David Heymann
Head and Senior Fellow, Centre on Global Health Security

With Arthy Santhakumar, Centre Coordinator.

Important developments in global health last year included Dr Jim Yong Kim taking the helm at the World Bank, offering a new promise for global health governance; and UN Secretary-General Ban Ki Moon announcing a high-level panel of advisers on the post-MDG development agenda. Towards the end of the year, nine people died after becoming infected with a new coronavirus - the type of virus that caused the SARS outbreak in 2002-03.  

Importantly, leading science journals published controversial papers. They described two separate laboratory experiments in which scientists in the United States and the Netherlands had introduced mutations to a lethal strain of bird flu (H5N1) that allowed it to transmit easily between mammals. Beforehand the issue had sparked a contentious debate over whether the journals should publish the studies and if so in how much detail. The full papers were eventually published in May and June in the journals Nature and Science respectively, but the debate raised important questions around biosecurity and managing the risks of dual use life sciences research. 

2013 is also likely to provide several global health events to reflect on, so we asked four of our experts to comment on what they consider to be the challenges and opportunities for global health over the next 12 months.  

Global Health; Role for Emerging Economies in a Time of Austerity?

Kelley Lee, Associate Fellow, Centre on Global Health Security

The year ahead will require global health to compete fiercely with a long list of other global issues demanding attention. The financial crisis and recovery are likely to remain top of the agenda further testing the moral resolve of finance ministers, most of whom have already cut aid budgets in the name of economic austerity. Many governments have also succumbed to the political temptation of tying aid policies closer to national economic interests. This means continued belt tightening for global health initiatives including WHO.  

A critical question is whether emerging economies, such as Brazil and China, will step up to fill the gap left by traditional donors. To date there has been a degree of reluctance, or at least a preference for bilateral channels, that allow governments to keep foreign policy and aid closely aligned. All of this suggests a lean year for financing global health at a time when there is a clear need for commitment to key agreements underpinning global health governance.  

Road maps for tackling non-communicable diseases, improving pandemic preparedness, and complying with the International Health Regulations, have all been agreed after much effort. But a lack of resources to realize these plans poses short-and long-term risks to the health of populations worldwide. The coming year will be one of hard financial decisions.

Health in the Post-2015 Development Agenda

Professor Sir Andy Haines, Associate Fellow, Centre on Global Health Security

The United Nations will host its General Assembly High-Level meeting on the Millennium Development Goals (MDG) in September 2013. Whilst three of the eight MDGs are directly relevant to health conditions, the post-2015 development agenda will pose a number of challenges and opportunities for health. Of the nine thematic consultations about the post-MDG framework, health is only one. 

Health is strongly influenced by policies in a range of sectors outside of health. Other relevant themes including environmental sustainability, population, inequalities, food security and nutrition, and conflict and fragility, present an opportunity to address health issues. 

The proposed Sustainable Development Goals (SDG), as recommended at last year’s Rio+ 20 summit, provide an opportunity to reflect on the growing evidence that improved policies to promote environmental sustainability, such as through low-carbon development, can also directly benefit health. For example reducing coal combustion leads both to reduced greenhouse gas (GHG) emissions and fine particulate air pollution. In addition increasing active travel (walking and cycling) can also reduce GHG emissions and air pollution whilst reducing the risk of major diseases related to sedentary lifestyles. 

There is growing consensus that priority for the SDG on health should be given to Universal Health Coverage; which implies that the whole population of a country has access to essential care. It will be a challenge to ensure that health goals are incorporated into the other SDGs, however it is imperative for different sectors to recognize the roles that they can play in improving health. 

Social Media and Global Health

Dr Heidi Larson, Associate Fellow, Centre on Global Health Security

The biggest challenges and opportunities for global health in the coming year are likely to come from outside of health. With the digital world evolving at a speed that we have not witnessed before, a big challenge for global health includes social media-networked resistance, such as that towards anti-vaccination groups. 

As mobile technology is becoming more widespread in developing countries, social media networks such as Facebook and Twitter have penetrated into many spheres and present both opportunities and challenges. These networks of communication when applied to health can facilitate valuable interactions between different communities, for example, in connecting individuals in remote and disparate locations directly with health care providers, especially in times of emergencies.  

Social media is often seen as primarily a mode of sharing information, and less recognized for its powerful capacity for like-minded groups to self-organize remotely. Mobilizing help in times of emergency is an opportunity, while mobilizing resistance, such as anti-vaccination networks, is a growing challenge for the international health community. For example, the UN halted its participation in a Pakistani-run polio vaccination programme following coordinated attacks on health care workers.

The continued evolution and use of social media will test the global health community, and failure to engage with these networks risks losing public trust.  Looking to 2013 and beyond it will be important to ensure that the challenges ahead become opportunities by acting globally - i.e. together - in the face of uncertainty.  

Non-communicable Diseases: A 'Wicked' Challenge

Anna George, Associate Fellow, Centre on Global Health Security 

The non-communicable disease (NCD) agenda represents a significant 'wicked' challenge for policy makers and their international negotiators. These diseases which include diabetes, cancer, heart disease and respiratory illness, have moved centre stage on the global health agenda. Looking ahead, the political focus will be on the production processes of the global food and beverage industries and their impact on NDCs. 

Addressing competing interests and priorities in the health and food industries will require high levels of governance and policy cohesion. A major industry transformation is being achieved through collaboration with the global and national chemical industries and related industrial sectors. Comparable to the NCD challenges are the objectives of the EU's Registration, Evaluation, Authorisation and Restriction on Chemicals system (REACH), which are designed to promote use of chemicals that are less harmful to humans and the environment.

The scale and impact of trade and consumption of chemicals is similar to that of the food industry. REACH will drive change across the global chemical industry and alter consumer preference as they become more aware of chemical safety issues. Other aspects of REACH regulation that may provide useful examples for NCD policy strategies include regulations based on scientific assessment, accurate labeling, recording and monitoring chemical inputs both imported and domestically produced, and, responsibility for compliance and liability defined.

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