Beef, the Climate, and Human Health: Changing our Wasteful Food and Land Use System

Today UCS is releasing a new report at the international climate negotiations in Warsaw, entitled “Climate-Friendly Land Use: Paths and Policies toward a Less Wasteful Planet.” The theme of the report is waste and inefficiency — how our current global pattern squanders resources, endangers human health, and damages our climate.

My three co-authors and I review evidence that there is enormous systemic waste in how we use land today. Important sectors of the food and agriculture system — in particular, beef — use enormous amounts of land, produce large amounts of global warming pollution, fritter away a substantial proportion of the cereals produced, and yet produce very little food for humans.

The report not only examines inefficiency in the beef sector but also in other forms of land use — palm oil, biofuels and natural forest management. In each case we show that policies today lead to great inefficiency, producing far less than the potential of less wasteful approaches. We not only criticize the current pattern (and projected future changes) but also show how there are positive alternatives. For example, not only plant-based foods but also other animal sources such as chicken, eggs, milk and pork, are also much better than beef from the land, climate, health and productivity points of view.

Ruminants, such as cattle and sheep, use large amounts of land and feed and emit methane, a potent source of global warming pollution.

Two important recent reviews, summarizing many different scientific studies, provide evidence sustaining this argument. Durk Nijdam and colleagues’ article on “The price of protein”, published last year in Food Policy, reviewed 52 different studies of the land needs and greenhouse gas emissions (GHGs) associated with different protein sources. Their data shows that beef production — even the most intensive systems — requires much more land and emits much more GHGs. “Meadow” and extensive systems were the most land-hungry and GHG-emitting. Beef was high not only in comparison with vegetarian foods, but also with other meats and with milk and eggs.

Another paper from last year, by Pete Smith and colleagues in Global Change Biology, makes the inefficiency of cattle and other ruminant animals clear, by tracing how much land and biomass is consumed and how much food is produced, by different parts of the global food system. (Full disclosure: I’m a co-author with Smith and other colleagues on a forthcoming paper in Nature Climate Change on this subject, although I wasn’t involved in the Global Change Biology review).

They found that ruminants use 28 hectares of land, on average, to produce a ton of food, versus just 1.4 hectares for “monogastric” animals such as chickens and pigs. Even if you ignore the ruminants’ pasture needs, and just look at the cropland used to produce their feed, they still require twice as much as chickens and pigs — 2.8 hectares per ton.

From a climate point of view, poultry and other kinds of animal protein are far preferable to beef.

In terms of biomass, ruminants consume a total of 6.22 billion tons annually, while the monogastrics consume only 0.79 billion tons. Yet the amount of food that results is almost the same — 0.14 billion tons of food (dry biomass) from ruminants, versus 0.12 from monogastrics.

Read the full report for more details — not only about the problems, but also our recommendations about what policies are needed to deal with them. It shows how we can make this world “a less wasteful planet.”

Posted in: Food and Agriculture, Global Warming Tags: agriculture, beef, climate-change, Global warming, land use

About the author: Doug Boucher is an expert in preserving tropical forests to curtail global warming emissions. He has been participating in United Nations international climate negotiations since 2007 and his expertise has helped shape U.S. and U.N. policies. He holds a Ph.D. in ecology and evolutionary biology from the University of Michigan. See Doug's full bio.

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Seven Takeaways for the Warsaw Climate Talks from the New IEA Report

There’s a distinct lack of optimism here at the Warsaw climate meeting. A recent report from UNEP shows that we are falling far short of the emissions reductions necessary to limit the global temperature increase to no more than 2°C above pre-industrial levels. The IPCC working group 1 report points out the grave implications of our rising carbon emissions. But, like the previous reports, IEA’s World Energy Outlook released today shows that, despite the grim emissions trends, we do still have choices: yes, we can cut our emissions sharply and, yes, that means making serious policy decisions now.

