By Cecilia Russell
BANGKOK & JOHANNESBURG, Jul 19 2023 – Countries with falling population growth face twin dilemmas: Ensuring their aging population live healthy and fulfilling lives and removing barriers to parenthood.

This was the focus of a recent workshop in Thailand reviewing the ICPD30 process and preparation for the Summit for the Future slated for next year (2024).

The workshop was opened by Professor Keizo Takemi, MP Japan and Chair of AFPPD, who contextualized the issue.

“In the Asia Pacific region, a profound shift awaits us. By 2050, one in four individuals will be about the age of 60, with a majority of them being women. The empowerment and the well-being of these women become essential for their meaningful and independent participation in the socio-economic development.”

The meeting sought to highlight what is required from lawmakers to ensure a dynamic and balanced aging society where older people will be physically, mentally, and economically self-reliant as possible, with a sustainable healthcare system.

Dr Rintaro Mori, Regional Adviser, Population Ageing and Sustainable Development at UNFPA, in an interview with IPS, said parliamentarians’ role included “macro level policy planning to prepare for the coming population aging and low fertility including both economic and human rights perspectives.”

Their role was to lead the governments’ reform policies and systems of the country to adjust for “the emerging population trend, such as pension reform and education sector reforms to accommodate all ages,” and “investing in early and later years to take preventative measures to improve social security, health, and well-being.”

Mori said this was possible using a life-cycle approach with a strong emphasis on prevention:

“Prevention is the most cost-effective way to promote healthy and active aging. Life-long investment in social security, health promotion, and psychological well-being (relationship) is the key.”

Parliamentarians and experts met in Bangkok to discuss the ICPD30 process and preparation for the Summit for the Future 2024. Credit: APDA

Boosting fertility was crucial for countries facing declining and aging populations. Dr Victoria Boydell from the University of Essex in the UK said it is vital to remove barriers to parenthood but not through the trend of reducing access to sexual and reproductive health services.

According to research by UN Women and the International Labour Organization, 1.6 billion hours a day are spent in unpaid care work – representing 9 percent of global GDP, and women carry out at least two and a half times more unpaid household work than men. These factors needed to be considered by lawmakers.

Boydell said policy responses to boost fertility and remove barriers to parenthood included supporting early childhood development, enrollment in quality childcare from an early age, compensation for the economic cost of children through the allocation of benefits, tax exemptions, and other subsidies.

Other practices include fostering employment, especially amongst mothers, for example, part-time and flexible working conditions, promoting equal pay, equal sharing of paid and unpaid work, and allocating benefits to low-income families.

Regarding SRH services, there could be an increase in access to infertility treatment, fertility targets and policies to support the higher number of children, cash or tax exemptions, and access to contraception and abortion. Choice was a key right that needed protection.

In a case study, Chalermchai Kruangam, an MP from Thailand, said it was expected that a growing number of older people would need institutional long-term care – with considerable costs to the fiscus. It was, therefore, crucial to encourage governments and stakeholders to support modifications of living arrangements for older people and provide access to knowledge and training on new technologies, particularly digitalization and information technology. This would ensure that older people remained independent for longer periods, especially if supported health facilities near their homes.

Willie Mongin, an MP from Malaysia, said governments needed to formulate and implement necessary measures to ensure that social systems are ready to meet the older adult’s needs, improve their lives and the well-being of their families and communities – so they can live their lives with dignity. With the World Bank, Malaysia was formulating a strategic plan or blueprint to address an aging population’s impact, including economic growth, productivity, social protection, and health care.

Mori told IPS it was important to note that “older persons are a quite diverse population. Some of the wealthiest persons are among the older population. The health status of older persons is quite different depending upon the individual. Any country should have basic social security infrastructure based on the needs and demands of the population, not solely on the age of a person.”

He also said governments should take into account the older persons’ diversity in their plans to, for example, encourage them to remain in the workplace beyond traditional retirement ages.

“The health, skills, and knowledge of older individuals are diverse, and governments should not plan such economic and labor market policies based on the assumption that older persons are homogenous, Mori said. Recently in Japan, trends show that small and frontline jobs seem to be suitable for older persons (Sakamoto 2022).

