European perspectives on global health: a policy glossary

3. Europe must assert its role in global health governance
set of financial resources which still mostly reside in
the Official Development Assistance ( ODA ) budgets
of nation-states. Frequently their conditionalities and
the increase in vertical programmes puts additional
burdens on the receiving countries.
International organisations without a health
mandate but with important impacts on
health should also be counted among the key
actors in global health. While the Word Bank directly
entered the field of global health in the 1970s, in
close cooperation with the International Monetary
Fund, for a long time it has been directly involved in
the management of foreign exchange problems and
adjustment policies. In particular, during the 1980s and
early 1990s, the so-called Bretton Woods institutions
were severely attacked by NGOs and global social
movements for their rather one-sided pressure for
“sound economic policies” based on structural
adjustment frequently disregarding the impact of
monetary policies and liberalisation strategies on
social development. Due to the absolute priority given
to austerity programmes for fiscal adjustment and the
favouring of cost-recovery principles in social services,
the construction of primary health care systems in
poor countries fell in disregard.
The WTO has been another international organisation
with important impacts on global health. In particular,
the Agreement on Trade-Related Intellectual Property
Rights ( TRIPS ) created problems regarding access to
new, patented medicines which are sold at high prices
allowing pharmaceutical companies to recover their
R&D costs. As long as developing countries were not
prevented from producing much cheaper generics, the
results of patent protection were basically limited to
industrialised countries, which were in a position to
cope with these problems through health insurance
and public health systems.
Health services are delivered by public and private
actors. The large play a decisive role in the
development of new, highly effective medicines
and thus also for the treatment of most diseases.
Their inherent for-profit orientation has led to a
concentration of research and development on the
diseases of industrial countries with a capability to
pay high prices for patented drugs – to the neglect
of research on diseases mainly prevalent in poor
countries. Due to their specific interests they have
been the major initiators and fervent defenders of
the TRIPS agreement. Nevertheless, due to increasing
public pressure through civil society organisations
but also UNICEF and WHO ( and to a certain degree
by shareholders ) corporate social responsibility has
become a factor of increasing weight in corporate
behaviour, leading to cooperation for the provision
of global public goods in the form of global publicprivate
partnerships ( GPPPs ). In general business
actors in health have become central. Health is
now one of the largest private markets in the world ;
industries that endanger health – such as tobacco
and alcohol – are amongst the most influential global
industries, as are industries with a high relevance
to health, such as the food industry. Health has also
become an important issue at the World Economic
Forum. Medical and pharmaceutical research is a
key area of research and technology development,
and a major factor in innovation and competition
between companies, regions and nations. But in many
cases, health agendas and economic growth and
investment agendas compete rather than complement
one another, and innovation is focused on the needs
of the rich rather than the poor countries – as in
pharmaceutical development.
Though NGOs have played a role in global health for
a long time ( for example, the Red Cross and religious
and philanthropic organisations ), during the last two
decades their impact has considerably increased.
They now constitute a dense network of actors,
which play an important role in the delivery of health
services as well as in advocacy work. A set of strong
new non-state players is defining priorities and
approaches. As global communication becomes
easier and cheaper the role of non-governmental
organisations has become much more prominent
both in setting agendas and in delivering services,
for example Médecins sans Frontières ( MSF ) or Care
International. Foundations as major new players have
gained high influence in agenda setting through their
resource-based power in global health, in particular
the Bill and Melinda Gates Foundation, which spends
about US$1 billion on global health annually. An
increasing number of global health initiatives – also
within the WHO – are dependent on support by this
foundation. The pharmaceutical industry and other
parts of the private sector are increasingly involved
in not-for-profit activities and alliances to improve
Global Health Policy Glossary
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