From Bedside to Boardroom – Parliamentarians Claim their Place in Global Health Debates
‘He died without feeling a last kiss from his loving mother,’ Ricardo Baptista Leite on his journey from the bedside to the boardroom to create UNITE

BERLIN – Nearly 20 years ago, Ricardo Baptista Leite began his work as a young medical doctor in an infectious disease ward in Portugal – an experience that changed his life. 

“I met patients who couldn’t make it to the hospital because they couldn’t afford public transportation,” he said.  “I diagnosed patients infected with multi resistant tuberculosis; keeping them in isolation, I prayed that the treatment would work that time. 

“I particularly particularly remember a man in his twenties who was in the hospital, and his mother would visit him every day, but she would not go inside the room because she was ashamed that her son was living with HIV. 

“He died without feeling a last hug and kiss from his loving mother. And all because of lack of education, stigma, discrimination, inequities and poverty have led to poor health and deaths across the world.”

Leite, who is now a member of the Portuguese National Assembly, recalled those early days at a ceremony this week where he signed a collaboration agreement between the World Health Organization and the UNITE Parliamentarians Network for Global Health, founded just five years ago.

The aim is to expand outreach to the world’s elected politicians on burning global health priorities, whose direction is ultimately “a political choice” to use the oft-cited mantra of WHO’s Director General Dr Tedros Adhanom Ghebreyesus.

‘Straightforward’ but not simple mission

Parliamentarians from six WHO regions speak about advancing global health goals at a World Health Summit event marking the establishment of official relations between the World Health Organization and the UNITE Network of Parliamentarians for Global Health.

UNITE was only a glimmer in the imagination of Baptista-Leite six years ago when he first proposed the idea of a global health-focused parliamentary intiative at the 2016 World Health Summit.

Established a year later in 2017, it now includes senators and congresspersons from more than 85 countries. Along with gaining formal WHO recognition, UNITE is also leading work with about a dozen other long-standing parliamentary networks under the umbrella of the International Forum on Global Health, to coordinate parliamentarians’ inputs to the WHO’s development of a pandemic treaty.

“Our mission is straightforward,” said Baptista Leite at the WHS event where he signed the MoU on behalf of UNITE with WHO’s Tedros. The ceremonial signing wa followed by a panel discussion with leading MPs from all six WHO regions of the world on the role parliamentarians can play in turning global health policies into reality. 

“We aim to transform scientifically sound recommendations into concrete laws. We ensure that money gets where it is needed through budgets, and we hold governments accountable,” Baptista Leite said, summing it up. 

“We will work together towards achieving a new pandemic treaty or convention to be ratified by parliaments to ensure that all will be done to contain outbreaks and prevent future pandemics. 

“We will actively transform current disease response systems into health ecosystems capable of promoting wellbeing for all and not just for the few. Together we will foster innovation and digital health as a means towards achieving universal health coverage and the SDGs by 2030. And by joining efforts with civil society and patient advocates, we will put citizens front and center. 

“And as we have seen in the COVID pandemic health threats do not recognize borders, and if we do not work together we will indeed fail the people we have been elected to serve, unite and who have come together to ensure that failure is not an option.”

WHO rolling out new parliamentary engagement strategy 

‘As a former parliamentarian myself, I know the critical role parliaments play’ – Tedros at the signing of an MoU recognizing formal relations with UNITE.

While UNITE is a relatively new parliamentary network, and small in comparison to groups like the Interparliamentary Union (IPU), which includes tens of thousands of members worldwide, its added value is its laser-focus on global health. Recognition by WHO can ease collaborations that support WHO’s efforts to reach out more directly to parliamentarians around the world, said Dr Tedros, noting that WHO is just now rolling out a first-ever strategy on parliamentary engagement. 

The WHO strategy includes the creation of a new global network of parliamentary chairs of health committees from all 194 WHO member states “to establish a systematic dialogue with national parliamentary bodies in charge of health and mobilize political support around key global health priorities,” Tedros said.  

“As new members of the WHO partners family, UNITE will support WHO’s engagement with parliaments with a focus on three major areas: equitable access to health with a focus on adequate budget allocation for universal health coverage; sustainable financing for health system strengthening; and strengthening the global health security architecture…especially the implementation of the international accord in countries,” said Tedros at the event.  

