AFI Changemakers at the United Nations Social Forum 2015

AFI Changemakers at the UN on ‘Right to Health and Access to Medicines’

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Š Ariel Foundation International 2015 Report prepared and edited by Summit Co-Chairs, Catherine White, Megan Smith and Michael Fox. AFI Changemakers Summit organised and facilitated by Ariel Foundation International, Dr Ariel Rosita King.

Special Thank you to: Ambassador Ireneo Namboka Roy Morris, Esq. Side Panel Co Chair Ambassador Collette Samoya Summit Organisational Committee: Sarah Crowe, Rory Evans, Michael Fox, Emma Robinson, Megan Smith and Catherine White Edited by Michael Fox, Megan Smith and Catherine White Photography by Rory Evans and Thun Thong Front cover image: Rinisha Yagarajah and Henry Gilliver

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AFI Changemakers Summit attendees

Doruk Akin Poonam Bhar Rory Evans Michael Fox Henry Gilliver Dominic King Nina Rachet Maria Radu Emma Robinson Megan Smith Daisy-May Super Thun Thong Catherine White Rinisha Yagarajah Dr Ariel Rosita King Ambassador Ireneo O. Namboka Roy Morris, Esq. Ambassador Collette Samoya

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We believe youth should take control of the future they want to see.

On the 18th and 19th of February 2015, youth representatives from around the world met at the United Nations in Geneva to tackle the most important issues for their generation’s future.

Facilitated by Ariel Foundation International, the summit deliberated on actions and recommendations concerning issues within the Right to Health and Access to Medicines to be taken forward to the United Nations, WHO, UN Right to Development Working Group and UNAIDS bodies.

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Table of Contents

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Foreword

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Working Groups within the AFI Changemakers Summit

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Section 1: Mental Health Introduction Legal Framework Medical Perspective Awareness and Acceptance Conclusion

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Section 2: Corruption within Healthcare Introduction The Economics and Politics of Healthcare Domestic Production Trade Agreements Public Awareness Conclusion

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Section 3: Sustainability of Healthcare Policies and Access to Medicines Outline Education and Awareness of Health Infrastructure Digital Infrastructure A Bottom-Up, Community-led Approach Conclusion

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Human Rights Council Social Forum AFI Changemakers Side Panel Event

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Moving Forward

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Foreword Young people comprise around a quarter of the world’s population (UNFPA); that is 1.8 billion people. The power of young people to act as Changemakers and influence the world around them has never been greater.

Technology has revolutionised the way we communicate, bringing young people from across the world closer and closer together in ways that have never been experienced before. These greater and more diverse connections allow for a sharing of ideas and a mobilisation for collective action that crosses international borders.

This is why we, as young people felt that it was imperative that we came together to discuss issues on the Right to Health and Access to Medicines, providing our unique and often overlooked perspective on issues that affect all of us. Mental health, corruption in health care and how to achieve a sustainable access to medicines are just some of the problems facing the new generation of Changemakers.

We are fully aware that we are almost within reach of being able to work to address these problems, driven by the knowledge that we have the tools that the previous generation did not have; the power of more diverse connections on an international level paving the way for the unification of the youth voice in a strong and steadfast stance against any opposition to youth participation. Time and time again, young people have proven themselves as leaders and thinkers; their participation is crucial and an opportunity not to be squandered.

This is why the participation of young people in the continued dialogue at the United Nations is essential for the continued legacy of the Right to Development as well as the progression of its subsidiary bodies. The UN High Commission for Human Rights Office of Development has actively sought opportunities to engage with young people and encourage their participation. It is for these reasons that in 2013 Ariel Foundation International (AFI) facilitated the inaugural AFI Changemakers Youth Summit. Building on the successes of 2013 and 2014 summits, the 2015 Right to Health and Access to Medicines summit sought to provide a voice to ever more young people in the changing world. AFI believes passionately in the mutual benefit possible from youth engagement and involvement in UN work, policies and practices.

It’s the change to make and we, as the voice of the youth – as the voice of 25% of the world’s population, are ready to make it. So let’s make it now.

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Working Groups within the AFI Changemakers Summit The AFI Changemakers summits act as open forums for free dialogue between young people from all over the world. At the beginning of the Summit participants worked together to identify key issues within the Right to Health and Access to Medicines that they felt should be prioritised or have been omitted from the international discourse. A number of issues were raised, including; the right to choose (encompassing the right to die), maternal health, reproductive rights, the right to health as a fundamental human right and the healthcare rights of migrants.

After discussion of the proposed topics and deliberation, the key issues chosen were; 1. Mental health 2. Corruption in healthcare industries 3. Sustainability of healthcare policies and access to medicines Participants then divided into three Working Groups, each focusing upon one of the chosen issues. Within these groups, participants shared their own ideas, opinions and experiences with the aim of developing preliminary conclusions and recommendations; these were then presented to and discussed with the other summit participants.

After the summit, participants worked extensively on the development of the preliminary discussions, collaborating and conducting research in order to produce comprehensive reports. This report compiles the work of the three Working Groups, in addition to providing an overview of the issues discussed during the highly successful Human Rights Council Social Forum AFI Changemakers Side Event. In addition to this, three stand alone reports have been produced, which provide more detail regarding the three issues.

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Section 1: Mental Health Poonam Bhar (Co-Chair, pictured), Megan Smith, Dominic King (Co-Chair, pictured), Rory Evans (Rapporteur), Catherine White

Introduction; Mental health disabilities and the lack of globally available treatment for them is a major, yet invisible, crisis. Average annual global spending on mental health is less than $2 per person. This report looks in detail at the legal framework in place to support people with mental health disabilities, the significant barriers to adequate mental health care from a medical perspective and the educational issues around awareness and acceptance of those who suffer.

In writing this report guidance has been taken from a report written by Mr Paul Hunt, Special Rapporteur on the Right to Health to the United Nations Commission on Human Rights from August 2002 to July 2008. In this report Mr Hunt discussed the need for the use of consistent and appropriate terminology and decided to use the term “mental disability�; this report will follow this.

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“In this report the umbrella term “mental disability” includes major mental illness and psychiatric disorders, e.g. schizophrenia and bipolar disorder; more minor mental ill health and disorders, often called psychosocial problems, e.g. mild anxiety disorders; and intellectual disabilities, e.g. limitations caused by, among others, Down’s syndrome and other chromosomal abnormalities, brain damage before, during or after birth, and malnutrition during early childhood. “Disability” refers to a range of impairments, activity limitations, and participation restrictions, whether permanent or transitory.”

Young people must play a crucial role in any dialogue concerning mental health. In the United Kingdom, for example, more than half of adults with mental health problems were diagnosed in childhood and less than half of those were treated appropriately at the time. The inclusion of young people in the dialogue on mental health is essential to ensuring that responses to mental health disability in this age group are appropriate and sensitive. Tackling mental disability in youth, both through educational awareness and through appropriate treatment, presents a vital opportunity for future mental health.

a) The Legal Framework; The Scope of State Parties’ Obligations under the Convention on the Rights of Persons with Disabilities It is submitted that the current terminology in the Convention on the Rights of Persons with Disabilities (herein the CRPD) impacts the clarity of State Parties’ obligations under the Convention and the general knowledge of concerned individuals as to whether they are guaranteed protection under international law The CRPD applies to persons with disabilities including those with; “long-term physical, mental, intellectual or sensory impairments which in interaction with various barriers may hinder their full and effective participation in society on an equal basis with others”. UN Enable clarifies that “[t]he reference to “includes” assures that this need not restrict the application of the Convention and State Parties could also ensure protection to others, for example, persons with shortterm disabilities or who are perceived to be part of such groups.” The use of the terms “need not” and “could” in this clarification is ambiguous. It appears to imply that State Parties, which have ratified the Convention, are not obliged to ensure protection of those with short-term disabilities, as opposed to those explicitly referred to in the text of Article 1.

