Dr. Andrew Cassels, Senior Fellow at the Global Health Programme, responded to the recent Lancet - University of Oslo Commission on Global Governance for Health report as part of the seminar “Health Inequities: A political choice?” hosted by the Columbia University Mailman School of Public Health and the Norwegian Mission in June. The seminar is part of the UN Global Health Seminar Series held by the Better Health Systems Initiative at Columbia-Mailman, designed to foster discussion among diplomats and key decision makers on significant issues in global health ahead of the UN General Assembly in September. 

 

Dr. Cassels offered his reflections on the findings of The Lancet’s report, “The political origins of health inequality: prospects for change”, which calls for states to address gaps in health inequity. He acknowledged the Commission’s success in highlighting the important political considerations that come into play and contribute to the complex normative landscape of global health in which a wide range of international organizations, government agencies, treaty bodies, public-private partnerships, national and trans-national commercial entities, civil society organizations, the media, social networks all have a role. 

 

Drawing on his experiences working at the World Health Organization, Dr. Cassels outlined the practical challenges of implementing global health diplomacy. For example, much of the normative work done by WHO involves negotiations that are both time and resource intensive and often any negotiations involving mandatory monetary contributions face considerable resistance. In terms of financing, WHO is dependent on bilateral and multilateral funding agencies which puts it in competition with other organizations offering country-level programme-based results. Furthermore, WHO has been slow to open up to non-state actors, making reform to a multi-stakeholder structure difficult.  

 

In this environment, the analytic function of WHO should be maintained, as it plays a vital role in providing objective, high-quality evidence about the impact on the political and other determinants of health. Dr. Cassels contended that this research should take precedence over soft advocacy and the promotion of an ill-defined ‘social determinants approach’ to national policies. Lastly, with the growing momentum behind universal health coverage and the negotiation of the sustainable development goals, there is a great opportunity - and yet much still to be done - to show that a positive impact on people’s health is a responsibility for all sectors.