Global Health Diplomacy: reflections on a graduate course

Dr SteynDaniela Steyn is a Family Physician in Ontario

 

Alumni of The Graduate Institute Geneva include former Secretary-General of the United Nations Kofi Annan. It seemed to me to be the obvious choice for a course on Global Health Diplomacy. Geneva hosts many of the well known international organizations in the world, including the headquarters of many of the agencies of the United Nations and the Red Cross. I joined a group of 30 executives from all over the world who got together to learn and share on the topic of Global Health Diplomacy.  There were participants from government sector as well as the private sector, Ministers of Health and of Finance, diplomats and doctors, academics, clinicians, policy developers, philanthropists and activists.  In a relatively short period of time we got to know each other, learn from each other’s diverse backgrounds, and build relationships.

The course consisted of lectures and discussion panels by internationally renowned experts, working groups and negotiation simulations on current global health diplomacy issues. Oh, and lest we forget, the 50 papers read in preparation for this course!

Ebola Neg Role play

Ebola Negotiations role play preparation with Katherine DeLand, WHO

With a beautiful view on Lake Geneva and lush green trees, our conference began with some speed dating - meeting the other participants with whom we would spend long days in the coming week.  Prof Ilona Kickbusch gave an introduction to Global Health Diplomacy, explaining the challenges and complexity of negotiating health in an interdependent world.  Well-conducted global health diplomacy should result in better health security and population health for all countries individually and an improved global health situation.  It aims at improved relations between states and the commitment of a wide range of actors to work together to improve health.  Fair agreements should support goals of reducing poverty while increasing health equity.

 Dr Dirk Engels discussed Neglected Tropical Diseases (NTDs), which isn’t only a Low-Middle-Income-Country problem.  We have all heard about the Ebola and Zika virus, but let’s not forget about NTD’s. Individually these NTD’s do not represent global priorities, but cause important local burden of disease. When calculating their cumulative DALY (disability-adjusted life year , this is a measure of overall disease burden, expressed as the number of years lost due to ill-health, disability or early death.) , their burden is similar to HIV/AIDs, Tuberculosis and Malaria, thus justifying a global response. There are 18 NTD’s in the WHO agenda. We need to focus on tackling the core of the infectious disease problem… not the Zika virus, but rather VECTOR control.  We need a vision, we need leadership, we need planetary health. No longer can we separate human health from planet health.

“No, our fight on AIDS is not over!” said Dr. Michel Kazatchkine. With so many other humanitarian crises AIDS should stay a priority focus.  He reminded us, “Leave no one behind.” Rob Yates from Chatham House explained why Universal Health Coverage (UHC) is the best route to the WHO Sustainable Development Goal (SDG) in order to leave no one behind.   So what is Universal Health Coverage?  UHC is a health system where all people receive the quality health service they need without suffering financial hardship.  In other words, the healthy wealthy cross-subsidize the poor sickly. Tommy Douglas (“The Greatest Canadian Ever”, CBC 2004) introduced North America’s first single-payer universal health care program.  It will be interesting to see what happens with the NHI plan prepared by Health Minister Motsoaledi in South Africa.What do we know currently about what works in health financing for UHC?

  • Market-driven, privately financed health systems do not result in UHC (e.g. USA)
  • Compulsory public financing should replace private voluntary financing especially user fees.
  • It is important to find workable ways for the healthy-wealthy to cross subsidize the sick and poor.
  • We must all engage ministries of finance and political leaders – incl. heads of state, ministers of Finance and Ministers of Health, since UHC is inherently a political issue.  (Great work has been done in Thailand and Rwanda on this issue; both countries serve as great examples of what can be achieved.)

As part of the course, we attended the International Security Forum held on the 15th of June 2016.  As in the case of Ebola, it is clear that a risk to one person, community, or nation is a risk to all people, communities, and nations. It is in the interest of each nation to ensure that every country has a strong, viable, and capacity-rich public health system. While this approach is a necessary component of global health security, it is not sufficient to address the full range of health security risks and the lack of appropriate responses. WHO has defined the provision of global public health security as the “activities required...to minimize vulnerability to acute public health events that endanger the collective health of populations living across geographical regions and international boundaries”.

The highlight of the course for me was a session on the role off Global Health Diplomacy in managing the issue of Antimicrobial Resistance (AMR). What does AMR mean for you? Fast forward 20 years in to your future.  You might want an ageing knee replaced, but you might be declined to undergo the procedure, as the risk of dying from an AMR superbug in hospital will outweigh the benefit of getting your knee fixed.  Bummer! What will we do about AMR?  Do we need a new instrument, or should we rather enforce what the WHO and UN already established?  The G7 (international organization established to facilitate economic cooperation among the world's largest industrial nations) acknowledged that AMR is a global health threat, that spread of AMR affects all nations and that we need an integrated approach comprised of many players to disarm this ticking time bomb. I eagerly await the AMR discussion in September in New York.

We discussed too many topics for me to cover in one blog, including the Framework Convention on Tobacco Control (FCTC), the problem of non-communicable diseases (NCDs) that now account for 60% of global mortality, and the importance of ensuring oral health.

The most valuable component of this course was the friendship developed with fellow course participants.   We engaged in inspiring conversations and long negotiations (till late at night!) that resulted in invaluable peer learning.  I would highly recommend this executive course to my fellow Canadian Physician Colleagues.

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