Further reflections

Interconnectedness through common humanity was the single overwhelming vision resonating throughout the recent UN DPI/NGO conference in Melbourne. Although initially omitted, the reworking of the conference communiqué to be founded on a human rights-based approach allowed the crucial and timely reassertion of a basic tenant of human rights which underlies development work: one person’s right is another’s reciprocal obligation.  It is a belief in both the logic and the morality of this social contract that first propelled me towards the field of global health, along with the realisation that, in an increasingly globalised world, delineating healthcare provision along national borders is not only unjust but ultimately counter-productive. As Ruth Bamela Engo – founder and President of African Action on AIDS - powerfully asserted during the conference:  “I am not human if you are not.”


Of course, despite the elegant simplicity of this statement, actually fulfilling our obligations and achieving the Millennium Development Goals remains a challenge of almost inconceivable complexity. Yet a number of recurrent themes throughout the conference indicated the process by which this achievement might occur. In particular, emphasis was placed on the importance of partnerships between NGOs and governments, but also with the private sector. Innovative mechanisms for funding development were also highlighted as a playing a fundamental role in the achievement of the MDGs. For example, GAVI (the Global Alliance for Vaccines and Immunisation) aims to change the markets for vaccines, by buying in bulk (thus pushing down prices) and guaranteeing demand for the product (thus encouraging pharmaceutical companies to spend more money on R+D and less on marketing). This creative solution is ultimately moulding the vaccine market to deliver a better (and cheaper) deal for the world’s most neglected populations. This is done without compromising the Alma Ata agenda, since GAVI also directs money into strengthening health systems to facilitate efficient delivery of its programs and to promote sustainable primary healthcare as the ultimate solution to “health for all”.


Certainly, there were moments of frustration and disillusionment throughout the 3-day meeting. I shared the frustration – elegantly articulated by a previous author - about the tendency for some groups at the conference to push individual agendas. I also felt frustrated by the constant barrage of sweeping statements quoting intolerable statistics imploring us to take action: the audience is a group of NGO representatives, who, broadly speaking, are the very ones who are taking action – they instead want to know how to take better action, and to be listened to. Nonetheless, the conference was an overwhelmingly positive experience. Meeting other young delegates and being exposed to their restless passion and sometimes palpable anger regarding global health issues was infectious. Similarly, listening to stories of survival from women like Lucy Chesire from Kenya was both agonising and inspiring. Lucy’s HIV positive status meant she suffered unbelievable discrimination in her workplace, expulsion from her family, and disseminated TB infection due to lack of access to diagnosis and treatment facilities. She now works with the Global Fund for AIDS, TB and Malaria, tracking donated monies and keeping service providers accountable. It was meeting these amazing people and hearing their stories that served as the ultimate reminder of why it is essential that we continue to act: so as to enable the world’s poorest to act for themselves.


Ultimately, then, this conference served as a call to action. Dr Aleida Guevara impressed upon us: “Don’t say what needs to be done, do what needs to be done.” So, what can we, as (relatively) poor and disempowered students, actually do?

• Advocate – get involved with campaigns, educate yourself and your peers about the issues, lobby government, volunteer, fundraise, and sign the petition to replenish the Global Fund (http://theoaktree.org/initiatives/campaigns/active-campaigns/global-fund/)
• Educate – educate your medical faculty about the need for global health teaching to be integrated into all medical school curricula – “doctors need to be taught to be health activists, not just body technicians” (Dr Claudio Schuftan)
• Inspire – join your global health group or a forum such as http://www.globalhealthgateway.org.au/ to share your experiences and skills with others, and finally
• Make it your business – “Do not underestimate what you can do, and do not leave it up to governments...Poverty is everyone’s business.” (Mick Gooda, Aboriginal and Torres Strait Islander Social Justice Commissioner)

Do not neglect your humanity.

Day 3

The final day of the UN DPI/NGO Advance Global Health Conference began with the same buzz of productivity, passion and good will that had become synonymous with the conference’s ethos.


The day commenced with the 4th Roundtable focused on the topic of “Achieving the MDGs in our changing world”. Panalist De Caleb Otto warned that multinational communication and globalization results in an ease of exploitation of the poor and a decrease in family values. Of note was Dr Sue Wareham’s discussion that the achievement of the MDGs would be easier if less money was on war ($US1.46 trillion globally/year) and more on health and aid. She estimates that only $US135 billion is needed in total to achieve the MDGs. Clearly there is room to put pressure on our governments to realign national priorities. Dr Wareham’s final words were a call to rid the world of nuclear weapons. In her words: “If one country has them, another country will want them too. If we have them, we will one day use them again and the results will be catastrophic.”


