The challenges of global health reform in the 21st century

This brief article was originally written for the newsletter of the Global Health Centre of the Graduate Institute of Geneva. Its aim is to introduce the second year of the research project on “How to Break the Gridlock in Global Health Governance”, on which I am working as one of the two principal investigators.

When looking at the changing landscape of global health over the course of the last two decades, it appears evident that the significant progress and breakthroughs that have occurred in this relatively short period of time have also left a number of issues unaddressed.

On the one hand, the three Millennium Development Goals (MDGs) relating to health have remained unmet, despite huge improvements in low- and middle-income countries with respect to infectious diseases as well as reproductive, maternal and child health. On the other, the emergence of new (and often unprecedented) health threats, such as those represented by the shifting burden of disease and mortality towards non-communicable diseases, more severe outbreaks and pandemics, and increasing risks associated with climate change and environmental degradation (link), poses troubling questions over the capability of the global health system to deal with the ever increasing interconnectedness and complexity characterising the field.

In this context, a central challenge to make the global health system fit for the 21st century is that of understanding what kind of role governance has played in some of the major achievements, and in particular what has made specific advancements possible; why certain solutions were chosen over others; and whether those solutions can now provide valuable insights into how to deal with emerging issues.

From such perspective, it can be argued that global health governance has witnessed a significant degree of institutional innovation and political agency, both within and beyond the World Health Organization (WHO) and other multilateral agencies, and WHO itself has demonstrated to be capable of organizational learning in the aftermath of health crises such as SARS and H1N1.

At the same time, however, two major concerns remain. First, these developments have been mainly driven by cosmopolitan moments which opened limited windows of opportunity for reform but left some of the structural weaknesses of the current governance architecture unaddressed. More specifically, the possibility of identifying pathways that may lead to gridlock in global health governance, while not entirely representative of the post-1990 global health landscape, certainly represents a critical alarm bell for a system which is called upon to deliver on the targets set by Sustainable Development Goal 3 while dealing with the daunting task of tackling the broader determinants of health in an increasingly interconnected world.

Secondly, as evidenced by the recent High-level meeting on antimicrobial resistance (AMR), which yielded a strong political declaration at the 71th Session of the United Nations General Assembly, increasing importance is attached to global health and its implications for national and international security, economic well-being, and economic and social development. In this sense, the shift of global health from sectoral issue to major topic discussed in the highest spheres of politics and governments, constitutes not only an opportunity but also an additional challenge for the global health governance system: as it creates the conditions for mobilizing action, it also requires multi-sectoral approaches to be adopted, coordination among actors to be strengthened, and increased institutional flexibility to be achieved.

At the Global Health Centre, the ongoing research project on “How to break the gridlock in global health governance”, which is currently entering its second year, is trying to provide an answer to these complex challenges and highlight potential options for reform by conducting in-depth research about how pathways to gridlock have manifested themselves across different health threats; identifying institutional changes and responses; and uncovering the causal dimensions between them. As such, the project will not only be able to provide a valuable contribution to the current understanding of how global health governance has evolved in the past two decades, but also, more importantly, describe how such gridlock has been overcome or can now be avoided.

Funded by the Swiss Network for International Studies (SNIS) and working with a number of different partners across academia, international organisations, civil society, and the private sector, “How to break the gridlock in global health governance” started in October 2015 and is expected to last for two years.

  • Download research summary (pdf)

SDSN Youth at UNGA71

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As the Leadership Council Meeting of the Sustainable Development Solutions Network gets underway in New York City on the eve of the 71st Session of the United Nations General Assembly, I am particularly proud of the ever increasing role played by the  Sustainable Development Solutions Network – Youth (SDSN Youth) in mobilizing action from all stakeholders around the urgent need to invest in youth as a key demographics for the achievement of the Sustainable Development Goals worldwide.

With a particular emphasis on my position with SDSN Youth, I am also enthusiastic about the work of my team (Dominique Maingot, Michela Magni, Kanika Joshi and Angga D. Martha + Michelle Huang) ahead of such a crucial week, which made it possible to:

  • organize one of the main sessions of this year’s International Conference on Sustainable Development (entitled “Supporting Youth Solutions for the SDGs”, and featuring the likes of Rebeca Grynspan, John Rutherford Seydel III, Morten Nielsen and Marieme Jamme as speakers);
  • allow a number of young entrepreneurs pitch in their ventures in front of a panel of United Nations Foundation experts during another session of the ICSD;
  • advance the agenda of the Youth Solutions Report among our partners and supporters; and
  • push decisively forward with our project aimed at building the capacity of youth organizations to contribute to the SDG indicator framework as part of our role in the Global Partnership for Sustainable Development Data (stay tuned for updates!).

