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13 June 2011: The Rise of Global Health in International Affairs, Chatham House

  • Last modified date:
    16 June 2011

At home, two of this government’s highest priorities are to return the country to the path of economic prosperity and to give people, especially the poorest and most vulnerable in society, access to excellent healthcare, with outcomes that are consistently amongst the very best in the world.

Those two priorities are also present when we look beyond our own borders. 

We want to do everything within our power to bring sustainable growth to all the countries of the world – and to the poorest in particular. 

And we want that growth to bring with it improving health outcomes that will in themselves underpin future prosperity.

Interdependence

Why are these priorities so important?  Why are we interested in the health and prosperity of those who don’t live here; and who don’t pay taxes here?

They’re important because we understand that today more than ever before – our national interest cannot be defined simply by what happens within our own borders – if indeed it ever could.

Because the strength of our economy, the health of our society and the success of our nation depends on the strength of our partners around the world.

Because we understand the fundamental importance to our long-term national interest of making the lives of others, wherever they may be, better than they are now. 

And one of the main ways of achieving this is through improving health.

The health challenges we face in Britain - an ageing population, the increasing costs of healthcare, a rising tide of lifestyle related diseases – these are not unique to us as Margaret so eloquently said.  They are shared and international concerns.

Across the globe, we share a common destiny. 

Borders are more open; travel is faster, more frequent and more affordable; our economies are more integrated than at any time in human history.  .

This interdependence means that, to a greater degree than previously imaginable, we share in each others’ prosperity – and indeed hundreds of millions of people lifted from poverty in China in recent decades can testify to that. 

But we also share the risks of failure. 

The risk of climate change – where the effects are felt by all, irrespective of borders.

The risks of diseases and infections – as the H1N1 pandemic demonstrated or as Margaret demonstrated in relation to the recent E. Coli outbreak, it can spread very quickly from country to country.

Or indeed the risks of collapsed and failed states bringing terror and conflict into the world.

Acting alone in any of these respects is not an option.  Acting together, acting in common purpose, that is the only way forward.

Economic interests

Of course, especially in times of economic difficulty, as Margaret said of financial austerity, we do all of us need to look after our own economic and trade interests.  Without a strong economy there is little we can do in any arena. 

I do want British companies, British healthcare organisations to succeed abroad, bringing more jobs and more prosperity to our people.

We’ve seen some examples - Moorfields Eye Hospital has a new facility in Dubai, and Imperial College Hospital operates a diabetes clinic in Abu Dhabi.  They are pioneers, seeking new opportunities on a global basis for the NHS and indeed by doing so providing new streams to fund better care for NHS patients.  I want more of this.

And some Trusts with well-developed international reputations, such as Great Ormond Street Hospital, already treat international patients here in England. 

Revenue again that is then invested back into the NHS to provide ever better care for NHS patients here in Britain.

The UK has long been a global hub for research and clinical expertise.  The life sciences are of particular importance to our economy now and for the future.  We want to build that base we have had here for many years in the future.  Encouraging global leaders like GSK to build on their success, creating new jobs and indeed many new treatments.

Always attracting new investment, always pushing the boundaries of medical science for the benefit of all.  Giving UK companies and NHS organisations that have so much to offer the world every opportunity to do so.

And with three trillion dollars invested in healthcare each year around the world, it pays to be a major player.

Development

But above and beyond self-interest, there is enlightened self-interest.

I am deeply proud of the fact that Britain has forged a reputation as one of the leading voices and principal donors in international development.

This is perhaps most obviously apparent in our commitment to lifting our development spending to 0.7% of gross national income.  A commitment made by the last government at Gleneagles in 2005 and one that will be realised by this government in 2013.

The international community can depend on the UK to keep its promises on development spending, and to use its influence to encourage others to do the same. And we know what that will enable us to do.

Training midwives to help make childbirth the joyful experience it should be instead of the potential death sentence it too often still is.

Working to eradicate the scourge of polio and Guinea worm disease.

Providing safe, fresh drinking water which can transform lives not only through an almost instantaneous improvement in their health, but also by freeing girls – because it is invariably they who work so hard to collect it – to go to school or work, improving their lives and those of their families still further.

And of course vaccinating children against diseases like severe diarrhoea that, for the sake of a few pounds, would otherwise kill them.

This has been a good month for progress in vaccinating children.  Earlier this month, GSK announced that it would make its rotavirus vaccine available to GAVI for two thirds the price at which it is currently available.

And of course, at today’s GAVI Replenishment Conference, I was delighted that the Prime Minister, David Cameron was able to announce an additional commitment of £814 million.  Money that, between now and 2015, will help vaccinate over 80 million children and save 1.4 million lives.  That’s one child’s life saved every two minutes.

We – government and industry – understand that, in the long term, their interests, the interests of those people who we help are our interests.  Because their problems, left unchecked and ignored, will sooner or later become ours whether we like it or not.

