Rio de Janeiro, august 2013

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WHO wants Post-2015 Agenda guided by Social Determinants of Health

“Health, in a sense broad enough to include the social determinants of health, should be prominently positioned in the post-2015 Development Agenda”: define how this goal will be attained become an urgent task for health global actors. The study conclusion is contained in the World Health Organization (WHO) consolidated report about the global consultation process for the definition of the Sustainable Development Goals (SDGs).

The report, released at the end of July, offers an analysis on the global consultation conducted by the United Nations beginning last year and health positioning during the process. It concludes that, in addition to its inclusion as a specific issue of new SDGs, health needs to have a cross-cutting participation within all the dimensions of the new Development Agenda, which, according to the report, is not yet ensured.

“Health positioning is an urgent challenge, since the discussions on the post-2015 Agenda forward quickly”, says the text. “It is crucial to know the extent to which key concepts of global health and other priority themes have been dealt, integrated and referred to in other thematic areas, as well as in parallel discussions on the SDGs.”

According to WHO, the challenge implies taking to the core of the debate the social determinants of health (SDOH), the challenges to health safety, and both the current and the “new” health agenda, such as Non-Communicable Diseases (NCDs) and mental health. “The next steps involve the need to ensure the recognition of the central challenges regarding governance in health.”

The action concerning social

determinants of health is one of the five strategic action axes of Unasur Health Council (CSS) – of which ISAGS is part - defined in its 2010-2015 Quinquennial Plan. In October 2011, ISAGS participated in the SDOH World Conference, held in Rio de Janeiro, and obtained, on behalf of SDOH, the insertion in Rio Declaration of issues important to the South American bloc. The document grounded part of the discussions carried out in UN Conference on Sustainable Development Rio+20, held in June 2012, and is considered a reference text for the negotiations on the post-2015 and the new SDGs.

SDGs and the Post-2015 Agenda

In recent months, eleven thematic consultations were held by UN for the definition of the new SDGs in replacement to the Millennium Development Goals (MDGs), whose deadline for achieving targets expires in 2015. The final report on health consultations was consolidated after the meeting held in Botswana last March and published in April, containing the guidelines to include the topic in the Post-2015 Agenda.

At the same time, two bodies were created: the High Level Panel of Eminent Persons on post-2015 linked to the UN Secretariat-General Secretariat, which presented a report in May; and the UN General Assembly

Working Group, still under the process of querying. The documents generated by the round of negotiations will be discussed in the next session of UN General Assembly, scheduled to take place in September at the Organization headquarters in New York (USA).

WHO document examines the suggestions derived from all ten thematic consultations - in addition to health -; the final report of the High-Level Panel delivered to UN Secretary-General Ban Ki-moon; the document approved at Rio+20; as well as the discussions about the new SDGs. It also offers suggestions for the inclusion of health from the perspective of social determinants as a cross-cutting axis in the post-2015 Development Agenda.

“Health, in its broad sense, must be prominently positioned in the Development Agenda,” states World Health Organization report

The action concerning social determinants of health is one

of the five strategic action axes of Unasur Health Council

High Level Meeting on Health in the Post 2015 Development Agenda, which was held in march 2013 in Botswana capital

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READ MORE• “Health should be the center of the sustainable development” Page 2

• “ISAGS’ activities balance is positive”, says Brazilian ChancellorPage 3

• “Unasur is very im-portant in Framework on Tobacco Control” Page 4

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In the report “Health in the Post-2015 Development Agenda”, WHO states that health should not be approached as a separate topic, but as “a global comprehensive goal which is a cornerstone of sustainable development in the 21st century”. According to the text, the suggestions put forward by the High-Level Panel fall short in this regard. On the other hand, health has been better addressed in SDGs discussions, as, for example, in Rio+20 Declaration. Here are some of the findings of the report released by WHO.

Post-MDGs Process“The Post-MDGs process is competitive

and uncertain. The challenge is great because in the past have a goal meant to attract the attention of donors to the issues at hand. The global health community needs to ensure a high level of involvement in defining the agenda for the period post-2015.”

