̽��ֱ�� of Cambridge - United Nations

Policies for People and Planet

plc32 — Wed, 06 Dec 2023 17:05:17 +0000

Cambridge Zero symposium gathers researchers to examine the rules and incentives needed to combat climate change.

Seeking climate justice at the 'world court'

fpjl2 — Wed, 29 Mar 2023 07:59:32 +0000

How a Cambridge professor helped the climate-embattled nation of Vanuatu put the question of global warming to the International Court of Justice for the first time in history.

Russian attempts to invoke international law dismantled

fpjl2 — Wed, 09 Mar 2022 17:01:16 +0000

Professor Marc Weller, a leading expert in international law and advisor on a large number of peace negotiations, debunks in turn Russia’s attempts to invoke international law.

Green recovery must end the reign of GDP, argue Cambridge and UN economists

fpjl2 — Tue, 15 Dec 2020 09:09:56 +0000

̽��ֱ�� ̽��ֱ�� helps the United Nations launch a new 'Ecosystem Accounting' framework: allowing governments to better include and reflect nature in their post-pandemic economic recovery.

Human rights of people with autism not being met, leading expert tells United Nations

cjb250 — Fri, 31 Mar 2017 14:30:16 +0000

In his keynote speech, Professor Baron-Cohen, Director of the Autism Research Centre at the ̽��ֱ�� of Cambridge, argued that even with the UN Convention on the Rights of People with Disabilities having been adopted in 2006, people with autism still do not enjoy human rights to the same extent as everyone else.

At least 1% of the world’s population is on the autism spectrum, which equates to some 70 million people with autism on the planet. Autism is a spectrum of neurological disabilities involving difficulties with social relationships, communication, adjusting to unexpected change, dealing with ambiguity, and entailing sensory hypersensitivity and anxiety. Autism also leads to a different perceptual and learning style, so that the person has a preference for detail, and develops unusually narrow interests, and an unusually strong preference for facts, patterns, repetition and routine.

“People with autism account for a significant minority of the population worldwide, yet we are failing them in so many respects,” he said. “This creates barriers to their participation in society and to their autonomy that must be addressed. We have had a UN Convention to support people with disabilities for over 10 years now and yet we still are not fulfilling their basic human rights.”

In his speech, Professor Baron-Cohen reminded the UN that in Nazi Germany during the Holocaust, people with intellectual disability were killed in their thousands, under the compulsory euthanasia laws. Many of these individuals likely had autism, even before we had a name for it, as the first report of autism by Dr Leo Kanner was published during the Second World War.

However, historical violations of the human rights of people with autism go back further than that: in the US, in the 1920s, many States passed laws to compulsorily sterilize people with intellectual disability, including those whom today we would recognize had autism, in the name of eugenics.

Professor Baron-Cohen highlighted six examples where he believes the human rights of people with autism are not being met.

First, the right to dignity: According to the National Autistic Society in the UK, half of adults with autism report they have been abused by someone they thought was a friend. Half of adults with autism report they stay home because of fear of being abused in some way. Individuals with intellectual disability, including those with autism, are three times more likely to be victims of abuse or neglect, robbery, or assault.

Second, the right to education: one in five children with autism have been excluded from school. Whatever the reason for being excluded, they are being deprived of the right to education. And of the other 80% of children with autism who have stayed in school, half report having been bullied, which is a risk factor for depression.

Third, the right to equal access to public services: one in three adults with autism experiences severe mental ill health because of lack of support. In Professor Baron-Cohen’s clinic for adults with Asperger Syndrome, a subgroup of autism, two thirds have felt suicidal and one third have felt so bad that they have attempted suicide. Research from the Universities of Cambridge and Coventry in the UK found that among those who have died by suicide, approximately 12% had definite or probable autism. Professor Baron-Cohen called for a minute’s silence to remember those people with autism who have died by suicide.

Finding such a high rate of autism in people who have died by suicide is not surprising when you consider how many of these individuals did not have the benefit of early diagnosis, explained Professor Baron-Cohen. Early diagnosis is possible in childhood – there are screening measures that can detect autism in young toddlers, but most countries do not screen for autism.