Here are seven important takeaways from the IEA report relevant for the climate negotiations:

What happens in the energy sector is crucial to our climate future. The sector is responsible for two-thirds of global warming emissions currently, and without significant policy action annual energy-related CO2 emissions will rise by 20% to 37.2 gigatonnes (Gt) by 2035, meaning that we would be headed for a long-term average temperature increase of 3.6 °C.Policy decisions that countries make right now can make a tremendous difference in how much more carbon we emit. This includes support for renewable energy and energy efficiency and removal of subsidies to fossil fuel producers.The energy sector is in tremendous flux globally with a lot of new capacity (mainly in China and India) and replacement capacity (mainly as old power plants are retired in the U.S. and Europe) being added. This creates an opportunity to make low carbon choices; taking full advantage of that opportunity is critical to meeting climate goals.Natural gas use will likely expand globally under a business as usual scenario. (But, as a recent UCS report points out, an overreliance on natural gas comes with significant climate risks.)The IEA says that under a business as usual scenario, renewable energy will grow significantly, from 20% of electricity generation in 2011 to 31% in 2035, approaching coal as a leading source of power. But this would still mean growing emissions from the power sector (an increase of between 13 to 15 Gt in that timeframe), leaving its share constant at about 40% of global emissions. NREL’s recent 80% by 2050 renewable energy report and the IPCC special report on renewable energy shows we can be much more aggressive in cost-effective renewables deployment both in the U.S. and globally.The power sector has several affordable low-carbon alternatives available already, including wind and solar energy, and electricity demand is growing rapidly. Therefore policies that encourage renewable electricity and energy efficiency are particularly vital to bending the emissions curve globally.Globally, nearly 1.3 billion people still lack access to electricity and 2.6 billion still depend on traditional biomass for energy (with grave health and pollution consequences). Global climate talks have to address this fundamental inequity, even as they negotiate a pathway to lower global emissions.

Here in the U.S. we have an incredible opportunity to make deep cuts in our power sector emissions. Uneconomic coal-fired power plants are being retired at record levels and renewable energy costs are declining sharply every year. There’s no doubt we can capitalize on this momentum through strong policies, including power plant carbon standards, renewable electricity standards and soon, one hopes, through a national price on carbon. Putting a strong target for emissions reductions on the table shouldn’t be a stretch for the U.S. And that would have a very significant effect on raising the level of ambition of a global climate agreement.

“Setting expectations” is a game everyone seems to play at the UNFCCC climate talks. No one wants to seem naïve about what’s possible here at Warsaw. After all, we are in the coal capital of Europe at a conference backed by fossil-heavy corporate sponsors. And bizarrely the Polish government has chosen to have the International Coal and Climate Summit simultaneously in Warsaw during the UNFCCC meeting. (Seriously, you couldn’t make this stuff up!)

But yesterday we all had a moment of heart-wrenching clarity. As Yeb Saño, the lead negotiator from the Philippines, so powerfully reminded us: “If not us, then who? If not now, then when? If not here in Warsaw, where?”

Posted in: Energy, Fossil Fuels, Global Warming Tags: IEA, IPCC, power plants, Renewable energy, UNEP, UNFCCC, Warsaw, World Energy Outlook

About the author: Rachel Cleetus is an expert on the design and economic evaluation of climate and energy policies, as well as the costs of climate change. She holds a Ph.D. in economics. See Rachel's full bio.

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Arizonans Stand Up for Solar Power

Blogged about a proposal that Arizona Public Service (APS) submitted to its regulator, the Arizona Corporation Commission (ACC), to dramatically reduce incentives to install solar panels on homes and businesses. On Wednesday more than 100 people descended on ACC to protest it. The event kicked off two days of hearings that will decide whether to maintain Arizona’s existing net metering policy, which allows solar customers to receive credit on their electricity bills for each kilowatt-hour of electricity generated by their solar panels.

Update (Nov. 15): Yesterday afternoon, the ACC voted 3-2 to maintain a solar net metering program, with a fee on rooftop solar customers of $0.70 per kilowatt (kW) installed. The fee will be imposed on new solar customers and is far less than that proposed by APS, which was in the $5.00 per kW range. The reduced fee is seen as a compromise, but it makes Arizona the first state to target rooftop solar customers with new fees.  Greentech Media reports that some in the solar industry believe this new charge is a slippery slope.

Photo: U.S. Department of Energy

A whopping 43 states plus the District of Columbia have adopted net metering policies, which has had a huge impact on the number of people going solar across the country.

In Arizona, the number of installed solar systems in APS’s service territory has increased from just 900 in 2009 to more than 18,000 today, and the ACC attributes much of this growth to the success of net metering.

A Republican pollster from Public Opinion Strategies named Glen Bolder recently surveyed 300 Arizonans, and found that 81 percent opposed APS’s proposal to reduce net metering incentives. Notably, 77 percent would be less likely to vote for a candidate who ends solar savings. While 300 people is just a small sample of the state’s population, those numbers are consistent with national polling showing Americans favor solar over all other energy types.

