GHF2010 – PL03 – Crisis as Catalyst for Health Reform: Quick Fixes or Sustainable Solutions?

Session Outine

Plenary session PL03, Tuesday, April 20 2010, 9:00-10:30, Room 2
Chair(s): Francisco Songane, Founder and President of Heartfile and Founder of Health Policy Forum, Pakistan
Perspectives on Economic Crises in Developing Countries
Viviana Munoz, Programme Officer, South Centre, Switzerland
Perspectives on Social Protection
Xenia Scheil-Adlung, Health Policy Coordinator, Social Security Department, International Labour Organization, Switzerland
Perspectives on How Crisis Could Represent the New Environmental Deal
Maria Neira, Director, Department of Public Health and Environment, World Health Organization, Switzerland

Session Video

This session is available to watch using Dudal. To watch it you will need to have Java installed on your computer.

Session Report

Submitted by: James Reynolds-Brown (ICVolunteers); Contributors: Claudio Todisco (ICVolunteers)

Photo by V. Krebs,

This was a key plenary session on how to make the best of a bad situation. The speakers discussed how crisis response could help form effective and sustainable health services and how using the climate change agenda as a vehicle may help achieve this.

Dr. Francisco Sangane, former Minister of Health for Mozambique, chaired the session. He challenged our perspective of crisis by stating that billions of people face a permanent crisis every day, on local, regional, sub-regional and global levels. But he said that “crisis can be used as an opportunity to do things better”.

Vivania Munoz opened the discussion by referring to the work of the South Centre, which she represents. The key elements of her presentation were the need to allow developing countries the policy space to cope with crisis and that current intellectual property instruments are not necessarily the most effective instruments for enforcing intellectual property rights in developing countries. In developing countries the economic crisis has, in general, resulted in negative growth figures; there has been a time lag in the recovery reaching those most affected. The two main problems for developing countries arising from the economic crisis are restricted access to finance and credit, and the change in trade. Additionally, the fiscal stress associated with the crisis has exerted pressure on health systems, which has created a need to encourage the protection of health services in developing countries.

Ms. Munoz went on to detail ideas the South Centre has for improvement as a result of the financial crisis. These include such ideas as reviewing intellectual property policies and instruments to promote access to medicine; taking concerted action against diseases that disproportionately affect developing countries; and promoting pharmaceutical/medical research based on health needs as opposed to market forces. Her closing remarks focused on the need to have a more systematic approach to the multiple crises that have arisen, rather than an ad-hoc one. The causes of the crises must be addressed to promote stability and sustainability.

Representing the International Labour Association (ILO), Xenia Scheil-Adlung focused her presentation on the importance of social protection, stressing how development is not likely to happen without effective access to healthcare services. Crisis assessment shows that huge shocks normally occur on top of pre-existing chronic needs, potentially resulting in negative development, with particular effects on health and economic growth. The health sector alone cannot provide sustainable solutions; therefore a wider policy approach is required.

The population groups most likely to be covered by social protection are composed not only of the poor, but also of other ‘weak’ categories, like women and workers in the informal economy. In fact the ILO indicators show how, beyond those who have no access to health at all, there are groups that spend a disproportionately high amount of their income on health services. Responding to these problems during a crisis is, for Dr. Scheil-Adlung, a matter of promoting effective access to healthcare and income support. Apart from examples like China or India, few countries took advantage of stimulus packages to increase social heath protection. Instead, Romania, Hungary and several African countries reduced their health expenditure. Resources invested in immediate needs concerning health and poverty alleviation have to be oriented towards sustainable, structured, social protection as a key tool in the long term. In Haiti a lot of time has been wasted due to the lack of such a structure. The Social Protection Floor initiative, led by ILO and WHO and joined by international agencies and donors, is an example of a policy aimed at establishing structures that provide basic income support and effective access to health care. Dr. Scheil-Adlung’s closing remarks focused on the need to create sustainability in any structure created as a response to a crisis.

The key word in the presentation of Maria Neira, Director of the Department of Public Health and Environment at World Health Organization (WHO), was ‘resilience’, referring to the capacity to withstand or recover quickly from crisis conditions. The Geneva Health Forum has been affected by the suspension of flights in European airspace, due to the volcanic eruption in Iceland. Today it is about the flights, tomorrow it could be internet. We have financial crises, food crises and climate change crises. It is in order to face such challenges that it is crucial to develop resilience.

Regarding climate change, Dr. Neira provocatively maintained that a phenomenon with negative connotations could turn out to be the biggest opportunity for global health. She noted that several million people each year die because of air pollution, the results of a sedentary lifestyle, road accidents and the need to cook with solid fuel. There is strong evidence that it is time to “jump on the climate change issue” and make such health issues “part of the agenda”, she said. A solution to health problems could be generated through sectors such as energy and industry, and these sectors regularly made decisions that affect health. The lack of a result from the Copenhagen conference, Dr. Neira felt, offered the opportunity to include health effects as part of the climate change agenda, which could in turn galvanise national sentiment and put pressure on those going to Mexico to reach agreement, whether at the international, national or sub-national level.

A question from the floor raised the problem of establishing stable structures in inherently unstable crises. The panels’ response was that 100% stability is not always required and the solidarity and investment generated by the response to a crisis can be a suitable substitute.

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