He drew attention to the fact that in the UK, in many areas, the waiting time for a diagnosis can be up to a year or longer, and that in high- and middle-income countries, people with autism may receive a formal diagnosis, but in low-income countries, the majority of people with autism may remain undiagnosed, either because of stigma, ignorance, or lack of basic services.

Fourth, the right to work and employment: Professor Baron-Cohen said that only 15% of adults with autism are in full time employment, despite many having good intelligence and talents. ̽��ֱ��right to work should extend to everyone, whatever support they might need. Unemployment is another well-known risk factor for depression.

He commended some enlightened employers, like the German company Auticon, the Danish company Specialisterne, and the German company SAP, for setting an example of how to help people with autism into employment and how employers can make reasonable adjustments for people with autism.

Fifth, the right to protection from discrimination, and the right to a cultural life, and to rest and leisure: He described how many people with autism have been asked to leave a supermarket or a cinema, because of their different behaviour. He said this is discrimination and again would never be tolerated for other kinds of disabilities.

In addition, half of adults with autism report feeling lonely, a third of them do not leave the house most days, and two thirds of them feel depressed because of loneliness. One in four adults with autism have no friends at all.

Finally, the right to protection of the law, and the right to a fair, impartial trial: one in five young people with autism have been stopped and questioned by the police, and 5% have been arrested. Two-thirds of police officers report they have received no training in how to interview a person with autism. Many legal cases involving someone with autism result in imprisonment for crimes the person with autism may not have committed, or for crimes others committed, but the person with autism became tangled up in, because of their social naivete. Some of these crimes are the result of the person with autism becoming obsessed with a particular topic, a product of their disability, and yet the courts often ignore autism as a mitigating factor.

Professor Baron-Cohen ended his address with a call to action. “We must take action. I want to see an investigation into the violation of human rights in people with autism. I want to see increased surveillance of their needs, in every country. And I want us to be continuously asking people with autism what their lives are like, and what they need, so that they are fully involved in shaping their future. Only this way can we ensure their human rights are met.”

̽��ֱ��basic human rights of autistic people are not being met, Professor Simon Baron-Cohen, a world expert on autism, told the United Nations in New York today, to mark Autism Awareness Week.

People with autism account for a significant minority of the population worldwide, yet we are failing them in so many respects

Simon Baron-Cohen

Lance Neilson

Coloring

̽��ֱ��text in this work is licensed under a Creative Commons Attribution 4.0 International License. For image use please see separate credits above.

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When ideas of peace meet politics of conflict

fpjl2 — Wed, 15 Feb 2017 12:00:36 +0000

Burundi has experienced cycles of violence, civil war and even genocide since achieving independence from Belgium in 1962. So, when this small central African country finally held democratic multiparty elections in 2005 following a lengthy peace process, the international community cheered.

Here, perhaps, was a nation set to become a model for post-conflict inclusive governance. A model for building peace.

Now, Burundi once again teeters on the brink. In 2015, President Nkurunziza refused to step down at the end of his term, violating the new constitution and leading to a failed coup attempt – the aftermath of which has seen violent repression of the population.

Hundreds of thousands have fled, including much of civil society and a once-flourishing media. Torture, rape, imprisonment and extrajudicial killings are now commonplace, and in July 2016 the United Nations (UN) Security Council strongly urged all parties to cease and reject violence. ̽��ֱ��language of ethnic difference and the politics of ethnic scapegoating are once again coming to the fore, and tensions are extremely high.

For regional and international actors, such as the African Union (AU) and UN, which played key roles in the peace initiatives that paved the way for the 2005 elections, come familiar questions: what went wrong, and what to do now?

Through hundreds of interviews with everyone from government officials to local activists, AU and UN representatives, ex-combatants and aid workers, Dr Devon Curtis from Cambridge's Centre of African Studies (see panel below) is exploring what happens when the lofty ambitions of peace programmes – the language of security and democracy – encounter, as she says, “African realities and politics on the ground”.

