Working towards a health vision throughout EU Development Policy

"A consideration of health in all aspects of the European Union's development policy." This principle, declared in two reference documents, a communication from the European Commission issued in March 2010 and a Council resolution in May 2010, both under the title of "The EU's role in global health”, is now a sacred rule says Juan Garay, Health Coordinator at the EuropeAid Development and Cooperation Directorate General at the European Commission.

Four priority areas for health policy development have been identified: governance, equality, consistency and knowledge. Garay reiterated that it was the recognition of a universal right to healthcare that inspired the creation of the WHO after the Second World War. The level of health has significantly increased worldwide over the past two decades, and with it life expectancy has also risen. But this has not occurred to the same extent everywhere. "The issue of equality is pertinent and must influence our actions. The objective of better health for all is not currently endorsed by international governance.”

Global governance for democracy

The first objective set out in the EU health policy is global governance, with a view to implementing democracy in decision-making. For now, the WHO is not well enough equipped nor is it sufficiently well organised to ensure equality in terms of healthcare to people in all countries. We must help it to perform this task. The WHO, as well as developing countries, is heavily reliant on the co-operation of the major contributing countries and private donors in setting its agenda. This global governance issue is linked to national governance. The EU believes that individual states also have a social role to play, in safeguarding the right to healthcare, in addition to managing their health services. This role requires them to demonstrate sufficient capacity, leadership and responsibility.

Relevance of choices for equality

The second objective relates to the EU's approach in its cooperation with countries where most premature deaths occur and focuses on the effectiveness of its aid. European citizens, in spite of the economic crisis, welcome the European institutions' interest in continuing to consider solidarity as a priority area. "We must effectively manage their generosity and reflect on the aid we provide to certain countries," said Juan Garay. "An extreme case is the example of Equatorial Guinea, which has very poor health indicators but where, as a result of oil revenue, the per capita income is higher than it is in the European Union.”

"On the other hand there are countries which, even though they enjoy positive conditions in terms of growth or tax revenues, will never have sufficient resources to finance their health systems and pay their healthcare staff enough to prevent them from emigrating. We must pay special attention to these countries."

In certain cases, the Commission believes that dialogue with the states on how they can better use their resources is more important than funding. This is also the case in Equatorial Guinea, where the GDP per capita is 20 times higher than that of Malawi, but which has a mortality rate for children under 5 double that of Malawi. Or Angola, with a mortality rate for the same age group twice as high as it is in Sri Lanka, while its GDP is twenty times greater than the Sri Lankan GDP.

Consistency and knowledge

The third objective, consistency, as defined in the European Commission communication and the EU Council resolution, involves ensuring that other EU policies do not impact on those relating to health. It is important therefore for the EU to be aware of the impact of trade agreements and funding on its development policy. The same applies with interference from the areas of foreign policy and security, food security or the provisions on climate change. 
The last of the four objectives identified in the Commission and Council documents is the sharing of knowledge, meaning the results of medical research.

During 2011 the member states will discuss the measures to be taken in order to achieve these aims through the implementation of concrete projects.

*(http://ec.europa.eu/development/services/dev-policy-proposals_en.cfm)

Hegel Goutier

Pacific: History and health systems

All Pacific Island Countries (PICs) ensure that their inhabitants have access to primary medical care. However the health system differs from one country to another and the systems are highly dependent on the country's individual history, according to the analysis carried out by the World Health Organisation, WHO.

In the French overseas countries and territories (OCTs), in the case of Polynesia, New Caledonia and Wallis and Futuna, the inhabitants have access to all necessary health care, as in Metropolitan France, through the national system of medical coverage. In those countries linked to the United States through "compact agreements", which is the case of three members of the ACP group, the Marshall Islands and the Federated States of Micronesia and Palau, the health system receives aid from the U.S. and benefits from the expertise of American technical agencies. In the Northern Mariana Islands, which are still under U.S. administration, the health system is run entirely by the USA. 

The independent countries which are members of the Commonwealth have developed their own systems, sometimes with the support of Australia and/or New Zealand. The system in Vanuatu, which was historically influenced by both France and Great Britain, combines the health care systems of those two countries.