UCS supporters are among the thousands of Arizonans who have taken action to tell the ACC to protect solar. In October, ACC staff listened and recommended that the utility’s request be rejected so that the issue can be taken up during the next hearing on APS rates in 2015. The memorandum from ACC staff also emphasized that the benefits of solar, such as avoiding fossil fuel costs, are integral to the conversation, and concluded that the value of these benefits can best be determined in the context of a general rate case.

When all the relevant facts can be considered, APS deserves props for the progress it is making on solar, including the innovative Solona project that provides solar power even when the sun does not shine. But APS has admitted to funding groups behind ideological attacks on solar in Arizona, including a fact-check-failing ad attempting to deceive Arizonans about the cost of net metering to non-solar customers. Many of the groups siding with APS are known for their history of climate denial, including the Edison Electric Institute and 60 Plus Association. Just last year, 60 Plus urged members of Congress to “oppose confirmation of any adherent of ‘global warming’ to the EPA.”

Recent headlines have highlighted “unlikely” support for solar policies from conservatives. In Arizona, it is easy to see why this support is actually not at all surprising. One APS proposal “removes a basic choice from the customer,” according to ACC staff, while another “denies the residential customer the right to offset energy purchases from the utility with self-generation on a one-to-one basis.”

Still, the outcome of Arizona’s solar debate could have far reaching implications. APS recently rejoined the American Legislative Exchange Council (ALEC), the same fossil fuel-funded group behind this year’s failed attacks on state renewable energy standards. As ALEC looks to weigh in on net metering, signs point to state solar policies as the next target of fossil fuel funded think tanks and advocacy groups.

The final decision could be made as soon as today by ACC’s elected commissioners, which means you still have time to take action by clicking here. Tell the ACC to maintain Arizona’s successful solar incentives!

Posted in: Energy Tags: ACC, APS, arizona, net metering, PV, Renewable energy, solar power

About the author: Laura Wisland is a senior energy analyst and an expert on California renewable energy policies. She holds a master’s degree in public policy. See Laura's full bio.

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All Eyes on Hydrogen Fuel Cell Vehicles at the LA Auto Show

Hydrogen fuel cell electric vehicles will take center stage at this week’s LA Auto Show. Three companies — Toyota, Honda and Hyundai — will unveil prototypes of new hydrogen fuel cell electric vehicles and announce details of their rollout plans for 2014 and 2015. Fuel cell vehicles may not be as well-known as hybrids and plug-in electric vehicles, but they are a vital part of the solution to reduce pollution and oil use from transportation. These vehicles have been promised for some time, so it’s exciting to be on the cusp of having fuel cell vehicles in new car showrooms.

Filling up a hydrogen vehicle is similar to a gasoline vehicle in time and effort. (Credit Flickr user uonottingham)

Hydrogen fuel cells join the advantages of clean, efficient electric vehicles with the convenience of fast refueling. The fuel cell combines hydrogen gas stored in a tank with oxygen from the air to produce electricity and water. The electricity from the fuel cell then powers an electric motor, similar to today’s plug-in electric vehicles. And like battery electric vehicles, there is no smog-forming or climate-changing pollution from the vehicle’s tailpipe.

However, just as producing electricity to charge a plug-in vehicle creates emissions, hydrogen also generates emissions. Hydrogen made today from natural gas gives about the same total emissions per mile as charging a plug-in vehicle with electricity generated from natural gas. But hydrogen can also be made from renewable sources like biomass and solar power, so in the future hydrogen-powered vehicles can be much cleaner than gasoline-burning vehicles.

Another advantage of hydrogen fuel cell vehicles is that they can be refueled at a filling station in a short time.  This means that drivers who would rather not plug in a battery electric car can still use a clean electric motor to get around. The filling time is about the same as a gasoline vehicle, about 5-10 minutes for a 300-mile range.

Of course, to take advantage of a hydrogen car, the filling stations need to be available. California is building the first wave of hydrogen filling stations with 28 currently operational or under construction and 68 planned for use by 2016. Starting in the Los Angeles and San Francisco metro areas, these stations are designed to fuel the first 20,000 fuel cell vehicles.

