GLOBAL HEALTH SPESIALISERING IN. Austen Davis

Transcription

1 GLOBAL HEALTH SPESIALISERING IN SAMFUNNSMEDISIN Austen Davis

2 SUSTAINABLE DEVELOPMENT GOALS THE POST 2015 AGENDA Where do we come from? 14 th C quarantine Tropical Health International Health Global Health

3 GLOBAL HEALTH A DEFINITION «A priority on improving health and achieving equity in health for all people worldwide. Global health emphasises trans-national health issues, determinants and solutions: involves many disciplines within and beyond the health sciences and promotes inter-disciplinary collaboration; and is a synthesis of population-based prevention with individual level clinical care.»

4 THE MDGS AND FOCUS AREAS Goal 1: Eradicate Extreme Poverty and Hunger Goal 2: Achieve Universal Primary Education Goal 3: Promote Gender Equality and Empower Women Goal 4: Reduce Child Mortality Goal 5: Improve Maternal Health Goal 7: Ensure Environmental Sustainability Goal 6: Combat HIV/AIDS, Malaria and other diseases Goal 8: Develop a Global Partnership for Development

5 WHAT HAPPENED IN BETWEEN The BRICS and other countries UNIPOLAR -> MultiPolar world LICs -> MICs about 70 LICs in 1990 now about 30. Far fewer percentage of worlds pop living in LICs 3:4 of those considered poor lived in LICs in 1990 to 1:4 in 2015 Most poor live in MICs not eligible for grants and with fiscal potential to act. Global health budgets largely domestically financed.

6 Significant progress but insufficient to meet MDGs 4 and 5

7 Challenges ahead: treatment cascade

8 GLOBALISATION - POPULATION

9 Figure Source: The Lancet 2014; 384: (DOI: /S (14) ) Terms and Conditions

10 THE GLOBAL BURDEN OF DISEASE HEALTH, POVERTY AND DEVELOPMENT

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12 THE SDGS Health and Welfare Goal 1. End poverty Goal 2. End hunger, (food security, improved nutrition, and sust. Ag.) Goal 3. Ensure healthy lives (+well-being all) Goal 4. Ensure quality education (+ opp) Goal 5. Achieve gender equality Goal 6. Ensure water and sanitation Goal 7. Ensure access to sustainable, energy for all Economic Development Goal 8. Promote sustainable economic growth, (employment and decent work) Goal 9. Build resilient infrastructure (industrialization and innovation) Goal 10. Reduce inequality within and among countries Goal 11. Make cities safe and sustainable Goal 12. Ensure sustainable consumption and production patterns Climate and Environment Goal 13. Combat climate change and its impacts*. Goal 14. Conserve the oceans, seas and marine resources Goal 15. Sustainable use of terrestrial ecosystems, (forests, desertification, land degradation and halt biodiversity loss) Global Governance Goal 16. Promote peace, provide access to justice for all and build effective, accountable and inclusive institutions Goal 17. Strengthen global partnership for sustainable development

13 SDGS THE HEALTH GOAL Goal 3. Ensure healthy lives and promote well-being for all at all ages 3.1 global maternal mortality ratio to <70/100,000 live births 3.2 End preventable deaths of newborns and under-five children 3.3 End the epidemics of AIDS, tuberculosis, malaria, and neglected tropical diseases and combat hepatitis, water-borne diseases, and other communicable diseases 3.4 Reduce by one-third pre-mature mortality from NCDs 3.5 Prevention and treatment of substance abuse (drugs and alcohol) 3.6 Halve global deaths and injuries from road traffic accidents 3.7 Ensure universal access to sexual and reproductive health care services (FP) 3.8 Achieve universal health coverage (UHC) 3.9 by 2030 substantially reduce the number of deaths and illnesses from air, water, and soil pollution and contamination 3.a strengthen implementation of the Framework Convention on Tobacco Control 3.b support research and development of vaccines and medicines for the communicable and non-communicable diseases that primarily affect developing countries, provide access to affordable essential medicines and vaccines 3.c increase substantially health financing and the recruitment, development and training and retention of the health workforce in developing countries, especially in LDCs and SIDS 3.d strengthen the capacity of all countries for early warning, and management of

14 MDGS Mortality Goals Service Coverage Risk Factor Reduction Reduction of under 5 mortality Reduction of Maternal Mortality Reduction of Mortality/Morbidity from HIV, TB, Malaria Skilled Birth Attendance Access to voluntary use of modern contraceptives

15 MDGS -> SDGS Mortality Goals Service Coverage Risk Factor Reduction Reduction of under 5 mortality Reduction of Maternal Mortality Reduction of Mortality from HIV, TB, Malaria Reduction of Morbidity from Hepatitis water born disease and other infectious diseases Reduction of Deaths from Traffic Accidents Reduction of Deaths from NCDs (<70 yrs age) Skilled Birth Attendance Access to voluntary use of modern contraceptives Universal Health Coverage = Basic package of health services + Financial protection from catastrophic health expenditure Tobacco Alcohol Drugs Traffic Pollution and Waste (air, water, soil)

16 THE CUBE - UHC

17 CRISIS IN HEALTH WORKFORCE

18 HDA TO Which Regions

19 HDA as % Government Expenditure

20 HEALTH ARCHITECTURE CROWDED AND UNDER- COORDINATED WHO 1948 mandate financing regional structure BMGF the BIG new kid on the block NGOs major cntenders CDC + USAID America plays alone GAVI GFATM Funds for managerial accountability and focus WB competition grows UN Agencies (Unicef, UNFPA, UNAIDS UNIFEM, UNHCR) Global governance for health (Lancet UiO)

21 CONCLUSIONS DIFFERENT LEVELS OF FISCAL STRENGTH AND GOVERNANCE CAPACITY BETWEEN NATION STATES LARGELY DETERMINE THE ABILITY TO PROVIDE PUBLIC HEALTH HOWEVER INCREASINGLY HEALTH IS DETERMINED BY GLOBAL TRENDS OUT OF THE CONTROL OF THE NATION STATE THE WORLD IS CHANGING FAST THE GLOBAL HEALTH ARCHITECTURE AND GLOBAL CAPACITY TO RESPOND IS NOT THE PROVISION OF GLOBAL PUBLIC GOODS ARE SIGNIFICANTLY UNDER-FINANCED AND MANAGED. FUTURE FINANCIAL CRISES AND CLIMATE CHANGE CREATE UNCERTAINTY IN THE FUTURE INNOVATION IS THE GREAT HOPE

22 6 POINTS FOR THE «NEW» DEVELOPMENT ASSISTANCE FOR HEALTH AGENDA 1. The Unfinished Agenda focussed largely on Africa. (<5 and maternal mortality and major infectious disease (HIV +) 2. A cross-sectoral approach to lifetime fertility reduction 3. Global Health Security (detection and response to potential pandemics) 4. Research and Development for the provision of global public goods innovation and knowledge. 5. Finance of health services to enhance well-being, equity and reduce catastrophic expenditure: (transitioning away from external grants and projects) 6. Extended Cost benefit of actions as they contribute to public health and environment/climate of significant actions: (Agriculture and diet; Clean air clean energy; Transport and physical activity (urban); Water and sanitation (use, protection, access) )