Global health (GH) = GH equity = GH Justice = Global Social Justice
The Opportunities of Joining EU and US Forces Together
Dr. Juan Garay
The World Health Organization is entrusted with possibly the greatest of all human's aspirations: the attainment of the highest standard of health for all people. This global and shared objective has an inherent element of equality. Equality and the measures towards it (width of variable distributions) is a mathematical concept. Equity is the fair and feasible level of equality. However, the minimum level of fairness at national and global levels has not yet been defined, and so measurement and progress cannot be interpreted. The analysis of global (in)-equity dynamics will enable the proposal of fair targets of equality (equity), and efficient strategies towards it.
In our preliminary analysis, excess mortality rates in children and adults in “developing countries” compared with those in high income countries translated into 20 million premature and avoidable deaths in 1990. This means that one out of three deaths in the world is premature and due to global health inequity, or global health injustice. This share of the burden of global health injustice has been stagnant since 1990, despite hundreds of declarations and a fivefold increase in health aid. Additionally, the main global health agenda, the Millennium Development Goals, only targets 60% of this burden, and is off track in most low income countries.
Health disparities within and between countries undermine social cohesion and stability, as well as the inclusion of growth and its impact into the wider developmental progress of societies. In a “catch 22”situation, the global average national income inequality (measured by the GINI index) has been increasing by some 3% annually. In OECD countries, higher degrees of income inequalities are correlated with poorer overall levels of health and higher but less equitable health spending. Health suffers from income disparities between and within countries, and as it feeds back, it further undermines social cohesion, equal opportunities and greater disparities.Health is also rooted in behavioural and socio-cultural contexts, and in the relations with ecosystems and the environmental factors enabling sustainable development.
At the global level, distribution of public resources for health reflects the large GDP disparities in the world, which are further enhanced by lower tax revenue rates on GDP in many developing countries and a lower share of their national budgets directed toward health. As a result, the ratio between high and low income countries in terms of public spending on health reaches a factor of 110. Under such a large gradient, the human and product resources for health are subject to global market dynamics and leave low income countries with insufficient means to allow delivery of equitable and pertinent health services.
Present levels of ODA (Official Development Assistance) are lower than committed, not sufficiently focused in low income countries, fragmented by parallel vertical programmes, and biased in favour of some health problems while neglecting others. In the best scenario of 0,7% of GDP of OECD countries for ODA and 15% of ODA for health focused in low income countries, ODA would increase from its current level of 16 billion dollars to 39 billion dollars. Still, this would be half of what low income countries would require from global solidarity to effectively train and retain health workers, obtain sufficient essential medicines and means to enable universal and comprehensive health care services, and reduce the present burden of health inequity. This calls for additional funding channels, such as those explored through innovative financing or the creation of greater opportunities for emerging economies and the BRICS (Brazil, Russia India, China and South Africa) to become involved in Global health.
Global health has been ill-defined and often used with no clear definition. It is used to define international work (inter-changed with International Health), to remind us about global health threats (Global Health security concept/s), to package dynamics aimed at addressing some of the world’s priority health problems or imbalances (Global health initiatives) or to mainstream health in non-sector external relations (Global health diplomacy). Without an agreed-upon common concept, it still dominates the debates on development cooperation and international health governance, and has a place in all high fora (be it UNGA, ECOSOC, G8 or G20, Davos or Portoalegre).
What is clear, is that we all share challenges in advancing global health knowledge and preventing and limiting health threats evolving with growing global flows, not just of toxins and bugs, but also of people, communication and goods. Across cultures, a healthy life is among the top aspirations of all individuals and communities, and is therefore deeply connected with national governance and stability. Health inequities (stagnant or even growing across and within countries) lead to instability and tensions. On the other hand, a healthy life has been often identified as the best and most sustainable investment in inclusive and sustainable development.
Thus, Global health is about health challenges that are connected to global factors (it is difficult to find any that are not), and which, therefore, require concerted global understanding and equitable (efforts according to capacities, objectives according to needs) coherent (across relevant national and international policies and relations) action.
On May 10th, 2010, the EU adopted an unprecedented participatory and cross- service policy in Global Health, which translates the EU health principles of solidarity, equity, universality, and quality into external action; reaffirms the central role of the health right approach (the driver of real governance); recognizes health inequities as the main priority (with a stagnant burden of 20 million deaths per year); and addresses key areas for coherent action across internal health, development cooperation, foreign policy and security, trade, migration and the key global determinants of climate change and food security.1 This policy was born with the adoption of the Lisbon Treaty and the setting of the European External Action Service. It is challenged by essential yet partial views from the development policy, the internal EU policy or other related policies as trade, home affairs or research.
Global Health is a key global issue for global cohesion, security and mutual cross-regional benefit. As the region with highest and most equitable health status and the highest net and share levels of ODA reaching 53 Billion dollars in 2010, the EU has a clear added value, as well as responsibility for a leadership role in advancing global health. The EU’s vision of health, its experience, and capacity can contribute to international relations as a clear translation of the EU’s role in championing human and social rights. The EU is also challenged by global health threats, a growing burden of disease with aging and rising costs of health care services and can benefit greatly from joint international work in global health.
The US, on the other side, attaches the highest priority to global health in its development policy and support to developing countries. Close to 10 billion dollars a year have been programmed under the Global health Initiative. As a result, the US is the major health aid donor in the world. Together, the EU and the US make up more than 90% of the bilateral and multilateral support to health in developing countries. The unmet challenges described above require an analysis of how the EU and the US can better join forces and upset this cycle of global and national disparities and its effects in global health inequities and injustice. There are many gaps in addressing the root causes of disparities and health inequities: the right to health is mainly aspirational and does not translate into a legal basis for enforcing it across and within countries, economic governance is too weak to tap into the growing speculative flows which have undermined public financing, fiscal policies are in most cases too weak to mitigate the effects of disparities and to enable social services that guarantee the rights to health and education, and ecological governance at global and country levels is also weaker than what the global challenge of climate change and shrinking biodiversity demands.
During my time as a visiting scholar at UC Berkeley, under the sponsorship of the Institute of International Studies (IIS) and working with the School of Public Health and various other units across the campus, I have been analysing the concept of global health, the dynamics of global health inequity, the gaps of the present global health framework and the opportunities for more effective cooperation between the EU and the US in addressing these global challenges.
UC Berkeley’s public status and traditions of inclusive participation position it well to address these challenges. The University employs a wide range of lead-researchers and policy analysts in the areas of global health, economy, social and public policy, political science, and international law and environment, as well as experts possessing leading skills in data analysis and casual inference. This effort will require a participatory approach with strong involvement on the part of policy makers, political leaders from the international community, the WHO, and community-based organizations, who together capture the views of the major actors in global health and the sensitivities and ideas of grass-root representative organizations. The challenge will also demand a strong link between scientific analysis and policy processes and decisions by local governments and the international community. The leading capacities at UCB on strategic analysis of international relations and national processes facilitate these links.