Security

For when people are poor, desperate and without hope, chaos can be close at hand.  States that are today fragile can, without outside support, soon fail.

And the risk of failed states are huge – unleashing fear and hatred that can bring terrorism, or conflict, unchecked immigration and crime to our doorstep.

David Cameron said only last month at the G8 in Paris, “If we [had] spent a fraction of what we are paying now in Afghanistan on military equipment, into that country as aid and development when it had a chance perhaps of finding its own future, would that have not been a better decision?”

No country can escape the logic of global interdependence, accepting the bountiful pros while somehow avoiding the inevitable cons, no matter how much we might want to.

So the question is, if we are all in this together, what should we do about it?

Britain’s response

Britain’s answer is to make Global Health an explicit aim of our foreign and economic policy. 

At home, we are working to ensure that all relevant government departments work together – sharing information and developing common goals and working to a shared strategy.

Abroad, we need to work ever more closely with other governments and with international organisations like the WHO and across civil society. 

Making and exploiting the connections between us, making the most of the talent, the expertise and the passion that exists in abundance out there in the world, and putting that work to the benefit of humanity.

International cooperation

Two years ago, the H1N1 pandemic affected just about every country on the planet.  The global response was swift, calm and impressive. 

I would like to pay particular tribute to Margaret for how she and her colleagues at the WHO handled that particular crisis.  A crisis that, throughout, was characterized by a high degree of international cooperation, openness and trust.  An approach, I was pleased to see, that was vindicated in a recent review of the WHO’s actions.

We of course were also lucky.  That particular flu strain proved in the event to be relatively mild.  Of course, we may not be as lucky next time. 

That is why all countries must continue to work closely together:

• to develop adequate warning systems,
• to quickly develop, produce and distribute effective treatments
• and to agree protocols of how the business of the world economy can be sustained during times of crisis.

Value for money

But we must also be clear as to the political and financial realities that donor countries face. 

Everyone is under pressure at the moment. 

Under pressure to put aside their development commitments and to contribute less than they promised. 

Under pressure to turn their backs on free trade and to try to protect jobs at home by raising trade barriers.

Under pressure to think of the national interest in the narrowest of terms.

We must and we will resist those pressures.

So here in Britain, we will not make the world’s poor pay the price for the debt crisis by abandoning our commitment to the 0.7% objective. 

We will not seek the false shelter of protectionism.

We will not close our eyes to the realities of a modern, integrated and globalised world.

Instead we are determined to prove to our citizens that the money they spend is making a genuine difference.

Outcomes Framework

That is why we updated the original Health is Global strategy through an Outcomes Framework For Global Health.

Here in England, we are modernising the National Health Service.  One of the most important elements of this modernisation is measuring how effective the NHS is in terms of the health outcomes it delivers for patients. 

So instead of saying that so many operations must take place, we want to measure the survival rates for those operations – to measure, publish and improve.

That way, not only can we in government, but clinicians and, most important of all, patients, can see just how good services are.  And if there is a problem, then clinicians will be challenged to sort it out.

Such an approach in this country for cardiac surgery has halved death rates in England over the last 5 years.

As at home, likewise abroad.  The Health is Global Outcomes Framework brings tangible, measurable outcomes to bear on our efforts to improve global health.  Focussing on some of the greatest challenges to global health across the key areas of for example global health security, health in development, and trade for better health:

• on food security,
• access to affordable immunisation and treatment,
• adapting to the effects of climate change on the health of the very poorest communities,
• And strengthening local health services to improve lives, reduce preventable death and improve prospects for peace and security.

In this way – working together across departments – we can focus our resources not only on what matters most, we will be able to see far more clearly whether or not what we are doing, whether the billions we are spending, is having the desired effect.  And if it’s not, we can adapt and change what we are doing.

Global Health Diplomacy

Taken together...

• the realisation that our interests reach far beyond both our own borders and our narrow, immediate economic interests,
• and the clarity of purpose that the Global Health Outcomes Framework brings with it...

... means the traditional approach to international relations is evolving. 

Global health is now central to effective foreign policy.

You cannot separate health from security – not when so much of our security means preventing or dealing with the aftermath of natural disasters, civil conflicts or of pandemics.

You cannot separate health from economics – not when a new pandemic could bring the global economy to an abrupt standstill or when positively life sciences and health industries have so much to contribute to global growth and trade.

And you can never separate health from our desire for social justice – for all people, from all countries, of all incomes, to share the dignity of good health.

The WHO will be central in tackling the challenges we face.  I would like to applaud the determination and leadership that Director General Chan has displayed in helping the organisation adapt to the changing nature of these challenges.

I hope that all countries will join the UK in integrating the global health agenda into all aspects of their foreign and economic policies and continue to work together and with organisations such as the WHO to meet the Millennium Development Goals. 

For when we work together, everyone benefits.

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