European perspectives on global health: a policy glossary

3. Europe must assert its role in global health governance
Politics of global health
The politics of global health encompasses
political strategies of states and non-state
actors for purposes of protecting and
promoting human health, referring to issues
which are beyond the capacity of individual
countries to address through domestic
institutions ( Kent Buse ). The role of Europe in
global health politics should be strengthened.
Beyond the multitude of initiatives and actors, certain
fields and strategies of primary importance emerge
which begin to constitute a sector which one might
rightly call the “politics of global health”.
Politics of global health has existed for quite a long
time ( cf. sanitary conferences in the 19th century ;
the League of Nations Health Organization ) but had
played a more important role only in specific fields
( infectious diseases, cooperation in medical research,
vaccination programmes ). WHO was established in
1946 as a specialised agency of the United Nations
to “act as the directing and co-ordinating authority
on international health work” ( WHO Constitution,
Article 2a ). For about three decades this role was
not challenged by any other organisation. The World
Bank started to work in the health sector in the 1970s
as part of its basic needs strategy. The Alma-Ata
Declaration ( 1978 ), stressing the right to “Health for
All” and the importance of establishing systems of
Primary Health Care in all countries, was an expression
of the same orientation, as was the WHO Essential
Drugs Strategy, established in 1977.
The 1980s saw a re-orientation of politics towards
a market-oriented structural adjustment and trends
towards the privatisation of health systems ; fiscal
austerity reduced the financial means available
for health systems in many poor countries. It was
in reaction to new and / or intensified challenges
through globalisation that the politics of global health
changed its face in the 1990s. This new face can be
characterised by three main elements :
1. A re-strengthened interest in the North, specifically
in the United States, in the health situation in
developing countries due to new threats from
infectious diseases, but also related to the rediscovery
of poverty as a political problem
( instability ). In addition to that, health threats
inherent in consumption habits and environmental
degradation are more broadly perceived.
Frequently this has been formulated in terms of an
extended concept of “human security”.
2. An increasing consciousness of global
responsibilities and obligations stimulated by
global civil society in a large sense ( including
radical social movements, different types of nongovernmental
organisations and also religious
groups ). The right to health has been increasingly
defended as one of the most important human
rights and the importance attached to the
Covenant on Economic, Social, and Cultural Rights
in general has considerably increased. This has
been reinforced by the increasing attention of the
media which has helped to draw a larger part of
the general public into global health politics and to
create a field of public interest and debate.
3. There has been a growing trend to limit the range
of public sector activities and to give more space
to forms of private activity in the economy and to
private actors. This has been linked to an increased
international movement towards deregulation, in
particular in the context of the WTO. In the 1990s,
this led to pressure on international organisations
to refrain from supposedly interventionist demands
and “politicised” ( in this case mostly North-South )
strategies, accompanied by reductions ( at least in
real terms ) of their budgets.
Thus, it is possible to discern a seemingly contradictory
tendency towards increasing commitments to
poverty alleviation and health, ( MDGs, Poverty
Reduction Strategy Papers ( PRSPs ) ), including new
international agreements on global health, while
at the same time reluctance among key actors in
global health to strengthen existing multilateral
institutions, in particular, but not only, on the part
of the US government. This was accompanied
by the strengthening of institutions concerned
with “global market creation” – primarily the
transformation of GATT into WTO, but also of a
number of smaller organisations ruling on specific
aspects of international economic relations like the
Codex Alimentarius. This did not help to build strong
national health systems but has favoured the role of
Global Health Policy Glossary
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