Author: Greg Paton

Politics and Global Health – Are we missing the obvious?

This week, a group of prominent health academics and leaders will meet in London to launch a renewed effort to narrow the evidence and implementation gap in the fight against humanity’s largest cause of premature death and disability.

Convened by The Lancet to launch its latest series on non-communicable diseases (NCDs), this gathering presents a critical opportunity for researchers to forge consensus on a plan of action to achieve the global NCD targets agreed by governments in November. Policy discussions in this area can easily be spread thin given the complexity of the systems that shape our health – global food systems, lifestyle patterns, physical environments, and culture, to name a few. A recent forum hosted by The Economist on NCDs and their social determinants featured what seemed like hundreds of suggested priority areas for action from the expert panellists.

The difficulty of distilling simple interventions from these broad areas should not be underestimated. Challenges the world once approached with hubris – polio eradication, for example – are now recognized as complex problems, intertwined with deep cultural and social factors. Despite such complexity, scientists and policy makers must derive simplicity from these challenges to create interventions that can be implemented and measured.

At a similar meeting convened by the Lancet in 2010, former UNAIDS Director Dr Peter Piot was asked how a group of diverse advocates, academics and politicians managed to agree on a set of concise targets at the United Nations Special Session on HIV/AIDS in 2001. “We scribbled them on the back of some napkins a few weeks before the meeting”, he quipped.

He explained that the process threatened to devolve into a diluted effort and lose direction, given the social complexity surrounding AIDS and lack of scientific consensus on interventions at the time. It ultimately fell to a few leaders to identify a small set of measurable actions and rally support. Although many of those targets did not address the core societal causes of AIDS, they were based on the best evidence of what could be achieved within political realities.

The NCD community woke up to these realities in 2009 and took a page from the AIDS playbook when it began pushing for its own global targets. The result, governments have now agreed to reduce salt consumption, trans-fats and tobacco use, increase access to exercise and healthy food, and a host of other targets that could create unprecedented health gains by their end date in 2025.

A major question still remains though – how can we incentivise governments to achieve these targets and change the systems that impede their achievement? They are non-binding and were agreed within the World Health Organization (WHO), where precedence exists for governments making aspirational speeches, endorsing resolutions, and then failing to translate this rhetoric into meaningful action.

Long progress reports will be issued by WHO containing pages of data, but these will likely avoid venturing into political territory or holding governments accountable. Are we beginning to see the limits of solving a problem that requires political change through an apolitical entity that has little power to influence the policies that create NCDs?

This is a key reason why many have advocated for bringing NCDs under an umbrella partnership that unites UN agencies working on food, development, trade, health and other areas, hoping that this approach would trickle down to countries. Such a global structure would inform and shape multi-disciplinary approaches at national and regional levels. Ministers of Health often lack the power of their counterparts overseeing trade, economic development, and agriculture. Their ability to address the wider determinants can be hindered or even impossible, without these counterparts on board and in the room.

If we play the politics wisely, the targets agreed by governments could offer a carrot and stick to incentivize countries to improve the social, political and economic policies that frame people’s behaviours and decisions – a necessity if the targets have any hope of being reached. If we don’t, there is little likelihood that progress reports and plans issued by intergovernmental agencies will have much impact or change the rules of the game. Lancet Editor Richard Horton said it best: “if we miss dealing with these determinants, we will have failed catastrophically.”

Greg Paton is a psychology and business graduate from Vancouver, Canada who has worked in international health since 2006 and consulted with NGOs, intergovernmental organisations and the private sector. He coordinated the initiative for the 2011 United Nations Summit on NCDs and played a lead role in developing and launching the NCD Alliance, serving as its first manager from 2009-2011. Greg currently lives in Kampala where he works as a consultant to organisations engaged in addressing cancer and other NCDs.

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