It has become clear from our own research that it is currently very difficult for individuals, without a very high-level of knowledge of the CRPD and its translation

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into national laws, to ascertain whether the Convention obliges State Parties to ensure the protection of rights within the Convention for those suffering from transitory mental disabilities. This issue is particularly vital to individuals and civil society organisations in those countries that have ratified the Optional Protocol to the CRPD, which permits individual complaints to be submitted to the Committee by individuals, groups of individuals or third parties on their behalf.

Recommendation 1.1: The Committee on the Rights of Persons with Disabilities, as a body of independent experts, should clarify the existence or extent of State Parties’ obligations under the Convention regarding individuals with transitory mental disabilities. This clarification may stem from a preliminary discussion during a Committee Session or in response to a State Party report, in which the content relates to transitory disabilities. In a 2011 Concluding Observation, the Committee urged Spain to “expand the protection of discrimination on the grounds of disability to explicitly cover multiple disability, perceived disability and association with a person with a disability”. The ability of the Committee to urge State Parties to extend protections should be built upon and it is submitted that the Committee should use its Concluding Observations not only to urge State Parties to expand the scope of protection but also to clarify their legal obligations.

The scope of individuals affected an absence of such a state obligation is wide.

Examples of short-term mental disabilities include adjustment disorders and brief psychotic disorder. Statistics show that within five years of an adjustment disorder diagnosis, approximately 20-50% of the sufferers go on to be diagnosed with psychiatric disorders that are more serious in nature.

If State Parties can use the term “long-term” as a “qualifier” this may have a substantial impact on the implementation of the obligations set out in the CRPD. For example, Article 13 imposes a duty to ensure “effective access to justice” which includes “the provision of procedural and age-appropriate accommodation”. It is currently unclear, from the guidance provided, whether State Parties are obliged under international law to provide such procedural accommodation to individuals suffering from transitory mental disabilities.

Recommendation 1.2: If the State Parties that have ratified the CRPD do not have a binding obligation regarding individuals with transitory mental disabilities, this must be addressed. This may be addressed by the Committee of the Convention on the Rights of Persons with Disabilities. It is also submitted that the WHO should consider and integrate the issue of individuals with transitory mental disabilities into its work under the WHO Project on Mental Health and Human Rights, particularly when assisting countries in developing and implementing national mental health legislation. Ensuring that mental health laws are as holistic and inclusive as possible must be a priority.

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The Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care The Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care (herein the MI Principles) must be read in light of the CRPD. Nevertheless, it is submitted that this is not sufficient to combat the potential negative effects of the MI Principles.

The MI Principles, in comparison to the CRPD, do not take a human rights based approach to the issue of mental illness. One main concern is the deployment of the word “patient” throughout the principles; this is used to refer to all individuals receiving mental health care and those admitted to a mental health facility. As discussed, the use of correct and sensitive terminology in this context is vital to eliminating stigmas and negative stereotypes of mental illness; this solely medical approach does not contribute to the achievement of this aim.

Recommendation 1.3: The Mental Illness Principles must either be revoked or revised in order to bring them in line with the protections guaranteed by the CRPD and other related human rights instruments. If the Mental Illness Principles are revised, they should follow the human rights based approach of the CRPD and the word “patient” should be removed from throughout its text. It is imperative that civil society is engaged in any revision.

b) A Medical Perspective; Hygiene in Mental Health Treatment Facilities In many cases, the general hygiene of institutions that provide mental health treatment is a major problem, especially in low-income countries. Not only do patients suffer from mental disabilities, but after hospitalization, they are also at risk of contracting nosocomial infections. According to the World Health Organization (WHO), poor hand hygiene of health workers is a contributing factor to hospital-acquired infections (herein HAI).

Patients residing in mental health facilities have unique characteristics that differentiate them from patients in acute medical facilities; they have fewer comorbidities and indwelling devices in place than patients admitted to intensive care units or medical floors. Mentally disabled patients also have a high incidence of chronic infection related to substance abuse and socioeconomic factors. The majority of healthcare workers in these areas have few financial incentives to modify performance and suffer from a lack of effective training. Institutions on the

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other hand, play a major role in resolving this problem. Unfortunately, they lack the time and resources for staff training and structures for compliance monitoring are weak or non-existent.

Recommendation 1.4: Good institutional hygiene is vital to prevent HAIs. Mental health professionals should receive effective training in basic hygiene practices and hospitals should be thoroughly inspected with frequency. The early 1980s saw a dramatic increase in Long-term Care Facilities (LTCF) infection control activities in the United States of America. There were LTCF infection control program structures, infection control professional (ICP), and epidemiologists in every hospital. Member states should be encouraged to establish such bodies that monitor and provide guidelines for hygiene and who should also be responsible for inspections. Hygiene procedures that apply in general hospitals should also apply to psychiatric facilities.

Abuse of Patients In all low, middle and high-income countries, there are cases of patients in mental institutions being abused physically, emotionally and sexually. Patients with mental disorders are widely exposed to human rights violations, particularly the right to a life free from cruel, inhuman or degrading treatment or punishment. Health care workers breach their legal duty of care and sexually abuse vulnerable patients..

Studies document that between 25% and 85% of the mentally disabled are victims of sexual abuse; such a variance in percentage underscores the clandestine and subtle nature of such abuse.

Recommendation 1.5: Stronger systems must be put in place for the reporting of abusive behavior, and a legal framework recognizing the right of hospital patients and vulnerable people to a life free from abuse. For example, in the United States, the government is working on improving the Criminal Justice System, through which specialized training for law enforcement and prosecutors are conducted.

When law enforcement officers understand the physiological effects of trauma, they can better elicit information from victims and understand their behavior.

Inadequate Access to Trained Mental Health Professionals Almost half the world’s population lives in a country where there is less than 1 psychiatrist per 200,000 people. With reference to the Mental Health Atlas 2011 by the WHO, at a global level, there are more graduates with degrees in nursing (5.15 per 100,000 population) than in any other health profession working in the field of mental health. After nurses, the most common health professional graduates are medical doctors (3.38 per 100,000 population). Comparatively, there is a much smaller pool of psychologists, psychiatrists and social workers that

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graduate on a yearly basis. The more restricted the access to quality care, the higher the chances of adverse events, such as inpatient suicides, suicide attempts and violence. Due to the lack of human resources and funding, patients do not receive the right medication and the right doses. Such negligence can cause deterioration in patients and it can also be fatal.

Recommendation 1.6: Support for a volunteer program of psychiatrists who train existing doctors in the developing world with basic psychiatric skills so they can better identify and treat those that are suffering as a complimentary health service alongside their other health provisions. Those who have received the training could become mental health ambassadors and help train others in local communities so that the knowledge spreads and the program is sustainable, eventually becoming an entirely national project. The pyramid nature of this scheme has been used by NGOs in many different areas from law to farming, and the three-month training aspect has been used in Somalia specifically in the area of mental health. We’d like to see these two ideas combined and expanded.

Ultimately, we’d like to see an increase in the number of fully qualified specialist psychiatrists, however this can only be possible following an increase in awareness of mental disabilities and better provisions, which we hope would follow the roll-out of this initial scheme.

c) Awareness and Acceptance;: Lack of Awareness One of the greatest barriers to effective mental health diagnosis and treatment is a lack of awareness among the general public. The stigma attached to mental health problems is particularly surprising given the large proportion of people who will suffer from a mental health problem at some point during their lives. 25% of people in Britain will experience a mental health problem at some point during any given year, and 17% will experience suicidal thoughts during their lifetime.

A lack of awareness of mental disabilities can be particularly damaging for several reasons: 1. Those directly affected by mental disabilities fail to recognise symptoms and therefore do not seek treatment, exacerbating their problems.

2. Medical professionals are not correctly trained to care for the psychiatrically unwell, and mental disabilities go ignored as a priority. For example a World Health Organisation Report from Palestine notes that in the West Bank in the whole of 2013 there was not a single hospital referral for psychiatric illness. This kind of statistic is also indicative of the unequal allocation of resources to the treatment of mental health.

