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Professional Humanitarian Development
THE HEALTH TRANSITION - Considerations for Developing Countries and Humanitarian Operations
The health transition is a pressing reality across the globe. Health needs are shifting at a fast pace worldwide. As a result, many developing countries as well as coordinators and managers of humanitarian operations need to plan for the future by considering shifting health trends. Should the implications of the health transition be neglected, the residual effects on countries may be profound.
What are these shifting health trends?
Until recently, communicable diseases (for example, malaria, tuberculosis, HIV and AIDS) have been a central focus for health policy decisions in developing countries. Of late however, developing countries are experiencing a transition; chronic diseases such as heart disease, obesity, diabetes, cancer, and stroke are also emerging as a serious and prevalent concerns for health officials. Today, 80 percent of chronic diseases occur in low and middle income countries. 1 Consequently, these countries are being affected by both extremes; they have unfinished agendas in relation to communicable diseases and are also enduring a quick rise in chronic diseases. Although countries transition at different speeds, such transitions have a dramatic and detrimental impact on the burden of disease.
The presentation of non-communicable diseases as well as communicable diseases in a developing country is vitally important.
The health transition embodies both a demographic and epidemiological change. 3 As countries modernise, they undergo urbanisation, industrialisation, developments in scientific medicine, escalation of income and expansion of education; a demographic evolution occurs. 4 This evolution is associated with increases in life expectancy and thus increases in elderly populations, coupled with decreasing child mortality. Malawi illustrates this demographic transition when it experienced a decline in its childhood mortality as it experienced greater economic development. In 1960 the child mortality rate was over 350 deaths per 1,000 live births, whilst in 2005 this rate had dropped to approximately 120 deaths per 1,000 live births. 5
To fully comprehend the demographic transition, the epidemiological transition must also be considered. The epidemiological transition has resulted in decreases in child mortality, especially in children under the age of five. This can be attributed to, in part, improvements in public health and social conditions, but specifically the initiation of scientific medicine. The ability to control infectious diseases in childhood has had a dramatic effect on the epidemiological transition. Reductions in malnutrition and communicable diseases, means that fewer babies die from preventable illnesses.
Children under five are not the only age group experiencing this epidemiological change. It is predicted by the World Bank that by 2020, the global pattern of disease will dramatically shift. The aging population of low to middle income countries will be affected by non-communicable diseases more than communicable diseases. Such non-communicable diseases include cardiovascular disease, depression and vehicle accidents. Changes in lifestyle are strongly associated with the increasing prevalence of non-communicable diseases. 6 Diet, nutrition and tobacco impact cardiovascular disease, cancer, diabetes, oral health and osteoporosis.
Both non-communicable and chronic diseases are a global reality. It is also a reality for aging populations in developing countries as these non-communicable diseases are now more likely to be the primary cause of illness than ever before. In 2005, India experienced over 400 deaths for every 1,000 worldwide cardiovascular disease related deaths and approximately 80 deaths per 1,000 that were caused by TB, malaria HIV and AIDS combined. 7
The transition is explicitly visible on population age distribution pyramids. Pyramids are shifting from being triangular in shape (having a heavy base and narrowing body) to a distribution with a heavy base and almost rectangular shaped body. This illustrates that there is almost an equal percentage of the population in each age bracket.
Ultimately, developing countries are presented with a double burden; dealing with existing infectious diseases and inadequate health services coupled with the evolving burden of non-communicable diseases. Humanitarians must consider the impacts of these shifting health trends in their development programs and education campaigns and work with governments to help minimise both of these challenges.
REFERENCES
1 Miranda JJ, Kinra S, Casas J.P, Davey Smith G, Ebrahim S. Non-communicable diseases in low- and middle-income countries: context, determinants and health policy. Tropical Medicine and International Health. 2008; 13 (10):1225-1234.
2 World Health Organisation. Chronic Diseases in Low and Middle Income Countries. Facing the Facts. [cited 2009 May 18] from www.who.int/chp .
