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Is another “great escape” in global health in the offing? Only if we defeat AIDS and climate change and at the same time advance global health

By Charles Birungi
on June 26, 2015

This week, I spent 2 days reading The Great Escape: health, wealth and the origins of inequalityIn this masterpiece, one of Bloomberg/Businessweek Best Books of 2013 (I only now managed to read it, shame on me!), Angus Deaton tells a compelling and extraordinary story of how humanity got healthy and wealthy, and why some people got so much healthier and wealthier than others. Unfortunately, this “Great Escape” (from poverty and poor health) only pertained to some parts of the world population, at least till now. The book challenged a number of my conventional opinions. While reading it, I actually had an ‘aha’ moment and the optimist in me now feels more energized than ever to moil and toil in revolutionizing global health, and spur another Great Escape 2.0 within my generation.

This uplifting story made me realize that just as 2015 is the MDG deadline, a defining year between the MDG and SDG era, this week could equally turn out to be a turning point for global health. The Lancet Commission diehards among you will surely know by now about the launch of two Lancet Commission reports in London this week. First, on 23rd June 2015, the 2015 Lancet Commission on Health and Climate Change came out. And yesterday, the UNAIDS and Lancet Commission: Defeating AIDS–Advancing Global Health report was launched. The two are strongly inter-related, in my opinion. They both emphasize the importance of urgent action, among others, and in order to achieve their goals, at least to some extent similar measures will have to be taken and political economy questions tackled. I, for one, am convinced that we can do it, and that we’ve reached a critical milestone for global health this week.

Without unnecessarily claiming to be comprehensive, this featured article for IHP offers my reflections on the above-mentioned two commission reports. This viewpoint is not “neutral”, it has indeed a partisan connotation as I have been involved (albeit remotely) in both Commissions as a UN staffer and student at UCL who co-authored a policy brief targeting the global health community. Nonetheless, the views expressed in this short piece are in my personal capacity. Now that I have declared any potential competing interests, the reflections follow.

Launched in May 2013, the UNAIDS and Lancet Commission brought together a remarkably diverse group of experts in HIV, health and development; scientists; young people; people living with HIV; people from affected communities; human rights defenders; activists; and political leaders – including sitting and former heads of state. In my view, the breadth of the Commission’s membership has been key to its success and another illustration of UNAIDS’ convening power and leadership. From meetings in Lilongwe, in June 2013, to London, in February 2014, and across several Working Groups and regional consultations, the Commission investigated how the AIDS response could evolve in a new era of (hopefully) sustainable development while contributing to meeting the SDGs. The Commission also explored the lessons, resources and the ‘whole-of-society’ perspective of the AIDS response that can inform—and transform—other spheres of global health.

Reading the report, it is obvious that it stands out for a number of reasons. First, it represents a consensus among a very diverse group. Second, it tells the story of the achievements of the AIDS response and its potential as a pathfinder for sustainable development at large. This MDG story may be familiar to many in global health, but it is not universally known. This way, I believe The Lancet (one of the most prestigious peer-reviewed journals in the field of global health) and the Commissioners can bring it to a wider audience. This is all the more important and timely, as the AIDS response moves further out of isolation and needs to find new partners.  Also, the lessons of the AIDS response, including its whole-of-society perspective, can be informative and even transformational for other spheres of global health. Third, as an authoritative and independent source, I find the report seminal as it presents compelling evidence of how the end of the AIDS epidemic as a public health threat is feasible with evidence-informed and rights-based strategies, reinforcing the Fast-Track approach in realizing the goal of ending AIDS by 2030 which was adopted in July 2014. By no means will it be easy, but it can be done, is the message.

Similarly, the Commission on Health and Climate Change posits that the world is on the cusp of a ‘once in human history’ achievement. Well, at least if you’re a ‘glass half full’ person. With climate change threatening to undermine half a century of progress in global health, action NOW is poised to be the greatest opportunity for global health in the 21st century. Given the evident nexus between climate change, global health and poverty, I almost feel “in my bones” the urgent call to action, just like Pope Francis who – last week – passionately argued a moral case for acting on both climate change and poverty. Humanity requires it. Our societies depend on it. Our children and grandchildren depend on it.

In conclusion, smartly acting on the right things, in the right places and right now on AIDS and climate change will greatly advance global health and reduce inequalities between people and nations. This is the surest path to sustainable development. Now let’s find out how smart humanity is. Whether the lessons in these Lancet Commission reports will be carried forward in Addis Ababa next month at the Financing for Development conference, the September 2015 SDG Summit and the COP21 in Paris later in the year, remains to be seen. But the cost of dropping the ball is unaffordable. As a citizen of the global South, I plea for taking forward the recommendations of these reports.

The Great Escape 2.0 is in sight, if we dare to think the unthinkable.



Follow me at: @C_Birungi

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