Introductory remarks at Global Health Roundtable

The Minister based his remarks on some
of the following points (check against delivery) 

• It is a great pleasure for me to be able to join such a distinguished group of health experts, representing some of the world’s most respected medical institutions.
• The location for this roundtable could not have been better.
• Houston is a medical hub with a medical centre that comprises around 50 different medical institutions and has over 120 000 employees. 18 000 international patients are treated in Houston every day. This shows that in a global world, health is no longer a domestic issue, but something that needs to be dealt with at a global level.
• With so much expertise concentrated in one place, there is great opportunity to learn from one another, and to develop new ways of treating diseases and illnesses. The partnership between medical institutions and educational institutions in the Texas Medical Center is a valuable model for teaching the next generation of medical workers.
• I particularly like the slogan of the MD Anderson Center: Making Cancer History, in which the word “cancer” has been crossed out for added emphasis. Houston’s excellence in the realm of medical knowledge can be attributed to precisely this kind of attitude.
• All the institutions have programmes or projects within global health, a field in which Norway is actively engaged and a priority area for the Norwegian Government.
• My key focus here: The linkages between global health and foreign policy. But first a few remarks on US-Norwegian cooperation in this field, which – I would say - stands out as one of the most fruitful bilateral partnerships in the world when it comes to addressing global health challenges.

US – Norwegian cooperation

• I am pleased to hear that contacts have already been established between some of you and institutions in Norway, such as the collaboration between the MD Anderson Center and the Norwegian Radium Hospital.
• Baylor College of Medicine has a history of collaboration with the Norwegian Agency for Development Cooperation and Oslo University Hospital in the area of tropical medicine. Furthermore, it has recently established contact with the Norwegian Ministry of Education and Research with a view to exploring further partnership opportunities.
• We are also committed to many common causes: together with ExxonMobil we are fighting malaria and together with the George W. Bush Center we are fighting AIDS and cervical cancer.
• At governmental level, Norway and the United States have cooperated closely for a long time on global health issues – and this is an area where we have achieved a great deal together during the last years. Our two governments are in the process of extending this partnership even further, particularly in the area of women’s and children’s health.
• Last year, the US and Norway, together with other partners, initiated the programme Saving Lives at Birth: A Grand Challenge for Development. The Saving Lives at Birth initiative has succeeded in focusing energy and innovation on the challenge of protecting mothers and newborns in the poorest places on earth during their most vulnerable hour. Furthermore, Norway and the US cooperate fruitfully within the framework of the UN Secretary-General’s Every Woman, Every Child campaign, which aims to save the lives of 16 million women and children by 2015.
• An exciting new academic collaboration has just been launched between the University of Oslo, the Harvard Global Health Institute and the Lancet: a Commission on Global Governance for Health will develop recommendations on how to improve global governance processes for health. Their findings will be presented in 2013.

Foreign Policy and Global Health

• Global health is a priority in Norway’s foreign policy. Why do I as Foreign Minister put so much emphasis on global health? Because I have experienced and learned how health challenges, health threats and health opportunities have an impact far beyond the area of health. I have learned how they even have significance in the field of security and foreign policy. In short, that the interdependence created by health challenges, threats and opportunities is one of the most striking effects of globalisation.
• From Julio Frenk’s notes (Ideas Lab Davos 2010): What is our point of departure? The 20th century: A revolution in global health – based on knowledge. We know the correlation between income and health – “if you’re wealthier you’re healthier” - but we also need to focus on the importance of knowledge. In the 20th century, mankind experienced more gains in life expectancy than in the whole of human history put together before that time. Key driver: Knowledge. In low- to middle-income countries today, life expectancy is not far from the average in the developed world.
• My point here: We have the knowledge to extend these gains even further. And it is an investment worth entering into, not least because we have begun to recognise the links between health challenges and conflicts.
• Many countries today face what is called “the triple burden” of health challenges:
• The unfinished agenda of common infections, malnutrition, maternal health and so on;
• The emerging challenges of non-communicable diseases, lifestyle-related health challenges;

And third, the challenges posed by globalisation, such as pandemics.

