Transcript 1. dia - Fiocruz

Mihály Kökény M.D.
Chairman of the Executive Board
WHO
2010
Globalization is not a new
phenomenon: it began with
migration from Africa
”It really boils down to this: that all life is
interrelated. We are all caught in an
inescapable network of mutuality, tied into a
single garment of destiny. Whatever affects
one directly, affects all indirectly”
Martin Luther King Jr.
The definition of globalization
„Globalization is a process of interaction and
integration among the people, companies, and
governments of different nations, a process driven by
international trade and investment and aided by
information technology. This process has effects on the
environment, on culture, on political systems, on
economic development and prosperity, and on human
physical well-being in societies around the world.”
The Levin Institute, The State University of New York
Global health
„… refers to those health issues that transcend
national boundaries and governments and call
for actions to influence the global forces that
determine the health of people. It requires new
forms of governance at national and
international level, which seek to include a
wide range of actors.”
Ilona Kickbusch
at Nobel Forum Seminar,2009, Stockholm
Governance
 Governance: Is the conscious creating, shaping, steering,
strengthening and using of institutions and regimes of
principles, norms, rules and decision making procedures
that influence how autonomous actors behave (Krasner
1983)
 Health governance: The actions and means adopted by a
society to organize itself in the promotion and protection
of the health of its population (Dogson, Lee, Drager 2002)
Global Health Governance
means taking responsibility for the determinants of health
in new ways. There is a growing understanding that health
is part of a joint responsibility to manage globalisation :
trade policy,security policy, agricultural policy,
environmental policy and foreign affairs
European Perspectives on Global Health
A Policy Glossary 2006
Kickbusch The Graduate nstitute I- Brussels
2010
Key global challenges at the
beginning of the 21st century
 No single, dominant world power – the rise of the rest
 „Frenemies” –neither enemies, nor friends – competing for
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world’s resources
New alliances: BRIC countries
The globe is beset by interdependent crises: climate
change, resource scarcity, food, health, financial crises,
nuclear proliferation
Traditional international organizations often fail to meet
today’s need: - new clubs: G20
Increasing inequalities within and between countries /see:
the Marmot- report on social determinants/
Migration, demography
The equity principle
„The carrying power of a bridge is not
the average strength of the pillars,but
the strength of the weakest pillar. I
have always believed that you do not
measure the health of a society by GNP,
but by the condition of its worst”
Zygmunt Bauman:
Liquid Times: Living in an Age of Uncertainity,
Polity Press, Cambridge, 2007
Inequity
 WHO Commission on Social
Determinants
 Wide variations accross EU
 But what about Sub-Saharan
Africa?
at least 20 million people die
prematurely, half of them under 5
 International aid to health
tripled in the last decade
increased fragmentation
Closing the gap in a generation
 Reducing health inequities is an ethical imperative as social
injustice is killing people at a grand scale
 Overarching recommendations:
1. Improve daily living conditions – universal health care
Brazil: the family health programme quoted –unified health
system/SUS/
2. Tackle inequitable distribution of power, money and resources
3. Measure and understand the problem, assess the impact of
action
www.who.int/social_determinants
Major follow-up conference on actions to be held in Brazil
Health in a multipolar world: new relevance
Health is now part of the agenda of G8, UNGA
ECOSOC and Strategies to fight poverty –
G20?
New importance of WHO as a platform to
negotiate global public goods
The powershift to emerging economies – new
relevance of geopolitics, regional groupings
(IBSA, Mercosur, UNASUL, EU)
G8 2001
Look who is talking
Recent high level of attention in:
 UN General Assembly on global health and foreign
policy, MDG’s and NCD’s / 2009, 2010, 2011/
 World Health Assembly: FCTC, IHR, Global Code
of Practice on the International Recruitment…
 EU : Foreign Affairs Council Conclusions on EU
role in global health/2010/
Policy attention in US, BR,UK, NO….
