Major Groups and other Stakeholders position papers
Official position papers were submitted as part of the preparations for the High-level Political Forum by Major Groups and other Stakeholders. They include:
Women’s Major Group (WMG); Major Group for Children & Youth (CYMG); Indigenous Peoples Major Group (IPMG); Non-Governmental Organizations Major Group (NGOMG); Worker & Trade Union Major Group (WTUMG); Local Authorities Major Group (LAMG); Business & Industry Major Group (BIMG); Scientific and Technological Community Major Group (STCMG); Education and Academia Stakeholder Group (EASG); Persons with Disabilities Stakeholder Group (PWDSG); Volunteer Groups (VG); Stakeholder Group on Ageing (ASG); Asia Pacific Regional CSO Engagement Mechanism (APRCEM); and Together 2030.
These position papers provide a rich resource of civil society organization (CSOs) thinking around SDG 3 Ensure healthy lives and promote well-being for all at all ages and health-related targets. The key messages are presented below. In general, they add content to the various targets and demonstrate a wide measure of agreement. They can assist both international and national level CSOs in their advocacy for the implementation, monitoring and review of the SDGs going forward.
On the one hand, they highlight concerns about financial risk protection in the context of universal health coverage (UHC), while on the other, they demonstrate support for sexual and reproductive health and rights (SRHR). In addition, antimicrobial resistance (AMR) is highlighted although it is not specifically in the SDGs, although it is included in paragraph 26 of the 2030 Agenda for Sustainable Development.
Targets 3.1 Maternal mortality and 3.2 Child mortality
The NGOMG recognizes the importance of investing in maternal and child health, which are also key to poverty reduction.
Target 3.3 Infectious diseases
Volunteers, as they build strong links based on mutual respect and trust, can deliver sensitive messages to communities and can therefore make a critical contribute in dealing with diseases such as HIV/AIDS, tuberculosis and malaria. The ASG also notes, moreover, that HIV rates are increasing among older persons, with an estimated 5.8 million people aged 50 and over now living with HIV globally.
Target 3.4 Non-communicable diseases
Trends and risk factors are changing and there is a shift from infectious to non-communicable diseases. Seventy-eight percent of the risk factor behaviours that cause premature mortality from NCDs, moreover, start during adolescence. Behavioural changes, such as better nutrition and more physical activity throughout the life course, can prevent or delay many NCD deaths. It is also important that persons over 70 are not excluded from NCD data collection.
Mental health
Many MGoS refer to issues related to mental health and well-being as being essential to society a whole. Its impact on different groups of individuals is also noted, eg persons with disabilities, for whom it must not lead to discrimination, stigmatization and exclusion. This may require the introduction of measures to improve the quality of mental health service delivery and to put an end to involuntary treatment and forced sterilization. Health facilities should be gender sensitive, and scientifically and medically appropriate, of good quality and respectful of medical ethics, including autonomy and agency without discrimination. Depression and dementia are a significant health problems for older people, affecting 15 percent of the global older populations. And, specific measures for collaboration should be implemented to address the mental health problems of indigenous peoples, particularly young people who are vulnerable to self-harm.
Target 3.5 Substance abuse and target 3.a WHO Framework Convention on Tobacco Control
The links between NCDs and tobacco use, alcohol consumption, poor diet, physical inactivity and are noted.
Target 3.6 Road traffic injuries and deaths
To prevent unnecessary injuries, ageing-related sensory impairments can be treated easily and inexpensively.
Target 3.7 Sexual and reproductive health and related issues, included target 5.6 on sexual and reproductive health and reproductive rights
Several MGoS include SRHR in their recommendations, with calls to enhance the scope of national policies to include SRHR. The WMG refers to gender inequalities in the reduction or elimination of essential services that women and girls rely on in health and social protection, as well as in the criminalization of abortion. They also affirm that a human rights approach be taken to enhance respect for girls and women of all ages, including by “respecting, protecting and fulfilling sexual and reproductive rights”. Sexual and reproductive health and rights violations continue to undermine and infringe on women and girls’ bodily autonomy and the agency over decisions about their bodies. Women’s health is compromised when women’s bodies are targeted by systemic and often epidemic levels of sexual and gender based violence against women and girls in all their diversity, and by the failure to uphold sexual and reproductive health and rights. Child, early and forced marriage and FGM can lead to daily psychosocial stress for women and girls with long term deleterious impacts on women’s health and well-being.
As recognized by the CYMG, the misguided and deliberate denial of young peoples’ SRHR, especially targeted at the ability of young women and girls to control their own bodies, remains a glaring barrier in the achievement of SDG 3. Discrimination and violence against girls, women, the LGBTQI community and non-gender conforming individuals, moreover, causes severe emotional and physical trauma, enhance health risks. The NGOMG calls for the ending of violence against women and ensuring access to SRHR, as the foundation for bodily autonomy and therefore of health and well-being.
Persons with disabilities around the world regularly experience violations of their rights to sexual and reproductive health and women and girls with disabilities worldwide face a wide range of unique human rights abuses in sexual and reproductive healthcare settings due to both their gender and disability. They include widespread inaccessible information services concerning sexual and reproductive health which inhibit their ability to exercise their sexual and reproductive autonomy. In general, moreover, volunteers can play a role in promoting access to reproductive education and reproductive health and combatting violence against women
3.8 Universal health coverage and financial risk protection
The importance of UHC is broadly supported, but with minimal or no out-of-pocket expenses.
Access to services
Efforts to achieve health-related targets should prioritize the full spectrum of services from promotion, prevention, treatment, rehabilitation, and palliation. Governments, through a multi-sectoral and multi-stakeholder approach, must endeavour to remove social, cultural, and economic barriers to ensure full access to affordable, quality physical and mental health services for all.
