In the last several months, I was invited to join a series of dialogues on healthy societies. The effort to define healthy societies is an important one, particularly in the context of a world in peril, faced with a convergence of forces with impoverishing impact. Climate change, armed conflict and a global pandemic and its associated global economic downturn are three interlocking crises. But there is more. Vaccine inequality, a crisis of trust in leaders and institutions, structural inequality within a economy for the world’s 1%, systemic and racial oppression and a culture of impunity characterised, by among others, the brutal killings of journalists, a system of excessive accumulation and ecological unequal exchange- all these form part of what characterises our unprecedented times.
The exploration of healthy societies amidst the undercurrents of the multiple crises offers an invitation to deconstruct notions that ignore underlying causes of vulnerability, negating, instead of contributing to, just, structural transformation. The “pathways to healthy societies” require thinking about a kind of governance and policy response that is committed to addressing gender and intersectional inequalities and differential impact of the crises in the context of social, economic and ecological justice.
The conversations on healthy societies prompted me to pause and consider the following:
· The segmentation of the labour market where there is an over concentration of women in the healthcare/health services, travel, tourism, hotel and domestic work sectors points to the intersectional impact of COVID; job losses are higher for women, even higher for women in the informal sector and for international migrant workers, mostly women, who have forced to return home with no benefits
· Unequal access to and distribution of resources heighten vulnerability to gender-based violence, food insecurity, diseases and health challenges, among others. For example, in more than 90 countries, female farmers lack equal rights to own land. The lowest rate of land ownership (14-16%) by women are in countries where more than half of the women are living off the land. In India for example, 85% of rural women work in agriculture but only 13% own any land. This results in disproportionate burden of malnutrition, not only for the women but their children and also increased vulnerability to risks of childbearing and child birth
· Prevailing inequalities within and between countries, with deep roots in colonialism and racism, means that people who have more, capture the benefits of nature and export the costs. Such is the existential threat to small island developing states in the Caribbean and the Indian Ocean and large ocean nations in the Pacific.
· Despite the growing evidence that pollution poses a threat, particularly in women’s health, there is not enough policy-level action to bring about any concrete change. Pallavi Pant, a senior scientist who studies the health impacts of air pollution at the Boston-based Health Effects Institute, raises the ”need more representation from women in the field of air quality so that their perspective is represented in platforms where decisions get made.”
· A new WHO report found that less than 20% of countries had assessed the health impact of their climate change mitigation efforts and that only 13% of nationally determined contributions, or NDCs, measure how policies and targets affect health outcomes.
· The 9th session of the Conference of the Parties (the other COP held around the same time as COP26) to the WHO Framework Convention on Tobacco Control was held recently. On the agenda is a $50 million investment fund to help raise additional resources for the treaty’s secretariat in its efforts to help countries implement tobacco control measures. At present, its budget is less than $20 million, whereas the tobacco industry’s spending to market cigarettes and smokeless tobacco products in 2019 in the United States alone amounted to $8.2 billion
· At COP26, vulnerable developing countries proposed the establishment of a Loss and Damage Facility under the Finance Mechanism of UNFCC, a proposal that faced opposition from the parties
The complexity of the global crises we face certainly deserves a more robust participatory governance response. The scale of the current crises can’t make do with the global status quo. We need different governance agendas responding to specific health needs of women, men, persons with disabilities, young people, people with non-conforming gender identities, children, needs in urban vs rural settings, among others. But we must also have a common governance agenda with policies, approaches and investments that aim to transform structural gender inequalities and power dynamics; a common global and public health agenda that is underpinned by social, economic and ecological justice and cognisant of planetary pressures. The paper, Achieving healthy societies-ideas and learning from diverse regions for shared futures by Rene Loewenson, Eugenio Villar, Rama Batu and Robert Marten argues that the pathways to healthy societies requires an “understanding that overcoming the inequities undermining health required radical political and economic transformation towards systems that promote equity and inclusion, that address commercial determinants of health and that do not commodify or subject healthcare to market rules.” How can people’s participation in governance support global, regional and national collective action in addressing commercial and political determinants? And what does this means for the global, regional and national political economy?
An understanding of the different intersecting systems of oppression and privilege and the recognition of the various ways that gender inequality is shaped by these intersections is crucial. Gender inequalities rooted in structural and well-entrenched power imbalances reinforce patterns of disempowerment and different types of exclusion and marginalisation for women and people in all their diversity. It is important for policy to recognise how race, age, class, gender, among others, overlap and form a web of interconnectedness. For instance, beyond the applause, what institutional reforms are on the table to compensate the “heroes of the times” more equitably, relative to the mega-profits of big business? How are feminist contributions in policy discussions included (or not) to address social protection and develop gender responsive policies? Are local capacities being matched with the need of the hour? Are finances being invested in ensuring administrative and implementation systems are in place and fit for purpose? For instance, the new special edition of Public Health Research and Practice suggest that less than 2% of global health funding is being spent on health systems strengthening and health policy systems research. Is there political will for substantive transformation? Are there more and more women authorised to be decision makers in policy and political processes? Are there formal spaces for community engagement and participation in decision-making processes, where women and communities, especially those less heard are part of co-creating solutions rooted in local knowledge and local ownership? As we ponder these questions, lessons must be learned on the quality of governance for an inclusive policy response in times of a pandemic and beyond. These unprecedented times highlight the global crisis of trust. And as community solidarity and movements rise to rescue, as often the case, governments and institutions must be held to account.
The pathways to healthy societies call for a re-imagination, a systemic response to the complexity of the realities individual and communities face; amplifying less heard voices with their new and alternative narratives; and stories of how it is possible to change certain power dynamics for a more inclusive society with a governance that makes a meaningful difference in people’s lives. Achieving healthy societies by Loewenson, et al argues that there has not been a singular idea of healthy societies and suggest that neither should one be imposed, acknowledging the diversity of pathways.There is a wealth of grassroots and country-specific stories, particularly from the global south, that can and must inspire, build and galvanise global action. The Prime Minister of Barbados, Mia Mottley, called for the correct mix of voices, ambition and action (and if I may add, outcomes) in her speech delivered at the opening of COP26 in Glasgow. Whose voice, ambition and action matter?
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