Advancing from One Year to the Next: Reflections on Global Health

3 months ago and after 13 years I transitioned from the position as Ambassador for Global Health at the Swedish Ministry for Foreign Affairs to an Advisor, Advocate, Activist, and former Ambassador, I would like to share my reflections on global health – the context and its future. This blog post is part of my continued engagement with the hope of stimulating discussions and debates around the complexities of global health.

The Evolving Context for Global Health

2023 was a year of major setbacks – the Russian aggression against Ukraine continued to kill thousands of people; the situation in Gaza was indescribable and the situation for women and girls in Afghanistan continued to be unacceptable. The lack of political will to apply the lessons of the Covid-19 pandemic and improve pandemic preparedness and response became a major threat to our future. But of course, there were also advances – COP28 for the first time devoted a full day to climate and health and a new malaria vaccine was introduced as well as a new medical treatment for obesities.

The question is where we go next. What are our priorities and strategies for improving health? Is there still a role for global health as a concept? Can we advance our ways of working together?

Revisiting the Past: Colonial Legacies and a New Agenda for Global Health

Many voices have been saying that global health is a colonial legacy and about the “global north” suppressing the “global south”. My view is that there is truth in this, but it is a too simplistic way of looking at the past as well as present situation. The critique of global health as a remnant of colonialism demands a nuanced exploration. However, if we delve into the complexities of global health, it becomes evident that understanding its colonial legacy and the role of governance is crucial. 

At the centre of this discussion are the financial resources and who controls them. Historically, financial control and aid conditions have been predominantly in the hands of high-income countries, leading to a pivotal question about the nature of our past approach. Could this have been done differently and how shall we advance our ways of working in the future?

An important question is also why we have low-, middle- and high-income countries at all. I see two main factors – again, resources and governance. The way that resources were accessible and managed or exploited during the time of colonialism certainly contributed to the present situation and continue to do so.

But good or bad governance also made a difference after independence and still does.[1] Governments of individual countries are always in charge and responsible for their populations and they can’t abdicate and position themselves merely as victims of colonialism. Increasing tax revenue, not providing international companies with exceptional conditions, and allocating resources for health in the national budget are all possible policy options for most governments. Yes, then there are exceptions where conflicts and crisis make this less feasible for the near future.

What has this to do with health and global health?

Global Health goes Beyond Aid

It is time to leave the understanding and perception of global health as equal to aid and development cooperation.

I would claim that most of development assistance made available have been done so with good intent especially for improving people’s health. This does not mean that the way the resources have been made available has been optimal, but they have contributed to some major health improvements. Development Assistance for Health is still needed but with a redefined role and relative importance. A mutually respectful relationship is key.

Then, we need different sources of financing, not development assistance, for global common goods for health, research cooperation or institutional collaboration between countries. Resources where all governments contribute based on common interest and benefits. Progress will also require a more proactive engagement of the private sector as well as civil society and academic institutions.

Global health goes beyond the health sector

Today’s association of global health with the development assistance agenda is also problematic from an epidemiological and health priority perspective. The legacy from the millennium development goals is still dominating. The fact that in most countries, more lives are lost prematurely due to non-communicable diseases is barely noticed.

NCDs are wrongly considered to be a disease of the rich people, rather than poverty related as they mainly are. Infectious diseases are still dominating in many of the lowest-income countries, but in countries like Sierra Leone where I worked recently, the situation is changing and there is a need for a more balanced approach to health priorities.

Today we have disease patterns and associated risk factors which are more similar across the world with the possibilities of new kinds of collaboration beyond the present global health agenda – and indeed beyond just the health sector.

Global health goes beyond narrow national interests

Yes, we need to leave the colonial era behind once and for all, but we still need international and multilateral cooperation at the global level for health.

With stronger national governments and regional political structures, it is also time to focus on global common goods. This could include politically agreed strategies for addressing common global health priorities, sharing of data and research findings, a global system for surveillance and alarms about health threats, rules and incentives for multinational companies with relevance to health (pharma, food etc) and technical and institutional collaboration between countries.

This approach should focus less on resource transfer and more on mutual interests and benefits based on professional and respectful relationships.

We need also reforms to advance the present international health system which is based on the MDGs to an international system for health focusing on enabling people and the planet to stay and remain healthy.

Looking Forward: Key Topics for 2024 and Beyond

As we step into 2024, it is time to discuss and debate our goals, strategies, and the very definition of global health. In upcoming blog posts, I will delve deeper into some specific topics, with the hope of stimulating a dialogue that moves beyond traditional narratives. The journey ahead is not just about addressing current challenges but about reshaping our future approaches to the health of people and our planet.

·        What is affecting people´s health and how should evolving epidemiological situations and societal transitions change our goals, priorities and strategies?

·        Climate and health - was COP28 a milestone for leveraging the interface between climate and health policies?

·        Can we avoid the next disease-outbreak with a potential of becoming a pandemic having the same devasting impact as we experienced during Covid-19?

·        Financing for health – exploring new models for financing global common goals and interests.

·        The future of WHO – three critical questions and choices for the future of organisation.

·        Global Health Diplomacy: Understanding the role of politics and diplomacy in shaping global health.

·        From an international health system to an international system for health.

Anders Nordström

[1] Why Nations Fail: The Origins of Power, Prosperity, and Poverty Daron Acemoglu, James a. Robinson