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A European global health strategy? Certainly not now

By Kristof Decoster
on March 13, 2017

Last weekend I read with interest the article ‘If not now, when’ – Time for the European Union to define a global health strategy’ in the Lancet Global Health. Some people (like Ilona Kickbusch) already commented on the viewpoint via Twitter – I suspect some people sleep next to their Twitter feed – and no doubt the piece will spark more comments and feedback in the days and weeks to come.  There’s certainly a lot to be said about the piece, both pro and contra.

Here I just want to focus on the ‘If not now, when’ part of the case built by Speakman et al. As you might have guessed, I beg to differ.  For plenty of reasons actually.

First of all, I’ve grown quite allergic to expressions such as “If not now, when?” or “The time is now for …” over the years.  But that’s just a personal thing.  I didn’t like these public health jargon  expressions pre-Trump, and I like them even more less. They just sound silly and hopelessly ineffective in the new era. In Trumpean speak: “The time is now to DUMP them”.

More on substance then. This is certainly NOT a good time for the EU to come up with (or rather update) a global health strategy, in my opinion.

The following should already give you an idea why:  some of the paragraphs and phrases used in the text about the EU sound rather naïve in the current political circumstances. Some examples: “At this time of existential crisis, it has never been so vital for the EU to demonstrate that it is indeed a union, that it is a force for good, and that this positive influence goes beyond Europe’s borders.”  The average EU citizen, when reading this, will grin (or worse).  The same goes for “It would also demonstrate the Union’s authority, expertise, and fundamental  integrity.”  Or “It would also show leadership from Europe, promoting the values of which the EU is justifiably proud: respect for human dignity and human rights, freedom, democracy, equality and the rule of law.”

No doubt in many other regions in the world, the situation is (still) (a lot?) worse, but it’s fair to say that the EU has a huge (and increasing) legitimacy crisis, for quite some years already now. My rough guess is that effectively, about 30 % of the EU citizens have more or less given up on the EU altogether – although the picture varies from country to country.  You might be tempted to think that the EU will be “saved” by a (likely) Macron victory for example in the second round of the French elections, but if it’s 60 % vs 40 % (for Le Pen) in this second round, then this result will still display – like in many EU countries now – a huge proportion of (French) people who feel “the system” doesn’t work for them.  (I’m of the opinion that in most countries, you have a maximum of 10 % of citizens who are hard core racists. The rest of the people voting for Le Pen, Wilders, … you name them, are angry for other reasons, often at least partially justified ones)

Against this backdrop, the question then is: will you boost EU legitimacy (at an all-time low now, and which should be the first priority now)  among its citizens (and certainly the ones who feel left behind or in a precarious situation due to neoliberal globalization) by drawing up a fancy global health strategy?

The answer is a resounding No, I’m afraid.  Put more bluntly: coming up with a European global health strategy now feels a bit like the Roman Empire, ever expanding until Romans suddenly realized that the heartland was imploding in front of their very eyes.

You might think, ok, let’s wait then perhaps till the French (or “à la limite” German elections) are over, and then we can draft an EU global health strategy “fit for the SDG & planetary health era”. But you would still be wrong. As long as the EU keeps producing “flexible” top politicians such as Macron or Schulz, it shows they haven’t understood a thing of why so many ordinary citizens are angry. Just imagine an EU with Macron in France and Schulz (or Merkel again) as the leaders of France and Germany respectively, later this year, together with a bunch of “centre-right” (or “centre-left” à la Dijsselbloem) EU leaders. Do you seriously believe they’ll come up with a ‘health for all’, ‘social justice’, ‘health equity’ inspired European “global health” strategy?

No, call it for what it is: with these sorts of leaders, it would not be a “global” health strategy but a European health strategy.  Or rather a European security strategy, broadly defined (with a little help from the Gates Foundation perhaps in terms of priorities).

In case you have any doubts about this, just check some of the current evidence of the implicit EU global health “strategy” already in place.  It’s the massacres in the Mediterranean Sea, the destroyed health care in Greece due many years of austerity, or the rather unsavory deals struck now with authoritarian leaders around Europe, Erdogan just being the most prominent of them. Among others.

In short, this viewpoint gets the sequence wrong. The 30 % I mentioned before are currently downright cynical about the ‘values of which the EU is justifiably proud’, and many of the others have strong doubts as well about whether this EU will ever become again the benign force in the world it should, ideally, be.

Yes, we need an EU global health strategy (one going beyond health security, that is) – you don’t have to convince me of the fact that transnational challenges need post-Westphalian governance.  But I’m afraid the EU first needs to win back legitimacy among so many of its citizens, otherwise the global health strategy (or European health strategy, if you want) will be built on – here comes Trump again – a SWAMP :).

Some obvious ways to win back this trust from citizens – first things first :

  • Instead of pushing through (neoliberal) trade & investment agreements like CETA, EU leaders should try to use “new generation” trade & investment agreements to push social and environmental standards elsewhere in the world upwards (if necessary, by using a form of smart protectionism as long as these standards and rights are being trampled in other parts of the world). Same for intra-EU trampling of social rights by the way.
  • Tax multinationals and other capital progressively, the way governments tax common people (and their salaries), so that citizens again feel that ‘the strongest shoulders indeed carry the biggest burden’.
  • More in general, prepare and plan for a post-capitalist economy or certainly a fairer, more humane and more sustainable economy – for example along the lines of Tim Jackson’s (recently updated) ‘Prosperity without growth’. As long as the world economy remains a ruthless competition-driven mean machine, you don’t need to be surprised if many people become selfish as well, and look for scapegoats, if they feel threatened.

Then, yes, an EU global health strategy inspired by the right to health & social justice, would not just become more likely but indeed also boost the legitimacy of the EU further among its citizens  – but only, thus, as a “package” together with the measures mentioned above.


I don’t see much evidence of this happening already in the ‘EU as it is now’. Which is why I think a global health strategy now, will, at best be a ‘European health strategy’.  A European security strategy, more accurately.



PS: I didn’t go here into the intricacies and implications which the (presumably, rather long) Brexit-related negotiations might have on developing such an EU global health strategy.   I leave that to the Brits 🙂 .

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