“Before I became an academic I worked with government and the UN and it was almost easier then to provide policy recommendations in broad bullet points. It’s not so easy now that I have a real sense of the complexities of a country like Burundi, based on extensive research,” says Curtis.

Her research, in collaboration with UK and African-based scholars, is revealing the myriad ways international peacebuilding is reinterpreted and distorted by the politics of post-conflict African countries.

“Various local groups attract attention, funds or delegitimise opponents by manipulating – or ‘instrumentalising’ – the simplistic categories set by international donor organisations,” she says. “This can lead to unintended consequences for international agencies.”

For instance, disarmament, demobilization and reintegration (DDR) of ex-combatants has become an integral part of international peace operations over the past 20 years and a key area of programmatic activity, yet even the very category of ‘combatant’ in DDR programmes is problematic.

“ ̽��ֱ��international distinction between combatant and civilian doesn’t make much sense in Burundi, where many people have been both at different times. In fact, armed movements used DDR programmes as the basis for recruitment drives – promising potential recruits ‘attractive demobilisation packages’ from international donors.”

In other cases, international actors keen to see regional stability and cessation of overt violence can be “instrumentalised” by a country’s ruling elites, such as in Burundi and its neighbour Rwanda, where funds and support were funnelled to the security services to increase the control and repression of populations.

“Grand ideas of democracy and empowerment can get lost in conversions towards militarisation that, on a short-term and basic level, meet with the international donors’ initial desire for security,” says Curtis.

International agencies have typically understood Burundi’s conflict to be along the same ethnic lines as Rwanda’s: the majority Hutu against the minority Tutsi.

These basic ethnic categories were deployed by internationals during peace talks, and ethnic power-sharing was promoted as the “anchor of the peace agreement”, says Curtis. “For a time, this succeeded in bridging ethnic divisions, as all political parties had to include representatives from each perceived ethnicity. However, it did not address other divisions in Burundi.”

“Also, at the time of the peace negotiations, inclusive power-sharing provided a perverse incentive to keep fighting if an individual or group didn’t get what they wanted. Violence continued to be a way to get a seat at the table.” Armed groups would continue to splinter – creating more and more subgroups that would then demand representation in the peace negotiations. “As soon as someone was brought in, another movement would break away, forming a new faction.”

This was in part an effort to gain power, but there were also tactics to keep the peace talks going indefinitely, for financial gain. “Burundian representatives were flown to the city of Arusha in Tanzania for talks, and paid per diem rates.” There is a well-to-do neighbourhood in Burundi’s capital city nicknamed ‘Arushaville’, which is said to be built on the earnings of these protracted negotiations.

While the peace negotiations meant one thing for international and regional mediators and donors, they were viewed in different ways by Burundians. In fact, the very language of the international donor community can be coopted and reinterpreted for local gain.

For instance, networks of traditional elders, called the Bashingantahe, were considered a thorn in the side of the current regime in Burundi. “ ̽��ֱ��regime implemented a ‘democratic decentralisation’ programme – something designed to appeal to donors – which established an elected government at the local level. It led to fierce competition between these newly elected local officials and the Bashingantahe elders, so the elders formed their own ‘NGO’ to appeal to international donors and to be able to attend donor-financed civil society forums.

“Everybody’s manoeuvering,” says Curtis. “These international ideas and labels are not imposed on a blank slate, but are forced to interact with existing political and economic agendas.

“I wanted to focus on Burundi partly because there are few strategic and economic considerations for the international donor community – so one would assume that they are going in with relatively unbiased good intentions. Yet, even in this case, peacebuilding programmes do not bring about their intended effects. What does this mean for the even more ‘difficult’ cases such as the Democratic Republic of the Congo or Somalia?”

With funding from the British Academy, Curtis recently co-edited a book on peacebuilding ideas in different African contexts. She continues to consult with and advise the peacebuilding commission at the UN and the UK’s Foreign and International Development offices on a number of issues related to African peace and security.