3 Merson M, Black R, Mills A. International Public Health: Diseases, Programs, Systems and Policies: Second Edition. Jones and Bartlett Publisher, Inc. 2006: 6-7.
4 Jamison D, Breman J, Meashan A, Alleyne G, Claeson M, Evans D, et al. Disease Control Priorities in Developing Countries, Second Edition. Oxford University Press and The World Bank. 2006.
5 World Health Organisation. World Health Statistics. 2007.
6 Pekka P, Pirjo P, Ulla U. Part III: Can we turn back the clock or modify the adverse dynamics? Program and policy issues. Influencing public nutrition for non-communicable disease prevention: from community intervention to national programme-experiences from Finland . Public Health Nutrition. 2002; 5(1A): 245-251.
7 World Health Organisation. Overview: Beyond Misunderstanding: A vision for the future. 2005.
Emma Sturrock
UN to establish single new agency to deal with rights of women
Four United Nations agencies and offices will be amalgamated to create a new single entity within the Organization to promote the rights and well-being of women worldwide and to work towards gender equality.
The General Assembly adopted a resolution on the 15 th of September on improving system-wide coherence within the UN, and the text spells out the support of Member States for a new consolidated body – to be headed by an under-secretary-general – to deal with issues concerning women.
The resolution means the UN Development Fund for Women ( UNIFEM ), the Division for the Advancement of Women, the Office of the Special Adviser on Gender Issues and the UN International Research and Training Institute for the Advancement of Women ( UN-INSTRAW ) will be merged.
In a statement issued today by his spokesperson, Secretary-General Ban Ki-moon said he was “particularly gratified” that the Assembly had accepted his proposal for “a more robust promotion” of women's rights under the new entity.
“An important step has been made in strengthening the United Nations' work in the area of gender equality and empowerment of women, as well as in ensuring the effective delivery of its operational activities for development, which constitutes the other key components of the resolution,” the statement noted.
Mr. Ban said in the statement that he had appointed more women to senior posts than at any other time in the history of the UN, including nine women to the rank of under-secretary-general. The number of women in senior posts has increased by 40 per cent under his tenure.
The Assembly's resolution tasks Mr. Ban with providing Member States with a comprehensive proposal outlining the mission statement, structure, funding and oversight of the new entity so that it can be created as soon as possible.
The resolution also calls for greater measures to harmonize business practices within the UN development system, ways to improve the funding system for such activities, and other steps to streamline practices within the world body.
After the resolution, UNIFEM – which currently operates in autonomous association with the UN Development Programme ( UNDP ) – issued a statement welcoming “the unanimous strong support” among Member States, which follow three years of extensive consultations on the structure and operational details of the new body.
“UNIFEM trusts that deliberations can resume soon to ensure an informed and swift establishment of the composite entity,” the statement said.
A Human Rights based approach to Aid and Development
What are human rights?
There is no universally agreed definition for human rights. The basic notion of human rights lies in people's recognition of the need to protect and affirm every other person's individual dignity.
The concept of human rights is not new – identifying and protecting important rights and freedoms has been part of all societies throughout history and is central to the world's major religions. The understanding of human rights continues to evolve today.
Where are human rights found?
Human rights can be found in laws, such as in national constitutions, domestic laws, regional laws or International Law.
Sometimes the phrase ‘human rights' is used to refer to binding international human rights laws. International human rights laws differ from the general concept of human rights because they concern the express human rights that have been universally agreed to by member states at the United Nations in treaties. (See the ‘International law and human rights' information sheet for more information).
Some domestic laws also refer to human rights and are usually based on the rights found in human rights treaties. In 2009, the Australian government is consulting on whether it will develop an Australian Human Rights Act.
