The political argument for investing in global health

An insular, nativist, authoritarian wave has been on the rise in countries around the world. These movements play on people's fears and insecurities. They create scapegoats, especially vulnerable minorities, and attempt to falsely blame these groups as the cause of people's fears. They also try to undermine institutions such as an independent media and judiciary, which are vital to maintaining the ties of accountability between the elected and the public: structures crucial to a nation's stability.

These political forces threaten to upend the post-World War II multilateral infrastructure that has produced some of the world's greatest improvements in prosperity and health. An architecture based on engagement, cooperation, and inclusion has, of late, given us the Global Health Security Agenda, the Sustainable Development Goals, and the Paris Agreement on Climate Change. Global health relies on this outward-looking, internationalist stance, since the threats we face know no borders. How can we advance global health in an era of retreat?

Politics drive policies and the public drives the political. All sectors must be politically active in order to affect the development and implementation of public policies. Academia in particular must be strongly engaged. No other sector is better equipped to bring evidence and science to bear on policy development and counter-falsehoods masquerading as facts. With this privileged knowledge comes a moral obligation to act. Failing to do so undermines our duty to society: to improve the wellbeing of people and the planet where we can. This is the definition of global health.

To successfully advance financial and political capital investments in global health, arguments must be framed by how they improve the security and prosperity of citizens and the nation. Policy suggestions should be backed up by economic data to demonstrate savings or enhanced revenues. Policymakers, and even more importantly the public, are the target audiences. Knowledge must be shared in a manner that is comprehensible to non-scientists and presented in ways that touch people's hearts as well as their minds.

Key areas where one may find traction include: preventing pandemics; strengthening public health systems to reduce the impact of non-communicable diseases (NCDs) and injury; investing in access to quality public health, primary, and surgical care; creating strong public institutions including ministries of health, finance, justice, public works, the environment, and education, which are critical to a nation's stability; preventing the ravages of climate change; and protecting the ecosystems that are our life-support systems.

The cost of failing to address these challenges must also be communicated. They are all around us: Zika, Ebola, avian influenza, yellow fever, and cholera; the devastating loss of life, disability, and costs incurred from cancer, cardiovascular diseases, diabetes, respiratory diseases, mental health, addiction, and injury; extreme weather events; food and water insecurity; conflict; gross inequality; poverty; and the tragic plight of refugees around the world. All of these create instability, are costly to address, and are far less expensive to prevent. No nation is that figurative island. Time and time again we have seen how events a world away can affect any nation.

Investing in global health and multinational actions is a path to address these threats that know no borders. The Consortium of Universities for Global Health's (CUGH's) 2017 annual conference, April 7–9 in Washington, DC, is co-hosted by Johns Hopkins University and Makerere University. Its theme, “Healthy People, Healthy Ecosystems”, highlights the succinct, modern definition of global health.

It features panels showcasing the political and public value of global health, including Lancet Commissions on Pollution Health and Development and on Global Health Law. The new journal The Lancet Planetary Health is being launched as a follow-on from the Lancet–Rockefeller Commission on Planetary Health. It will be a vehicle to share new research and information about effective, evidence-based programmes that can put us on a path to sustainability.

Also featured are women's health and access to a full range of reproductive options, including safe abortions; the migration crisis; the Global Burden of Disease 2015 Report; protecting health workers in conflict zones; NCDs in developing nations; the impact of climate change on health; building ethical collaborations with institutions in developing nations; and more. Satellite sessions include: the global surgery crisis; urbanisation; global cancer; global health education; quality in global health; global health education; and the role of academic institutions in addressing public health challenges in their communities. Also, the US National Institutes for Health's Fogarty Center will kick off its 50th anniversary celebrations.

The conference has attracted over 1000 abstract submissions, 500 of which were displayed during the conference. Those presented orally are featured in this special issue of The Lancet Global Health.

It has been inspiring to see people around the world raise their voices in opposition to policies that jeopardise people's wellbeing and human rights. CUGH has done so by mobilising its members: against President Trump's ban on Muslims from seven specific nations; against the US gag law that removes life-saving funding for the health needs of the world's most vulnerable people; supporting people's access to a full range of reproductive options including safe abortions and more. This is a moment when all of us must get politically active to affect the decisions we, and our planet, need for our survival. This is not a time for ambivalence. It is a time for action.

Keith Martin, Zoë Mullan and Richard Horton
The Lancet Global Health
public health, global health, political determinants, policy