Ministry of Foreign Affairs
Meld. St. 11
Report to the Storting (white paper) Global health in foreign and development policy
Summary and introduction
Recommendation from the Ministry of Foreign Affairs of 3 February 2012,
approved in the Council of State the same date.
(White paper from the Stoltenberg II Government)
This white paper highlights the challenges and establishes clear priorities for a coherent Norwegian policy on global health towards 2020 with particular focus on three priority areas:
• Mobilising for women’s and children’s rights and health
• Reducing the burden of disease with emphasis on prevention
• Promoting human security through health
The cornerstone of Norwegian policy is to promote and respect fundamental human rights. The principle of equal access to health services based on comprehensive, robust health systems serves as a guideline.
Health is a global public good. Through political leadership, diplomacy and economic support, Norway will be at the forefront of efforts to mobilise a strong and broad global consensus on cooperation to address national health needs. At the same time, we will encourage national authorities to take responsibility for establishing and securing universal access to health services.
One of the objectives of Norway’s global health policy is a better integration of health objectives into foreign and development policy. The various meeting places for heads of state and government and the UN system, including the WHO, are important arenas. Political networks that cut across traditional forums and alliances are also important. One example is the network of foreign ministers from seven countries, including Norway, which focuses on the links between heath and foreign policy.
Mobilising for women’s and children’s rights and health is the Government’s foremost priority. The UN’s Millennium Development Goals (MDGs) – specifically MDGs 3, 4, 5 and 6 – contain ambitious targets in this area, and the Government recognises that health is essential for development and poverty reduction. The global strategy Every Woman Every Child, which was launched by the UN Secretary-General in 2010, forms the basis for these efforts. This priority applies primarily to our development policy. This strategy is also important for WHO’s normative work and for the health component of the EEA and Norway Grants. A strong commitment to women’s and children’s right to health is laid down in several instruments of international law. The promotion of women’s and children’s rights and health is one of the main themes of political mobilisation efforts, both internationally and in our dialogue with national authorities.
Efforts to reduce the burden of disease with emphasis on prevention are directed particularly at diseases that account for a large proportion of lost life years in the poorest countries, and to strengthening health systems with universal access to health care. Vaccination – with GAVI and routine vaccination as the flagship – is, and will remain, a key strategy. Great progress has also been made in treating and preventing the major life-threatening communicable diseases – HIV/AIDS, malaria and tuberculosis. Norway will remain in the forefront of these efforts. Weak and vulnerable health systems and the global health workforce crisis are the greatest challenges to reducing the burden of disease, particularly in low-income countries. The Government will promote health systems where the national authorities assume overall responsibility for public health services, and where services are geared towards meeting the needs of vulnerable groups. A coherent approach to the health workforce situation is part of this effort. A key theme in our dialogue with the authorities of low-income countries that are moving into the group of middle-income countries is the importance of overall government responsibility for health services.
Non-communicable diseases, including lifestyle diseases, account for a growing proportion of the global burden of disease. They entail challenges that are to some extent different to those connected with communicable diseases, as there are significant economic interests behind the marketing of harmful products like tobacco, alcohol and unhealthy food. Preventing and reducing non-communicable diseases requires not only coherent national health policies, but also regional agreements that promote global solutions. WHO has an important role in this work.
Promoting human security through health involves identifying how health goals can be more closely integrated into general foreign and development policies. Climate change, pandemics, lack of access to pharmaceuticals and sexual violence are all threats to health. Climate change could have huge negative impacts on health. Efforts to prevent these, with emphasis on food security, water supply and sanitation, will be strengthened. Control of communicable diseases and pandemics is also vital for maintaining safety and security, and can be bolstered by including health on the foreign policy agenda. Norway will strengthen and support WHO’s work in the field of pandemic preparedness. Furthermore, the Government will continue its efforts to improve access to pharmaceuticals for poor countries, for example by ensuring that this aspect is taken into account in our trade policy and by supporting innovative arrangements for improving developing countries’ access to effective pharmaceuticals within the framework of the patent system. Sexual violence in conflicts is a complex problem that must be addressed by prevention, by providing adequate medical treatment, and through instruments and institutions of international law and international political mobilisation.
The Government’s approach to global health is described in Chapter 5. Norway’s global health policy will be knowledge based. A strong knowledge base and sound analyses are essential for making good decisions with regard to innovation and willingness to take risks, and for setting the right goals and criteria for results. In the global cooperation on health, Norway will actively promote frequent reviews to identify effective ways of organising cooperation, and develop new instruments, including innovative instruments that require a willingness to take risks. The goal is a broad political and economic mobilisation for global health. These efforts will be results driven. Norway will be a predictable and credible partner, and will take responsibility through leadership and dialogue.