Note: The workshop was organized by the Asian Population and Development Association (APDA) and supported by the United Nations Population Fund (UNFPA)

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By Abigail Van Neely
UNITED NATIONS, Jul 19 2023 – The Ukrainian Minister of Foreign Affairs, Dmytro Kuleba, held up a child’s glittery, crimson-red diary as he addressed the Member States at the 88th plenary meeting of the General Assembly on Tuesday.

The regularly scheduled event was set to discuss “the situation in the temporarily occupied territories of Ukraine.” Many speakers took the opportunity to address the recent termination of the Black Sea Grain Initiative and the humanitarian toll of Russia’s war in Ukraine.

Kuleba centered his remarks on an emotional appeal to protect Ukraine’s 7.9 million children the Russian invasion had “deprived” of their normal lives. He shared a series of diary entries he said were written by Ukrainian children.

One eight-year-old boy in blockaded Mariopole writes bluntly about the deaths of his family members. A 13-year-old girl, who has been living in occupied territories for four months, writes about her fear of leaving the house. “Mom tells us not to go for a walk in places where they are many people because many girls get raped,” Kuleba read.

“There are thousands of children like this who go through the same suffering,” Kuleba said as he held the diary in the air, where it sparkled.

Throughout the ongoing High-Level Political Forum at the United Nations, the war in Ukraine has been repeatedly cited as one reason the world is failing to make progress on the sustainable development goals set for 2030.

“This war is intrinsically linked to our sustainable development agenda and the sustainable development goals,” the President of the General Assembly, Csaba Kőrösi, said.

Goal ten addresses the dire support needed for refugees. An update on the sustainable development goals released by the UN last week reports that the number of global refugees has hit a record high of 34.6 million. 41% of these refugees were children.

According to Kuleba, only 383 of Ukraine’s 19,474 illegally transferred children have been reunited with their families. He called for a joint demand that Russia “immediately provide the list of children from Ukraine and grant access to them for international human rights and monitoring missions.” Kulebal also encouraged the development of new international instruments to punish the taking of civilians as hostages.

He concluded with a commitment to ending the war through Ukrainian victory: “This war needs to be won. Unfortunately, on the battlefield, and at a high cost so that the aggressor drops plans…”

Péter Szijjártó, the Hungarian minister of Foreign Affairs, focused on achieving peace through diplomacy rather than battle to mitigate skyrocketing inflation, food scarcity, and energy demands felt by people around the world—additional threats to the sustainable development goals.

Szijjártó suggested that grain from Russia and Ukraine be transported through Central Europe, where countries like Hungary would help prevent food shortages. This would offer an alternative to the Black Sea Grain Initiative, which allowed for the transportation of goods across the Black Sea to Turkey until its termination by Russia yesterday.

“We do not only keep the opportunity open for transiting Ukrainian grain through Central Europe, we have invested in huge infrastructural development in Hungary to increase the volume of grain from Ukraine [to reach other ports] where they can be shipped to Africa and Middle East countries where this grain is badly needed,” Szijjártó said.

Dmitry A Polyanskiy for the Russian Federation, meanwhile, described injustices experienced by Russian-speaking civilians in Crimea under Ukrainian governance. He called leadership in Kyiv a “puppet regime” of the West and criticized lies about Russia in “contemporary Western society.”

“Colleagues in developing countries have a clear understanding of what is taking place,” the representative said, referring to what he said was a “colonial tradition of pitting countries against each other.”

Kőrösi expressed disappointment at the Security Council’s failure to adopt any resolutions regarding the war in Ukraine, noting the General Assembly’s passage of six resolutions in support of Ukraine. He condemned ecological warfare, the targeting of civilian infrastructure, and the “consistent and systematic violations of international law.”

“This war constitutes a serious threat that risks jeopardizing the prospects for a sustainable future for humanity and the planet,” Kőrösi said.

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By Catherine Wilson
SYDNEY, Jul 19 2023 – The Canada-based Ocean Frontier Institute is very clear about the significance of a new collaborative ground-breaking ocean research program. Global warming cannot be effectively tackled, and human life cannot survive on Earth without the ocean.

The ocean covers more than 70 percent of the planet’s surface and absorbs 25 percent of carbon dioxide emissions from the atmosphere, yet there is a critical lack of understanding about the changes occurring in the seas as greenhouse gas emissions increase.

