The election of Joe Biden as President of the United States of America, with Kamala Harris as his able Vice President, spells well for global health. After a turbulent period of fraught relations with the World Health Organization, President Trump had initiated withdrawal from the global health body. Hours before the election result was called, he signalled the start of formal proceedings for American withdrawal from the Paris accord on climate change.
Both these will be reversed by the Biden administration, which will again warmly embrace global health and re-enter the global climate protection coalition.Biden has been elected during an extraordinary period in history, when the world has been reeling under the unrelenting attack of a new virus. The US, with all its technological prowess and much-vaunted leadership in global health, has been the worst victim of the virus in terms of infected persons and lost lives.
The American people became victims of wishful thinking of the current US administration that the virus will just ‘go away’ and the disdainful dismissal of science as a guide to public health policy. It will be good to see sanity restored, science respected and public health prioritised.However, it would be unfair to view Biden just as a passive beneficiary of the Covid-19 crisis, lifted to the presidency by a wave of popular anger against the incumbent’s mismanagement.
He has other claims to positive leadership, having taken an unambiguous stand against racism, affirmed support for environmental protection and demonstrated respect for women along with commitment to gender equity. All of these matter to advancement of health—at individual, national and global levels.
The one place where he has not reached as high is in his commitment to universal health coverage, where he is at some distance from the Bernie Sanders plan.
The nature of US politics and the power of insurance and medical industries may prevent the new administration from venturing far in that direction, but it will be a victory nevertheless if it can protect Obamacare from being ripped apart. Global health poses complex challenges in an interconnected and interdependent world. It is not just viruses that cross national boundaries. Tobacco, unhealthy ultra-processed foods and sugar sweetened beverages are transnationally marketed maladies and aggressively advertised addictions.
Climate change accelerates a cascade of harmful health consequences, from extreme weather events and rampant spread of vector-borne diseases to adverse impacts on agriculture and food systems that threaten global nutrition and health security. Each threat to global health needs a global thrust to counter it. Shaken by the disruptions to global supply chains caused by Covid-19, countries will rightly pursue the path of greater self-reliance, but that must not veer them away from commitment to global collaboration. Certainly, vaccine nationalism will fly in the face of global solidarity.
Investment in global health, by high-income countries, is not a gesture of benevolent altruism. It is also a demonstration of enlightened self-interest. In an interconnected and interdependent world, shared vulnerability brings the world together. Indeed, global health drew impetus in the past three decades from the potential worldwide threats of bioterrorism, pandemics and antimicrobial resistance. With the global economy extensively and inseparably integrated, damage to population health in any country can have adverse impacts on labour and consumer markets, trade and travel, with rippling effects across the world. Global health provides a productive platform for scientific collaboration to address the complex challenges of our time and enables the synergy of creative minds from all continents to provide innovative solutions.
Global health must, however, move beyond a fear of shared vulnerability to gain momentum from shared values. Health must be recognised as a human right, with a commitment to universal health coverage, poverty alleviation, gender equality and other Sustainable Development Goals. Shared commitment to global solidarity must be the path on which the world’s health advances. All the determinants of health, within and beyond the sector, must be positively influenced to promote global health equity. Within this framework, intergenerational equity must receive high priority so that the rights of future generations to enjoy healthy lives on a healthy planet are not compromised by detrimental political, commercial and environmental actions that are presently taken at national or global levels.
Even as a relieved world welcomes America’s return to the global forums for consultation and concerted action on vital health and environmental issues, the approach by any nation must be participatory and not prescriptive. While American isolationists shun the rest of the world, their globalist counterparts tend to impatiently press their preferred solutions on countries that have a varied context. Global solidarity is best established on the platform of mutual respect. Biden’s healing message of respectful relations with all and conciliatory conduct towards the Americans who differ with him is the spirit with which global health must be steadily rebuilt after the damaging quake of the Trump administration.
DR K Srinath Reddy
Cardiologist, epidemiologist & President, Public Health Foundation of India
(The author has written Make Health in India: Reaching a Billion Plus. Views are personal.)