Beginning the process: shaping global health in a multipolar world for the next 25 years
The field of global health is becoming ever-more multifaceted and complex
Richard Seifman is a board member of the National Physicians Alliance and has over 45 years high level experience in international development, mainly in health and nutrition with bilateral, multilateral and non-governmental organisations.
In a previous post on this site in April 2018, I discussed the need for greater streamlining and inclusivity in the global health landscape. Leaders of Germany, Ghana, and Norway, have recently called upon the WHO Director General to prepare a Global Plan for Healthy Lives and Well Being for All for presentation at the World Health Summit in Berlin this October. It is hoped that this report will act as an impetus to unify “global actors such as… UNAIDS, UNICEF, UNODC, UNDP, the World Bank and Global Fund to Fight AIDS, TB, and Malaria, the Global Alliance for Vaccination and Immunizations, the Global Financing Facility, and other relevant organisations”, under the guidance of WHO, in order to “streamline their efforts”.
While this proposal is certainly a step in the right direction, it still fundamentally looks to the same limited pool of predominantly western-centric government and international institutions that have been the major players all along; it meets the streamlining criterion but does little to move towards greater inclusivity. While organisations like WHO still have an important role to play, financial, logistical, and diplomatic limitations mean that they cannot do it alone. An example of these limitations is in the implementation of the WHO International Health Regulations (IHR), the potential of which was demonstrated in the relatively successful management of the recent Ebola outbreak in the Demogratic Republic of Congo. But while the IHR include mention of a process for pursuing claims of failure to comply, WHO has been powerless as yet to enforce any penalties. Without some pressure or incentive, neither of which WHO is currently able to provide, the potential impact of these guidelines will be severely limited through a lack of compliance.
We now live in a much more complex, multipolar world, where the key actors on the global health stage are no longer entirely from what might be called the West. Shaping any new global health action plan will require bringing a wider range of stakeholders, be they countries or the “other relevant institutions”, mentioned almost as an afterthought in the proposal, centrally into the discussion to allow for greater consideration of new issues, and new solutions, that might not be on the inevitably limited radar of the organisations referred to by name.
Brazil, Russia, India, China, and South Africa (BRICS) are clearly among the new powerhouses that must be brought into consideration. China alone has 20% of its population, roughly 260 million people, earning close to $40,000 per year. The “population and market weight” of all of Asia when combined in terms of numbers of people and purchasing power, has the traditional West pale by comparison. And, as further noted by Jim O’Neill, there are “Next Eleven” countries with rising economies which need to be in the mix (South Korea, Mexico, Indonesia, Turkey, Iran, Egypt, Nigeria, The Philippines, Pakistan, Bangladesh and Vietnam), to which Saudi Arabia should be added.
Then there is the growth of non-State entities. The amounts spent by the private sector, combining profit and not-for-profit entities, are vastly larger than what is coming from the public sector. Technical expertise, as well as research and development of new drugs, devices, and medical procedures, lie far beyond public sector capability. Technical fields outside the health sector per se, such as information technology, artificial intelligence, and biological and electronic combinations, are merely the tip of the iceberg in terms of what needs to be taken into account in a forward-looking global health action plan. And those with experience in these emerging fields, outside the government and international institutions, need to be explicitly seated at the table as equals.
Commerce between countries is more significant now than ever before. Conspicuous in its absence in the institutions listed above is the World Trade Organization. The full gamut of trade interests and global health is central to any future proposed treatment of global health. One need only look at the current trade confrontation between the USA and China to realise the breadth of this issue; China has the second largest pharmaceutical market in the world, forecasted to grow from $108 billion in 2015 to $167 billion by 2020, so any hits to China’s economy could have serious ramifications for drug availability and R&D efforts.
After the Berlin Summit, what should happen next is an agreement on broadening the agenda, leadership, and discussion of any new global health compact to one that looks to a longer term, say to 2050. A global gealth Bretton-Woods-type preparatory process could be developed with a goal of having preparatory milestones, culminating in a decision conference within a defined time period. A limited number of topical Commissions such as on infectious diseases, non-communicable disease, trade and health development coordination could be created which look to the old—and new—elements of global health to produce an agreed framework for the decision conference. This is a moment in world health history when we go forward collectively, one in which “a rising tide will lift all boats”—or none.
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