Washington has been abuzz the past few months over effort to develop a comprehensive global health initiative (GHI). It is hoped that the GHI will connect the dots and put some strategy behind the wide array of health related foreign assistance efforts funded by the U.S. government. While it can be difficult sometimes to see beyond ‘the beltway’, perhaps the U.S. efforts at a ‘global’ strategy should take into consideration similar efforts from around the globe.
For instance, from October 14 to December 9, the European Commission (EC) is engaging in a public consultation on what role the European Union (EU) should take in global health. In their own words “the objective of this consultation is to identify the global situation and challenges and the present EU role and potential added value on the global scene and to promote the European social model for global health”. This consultation will feed into a communication (I think that’s EU speak for a policy) that embodies a global health strategy for the EC and EU member states. This is part of a larger policy approach in the EU for ‘policy coherence for development’ (what they call ‘PCD’). In laymen’s terms, PCD is meant to help address contradictions among national or regional global health policies and policies in other sectors that have impacts on global health. In theory this will lead to improved effectiveness of global health efforts across Europe. To facilitate their consultation, they have produced an issue paper and a list of questions. Disclaimer: I have no idea if these efforts are working or if they have any hope of working. However, there may be helpful lessons for the U.S. in Europe’s various national and regional efforts at policy coherence in global health.
From my reading of the issue paper, and what I know of the UK and Swiss (non-EU) global health strategies, there is an important difference between European efforts at global health strategies, whether national or regional, and U.S. efforts towards the GHI. The Europeans already have a high level of coordination in their international development programs, with overarching strategies that bring together all sectors, including health. When they talk of a global health strategy, they are talking about bringing their international development work in health together with other policy areas that have major impacts on health, such as trade, migration, and their domestic health systems including R&D. In the U.S., international development programs are diffused across a number of agencies and there is no overarching strategy. When policy coherence happens across agencies, it is usually only around a single vertical program such as PEPFAR. So, global health strategy efforts in the U.S. face two layers of needed policy coherence: first, they must bring coherence across diffused global health programs, and second they must then bring coherence with other areas of policy that have major implications for global health. While the U.S. is clearly on a different road to improve policy coherence, perhaps there is something to learn from national and regional efforts, which seem to be a step or two ahead in this area.
I’d encourage U.S. policymakers working on the Global Health Initiative and stakeholders in developing countries to take a look at the EC issue paper on their role in global health and make a contribution if possible. The EU is no small potatoes when it comes to health ODA to developing countries. In 2007 they collectively provided around US$7.3 billion in health ODA (compared to US$6 billion from the U.S.), as part of the US$61.5 billion of their total ODA (compared to less than US$22 billion from the U.S.). Improving policy coherence at this level would be no small feat, and would set a high bar for the U.S. to get its global health ducks in a row.