Global health governance for the world’s well-being

Global health governance for the world’s well-being

Innovatively investing in Health For All is the key to a future unblighted by debilitating illnesses, diseases and pandemics, but it places new demands on governance around the world

Global health challenges are growing, as policymakers still struggle to mount an effective response. Almost three years after it erupted, the Covid-19 pandemic continues, having taken many millions of lives and now spreading in countries that had largely escaped its initial waves. Joining it is a monkeypox pandemic. Even polio has reappeared in New York, London and Jerusalem.

Also more abundant and apparent are the many impacts of Covid-19 on chronic and non-communicable diseases and of other illnesses fuelled by the broader economic, social and ecological determinants of health. The compelling claims of Covid-19 on always limited and often inadequate healthcare resources have led to delayed treatments, surveillance, appointments, and research and development for many other illnesses. Covid-19 has infected and exhausted skilled and dedicated healthcare workers. The growing prevalence of long Covid and its physiological and neurological harms will burden health and social security systems, patients and their families for many years.

Policymakers struggle to cope with these challenges, amid the many interconnected, inherently global, economic, ecological and geopolitical crises they now face. These include soaring inflation, slowing economic growth, the increasing ecological assaults of climate change and biodiversity loss, and military conflict in poor countries and now in Europe too. They place new demands on global governance and on the intergovernmental institutions of global relevance and reach at the core.

The central pillar is the World Health Organization, created in 1948 with a mission that recognised that “health is a state of complete physical, mental and social well-being … The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition. The health of all peoples is fundamental to the attainment of peace and security and is dependent on the fullest cooperation of individuals and States.”

Innovative progress in health

The Covid-19 pandemic has spurred much innovative progress in investing in health at the WHO. Its members’ World Health Assembly agreed to increase the portion of the WHO budget coming from their assessed contributions rather than voluntary donations. The WHO has played a key role in launching many new partnerships, notably the Access to COVID-19 Tools Accelerator, COVAX and the COVID-19 Technology Access Pool. WHO director general Tedros Adhanom Ghebreysus swiftly declared monkeypox to be a public health emergency of international concern. WHO members have agreed to negotiate a new pandemic treaty, to prepare for and help prevent the next pandemics sure to come. Yet the WHO, with a biennial budget of only $6.12 billion for 2022–23, rising only 5% from the previous period, still has fewer resources than hospitals in a single major city have to meet the global need.

The World Bank, founded in 1944 with an exclusively economic mandate, is increasingly investing in health. It has offered developing countries much financial support to counter Covid-19. Its governing board has agreed to host the new Financial Intermediary Fund for Pandemic Prevention, Preparedness and Response, to be managed in partnership with the WHO.

The International Monetary Fund, also founded in 1944, shares the World Bank’s exclusively economic mandate, but has also responded to the Covid-19 crisis with financial support. It recently issued $650 billion in new special drawing rights and encouraged its rich country members to channel some of theirs to poor countries through its new Resilience and Sustainability Trust designed to address health and climate change. Yet it and the World Bank both face the crises of proliferating poverty among many of their members, caused by the food and energy crises and the resulting diversionary demands on their own resources.

Supporting vaccine equity

The G7 major developed democratic powers have also acted. On 19 May 2022, G7 health and development ministers met jointly for the first time to support vaccine equity and pandemic preparedness in developing countries. On 22 May, health ministers met to create the G7 Pact for Pandemic Readiness, to strengthen surveillance and response through a global network approach and the public health emergency workforce. They also addressed antimicrobial resistance and the connection between climate change and heath.

G7 leaders at their Elmau Summit in June made 41 commitments on health, led by those on pandemic preparedness, One Health, Covid-19, antimicrobial resistance, universal health coverage and the United Nations 2030 Agenda on Sustainable Development. Their commitments also covered local vaccine manufacturing, vaccine access, new variants, R&D, sepsis, AIDS, tuberculosis and malaria, primary health care, non-communicable diseases and mental health, neglected tropical diseases, sexual and reproductive health and rights, polio, and women, children and adolescents’ health.

G7 leaders also launched the Partnership for Global Infrastructure and Investment to mobilise $600 billion for developing and emerging countries to build modern health infrastructure, including hospitals, primary healthcare centres, cold storage and transportation facilities for Covid-19 vaccines to reach those who need them most, and, potentially, to allow poor countries to produce and invent safe, effective, affordable vaccines of their own. Still, the summit did nothing on long Covid, little on mental health and brain health, and little linking health to climate change.

The broader, more diverse G20 systemically significant states acted too. They held a special health summit in May 2021. The G20’s regular Rome Summit in October 2021 made 35 health commitments. It has pioneered and continually pushed for the new Financial Intermediary Fund. But it neglected mental health and many other illnesses beyond Covid-19. It has held no special summit on health in 2022. And although its priorities for its Bali Summit on 15–16 November put health first, they focused on the global health architecture and were soon competing with, and potentially crowded out by, Russia’s invasion of Ukraine.

This leaves much need and space for the many contributions to global health governance of other actors, notably non-governmental organisations, scientists, business, philanthropies, sub-federal governments, parliamentarians and Indigenous peoples.

Combing all actors

Multi-stakeholder forums that combine all actors are key. One is the annual H20 summit, organised by the G20 Health and Development Partnership and co-hosted by the Think 20 this year. It assembles G20 policymakers and those from international organisations, the broad global health community, the private sector, civil society and academia to consider and craft specific recommendations for the G20.

Most broadly, at the established centre stands the World Health Summit, held each autumn in Berlin. As one of the key multi-stakeholder policy forums on global health, it brings together stakeholders from relevant communities and sectors across the world. We are proud to produce this book in the context of the WHS and that many of this year’s speakers, among others, have agreed to share their thinking with us. 

The chapters ahead

Indeed, this book focuses on innovatively investing in Health For All. It begins with “Making the choice for health”, which explores how key leaders have paved the way on key components. After the editors’ introductions, the next section, “Societies built on health”, examines how to go beyond narrowly conceived economic growth to generate people’s well-being as a whole. “Resilient health systems” covers making societies and their health systems better able to withstand the many shocks of today and the future. “Long-term health for all” addresses where the needed financing and in-kind resources can and should be found. “People and planet: a better world” focuses on the major ecological determinants of health, from climate change, biodiversity loss, chemical and other pollution, and their significant impact on women, small island developing states and Indigenous people – as well as the contributions from those communities. “Well-being of the future” analyses the promising developments and how to turn them into solutions for all. “The fallout of conflict” examines how deadly militarised conflict within and between countries directly kills and hurts combatants, healthcare workers and civilians, destroys and damages the healthcare facilities that treat them, and constrains NGOs in delivering the desperately needed humanitarian relief – and also highlights the dedication of healthcare workers who rush in to help, and the innovative adaptations amid the violence raging. The final section, “How to get governance right”, returns to the key questions of how those with public authority and influence can and should make the right choice to innovatively invest in Health For All.