While governments’ can approve new WHO initiatives and  policies, it remains up to parliaments to pass the legislation to actually implement them – along with ensuring sufficient budget allocations, Tedros noted.  And that is what makes their role so pivotal.

Speeding up ratification of a new pandemic accord 

This is a key particular concern with regards to any new pandemic treaty or accord.  Even if an accord is approved on schedule by May 2024, it would still have to be ratified by a critical mass of countries in order to take effect as international law and be universally binding. 

And that process could take years, critics have warned. In fact,  the International Health Regulations (IHR), the present-day set of WHO rules on health emergencies, only became legally binding in 2020 – 15 years after the IHR was approved by the World Health Organization member states.  

“As a former parliamentarian myself, I know the critical role parliaments play in driving progress in global health by passing legislation;  keeping governments accountable, allocating adequate funding for health and by representing the needs of the communities they represent,” Tedros added.  

“Over the last few years, WHO has intensified its engagement with parliaments on our key priorities of: universal health coverage, global health security and health promotion, especially for vulnerable groups, including women, children and adolescents. 

“A significant milestone was the adoption by the Interparliamentary Union Assembly of a resolution on Universal Health Coverage in 2019. 

“This is only the first of many milestones we would like to achieve with your support,” said Tedros, turning to Baptista-Leite and the parliamentarians on the panel, including Spain’s José Ignacio Echániz, chair of the advisory group on health at the IPU, a broad-based body representing 46,000 MPs around the world.  

Inherent tensions between parliamentarians and government 

Ghanaian politician Akua Sena Dansua describes experiences serving in parliament and government.

Reaching out to parliamentarians is a delicate, but important task for WHO, in light of the inherent tensions that typically exists between the parliamentary and executive branches of government.  It is with the latter that WHO maintains its formal relations.  But presidents or prime ministers and their cabinet ministers don’t always have the last word either, as anyone watching the hotly-debated US mid-term elections knows. 

Within any presidential or parliamentary democracy, there is typically a wide array of of political parties and constituencies that need to be persuaded to support measures that require legislative action, including spending on new domestic programmes as well as international accords.

Ghana’s Akua Sena Dansua can speak to that issue well, 

“I had the benefit of experience on both sides of the aisle,” recalled Dansua, who moderated a panel discussion that followed the ceremonial signing of the MoU. “I was in opposition for  8 years, and then in government for four years, 

“And during this time, I will say that I had the best time in opposition, because then I had the opportunity to criticize the government of the day – you can shout at the top of your voice. 

“But the government is adamant – they are there to promote their vision, which may not include what you are trying to propose to them. So you can shout the loudest but you will not, unfortunately, [always] get the hearing you deserve.” 

Conversely, when her party was controlling the government, “you have to tow the party line. You have to tow the government’s line. … Even if you have issues to raise, you couldn’t express yourself.”

WHO’s recognition should empower parliamentarians 

Andrew Ullmann, chair of the Health Committee in the German Budestag.

Against those limitations and constraints,  WHO’s engagement can equip parliamentarians with evidence based know-how, enabling them to provide better guidance and leadership on critical health issues, Dansua said. 

“We are happy that WHO has recognized or is recognizing parliamentarians as a very strong partner. What we ask for them is to empower us,  to give us the training, to give us the information and to give us the support that parliamentarians need in their various countries to push the global agenda forward,”  Dansua said. 

Health can also be a unifying theme amongst disparate political parties, observed another panelist, Andrew Ullmann, chair of the Health Committee in Germany’s Bundestag.

“We as parliamentarians are essential to achieving global health goals because of our ability to enact legislation, harmonize existing laws, create an enabling legislative environment, and eliminate existing legal barriers to existing health care,” Ullmann stressed. 

“We are responsible for budget allocations and keep our governments accountable. For my experience as chair of the subcommittee, I can assure you that German parliamentarians independents, in the governmental coalition or the opposition, are committed to global health.

Germany has also become the first country in the world to create a subcommittee on global health within its parliament, Ullmann noted. 

