Sixty-third General Assembly

Second Committee

Panel on Globalization and Health (AM)

Only fundamental change in global economic, trade order can make equitable

health care a basic human right, WHO Head tells second committee

Panel Discussion Highlights Links with Productivity, Prosperity, Stability

The global economic and trade order must change fundamentally to make equity in health care an explicit policy objective and a basic human right, Margaret Chan, Director-General of the World Health Organization (WHO), told the Second Committee (Economic and Financial) this afternoon.

“The policies governing the international systems that link us all so closely together need to be more foresighted,” said Ms. Chan, underscoring the need to look beyond financial gains, trade benefits and economic growth for its own sake.  Balanced public health was the foundation of economic productivity and prosperity; it led to social cohesion and stability.

The Director-General was participating in a panel discussion on “Globalization and health”.  The other panellists were Luvuyo Ndimeni, Deputy Permanent Representative of South Africa to the United Nations in Geneva; Nils Daulaire, President and Chief Executive Officer of the Global Health Council; and Daniel Halperin, Lecturer on international health at the Harvard School of Public Health.  The moderator was Jeffrey Sachs, Director of the Earth Institute at Columbia University, where he is also Professor of Sustainable Development and Professor of Health Policy and Management.

Ms. Chan said that, as illustrated by the present financial crisis, health had traditionally been at the mercy of the global economy, and its budget was cut when money got tight.  Health and other sectors had the right to ask for fundamental change in the global economic structuring, a demand that the final report of the WHO Commission on Social Determinants of Health, issued in August, had made to Governments in the form of recommendations aimed at protecting the poor and guaranteeing universal access to health care.  “Gaps in health outcomes are not matters of fate.  They are markers of policy failure,” she said.

This year’s World Health Report called for a renewal of the focus on primary health care, which the 1978 Declaration of Alma-Ata had established as the basis for greater fairness in health, she said, adding that the “visionary thinkers in 1978” could not have foreseen subsequent world events –- an oil crisis, a global recession and the emergence of a life-transforming disease like HIV/AIDS.  Huge mistakes had been made in restructuring national budgets, with the result that health in sub-Saharan Africa and much of Latin America and Asia had yet to recover.  There was too much at stake for the global community not to learn from those past mistakes.

The WHO annual report, released last week, found striking inequalities in health outcomes, access to care and health care costs, she said.  Global annual Government health expenditures varied, from as little as $20 per person to well over $6,000, while differences in life expectancy between the richest and poorest countries were now greater than 40 years.  “At a time when the international community supports health as a key driver of economic progress and a route to poverty reduction, the costs of health care are themselves a cause of poverty for many millions of people,” she said.

Personal health expenditures pushed another 100 million people into poverty every year, she said, adding that 58 million of the estimated 136 million women to give birth in 2008 would receive no medical assistance, endangering their lives and those of their infants.  More than half the health care costs of 5.6 billion people in low- and middle-income countries were paid for out-of-pocket, forcing many people to postpone treatment until conditions worsened and became more costly to treat.

As food prices soared, people were also giving up healthy food, which was more expensive than processed, fatty foods, she pointed out.  Households in developing countries spent, on average, 80 per cent of their disposable income on food, and vast rural populations in Africa survived hand-to-mouth on subsistence farming, with no surplus or coping capacity.  By as early as 2020, 75 million to 250 million Africans would be severely affected by climate change, and crop yields in some of their countries would drop by 50 per cent.  “When something so fundamental to life as food is priced beyond the reach of the poor, we know that something in our world had gone terribly wrong,” she concluded.

Echoing those concerns, Mr. Ndimeni said health was deeply connected to the environment, trade, economic growth, social development, national security and human rights.  As migration, integration, technological innovation, the entry of non-State actors and other factors rapidly changed foreign policy and international relations, there was a growing tendency to approach foreign policy through a health lens.  New and emerging diseases, such as avian influenza, severe acute respiratory disorder, severely drug-resistant tuberculosis and malaria, did not respect geographical borders.  They could only be tackled if countries worked together.  Health was a major component of the Millennium Development Goals, which showed the link between the structural causes of poverty and underdevelopment.

He recalled that, in March 2007, the foreign ministers of Brazil, France, Indonesia, Norway, Senegal, South Africa and Thailand had launched the Foreign Policy on Global Health Initiative, based on the recognition that health issues were of a cross-cutting nature, and did not fall solely within the jurisdiction of health ministries and the WHO.  The Initiative focused on preparedness, controlling infectious diseases, governance, trade policy, human resources for health, natural disasters and other crises, as well as the relationship linking health with conflict, the environment and development.  South Africa was currently negotiating a resolution in the General Assembly on the impact of foreign policy on global health.  It had an incremental approach and drew on inputs from the WHO Director-General and the United Nations Secretary-General.  Hopefully, the text would be tabled in November.

