Source: World Health Organisation
Healthcare and medicine have disproportionally affected governance and International Relations concerns recently due to the massive impact of the pandemic and the issues arising from it. The pandemic has also demonstrated the importance of countries collectively working towards ensuring healthcare cooperation and working on the development of facilities and medicine. It has shown how healthcare issues are to be carefully dealt with keeping in the mind the snowball effect of medical conditions and emergencies. This article will deal with issues of international healthcare cooperation apart from the pandemic, and the future of global public health.
International Cooperation on health is much wider in scope than simple medicine and technical issues, it encompasses issues of international law, trade patterns, conflict zones, geopolitics, long-term alliances, etc. This is due to the dynamics of the health issues affecting people in contemporary times. Most of these health issues are complex to solve due to the barriers of inter-state relations and in some cases, healthcare denial is even used as a tool of subjugation and leverage.
This cooperation is especially important in light of the fact that the right to health is considered a fundamental right under international law. Article 25(1) of the Universal Declaration of Human Rights, and Article 12 of the International Covenant on Economic, Social, and Cultural Rights specifically codify this right and discuss of its importance. General Comment no. 14 of the Committee on Economic, Social and Cultural Rights take this further by codifying the right as a right to the highest attainable standard of health.
There are a number of international conventions and agreements in power between states and international organizations that largely drive health cooperation. The most important organization among these is the World Health Organization, and the International Health Regulations of 2005. These are the driving document behind contemporary cooperation and health protocol. However, the Covid-19 pandemic has shown that there still remain gaps in both the comprehensiveness of these regulations and their implementation.
International Cooperation for Good-Faith Capacity Building
Global developmental programmes in small developing nations have been routine in the recent past, with funds diverted from major international programmes on health, the WHO, or emergency interventions in the case of public health emergencies such as outbreaks. Even though some of these schemes have been able to stimulate the health structures for the very short term and increase responsiveness, structural problems have largely persisted.
This is because of the fact that most international interventions carried out by developed countries either bilaterally or through multilateral efforts such as WHO responses is that they tend to be extremely limited in both scope, and time. Since most interventions are planned for a short period of time, they focus on delivering temporary results by pumping money into the system without making much needed organizational changes. Most healthcare problems in developing countries arise out of a lack of funding, pumping in money solves that. However, organizational inefficiencies such as lack of communication & coordination, ineffective distribution of services, corruption etc. are main causes behind long-term healthcare system problems in developing countries that need to be addressed.
This can be better solved by incorporating programmes and healthcare interventions that last for longer periods of time, focus on strengthening institutions and organizations, and build resilient systems that are based on principles of effective coordination.
One can find demonstration of the principles in the report submitted by a collaboration of the WHO, the UK Department for International Development, and the Kyrgystan Ministry of Health. The report theorizes essentially, that for sustainable changes, three main objectives need to be fulfilled: The interventions need to have a longer timeline, there needs to be an intimate working relationship between the partners, and the donors, which would mean, the international actors need to be more flexible in their management approach.
Climate Change and Healthcare
In September 2021, more than 200 reputed medical journals, including The Lancet and The New England Journal issued a joint statement which called upon the international community to address the risk of climate change and called it the “greatest risk to public health”, reiterating years of research into the subject and highlighting how rising temperatures and extreme weather events have a massive impact on global healthcare systems and overall public health.
Climate change effects have the potential to hugely exacerbate inequity that already exists in the provision of healthcare. Historically marginalized communities are likely to be affected disproportionately, feeling the brunt of both climate change, and the accompanying decay in healthcare systems together.
The fight against climate change at its very root, underpinned by global cooperation and interaction. Due to the linkage of global health with climate change, there is a need for international actors to cooperate on ensuring that health systems that are more reslilient to effects of climate change can be created.
The WHO has recognized the threat posed by climate change to health, and has already created the ‘WHO Operational framework for building climate-resilient health systems’ which seeks to equip national health systems with appropriate guidance and tools to create such structures. It focusses on 10 main components which include climate-informed health programmes and climate & health financing. Perhaps the most important component in this setup is the Vulnerability and Adaptation Assessments (V&As) since they allow for early detection of emerging health risks and allow policymakers to enact policies tailored to the specific risk. Further, the WHO climate change and health toolkit has extensive resources needed for interventions in climate related healthcare environments.
Therefore, nations and health systems need to carefully collaborate with the WHO, and in this case in lines with the recommendations of the UNFCCC, to effectively tackle the risk of climate change affecting the healthcare apparatus. Since this a problem that can only be solved through global cooperation, effective negotiation and information mechanisms must be created that individually deal with the effects of climate change on health.
Healthcare in conflict zones
The increasing prevalence of urban warfare and dwellings becoming conflict zones has given a rise to the importance of addressing the issue of healthcare access in these zones. Healthcare is much needed for the survival of the people in a region. However, during a conflict, this is likely to be hampered due to the constraints of lesser supplies, power outages, a strain on resources etc. The UNSC Res. 2286 passed in 2016, titled Healthcare in Armed Conflict seeked to make this better by taking more proactive steps to ensure protection of healthcare facilities. Moreover, in the recent past, there is a trend of targeting of civilian healthcare centres as a measure of war, and denial of healthcare as a way of subjugating the enemy civilian population. This has been seen in Syria, for example, where 68% of healthcare workers report being in a facility while it was under attack. This has of course been accompanied by a decrease in confidence among the civilian population to use these facilities. This compounds problems for the already crippled healthcare system, and has led to a 20 year decrease in life-expectancy in the country since the start of the conflict. This, and many other examples highlight the need for high-level arrangements between the parties to the conflict. There is also the problem of accidental targetting, or targetting sites that potentially are used by enemy forces but also contain civilian populations. Examples include the targeting of an MSF site in Afghanistan, and similar incidents in Yemen and elsewhere.
The solution of these issues lies in the mutual creation of No-Strike Lists (NSLs), clear communication and proof if these sites are being dual-used for easy evacuation of civilians in the case of strikes, and a well coordinated agreement between the parties to the conflict. An example is the polio vaccination drive of 2001 undertaken by the Ministry of Public Health of Afghanistan in Taliban held areas in cooperation with the International Committee of the Red Cross.
The multitude of issues affecting global healthcare today require intense and continuous international cooperation that is responsive, and relies on emerging technologies. The steps taken today will define how healthcare is distributed globally, and will decide the course of global public health.