3.5 A NEW GLOBAL HEALTH ORDER
infrastructure, but also taxing limited human resources, and highlighting the failure of health financing and governance. Pakistan had achieved the near elimination of malaria in some provinces, but saw a four-fold increase to more than 1.6 million cases after the 2021 floods. In Malawi, the worst cholera outbreak in the country’s history was caused by severe storms brought on by climate change. In South Africa, drought has introduced food insecurity and disrupted the access to and provision of HIV services. The fragility of our health systems today should be well understood. Covid demonstrated their profound vulnerability: as the pandemic shut down our economic systems, consumed our health resources and challenged our commitment to equity, we saw years of progress reversed. Over 90% of countries saw disruptions in health services, leading to increased deaths from preventable causes, as well as trillions in GDP losses, and a surge in poverty. There is hope. We now have an opportunity to learn from the mistakes of the past. We must meet this crucial moment with a new approach – one vested in our collective well-being and one that prioritises people and health equity, and properly values social investments as a global public good. A NEW APPROACH First, we must embrace the fact that good human health is the fundamental building block to every aspect of a flourishing society. Without robust and expansive physical and mental well-being, individuals, communities and countries cannot grow their economies or gain long-term security and political stability. Second, we must not respond to the climate crisis with the old approaches used in global health or international development. For too long, our investments in health have been largely siloed, technocratic and disease-focused. Short timelines too often driven by Global North funding agendas rarely affected the priorities of the communities and countries purported to be served. The result has been piecemeal progress in a few select disease areas at the consequential expense of helping countries build resilient, fit-for-purpose, comprehensive healthcare systems that can handle repeated shocks. We only need to look at the examples of Ebola and Covid to understand that a health system without a solid across-the-board foundation will always be vulnerable. It is time to stop thinking segmentally. We need to embrace the complexity of building strong healthcare systems in their entirety. A holistic approach centred on health system strengthening – long-term financing, strong governance, management and leadership, updated infrastructure, reliable supply chain operations, and a fit-for-purpose skilled workforce to deliver care – is the best adaptation investment to address the inevitability of climate change.
Third, we need to accept that investments in strengthening a health system are savings, not costs. In the dominant neoliberal order, health expenditure is all too frequently sacrificed for fiscal austerity. By bankrupting the public health sector, we only leave ourselves more vulnerable. We end up paying more in lost productivity or reactionary funding when health emergencies strike. Investments in reducing air pollution, for example, will prevent a future loss of the almost $50 trillion that has been spent since 2010 to address its consequences. Studies have shown the economic return of every dollar invested in health is at least $4. Focusing on prevention VANESSA KERRY Vanessa Kerry is CEO of Seed Global Health, a non-profit organisation focused on health systems strengthening. She was appointed WHO Special Envoy for Climate Change and Health in June 2023, and is building advocacy to ensure equitable and just climate action. She also co-chairs a workstream on the World Health Organization’s Public Health and Emergency Health Workforce Roadmap. She is a critical care physician at Massachusetts General Hospital in the United States and directs the Global Public Policy and Social Change programme at Harvard Medical School. X-TWITTER @VBKerry
“ Seven million people a year die from air pollution – more than died in the entire Covid-19 pandemic globally”
and the adoption of known healthcare interventions could increase the GDP of lower-income countries by $4.4 trillion by 2040. As these investments lead to better health, they grow economies, create jobs, and foster social inclusion and gender equity, as women comprise around 70% of the health workforce – with returns as significant as nine to one. Finally, we must invest more ambitiously – with flexible funding that is context sensitive, in line with local priorities, equity focused and longer time horizons. Health system strengthening takes time. Training a necessary workforce, building infrastructure, developing reliable supply chains and cultivating good governance have never occurred in a two-year funding cycle, let alone a five-year one. Today we are standing on a precipice that will determine the future of humanity’s
survival. At the crux of the climate and health nexus is a choice about whether we are willing to change the status quo. Recent history has shown us unequivocally that we can no longer afford to suffer from the pandemic of poor and expedient choices that continues to harm our planet and its population. We cannot choose to continue down a road to nowhere with marginal and reactive, donor-driven investments. We must take an ambitious, comprehensive, long-term and equitable path – the only route that offers the possibility of leading all of us to a more just and hospitable world. ▪
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