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CiviC BRiCS GReen PaPeR:
MeSSaGe foR the BRiCS LeadeRS
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B R I C S
munity presented a number of new interesting ideas and recommendations for their
leaders. As a result BRICS Think Tank Council (BTTC) adopted the document —
“Towards a long-term strategy for BRICS” — suggesting five pillars of cooperation
between our five countries. The National Committee on BRICS Research (NCR
BRICS) is the key institution to coordinate the Russian BRICS expert track. It is
also coordinating the Russian involvement into the civil track and respective co-
operation path of the five countries. Thus, BRICS Civic Forum could be seen as
a natural continuation and enhancement of the work of experts. Inclusion of dif-
ferent civil society groups and stakeholders in strenuous efforts to discuss a wide
range of issues of concern to our countries will further deepen cooperation and help
specify ideas for the leaders of our countries. It is also bound to lead to a greater
understanding of the common concerns and aspirations of our peoples.
I do believe that the contribution of civil society will significantly enrich the dis
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cussions among BRICS leaders and lead to achieving nationwide consensus on
a range of burning issues in economy, politics, social interaction between state and
society.
Vyacheslav Nikonov
Chairman of the Board,
National Committee on BRICS Research
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Рекомендации гРажданского
общества лидеРам стРан бРикс
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B R I C S
Уважаемые друзья, коллеги!
В этом году Российская Федерация председательствует в межгосудар
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ственном объединении пяти стран – Бразилии, России, Индии, Китая и ЮАР.
Важность взаимодействия в рамках БРИКС сложно переоценить. Ведь имен
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но эти пять стран являются цивилизационными и культурными центрами при
-
тяжения в своих регионах. Именно они представляют собой локомотив гло
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бальных перемен, новый центр силы современного мира, постепенно перете
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кающий от развитых стран к развивающимся. Отличительной особенностью
БРИКС является собственная система ценностей, основанная на принципе
суверенитета, культурного разнообразия, укрепления роли международного
права в противовес односторонним действиям, усиления роли ООН при рас
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ширении Совета Безопасности этой Организации.
БРИКС – это инструмент глобальной исторической справедливости. При
этом «пятерка» обоснованно ставит вопросы об осуществлении коллектив
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ного лидерства, но не приемлет гегемонизм и диктат. Страны БРИКС пред
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ставляют новую модель глобальных отношений по линиям Восток-Запад,
Север-Юг, Юг-Юг, основанную на равноправии и взаимном уважении, мирном
разрешении споров и неприемлемости использовании силы и угрозы силой.
Россия инициировала диалог в формате БРИКС еще в 2006 году. Со време
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нем значение сотрудничества в рамках «пятерки» для России только возрос
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ло. В этом году наша страна инициировала еще целый ряд новых форматов,
призванных углубить взаимодействие между пятью государствами. Совсем
недавно прошел уже седьмой по счету Академический форум БРИКС, его
итоги были высоко оценены руководством пяти стран. Академическое и экс
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пертное сообщество «пятерки» представило целый ряд свежих и интересных
идей и рекомендаций для лидеров государств БРИКС. Продуктом регулярных
встреч и работы экспертов стал документ «На пути к долгосрочной стратегии
БРИКС», выработанный Советом экспертных центров. Ключевым институтом
по координации российского экспертного трека БРИКС является Националь
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ный комитет по исследованию (НКИ) БРИКС, также осуществляющий коорди
-
нацию взаимодействия гражданского общества пяти стран. Таким образом,
нынешний Гражданский Форум БРИКС является естественным продолжением
экспертной работы. Включение разных групп и слоев гражданского общества
в активную работу по всем проблемам, волнующих наши страны, позволит
еще более углубить и конкретизировать предложения руководству, приведет к
большему учету озабоченностей и чаяний наших народов.
Уверен, что вклад гражданского общества позволит значительно обогатить
дискуссии лидеров БРИКС и приведет к формированию общенациональных
консенсусов по целому ряду важнейших проблем в сфере экономики, полити
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ки, социального взаимодействия государства и общества.
Вячеслав Никонов
Председатель правления
Национального комитета по исследованию БРИКC
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B R I C S
HEALTHCARE
The right of life is an absolute right of every human being. This right is protected
by law
1
. The most important priority for the international development of BRICS
countries is the improvement of public health through increased access to health
services AND essential drugs.
The current threat to public health comprises infectious and chronic non-com-
municable disease and includes aspects of; poverty, migration flows and climate
changes which require attention through a joint financial and HR approach at the
domestic and international level.
