For decades, developed countries have shaped the global health agenda through leadership in multilateral organizations and by engaging in bilateral assistance programs. However, the landscape and actors are changing. Russia, China, Brazil and India are using their new wealth to influence the outcomes of global health policy discussions, and many are supporting overseas health-related activities to create alliances and strengthen their international position. Business is driving not only economic growth in countries to which they expand, but also influencing local policies and health outcomes.
Panelist Yanzhong Huang, a Senior Fellow at the Council on Foreign Relations, discussed emerging powers and their role in health diplomacy. What makes today’s health diplomacy different from that in the late 19th century? Huang argues that over the past two decades, there have been dramatic changes that have transformed the landscape of global health diplomacy (GHD). Rising rates of infectious disease in a globalized context have made it necessary to strengthen collective action against the transnational spread of disease. There is a proliferation of new and diverse actors conducting GHD. Traditional nation states are no longer the only actors: key players now include non-state participants such as foundations and inter-governmental organizations, NGOs, faith-based organizations, and particularly multinational corporations.
Huang pointed out that the World Health Organization is no longer the only official venue for vetting international agreements and health policy. Recognizing this shift, in 2010 the WHO began a restructuring process to focus its efforts on being a convener of experts and a coordinator of the global response to public health challenges, especially emergencies of international concern. For example, during the SARS epidemic the WHO played a critical role in mobilizing resources and capacity along the global alert network by engaging state and non-state participants.
Jennifer Hooper, the Global Director of Health and Safety at Vale, the second largest mining company in the world, discussed Vale’s efforts to be a sustainable business focused on workforce and operations. With its passion for creating a positive social regional legacy, Vale wants to be a strong agent of global change in policy and advocacy areas. Since mining is not an impact-free industry, Vale strives to be the partner of choice in emerging markets. The company ensures that it understands health risks and health capacity in the 38 countries in which it works before deploying a health program. It has partnered with Columbia University to ensure transparency of agreements between governments and the mining industry, and is exploring how taxes can be used for social benefit. Vale uses on the ground education, training and wellness promotion to improve the lives of its employees and communities in which it operates.
Nicolai Lohse, the Programme Director of Global Health Diplomacy at the pharmaceutical company Novo Nordisk A/S, which produces insulin, described the diabetes epidemic. Similar to the HIV epidemic 10 years ago, diabetes is an epidemic that is out of control, yet it is a preventable and treatable disease. There are now 366 million people with diabetes, and in 20 years this number will grow to half a billion people, mainly in lower and middle-income countries. Lohse says that “Half of those with diabetes don’t know they have it. Half that know don’t have access to care. And half of those with access to care don’t get the proper treatment.”
Yet in today’s financial setting, money for global health is drying up and non-communicable disease (NCD) in particular face a lack of civil society mobilization and international funding, Lohse said. There is a new focus within the UN system on NCDs, but the health community is still waiting for big international donors to come on board. This leaves a space for the private sector to step in, he said. Pharmaceutical companies have been criticized for too high drug prices. The food and beverage industry is criticized for products that can create harm in terms of obesity related disease. Lohse believes that companies can turn a profit while at the same time support the public health agenda. This requires defining the private sector role in the changing global health landscape. He gave the example of Novo Nordisk’s program in China. Through bold and transformational leadership and by creating a local presence, Novo Nordisk was able to lower the price for diabetes drugs by three times, making treatment widely accessible.
Bishop Malusi Mpumlwana said that GHD must take into account the realities of local politics, norms and values. Institutions such as the Global Fund to Fight AIDS, Tuberculosis and Malaria have refocused minds on the issue of health policies in the world. The Global Fund has subsidized health costs for poor countries, allowing them to expand access to health interventions. While initiatives such as former President Bush’s Emergency Plan for AIDS Relief (PEPFAR) have received mixed reviews, companies can have a unique role in empowering countries to produce their own medications, bringing down costs and transferring those savings to affected communities. Mpumlwana argues that we can recover the costs for research and development without punishing the consumer through the use of new channels of health diplomacy, such as working through the World Trade Organization’s provisions for producing generic drugs in resource-poor settings.
During the question and answer session, Alene Gelhard from the Public Health Institute described the challenge of trust in PHI’s public-private partnerships in Indonesia. She asked panelists how much of an obstacle the issue of trust has been for enacting successful programs.
Lohse responded that there must be a basic level of trust between stakeholders and beneficiaries. Toward this end, every employee is trained to be open, honest and decent, treating people with respect. He recommends meeting others with an open mind, identifying your shared agenda, and facilitating dialogue. Mpumlwana commented on how issues of corruption have impacted the Global Fund’s ability to raise enough funding this past year, emphasizing the need to build and retain trust between multilateral institutions and governments as well. Panelists were also asked about the duplication of efforts between companies and government programs, and what opportunities exist to rationalize and align the delivery of health care.
Hooper gave the example of Vale’s program in Brazil, which uses a whole person, whole healthcare perspective. The challenge in many countries is the lack of infrastructure. Companies can go it alone and try to put infrastructure in place, and offer fringe benefits for the surrounding community. Or they can partner with the local government, NGOs, development banks, and other companies. For example in Mozambique and Malawi, Vale is looking at the countries as economic corridors. They assess logistics supplies and bring in experts to build capacity and address basic needs.
Session moderator Alan Court, the Senior Adviser of the Office of the United Nations' Secretary General’s Special Envoy for Malaria, remarked that the GHD environment is changing. There has been a “shift in the global map away from a top down approach from a single approach to a multipolar, multifaceted one.” By building on shared values, working with workforces and local communities, business and governments can use royalties and taxes for the mutual benefit of the country and the people working there.