Health’s Role“Health needs to be prominently

positioned in the post-2015 development framework, what is not yet ensured. In the upcoming negotiations, health advocates must hone their skills and arguments in presenting health not as a sectorial, functional or technical area but as an overarching fundamental global goal which is a cornerstone of sustainable development in the 21st century.”

Equity and Human Rights“Health should also be presented as

conceptually fundamental in both a normative and a strategic sense to any future post-2015 framework that might emerge. Its deep relations to human rights, equity and governance need to be highlighted. Health has much to contribute and this includes the discussions on global public goods.”

Social Determinants“Health sector must build the bridges to key

areas of action that are critical determinants of health, in particular education, food, water and energy: which global public goods need to be put into place to ensure security and safety in health. Many of these issues have similar challenges towards universal access (i.e. water as a human right), as does the debate on universal health access. The work done over the last years on SDOH should be made widely available while briefing Report published in april about Health in the Post-2015

“Health should be the center of the sustainable development”WHO understands that development has a strong political dimension beyond to the technical question, and requires an SDOH approach

materials and negotiation events should be conducted in capitals and negotiation hubs such as New York, Geneva, Washington, Addis Abeba, Djakarta and the like.”

Sustainable Development“Health must contribute more actively to the

sustainable development debate. Contrary to the period of negotiating the MDGs, the constraints to lead a healthy life are broader than a life lived in poverty. They relate to the very life support of our planet and models of growth based on unsustainable production and consumption. These points are expressed in the Rio Political Declaration on the Social Determinants of Health as well as the statements on health in the Rio+20 Declaration.”

Visit WHO report “Health on Post-2015 Development Agenda”, and the document “Health in Post-2015

Agenda”, result of UN Thematic Consultation in health, in bit.ly/ISAGSLibrary

Global Governance“Global governance of global issues

with ensured financing will be a challenge that will gain more attention in this round of setting global goals. Health need to be aware that any new set of goals will also lead to questions of institutional mandates and responsibilities of international organizations. This has consequences for a number of health organizations in the global arena, as WHO and UNAIDS. This needs to be factored into the debate”

WHO’s Role“WHO would do well to brief member

states (and not only Ministers of Health) on the post-MDG processes, the importance of positioning health prominently in post-2015 development framework, and suggested priorities and approaches for post-MDGs negotiations. This could be done by convening meetings of representatives from member states involved in the negotiations to discuss priorities and approaches for health. It is important to note that many of the chief negotiators will come from ministries of foreign affairs or agencies for development. WHO will need to explain preferred health terminology and promote common use of language across sectors.”

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Surinam will take charge of the Health Council

“ISAGS’ two-year balance of activities is very positive”, affirms Brazilian Foreign Minister

REFORM IN PERUPeru’ National Health Council (CNS) approved last July a proposal concerning the Peruvian health system reform. The group had been tasked by the Peruvian Government “to formu-late and propose measures and actions allowing for the health sector reform”. The document is now in the process of public appraisal and can be accessed on the Ministry of Health website. According to CNS, the measures formulated fol-lowed the objective of “improving the national population health, recognizing health as a fun-damental right”.

ACCESS TO MEDICINEOn July 31 - August 1, ISAGS took part in an event on access to medicines held in Philadel-phia (USA). The Institute was represented by its technical consultant for the Industrial Complex of Health and Regulation, Dr. Monica Sutton, who presented a Panel on actions and policies able to strengthen and promote access to medicines. In October, ISAGS is expected to hold the work-shop “Access, industrial development and inno-vation in health”, which should count on the par-ticipation of representatives from the Ministries of Health of the twelve Unasur countries.

RETS MAGAZINEThe Network of Technical Schools in Health (RETS) published at the end of July a new edi-tion of its quarterly bilingual magazine, which stimulates the discussion “Curricular content: a theme that deserves reflection”. RETS also announced its 3rd General Meeting, to take place on November 7-8 in Recife (Brazil). At the same time, two events take place: the 2nd Meeting of RETS-Unasur, which is part of the Network and integrates the South American Health Council (CSS), and the 2nd Meeting of RETS-CPLP (Community of Portuguese Lan-guage Countries).