Barriers to improving health care identified by the ASG include poor physical access to health facilities, particularly in rural areas; high cost of health services and essential medicines; a lack of awareness of health conditions in older age and of available health and social care services, discrimination, and the absence, or inadequacy, of long-term and palliative care services.
Sustainability of health targets will require long-term investments by government and other stakeholders, including the private sector. Such sustainable healthcare would require systems to able to meet health needs at all stages of a person’s life. As such, according to the BIMG, Member States should focus on long-term sustainable development frameworks to prevent and manage infectious, chronic, and injury-related conditions, as well as commit to prioritizing health in all policies and involve all relevant stakeholders.
Financing healthcare
There should be adequate finances and resources for targeted programme in plans that address health. Nevertheless, as noted by the NGOMG, treatment of non-communicable diseases plunges millions of families into debt each year and, as stated by the EASG, States must deliver their responsibility to finance the SDGs. Older women are especially vulnerable. There is a need for financial risk protection for health costs related to disability with all levels of existing healthcare systems being made fully inclusive and accessible for persons with disabilities
CYMG suggests that the framework for domestic resource mobilization should incorporate health outcomes in financing strategies through mechanisms such as taxation of harmful substances like sugar.
Essential medicines
Concern is expressed about access to affordable medicines as well as a life course approach to immunization, which prevents an estimated 2-3 million deaths annually. Adults aged 65 and over face increased risk of infections due to normal processes of a weaker immune system.
3.9 Health and environmental issues
Some groups make the links between exposure to pollutants and their impact on health. This is an area, however, where more CSOs and groups could make more input on environmental issues and their impact on health.
3.b Research and development of vaccines and medicines and TRIPS
Trade
BIMG refers to a parallel commitment to foster an innovative eco-system in life sciences that will continue to enable the research, development and scientific partnerships that lead to new, patient-centred, medical interventions and health services.
Meanwhile, as stated by the CYMG, intentional political and structural barrier prevent countries in need from full use of trade-related intellectual property rights (TRIPS) flexibilities. A non-regression based process to overhaul these is needed to provide countries with the sovereignty to invoke compulsory licensing to meet shortages in reliable access to quality medicines.
3.c Recruitment and retention of health workforce
Although recruitment and retention are not commented on in general, quality services and trained personnel are need to meet the needs of indigenous peoples, persons with disabilities.
3.d Early warning and risk reduction
Antimicrobial resistance
In the context of risk reduction, some MGoS express concern about emerging issues, particularly AMR. In the changing context of the national and global health landscape, emerging issues like AMR, infectious pandemics, and the shifting burden to non- communicable diseases should be addressed. AMR was the focus of a special meeting on AMR at the UN General Assembly in 2016 and national plans should make special efforts to include interventions to address it. The increased occurrence and intensity of global infectious pandemics, moreover, is a serious threat to our collective resilience, and needs a global action plan with dedicated resources.
Rights-based approach to the implementation of SDG 3
There is agreement on the need to ensure a rights-based approach to achieve the full scope of SDG 3, as well as in the deliberations of the World Health Assembly. All national policies should be broadly delivered also through an age friendly approach.
Meeting the needs of vulnerable groups
There is a lack of data on indigenous peoples’ health and social conditions as well as a lack of information, analysis, and evaluation of programmes and services to address them. They include, for example, the lack of health facilities in indigenous communities and cultural differences with health care providers such as differences in languages, illiteracy combined with a lack of understanding of indigenous culture and traditional health care systems. There is also an absence of adequate health insurance and lack of economic capacity to pay for services, if available. Health systems must be strengthened also to provide persons with disabilities with quality essential healthcare services that are inclusive of and accessible to them.
Sixty-seven percent of older persons live in lower and middle income countries and are at higher risk of multiple chronic conditions. They often require increased support with tasks of daily living and to be able to continue to do the things they want in the places they want to be. Health and social systems, in both the developed and developing world, have, moreover, responded inadequately to the changing requirements of older populations.
The VG points out that volunteers provide vital supplements to the health care available through government health provision, reaching out to especially marginalised and excluded groups, and delivering healthcare to the neediest populations in even the most dangerous contexts, often at great risk, as the recent battle against the Ebola crisis in West Africa powerfully demonstrated.
Links with other SDGs…
SDG 4 Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all
The EASG makes the link between SDG 4 on education and health, as well as with the other goals as reviewed in 2017. They note that when women are educated, child health and mortality are improved. If all women, moreover, completed primary school, maternal deaths would decrease by two thirds. Education improves nutrition, which in turn has an impact on child mortality rates. Children of educated mothers are also more likely to be vaccinated, and less likely to be stunted because of malnourishment.
SDG 5 Achieve gender equality and empower all women and girls
Two issues that are highlighted are older women in some countries being subject to harmful practices such as widow-burning, discrimination and physical violence from accusations of witchcraft. Added to these are pervasive harmful traditional practices such as female genital mutilation and early, child and forced marriage which have adverse consequences on the sexual and reproductive health of girls and women, inhibiting their ability to fully participate in society .
SDG 6 Ensure availability and sustainable management of water and sanitation for all
In linking SDG 6 to SDG 3 ensuring access to safe water, sanitation and hygiene (including menstrual hygiene management), ending hunger and improving nutrition for all are highlighted. These will require investments in social and economic infrastructure.
SDG 11 Make cities and human settlements inclusive, safe, resilient and sustainable
The Programme on Health and Wellbeing in the Changing Urban Environment – a Systems Approach is noted which proposes a new conceptual framework for considering the multi-factorial nature of both the determinants and the manifestations of health and wellbeing in urban populations.