European perspectives on global health: a policy glossary

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4. Europe must establish a societal dialogue for global health often surpass that of host country governments and also sometimes play an important advocacy role. Certain aspects of globalisation have further undermined the ability of developing country governments to provide health care for their populations. For example, the development of agreements under the World Trade Organization ( WTO ), notably Trade-Related Intellectual Property Rights ( TRIPS ) and its interpretation by powerful corporate interests and governments, has already threatened to circumscribe countries’ health policy options. The best-known case relates to the recent legal battle around the attempt by South Africa to secure pharmaceuticals, especially for HIV / AIDS, at a reduced cost. In 1997 Nelson Mandela signed into legislation a law aimed at lowering drug prices through “parallel importing” – that is importing drugs from countries where they are sold at lower prices – and “compulsory licensing”, which would allow local companies to manufacture certain drugs, in exchange for royalties. Both provisions are legal under the TRIPS agreement as all sides agreed that HIV / AIDS is an emergency. This was confirmed during the WTO meeting in Doha in 2001. The US administration did not bring its case to the WTO but instead, acting in concert with the multinational pharmaceutical corporations, brought a number of pressures ( e.g. threats of trade sanctions and legal action ) to bear on the South African government to rescind the legislation. This followed similar successful threats against Thailand and Bangladesh. However, an uncompromising South African government, together with a vigorous campaign mounted by the local Treatment Action Campaign ( TAC ) and international AIDS activists and various health NGOs, forced a climb-down by both the US government and the multinational pharmaceutical companies. The above example is an unusual one of collaboration between a local social movement ( TAC ) and international NGOs with a specific focus and expertise, and an alliance with a national government. International NGOs sometimes perceive their role as acting as a conduit to communicate the demands and needs of poor people in developing countries. A recent example is the ”Make Poverty History” campaign. While such a role is important, tokenism must be avoided. International NGOs in developed countries need to work with and through southern-based NGOs, and UN agencies and intergovernmental bodies must find ways to create a more prominent involvement of southernbased NGOs, academics and health institutions in shaping the international health policy agenda. Globalisation has increased the need to engage with actors and policies from beyond the local area : this poses a particular challenge for civil society. Social movements may need to bring together the concerns of multiple communities and then find ways to present collective views and concerns at the national or international level. This form of community involvement requires an advanced level of organisation, capacity-building and civil society networking. The most active and coherent global health-related networks have been organised around women’s and reproductive health issues and have been influential in population policy as well as around opposing the commercialisation of infant feeding. A current example of a developing global network is the recently-created People’s Health Movement ( PHM ). The PHM is a large global civil society network of health activists supportive of the World Health Organization ( WHO ) policy of Health for All and organised to combat the economic and political causes of deepening inequalities in health worldwide and revitalise the implementation of WHO’s strategy of Primary Health Care. The PHM, formed in 2000 at a People’s Health Assembly attended by 1500 delegates from over 90 countries, now comprises a range of NGOs and community-based organisations and is playing an increasingly active advocacy and educational role at both national and global levels. It has already had some success, in alliance with selected country governments, in clarifying and strengthening WHO’s position in revitalising its commitment to the principles of Primary Health Care. <strong>European</strong> organisations play a major role in this dialogue and many donors from the North increasingly support civil society actors from the South. The <strong>European</strong> Union Institutions increasingly acknowledge the need to include civil society in the policy process and have created a special <strong>European</strong> Health Forum to dialogue with non-governmental organisations and patient groups. The Commission has had frequent consultations with civil society in decision making related to health, for example ongoing consultation of the <strong>European</strong> Commission Green Paper on Mental 52 <strong>European</strong> Foundation Centre – <strong>European</strong> Partnership for Global Health
4. Europe must establish a societal dialogue for global health Health, or past ones on pharmacovigilance or the health effects of smokeless tobacco products. This reflects the recently expressed desire for EU institutions, including the Commission and the Parliament, to “bring Europe closer to its citizens”. As part of a new community programme launched in 2006, the Commission has proposed three lines of actions to encourage active <strong>European</strong> citizenships, including “Active Citizens for Europe”, “Active Civil Society in Europe” and “Together for Europe.” Action : the dialogue on a <strong>European</strong> health strategy must seek to engage civil society and be continuously aware of the interface between local and global health action. It must explain to <strong>European</strong> citizens the added value of taking an active role in global health and be responsive to civil society concerns. References : Loewenson, R. Civil society influence on global health policy. World Health Organization Training and Research Support Centre, 2003. http : / / www.tarsc. org / WHOCSI / globalhealth.php Europa, The <strong>European</strong> Commission. Active Citizens for Europe. http : / / ec.europa.eu / dgs / education_ culture / activecitizisenship / new_programme_en.htm The People’s Health Movement. Health for All Now. http : / / www.phmovement.org / Global Health Policy Glossary 53
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