France and global health governance

Changes in health diplomacy facing the challenges of the 21st century

The acceleration of global exchanges and interdependence has increased the need for coordinated and efficient governance of health issues, centred around the World Health Organization. AIDS, malaria and tuberculosis pandemics have triggered an unprecedented response from the international community with the creation of the Joint United Nations Programme on HIV/AIDS (UNAIDS) in 1994, the Global Fund to Fight AIDS, Tuberculosis and Malaria in 2002, and UNITAID in 2006. Furthermore, the Development Agenda places great importance on health, as it concerns three of the eight Millennium Development Goals adopted by the United Nations in 2000.

France: a driving force and front-line financial contributor

In order to meet global health challenges, France has strongly stepped up its efforts since 2000. Its development assistance for health represented €773 million in 2012 (OECD/DAC figures).

In the fight against the three pandemics (MDG 6), France was behind the creation of the Global Fund to Fight AIDS, Tuberculosis and Malaria, of which it is the second largest financial contributor, with an annual contribution of €360 million (commitment for the 2014-2016 triennium). It also proposed the creation of the UNITAID International Drug Purchasing Facility, of which it is the main contributor, with €110 million granted in 2013.

Alongside its G8 partners, France increased its assistance to reduce maternal and infant mortality (MDG 4 and MDG 5) as part of the Muskoka Initiative (2010), and made a commitment to earmark an additional €100 million per year to this policy from 2011 to 2015. It is the fourth largest financial contributor to GAVI - the Global Alliance for Vaccines and Immunization (€79 million in 2013).

France has pioneered the mobilisation of innovative financing for health, thus rallying new resources and helping ensure greater predictability of financing. France’s entire contribution to UNITAID comes from the solidarity levy on air tickets implemented in 2006. Most of the contribution to GAVI Alliance is through the International Financial Facility for Immunisation (IFFIm), to which France made a commitment of €1.3 billion over a twenty-year period.

France has brought the theme of universal health coverage to the international arena. France was behind the resolution adopted by the United Nations General Assembly in December 2012 on this subject. Along with Germany, it created the “Providing for Health” partnership, hosted by the World Health Organization. In 2013, it launched the Solidarité – Health (Santé) – Sahel (I3S) initiative to promote free health care to children in the Sahel.

France and WHO

WHO is a key institution for global health that performs normative functions, data collection and makes recommendations to States. It also has operational functions as regards technical assistance for countries and coordination of global health players.

France is a founding member of WHO, whose vision and fundamental goals it shares. It maintains very close relations with this organisation, due to its health expertise, its compulsory contribution (fifth largest) and its status as semi-permanent member of the WHO Executive Board.

A framework agreement between France and WHO has set joint priorities for the 2014-2019 period, based on four areas of cooperation:

  • international health security: fight against epidemic and pandemic diseases, particularly through the implementation of the International Health Regulations (IHR);
  • development goals in health, both the Millennium Development Goals and the United Nations post-2015 Development Framework;
  • action on risk factors, in relation to non-communicable diseases and environmental health determinants;
  • strengthening of health care systems, as part of the progression towards universal health coverage.

The presence of a WHO office in Lyon since 2001, in charge of capacity building in countries to respond to international health emergencies, has also strengthened these relations. This office plays a key role in the implementation of the International Health Regulations, which is a priority for both France and WHO.

France also supports the application of WHO strategies to reduce risk factors linked to non-communicable diseases (mainly cancers, diabetes, chronic respiratory diseases and cardiovascular disorders), which are responsible for two-thirds of deaths worldwide. France promotes, in particular, support for the Framework Convention on Tobacco Control (FCTC) and for the Protocol on the Illicit Trade in Tobacco Products (www.who.int/ftct/)

In the field of health care systems, coordination of health RD, sustainable financing of health care systems, training and stability of human resources for health, drug prequalification and the fight against their counterfeiting are decisive issues for the of credibility WHO in meeting the health challenges of the 21st century.

