“Stop talking around projects and talk about solutions”: Positioning health within infrastructure policy to achieve the sustainable development goals

Purpose and settingInfrastructure is a global multi-trillion dollar market presenting many opportunities and risks for sustainable development. This article aims to foster better conceptualisation of the connections and tensions between infrastructure policy and public health in the light of the Sustainable Development Goals, especially ‘good health and wellbeing’ (number 3) and ‘industry, innovation and infrastructure’ (number 9), based on findings from interviews with a purposive sample of senior practicing Australian infrastructure policy makers.Principal findingsWe use an institutional framework to explore the ideas, actors, rules and mandates, and procedures underpinning the inclusion of health in infrastructure policy. Informants defined infrastructure as the construction and provision of services that facilitate economic, environmental and social outcomes. The tendency to default to infrastructure as essential for economic success has fundamental challenges for the SDGs, particularly the politically driven pursuit of ‘mega-project’ legacies, sector-specific siloed governance arrangements, and inadequate conceptualisations of costs and benefits.ConclusionsPublic health and infrastructure policy are mutually re-enforcing given they both concern the public interest with implications for all 17 SDGs. Positioning health and wellbeing as fundamental societal outcomes from infrastructure decisions would go a long way to helping achieve the SDGs.     

Policy coherence,health and the sustainable development goals: a health impact assessment of the Trans-Pacific Partnership

The international community, comprised of national governments, multilateral agencies and civil society organisations, has recently negotiated a set of 17 sustainable development goals (SDGs) and 169 targets to replace the Millennium Development Goals, which expired in 2015. For progress in implementing the SDGs, ensuring policy coherence for sustainable development will be essential. We conducted a health impact assessment to identify potential incoherences between contemporary regional trade agreements (RTAs) and nutrition and health-related SDGs. Our findings suggest that obligations in RTAs may conflict with several of the SDGs. Areas of policy incoherence include the spread of unhealthy commodities, threats to equitable access to essential health services, medicines and vaccines, and reduced government regulatory flexibility. Scenarios for future incoherence are identified, with recommendations for how these can be avoided or mitigated. While recognising that governments have multiple policy objectives that may not always be coherent, we contend that states implementing the SDGs must give greater attention to ensure that binding trade agreements do not undermine the achievement of SDG targets.     

全球开始关注卫生体系加强

在过去很长一段时间内,某一具体疾病是主要研究对象,但近几十年特别是2005年以来,许多组织开始参与全球卫生研究并关注卫生体系加强。本文对这一关注产生的原因及方式展开研究。研究采用了过程追踪的定性方法,并对政治层面引发和限制其关注的因素进行分析。研究发现加强卫生体系之所以得到广泛关注,主要是因为：全球卫生的参与者担心卫生体系方面的问题会影响千年发展目标的实现,并担心全球卫生行动可能会给国家卫生体系带来负面影响。此外,许多全球卫生组织已经意识到,薄弱的卫生体系会成为实现组织既定目标的瓶颈。尽管目前有众多的参与者支持加强卫生体系,但这些行动者还未形成有凝聚力的政策联盟。此外,加强卫生体系的概念不清晰,而且加强卫生体系的证据很薄弱。由于全球金融危机、全球卫生政策的不确定性以及一些行动者暂时性地支持等,对加强卫生体系的关注是否具有可持续性,目前尚未有定论。     

Reproductive health and the Millennium Development Goals: the missing link

This report was commissioned by the Population Program of the William and Flora Hewlett Foundation in December 2004. The author was charged with analyzing the United Nations' deliberations that led to the adoption of the Millennium Development Goals (MDGs) to answer the question of why there is no specific reproductive health goal. Her report, of which this is a lightly edited version, is also available online at . This coverage of the MDG process will be complemented by a special section of Studies in the June 2005 issue on reproductive health and the MDGs. The section will include excerpts about reproductive health from the final report of the Millennium Development Project entitled "Investing in Development: A Practical Plan to Achieve the Millennium Development Goals," which was submitted to Secretary General Kofi Annan in January 2005, as well as commentaries by leading scholars and policymakers in the fields of population and reproductive health.     

Future-proofing global health: Governance of priorities

The year 2015 was a significant anniversary for global health: 15 years since the adoption of the Millennium Development Goals and the creation of the Global Alliance for Vaccines and Immunization, followed two years later by the Global Fund to Fight AIDS, TB and Malaria. 2015 was also the 10-year anniversary of the adoption of the International Health Regulations (May 2005) and the formal entering into force of the Framework Convention on the Tobacco Control (February 2005). The anniversary of these frameworks and institutions illustrates the growth and contribution of ‘global’ health diplomacy. Each initiative has also revealed on-going issues with compliance, sustainable funding and equitable attention in global health governance. In this paper, we present four thematic challenges that will continue to challenge prioritisation within global health governance into the future unless addressed: framing and prioritising within global health governance; identifying stakeholders of the global health community; understanding the relationship between health and behaviour; and the role of governance and regulation in supporting global health.     