Adding more range or power to a battery electric vehicle requires more battery cells, but adding cells increases costs. In fuel cell vehicles, the amount of energy stored can be increased without a proportional increase in cost because only a larger hydrogen tank onboard is required. The practical result is the ability to make an electric-drive SUV-style vehicle with the same cargo capacity and range as a gasoline version. In real-world tests in southern California, a fuel cell-powered Toyota Highlander SUV demonstrated a range of more than 400 miles range and the equivalent of 69 miles-per-gallon efficiency.

On an even larger scale, the Bay Area’s AC Transit runs clean hydrogen fuel cell buses by our Berkeley office many times a day. These buses have logged over 750,000 clean miles in the last 13 years, showing that fuel cells are a workable solution for electrifying large vehicles.

Battery electric, fuel cell electric, and more efficient gasoline vehicles have often been portrayed as competitors. However, this isn’t a winner-take-all situation because these technologies are complementary. Plug-in electrics can take advantage of the existing electric infrastructure and smaller electric cars can be especially efficient and cost-effective. Hydrogen fuel cells are a good option for larger vehicles, longer distance driving, and for drivers without a spot to recharge. And since many gasoline-powered vehicles will be sold in the coming years, more efficient conventional vehicles will also play a key role in transportation. All of these technologies are part of our strategy to cut projected oil use in half and tackle climate change. I’m excited that with the addition of hydrogen fuel cell vehicles, some car buyers will soon have more clean vehicles to choose from at the dealership.

Posted in: Vehicles Tags: electric car, fuel cell, fuel cell electric car, hydrogen

About the author: David Reichmuth is a senior engineer in the Clean Vehicles Program, focusing on oil savings and vehicle electrification. See Dave's full bio.

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CDC’s “Get Smart About Antibiotics” Campaign Still Ignoring Animals

“Although previously unthinkable, the day when antibiotics don’t work is upon us. We are already seeing germs that are stronger than any antibiotics we have to treat them.” These are the words Dr. Arjun Srinivasan of the Centers for Disease Control and Prevention (CDC) used last year to kick off the agency’s educational campaign on antibiotic resistance, “Get Smart About Antibiotics Week 2012.”

In a blog posted at the time, I registered my surprise and disappointment that CDC had failed to include animal settings in its 2012 campaign and urged the agency to expand the focus this year. I’m sorry to report that CDC did not get the message. Get Smart About Antibiotics Week 2013 (November 18-24) again focuses almost exclusively on human medical use.

CDC’s Dr. Tom Chiller explained (in a letter to a colleague) that the agency’s educational site aimed at food animals, Know When Antibiotics Work on the Farm, 

is not currently funded and doesn’t have any dedicated staff.

Given the urgency of the issue, why, for heaven’s sake, not?

Crowded pigs in a confinement facility. Source: AgStock.

How many swine producers know that routine use of antibiotics doesn’t deliver economic benefits in finisher pigs? Dan Charles of National Public Radio did a great piece highlighting this fact, but it needs to be hammered home across farm country. Swine producers, just like human patients, need to be educated about opportunities to reduce the demand for antibiotics.

There are many avenues animal producers could take to avoid unnecessary use of antibiotics, among them encouraging appropriate weaning times, all-in-all-out animal management systems, and clean, uncrowded facilities. Consumers could be urged to do their part by looking for and purchasing meat produced with fewer antibiotics.

Ignoring the problem of animal antibiotic use has not made it go away. FDA 2010 data reveal that 80 percent of antibiotics sold in the US were intended for use in animals. Many of those drugs–for example, penicillins, tetracyclines and erythromycin–are in the same classes as drugs critical for human medicine.

Feeding enormous quantities of antibiotics in feedlots and poultry and swine houses generates huge populations of bacteria in animal guts that are resistant to human drugs. Resistant bacteria have easy routes to humans: on food, through the environment, and via people who work with and around the animals.

Antibiotic-resistant food-borne illness is becoming all too common. Recently, Costco announced an expanded recall of Foster Farm chicken implicated in an outbreak of antibiotic-resistant Salmonella

 that has already sickened over 320 people.

Scientists agree that antibiotic use on farms contributes to increasing levels of severe and difficult-to-treat human (and for that matter, animal) disease. Just this month, two former Commissioners of the FDA, Donald Kennedy and David Kessler, wrote to the Executive Office of the President urging “swift action to curb unnecessary use of medically important antibiotics in food animal production.”

