After listening to the high-level experts’ opinions in Closing Plenary carefully, some Young Gasteiners were eager to experience more about European and Global health politics and had a great chance to interview Prof. Ilona Kickbusch, Director of the Global Health Centre and adjunct professor at the Graduate Institute of International and Development Studies in Geneva.
MARIUS: In your speech at the closing plenary, you detailed what Germany has done to position itself as a leader in global health and shared valuable insight on inter-ministerial collaboration, in particular. What do you consider to be some lessons that Germany has learned in this process that can be taken up by other Member States?
ILONA: I believe one of the lessons is that it is absolutely critical to have the support of your head of Government. In Germany’s case, that gave additional energy for the ministries to talk to each other and work together. The idea was that it would not be a strategy of one industry, but, rather, should be approved by the cabinet, so it was also in a discussion process with all ministries. That led ministries to think about health without them having anything to do with health. It led to a better understanding of the tasks and work of different ministries. Additionally, the current strategy made it quite interesting: when the Ebola crisis hit, people actually knew each other. So, it allowed for a quicker and better discussion, and there was less competition between ministries than there might have been if they hadn’t gone through this rather tedious process before. It’s something that helps you focus. The first strategy was just trying, at first. Many people criticized it, saying it hadn’t set clear goals. All of that is true, but it did what it was able to do at that point. Moreover, as Germany has since worked extensively in this space, it is important to see how one can address “the weaknesses” of the new strategy. There’s a great willingness to do so. Basically, three ministries are very much in forefront: The Ministry of Health has the lead, together with the Development Ministry and the Research and Innovation Ministry. The Environment Ministry also plays quite a large role because it invests a lot in environmental health. So, after the election, one will be able to see the (new) constellations in terms of how ministries are grouped, and how to move forward. All in all, it’s worth doing, and I would recommend any country to try and get a bit more policy coherence.
SARAH: You said in your intervention that the budget for research and innovation for global health was doubled in Germany. Do you think we need more research & innovation, or would it be better to just implement what we already know has worked (for example, from tobacco and alcohol policies)?
ILONA: I don’t think that’s an either-or-discussion. Obviously, we also do need implementation science, that is how it’s done. You also need more research in the areas of non-communicable diseases, both on the medical side, and on the prevention side. More work needs to be done on what people call translation science. Much of the work is not interdisciplinary enough yet. Even where we do have certain diagnostics, there is still a challenge of how to improve them. So, all those things are there, and I do think investment in science and technology is critical, as long as it’s not the only thing you do, and you don’t expect all your solutions to come from that. In some, like with tobacco, the science part is very well, but at the same time it would be beneficial if we found a strategy to control the tobacco industry and take some tough political decisions there. It’s not an either-or-decision, yet, science and technology can’t replace a strong political decision.
TUGCE: As we have just heard from Ms. Agneta Karlsson, State Secretary to the Minister for Health and Social Affairs, Sweden, there are some Public-Private-Partnerships that could work as it was the case in Ericsson. Could you imagine this kind of PPP opportunities in Germany? What could be the options globally?
ILONA: It is a shifting ball game than the ones 20 years ago. Those times everybody wanted to work with Coca-Cola in the developing countries. This was because it had the system to manage cold chain, which kept both coke, and vaccines and medications cool. Therefore, the Global Fund announced its partnership with Coca-Cola to fight against e.g. tuberculosis and malaria. But that might not be necessary anymore, particularly because through the new technology, such as drones, we can let the medicines allocated in remote places. The things shift with time, as well as the perception of companies. 20 years ago, we would say “never with tobacco or alcohol industry”, but soft drink industry was not alarming. Now it is obvious that the soft drink industry is as dangerous as tobacco or alcohol. In Germany, as you know, the German Healthcare Partnership brings small-sized German companies together and works on some health investments in developing countries. So, there are many different types of opportunities. You should ask yourself: “Where would I have the most impact”? If you think to work with coke on physical activity promotion, that will not bring you a huge impact. This would bring benefits only to the coke company itself because of their advertisements. So, I think it is not necessarily a question of “should I work with an industry or not?”, but rather, what kind of an industry, in which time, and on what issues the collaboration would be established. If you find the right match, this will make a difference. Also, some public health agencies in the UK ended their collaboration with soft drink industries in open parks. Namely, they realized that it would not make a big difference on public health, and point two, it actually allowed the soft drink industry to have a new “free” advertising space. Otherwise, they would not have had an opportunity to use e.g. trees for their advertisement purposes, but by this way they could put their flag in all over the parks, in order to “promote the physical activity”. One needs to think strategically about PPPs and consider that industries themselves work against each other in some terms. Not every NGO is the same, not every government is the same, and not every company is the same. The really worrisome thing in the sector is that the strategy of the active equity investors is actually harming the potential of corporate social responsibility possibilities of consumer good companies. This is the effect of tendencies to obtain quick, rapid profit in a very short period of time: You go in, you sell. You take the profit and you run away. That’s what they do.
