Addressing the deficiencies of globalisation

healthy and sustainable world for the future if we establish a coordinated reaction – and transition from fragmentation to integration.

The world is facing more and more truly global threats and challenges. As an example, Covid-19 did not respect national or regional boundaries, effectively making the entirety of humankind an infection reservoir and breeding ground. Similarly, the climate crisis endangers living conditions in all regions of the world. This year perhaps more than ever, people everywhere have experienced its devastating effects and its impact on health and well-being.

Humanity is not passively suffering from different plagues and natural events – it has, in fact, caused or exacerbated many of these developments. This is reflected in the scientific discussion over the term ‘Anthropocene’, the proposed geological epoch characterised by humankind’s dominating force. We have drastically reduced living spaces for many species and significantly changed the composition of the atmosphere. The human domination of the biosphere has not been carried out systematically but results from increasing industrial, technological and scientific achievements and the fragmented actions of individuals and countries, according to their interests and motivations.

The corollaries of human development are far-reaching in their scale and impact. We can only face these threats, mitigate the negative impacts of human-made changes, and secure a

By Axel R Pries and Frederike Sontag, World Health Summit

For this change, 2023 is a ‘Defining Year for Global Health’ as reflected by the theme of this year’s World Health Summit. It is defining with respect to tilting the balance towards coordinated and strong multilateral action and away from fragmentation and national egoism. We must seize this chance and live up to our responsibility.

This year, the 78th United Nations General Assembly focused on health, underlined by various high-level meetings in New York in September. Long-standing, yet pressing, issues such as universal health coverage, the fight against tuberculosis, as well as pandemic preparedness, prevention and response were covered. Yet the initial reactions to the draft declarations for these meetings were dominated by disappointment and frustration. Despite much anticipation, there appears to be little advance from the status quo.

Underlying the disappointing progress is a phenomenon that may be referred to as a ‘globalisation mismatch’: science and industry operate effectively at the global scale, while political power is largely focused on a national level.

Barriers To Cooperation

The globalisation mismatch describes barriers to international cooperation on a political scale that do not exist in the same way in other domains such as scientific research and innovative technology. The globalisation mismatch and the lack of political power on an international, global level favour already powerful states, enterprises and individuals. This has ultimately led to inequality within and between countries, which in turn has reduced social cohesion as well as trust in political institutions. Most importantly, it has obstructed effective global responses to pressing global challenges in health, climate, pollution and migration.

Governments still aim to protect national sovereignty while the strengthening of international cooperation seems to have a set limit. This is an understandable reaction considering national election processes and geopolitical tensions are making truly global cooperation impossible. Yet the deeply rooted mechanisms of the past cannot help us through the crises that these reflexes have themselves generated. As Einstein said: “You can’t solve problems with the same mindset that created them.” With climate-related crises happening regularly across the globe, there are no real alternatives to international cooperation. We need to strengthen international institutions to ensure solid, multilateral non-nationalist leadership in times of global challenges. In the health sector, a strong World Health Organization is needed to avoid fragmented responses to future health threats.

At the World Health Summit in 2021, the Global Preparedness Monitoring Board launched its annual report, From Worlds Apart to a World Prepared. It warned of a “cycle of panic and neglect” and called for a level of ambition to match the global need. Two years later, these requests for change remain highly relevant and, to a large part, still not fulfilled. With regards to the climate crisis, governments seem immune even to entering the panic stage, regardless of how many climate activists are flocking to their doorsteps. We seem to be entering a phase of neglect regarding pandemic preparedness and corresponding international commitments.

Improving Health Worldwise

Fragmentation in global health is prevalent in governments, research and

Industry and science

Globalized approaches and power

The Globalisation Mismatch

Governance

National interest and power

Axel Radlach Pries

Axel Radlach Pries became president of the World Health Summit in 2021. He was the dean of Charité from 2015 to 2022, having been head of the Charité Institute for Physiology from 2001. He has chaired the Council for Basic Cardiovascular Science and the Congress Programme Committee basic section in the European Society of Cardiology, was president of the Biomedical Alliance in Europe and CEO of the Berlin Institute of Health. He has received the Malpighi Award, the Poiseuille Gold Medal and the Silver Medal of the European Society of Cardiology.

X-TWITTER @WorldHealthSmt @ChariteBerlin  worldhealthsummit.org charite.de aid programmes. Private foundations are trying to play an integral role in improving health worldwide. The number of global health actors with somewhat different missions all aiming to benefit health and well-being for all is countless. The integration of these efforts has fallen short. The goal of the World Health Summit is to overcome fragmentation, to bring together stakeholders from various sectors, including academia, politics, the private sector and civil society, and to stimulate new and coordinated approaches. It raises awareness of the urgency of such change and provides an opportunity for global health actors to interact and synergise in their different perspectives. This alone will not suffice to address the globalisation mismatch, which requires a fundamental change in political approaches. But such a change should be motivated by the equally fundamental change in the nature of challenges to humankind. It is not about who wins or how to help in cases of regional calamities. We must stand together in unprecedented ways to safeguard life on Earth in the way we know it and want to preserve for future generations.

I am confident that this synergy will prove that health is a political choice. ▪

Acknowledgement: The support of Maeve Cook-Deegan in generating the manuscript is gratefully acknowledged.

By Amina J Mohammed, deputy secretary-general, United Nations

Everyone has a right to health and medical care – a right enshrined in the Universal Declaration of Human Rights and the Constitution of the World Health Organization. Yet hundreds of millions of people, in rich countries as well as poor, do not have access to the care they need. This jeopardises their health, undermines their rights and deepens inequalities. And it makes it more difficult to meet the Sustainable Development Goals.

Far too often, people are faced with costly, fragmented and poorly integrated care systems that fail to uphold their health and well-being. Such fragmentation can be fatal, leading to complications, duplications, and delayed or discontinued care. Even where health care is accessible, access can be fragile, as the Covid-19 pandemic illustrated. More than 90% of countries reported that the pandemic disrupted essential health services. Some 25 million children under the age of five missed out on routine immunisation.

Each of us needs timely, affordable access to comprehensive, quality health care, staffed by people we trust. Accessibility of health care is vital to ensuring no one is left behind. That means integrating health care into other services and sectors, supported by systems and environments that promote health and well-being. Tuberculosis, diabetes and many other conditions are preventable through societal and environmental changes – improved hygiene, nutrition and air quality, for example. We need to recognise that we are not islands; our health is intertwined with the well-being of our planet and our societies. We need to create health systems that invest in managing disease as well as in promoting good physical, mental and social well-being, prioritising interventions that address major risk factors. We also need to redesign infrastructure and systems to promote health and social cohesion, ensuring they support everyone equally and respect our environment.

Think of a mother, a nomad, in the deserts of the Sahel, who awakes in the night, alarmed by her baby’s high temperature. She needs good roads so