Geneva, Switzerland
June 18, 2012
Thank you Professor Kickbusch, Ambassador Silberschmidt, for inviting me here today. Good morning colleagues, ladies and gentlemen.
I was pleased to be asked to help set the stage for your course this week by providing some context to the challenges and opportunities of global health. It’s been my honor and privilege to spend the greater part of my adult life focused on just these issues and whether it is original Millennium Development Goals, the agreement last year at WHO on pandemic influenza preparedness, or looking ahead to new challenges such as non-communicable diseases and scaling up toward universal health coverage, my aim has been find ways to enable the multilateral system to successfully address shared public health challenges.
From increasing prevention of diseases such as polio and heart disease, to conducting lifesaving research, to strengthening our humanitarian response and protection of vulnerable and marginalized populations, all of our efforts are enhanced through our partnership in the United Nations, and in particular the WHO. But make no mistake, the challenges we face are significant and the political divisions are real. Any of these can and do threaten to derail the important global health work of WHO, which is why I believe courses like this are so important.
Global Health Diplomacy
I think this phrase is interesting. Many of us who will be speaking to you this week use it regularly, but I wonder if it is meant to be “diplomacy” in the service of “health” or “health” in the service of “diplomacy.” I think that it is too often the latter, but that we strive, particularly in this Administration, for the former.
Late last year, under Secretary Sebelius, the Department of Health and Human Services published its first ever Global Health Strategy as a way to help sort out U.S. priorities and approaches on global health diplomacy. Goal three of this new strategy is particularly interesting and states that we will: Advance United States interests in international diplomacy, development and security through global health action. The strategy points out the growing recognition that global health engagement is a necessary component of international diplomacy, development and security. Disease surveillance and health system response capability to protect the health security of all people by reducing risks and responding to crises, whether natural, accidental, or deliberate is a fundamental challenge faced by all countries and any action that strengthens the weakest of us, strengthens us all.
The 194 Member States of WHO face many different challenges related to our unique populations, climates and geography. But one challenge we all face is how to keep our nations healthy and how to make sure all our people can access the care they need when they get sick.
United States Health Care Context
In the United States, we just marked the two-year anniversary of a historic health care law.
The law is our country’s most significant step towards universal health coverage in nearly 50 years and it will expand coverage to 33 million Americans who have been unable to access health insurance. It moves us toward justice and equity.
Under the law, we’ve taken steps to improve our health system by putting individuals and families on even footing with their insurance companies. And the biggest changes will come in 2014, when each state will have an insurance marketplace that gives every resident the ability to find health coverage that fits their needs.
But we know that to improve health we have to do more than expand coverage. Health is affected by the food we eat, the air or smoke we breathe, and the communities where we live.
If we want our children to eat healthier food, we need to work with schools to serve healthier meals. If we want people to get more exercise, we need to work with transportation planners to design neighborhoods where it’s easier to walk or bike. We have adopted our first ever National Prevention Strategy to promote these actions domestically.
Social Determinants of Health
Internationally, we have been strong supporters of the Rio Conference on Social Determinants of Health, held last year in Rio. I joined HHS Secretary Kathleen Sebelius where together with more than 100 nations we adopted the Rio Political Declaration on Social Determinants of Health that enshrines the philosophy of “health in all policies” into the work of WHO. Health in all policies is the idea that any time a government makes a decision, we should be asking: what are the health consequences?
In all these efforts domestically and abroad, we recognize that poverty and poor health are closely linked. People who live in underserved communities have less access to medical care and good nutrition, face greater environmental health hazards, and are harder to reach through outreach and education efforts.
So we’ve made a special commitment to address these social and economic factors that put people at greater risk for both chronic and infectious diseases. Our new health care law has already extended critical preventive services to millions of the most vulnerable Americans and through President Obama’s Global Health Initiative we are promoting greater access to primary health care services and a more integrated approach to health assistance abroad.
Trade, Intellectual Property and Health
One of the most challenging aspects of global health diplomacy is finding a coherent and rational approach to trade, intellectual property and health. Here in Geneva if you go to one forum where one of these three is discussed, you will inevitably find the others and there is an intense focus on improving access to quality, safe, effective and affordable medicines. This is difficult because national interests are at stake for all countries and so it can be the case that health arguments are used and abused to promote national interests.
We are lucky that in the heads of WHO, WIPO and WTO, we have leaders who are interested in finding ways forward for their Member States on this issue and we salute the creative approaches that they are finding to work together, sometimes leading to real innovations such as the WIPO Re:Search initiative that seeks to promote innovation for neglected tropical diseases.
In seeking to find solutions to global health challenges, we have to be careful about spending scarce resources on ideas with a low probability of success. One such case was last month at the Health Assembly, where we considered the results of a Consultative Expert Working Group (CEWG) on research and development financing. The main recommendation of that group as I’m sure you all know was for WHO to begin negotiations on a legally binding convention that would require a certain percentage of GDP to be invested in R&D financing for diseases primarily affecting developing countries.
While the United States, through the NIH primarily, would already be in compliance with the proposed Convention, we vigorously opposed, and continue to oppose the idea as expensive and wrong-headed in this era of challenge. We appreciate the analysis done by the CEWG on the need to improve coordination and promote greater incentives for R&D of neglected diseases, but our view is we should focus on practical and affordable solutions rather than spend 4-6 years negotiating a convention that may likely never even enter into force.
Before and during the WHA, we have heard Ambassador Silberschmidt calling for policy coherence and a sober look at these issues. We highly support his approach and will take that attitude forward into the fall, on this and other issues on WHO’s full plate of activity.
All of these various health challenges test countries of every size and at every stage in development. And we have our best chance of addressing them if we work together, share ideas and help each other succeed. That is why we remain committed to this work and why even in times of budget challenges at home, the President and Congress remain committed to our work in global health.