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The patchwork of global health policymaking
T he calls for more integration, coherence and cooperation in matters of global health are intensifying as the global health universe expands. Discussion about which of the many existing bodies – new and old – is the most appropriate for taking certain agendas forward becomes ever more contested, especially as frustration mounts over the lack of progress, particularly in global health. Many questions have arisen in recent years. Which is the best place for global policymaking on health as the issues expand far beyond traditional health policies? Is it better to negotiate within the World Health Organization? Would a high-level council at the United Nations really make a difference? Can political clubs such as the G7 and the G20 achieve more than staid UN bodies? Are totally new bodies needed to reflect the geopolitical powershift? Does decision-making improve when the number of stakeholders is expanded? Does fragmentation reflect a lack of political will to address global challenges jointly? There is probably only one issue on which nearly everyone agrees: reforming the UN Security Council. And that is probably the most difficult reform of all. Excitement was high in global health circles when health was finally regularly included in UN deliberations and at the G7 and the G20. An analysis of the most recent outcomes of the meetings in 2023 have poured some cold water on that enthusiasm. The results are bland and meagre compared to the challenges at hand: the financing crisis of health systems, the tragic cycle of increasing poverty and ill health, the expansion of profitable industries that produce non-communicable diseases and the devastating climate and health nexus, the rollback of the right to health. Indeed, the situation was so bad that the fact that there were declarations at all was considered a success. Yet the skies over New York were filled with colourful drone messages as the 2023 UN General Assembly opened. The world is changing dramatically, and never has the need for greater integration, coherence and cooperation from our global organisations been more critical. There is no easy solution, but bold steps are worth taking
By Ilona Kickbusch founding director, Global Health Centre, Graduate Institute of International and Development Studies
Perhaps we do need to celebrate the fact that countries are still talking despite the strong nationalist tendencies, the North-South divide, conflicts between the West and China, and the impacts of the war in Ukraine. This is today’s real world, defined not by the haze of hegemony but by deep differences and power inequalities, which are no longer accepted. The inability to reach consensus is an expression of that powershift. Politics and ideology are back with a vengeance, and play out in global health over issues of intellectual property, sexual and reproductive health and rights, access to technologies and much more. For too long they have been glossed over until Covid-19 brought them to the fore. Yet many organisations and negotiators are inadequately prepared for differing values and competing world views. They have forgotten that this was why many organisations were created in the first place: to address conflicts and play out power dynamics. This is a new phase of global health diplomacy. TO SOLVE COMMON PROBLEMS The role of the UN organisations shifted dramatically from their post-war function to resolve political conflicts before they turn into military action to producing global goods. This is one reason that global governance has been approached in a very functionalist manner without regard to power differences: the priority to deliver the international cooperation required to produce results to solve common problems. Consequently, a very managerial approach built on goals, targets and investment cases was institutionalised. In many cases the targets were bold – the Sustainable Development Goals are a testimony to that – but the mechanisms to reach them have not followed the same level of ambition. This imbalance has redefined global solidarity and contributed to a development that has made the UN the major provider of humanitarian support – first and foremost food, shelter and medical care – as one emergency follows another. The failure to reach the objectives is consistently put down to political will. Yes, many countries could and should be doing more to ensure planetary and human health, both at home
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