Health Promotion International, Vol. 30 No. 1 doi:10.1093/heapro/dau115

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EDITORIAL

Health promotion research in the United Nations’ Post-2015 agenda

UN POLICY LEADERSHIP UN policy initiatives are interesting to examine through the lens of health promotion: how are contextual factors affecting implementation, what participation is invited in its development, are they empowering processes and so on. The first such large-scale global health promotion policy was Health for All by the Year 2000.

Health for All was an initiative that 134 health ministers agreed to in 1978 for the provision of universal primary care. A literature review examining the obstacles faced highlighted the impact of the introduction of austere economic policies (structural adjustments), the misinterpretation of the meaning of ‘Primary Health Care’ and the transition from the conception of horizontal community-driven health work to vertical programs implemented by ‘experts’ (Corbin, 2005). Similar work has examined the Millennium Development Goals (MGDs). Fehling et al. (Fehling et al., 2013) noted the failure to incorporate existing development objectives, and objections that the MDGs were ‘unachievable and simplistic’, and could not be adapted to the needs of national contexts. Fehling et al. (Fehling et al., 2013) also noted the omission in naming accountable actors, the reinforcement of the implementation of vertical interventions and a lack of stakeholder involvement in their development (especially from low- and middle-income countries). While it is important to go back and examine these initiatives with a critical eye to learn from our mistakes and develop better global policy, it is also crucial to acknowledge the important role of the UN agencies in global health, development and environmental work at this moment in time. The UN system is still the only body which has the capacity, authority and accountability required to engage in large-scale, consultative, international goal-setting processes. Indeed, so much global health and development work is initiated and funded by private foundations which have no obligation or accountability to anyone save a small governing board (Stuckler et al., 2011). With the post-2015 agenda, the UN is expanding its efforts to make the processes more accessible and inclusive than it has been before. 1

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The health promotion community has an important role to play in the development and implementation of global development goals. This issue of our Journal shows how we align our efforts with global relevance and a broad vision of health promotion research and action. The 65th Annual United Nations Department of Public Information/Nongovernmental Organization (DPI/NGO) conference took place at the UN headquarters in New York from 27 to 29 August 2014. The title this year—‘2015 and Beyond: Our Action Agenda’—reflected its goal of examining ‘The role of civil society in the post-2015 development agenda’ (UN DPI/NGO, 2014a). Over 4000 NGOs participated in person at the conference, with even more following sessions online (UN DPI/NGO, 2014b). The conference brought together diverse interest groups in sessions discussing poverty eradication, inequity, sustainable development, human rights, climate change and a range of other topics. The content of the conference was timely, but the process of participant engagement was equally of note. Twice-daily roundtable sessions were held where the Declaration Drafting Committee would take, entertain and discuss additions and deletions to the Conference Declaration, which would be the official recommendation of the conference participants on the Post-2015 agenda.

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EFFORTS TOWARD PARTICIPATORY GLOBAL POLICY DEVELOPMENT

At the time of this writing, the OWG has proposed 17 SDGs.

Goal 1 Goal 2 Goal 3 Goal 4 Goal 5 Goal 6 Goal 7 Goal 8 Goal 9 Goal 10 Goal 11 Goal 12 Goal 13 Goal 14 Goal 15

Goal 16

Goal 17

End poverty in all its forms everywhere End hunger, achieve food security and improved nutrition and promote sustainable agriculture Ensure healthy lives and promote well-being for all at all ages Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all Achieve gender equality and empower all women and girls Ensure availability and sustainable management of water and sanitation for all Ensure access to affordable, reliable, sustainable and modern energy for all Promote sustained, inclusive and sustainable economic growth, full and productive employment and decent work for all Build resilient infrastructure, promote inclusive and sustainable industrialization and foster innovation Reduce inequality within and among countries Make cities and human settlements inclusive, safe, resilient and sustainable Ensure sustainable consumption and production patterns Take urgent action to combat climate change and its impacts Conserve and sustainably use the oceans, seas and marine resources for sustainable development Protect, restore and promote sustainable use of terrestrial ecosystems, sustainably manage forests, combat desertification, and halt and reverse land degradation and halt biodiversity loss Promote peaceful and inclusive societies for sustainable development, provide access to justice for all and build effective, accountable and inclusive institutions at all levels Strengthen the means of implementation and revitalize the global partnership for sustainable development

FROM A CONSULTATIVE PROCESS TO GENERAL ASSEMBLY ADOPTION: POLITICAL CONCERN At the conference there were murmurs of concern that while the consultative process was a step in the right direction, the diverse interests and perspectives of the ‘people’ might not