Recently, in discussion with a network of African scholars, she has turned her attention to possible new approaches and ideas of peacebuilding: “International packages for peace tend to focus first and foremost on stability and electoral democracy, both of which are important, but which don’t affect the entrenched self-interest of ruling elites.

“Questions of social justice and equality are expected to come later – but what if it was flipped so they were prioritised? There are very few success stories in international peacebuilding, and I’m concerned we’re in danger of learning the wrong lessons: that peace is too problematic, and that we should focus on narrower goals of counter-insurgency.

“I’d like to try and shift the debate towards questions of social justice and international solidarity. If we changed the notion of what is important in peacebuilding, I wonder what peace might look like then?”

Inset images: Voluntary disarmament and demobilisation of combatants as part of the UN Operation in Burundi in 2004-2005; credit: United Nations Photo.

To keep up to date with the latest stories about Cambridge’s engagement with Africa, follow #CamAfrica on Twitter.

Research by an expert in peacebuilding shows how international ideas, practices and language of conflict resolution are transformed when they meet African “realities and politics on the ground”.

Everybody’s manoeuvering. These international ideas and labels are not imposed on a blank slate, but are forced to interact with existing political and economic agendas.

Devon Curtis

United Nations Photo

United Nations Operation in Burundi (crop)

Centre of African Studies

For half-a-century, the Centre of African Studies has served as the hub of research in the humanities and social sciences at the ̽��ֱ�� of Cambridge. Collaboration with research institutes and individual researchers in Africa has long been key to its work, from its founding director Audrey Richards’s contribution to the establishment of social sciences in Uganda to a range of more recent forms of collaboration. In a scheme that is unique to Cambridge among African Studies Centres in the UK, the Centre hosts each year visiting research fellows from Africa, who spend six months in Cambridge unencumbered by duties in their home institutions.

Although the Centre does not have permanent academic staff, at present it hosts postdoctoral researchers whose interests range from heritage in Southern Africa to religion and popular culture in Rwanda. ̽��ֱ��Centre also monitors the provision of Africa-related teaching and research across the ̽��ֱ��. Cambridge’s well-established strengths in history and social anthropology have recently been complemented by growth in African politics – in both student demand and staff numbers.

̽��ֱ��Centre has the only specialist African Studies library in Cambridge. Its archival collections are also significant. Academics across faculties and schools take part in teaching the interdisciplinary MPhil in African Studies. ̽��ֱ��Centre also hosts weekly research seminars and organises academic conferences in Cambridge and Africa. Some of the outcomes of these activities are published in its book series with Ohio ̽��ֱ�� Press, a leading publisher in African Studies.

̽��ֱ��text in this work is licensed under a Creative Commons Attribution 4.0 International License. For image use please see separate credits above.

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̽��ֱ��war that fed itself - and the hollow democracy it left behind

tdk25 — Wed, 14 Oct 2015 07:37:39 +0000

̽��ֱ��voices of ordinary people who lived through Angola’s devastating, 27-year civil war have been captured in a damning study that reassesses both how the conflict happened, and the nature of the country’s so-called democracy today.

From 1975 until 2002, hundreds of thousands of Angolans were killed and millions more displaced in a brutal conflict that was described by the United Nations as “the worst war in the world”. By the time it ended, it had become synonymous with child soldiers, human rights atrocities, landmine victims and blood diamond economics.

̽��ֱ��bloodshed has usually been seen as the result of ethnic divisions in Angolan society, which mixed with Cold War politics as international powers intervened.

In a new book that draws on extensive interviews with those caught in the crossfire, however, Dr Justin Pearce – a former BBC correspondent in Angola who is now a Research Associate at St John’s College, ̽��ֱ�� of Cambridge – brings the political motivations of Angolans themselves to the centre of the analysis. He reaches a bleak conclusion: This, he suggests, was a war that for most people meant nothing when it started, and then found reasons for existing as it developed, almost as if it were feeding itself.

His study challenges conventional views about why the devastating conflict happened, and considers what it means for Angola today – a supposed democracy which, Pearce says, is for all practical purposes a one-party state.

