18 March 2015

ILONA KICKBUSCH ASKS: What do you consider to be the priority global health diplomacy challenges in 2015?

For every newsletter, a selection of leading global health experts answers a new question from Ilona Kickbusch on global health challenges.

Andrew Cassels, Former Director of Strategy, World Health Organization; Director, GH Associates
The aftermath of Ebola
A new spur to the reform of WHO, and recognition of the importance of resilient health systems.
On WHO, the challenge is to increase WHO’s effectiveness in all forms of emergency response while recognizing that this is but one of the functions the Organization is asked to perform. Technical norms and standards; direct support to all countries; political advocacy for health; and emergency responses. Can a decentralized organization really do all four effectively?
More on health systems below….

Not all important health issues pose a security problem
The technical and economic case has been made for acting on noncommunicable diseases and, to a lesser but equally important extent, the societal re-engineering that will be required to address the needs of ageing populations.
The challenge is to link political engagement, across governments, with practical actions that extend beyond advocacy and special pleading. In too many middle- and low-income countries a practical response to these challenges is barely on the horizon.

Fixing health systems is hard and highly political
Resilient health systems protect populations from the devastation we have seen in West Africa. A point now very well established.  But the response is not amenable to a quick technical fix.
The challenge is making health care of decent quality available - not just for special groups or for selected conditions - but for all that need it. So, less emphasis on new special funds, new initiatives, and new global champions; and more attention to the resources needed for hard graft on the ground.  

Learning to use a new set of global goals
The new set of sustainable development goals has yet to be agreed. It is a fairly safe bet however that in health the list will be similar to, but longer than, the MDGs.  
The challenge will be to use the SDGs creatively (and in the integrative way they were originally intended, before being overwhelmed by multiple competing interests).  If they merely drive a renewed focus on a narrow range of development results, of primary interest to funding agencies, we will have missed a major opportunity.

Michel Kazatchkine, UN Secretary General’s Special Envoy on HIV/AIDS in Eastern Europe and Central Asia

I expect year 2015 to be a busy and challenging year for Global Health diplomacy. Health diplomacy will be active on many different fronts, either very visible (e.g when debating the future of WHO), or as part of a broader global, political, societal, economic or human rights-related set of issues. Deliberations ahead of the Sustainable Development summit in September will delineate how “ensuring healthy lives for all” can and will remain a priority in the forthcoming integrated sustainable development agenda. Health diplomacy will be challenged in ensuring sustainable resources for Health in a challenging financial and economic environment. Traditional donors will have to reconcile their approach to health as a key component of development with the new context of most poor people (and most people affected by diseases of poverty) now living in middle- income countries. Economies in transition will have to move more decisively towards social investments. The world will have to go back to the - somehow lost- concepts of Global Public Goods. The global governance of/ and for Health will be intensively debated as its failures and gaps are increasingly recognized by the global public opinion, beyond the restricted circles of delegates to the World Health Assembly. How will the debate shape itself, to be truly global, remains unclear. Attention to Health will come with the preparations of the Conference on the climate convention at the end of the year. How much will health be an issue in negotiations that will be captured by the tensions between the developed and the developing worlds? Where is Health diplomacy in these discussions, beyond expert contributions?  And then, Health diplomacy will have to scale up its efforts “at home” in all countries across the world to advocate for health in unfavorable political, societal, economic, conflict, human rights abuses, environments.
For when we talk about equity in health, we are speaking of social justice.

Mihály Kökény, Former minister of health of Hungary

Four high-level international meetings this year – taken together - give us the opportunity, and – many would say – the responsibility, to chart a new era of sustainable development including health:
In March, the 3rd World Conference on Disaster Risk Reduction in Sendai;

  • The International Conference on Financing for Development in Addis Ababa in July;
  • The Special Summit on Sustainable Development in September (the culmination of a long process to define the post-2015 development agenda) and
  • The 21st Conference of the Parties of the UN climate convention in Paris in December.

These conferences are all connected, and coherence and reinforcement between them is critical also from the point of health challenges.
The “state-of-play” of health among the proposed SDGs is still not satisfactory, however lessons learned from Ebola outbreak can trigger a more explicit health goal (possibly an additional one on health security). German presidency guided G7 summit also might influence this.
Checking the draft agenda of the 68th WHA it is still unpredictable whether WHO tables any strong and urgent initiatives attracting global health players. Strengthening IHR, roll back AMR could fall in this category but the list of everlasting, unfinished WHO businesses is also long.
Additionally, health impacts of the civil war in Ukraine as well as in the Middle East and Libya (against IS) are likely to dominate diplomacy and the health diplomacy agenda too. The health status of the increasing flow of refugees and the collapse of public health system on the areas of armed conflicts are of major concern.

Jonathan Patz, Professor of Environmental Studies and Population Health Sciences and Director of the Global Health Institute, University of Wisconsin–Madison

For too long we have constrained what we call “health policy” to the healthcare system. Health diplomacy, therefore, needs to focus more on key determinants outside the health sector, particularly the condition of our air, water, food, neighborhood streets or urban design, and the earth’s climate. While equitable access to medical care remains a priority, I argue that at the population level, larger health benefits will accrue from policies outside the health sector.
Rising rates of Non Communicable Diseases (NCDs), for example, arise as emerging countries emulate western diets and lifestyles. Globally, a carbon-intensive economy –powered by fossil fuels– while at first health promoting, is causing today’s climate crisis that poses a substantial threat to global health. At the same time, deforestation and disruption of natural ecosystems is shifting the ecology of infectious diseases.
The interdependence of these challenges, however, affords a golden opportunity for global health. A low-carbon economy can promote healthy lifestyles, e.g. from “active transport,” reduced meat diets, and improved air quality from shifting to renewable energy. Such energy and agricultural policies define global health in this 21st century and demands that those in global health diplomacy fully engage across sectors and effectively communicate how decisions in those sectors are critical to global health.