In September of this year, CDC itself issued a report, Antibiotic Resistance Threats in the United States, 2013

, calling antibiotic use the single most important factor leading to antibiotic resistance and noting that there is more use of antibiotics in food production than human medicine. The report endorsed phasing out the use of antibiotics for growth promotion, saying the drugs should “only be used to treat infections.”

Just like the CDC’s human campaign, the CDC campaign on animals should be aimed at unnecessary uses: feed efficiency and growth promotion (purely economic uses) and routine disease prevention, which often compensates for stressful conditions in crowded animal facilities.

The best approach is to legally restrict the sale of antibiotics for routine purposes, a goal that would be accomplished with the passage of the Preventing Antibiotic Resistance Act of 2013 introduced by Senator Diane Feinstein (D-CA) and the Preservation of Antibiotics for Medical Treatment Act of 2013 introduced by Representative Louise Slaughter (D-NY). But even with successful legislation, a broad appreciation of the opportunities to reduce antibiotic use in food production would be important.

I applaud the CDC’s campaign to address the overuse and inappropriate use of antibiotics in human medical settings. Such use is an essential driver of antibiotic resistant disease. But the CDC should be campaigning with equal vigor against overuse and inappropriate use in food animal production.

It simply makes no sense to urge the parents of sick children to forgo unneeded antibiotics, while silently standing by as producers of cattle, swine and poultry continue to overuse the same drugs just to avoid the transition to modern management systems.

Expanding CDC’s Get Smart campaign to include animal settings would have been a smart idea last year–and it still will be next year. CDC should find the funds to make it happen.

Posted in: Food and Agriculture Tags: agriculture, animal food production, antibiotics, public health

About the author: Margaret Mellon is one of the nation's most respected experts on sustainable agriculture as well as the potential environmental risks of biotechnology. She holds a doctorate in molecular biology and a law degree. See Margaret's full bio.

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10 Reasons to Come to ACE East

Still trying to decide whether ACE East is for you? We have 10 reasons to help make your decision easier. Join us on October 17-19 in Orlando for three days of carefully selected programming and a showroom full of the latest products and research.

1. Amazing Speakers

Hear insight from 40 of the brightest minds in the industry including Chris Freytag, Bill Parisi, Chris McGrath, Jonathan Ross, Bill Sonnemaker, Vonda Wright and others.

2. Rich Real Estate

Our exhibitor showroom will be packed with new equipment, apparel and research from SPRI®, EAS®, VIVOBAREFOOT™, TRX®, Power Music®, Total Gym® and more.

3. Stylish Digs

Booking a room at the luxurious Renaissance Orlando at SeaWorld will keep you in the middle of all the action and near tons of attractions including Walt Disney World.

4. Up to 2.0 CECs

Take care of all the continuing education credits you need for recertification in one swoop by attending workshops, lectures and interactive sessions hosted by top experts.

5. Learning Upon Learning

Cast your net for knowledge wide by attending your choice of 60 sessions on kettlebells, health coaching, biomechanics, weight loss, group fitness, nutrition, obesity and more.

6. Free Stuff

In addition to merchandise and samples you can snag in our exhibitor showroom, you’ll receive a grab bag of free swag from ACE to rock while you’re at work or play.

7. A Chance to Reconnect With Your Inner Kid

Who doesn’t love Walt Disney World? Turn your ACE East stay into a fun getaway by meeting Mickey and checking out SeaWorld, Aquatica, Universal Studios and more.

8. Networking, Networking, Networking

Connecting with other professionals will be easy at ACE East. We’ve put together a networking events designed to help you get up close with peers and industry experts.

9. A Certain Gold Medalist

Don’t miss hearing Bryan Clay share how he went from a troubled, drug-abusing kid to the “World’s Greatest Athlete” by earning a gold medal at the 2008 Olympic Games.

10. Inspiration

Get inspired by hundreds of leaders who spend their time helping people change their lives through fitness. There’s no better place to fuel your passion than ACE East.

Click here to register for ACE East.

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Abstract – Toward a legal framework that promotes and protects sex workers’ health and human rights

Cheryl Overs, Bebe Loff

Complex combinations of law, policy, and enforcement practices determine sex workers vulnerability to HIV and rights abuses. We identify “lack of recognition as a person before the law” as an important but undocumented barrier to accessing services and conclude that multi-faceted, setting-specific reform is needed—rather than a singular focus on decriminalization—if the health and human rights of sex workers are to be realized.