“The ocean has absorbed 90 percent of the excess heat from the atmosphere, but will that continue? We know the ocean is a big factor in climate, but we need a much better level of detail to understand how the ocean is functioning now and how will that change in the future.” Dr Anya Waite, CEO and Scientific Director of the Ocean Frontier Institute told IPS.

The Institute was established by Dalhousie University, Nova Scotia, on Canada’s east coast in 2015 to accelerate global leadership in ocean research with a focus on the North Atlantic Ocean and Arctic Gateway. On 12 May 2023, it launched the Transforming Climate Action (TCA) research initiative with its academic partners, Université du Québec à Rimouski and Université Laval in Quebec and Memorial University in Newfoundland and Labrador.

The Institute describes it as “the most intensive investigation ever into the ocean’s role in climate change.” And it seeks both knowledge breakthroughs and climate action solutions in association with Indigenous communities, including the Mi’kmaq people, custodians of indigenous land and knowledge on Canada’s Atlantic coast.

Youth host Nesha Ichida gathering fish samples in Raja Ampat, Indonesia. Credit: Nick Hawkins/Ocean Frontier Institute

“Our relationship with the ocean is an ancient one built on balance, respect, and knowledge passed down from generation to generation,” stated Angeline Gillis, Executive Director of the Confederacy of Mainland Mi’kmaq, at the program’s launch. “It will provide a unique opportunity to bring together our common experiences and understandings of the ocean in a partnership that will ensure we move towards a sustainable future for our children.”

Coastal communities in Canada have long depended for generations on the sea and coastal marine life for food, culture and socioeconomic survival.

The world’s ocean is the greatest form of protection against an overheating planet. It removes more carbon dioxide from the atmosphere than all the rainforests and stores 90 percent of the excess heat generated by greenhouse gas emissions. A critical marine organism, phytoplankton, captures carbon dioxide from above the sea’s surface and circulates it to the deep ocean, where it is stored for millennia. And, so, the ocean moderates the effects of global warming and, in turn, determines climate and weather patterns while generating 50 percent of the oxygen we need to breathe.

But, as global temperatures keep rising, scientific data collected from a vast network of submergible floats scattered across the ocean indicates that there are changes occurring in the sea as the amount of carbon dioxide it takes in endlessly grows. This year, scientists recorded the highest temperature of the world’s ocean in 40 years. Waite says there are warning signs about a possible decline in the health of the ocean and its ability to regulate our climate to safe levels.

“We know extreme climate events are becoming more common. The probability is that there will be more extreme events in the future, but climate modellers are currently not able to predict them,” she said.

Fanny Noisette, Professor of Biological Oceanography at the Université du Québec à Rimouski, told IPS that she had witnessed severe levels of deoxygenation in the bottom waters of the sea near the coastal town of St. Lawrence on the Burin Peninsula. This has resulted, for example, in shoals of Northern Shrimps migrating from the deeper ocean to shallower coastal areas where oxygen is more readily available, she said.

“The decrease in some species abundance, such as Northern Shrimps, could lead to the transformation of economic activities and sources of revenue in local coastal communities,” Professor Noisette predicted, adding that “these environmental changes are superimposed on to other local disturbances already happening in coastal zones, such as pollution and invasive species. Management of coastal zones will need to be more rooted in holistic and ecosystem-based approaches.”

The North Atlantic Ocean, which is the largest oceanic carbon sink, is a critical site for climate-oriented research, and the TCA program will draw on the expertise of many disciplines, from oceanography and atmospheric science to maritime law, social science and justice to Indigenous knowledge. It will also include collaboration with 40 national and global partners in industry, government and the non-profit sector.

The program will strive to generate new scientific data that will be critical to making better decisions about climate action. And identify more effective solutions for the planet’s survival, including the development of new technologies to remove the build-up of carbon dioxide in the sea.

Scott Simpson filming Jordan Wilson and Nicola Rammell of the John Reynolds Lab near Bella Bella, British Columbia. They were doing an experiment to see how salmon impact flower growth in estuaries. Zan Rosborough is recording sound. Credit: Nick Hawkins/Ocean Frontier Institute

Helen Zhang, Canada Research Chair of Coastal Environmental Engineering and Professor of Civil Engineering at Memorial University in St. John’s, Newfoundland, told IPS that micro-algae will be critical to this goal. “Micro-algae widely exist [in the ocean] and have the robust capacity to employ a carbon dioxide conversion factory in the cold marine environment, such as the North Atlantic and Arctic gateways,” Zhang explained. Micro-algae convert carbon dioxide to biomass, which “can then be used to generate bio-products, such as bio-surfactants and biofuels, that can support the growth of various ocean industries, such as transportation and fisheries, as an alternative energy source.”

