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Investing in health systems for sustainable societies
Priority for cooperation in the ‘new normal’
08 May 2020
Photo: World Bank | Sambrian Mbaabu | Flickr | CC BY-NC-ND 2.0For global cooperation towards sustainable and resilient societies, the Corona pandemic is like a burning glass: it accelerates underlying systemic inequalities and threatens development achievements of the last decades. Given Germany's privileged position in the international system, the German government should continue to advance the holistic approach of the 2030 Agenda.
This is a time of ambivalences – of sameness and differentness, of local and global, and of a health crisis and long-term systemic challenges. For global cooperation towards sustainable and resilient societies, the Corona pandemic is like a magnifying glass: It accelerates underlying systemic inequalities and threatens development successes of the last decades. Given the EU Council Presidency as well as current seats in the Security Council and Human Rights Council, the German government is in a privileged position. Germany should use this position to further push for the holistic approach of the Agenda2030 and revive it with a new paradigm for global cooperation.
Use momentum of shared experience to push for different paradigm in cooperation
Covid-19 is a global pandemic -- it permeates all borders and affects all countries. This universal experience and ‘sameness’ mark the crucial difference from any epidemic of the post-war history. The current pandemic has, at least until now, taken the highest toll on the richest countries in the world. More than 90% of all deaths have been reported from “western” countries. All of a sudden, it is not the categories of “developed” vs. “developing” or “Global North” vs. “Global South” that predetermine how likely and severely people are to suffer from a disease. Vulnerability is high across all regions and our fates are closely intertwined. This awareness should fast-track the transformation of still powerful aid or ‘help’ paradigms towards strong international cooperation for global resilience. At the moment, not only unilateralism and geopolitical struggles over the WHO are weakening multilateralism. Also, attempts to strengthen the global response to Covid-19 might contribute to sidelining the core organization in international health governance. Donor pledging conferences (e.g. the EU’s on May 4th) and funding decisions by private actors (e.g. the Gates Foundation) raise important questions: How can ‘the many’ be included in the future governance of the money of ‘a few’ and how can accountable decision-making be ensured? Germany should use its role to push cooperation towards the normative goal of ‘global partnerships’ (SDG17) by strengthening the multilateral system, civil society engagement and relationships beyond the aid paradigm.
Local contexts need global support, not global solutions
The Corona pandemic has unequal effects on livelihoods across all societies: the virus affects people differently and the social and economic costs are hitting some more than others. Those struggling before are now more likely to be left behind. Corona is an unprecedented global health crisis and crisis-action is crucial. However, it needs to be locally adapted and context specific. In many fragile states and developing countries, protection measures as physical distancing are impossible – be it in South Africa’s townships or Indian slums. Fragile states and developing countries are most vulnerable – health care systems are weak and other social safety provision scarce. They are already experiencing the socioeconomic effects of a shock in demand for goods and services. Accompanied by the decimation of livelihoods in the informal economy, severe drops in remittances and recessions pushing larger parts of societies into extreme poverty and hunger. Economic, gender and social inequalities will be exacerbating. The poorest and powerless and their countries need global support: from financial help by IMF and World Bank to longer term debt-relief pledges. There is acute need to scale-up humanitarian aid, pool efforts and adapt it to current challenges, while keeping aid commitments and allowing for more grants. We currently experience that the strength of health care systems decides the risks and costs of the Covid-19 pandemic. Investments in health systems and universal health coverage as envisioned in SDG3 should be given priority in global commitments. Germany can use its prominent role in global health to keep agenda-making on track.
Health crisis requires systemic answers and lasting changes
Notwithstanding the need for immediate action, this pandemic is arguably neither a surprise nor should it be treated as an exception. Corona dramatically highlights, as have other epidemics such as Ebola or SARS before, that health is (and has always been) an intersectional issue and is inextricably intertwined with more systemic and long-term challenges. Health is a product of its social and ecological environment. Other policy fields such as gender politics, nutrition and poverty reduction and more have direct repercussions for the health of populations. In the past, lessons from infectious diseases were rather “narrow” and mainly led to health being framed in terms of security and containment. Diseases like Ebola also led to increased vertical financing instruments, the creation of new institutions or alliances – or they were simply forgotten. With Corona, it should be different. To protect the most vulnerable of all our societies and to enhance global resilience we need to promote health as a human right and implement the holistic approach of the Agenda 2030 towards sustainable development. Investing in global public goods in the spirit of ‘global partnership’ changes the politics of global health profoundly and should be reflected also in Germany’s governance and its current reform of development cooperation.