Foreign Policy & Global Health Initiative

At the behest of the Norwegian and French Foreign Affairs Ministers, the Foreign Policy and Global Health initiative was launched in New York in September 2006. The “Diplomacy Health” group involves seven countries of varying levels of development (Brazil, France, Indonesia, Norway, Senegal, South Africa, Thailand), united in their joint commitment to draw greater attention to global health issues in the field of foreign policy. The “Foreign Policy and Global Health” initiative operates as an informal consultation framework between the seven countries to bring these issues to the fore at global level.

On 20 March 2007, the seven initiative countries defined an agenda for action through the Oslo Ministerial Declaration, which defined ten priority areas:

  • preparedness and foreign policy,
  • control of emerging infectious diseases and foreign policy,
  • human resources for health and foreign policy,
  • conflict (pre, during and post conflict, and as peace is being built),
  • natural disasters and other crises,
  • response to HIV/AIDS,
  • health and the environment,
  • health and development,
  • trade policies and measures to implement and monitor agreements,
  • governance for global health security.

The seven countries reiterated their commitment towards global health through the Ministerial Declaration of 22 September 2010 "Foreign Policy and Global Health – Responding to New Challenges and Setting Priorities for the Future: The Oslo Ministerial Declaration Three Years Later and Beyond". This declaration namely foresees to "promote unilateral health coverage in the multilateral agenda".

The “Foreign Policy and Global Health” group has brought the following resolutions before the United Nations General Assembly since 2008:

  • Resolution A/RES/63/33 (PDF), of 26 November 2008, defining the objectives of the Foreign Policy and Global Health initiative, and brings a standing agenda item to the General Assembly entitled "Global health and foreign policy";
  • Resolution A/RES/64/108, of 10 December 2009 (PDF), deals with the issues of emerging infectious diseases and human resources for health;
  • Resolution A/RES/65/95, of 9 December 2010 (PDF), argues in favour of global governance for health security and achieving the Millennium Development Goals for development in the field of health;
  • Resolution A/RES/66/115, of 12 December 2011 (PDF), raises the issues that intersect the areas of health, environment, and natural disasters;
  • Under French coordination, on 12 December 2012, the “Diplomacy Health” group brought Resolution A.67/81 (PDF) focusing on universal health coverage, and co-sponsored by 90 States, before the General Assembly;

The International Health Regulations (IHR), a legally binding instrument to address public health emergencies that may have international consequences

Under the aegis of the World Health Organization (WHO), the IHR sets the obligations of the 196 States Parties to “prevent, protect against, control and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks, and which avoid unnecessary interference with international traffic and trade” (Art.2). Since 2007, its goal extends to any disease defined as an “illness or medical condition, irrespective of origin or source, that presents or could present significant harm to humans”. The national referent of States Parties to the IHR are obliged to notify WHO, within 24 hours, of any event likely to be a “public health emergency of international concern”.Since the first conference on health security in 1851, France has played a leading role in favour of a collective response to cross-border health threats. Before that, only “quarantinable” diseases such as yellow fever, plague and cholera received coordinated health monitoring. With the acceleration of exchanges, the reemergence of infectious diseases has strongly increased the risk of spread of epidemics (Severe Acute Respiratory Syndrome, flu pandemics, etc.). In addition to infectious diseases, health threats linked to industrial accidents or chemical, biological, radiological and nuclear risks (CBRN) now undergo collective monitoring. The need to protect health security as a global public good, through the concerted action of governments, has never been so great.

French financing, amounting to €15 million since 2007, represents a major part of WHO resources for implementing the IHR. Furthermore, France has provided its expertise in the creation of tools for training in IHR, certification of entry points (ports, airports, and border posts), capacity building of laboratories and the prevention of biological risks. Lastly, the Rhône-Alpes region, the Rhône department and the urban community of Greater Lyon (south eastern France) support the WHO office in Lyon as part of an approach to make the region more attractive.

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May 2014

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