3. Those suffering from mental health problems experience social stigma and discrimination.

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4. The encouragement of an environment in which individuals do not feel able to speak out when suffering from a mental health problem Furthermore, there is a lack of recognition or willpower to tackle the reality that cultural attitudes, behaviour and practices can directly lead to mental health problems in societies, both in the developed and developing world. Some cultural factors that contribute to mental health issues at a regional level include: The presentation of idealised images of the human appearance can result in negative body image that leads to eating or body dysmorphic disorders. In the United Kingdom, for example, 60% of adults report that they feel ashamed of the way they look, while in the United States over half of teenage girls and a third of teenage boys use unhealthy weight control methods like skipping meals, fasting, smoking, vomiting or taking laxatives. In India, the skin-whitening cream industry was worth $432m in 2010 and was growing by 18% a year.

In conflicted societies, Post-Traumatic Stress Disorder (PTSD) is a common problem; one study from Juba in South Sudan suggested 36% of the sampled population met the criteria for PTSD and 50% for depression. While it is often assumed that victims of war will require treatment for PTSD, they often also require much longer term care for depression and anxiety.

The marginalization of minority ethnic groups, can be one contributing factor; studies have suggested that Latino youths in the United States experience disproportionate rates of anxiety, behavioural disorders, depression and drug addiction than their white counterparts.

Moreover, there are cultural beliefs around the world that do not lend themselves to the open expression of feelings of unhappiness. South Korea has one of the highest suicides rates in the world; 40 South Koreans kill themselves every day, and suicide rates doubled between 1999 and 2009. Some sociologists have suggested that Korea’s cultural that emphasises diligence, stoicism and modesty have created a climate in which mental health sufferers remain quiet.

Recommendation 1.7: Mental health to be included in the Sustainable Development Goals (SDGs). Goal 3.4 of current proposals reads: “by 2030 reduce by one-third pre-mature mortality from non-communicable diseases (NCDs) through prevention and treatment, and promote mental health and wellbeing�. We see mental health as an afterthought in this proposal. We would like to see an entirely separate SDG that focuses on mental health and wellbeing and underlines strong mental health as being essential to all human life. There is no health without mental health. We understand the challenge of setting specific targets in relation to mental health when compared to physical health, but this is not a reason to maintain the status quo. This is the place to repeat the call of the

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WHO “to increase the amount invested in mental health budgets by 100% by 2020 in each low and middle-income country”.

The strengthening of mental health within the Sustainable Development Goals would not only encourage states to take more proactive and concrete steps towards combatting the issue of mental health, but would also signify an international awareness of and commitment to the need to address the issue of mental health.

Lack of Acceptance We must accept that only with an increase in awareness can come an increase in acceptance. People with mental disabilities face discrimination and marginalization in all societies, and only through a greater awareness of mental health issues can the public come to understand an appropriate way to behave towards sufferers.

As has been discussed previously in this report, legal discrimination at a national and international level that leaves mentally disabled people unprotected is a major problem.

Recommendation 1.8: A large-scale international UN media campaign to promote mental disabilities and remove stigma. For maximum impact this could have an internationally recognised celebrity ambassador who has suffered from mental disabilities themselves. This could replicate the success of the ‘He For She’ campaign for gender equality. An international campaign of this kind would be highly effective; not only raising mental health on the international agenda but also working to combat the stigmas and discrimination that those with mental disabilities face.

Conclusion; This report has shown that the attention currently paid to mental health issues is inadequate. This year, 2015, is a crucial year with regards to the future of global development. The transition from the Millennium Development Goals to the Sustainable Development Goals presents a vital opportunity to see the realisation of the right to mental health. There truly is no health without mental health, and we call for a focus on mental health care and awareness as essential to ensuring the correct, equal and appropriate treatment of those with mental health disabilities, whether permanent or transient. Tackling mental disability in youth, both through educational awareness and through appropriate treatment, presents a golden opportunity not just for future mental health, but also for a new generation free from the mental health stigma of the past and present.

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Section 2: Corruption within Healthcare Doruk Akin (Chair, pictured right), Thun Thong (Rapporteur), Nina Rachet (pictured left), Michael Fox (pictured, middle)

Today’s international health care system is neither healthy nor caring. Millions of individuals do not have access to efficient medicines and view their health severely impaired as a result. Epidemics like the Ebola crisis in Western Africa cannot be prevented. The World Health Organisation (WHO) lacks the resources, the influence and the power to effectively act on those matters. Global health is, like numerous other international matters, a major, global problem.

In this report, four issues are highlighted that need to be addressed in order to help repair the global health care system; 1) the economics and politics of healthcare, 2) domestic production issues, 3) trade agreements and 4) public awareness of health care issues. a) The Economics and Politics of Healthcare; The economics and politics of healthcare are a plenty, which makes it all the more difficult for individuals to enjoy their natural entitlement to adequate healthcare

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and to access medicines. Simply put, corruption is multi-faceted and in this context of healthcare, corruption exists in foreign aid, in the government regulation of the healthcare sector, and in the blurred lines between business and healthcare.

Recommendation 2.1: A system of traceability drawn up by the International Aid Transparency Initiative (IATI) would ensure the funds travel along the delivery chain in its entirety and further enhance transparency and accountability.

Foreign Aid Transparency One serious issue highlighted is the pocketing of aid money by those in leadership positions. Indeed, foreign aid funds are not reaching the intended beneficiary in its entirety. A minimum of 30% of donations are either wasted due to inefficiency and high-cost events, or used for illegal purposes such as terrorism, drug and human trafficking due to a lack of transparency.

Recommendation 2.2: A system of checks on the qualifications of medical personal will gradually eradicate the practice of bribery and ensure accountability, responsibility, and transparency.

Government Regulation of the Healthcare Sector Another prevalent issue is the lack of qualified personnel working in the healthcare sector; both medical clinics and pharmacies. This allows for unethical and unsafe medical practices not in alignment with the Standard Treatment Guidelines (STG). Additionally, due to patients’ habits to seek medical help from pharmacy because of cost-efficiency and low availabilities of doctors, the existence of pharmacies in developing countries operating solely as a business rather than a healthcare service leads to the delivery of inadequate pharmaceutical services, further endangering the lives of patients.

Finally, the narrow gap between the healthcare sector and private companies often leads to corrupt officials as they tend to place the satisfaction of personal interests above the interests of the community.

Recommendation 2.3(a): There should be unannounced and sporadic inspections of medical clinics conducted by the WHO and primary governmental authorities around the country to ensure safe and ethical medical practices. Personnel and pharmacists undergo regular written and/or practical examinations to ensure adequate healthcare services and the maintenance of current knowledge on health.

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Recommendation 2.3(b): There should be substantial emphasis on the importance of abiding by the STG and other medical oaths. We recognize this in order to ensure medical personnel adhere to these regulations. Thus, we recommend larger penalties and punishment if medical personal violates these regulations, with a particular emphasis on corruption.

Recommendation 2.3(d): In combatting the integration of healthcare with political and business interests, there needs to be legislation capping of the monetary amount allowed to be donated by private companies to politicians – less money will mean less influence. The less political/business interests are involved with the healthcare sector, the more healthcare can shift its focus back to delivering adequate healthcare and satisfying an individual's natural right to health. b) Domestic Production; Domestic production of medicines is important because it enables countries to be self-sufficient in terms of healthcare. Producing medicines locally increases the access to important medicines. Being highly dependent on imports of essential medicines can lead to trade deals centered around medicines. Thus, due to the degree of importance of medicines, countries without production capacities have much less bargaining power at the WTO and other international trade platforms.

Where there are major deficits between those suffering from disease and those who have access to medicines, local production can be seen as an effective solution in creating cheaper drugs that can therefore be delivered to a greater number of people in need.

Recommendation 2.4: UN member states should be encouraged to include the Right to Health within their governmental framework, whether by constitution or policy. This will give more protection to their national public, as they demand access to important health care.

TRIPs and TRIPs Plus TRIPS is concerned with the protection of patents and it is bilateral agreements also known as TRIPs plus agreements that are set up to tighten patent laws to prevent states removing certain patents.