The workshop titled “Enhancing Access to Medicine – A Crucial Step in Achieving the MDGs” sparked similarly enriching discussion. Dr Faith Mwangi-Powell from the African Palliative Care Association, Uganda, opened the workshop by probing delegates to contemplate the ‘bucket list’ of a male American cancer patient versus a female African cancer patient. She discussed the deficiency of adequate morphine use in Africa (10% of the world’s population consumes 84% of the world’s morphine) and the obstacles faced in addressing this issue. Presentations from Lloyd Sansom (World Health Professions Alliance), Jonathan Liberman (International Union Against Cancer) and Nick Watts (International Federation of Medical Students’ Association) followed. Lloyd Sansom in particular provided intriguing and informative insights. Opening with a comparison of the cost of medicine for chronic disease in the developing world compared to Australia, he effectively articulated the inequity and scale of the problem. With Australia as the case example, he detailed the fundamental role of a National Medicine Policy in the provision and affordability of medicines within a nation. He reflected on the importance of consumer confidence in generic brands as well as adequate distribution of drugs in developing nations. Jonathan then discussed intellectual property law with regard to drug patents and placed the discussion in the context of up scaling global emphasis and treatment for non-communicable diseases. Nick Watts rounded up the session with some inspirational examples of how universities and students can successfully campaign to increase access of essential medications in the developing world (see http://essentialmedicine.org/).


At the Closing Ceremony, simple but touching performances from Collingwood Primary School and the Australian Children’s Choir reminded us all why we were there. Indeed, as a youth delegate, the conference as a whole not only acted as a reminder of what needs to be done in global health but significantly, also imbued a sense of empowerment in participants. The UN DPI/NGO conference reinforced that Youth do have a valuable voice. Youth can make valuable contributions towards achieving the MDGs. The fate of our world depends on our collective actions. It is our responsibility and moral imperative to act so that good health and well-being is not just reality for the fortunate few but, for everyone.

Day 3

Reflecting on the 63^rd UN DPI-NGO Conference, it was a mixed bag. There is a common belief that we must remain positive about our experiences, to the extent that it makes us uncomfortable to criticise that which needs critique. Regardless, I shall give my honest thoughts on the conference and its proceedings, and a brief justification on why this is important.

There are three main reasons why a productive conference was vital. The first is that we must remember that while we sat in the Melbourne Convention and Exhibition Centre, children and mothers continued to die of preventable causes in the world outside. So any diversion of the attention of the world’s NGO leadership must be for a good reason. The second is that it is extremely rare for such a diverse and comprehensive range of NGOs to come together for the express purpose of idea sharing and reflection, collaboration and co-ordination. The potential was indeed immense. We therefore must make maximal use of our time together to secure the future of our world through successful pursuit of the MDGs. The third is the many youth who were present at the conference. Youth will be the ones who lead the MDG effort into our changing world, and we hoped to experience an inspirational and informative conference, and to gain a glimpse into the world and NGO community they will inherit.

However, I was both dismayed and frustrated at the lack of direction, the lack of co-operative spirit, and the subsequent lack of forward movement and learning in the majority of the plenary roundtable discussions. Many delegates distracted the conference with questions and comments that showed a disregard of the topics at hand, the dire nature of the problem we are trying to address, and an understanding of where their contribution sat within the larger picture of global health efforts as a whole. To ask a roundtable of world leaders in the MDG campaign to comment on whether the conference should be held with Esperanto as the official language is inappropriate. To ask off-topic pre-drafted questions merely to practice public speaking or to assert your NGO’s presence at the conference is inappropriate. To have speakers misunderstand the few questions that were on topic due to lack of interpreters was farcical.

This was a conference between the largest and most active NGOs in the field of global health, addressing needs such as the 1 in 4 people in the world living with less than $1.25 a day, the dire state of maternal health, the lack of universal access to primary schooling, HIV/AIDs, TB, and Malaria. It was great that there were so many new NGO’s, youth, and others less experienced in global health at the conference.  However, it is important we let the more experienced NGOs/WHO/UN have productive discussion for the benefit for all. Pushing of individual agendas only serves to undermine meaningful discussion on the relevant topics and stagnate progress on the overall picture.

