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Rahim Kanani

Rahim Kanani

Posted: December 10, 2010 04:49 PM

Recently, I sat down with Julio Frenk, Dean of Harvard's School of Public Health and former Minister of Health of Mexico to discuss, in-depth, global health and international crises, comprehensive healthcare for women and girls, gender violence and social systems, gaps in education and training, the role of faith-based organizations, health and human rights, and the role of technology as an enabler in advancing health outcomes around the world.

The following is an excerpt, while the full interview can be found here.

Rahim Kanani: At the recent mHealth Summit in Washington, of which you were a part, Bill Gates linked the issue of global health to virtually every crisis the world faces. How would you characterize the relationship between global health and the range of international challenges we face today?

Dean Frenk: I think the big change that has happened in global health, particularly during the last decade, is that health stopped being the concern only of the domain experts, people who are experts in health, like myself, and started becoming a central component of the most pressing issues on the global agenda. This is a big credit to Dr. Brundtland, an alumnus of the Harvard School of Public Health, who was Prime Minister of Norway for ten years and then became the Director General of the World Health Organization. I had the privilege of working very closely with her as a member of her cabinet and as the Executive Director in charge of information for policy work. [more]

Because she had been the head of a government, she had a broad perspective. She is a physician and she got her Master of Public Health from the Harvard School of Public Health, but then she went into politics in a very mature democracy. She had the opportunity to see how her own medical and public health training was so relevant to actually conducting the affairs of an entire government. She brought that larger perspective to the World Health Organization. I think for the first time, the World Health Organization, in addition to pursuing its excellent technical work on specific diseases and providing norms and standards for the world around very specific technical issues, elevated the topic of health to be a central part of all the issues on the global agenda. [more]

So to my mind, nowadays, we do understand that health is absolutely crucial to at least three of the fundamental issues on the global agenda.

The first one is the issue of economic development, economic growth and the distribution of the fruits of that growth. The second is the issue of national and global security, and the third is the issue of democratic governance and the realization of human rights. Within those three, all of which are big items on the global agenda, health is central. [more]

We now understand that health is not just the result of economic development, it is one of the conditions for development to happen at all. That idea actually came out of one of Dr. Brundtland's initiatives, a commission she convened on macroeconomics and health. I was in charge of facilitating that commission along with a group including not health experts, but rather development economists and macroeconomists. At the end of a two-year study, we concluded that a big part of the explanation for why some economies have developed better than others lies in the fact that the health of the people has been better. [more]

So we changed the terms of the debate a little bit. We have known for a long time that wealth leads to health, but what that commission said is that the relationship also operates in the other direction. Better health produces economic development and not only makes the economy grow, it also generates a fairer distribution of the fruits of that growth and a fairer distribution of income. [more]

That is also a theme cultivated here at the Harvard School of Public Health in the work of David Bloom and David Canning who have written about the health and wealth of nations.

That is the first big connection: that health is a key component of economic development, not only as a consequence of, but a condition for development.

The second big topic is national and global security, and that is obvious in the case of pandemics. For example, the H1N1 pandemic--especially if it had been a more severe virus than the one that fortunately, finally materialized--would not only have been a public health crisis, it would have been a security crisis. If you have a pandemic that kills a huge proportion of the population and disables another huge proportion., we are talking millions of people. You have a security issue, not just a health issue. [more]

The AIDS pandemic was fundamentally a global security issue. The Central Intelligence Agency (CIA) expressly said the AIDS pandemic is a security concern. That is a more obvious and dramatic example, but I would argue that this ongoing, slow-burning persistence of huge inequities around the world actually creates the social discontent where you can see extremism, fundamentalism, and resentment against the West brew. You still have millions of children dying from unnecessary causes and hundreds of thousands of women dying in pregnancy and child birth--about 380,000 per year --and 99% of this is happening in the poor countries of the world. It is this persisting sense of fundamental injustice that breeds terrorism. I am not in any way justifying terrorism because I think it is unjustifiable, even under the most ardent conditions. But it certainly explains this fundamental tear in the social fabric that then breeds insecurity. [more]

So health is a fundamental part of national and global security concerns, both through pandemics and through this more chronic, slow-burning persistence of fundamental injustices.

Lastly, the third big topic is the spread of democratic governance and the realization of human rights. Again, health has become a specific arena where we can actually have debate and make those discussions very concrete, so that democracy is not exhausted in the exercise of civil and political rights but includes social rights such as, very prominently, the right to the highest obtainable standard of health. [more]

We see today that a lot of the more abstract discussion of human rights becomes very specific when we connect it to health concerns. I think this has been the big change in global health. It has now become a central part of the global agenda.

But then you add other topics that are emerging in the global agenda. You look at the food crisis and there is obviously a fundamental link, because food is essential for sustaining life and good health. Poor food can become a risk factor, as we know from junk food, food that is high in fat and calories, and food that is contaminated with infectious diseases. There is a very profound link there, especially regarding nutritious food. Where the price rises, you see immediate consequences in as a result of malnutrition, which obviously translates into health. [more]

Climate change is very, very deeply linked. A big part of the reason we worry about climate change is because of its consequences on human health. Ecological changes that are now bringing mosquitoes that can transmit Dengue Fever or malaria to ecosystems where those mosquitoes didn't use to exist is a very visible example of that link, but there are many, many others. [more]

Clearly the whole idea of efficient and clean energy is very central to health concerns. Just to give a dramatic example, one of the largest risk factors for poor families is indoor pollution brought about by the use of biomass for heating and cooking purposes in the poorest households in the world. That is an example of something that is ecologically very negative for the planet, because you are burning biomass that, first of all, destroys forests and other ecosystems. It is also highly pollutant and is a huge risk, especially for women who do most of the cooking and for children who spend long periods of time indoors. So that is just one example of how in every topic you see today, you find a health dimension. [more]

The full interview can be found here.

Future publications include interviews with Valerie Jarrett, Senior Advisor to President Barack Obama, Drew Faust, President of Harvard University, and many more. To see the full list, click here.

 

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