Recommendation 2.5: Bilateral agreements that remove freedoms in TRIPs allowing for States to remove or revoke patents on medicines should be strongly discouraged. TRIPs must be respected by all member states of the WTO and the UN should pressure can be to ensure the correct implementation of all rights including in TRIPS.

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Weak National Policies or Constitution Only one country, Brazil, has the Right to Health listed as a constitutional human right. This encourages the Brazilian Government to place more emphasis on their health system and encourages the production of domestic medicines. However most countries lack any mention of the Right to Health in their constitution, which leads to health policies lacking priority and undermining the protection of domestic producers of medicines in international trade deals.

Recommendation 2.6: States should be further made aware of all TRIPs flexibilities in order to ensure the correct implementation of those flexibilities and to develop their domestic production of generic medicines. States should be supported in the appropriate use of TRIPs flexibilities.

Poor technology transfer and lack of investment An important reason for the lack of domestic production also lies in the politics of aid. In treating diseases, most of the international aid is directed into buying medicines, commonly produced in the US or EU, directing finances back into those countries. There is no allocated fund for developing domestic production of generic medicines, which would be a sustainable answer to providing developing countries with the ability to care for their sick.

Recommendation 2.7: Foreign aid should focus also on building infrastructure and a pharmaceutical industry in developing states allowing for the local production of important lifesaving medicines. This will need funding and transfer of technology from developed nations. The WHO should cooperate with the growing pharmaceutical industry in the developing world to coordinate this technology transfer. The body should also recommend medicines lists in order for developing countries to produce quality medicines at an appropriate amount. c) Trade Agreements; Trade agreements have been covered in this section as the relevance of international trade deals in access to medicines globally is important. Legal frameworks protect intellectual property, thus allowing the emergence of patents in medicine. Consequently, there is a need to look closer at the institutions and laws that protect these patents in order to understand barriers to access to medicine. Trade agreements must also be looked

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at because powerful States usually own the means of production for medicines, thus have a greater bargaining power on international trade platforms and in trade agreements. Consequently, those states can increase the prices of their medicines with ease and restrict the use of certain international agreements on patents.

Price of Medicines There is a lack of control over the price of medicines. Multinational pharmaceutical companies have the right to sell medicine at unattainable costs to developing states in order to make exponential profits. Consequently, low-income and middle -income countries, which have low resources, are unable to meet the health needs of their public.

Recommendation 2.8: The WHO and WTO should initiate negotiations on a price-control treaty regarding the access to medicine in order to stop the abusive use of treaties on intellectual property by pharmaceutical companies.

States’ rights Since TRIPS, agreements known as TRIPS-plus and TPP have undermined the original treaty. The restrictions of the use of compulsory licensing, which increases access to health for underprivileged population, in the aforementioned free trade agreements place individuals in developing states at higher risks of epidemic than the ones in developed States since the first cannot afford the appropriate treatments.

Recommendation 2.9: The WTO should enforce that trade agreements do not exclude or undermine the State’s right to use compulsory licencing, thus recognising it as a sovereign right.

Lack of ethics and equality in trade Post-TRIPS agreements severely decrease access to health and normalise unethical practices where profits are more important than the lives of millions. In addition to the disregard for human life in the health industry, free trade agreements between developed and developing states lack equality by violating state’s rights.

Recommendation 2.10: The international system should encourage the establishment of an international bill on ethical trade negotiation and equal rights between trade partners.

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d) Public Awareness; Awareness of public health problems is relatively low. The public are not informed of the challenges that hinder access to medicines around the world and have little say in huge political decisions that can affect the supply of medicines to millions of people. During the summit, we highlighted the unacceptably low level of public awareness. On the contrary, we argue that an informed public can participate democratically into helping to solve issues on access to health.

Health and Human Rights One of the main problems of universal access to health is that health is not yet recognised widely as a fundamental Human right. Indeed, the subject is still relatively unfamiliar and is often disregarded in most of the debate on Human Rights.

Recommendation 2.11: It is urgent that the international community globally recognise the Right to Health as a fundamental Human right and inscribe it in international public law.

Awareness and Knowledge of Civil Society The lack of global awareness and knowledge regarding the Global Health issue is caused by inefficient promotion and information accessible to the global public at large. As a major actor in international politics, the global civil society is only functional if well informed about this global concern and its processes.

Recommendation 2.12: In order to effectively inform the global public of their right, it is necessary to intensify the public dialogue on the Right to Heath by strengthening the mechanisms of information at all levels of discussion.

The Role of International Organisations In certain instances, international organisations such as the UN, the WTO and the WHO can be limited or restricted in their resources by member states. As a result, they are unable to openly advocate and instigate changes at an institutional level, which leads to a stagnation of the development and progress of the implementation and fulfilment of the Human Rights programme at the national and international level.

Recommendation 2.13(a): International organisations need to embody their role as global platform of discussion and establish an effective multilateral debate on

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the Right to Health. There is an urgent need to intensify the cooperation between the UN, the WHO and the WTO on the legal and policy factors in order to promote the distribution of essential medicine as well as the dissemination of medical technologies. Additionally, all actors including NGOs, pharmaceutical firms and civil society organisations should participate in the negotiations on a Universal Health Policy in an attempt to increase the representation of all in the global debate on health.

Recommendation 2.13(b): In addition to stressing the effective implementation of various policies on the Right to Health, we urge the international community to establish a strict language within the suggested treaties to avoid different interpretations of the same agreement.

Conclusion; The problems facing the medicine industry are large but clear. The politics of aid and investment combined with Western led economic structures and legal systems seriously hinder developing countries domestic production of medicines, corrupted governments and pharmaceutical companies continue to reap profits in the name of healthcare and mean while public awareness that one billion people around the world do not have access to the drugs they need is unacceptably low.

It is public awareness that is needed to educate citizens around the world on the problems that the global healthcare system faces. Only together can solutions be made that will create an environment where patents do not restrict millions from lifesaving medicines, where governments do not become corrupted by pharmaceuticals, where pharmaceutical companies do not abuse their financial power and where all countries can begin to produce the medical resources they need.

Living in a time where necessary technologies exist, necessary medicines exist, necessary procedures that will save millions from dying are known, this is an incredible opportunity to prevent millions of avoidable deaths in countries around the world. In protecting these people it is not only better for humanity but it will enable these people to live and have an impact on the people around them in their communities.

However, it is essential first that countries and companies change mind-sets away from seeing healthcare as a great money-maker, and instead think of innovative approaches to the Global Health problem. No profit should deter life-saving treatment and this must be widely recognised by the international community.

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Section 3: Sustainability of Health Policies and Access to Medicines Maria Radu, Rinisha Yagarajah, Henry Gilliver (Chair), Daisy-May Super (Rapporteur), Emma Robinson (all pictured left to right)

Outline; Ensuring the provision of sustainable access to healthcare and medicines is a challenge faced by all nations, from the least to the most developed. Many factors can inhibit the sustainability of these provisions, including poverty, environmental challenges, corruption, poor educational opportunities, economic instability, and lack of direct access to competitive markets. In order to tackle these issues at a global level we must first ensure that we have an understanding of them as they exist within local communities. That is, the international community must orient their approach to work from the local level upwards; i.e., a ‘bottom up approach’.

Sustainable Development and Sustainability in relation to Healthcare and Access to Medicines

Sustainable access to healthcare and medicines can best be understood as a subset of sustainable development. Therefore, an understanding of this broader concept will help inform sustainability in relation to healthcare. Sustainable development may be summarised as follows: "Development that meets the needs of the present without compromising the ability of future generations to meet their own needs�.

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In relation to healthcare, sustainability must be ensured in order to guarantee that the supply of provisions and services can continue indefinitely. In order for this to be achieved, health policies must be formulated with the long-term aim of selfsufficiency in mind, such that they do not rely on contingent external aid for their continuation.

There are many non-fiscal factors that must be considered in order to achieve sustainability in healthcare services. Such services must be able to adapt to changing environments and use innovative approaches to tackle difficult challenges, often with limited resources. In order to maximize the effectiveness of such approaches, sustainable and comprehensive solutions that are tailored to the needs of local healthcare should be pursued.

