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COVID-19 and RMNCAH and Nutrition: “Build Back Better”

COVID-19 and RMNCAH and Nutrition: “Build Back Better"
DEBRA JACKSON: Welcome to the last week of the MARCH massive online course. Congratulations getting this far. I’m Professor Debra Jackson, Takeda Chair in Global Child Health, recently joined the London School in August. And I’ve been the one who’s added the COVID-19 pieces to each of the weeks. So, this week, as our last and final week, I wanted to talk more about collateral damage and building back better. We’ve seen how COVID has impacted our system and laid bare our deficiencies, particularly, in health systems and response resiliency. And so, also– but it’s also presented some innovative opportunities. So I’m going to just speak quickly about them.
In a recent report by the Gates Foundation Goalkeeper, which monitors our progression towards achieving the Sustainable Development Goals, they noted that, because of COVID, we’ve been set back about 25 years in about 25 weeks, noting that this is a mutually exacerbating catastrophe, not only the disease itself, but the government’s moving resources to address the pandemic. And the IHME found that 2020 coverage is dropping to levels last seen in the 1990s. So one of the important questions is how quickly can countries catch back up and start making progress. And we also know that the hardest hit will be needing support. So, in this lecture, I’m going to speak really about broader social determinants of health.
I don’t know how many of you have seen this particular cartoon, but I really liked it because, while COVID-19 has reaped disaster across the world, it’s also causing a major recession, which, as we know, also very much impacts health and sets our goals back. But, behind that, even a bigger problem is climate change. And so, when we think about addressing COVID, addressing the recession, we have to think about climate change. So, the global economy, the growth is projected at minus almost 5% in 2020. And the pandemic has had more negative impact on activity in the first half of 2020 than was anticipated and could push half a million people into poverty globally.
And, for climate change, there’s been the bads– delays in COP26, international regulations, negotiations, and research, weakening of policies and regulations, more plastic and cars, as people are using public transportation less. But, for the better, we’ve seen a green recovery in many countries– renewable energy extension, more walking, biking, and, as we all know, less international and air travel, which is why all this work is online.
Colleagues Guerriero, Haines, and Pagano, in Nature Sustainability, have written about what we’ve seen in the drop in the economy. You can see very hard in Q2 of 2020 and a slow recovery, but the concern is that, as in previous crises, governments often have a narrow focus on fighting the recession and that this could have adverse effects on the environment and health if they just try to do something quickly. And they suggest that health and economic sustainability should be at the heart of any economic reform to address the pandemic recession. Moving back to climate change, I’m sure many of you have seen these photos on the left.
That is Mount Everest viewed from North India, which has not been visible for many, many, many years due to pollution. And you can see even the sort of carbon dioxide and nitrogen dioxide pollutants across India, the orange being hot spots. And you can see how those have substantially reduced between the first quarter of 2020 and then March, April 2020, so in a very short time. And you can see the CO2 emissions on your right, how they dropped precipitously in April and May, and are– but are rising again back up to pre-COVID levels. So what this shows is that it is possible to reduce greenhouse gases.
The World Health Organisation, in May 2020, actually released a manifesto for a healthy, green recovery, taking into account health and climate change. And prescriptions for a health, green recovery they say are to protect and preserve the source of human health, nature, invest in essential services, including water, sanitation, clean energy, and health care, ensure a quick healthy energy transition, promote healthy sustainable food systems– and you heard about those last week– building healthy and livable cities, and stop using taxpayers’ money to fund pollution, such as the petrol industry and others. And so these are things that we should be thinking about, as health professionals, as we start to recover from this pandemic.
So one interesting development is that we have seen that Africa has had a better, in some ways, COVID-19 response than North America, than Europe. And many people are wondering about this. Why is this true? And, obviously, there are some theories around lower age population demographics, also, experience in handling former outbreaks, such as Ebola, which– and, also, the fact that they had– the CDC, Africa CDC, has been quite good at multilateralism and coordinated responses. And so there’s still a huge concern for Africa, but it is a nice development that, for once, we are seeing some good news coming out of Africa and the fact that we need to also learn from our colleagues in the South.
