The World Health Organization process of selecting a new director-general moves into high gear this week. As the U.S. presidential election has held global attention for much of 2016, this is likely the most important vote the world isn’t watching. We cannot afford to ignore the WHO leadership choice, which comes in the midst of a global health crisis.
That crisis is the ongoing epidemic of health inequalities. It is an emergency that lurks beneath the headlines, existing instead in the daily realities of vast portions of the world’s population. We come from two countries, South Africa and Bangladesh, where our governments and civil society are making tremendous efforts to improve the health of our people. We have seen important strides, including scaling up HIV/AIDS treatment in South Africa and unprecedented progress in child and maternal health in Bangladesh.
Yet we continue to see snapshots of huge global inequalities of health on a regular basis. In a sprawling township outside Cape Town, many residents live in wood, tin, and plastic shacks, with toilets far and few between. The latrines are often unusable and, even when functioning, unsafe for women and children to access. In isolated parts of Bangladesh, meanwhile, it is still not unusual for a woman to give birth on the dirt floor of her own home without any trained personnel present.
The scale of this crisis is difficult to fathom. By one set of measures, 17 to 20 million deaths every year are linked to inequities. That’s about one in every three deaths in the world. Much of this carnage takes place in less wealthy nations, making it easy for the Western media to ignore it. Inequalities in financing are a major underlying factor. Public health spending is more than 200 times greater in wealthy countries than low-income ones. The average low-income country spends just $13 per person per year. Little surprise, then, that people born in wealthier countries tend to live a generation longer than those in poorer countries.
Yet inequalities exist even within the so-called developed world. In the United States, for instance, there are 14 neighborhoods in Baltimore, Maryland, where the life expectancy is shorter than in North Korea. On one Native American reservation in South Dakota, approximately half the adults over the age of 40 have diabetes, and tuberculosis rates are eight times higher than the American average.
This is why the coming election for WHO leadership demands our attention. WHO has just completed, for the first time, a two-day candidate forum, providing the public a unique window into the six candidates’ visions for WHO. The campaign is now in full swing.
We urge the candidates to use this opportunity to commit that, if elected, they will put the full weight and resources of WHO behind a proposed global treaty based on the human right to health, the Framework Convention on Global Health. A treaty is needed because the right to health cannot be achieved by individual countries acting alone. The new treaty would facilitate the coordinated global effort needed to achieve the right to health everywhere.
The accord would force us to confront the deadly underlying deficiencies of existing health systems. These include inadequate financing, health systems that are not accountable to the people they serve, and the harmful health effects of nonhealth policies, including trade systems that can make medicine less affordable. A treaty would take a stand for and empower those struggling with discrimination, including people with disabilities, indigenous peoples, and women. Instead of perpetuating inequalities, health systems should be in the vanguard of ending them.
Health must be the responsibility of all authorities, not only health ministers. Those charged with economic development, such as energy and transportation ministries, need to include pollution among their central concerns. Justice ministries and prison officials need to ensure that prisons, which too often house the mentally ill, are not overcrowded, serving as incubators of disease.
A health treaty will benefit everyone, not only the poorer countries. As we have seen with Ebola, Zika and other outbreaks, today’s threats know no borders. Ebola spun out of control due in part to understaffed health systems in the countries immediately affected. There was also a lack of public trust in health authorities and a gulf between communities and health professionals. A treaty for more equitable health systems would push governments and international bodies to remedy these underlying problems, leading to faster containment of outbreaks.
For those who argue that such a treaty would be ignored by the very governments that sign it, we call attention to a previous WHO treaty, the Framework Convention on Tobacco Control, which has led to the rapid growth of forceful tobacco control legislation around the world. Little more than a decade since the treaty took effect, dozens of countries have banned smoking in public places, cracked down on tobacco advertising, and instituted significant tobacco taxes. The new Framework Convention on Global Health could be similarly transformative and is every bit as necessary.
We are under no illusions. Establishing a Framework Convention on Global Health is an ambitious undertaking. But ambition, rooted in universal human rights, is precisely what is needed to eliminate unconscionable health inequalities, protect us from emerging threats, and better promote public health. The right to health for all is the path toward true global health security. Joining together in this treaty would bring countries together in a common venture for global health — and help heal a fractured world.
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