The Sustainable Development Goals: One-Health in the World’s Development Agenda

The Sustainable Development Goals (SDGs), adopted by the UN General Assembly in September 2015, embody a One-Health strategy—healthy people living on a habitable planet. Extending beyond the social development emphasis of the Millennium Development Goals (MDGs), which accelerated progress globally, though unequally, the SDGs also encompass a range of environmental and economic goals, with a health goal that is far more comprehensive than the infectious diseases and maternal/child health focus of the MDGs. To be achieved, the SDGs require resources and political commitment that is yet to be demonstrated. With a cost that could reach $5 trillion for the SDGs overall, achieving health targets will require a mix of increase domestic resources, including taxes on unhealthy foods and products, international assistance, and innovative financing. Annual reviews should identify and monitor threats to the SDGs, both internal contradictions and contradictory government policies such as discriminatory laws, and the necessary rights-based pathways forward. To improve accountability, health information systems with disaggregated data should be prioritized, along with independent monitoring and key governance indicators. Ambitious national benchmarks, drawing on WHO strategies and action plans, could provide markers of success for presently vague health targets. Three early indicators of progress on the health SDGs could be: 1) whether countries establish clear policies on universality, encompassing all people without discrimination, identifying and prioritizing populations with the least access; 2) whether universal health coverage fully incorporates population health; and 3) whether countries provide rapid and sustained increased funding for such necessities as adequate sanitation and nutritious food. A Framework Convention on Global Health, a global health treaty based in the right to health, could fill in critical gaps in the SDGs, creating accountability through capacity-building and compliance-enhancing mechanisms, establishing a financing framework, and ensuring right to health assessments and health in all policies. It could help establish a path forward based on equity and the right to health that would be truly transformative

The United Nations Sustainable Development Goals: Achieving the Vision of Global Health with Justice

We are resolved to free the human race from the tyranny of poverty and want and to heal and secure our planet” (UN General Assembly, 2015, September 25, preamble). So pronounces the 2030 Agenda, the United Nations declaration on the Sustainable Development Goals (SDGs), adopted on September 25, 2015, succeeding the Millennium Development Goals (MDGs). If achieved, the SDGs will secure an improved level of health, development, and global justice. However, if the international community fails to live up to its commitments, an untold number of people will likely perish prematurely, people’s opportunities to thrive will be cut off, social dynamics will continue to leave people behind, and unsustainable environmental pathways will create risks to the health and well-being of generations to come. Here, we systematically review the MDGs—specifically, their formation, achievements, and shortcomings. Next, we review the transition to the SDGs—how they differ from the MDGs, some of the critical challenges they present, and suggestions for a response to these challenges, using a human rights-based approach. Finally, we will offer early markers to assess whether states are sincere in their commitment to longer, healthier lives for all, and offer a next step to ensure that commitment: a global health treaty based on the right to health—embodying the vision of global health with justice

Large-Scale Synchrony in Weakly Interacting Automata

We study the behavior of two spatially distributed (sandpile) models which are weakly linked with one another. Using a Monte-Carlo implementation of the renormalization group and algebraic methods, we describe how large-scale correlations emerge between the two systems, leading to synchronized behavior.Comment: 6 pages, 3 figures; to appear PR

Reimagining WHO: Leadership and Action for a New Director-General

Three candidates to be the next WHO Director-General remain: Tedros Adhanom Ghebreyesus, David Nabarro, and Sania Nishtar. The World Health Assembly’s ultimate choice will lead an Organization facing daunting internal and external challenges, from its own funding shortfalls to antimicrobial resistance and immense health inequities. The new Director-General must transform WHO into a 21st century institution guided by the right to health. Topping the incoming Director-General’s agenda will be a host of growing threats—risks to global health security, antimicrobial resistance, non-communicable diseases, and climate change—but also the transformative potential of the Sustainable Development Goals, including their universal health coverage target. Throughout, the next Director-General should emphasize equality, including through national health equity strategies and, more boldly still, advancing the Framework Convention on Global Health. Success in these areas will require a reinvigorated WHO, with sustainable financing, greater multi-sector engagement, enhanced accountability and transparency, and strengthened normative leadership. WHO must also evolves its governance to become far more welcoming of civil society and communities. To build the political support for these transformative changes, the Director-General will need to focus first on gaining political support. This entails improving accountability and transparency to gain member state trust, and enabling meaningful civil society participation in WHO’s governance and standing up for the right to health to gain civil society support. Ultimately, in the face of a global environment marked by heightened nationalism and xenophobia, member states must empower the next Director-General to enable WHO to be a bulwark for health and human rights, serving as an inspiring contra-example to today’s destructive politics, demonstrating that the community of nations are indeed stronger together

Pillars for Progress on the Right to Health: Harnessing the Potential of Human Rights Through a Framework Convention on Global Health

