Global Health Europe (GHE): In your acceptance speech you called for serious debate on global health governance. What do you see as the key challenges of global health governance today?

Dr. Mihaly Kökény (MK): Health issues have changed a lot in the last two decades. We all know that the world today is beset by interdependent crisis and challenges-climate change, migration, financial and economic crisis, food crisis, etc. Of course all have their impacts on the health status of the population. The problem I see is that in most countries, and partly at the international level, the response from public health often follows the old norms, the old style, based on what has been learnt 20-30 years ago. In my opinion what is really important to learn is that adequately responding to all these phenomena cannot be done just in a traditional way where we just focus on national health policies.

Of course developing health strategies at national level are important and of course in the UN national governments are the key stakeholders, and in the WHO governments are usually represented by health ministers. The problem is that many important actors-national parliaments, NGOs, the health industry, the private sector and other new actors, international foundations, etc. are not all less involved in facing global challenges at the WHO. It is important to see how we can elevate, refine or transform this type of international decision making into something much more deliberative and networked.

That's the most important thing, and not only in WHO. There are new initiatives for health governance expected to come out of the US and there are also countries in Latin America where they are discussing several initiatives. There is the new policy framework adopted by EU foreign ministers and the UN also has passed recent resolutions, such as that on Global Health and Foreign Policy. I think what this all means is that our understanding of health has changed, and now the way we work has to be changed as well.

GHE: How can WHO better address these challenges at the global and regional level?

MK: We had a very long discussion on this during the EB in response to my acceptance speech and in responding to the outcome of this year's World Health Assembly. This has been a very overcrowded Assembly, and we came to the conclusion with many supportive comments, that it is not the right approach to keep the constitutional fora of the WHO busy with single disease oriented items which clearly could be discussed at regional level. The World Health Assembly and EB should pay more attention to important global issues. In other words, it has become quite clear that a very careful priority setting is necessary. We have to be selective on what issues are discussed at the global level; whether that process of selection is painful or not. Then we probably should discuss more how to transform or rearrange the settings of the decision making. Take for example the initiative to establish the Committee C to channel the contributions of other actors in health, NGOs etc. into WHO deliberations. I raised this issue during the EB, as has been the case with the WHO Director General in January. I really think this is the time to discuss it, I don't know how fast the decision making process would be, but anyhow we have to very seriously consider this.

Second, I was very glad, considering WHO history, that this assembly created the fourth very important treaty like resolution. We all know there are two binding treaties, the Framework Convention on Tobacco Control and the International Health Regulations. And now we have two non-binding agreements, the first was on breast feeding that came out some 20 years ago, and now finally-after long debates- we came to a conclusion about the international recruitment of health personnel. It is one of the success stories that the World Health Assembly was able to vote on this. It is a voluntary code but still, I believe that this type of policy commitment is necessary for the future. It could be a clear guide for member states and other actors as well.

GHE: In your speech you also mentioned that conclusions regarding the future financing of the WHO should be a priority for the next EB - why is this such a crucial issue?

MK: I think it is crucial, but in order to discuss it we have to come to an understanding on what type of a WHO we really want to have. Then the second discussion is how to finance it. But these two discussions are linked and I think it was absolutely right that the Director General raised this issue, because the financial environment of the WHO has become fragile due to the economic and financial crisis. And if you take into account that nowadays around 75% of WHO's income comes from non-assessed contributions, this means that it is not from the fees paid by member states but just from voluntary contributions. What makes it even more difficult that 90% of these voluntary contributions are earmarked. This means that those who are donating, whether it is a member state or a foundation like the Bill and Melinda Gates Foundation and many others as well, they make the decisions on the WHO work agenda which is based on what's important to them. This creates imbalances among the strategic objectives of the WHO. For example communicable diseases often get quite a lot of resources, whereas we face a situation in which WHO programmes, such as for the non-communicable diseases or maternal health and reproductive health, are chronically underfunded. If member states and other supporters had the confidence in WHO governing bodies, like the EB to make the right balance and to make the right priorities, then of course it's important to provide these voluntary contributions earmarked to a lesser extent than it is now.

