Part 3 – Global Action: What Will We Do?
This is the third in a three-part series on how our response to the COVID-19 experience did, is and will transform each, and all, of us.
In Part 1 we affirmed that we must renew our worldview to “see” differently in order to decide differently (Part 2). In this Part 3, we address how to act differently (Part3).
The image above is from Global Health Action, an international journal publishing research in the field of global health, addressing transnational health and policy issues.
“Never waste a good crisis.”
- Winston Churchill
In Part 1, we noted that our personal leadership was called on to evolve our worldview. In Part 2, we spoke of the need for community health leadership to relate to and integrate with an increasingly smaller and more interdependent world. In this Part 3, we discuss the need for, and challenges with, global health leadership: global health action.
In this 3-Part series, we reviewed three fundamental questions that surfaced from our time in collective quarantine:
- Reflect – Did we review and renew our worldview? (Part1);
- Decide – Did we decide to recover or rediscover health and healthcare in our world? (Part 2); and
- Act – Will you and I resume and redux: or will we reset and redo our approach to globalization? And if we want the latter, then how will we act differently to so? (Part 3)
Globalization of industry is a given and generally viewed in a positive light. However, health is more a matter of rights and a public sector duty than a tradeable commodity. Experience highlights that commercialization of key social goods, such as education and health care, produces health inequity. It is critical that resources for health be equitable and universal. Universal health equity is not merely a moral value, if this was not sufficient. It is critical because health inequities threaten sustainability; from Part 1 of this series, inequities breed unrest, more inequities…and disease.
Transcending community health, global health requires understanding the international transfer of health risks among the pattern of health conditions: the way in which the movement of people, products, resources, and lifestyles across borders can contribute to the spread of disease. Globalization has intensified cross-border health threats leading to a more intimate health interdependence — the notion that no nation or organization is able to address single-handedly the health threats it faces but instead must rely to some degree on others for an effective response (Frenk & Moon, NEJM, 2013).
One could argue that the term global health system is a misnomer, since “system” suggests an organized social response to health conditions at the global level. It is more accurate to say we have global health services, but not a global health system. The way in which the services, if not the system, is managed is what we refer to as governance – or global leadership.
Global Leadership Challenges: WHO’s in Charge?
The first global health leadership challenge is that there is no CEO of Global Health (or even of your community’s health for that matter). The World Health Organization (WHO) of the United Nations (UN) was started just after WWII. It was the first multilateral global health organization, the only one that has universal membership of all sovereign nations and is the most respected. But the WHO has no sovereign authority over its members – at best it may have moral authority. Because there is no government authority at the global level, the WHO is more of a platform for consultation. If “the most impossible job in the world” is the head of the UN, as Trygve Lie, Norwegian leader and first head of the U.N. famously said about the role of the Secretary-General of the UN, then the head of the WHO must be right behind it.
The second global health leadership challenge involves the fact that the social determinants of health (SDOH) are so broad and far-reaching: water, agriculture, food, education, income, etc., dwarf the modest 10-20% contribution to health offered by healthcare. And the multisectoral impact on health requires inter-disciplinary policy making which is absent in global health. For example, agencies that deal within and across nations with agriculture and trade typically operate independent of health concerns. Focusing on healthcare to drive health is like focusing on the proverbial tail to wag the dog.
The third global health leadership challenge is that there is no clear mechanism for accountability of non-state actors. Inter-governmental organizations as well as non-state actors have a significant influence on the health policies of a country or region of countries. But how are they held to account in some manner as national governments are? If they are not actually held accountable, then how should and how can they take account? This challenge requires leaders to step up to a global leadership role that transcends short-term free-market self-interests and the traditional responsibility scope of their own organization’s boundaries.
The emerging discipline of planetary health looks at the links between human and ecosystem health. The broader idea of planetary health includes global health and it adds the
- health of the physical planetary systems our species depends upon for life and
- health of the human civilizations we have created (and which, as history attests, can so easily collapse).
The ‘Big Picture’ worldview, as Richard Heinberg (author, Senior Fellow of the Post Carbon Institute) terms it, advocates for leaders to zoom out in order to see with urgency a new set of priorities that are currently being neglected. This is the thinking behind the theme for this year’s 50th anniversary of Earth Day: “Climate Action.”
Now what? What will we do?
The SARS CoV-2 virus is showing all of us the link between human and planetary health. Are we learning the lesson? Clearly, this pandemic is a wake-up call for the world. The purpose of this series is to challenge us as healthcare professionals to hear the call and make the call to act. To step up to be the global leaders that our world needs, we need to
- Renew and enlarge our worldview;
- Decide to rediscover health and healthcare; and
- Act to reset our organization’s priorities, resources and energy to better align with global and planetary health.
Thank you for what you do!
Rob Thames serves as director of Global Health Administration Partners (GHAP), the consulting arm of Global Health Ministries (GHM). GHAP partners in 14 low-resource countries to improve health by strengthening leadership, governance and financing. He writes about global health and healthcare leadership at robthames.com.
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