Health Financing and Structural "One Health" in An Age of Pandemics

The world is still reeling from the ongoing Covid-19 pandemic. World leaders have expressed their concern to make this the last global health emergency with such devastating impact. They have presented the "One Health" approach as the framework for achieving this aim at the 9 September Civil 20 (C20) meeting, attended by PSI Health and Social Sector Officer Baba Aye.

At the 9 September Civil 20 (C20) meeting on “One Health in future policies: cooperation, gender and health financing”, PSI Health and Social Sector Officer, Baba Aye, pointed out the need for radical changes that address both immediate short-term concerns and structural issues underpinning the global political economy, to finance health in all policies, for the lofty aims of a Structural One Health approach to be achieved.

The C20 brings together the civil society movement as one of the official Engagement Groups of the G20. It organized the meeting to facilitate dialogue among civil society and international institutions, in the two months leading to the G20 Leaders’ Summit in Rome.

The meeting had three thematic sessions: global health, finance, and cooperation and the 2030 Agenda. Leaders of several civil society organizations, C20 Working Groups, and officials of the Italian health, finance, and foreign affairs ministries made presentations. Mabel Bianco, the C20 Gender Working Group Coordinator, provided a gender and women's rights focus for each thematic session.

Declarations and promises are not enough; genuine commitment through action is needed.

Speaking on the first panel, Kurt Frieder, the C20 Global Health Working Group Coordinator, pointed out that “the health of people is connected to the health of animals and the environment.”

Most health emergencies in the 21st century are spillover events, emphasizing this point. Economic activities that despoil the environment, further biodiversity loss, and deepen the climate crisis have accelerated zoonotic transmission of diseases.

Several international covenants and national proclamations have been made to realize health for all and ensure sustainable development, which entails caring for the earth's health and all that dwells in it. However, concrete action has been lacking. Governments have not taken adequate steps to address health inequities and the climate and environmental crisis. As Frieder correctly sums it up: "declarations and promises are not enough; genuine commitment through action is needed."

Stefano Prato of the Society for International Development and the C20 Finance Working Group Coordinator reinforced Frieder’s perspective. He argued that, while the “One Health” approach has been promoted in words for long, it has never really been taken up by governments and the international community.

Baba Aye underlined that the "One Health" approach would always be a mirage without radical restructuring that puts people and the planet first, before profit. Universal quality public services are central to doing this.

There is an abundance of evidence, that countries which have made more significant progress towards achieving universal health care rely predominantly on public funding. As even the World Bank shows in its High-Performance health financing Universal Health Coverage, 2019 publication, these countries have been able to promote health equity, service quality, and financial protection.

Curiously though, International Financial Institutions and governments worldwide have been pushing the privatization of the health agenda. Their twin arguments have been that the private sector brings resources and efficiency to health and care delivery. Baba debunked these arguments underlining that they are ideological and run against the grain of transparent facts.

Governments have to make corporations and wealthy people pay their fair share for the health of all and the planet. This requires a fundamental architecture of the global tax system and financing architecture.

$427 billion in tax is lost each year globally to tax havens. This is equivalent to the full salaries of 34 million nurses each year.

The new tax system of 15% minimum global corporate tax rate agreed upon by the G20 and OECD to start in 2023, is a point of departure. But it is still a far cry from what is needed. $427 billion in tax is lost each year globally to tax havens. This is equivalent to the full salaries of 34 million nurses each year, at a time that nurses and other health workers are being grossly underpaid.

Illicit financial flows, which haemorrhage resources needed to fund healthcare from countries in the Global South, must be stopped to make these stolen monies available to fund healthcare. For example, Africa, the region with the most tremendous disease burden and weakest health systems, loses $86.6 billion annually in illicit capital flight.

The heavy burden of debts on the necks of low- and middle-income countries (LMICs) makes is an added millstone on the necks of people already made vulnerable by the capital flight, dispossession and unfair trade. Just before the pandemic started, the external debts of developing countries and economies in transition was a staggering $10 trillion. According to Eurodad, 46 countries spend more on public debt (average 7.8% of GDP) servicing than on health (average 1.8% of GDP).

As if all these were not bad enough, trade rules weigh heavily on less developed countries (LDCs). Intellectual property rights are used as rent-seeking scaffolds to enrich a few corporations at the expense of the health of billions of people in the Global South. “At least nine people have become billionaires since the beginning of the pandemic, thanks to the excessive profits pharmaceutical corporations with monopolies on Covid-19 vaccines are making” according to the People’s Vaccine Alliance.

There is no way the right to health can ever be realized in this context of for-profit domination of the world. “One Health” approach would be mere meaningless words. We must learn the proper lessons from the Covid-19 pandemic. At the heart of these is the need for radical changes that include:

  • Promoting debt cancellation for LDCs, debt relief for developing countries and the removal of artificial debt to GDP ratios for developed countries

  • Enabling the needed fiscal policy space for governments (particularly in LMICs) to invest in public health systems

  • Removing IFIs conditionalities which constrict public funding (including public sector wage bill caps)

  • Halting and reversal of austerity measures. Health and care services must be well funded, and adequately staffed in line with the recommendations of the 2016 United Nations’ High-Level Commission on Health Employment and Economic Growth

  • Stamping out illicit funding and tax havens. We must make the rich and their corporations pay their fair share

  • Adopt a global multinational corporations’ tax reform (15% global minimum tax rate is a welcome point of departure, but probably not adequate)

  • Reforming international trade rules to put people over profit (by freeing funds for governments, democratizing technical know-how, and building solidarity). We demand the TRIPS waiver for Covid-19 vaccines to be available free of charge to everybody. The automatic suspension of intellectual property rights on required medicines, therapeutics and technology must be built into the post-Covid-19 trade regime.