Such an approach to the provision of healthcare and services will require a holistic vision regarding development projects, as well as close collaboration between the public and private sectors. Only by adopting this vision will we ensure access to vital primary care to all of the world’s most impoverished people.

a) Education and Awareness of Health; Throughout the developed and the developing world, there may be a lack of understanding and awareness about good health practices. In the developing world, access to comprehensive medical services may be extremely limited, particularly to people living in poverty, and in remote areas. Knowledge of good health and sanitation practices can dramatically reduce the risk of infection and disease. As UNICEF states, “hand washing with soap is among the most effective and inexpensive ways to prevent diarrheal diseases and pneumonia, which together are responsible for the majority of child deaths�. Education and awareness campaigns can be an effective tool in spreading simple messages that can combat these serious problems. The spreading of this knowledge through West and Central Africa could save about half a million children a year, and yet across the world hand washing with soap at critical moments ranges in frequency from zero to 34%.

Education and awareness is key to delivering individual-led preventative healthcare. In countries where there is less than one doctor for every 2000 people, spread unevenly throughout populations, the benefit of preventative measures cannot be overstated. However given the small number of doctors per capita in many countries, healthcare messages must be conveyed through alternative methods in order to successfully reach the population.

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Schooling is one method through which health messages can be conveyed.

Achieving primary education for every child has been a key aspect of the MDGs, and in the Least Developed Countries (LDCs), 73% of children attend primary school.

Recommendation 3.1: Curricula worldwide, whilst remaining culturally sensitive and age appropriate, should be used to create awareness of the body, and how to protect it from disease, both through healthy lifestyle and correct sanitation and hygiene. Children may also be encouraged to pass information they have learned at school on to their parents, spreading these positive messages further into the community. A standardized curriculum in basic health and sanitation, drafted and approved by the World Health Organization and distributed at a local level to educational institutions would ensure these messages were conveyed correctly and effectively to children of all ages.

Information must always be provided in an accessible manner, particularly in local dialects, to ensure it is as far-reaching and effective as possible. In places with low literacy rates, radio broadcasts can be another cost-effective method of disseminating crucial medical advice. Graphic representations rather than words are another method of transmitting information quickly and easily, especially for those who may be illiterate.

However, vocalised education is not enough; making toilets and hand washing stations available at schools to instill routine behaviour is crucial. In the Democratic Republic of Congo, for example, less than 25% of schools have adequate sanitation, a significant barrier to the education of children in preventative hygiene methods. b) Infrastructure; As in all sustainable development, the prevention of a crisis in the first instance is preferable to emergency crisis relief. Health education is an important first step in any long-term preventative health policy, but will only be maximally successful when implemented as part of a holistic approach to public health. Of equal importance is a readily accessible infrastructure network of health services and provisions, as well as basic sanitation services, such that any provided health education can be put into practice. A top down approach to health and access issues is insufficient, as physical barriers resulting from poor local infrastructure often go unobserved or ignored.

An example of such infrastructural inadequacy is the fact that basic sanitation services are still lacking in many developing countries; 780 million people do not

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have access to clean drinking water, and 2.5 billion don’t have access to improved sanitation. According to the WHO, around 760,000 children under five die each year as a result of Diarrhoeal disease; leading causes of which are poor sanitation and hygiene, and lack of access to safe drinking water.

Research indicates that investing $3.35 in hand washing brings the equivalent health benefits as investing $11.00 in latrine construction and thousands of dollars in immunization programmes. Furthermore, heavily promoting hand washing will internalize the practice within communities, which will be passed on to future generations. Investments of this kind are therefore efficient, effective, and sustainable.

In many of the least developed areas of the world, road networks and transport links are severely lacking. For example, the UN report on Infrastructure states that only 2757km of Somalia's 22,000km road network is paved. Of these, only 2900km are passable year round due to seasonal environmental conditions. A community cannot benefit from health services, regardless of how comprehensive they are, if the local environment constitutes a physical barrier to these services.

These barriers will not be adequately accounted for without the involvement of local people and governments who can best advise on how to integrate health services with the existing infrastructure.

The infrastructural challenges mentioned above will be different on a case-by-case basis. The levels of existing infrastructure will vary between regions, as may regional political stability, which can impact people’s ability to safely seek medical services. Therefore there is no “one size fits all” solution to the problem of making healthcare sustainable. In order to implement sustainable policies, each region must be assessed independently to ensure the most appropriate solutions are adopted.

Recommendation 3.2: Greater planning and sustainability studies must be implemented to ascertain the long-term viability of clean water and sanitation developments. As a necessary precursor to the right to health, such developments must be prioritized and seen through to the most efficient completion possible.

Health policy must include infrastructural assessments, including the knowledge of local actors, to ensure everyone in the policy target areas will have safe, sustainable access to the services to be provided. The cost of any required infrastructural improvements must be included and implemented as part of a holistic health policy.

Should it be determined that identified infrastructural inadequacies cannot feasibly be completed; health policy must be adjusted appropriately to ensure the widest possible access to the proposed health services. Where necessary this will include

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the replacement of proposed health service access points with decentralised general practitioners who will be able to provide care to isolated communities, until such a time that the local infrastructure can be sufficiently improved. c) Digital Infrastructure; Despite the aforementioned policy recommendations, global infrastructural improvements will not happen immediately. In a globalized world, digitalized infrastructure address some of the shortcomings of physical infrastructure. Such digital infrastructure can also serve to strengthen and complement any existing hard infrastructure that is already in place. Digital infrastructure can be used as a platform to spread ideas, messages and information; vital to the provision of sustainably accessible healthcare.

There are many initiatives delivering health services in different parts of the world, but there is no network for the integration and sharing of these initiatives. In order to create accessible and sustainable healthcare systems on a global level, it is vital that there is a place to share and combine ideas, skills, resources, funding and expertise.

Recommendation 3.3: A platform for people to share their ideas through a digital medium must be constructed; knowledge sharing is a crucial aspect of globally accessible health care. Mobile and Internet technology is the most far-reaching and cheapest platform for sharing best practices, innovative solutions and advice quickly and efficiently. A 'global initiative platform for access to healthcare' should be set up as an international organisation that is free at the point of access and cannot be politicised by governments.

This ‘global initiative platform’ would provide the digital infrastructure to enable the: · Sharing of expert advice on good medical and healthcare practice · Sharing of creative ideas and solutions for social enterprise and health businesses · Sharing of positive experiences in how medical care has been transported to rural areas · Implementation of targeted training programs to train healthcare professionals and local staff in new skills A fundamental barrier to accessing healthcare programs is that many of the world’s population live isolated and inaccessible areas. For example, for those living within conflict zones, seeking medical services may be too dangerous. This danger may also prevent health services from operating in these regions.

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Technology can be harnessed to deliver many services usually performed face-toface by health professionals and also many that cannot. Therefore, we recognise the need for a strengthened network of remote healthcare programs.

One billion people will never see a healthcare professional in their lifetime, although 95% have access to a mobile signal. The nature of the technology is that it can be adapted for global use by different demographics, age groups, and locations.

Samsung plans to incorporate a free app entitled “Smart Health” into all devices distributed to the African continent. “Smart Health” is said to be the ‘first ever Pan -African Mobile Health Delivery Network’ and was launched in 7 countries. The app provides real-time information on three pandemics; HIV/AIDS, tuberculosis, and malaria, along with approved symptom checkers for each disease.

Medic Mobile is another example of mobile technology facilitating access to healthcare. Examples of how this technology has been used include antenatal care, childhood immunization, disease surveillance, and drug stock monitoring in the developing world.

Recommendation 3.4: Mobile technology companies should be encouraged to work with local communities to build free, culturally sensitive apps which use human-centred design to address the particular needs of that community and preinstall them on devices or make them free to download and use. It must be a collaborative effort with community health workers, nurses, patients, and community members who are seeking ways to make health care delivery more efficient, effective, and wide reaching.

Remote access to healthcare must also be provided to treat mental health conditions. For example, in conflict zones and refugee camps, where it is not possible to reach a trained mental health professional, advice and therapy could be provided remotely via digital platforms such as Skype.