CEED SEMINARUnasur Center for Strategic Studies in Defense (CEED) hosted on July 25 the international semi-nar “New Dimensions of Integration and Region-al Security”. The event was attended by CEED Director, Alfredo Forti, the Minister of Defense of Argentina, and the ambassadors of Venezuela and Nicaragua, among other authorities, in ad-dition to ISAGS. The seminar, held in Casa Pá-tria Grande Presidente Néstor Kirchner, Buenos Aires, was part of the celebrations for the Week of Latin American Integration.

Peru conveys to Suriname the Pro Tempore Presidency (PPT) of the South American Health Council (CSS) in the upcoming months, after having taken charge of the position for about a year. CSS is one of the twelve Sectorial Councils that compose the Union of South American Nations (Unasur) and houses in its structure six Networks and five Technical Groups, in addition to ISAGS.

Suriname will take up the position for the first time and confirmed the interest in taking

The Minister of Foreign Affairs of Brazil, Antonio Patriota, considered ISAGS’ balance of activities “quite positive” after two years of operation. “The Institute held seminars and workshops on topics relevant to public health, created and strengthened networks among South American countries and contributed to the qualification of public managers,” affirmed the Brazilian Chancellor.

The assessment was published in a message sent by Patriota to ISAGS on the occasion of its second anniversary, celebrated on July 25. The two years of activities were celebrated by means of a series of interviews with personalities linked to the Institute and disseminated throughout the month, the issue of a Special Report with a balance of actions and perspectives, and the organization of an internal seminar.

According to the Chancellor, ISAGS currently produces “knowledge about the health systems of the Member States [of Unasur], also, by means of two publications”. “Surely, challenges still persist. In this context, it is important to note that the creation of Unasur and ISAGS are very recent cases still under the process of institutional consolidation, being built

HEALTH CONNECTION

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Ambassador Antônio José Ferreira Simões (center) is received by the Director José Gomes Temporão and ISAGS employees

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International seminar promoted by the CEED-Unasur

charge of CSS-PPT at the end of July. During the period of twelve months in which the Country is responsible for the Presidency, ISAGS offers its full support and has pledged to help the Country’s Ministry of Health on this important task.

Suriname government will also take up the Culture and Electoral Councils, in addition to the Working Group on Food Security and Fighting against Hunger and Malnutrition of the Social Development Council.

Minister Antonio Patriota stressed the importance of the Institute for the regional integration

step by step. The gradual strengthening of Unasur Secretariat General will provide further conditions for ISAGS development”, added Patriota.

The Minister affirmed that Fiocruz achievements in Brazil’s public health are “important assets for the Institute upcoming challenges, including topics such as the increase in regional production of medicines and the financing of universal health care systems”. “The common agenda is sound: to build and improve public management tools that enable countries to provide health services of quality.” According to Patriota, “ISAGS creation and establishment in Rio de Janeiro show Brazil’s commitment with Unasur consolidation. (...) reflects a fundamental aspect of integration: the social dimension.”

At the end of July, also on the occasion of its second anniversary, ISAGS hosted the Ambassador Antonio José Ferreira Simões, Secretary-General for South America of Brazil’ Ministry of Foreign Affairs. Simões was welcomed by ISAGS Executive Director, José Gomes Temporão, and discussed actions for the strengthening of the Institute and Unasur.

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ISAGS-UNASULExecutive Director: José Gomes Temporão Head of Office: Mariana Faria Technical Coordinator: Henri Jouval

INFORMATION AND KNOWLEDGE MANAGEMENTCoordinator: Camilla Ibiapina ISAGS Report Editor: Amaro GrassiTeam: Flávia Bueno, Felippe Amarante and Mariana Moreno

Contact: comunicacao@isags-unasur.org Phone: +55 21 2215 1858

This is the report from the South American Institute of Government in Health (ISAGS), the think tank on health of the Union of South American Nations (UNASUR) that aims to contribute to improving South America government quality in health by means of leadership training, knowledge management and technical support to health systems.

