2 Introduction

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 GNI, 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.

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,1 Climate, Conflict and Capital,2 Towards greener development,3 Interests, Responsibilities and Opportunities,4National strategy to reduce social inequalities in health5 and Norway’s Humanitarian Policy.6 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.