Heroes!
It’s not every day that you can say that you got to hear Kofi Annan, former General Secretary of the UN, but I am lucky enough to be able to say that today! I attended the launch of the Humanitarian Response Index which is a tool for improving humanitarian response by measuring the behaviour of 23 OECD donors against the commitments they made. The tool measures 57 indicators and Sweden comes out tops. I will be writing more about this later but I am still a bit starry-eyed about Kofi Annan answering my question (about what happens next) so I just wanted to tell you a bit about it now!
And in our new peer-reviewed Articles published this week, Sarah Walpole interviews another of my heroes-Hugh Montgomary, probably one of the most interesting people I have ever met. In addition to working full time as a Consultant in Intensive Care and the many other things he does, he spends at least 4o hours a week on project genie- an initiative to make children more aware of climate change. Sarah also teams up with Sophie North to discuss young people’s involvment in activism and Johnny Boylan discusses equality and diversity awareness training for in medical training.
Finally for today, I told you a wee while ago that I met with delegates from the Foreign Affairs office of Japan. Japan are hosting the G8 next year and want to take a strong stance in global health. So I thought you might be interested to see what the Japanese Foreign Minister, Masahiko Koumura has just written for The Lancet. You can access it on www.thelancet.com but I have also copied it for you here. Rhona
Lancet Comment: Global health and Japan’s foreign policy
In 2008, Japan will host two major conferences, the Fourth Tokyo International Conference on African Development (TICAD IV) and the G8 Hokkaido Toyako Summit. At this important diplomatic juncture, Japan will take up and call for a stronger engagement of the international community in global health.
In 2000, during the G8 Kyushu Okinawa Summit, Japan launched the Okinawa Infectious Diseases Initiative (1) and appealed for international collaboration. This led to the establishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria. The UN Millennium Summit, in 2000, laid the foundation for the Millennium Development Goals (MDGs), including health goals to be achieved by 2015. Also in 2000, a historical statement announced the eradication of poliomyelitis in WHO’s Western Pacific region. (2)
Since then, international awareness about the need to tackle infectious diseases has increased. The Global Fund now saves 3000 lives each day; it has saved 1·5 million so far. And yet, 6 million people still die every year from AIDS, tuberculosis, or malaria. We still face serious challenges in maternal, newborn, and child health. In sub-Saharan Africa, 166 in 1000 children die before their fifth birthday, which is 20 times higher than the number in developed countries. The risk of death related to pregnancy and childbirth is one in 16, which is 200 times higher for women in sub-Saharan Africa than for those in developed countries. At this rate, we are likely to miss the health-related MDGs.
One vital aspect of health is water and sanitation. In a developed country such as Japan, nearly everyone has access to safe drinking water. In sub-Saharan Africa, the proportion is only 56%. For adequate sanitation facilities, including toilets, nearly all the developed world has access, compared with only 37% in sub-Saharan Africa.
Next year we reach the midpoint for the achievement of the MDGs by 2015. At TICAD IV, Japan intends to take up the issue of health in Africa, and at the G8 Summit, the wider issue of global health. The objective will be to develop a common framework for action shared by the international community. Where should the international community go from here? Human security is a concept that is very relevant to cooperation in the 21st century. That is to say, it is vitally important that we not only focus on the health of individuals and protect them, but also strive to empower individuals and communities through health-system strengthening.
To date, international efforts in the health sector have largely centred on measures against infectious diseases. From now on, it is essential to promote a comprehensive approach to strike at the root of the problem, especially through the promotion of research and development and strengthening of health systems, including human-resource development and retention. Disturbingly, sub-Saharan Africa contains 11% of the world’s population and 25% of the disease-related burden, but the region has only 3% of the world’s health workers. The importance of human-resource development and retention on a considerable scale is self-evident. The disease-specific and comprehensive approaches complement each other. Striking a good balance between them will be at the core of the international framework that we aim to develop at Toyako.
The effectiveness of integrating two intersecting approaches has been empirically proven by Japan’s experiences. Postwar Japan focused on the promotion of maternal and child health and tackled infectious diseases, such as tuberculosis. A holistic approach included the spread of vaccinations and regular health check-ups at health centres and schools, provision of nutritional education, and school lunches, which together led to overall improvements in the population’s health.
Japan has shared its experience with developing countries by, for example, dissemination of the Maternal and Child Health Handbook in Indonesia. (3) It began when one Indonesian doctor came across this handbook during training organised by the Japan International Cooperation Agency. This empowerment tool for mothers has reached several other countries in Asia and the rest of the world, for example, in Palestine.
The development and retention of human resources is important for the running of health systems. Basic education and gender equality are essential, because they underpin health systems. The development of road networks is also relevant. We may have to transport patients, doctors, nurses, and medical supplies quickly. We also need means of communication that are readily available.
The proposed framework for action cannot be promoted by the Japanese government alone. Diverse stakeholders will have to collaborate. Developing countries, including those in Africa, must have ownership of the health agenda. The Hideyo Noguchi Africa Prize (4) will be supporting various health efforts in Africa, and will be presented for the first time at the TICAD IV. Major developed countries, including the G8 and international organisations, need to show clear political will to support the efforts of developing countries as their partners. New emerging donor countries, NGOs, the business sector, and private foundations also have roles to play. No less important, any proposed framework for action cannot be formulated by health experts alone. We need experts from various fields to be involved in this process.
The TICAD IV and G8 Summit next year will be excellent opportunities for the international community to strengthen their collaboration and build a framework based on a participatory approach suited to the 21st century. Japan, as G8 chair and host to TICAD, will aim to achieve this. Masahiko Koumura, Minister of Foreign Affairs, Japan.
(Note from Rhona: Please see the Lancet article for the references)