IHP news #524 (May 31, 2019)

Towards a holistic SDG “wellbeing” agenda, spearheaded by the new WHO division for healthier populations ?

By on May 31, 2019



Dear Colleagues,

This week’s issue zooms in, among others, on the new Lancet series on Gender Equality, Norms, and Health; the final days (and more analysis) of #WHA72 (& ensuing 145th EB meeting); the continuing (and no doubt tricky) path towards a strong declaration at the UN High-Level Meeting on UHC in September (with, as the next milestone, probably the G20 summit in Osaka, end of June);  Menstrual Hygiene Day (important day, even if I’m rather unqualified on the matter), World No Tobacco Day, an LGBT setback in Kenya, and the Ebola DRC outbreak, unfortunately a fixture in this weekly newsletter, even if there were (tiny) glimmers of hope this week.

With some important elections now behind us in a number of big countries (India, Australia, …) and regions (EU), Boris Johnson lined up in pole position to replace Theresa May (which is sparking some existential questions for DFID in some corners), and plenty of presidential hopefuls already warming up for ‘the Mother Of All Elections’ in the US next year, a key worry in our “democratic” systems nowadays is that specific issues and performance in government don’t seem to matter much anymore (especially now that authoritarian leaders show themselves very savvy in capitalizing on their huge army of social media followers, fans and trolls to create a certain – ugly – momentum and ‘election mood’ ).  In addition, rightwing populist parties now often combine xenophobic anti-migration policy proposals with (ostensibly) “leftwing” socio-economic agendas (at least for ‘their own’ people), a dangerous cocktail that reminds us of the worst decade of the past century. So this is clearly a very worrying point in time, even if there were also encouraging signals last weekend (for example, the further rise of Green parties in some West-European countries, which considerably strengthens the Green fraction in the EU parliament and will hopefully provide some counterbalance to the nationalist populist parties in the parliament, for example on EU policies on migration and climate change).

Against this difficult political backdrop, the brand new WHO division/pillar for healthier populations certainly has its work cut out in the coming years. The new pillar, which should ensure that one billion more people will enjoy better health and well-being by 2023, has 4 subdivisions: climate change, health and environment; social determinants of health; health promotion; and nutrition and food safety.

As a take away message from #WHA72 (and with momentum slowly but steadily rising for WHO to declare a planetary (health) emergency, if I’m being optimistic for once), I think it’s more than time for WHO (and especially this new branch of it, perhaps) to take the lead in taking on the neoliberal paradigm (now in its death throes anyway), propagating instead an entirely new (SDG/planetary health) ‘wellbeing’ agenda, a “syndemic” one that would imply an NCD/climate change/gender equality ‘triple win’ (and I probably forget a few potential SDG (health) wins).  (New Zealand already gave a good example this week, with its world-first wellbeing budget,  tackling mental illness, family violence and child poverty. )

While I understand the merits of ‘Health as an Investment’ framing and the ‘health economy’ agenda (via healthier populations, over more productivity to more economic growth)  when Tedros talks to Ministers of Finance of LMICs, I think it’s essential he diversifies his rhetoric and so adjusts his core narrative for UMICs, BRICs and certainly “rich countries”, perhaps as a key part of the new GAP for healthy lives and well-being for all?

And so, at every high-level decision making forum (G20, G7, …) he attends, he should actually forcefully advocate for ‘ending the mantra of economic growth’  ( I’m sure his speechwriter can come up with a few decent one liners), link progressive taxation & ending tax havens with the world-wide drive for UHC, argue for decent wages (for the poor/precarious/migrants…  but also, on the other side of the spectrum, for ultra-rich billionaires), and for far more division of labor & shorter working weeks  (now that burnout has been officially redefined in ICD-11, why does WHO, for example, not put forward an SDG-style roadmap for 30-hour work weeks by 2023, 25-hour work weeks by 2030, etc. ?), the right to a sabbatical year every 7 years, …      There are already a lot of interesting ‘post-growth’ ideas  around, just waiting for Dr. Tedros & WHO to embrace them. Heck, they can be syndemic ‘best-buys’! 😊

Not sure Tedros would still be invited next time by Johnson, Xi et al, and it’s probably also not the smartest move to boost WHO funding in the short term, but if WHO really wants to be a “World” health organisation, and thus be there for all countries, also ‘developed’ ones in the North (and increasingly also UMICs and BRICs which also struggle with neoliberalism and the havoc it wreaks in their societies, also via the political backlash we see now), it’s time for him (with his new division for healthier populations perhaps as his personal ‘storm troops’) to take the lead in advocating for this alternative discourse, paradigm and future.  The NCD Alliance, the gender equity community, climate movements, … could and should join this new SDG “wellbeing” agenda.  As Rutger Bregman argued in his book ‘Utopia for Realists’, countries with shorter working weeks have smaller environmental footprints – many progressive think tanks have already made a similar point. And if people (women ànd men) are expected to work only, say, 25 hours a week, it might become easier to also do something substantially about gender inequity and gender norms. That’s a case Femma, a women’s organisation in my country for example, makes.

As Dr. Tedros no doubt knows, many of the world’s current key challenges such as “inequality, wealth redistribution, precarious work, and digitisation”, increasingly also affect ‘developed’ or ‘wealthy’ countries. That leads to aberrations such as (now ex-) Mrs MacKenzie Bezos enjoying a 36.6 billion fortune, having the ‘luxury’ to  give away half of it, as became known earlier this week. In case you wonder how the many precarious and poor in the world perceive this sort of thing, just have a look at the election results in recent years. And probably many more to come if we don’t do anything ‘transformative’ about it.

As for that other (tricky) issue that also plays a vital (but ugly) role in many elections, migration and especially the way it’s cunningly being instrumentalized by xenophobic populist politicians all around the globe, there I guess the global health community can’t do much except continuing to make the case that every human life has the same value, for example in integrating migrant health in UHC. What progressives (including global health people) can do, though, is at the same time putting into practice all their grand rhetoric on ‘down with patriarchy and gender norms’, whatever the setting, whatever the cultural environment, whatever the religion. In the 21st century, the rights of men and women should be totally equal. Full stop. The same goes for LGBTQI. Call it the global version of Trudeau’s famous answer, ‘Because it’s 2015’, when asked about the equal representation of women in his cabinet (in somewhat better times for Justin, admittedly).

I leave it up to your imagination what such a ‘no compromises’ stance on gender equity & rights should entail, in faraway countries (where global health events are often organized nowadays) as well as in our own countries.   Once progressives make it clear they always go for gender equity, anywhere, under all circumstances (as it’s 2019!)   (which also includes not avoiding difficult debates for fear of not being culturally respectful enough, and thus largely leaving the field to far-right populists & xenophobes (as too often is the case now), who of course cunningly exploit this issue as well, for their own goals), then all that remains for xenophobic populists (or worse) to use in election campaigns will be racism. On which we should never give in.

Enjoy your reading.

Kristof Decoster




(PS: you find the pdf of the full newsletter here: IHPn524 )

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