After the start of the war in Ukraine, the challenge of improving our global health fell into oblivion. This represents not only a medical problem, but a serious ethical issue as well. According to the United Nations Secretary General António Gutierrez, health inequalities after the pandemic were “an obscenity”. The picture is getting worse every day due to an appalling loss of the world's ability to react to new health threats, and the deterioration of living conditions of the poorest populations with its clinical consequences. The next G20 summit should seriously address this problem on a technical and (primarily) ethical basis. Global health architecture is indeed shaped by global priorities.
The global health problem is undoubtedly a scientific challenge, but more importantly, it is also a moral one. Health inequality has economic consequences and political impacts. Democracy faces its most serious crisis in decades. Democratic governments need to show their ability to promote the general welfare; otherwise, it would be extremely difficult to consolidate their endangered prestige and achieving public support. What does a widespread neglect of global health indicate about the moral beliefs of our global society? The promotion of global health could open a path towards equality and world peace, two fundamental values on which democratic societies can thrive. Collective action and inclusive collaboration among major developed countries is the core purpose of the G20, and concrete steps towards healthier and more equitable communities would be a catalyst of the endeavor.
An essential public good and its crisis
A healthy population represents a true global public good. Everyone would benefit from it and no one's health is compromised by other’s healthy life.
However, health is expensive, the search for health goods and services triggers a global competition, and the provision of health services requires complex skills exceedingly difficult to develop. Additionally, many health technologies have turned into strategic security goods in the ongoing race for global supremacy.
Therefore, a consistent degree of global cooperation is essential to offsetting present vast levels of competition and granting equality in access and outcomes. The impact of the pandemic should be an impetus for the global community to begin working hand in hand to build a more effective, equitable, and scientifically up-to-date health infrastructure. To do that, cooperation will certainly hurt vested individual interests which stand in the way of treating global health as an essential public good.
It is easier to talk about cooperation in a talk show than to put into action, though. Real cooperation encompasses self-restrains and generosity, and it is driven by mutual convenience (not always present or recognized), and shared humanitarian values.
Recent global threats like COVID19, the recurrence of monkeypox or poliomyelitis in non-endemic countries, new Ebola outbreaks, or the surge of multidrug-resistant bacteria and fungal pathogens, have renewed awareness about the mutual convenience of cooperation. From a scientific point of view there is no doubt that it would be impossible to rise global health standards and to prevent future health catastrophes without wide international cooperation. Climate change reinforces this sense of urgency, as it threatens to become the most fundamental problem for human health in living memory. Unfortunately, excessive subjectivism and relativism in relation to scientific evidence work against cooperation, as the pandemic painfully taught us.
On the other hand, the rising of friendshoring, superpower rivalries, deglobalization, fanatisms, and intolerance represents a grim symptom of a deep crisis in humanitarian values. Without shared moral values no agreement on the mutual convenience of cooperation is possible. Mutual convenience follows reciprocal recognition as potential allies in a collective undertaking. Sadly, the Ukraine war has accelerated the pulverization of mutual recognition among peoples and nations.
Challenges are real
Undeniably life expectancy is increasing also in the poor communities, albeit at a sub-optimal pace. But it stagnates in reach nations like United States or the United Kingdom, even decreasing among certain groups. The reasons behind this phenomenon are complex, but deaths due to despair, directly caused by suicide, drug overdose, and alcoholism, rank on top. It is not difficult to relate these drivers to the general trends of distrust and loss of social cohesion and shared values. Stalling life expectancy and increased mortality in working ages deserve urgent global attention.
Emergence of new pathogens also represents a major challenge, since it could cause more than a million preventable deaths every year. Ebola is a potential global threat that deserves more attention and research. And we still face the menace of malaria, Zika, and Chikungunya.
Illicit drugs use deserve a global action from security authorities and public health officials as well. Healthcare workers training and their territorial distribution is another matter of global concern, as it is the case with production of medicines and health technologies transfer, all of them related to the architecture of global health knowledge.
Finally, clime change and the loss of biodiversity will impact dramatically on human health and healthcare resources. Any action to prevent this calamity will be completely useless if not based on international cooperation. In no other case the necessity of cooperation is clearer, and mutual convenience so evident. Again, the crisis roots in our shared values.
Towards a New Global Health Architecture
Pandemic preparedness requires new ways of monitoring epidemics globally. Artificial intelligence algorithms and disease modelling tools, as well as global standards of health information data sharing, can provide unvaluable assistance. To benefit of these technological advancements, we need to develop a global platform for knowledge sharing though.
Besides that, specific policies would be advisable to advance a transformative health global infrastructure. Granting global access to essential medicines through technological transfer, local production, patents easing, price monitoring, and thoughtful cost-effective analysis would be a huge step forward. Globalization of medical knowledge through free access to scientific publications, promotion of regional scientific meetings, and wider dialogue between practitioners, academics, and policymakers, is another pillar of this new global health strategy. The health-care sector desperately needs also a critical reform of anti-corruption tools, consisting of a guide for international price of essential medicines, control over dishonest marketing behaviors, and regional pharmacoepidemiology, as well as publicity of regional agreements on acquisition of medicines and some critical equipment.
. A curated guide for international price of essential medicines, control over dishonest marketing behaviors, regional pharmacoepidemiology, as well as publicity and public audit of regional agreements on acquisition of medicines and some critical equipment would help on this regard.
But a renewed leadership is the most needed vital component of a renewed global health architecture. Programs to promote global health leadership among healthcare practitioners and researchers, as well as businesspeople, are an innovative way to recreate a new public conscience about health, equality, and in the end, democracy.
Inseparable twins: health and democracy
Democracy desperately needs health promotion, because good health endorses essential components of democratic societies such as individual independence, usefulness to others, strength, productivity, and quality of life. If democracy is going to be global, then must be health. The opposite is equally true; global health desperately need democracy, mostly in modern societies, where possibilities of medicine expand day after day at a relentless pace. Health equality is in itself a core democratic value. Consequently, global democracy and health advance together in ranks.
It is mandatory to recognize the demands of social justice within our society, and to make a case of global health as a moral imperative. The search for peace deserves human life to be at the center of our global endeavor.