521352
editorial2014
PED0010.1177/1757975914521352I. KickbuschEditorial
Preface Governance for health, wellbeing and sustainability – what is at stake Ilona Kickbusch1 Health is about political choices. Not just choices about health systems, but in a much more fundamental way about how we want to live. This implies contested visions of what is considered a good society and a good life and what we would deem to be good governance for health. In a global world it becomes more difficult to define what constitutes the common good and even more difficult to resolve collective action problems which no longer stop at national borders. The debate on what should follow on from the Millennium Development Goals (MDGs) reflects this in its title slogan: The world we want. The Report of the Highlevel Panel of Eminent Persons on the Post-2015 Development Agenda has called for five transformative shifts, all of which require political choices by governments to act not only nationally but towards a global agenda: •• Leave no one behind; •• Put sustainable development at the core; •• Transform economies for jobs and inclusive growth; •• Build peace and effective, open and accountable public institutions; and •• Forge a new global partnership. Each of these shifts – and particularly their interface – would contribute significantly to the health and wellbeing of populations. Indeed, the global health community has staked three claims so that in health no one is left behind: introduce universal health coverage, tackle noncommunicable diseases (NCDs) and address the challenges remaining from the MDG agenda: women’s and children’s health as well as a priority group of infectious and neglected diseases. In consequence the public health debate has become more global, social and political and there are many more actors who have a stake in its success or failure
than before. I would add the threat of antimicrobial resistance and the interface of climate change and health to the challenges we face. The 21st century action areas of public health – and health promotion – also find their expression in a new language. In 1986, the Ottawa Charter set the course for the new public health by introducing terms like healthy public policy, supportive environments and settings for health – today we are concerned with whole of government and whole of society approaches, complex systems, health in all policies, sustainable production and consumption, global public goods, multi-stakeholder governance, health co-benefits – to name but a few. They express the enormous strategic shift under way. The dynamics of health in the late 20th century found their expression in addressing the HIV/AIDS epidemic and the tobacco epidemic with new mind frames, policies and strategies, all based on a strong political and social movement forcing governments, international organizations and the private sector to act, creating new global agreements, new financing mechanisms and new institutions. The new 21st century dynamics of health find their paradigmatic expression in the global obesity epidemic. It reflects the global drivers and flows of ways of life, ideas and products and the global nature of the response. Issues such as these can no longer be resolved by business as usual; they require a similar strategic breakthrough as with HIV/AIDS or tobacco. No longer is it sufficient to focus on a lack of technical capacity (i.e., do it better) to address noncommunicable diseases – rather it will require facing the political matrix of power, interests, institutions which reinforce unsustainable production and consumption patterns, unsustainable lifestyles and inequalities. Public health action at this point will require a mind shift towards a new political and social movement for health which addresses the social, commercial and political determinants of health.
1. Global Health Programme, Graduate Institute of International and Development Studies, Geneva, Switzerland. Email: [email protected] Global Health Promotion 1757-9759; 2014; Vol 21 Supp. 1: 83; 521352 Copyright © The Author(s) 2014, Reprints and permissions: http://www.sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1757975914521352 http://ghp.sagepub.com Downloaded from ped.sagepub.com at FU BerlinLateinamerikanisches on May 11, 2015
editorial2014
PED0010.1177/1757975914521352I. KickbuschEditorial
Preface Governance for health, wellbeing and sustainability – what is at stake Ilona Kickbusch1 Health is about political choices. Not just choices about health systems, but in a much more fundamental way about how we want to live. This implies contested visions of what is considered a good society and a good life and what we would deem to be good governance for health. In a global world it becomes more difficult to define what constitutes the common good and even more difficult to resolve collective action problems which no longer stop at national borders. The debate on what should follow on from the Millennium Development Goals (MDGs) reflects this in its title slogan: The world we want. The Report of the Highlevel Panel of Eminent Persons on the Post-2015 Development Agenda has called for five transformative shifts, all of which require political choices by governments to act not only nationally but towards a global agenda: •• Leave no one behind; •• Put sustainable development at the core; •• Transform economies for jobs and inclusive growth; •• Build peace and effective, open and accountable public institutions; and •• Forge a new global partnership. Each of these shifts – and particularly their interface – would contribute significantly to the health and wellbeing of populations. Indeed, the global health community has staked three claims so that in health no one is left behind: introduce universal health coverage, tackle noncommunicable diseases (NCDs) and address the challenges remaining from the MDG agenda: women’s and children’s health as well as a priority group of infectious and neglected diseases. In consequence the public health debate has become more global, social and political and there are many more actors who have a stake in its success or failure
than before. I would add the threat of antimicrobial resistance and the interface of climate change and health to the challenges we face. The 21st century action areas of public health – and health promotion – also find their expression in a new language. In 1986, the Ottawa Charter set the course for the new public health by introducing terms like healthy public policy, supportive environments and settings for health – today we are concerned with whole of government and whole of society approaches, complex systems, health in all policies, sustainable production and consumption, global public goods, multi-stakeholder governance, health co-benefits – to name but a few. They express the enormous strategic shift under way. The dynamics of health in the late 20th century found their expression in addressing the HIV/AIDS epidemic and the tobacco epidemic with new mind frames, policies and strategies, all based on a strong political and social movement forcing governments, international organizations and the private sector to act, creating new global agreements, new financing mechanisms and new institutions. The new 21st century dynamics of health find their paradigmatic expression in the global obesity epidemic. It reflects the global drivers and flows of ways of life, ideas and products and the global nature of the response. Issues such as these can no longer be resolved by business as usual; they require a similar strategic breakthrough as with HIV/AIDS or tobacco. No longer is it sufficient to focus on a lack of technical capacity (i.e., do it better) to address noncommunicable diseases – rather it will require facing the political matrix of power, interests, institutions which reinforce unsustainable production and consumption patterns, unsustainable lifestyles and inequalities. Public health action at this point will require a mind shift towards a new political and social movement for health which addresses the social, commercial and political determinants of health.
1. Global Health Programme, Graduate Institute of International and Development Studies, Geneva, Switzerland. Email: [email protected] Global Health Promotion 1757-9759; 2014; Vol 21 Supp. 1: 83; 521352 Copyright © The Author(s) 2014, Reprints and permissions: http://www.sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1757975914521352 http://ghp.sagepub.com Downloaded from ped.sagepub.com at FU BerlinLateinamerikanisches on May 11, 2015
