Last week the new EU Global Health Strategy (EUGH) was released. This short piece, which ought to be followed by more in-depth analysis, provides some first reflections on what can be expected, and what the limitations are of the implementation of such a strategy. This blog touches upon 3 aspects: where is EUGH coming from and why is it presented now; what is the content of the strategy; what would implementation look like?
EUGH is in essence the external representation of the European Health Union, the initiative established by the European Commission (EC) and the EU member states with the mandate of ‘protecting the health of Europeans and collectively responding to cross-border health crises’. It has hence a strong health security orientation. The European Health Union was established in the wake of the Covid-19 pandemic when (most) European leaders realized that transnational health threats need to be dealt with in a collaborative way. It also closely aligned with the Global Gateway initiative, basically the global investment arm of the EC, which works in close collaboration with the European Investment Bank. EUGH has been initiated under the 2022-2023 EU presidency trio of France, Czech Republic and Sweden. The Lyon declaration for a European Health Union (Feb 2022) also laid the foundation for EUGH. A core element in this declaration was the need to take a ‘One Health’ approach. EUGH is technically a ‘Communication’ from the EC to other European institutions, which implies that there are no legal implications involved. If so, these would need to be established by the European Council. This might explain why an earlier Communication, the EU Role in Global Health (2010) was relatively neglected in the decade that followed. EU4GH is a policy commitment for the time being, nothing more and nothing less.
The strategy is built around three themes: 1) Deliver better health and well-being of people across the life course; (2) Strengthen health systems and advance Universal Health Coverage; and (3) Prevent and Combat health threats, including pandemics, applying a One Health approach. These are complemented by sections on improving international and multinational governance for an ‘emerging global health order’; expanding the Union’s partnerships; and lastly, on how to enhance EU finance for Global Health. If you just quickly scan the EU4GH, it appears all the right boxes have been ticked including on notions of human rights, health equity and social determinants of health. When looking more closely, though, one realises that a certain discourse gets prioritised. This includes the One Health approach which is, arguably, focusing mostly on health security. Through this anthropocentric framing, human health and biomedical approaches are put at the centre, while the animal and environmental sectors are primarily framed as a risk. The question is whose health risks and what kind of health risks are being considered, as these differ very much across contexts Moreover, EU4GH puts quite some emphasis on partnerships, investments, innovative financial instruments, and collaboration with the private sector. Such a promotion of pro-private finance and trade collaboration neglects the considerable negative side-effects and inequities as seen recently with the international COVAX vaccine mechanism as well as with mixed-provider models for advancing Universal Health Coverage. There are thus inherent contradictions between the equity, trade and security elements of EUGH. Several elements are also being neglected in the strategy, most notably on the interrelation between health and climate change, biodiversity. This nexus, known as ‘planetary health’ is not covered. In addition, under the finance chapters on debt and taxation, there is no reference to the need for a multilateral sovereign debt restructuring mechanism under the auspices of the UN, nor to a UN tax convention as proposed at the UN General Assembly in 2022. Likely all these issues have been left out for political and strategic reasons.
So what can we expect from the implementation of EUGH? Let us start with the positive, there is now a renewed strategy and its Annex A provides lines of action that will support implementation. Interestingly, this is a lot about financing and sustaining International funds (Global Fund, Pandemic fund, UHC Partnership, CEPI, …) and does not go in detail about how to strengthen, democratize and finance UN institutions like WHO (even if that’s a self-proclaimed aim of this strategy). Annex A is a selective lists of global projects and initiatives the EU is engaged in, followed by regional and bilateral projects . The question is how inclusive, reciprocal and sustainable those initiatives really are, for example the new Pandemic Fund.
The proof of the pudding of EU4GH will eventually be in its eating. We should have humble expectations here. In a time of geopolitical crises and many ‘other’ urgent political priorities, Global Health issues can quickly become secondary issues. The difference between 2010 and 2022, and this is recognised in EU4GH, is that we are not living in a “sustainable development era” anymore but instead have already arrived in a World Risk Society, whether we like it or not. Global risks, and possibilities to mitigate them, are unfortunately not evenly distributed, whether in the health, food, climate or other domains. This builds on long-standing injustices that are rooted in coloniality relations of appropriation, extractivism, violence and domination. This mindset continues in the 21st century, and I sincerely hope that EUGH can make a real difference here. The crisis of the Covid-19 pandemic might not have been deep enough to enable such a transformation. It is likely that future, different, and interrelated crises will go deeper. Our task is to ensure that we engage with the upcoming crises through a planned, democratic, inclusive and legitimate approach. The EU aims to enhance its strategic autonomy. If EUGH, and its implementation, doesn’t stimulate a deliberative, fair and democratic approach, then the EU will just build back worse.