International health governance
World Health Day is celebrated on 7 April to mark the anniversary of the founding of the World Health Organization (WHO) in 1948. WHO continues to play a central role in global health governance, a field now populated by multiple actors and initiatives. The organisation’s goal for 2030 is to adapt to the challenges of epidemiological transition and sustainability.
The origins of health diplomacy
Health diplomacy traces its history back to 1851, when a group of European diplomats and medical practitioners met in Paris at the first International Sanitary Conference, convened to combat cholera, plague and yellow fever. The first International Sanitary Convention was signed in 1892. The task of preventing diseases spreading across borders was entrusted to international sanitary organisations such as the Office International de l’Hygiène Publique (International Office of Public Hygiene) founded in 1907, the League of Nations Health Organisation set up in 1923, and the World Organisation for Animal Health (OIE) created in 1924. The World Health Organization came into being on 7 April 1948.
WHO, the directing and coordinating authority for international health governance
The World Health Organization (WHO) is the directing and coordinating authority for health within the United Nations system. Its goal is to enable all the peoples of the world to achieve the highest possible level of health. The WHO constitution defines health as a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity. Employing close on 7,000 agents in over 147 country offices, six regional offices and its Geneva headquarters, WHO has an annual budget of over USD4 billion.
Since 2010, WHO has been engaged in a process of reform designed to refocus its priorities, strengthen its internal governance and improve its management at every level, including the country offices.
France enjoys privileged relations with WHO, founded largely on its recognised health expertise, substantial financial contributions to the organisation (8th biggest donor country at close on USD84 million in 2010-2011) and status as a semi-permanent member of the WHO Executive Board.
Global health governance: now a complex landscape with multiple actors
From the 1990s onwards, the impact of globalisation has underscored the need for global health diplomacy. As the volume and frequency of international travel has soared, the world has faced one international health crisis after another, raising health to the rank of a global public good. The unrelenting challenges of preventing the outbreak of pandemic disease and improving maternal and child health call for a concerted response from all health organisations, built on long-term resources and new approaches. Gradually, spending on health is coming to be perceived not as a cost but as an investment in development.
France had quadrupled its health aid budget since 2000 (to close on €1 billion in 2012, representing 12% of French ODA), primarily through multilateral channels.
The landscape of health governance is characterised by multiple initiatives and new entrants. Innovative mechanisms, emerging donors and philanthropic foundation have brought additional resources to the financing and coordination of health development assistance. Inspired by the Paris declaration on aid effectiveness, some countries are making every effort to limit scattergun health initiatives so as to ensure maximum effectiveness. Since 2007, the International Health Partnership (IHP+) has promoted putting the principles of the declaration into practice by setting up country compacts under the auspices of WHO.
At the heart of global health initiatives: combating three major pandemics and reducing maternal and infant mortality
The HIV/AIDS pandemic triggered a rapid transformation in global health governance. In response to the specific challenges it presented, UNAIDS was set up in 1994 to coordinate the action of United Nations agencies. In 2000, health was once again at the top of the United Nations agenda for 2015, featuring in three of the eight Millennium Development Goals (MDGs).
As part of the fight against the three pandemics identified in MDG 6, the Global Fund to Fight AIDS, Tuberculosis and Malaria raised an unprecedented flow of investment directly targeted towards providing universal access to treatment for these three killer diseases. As one of the founders of the Global Fund in 2002, France is now the second biggest donor, contributing €360 million in 2012.
True to its values of universality, non-discrimination and solidarity, France has also pioneered innovative mechanisms for financing health. UNITAID, the International Drug Purchase Facility, was founded in 2006 as the result of a joint initiative by France and Brazil. The organisation obtains the bulk of its funding from a solidarity levy on airline tickets and focuses its efforts on reducing the prices and accelerating the development of high-quality drugs to treat the three target diseases. UNITAID has also contributed to the creation of the Medicines Patent Pool, which helps to speed up the process of bringing out generic versions of the latest anti-retroviral drugs. France has financed 60% of UNITAID’s budget since its founding, amounting to €826 million between 2006 and 2012.
In the field of maternal and child health (MDG 4 and MDG 5), France has made an additional commitment of €500 million over five years, making good on the promise made at the G8 Summit in Muskoka (2010).
Another symbolic health initiative dating from the 2000s, the Global Alliance for Vaccines and Immunisation (GAVI Alliance) prompted long-term strategic commitments to a simple, tried and tested preventive measure: vaccination. France committed €1.3 billion over a twenty year period, thanks to funds raised through the International Finance Facility for Immunisation (IFFIm), plus a further €100 million from 2011 to 2015 via the GAVI Alliance. A quarter of the GAVI Alliance’s funds come from private donors, among whom the pharmaceutical companies play a leading role.
Between them, UNAIDS, the Global Fund, UNITAID and the GAVI Alliance have radically transformed global health governance, particularly by encouraging representatives of recipient countries, NGOs, civil societies and patients’ groups to sit on their governing bodies.
The challenges of global health governance by 2030Health stands high on the agenda of the Millennium Development Goals. Looking ahead to 2013, global health governance must contend with the challenge of sustainable development. The efforts made to achieve the MDGs must be consolidated, in order to preserve the gains that have been made and speed up progress in combating the three pandemics and improving maternal and child health. It is increasingly clear that economic, social and environmental factors can no longer be ignored in any initiatives aimed at improving healthy life expectancy.
While a certain epidemiological convergence is apparent at global level, under the impetus of results achieved in combating infectious diseases, the burden of non-communicable diseases is growing. The theme of World Health Day 2013 is hypertension, or high blood pressure, a chronic medical condition affecting one adult in three and responsible for the majority of deaths from stroke and heart disease. Non-communicable diseases such as cardiovascular disorders, cancers, metabolic diseases and chronic respiratory diseases currently account for two thirds of all deaths, and will place an increasing burden on healthcare systems in both the developed and the developing world.
In this landscape, effective and fair healthcare systems could turn to innovative financing mechanisms and to the extension of healthcare coverage. From this standpoint, pursuing the aim of universal healthcare coverage represents a promising horizon for the future of global health governance.
Updated on 07.04.13