The Government’s intention is to promote a policy of health for all. There are several key factors in these efforts. Prevention – including access to clean water, safe food and correct nutrition, good sanitation, vaccination and knowledge about how to promote good health and avoid disease – is one such factor. Reducing social inequalities in health – through a general reduction of economic and social disparities, both between and within countries, and by securing universal access to basic health services through the establishment of good public health systems – is also a central concern. National ownership and control must be safeguarded in order to ensure that health cooperation is based on national priorities and on systems that produce real gains in health. Transparency, good governance and zero tolerance for corruption are crucial.
The Government’s approach to global health is rights based. The point of departure is international human rights, as set out in for example the International Covenant on Economic, Social and Cultural Rights, and the conventions on the rights of children, women and persons with disabilities. It is the authorities in each individual country that have the main responsibility for ensuring that human rights are respected. International cooperation can strengthen the capacity and willingness of national authorities to meet these responsibilities, and should promote robust health systems and universal access to health services. Norway will speak out with a clear voice internationally, and will particularly advocate the human rights of oppressed and marginalised groups.
Skewed power structures, war and conflict, climate change, discrimination against women and economic and social disparities are among the causes of poor health. Resources are often wrongly allocated, for instance when it comes to access to health workers within countries and between countries, and problems due to inadequate health worker training. Weak incentives for developing pharmaceuticals and medical equipment for the diseases that dominate in poor countries combined with high prices are reducing the availability of vital pharmaceuticals for those who cannot pay in poor countries. War and other forms of armed conflict lead not only to deaths and injuries from the hostilities themselves, but also to a strong increase in mortality and morbidity due to the collapse of health systems, damage to sanitation systems, mined agricultural land, etc. Climate change can increase the risk of infection and reduce the supply of drinking water and safe food. Women face particular health risks due to lack of empowerment and control over their own bodies, and many do not have access to education or health care. Malaria, HIV/AIDS and tuberculosis remain serious health problems.
Norway’s foreign and development policy seeks to address both the major health challenges of today and the fundamental causes of disease and poor health.
In its policy platform, the Government set out that health would have higher priority in its foreign and development policy. Norway has gained an important position internationally in the field, through its political, diplomatic and technical engagement over a number of years, and we play an important role in international political processes. Our engagement in global health spans from the establishment of WHO, UNICEF and UNAIDS, and more recently, GAVI, the Global Fund to Fight AIDS, Tuberculosis and Malaria and UNITAID, to the launch of the Global Strategy for Women’s and Children’s Health at the UN General Assembly in 2010.
Today, Norway is highly visible in the field of global health, not only in terms of financial contributions as a percentage of GDP, but also in terms of health diplomacy and political mobilisation. Norwegian efforts to integrate health in foreign and development policy are particularly directed towards child and maternal healthcare and prevention and treatment of communicable diseases like HIV/AIDS, malaria and tuberculosis. Strengthening health systems, managing pandemics and addressing the health workforce crisis, protecting and promoting sexual and reproductive health and rights, supporting global health research and knowledge development, and the fight against female genital mutilation are also important priorities.
Norway’s engagement in and commitment to global health is a strategy for both combating poverty at international level and promoting public health at home. Norway has shown political leadership in the field of global health diplomacy, which has proven an effective way of increasing awareness about global health. Norway has been at the forefront of new approaches, innovative funding mechanisms and the establishment of new results-oriented methods, which have mobilised new donors and more resources. This is groundbreaking political work which is opening up new opportunities in other areas and through new forms of cooperation and focus on results.
Substantial achievements in health have been made during the past ten years. More than 300 million children in low-income countries have been vaccinated with vaccines they previously did not have access to. Deaths from measles have been reduced by over 90 % in sub-Saharan Africa. At the global level, the WHO Framework Convention on Tobacco Control has been established, as well as the International Health Regulations for identifying, reporting and managing outbreaks of communicable diseases of importance for international public health and a framework for preventing and responding to pandemics. This shows the importance of results-oriented policies. Norway has contributed to these developments, through both funding and political mobilisation efforts. The Government will continue to build on these achievements through a carefully targeted policy on global health, focusing on the areas where Norway can make a real difference in terms of the priorities we have set for both national and international health.