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Abstract – The Framework Convention on Global Health: A tool for empowering the HIV/AIDS movements in Senegal and South Africa

Ella Scheepers

Despite the Alma Ata-inspired slogan “health for all by 2000,” the world remains afflicted with poor health in the second decade of the 21st century.1 This situation has generated much debate, and as a result, national and global responses have arguably entered a new era, building on the past success and failures of health movements, most notably on the back of the global HIV/AIDS movement.2

This article aims to contribute to the existing knowledge around a Framework Convention on Global Health (FCGH) from the perspective that any international legal framework conceptualisation on the right to health must involve those whose health is at stake. In order to achieve this analyses of the role played by civil society, who aim to give a voice to those unheard in the halls of state power, are vital for any discussion around the international right to health framework.

The two case studies, Senegal and South Africa, were used to look at the current status of the international right to health framework, specifically in the context of the civil society’s role in combating the HIV/AIDS epidemic. Through this, the article explores the possible role of an FCGH in empowering the HIV/AIDS movements in the protection and promotion of the right to health in Africa.

The findings discerned that African states face different challenges regarding the realization of the right to health in the context of HIV/AIDS. However, the important role played by civil society in this realization is highlighted in both cases. They emphasize the diverse roles that an FCGH could play in empowering civil society, through the formulation of a global standard and framework on the right to health, in the form of an FCGH, particularly if it is as a result of a movement of rights education and advocacy from below.3

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Abstract – Respecting the right to access to medicines: Implications of the UN Guiding Principles on Business and Human Rights for the pharmaceutical industry

Suerie Moon

What are the human rights responsibilities of pharmaceutical companies with regard to access to medicines? The state-based international human rights framework has long struggled with the issue of the human rights obligations of non-state actors, a question sharpened by economic globalization and the concomitant growing power of private for-profit actors (“business”). In 2011, after a six-year development process, the UN Human Rights Council unanimously endorsed the Guiding Principles advanced by the UN Secretary General’s Special Representative on Business and Human Rights, John Ruggie. The Ruggie Principles sought to clarify and differentiate the responsibilities of states and non-state actors—in this case, “business” —with respect to human rights. The framework centered on “three core principles: the state duty to protect against human rights abuses by third parties, including business; the corporate responsibility to respect human rights; and the need for more effective access to remedies.”1

The “Protect, Respect, and Remedy” Framework emerged from a review of many industrial sectors operating from local to global scales, in many regions of the world, and involving multiple stakeholder consultations. However, their implications for the pharmaceutical industry regarding access to medicines remain unclear. This article analyzes the 2008 Human Rights Guidelines for Pharmaceutical Companies in relation to Access to Medicines advanced by then-UN Special Rapporteur on the Right to Health, Paul Hunt, in light of the Ruggie Principles. It concludes that some guidelines relate directly to the industry’s responsibility to respect the right to access to medicines, and form a normative baseline to which firms should be held accountable. It also finds that responsibility for other guidelines may better be ascribed to states than to private actors, based on conceptual and practical considerations. While not discouraging the pharmaceutical industry from making additional contributions to fulfilling the right to health, this analysis concludes that greater attention is merited to ensure that, first and foremost, the industry demonstrates baseline respect for the right to access to medicines.

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Abstract – Governance for global and national health: A role for framework conventions?

Timothy G. Evans

In the last two decades, the mushrooming of global health partnerships, alliances, funds and initiatives accompanied by a shift in the resource psyche from millions to billions has been exciting but also bewildering.  The landscape of global health is no longer defined primarily by multilateral institutions comprised of member states, but has been forced to expand to consider new types of international institutions with constituency representation from the private sector, civil society, academia, and philanthropy. Complex challenges like those related to pandemic flu, health worker migration, or HIV/AIDS are demanding intensive, intersectoral coordination and negotiation for which most institutions are ill-equipped to manage. From a governance perspective, it has challenged all institutions to rethink their roles and positions in a new global reality of health interdependence in which there is no single leader, issue, or comparative advantage that one institution can claim exclusively as their own. Not surprisingly, in the midst of such rapid change, which some have referred to as “open source anarchy” questions such as “who runs global health?” are leading to calls to reform multilateral institutions such as WHO and to rethink the global health architecture or governance.1-4

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Abstract – Funding global health

Sophie Smyth and Anna Triponel

Experience teaches that the Framework Convention on Global Health (FCGH) will need a financing facility if it is to garner widespread acceptance among low-income countries. The promise of financing is a well-established carrot to encourage countries to assume new convention-imposed obligations that will be costly to carry out. Promising to provide financing as part of an intergovernmental call for commitment also activates a rights-based approach. For donor and recipient countries, a funding facility embodies an actualization of their commitment to a convention’s collective undertaking to address a given issue. Donors signal their commitment through their contributions; recipients signal commitment through their efforts to use any support received to achieve the convention’s objectives. This essay highlights the need for an FCGH financing facility, provides a preliminary sketch of what it should look like, and urges the facility’s creators to adopt a bold and innovative approach that draws upon, but improves, current precedents.

