Friday, April 7th will be celebrated around the globe as World Health Day. Sponsored by the World Health Organization (WHO), World Health Day is a day dedicated to raising awareness about the interconnections between all of us and the future of global health. This year’s theme is “Depression: Let’s Talk,” and events will be held around the world and online to bring greater attention to depression and mental health more generally.
World Health Day is also an excellent opportunity to reflect back on the role of global health in larger international development efforts and the roles that the United Nations system has played in promoting these efforts.
This is particularly true as the global health community is undergoing a series of far-reaching changes and challenges. Some of the leading global health organizations, including WHO and the Global Fund to Fight AIDS, Tuberculosis, and Malaria will undergo leadership transitions in 2017. WHO is continuing to wrestle with the need for the organization to reform in the wake of its response to Ebola in 2014-2016 and to better engage with non-state actors. The United Nations General Assembly has taken a leading role on studying international efforts to stop the spread of antimicrobial resistance. There is continued worry about outbreaks of diseases like Zika, H7N9 influenza, and yellow fever.
Since WHO began its operations in 1948, its mission has included the responsibility “to act as the directing and co-ordinating authority on international health work.” This means providing technical assistance to member-states, encouraging cooperation and collaboration on health matters, standardizing medical and health nomenclatures, and responding to disease outbreaks. WHO is not so much an implementing agency as it is a coordinator and norm promoter within the global health realm.
Over the past 25 years, it is undeniable that health has assumed greater prominence on the international political agenda. Since 1990, total development assistance for health has increased more than 500 percent (in 2015 US dollars), and a broader array of states, international organizations, non-governmental organizations, and philanthropic groups have taken an active role in addressing health issues. Much of the increase in attention and funding started with the emergence of HIV/AIDS as an international issue. While WHO and the United Nations initially responded to HIV/AIDS sluggishly, they soon took an active role in encouraging international cooperation, combating the stigmatization of HIV-positive persons, encouraging research on new treatment options, and reconceptualising HIV/AIDS as a human rights issue.
Two current global health issues—Zika and antimicrobial resistance—highlight how the international community is responding to global health concerns and their connection to development more generally.
Zika is not a new disease; scientists first described it nearly 70 years ago. For the longest time, it received almost no attention. Its areas of transmission were relatively isolated, it caused no long-lasting problems, and the annual number of infections was incredibly small. This all changed in 2015, when Zika first appeared in Brazil and throughout South America (where it was not previously known), spread rapidly, and caused severe problems like microcephaly and Guillain-Barré syndrome. Adding to worries about the outbreak, Brazil was getting ready to host the 2016 Summer Olympics. Millions of tourists would be coming to Brazil, and the fear was that they would then take Zika back to their home countries. While the concerns that the Olympics would cause an even more widespread Zika outbreak did not come to pass, the steep increase in the number of babies born with microcephaly and the ability of the Brazilian health care system to respond became particularly worrisome.
The previously-unseen connection between Zika infection during pregnancy and children being born with microcephaly is particularly concerning. Poor infrastructure and inadequate sanitation means that poorer neighbourhoods may experience higher rates of Zika and bear greater associated costs. Poverty and inequality are thus contributing to Zika and making the outbreak harder to address. Making the situation more difficult, most women in the countries where Zika transmission is highest have limited access to sexual or reproductive rights and health services. As a result, a survey in December 2016 found that half of all adult women in Brazil were avoiding sex or putting off getting pregnant because of fears of Zika.
WHO responded by declaring a Public Health Emergency of International Concern (PHEIC) on February 1st, 2016—only the fourth time WHO had taken this step. A PHEIC is an “extraordinary event” that threatens public health around the world and necessitates a coordinated international response to effectively address. By declaring a PHEIC related to Zika, WHO was signalling to the world that this was a crucial issue that needed a high level of global attention and would require additional funding. A PHEIC is not a long-term strategy, but it can jumpstart the international community’s response.
Antimicrobial Resistance (AMR)
Antibiotics are one of the great discoveries of the 20th Century, dramatically reducing the death rates from bacteria, viruses, parasites and other threats to human health. The problem is that more and more of these microorganisms are developing resistance to these drugs. That makes our medicines less effective and increases the likelihood that infections could spread to others.
AMR has many causes: the over-prescription of antibiotics, the use of antimicrobial drugs in agriculture, the ease with which people and animals cross borders for travel or economic exchange, and the lack of research in developing new antimicrobials in recent years. AMR’s multifaceted causes mean that international cooperation will be absolutely necessary in order to effectively address the issue; no country can stop AMR on its own.
AMR is not just a health issue; it is also a development and economic issue. Without effective antibiotics, AMR could lead to 444 million deaths by 2050 and cost the global economy more than 100 trillion dollars during that same time period. It would also undermine the international community’s efforts to address Sustainable Development Goal 3—ensuring health lives and promoting well-being for all at all ages.
The importance of a coordinated international response in order to address AMR makes the United Nations General Assembly (UNGA) an ideal site for bringing parties together. In September 2016, it hosted the High-Level Meeting on Antimicrobial Resistance. It brought even more attention to the Global Action Plan on Antimicrobial Resistance adopted by WHO the previous year.
The UNGA High-Level Meeting led to the adoption of a political declaration that spelled out a number of commitments that recognized the close connections between addressing health threats and promoting international development. The declaration called on the UN to work with countries to develop their own AMR action plans, mobilize additional resources to address the issue, and encourage collaborations between human and animal health. It also instructed the Secretary-General to create an inter-agency working group to provide recommendations and offer a progress report in two years. These recommendations could include drafting a new international treaty on antimicrobial resistance.
The Future of Global Health and Development
Global health cannot be addressed in isolation; it is not simply a technical matter. Without understanding how health relates to economic and social conditions, global health programs cannot succeed. One of the key innovations within the international system over the past 25 years has been the increasing recognition of this fact. The United Nations, World Health Organization, and other intergovernmental organizations have played important roles in promoting increased attention to the social determinants of health. With the continued health challenges the international community is facing and the concerns about the future of global health funding, it will be all the more important that WHO and other elements of the UN system continue to advocate for the connections between global health and our development goals.
Dr Jeremy Youde joined the Department of International Relations, Coral Bell School of Asia Pacific Affairs, at the Australian National University (ANU) as a Fellow and Senior Lecturer in January 2016. Prior to joining ANU, he held appointments at the University of Minnesota Duluth (where he also served as department head), Grinnell College, and San Diego State University after receiving his PhD in political science at the University of Iowa. His work focuses primarily on global health politics and the institutions that facilitate or hinder international responses to cross-border health concerns. He is the author of three books, co-editor of two books, and more than 30 peer-reviewed articles. He also contributes articles to the Duck of Minerva blog, the Washington Post’s Monkey Cage, and World Politics Review, among other general interest outlets. Youde is the past treasurer and current chair of the Global Health Section of the International Studies Association and a member of the ISA Governing Council.