“We think of most wars as starting with two groups with antagonistic interests,” he said. “Probably the most surprising finding was that this conflict didn’t arise from a broad identity split across Angolan society; it created it. Its end marked the culmination of a process whereby firepower, bloodshed and starvation were employed to transform the possibilities of what Angolans considered imaginable.”

̽��ֱ��roots of the Civil War pre-date Angola’s independence from Portugal in 1975. Amid abrupt decolonisation, the rival movements that had opposed colonialism began fighting for the right to rule the new state. ̽��ֱ��Popular Movement for the Liberation of Angola (MPLA) took control in the capital, but the National Union for the Total Independence of Angola (UNITA) contested the power of the MPLA government.

Despite the intervention of Cuba and South Africa, with the support of the Soviet Union and the United States during the Cold War, the resulting struggle was frequently ignored in the West. In the mid-1990s, when the daily casualty rate was higher than in Bosnia, Margaret Anstee, the United Nations’ special representative to Angola called it “the forgotten tragedy”. “Even now it is difficult to lift the veil of silence,” she wrote in 1996. “ ̽��ֱ��argument is that there is no public interest – and apparently no desire to awaken it, either.”

Pearce’s study seeks to fill a gap by examining what motivated ordinary Angolans to participate in Africa’s worst conflict: did they believe in a cause, it asks, or did they really not have a choice? Focusing on the Central Highlands region, he spoke to many of the country’s poorest people – rural peasants – as well as town dwellers, farmers, soldiers and politicians.

In part, their personal accounts add to what is already known about the war’s horrors. Some gave examples of the extreme tactics with which UNITA and the MPLA sometimes controlled the population – tales of public executions, kidnappings, forced marriages, and even the burning of alleged “witches”.

In addition, however, their accounts show that the ideological divisions associated with the Cold War meant little to ordinary Angolans. Instead, Pearce found that after years of political suppression by the Portuguese, few Angolans were engaged with politics in 1975. As the MPLA and UNITA seized parts of the country, the locals simply accepted their military domination as legitimate political power.

For most, therefore, the war began not for a cause, but as a reality that was imposed upon people. Many of Pearce’s interviewees described their lives under UNITA and the MPLA as if they had been “owned” by the warring factions. “People lost the notion of being independent,” one interviewee told him. “People became possessions.”

̽��ֱ��study found that such political affiliations were often fluid. When territories changed hands, “UNITA people” simply became “MPLA people” instead, and vice-versa. In one particularly extreme case, Pearce was told about a train journey in which the passengers switched allegiances at different stations, to avoid being executed by the opposing militias.

That situation made a mockery of attempts by the West during the 1990s to end the war through democratic means. As the war went on, however, the study suggests that it developed its own reasons for existing. Control was founded upon force and fear, but it was maintained by means of persuasion. Both parties created jobs and provided local services. They also used education programmes to strengthen their claims to rule, while cultivating a fear of the adversary.

Gradually, these strategies turned many Angolans into die-hard supporters of either UNITA or the MPLA. Citizens came to depend on their local party for their livelihoods, and came to define their sense of national identity with the fight against the other side.

Pearce suggests that the consequences were disastrous, because this made the conflict a “zero-sum game”, in which one side had to undermine the other’s ability to support its people in order to win. ̽��ֱ��MPLA government’s counter-insurgency operations, which intensified in the late 1990s, finally achieved peace on this basis – in the process causing widespread starvation, large-scale population displacement and appalling suffering.

Seen through the prism of this bleak recent history, the book argues that 13 years later, Angola’s supposed democracy remains the result of a war that was won through domination.

Since its end, the MPLA has implemented a reconstruction programme on the back of an oil boom that is now stalling. While Pearce says that this has created “the most disgusting rich-poor gap imaginable”, he also notes that the government still suppresses political opposition using repressive tactics that echo the war itself.

“It goes through the rituals of multi-party democracy, but I would say it’s a strongly authoritarian state with the trappings of a democracy that doesn’t really function,” Pearce added.