In a little more than a year, SDSN Youth has become a key global actor for youth involvement in the 2030 Agenda, and I am confident that we will continue to go beyond advocacy to support effective problem-solving by young people around the SDGs while also harnessing their skills as a necessary step for the sustainable development of all countries and regions.

* Make sure you follow updates from our delegation in New York on Twitter: https://twitter.com/SDSNYouth.
* Remember to RSVP to our event on “Reimagining the World in 2030”, taking place at Columbia University on September 20: https://www.eventbrite.com/e/reimagining-the-world-in-2030-tickets-27453691731.

 

The Sustainable Development Goals and international law: legal challenges to the achievement of ‘environmental’ Goals in the 2030 Agenda

 

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Photo Credit: UN Photo/Cia Pak

On 25 September 2015, Heads of State and Government from the 193 Member States  of the United Nations gathered at the 70th Session of the UN General Assembly in New York to adopt the 2030 Agenda for Sustainable Development, a “comprehensive, far-reaching and people-centred set of universal and transformative Goals and targets” which will “stimulate action over the next fifteen years in areas of critical importance for humanity and the planet”.

In its essence, the outcome document of the UN Sustainable Development Summit (which contains the much-heralded Sustainable Development Goals) delineated a policy framework concerned with mobilizing efforts at the international, national and subnational level around a set of common priorities relating to sustainable development, and by doing so, it then sought to address challenges as diverse and ambitious as ending poverty and hunger, combating inequalities, building peaceful and inclusive societies, promoting human rights, and ensuring the protection of the planet and its natural resources.

From this perspective, the adoption of the SDGs represented an unprecedented effort not only to move away from a development agenda still heavily dominated by a narrow focus on the economic and social components (something which is evident in the design -and failures– of the Millennium Development Goals), but also to positively identify the reciprocal interactions between the various components of sustainable development that must be taken into account by States at the stage of implementation. This effort, in turn, will now require transformative changes in the way all sectors of society deal with the above-mentioned challenges: from the economy to life sciences to law, existing institutions and systems of rules will be called upon to remove the obstacles to sustainable development and actively promote the achievement of the 17 Goals and 169 targets.

As a legal scientist with strong interests in the field of the environment, I believe that legal regimes are particularly bound to interact with the 2030 Agenda, and that ensuring a mutually supportive relationship between them will be necessary if human development is to stay within the Earth’s planetary boundaries in the next fifteen years and beyond. While I will explore this topic more in depth in an upcoming journal article which I am currently writing with Professor Riccardo Pavoni of the University of Siena (Italy), here I want to highlight the important governance function that international environmental law can play in the implementation of the ‘environmental’ goals and targets contained in Resolution 70/1. In fact, on the one hand, as recently maintained by the UNEP, violations of international environmental law “have the potential to undermine sustainable development and the implementation of agreed environmental goals and objectives at all levels”. On the other, international environmental law constitutes the normative backbone of many (possibly all) of the SDGs, in the sense that institutional and legal developments in the field of the environment can either “foster” or “frustrate” such goals, and that the development of innovative legal approaches, coupled with increased stakeholder engagement, is necessary to accommodate environmental protection concerns in the operationalization of the 2030 Agenda.

Indeed, it seems prohibitive to outline all the potential challenges that international environmental law will have to address in order to enable a mutually supportive relationship with the post-2015 development framework. Moreover, it could be convincingly argued that the underlying problem in this respect will remain the lack of integration between international environmental law and different legal regimes, with a strong emphasis on areas such as trade and investment law and human rights. At the same time, it appears possible, when examining the content of the 2030 Agenda in the context of other recent developments both in the activities of the UNGA and generally in international environmental law, to pinpoint at least some of these recurring challenges. Pavoni and I hold nine of them to be particularly important. More specifically, four are concerned with substantive issues (broadly corresponding to SDGs 12-15) while the rest mainly relates to procedural elements, means of implementation, and shortcomings in the general architecture of international environmental law.

