3 Global health – interests and rights
Figur 3.1
Steve McCurry/Magnum Photos/All Over
3.1 The Government’s global health efforts
The Government attaches great importance to global health, and has made it a priority in foreign and development policy.
Our global health efforts include work on fulfilling the health-related Millennium Development Goals (MDGs) and protection of the rights of individuals throughout the world. They also involve safeguarding Norwegian public health. Our foreign and development policy is built on the goal of promoting and respecting fundamental human rights. This rights perspective is the basis for the Government’s strong commitment to the MDGs. Our global health efforts are also an investment in human security, growth and stability.
Boks 3.1 What is a public good?
Economists describe pure public goods as nonrival and nonexcludable. Nonrival means the supply of the good, such as clean air, to one person (or country) does not lead to there being less of it for another. Nonexcludable means that once the good is provided for one person, it is available for all to benefit from it. Typically, at the margin, the net benefits accruing to private individuals from such goods are less than the net benefits for society as a whole, and hence the public good is undersupplied in private markets. Public goods require collective action to be properly provided and, at the national level, this can often be coordinated by using government powers (including taxation, spending, and regulation).
Importantly, public goods also have a spatial dimension. Their geographic reach runs across a continuum from local community boundaries, to national borders, to regions of several countries, to the global sphere. The usual problems in supplying public goods are exacerbated for truly global public goods. That is because there is a divergence between the costs and benefits captured at the national and global levels, and it is particularly difficult to secure collective action across countries.
Kilde: World Bank, Annual Review of Development Effectiveness 2008, p. 41
The MDGs for development and poverty reduction form the cornerstone of the Government’s development efforts. Three of the eight MDGs deal specifically with health. They include targets on reducing child mortality, improving maternal health and combating communicable diseases, particularly HIV/AIDS, tuberculosis and malaria.
The principle of universal and equal access to health services is the guiding principle for Norway’s health engagement in all forums. The principle of access to health services for women and children, as well as for vulnerable groups like the disabled, the poor, refugees and minorities, is central to the Government’s work.
Global health efforts are also about safeguarding public health in Norway. Migration and the growth in travel have given a stronger cross-border dimension to the challenges of communicable diseases and food security. International commitments and regulations apply in Norway too, and have an effect on Norwegian public health. There are cross-border aspects to life-style related health factors like alcohol and tobacco. Moreover, the threat of pandemics can only be met through a coordinated international response.
The strategic focus on new approaches with strong political support has produced results. In the next decade, Norway will continue its efforts to mobilise political will internationally, and to further develop its position as a recognisable and credible actor in global health policy. Norway’s efforts will be targeted, result-oriented and involve innovation and a willingness to take risks. At the same time, commitments should be long-term and predictable. Norwegian policy will be founded on a strong knowledge base.
3.2 Arenas for global health efforts and Norwegian health diplomacy
Health diplomacy includes development cooperation, other forms of international cooperation and political mobilisation. Norway plays a clear and visible role in developing global health and health aid. For a number of years, Norway has provided political, financial and technical contributions to global health and health aid.
The aim is improved cooperation between the UN system, the World Bank, the regional development banks and global health initiatives in order to achieve more results faster at country level. Norwegian support for development cooperation in the field of health has seen a substantial increase since 2000.
In 2007, Prime Minister Stoltenberg launched the Global Campaign for the Health MDGs and the Network of Global Leaders (a network of 11 heads of state or government). In the UN in 2009, he announced that Norway would provide NOK 3 billion for global cooperation on women’s and children’s health in the period up to 2020. In 2006, the Minister of Foreign Affairs presented his agenda for highlighting how public health and health security are part of foreign policy. This resulted in the Oslo Ministerial Declaration from the network of foreign ministers from seven countries on foreign policy and health the following year (cf. Chapter 4.3.5). The Norwegian effort is also underpinned by seats on several board, for instance in WHO 2010–2013. Taken together, this is the basis for a large part of the Norwegian global health effort, and has made it possible to establish important strategic alliances in foreign policy, development policy and health policy.