Recommendation 3.5: In order to implement the best practices of sustainable, advanced healthcare to every global citizen, access to a mobile signal must be recognised as being a necessity for humans; therefore, it should be included in the sustainable development goals. In turn, this would mean that governments must build better digital infrastructure to ensure that their citizens are not denied access to these healthcare initiatives. d) A Bottom-up, Community-led Approach; International and non-governmental organisations carry out invaluable work regarding healthcare services in the developing world. Such actors help drive

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development projects, and have excellent expertise in the areas in which they work. It is important, however, that wherever possible, local people and communities are integrated into development projects. There are many benefits to involving local actors in every possible stage of healthcare programmes.

Sustainability. International interventions to health issues require large amounts of funding and on going support. The involvement and inclusion of local actors has

the potential to enable healthcare developments to become self-sufficient within the communities in which they operate: 1. Cultural integration. By fully internalizing health care in a given region, good health practices will become normalized and health stigmatization will be reduced.

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2. Economic Value. By increasing production and distribution of healthcare materials within a state, opportunities for employment and social enterprise will arise.

3. Implementation. Awareness and enthusiasm for initiatives being implemented will increase if a community feels that it is an integral part of its operation. Furthermore, the more local actors who are involved in healthcare programmes, the further that awareness of them is likely to spread. Knowledge and behaviour relating to such health initiatives will become internalized more effectively within communities with the involvement of local actors.

Recommendation 3.6: Whenever crisis relief is not the focal issue in a region, a long-term strategy to domestic health care in states should be a priority. A continued reliance on international intervention and aid in response to health issues is not sustainable and does not remove the sense of dependency throughout the developing world. Internalizing the production and delivery of healthcare services will contribute to economic growth, employment opportunities and improved public health across the world.

We acknowledge that production and manufacturing outside of the target state can often be cost effective. Despite this, the overall benefits of regional and domestic production, distribution, and delivery of health related materials and services must also be considered. Job creation for local actors, who may otherwise be unemployed, brings both economic and social benefits to a region, as well as increasing the likelihood that the healthcare services provided will be positively perceived.

Recommendation 3.7: Implement the use of a general framework of considerations that can be applied to a health programmes; in order to assess the viability of the inclusion of community based actors. The differences between regions, cultures, the health issues they face and the services that must be provided means that every situation must be considered independently. In some policy areas it may be relatively straightforward to implement this at every stage of the process. In others, technical challenges, or the necessity for specific expertise may make this unfeasible.

Any proposed health policy should be disaggregated into its component parts during formulation. Each of these constituent parts should then be considered in turn, with a view to involving as many local people from within the policy target area as possible. This may be achieved by analysing the proposal in terms of its primary, secondary and tertiary stages, and each should aim to provide additional benefits to the community in question. By following this process, each element of healthcare provision can be considered as a separate opportunity to improve the long-term sustainability of the proposal.

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Human Rights Council Social Forum; AFI Changemakers Side Panel Event Co-Chairs; Dr Ariel King, President Ariel Foundation International & Ariana-Leilani Children’s Foundation International Ms Catherine White, Co-Chair AFI Changemakers Summit H.E Ambassador Collette Samoya Speakers; Mr Thun Thong, Australia Ms Megan Smith, United Kingdom Mr Michael Fox, Northern Ireland Ms Poonam Bhar, Malaysia Ms Rinisha Yagarajah, Malaysia Ms Maria Alexandra Radu, Romania

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Mr Thun Thong “Social Equity and Health in Developing Countries” Thun highlighted the global problems concerning the "Right to Health and Access to Medicine" and their significant impact on developing countries. Such countries are the most affected when it comes to healthcare due to a number of factors; geographical boundaries creates logistical difficulties, economic considerations such as the high cost of healthcare, which is the primary factor plunging individuals into poverty. In addition, political affairs put the interests of the government before the well being of citizens. Above all, the paradigm of wealth, as a prerequisite to healthcare is a common practice among developing nations which makes it increasingly difficult for the population to receive adequate healthcare, if at all. Thun recommended the establishment of traceability as a way to regulate expenditure of developing countries' foreign funds and increase their transparency, thus enhancing accountability.

Ms Megan Smith “Access to Abortion Procedures for Women and Girls Raped in Conflict” Megan drew attention to the effects of both the 1973 Helms Amendment to the US Foreign Assistance Act 1961 and the aid policy of the European Commission’s Humanitarian aid and Civil Protection department (ECHO). The current interpretation of the Helms Amendment, which prevents USAID from being used to facilitate abortion procedures in times of conflict, is in violation of Common Article 3 of the Geneva Conventions; Common Article 3 guarantees that the “wounded and sick” have access to comprehensive and nondiscriminatory healthcare. The ECHO’s deference to national abortion laws also undermines the very aim of International Humanitarian Law, which is to establish universal laws and standards to be followed by all in times of armed conflict. As a result of these humanitarian aid policies, both women and girls, having been used as a weapon of war, often have two options; to turn to potentially lifethreatening methods of abortion or to continue with the unwanted pregnancy facing high risks of maternal mortality and, in many situations, being ostracised from their own community.

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Mr Michael Fox “Patents in Medicine” Michael argued that it is time for the issue of intellectual property in medicine to be raised in an international setting to discover how best to provide medicines to those who need them most; the current situation is not acceptable. A medicine can be patented for 20 years, where only the patent owner can produce and sell the medicine. Michael noted that whilst TRIPs flexibilities do allow for the removal of patents when public health is a serious risk, the HIV/AIDs case in South Africa from 1997 to 2003 highlighted the reality of the situation, during which ten million people in Sub-Saharan Africa died as patent owner Pfizer (USA) sold antiretrovirals for $15,000 a year, while Indian company Cipla offered the same drug for $300 a year. Moreover, the pharmaceutical lobby in America is the biggest spending lobby, spending billions every year on applying political pressure to ensure their patents stay protected and enforced internationally regardless of international access to health care..

Ms Poonam Bhar “Mental Health Care-centres and the Ill-treatment of the Mentally Ill”

Poonam discussed the deprivation of the mentally disabled of their basic needs, when institutionalized in unhygienic and inhuman environment. Beyond the institutional context, stigma and discrimination towards the mentally disabled have restrained these individuals from exercising their civil rights in fields of education, housing and employment. They are constantly abused and exploited in mental health facilities and in the broader community context. For example, a report from Turkey’s psychiatric hospitals mentions the horrific abuses where patients were subjected to raw electroshock as a form of punishment. Somalia has one of the highest rates of mental illness in the world and with healthcare system devastated by years of war; most sufferers received no medical help. Many are chained up to trees or at home. Some are even locked up in cages with hyenas. This is because they believed that it is not an illness but an evil spirit.

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Ms Rinisha Yagarajah “Sexual health rights of Sex Workers” Rinisha chose to speak about the rights of sex workers as they are an isolated and often marginalised group. She highlighted that an estimated value of 210,000,000 – 300,000,000 (3.5 – 5%) of world populations are sex workers. The average age of entry into prostitution is 13. Sex workers often report their difficult experiences with public health care providers. Poor interpersonal communication and even insults from health care providers together with inaccurate diagnoses are some of the problems they confront on a daily basis.

One of the main issues highlighted was the stigma and discrimination sex workers face in their work and lives. Rinisha argued that sex work must be decriminalized to afford sex workers’ sustainable access to services, condoms, and safe workplaces. Sex workers are human beings like anyone else and are entitled to human rights under numerous internationally agreed upon standards for treatment of all people, regardless of profession.

Ms Maria Alexandra Radu “Universal Healthcare; there’s an App for that!”

Maria noted that one billion people will never see a health professional in their lives, yet 95% of the world’s population now have access to a mobile signal. Maria drew attention to Medic Mobile, a start-up mobile communication platform for remote health workers. This software focuses on four key areas; antenatal care, childhood immunisation, disease surveillance and drug stock monitoring. The design process begins by opening a discourse with community health workers, nurses, patients, and community members all seeking ways to make health care delivery more efficient, effective and far-reaching. The focus of the work has been, and will continue to be, to serve the most vulnerable communities in the most difficult environments. We need to promote the importance of global civic responsibility and not be afraid to harness the latest technological developments to achieve this. If we want to live in a world where anyone, anywhere, can access healthcare services and medicines, this must become our new reality.

