I’m just back from the 2015 World Health Summit (WHS) in a (rather cold) Berlin, and still recovering from a nasty cold. It was the first time I attended the event, so I’m perhaps not the best placed person to give you an overall account and/or comprehensive analysis of everything that happened between 11-13 October. So instead of doing that, let me just give you some of my idiosyncratic reflections on this high-profile event, as well as some quotes that will give you a flavor. (as for the cold, I was in pretty good company – Margaret Chan (who gave one of the opening keynote speeches – told the audience she had the same problem. Which saved us from one of those “notorious” Chan songs)
This year was a good year to attend the WHS as 2015 is a crucial year for global health (with the SDG agenda just launched, and COP 21 in Paris coming up; in addition, Germany presided the G7 this year, and has even turned into a ‘global health champion’ in the process). But to be honest, every year is probably a good year to attend the WHS.
The summit was organized for the 7th time this year, and a ‘second stage’ was formally announced by Shunichi Fukuhara, WHS president: ‘action’ will henceforth be the mantra. As you can see from the final M 8 Alliance statement, that was no exaggeration. This summit clearly lived up to Fukuhara’s promise: WHS 2015 calls on world leaders to take “bold action for global health” in five key areas of global health: 1. The health of refugees and other forcibly displaced persons 2. Global health security, sustainability and solidarity 3. Universal health coverage 4. Climate change and health 5. Digital health.
With these five areas, you already get an idea on most of the key discussions in Berlin. In another show of “action”, this year’s summit also paid quite some attention to start-ups, with a start-up competition.
The summit was attended by more than 1800 people from over 80 countries, a rather diverse audience. Especially in the plenary sessions, one gets a bit a feeling of being at a ‘mini-Davos’ event at times, which is just as nice as it forces you out of your (intellectual and ideological, and dare I say emotional?) comfort zone, when you listen to people like Jimenez (CEO Novartis), Birgit König (Allianz insurance) and many more. The meeting is conceived as a ‘multistakeholder’-event, with however some key stakeholders notably absent (nursing organisations being one of them), and still too many ‘male-only’ panels…
The young leaders got a forum (in separate workshops), but should probably be mainstreamed in the plenaries as well. As for the presence of women in the plenaries, ‘Women in Global Health’ still has its work cut out; as was pointed out in a wry tweet, in some sessions, the only woman on the stage was ‘the one bringing the water’. The Health Systems Research symposia (my reference point here) do better in this respect. Nevertheless, it was very interesting to see Nobel prize winners (passionate about science) exchange views with CEOs from Big Pharma (passionate about the bottom line and the “business case”), and WHO representatives (passionate about who knows what 🙂 ). And the setting – in the German foreign office premises – is a good one, as it shows the increasing importance of global health diplomacy (and the vital and increasing links between foreign policy, trade, … and health, in a globalized world). In the new SDG era, you clearly need these sorts of multi-stakeholder events, more than ever, even if sometimes one would want to wish away some of these stakeholders, while other stakeholders should (still) be included.
But as this is a ‘mini-Davos’, you do get exposed to an abundance of ‘paradigm shifts’, ‘next generation’-talk …, business models, invariably huge ‘returns on investment for health’… People from certain corners are also remarkably quick to see opportunities to ‘unleash the potential’ of this or that, ‘embrace the future’, etc. A few telling quotes: ‘If you are not part of the solution, you’re part of the problem’ (G Oettinger, EC Commissioner Digital economy & society) (they know all about that at the European Commission, I reckon); or ‘There are three kinds of people when it comes to the future: the ones who make it happen, the ones who let it happen, and the ones who wondered what happened’ (Klaus Lindpaitner, Thermo Fisher Scientific inc – who clearly thought himself to be part of the first category). And of course, the billons and even trillions were very, very common in some of these sessions – with the NCD session as a case in point (doesn’t have anything to do with development assistance for health going to NCDS, as you know, but more with Suresh Kumar being part of the panel).
Speaking of which, you do have people from the private sector whose body language and the way they’re speaking is very much in line with your worst (ideological) nightmares: Suresh Kumar (Sanofi, former US assistant secretary of Commerce), a fixture at the “real” Davos apparently, just radiates power. As in Power. But there were other examples. However, many people from the private sector present here made a really good impression, obviously caring a lot about the public good, while trying to find a balance with the way a for-profit company functions. The workshop on product-development partnerships was a good example (with very committed people like David Reddy & Robert Arch). Conversely, you also have a certain mentality/mindset and “telling” short sentences sometimes coming from other influential stakeholders – see for example Victor Dzau (National Academy of Medicine, US), stressing in his opening ceremony keynote, “of course public-private partnerships”. Of course.