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At the UN Conference on Sustainable Development (Rio + 20) members committed to an ‘inclusive and transparent intergovernmental process open to all stakeholders, with a view to developing global sustainable development goals to be agreed by the General Assembly’ (Sustainable development goals, 2013). Thus, unlike the MGDs, the Sustainable Development Goals (SDGs) are being developed through a large-scale, multi-year consultative process—with the UN system mobilizing its vast capacity and resources to draw together multiple perspectives, experiences and expertise. This consultative process, begun in 2013, has involved creating a 30-member Open Working Group (OWG), support for the involvement of the Group of Least Developed Countries, meetings with experts in science, technology, measurement and sustainable financing. It has also spurred the creation of the Sustainable Development Solutions Network (SDSN), an independent network of research institutes, universities and technical centers that work with stakeholders in business, NGOs, UN agencies and other international bodies (United Nations Development Group, 2012). The UN Development Group (UNDP) also engaged in a large-scale effort to solicit input from people through its World We Want website and outreach work which culminated in its report entitled ‘A Million Voices. The World We Want. A Sustainable Future with Dignity for All’ (United Nations Development Group, 2013). The aforementioned DPI/NGO event in August was another opportunity for civil society to provide input into the development of the post-2015 SDGs before they go into the final stage of adoption by member state representatives in the UN General Assembly. Similar to the development of the health promotion declarations, statements and charters at the World Health Organization meetings, a declaration committee convened twice per day roundtable sessions to take suggestions and work overnight to incorporate changes from participant input and produce a new draft for discussion the following morning in the next roundtable session.

THE PROPOSED SDGS

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COMPLEXITY, SUSTAINABLE DEVELOPMENT AND HEALTH PROMOTION RESEARCH As health promoters, we should view ourselves centrally in these conversations. The 17 goals listed above are health promotion goals. They address the political, commercial, social and environmental determinants of health (Kickbusch, 2012). Health promotion research and theory can contribute much to addressing them. Taking the current issue of this Journal as a convenient sample, one sees how Health Promotion International is already addressing the diverse, complex topics. A quick glance at the abstracts of these 18 articles, we immediately see at least 11 of the 17 SDGs addressed in this issue.

• Goal 3, ‘Ensure healthy lives and promote well-being for all at all ages’ would of course be addressed in a general sense by all our articles. What is interesting is that in the 18 papers in this issue, only five of them have Goal 3 as the exclusive SDG addressed. • Goal 2, on food security and improved nutrition is addressed by Barr et al. (Barr et al., 2014), Mandiwana et al. (Mandiwana et al., 2014) and Power et al. (Power et al., 2014). • Goal 4, on education and lifelong learning is addressed by Deasy et al. (Deasy et al., 2014), Mandiwana et al. (Mandiwana et al., 2014) and Vranes et al. (Vranes et al., 2014). • Goal 5 on gender equality is taken up by Pederson et al. (Pederson et al., 2014). • Goal 6, on water and sanitation, is addressed by Sigler, Mahmoudi and Graham in their examination of community-led programs. • Goal 8, on full and productive employment, is explored by the worksite-based research papers (Lawton et al., 2014; Milner et al., 2014). • Goal 10, on reducing inequality, is ubiquitous in health promotion work and addressed by multiple articles. • Goal 11, on making human settlements inclusive, safe and sustainable, is addressed in a unique way in the article on Indoor Nature Exposure (McSweeney et al., 2014). • The article on using automated cameras to capture exposure to food marketing to children examines the intersection of Goals 2 (food), 3 (health) and 12 (sustainable consumption) (Barr et al., 2014). • Goal 16 on creating peaceful and inclusive societies with justice for all is the focus of Doron et al.’s article on human rights within the healthcare system in Serbia. • Lastly, Goal 17 on strengthening global partnerships for sustainable development is examined by Gibbs et al. (Gibbs et al., 2014) as they explore the obstacles to sustainability in local–global partnerships for HIV in South Africa. The multiple goals suggested so far reflect the participatory process the UN strived to achieve. As far has health promotion is concerned, we should take note that our values seem reflected in the UN’s process. Truly inclusive work embraces multiple perspectives and multiple

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withstand the General Assembly agreement process. These concerns were mainly voiced in the twice-daily roundtable discussions. During these sessions, participants expressed concern that while the currently proposed SDGs are expansive and inclusive, they might be whittled down to a handful of more narrow goals. [Jeffery Sachs attributes some of the MGDs staying power to the simplicity of the eight goals that ‘fitted well on one poster!’ (Sachs, 2012).] The skepticism voiced during the session was that Member States would hide their own policy agendas behind the argument that so many goals might undermine focus. During a session on indigenous communities, concern was expressed that earlier drafts of the SDGs included several references to ‘indigenous communities’ but that the current form, as quoted above, makes no direct mention. During one of the last of these sessions, a woman from Francophone Africa stood and noted that no translation was provided during the conference for non-English speaking participants and questioned how the event could be considered an inclusive process when there was this clear exclusion of some attendees. Such issues have not been quantified objectively and I just selected anecdotes of people during the event. They reflect, however, the general mood—people appreciated a real opportunity to make an impact, to truly shape the future but some voiced leeriness of the authenticity of the process.

