UNDP: Use HIV lessons to fend off new health threats
30 January, Bangkok – Many of the policies and approaches used to reduce new HIV infections in Asia and the Pacific could be effective in stemming the growing threat of diseases like cancer, heart disease, diabetes and other emerging development issues, says a new UN Development Programme (UNDP) report.
HIV responses – ones that moved away from largely biomedical responses, and towards multi-sectoral responses that addressed governance issues like law reform, access to justice, and human rights – led to one of the greatest achievements of Millennium Development Goals (MDGs) in the Asia-Pacific region, according to the report.
The number of new HIV infections declined by 20 percent on average over the last decade in the region, and by more than 50 percent in five countries – India, Myanmar, Nepal, Papua New Guinea and Thailand – that account for substantial numbers of people living with HIV.
A Post-2015 Development Agenda: Lessons from Governance of HIV Responses in Asia and the Pacific describes examples of new governance approaches to health issues. “The HIV response in the Asia-Pacific region has successfully integrated key democratic governance principles into what had previously been a traditional health sector-focused response”, says Haoliang Xu, UNDP Director for the Regional Bureau for Asia and the Pacific.
Non-communicable diseases are now the leading cause of death in the Asia-Pacific region. Recent data indicates that diseases like cancer, diabetes and heart disease have been the top killers in South-East Asia, causing nearly 7.9 million deaths. That number is expected to increase by 21 percent over the next decade.
“The effective approaches to HIV in Asia and the Pacific have illustrated that a focus on law and human rights, and attention to the needs of marginalized people, can support the achievement of human development objectives,” says Clifton Cortez, UNDP’s HIV, Health and Development Team Leader in Bangkok. “We think the same lessons can be applied to reducing the threat posed by chronic non-communicable diseases that will have catastrophic human and financial impacts in this region,” he says.
The report examines key factors of success in addressing HIV through a democratic governance perspective. “At least 14 countries in the region have taken positive legal and policy reform decisions in the context of HIV, including decriminalization of same-sex relationships, removal of HIV-related travel restrictions, and use of trade-related intellectual property measures to increase access to affordable life-saving HIV medicines,” according to the publication.
It asserts that effective HIV responses have been characterized by the following elements of democratic governance:
• Political leadership has provided the foundation for success of national HIV responses and is key to health and development efforts that promote the needs and rights of marginalized people and bring together different sectors.
• Decentralization combined with local democracy improved the responsiveness of policies and programmes, provided that there was local leadership and political will, and that local authorities had sufficient resources and autonomy to meet their responsibilities.
• Focus on laws, access to justice and law enforcement practices has been essential for HIV programmes that seek to reach marginalized people. Legal empowerment has focused on populations that are highly stigmatized and whose conduct is often criminalized.
• Equitable trade policies – A key lesson from HIV has been that health and development objectives must not be given lesser priority than trade objectives when countries are defining national policy on issues such as pharmaceutical patents. “Free trade agreements should not impede the ability of countries to apply laws and policies … that best suit their development needs”, says the report.
• Participation – HIV responses have included strong civil society leadership, including the central role of people living with HIV in activism, advocacy, awareness, policy setting, programme design, and monitoring and evaluation.
• Partnerships between governments and private sector companies can help to ensure corporate social responsibility programmes align with national health and development aims.
The response to non-communicable diseases can benefit immensely from addressing these same elements of governance, including the role of political, business and civil society leadership. Effective responses to prevent and control these health challenges also need to engage the legal, trade and education sectors in coordinated efforts, according to the report.
The report stresses that democratic governance lessons should also be applied to priority development issues, as the 2015 MDG deadline approaches and a new development agenda takes shape. Contemporary challenges include environmental degradation, gender-based violence, lack of universal health coverage and some of the adverse effects of unprecedented urban growth in Asia. Democratic governance principles can have enormous impact on a wide range of health and development aims.