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Health Security from Economic and Environmental Innovation

By Jeffrey L. Sturchio, president and CEO, Global Health Council

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In an increasingly interdependent world, health security should be an integral element of the foreign policy and national security agendas of the G20.

At their Washington Summit in November 2008, with a focus on trying to understand and respond effectively to the global financial crisis, the G20 political leaders acknowledged that re-regulating financial markets and reviewing the workings of the international financial institutions alone would not be enough to restore economic growth, increase employment and enhance poverty reduction.

Moreover, they acknowledged that the impact of the global recession would rest disproportionately on the most vulnerable populations. Accordingly, the G20 leaders said: “We reaffirm the importance of the Millennium Development Goals [MDGs], the development assistance commitments we have made, and urge both developed and emerging economies to undertake commitments consistent with their capacities and roles in the global economy.” After noting the importance of country ownership and mobilising all sources of financing for development, they continued: “We remain committed to addressing other critical challenges such as energy security and climate change, food security, the rule of law, and the fight against terrorism, poverty and disease.” Global health – the fight against disease, and specifically the MDGs of improving child survival, maternal mortality and the response to the HIV, tuberculosis and malaria epidemics – thus featured prominently among the commitments made in Washington.

Yet, just six months later, in London in April 2009, health was hardly in evidence. With a strong emphasis on restoring confidence, growth and jobs, repairing global financial institutions and “strengthen[ing] financial institutions to rebuild trust”, the G20 leaders focused on finance and trade, while introducing new commitments to food security and addressing the threat of irreversible climate change. While these emphases are understandable and welcome, the London Summit did not identify how its promises on finance, economics, the development agenda and climate change will improve ‘health for all’, the long-term rallying cry from the Alma Ata conference of more than 30 years ago.

As the G20 leaders prepare to gather in Pittsburgh for their next set of deliberations, it is worth asking the questions: Should health matter to the economic and environmental agenda outlined by the G20? And how can we forge links with the finance, economic development and climate change initiatives of the G20 to ensure health security as part of the inclusive, green and sustainable recovery they envision? The answer to the first question – based on a growing consensus among global health and development professionals, policymakers and advocates worldwide – is a resounding yes. And finance, food security and climate change cannot be considered in isolation from global health: indeed, by making health a priority, the G20 and the global community can improve the prospects for long-term growth and development.

Global health matters

As Margaret Chan, director general of the World Health Organization, has argued, “equitable access to health care, and greater equity in health outcomes are fundamental to a well-functioning economy … Health had no say in the policies that led to the financial crisis or made climate change inevitable. But the health sector will bear the brunt of the consequences.” Improving health security by lowering the burden of disease in developing countries and improving population health contributes to poverty reduction, catalyses economic growth and aids in creating political stability. As Dr. Chan notes, “a world that is greatly out of balance in matters of health is neither stable nor secure”. This insight provides an imperative for the G20 to address critical health challenges in a systematic and sustainable way. Investments in health are not luxuries to be shelved until more pressing financial and environmental issues are resolved: health, as a global public good that provides the foundation for stronger and more secure societies, must be a central focus for collective action.

Health security supports food security and environmental security. Whether considering cholera epidemics in Zimbabwe or Bangladesh, malaria in East Africa, the European heat wave of 2003 or the aftermath of Hurricane Katrina in New Orleans in 2005, one can see that climate change has direct, predictable and measurable impacts on health. Heat waves, floods and rising sea levels, for example, have consequences for the spread of vector-borne diseases such as malaria. Scarcity of clean water can lead to outbreaks of diarrhoeal disease and trachoma. And the vulnerability of the agricultural sector to extreme weather leads to food insecurity and malnutrition that exacerbate the problems of ill health already affecting many developing countries and small island nations. But there are solutions available to these malign aspects of climate change and food insecurity. To take just one example, the Global Alliance for Improved Nutrition has successfully developed a programme of food fortification through micronutrients that is reaching millions of the poor, with important consequences for their health – and their ability to work and be economically productive.

In an increasingly interdependent world, health security should be an integral element of the foreign policy and national security agendas of the G20 members. There are encouraging signs that many of the G20 leaders understand and are acting on this principle, seeking solutions that work and planning to scale them up. This broadened focus is also evident in the United States in the Obama administration’s ambitious $63 billion, six-year Global Health Initiative announced in May 2009. Secretary of State Hillary Rodham Clinton noted that this initiative “will be a crucial component of American foreign policy and a signature element of smart power. Bringing better health to people around the globe is an avenue to a more secure, stable and prosperous world.”

Thanks to the combination of effective advocacy, political leadership, new tools and new resources, the world has seen encouraging progress in global health in recent years. Despite many remarkable accomplishments, much remains to be done. The G20 leaders in Pittsburgh have an opportunity to think innovatively about health security as that avenue to a more secure, stable and prosperous world. Let’s hope they capitalise on this opportunity: we all have a stake in the outcomes.

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