“The idea was born out of the fact that health challenges go beyond national borders, health and well being need to be understood on a global level,” he said. 

“The effects of infectious diseases such as Ebola or tuberculosis, as well as antibiotic resistance and climate change go far beyond national borders. In order to take this development into account, and to facilitate bridging cooperation exchange between all voluntary bodies involved, the global health committee established this subcommittee, which gives global health policy more visibility and real relevance among the members of the Budestag,” Ullmann added. 

Addressing health versus healthcare

Parliamentarians Andrea Álvarez Marín, Costa Rica and José Ignacio Echániz, Spain, discuss the role of MPs in global health policy-making Tuesday 18 October at the World Health Summit in Berlin.

One other key challenge parliamentarians face is understanding and championing health-based legislation that address the upstream determinants of health, social, commerical or environmental, as compared to healthcare per se, pointed out Andrea Álvarez Marín, an MP from Costa Rica and president of the Costa Rican National Assembly’s social affairs committee. 

“If we focus on the kinds of conversations that we have been having in this summit, all of us usually speak about the social determinants of health and risk factors and the causes of the causes.” she observed. “But if we go to the general public, the general public still thinks of health as access to health care only. 

“And this makes it hard to push legislation and partly explains why recently in our committee on social issues, a cancer treatment bill passed swiftly through – although in my opinion, it will have a low impact, while legislation such as labeling, taxes and food marketing tends to be archived. It’s because other Congress people don’t see these measures as being effective for prevention.”

She said that regional networks of parliamentarians, complementing global networks like UNITE, can also help bridge the knowledge gap.  

“Since 2015, the Pan American Health Organization (WHO/PAHO) has been organizing yearly conferences in which the heads of the [parliamentary] health and social committees come together and discuss best practices, common failures and the most recent evidence, so that among parliamentarians, we can see what worked in other countries and apply it to our own. 

“So I still think that a global network such as the one that was announced today has to be complemented with regional networks, because globally the conversations will be around the main challenges and the main solutions, but these solutions always need to be operationalized on the national level. And by having regional networks, such as the one we have in PAHO, we can get with countries that have a common history and common challenges.” 

Health emergencies intertwined with conflict, economic and food challenges

British MP Liam Byrne speaks at a World Health Summit event on the role of parliamentarians in advancing global health policies on Monday, 17 October.

Recognizing the increasingly complex relationships between social, environmental and economic risks and the health emergencies that they can produce has never been so important,  underlined participants at another UNITE session the day before, focusing on the pandemic accord. 

Today’s global health issues are intertwined more deeply than ever with global challenges of war and peace, migration and climate change, and even the debt crisis, emphasized Liam Byrne, a British MP and former member of Prime Minister Gordon Brown’s cabinet, from 2008-2010.  

“Some 41 countries now face a threat of civil war and conflict and violence. That now means the number of people living in conflict zones has doubled in the last 10 to 15 years; we have something like 20 million refugees around the world, living in the most unspeakable conditions. 

“But that is not the only crisis. Because as countries came out of COVID with debts high and we now face the rising American interest rates, we have something like 40 to 50 countries now facing debt distress. On top of that, there is the food crisis that is now confronting hundreds of millions of people around the world with the threat of starvation,” he added. 

“After millennia of being able to predict the seasons, actually we can’t predict the seasons anymore.…We now face a crisis of farming and food insecurity that threatens the lives of 205 million people. 3.1 billion people now do not have enough money to afford a good diet.

“And 11 million people now die each year because they cannot afford the nutrition that they need. So when you put all of that together, the risks are really clear. 

“We have to be so careful today that we don’t get caught in a vicious cycle of how a pandemic of disease triggers a pandemic of poverty, which in turn triggers future pandemic disease in the years to come. 

“We know that prevention is better than cure. So what do we, as parliamentarians do, sit back and hope it doesn’t happen again?  

“That is why this initiative is so important. We have to insist as representatives of the families of the 6.5 million people who lost their lives in this pandemic, that this never happens again.”

Image Credits: Fletcher/Health Policy Watch , Fletcher/Health Policy Watch.

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