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Home page  About CSIS Programs Africa Program Strengthening Transatlantic Cooperation on Global Health: Paris Forum
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Strengthening Transatlantic Cooperation on Global Health: Paris Forum
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CSIS, in partnership with the French government and with the support of the Bill and Melinda Gates Foundation, organized the Paris Forum as a first concentrated step intended to test whether sufficient political will existed to advance thinking on global health and “governance,” and what concrete opportunities might exist for expanded future transatlantic cooperation in promoting health in low and middle income countries.
The results of the Paris Forum were positive and encouraging. At the same time, the forum revealed key sobering challenges that will have to be surmounted if this kind of activity is to continue with the promise of achieving meaningful impacts and sustaining participation.
The Paris Forum began with dinner Sunday, March 12 at the Quai D’Orsay. French Foreign Minister Dr. Philippe Douste-Blazy unequivocally endorsed the Paris Forum in his pre-dinner presentation and Congressman James Kolbe (R-AZ), in his keynote address at this occasion, called for an expanded trans-Atlantic exchange and outlined the complexities of moving the U.S. congressional agenda on global health. USAID Assistant Administrator Kent Hill, CSIS President and CEO John Hamre, and senior representatives of the French government, the European Commission, the United Kingdom, and World Health Organization also spoke in support of the goals of the Paris forum.
The conference commenced Monday, March 13, at the Kleber International Center. Throughout the day, government representatives and other individuals outlined approaches and perspectives, which were essential in establishing a spirit of openness and inclusion. Forum co-sponsors Dr. Michel Kazatchkine, French Special Ambassador for HIV/AIDS and Transmissable Diseases and J. Stephen Morrison, director of the CSIS Task Force on HIV/AIDS, addressed the rising strategic significance of global health to both European and U.S. foreign policy.
A CSIS/Kaiser Family Foundation analysis of funding trends by donors for global health, presented by lead author Jennifer Kates, reinforced the important role of outside groups in bringing new research into policy dialogues. Tony Barnett and Alan Whiteside discussed global spending on HIV/AIDS, and addressed its current purposes and challenges. (paper, presentation). Jennifer Cooke, co-director of CSIS's Africa Program, prepared a brief on multiple areas of constructive cooperation in the transatlantic relationship, and the opportunities these quiet gains imply for future action on global health set a foundation for discussion.
Achievements1. We renewed a trans-Atlantic dialogue on global health that had languished for some time, and we began to define the terms for that dialogue.
Despite points of tension and some clear differences in approach, there was a surprisingly strong appetite among both European and American participants for this type of dialogue. While there are established global fora on public health, there are none expressly meant to reinvigorate dialogue between the United States and Europe, facilitated by a U.S.-based independent foreign policy-centered institution and backed by a major European government.
2. We generated positive political momentum behind a renewed U.S.-European dialogue.
3. We clarified points of consensus – and lack of consensus – exists on a concrete follow-on agenda.
Two principal conclusions, each with promise, flowed from the discussion.
A) The infrastructure for effective discussions of health policy is impoverished. Participants agreed that health over the last decade has been discussed more frequently, in more policy venues, but it was striking that crucial facts have not been reported (for example, on health care spending, recruitment of nurses and doctors from the developing world). It was also interesting that, although participants agreed that there was more interest in health, few participants focused on how to translate ideas into initiatives that receive sustained political attention. A more mature form of policy dialogue would have by now developed its own paths for bringing ideas to policymakers for decision and implementation. More can and should be done to map influential persons and venues (see below) and identify ways for information to flow more quickly among decision makers.
B) Interest in shifting the discussion toward practical cooperation on specific areas.
- Prevention. There was strong skepticism expressed about the value of HIV prevention as a priority future focus. It may be worth considering this area further, however. There is strong interest among some senior figures in the U.S. government to see a trans-Atlantic debate on prevention as a way of also having a new domestic conversation. A Washington-based event might build on this interest and help cement a U.S. official commitment to an ongoing trans-Atlantic dialogue on health.
- Human resources: the drain on health workers: from low and middle income countries to the developed world; from low paying (or bureaucratic) public sector jobs to more lucrative jobs in the private sector, intergovernmental organizations or NGOs; and into southern Africa from the rest of the continent is a blockage on future progress that profoundly binds the interests and policies of north and south.
- Finance. Uncertainty over the future sustainability of financing to meet projected demands and the arrival of new technologies (diagnostics, vaccines, medications) is another profound blockage that binds the interests of north and south.
- Improved global surveillance of emerging infectious diseases. This would build upon the new WHO regulations which provide for much quicker tracking of disease outbreaks.
- Malaria as an emerging global infectious disease priority on a promising trajectory. In general, there was enthusiasm for working on a specific illness, both to improve response to it, and to learn how the effort could be incorporated into national health systems and avoid creating a new stovepipe.
Challenges1. There is no macro, integrated vision of what constitutes the global health universe. There are multiple institutions, new initiatives, and a confusing array of different understandings of what is meant by “governance” in global health. There was consensus that the international health policymaking should move beyond general, ad hoc commitments to more specific, sustainable policies. Europeans tended to phrase the desired end state in terms of health or its components being regarded as “rights” or “public goods” or in seeing health commitments turned into legally binding obligations upon governments, such as an international tax or a long-term funding stream. U.S. participants resisted these approaches but suggested few alternatives.
2. Risk of a new isolationism caused by the threat of disease transmission.
This has been evident in the national responses over recent years to outbreaks of mad cow disease, SARS, and now avian influenza. Alarmed by proliferating pandemics, major powers in the future might seek to reduce contact with persons from infected areas and become less inclined to support strengthening weak health systems in low and middle- income countries.
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Elizabeth Sullivan
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