The World We Want, leaving no one behind: did the Go4Health project represent the voices of marginalised communities into the post-2015 global health discourse?

Abstract

The evolution of the Sustainable Development Goals (SDGs) has given rise to a critical post-2015 discourse around what the UN refers to as the World We Want. The unfinished business of the Millennium Development Goals (MDGs) remains conspicuous, with the recognition that inequity has increased, despite its gains. Sustainable development was framed early as a universal agenda, with an imperative to leave no one behind. But how do we hear those who have been left behind? In response, Go4Health, a collaboration between academics and health rights NGOs, was commissioned by the European Union to track the development of the post-2015 goals and specifically to identify the essential health needs of marginalised communities. This thesis is nested within that research, but differentiates itself from it. In a reflexive exploration of how marginalised peoples were heard through the Go4Health project into the post-2015 SDG policy-making discourse, I examine the voices of two marginalised communities in Bangladesh and the Lived experiences in their social, environmental and political context bring to light issues around livelihoods, land tenure, and access to basic services, including health care. In the Chittagong Hills, communities described identity and everyday life as shaped by the geography of the region, that also pushes them to the margins-a geography that is remote and difficult, and "justifies" the ii limited state infrastructure provision, the militarised violence, the confiscation of lands resulting in the loss of community livelihoods, but a geography rich in large tracts of forest and arable land, and natural sources of water-sources of sustenance for the communities. In Mindanao, a different scenario, defined by armed violence in a complex interplay of local, regional, and national conflict.Communities live in a typhoon belt, where the only certainty is uncertainty-food security issues in a region known for agricultural production and export, housing that is frequently destroyed or abandoned, and peace that is elusive-where change is only possible through informal connections with the local elite. The concerns of these communities, and of those in 7 other countries, are all synthesised in Go4Health's reports and publications targeted to the post-2015 SDG discourse.Sometimes homogenised and filtered, their voices are heard, represented in global health discourse, and even acknowledged by the UN. Yet the marginalised continue to be marginalised: politically pushed aside with promises of change with little or no follow through from state governments, their capabilities for exercising freedom of agency and well-being in contexts of structural violence are severely constrained.I conclude that representing the voices of the marginalised in wider discourse is possible. But they also need resources for critical health literacy and capability enhancement, which requires substantial change in social, political, and economic structures. Enabling the marginalised to truly speak, to have agency in their own com...

Health intersectoralism in the Sustainable Development Goal era: from theory to practice

“…Nor is there any questioning that moving forward on the Agenda requires greater intersectoral action and multisectoral collaboration. As one example, SDG 3-Good Health and Well-being-is focused on ensuring healthy lives and promoting well-being through the life course and is contingent upon reducing inequities in social, commercial, cultural, economic, environmental, and political determinants of health [1,5]. Despite broad acknowledgement of the foundational importance of intersectoral action, there remains a dearth of evidence on strategies and approaches for meaningful crosssectoral engagement and implementation of crosscutting policies specific to the SDGs [6,7].…”