Improving Health through Foreign Policy

The Lancet—University of Oslo Commission on Global Governance for Health, Oslo 11 February 2014

State Secretary Hans Brattskar's speech at the the launch conference of the report of the Lancet - University of Oslo Commission on Global Governance for Health in Oslo 11 February 2014.

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Rector Ottersen, Excellencies, Commissioners,
Ladies and gentlemen,

Thank you for having me here for the launch conference of the important report of the Lancet - University of Oslo Commission on Global Governance for Health.

Investment in health is fundamental to economic growth, development and security. Threats to health may compromise a country’s stability and security. I would also like to stress the strong link between education and health. Investment in education, done correctly, is one the best investments we can make for health, growth and development. This is one of the reasons for our Government’s ambition to assume a leadership role in education for development to match the role we already have assumed in the health sector.

Statssekretær Hans Brattskar talte under rapportlansering i Oslo 11. februar 2014. Foto: Utenriksdepartementet/Astrid Sehl
State Secretary Hans Brattskar's speech at the launch conference of the report in Oslo 11 February 2014. (Photo: Astrid Sehl/MFA)

Our government has committed to further develop our efforts on global health and maintain financial support at a high level. It is also a priority to increase substantially the political attention and funding provided for education.

Before I continue, I would like to say a few “thank-yous”. Former Norwegian Foreign Minister, and co-signer of the Oslo Ministerial Declaration on Foreign Policy and Global Health, Jonas Gahr Støre is with us today. He played an important part in initiating this report and it is very important to note that these efforts have received broad support in the Norwegian parliament.

And a warm thank-you to all the commissioners for their work, and of course I would also like to acknowledge the instrumental part played by Richard Horton, editor of the Lancet.

Norway’s work on global health is an important foreign policy and development issue.

Our aim is to address global health comprehensively at both a political and strategic level.

Let me explain why:

- You cannot eliminate poverty without safeguarding the right to health, and vice versa.

- It is also self-evident that equitable access to health is not possible without peace and reconciliation. For example, it is in states in conflict that polio is still endemic, or could easily become so.

Last year – as Norway’s ambassador to Kenya – I remember vividly how worried people in the region were for the danger of having polio migrating from war-torn Somalia as outbreaks occurred in that country.

- We must also remember that trade and investments are more important to developing countries than aid, although they are not mutually exclusive. Suitable trade and investment policies are needed to remove barriers to access affordable medicines and safe and nutritious food.

- Governance must be improved in many countries. Corruption undermines the distribution of public goods, also within the health systems.

- Our policies must also address climate change and environmental issues effectively. Otherwise we will face increasing health problems as a result of natural disasters and pollution.

My message here this morning consists of three points.

First: States bear the primary responsibility for securing health for all, including the most marginalised groups. Although challenges to health are increasingly international and global, it is the responsibility of individual states to ensure a good standard of health for all their citizens. But in order for states to assume their responsibility, they must of course have the capacity to act.

And - it is not possible to effectively act if the state is fragile, and if it is ridden by conflict or war. Armed conflict can wipe out 30 years of development in a matter of months. Look to Syria and see how quickly a country can deteriorate.

Peace and reconciliation efforts are therefore a central part of Norway’s foreign policy. I will mention one example: Colombia. Colombia has been suffering under a 50-year long conflict that has cost over 200 000 lives. President Santos and the FARC recently returned to the negotiating table, with Norway acting as one of the facilitators. We consider the role we can play to encourage negotiations to be an investment also in long-term development.

When conflicts arise, we must provide humanitarian support and assistance for reconstruction, and we must also push for political solutions.

The fight against poverty is also of key importance. A poor nation with an unhealthy population is of course unlikely to be able to establish and sustain health services for all without significant assistance. We must therefore be generous, but we must also focus our efforts in areas where they can have a real impact.

Respect for human rights, is another vital factor. The right to health for all is the cornerstone of all our global health efforts.

To recap: Securing the health of its citizens is one of a state’s fundamental tasks. Health is a human right. And we must cooperate to help states function in the best possible way.

My second main point is that new partnerships across different platforms and sectors will be crucial for advancing the health-for-all agenda.

Norway works with a broad range of actors, including private foundations, organisations such as GAVI, the Global Fund and UNITAID. We are engaged in innovative partnerships that have helped to shape markets and even create new markets. And as a result, we have seen dramatic increases in access to health services in many countries.

For example, GAVI has made it possible for 440 million children to be vaccinated. UNITAID has made child friendly HIV/AIDS medicines available to 400 000 children with an 80 % price reduction. These are massive achievements. I was in Washington in December 2013 at the Global Fund replenishment, meeting with an impressive set of global leaders committing 12 billion USD. Norway is pleased to be a part of a partnership that now can transform the lives of millions more children, women and men.

Through our partnerships with GAVI and the Bill & Melinda Gates Foundation, and in cooperation with Rotary, it could be possible to eradicate polio within the next five years, but this depends on political developments in the few states where polio is still endemic. This will be a major achievement. It is important to stress that we must remember that incredible progress has been made on global health issues during the past few years. I would in this context like to congratulate India, which has recently been declared polio-free, after an impressive three-year period without any new cases.

We have also taken part in the cooperation under the framework of the UN Commission on Life Saving Commodities, to provide volume guarantees to the private sector to improve access to affordable contraceptive implants for women.

As a result, the price for these implants has been more than halved: now 8.50 US dollar, previously 18 US dollar.

Our cooperation with research communities on the development of new medicines has brought about progress that was not possible to achieve through markets alone.

There are many areas where public–private partnerships should be further explored as an option for promoting health for all. We can see a growing financial gap between health needs and the health funds available in many countries today. Partnerships can make more financial and technical resources available for such countries. Today there is a willingness among multiple stakeholders to contribute to the health agenda. However, it is fair to say that many more actors – both commercial and civil society organisations – could and should take on much greater responsibility. It is vital therefore to provide a meaningful way for a broad range of actors to participate in a common effort towards better health for all. I hope that this conference will provide some input to help us on the way to further progress.

Then my third and last point: States have to strengthen their engagement in both regional and global cooperation to be successful in advancing the health agenda.

As the report points out, transnational developments and processes have an important influence on health equity.

Good health is a global common good. Diseases do not respect national borders. It makes sense therefore for both health policy and measures to implement this policy to be developed through regional cooperation.

An example I can mention, is the African Union roadmap on shared responsibility and global solidarity for AIDS, Tuberculosis and Malaria, which was drawn up in 2012 to strengthen African cooperation on Millennium Development Goal 6.

Norway’s own cooperation with the EU and in the Barents Cooperation has fostered transfer of knowledge and experience, and helps us to constantly improve our own health policies.

I am confident that regional cooperation can be equally beneficial for others.

I would like to stress that we have two years to make progress in the MDG framework. The new goals to replace the MDGs – the post-2015 framework – will also be important for advancing health globally.

In this work, we will have to take a new, comprehensive look at development, including health. It will be a major opportunity to assume a multi-sectoral approach and integrate our efforts to achieve health for all. We will therefore need to take stock of how well global governance for health is suited to the challenges ahead. If we are to succeed, the new global development agenda will have to involve more stakeholders, and encourage broader cooperation. I hope you will find this conference useful and inspiring, and that it will provide an opportunity for fruitful discussions.

I wish you the best of luck with this work. Thank you for your attention.

Thank you.