Globalisation and Health – the way forward
Seminar at Radisson SAS Hotel Oslo

Health and Globalisation – Norwegian perspectives

Minister of Health, Mr. Dagfinn Høybråten

Madam Director-General Gro Harlem Brundtland, distinguished guests, ladies and gentlemen !

I am pleased to be part of this important conference. It’s a challenging task we have in front of us. It is a task that consists of nothing less than creating a better world; a world based on ethical principles and values implying solidarity, respect for human dignity, equal rights, sustainability and enhanced communication between individuals and nations. We have already placed health at the very core of this task considering the Report on Macroeconomics and Health so eloquently presented this morning. I would like to commend Professor Sachs for the work done with this Report. An easy way to deal with this issue for myself and my fellow ministers of health in the developed world would be to leave this task entirely to my colleague in the Ministry of Development and continue to occupy myself solely with internal national affairs; a field in which there are numerous tasks to be solved.

There are however, no closed systems, and health care systems are indeed more open than many other systems. In fact by including the preventive and promotive aspects of health, the system becomes even more open and dependent on other sectors of society. This again viewed in a global perspective will make it evident that international relations also within health and the health sector have to be based on common ethical platforms and be directed towards common goals. Multinational organisations like the WHO have an increasingly important role to play in this matter. This role is one of normsetting, facilitating communication and initiate binding or non-binding agreements.

I was recently attending a Ministerial Conference in Poland on tobacco and health successfully convened by the WHO EURO. This conference became to me one of many examples of how an important health matter can be taken forward through communication between ministries at a regional level, bringing suggestions and common opinions into the process that WHO has initiated on a binding convention for international tobacco control. Thus this is an instance on how globalisation should be utilised as a means of creating conditions that will promote better health for our citizens.

In my intervention this morning, I would like to highlight the following major points:

• Possible advantages for health in the globalisation process
• Problems for health in a globalised world
• How health could be secured and failures avoided
• How one can secure a right direction of the process.

Some while ago Professor McKeown has shown that health is linked with economic development and that prosperity causes improved health conditions for people. It is obvious that global integration has brought benefits.

Free movement of goods, services, capital and; may be even more important; free exchange and intermingling of ideas and thoughts may bring mankind forward towards general improvement. An open global market system as George Soros describes it, has, however, it’s disadvantages which are mainly connected with the asymmetry between centre and periphery. Markets do not tend towards equilibrium, a fact which implies that governments must in exercising their political influence continuously steer the markets so that basic social and environmental conditions can be adhered to.

Disease patterns have undoubtedly been influenced by increased global mobility. This in its turn implies increased mobility of infectious diseases. Without any evocation of fear and closed borders, neighbouring countries should nevertheless face the facts, and should collaborate in diminishing the impact of increased travel and trade on public health. A few years back, an immigrant in Norway was hospitalised in a specialised ward, at extreme high costs, for 18 months for multi-drug resistant tuberculosis. In January this year, a 3 months old baby in Finland, not yet vaccinated, died of diphtheria. The infection was transmitted through a silent carrier from Russia. These are stories that should have been avoided or minimised through adequate communication between neighbours.

The Summit of the Baltic Sea States established in the year 2000 a Task Force of Special Representatives, reporting directly to the Prime Ministers, and the President of the Commission of the European Union. The mandate is to collaborate in the field of communicable disease control. Let me also briefly mention the Program on Health co-operation in the Barents Sea Region. Resources to this program are allocated as part of a bilateral agreement with The Russian Federation. I have been informed that the work in these areas has been progressing quickly; there are now more than 50 smaller and larger projects under implementation. The collaboration is evidently in the interest of all of us. Let me also briefly mention the serious threat from the epidemic of HIV/AIDS in our neighbouring countries. Apart of protecting us from imported infections, it has also a large scale people-to-people dimension in the common global effort. Health has become part of "soft diplomacy".

Norway welcomes the benefits of increasing trade in food, widening the basis for the consumer’s choice of food and increasing the multiplicity of products; thus improving the possibilities of good nutrition. On the other hand, we are fully aware of the challenges caused by globalisation of food trade resulting in an increased focus on ensuring protection of the consumer’s health and maintaining a high level of protection.