Despite increased funding of health services in BRICS countries it still remains
insufficient (Table 1) and member states face significant challenges in this sphere,
thus working together to overcome national limitations through collaboration.
In Brazil the serious problem is the spread of HIV/AIDS, malaria, tuberculosis,
and NCDs, such as diabetes, high blood pressure etc. The biggest problem of
Russia is the death rate which is considerably higher than average. This issue is
directly connected with alcohol consumption and an unhealthy lifestyle. India faces
the problem of the access to the medical service, which links to the lack of health
financing and fast increase of urban population. Moreover, in spite of the reduction
of the neonatal and maternal morality these two indicators are still the highest in the
world. In China the number of NCDs has increased with the threat of communicable
diseases being still relevant. The main problem is to keep control over their spread.
Communicable diseases particularly HIV/AIDS is the biggest threat for South Africa
(19,1% population),2 with the inequality between urban and rural population in their
access to potable water, sanitation and hygiene, and child health coming next. Life
expectancy is the lowest within BRICS — 51,6 years.
Healthcare was not on the agenda until 2011, when leaders pledged to “strength-
en dialogue and cooperation in the fields of social protection, decent work, gen
-
der equality, youth, and public health, including the fight against HIV/AIDS”
3
. An
agreement was reached to host the first “Meeting of Ministers of Health in 2011
in China”
4
. Nowadays such meetings with BRICS Health Ministers have become
commonplace. The most recent one was held on May 19-20th, 2015 on the side-
lines of the World Health Assembly in Geneva.
Corresponding with the October ministerial summit in Moscow, experts and high
level officials in the area of cardiovascular disease, HIV/AIDS, and other health is
-
sues, came together in St. Petersburg and Irkutsk. Subsequently in Ufa, civil societ
-
1
Article 6 (1) of the International Covenant on Civil and Political Rights. Adopted by General As
-
sembly resolution 2200A (XXI) of the General Assembly on December 16, 1966
2
2015 World Development Indicators: Health risk factors and future challenges, http://wdi.world
-
bank.org/table/2.20
3
The 3d BRICS Summit: Senya Declaration. Senya, Hainan, China, April 14, 2011
4
The 3d BRICS Summit: Senya Declaration. Senya, Hainan, China, April 14, 2011
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B R I C S
ies offered insight and further input into health issues with expert recommendations
for the final declaration of the October Health ministers meeting.
BRICS in focus
5
According to the statistics of the WHO NCDs account for about 65% of deaths and
around 80% of chronic diseases nowadays kill population in LMICs. The so called “big
four” (cardiovascular diseases, cancer, diabetes, and chronic lung diseases) caused
about two thirds of all deaths in the world (or 36 million people) in 2008
6
, and it is
estimated that NCDs will cost around 47 trillion USD for the period of 2010-2030.
7
An-
other serious problem would be mental health problems and antimicrobial resistance,
which is mostly driven by changing lifestyles and rapid urbanization, gaining ground.
In 2010 about 14 million people died of NCDs in the world. While it is projected that
by 2020 this figure could surge to 49.7 million people. Non-communicable diseases
are inflicted highly on the dynamic emerging countries of BRIC countries. This leads
to the fact that around 85% in China, 81% in Russia, 75% in Brazil of people die of
chronic diseases, while African countries, South Africa included, suffer mostly of the
HIV/AIDS.
8
Also it is a fact that in low and middle income countries high death rates
of non-communicable diseases (NCD), as well as infectious diseases is much higher
than in high income countries. This is even more obvious for the rates of middle-aged
groups of population. BRICS also lead deplorably in another statistics — 40% of
those with diabetes live in China and India.
Same applies with tuberculosis cases, the same two countries also lead in that.
According to the WHO in 2013 the number of tuberculosis cases rose from 8.6 to
9 million people. In the world of tuberculosis mortality from 1990 to 2013 it fell by
45%, but from 2012 to 2013 the number of deaths from tuberculosis rose from 1.3
to 1.5 million people. More than half of all TB cases in 2013 were registered in the
BRICS countries. Of particular concern is the further increase in the frequency of
HIV-associated and multi-drug resistant tuberculosis.
Also when talking of diabetes alone, a report released by Diabetes Research
and Clinical Practice showed that China and India have largest number of citizens
with diabetes in the world — 51 and 43 million respectively.
