From the Global AIDS Response towards Global Health?

High Level Taskforce on Innovative International Financing for Health Systems
A discussion paper For the Hélène de Beir foundation and the International Civil Society Support group
Written by Gorik Ooms - January 2009

Available online as PDF file [47p.] at:
http://www.internationalhealthpartnership.net/pdf/IHP%20Update%2013/Taskforce/taskforce/090101_Ooms_Global_Health_Discussion_Paper%20(2).pdf

“………..Global Health’ has recently become a fashionable term. New Global Health institutes have been created, and new Global Health trainings organised. But what does the term Global Health really mean? Perhaps it is best defined by the World Health Organization (WHO)’s mandate: “health is a shared responsibility, involving equitable access to essential care and collective defence against transnational threats”.2

There are two ‘global’ elements in this description: a globally shared responsibility for the health of all people, and global threats posed by infectious diseases. However, these two global elements of an emerging Global Health paradigm are not mutually exclusive. The fact that viruses do not respect national borders contributes to an awareness of global responsibility for the health of all people. Further, the risk of uncontrolled epidemics proliferating from low-income to middle- and high-income countries motivates the more wealthy to help poor people because the more wealthy do not want to get poor people’s diseases. It is probably not a coincidence that Official Development Assistance (ODA) for health seems to focus on infectious diseases disproportionately.3 However, a global responsibility for the health of all people should extend beyond a willingness to tackle the global threats posed by infectious diseases and ensure that there is equal attention and solidarity for non-infectious diseases. In this discussion paper, I will examine the emerging Global Health paradigm as one that addresses a global responsibility for the health of all people….”

In the first section of this paper, I will argue how a Global Health paradigm – through the global AIDS response – is emerging from a synthesis of the medical relief and health development paradigms.

In the second section, I will discuss how the Global Health paradigm is promoting the extension of social health protection, as intended by some of the major donor countries and the International Labour Office (ILO).8 I will argue that if the extension of social health protection is understood as the export of social health protection models – in the sense of promoting national social health protection schemes as a strategy to achieve domestic self reliance – it is doomed to fail, at least in the low-income countries. But I will also argue that if the extension of social health protection is understood as the expansion of present national social health protection schemes beyond their borders, it could become a real Global Health paradigm.

In the third section, I will argue that a new philosophical, ethical or legal basis for a Global Health paradigm is not needed. If we simply recognise and treat health as a human right, the underlying conceptual framework of this approach encompasses trans-national obligations, on which a Global Health paradigm can be built…..”

Table of contents

General introduction and overview
Section 1. The global AIDS response: a synthesis of medical relief and health development paradigms
1.1. Introduction
1.2. The health development paradigm: aiming for sustainability, defined as self sufficiency
1.3. The medical relief paradigm: not aiming for sustainability
1.4. The global AIDS response: technical sustainability at the national level, financial sustainability at the international level
1.5. The expanding mandate of the Global Fund
1.6. ‘Fiscal space’ and ‘fiscal sustainability’: a straitjacket to ensure self-sufficiency
1.7. Conclusions of the first section

Section 2. Global Health: moving towards global social health protection?
2.1. Introduction
2.2. A global social health protection floor: an inclusive and a minimalist design
2.3. The Global Fund, seen as an emerging global social health protection floor
2.4. Conclusions of the second section

Section 3. Global Health: if health is a human right, there is a globally shared responsibility for the health of all people
3.1. Introduction
3.2. Defining the right to health
3.3. Progressive Realisation: what it does and does not mean
3.4. Core obligations and the obligation to provide assistance
3.5. Collective entitlement, collective obligation and ways to manage them
3.6. Conclusions of the third section

Section 4. Global Health in practice: moving towards a single Global Health Fund?
4.1. Introduction
4.2. From the global AIDS response to Global Health, through a single Global Health Fund?
4.3. Ten pragmatic reasons for a single Global Health Fund
4.4. Conclusions of the fourth section
Section 5. General conclusions
References

Who is in the High Level Taskforce?
http://www.internationalhealthpartnership.net/taskforce.html

The members of the Taskforce comprise a small number of leading figures in the international community selected on the basis of the perspectives they can each offer on innovative financing, health systems or political feasibility. They will be serving the Taskforce acting in their individual capacity and not as representatives of their government or agency:
Prime Minister Gordon Brown (United Kingdom) (co-chair)
Robert Zoellick (President of the World Bank) (co-chair)
President Ellen Johnson-Sirleaf (Liberia)
Prime Minister Jens Stoltenberg (Norway)
Tedros Adhanom Ghebreyesus (Health Minister, Ethiopia)
Bernard Kouchner (Foreign Minister, France)
Giulio Tremonti (Finance Minister, Italy)
Heidemarie Wieczorek-Zeul (UNSG Special Envoy for Finance for Development Conference & Development Minister, Germany)
Stephen Smith (Foreign Affaires Minister, Australia)
Margaret Chan (Director-General of the World Health Organization)
Graça Machel (President and Founder, Foundation for Community Development, Mozambique)

Also at: International Civil Society Support group:
http://www.icssupport.org/PDF/Global%20Health%20Discussion%20Paper.pdf