Global imbalances in power undermine efforts to improve health and save lives

February 10, 2014, Lancet

The organization of political power within and between nations and citizens fails to protect the public's health, according to the findings of a new Commission from The Lancet and the University of Oslo, published today.

These power asymmetries, together with the piecemeal way that global decision-making has developed since World War II, are having a disastrous effect on , say the report's authors. The fact that people's life chances differ so sharply from one community to another is not simply a problem of poverty—it is one of socioeconomic inequality. Poor countries and populations that are already disadvantaged suffer the most.

The Lancet-University of Oslo Commission included 18 leaders in research and policy-making from diverse fields, including health, finance, development, environment, human rights, and foreign policy. The Commission gathered evidence over two years to examine how human health is affected by the current system of global decision-making (global governance). Its findings add to the growing public discontent with an unjust global economic system that favours a very small elite with great wealth at the price of environmental and social degradation that negatively affects .

To reverse this trend, the Commission recommends that health equity should be an objective of all political, economic, and social sectors. Although biomedicine has delivered enormous benefits to individuals—eg, a continuous stream of effective new vaccines, medicines, and diagnostics—this technological approach alone cannot address the root causes of health inequity. A fundamentally unjust global economic system that favours a very small elite with great wealth requires those responsible for the public's health to adopt a much broader agenda for change.

The Commission identifies seven areas where political and economic injustices especially affect population health—the and resultant policies of austerity; knowledge and intellectual property; investment treaties; food security; transnational corporations; migration; and armed violence.

For example, is enough to cover 120% of global dietary needs—there is more than enough food to meet global demand. However, the availability of food is not spread evenly. Food security, the Commission concludes, is a political choice, and political corporate interests are preventing the equitable distribution of food sources worldwide by prioritising wealth over health. This inequity not only affects the millions who experience undernutrition and food scarcity, but also the ever-increasing numbers of people in countries of all incomes who experience ill-health and premature death from overnutrition and obesity.

According to the Commission, five key dysfunctions in global governance, are severely impeding improvements in health outcomes. These dysfunctions include democratic deficits (the exclusion of civil society and marginalised populations from national and global decision making); weak accountability (inadequate means to constrain power); institutional "stickiness" (decision-making processes that fail to adapt to the changing needs of people); inadequate policy space for health (health concerns are too often subordinated to other objectives, such as economic growth and national security); and the absence of international institutions (eg, treaties and courts) to protect and promote health.

The Commission concludes that existing mechanisms of global governance are unfit for purpose—they are too fragmented and ineffective to deliver better health for the majority of people in the world. As the international community negotiates a post-2015 global development agenda, the Commission argues that the current system of global governance for health should be reformed. The Commission makes four specific recommendations: first, the creation of a Multi-stakeholder Platform on Governance for Health (a place for deliberation and debate to strengthen accountability for health); second, the formation of an Independent Scientific Monitoring Panel to measure and track progress in overcoming the political, economic, and social determinants of adverse health outcomes; third, health equity impact assessments of all policies and practices; and finally, strengthening existing mechanisms (eg, human rights instruments and mechanisms for sanctions) to protect health and build commitment to global solidarity and shared responsibility.

According to the Commission's chair, Professor Ole Petter Ottersen (University of Oslo, Norway), much greater political will is needed for substantial reform: "Health inequities are morally unacceptable and are exacerbated by the current system of global governance that places wealth creation over human health. Health equity is a precondition, outcome and indicator of a sustainable society and should be adopted as a universal value of a nation's success alongside economic growth. This should be a shared social and political objective for all."

"There have been tremendous advances in the screening for diseases and treating ill heath within the health care setting over the last two decades. But only a very small proportion of the world's population has benefited. These unacceptable health inequities within and between countries cannot be addressed within the health sector by technical measures, or at the national level alone. We urgently need all policies tested for their potential impact on human health. And that requires global agreement that economic growth is celebrated in partnership with health equity.

"Economic growth alone will not deliver good health to the most vulnerable sectors of society without addressing the intertwined global factors that challenge or destroy healthy lives," says Richard Horton, Editor-in Chief of The Lancet. "These challenges can be addressed only by reaching beyond the sector. Solutions will require...a more critical understanding than has hitherto been displayed by policy makers of the determinants of human survival and wellbeing. Success will demand courage and flexibility to challenge the consensus that so inhibits the changes needed to bring about greater equity. This Commission can, we hope, be a contribution to this need for greater critical understanding and challenge."

Explore further: Framework convention on global health needed

More information: www.thelancet.com/commission/g … goverance-for-health

Related Stories

Framework convention on global health needed

May 11, 2011
In this week's PLoS Medicine, Lawrence Gostin from Georgetown University, Washington DC, and colleagues argue that a global health agreement—such as a Framework Convention on Global Health—is needed and would inform ...

Food insecurity leads to increased incidence of tuberculosis in Zimbabwe

February 5, 2014
The rise of tuberculosis (TB) in Zimbabwe during the socio-economic crisis of 2008-9 has been linked to widespread food shortage, according to a new study led by Canadian researchers from the University of Toronto Dalla Lana ...

Economic crisis has made Europeans and Americans less likely to visit the doctor

February 4, 2014
The global economic crisis has wrought havoc to economies on both sides of the Atlantic, but new research in Social Science Quarterly suggests it has also made both North Americans and Europeans more reluctant to seek out ...

A new mental health framework is needed to prioritize action on global mental health

February 28, 2012
For mental health to gain significant attention, and funding from policymakers globally, it is not enough to convince people that it has a high disease burden but also that there are deliverable and cost-effective interventions ...

Falling short of the mark on maternal health in Pakistan

January 31, 2014
The clock is ticking on the United Nations' Millennium Development Goals as the 2015 deadline approaches. For University of Alberta researcher Zubia Mumtaz, that raises a lot of questions about her area of research—maternal ...

Recommended for you

Americans are getting more sleep

January 19, 2018
Although more than one in three Americans still don't get enough sleep, a new analysis shows first signs of success in the fight for more shut eye. According to data from 181,335 respondents aged 15 and older who participated ...

Wine is good for you—to a point

January 18, 2018
The Mediterranean diet has become synonymous with healthy eating, but there's one thing in it that stands out: It's cool to drink wine.

Sleep better, lose weight?

January 17, 2018
(HealthDay)—Sleeplessness could cost you when it's time to stand on your bathroom scale, a new British study suggests.

Who uses phone apps to track sleep habits? Mostly the healthy and wealthy in US

January 16, 2018
The profile of most Americans who use popular mobile phone apps that track sleep habits is that they are relatively affluent, claim to eat well, and say they are in good health, even if some of them tend to smoke.

Improvements in mortality rates are slowed by rise in obesity in the United States

January 15, 2018
With countless medical advances and efforts to curb smoking, one might expect that life expectancy in the United States would improve. Yet according to recent studies, there's been a reduction in the rate of improvement in ...

Can muesli help against arthritis?

January 15, 2018
It is well known that healthy eating increases a general sense of wellbeing. Researchers at Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) have now discovered that a fibre-rich diet can have a positive influence ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.