A Comprehensive Approach
185. In 2007 the Government published its proposals
for a government-wide Global Health Strategy[30].
In his foreword, the UK Chief Medical Officer spoke of the need
for "concerted action on global health and for developing
a global health strategy, one that will benefit the health of
the UK population and those of the rest of the world". Professor Harper
described this initiative as being "very much a cross-Whitehall,
cross-agency strategy" whose purpose was "to try to
brigade the interests so that we have a more efficient system"
(Q 11). He told us:
"There is a Ministerial group that is chaired
by the Minister of State for Public Health, Dawn Primarolo. She
chairs a top-level group of Ministers from various Departments,
including of course DFID, FCO, Treasury, Ministry of Defence,
Defra, what is now DBERR and others—the Devolved Administrations,
for example. There is a shadow group of officials who are working
to pull together the strategy" (Q 24).
186. Dawn Primarolo told us that, while the Department
of Health (DH) was the lead department for developing the Global
Health Strategy, ""it is not only about health and should
not only be left to health. It is important that we look for the
policy synergies in other departments as well": she instanced
DFID and the Foreign and Commonwealth Office (FCO) as having particular
interests (QQ 1150-1151). The Minister gave "a very
specific assurance to the Committee that our departments—the
Department of Health, DFID and the FCO—are working together
on the institutional strategy. We are finalising that, and it
is the UK's engagement with the World Health Organisation, which
of course the Department of Health takes the lead on" (Q 1144).
187. While we applaud the initiative which the
Government is taking in developing a Global Health Strategy, we
would place a question mark over whether the lead should necessarily
lie with DH. The answer to this question depends, to a large extent,
on what the strategy is meant to achieve. Though the Minister
suggested to us that it was "about how the whole of government
should be interacting and working with the WHO", the Government's
Health is Global report takes a rather wider view, including
international development and interaction with a range of IGOs.
There is no doubt that, with its responsibility for formulating
health policy for this country and for representing the UK at
the WHO, DH is a substantial stakeholder in the Strategy. However,
it is arguable that, from the point of view of global infectious
disease control, others are equally, if not more, heavily engaged.
DFID, as will be apparent from Table 1, provides the lion's share
of UK funding for international disease control and is the department
with staff working on the ground in developing countries. Indeed,
we have been struck during our inquiry by the de facto
lead which DFID has assumed in providing evidence and answering
our questions. FCO too has a considerable stake in an area of
activity which is increasingly becoming focused on the conduct
of relations with other countries and with intergovernmental organisations.
At a recent symposium in Geneva on "Foreign Policy and Global
Health", Dr Margaret Chan, Director-General of WHO,
called for health "to be given a high priority in foreign
policy" and for health to be regarded as "a worthy area
for foreign diplomacy"[31].
188. Switzerland has recently given serious consideration
to this question of how health policy can best be nationally coordinated
in an era when health management is becoming increasingly subject
to external drivers. Like the UK, Switzerland has its Health,
International Development and Foreign Ministries[32].
Dr Silberschmidt, of the Swiss Federal Office of Public Health
(SFOPH), told us:
"I have had exchanges with many colleagues
from other industrialised countries and the tension we most often
have is that the Minister of Health is in the lead in the WHO,
whereas the Ministry of Development has most resources and is
paying most money to WHO. All the time there is the question as
to who is really the decision-maker" (Q 588).
This has led the Swiss to develop the concept of
a 'Health Foreign Policy', in which the Federal Department of
Foreign Affairs (in Dr Silberschmidt's words) acts as broker
between the Health and Development Ministries. It has also involved
the creation, within the Swiss Federal Department of Foreign Affairs,
of a Coordinating Office which is "the contact point for
all relevant enquiries from the FOPH and other offices of the
federal administration" and which "ensures the coherence
of health foreign policy as part of overall Swiss foreign policy"[33].
189. We do not suggest that the UK should
simply replicate the Swiss arrangements. Nor do we have a ready-made
solution to the problem to offer. We do, however, recommend that
the Government should take another look at the machinery for coordinating
UK policies with a view to ensuring that the interests of those
Whitehall departments who are closely involved with the international
dimension of global health are given their due weight and that
this is reflected in the arrangements for leadership of the Global
Health Strategy.
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