TUGCE: I guess what you have just mentioned could also apply to the politicians in some countries, that they do not set their goals for long-term outcomes. Or the other way around: a politician sets an agenda for long-term goals and the next one takes the good outcomes from the previous one for granted…
ILONA: That is actually what the whole debate is about: When politics are done based on some ideas and goals, but not on common surveys, which try to understand what do people really want. Do I elect the party because of its vision? Do I construct the program as a party around the surveys which tell me the issues which people are concerned about? If you cannot tell the people what you are all about, people will not vote for you. I guess we will also rather see a new type of politics, and we’ll see what that means: the different model of politics in Europe and in the USA. You see, somebody like Macron talks very differently than somebody like Theresa May. The questions are: what does digitalization mean, does automatization mean I won’t have a job, will these people take my job from me, what are the Chinese up to…? We are in an enormous change of our societies. I personally think the politics has not realized yet how deep these changes really are, and I don’t know how the politicians are going to deal with that. It is because they take the short-term decisions as keeping the jobs in the tobacco industry, or the ones for diesel. But China might say: “We’re not going to buy your cars anymore”. There you go.
MARIUS: We listened to you speaking about civil society organizations, and the Commissioner Andriukaitis mentioned their impact at national level. How do you see the role of civil society organizations in the global health arena?
ILONA: I was very active myself in social movements. But one has to get involved in shaping politics, and my own wish would be, just like my generation created the Green Party, that the next generations become more politically involved in a new way and help shape our society. The critical voice of civil societies is incredibly important, but it tends to be from the outside looking in. I wish that more of those critical voices really went to Parliament, really went right into the debate. I can see on the one hand that going into the traditional parties is not particularly exciting, but my generation, we left the Social Democrats, and we entered the Greens. And now the Greens seem relatively old in fighting this war, but the question is what kind of politics does one need. I think Google Health and Public Health can place its seeds in the political sphere. Is not sufficient to be technical.
SARAH: Speaking of a specific topic – childhood obesity prevention – do you think there is a possibility that we someday can have something like a framework convention on unhealthy foods, or is there anything we can learn from tobacco that can be applied to unhealthy diets?
ILONA: We need rules. The tobacco convention worked because it was specific. It’s one kind of product, and even the tobacco convention is getting more difficult because of electronic cigarettes and chewing tobacco. It’s still far from implemented. “Hard law” is not necessarily the best option. A framework convention on alcohol probably has more chance than a framework convention related to food and obesity, primarily because it involves so many different players and actors. It should definitely be a global movement, e.g. on taxing sugar and similar things that are very tangible goals, and we can see that picking up already. You can see how that leads to changes in the industry, shaping the new public discussions on obesity. It is partly related to your question. You might not even get tax in the end, but the issue will have such a high political discussion that maybe some other political decisions will have been taken or, as also happens in a number of retailers, the industry itself starts changing their products. I do think we’re at the beginning of a food movement. That’s quite important and that’s what we should attack from various sides. That doesn’t mean one shouldn’t advocate for a framework convention. It gets a lot of people angry and upset. And then you have a real hard debate: “you will tell us why you don’t want it. I’ll tell you why I want it. This is what my draft would look like. What don’t you like?”. It’s important to start being controversial and to start throwing things in. That makes public health important, lively and relevant. We’ve perhaps gone on a bit of a tangent on research and evidence, and technical solutions, and, well, everything. Public health, from the start of its history, has been incredibly political, and we have to gain that political essence.
TUGCE: Last but not least, a question which is relevant for many Young Gasteiners: Sometimes it is challenging to be young in national health politics in Europe. Do you have an advice to us?
ILONA: Get organized and speak up! It is and has always been challenging. But it was also challenging to be a feminist in the 1960s. You don’t get change easily. You have to pay a price. That’s a decision every person must take for himself. Get organized with the others, with the ones willing to take risks, the ones committed to move an agenda forward. This way, you can make an impact.
Interview conducted by the Young Gasteiners Marius Ungureanu, Sarah Czernin and Tugce Schmitt