9
Those countries also loose in terms of economic development rates — over
20 million productive life years annually to chronic disease. According to research
5
This full paragraph presents a slightly updated version of the chapter excerpt from Victoria V. Panova,
Universal Access to Health Care: Russian View of Global Health Governance Prospects in BRICS in Search
of Stability, Security and Growth: BRICS and a New World Order, eds. HHS Vishwanathan, Nandan Un
-
nikrishnan and is introduced with the consent of the author of that publication, but also editor of this volume.
6
WHO Global Health Observatory (GHO). http://www.who.int/gho/ncd/mortality_morbidity/ncd_to
-
tal/en/index.html
7
John Kirton, Laurette Dube. From New York to Cannes: Baby Steps in the Battle against Non-
Communicable Diseases. Globe and Mail, September 21, 2011. http://www.ghdp.utoronto.ca/pubs/
kirton-dube-110921-gm.shtml
8
Yanzhong Huang. The Fight Against Chronic Disease. Council for Foreign Relations. August 19,
2011. http://www.cfr.org/global-health/fight-against-chronic-disease/p25682
9
Ben Yue, Finding real wealth in health industry: Asia is revolutionizing the global medical enterprises
with cost-saving and quality measures. China Daily/ Business weekly, Monday, February 17, 2014, p. 13
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B R I C S
10% increase in chronic diseases leads to 0,5% of decrease in annual economic
growth. Thus Dr. Fineberg when talking at the Center for Strategic and International
Studies remarked that between 2005 and 2015 China, India and Russia might lose
between 200 and 550 billion USD of national income due to effects of the NCDs.
10
And the paradox of the situation is that those countries would for a long time over-
look their social sectors and healthcare systems in pursuit of the economic growth
11
,
but nowadays it comes back with the counterstroke.
It is also believed that what is especially true for Asian countries is that health-
care costs rising quicker than their respective capacity to meet those demands.
Economist Intelligence Unit published report which stated that average per cap
-
ita spending on healthcare in Asia Pacific per year rose more than twice — from
150 billion USD in 2001 to 362 billion USD in 2011 and is bound to achieve figure of
546 billion USD in 2016.
12
Progress was achieved in many cases thanks to international donors coopera
-
tion. Thus India achieved polio-free status in 2011, being one of the four last big
countries where this virus persisted (the remaining ones are Afghanistan, Pakistan
and Nigeria). Success could be attributed to the WHO polio eradication campaign
that cost 2,2 billion USD globally. But this tendency to rely too much on disease-spe
-
cific programs doesn’t lead to ameliorating the overall health systems, that prove
essential to general combat against chronic and infectious diseases epidemic.
Evolution of the health topic in BRICS deliberations
The Beijing Declaration, which underlined the importance of collaboration in the
protection of public health, was signed at the first Meeting of Ministers of Health on
July 11
th
, 2011. While reaffirming the principle role of the World Health Organization
(WHO), the Ministers also mentioned the necessity of its reform. The Beijing Declara
-
tion articulated 13 provisions on various aspects of public health to improve National
Health Service by technology exchange. The Ministers defined 3 priority areas:
“I. Collaboration to strengthen health systems and overcome barriers to access
to affordable, quality, efficacious, safe medical products, vaccines and other health
technologies for HIV/AIDS, tuberculosis, viral hepatitis, malaria and other infectious
diseases and non-communicable diseases.
II. Collaboration to explore and promote, where feasible, effective transfer of technol-
ogy to strengthen innovation capacity to benefit public health in developing countries.
III. Collaboration with and support of international organizations, including WHO
and UNAIDS, the Global Fund to Fight AIDS, Tuberculosis and Malaria and the
GAVI alliance, to increase access to affordable, quality, efficacious and safe medi
-
cines, vaccines and other medical products that serve public health needs.”
13
10
Margaret Reeves. Dr. Harvey Fineberg speaks at CSIS. February 3, 2011. http://www.smartglob
-
alhealth.org/blog/entry/dr.-harvey-fineberg-speaks-at-csis/
11
Huang, Yanzhong, “The Sick Man of Asia: China’s Health Crisis,” Foreign Affairs, November 2011,
90(6), pp. 119-136.
12
Ben Yue, Finding real wealth in health industry: Asia is revolutionizing the global medical enterprises
with cost-saving and quality measures. China Daily/ Business weekly, Monday, February 17, 2014, p. 13
13
BRICS Health Ministers' Meeting: Beijing Declaration. Beijing, China, July 11, 2011