Elevating Global Health to the UN Security Council

11. Oktober 2018   ·   Katherine Polin, Roopa Dhatt

Focusing on global health in the Security Council could unite its members and support Germany’s aim to reform its “two-class” structure. To ensure that this goes beyond political maneuvering and has an impact, Germany should increase funding to health systems and broaden the discussion to include other issues such as non-communicable diseases and human rights at the Security Council.

Germany has increasingly become more active in global health over the last decade, showing strong leadership since the 2014 Ebola crisis. It was the third largest donor to health Official Development Assistance (ODA) after the US and the UK in 2016, surpassing France for the first time. It placed health atop its G7 and G20 presidency agendas in 2015 and 2017. Furthermore, it launched several new initiatives, including a Research and Development Collaboration Hub for Anti-Microbial Resistance (AMR) and was the first to establish a country chapter of Women in Global Health, a movement for women’s leadership and gender equality in global health.

In many ways, this strengthened engagement typifies Germany’s efforts in the last ten years to step up its leadership generally. Germany considers the UN system to be critical to its leadership model going forward. As the fourth largest contributor to the UN budget overall, it is already an influential player in the system. However, with a seat on the Council, Germany can exert more influence over the UN’s agenda and foreign policy.

Mainstreaming global health as part of Germany’s holistic view of security

The Council has historically dealt with crises and conflict after they reach a certain level of exigency. Now Germany is promoting security as a longer-term, broader project – one predicated on triage, peace-building, prevention, and human rights.

Global health challenges run the spectrum of this two-pronged approach. Pandemics and outbreaks such as SARS (2003) and Ebola (2014) risk global and national security; AMR presents an ominous, transnational threat; and conflicts and failing states make basic public health activities extremely difficult. These, however, are often partially a consequence of inadequate health systems, reflecting other systemic development issues. 

For example, half the world’s population lacks essential healthcare; 100 million people spend at least 10% of their household budget on health expenses; and 100 million more are forced into extreme poverty annually because of high out-of-pocket health expenses. Basic, affordable, inclusive, and quality health services – or, Universal Health Coverage (UHC) – is a protection against insecurity. And health care delivery (or lack thereof) contribute to and are a cause of other determinants of instability such as poverty, discrimination, and other human rights violations. SDG 3 of the UN’s 2030 Agenda asserts that healthy lives and the well-being of all is essential to sustainable development, peace, and stability.

Health and health security is an opportunity for consensus at the Council

Health is one of the biggest social sectors to receive ODA – both bilateral and multilateral. Between 2012 and 2016, funding to health grew by a total of 15%, peaking at US$23.7 billion. In 2016, three of the top four donors were permanent members of the Council: the US (US$9.9 billion), the UK (US$2.4 billion), Germany (US$1.1 billion), and France (US$944 million). Russia has begun to domestically strategize and internationally collaborate on health security threats and China has emerged as a major player in global health. Though not large in absolute numbers, many other nations also prioritize global health, from Norway and Sweden to Australia and South Korea.

While strategic priorities within health engagement are wide-ranging, global health security, including pandemic preparedness, biosecurity, and AMR,  has received new financial and political support. For example: the Global Health Security Agenda, which was launched in 2014 and endorsed by the G7, has 65 signatory nations, including several on the current and next Security Council in 2019-2020.

Germany has stated that it hopes to be a mediator working with all Council members towards a positive dynamic in its upcoming term. Elevating global health is a first step. Given the immense financial investments, precedent of multilateral cooperation, and sustained political support, global health may be one of the few issues, which the Council, fraught by increasing friction among its members, could support.

This is also the case for an embattled EU, whose division undermines its political weight at the UN, giving Germany an important opportunity to show leadership. Building on commitments to global health could unite states. Such a development would support Germany’s aim to reform the “two-class” structure of the Council – between permanent and non-permanent members – through opening ownership of situation-specific issues to non-permanent members in their areas of experience and expertise.

Germany must lead by example

Elevating global health to the highest level of the UN is a strong strategic move. However, to ensure that it is not just political manoeuvring and but also has an impact, Germany must lead by example:

  • Ensure that political focus on global health in security translates into investments in global health overall through increasing Germany’s own spending and advocating peers to do the same. The Ebola outbreak demonstrated how inaction and chronic underinvestment can compromise human health and lead to economic and social setbacks. Economic growth and development require a healthy population: about 25% of economic growth between 2000 and 2011 in low- and middle-income countries is estimated to result from improved health. Further, returns on investment to health are nine to one; one extra year of life expectancy has been demonstrated to increase GDP per capita by 4%. Yet health ODA growth has slowed compared to overall ODA, with the share going to health decreasing. Germany should push for stronger investment in health systems as robust health systems encourage economic growth, provide social protections, and help promote stability.
  • Allocate and promote more spending to health systems, especially universal health care and health workforce through UHC2030, Working for Health, the Global Financing Facility, and the SDG Global Action. Universal health care safeguards lives, protects against future epidemics, prevents poverty, and promotes economic growth and social stability. A stronger health workforce – including well-trained nurses, doctors, researchers, community health workers – advances universal health care, but also innovation and health security as well as social protection and cohesion. And it is a huge economic opportunity: as the world’s population increases and people live longer, they need better access to quality care, and long-term employment. From 2000-2014, employment in health and social work grew by 48% in OECD countries.

Germany should encourage investments in health workforce to take a gender perspective, focusing on job creation for women and youth, and women’s leadership. It should also advocate for international recognition of health workers’ qualifications to optimize skills use, mitigate negative effects of health worker migration, safeguard migrants’ rights and foster social cohesion, domestically and elsewhere.

Entwicklungszusammenarbeit UN-Sicherheitsrat

Katherine Polin

Katherine Polin works as a Research Fellow at TU Berlin’s Department of Health Care Management.

Roopa Dhatt

Roopa Dhatt is a physician and an advocate for greater health and well-being for all people. She is the executive director of Women in Global Health, a movement that strives to bring greater gender equality to global health leadership.