Boks 3.2 The role of civil society in global health
Civil society is recognised as a central actor not only in local communities and at country level, but also internationally. In most countries, including Norway, civil society organisations have played an important part in the development of today’s health systems, and have since been a driving force in efforts to combat individual diseases and improve public health in general.
In many developing countries, a large proportion of health services are run by faith-based organisations, often as the result of the longstanding efforts of missionary and other church and religious organisations.
Recently, civil society has played a particularly important part in the efforts to achieve the health-related MDGs. One example of this is the work of civil society organisations on combating HIV/AIDS. They have been actively engaged in both prevention and the provision of services, but perhaps their most important contribution has been the leading role they have played in disseminating information, combating stigmatisation, and promoting the right to treatment and access to pharmaceuticals. Another vital civil society task is to act as watchdog, and hold authorities accountable for their commitments.
Civil society organisations are engaged in global health initiatives, like GAVI and the Global Fund, participating right up to the board level. They also play an important part in relation to UN processes, although there they are observers rather than full members.
The large international civil society organisations provide important support for multilateral organisations. They are independent of governments, and are often more flexible. They thus complement other bodies, for instance the UN system, and can use their extensive expertise to promote global health. International organisations and their local networks of national organisations play a particularly important part in the area of sexual and reproductive health and rights, for instance promoting safe abortions, and protecting and promoting the rights of vulnerable groups. The International Planned Parenthood Federation (IPPF) is one of several such organisations that have received Norwegian support through the aid budget for a number of years.
In other words, civil society organisations are important agents of change, promoting rights for the population as a whole, and for vulnerable groups such as the disabled, persons who are HIV positive, and girls who have been subjected to genital mutilation. Norway supports Norwegian and international civil society organisations both directly and through various funds and partners.
A substantial part of Norwegian bilateral health aid, not least in humanitarian and conflict situations, is channelled through civil society actors like the Norwegian Red Cross, Norwegian Church Aid, Save the Children Norway, Digni, Médecins Sans Frontières and the Atlas Alliance.
The UN Human Rights Council is particularly important when it comes to rights issues. The Security Council is also an important political arena, cf. for instance resolution 1325 on women, peace and security and resolution 1983 on HIV/AIDS and security in conflicts, including peacekeeping operations.
Development policy arenas
The most important channels for Norwegian development cooperation in the area of global health are multilateral, and include the GAVI alliance, the UN Population Fund (UNFPA), the Global Fund to Fight AIDS, Tuberculosis and Malaria, the World Health Organization (WHO), the Joint UN Programme on HIV/AIDS (UNAIDS), the international drug purchase facility UNITAID, the United Nations Children’s Fund (UNICEF) and the World Bank. As a group, these organisations are particularly well placed to deal with cross-border problems, and provide the arenas and channels for most of Norway’s health effort. The large health-related multilateral organisations are particularly important as arenas for political mobilisation.
Norwegian bilateral development cooperation is also an important arena for Norway’s efforts on the health-related MDGs, primarily through innovative bilateral projects for results-based management, often involving heads of state and government, and aid channelled through various civil society organisations including FK Norway. The right to basic health services and access to pharmaceuticals, particularly for vulnerable groups, is also emphasised in bilateral dialogues with politicians and authorities in partner countries, and in the design of projects and programmes. In many countries, civil society and the private sector can provide an important supplement to the public sector in terms of strengthening health systems, innovation and providing services. They are also key drivers for the right to health.
Political and normative health work
Since WHO is the UN’s normative body on health, it is a vital arena. The WHO Constitution sets out that the objective of the organisation is «the attainment by all peoples of the highest possible level of health». A strong WHO, with a clear mandate and the necessary authority and legitimacy to fulfil its roles, is in the interests of all member countries.