What we know for sure is that universal health care, primary health care, and resilient health systems are needed now and in the future to both address current COVID collateral and mitigate the impact of COVID, but also for future, preparation for future pandemics or epidemics or other natural disasters.
We can see here that, when we’re thinking about mothers and children in the middle, and we’re looking for every girl and boy to survive and thrive, we have to think about the front-line health workers, the primary level, the district, the supply chain, and our primary health care and universal health care systems, but we also have to think about communities, social networks, local governance, justice, education, and, underlying it all, as we’ve been discussing, food systems, water, sanitation, and a healthy environment. So we must remember all of these pieces, as we try to build back in our COVID response. So how do we build back better? The first thing I think we need to think about is equity or social justice.
So we talk about– and many of you have probably seen this little cartoon on the left that equality is when we give everyone the same thing, but that’s not justice or social justice, and it’s not equity. Equity is where people are assisted according to their need. And so, when we think about COVID-19 collateral measurement and mitigation for mothers and children, we must think about equality, equity, social justice, economic development, climate change, but we also have to think about healthy communities, collaboration and accountability, health systems and resilient health services, and we also need to look at innovative technologies and programmes for improving programming. So, finally, today, I want to present something to you by Kelly et al.
on practical social justice in the COVID-19 global response. The first is they recommend self-determination and agency. Uphold and respect and develop contextually relevant public health and other innovations. We have to think things about giving a priority to the poor and the marginalised who have the least capacity to absorb the shocks. We have to think about equity in health care provision. We must protect and expand health and welfare safety nets. We must have improvements in standards of care, but it should not come at the expense of essential care and routine health and other services.
We know that outbreaks can worsen existing vulnerabilities due to racism, social inequality, and have increased distrust in society, which we’re seen extensively in the US, possibly in Britain, but we’re starting to see it in some of our– some other countries such as some of the recent unrest in Nigeria. And so this is a real concern. How do we build back trust in health care, in government, in our systems and our communities? So what’s important is that all countries are currently making decisions based on imperfect and rapidly emerging information. Research is rapid. And we’re having to make decisions before research is complete, but we will be more resilient if we’re acting together in cooperation and not in isolation.
And so we must work all together as a message coming from authors, experts, and, also, our colleagues in some countries that are doing well, such as in Africa. So I want to thank you for your attention and participation in this MARCH MOOC. And, at the top there, if you’re interested in resources on maternal, child, adolescent health from the World Health Organisation, there’s a link there for data on COVID-19 data, COVID-19 guidances. And that can assist you in your efforts to assure the health and welfare of women, mothers, children, adolescents, across the lifespan and to address COVID and, also, mitigate the impacts on our communities and our societies. So thank you.

COVID-19 has laid bare our deficiencies in both high income and low-middle income countries.

As a global pandemic, COVID-19 has impacted all countries politics, economics, policies, and services, not just health. It has exposed existing racial, economic and social disparities. We have seen the most vulnerable be disproportionately affected by the pandemic as highlighted by other speakers in this session. Loss of income and decreased food security have highlighted the failings of our safety nets. Poor health and poor access to quality health services in historically disadvantaged populations continues and compounds the impact of COVID-19. COVID-19 however, has also presented us with a great opportunity to address a range of issues beyond just health services – too look to social and economic justice as a key to “Health for All” and to achieving the 2030 Sustainable Development Goals.

The severe strain on our global lives has spurred renewed efforts, such as Black Lives Matter, to address social and economic injustices. New or adapted technology and innovations are being leveraged to address challenges to health, nutrition, education and other systems and services. Even climate change has seen benefits of reduced human impact on pollution and energy consumption. How can we capitalize on these opportunities for MCH populations and our wider societies? The world is discussing how can we “build back better”? This session will highlight these issues to spur discussion and commitment for mothers and children in the era of COVID-19 and beyond.

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