Shaping the European approach

The European approach to global health has been shaped by three main developments:

  1. An increasing awareness of global responsibilities and obligations stimulated by global civil society (including radical social movements, different types of non-governmental organizations and religious groups). Health as a human right has been identified as one of the most important human rights and the importance attached to the International Covenant on Economic, Social and Cultural Rights (ICESCR) in general has greatly increased. This has been reinforced by the media, which have helped draw the general public into global health politics and to create public interest and debate. This is further evidenced by the unprecedented expansion in related university programmes and courses to serve the interests of a more globally minded generation. In Europe, a human rights approach to global health has also shaped the debate on European health values, not least in relation to gender inequality and their application to global health.
  2. There is a renewed interest, specifically in the USA, in health in poor countries due to new threats from infectious diseases and the fear of instability due to lack of development and failed states – a problem of increased political importance in the post-cold war context. In addition, health threats resulting from lifestyle changes and environmental degradation are more widely acknowledged. This has often been formulated in terms of an extended concept of ‘human security’.
  3. During the 1990s, there was pressure on WHO and other international institutions and their budgets, which led them to reduce their directly managed intervention programmes. At the same time, the importance of health, not only as a humanitarian and human rights issue, but also as a potential human security threat and barrier to globalization and development, was increasingly recognized. New forms of organization, chiefly public-private partnerships and philanthropic foundations, began to fill the gaps in the provision of global health programmes. These usually concentrated on specific areas of health, applying disease-focused solutions, sometimes distorting local health priorities to meet global targets, which was only partially offset by the general budget support provided through bilateral aid, predominantly from European countries. This was based on a general belief in private-sector and market-driven solutions and a lack of confidence in global governance structures. The collapse of international financial markets, due in part to lack of global regulation, has exposed the fallibility of this approach, which led European leaders at the 2009 London G-20 meeting to call for renewed global governance structures for financial regulation. This was not simply a response to the crisis, but rather a reflection of a European approach to globalization that sees the need for global governance for health and other global public goods.