Thirteen years ago the largest-ever gathering of world leaders took place on 8 September 2000 at the United Nations (UN) General Assembly in New York, where the UN Millennium Declaration was made. The Declaration was the most supported, ambitious and specific list of global development goals agreed upon to date, and established a list of commitments to reduce extreme poverty by 2015 which became known as the Millennium Development Goals (MDGs).
The Millennium Development Goals set in 2000
Source: United Nations
The MDGs were significant for global development cooperation due to their ability to stimulate global support, specifically financial resources. Many aid agencies and donors used them to direct their funding projects, and several governments also largely founded their health strategies upon them to receive external funding, which could comprise over 50 per cent of the state’s health budget. The MDGs thereby created a specific global development agenda, which some critics however now argue was not entirely in tune with the real needs of development of low- and middle-income countries. For example, proponents of a greater focus on non-communicable diseases (NCD) criticise that despite NCDs are now the leading cause of death worldwide, they did not receive a single mention in the 2000 MDGs.
Less than 3% of an estimated $21.8 billion global development assistance for health in 2007 was allocated for NCDs. Consequently, calls to include NCDs in the post-2015 MDGs at the review summit in September this year are echoed by a transnational range of actors from the United Nations agencies to governments of developing nations. The question of why the original Millennium Goals lacked any mention of NCDs remains poignant, and answers may shed light onto ongoing (and future) processes of goal-setting and standard-setting in transnational health and development policy.
WHO and World Bank: conflicting agendas
In November 1995, the World Health Organisation (WHO) released an early report on the burden of NCDs in the Global South, which argued that NCDs were the major cause of death in developing countries and mortality rates would continue to rise very sharply. More attention should be paid and more resources allocated to NCDs in poorer countries, the WHO concluded. One year later, in September 1996, another report warned that: “[NCDs] could soon dominate governments’ health care budgets, and yet they have been almost totally neglected by international health research.”
However, in 1999 the World Bank challenged the WHO’s findings, arguing:
“Caution is needed before policy makers embrace the current shift in emphasis from communicable diseases among the young towards non-communicable diseases at older ages. Such a shift is no doubt justifiable from an overall global perspective, but the figures developed here suggest that this shift turns away from the diseases of the greatest importance for the world’s poor, and turns towards those of less importance for the poor, and greater importance for the rich”.
Remarkably, the WHO gave no official rebuttal to this argument by Davidson Gwatkin, a health economist.
According to Dr K. Srinath Reddy, President of the Public Health Foundation of India and the World Heart Federation, the World Bank and related agencies developed a conviction during this time that by committing any energy or resources towards NCDs “you’re hurting the poor and helping the rich.” Reddy suggests that this way NCDs were steered off the transnational development agenda and ultimately excluded from the MDGs in 2000.
New agenda including “priority” NCDs
Thirteen years on, as the original round of MDGs draws to a close, the prospects of NCDs featuring on transnational health agendas appear much improved. Just a few weeks ago British Prime Minister Cameron, the President of Indonesia Yudhoyono, and the President of Liberia Johnson Sirleaf delivered a report on the post-2015 global development agenda to the United Nations Secretary General. The three heads of states had co-chaired a twenty-seven “eminent persons panel” tasked with providing expert recommendations for the progression of global development initiatives prior to the MDG review summit in September this year.
This report includes non-communicable diseases (NCDs) under its formulation of Goal 4 (“Ensure Healthy Lives”), stating that the international community should:
“e) Reduce the burden of disease from HIV/AIDS, tuberculosis, malaria, neglected tropical diseases and [the] priority non-communicable diseases.”
This concise (and evidently compromissory statement) summarised the results of global thematic consultations under the guidance of the United Nations Development Groups (UNDG); regional consultations by the UN Regional Commissions; consultations with businesses around the world directed by the UN Global Compact; the scientific and academic community through the Sustainable Development Solutions Network; and the views of over 5000 civil society organisations and 250 chief executive officers of major corporations.
Private sector pushing the envelope?
It is interesting to note how the private sector has joined in the debate on NCDs and development. In April of this year, experts from the private and public sectors met at a panel luncheon hosted by the Business Council for the UN to discuss whether NCDs were a development issue. The pharmaceutical giant Pfizer sponsored the meeting.
Sitting at the table was Laurent Huber, director of the Framework Convention Alliance, a civil society alliance that aims to help develop and implement the WHO’s Framework Convention on Tobacco Control. Mr Huber explained that: “Governments are just now becoming more aware of the financial costs of NCDs.” Also present was Pol Vandenbroucke, Vice President for Development and Emerging Markets at Pfizer, who added: “There are many affordable pharmaceutical options available at a low cost… Awareness is really the first issue to tackle…”. Additionally, George Alleyne, the United Nations special envoy for HIV/AIDS in the Caribbean and Director Emeritus of the Pan American Health Organization, commented: “For a long time it was honestly felt that non-communicable diseases were just a question of the rich North. That is why they were not included in the Millennium Development Goals.”
A wider range of transnational actors appear to be recognising NCDs as a major challenge for the development of poorer countries and a growing issue for transnational governance. Accordingly, NCDs are now being considered for the post-2015 MDGs at the MDG review summit in September this year. The next blog will explore how the NCD debate has transformed since 2000 and will investigate the main actors pushing the agenda to understand how the framing of NCDs has developed.
Eloise Johnston was a panelist at the 2012 World Trade Organisation Youth Ambassador Forum, Geneva. She is an MA student in International Relations at Macquarie University, Australia, and currently a research intern at the Max Planck Institute for the Study of Societies.