The Campaign News

Advancing Global Health: A Shared Responsibility

By Gro Harlem Brundtland and Mary Robinson

Imagine living in a country in which you share your doctor with 50,000 others: this is
Malawi today. According to the World Health Organization, people in 36 countries in
Africa live a similarly grim reality.

Africa faces a shortage of 800,000 doctors and nurses, and currently trains only between
10 and 30% of the skilled health workers required to meet ongoing need. Every year,
the continent that already manages 25% of the global burden of disease with only 3%
of the global health workforce loses 20,000 trained health professionals to migration.
This is due in part to poor working conditions and in some cases political instability and
conflict.

But the increasing migration of health workers from Africa is also caused by other
factors. Industrialized countries, including the United States, are suffering a shortfall
in health professionals, driven by rapidly ageing populations, the rising demand for
health services and lack of attention to education and professional training to meet
domestic health needs. This means they look abroad to countries where loss of health
workers can result in near-collapse of already fragile health systems.

The global shortage of health workers is one of the critical issues we will be addressing
later this week in a meeting convened at the Carter Center with United Nations
Secretary-General Ban Ki-moon and leading health experts and officials from the UN
system. As members of The Elders, a group which came together last year under
Nelson Mandela’s inspiration and Archbishop Desmond Tutu’s chairmanship, we have
made global health a priority and are working with the Secretary-General to bolster UN
leadership in this area.

At least one billion people continue to suffer from one or more largely treatable
neglected tropical diseases. Progress on maternal health remains the slowest-moving of
the UN Millennium Development Goals. Without a strong and effective human
infrastructure, health systems will never be able to tackle crippling diseases or achieve
national and global health goals. Concerted efforts are being made at national and global
levels to address health systems weaknesses, including through enhanced development
cooperation which is aligned with national priorities. Global partnerships such as the GAVI
Alliance have generated critical opportunities for addressing these weaknesses, including
support for human resources, in countries where assistance is most desperately needed.
Uptake for this support has been greater than expected, and is increasing.

But a great deal more needs to be done. New policy efforts to craft mutually
responsible health-worker migration policies between sending and receiving countries
are urgently needed. Addressing the challenges of migration requires a commitment to
informed dialogue between countries where mutual benefit and mutual responsibility are
the starting point for practical policy action. It requires Ministers for Health, Finance and
Education in source countries to examine what they can do to retain health workers and
to train them in adequate numbers, as there is evidence that “push” factors have to
outweigh “pull factors” to encourage health professionals to leave their home countries.

What is too often forgotten is that taking these and other steps to advance global
health aren’t just matters of moral concern. They are issues of fundamental human rights.
Sixty years ago the architects of the international human rights system understood the
importance of health to human dignity, well-being and security. Article 25 of the
Universal Declaration of Human Rights declares that “everyone has the right to a standard
of living adequate for the health and well-being of himself and his family, including
medical care”.

The Elders have chosen to highlight the right to health as part of our Every Human
Has Rights Campaign. Partner organizations like Save the Children, Amnesty International
and UNICEF are working with us throughout 2008 to reaffirm and renew commitment to
the Universal Declaration of Human Rights during its 60th anniversary year.

The Universal Declaration’s message that access to adequate health care is a
fundamental right must be heard again today. The right to health is about ensuring
that effective health systems are in place and accessible to all. We call on all countries to
help move us towards a future where basic access to health care, with a robust health
workforce as its anchor, is a human right enjoyed by all women, men and children.

Gro Harlem Brundtland is a former prime minister of Norway and former director-
general of the World Health Organization. Mary Robinson is a former president
of Ireland and former United Nations High Commissioner for Human Rights. Both are
members of The Elders.