Comment www.thelancet.com Vol 375 May 1, 2010 1505 poor people also lack access to essential medicines, which is an inexpensive way to treat common infections. For example, intestinal worm and bacterial infections can be treated in a short time for a relatively low sum. Public health emergencies, such as influenza A H1N1, underscore the crucial need for fair allocation. Mass disasters almost inevitably lead to scarcity caused by limited supply and a surge in demand. Governments face intense pressure to protect their own citizens during mass disasters, leaving the poor vulnerable as the rich stockpile life-saving vaccines and medicines. Biological interventions have limited effect because they treat only specific diseases. What is truly needed, and which richer countries instinctively do for their own citizens, is to meet basic survival needs—services essential to restoring human capability and functioning. Basic needs include sanitation and sewage, pest control, clean air, potable water, tobacco reduction, diet and nutrition, health education, and well-functioning health systems. 9 The Millennium Development Goals and the right to health both support the basic needs approach. 1 The scientific consensus is that climate change is anthropogenically forced and affects ecological systems and public health. Climate change disproportionately affects the most vulnerable. Yet, international negotiations still focus more on environmental degradation and species reductions than on human health. In the interests of global justice, the international community should not only mitigate further climatic changes, but also implement adaption strategies that enhance resilience. Disadvantaged populations live on the edge and lack the capacity to ameliorate the devastating effects. Rancorous disagreements marked the Copenhagen summit, with protesters demanding “climate justice”. The non-binding accord calls for $30 billion in aid allocated between mitigation and adaption. The UN previously established adaption funds, but thus far developed countries have pledged only $300 million, which is seriously inadequate. The international community must do more than lament ongoing, unconscionable health inequalities. It must act boldly and with a shared voice, such as through a global plan for justice. If the world does not act, the avoidable suffering and early death among the world’s least healthy people will continue unabated—a breach of social justice that is no longer ethically acceptable. Lawrence Gostin O’Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC 20001, USA gostin@law.georgetown.edu I declare that I have no conflicts of interest. 1 Committee on Economic, Social and Cultural Rights. General comment 14: the right to the highest attainable standard of health. Aug 11, 2000. http:// www.unhchr.ch/tbs/doc.nsf/(Symbol)/40d009901358b0e2c1256915005 090be?Opendocument (accessed Jan 4, 2010). 2 World Health Assembly. Reducing health inequities through action on the social determinants of health. May 22, 2009. http://apps.who.int/gb/ ebwha/pdf_files/EB124/B124_R6-en.pdf (accessed Jan 4, 2010). 3 WHO. Final report of the Commission on Social Determinants of Health. 2008. http://www.who.int/social_determinants/thecommission/ finalreport/closethegap_how/en/index1.html (accessed Jan 4, 2010). 4 Ravishankar N, Gubbins P, Cooley RJ, et al. Financing of global health: tracking development assistance for health from 1990 to 2007. Lancet 2009: 373: 2113–24. 5 Ooms G, Hammonds R. Correcting globalization in health: transnational entitlements versus the ethical imperative of reducing aid-dependency. Public Health Ethics 2008; 1: 154–70. 6 General Assembly of the United Nations. International development strategy for the Second United Nations Development Decade—UN General Assembly Resolution 2626 (XXV). Oct 24, 1970. http://daccess-dds-ny.un. org/doc/RESOLUTION/GEN/NR0/348/91/IMG/NR034891. pdf?OpenElement (accessed Jan 4, 2010). 7 WHO. Essential medicines. 2010. http://www.who.int/medicines/services/ essmedicines_def/en/index.html (accessed Jan 4, 2010). 8 Wolfson LJ, Gasse F, Lee-Martin SP, et al. Estimating the costs of achieving the WHO-UNICEF Global Immunization Vision and Strategy, 2005–2015. Bull World Health Organ 2008; 86: 27–39. 9 Gostin LO. Meeting basic survival needs of the world’s least healthy people: toward a framework convention on global health. Georgetown Law J 2009; 96: 331–92. IHP+: little progress in accountability or just little progress? The International Health Partnership+ (IHP+) was launched in September, 2007, “to better harmonize donor funding commitments, and improve the way international agencies, donors, and developing countries work together to develop and implement national health plans”. 1 IHP+ signatories (panel) also pledged to evaluate and report their work in line with commitments in the IHP+ Global Compact, 2 the Paris Declaration on Aid Effectiveness, 3 and the Accra Agenda for Action. 4 IHP+ Results, an independent consortium, did the evaluation. 2 3 years into the Partnership, and on the basis of the first report, there is little sign of progress. More worryingly, SuRG (the Scaling-up Reference Group that oversees the IHP+) has decided to withhold the progress report from