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Editorial – Governance for global and national health: A role for framework conventions?

Timothy G. Evans

In the last two decades, the mushrooming of global health partnerships, alliances, funds and initiatives accompanied by a shift in the resource psyche from millions to billions has been exciting but also bewildering.  The landscape of global health is no longer defined primarily by multilateral institutions comprised of member states, but has been forced to expand to consider new types of international institutions with constituency representation from the private sector, civil society, academia, and philanthropy. Complex challenges like those related to pandemic flu, health worker migration, or HIV/AIDS are demanding intensive, intersectoral coordination and negotiation for which most institutions are ill-equipped to manage. From a governance perspective, it has challenged all institutions to rethink their roles and positions in a new global reality of health interdependence in which there is no single leader, issue, or comparative advantage that one institution can claim exclusively as their own. Not surprisingly, in the midst of such rapid change, which some have referred to as “open source anarchy” questions such as “who runs global health?” are leading to calls to reform multilateral institutions such as WHO and to rethink the global health architecture or governance.1-4

This global myriad of actors and partnerships is mirrored and magnified at the country level.  The influx of external initiatives and projects in low-income countries has led to concerns about their duplicative, distorting, disrupting, and distracting impacts on overburdened national systems.11,12  Yet the underlying reality of national health systems is much less a single coherent system and much more a plurality of actors spanning the public, non-governmental, informal and for-profit sectors with a host of endemic public and private sector failures referred to by some as “mixed health systems syndrome.”8 Efforts in the global community to “align and harmonize” around a single health plan have struggled to embrace the complex plural character of national health systems.4,9,3,7 Moreover, the growing recognition of the intersectoral, social and transnational character of health challenges—be it related to tobacco control, urban slums, healthy diets, medical tourism, or migration of health workers—is placing demands for flexible and innovative governance arrangements that traditionally structured Ministries of Health are largely unable to meet. The emergence of national strategies for global health and the new field of global health diplomacy are indicative of efforts to begin to embrace the complex and interdependent realities of global health in the 21st century.10

It is in this context of rapid, complex change that the idea of a Framework Convention for Global Health (FCGH) must situate itself. The aim of the FCGH is to reduce inequities in health within and between countries by enshrining the right to health and mutual responsibility in a treaty-like instrument and thereby ensuring the three essential conditions for a healthy life: public health, health care and the social determinants of health.  In the spirit of promoting reflection on this ambitious and exciting idea, this editorial raises three issues: i) the fit of the FCGH in the global health landscape; ii) the focus of the FCGH in relation to the governance instrument; and iii) the value of a broad platform to deliberate on health equity.

At the heart of the FCGH is the core value of equity in health. In many respects, an intolerance of inequities in health is a mobilizing value driving the global health agenda. In the area of child survival for example, from the establishment of the Global Task Force for Child Survival in the 1980s to the creation of the Global Alliance for Vaccines and Immunization (GAVI) in 1999 to the recent consensus to eliminate avoidable child mortality by 2030—there appears to be concerted global action and commitment to realizing this right over what will end up being a half century. The question, therefore, is what the FCGH can add to this already active agenda? Could it bring broader participation and voice of the disadvantaged? Could it bring more action on neglected social determinants of child survival? Could it ensure sustainability of financial commitments through its legally binding articles? Could it accelerate progress in attaining the goal of equity within and/or between countries?