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missions. The number of goals is likely a sign of success in this regard. These goals reflect the complexity of modernity. As health promotion researchers, we live in this complexity. We develop theoretical frames and methodologies to understand it, work within it, evaluate it and transform it. We understand the importance of complexity. We also accept its inevitability. This awareness puts health promotion at the cutting edge of the global sustainable development work. This Journal is proud to play a support role to the process and continues to commit to it.

REFERENCES Barr, M., Signal, L., Jenkin, G. and Smith, M. (2015) Capturing exposures: using automated cameras to document environmental determinants of obesity. Health Promotion International, 30, 56–63. Corbin, J. H. (2005) Health for All by the year 2000: a retrospective look at the ambitious public health initiative. Promotion & Education, 12, 77–81. Deasy, C., Coughlan, B., Pironom, J., Jourdan, D. and Mcnamara, P. M. (2015) Psychological distress and lifestyle of students: implications for health promotion. Health Promotion International, 30, 77–87. Fehling, M., Nelson, B. D. and Venkatapuram, S. (2013) Limitations of the Millennium Development Goals: a literature review. Global Public Health, 8, 1109–1122. Gibbs, A., Campbell, C. and Maimane, S. (2015) Can local communities “sustain” HIV/AIDS programmes? A South African example. Health Promotion International, 30, 114–125. Kickbusch, I. (2012) Addressing the interface of the political and commercial determinants of health. Health Promotion International, 27, 427–428. Lawton, R., Mceachan, R., Jackson, C., West, R. and Conner, M. (2015) Intervention fidelity and effectiveness of a UK worksite physical activity intervention funded by the Bupa Foundation, UK. Health Promotion International, 30, 38–49.

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J. Hope Corbin, Associate Editor [email protected]

Mandiwana, T. C., Mbhenyane, X. G., Mushaphi, L. F. and Mabapa, N. S. (2015) Knowledge and practices of pre-school teachers on growth monitoring program— South Africa. Health Promotion International, 30, 50–55. McSweeney, J., Rainham, D., Johnson, S. A., Sherry, S. B. and Singleton, J. (2015) Indoor nature exposure (INE): a healthpromotion framework. Health Promotion International, 30, 126–139. Milner, A., Page, K., Spencer-Thomas, S. and Lamotagne, A. D. (2015) Workplace suicide prevention: a systematic review of published and unpublished activities. Health Promotion International, 30, 29–37. Pederson, A., Greaves, L. and Poole, N. (2015) Gender-transformative health promotion for women: a framework for action. Health Promotion International, 30, 140–150. Power, E. M., Little, M. H. and Collins, P. A. (2015) Should Canadian health promoters support a food stamp-style program to address food insecurity? Health Promotion International, 30, 184–193. Sachs, J. D. (2012) From millennium development goals to sustainable development goals. The Lancet, 379, 2206– 2211. Stuckler, D., Basu, S. and McKee, M. (2011) Global health philanthropy and institutional relationships: how should conflicts of interest be addressed? PLoS Med, 8, e1001020. Sustainable development goals. (2013) Sustainable development knowledge platform. http://sustainabledevelopment. un.org/?menu=1300 (last accessed 1 December 2014). UN DPI/NGO. (2014a) Conference 2014 | NGO Relations. http://outreach.un.org/ngorelations/conference-2014/ (last accessed 1 December 2014). UN DPI/NGO. (2014b) Event: 65th Annual UN DPI/NGO Conference - Sustainable Development Policy & Practice. http://sd.iisd.org/events/65th-annual-un-dpingo-conference/ (last accessed 1 December 2014). United Nations Development Group. (2012). Post 2015 process. Sustainable development knowledge platform. http://sustainabledevelopment.un.org/index.php?menu=1561 (last accessed 2 December 2014). United Nations Development Group. (2013) A Million Voices: The World We Want. A Sustainable Future with Dignity for All. Vranes, A. J., Mikanovic, V. B., Vukovic, D., Djikanovic, B. and Babic, M. (2015) Education on human rights and healthcare: evidence from Serbia. Health Promotion International, 30, 101–105.

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