“It’s as if the channels simply don’t exist for the expression of an alternative vision. Even now, with the economy suffering from plunging oil prices, all you see are occasional, small, street protests by a few disaffected young people. It’s hard to see how that alone is going to chip away at the edifice of power, and the government’s response has been brutal. Fifteen activists were imprisoned without trial in June this year, and their mothers were beaten by police when they demonstrated for their sons’ release. I fear that there is going to have to be some sort of severe crisis in Angola before things really get better.”

Political Identity And Conflict in Central Angola, 1975-2002, by Justin Pearce, is published by Cambridge ̽��ֱ�� Press. Dr Pearce is a Leverhulme Early Career Fellow in the Department of Politics and International Studies, and a Research Associate of St John's College.

Inset images: (1) UNITA troops during a handover of their weapons to government monitors at the war's end in 2002; (2) Civilians carry sacks of food flown into Kuito during the humanitarian crisis of 2001; (3) Landmine clearances in Angola, one legacy of the conflict. All images credit Justin Pearce.

A new study using extensive eyewitness accounts re-examines the causes and legacy of Angola's brutal 27-year civil war, once described by the United Nations as "the worst war in the world".

Probably the most surprising finding was that this conflict didn’t arise from a broad identity split across Angolan society; it created it. Its end marked the culmination of a process whereby firepower, bloodshed and starvation were employed to transform the possibilities of what Angolans considered imaginable.

Justin Pearce

Justin Pearce.

Angolan civilians walking past the remains of tanks in 2004. Relics of the conflict still litter the Angolan countryside.

̽��ֱ��text in this work is licensed under a Creative Commons Attribution 4.0 International License. For image use please see separate credits above.

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Ethical dilemmas and global health

lw355 — Tue, 15 May 2012 10:00:52 +0000

Ever since a popular theory arose in the early-1970s (known as a theory of ‘epidemiologic transition’), we have become used to thinking that a country’s burden of disease shifts from acute infectious diseases to long-term chronic conditions as it develops.

Over the past few decades, however, this theory has been countered by the occurrence of emerging and re-emerging infectious diseases in developed countries and the growing burden of non-communicable diseases (NCDs, such as cardiovascular disease, cancer, chronic lung diseases and diabetes) in developing and developed countries alike, as well as by the rapid acceleration in the movement of diseases and their causes across borders. While much global attention has been given to the rapid spread of infectious diseases, less attention has been given to the rising burden of chronic non-communicable diseases around the world.

To address the oversight of chronic diseases in the world’s development programmes, in September 2011 the United Nations (UN) General Assembly held a rare, special session on the prevention and control of NCDs. Such a high-level session on a health issue was held only once before, on HIV/AIDS in 2001. Partly motivated by the arguments that HIV/AIDS was not just a health crisis but also a threat to national security, 189 countries signed up to the Declaration of Commitment on HIV and AIDS. That event proved a turning point in the global response to HIV/AIDS epidemic. ̽��ֱ��High-Level Meeting (HLM) on NCDs aimed to create a similar turning point by galvanising an increased and coordinated global response to NCDs.

There are wide-ranging arguments for why governments and their leaders should care about the prevention and control of NCDs both within and outside their borders. ̽��ֱ��main case for action includes the identification of the health burden of NCDs; NCDs as threats to economic and social development; the cost-effectiveness and -savings produced by NCD interventions; and the recognition that addressing NCDs requires leadership and coordinated, multi-sectoral policies domestically and across countries.

However, as anyone familiar with making health policy or with high-level UN conferences will tell you, there are politics involved. In the case of a UN conference, by signing up to a declaration, governments make a global public commitment to what is stated in the declaration. And so, understandably, months of preparatory work is done developing a final conference document which hopefully has a coherent vision, reasoning, and action plan. ̽��ֱ��few final months before the NCD conference involved difficult negotiations between various representatives of governments and some non-governmental organisations regarding what concrete commitments were being asked of different governments and non-state actors as well as what will be, and importantly, will not be included in the final conference document.

