The media buzz this week about the tour of Europe by Barack Obama (his Irish roots and Westminster speech) and his wife Michelle (her dresses and Oxford chat with talented but underprivileged North London kids ) nearly eclipsed two much more important events: the meeting in France of the pretty much outdated G8 which meets with the weight of broken aid promises on their head and an apparent exclusion of global health issues from the agenda. One can only hope that the more heterogeneous G20 steps up to fill G8’s fast shrinking shoes. The second event was the arrest of Europe’s most wanted war crimes suspect, General Ratko Mladic, who was arrested in a north Serbian village this week, 16 years after commanding the worst atrocity in Europe since the Nazi era. The legitimacy of the International Criminal Court is often challenged on the grounds that it only seems to indict Africans. This is another reminder (others are Slobodan Milosevic and Radovan Karadzic) that Europe too produces war criminals who end up in the Hague.
Further on the topic of human rights, Michelle Gagnon and Ronald Labonte propose that those who move the global health agenda within governments (i.e. global health diplomats) need a robust grounding in human rights treaties and a capacity to undertake a rapid human rights impact assessment of any policy issue. Emerging voice Vincent Okungu does this together with a colleague by viewing the Kenyan health system through an equity lens. They come out with interesting, albeit unsurprising results: the Kenyan health sector is largely underfunded, relies heavily on out-of-pocket payments, the poor contribute a larger proportion of their income to health care than the rich, and Kenya, like most other African countries, has made little progress towards achieving the Abuja target of allocating 15% of government budget to health.
These are some of the reasons why GSK announced this week that they will be partnering with three NGOs as a channel for their commitment to spend 20% of their profit on health care in poor countries where some of those profits are made. There has been much resistance to the role of the private sector in global health and in health care provision in poor countries, but Tracey Koehlmoos argues that in Dhaka, where she lives and works, the private sector provides the majority of outpatient care, for example up to 90% of care for children with acute respiratory infection or diarrhoea. Richard Smith also says it’s only the rich world that can indulge in the fantasy of healthcare disconnected from profit, arguing that to improve their healthcare systems poor countries will have to use the power of profit, just as richer countries across Europe increasingly do.
This will require new tools to strengthen health systems so that they can openly incorporate all players globally and within countries or regions, public and private, to the benefit of the poor. No matter the amount of scepticism, it is important to bring every interest (except the tobacco industry of course) to the table, and have all conflicts of interest openly declared. Like Margaret Chan says on the same issue, “know your friends, enemies, and spies.”