June 26, 2012

Post RIO+20 must be about local action to cash in on the promises

With the Rio+20 conference ending in Brazil, it appears that much of the recommendations outlined 20 years ago in the 1992 conference still remain unattained. Known as the Agenda 21 (a global development agenda for the 21st century anchored in sustainable development), the historic document of the first Rio meeting described the connection among various development sectors and the need for them to work together if sustainable development was to be achieved. The call for action in the form or the Rio Declaration also captured the endorsement of so many Heads of State in this commitment. These outputs pointed to the fact that our world is really one entity; that anything we do to our ecosystem affects everything else – visibly or invisibly. The proverbial “flutter of a butterfly in Rio affecting the weather in China” is to be believed. The commitments then were that we would all work together for the protection of the environment (our common denominator) on which we all depend for our survival.

But in the twenty years hence, our present predicament has proved ourselves forgetful, with selfish gain being the winner. Instead of coming together, we have partitioned the world as never before and driven the divide between the haves and the have-nots even wider. With globalization and the IT technology that have sprouted during the interim, we have drifted ever farther apart even as the social media has made the chatter among ourselves longer and louder. The meeting in Rio that just ended, seemed for many, too influenced by the business sector and politicians on the one side and civil society on the other. As a public health professional, my work for the past several years has been to help bridge this awareness gap on the connection of human health and the environment. Taking Chapter 6 of the Agenda 21 as the basis, my effort has been to show how human health is linked to our development action in the other sectors.

A simple example may suffice. Let’s take the case of agriculture and transport. One would perhaps ask, “what do these have to do with health? Neither builds hospitals nor produces doctors?” This kind of parochial response was precisely what one would have got even then twenty years ago. Even 20 years later, we are still grappling with these basic questions. A new generation of policy makers and practitioners need to be re-oriented or re-educated. We need to realize that these sectors are man-made entities; not divine dictates. What god gave us are our lives not the tribes that we live in - that was our choice or making. It is our management gurus that have divided our world, and isolated our working environment -- separated ourselves for our political motives (or sometimes in the name of managerial efficiency) and ensconced in the comfort of that awareness or ignorance as the case may be, have taken this to be the reality of the universe. Yes, ignorance is bliss indeed; until reality strikes us, as when thronged and chaotic roads maim us, or contaminated vegetables poison or kill us.

The fumes from our motor vehicles and our factories are what give us the air pollution we have to breathe.  And it’s the resulting effects that we feel in our chest, our eyes, and fill our hospital emergency rooms. Similarly how many of us are aware of the chemicals used in agriculture and their grave danger to human health? The lure of big business distracts us from using the safer manure we can make ourselves from the waste nature leaves with us. Consequently, many agriculture workers are poisoned in their workplace, and we too as the recipients of the final product are exposed in varying degrees to the pesticide residues on our nice looking fruits and vegetables. This is the link of health with the other players in our development process. In these two cases, getting healthy means others having to play their part in reducing the use of pesticides, or growing more nutritious crops nationally, or regularly buckling-up when driving our cars, using unleaded gasoline, reducing the numbers of motor vehicles, or our traffic police doing a better beat. With such awareness comes the realization for undertaking collective action.

So we can now see that our health care costs are in fact the responsibilities of our development sectors as a collectivity. Our energy, environment, trade, education, social, sectors are all partners in this endeavor. Conferences such as that at Rio then and now and the many global UN sponsored conferences of the decades since then have had the same refrain of needing people of the world to be working together. However, the challenge really is at the national levels – to get political decision makers, the big business and civil society to work together. Unfortunately, it is in these details that we find the devil that stymies us. With collective thinking we can overcome. 

For Maldives, and our health sector, this realization needs to be instilled in our atoll leaders – the counselors – who must now take the reigns of leading health development in our decentralized system. The ministry of health cannot wait for making this happen. It is imperative that training and awareness be brought to bear on them so that we can maintain the gains the health sector has reaped over these past 5 decades or so.


Mohamed Saeed said...

So many conferences like Rio. Lots of inputs but hardly very little impact. One good example is UN MDG's . Year 2015 is at our door step and where are we now today? Decentralization of health services is only a name. Only recently, MOH announce they will have all health workers under CCHDC. I think we have a centralized health system! We are facing the “Triple Threat” like malnutrition, food insecurity and weakened institutional capacity. Each of these problems alone poses a major obstacle to implement a good heath system- saeed

Abdul Sattar Yoosuf said...

The big international conferences (albeit the expenses) is a way to keep global issues in the limelight. Otherwise these tend to die in people's and nations' minds. You are right to say we need more real action at the national level on the real health issues we face. And with issues becoming seemingly more interconnected, the challenge to get more stakeholders together is another competing consideration of program management in particular and of health governance in general.