In an article published in the Bulletin of the World Health Organization, we reviewed the regional declarations leading up to the HLM in September to identify areas of intersection and divergence. Our analysis identifies four ‘ethical dilemmas’ facing Europe and the global community. We frame them as ethical dilemmas, in contrast to ‘concerns’ or ‘questions’, because underneath the politics and practical deliberations on what language to include and exclude in the final declaration and indeed, global response, lie different conflicting ethical principles. We are driven by the notion that politics, especially global health politics, can be richer than the pursuit of self-interest of different actors through greater reflection on the ethical issues at stake. These ethical dilemmas are not exhaustive or mutually exclusive. Without one general ethical theory that would organise and guide consistent reasoning through all of them, we identify them separately.

̽��ֱ��four dilemmas we identified included:

Dilemma 1. Human rights approaches

Effective action on non-communicable diseases involves addressing multiple human rights, such as the right to information to make informed choices about diet and activity (e.g. food labels that people can understand), the right to bodily integrity (e.g. freedom from exposure to second-hand smoke), and the right to health (including access to essential medicines). These human rights may conflict with corporate rights such as the right of pharmaceutical companies to exploit patents or express freedom of speech (through marketing).

Dilemma 2. Social determinants or healthcare

̽��ֱ��World Health Organization Commission on the Social Determinants of Health showed how an individual’s health is influenced by the circumstances in which they grow, live, work and age, and the systems put in place to deal with illness. ̽��ֱ��Commission also highlighted how health and longevity in both rich, middle-income and poor countries follow the socioeconomic gradient, and how inequalities in health within and across countries are increasing. Political leaders face difficult decisions about where to invest resources along the causal chain of disease. They must care for those already ill but also tackle the underlying causes of the diseases.

Dilemma 3. Resource allocation between domestic and global needs

Governments must balance the needs of their own citizens with their obligations to provide aid to other countries. There is a glaring global inequality in the burden of NCDs and in the domestic resources available to address them. This raises the basic question of the obligations of rich countries to help poor countries to deal with these diseases.

Dilemma 4. Setting priorities on NCDs

All governments must set priorities for action, such as whether to focus on interventions for those people in most need, those who would benefit most or on actions that would benefit the most people. ̽��ֱ��HLM initially prioritised four diseases (cardiovascular disease, cancer, chronic lung diseases and diabetes) with high mortality burdens and four risk factors (tobacco use, poor diet, harmful use of alcohol and physical inactivity). ̽��ֱ��case for focusing on these four NCDs is that they have common causes, and there are knock-on benefits of interventions into these specifics for the prevention of other NCDs. However, such a justification does not seem to be fully satisfactory in relation to individuals suffering from mental illnesses. ̽��ֱ��full extent of mental illnesses worldwide, and particularly in developing countries, is grossly under-recognised, requiring distinct interventions that do not completely come under the secondary benefits of addressing the four identified NCDs.

̽��ֱ��final declaration signed at the HLM contains mixed messages regarding these four dilemmas. This is partly due to the need for achieving a consensus and pressure to achieve an outcome. However, the dilemmas still remain, and much greater deliberation, both at the national and global level is necessary in order for there to be an effective and enduring global response to the rising burden of NCDs within and across societies.

Dr Sridhar Venkatapuram is an affiliated lecturer at the ̽��ֱ�� of Cambridge Department of Sociology and holds a Wellcome Trust fellowship at the London School of Hygiene and Tropical Medicine (LSHTM). Dr David Stuckler is a lecturer at the Department of Sociology and an honorary research fellow at LSHTM.

For further information, please refer to the authors’ article published in the Bulletin of the World Health Organization March 1 (2012); 90(3): 241–242.

Sociologists David Stuckler and Sridhar Venkatapuram discuss how tensions within society are slowing down the process of combating disease worldwide.

We are driven by the notion that politics, especially global health politics, can be richer than the pursuit of self-interest of different actors through greater reflection on the ethical issues at stake.

David Stuckler (left) and Sridhar Venkatapuram (right)

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