Boks 3.3 Health and human rights
The right to health is established in international human rights instruments, such as the International Covenant on Economic, Social and Cultural Rights (article 12), the Convention on the Elimination of All Forms of Discrimination against Women (article 12), the Convention on the Rights of the Child (article 24) and the Convention on the Rights of Persons with Disabilities (article 25), which all emphasise every person’s right to the highest attainable standard of health. A Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health was appointed by the UN Commission on Human Rights in 2002. Since then, the understanding of the framework for and good practice related to the right to health has been strengthened.
Human rights instruments establish that the primary responsibility for fulfilling such rights lies with the national authorities of the individual country. This means that the national authorities are obliged to provide the highest attainable standard of health given the national resources and opportunities available. Universal health services must be safeguarded through national policies with the necessary financing and regulations. They must be based on the principles of dignity and non-discrimination. A healthy population is not only a goal in itself; it is also an important contribution that national authorities can make to promote a well-functioning private sector.
Norway is a member of the WHO Executive Board for the period 2010–2013. The Government’s WHO strategy of september 2010 emphasises the normative functions of WHO, and its role in global knowledge management. This is also an important foundation for the results-based efforts through other channels, for instance GAVI. The strategy sets out the following overarching goals for Norway’s board membership:
Fight poverty by helping to achieve the UN Millennium Development Goals
Support and promote the right to health services
Help to reduce the great social inequalities in the world
Help to reduce the burden of disease
Promote women’s rights and gender equality
In addition to the assessed contribution to WHO, Norway is one of the largest contributors to WHO’s development activities through additional funds allocated through the aid budget. For the period 2010–2011, these amounted to NOK 238.5 million per year. Norway particularly emphasises WHO’s work on the health-related MDGs, research and women’s health.
Underlying factors for health
Key factors for health are: access to sufficient safe, nutritious food and clean drinking water, safe working conditions, and a clean environment. The underlying factors for health are on the Government’s agenda in multilateral forums like the UN Environmental Programme (UNEP), the UN Development Programme (UNDP), the UN Population Fund (UNFPA) and the regional development banks. This is also an important issue in our bilateral cooperation. The Government seeks to integrate health into its other UN policies and into its bilateral cooperation.
Other arenas
Our focus on the MDGs links our global health policy to poverty reduction in developing countries. At the same time, the global health effort also involves many other arenas. Health cooperation is an important component in the EEA and Norway Grants, which cover programmes on developing health systems of the beneficiary states, and on preventive work, with a particular focus on the health of children and young people. In the period 2004–2009, EUR 166 million was provided for health projects, in addition to substantial funding for research, scholarships and strengthening civil society. Health will continue to be a priority in the programme period 2009–2014. Interest in the beneficiary states is growing. For 2009–2014 the scheme will include bilateral programme partnerships between various departments in the Norwegian health administration and partners in the beneficiary states.
Norway cooperates closely with the EU on health and food safety. Since the EEA Agreement came into force in 1994, developments in the EU have had increasing significance for Norwegian legislation. In recent years, the member states of the EU have become increasingly engaged in health cooperation in areas outside the EU’s internal market. Norway is an active participant in this cooperation.
Norway cooperates closely with Russia in the health and care sector. The Ministry of Foreign Affairs allocates NOK 20 million a year to health cooperation with Russia. These funds, which are managed by the Ministry of Health and Care Services, support the work of the Barents Cooperation Programme on Health and Related Social Issues and the Northern Dimension Partnership in Public Health and Social Well-being. The main priorities of this cooperation are to prevent and combat communicable diseases and life-style related social and health problems, and to develop an integrated specialist and primary health service. There is particular emphasis on HIV/AIDS, tuberculosis, prison health, and vulnerable children and young people.
Our bilateral health agreement with China is being followed up through a multi-year action plan, with particular emphasis on public health and prevention of disease, health system development, primary health services, infectious diseases (prevention and control), and global health.