Public Health www.thelancet.com Vol 369 March 10, 2007 857 Health is global: proposals for a UK Government-wide s Liam Donaldson, Nicholas Banatvala Global health enables the harmonisation of international and domestic-health concerns—its outlook is much w than a development or foreign-assistance perspective alone. Engaging globally in health requires the relevant and eff ective partnerships to implement solutions for shared or common problems. To build on the U achievements and leadership in global health, the central government Department of Health is now l development of a UK Government-wide global strategy. This paper describes the rationale and process for de the new UK Government-wide strategy for global health and highlights some of the issues that must be discu Global health Worldwide, communicable diseases, maternal health, peri- natal conditions, and nutritional defi ciencies account for about 30% of all deaths and 39% of ill health. Deaths and illness from chronic diseases are, however, increasingly important. Preventing chronic diseases: a vital investment 1 highlighted the global burden of heart disease, stroke, cancer, chronic respiratory diseases, and diabetes. Four out of fi ve deathsfrom chronic disease now occur in low-income and middle-income countries. Improving the world’s health and reducing premature deaths means the underlying determinants of health must be understood and tackled, health systems strengthened, and spending on health care and health research increased. Poverty, social exclusion, and access to safe housing, food, water, and sanitation are all important determinants of health. In 2005, WHO established the Commission on Social Determinants of Health 2 to draw the attention of governments, civil society, international organisations, and donors to ways of creating better social conditions for health, especially for the world’s most vulnerable people. The eff ects of climate change, environmental pollution, and degradation of natural resources on a global scale might be some of the biggest hazards to health in the fu- ture. Natural disasters and scarce resources can lead to mass population movements and confl ict, which are asso- ciated with increased mortality and reduced physical and mental health. The causes of climate change and pollution, like their eff ects, are common to many countries and require shared solutions. The state of human health in many developing countries continues to decline at a time when the world’s funding of biomedical research is increasing. This situation creates the need to promote greater international cooperation in biomedical research that is relevant to such countries. 3 The health and wellbeing of populations is also crucially dependent on the performance of the health systems that serve them. Yet the health systems of many poor countries are overburdened and some are on the brink of collapse. The result is large numbers of preventable deaths and disabilities, unnecessary suff ering, injustice, inequality, and denial of individuals’ basic right to the highest attainable standard of health.Moreover, despite the burgeoning economies of India and China, health systems in those countries are not advancing as quickly as they could. Investment in systems, services, and public health are crucial if thesecountries are to maximise their economic and human development potential. Globalisation and health Globalisation can bring benefi ts for human health: via improved trade, sharing of medical research, and the pooling of fi nancial, technical, and intellectual resources for solving shared health problems. Globalisation can also pose risks to human health—for example, through unfair trade and its regulation, inequitable distribution of natural resources, and poorly managed migration. The key issue for policymakers is how these benefi ts can be harnessed while minimising the potential for harm. The Whitehall Permanent Secretaries regularly discuss how the UK government best responds to globalisation. The group promulgates UK action to maximise the oppor- tunities of globalisation in areas such as development, climatechange, energy security, trade and industry, science and innovation, education, and global health. Rationale for a Government-wide strategy The US Institute of Medicine, in a 1997 report, 4 made a strong case for why that country would benefi t from investing in health abroad. The report identifi ed three pillars: protecting people, enhancing the economy, and advancing international interests. In 1999, the then directorgeneral of WHO, Gro Harlem Brundtland, reminded the international community that investing in global health was good politics, good economics, and good for national and international security. 5 A Lancet Editorial recently described the advantages of using health as an instrument of foreign policy, 6 such as protecting nations against health threats, social cohesion, strengthened national infra structure, improving bilateral relations, and encouraging trust across global multilateral agencies. Five key reasons exist for why the UK Govern- ment should do more than it does at present to prom ul- gate global health. Engagement with the global health agenda can improve global security and health protection, enhance sustainable development, improvetrade by promoting health as a commodity, maximise potential of globalpublic goods, and encourage a human rights approach to health. Potential confl icts exist between them. For example, reconciling UK trade interests (includ ing trade in health commodities) with sound pro-poor development policy and maintenance of international Lancet 2007; 369: 857–61 Published Online March 7, 2007 DOI:10.1016/S0140- 6736(07)60327-4 See Comment page 806 Department of Health, London UK (Prof L Donaldson MD); and Department of Health, Wellington House, London SE1 8UG, UK (N Banatvala MD) Correspondence to: Dr Nicholas Banatvala nick.banatvala@dh.gsi.gov.uk