GHE: As you come from an EU country, what is your reaction to the Council Conclusions on the EU Role in Global Health policy framework the Commission has produced this spring?

MK: I think, without overemphasising the issue, from the perspective of public health it really is a historical milestone. It was not long ago that health issues, even those that had been the legal competence of the committees in the EU had been less important and always pushed aside. The situation has completely changed, probably due to recent pandemics, and the EU itself is one of the organisations that has gradually recognised that health could not be left to health sectors only. The EU now with this council conclusion came back to the truth of Rudolf Virchow, a public health scientist in the mid 19th century who said that Medicine is a social science and politics is nothing but medicine on a grand scale. If we translate what is in the Council Conclusions and the Communication on the EU Role in Global Health I think more or less it reflects a return to this old truth.

The EU also already had quite a lot of good initiatives to address some globalized issues like tobacco or alcohol campaigns and the health sector is becoming one of the largest industries worldwide and already it has major consequences for the global economy. These all together represent the stories the recognitions which all led to first the Communication and then, very quickly-luckily, very quickly-to the Council Conclusions. But there are challenges and risks in going forward. There are of course the threats that exist everywhere, but do we know, within our traditional member states, what are the capacities that we have to implement what has been said in the council conclusions? Therefore, the first thing that would really be necessary is that somebody must investigate this, I don't say who, whether it's the Commission or whoever. I am convinced that in the 27 EU member states there is very large trained public health intelligence-is the EU able to map them and to mobilize them as experts in giving support in the EU joint foreign service or other EU agencies? I ask this because I do not presuppose that from one night to the next morning that the EU diplomats and those that are in the staff and working in various fields under various directorates in the big administrations will be able to understand all the complicated public health issues and how they interconnect with their own fields. For me that is the real obstacle to get through.

GHE: What do you think should be the next steps for the EU as a global health actor?

MK: It is important that first of all the other decision making bodies, the Council in other policy areas should discuss how they can understand the Council Conclusions and how they can implement them in their own area. So for example in the Employment Council they could talk about migration and see that similar discussions are had in Council configurations that discuss security and trade and finance and so on. It's important that in addition to health the other 11 decision making bodies have to discuss the issues raised in the Communication. Then I think the EU needs to come up with some concrete proposals and probably have discussions with those powers such as the US and in Latin America for example, where there are already global health policies. Based on all these new global health strategies probably one of the next G8/G20 summits, after necessary preparation, could discuss it, even if only within some very carefully selected areas. The EU should use its presence in these forums to bring health high up the agenda.

The EU has moved forward very quickly with this policy framework, I feel that it is also very important to make these Council Conclusion quite understood in other parts of the EU, to be discussed in the European Parliament in all the necessary committees, and to explain what this really is all about in all parts of the hierarchy. I am afraid that currently people, even in the health councils, are not aware what this communication is about. They may wonder if it is about the health of the diplomats or what? So, I think there still is a need to provide a type of internal training or information course on the content and then as I said before a very careful capacity mapping to discuss what human and other resources we really do have in member states and at Commission level to implement all this.

Dr. Mihály Kökény
Trained in medicine, cardiology and political sciences, Dr. Mihály Kökény was a Member of the Hungarian Parliament from 1994 - 2010. He has served in various government positions including Health and Welfare Minister (1996-98, 2003-4) and chairman of the health committee of the Hungarian Parliament. Dr. Kökény elaborated the first national public health programme in Hungary in 1987.

Dr. Kökény's international activities cover broad fields of health promotion, environment and health and health care reforms as WHO consultant and speaker at major conferences. As of 2008 he has been a Member of the Executive Board of WHO of which he was elected chairman in May 2010