Open Working Group opens interactive exchange of views on Health, Population Dynamics

The Open Working Group (OWG) considered Health, Population Dynamics during its 4th session on 18-19 June 2013. The topics were introduced through keynote addresses by Dr Anarfi Asamoa-Baah, Deputy-Director, WHO and Dr Hans Rosling, Karolinska Institute, Gapminder Foundation and the TST issues notes were presented by WHO and UNFPA. The panelists for the interactive exchange of views were Dr. Jeanette Vega, Managing Director, Rockefeller Foundation and Dr. Paulina K. Makinwa-Adebusoye, Nigerian Institute of Social and Economic Research.

Keynote address Dr Anarfi Asamoa-Baah, Deputy-Director General, WHO

In his introduction to the discussions on Health, Population Dynamics Dr Anarfi Asamoa-Baah, Deputy-Director General WHO, noted a sense of change as highlighted in the reductions in infant and maternal mortality and the increased use of anti-retrovirals in the treatment of HIV.  More remained to be done, however, and the work should be accelerated on the current MDGs. The agenda should be broadened to include adolescents, ageing populations and non-communicable diseases (NCDs).

The OWG should be concerned with social determinants of health, including costs of care and a more comprehensive approach to social protection. There should be one over-arching health goal that relates to health at all stages of life. Priorities will differ from country to country. NCDs should be added to the current health concerns included in the MDGs and people should be able to access the services they need. He referred specifically to universal health coverage (UCH) stating that the emphasis should be on equity. The MDGs did not put a premium on equity, but this should be addressed in the future. 

Keynote address Dr Hans Rosling, Karolinska Institute, Gapminder Foundation

Dr Hans Rosling of the Karolinska Institute and Gapminder Foundation gave a dynamic presentation to show the impact of population dynamics using his Gapminder software, showing the differences between regions and the future growth that will take place in Africa by the end of the century.  He also emphasized the differences that exist within countries as well as between countries. Dr Rosling’s presentation can be viewed on the webcast.

Presentations on the TST Briefing Papers

Health and Sustainable Development

A presentation was made by WHO on the TST Issues Brief: Health and Sustainable Development:

Health can be a key indicator, with more people going into poverty each year, as they cannot pay for their services. This can undermine development policies and programmes. There is, moreover, a need to emphasize the social, economic determinants of health. Eight hundred women died in childbirth each day in 2010, and there are 222 million women who don’t want to become pregnant but don’t have access to contraception. Issues related to violence against women and girls, including sexual violence, should also be addressed. Persistent inequities also continue to exist in children’s health, while HIV and infectious diseases continue to dominate in countries in Africa, with NCDs presenting a problem in middle-income countries. Further progress will require measures to reduce health inequities. A further challenge that must be addressed is the increase in ageing in some countries, while in others countries there are high numbers in those under the age of 24. 

The Sustainable Development Goals (SDGs) should deliver on health and wellness. Attention should also be paid to new diseases eg SARS. There are many opportunities for health and development as related to each other that have not been explored, health should therefore be considered taking into account its nexus to other SDGs. Accountability is also important as are human rights and gender equality. Going forward the focus should be focused on maximizing healthy lives, universal health access and the social and environmental dimensions. 

A global health goal should address poor governance and accountability, shortages of trained health workers, quality assurance. Progress will depend on empowering people and communities.

Sustainable development and population dynamics: placing people at the centre

The world population has surpassed the 7 billion mark and is projected to grow to over 9 billion by 2043. While many of the poorer countries continue to be characterized by rapid population growth, others are experiencing rapid population ageing and even population decline in some cases and there are also increasingly complex international migration patterns and very high rates of urbanization. The challenge, therefore, is to meet the increasing needs and expectations of a growing population while modifying current production and consumption patterns to achieve a more sustainable development model and address the links between development and rapid population change.

Population growth, population ageing, as well as migration and urbanization affect consumption, production, employment, income distribution, poverty and social protection, including pensions, and complicate our efforts to ensure universal access to health, education, housing, sanitation, water, food and energy.  At the same time population growth places increasing pressures on the planet’s resources, contributing to climate change and challenging environmental sustainability. 