If global warming is not contained, scientists predict that higher sea temperatures will generate more severe marine heat waves, acidification of seawater and bleaching of coral reefs. That, in turn, will have detrimental impacts on marine life, their habitats and ability to breed. Therefore, removing toxic carbon dioxide from the ocean is essential to its long-term health, the survival of marine life and the sustainable lives of coastal communities. Nearly 10 percent of the world’s population, or more than 680 million people, live in low-lying coastal areas of continents and islands.

While global unity and action to limit the planet’s temperature rise to 1.5 degrees Celsius remain in limbo, the Ocean Frontier Institute and its partners are forging ahead with a clear vision and timeline of action. That leadership is fully backed by the Canadian Government, which has contributed $154 million to the ‘Transforming Climate Action’ program through its Canada First Research Excellence Fund. In total, about $400 million has been committed to the TCA research program. And, in line with Canada’s national goal, the Institute is focused on achieving net zero carbon emissions by 2050.

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By Kwan Soo-Chen and David McCoy
KUALA LUMPUR, Malaysia, Jul 19 2023 – For years, the concept of climate justice has been built on the understanding that countries and communities contributing the least to global warming are disproportionately bearing the impacts of climate change.

For example, developing countries have been more affected by climate events due to their existing vulnerabilities and limited capacities to respond – eight out of the top ten countries most affected by climate extreme events from 2000 to 2019 were developing countries, where six were located in Asia.

Based on the principle of equity, climate justice was embedded in the UN Climate Convention in 1992 through principles of “polluter pays” and “common but differentiated responsibilities and respective capabilities”, placing responsibilities to combat climate change on the richer nations.

However, the lack of effective mechanism to operationalize these principles remains an issue to this day. Discussion on “loss and damage” was revived in COP27 in reaction to the failure of developed countries to fulfil their pledge to climate financing to help vulnerable states with climate actions.

While there is currently no clear definition for “loss and damage”, the term essentially refers to the much-contested obligations of countries that have historically benefited from fossil fuel investment to pay for the residual consequences and permanent damage caused by climate change to nature and human societies, predominantly in the developing countries.

Loss and damage encompass both economic and non-economic losses. While economic losses cover damage to resources, physical assets and services; tangible or intangible non-economic losses hold a larger share of the loss and damage, including the impact on individuals (loss of life and health, mobility), societies (loss of cultural heritage, identity, indigenous knowledge), and environment (loss of biodiversity and ecosystem services).

Climate justice and the right to health

Health is the most essential asset of human beings. However, population health, particularly of poor communities in developing countries, is increasingly threatened by the environmental and social changes brought by climate change. This brings in a different outlook on climate justice through the human rights lens.

As health is underpinned by various social and environmental determinants, such as air, water, food, housing and development, the impacts of climate change on those determinants are infringing the fundamental human right to health.

While the Constitution of the World Health Organization (WHO) in 1946 emphasizes the entitlements to equal opportunities to enjoy the “highest attainable standard of health” without discrimination to “race, religion, political belief, economic or social condition”, climate change is exacerbating the existing health inequity and vulnerabilities across the structural social hierarchies, making the progressive realization of the highest attainable standard of health increasingly difficult. This is particularly true among the traditionally discriminated and marginalized communities.

For example, while climate change affects everyone, the health of Indigenous communities is especially vulnerable to climate change due to their close relationships with nature (many Indigenous peoples still rely directly on nature for their basic necessities) and their social and economic marginalization.

In addition, there is emerging evidence showing mental distress among indigenous communities due to the threats upon their culture, identity and sovereignty as they lose or are forced to migrate from their traditional territories due to environmental changes.

Along the same lines, while men and women are affected differently by climate change, women face greater health risks and vulnerabilities due to their particular health needs (e.g. in maternal and reproductive health), household and caregiver roles (e.g. water and food preparation), and underlying gender gaps in access to supports such as resources and critical information that affect their capacity to respond effectively to climate variability, especially in rural and remote areas.

