Tag Archives: health

Health Bar:  Ensuring Vitality for Sustainable Development, Dr. Robert Zuber

8 Jul

dayoffriendship

We are healthy only to the extent that our ideas are humane.  Kurt Vonnegut

Healing is impossible in loneliness; it is the opposite of loneliness. Wendell Berry

A sign of health is that we don’t become undone by fear and trembling, but we take it as a message that it’s time to stop struggling and look directly at what’s threatening us. Pema Chödrön

What drains your spirit drains your body. What fuels your spirit fuels your body. Caroline Myss

One of the things that we have noticed (with gratitude) over this past year about the UN policy agenda is the emphasis on health—not only on leveling access to health care but on indicators and implications of health for both our sustainable development and peace and security responsibilities.

As the ECOSOC High Level Political Forum prepares to convene on Monday, governments and NGOs will convene in large numbers from all directions to review progress on some of the most important Sustainable Development Goals (SDGs) – from clean water access and sustainable energy to reversing desertification and biodiversity loss, and sustainable production and consumption.  Through plenary reviews of national SDG progress and a remarkable series of policy-focused side events, the HLPF will provide the opportunity for all of us to assess the degree to which what is arguably the most comprehensive and urgent promise the UN has ever made to future generations is being properly honored.

Recent weeks have seen UN discussions on a range of health-implicated policies, from efforts to end tuberculosis to the expanding global crisis of access to safe drinking water in an era characterized by both diminishing supply and growing privatization. In the past few days alone, the UN has seen interesting events and negotiations focused on universalized health care, the role of “cooperatives” in increasing healthy food security, and an “interactive hearing” on Thursday in preparation for the third High-Level Meeting of the General Assembly on Non-Communicable Diseases.

At first glance the “non-communicable” disease focus might seem a bit trivial stacked up against Ebola, tuberculosis and a host of other pandemics – potential and actual – made more frightening by the increasing inefficacy of our antibiotics.  But we know that there are numerous and deadly health threats that we don’t “catch” from others but which we routinely impose on ourselves and our neighbors – the diabetes tied in large measure to our processed diets and immobility; the toxic substances that collect in women’s mammary glands and create breast cancer emergencies; the impediments to clean water access in our “privatizing planet” that sicken and suppress children and their caregivers; the substance addictions that ruin relationships and drain the spirit of resolve.  The environmental burdens we impose in the name of “progress,” the “lifestyle” choices we make in what are often futile efforts to overcome fear, anxiety and isolation – this and more has led increasingly to the ironic circumstance of longer lives characterized by only episodic vitality and enthusiasm for living.

Indeed, one of the takeaways from the interactive hearing was the degree to which “health” in our time is largely a matter of overcoming our battered spirit, our psyches filled with anxiety and remorse, our political climates of recrimination and repression, our propensity for inflicting violence that solves few problems but ensures lasting distress.  We are living through a moment where our already besieged spirits are under fresh assault.  And few medical professionals are now prepared to deny the impact that our collectively impaired mental health is having on our physical vigor.  Those seemingly growing numbers (including of our children) who suffer from depression or trauma are less likely to practically cherish their physical well-being.  Where the web of health is damaged, all aspects of vitality seem to be called into question.

Another of the many take-aways from the hearing had to do with the role of health professionals and private sector entities tasked with providing what we ostensibly require to overcome health threats – the doctors and nurses who bind wounds and diagnose deeper sickness, and the pharmaceuticals that provide us with the chemicals we need to overcome (but not necessarily prevent) health impediments.  As one might predict, there was considerable and sometimes heated discussion about the imprecise and shifting lines connecting regulation and innovation, connecting the need for companies to turn a profit and the needs of communities for life-saving generics, connecting  investments in high-tech therapies with (more human-effective) investments in prevention.   And of course the lines connecting the need for “evidence-based” health commitments with the fact that, as more than one expert noted, the available evidence in some instances is pointing in diverse directions.

There are clearly some trust issues to overcome amidst all of this uncertain balancing.  In one of the sessions, a professor from Rwanda challenged the sometimes facile articulation within and beyond the UN of the “public-private partnership model,” noting that while better “quality control” over agricultural and pharmaceutical production is important, the current preoccupation in some quarters with diets and other “lifestyle” issues is likely an over-reach. Such a preoccupation, she noted, tends to just “put the blame on the people.”  What she called for in addition was a greater commitment to transparency and broad public participation regarding government health policy, to lift the veil on the mostly off-camera “public-private” dealings that can saddle communities with medicines they don’t particularly need at prices they can’t afford.

If “leaving no one behind” is to be something more than the tag line for this HLPF, we must consider what keeps us vital in these challenging times, what make us not only able to benefit from sustainable development but allows us to participate fully and energetically in building a more sustainable world.  In this second and critical dimension of SDG implementation, the role of good health cannot be over-stated.  It is truly one of the blessings of life to be able to early rise from sleep and feel healthy enough to help take on some of the world’s problems, perhaps even ease a few burdens for others.  If the SDGs are to achieve their full promise (and there is really no planetary alternative to doing so), the vitality of the world’s peoples – our personal connectivity, “humane ideas,” uncontaminated environments and other indicators of well-being — must be better assured.

Health is a core dimension of sustainable development that the UN seems well-suited to address, and we strongly encourage its continued focus.  In its absence, woes of body and mind will continue to sideline too many of the skills, passions, ideas and connections needed to ensure a more peaceful and sustainable future.

