A joint commission from The Lancet and the University of Oslo in Norway finds that the imbalance of political power between nations is failing to protect the public’s health, and calls for urgent reform in global decision making.

According to the report, the differences in chances of survival between communities are not just down to poverty. It raises wider questions of socioeconomic inequality and the will to improve global governance.

The Commission’s chair, Prof. Ole Petter Ottersen from the University of Oslo, calls for a political commitment to reforming a system of global governance that he says prioritizes wealth creation over human health.

“Health equity is a precondition, outcome and indicator of a sustainable society,” Prof. Ottersen says, “and should be adopted as a universal value of a nation’s success alongside economic growth. This should be a shared social and political objective for all.”

Eighteen leaders of research and policy making contributed to The Lancet-University of Oslo Commission, drawn from health, financial, developmental, environmental, human rights and foreign policy backgrounds. They spent more than 2 years gathering data on how global health is affected by the current decision-making systems of global governance.

The main agenda promoted by the Commission is that health equity should be a priority of all political, economic and social sectors.

Prof. Ottersen acknowledges that there have been impressive advances in disease screening and treatment over the past two decades, but he reminds that:

…only a very small proportion of the world’s population has benefited. These unacceptable health inequities within and between countries cannot be addressed within the health sector by technical measures, or at the national level alone. We urgently need all policies tested for their potential impact on human health. And that requires global agreement that economic growth is celebrated in partnership with health equity.”

Within their report, the Commission outline seven areas where political and economic injustice affect population health. These are:

  • The global financial crisis and ensuing austerity policies
  • Knowledge and intellectual property
  • Investment treaties
  • Food security
  • Transnational corporations
  • Migration
  • Armed violence.

Within global governance, the Commission also outline what they perceive to be five key “dysfunctions”:

  • Democratic deficits (“the exclusion of civil society and marginalized populations from national and global decision making”)
  • Weak accountability (“inadequate means to constrain power”)
  • Institutional “stickiness” (“decision-making processes that fail to adapt to the changing needs of people”)
  • Inadequate policy space for health (“health concerns are too often subordinated to other objectives, such as economic growth and national security”)
  • Absence of international institutions (such as treaties and courts) to protect and promote health.

Concluding that “existing mechanisms of global governance are unfit for purpose,” the Commission make four recommendations. They request:

  • The creation of a multi-stakeholder platform on governance for health (“a place for deliberation and debate to strengthen accountability for health”)
  • The formation of an independent scientific monitoring panel to “measure and track progress in overcoming the political, economic and social determinants of adverse health outcomes”
  • Health equity impact assessments of all policies and practices
  • Strengthening existing mechanisms (such as “human rights instruments and mechanisms for sanctions”) to protect health and build commitment to global solidarity and shared responsibility.

“Economic growth alone will not deliver good health to the most vulnerable sectors of society without addressing the intertwined global factors that challenge or destroy healthy lives,” says Richard Horton, editor-in chief of The Lancet.

Horton adds that such challenges can only be addressed by reaching beyond the health sector:

Solutions will require […] a more critical understanding than has hitherto been displayed by policy makers of the determinants of human survival and wellbeing. Success will demand courage and flexibility to challenge the consensus that so inhibits the changes needed to bring about greater equity. This Commission can, we hope, be a contribution to this need for greater critical understanding and challenge.”

Last year, Medical News Today looked at a report The Lancet produced in association with Harvard Medical School, assessing the greatest global challenges to providing health care in developing countries.