Human rights are not only found in specific laws; the phrase ‘human rights' is often used in a general sense to refer to human dignity. Therefore, people also use the general concept of human rights to add weight to their argument that they have are have suffered an abuse of their inherent dignity as a person or that they are entitled to particular treatment. For example, some groups claim free public transport is a right but there is no specific human rights law that deals with this issue.
What is the link between human rights and development?
Human rights and human development share a common purpose – to secure the freedom, wellbeing and dignity of all people everywhere.
Human rights add value to the development agenda because states can be held to account to human rights laws – especially those to which they have agreed to be legally bound.
Human rights also provide a common language and framework within which development agencies can explain the diversity of their work from programs to advocacy.
What is the 'human rights based approach' to development?
A human rights based approach to development refers to a framework for human development that is normatively based on international human rights laws and operationally directed to promoting and protecting human rights.
Therefore, a human rights based approach is:
- normative: in that it provides a vision of what development strives to achieve – freedom, well-being and dignity of all people everywhere;
- operational: in that it provides a set of tools for planning, implementing, monitoring and evaluating human development programs.
Sometimes a more general definition of a human rights based approach to development is used which refers to the protection and promotion of human dignity through the empowerment of aid beneficiaries.
Why is the human rights based approach to development important?
According to the United Nations Development Program, a human rights based approach enables better development outcomes by analysing and addressing the inequalities, discriminatory practices and unjust power relations which often obstruct human development.
A human rights based approach highlights the human rights entitlements of people and corresponding obligations of a state in development debate, and encourages empowerment and capacity building with local communities.
A human rights based approach also focuses on the most marginalised and disadvantaged in society as their human rights are most widely denied or left unfulfilled. Focusing on marginalised and disadvantaged persons should greatly improve human development for everyone.
What is the right to development?
The right to development is often confused with a human rights based approach to development but these are different concepts. The right to development is contained in a Declaration that was adopted by the United Nations General Assembly in 1986. A declaration is not legally binding in international law. (See the ‘International law and human rights' information sheet).
The United Nations Commission on Human Rights (now the Human Rights Council) established a Working Group on the Right to Development in 1998.
See OHCHR — Right to development .
Further information:
Gathering Pace - Human Security Debate at the General Assembly
On 22 May 2008, the General Assembly held an informal thematic debate on human security, honoring a commitment from the World Summit in 2005 to further discuss and define the notion of human security.
Human Security and how it relates to humanitarian operations.
The debate cemented a broad consensus on the need for a new culture of international relations that goes beyond fragmented responses and calls for coherent, integrated, and people-centered solutions. Member States recognized the added value of the human security concept in this regard and emphasized the concept's comprehensive approach in responding to old and new insecurities, ranging from persistent hunger and poverty to armed conflicts, environmental degradation, food insecurity and human trafficking. By focusing on the security of individuals and communities, human security acknowledges the inter-linkages between these threats and uses a multi-sectoral approach that brings together the three pillars of the United Nations system. As such, human security strengthens efforts to improve security, development and human rights and allows for earlier and better coordinated responses among Member States, international organizations, UN agencies, NGOs and civil societies.
A humane world where people can live in security and dignity, free from poverty and despair, is still a dream for many and should be enjoyed by all. In such a world, every individual would be guaranteed freedom from fear and freedom from want, with an equal opportunity to fully develop their human potential. Building human security is essential to achieving this goal.
In essence, human security means freedom from pervasive threats to people's rights, their safety or even their lives.
Human security has become both a new measure of global security and a new agenda for global action. Safety is the hallmark of freedom from fear, while well-being is the target of freedom from want. Human security and human development are thus two sides of the same coin, mutually reinforcing and leading to a conducive environment for each other.
The concept of the “Responsibility to Protect” in humanitarian interventions.
During the recent cyclone that devastated Myanmar there were calls by some members of the international community to intervene, by force if necessary, based on the concept of the “Responsibility to Protect” (R2P).
