Bonn: German Development Institute / Deutsches Institut für Entwicklungspolitik (DIE), The Current Column of 8 October 2018
Bonn, 8 October 2018. The World Health Summit (WHS), an important forum in global health, is being held in Berlin at the end of this week. Led by Angela Merkel, Emmanuel Macron and Jean-Claude Juncker, key actors from politics, science and academia, civil society and the private sector will be discussing pressing global challenges facing healthcare.
Germany has become a prominent actor in global health policy over the past few years, with the federal government harnessing opportunities to progress the issue at the very highest level, including at the G7 and G20 summits. With doubts surrounding whether the US and UK will maintain their current level of commitment, Germany and other countries need to step up their own efforts.
Introduced in 2013, the German federal government’s existing global health policy is currently undergoing reform. A consultation process involving non-governmental actors began in early June. This reform is necessary because the framework conditions have changed since the United Nations adopted its 2030 Agenda, with the previous strategy not giving due regard to issues such as digitalisation and the effects of climate change. In the next steps of this process, healthcare will need to be understood and examined on a global scale in all its various dimensions and facets. The federal government should align its global health strategy consistently with the 2030 Agenda and its 17 Sustainable Development Goals. The SDGs act as key points of reference at global, national and regional level that are either explicitly or implicitly related to health, emphasising the need for action but also highlighting conflicts between individual goals. These conflicts must be acknowledged and addressed in Germany’s new strategy as this is the only way to achieve the best possible leverage and thus the maximum overall effect. Using the SDGs as a framework and tool will allow the government to bring basic principles, old and new priority areas and even specific measures consistently in line with one another as well as to find appropriate ways to involve existing and new actors. Guiding principles and priority areas should also build on the potential of the German economy and on previous experience, implement lessons learned from e.g. the 2014 Ebola epidemic, and overcome weaknesses in the 2013 strategy paper, including the excessively narrow treatment of certain issues. A review mechanism is also required.
Global health policy requires limitations in the existing system to be overcome and global cohesion to be improved: the global health architecture is known for its plethora of actors and the same is true of the healthcare market. Identifying new strategic topics will set the priorities for how government funds are distributed in future and how the interests of industry sectors and civil society as well as other countries will be taken into account. International organisations have a pivotal role to play in regulating and coordinating these efforts. That is why the World Health Organization must be bolstered and adequately funded in its capacity as a policymaker and setter of standards. At national level, there needs to be greater cohesion between related fields of policy and the involvement of relevant ministries. This is why it is important to cultivate an international approach and to encourage greater commitment from all the relevant actors in global health, not just the traditional ones. This also includes Germany’s Federal Ministry for the Environment and Ministry of Defence, amongst others. At the same time, the country’s health policy must be dovetailed even more closely with global health policy. The strategic reforms must also leave room for a public health strategy – itself to also be based on the 2030 Agenda – which is currently lacking and needs to be developed.
Having a global understanding also means involving relevant actors fully and continuously throughout the entire strategy development process and beyond. The federal government needs to develop and exploit existing incentive mechanisms and regulatory tools such as multi-actor partnerships with companies without impinging on the human right to health. This right cannot be allowed to simply be paid lip service but must instead be at the heart of any course of action. Regular dialogue, including with international actors, will allow non-governmental actors an even greater say. The interfaces between the SDGs (between health and decent work, health and climate change, etc.) offer suitable starting points, while many of the salient issues have already been addressed in the coalition agreement. Germany certainly cannot handle the necessary measures alone. But it does have enormous potential, which is far from being fully exploited when it comes to global health. This includes its experience from the German healthcare sector, its (financial) resources, its involvement of German business and the strategic positions it occupies in international organisations.
Paul Marschall is researcher in the Programme "Inter- and transnational Cooperation" at the German Development Institute / Deutsches Institut für Entwicklungspolitik (DIE).
Maike Voss is supervisor of the project "Challenges and opportunities for German global health and development policy for achieving health-related sustainable development goals (SDGs)" at the German Institute for International and Security Affairs (SWP).