Ever more constitutions incorporate the right to health, courts continue to expand their right to health jurisprudence, and communities and civil society increasingly turn to the right to health in their advocacy. Yet the right remains far from being realized. Even with steady progress on numerous fronts of global health, vast inequities at the global and national levels persist, and are responsible for millions of deaths annually. We propose a four-part approach to accelerating progress towards fulfilling the right to health: 1) national legal and policy reform, incorporating right to health obligations and principles including equity, participation, and accountability in designing, implementing, and monitoring the health sector, as well as an all-of-government approach in advancing the public\u27s health; 2) litigation, using creative legal strategies, enhanced training, and promotion of progressive judgments to increase courts\u27 effectiveness in advancing the right to health; 3) civil society and community engagement, empowering communities to understand and claim this right and building the capacity of right to health organizations; and 4) innovative global governance for health, strengthening World Health Organization leadership on health and human rights, further clarifying the international right to health, ensuring sustained and scalable development assistance, and conforming other international legal regimes (e.g., trade, intellectual property, and finance) to health and human rights norms. We offer specific steps to advance each of these areas, including how a new global health treaty, a Framework Convention on Global Health, could help construct these four pillars

An O\u27Neill Institute Briefing Paper: Ebola, the World Health Organization, and Beyond: Toward a Framework for Global Health Security

The West African Ebola epidemic has demonstrated that the world remains ill-prepared to respond to infectious disease outbreaks. A host of institutions are now reviewing what went wrong, and new institutions are being considered, including an African Centers for Disease Control and Prevention and World Bank-initiated Pandemic Emergency Facility. The World Health Organization itself failed in one of its core functions by allowing a preventable infectious disease to spiral out of control in the world’s poorest region. The 68th World Health Assembly (WHA), held in May 2015, provided an opportunity for the Organization to reflect on what went wrong and reform the organization to be better able to address the next epidemic. In this Briefing Paper we lay out the present landscape, including reforms needed of the International Health Regulations, and assess the strengths and weaknesses of the outcomes of the 68th WHA, including integrating WHO’s outbreak and emergency response programs; creating a global health emergency workforce, deployable on short notice; and setting up a global health emergency contingency fund. We also consider the vital structural issues the WHA failed to effectively address, including bolstering WHO’s core funding, increasing coherence between the WHO headquarters and regional offices, and enhancing civil society engagement

The International Health Regulations 10 Years On: The Governing Framework for Global Health Security

The World Health Organization (WHO) and its global health security treaty, the International Health Regulations (2005) (IHR) have lost the world\u27s confidence after the West African Ebola epidemic. The epidemic led to several high-level reviews of the IHR and global health security more broadly. Here, we propose a series of recommendations for operational and legal reforms to enhance the functioning of the FCGH. It is critical that WHO act on them quickly, before the window of opportunity for fundamental reform closes. WHO should ensure that all states fulfill their obligations to develop national core surveillance and response capacities, including through funding, possibly through additional assessed contributions, and an independent peer-review assessment process, with assessments identifying gaps and strategies and financing to fill those gaps. Civil society could also participate in ensure the validity of assessments. Independent assessments will improve confidence in the IHR, as would increasing the transparency of Emergency Committees deliberations, supplemented by an independent body to review disease data and offer recommendations to the WHO Director-General. States might more promptly notify WHO of events that may constitute public health emergencies of international concern with enhanced training and if the IHR\u27s decision instrument is amended to make more diseases automatically notifiable. WHO should also further encourage and facilitate reporting from non-governmental sources. A harmonized, gradient system for health emergencies would also bring greater clarity to disease response, while maintaining the power of a declaration of a public health emergency of international concern. To improve compliance with temporary recommendations and deter harmful additional measures, WHO could use public pressure, acknowledging compliance while publicly naming states parties and businesses that fail to comply, along with requesting justification for additional measures. States could use dispute mediation, arbitration, or other legal procedures, such as through the World Trade Organization, to discourage harmful trade and travel restrictions. And to advance a One Health approach, based on the links between human, animal, and environmental health, WHO should increase its use of cooperative agreements with other intergovernmental bodies, while integrating the Pandemic Influenza Pandemic Framework with the IHR to encourage equitable sharing of vaccines and therapies

Fighting Novel Diseases amidst Humanitarian Crises

Humanitarian crises are becoming more prevalent and, frequently, more complex, in zones of mis-governance, lack of government presence, and even active conflict, marked by public mistrust and insecurity. The WHO and other health emergency responders lack the capacities and mandate to adequately respond. The current Ebola outbreak in an area of an active insurgency in the Democratic Republic of the Congo is just such a crisis. The State Department has banned U.S. personnel from the outbreak zone due to safety concerns, leaving the population feeling abandoned, potentially increasing the threat to the few brave health workers who remain. We need is to rethink health emergency response during complex crises and devise new strategies. We offer a blueprint for responding to health emergencies amidst complex humanitarian crises. This blueprint includes peacekeepers who have the mandate and modalities fit for the purpose of quelling a health emergency; “smart” diplomacy to negotiate with belligerents and community members to ensure health and humanitarian worker safety; and deploying all needed health, security, and diplomatic assets. We also call for international development assistance for health, including to support states in developing core public health capacities, creating inclusive health systems, and meeting other need like clean water and nutritious food. Political actors will need to assume their responsibilities if humanitarians and health workers are to carry out theirs