The global financial turmoil must not sway G8 nations from their exisiting commitments to global health or from their commitment to strengthen health systems, showcased at the Tokayo summit in July 2008. These issues are discussed by Professor Michael R. Reich, Harvard School of Public Health (HSPH), USA, and Professor Keizo Takemi, Tokai University, Tokyo, Japan, in a Health Policy paper published Online First and in an upcoming Edition of The Lancet. Comments from WHO Director General Margaret Chan and Julio Frenk, Dean of HSPH, accompany the paper.
The global health agenda is shifting from an emphasis on disease-specific approaches to a focus on strengthening of health systems. These two approaches are often called the vertical and horizontal approaches to health improvement. Some have argued for a third compromise strategy that would combine the two into a so-called diagonal approach, whereas others have called for this debate to "rest (in peace)". The authors believe that a better balance needs to be struck between the two approaches, so that efforts at fighting specific diseases and strengthening health systems can support each other effectively.
Following the Tokayo summit, Japan continued its momentum and leadership on health-system strengthening by preparing three policy papers focusing on health workforce, health finance, and health information — a project which took place outside the formal channels of government agencies but with informal participation and help from key ministries concerned, eg, health, finance, and foreign affairs. All three papers agreed on three issues — firstly, they stressed the need for the G8 to address the quality of resource use and the amount of resource provision; secondly, they called on the G8 to enhance country capacity and ownership to strengthen health systems; and thirdly, they agreed that the G8 should implement a yearly review for global health commitments, with a standard set of common measures to assess how resources are being provided and used to improve performance.
The authors conclude: "The global financial crisis makes it all the more important for the G8 to address health-system strengthening and deliver on existing commitments to global health. Fears are increasing about potential cutbacks from high-income countries in official development assistance, as well as private contributions to non-governmental organisations. But, as the UK Prime Minister Gordon Brown stated in September, 2008, the international community should do more, not less, to help the world's poorest people in this time of economic crisis. The G8 can play a catalytic role in assuring that pledged funds are delivered in ways that create tangible benefits for the poorest people. The G8 can also work to protect government budgets for social welfare in developing countries from being tightened by the financial crisis, and to avoid a repetition of the financial cutbacks that occurred under the structural adjustment and economic turmoil of the 1980s."
Dr Margaret Chan, Director General of WHO, concludes in her accompanying Comment: "The net result of all our international policies should be to improve the quality of life for as many of the world's people as possible. Greater equity in the health status of populations, within and among countries, should be regarded as a key measure of how we, as a civilised society, are making progress. Strengthened health systems, ideally based on primary health care, are indeed the route to greater efficiency and fairness in health care and greater security in the health sector and beyond."
And in a second accompanying Comment, Dr Julio Frenk concludes: "In the effort to promote health security for all, health systems have a crucial role by protecting individuals and populations against the different forms of risk associated with health. Through this comprehensive concept of security, improved health can contribute to the stability and prosperity of nations, which in turn nourish our global freedom from harm. Let a keen awareness of challenges, tempered by the realistic optimism offered by current opportunities, inspire efforts during this time of crisis. Our generation has no task more urgent or important than to achieve health security for all."
See also third Comment by Carla Abou-Zahr.
Professor Michael Reich and Dr Julio Frenk, Harvard School of Public Health, Boston, USA, please contact Robin Herman, Office of Communications T) +1 617-432-4752 E) rherman@hsph.harvard.edu / michael_reich@harvard.edu / jfrenk@hsph.harvard.edu
For Dr Margaret Chan, Director General of WHO, please contact Dan Epstein, Press Office T) +41 475 5534 / +41 22 791 1492 E) epsteinda@who.int / chanm@who.int
For full Health Policy and Comments see: http://press.thelancet.com/G8final.pdf
Journal
The Lancet