Mr. Daulaire noted that civil society had taken on an unprecedented role in providing most of the health care offered to the world’s poorest societies.  Civil society did not oppose globalization; rather, it believed globalization must not fail to address the critical needs of the poor through the Millennium Development Goals, active community involvement and the emergence of a global consensus based on equity and justice, and the right to a reasonable standard of health for all people.  Health was not simply another marketable commodity sold to the highest bidder; it was something that must be broadly available.

Ten years ago, he recalled, the United States invested less than $1 billion annually in global health issues.  By 2008, it was investing $8 billion annually.  The increase was due to the confluence of an active civil society and the growing recognition of global health in foreign policy.  Civil society groups in the United States were working with the campaign teams of both national presidential candidates to push for a strong focus on global health in the White House.  For too long, the United States had told the world that it knew better, and others should follow suit.  But, since the current financial crisis had clearly demonstrated the downside of separating benefits from risks, the United States Government was now looking to work with others.  With the negative consequences of shared risks inevitably falling on the poor and powerless, globalization obliged the world to find new cross-cultural mechanisms and an active role for all stakeholders.

Mr. Halperin said it was interesting that of all the Millennium Goals, the one that had already been met was the one on HIV/AIDS.  However, a better job had not been done on HIV prevention because countries were driven by inertia andassumptions, and did not always use the best evidence.  In most of the world, HIV/AIDS was still concentrated overwhelmingly in high-risk populations, without spreading to the general population.  However, 12 sub-Saharan African countries had true epidemics; it was common for people to have multiple sexual partners, but in Africa, those partnerships were concurrent, which led to an increase in the spread of the virus.  If those African countries could help people reduce the number of their sexual partners even slightly, the effect could be dramatic.

Uganda had achieved the most success in preventing the disease, and had done so with very little money, he pointed out, adding that the Government had been extremely aggressive in promoting behaviour change.  Male circumcision was one of the most important ways to prevent HIV infections.  Standard prevention approaches included the distribution of condoms and contraception, in addition to counselling and testing.  The role of churches was also very important, as was more funding for family planning and reproductive health.

During the ensuing question-and-answer session, Ms. Chan said it was important to see Governments as stewards, custodians or protectors of their people’s health.  The most important Government role was to ensure high-quality, affordable health services and safety nets.  While there was a role for the private sector, Governments could not leave health totally to the market because it was not the usual commodity where the consumer had the knowledge to judge the services being provided.

Neither could Member States “drop the ball” on the Millennium Goals, she said, noting that, at its upcoming Executive Board discussion on health in January and other forthcoming discussions, the WHO would provide thoughts on scaling up efforts to meet the targets, guided by Member States.  Science and technology also played an important role, and the WHO, in particular, was setting up vaccine companies in developing countries.  The role of health ministers was not very strong in most Governments, and countries must examine how they could make interventions and innovations to reach people in need.  Prevention was also important, since 70 per cent of global disease burdens were preventable.  The way forward was to strengthen the health system, detect early trouble and prepare the system to respond.

Opening the panel discussion earlier, Committee Chair Uche Joy Ogwu ( Nigeria) said that managing health risks required global cooperation to protect and promote public health.  Although all countries were affected by globalization, developing countries were more vulnerable than developed ones to the effects of an unhealthy environment, a lack of social services, and inadequate infrastructure.  An effective approach to improving health in a globalized world would require the involvement of all sectors and actors related to the effects of, and solutions to, health outcomes.  Governments and international organizations must adjust to and overcome governance systems that led to fragmented policy formulation.

Mr. Sachs said it was fitting that the meeting was taking place during the sixtieth anniversary of the United Nations Declaration on Human Rights, the thirtieth anniversary of the call for “Health for All”, and midway to the deadline year for attaining the Millennium Development Goals.  Globalization had helped speed up the transmission of health care knowledge, as well as science and technology, to many previously off-limit parts of the world.  Many diseases were about to be eradicated, and HIV/AIDS, tuberculosis and malaria were beginning to get the requisite resources, attention and global commitments to combat them.  But, globalization had also complicated health.  Diseases were transmitted internationally more rapidly than ever before; globalization had put tremendous pressures on poor countries to keep intact health systems; and climate change was bringing new and massive health threats.  There were also epidemics in nutrition; malnutrition affected the 1 billion hungry people worldwide, as well as the 1 billion to 1.5 billion suffering from obesity or near-obesity, which were related to changing diets and global patterns.

Also participating in the discussion were the representatives of Luxembourg, Comoros, the United Kingdom, France, Venezuela, Iran, Brazil, the Dominican Republic, Japan, Malaysia and the Republic of Korea.

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For information media • not an official record