The seminar Building a Global Health Social Contract for the 21st Century, organised by ISGlobal on 7 and 8 November, helped to identify the component elements of the foundations for a new conception of global health that places the needs of people firmly centre stage. That statement leads inevitably leads to a pressing question: When did people stop being at the centre of policy-making? And, if the welfare of people is not the main line of action in national and international health matters, then what is?
The advent of the current crisis and the austerity measures it brought in its wake have revealed a fact that is hard to stomach but impossible to deny: the needs of the financial system (which serves very, very few people) determine the ability of states to fulfil their principal function, which is to protect their citizens and provide for their basic needs. The economic crisis has become a moral crisis, and public interest has steadily lost ground to private interests. Given this state of affairs, the prerequisite for any kind of solution will be to once again situate political action above economic benefit. Is this going to be difficult? Yes. Is it possible? Definitely, because the economy is not a natural phenomenon that we have no choice but to accept, but rather a human construct.
Orchestrating a response on a global level will involve the coordination of many complex elements. The list of actors that can contribute to the international health agenda today is a very long one, including the traditional intergovernmental organisations, such as the World Health Organisation, new forums like the Global Fund to Fight AIDS, Tuberculosis and Malaria, major philanthropic foundations, pharmaceutical companies, and non-government organisations, to name just a few. However, the role and legitimacy of these actors is not yet entirely clear. Only when their roles and competences have been clearly determined can we move forward with the task of building a system of global governance that can prioritise and regulate their activity and respond to global health needs.
At state level, however, the possibilities for action are diverse and, more importantly, steps can be taken immediately. On the one hand, states have a duty to and can regain the ground lost in health matters. To do this, besides restoring the protection of the individual to the centre of government action, they must mobilise the resources needed to ensure that no individual or group is excluded from public health protection. The financial transaction tax, which in Spain could bring in a staggering 5,000 million euro a year, would appear to be a good way to do this. Our government recently rejected an opportunity to implement this levy and to oblige the financial sector to return to society a small part of the rescue funds it has received. Starting next January, a decisive battle will be fought to implement the financial transaction tax throughout Europe and to ensure that the money raised is allocated to combating national and international poverty. We hope that other European states will adopt a more courageous stance.
On the other hand, states are still in a position to maintain their commitments to development cooperation. The commitment to reducing inequalities between developed and developing countries is not only ethical, it is also strategic. In an increasingly interconnected world economy, ensuring decent living conditions for people in Brazil has a positive impact on the welfare of, for instance, people in Madrid. At an even more immediate level, cooperation creates strong ties between countries, an effect that can only be beneficial in a changing world in which the terms "developed" and "developing" reflect an increasingly blurred distinction.
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Gonzalo Fanjul, a researcher at the ISGlobal Think Tank, is the author of a recent report published by UNICEF that analyses the specific case of Mozambique, the third poorest country in the world.