The Government’s priorities are:
1. Mobilising for women’s and children’s rights and health
2. Reducing the burden of disease with emphasis on prevention
3. Promoting human security through health
At the same time, we will keep a watchful eye on developments over the next ten years. The global health challenges are developing fast, as exemplified in the increase in non-communicable diseases. This requires a continued willingness and ability to adjust the course as needed.
Box 2.1 Global health
Global health is a relatively new concept, and does not yet have a universally accepted definition. It emphasises the importance of ensuring health for all, reducing inequalities in health and addressing health problems that cut across international borders and sectors. Our efforts include preventing disease, and ensuring robust health systems, universal access to good health services and health security for all.
Health is a global public good. There is potential in both rich and poor countries to increase growth through improvements to health. Likewise, if the general level of health deteriorates, this can be a threat to prosperity and stability. Health issues are deeply woven into the social fabric of all countries, and often cut across sectors. Health is therefore of great political importance.
As a consequence of this white paper, global health will for the first time be the subject of a comprehensive debate in the Storting (the Norwegian parliament). Norway’s largest allocation for global health by far is through its aid budget. This covers work on the UN Millennium Development Goals (MDGs) from 2000, efforts to promote health in the poorest countries, and continued international political mobilisation to achieve these goals. However, global health encompasses more than development cooperation alone. The global health agenda also includes regional and bilateral arenas, and is far from being limited to the poorest countries. The Government’s approach to global health recognises that the complexity of the global health challenges requires flexibility and the ability to see how different policy areas are interconnected.
This white paper reflects the Government’s emphasis on global health, the increased political focus on health issues in recent years, and the fact that global health efforts involve several parts of the public administration. Health is a global public good, an important part of foreign and development policy and involves both political efforts and substantial funding through the aid budget, which is administered by the Ministry of Foreign Affairs. The Ministry of Health and Care Services is also engaged in extensive international technical and political cooperation in the health field. Taken together, these efforts underpin a broad approach to health diplomacy. The diversity and scope of our efforts entails major challenges in terms of the need for coherent policy and the ability to see various aspects of global health efforts as a whole.
The scope of the Government’s global health policy, as it is understood in this white paper, is defined primarily by the health related MDGs. This means that the primary focus is on multilateral channels and partnerships at the international level, and on the thematic areas connected with the MDGs. Nevertheless, the white paper also looks beyond 2015, as do several of the activities Norway is committed to, for instance in the areas of vaccination and health systems. The purpose of the white paper is to place these commitments within a broader foreign policy and technical health framework, which also has a broader set of objectives.
Chapter 3 outlines the basis for the Government’s global health policy, and gives an overview of its current activities and the related arenas and channels, and of the broad scope of Norway’s international health commitments. Chapter 4 sets out the Government’s priorities in its global health efforts towards 2020, and Chapter 5 outlines the approaches on which the Government bases Norway’s global health effort.
2.1 Economic and administrative consequences
Health issues lie at the centre of the Government’s follow-up of the MDGs, a follow-up that involves both development cooperation and international political mobilisation. Global health issues affect and must be taken into account in safeguarding Norwegian public health, for example in connection with international pandemic preparedness and the fight against communicable diseases. Norway’s policy of engagement is also part of our global health work as it involves efforts towards fulfilling health related human rights and providing universal access to health services.
Global health goals are followed up in UN forums, in cooperation with the EU, through the EEA and Norway Grants, the High North cooperation, and in a number of other forums. The health dimension has implications for several other general foreign policy goals, such as strengthening women’s rights and gender equality. On the other hand, several foreign policy processes that are not primarily health related also have significant health implications, for instance the Mine Ban Convention and the Convention on Cluster Munitions.
This white paper aims to present this diversity of efforts, cooperation partners, arenas, processes and interconnections in a comprehensive way, and to delineate the Government’s global health policy – its basis, priorities, approaches and challenges. This should in turn provide a basis to further develop policy coherence and focus on results.
Due to the close relationship between global health challenges and the general development of society, global health issues have been dealt with in several earlier white papers. For example On Equal Terms: Women’s Rights and Gender Equality in International Development Policy, Climate, Conflict and Capital, Towards greener development, Interests, Responsibilities and Opportunities, National strategy to reduce social inequalities in health and Norway’s Humanitarian Policy. The present white paper does not aim to reiterate the policy that has already been established in these reports. In addition, the Ministry of Agriculture and Food presented a white paper on agricultural and food policy in the autumn of 2011 that borders on several of the themes treated in the present white paper.
The costs involved with the measures discussed in this white paper will be met within the current budgets of the ministries concerned.