Stating the Obvious:  Good Governance as a Justice and Health Priority, Dr. Robert Zuber

28 Feb

This week at the UN provided more fodder for policy writing than most weeks, and more than can possibly be summarized in a small space.   From Monday’s extraordinary Operational Activities for Development segment of the Economic and Social Council to late Friday in the Security Council as Special Envoy de Mistura counted down the final moments before the start of the Syria “cessation of hostilities” agreement, the week was diverse, notable and hopeful.

Steady movement towards diplomatic consensus could be seen at high level events this week focused on issues as diverse as the development implications of migration, increasing gender-balanced mediation resources, and motivating more engagement by the full General Assembly membership on peace and security issues, including on our civilian protection responsibilities.  But sometimes it is the smaller events that highlight important linkages we need to pursue further.

Two such events occurred this week, one “off campus” involving medical personnel discussing the spread of the Zika virus and the other at UN Headquarters highlighting the need for additional resources for Legal Aid as one component of state commitments to justice and criminal accountability. The Zika discussion was sponsored in part by Women in International Security whose programming we broadly endorse.  The Legal Aid discussion at the UN was sponsored by Norway, the US, South Africa and the International Legal Foundation (ILF).

While it might not seem so at face value, these two events had some important dimensions in common.  For one thing, the events highlighted the many “pro bono” services both medical and legal professionals offer, often under extremely challenging circumstances, in an attempt to help redress access and resource imbalances and the injustices that often flow from them.  Indeed, generations of lawyers have put their lives on the line to uphold the work of human rights advocates and other, perhaps more ordinary people, in danger of having wrongful abuses swallowed up by inattentive or corrupt states. At the same time, many of us have watched in awe and mainly at a distance as doctors with Médecins Sans Frontières (MSF) and other groups keep societies on life support through bombing raids and grisly pandemics. While Zika impacts are not to be equated with those of Ebola nor HIV in its earlier iterations, there are risks to take account of here as well, including to expectant mothers in areas of limited medical care and female doctors who might themselves wish to conceive at some later time.

Those of us with relatively “easy duty” here in New York surely do not give sufficient honor to those with high professional credentials who choose a much more challenging path, bringing some measure of justice and healing to places most of the rest of us hesitate to go.

The other major commonality of these events is an implication for good governance.  At the Zika event, the medial professionals competently explored the epidemiological implications of the disease and drew connections to other (often more severe) pandemics.  But it soon became apparent that descriptions of disease response needed to be placed in their larger political and social contexts.   What are the security, development and governance dimensions of a viable health response framework?   What does the medical profession need from states, all states, such that doctors can contribute more than helping patients recover from disease or injury only to face economic deprivation, insecurity in many forms, even abuses at the hands of their own leaders? The doctors in this discussion were not entirely comfortable responding to this inquiry, but all have served in challenging settings and all understood the “enabling” criteria for effective medical response which many states are unable or unwilling to provide.

The event on Legal Aid offered another lens on this problem.   As with response to pandemics, no one in the UN conference room would have suggested that Legal Aid was not a useful commitment.   All of the designated presenters and diplomats who followed voiced concern about chronic imbalances our justice outcomes.  US  Amb. Power gave full support to ILF’s work while noting the degree to which the US continues to fall short on legal fairness.  Argentina’s Amb. Garcia Moritan made clear that legal access – a core provision of the Sustainable Development Goals (SDGs) – should privilege free legal assistance if such access was ever to become universal.  South Africa’s Mlambo highlighted Legal Aid as a key element in any successful effort to eradicate poverty, itself perhaps the single key objective of the SDGs.

Ever-thoughtful Brazil reminded the audience that access to justice and access to the courts are simply not the same thing, and urged more dispute resolution resources outside formal courts.  What was not discussed at great length, to the chagrin of some listeners, is the ability of Legal Aid, court-appointed legal assistance, or any other form of pro-bono aid to overcome the enormous legal advantages accruing from the growing economic inequality within many states. As access to legal aid is not the same as access to courts, neither is it the same as legal clout sufficient to take on the corporate and political hegemonies that can pay for (or in some instances pay off) the highest caliber of legal services.

The sad reality is that, while Legal Aid should command higher policy attention, many of those who could benefit most from that assistance already feel “burned” by their justice system.  This was certainly the case in my Harlem parish, and I have heard similar stories in poverty stricken areas worldwide.  Many people know (or think they know) that the legal system is “rigged” against them, not just because they have irresolvable difficulties locating some form of legal assistance, but because economic and social inequalities have clear, compelling and largely detrimental legal dimensions. Rightly or not, these people have developed significant trust issues with the state and its legal institutions.

When I was a child, it was common to see summertime trucks passing through the neighborhood spraying chemicals designed to suppress mosquito populations.  And while the fumes seemed toxic enough (and in fact turned out to be of some medical consequence to more than just the bugs) folks in the neighborhood had sufficient residue of trust in the government to allow the sprayers to pass without protest.  But in too many parts of the world, such spraying might be interpreted as an attack of the state.  In too many parts of the world, the urgent instructions of medical personnel seeking to control a pandemic might be interpreted as a state-endorsed violation of their personal and cultural integrity.  In too many parts of the world, people have had painful, interactive lessons with the legal systems in their countries of residence and, as a result (as quoted recently in a NY tabloid), simply “don’t do courts” any longer.

Building trust in the principles and practices of states is not an optional measure, but is essential to any medical healing or legal leveling in the social order.  At the same time, recognizing the myriad of consequences for medical healing, legal assistance and more from both an unequal social order and the resulting deficit of public trust is just as important.  Those of us seeking to expand medical, legal and other assistance must commit more to ensure a proper “enabling environment” for needed services; which in large measure is tantamount to better ensuring more effective and trustworthy patterns of governance.