Panel debates equity of Millennium Development Goals amid entrenched disparities in health, life expectancy, as United Nations DPI/NGO Conference continues

31 Aug 2010

(Melbourne, Australia) - Amid broad agreement that profound disparities in health and life expectancy between the citizens of developed and developing nations were wide and entrenched distinguished panel today debated the equity of the Millennium Development Goals for the poorest and most marginalized in society, as the sixty-third annual DPI/NGO Conference entered its second day. 

The roundtable discussion on equality, rights and progress towards the Millennium Development Goals –- part of the three-day Conference organized by the United Nations, together with the Australian Government and the NGO/DPI Executive Committee -- was premised on the notion that as momentum built towards accelerating progress to meet the Goals, there was a danger of creating greater inequity.  

Addressing an assembly of representatives of close to 250 non-governmental organizations gathered at the host city of Melbourne on the shore of Port Philip Bay were panellists from Australia, India, Chile and the United States.  The focus this morning was mainly on ways in which non-governmental organizations could advocate for more attention to be paid to the health needs of the poorest and least well-served, and the use of equity-sensitive indicators to measure progress towards achieving the Millennium Development Goals.

Attaining the Millennium Development Goals would only modestly advance global health, if at all, asserted Dr Claudio Schuftan of Chile, specialist in pediatrics and international health, and an active member of the People’s Health Movement and coordinator of its Global Right to Healthcare Campaign. The Goals “for us are too little too late,” he said, adding that they were nothing more than “rehashed goals from earlier international goals with a new date”.  

The Millennium Development Goals did not require any promises from the rich countries, but they quantified obligations for the poor, he continued.  They focused on outcomes and disregarded processes, and suffered from a “rhetoric action gap”.  He agreed with what had been said at the meeting the day before, that passion alone would not be enough to achieve the Goals because only words and promises would result.  Civil society inputs were indeed vital in this debate.  

Health for all, he insisted, would not come from a push from above, but from a pull from organized people demanding health rights.  The non-governmental organizations in this room, and outside of it, should ask themselves if they were part of the problem or part of the solution.  If they were not sure, then it was time for them “to retreat for a revision and remission.”  

Underpinning the morning’s agenda was the perception that it was easier to improve the health of those who were already better off than it was to address the needs of the poorest and who had no access to health care.  Expanding on that point, Dr Cathey Eisner Falvo, moderator and long-time United States-based activist in the movement for peace and justice, said it must be assured that the spotlight was on the numbers related to the poorest, most marginalized and least served, rather than on populations as a whole.

Jane Freemantle, pediatric epidemiologist working with indigenous children and communities in Australia, said Governments had an international obligation to improve the health and well-being of marginalized groups, for which improved data collection particularly on indigenous persons and disadvantaged children, was essential. The collection of accurate and complete data on those population groups, however, was not possible in many communities.   For example, 59 per cent of children’s deaths among indigenous Australians were not counted.  Without data, there was no indication of a problem and, thus, no solution.  That clearly did not serve the achievement of the Millennium Development Goals.  

Every child should be counted so progress, along with the effectiveness of interventions, must be monitored, she stressed.  If child mortality among the indigenous population was to be prevented, then every child must be “counted and respected”.  She also emphasized the importance of community “ownership” of the data – it was the community that should collect, interpret and control the data.  And, the community should determine the questions to be asked and ensure that all of its members were counted.  Governments were obliged to support the community and help build its capacity.

Data was critical, as was its utilization, added Thelma Narayan, Director of the Centre for Public Health and Equity of the Society for Community Health, Awareness, Research and Action in Bangalore, India. She agreed that communities understood much about the determinants of their own health.  In India, 40 per cent of the children under the age of 5 were under-nourished, and that figure had not changed over the years.  But, just having that data had triggered the push for social and political action.  Despite India’s economic growth, there remained a high level of malnutrition, which was known as “biological poverty”. Towards combating it, the country had embarked on a very strong right to food campaign.

While she was on board with the need for universal access to good-quality health care, she recognized that it was the budgets for health care that determined its quality.  There was global recognition of the inextricable link between health and development, and that was very positive.  But there was still a need to “grapple with the politics of health and the politics of health care”.  If the relevant political issues were not addressed, then it would not be possible to reach the health-related Millennium Development Goals, she said, adding “I very much doubt the MDGs will be achieved”. 

Concerned along with other panellists about the lack of data, Justin Mohamed, Director of Goulburn Valley Partnerships and Academy of Sport, Health and Education (ASHE) at the University of Melbourne, said that even the research that had been conducted had not made a difference on the ground to the indigenous communities.  The data had to result in actions or it would make no difference and leave communities “high and dry”.  At the same time, data was very important to planning, but the communities themselves should develop the sort of data that was needed and be part of its collection. 

The Conference will continue with another roundtable today at 4:30 p.m., 31 August, on strengthening an integrated and systems approach to achieving the health-related Millennium Development Goals.