Children and the elderly are also disproportionately affected by the direct and indirect impacts of climate variability on temperature, air quality and food sources due to their unique physiology.

Marginalized groups such as indigenous people and women have often been excluded in decision-making processes concerning climate actions that could affect their health and well-being. Nonetheless, they could be important agents of change while promoting health equity in climate mitigation and adaptation.

For instance, indigenous knowledge on sustainable management and conservation of the environment is a valuable resource. While gender equity in climate actions are increasingly recognized and incorporated in climate finance, youths are at the forefront of climate advocacy fighting for the intergenerational rights to their future well-being.

Climate litigation – a way forward?

On this front, various efforts have been made to call for the acceleration of climate actions around the world. In the past years, advocacy campaigns, strikes, public demonstrations, and activists’ protests have been increasingly reported across media platforms, lobbying for countries to fulfil their climate pledges. Although some progress has been made, they are not enough to catch up with the fast-rising global temperature.

Increasingly individuals and non-governmental organizations are turning to climate litigation as part of the social movements, using human rights law as a strategic instrument to enforce climate actions.

Since the Paris Agreement in 2015, the number of climate change-related lawsuits has doubled from just over 800 cases (1986 -2014) to over 1,200 cases (2015 – 2022), with most cases based in the Global North (particularly in the US) and a growing number of cases from the Global South.

Human rights law offers strong grounds for litigation against states as states hold the primary responsibility and duty to protect human rights. At the European Court of Human Rights, three climate cases are pending before the Grand Chamber of the Court.

Among others, the climate cases were made on the grounds of the human rights violations of the right to life (Article 2), and the right to respect for private and family life (Article 8) as enshrined in the European Convention of Human Rights.

Across Southeast Asia, increasing number of environmental conflicts leading to lawsuits have been documented, prominently in countries like Thailand, Indonesia and the Philippines. Plaintiffs were often communities, non-governmental organizations and civil societies, with cases grounded on state governments’ failure to fulfil treaty obligations (Paris Agreement) and reduce carbon emissions; and corporations’ environmental destructive activities such as illegal logging and peatland burning that violate the human rights to life and healthy environment.

At the local level, government agencies have been sued over their failure to perform duties in ensuring environmental and social protections through governance mechanisms, such as the lack of transparency of environmental impact assessments for project development and inadequacy of environmental standards (e.g. air pollution standards) in protecting citizens’ health.

However, there remain issues of enforcement and jurisdictional limits within the international politics to be dealt with in climate litigations. Besides, lawsuits against governments could be counter-productive if states have limited capacity to respond. Nonetheless, a court proceeding is a catalyst to bring up the longtime debate on climate justice and enforce actions among those held accountable.

Interestingly, a recent study found that these litigation processes are posing financial risks to the polluting carbon majors companies as their market share prices fell after lawsuits.

In addition, the recent advancements on the recognition of human rights in the context of climate change look promising. In June 2022, the UN General Assembly passed a resolution recognizing the human right to a clean, healthy and sustainable environment, and in March 2023, another UN resolution, led by Vanuatu, was passed to secure a legal opinion from the International Court of Justice (ICJ) on states’ accountability and consequences for inaction in the first attempt to establish climate action obligations under international law.

As the establishment of international legal rules are influential on judges and governments, it is hopeful that these efforts will build the momentum in countries’ commitments to climate actions in all member states. The role of civil societies as climate watchdogs remains fundamental in ensuring effective actions are followed through in the quest for climate justice.

Kwan Soo-Chen is a Postdoctoral Fellow and David McCoy is a Research Lead at the United Nations University International Institute for Global Health (UNU-IIGH)

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By Jomo Kwame Sundaram and Nazihah Noor
KUALA LUMPUR and BERN, Jul 19 2023 – In 2015, almost all heads of government in the world committed to the United Nations’ Sustainable Development Goals (SDGs), including universal health coverage (UHC). This was consistent with the World Health Organization’s commitment to Health for All.

The COVID-19 pandemic exposed most countries’ under-investment in public healthcare provisioning and other weaknesses. Clearly, health system reforms and appropriate financing are needed to improve populations’ wellbeing.

Jomo Kwame Sundaram

Instead of helping, more profit-seeking investments and market ‘solutions’ in recent decades have undermined UHC. Health markets the world over rarely provide healthcare for all well. Instead, they have increased costs and charges, limiting access. Worse, public funds are being diverted to support profits, rather than patients.