Note: All views expressed here are those of the individual speakers and do not necessarily reflect those of Ariel Foundation International.

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Moving Forward The AFI Changemakers are currently working on ways to ensure that all youth, regardless of their socio-economic, cultural and regional backgrounds, are given the chance to have their voices heard. In pursuance of this aim, a platform is being constructed through which young people from across the world can contribute to our discussions and work despite being unable to attend summits in Geneva.

The AFI Changemakers Summit was founded with the vision of promoting the inclusion of the voices of young people within the UN. Despite its seemingly gargantuan ambition, the inaugural summit saw this vision finally brought to life, and then built upon with the success of 2014’s summit, with the Right to Health and Access to Medicine taking this even further. It is only through this drive and determination to increase the presence of the youth voice within the heart of the United Nations that we will truly be able to make a change.

Next Steps

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

AFI Changemakers Summit at the World Health Assembly, Geneva (18th20th May 2015)

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Presentation of the AFI Changemakers Right to Development report to Right to Development Working Group (April/May 2015) which can be accessed at: http://www.arielfoundation.org/images/changereport.pdf

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AFI Changemakers Summit on the Right to Development (December 2015)

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AFI Changemakers representatives will also be present at the International Labour Organisation, UNAIDs and the UN Human Rights and Business Conference throughout the year

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Increasing the capacity of young people to have their voices heard through an AFI Changemakers blog, which can be accessed at http:// www.changemakers-un.org/315-2/.

AFI Changemakers Delegates Catherine White, 21, United Kingdom Catherine is an English and French student at the University of Warwick and hopes to pursue postgraduate study in human rights. Being half Jamaican and half English, she has been sensitive to discrimination from a young age. This has led her to pursue overseas internships and volunteering opportunities, including being a translator in Guadeloupe, a research assistant in Madagascar and teaching English in Uganda. Catherine was a Co-Chair of the AFI Changemakers ‘Right to Health and Access to Medicines’. Summit.

Daisy-May Super, 21, United Kingdom Daisy is in her fourth year studying English Law with Australian Law at King's College London. She is currently undertaking an internship with an NGO specializing in social enterprise and community empowerment with Tanzanian youth and women and has previously volunteered with an NGO in Kenya implementing sustainable development initiatives in secondary education. She believes that the way out of poverty and national inequality is through business and economic stimulation achieved through global co-operation and discipline.

Dominic King, 21, United Kingdom Dominic assisted in drafting a report on the state of children’s rights in England for the UN Committee on the Rights of the Child when he was fourteen. He has had input into major publications and made public presentations in the field of human rights. Over the last year he has been working on strategic communications and has previously co-ordinated a UK wide children’s rights partnership, been a Trustee for one of the world’s largest human rights alliances and developed a public speaking course for a school in Uganda.

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Doruk Akin, 30, Netherlands Doruk worked in the role of communication and media in political affairs specifically while working at a non-governmental organization that works towards the development and reinforcement of independent media in conflict areas, and countries in transition.

This has led her to continue to expand her academic knowledge in this area, by graduating in Political Science, and obtaining her MA in International Relations. She has taken a great interest in the UN model and the role (global) civil society and mass media in the international political system. She focusses on the question of how to create social movements and bring change in governance structures and political institutions that negatively affect the global development and progress.

Emma Robinson, 23, United Kingdom Emma is a student of Theoretical Physics at King's College London. She is passionate about addressing educational inequality and childhood disadvantage. She has worked for a variety of organisations and NGOs that aim to promote social justice and hopes to continue pursuing a career that allows her to help to create more equal opportunities for all. Emma is currently on the AFI Changemakers organisational team.

Henry Gilliver, 23, United Kingdom Henry is currently studying for a master’s degree in International Public Policy at University College London.

He is specifically interested in the power of international norms, and the individuals and organisations that create and promote them. He is involved with AFI Changemakers because he passionately believes that young people have a vital role to play in this process, and can be instrumental in bringing about positive global change. Henry is currently on the AFI Changemakers organisational team.

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Maria Alexandra Radu, 22, Romania Alexandra is currently reading Business Management and Media Publishing in the UK where she is currently based. Her passion for international development and social entrepreneurship has led her to work in various countries and for multiple projects in India, Zambia, UK, Romania, Belgium to name a few. She is dedicated to connecting and sharing ideas with people from all corners of the world and wants to continue to work in empowering women and allowing them to access STEM fields.

Thun Thong, 22, Australia.

Thun is an undergraduate student of International Studies with a minor in French from Monash University in Melbourne, Australia, currently studying abroad at Leiden University in the Netherlands. He has worked with youth leadership organizations and h been involved with a environmental conservation project. His areas of interests are human rights and social equity. He intends to work with the United Nations and other relevant organizations to promote these issues and initiate resolutions which he believes are key to tackling the inequitable horizontal societies across the globe and to transform them into vertical societies - a structure where all individuals are equal and treated fair and just.

Megan Smith, 22, United Kingdom Megan is studying European Legal Studies at King’s College London, and is currently on Erasmus at Leiden University in the Netherlands. After volunteering as part of an access to justice scheme in Ghana, she is interested in the way grass-roots initiatives and education can play a role in combating problems. She is also actively involved with Lawyers Without Borders and hopes to continue legal work in international human rights law, focusing on the rights of women in developing regions affected by conflict. Megan was a Co-Chair of the AFI Changemakers ‘Right to Health and Access to Medicines’ Summit.

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Rinisha Yagarajah, 24, Malaysia Currently a final year medical student in Moscow, Russia, Rinisha believes in being the change that she wishes to see in the world.

Michael Fox, 23, Northern Ireland Michael is a final year Politics student in Belfast, Northern Ireland. He is currently co founding a charity to support young girls in Old Moshi, Tanzania through secondary school. He is passionate about access to patented medicines, access to secondary education, youth development and social enterprise.

Nina Rachet, 22, France Nina Rachet is a postgraduate student at UCL in International Public Policy. Her goals are to better the lives of others and give them the opportunities to achieve their dreams while building a less individualistic world. She specialised in conflict resolution and postwar development

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Poonam Bhar, 24, Malaysia Poonam is currently enrolled at medical school in Moscow, graduating in June 2015. She is involved in a variety of influential medical projects within Russia, including providing medical help to small towns and delivering much needed support to rural orphanages.

Rory Evans, 23, United Kingdom

Rory is a recent Religious Studies graduate who has experience working in media and communications for a sustainable food security NGO operating in eastern Africa. He is currently volunteering in Palestine, working with young people struggling to find employment. In September 2015 he will start an MA in Development, Violence and Conflict at SOAS in London. Rory wants to pursue a career in international development, developing sustainable, long-term assistance programs. Rory has previously represented AFI Changemakers at the informal intersessional meeting for the Working Group on the Right to Development at the United Nations in Geneva.

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Roy L Morris Esq Roy has expertise in complex litigation case management, economics, finance, telecommunications regulation, administrative law, angel and venture capital, and communications and control systems engineering. Former Chair MIT Enterprise Forum Washington DC/Baltimore (current member of Board), high tech startup advisor, and adjunct professor, Capitol College Graduate School. He has also provided strategic advice to non-profits as part of the COMPASS program of Greater DC Cares. Over 20 years experience in telecommunications regulation, investing, financial analysis, management, a pioneer in telecommunications competition, deregulation, and engineering design with leading firms and institutions, including Bell Telephone Laboratories, MIT, MCI, US One Communications, ALC Communications Corp, Zip Communications, WebPerfect, the Federal Communications Commission, and Frontier Communications (now Global Crossing. Mr. Morris holds an MBA (Wharton; emphasis in finance), JD (GWU emphasis corporate law and antitrust), and SMEE (MIT) degrees. Mr. Morris has published numerous papers and articles on entrepreneurship, investing, telecommunications, economics, and law, including, Voice Over Internet Protocol (IP), Internet Encyclopedia at Vol III, 647, Wiley, 2004; A Proposal to Promote Telephone Competition: The LoopCo Plan,CCH Power and Telecom Law, January/February 1998 at 35; and Wanted: More Lead Angel Investors, Potomac Tech Journal, February 18, 2002 Ambassador Colette Kirura Samoya Colette K. Samoya former Ambassador of Burundi at the UN. Colette Samoya Kirura was born in 1952 in Nyakirwa, Burundi. At that time the education of girls was not encouraged; however, she completed her studies in 1975, gaining a University Degree in History and Geography. She then involved herself in the struggle for the rights for the women of Burundi, taking the battle to the many political institutions and right to the parliamentarians.

