Global health and multilateral diplomacy

According to Chinese wisdom, "Health is preferable to wealth".This truth could not fail to have an inspirational impact on diplomacy.

In 2007 the foreign ministers of Brazil, France, Indonesia, Norway, Senegal, South Africa and Thailand adopted a valuable initiative entitled "The Global Health and Foreign Policy".This initiative was contained in a comprehensive document under the title "Oslo Ministerial Declaration-global health: a pressing foreign policy issue of our time".

The first paragraph of the Declaration asserts that " We believe that health is one of the most important, yet still broadly neglected, long-term foreign policy issues of our time. .... We believe that health as a foreign policy issue needs a stronger strategic focus on the international agenda. We have therefore agreed to make impact on health a point of departure and a defining lens that each of our countries will use to examine key elements of foreign policy and development strategies,and to engage in a dialogue on how to deal with policy options from this perspective".

The same document contains the clear commitment of its authors to " work to: increase awareness of our common vulnerability in the face of health threats by bringing health issues more strongly into the arenas of foreign policy discussions and decisions, in order to strengthen our commitment to concerted action at the global level; build bilateral, regional and multilateral cooperation for global health security by strengthening the case for collaboration and brokering broad agreement, accountability, and action; reinforce health as a key element in strategies for development and for fighting poverty..... to ensure universal access to medicines; strengthen the place of health measures in conflict and crisis management and in reconstruction efforts".

This diplomatic document proved to be highly instrumental in a successful worldwide lobby which led to the inscription on the agenda of the United Nations General Assembly (UNGA) of the item "Global health and foreign policy".

Since 2008, as a result of fruitful negotiations, this item was permanently on the UNGA agenda and was considered on the basis of professional reports prepared by the World Health Organization (WHO) Director-General. The reports , discussions and resolutions resulting from the consideration of this item revealed the existence of different areas of collaboration between health and foreign policy, helped to formulate specific recommendations, and thus contributing to better understanding of the importance of health in international policy and developmental discussions.

Until 2018 all resolutions on this item were adopted by consensus which illustrates the positive role of multilateral diplomacy in obtaining a general agreement of 193 UN member states on a highly significant global issue.

We will refer in this article to the first (2008) and to the most recent 2018 resolutions.

A vibrant appeal for action

In the first resolution adopted on 26 November 2008 the UNGA underscored the fact that global health is a long-term objective which is national, regional and international in scope and requires sustained attention,commitment and closer international cooperation beyond emergency.

The UNGA appreciated the contribution made by civil society, including non-governmental organizations and the private sector, on issues related to foreign policy and global health, and welcomed the ongoing partnerships between a variety of stakeholders at the local,national, regional and global levels aimed at addressing the multifaceted determinants of global health and the commitments and initiatives to accelerate progress on the health-related goals.

The significance of this resolution is highly emphasized by the clear recognition in its first operative paragraph of the the close relationship between foreign policy and global health and their interdependence, and in that regard also the recognition that global challenges require concerted and sustained efforts by the international community.

The UNGA urged member states to consider health issues in the formulation of foreign policy.

A much more elaborated diplomatic approach to this issue is illustrated by the most recent resolution introduced by Brazil and adopted by UNGA on 13 December 2018 and disseminated worldwide on 10 January 2019.

Regrettably, mass-media ignored this document.

This resolution is based on the 2030 Agenda for Sustainable Development, and emphasizes that health is a precondition for and an outcome and indicator of all Sustainable Development Goals, and reminds that, despite progress made, challenges in global health still remain, with special regard to inequities and vulnerabilities within and among countries, regions and populations, and that investments in health contribute to sustainable, inclusive economic growth, social development, environmental protection, eradication of poverty and hunger, achieving gender equality and reducing inequalities.

In this resolution the UNGA refers to the fact that global health is a long-term objective which is national, regional and international in scope and requires sustained high-level commitment and closer international cooperation, including far-reaching partnerships among stakeholders, and the need to safeguard the progress made and to further advance by paying due attention to the continuity and sustainability of current actions on global health.

There is no doubt and the resolution reconfirms this fact by reminding that it is the primary responsibility of member states to determine and promote their own path towards achieving universal health coverage that comprises universal and equitable access to quality health services and quality, essential, affordable and effective medicines for all, while ensuring that the use of such services and medicines does not expose the users to financial hardship, with particular attention to those who are vulnerable or in vulnerable situations, and that is critical to promote physical and mental health and well-being, especially through primary health care, health services and social protection mechanisms, including through community outreach and private sector engagement, and with the support of the international community.