Global health agenda update
As the event’s program promised, you do get a good update on (big chunks of) the global health agenda – with among others, AMR, Ebola lessons, G7 & G20 global health policies from this year or in the pipeline, the refugee crisis, climate change, NCDs, … For me, it was also a first (thorough) introduction to Big Data & ‘precision medicine’ (do not say “personalized medicine” – doctors don’t like the term) and some of the scientific breakthroughs behind it. Fascinating stuff, even if I only understood half of it.
There was, as could have been expected, a great amount of praise for Angela Merkel – Germany is now officially considered a ‘global health champion’ (for its indeed very important G7 leadership in this respect, and the positive role it is playing in the European refugee crisis and the fight against climate change, among others). No mention though of the disastrous austerity policies in the Eurozone (in which Merkel and Schäuble also played a key role, last time I checked) or of Germany’s steadfast support for the new generation of ‘Trade and investment agreements’ – which will have a lot of bad implications on global health, if they materialize (see below). So yes, speeches could have been a bit more balanced in this respect.
Some of the highlights for me – based on the sessions I attended, that is – in more or less chronological order:
Young leaders in global health
In the workshop ‘Developing young leaders in global health’, and also in short speeches by three of these young leaders at the official opening ceremony (on Sunday), it was clear that this new generation of leaders doesn’t just want to be the leaders of the future, they also (already) want to be leaders now. I agree, they should certainly be part of the present architecture and decision making, for a number of reasons. Not just because they’re “idealistic” (not all young people I know are idealistic), are more flexible in their approach, can only become good leaders by ‘doing’ things ( which includes taking part in real decision making), but also because for me, one of the key aspects of a real SDG “shift” (in mindset and approaches) involves making sure that key constituencies are represented at all these global decision making fora and High-level events (and listened to), including in plenaries and in backrooms where decisions are taken. That is true for youth (although preferably much broader than young health professionals only; governance & leadership should be increasingly ‘transgenerational’); but also for marginalized communities & people, and women, last but not least – not just a key constituency, but more than half of the world’s population. Two quotes from the summit underlining this: “No SDG goal will be reached, without gender equality” (Mark Dybul); “No SDG target is met, unless it’s met for all socio-economic groups “ (Debra Jones (Save the Children)). A good start in this respect would be more representation of these constituencies on the stage at high-profile events like the WHS.
I also learnt in this first session that young Germans have a problem with the term ‘leadership’ (for reasons not entirely clear to me, although it seemed to have to do with their aversion of top-down leadership). And I hope that the world doesn’t follow young German students in at least one respect: if they agree strongly with something said, they all knock on the table. Very silly habit, if you ask me (but then again, I’m probably too old for this sort of thing).
As there are now quite some ‘young leaders’ initiatives around, it’s probably time to streamline them a bit, and look for more synergies and collaboration. There’s some progress on this front, from what I heard.
Refugee crisis and opening ceremony
As mentioned already, for obvious reasons, the summit paid a lot of attention to the refugee crisis and made it clear that this has to be a key global health concern. Large scale-migration to Europe is here to stay, and will become routine (rather than an exception). The mental health aspect of the crisis was underlined, and rightly so, in one of the final plenaries – I very much enjoyed Robin Murray’s (King’s College) remarks on this. In addition to pointing to the huge current mental health needs of the many traumatized refugees and many other migrants, he also emphasized how important hospitality, non-discrimination and social protection are to avoid future mental health issues.
In the Sunday workshop on migration and refugee health, Samuel Loewenberg’s analysis struck a chord. The 1 million refugees in Europe are just the ‘tip of the iceberg’ and media focus too much on the crisis at hand; he focused, instead, on the underlying issues of hunger and underdevelopment in (too) many countries in the world. Hunger is not due to conflict alone, he emphasized; people are often already badly food insecure, in countries facing long term chronic underdevelopment and poverty. When a shock comes (a climate shock, war, civil war, …) this pushes people over the edge. International agencies are overstretched and underfunded, and have been so for years. In short, the global community is clearly behind the curve: “We’re going from crisis to crisis, and are not dealing with underlying issues. People live in refugee camps for decades. We can’t continue to ignore them.” And yes, large scale migration to Europe will become routine, as others said as well. We ain’t seen nothing yet, so let’s try to prepare a bit better.
With a (very un-German) delay of 20 minutes, the opening ceremony of the WHS then started. It featured the German Minister of Health, Hermann Gröhe, who showed why Germany has become a ‘global health champion’ and has seized the opportunity the G7 presidency provided to show leadership. The minister’s example shows that people can still make a difference in our complex multi-level governance world, if they show the drive (and analytical skills) required – arguably, his smooth collaboration with his Chancellor was also a key factor. Let’s hope many other countries will follow suit, and also develop ‘global health frameworks & strategies’ in the coming years.
