The 69th session of the World Health Assembly (WHA) took place in Geneva from 23-28 May 2016. If dealing with a record agenda of more than 70 items was not enough for the 3’000 representatives of governments, health-focused international organisations, non-governmental organisations (NGOs), the private sector, and the press who took part in the WHA, global health events, meetings and negotiations were on the menu all throughout Geneva. International Geneva is also home to a wide range of organisations in the trade, intellectual property, human rights, humanitarian, and development sectors, among others, offering unequalled opportunities for multisectoral and multistakeholder exchanges. This exceptional annual gathering has, therefore, increasingly transformed the WHA into a “Geneva Global Health Week”. The Global Health Centre (GHC) contributions to the week well illustrate its great intellectual and creative potential.
Following last year’s success, the GHC and the United Nations Foundations held an “Introduction to the World Health Assembly: A Briefing for New Delegates” on Sunday 22 May 2016 at the Maison de la paix, attended by nearly 400 participants.
The increasing complexity of WHA diplomacy and governance requires new delegates and participants to familiarise themselves with the Assembly’s processes and key issues. However, the Briefing’s audience composition suggested that WHA veterans may also feel the need to go back to the basics to take stock of the fluid global health landscape and of new developments in relation to the WHA meetings.
Preparing for WHA is, therefore, a key task, both for country delegations and civil society organisations. Main challenges include considerations on the delegation composition and size – taking into account the need for technical experts for specific agenda items – combined with resource constraints.
Some civil society organisations nevertheless can count on delegations of up to 100 members – contributing to questions in relation to WHO’s role and functioning. The organisation’s financing, its relations with other global health actors, and its leadership are among the key factors that will determine WHO’s role in global health governance in the coming years. “No more business as usual” should be the guiding principle for the way forward – not only for WHO.
Towards Universal Health Coverage: The New Health Economy
Close interlinks exist between the health sector and the economy. Global health expenditures constitute a market of several trillion dollars a year. As countries increasingly introduce policies to move towards Universal Health Coverage (UHC), the health sector is expected to grow further. But what is the role of the private sector in UHC, and what are the implications of the emerging “health economy”? These and other questions were addressed at the event “Universal Health Coverage and the New Health Economy”, organised by the GHC in partnership with Rabin Martin and the Johns Hopkins Institute for Applied Economics, Global Health and the Study of Business Enterprise on 24 May 2016.
In his keynote address, Mark Dybul, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, highlighted the need for “systems for health” instead of “health systems”, and identified UHC as a driver for change to focus on people and reach the most vulnerable.
Although the opposition between people-focused versus profit-driven action still nourishes mistrust with regard to private sector involvement, the emerging concept of the “New Health Economy” has the potential to translate investments in health into both economic growth and equitable improvements in health. In this context, mixed economies of health can provide more resources and creativity. However, there are no one-size-fit-all solutions, as national contexts and political decisions will determine the chosen path to UCH in each country. A common challenge will be that of increasing investments in health, for which health will need to be embedded in economic risk analyses to get out of the silos of health ministries and traditional health actors.
A first important step will consist in consolidating the notion of “New Health Economy” through a better understanding of its nature, scale and challenges. The GHC, Rabin Martin and the Johns Hopkins Institute for Applied Economics, Global Health and the Study of Business Enterprise paved the way with the publication of an annotate bibliography on the topic.
SDGs: Are we ready for a global health revolution?
The SDGs imply a more holistic vision of health, requiring the development and implementation of transformative approaches to "Ensure healthy lives and wellbeing for all". Grater coherence and coordination across sectors, new investments and the integration of structural drivers of health will only be possible if we reimagine global health and its role in sustainable development – to the extent, some argue, of a paradigm shift. But are global health actors ready for a – “Kuhnian” – revolution?
The GHC event “SDGs 2030 – A transformative agenda for global health?”, held on 26 May 2016, tried to answer this question by looking at the transformation challenges that global health actors face in adapting their approaches and governance, and considering the wider implications of a paradigm change for global health governance.
Despite agreement on the transformational nature of the SDGs for health, in practice many challenges still need to be addressed. The limited mandate of some organisations, not reflecting the holistic approach of the 2030 Development Agenda; recurrent crises overshadowing a more consistent debate on a new understanding of global health; and open questions in relation to the role of the private sector and the capacities of governments to negotiate with private actors are just some examples of the long way ahead. In this regard, it was suggested that this year’s WHA represented a missed opportunity, in particular as discussions over health emergencies obfuscated the SDG debate, and cross-cutting themes such as the health workforce failed to be framed into the broader SDG context.
Accountability constituted a key topic of discussion. Despite its centrality, defining and implementing accountability mechanisms for SDG implementation will prove extremely challenging. One global mechanism is considered to be insufficient, as it would be too broad to be actionable. At the organisational level, current accountability mechanisms for global health actors do not specifically include SDGs, and institutions might not be ready for a paradigm change in their governance yet.
If much still needs to be done, a paradigm shift is firstly a change in our vision of the world. The underlying reality does not change, only the way we approach it. In this sense, debates on the transformational nature of the SDGs already constitute an important first step, but they must bring us back to the very foundation of the international system: “We, the people”. The “transformation” can only mean a better life for all, with no one left behind.
Beyond the WHA: Why the “Geneva Global Health Week” needs to go global
If the “Geneva Global Health Week” was rich in intensity and creative thinking for the future of global health, other major fora with an impact on health were being held at the same time. The World Humanitarian Summit took place in Istanbul on 23-24 May 2016, while the G7 heads of state met in Japan on 26-27 May 2016.
Speaking of paradigm shift, transformational approaches to health must also take this expanding global health policy space into account. Accordingly, future Geneva Global Health Weeks will need to go beyond the WHA to promote interlinkages among these different dimensions for a more coherent approach to global health at the global level.