The Changing Global Health Agenda-post 2015

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First, I would like to congratulate the organizers of this 9th Conference on Global Health and Vaccination Research. The conference keeps growing year by year and is a main meeting platform for global health research in Norway. With its broad appeal to Norwegian and international participants, it is a great arena for researchers, students, policy makers and others to present research results, discuss new ideas, establish contacts and partnerships. Norad is happy to be one of 7 partners in this endeavour.

The GLOBVAC programme at the Research Council is also a success story and has grown and matured over several years. From initially having a main focus on vaccine and vaccination research, the scope has been broadened to take up other relevant priority areas related to the MDGs, such as health systems research and innovation. The programme has been extended for the period 2012-2020.

The GLOBVAC programme has contributed to strengthen global health research in Norway. The programme now attracts a record number of applicants. Last year, GLOBVAC allocated grants for NOK 270 mill. This was the largest health call ever launched by the Research Council of Norway. Partnerships are essential, and the Norwegian Forum for Global Health Research is a key partner.

The GLOBVAC programme has been strategic and obtained results that will have public health impact. One example is how it contributed to developing a new and cheaper rotavirus vaccine in India, which is now being introduced by the Indian government. With a strong international board in place, GLOBVAC was able to rapidly channel funds for vaccine research in response to the Ebola epidemic last autumn.

Global health has become more central among Norwegian institutions. “Meeting the global health challenges” is one out of 10 priorities in the recent national strategy Health&Care21. Even though the Ministry of Foreign Affairs has a main responsibility, the strategy calls for other ministries to be involved in research, education and innovation in this area. The strategy provides recommendations that will be followed up in a separate action plan, including stronger involvement from all relevant actors in global health.

The changing global health agenda – post 2015

Since the year 2000 the international development agenda has been defined (at least in Global Health) by the MDGs. As we assess the status of achievements against those goals, the new Sustainable Development Goals are being negotiated. They will form the development agenda towards 2030.

The MDGs and the SDGs are totally different animals

The MDGs were negotiated by a relatively small number of technical agencies, to define the international development assistance agenda.  As such the MDGs

• focus on the priority needs of the poorest countries and
• served to focus and thereby coordinate aid flows
• served to allow development of a coherent set of indicators and an accountability framework.

In contrast:  The SDGs have been developed through massive public consultations such as “the world we want” and a long and broad political negotiation.  The SDGs represent a development agenda and compact for the world.  This is an enormous achievement – but they are normative as opposed to operational.

• They focus on the majority needs – and most live in MICs.
• They represent a broad range of global public goods and development priorities.
• They are inherently inter-linked and hence make accountability very difficult.
• They are broad and much more expansive making financing and accountability more difficult.
• They expand the concern of the MDGs focussed on fighting poverty (and the impact of poverty) to include sustainability – essentially environmental protection and climate change.

Whereas health made up 3 of a total of 8 goals under the MDGs, Health is now one of 17 goals under the SDGs. And that single health goal is much more expansive than the 3 previous goals combined.

Never in human history have so many people exited out of poverty – and never have we seen faster declines in maternal and child mortality. 

We can now imagine within our generation some sort of equality regarding the probability of dying before you are five or whilst giving birth to new life.  This is extraordinary – it marks the end of a divide between developed and developing worlds and holds the promise of a level of equality that will completely re-set the way states and economies interact.  We are talking about the end of organised and institutionalised development assistance – towards a system of global cooperation.

In global health, we have seen the transition in the past 5 years from a world dominated by infectious disease and early death to one in which more than 50% of people are dying from Non-Communicable Diseases (NCDs).  The only continent on earth that still demonstrates patterns of mortality dominated by infectious disease is now Africa.

The major cause of preventable mortality on earth today is self-created – self-imposed conditions of lifestyles!

This means the Global Public Health Agenda has radically altered – and to a large extent, all populations face similar public health threats (excluding Africa and a few states outside of Africa). 

While the MDG agenda is dominated by reduction of mortality for mothers and children and combatting the global pandemics of HIV, TB and Malaria, the SDG agenda is really very different.

The SDGS include broader mortality reduction goals – reducing traffic accident deaths; reducing deaths from NCDs; and broadening out the agenda on infectious diseases.

However, there is also an expanded agenda on how we reach good public health – through universal health coverage.

There is a far more complex demographic/population growth agenda as population is growing fast – but mainly in Africa.  As population growth can deliver a demographic dividend if managed well; as populations are ageing; and as population growth impacts on environmental protection and climate change.  Hence there is a much greater emphasis on reduction of fertility – an agenda which is partially in the health domain.

Lastly reflecting the problems of lifestyle there is a greater emphasis on risk reduction – alcohol, tobacco, diet, drugs, pollution etc.

With such a large and complex agenda – the development assistance consensus is lost.  We have an ambitious compact for cooperation – but the development assistance agenda will be a subset of the SDG agenda.

The new agenda will need to reflect new imperatives for action and yet remain focussed enough to impact on core strategic responsibilities for change.  It will be larger than before yet more focussed than the SDG agenda.  No one can say exactly what it will be – it will emerge within the SDGs and change over time.

But for now, I would like to suggest it is likely to lie around 6 key axes:

1) Given that aid should be focussed on the poorest, a disproportionate amount of assistance will flow to finishing the unfinished business of the MDGs – namely and continuation of the operational response for:

• Child and maternal mortality reduction and
• Infectious disease control

2) A cross-sectoral approach to lifetime fertility reduction

3) Increased emphasis on Research and Development for the provision of global public goods – innovation and knowledge. 

Evidence to inform operational agendas around major topics like NCDs, clean air, tobacco use reduction.

Finance will focus also on the creation of a pipeline of affordable appropriate technology to enhance the capacity of health systems to serve – such as our recent innovation 2030 conference in Trondheim.

4) The Ebola shock will reinforce the collective will for the creation of systems to enhance global health security (detection and response)

5) We need to know how to finance health services and better health – and how to transition countries towards sovereign control and financing.

6) The need for prioritization and emphasis will drive extended cost benefit analysis of other sectors as they contribute to health and the co-benefits to health and environment/climate of significant actions regarding:

• Agriculture and diet
• Clean air – clean energy
• Transport and physical activity (urban)
• Water and sanitation (use, protection, access)

These agendas must prioritise health and climate co-benefits of their programmes.

Conclusion

GLOBVAC is an excellent tool to face these new challenges – especially given the heightened emphasis on research and development.  Globvac has been dynamic in the past and will need to continue to do so.  IN order to continue to have a real impact on the lives and health of women and children, Globvac will have to focus on major game changing themes, to deliver new knowledge and technologies within a larger and more complex agenda. 

If Globvac can remain focused, responsive and attuned to issues of major significance, Globvac will continue to contribute to the global public health agenda and Norway’s programme of assistance.