commission to demand specific changes in the policies of national governments\u2014such as the City of London\u2019s tax haven status in the UK, which literally steals hundreds of billions of dollars from the developing world each year, or to suggest reforms of the key international structures\u2014such as the global tax secrecy network\u2014whose governance and policies are supposedly being criticised. The commission\u2019s principal recommendations\u2014a talking shop and a monitoring mechanism\u2014are disappointingly pedestrian for a report that calls for radical change to address the fundamental global inequities harming health.<\/p>\n<p>Just because the issues are \u201ccomplex and politically sensitive\u201d does not excuse a response lacking in bite. Health inequalities and inequity are problems of power, and as such deserve powerful rejoinders. Anything less is feeble and\u2014in today\u2019s context of planetary crisis\u2014morally indefensible.<\/p>\n<p><em>Competing interests: I declare that I have read and understood the BMJ Group policy on declaration of interests and I have no relevant interests to declare.<\/em><\/p>\n<p><em><strong>Guddi Vijaya Rani Singh<\/strong> is a doctor training in paediatrics in London. She also has a masters in public health from Harvard University and has worked for the World Health Organization (WHO). She is passionate about social justice, human rights, and challenging barriers to access to health. Most recently, she has worked with 38 Degrees and openDemocracy on the Save the NHS Campaign, and is now working with Medact to set up the People&#8217;s Health Movement UK.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Last week saw the release of the much vaunted \u201cPolitical origins of health inequity\u201d report by the Lancet-University of Oslo Commission on Global Governance for Health\u2014an analysis of how policies [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2014\/03\/05\/guddi-vijaya-rani-singh-why-the-political-origins-of-health-inequity-havent-been-tamed-just-yet\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[223],"tags":[],"class_list":["post-31168","post","type-post","status-publish","format-standard","hentry","category-guest-bloggers"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - 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