The core of R2P is that, sovereign states should retain the primary responsibility to protect their own people from mass atrocities. But if they manifestly fail to do so, through either incapacity or ill will, then it becomes the collective responsibility of the international community to take appropriate action. Sovereignty conveys no immunity when massive human rights violations are involved. The emphasis is on prevention and assistance for states in need. And any further response necessary stresses using the least coercive and intrusive effective means possible. Force might be needed, but only in extreme and exceptional cases, and with Security Council approval.
The R2P concept was proposed by a Canadian-sponsored international commission in 2001, and it took only four years for the principles to be adopted, without dissent, by the UN General Assembly.
Gareth Evans, former Australian foreign minister, who is president of the International Crisis Group and author of "The Responsibility to Protect: Ending Mass Atrocity Crimes Once and for All" has stated that:
“Three big challenges remain for like-minded governments and civil society organizations who understand and accept the power of the R2P norm:
First there is the conceptual one of ensuring that its scope and limits are fully understood, so that it is not seen as either too broad to be useful or too narrowly militarily focused to be acceptable. Second, there is the institutional one, of ensuring diplomatic, civilian, and military capacity is available to respond effectively to new situations. And last, there is the political one of ensuring that, when preventive or reactive action becomes necessary, the will is there to mobilize that capacity”.
The Regulation of Private Security Companies operating in the humanitarian sector.
On the 17 th of September 2008, experts representing 17 countries agreed on a new set of recommendations to enhance state control over private security companies and also reaffirm the obligations of states to ensure that these private contractors abide by international humanitarian law, according to a statement issued by the International Committee of the Red Cross (ICRC).
The “Montreux Document” was organized by the Swiss government under an initiative launched in 2006 and was presented by the ICRC who had been associated with the initiative since the beginning. According to the ICRC,
"The document clearly reaffirms the fact that military and security contractors dispatched to war zones must comply with international law, and that States have a particular responsibility for ensuring compliance,"
"It is now very important that states take concrete measures to prevent violations from occurring and to hold contractors to account for unlawful behavior"
The document, which is not legally binding, outlines for the first time ever detailed and practical measures to help states enhance compliance with international humanitarian law and ensure respect for human rights.
The measures are relevant when a state hires a private military/security company, when these companies are operating in its territory, or when a company is based in the territory of a state and provides military and security services abroad.
Should NGO's Engage with the Military in Humanitarian Operations?
Engaging military support for humanitarian operations is not a new endeavor. In today's security environment, however, the military are ever more involved in the ‘direct' provision of aid, while humanitarian actors are often faced with situations where there are no alternatives but to rely on the military, as a last resort, for safety and to access populations in need - at the serious risk of compromising their neutrality, impartiality, and/or independence, and thus their ability and/or credibility to operate.
“CIVIL-MILITARY GUIDELINES & REFERENCE FOR COMPLEX EMERGENCIES” is a collection of core humanitarian instruments developed by the United Nations (UN) and the Inter-Agency Standing Committee (IASC) on civil-military relationship in complex emergencies. Its goal is to help promote respect for international law, standards and principles in these situations.
The guidelines can be accessed at http://ochaonline.un.org/cmcs/guidelines.
How the IFRC Code of Conduct is relevant to NGO's in Disaster Relief
Often described as the “mother of all codes”, the Code of Conduct for The International Red Cross and Red Crescent Movement and NGOs in Disaster Relief, was developed and agreed upon by eight of the world's largest disaster response agencies in the summer of 1994 and is used to monitor and set standards for relief delivery and disaster response.
The Code is not about operational details, such as how one should calculate food rations or set up a refugee camp but rather, seeks to maintain the high standards of independence, effectiveness and impact to which disaster response NGOs and the International Red Cross and Red Crescent Movement aspires. It is a voluntary code, enforced by the will of organisation accepting it to maintain its standards.
AAI is a signatory to this Code and adheres to its principles in the delivery of relief. More information about the Code is available at www.ifrc.org/publicat/conduct/index.asp