What Role Should UNDP Play in the Context of Sustainable Human Development, the SDGs and Health 2020?
Inequalities are a priority theme for UNDP across all its programmatic areas and UNDP’s Regional Bureau for Europe and CIS has launched the Istanbul Development Dialogues. During the upcoming Istanbul Development Dialogues #TalkInequality in February 2016 and together with civil society partners and leading specialists of the region, UNDP aims to identify key analytical and programming areas to craft more effective responses to the region’s inequality challenges across various thematic areas:
- Measuring inequalities
- Labour markets and inequalities
- Gender inequalities
- Inequalities and health
- Inequalities and inclusive governance
- Inequalities and natural capital
In the run-up to the event and as part of its work on the Regional Human Development Report 2016, UNDP’s Regional HIV, Health and Development Team is seeking input, comments and advice from all UNDP partners, experts and the interested public audience via this e-discussion the following questions in order to direct its further programming.
1.What is UNDP’s role in addressing Social, Economic and Environmental Determinants (SEEDs) of health and health equity in a whole-of-government and whole-of-society approach? Which programmatic actions should UNDP implement at national and subnational level and in terms of broader regional partnerships to support the implementation of Health 2020 and to contribute to improving health equity and well-being as a central goal of the sustainable human development agenda?
2.How should UNDP address HIV in the EECA region meaningfully as an integrated part of a SEEDs of health and health equity[i] concept using a whole-of-government and whole-of society approach on regional, national and sub-national level? Would such an integrated approach add value in times of transitioning funding for national HIV responses in the EECA region from external to domestic resources and in which way?
Please contribute to this e-discussion using the comment function (click on ‘comments’ right to the heading of this post) and follow @cahamelmann on twitter for further updates. Use #TalkInequality when you share and help us encourage participation in this e-discussion.
Continue reading below for further background on the e-discussion questions.
Health and Health Inequities in EECA
Following the collapse of the former Soviet Union and the associated breakdown of social institutions, economic decline, privatisation and rising unemployment, the EECA region saw steep drops in life expectancies unprecedented in absence of war, natural disaster or epidemics[ii] . To this date, EECA life expectancies lag far behind the EU average due to a high burden of premature mortality at working ages. In addition, life expectancy shows distinct gender differentials: women in the EECA region generally live longer than men, but the quality of life and well-being they experience is often not satisfactory. There are considerable women’s heath inequalities along the life course in terms of risk exposure, quality of services and health outcome across and within countries, and high rates of loss of healthy life years[iii].
In addition, the EECA region has seen the highest rise in officially recorded HIV incidence (30%) worldwide, while HIV-related mortality more than tripled over the past 15 years[iv]. In contrast, HIV incidence and mortality have declined in all other regions besides the Middle East and Northern Africa during this period. As typical for concentrated epidemics, HIV affects mainly marginalised populations in EECA, such as gay men and other men who have sex with men, women, people who use drugs, sex workers and their clients and partners, prisoners, migrants and ethnic minorities. Similar inequities in exposure, morbidity and mortality can be seen for other communicable diseases (CD) including tuberculosis[v].
The region is also experiencing a high burden of non-communicable diseases (NCDs), such as cardiovascular disease, cancer, respiratory diseases and diabetes, accounting for 77% of the disease burden and almost 86% of premature mortality[vi]. Various dimensions of inequity such as gender, age, education, income, rural/urban, ethnicity, disability, migrant status etc. impact on differential exposure to SEEDs of NCDs, to specific risk factors like tobacco use, harmful use of alcohol, physical inactivity and unhealthy diet, on quality of services and on the distribution of the NCD burden within and across countries[vii].
Promoting Health Equity in EECA
Realizing the basic human right to health and tackling the health and development burdens of CDs, NCDs and health inequities requires addressing these root causes in social, economic and environmental spheres – rather than changing individual behaviour in isolation. Working alongside specialist health partners, actors outside the health sector are well positioned to address the SEEDs of health and health equity.
The current policy landscape is conducive to addressing SEEDs of health and health equity: The SDG Agenda aspires to address inequality across all of its 17 goals and explicitly through SDG 10 specifically focusing on reducing inequality within and across countries. Health 2020, the European policy framework supporting action for health and well-being across government and society, envisions stronger equity as one of its two strategic objectives. Health 2020 has been adopted by all 53 WHO Europe member states in 2012, including all countries of the EECA region.
UNDP’s mandate is to promote sustainable human development and resilient inclusive societies by working with governments, civil societies and other stakeholders across the social, economic and environmental spheres using a rights-based intersectoral approach[viii].
[i] Ruth Bell, Laura Grobicki, Christoph Hamelmann. Ensure Healthy Lives and Well-Being for All: Addressing Social, Economic and Environmental Determinants of Health and the Health Divide in the Context of Sustainable Human Development: Analysis of the Project Portfolio of the UNDP Regional Bureau for Europe and the Commonwealth of Independent States.2014: UNDP. At http://www.eurasia.undp.org/content/dam/rbec/docs/UNDP-RBEC-HIV-SEEDS.pdf
[iii] WHO, Beyond the mortality advantage. Investigating women’s health in Europe, 2015. At: http://www.euro.who.int/en/health-topics/health-determinants/gender/publications/2015/beyond-the-mortality-advantage.-investigating-womens-health-in-europe
[iv] UNAIDS, AIDS by the numbers 2015, 2015. At: http://www.unaids.org/sites/default/files/media_asset/AIDS_by_the_numbers_2015_en.pdf
[v] WHO, Towards the end of tuberculosis in the WHO European Region, 2015. At: http://www.euro.who.int/en/health-topics/communicable-diseases/tuberculosis/publications/2015/towards-the-end-of-tuberculosis-in-the-who-european-region-2015
[vi] WHO, Noncommunicable diseases, 2015. At: http://www.euro.who.int/en/health-topics/noncommunicable-diseases/noncommunicable-diseases
[vii] UNDP, Addressing the Social Determinants of Health. Discussion Paper, 2013. At: http://www.undp.org/content/dam/undp/library/hivaids/English/Discussion_Paper_Addressing_the_Social_Determinants_of_NCDs_UNDP_2013.pdf
[viii] UNDP, Changing with the world. UNDP Strategic Plan, 2014-2017. At: http://www.undp.org/content/dam/undp/library/corporate/UNDP_strategic-plan_14-17_v9_web.pdf