End of golden era of global health governance: What it means for women
Recently completed her Master’s degree in health communication from the University of Sydney
One of the biggest improvements in global health is perhaps in the reduction of infectious diseases as well as maternal and infant deaths over the past decades. They were possible partly due to the development of technology, vaccines and antimicrobial medications.
However, one aspect that is often forgotten in the discussion about global health is the governance. Actors in the global health governance, such as the World Health Organization, along with the assistance of powerful states, such as the United States and United Kingdom, decide priorities of diseases, allocate funding and introduce health policies.
Today, I often question whether the global governance is still performing its best in an ever-changing world. Financial crisis has hit powerful nations. The changes in environment and the rise of conflicts have increased the spread of life-threatening diseases. Changes in diet and lifestyle have also brought the rise of non-communicable diseases (NCDs). These are very few of vast problems taking place in the world today. Are current efforts in governance adequate to cater to these problems?
This brings me to the recent study among global health scholars about the end of the “golden era” for the global health governance. The “golden era” of global health is identified through the success of policies shaped by multilateral processes, immense monetary aid and success of the actors in addressing infectious diseases. Some studies predicted that the golden era started from 2000 until 2016, a few years after the big financial crisis took place. Thus the “golden era” of global health may be over.
Women are more impacted by global challenges. It is also more difficult for women to access important resources for their wellbeing. Therefore, the inclusion of women’s health is central in achieving sustainable development.
The golden years of global health for women is strongly indicated by the reduction of maternal deaths. After the introduction of the global Millennium Development Goals in 2000, we saw a massive decline of maternal deaths by an impressive figure of 45 percent globally in 2015 from 1990.
The world may have addressed one crucial aspect of women’s health. However in recent years, there has been a shifting trend of diseases among women. NCDs, such as ischemic heart disease and stroke are now the major causes of death among women.
During the golden era, large priority was given in eradicating infectious diseases along with maternal health. The global health community also defined the health of women only in terms of their reproductive health.
With the rise of NCDs today, past efforts may no longer be adequate to address the contemporary challenges of health for women. The international organizations have yet to design a health development model that will effectively address the new challenges.
However, small initial steps have taken place in response to the growing new challenges, such as the development of Sustainable Development Goals, and the WHO’s global strategy for Women’s, Children’s and Adolescent’s Health for 2016-2030. These frameworks may address some barriers, including new challenges such as the vulnerability of women towards NCDs.
However, the discussion regarding NCDs in the WHO’s recent global strategy was only integrated into other “bigger” issues.
Furthermore, funding for eradicating global diseases has shown volatility and scanty growth from 2011 onwards due to the financial crisis. Studies have acknowledged that after calculating inflation, along with the risk factors existing today, funding is far from adequate.
The financial crisis in recent years has tightened the budget from the US and European states. As the developed countries struggled to cope with the effects of the crisis, the emerging economies showed a more steady performance.
This created a shift of power. In global health governance, the ones with the biggest financial capital can influence policies the most. The emerging economies, such as Brazil, Russia, India, China and South Africa or BRICS have shown some clout in shaping global health agenda.
Spending in global maternal health for women has also recently changed. The US has always been the biggest contributor of maternal and reproductive health initiatives. In 1994, the US contributed to US$830 million. After the crisis, US contribution to the maternal and reproductive health decreased to $680 million.
In April 2017, the US also declared to cut off funding for family planning through the United Nations Population Fund (UNFPA) due to their discontent towards UNFPA’s assumed recent initiatives with China. This controversial decision will harm many marginalized women and girls.
The Bill and Gates Foundation is also among the rising powerful private players in global health. Their most recent spending of $84.3 million out of the many more millions of dollars prior to this in maternal and newborn health has been game-changing. Their contribution has continued to highlight maternal and child health as top priorities amid global diseases.
But there is also lack of justification in allocation of the funding. The funding has not been disbursed into the key issues for women. NCDs have killed more women than ever before. However, funding for NCDs has not been sufficient.
The existing global health frameworks need to be evaluated to address the changing politics due to the dynamics among donors. Improvement also needs to be done across multiple socioeconomic factors. A new health development model is therefore crucial to protect the lives of these women
The writer recently completed her Master’s degree in health communication from the University of Sydney, Australia.
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