Framing health and foreign policy: lessons for global health diplomacy

Global health financing has increased dramatically in recent years, indicative of a rise in health as a foreign policy issue. Several governments have issued specific foreign policy statements on global health and a new term, global health diplomacy, has been coined to describe the processes by which state and non-state actors engage to position health issues more prominently in foreign policy decision-making. Their ability to do so is important to advancing international cooperation in health. In this paper we review the arguments for health in foreign policy that inform global health diplomacy. These are organized into six policy frames: security, development, global public goods, trade, human rights and ethical/moral reasoning. Each of these frames has implications for how global health as a foreign policy issue is conceptualized. Differing arguments within and between these policy frames, while overlapping, can also be contradictory. This raises an important question about which arguments prevail in actual state decision-making. This question is addressed through an analysis of policy or policy-related documents and academic literature pertinent to each policy framing with some assessment of policy practice. The reference point for this analysis is the explicit goal of improving global health equity. This goal has increasing national traction within national public health discourse and decision-making and, through the Millennium Development Goals and other multilateral reports and declarations, is entering global health policy discussion. Initial findings support conventional international relations theory that most states, even when committed to health as a foreign policy goal, still make decisions primarily on the basis of the 'high politics' of national security and economic material interests. Development, human rights and ethical/moral arguments for global health assistance, the traditional 'low politics' of foreign policy, are present in discourse but do not appear to dominate practice. While political momentum for health as a foreign policy goal persists, the framing of this goal remains a contested issue. The analysis offered in this article may prove helpful to those engaged in global health diplomacy or in efforts to have global governance across a range of sectoral interests pay more attention to health equity impacts.     

Performance incentives for global health: Potential and pitfalls

Abstract

Political analysis can enrich our understanding of the interface between health and society. Here, a theoretical framework called ‘the biomarket’ is proposed, one that describes the interaction between life, power and the market, and the progressive institutionalisation of this dynamic by state actors. This framework expands upon ‘biopower’, a social concept developed by Michel Foucault. The role of the biomarket is illustrated by analysis of a range of cases, namely the relationships between global health and the pharmaceutical and tobacco industries. The potential adverse consequences of the biomarket are demonstrated, revealing how in some instances, important social measures of welfare are discarded for the sake of economic efficiency and profit. The authors conclude that the biomarket may serve to deepen our understanding of the authority and control exerted by corporations over life, positing that the biomarket must be further regulated for sustainable advances in global health.     

Non-communicable diseases and tuberculosis: Anticipating the impending global storm

ABSTRACT

The epidemiological transitions that have occurred in low and middle income countries (LMIC) during the past decades have led to an increased prevalence on non-communicable diseases (NCDs) in these countries, where the burden of infectious diseases (IDs), especially tuberculosis (TB), remains high. Although the true dimensions of this comorbidity have not yet been fully understood, there is a growing amount of data, over the last 10 years, that suggest a clear association between NCDs and TB. In particular, there is a continuously increasing body of evidence that diabetes mellitus, chronic respiratory conditions, tobacco use, mental health illnesses and chronic kidney disease increase TB morbidity and mortality and vice versa. This bidirectional negative association between diseases may jeopardise the achievement of the Sustainable Development Goals (SDGs) specific TB targets, thus underlying the importance of integrated public health responses towards both epidemics. Population as well as individual based approaches are required, along with both strategic and operation integration on a global scale. This year's United Nations High Level Meetings (ΗLMs) presented a rare opportunity for the political foundations of the TB and NCD responses to be dug together, thus creating a potential breakthrough in the global response to both epidemics.     

Globalisation and global health governance: Implications for public health

Abstract Globalisation is a defining economic and social trend of the past several decades. Globalisation affects health directly and indirectly and creates economic and health disparities within and across countries. The political response to address these disparities, exemplified by the Millennium Development Goals, has put pressure on the global community to redress massive inequities in health and other determinants of human capability across countries. This, in turn, has accelerated a transformation in the architecture of global health governance. The entrance of new actors, such as private foundations and multi-stakeholder initiatives, contributed to a doubling of funds for global health between 2000 and 2010. Today the governance of public health is in flux, with diminished leadership from multilateral institutions, such as the WHO, and poor coherence in policy and programming that undermines the potential for sustainable health gains. These trends pose new challenges and opportunities for global public health, which is centrally concerned with identifying and addressing threats to the health of vulnerable populations worldwide.     

Cervical cancer prevention and the Millennium Development Goals

The advent of new technologies such as the human papillomavirus (HPV) vaccine and HPV DNA tests – along with new insights into the appropriate use of low-resource technologies such as visual inspection of the cervix and treatment of cervical lesions with cryotherapy – have increased optimism about the potential for effective disease control in low-resource settings. Nevertheless, it is also important to ask ourselves how new health initiatives contribute, or fail to contribute, to major global undertakings such as achievement of the Millennium Development Goals (MDGs).While reproductive health in general, and cervical cancer prevention in particular, are not explicitly mentioned among the MDGs, they are implied; and it is certain that women cannot contribute to sustainable development without good health. The question is, in what ways do scaled-up cervical cancer prevention activities, including introduction of the new HPV vaccines and increased access to precancer screening and treatment, contribute to attainment of the MDGs?