Health inequalities growing
Recent decades have seen healthcare in many developing countries trending towards a perceived two-tier system – a higher quality private sector, and lower quality public services. Many doctors, especially specialists, have been leaving public service for much more lucrative private practice.

This ‘brain drain’ has worsened already deteriorating public service quality, increasing waiting times. Hence, more of those with means have been turning to private facilities. As private medical charges are high in developing countries, many who can afford private health insurance, buy it.

If unchecked, the gap – in charges and quality – between private and public health services will grow, increasing disparities between haves and have-nots. Social solidarity implies cross-subsidization in health financing – with the healthy financing the ill, and the rich subsidizing the poor. Social solidarity also enables universal coverage and equitable access.

Better healthcare for all
Most governments need to strengthen public provisioning of comprehensive health protection with adequate financing. Meanwhile, healthcare costs have gone up due to more ill health, the rising costs of new medical technologies, privatization and less public procurement.

Everyone – nations as well as families – faces more unexpected health threats, worsened by rising catastrophic and other medical expenses, more economic vulnerability, greater income insecurity, declining public provisioning, and costlier coping strategies.

Nazihah Noor

‘Premature’ death, disability and illness have meant losing billions of years of healthy life, largely due to preventable non-communicable diseases (NCDs). Although they cause many health losses, relatively little public health spending goes to NCD prevention.

Spending and outcomes
Most countries, including in the developing world, have seen rising healthcare spending. But there is no direct relationship between health expenditure and wellbeing. Hence, more spending does not ensure better outcomes, whereas appropriate public healthcare provisioning does.

Although health spending has been rising in many developing countries, it has generally remained low in relation to income. Government health services were already facing fiscal constraints before the pandemic. To cope with COVID-19, public health expenditure in many middle-income countries spiked.

Chronic underinvestment in public services has undermined healthcare overall. Many underfunded systems have nonetheless improved health conditions, reducing morbidity and mortality. Decent health outcomes, despite relatively low health spending, imply greater public expenditure ‘cost-effectiveness’ or efficiency.

Nonetheless, much more could be achieved with better policies, increased spending and more appropriate priorities. Thus, reducing child and maternal mortality, besides improving sanitation and water supplies, have significantly raised life expectancy in developing countries.

Improving policy
To enhance wellbeing, health systems must better protect people from current and future threats and challenges. Better public healthcare financing – with absolutely and relatively more, but also more appropriate funding – seems most important.

Developing country governments are often fed oft-repeated, but doubtful claims that current government healthcare spending is too high, and health insurance is necessary to fill the funding gap. Instead, official revenue should mainly fund health budgets to ensure efficiency and equity.

Health promotion should involve more preventive efforts. By mainly focusing on curative interventions, most government spending and policy priorities neglect determinants of wellbeing, including inequities. Some WHO recommended policies deemed most cost-effective target tobacco products, harmful alcohol use and unhealthy diets.

Policy coherence
To better address overall wellbeing, a more comprehensive and integrated approach should integrate health with related public policies. Affordable healthier food options, physical exercise and healthier lifestyles deserve far greater emphases.

For example, a cheap, but nutritious, safe and healthy daily school feeding programme in Japan – introduced a century ago, when it was still quite poor – has ensured life expectancy in the archipelagic nation has been the world’s highest for decades.

An ‘all-of-government’ approach should ensure meals planned by dieticians, mindful not only of good nutrition, but also of local food cultures, costs, safety and micronutrient deficiencies. With a ‘whole-of-society’ approach, involved parents can ensure schoolchildren are fed safe food from farmers not using toxic pesticides.

This can be ensured with the food or agriculture ministry’s participation. Farmer organizations can be contracted to supply needed foodstuff with initial support from government agricultural extension services, not corporate salesmen. This, in turn, improves the safety of all farm produce, ensuring healthy food for all.

Health reform recommendations should prioritize governments’ major commitments – to the people and the international community – of ‘universal health coverage’ to ensure ‘health for all’.

Nazihah Noor is a public health policy researcher. She led two reports on health system issues in Malaysia, Social Inequalities and Health in Malaysia and Health and Social Protection: Continuing Universal Health Coverage. She is currently pursuing a PhD in public health in Switzerland.

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