When addressing questions about the place of global health in international relations, I will talk about successes, blows, surprises and moral and ethical aspects.
The 21st century started off well for public health. When the governments of 189 countries signed the Millennium Declaration and pledged their commitment to achieving its goals in 2000, they launched the greatest attack on human suffering in history. The contribution of health to the overarching goal of poverty reduction was strongly recognized, as was the need to tackle the root causes of ill health in other sectors.
World leaders were optimistic, forward-looking and determined to make their vision a reality. A huge number of initiatives have emerged in the field of global health, many of which have focused on the massive implementation of life-saving interventions. New financial instruments have been created and smart ways have been found to secure new funds for the purchase of drugs and vaccines.
Presidents and prime ministers have embarked on international programs to tackle diseases rare in their own countries.
Official development assistance for health has more than tripled. Unmet need for new drugs and vaccines has led to the creation of a new generation of strategic R&D partnerships that have already licensed impressive innovations.
The number of people in low- and middle-income countries receiving antiretroviral therapy for AIDS has increased from less than 200,000 at the end of 2002 to 6.6 million today. Under-five mortality has dropped to its lowest level in more than 6 decades. The number of people diagnosed with tuberculosis peaked and began to decline slowly but steadily.
For the first time in decades, the steadily worsening malaria situation began to improve. Countries that have implemented WHO-recommended strategies have seen a 50% or more decline in malaria deaths.
However, for most of this decade, maternal mortality has remained stubbornly high. An explanation for this is not difficult to find. Achieving the goal of reducing maternal mortality is absolutely dependent on strong and affordable health services. Initially, strengthening health systems was not the primary goal of most global health initiatives to tackle individual diseases. But now it has become the main goal.
A campaign to achieve these goals has shown us that commodities such as pills, vaccines and bed nets, and the money to buy them, will not have the desired impact if there are no delivery systems tat reach the poor. An overarching goal of poverty reduction loses its meaning if poor people are left unreached.