I share the concerns of the World Health Assembly regarding the serious threat to health associated with microbial pathogens, biotoxins and chemical contaminants in food and I would like to give high priority to keeping the food safety systems efficient, flexible and adjusted to current and emerging problems. When focusing upon the consumer’s protection we should also take into account the consumer’s perception of risk. The "stable-to-table" approach is being integrated in food safety legislation, enforcement and control. The systems are currently reorganised within the framework of risk analysis. Assessment of risks relating to food and food intake is being functionally separated from risk management. These elements are the responsibility of different Ministries. The Norwegian government has a policy of openness and transparency in this matter.

The work being done in international fora has always been regarded highly important in Norway, and we actively support the work being done within the FAO/WHO-system; notably the Codex Alimentarius and other joint bodies and activities of these organisations.

The free trade in pharmaceuticals is another problematic area which is a consequence of globalisation. According to the Declaration of the Doha-meeting, time is at present ripe to establish differential pricing as far as low prices in low-income countries will not undermine market pricing and patent protection in the high-income markets. The pharmaceutical industry should co-operate with the international community; using a wide range of tools: e.g. donor funding for purchase and proper utilisation of the drugs, differentiated drug pricing by the pharmaceutical industry.

I would like to emphasise that I strongly support WHO’s guidelines which aim at securing the access to essential medicines in low-income countries. We know of the main burden of diseases in low-income countries, this is also highlighted in WHO’s annual Health Reports; and we know that this burden could be substantially improved if these countries had access to essential affordable medicines.

Each year 7,500 Norwegians die from tobacco-related illnesses. World wide the number of deaths are increasing. The WHO reported 4.2 million tobacco deaths in the year 2000. Two decades ahead, i.e. approximately 10 million people will die every year – if the tobacco epidemic is not contained. Seven out of ten deaths will occur in developing countries. This is in fact an epidemic that will increasingly strike the poor; a gloomy fact which implies that low-income groups in the developed world as well as in developing countries in general.

Both national and international measures are needed to fight the tobacco epidemic. The World Health Organisation has taken on a leading role in this matter. The Government of Norway is actively my supporting for a strong and substantial frame work convention. A strong convention could function as a public health guide for control of similar effects of globalisation in future.

Last year's World Health Report was devoted to mental health. Around the world, people suffering from mental health problems have too often been left out in the cold. In 1998, I presented to the Parliament a scaling-up plan for mental health services in Norway for the period 1999 – 2006. Considering all our world wide efforts world wide to improve health, we must not forget those suffering from mental disorders.

The antibiotics resistance is another effect that can be viewed as a consequence of increased global economic integration. Together with 5 other ministers, I presented a national action plan to deal with the problem. The plan contains obligations for several sectors of society. Instead of using new antibiotics to treat infections caused by increasingly resistant micro-organisms, our efforts must be directed towards using existing antibiotics more sparingly and more correctly. We have established a national surveillance system with links to international systems giving us the possibility of being more responsive to epidemic threats.

Let me also briefly mention the revision of the International Health Regulations. In my opinion the revision of these regulations is overdue, and I have instructed my Ministry and our National Public Health Institute to take part in the pilot project of the WHO . Some kind of agreements at an international level could enhance the aspect of public health as a key requisite for international trade and communication.

Ladies and Gentlemen,

A number of the statements that I have made today, conclude in the acknowledgement that too many people in this world live in poverty, deprived of basic assets for their own life mastery; thus being excluded from global integration without access to possible benefits so crucial to experiencing dignity.

Poverty is unacceptable, and it is in our common interest to fight against it. The pursuit of national political interests has relevance for poverty and development beyond our national borders. Wherever it prevails poverty counteracts the promotion and protection of health.

The Commission on Macroeconomics and Health has given potent evidence of the interdependent relationship between health, poverty reduction and economic growth. Investing in health simply pays off. It is my hope that the Commission’s report will be debated thoroughly, during the next months and years; thus generating new knowledge on the macroeconomic impact of investments in health among leaders, in all areas of public life. Such knowledge is an asset for governments and public health everywhere. During this intervention I have highlighted a few points that have international relevance and represent areas of possible co-opoeration bilaterally between countries or co-operation with multinational organisations like the WHO. I am convinced that twinning arrangements and collaborating projects with developing countries can increase knowledge and enlighten our health care systems and, by improving health in general, contribute to a reduction of poverty.

Thank you for your attention.