What we have come to realise: These health challenges also have clear effects on foreign policy.

For instance, the effects of a global pandemic: In 2009, we saw how the influenza A H1N1 virus spread from one city to 212 countries and territories within 8 months. The pandemic threatened to disrupt fundamental social and economic activities within and across countries. Consider also the lessons of the SARS outbreak in 2002. Some estimates put its costs for the Asia Pacific region alone at USD 40 billion. Such pandemics create severe foreign policy challenges related to restrictions on travel and trade, the closing of borders, and questions of equitable access to vaccines and drugs for both rich and poor countries.

• The way in which poor health and poverty can be a source of conflict, violence and even terror. This is why investing in health in developing countries is not only morally right but is also important for our own national security. I have been told that the CIA uses the infant or child mortality rate to evaluate whether a state is moving towards failure. High figures are the best indication of an emerging failed state.
• The AIDS pandemic in Africa is perhaps the most striking example of how failing to address health conditions can have massive costs for foreign policy goals. The pandemic alerted the world to the broader consequences of failing to address health issues. We witnessed the tragedy that hit countries in which entire swathes of the productive workforce – police officers, doctors, teachers, civil servants and business people – were disappearing, dying – turning children into orphans and weakening the human capital that constitutes the backbone of society.
• Intra-state violence and war is one of the most concrete threats to a population’s health. Combat deaths are only the most obvious cost. It is estimated that for every soldier killed, 10 or more civilians die, and many more are injured. Conflict-related sexual violence has affected the physical and mental health of hundreds of thousands of women over the last decades. It has had serious and lasting consequences for peace, stability and reconciliation efforts. Moreover, conflicts have devastating effects on health care systems. Before the civil war in Liberia, there were 237 doctors in the country. When peace was declared in 2003, only 23 remained.
• That is why addressing conflicts and violence – a key domain of foreign policy – is a crucial health-promoting activity.
• The probable impact of climate change on health: Many of the most dangerous infectious diseases are highly sensitive to climate conditions. Global warming will increase their intensity and range. This means that many of the countries with the least resources will face additional grave challenges – including a new tide of refugees.
• The growth of a global labour market has a major, indirect impact on health in developing nations. Many developed countries recruit health care workers from developing countries. This may be a good thing both for host countries and for health care professionals. But one unfortunate effect is that it drains developing countries’ health systems of crucial human capital. Given the demographics of an aging western population and labour shortages in certain sectors, this situation is likely to become even more acute. The international community will have to resolve the ethical and policy issues raised by this trend.
• Many important health threats must be met by means that lie far beyond the domain of the health sector. Take the tide of chronic diseases – or lifestyle diseases - now hitting most countries. Addressing these challenges also means confronting powerful economic interests, such as those of the tobacco industry. Norway is one of a group of countries that is facing legal action from the tobacco industry for our implementation of the Framework Convention on Tobacco Control. In the World Trade Organization (WTO), initial discussions have taken place on possible inconsistencies between WTO requirements and tobacco control regulations.
• How can we better address the linkages between health and foreign policy?

The “Foreign Policy and Global Health Initiative”

• First, we need better advocacy to focus attention on the interconnectedness of health and foreign policy. When I became Foreign Minister, I contacted my colleagues from Brazil, France, Indonesia, Senegal, South Africa and Thailand, and we met on the margins of the UN General Assembly to create the Foreign Policy and Global Health Initiative.
• In March 2007, we met again in Oslo to adopt the Oslo Declaration and Agenda for Action on global health. The Oslo Declaration identified 10 key policy areas where we believed the international community needed to better understand the health implications of foreign policy.
• The seven countries in this group differ considerably in terms of their size, geography and regional networks. This makes the network useful in finding diplomatic solutions to global health issues.
• One example is the negotiations on Pandemic Influenza Preparedness and Response, which were successfully concluded last year after several years’ work. The seven-country group helped find solutions that could work for all the actors involved – and that finally led to a breakthrough.
• In order to better understand the impact of foreign policy on health, more knowledge and documentation is needed. The Foreign Policy and Global Health Initiative has therefore initiated a research project involving Harvard and institutions in Norway, South Africa, Brazil and Indonesia. The project will seek to better understand the impact of various foreign policy domains on health, and what methods we should use to promote global health solutions in international politics. 
• A similar effort will be made by the Commission on Global Governance for Health, launched by the University of Oslo and the Lancet in collaboration with Harvard Global Health Institute. The Commission will finalise its work in August 2013 and the recommendations will be presented to the Foreign Policy and Global Health Initiative as well as to the UN General Assembly. 