Useful reference is also made to the reality that health inequities within and between countries are politically, socially and economically unacceptable, as well as unfair and largely avoidable.

At the same time the UNGA noted that many of the underlying determinants of health and risk factors of communicable and non-communicable diseases are associated with social, economic, environmental and behavioral conditions.

Special attention is paid in this document to the need to eradicate hunger and prevent all forms of malnutrition worldwide, including undernourishment, stunting, wasting, underweight and overweight in all age groups, in particular among children under 5 years of age, and deficiencies in micronutrients, in particular vitamin A, iodine, iron and zinc, among others.

The UNGA informs the world community of nations that it is conscious that multiple forms of malnutrition can affect all countries, can occur not only within countries and communities but also within households, and can affect the same person multiple times over his or her lifetime.

In the UNGA's opinion undernutrition and overweight and obesity are commonly referred to as the double burden of malnutrition, and concern was expressed about the burden of diet-related non-communicable diseases in all age groups and the rising trends of undernourishment and overweight and obesity, as well as the increase in anaemia among women and the still unacceptably high levels of stunting in children.

Special concern is expressed by UNGA about the increasing number of people facing crisis-level food insecurity or worse, up from almost 108 million in 2016 to 124 million in 2017 in countries affected by, inter alia, conflict and exacerbated by climate -related events, environmental factors, including natural disasters, and excessive food price volatility.

The same resolution does not fail to mention the essential contribution that older persons can continue to make to the functioning of societies and towards the implementation of the 2030 Agenda for Sustainable Development, and expressed concern that many health systems are not sufficiently prepared to respond to the need for promotive, preventive, curative, rehabilitative, palliative and specialized care.

Several preambular paragraphs of the resolution are dedicated to institutional aspects and with interesting references to the relationship between health and nutrition.

The first operative paragraph of the resolution contains a strong call addressed to member states to reinforce actions towards the improvement of nutrition, health conditions and living standards of populations around the globe as a key element of strategies for the eradication of all forms of malnutrition and poverty in all its forms and dimensions, as well as the promotion of sustainable development.

A very interesting provision of the resolution aims to encouraging member states to develop health and nutrition by promoting environments, including through nutrition education in schools and other education institutions, as appropriate, and to scale up community-based actions that support children and families, through the promotion of maternal health .

In strong diplomatic language the UNGA calls upon member states, in partnership with other relevant stakeholders, including international and regional organizations and academia, to consider scaling up research and knowledge dissemination on the correlations between health, notably its economic and social determinants, and nutrition and food systems to generate evidence and guidance on effective nutrition programmes and policies.

A topical provision which deserves to be mentioned is about UNGA's encouragement for greater coherence and coordination among United Nations bodies, specialized agencies and entities on matters related to global health and foreign policy.

From the diplomatic point of view it should be noted that the UNGA treats the item under consideration in this article with a special attention for its continuity. Thus, the UNGA looks forward to the high-level meeting of the General Assembly on universal health coverage, to be held in New York in September 2019, under the theme "Universal health coverage: moving together to build a healthier world".

Finally, the UNGA requests the UN Secretary-General, in close collaboration with the Director General of the WHO, as well as other relevant international organizations, to report to the General Assembly at its seventy-fourth session,in 2019, under the item entitled "Global health and foreign policy", on improving international coordination and cooperation to address health needs and the challenges for the achievement of a healthier world through better nutrition.

We have summarized above, without entering into details, the content of the most recent resolution dedicated to global health and foreign policy as a major issue of contemporaneity, able to attract adequate and constant diplomatic action.

The adoption of this resolution can be considered as a real success of multilateral diplomacy in the general process of international cooperation in specific human fields.

However, this success can be measured only in the light or the actual implementation of recommendations addressed to the 193 UN member states. There is no special mechanism able to monitor the implementation of this resolution by various groups of states.

Nevertheless, the preparation of the high-level meeting of the General Assembly on universal health coverage in September 2019 will, politically speaking, encourage member states to pay adequate attention to the implementation of recommendations addressed to them by the most representative forum in world politics which is the UNGA.

It should be noted that the resolution Scope, modalities, format and organization of the high-level meeting on universal health coverage was adopted without a vote.

The document which will be adopted in September 2019 at the end of the high-level meeting dedicated to this item should be treated very seriously and should be fully implemented at the national and local levels by all member states.

That could be considered to be a remarkable success of multilateral diplomacy in the service of global health.