Migration can be an important enabler of social and economic development both in enabling more than a billion people to escape from poverty and conflict etc and through annual remittances.  Urbanization can be a powerful driver of sustainable development as higher population density enables governments to deliver essential infrastructure and services in urban areas at relatively low cost per capita. However, the benefits of demographic transitions, urbanization and migration do not materialize automatically and inevitably. To address and harness the opportunities of population dynamics for sustainable development, countries should seek to enlarge, not restrict, individual rights. 

Policies should be human rights-based and gender-responsive policies, promoting universal access to sexual and reproductive health and rights, including voluntary family planning, and to education, including comprehensive sexuality education. Rights-based and gender-responsive policies are also critical in a context of low fertility and rapid population ageing or population decline. Policies addressing low fertility should promote a better work life balance and ensure access to essential services, such as childcare and social protections. A human rights approach is also crucial in migration policies, which should respect and protect the human rights of migrants and migrant workers. A rights-based approach is also essential in choosing policies for addressing urbanization and sustainable settlement patterns.

In today’s world there is no place for coercive measures of population control or for setting demographic targets. Such policies are contrary to the respect for human rights, and experience has shown that such measures are likely to be counterproductive in the long run.

The consultations on population dynamics have suggested the importance of mainstreaming the following priorities into the post 2015 development agenda:

• Strengthen the formation of human capital throughout the life course, with particular focus on health, including sexual and reproductive health and rights; education, including comprehensive sexuality education; and poverty reduction, decent work and social protections; as well as a particular emphasis on human rights, non-discrimination, equal opportunities, women’s empowerment and youth participation. 
• Promote the development benefits of migration, with a focus on ensuring the rights and safety of migrants and combating discrimination against migrants, and a perspective on realizing the developmental benefits of migration for both sending and receiving countries.
• Create equitable, liveable and sustainable cities that can accommodate increased demands for livelihoods and services, while strengthening the linkages between rural and urban areas, and promoting the sustainable development of rural communities. 
• Strengthen national capacities to collect, use and analyze population data and projections. People-centred development strategies must systematically consider changes in the number, age and location of people; and use population data and projections to inform development goals, targets and indicators, as well as policies and programmes. Data producers should systematically disaggregate relevant socio-economic data by sex, age and location. 

Sustainable Development and Population Dynamics: Placing People at the Centre by Anne-Birgitte Albrectsen, Deputy Executive Director Managment, UNFPA at the Open Working Group on Sustainable Development Goals is available on UNFPA's website.

In her presentation on Universal Health Coverage, Sustainable Development and the Post-2015, Dr Jeannette Vega considered the contribution of the health sector in access to care. The health sector should contributes to the post-2015 development agenda by providing health coverage. It should provide access to integrated health systems, which translates for patiens into prompt access. It must also be universal, including all people included and all services. This can only happen through efficient systems. 

In considering the other criteria for the health goal, Dr Vega emphasized the importance of indicators that can also measure for different events, financial protection and catastrophic rates. UHC should link to other sectors as it is the right thing to do and should recognize that health is a human right. For presentation click here 

Dr. Paulina K. Makinwa-Adebusoye, Nigerian Institute of Social and Economic Research emphasized that the health of populations is central to sustainable development. More needs to be done to make progress related to inequitable health within and between countries. 

More than half of the maternal deaths occur in sub-Saharan Africa, where there are more risky pregnancies than in other regions. Maternal deaths are also associated with HIV and with other diseases. In Nigeria, most pregnancies are very risky, so mothers are at higher risk as a result of too many pregnancies that are too frequent, too early or too late. There are also dangers for babies born to high-risk mothers, which also increase infant mortality. The most important factor for child survival is the age of the mother.  A combination of risk factors has the effect of increases death probability.

Child marriage, ie marriage under the age of 18, is also a contributing factor as it violates girls’ rights and affects their health and well-being insofar as it means that they are taken out of school. The total fertility rate is increased among this age group. Girls’ education is an important factor in decreasing child-bearing in this age group. 

For full presentation please click here.