Why is health on the global
agenda?
 a security agenda: global pandemics; the intentional spread of
disease; maaging risks
 an economic agenda: economic impact of poor health on
development, economic impact pandemic outbreaks on the global
market place, the economic relevance of the health sector and of
certain industries such as tobacco, food and pharmaceuticals and
the growing global market of goods and services in relation to
health;
 a social justice agenda: health as a social value and human right, the
social determinants of health, equity, access to medicines,
Millennium Development Goals
 A soft power and philanthopic agenda: instrument of foreign policy,
charity based global initiatives, venture philantropy
Rapid increase of global health actors: extreme
fragmentation of resources ?
MSF
G8
BONO
250 PPPH
WEF
PHA
World Bank
National level : coherence between increased
number of policy arenas
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Public Health: Mortality, Morbidity, global burden,
Foreign Policy: Interests, influence, security, stability, trade
Development aid: MDGs, poverty reduction, human rights
Other players, stakeholders……………………..
Global Health
Good Global Health begins at home
National global health strategies Joint Policies,
staff exchanges, secondments, placements….
Steps being taken to promote coherence at the global
level in health
 The International Health Partnership+ ; a flexible mechanism to put
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the 'Paris Principles' into practice at the country level
'H8' – regular informal meetings of heads of health-related agencies
and funders – Gates Foundation, GAVI, GFATM, UNAIDS, UNFPA,
UNICEF, WB, WHO
The 'Health Cluster' approach in humanitarian crises
WHO Partnership Policy – new initiatives in Europe
The Foreign Policy and Global Health Initiative (a network including
Brazil, France, Indonesia, Norway, Senegal, South Africa and Thailand)
Follow through of treaty processes
Committee C
Platforms NCD net
A new committment to the role of WHO
„the coordinating authority
on international health work“
 First decade: major diseases
 Second decade: liberation of former colonies – health manpower
development
 Third decade: eradication of smallpox, new issues such as family planning
 Fourth decade: Primary health care - Health for All – Equity – cooperation
 Fifth decade: investment in health, poverty eradication
 Sixth decade: common health security and health as a global
public good
Agenda often remained unfinished !
Governance challenges for WHO
 Link the new global health actors to the system of
multilateral intergovernmental institutions, in
particular the WHO
 Engage in new ways with the many non-health actors
that can influence health both positively and
negatively
 Perform its coordination function in relation to the
development of legal instruments with a broader range
of players
The future of financing for WHO: 3
headlines themes
 Capitalize more effectively
the leadership position in
global health
 Retain the flexibility to a
changing environment and
to address new challenges
as they arise
 The diversity of current
activities is unsustainable:
WHO must be more
selective in priority setting
The future of financing for WHO:
the core business
 Health security
 Humanitarian action
 Normative and standard
setting work
 Convening role in the
negotiation of treaties for accessing to global
public goods
 Monitoring and
responding to health
trends
 Technical cooperation –
country presence
The future of financing for WHO:
considerations for governing bodies in
2011/ EB, WHA/
 How to increase the level
of non- earmarked
donations?
How to
increase credibility,
transparency and
accountability?
 Priority setting,
stakeholder involvement
and future of financing
to be addressed in the
same reform process
Task Force on Managerial Response
to Financial Situation
 Purpose: to prepare a detailed analysis of the financial
situation and a comprehensive strategic action plan
(Austerity Plan) to respond;
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Review core functions and priorities
Resource mobilization
Resource distribution and monitoring
Efficiency saving
Organization design and business processes
HR actions (as needed)
Issues in global health in 2011
 Non-communicable diseases /Davos, Moscow, UN/
 Anti- microbial resistance/ World Health Day, Mexico/
 Health system financing – universal coverage, human
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resources/ World Health Report/
Pandemic review
Dengue
Aggressive approach by the tobacco industry
Aging
Global health governance incl. WHO reform
A Framework Convention on Global Health?
Thank you for your kind attention
„Even if you are on the right
track you will get run over if
you just sit there”
Mark Twain
E-mail: [email protected]