Germany’s new global health strategy provides a solid foundation for political action, yet it lacks a forward-looking approach. There is still time to develop a policy with foresight, says Susan Bergner.
Praised as ambitious by the government, criticised as a drop in the ocean by the opposition: Under the leadership of the Federal Ministry of Health, the German cabinet adopted its new global health strategy on 7 October. Compared to its predecessor from 2013, “Shaping Global Health – Taking Joint Action – Embracing Responsibility”, this strategy has made progress in critical areas. New topics and approaches have been included: the intersection of climate and health; human, animal, and environmental health are linked through the One Health approach; for the first time, occupational health and safety are considered health issues; and coordination mechanisms between the ministries responsible for global health have been expanded. However, the document lacks political foresight.
In Germany, the scientific community and civil society have been waiting a long time for the strategy to be updated. At the same time, expectations towards Germany are growing internationally, since key players have largely withdrawn from international health policy. While the United States is dropping out of the World Health Organization (WHO), the United Kingdom’s commitment to global health is diminishing amidst Brexit and the domestic outbreak of COVID-19.
The new global health strategy presented by the federal government is anchored in Germany’s value-oriented and multilateral foreign policy. Moreover, the strategy embeds health policy action within the United Nations 2030 Agenda for Sustainable Development, within partnerships – in particular with WHO and African countries – as well as within a human rights-based approach. According to the new strategy, health systems are to be strengthened globally, research for global health shall be expanded, and challenges such as Covid-19 are to be addressed. However, the strategy comes across as a stocktaking exercise full of vague statements that are hardly forward-looking.
If Germany wants to shape the global health landscape, an implementation of the strategy over the long term with a view to future developments is indispensable. Setting long-term objectives for global health policy would give Germany a clear international profile and make it easier to pool and align various health issues. Ultimately, having a clear objective would make it easier to produce concrete guidelines for action. This would, in turn, contribute to the strategy’s binding nature and verifiability. The German Parliament could take the lead in this, and the subcommittee on global health could monitor the strategy’s implementation process and review progress annually.
Three elements could make the implementation of the federal government’s global health strategy more forward-looking: setting overarching goals, providing perspectives on future roles, and continuing current efforts. When compared internationally, Germany stands out for its global commitment to strengthen health systems, and it does not focus solely on infectious disease control, such as Covid-19, as does the United States. The overarching goal in implementing the strategy should therefore be to prevent future crises by focusing on resilient health systems. This would enable Germany to take future events into account and to think beyond conventional health crises such as pandemics. Upcoming challenges – namely global mental health crises, with increasing incidences of depression and trauma; a worldwide shortage of health workers with serious consequences for standard care; and conflicts in the global health economy, where patent protections for medicines and the diversification of supply chains are under discussion – can already be considered when implementing the strategy.
Where does Germany, the EU, and WHO want to be in 10 years, and where should they be? Germany can find answers to those questions when implementing its strategy, thereby providing incentives for others and contributing to the international debate. This would eventually result in concrete proposals for shaping international health governance. Within the global health landscape, Germany could see itself even more as a cornerstone of the European order and support the EU in its global health policy in the long run. The EU could potentially take a clear stance on global health via a new strategy and strategic unit for global health within the European External Action Service. Internationally, the EU could improve its position through its partnership with the African Union, and it could gain a more influence within WHO by going beyond mere observer status. A WHO office in Germany could not only support national health policy, but also demonstrate Germany’s commitment to expanding WHO structures – a continuation of Germany’s strategy could provide the impetus for this.
Through national export bans and border closures, the pandemic revealed the role of Germany’s health policy within the international context. The German government should take this into account when implementing the strategy. It should also think ahead about an action plan for health that links domestic and foreign policy more closely.
It is not too late to strengthen the implementation of the strategy using an action plan with political foresight. The German government and Parliament should use this opportunity to successfully implement the strategy in order to strategically shape global health.
The Covid-19 outbreak is an acid test for the international order, which was already under enormous pressure before the crisis. According to Susan Bergner, Nadine Godehardt, and Maike Voss, the political will to shape health policy globally is needed to achieve sustainable success.
An Agenda for the German Council Presidency