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May 1, 2023

Responding To: Georgetown Reflects on CUGH 2023: "Global Health at a Crossroads: Equity, Climate Change and Microbial Threats"

A Central Debate: Should the Sustainable Development Goals Be Included in the Practice of Global Health?

Julia Damski (SFS'24)

At the Consortium of Universities for Global Health 2023 conference (CUGH), which focused on climate through the theme of “Global Health at a Crossroads: Equity, Climate Change and Microbial Threats,” the keynote debate, led by Tom Quinn, director of the Center for Global Health at Johns Hopkins University, scrutinized the future of global health interventions with regards to the sustainable development goals (SDGs). The United Nations established the 17 SDGs in 2015 as an “urgent call to tackle climate change and preserve our oceans and forests.” Quinn posited that "the practice of global health is too narrow and should be broadened to encompass the sustainable development goals.” He asked Agnes Soucat, head of the division of health and social protection of the Agence Française de Developpement, and Soji Adeyi, president of Resilient Health Systems and former director of health, population and nutrition at the World Bank, to debate the issue.

This was a bold move to make in a debate sandwiched by at least 10 sessions that directly referenced the centrality of climate change to the future of global health. The main speakers in this debate, Agnes Soucat and Soji Adeyi, offered a review of the field’s history and failures during their presentations in defense of each side. The question did not seem to be such a defining topic at first, but the way that guests got riled up after the official statements proved that the original statement had serious implications. Adeyi turned the crowd towards a “no” as he refreshed our memory of the colonial history of global health and the imbalance of power that persists. He spoke of evidence within the long-running dependency on the Global North that the Global South has, and within the World Health Organization supply chain and logistic network, while calling for tax breaks and the elimination of intellectual property rights. He threw some jabs at the United States Agency for International Development (USAID) as a “wasteful” organization that refuses to learn. The field could not pretend to take up another issue and expand its scope (to include SDGs) when it still had so many mistakes to correct. This inspired one guest who stood up and asked the question many were wondering: “Is global health ‘global’ at all?” (to great applause).

It was difficult to deny the importance of climate—the driving force behind the SDGs—when many of the other lectures at CUGH pointed out the complex intersections by a dizzying array of titles: One Health, Planetary Health, and “environmental health threats,” which included mentions of how every community either already is, or soon will be, impacted. The tangle of climate change’s effects on the planet and on human health were widely agreed upon, but there was another debate in addition to the debate about the centrality of climate health to global health: what to call it. The significance of labeling reveals that the issue of climate already plays a role in the political side of global health, even if not strictly included in the mission. Some unexpected issues not often at the table for global health interventions, including animal health, were brought up. The diversity of these related issues underscored the importance of cross-sector collaboration. Another message—and maybe this is characteristic of the field of global health—was of persistent optimism that much of this damage can be mitigated. It was reassuring to hear from zoologists and water scientists who, despite showing us the evidence of planetary harm, believed that conference attendees could have a positive influence.

Soucat finished the debate with a powerful declaration that “addressing social and environmental determinants of health are one and the same agenda.” There is so much progress to be made that involves more than using buzzwords like “decolonization,” and the conference leaders accordingly exaggerated the need to fix global health systems. Global health will hopefully shift towards insisting on accountability on a local and country level and resisting the incentive to “leave things in disarray so the Global North will provide more aid,” Adeyi said. This debate ended with Agnes Soucat calling for the separation of science and politics in light of the many frustrations with the power imbalance in global health interventions.

The debate persuaded audience members to take a real stake in the issue, as evidenced by the decisive raise of hands after the debate. The audience, just like me, likely wondered why this was the debate question and where they really stood on the issue as they looked around and tentatively raised their hands for the first vote. It ended with a feeling of pride emanating from the guests who spoke passionately about their own experiences and renewed interest from those who would continue to think about the issue as they continued their work.

Julia Damski (SFS’24) is an undergraduate student in the School of Foreign Service at Georgetown University studying science, technology, and international affairs.

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