INSTITUTIONAL

Tobacco control policies were the subject of a course offered by Fiocruz-ENSP at ISAGS in July, under the coordination of Dr. Vera Luiza da Costa e Silva. For more than 20 years, Dr. Costa e Silva worked for Brazil’ National Institute of Cancer as coordinator of the National Program for Tobacco Control. Since 2001, she works for WHO helping countries to discuss and evaluate policies against smoking and to formulate proposals and policies for tobacco control. According to WHO report released in July, cigarettes kill six million people a year. During the course, Dr. Vera Costa e Silva spoke to ISAGS Report.

What are the main international tobacco control initiatives and how South America has performed in this issue?

According to the last WHO report on smoking programs in the world, especially concerning demand reduction policies, Brazil is placed second among the most advanced countries in the fulfillment of such policies; Turkey is in the first position. We develop very interesting initiatives in South America.

Uruguay is a State-of-the-art country regarding tobacco control. In five years, the country achieved the highest results by means of advertising banning, health warnings, and a tax and prices policy very well outlined. It’s important to note that Peru enjoys a very good legislation, Ecuador has experienced the great strides in the area of tobacco control,

and Colombia works heavily articulated and has a very active civil society. Venezuela has put much work on it. South America has progressed a great deal in this issue.

How regional integration, by means of Unasur, can further incentives on health promotion and tobacco control?

Mercosur and Unasur are examples of initiatives that respond to those needs and will certainly help policies of risk factors control. As for tobacco control, the committee created within Mercosur scope to promote collaboration among countries, and the Ibero-American Network for Tobacco Control (RIACT) [launched in 2007 on the World No Tobacco Day by ISAGS Executive Director and Health Minister of Brazil at the time, José Gomes Temporão] are initiatives that already reap fruits, such as the creation of a virtual bank of health warnings for tobacco products made available to Mercosur countries.

Unasur certainly plays an important role in the process of WHO Framework Convention on Tobacco Control, especially supporting

Dr. Vera Luiza Costa e Silva, coordinator of the Cetab-ENSP and WHO consultant, during the course held in ISAGS headquarters

“Unasur is very important in Framework Convention on Tobacco Control of WHO”Dr. Vera Luiza Costa e Silva, WHO consultant, talks about tobacco control policies

SCHEDULE• 06-07/08 - Meeting of the Working Group on Cancer Registration of RINC-Unasur• 19-21/08 - Meeting of “Persons with Discapacities in South America” - Oras-Conhu/Unasur• 30/08 - Meeting of the Council of Heads of State and Government of Unasur (Surinam)

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“Governments have the right and the duty to protect the health of their population

from the wrong interference of the tobacco industry”

those bloc countries that compose the Treaty implementation. The approach of difficult and controversial issues such as the post-2015 tobacco control agenda, known as The End Game, is also an field in which Unasur can certainly help bloc countries to deepen in the future of risk factors regarding Chronic Non-communicable Diseases.

For the occasion of the World Health Assembly held in May, WHO Director, Margaret Chan, said he was open to negotiate with the pharmaceutical and food industries, but that there is no dialogue in the case of the tobacco industry. How do you evaluate this statement?

There is no dialogue because we need food and medicines, but nobody needs tobacco. The tobacco industry has a long history of subversion to science, lies, and consumer deceiving. One cannot negotiate with a money driven industry that kills one in two regular consumers. Smoking is a disease. So, it is an industry that incentives the disease. In this sense, the Framework Convention on Tobacco Control itself provides in its article 5.3 that governments have the right and the duty to protect the health of their population from the wrong interference of the tobacco industry.

Considering ISAGS’ role of contributing to improve the government quality in health in South America, how could the Institute enhance tobacco control measures?

I think ISAGS can raise the issue to the South America governors. I understand the discussion on industries interference, not only on tobacco industry but also on alcohol’s, soft drinks’ and processed foods’ must be discussed with governors. They know that those industries aim to increase their profits, thus voluntary agreements with these industries do not work. It is important to make transparent the whole process of meetings with those industries, to make public that agenda, and to disclose what those companies do.