Global health initiatives and Norway’s response

• Second, we need to build support for political initiatives that promote a coherent global response to health issues.
• The Millennium Development Goals is one such global response, with three out of eight goals directly related to health. The G8 commitment to focus on child and maternal health and the UN Secretary-General’s global strategy for women’s and children’s health, which has mobilised pledges of USD 50 billion, are important parts of the common effort towards reaching the Millennium Development Goals.
• Norway has taken on special responsibility for the goals related to maternal and child health, which are the ones lagging furthest behind. And we have seen results. 20 years ago, some 12.5 million children under the age of five died each year. Now, thanks to health policies, economic growth and vaccine programmes, that figure has been reduced to 7.2 million. That is a major success story. 
• The number of young mothers dying during pregnancy and childbirth is also declining rapidly: there has been a reduction from 350 000 women in 2010 to 275 000 this year. Thanks to national efforts, and initiatives such as Every Woman, Every Child, millions of girls and young women will live through the most dangerous day in their lives. 
• However, much remains to be done, and as we get closer to 2015 it becomes ever more urgent to scale up our efforts. The fact that so many women and infants still die during pregnancy and childbirth is still the most brutal expression of the neglect experienced by women and children.
• Another crucial initiative is the GAVI Alliance, which seeks to promote access to immunisation in the world’s poorest countries. GAVI is an alliance of major UN organisations, governments in developed and developing countries, the vaccine industry, and private actors such as the Bill and Melinda Gates Foundation. Prime Minister Jens Stoltenberg was the first prime minister to engage his government actively in this effort, and we have ever since been a staunch supporter of GAVI, with its ambitious vision of helping to immunise every child in the world. This is a new way of working, based on public–private partnership, and focusing on performance and new incentives for partners to work together.
• In my view, the results have been impressive: WHO estimates that between the years 2000 and 2011, some 5.5 million future deaths have been prevented through immunisation campaigns supported by GAVI.
• New vaccines are being introduced. The HPV vaccine to prevent cervical cancer will be part of GAVI’s programme from 2012.
• Norway has also been actively engaged with the Global Fund to fight AIDS, Tuberculosis and Malaria since its creation. The Global Fund is also made up of a dynamic mix of governments and private actors, and it receives support from WHO, UNAIDS and the World Bank.
• As a result, the treatment and prevention of HIV/AIDS and counselling activities have received a huge boost. By 2010, three million people had received treatment for HIV, eight million had received treatment for tuberculosis, and 160 million bed nets had been distributed to help prevent malaria.
• In conclusion, millions of lives have been saved as a result of the combined efforts of governments, private actors and the UN system. The focus on building national health systems is crucial, and has become increasingly important in the work of international initiatives such as GAVI, the Global Fund and Every Woman, Every Child.
• We will continue to promote health as an integral part of foreign policy and make sure health stays at the top of the international agenda.
• Finally, I would like to extend an open invitation to the top-level Texas Medical Center Institutions present here this afternoon to expand and deepen their cooperation with Norwegian partner institutions. We will explore ways of finding additional funding for the exchange of researchers and joint research projects. I would like to encourage our Consulate General here in Houston to continue its role as active facilitator of enhanced collaboration between the Texas Medical Center and Norway in critical areas such as global health.