These frustrations were shared by many delegates who felt discussion had been hijacked (and said so openly to the conference). I couldn’t help feeling that if this is the state of world affairs, it seems our generation has a lot to fix.

It should, however, be recognised that perhaps it was a unique set of circumstances which caused a less productive UN DPI-NGO conference than is usual. The uncertain political situation in Australia post-election prevented a number of high-profile UN officials and Australian politicians from attending. This undoubtedly led to a lack of clear leadership and vision, and a lesser sense of urgency and importance that productive discussion need take place.

So did I regret attending the conference? No. There were undoubtedly some exceptional delegates present, and the conversations which resulted (on topics from the mundane to philosophical, from policy issues ranging from Indigenous health and Access to Essential Medicines to vertical versus horizontal aid programmes) was undoubtedly of great benefit to the delegates personally, and therefore also to the people their organisations help. The time allowed for networking was certainly a useful insight into the breadth of global health activities, from the Global Alliance for Vaccines and Immunisation, to the work of the Burnet Institute based in Melbourne. The growing recognition that addressing non-communicable diseases and climate change is fundamental to achieving the MDGs is a positive step. The consistent advocacy for strengthening health systems over running vertical aid programs focussed on specific diseases was great to see. The observation that “everyone wants to co-ordinate, but no one wants to be co-ordinated” is a poignant indictment and call for action. If the plenaries reached that level of discussion, it would be a hugely productive conference indeed!

I suppose the point made here is that good process is important to good outcome. Such a large gathering of delegates is most productive when there is a clarity of purpose, and strong leadership to steer discussion and ensure we stay on task. Should I be so negative? I don’t think this message was negative. It was an honest evaluation of the impressions I had of my first ever UN-level conference. As was emphasised at the Nossal Global Health Forum, evaluation is a crucial aspect of running aid. The appropriate response to a fear of donors withdrawing support due to deficiencies identified by evaluation of aid programmes (or, similarly, voter support for government initiatives) is not to neglect critique. It is to educate donors that evaluation is a crucial aspect of improving evidence-based best practice. Indeed, improvement, not the outcome per se, should be the measure of success.

We should remember this in the context that achieving the MDGs is not just necessary, but possible.

Day 2

Tuesday: Another day of impassioned speech and demand for action.


Key ideas which were raised in the course of the day:

Dr Jane Freemantle (Australian epidemiologist): We are not collecting
enough data - every person should be counted, no matter how remote or
marginalized. Without accurate data, we cannot accurately define our
problems, and cannot find appropriate solutions.

Justin Mohamed (Aboriginal health expert): We need to start involving
local people in collecting data on their communities, and then we must
utilise the data to bring about change. We must ask ourselves whether
poor people and indigenous people of the world are truly valued.

Dr Claudio Schuftan (Chilean freelance medical consultant): achieving
the MDGs would only modestly (if at all) improve global health. What
we need is a human rights based approach, where the goal is fulfilling
human rights for all, rather than an approach that 'fills deficits'.
The MDGs are flawed in their lack of long term commitment, focus on
communicable disease and reliance on technology.

Kenneth Ndubuisi Okoh: we must fight corrupt governments who pocket
international aid. The western world should "close their funds" to the
greedy and the corrupt.

Day 1

In addition to Michel Sidibe, Executive Director of UNAIDS, other addresses were delivered as part of the conference opening ceremony by:

• Kiyo Akasaka – United Nations Under Secretary General for Communications and Public Information
• The Hon. Bob McMullen – Federal Parliamentary Secretary for International Development
• Ban Ki-moon – United Nations Secretary General
• Navi Pillay – United Nations High Commissioner for Human Rights
• Barbara Flick Nicol – Aboriginal Health Campaigner
• Dr Mary Norton – Conference Chair

Articles in today’s press highlight some of the key themes and messages discussed by the keynote presenters. See:

• http://news.theage.com.au/breaking-news-national/mothers-babies-need-help-un-summit-20100830-1478h.html
• http://news.theage.com.au/breaking-news-national/aboriginal-health-record-upsets-adviser-20100830-14720.html
• http://news.theage.com.au/breaking-news-national/un-chief-addresses-melbourne-summit-20100830-140ce.html

The afternoon session marked the commencement of both the conference workshop program and a series of roundtable plenary discussions. See the previous post for more details.