The four substantive challenges are: (i) swiftly implementing the Paris Agreement on climate change and ensuring that commitments contained in the Intended Nationally Determined Contributions (INDCs) of the Parties remain ambitious on a pathway to the decarbonization of the economy by 2050; (ii) developing a new regime for the conservation and sustainable use of marine biological diversity in areas beyond national jurisdiction under the UN Convention on the Law of the Sea, as currently mandated by Resolution 69/292 of the General Assembly; (iii) strengthening integration within international environmental law by promoting the definition of linkage-based plans, policies and programmes, with a particular focus on the widespread adoption of an ecosystem-based approach to environmental protection, increased consideration of the underlying drivers of biodiversity loss and ecosystem destruction, and the role of environmental impact assessment (EIA) laws; and (iv) advancing a holistic approach to the management of chemicals and waste under existing international conventions and developing new multilateral agreements on the subject, where needed. Taken together, these challenges continue to highlight major gaps in international environmental law, and addressing them would also mean achieving concrete progress around at least five critical planetary boundaries, including climate change, biosphere integrity, land-system change, and introduction of chemicals, nanomaterials, and other novel substances.

The remaining topics emphasize the need to further advance key procedural norms and to strengthen the means of implementation in legal regimes in the field of the environment. Most of them reflect long-standing normative trends in the development of international environmental law, while others represent relatively new topics lying at the intersection of law and policy which must increasingly inform the development of multilateral environmental agreements and the evolution of already existing institutions and regimes. They are: (i) harnessing foreign direct investment, official development assistance, and domestic finance for environmental protection, including through further promotion of the role of market-based instruments such as payments-for-ecosystem-services schemes (PES), consistent with the vision outlined in the Addis Ababa Action Agenda; (ii) increasing capacity-building in, and technology transfer to developing countries in order to operationalize the global indicator framework and, more generally, foster conservation and sustainable use efforts (i.e. in terms of establishment, management and effective monitoring of protected areas); (iii) reinforcing science-policy interfaces and bolstering the role of intergovernmental platforms in building capacity for the effective use of science in law- and decision-making at all relevant levels (i.e. in terms of the assessment and accounting of the economic value of ecosystem services); (iv) enhancing public participation in decision-making and access to justice and information as an indispensable component in the implementation of the procedural and substantive environmental rights of individuals and communities, as most recently urged at Rio+20; and (v) advancing liability regimes at the domestic and international level (but also, more generally, non-compliance procedures), particularly by moving away from the traditional rules of State responsibility in favor of more stringent civil liability rules.

It should be noted that it was not by chance that I reserved these two essential aspects for last. On the one hand, despite the message contained in Principle 10 of the Rio Declaration, progress on the topics of public information and participation and access to justice remains uneven, held hostage by geographical differences in the way human rights are being re-considered, translated into law and interpreted from an environmental perspective. As a consequence, it will be important to ensure that ambitious regional achievements on this topic, such as the Aarhus and Espoo Conventions, which provide for key procedural rights in the field of the environment, inform significant developments in other parts of the world. On the other hand, more than 20 years after the proclamation of Rio Principle 13 on liability and compensation, the emergence of rules of strict State liability and civil liability regimes in domestic legislation and/or multilateral environmental agreements continues to be undermined by the conflicting perspectives of States on issues such as the very definition of environmental damage, the role of the State in redress, the burden of proof, the scope of compensation, the limits of liability, and so forth. That these problems were carefully ignored in the drafting of the SDGs (not to mention the specific provision excluding liability and compensation contained in paragraph 52 of the decision adopting the Paris Agreement) bears further testimony to the steep task placed upon international environmental law in the implementation of the 2030 Agenda.

[Use the following citation when quoting from the article: Riccardo Pavoni and Dario Piselli, ‘Sustainable Development Goals and International Environmental Law: Normative Value and Challenges for Implementation’ (2016) forthcoming]

#KnowYourGoals – A Campaign for the SDGs

Twitter_headerLast July 28th, the UN Sustainable Development Solutions Youth Network announced ‪#‎KnowYourGoals‬ – a global campaign to bring awareness of the UN Sustainable Development Goals (SDGs) to communities all over the world!

In partnership with oikos and Project Everyone, #KnowYourGoals calls upon everyone – organisations and individuals – to host an event during the month of September.

