Why we need a Commission on Global Governance for Health

Five years ago, the foreign ministers of Brazil, France, Indonesia, Norway, Thailand, Senegal and South Africa, launched the Global Health and Foreign Policy Initiative in recognition of the central importance of health and its connection to multiple global governance processes in which we were engaged.  In many ways, protecting and enhancing the health of its population is one of the most important goals and duties of any state. With globalization and increased interdependency among countries, health issues have become even more central to states’ interests. 

The elevation of health considerations onto the foreign policy agenda is a recognition of at least three new realities. First, national health is no longer determined solely by domestic conditions but also by global forces that lie outside the control of any one state.  Second, protecting and enhancing health has widespread implications, and requires engagement by those of us who sit outside the health sector, including – but not only – foreign affairs ministries.  And third, health must be considered alongside the most pressing issues on national and global agendas, including security, sustainable economic growth, democratic governance, and human rights.  In 2007, we jointly adopted the Oslo Ministerial Declaration, in recognition that “a focus on people’s health and wellbeing must become part of the collective consciousness of policy makers at the highest level” and that “health issues do not only belong to ministries of health and the WHO, especially when they are cross-cutting in nature.” (1).

Health is not peripheral to foreign policy and the national interest – rather, in our globalized and interdependent world, health is at the core of it. The challenge, therefore, is to create processes and institutions that allow us to manage and coordinate around health issues as seriously and effectively as we do in other areas of international politics. But achieving this has turned out to be a demanding task.

The cracks in the system appear each time we face a new crisis. In 2009, we were confronted with the spectre of a truly global pandemic. Within eight months, the H1N1 flu virus spread from one city to 212 countries and territories, threatening to disrupt fundamental social and economic activities both within and across countries. It created enormous policy challenges for individual countries and the global community regarding restrictions on travel and trade, and how to ensure equitable access to vaccines and drugs for both rich and poor countries. It is not only fast-moving border-crossing infectious diseases that require international attention, but also the shared challenges of chronic diseases, such as HIV/AIDS, diabetes, cancer, cardiovascular disease, and mental illness, that put a heavy burden on countries’ economies and health systems.  These complex health challenges raise difficult questions about food and agricultural policies, about safe drinking water and sanitation, about the trade in and marketing of tobacco, about migration, about regulating pollutants and toxins, about intellectual property and access to medicines, and about universal health coverage, among many other issue areas. Addressing social determinants of health, as pledged by leaders in the World Conference on Social Determinants of Health, is also of paramount importance to promote sustainable development. 

However, governance processes at the global level tend to be isolated by sector, fragmented among a number of arenas, with insufficient mechanisms for ensuring coherence, and frequent conflicts between those with opposing interests.  Effective protection and promotion of health is too often sacrificed in the process. Cross-cutting issues challenge the efficency of our public policies, and we look forward to the upcoming United Nations Conference on Sustainable Development (Rio+20) in June 2012 to pave the way for greater coherence in international governance.  Also the ongoing reform of the World Health Organization holds potential in this regard.

Therefore, the Global Health and Foreign Policy Initiative[1] has made governance its overarching theme for its next phase of collaboration, in recognition that the world needs more functional and coherent global governance for health.

But we have realized that we have insufficient knowledge to make major progress.  There is little clarity about how to ensure that health is protected and promoted in global policy arenas outside the health sector.  A systematic and independent process is needed, representing a broad range of disciplines and regional diversity, to develop a set of concrete recommendations on how to improve global governance processes for health.

As such, we welcome the creation of the independent academic Commission on Global Governance for Health organized by The Lancet, the University of Oslo and the Harvard Global Health Institute.  The aim of this commission, announced in the November edition of The Lancet, is to carry out rigorous scholarly analysis, based on empirical evidence, to offer actionable ideas and a roadmap for the future protection and promotion of health in the many global governance processes affecting health. We count on this report to catalyze discussions and debates, and to lay the foundation for a second stage of consultations and deliberation at appropriate international decision making fora. We look forward to receiving the report and to take it forward at the political level as part of our Global Health and Foreign Policy Initiative.

 

References

1. Amorim C, Douste-Blazy P, Wirayude H, Store JG, Gadio CT, Dlamini-Zuma N, et al. Oslo ministerial declaration -- global health: A pressing foreign policy issue of our time. The Lancet. 2007.

[1] Reference to Lancet statement, Ministerial Statement 2010 and UNGA Resolution 2010