Health inequities need global political solutions

Continuing health inequities in and between countries require global political solutions, according to an international commission convened by The Lancet and the University of Oslo. The problem cannot be tackled by the health sector alone, at the national level or with technical measures.

University of Oslo Rector Ole Petter Ottersen chaired the Commission on Global Governance for Health, which published its report last month in The Lancet, titled "Political Origins of Health Inequity: Prospects for change".

The commission comprised 17 experts from Belgium, Brazil, Canada, Ghana, India, Namibia, Norway, South Africa, Tanzania, Thailand, the United Kingdom, the United States and West Bank occupied Palestinian territories.

Its work was financed by the University of Oslo, the Norwegian ministries of foreign affairs and of education, and the Norwegian Agency for Development Cooperation, NORAD.

The point of departure for the commission was stated in a 2011 commentary in The Lancet: "An increased understanding of how public health can be better protected and promoted in various global governance processes is urgent, but complex and politically sensitive.

"These issues involve the distribution of economic, intellectual, normative, and political resources, and require a candid assessment of power structures."

Key messages

One of the key messages of the report is that "unacceptable health inequities" in and between countries require global political solutions.

Another is that: "Global governance for health must be rooted in commitments to global solidarity and shared responsibility; sustainable and healthy development for all requires a global economic and political system that serves a global community of healthy people on a healthy planet."

One of the most important, and concrete, recommendations is the establishment of an international panel of experts. The Lancet recommends that this work starts as soon as possible.

A multi-stakeholder platform on governance for health "would serve as a policy forum to provide space for diverse stakeholders to frame issues, set agendas, examine and debate policies in the making that would have an effect on health and health equity, and identify barriers and propose solutions for concrete policy processes".

The commission called for independent monitoring of how global processes affect health equity, to be institutionalised through an Independent Scientific Monitoring Panel and mandated health equity impact assessments within international organisations.

Support needed

Discussions are under way on how Norway could fund a secretariat for a monitoring panel, working much in the same way as the UN's Intergovernmental Panel on Climate Change and the newly established Intergovernmental Platform on Biodiversity and Ecosystem Services.

There is now a dialogue between the University of Oslo and Norway's Ministry of Foreign Affairs and NORAD on how to follow up on the report and its recommendations, at home and internationally. The university has raised the possibility of support for an international panel of experts.

Support from the ministry-NORAD is seen as essential to providing legitimacy for the panel and to take the idea forward to the United Nations system and to the so called 'seven global health countries group' comprising health ministers from Brazil, France, Indonesia, Norway, Senegal, South Africa and Thailand, which met at the WHO assembly last May.

In particular, funding is important for producing knowledge based on research in the field of global health, governance and politics.

At the launch event in Oslo, The Lancet editor Richard Horton praised the work done by Ole Petter Ottersen and the University of Oslo, and said: "This vision of a university having a social objective to build capacities [for health governance] as the University of Oslo and colleague institutions around the country are doing, needs to be broadcast to the world."

An example of a feedback from the international community comes from Dr Alex Scott-Samuel, director of IMPACT - the International Health Impact Assessment Consortium of the University of Liverpool - who wrote to Ottersen and described the report as one of the most important papers ever published in The Lancet.

"I have spent much of my 40 year career in public health arguing for the kind of understanding of health politics which is proposed in your report, and for the development of the political science of health as a health science discipline."

Scott-Samuel said he had published peer reviewed material on this theme since the late 1970s, and in 1979 established a politics of health journal, which later became the journal Critical Public Health. More recently he had established the UK Politics of Health Group.

"My purpose in writing is to express enthusiasm for your proposed initiatives for taking forward the recommendations of the commission's report, and to request any possible opportunities to engage with these initiatives."

Ole Petter Ottersen told University World News: "Obviously, the panel will need to analyse the complex interaction of forces that lead to health outcomes, the risk factors we face and the varying effectiveness of different global governance arrangements for enabling and protecting health.

"Competing or conflicting interests among stakeholders underline the need for a fully independent global monitoring mechanism.

"As I see it, the panel will call for, receive, assess, analyse, debate and communicate multiple lines of independent evidence - across disciplines - and provide independent and transparent strategic information to the UN and other actors influencing global governance for health."

* A video of the presentations from the launch event in Oslo can be found at the project's website.