Then it was “Margaret Chan time”…
With a cold, as mentioned already, but that didn’t affect Maggie too much. In a strong speech, among others, she said Global Health Initiatives (like Gavi & GF) had showed “the best of humanity”, while the news headlines nowadays seem to show us “the worst of humanity”. Then she went on to give her usual (slightly apocalyptic) vision of all the new 21st century global health challenges that await us – many of them very complex (“wicked”) problems, which will require multi-sectoral action, a holistic vision, and much more, to properly deal with them (including ‘speaking truth to power’) ).
It’s a great pity the Bible was already finalized 2000 years ago, as I do have a feeling that Margaret could write a few nice extra chapters. One gaffe though: Margaret reiterated the ‘teach them how to fish’ metaphor, while talking about Africa. A very patronizing and stupid remark, baffling in the year 2015. Let’s blame it on the cold.
I didn’t attend the workshop on UHC & the private sector – that one was ‘universally attended’, unfortunately. Not sure the relatively small rooms can still be used in the future for workshops, if the WHS becomes more and more popular. Earlier on Monday, I very much enjoyed the AMR session, even if it was a bit early in the morning. Among others, I will surely remember the wise words of another Nobel prize winner, Ada Yonath: “bacteria are cleverer than us and will no doubt outlive us”. (I’ll remember her fancy haircut as well, actually. )
As for the post-2015 plenary, it started off well – with Mark Dybul (as you know, an upgrade of Vladimir Putin: younger, more handsome, smarter, and equipped with a conscience) on the changing global health and development landscape. In a very focused keynote, Dybul showed that in many respects, he “gets” the SDGs; the GF seems to be already working more and more with stakeholders like the Global Education partnership, and many others, at the national level, for example, as part of a more holistic approach. The Pfizer representative, who followed him, was ok as well, in a gently bullish way – discerning, among others, a new ‘Golden age of medicine’. She wasn’t talking about the prices for drugs. A trademark quote (on our ageing societies): “We don’t live longer, we’re just taking longer to die”. After her, the session went a bit downhill – let’s hope that’s not a bad omen for the SDG agenda. Still important to note: Debra Jones (Save the Children) pointed out, rightly, that we can’t afford a slow start for the SDGs (as was the case for the MDGs). And youth, children and the marginalized should be involved in accountability & monitoring mechanisms. Easier said than done, but essential indeed.
As a side note, and a general suggestion, let me just say that I’ve had it now with final slides featuring some needy African children with eyes full of hope (still far too common, throughout the summit), or speeches ending with ‘I’ll leave you with a quote from a 19-year old Somalian woman…’
Everybody likes cute African children, or feels sorry for vulnerable female adolescents from the Global South; yet, for some reason, many Europeans, Australians, Americans… are far less enthusiastic when these children have grown up and come to us, as refugees or immigrants. The global health community should begin to ‘ask the hard questions’ on what explains this big gap. It’s too easy to just blame xenophobes and racists (even if you, like me, don’t like what they’re saying and thinking). The SDGs start doing that, somewhat hesitatingly, offering a more holistic vision, but in global health circles like the WHS, you still barely hear the words ‘decent work’ or a ‘fairer economic system’. Action still seems to be framed, broadly, within a (not really questioned) global capitalist system, aiming to make it a bit more inclusive and more sustainable (towards a low carbon economy), believing a great deal in ‘finding the right incentives’, among others. Really questioning our economic system seems to be a bridge too far, in spite of all the ‘paradigm shifts’ and ‘out of the box thinking’ on offer. Even (part of) civil society present here refrained from that (with MSF perhaps as an exception), as was clear from an NCD Alliance spokesperson talking about the three-fold role she saw for civil society (advocacy, accountability, delivery). Whether that will be enough in the 21st century, when we try to deal with the dizzying array of challenges facing humanity? As somebody pointed out, we still haven’t found “the right incentives” to deal with climate change after all these years… Wonder whether that’s a coincidence in our current system. On the final day, Robin Murray talked about the collective delusion of German people in the 30s (on the Jewish). I wonder whether future generations, if they still make it to this planet, will not spot a similar collective delusion among us (believing so much in the presumably many blessings of a global capitalism that, unfortunately, needs growth to be ‘sustainable’).
There were some very good videos and films on offer in Berlin (on Ebola for example, or one on a German station in the Antarctic, during the climate change plenary – Deutsche Welle was one of the media partners of the WHS ). One exception – the opening video of the opening plenary on Sunday : I got a ‘Desparate Housewives’ feeling, while listening to the voice over. Which was probably not the intention.