The aim of these events will be to explore the SDGs and most importantly, WHY they are important. SDSN Youth will host the events on its website and provide you with all the resources you need to make your event a success!

Find out how you can participate by visiting http://www.sdsnyouth.org/knowyourgoals.

Forests are about more than survival

by Dario Piselli, Greening USiena coordinator

I am sorry for the late timing, but I thought some words were needed to address the firstInternational Day of Forests and the IDF_poster_ENTree, which was held yesterday after a UN December resolution declared that 21 March of every year was to observed as an occasion to “celebrate and raise awareness of the importance of all types of forests and trees outside forests“. Apart from the consideration that international occurrences may or may not be pivotal in achieving the goals they are concerned with, depending on countries’ willingness to commit to tackling the issues that have been raised, it should not be unfair to say that the recognition of the value of forest ecosystems and the services that they provide brings up one the biggest and most evocative challenges the human race and the planet are facing today. Forests are not only the core of the earth’s biosphere and the cornerstone of life, functioning as soil conservers, climate change regulators, primary producers, hydrologic flow modulators, habitats for wild species and holders of about 90% of the world’s terrestrial biodiversity; in fact, their history is inextricably linked to mankind’s one, and mankind’s biological (but also anthropological) evolution has developed in strong connection with them. On one hand, forests still host roughly 2,000 indigenous cultures which deserve respect and the right to be held keepers of their environment (not to mention the need for us to leave them alone, recognizing their will for an autonomous model of development, that be really their own); on the other, they have accompanied human progress throughout time, providing man with a (seemingly) never ending source of food, building materials, heating sources, shelter and a (truly) never ending source of thought and mysterious fascination.

This is what strikes me the most about forests. Nearly everything that could have been said on the ecological, social and economical crisis that we may expect if we keep on destroying these ecosystems for livestock breeding, indiscriminate agriculture, paper, timber and so on is contained in the brilliant message that UN Secretary-General Ban Ki-Moon has delivered yesterday (and that can be read here). But there is much more than that. There is, at least in me (and I hope in many), a deep sense of belonging, even though I never lived within close range of a ‘forest’; there is a sense of moral connection, of our shared place ‘in the family of things’, as Mary Oliver once put it; there is, finally, a sense of mutual relationship which has helped (and continues to) shape the world and our very same spirit, in the meantime.

This is especially evident in those indigenous cultures, to which I pointed earlier, that have retained and nurtured their likeness to the nature that surrounds them: without trees and forests, they simply wouldn’t exist, and not just because they would-Yasuni-National-Park-in--001 have developed another type of civilization, but especially because they would have lost their identity. However, it is not exclusive of them. Through the centuries, there have been men who have worshipped forests and protected them, by words or by action, from destruction; and they have done so for more than their beauty, and surely for more than that (sometimes) emotionless adhesion people express for a cause which is being put forward by an NGO they donate to. What these men (think of John Muir, for instance) pursued was not the somehow egoistic goal of defending their primary mean of survival and existence (and that especially because in the nineteenth century no one could even imagine mankind facing the global challenges we need to address today); what they pursued was the recognition of us and the forests being part of the common tissue of life, a tissue which encompasses a ‘give and take’ mentality (and not a ‘Giving Tree’ mentality) but which also goes beyond physical interactions to penetrate the very heart of human history on this planet earth, and they did so because they understood that “in wildness is the preservation of the world”.

(from The Maine Woods, Chesuncook – by Henry David Thoreau)

john_muir_washington_column“Strange that so few ever come to the woods to see how the pine lives and grows and spires, lifting its evergreen arms to the light, — to see its perfect success; but most are content to behold it in the shape of many broad boards brought to market, and deem that its true success! But the pine is no more lumber than man is, and to be made into boards and houses is no more its true and highest use than the truest use of a man is to be cut down and made into manure. There is a higher law affecting our relation to pines as well as to men. A pine cut down, a dead pine, is no more a pine than a dead human carcass is a man. Can he who has discovered only some of the values of whalebone and whale oil be said to have discovered the true use of the whale? Can he who slays the elephant for his ivory be said to have “seen the elephant”? These are petty and accidental uses; just as if a stronger race were to kill us in order to make buttons and flageolets of our bones; for everything may serve a lower as well as a higher use. Every creature is better alive than dead, men and moose and pine-trees, and he who understands it aright will rather preserve its life than destroy it.’