As currently framed, the FCGH takes on a broad whole-of-global society approach through its focus on equity within and between countries, its engagement of civil society and sovereign states, and its explicit model of determinants of health that stretches beyond medical care to the social determinants of health. This “framing” of the FCGH raises questions as to whether the instrument of a “treaty” is fit-for-purpose. Other precedents in global health for a treaty mechanism are focused more narrowly, as in the case of tobacco control, pandemic influenza, or trade agreements. Understanding the complexity and significant transaction costs associated with those more tightly focused undertakings raises questions as to whether a treaty for such a broad set of issues is feasible, or even the optimal global governance instrument. Might there be, for example, a “softer” instrument that accommodates the whole-of-society approach, such as multi-stakeholder forums on inequities in health? And from these forums, might more specific issues be targeted for “harder” or binding instruments, like a treaty?

The value of a menu of instruments from soft to hard allows the tailoring of responses that may better accommodate the divergent interests of the wide array of actors that typically are involved in complex global health challenges. This will be important in engaging partners who may view the FCGH as taking a blind view with respect, for example, to the for-profit private sector. The FCGH must establish early on that, a priori, health equity is not incompatible with market mechanisms; rather, it must be clear that failures in governance for health equity implicate all actors with a commensurate responsibility to examine ways of doing business differently.

While a more targeted use of the treaty mechanism might be considered more pragmatic, this should not mean necessarily that the FCGH should also narrow its scope. Indeed, its broad aim of creating a process for deliberation, commitment, and collective action towards the realization of the right to health and health equity might augur well to counter the risk that the global health justice agenda is set aside because a single goal or small set of targets has been achieved.  What form this process of deliberation would take deserves further reflection: is it a modification of the World Health Assembly, as some have suggested, through the introduction of a Committee C?5 And might it have a national level expression as seen, for example, in the recent creation of the National Health Assembly in Thailand?

The aim of the FCGH to reach to the country level and redress within country inequities in health raises the critically important issues of national governance for health.  As stated above, the governance challenges at country level are enormous and are ones that most states are struggling with, not simply because of challenges associated with global health interdependence. In this regard, the FCGH might help to bring overdue attention to these national challenges for governance and shed light on ways in which health justice can be stewarded more effectively in the national setting.

In this regard, further development of the FCGH can help to redefine and re-vitalize national and transnational governance mechanisms for health and thus contribute to a badly needed reservoir of ingenuity to address dynamic and rapidly changing health problems that threaten equity across and between countries.

Timothy G. Evans, D.Phil., MD, is the Director of Health, Nutrition and Population at the World Bank in Washington, DC, USA, and the former Dean of the James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh.

1. D.P. Fidler, “Architecture amidst anarchy: global health’s quest for governance.” Global Health Governance, Volume 1, No. 1, pp. 1-17. Available at http://diplomacy.shu.edu/academics/global_health.

2. J. Frenk and S. Moon, “Governance challenges in global health.” New England Journal of Medicine

, 2013; 368, pp. 936-944.

3. G. Hutton, M. Tanner, “The sector-wide approach: a blessing for public health?” Bulletin of the World Health Organization

82:12:893.

4. IHP (2013). Available at http://www.internationalhealthpartnership.net/en.

5. I. Kickbusch, W. Hein, and G. Silberschmidt, “Addressing global health governance challenges through a new mechanism: The proposal for a Committee C of the World Health Assembly.” Journal of Law, Medicine and Ethics

38 (3):550-563.

6. “Editorial: Who runs global health?” Lancet

, Volume 373, Issue 9681, Page 2083, June 20, 2009.

7. C.J.L. Murray, J. Frenk, T.G. Evans, “The Global Campaign for the Health MDGs: challenges, opportunities, and the imperative of shared learning.” Lancet 2007; 370 (9592): 1018-20.

8. S. Nisthar, Choked pipes: reforming Pakistan’s mixed health system

.  Oxford University Press, 2010.

9. OECD (2008), The Paris Agenda on Aid Effectiveness and the Accra Agenda for Action.   Available at www.oecd.org/dataoecd/11/41/34428351.pdf.

10. E. Rosskam  and I. Kickbusch, eds. Negotiating and Navigating Global Health: Case Studies in Global Health Diplomacy

(New Jersey, 2011).

11. P. Travis et al., “Overcoming health-systems constraints to achieve the Millennium Development Goals.” Lancet 364(9437): 900-6. Erratum in: Lancet

2005; 365(9456): 294.

12. WHO Maximizing Positive Synergies Group, “An assessment of the interactions between Global Health Initiatives and country health systems.” Lancet

2009; 373: 2137-2169.

13. World Bank (2007) Healthy Development.  The World Bank Strategy for Health Nutrition and Population Results

(World Bank: Washington, D.C.)

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