Colette Samoya Kirura was appointed Permanent Ambassador to the UN in Geneva in February 1992, becoming the first Burundi women to gain this prestigous post. She still lives in Geneva (2002) where she is a now consultant responsible for projects within Non-Governm Elle est Historienne et Géographe et a débuté la carrière professionnelle dans l'Enseignement.

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Dr Ariel Rosita King, MPH, MBA, PhD, DTM&H Dr. Ariel R. King is the Founder, and President Ariel Consulting International, Inc. (http://www.ArielConsult.com) founded in 2000, a company that creates and enhances Public-Private Partnerships in international health, policy, and management with focus on developing countries She also founded The Ariel Foundation International (http://www.ArielFoundation.org) founded in 2002 as a nonprofit organization with an international focus on children and youth in Leadership, Entrepreneurship and Community Service world-wide. More recently, in 2008 Dr. King founded the Ariana-Leilani Children’s Foundation International to educate and advocate for Children’s Human Rights Worldwide (http://www.Ariana-LeilaniFoundation.org).

Dr. Ariel King is an Economic, Cultural and Social Council (ECOSOC) Permanent Representative currently for Le Collectif des Femmes Africaines du Hainaut (C.F.A.H.) and over the years various Non-Governmental Organizations (NGOs) at the United Nations in Geneva since 2008, the United Nations in Vienna (UNOV) since 2010 and United Nations in New York since 2000. Dr. King’s life focus is the human rights and participation of worlds’ children and youth. Ariel Foundation International has become a member of EuroChild.

Dr. King has over 35 years of experience in international health, international public health policy and international management in government, business and NGOs. As a Professor in International Health, Management, Policy and Environment she has taught at Universities in the USA, Europe and Africa. Dr. King has published on the topics of Kangaroo Newborn Baby Care, International Health Policy and Management, Medical Ethics, Organ Transplantation, National Essential Drugs Policy, HIV/AIDS; Breast Cancer; Violence Against Women; Youth Participation at the United Nations and Children’s Human Rights.

Dr. King was chosen to be on the Expert AIDS Prevention working Group with the Bill and Melinda Gates Foundation (USA) and Human Science Research Council (South Africa). Dr. King was a part of SAHARA: Social Aspects of HIV/AIDS Research as the Chair of the Continental Advisory Board. Dr. King's focus is on International PublicPrivate Partnerships in Development that has its foundation of 35 years of living and working in 12 countries and traveling to over 65 countries..

Dr King is a Trustee for Childrens Rights Alliance England (CRAE) and the Acid Survivors Trust International (ASTI) both based in London, UK. She has served as a representative for the International Council of Women (Paris) at various UN meetings and has served on the board of directors of the National Black Women's Health Project (Atlanta, USA), Positive Art: Women and Children with HIV/AIDS (South

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Dr Ariel Rosita King, MPH, MBA, PhD, DTM&H Africa), The Life Foundation: AIDS Foundation of Hawaii (Honolulu, Hawaii) , The Black Alliance for AIDS Prevention, the Pediatric HIV/AIDS Care, Inc., and the Ronald McDonald House. Dr. King is a Founding and Board member of Women Impacting Public Policy (WIPP), member of the Women's Foreign Policy Group (WFPG), and has been active member of various International Rotary Clubs for twenty years.

Dr. King is currently completing a research degree (PhD) in Sociology on Community Engagement in the Psychosocial Care of Traumatised Children – A Case Study of Botswana, Liberia and Morocco at the Unitersité de Franche-Comte, France (expected 2016). She also has completed advance certificates in the study of Children’s Human Rights, from the UER Droits de l'enfant/Children's Rights Unit, Institut Universitaire Kurt Bösch (IUKB) in Switzerland.

Dr. King holds a Diploma Tropical Medicine and Hygiene (DTM&H); Doctorate (PhD) in Philosophy in Public Health and Policy from the London School of Hygiene & Tropical Medicine, University of London; a Master in Business Administration (MBA) in International Health Management from Thunderbird American Graduate School of International Management, Master in Public Health (MPH) in international Health from the University of Texas School of Public Health; and a Bachelor of Arts (BA) from the University of Hawaii.

Dr. King is the very proud mother the 11-year old “Little Ambassador” ArianaLeilani Margarita Alexandra King-Pfeiffer, whose life has inspired the founding of the Ariana-Leilani Children’s Foundation International (2008) to educate and advocate for children’s human rights worldwide.

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Ambassador Ireneo Omositson Namboka,- Deliberations advisor Former UN Staff. Ugandan and French Participated in three United Nations peacekeeping operations. He served at the Geneva United Nations High Commission for Human Rights HQ, and as the Regional Programme Officer for OHCHR’s Southern Africa (SADC) regional office, Pretoria (2003 - 2004.

Joined the United Nations Department for Peace-keeping (DPKO) Mission in Liberia (UNMIL) where he served till June 2010.

Since leaving the UN Mr. Namboka undertakes activities in the defense of human rights, transitional justice, peace-building through creative writing, training with module designing and conference work. From March to September 2012 Mr. Namboka served as the international senior consultant (Advisor) to the CoChairmen of the Provisional Commission of reflection on national réconciliation, Guinea. From Jan 2015 he is an Expert Advisor with UNITAR on the protection of civilians in post conflict- countries, pre-deployment training of military personnel to Peacekeeping operations in Africa and takes part in actual mentoring in the field.

Mr. Namboka served on special assignment as Senior Advisor to the Special Representative of the Secretary General (SRSG) in the United Nations Office for West Africa (2008) in the capacity of Head of the Human Rights and Gender Affairs division – June to October, laying a solid basis for close cooperation between UNOWA and the OHCHR West Africa regional Office also based in Dakar.

He has conducted a wide range of workshops and seminars for government officials, police and military as well as for members of civil society/ nongovernmental organisations. He was part of the team of trainers with the King’s College of London NGO - Africa Office based in Nairobi Kenya.

Prior to joining the United Nations service Mr. Namboka served as a career diplomat for 13 years in the Uganda civil service - at headquarters and abroad at Ugandan Embassies in Gabon, Great Britain and France. An alumnus of Makerere University, (BA Hon. Political Science) he also attended the University of Paris I – Sorbonne Pantheon (Ėtudes du 3ème Cycle Droit - International Public), the Centre d’Études Supériuères Industrielles (CESI)Aix en Provence –MA; United Nations Staff College, Turin - Italy and the United Nations University,

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AFI Changemakers Reports AFI Changemakers Summit 2015 group reports on the Right to Health and Access to Medicine can be accessed at: Mental Health: http://www.arielfoundation.org/documents2015Mental Healthreport.pdf

Courruption in Healthcare: http://www.arielfoundation.org/ documents2015CorruptioninHealthcarereport.pdf Sustainability in Healthcare: http://www.arielfoundation.org/ documents2015Sustainabilityhealthcarepoliciesreport.pdf December 2014 Summit on the ‘Right to Development’ Copies of stand-alone reports on Discrimination and Slavery and Trafficking, from the Right to Development Summit 2014 can be accessed at: Discrimination: http://www.arielfoundation.org/ documents/2015discriminationreport.pdf Slavery and Trafficking : http://www.arielfoundation.org/ documents/2015slaveryreport.pdf

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