On Monday evening, I was fortunate to be in the Digital health plenary – a really great session, as the moderator proudly had announced at the beginning (saying “we have a fantastic panel of people” – which happened to be then all male 🙂 . So still some work there, for the WHS organizers, to ensure more representativity. But for somebody with my background (political science), it was indeed a fascinating session. It started with the EC commissioner Oettinger (Digital economy & society) (who would have made a fine Allo Allo! actor, if you ask me), and it only got better afterwards. Thomas Südhof, another Nobel prize winner, even blew me away with a very didactic presentation, showcasing both his passion for science and caring about the suffering of humans.
The final day saw plenary sessions (in the morning) on global health policy in the G7 & G20 ( again no women to be spotted on the stage; and also nobody from the Global South, in a session at least partly dedicated to the G20); on Ebola (couldn’t make it to that one, unfortunately, as I opted for the workshop on Trade Diplomacy and health). Speaking of the latter, it was really insightful to listen to the presenters there, who discussed the increasing clash between the SDG agenda (& access to medicines in particular), on the one hand, and the array of bilateral and regional free trade (and investment) agreements in place or in the making. The presentations of Thomas Krafft, from Maastricht University (with a three-fold concern) & Srinath Reddy (PHFI, from a developing country perspective) were crystal clear. The list of global health concerns is so vast, that one almost can’t escape the conclusion that we should just fight TTIP, TPP and the like “tooth and nail”, and better align with social movements & politicians (Hillary ?) who want to shoot them altogether – so that the world can start all over again (ideally, at the WTO, with this time public health people involved from the start and throughout the process). A few quotes: Srinath Reddy wondered ‘whether the spirit of Doha and Cancun will evaporate under the heat of these FTAs’. He also wasn’t a big fan of the (downward?) harmonization – “just check out the first four letters of the word”, he noted.
Having said that, I also very much appreciated Peter Beyer’s (a lawyer who now works for WHO) insightful remarks, and plea not to demonize these trade and investment agreements (I plead guilty), but rather be skeptical and watch out, look at what’s in them (or not), and focus on the evidence to counter some of the likely bad impacts; or another plea by Susanne Weber-Mosdorf (also WHO), for the public health community to delve into the complexity of these negotiations and come up with evidence and hard figures to try to counter some of the worst impacts, and prepare ourselves (better) for when we get a seat at the table. It was also mentioned during the workshop that there should be a mechanism built in to adjust for bad (public health) impacts, if they turn out to be the case. But as Peter Beyer said, these agreements are called ‘Trade Agreements’ for a reason – they aren’t ‘public health’ agreements. Srinath Reddy called them ‘Jekyll & Hyde’ agreements – which sums it up nicely.
In the afternoon, I enjoyed the NCD session – with as one of the highlights, again, quotes by Srinath Reddy, that “PPPs should stand for ‘partnerships for public purpose’”, and that “the health sector cannot be the ‘mopping brigade’ for everything that is going wrong in other sectors’. It was also obvious that the NCD community is happy to be part of the SDG health agenda (finally!) (like others here, with UHC proponents as a key example). (But you have to admit that ‘making it to the SDG health agenda’ was a bit like qualifying for the European football championships: you have to seriously mess up (like the Dutch), to not make the final tournament… )
The last plenaries concerned climate change and health, and global health security, respectively. The first one had quite some focus on planetary health, or “public health 2.0” (see also the Rockefeller foundation (Myers), earlier in the day), even if the concept wasn’t used anymore in the afternoon; the many health co-benefits of tackling climate change (see Andy Haines) were emphasized as well, and Germany’s plans for CoP21; last but not least, the session had a lovely moderator (Hartmut Graβl) – from Max Planck ). Hartmut was heartwarmingly entertaining and stole the hearts of the audience. He also pointed out – rightly I think – that the horror scenarios (of a 4, or even 6 degrees rise) shouldn’t be overemphasized too much, as it’s likely that the economic system will (at least partially) collapse way before, if we continue as we’re doing. (valid point, but there’s also such a thing as vicious feedback loops, which could lock the planet into a deadly spiral).
WHO also advertised its campaign, calling on the global health community to add its voice to the call for a strong and effective climate agreement. But here again: if you really want health to be more important in the Paris protocol, why not align with Naomi Klein et al – who are much more used to “making a hell of a noise”? Just having Margaret Chan hand over the call (with all the signatories) in Paris is probably not the (only) way to go, if we want health to make a meaningful contribution to the climate change battle (at least still in the Paris protocol, only two months away from now). From the session, I’ll also remember Andy Haines’ remark that public health needs to get better at inter-generational rights. And that, in the words of another speaker, “doctors cannot adapt away health impacts beyond a two degrees temperature rise”. Like it or not.
And then it was time to go home, and – in the words of Rita Schwarzelühr-Sutter (from the German government) – “stay healthy” …!