04 February 2009
Opening og the Copenhagen School of Global Health - Copenhagen, 2 February 2009
Opening speech by Ulla Tørnæs, Danish Minister for Development Cooperation
Rector, Distinguished Guests, Ladies and Gentlemen,
The landscape of research for health is changing.
More than ever there is recognition that health issues have implications that extend far beyond the health sector. The AIDS epidemic in Africa has caused severe problems for all parts of society and for the future of the most affected states. Pandemic diseases do not respect national borders and call for new health security systems. Unequal distribution of income and decent health services cause migration in search for a better life next door or further away. Human health and global health are important to so many dimensions of society today. Still, the developing countries bear the heaviest burden. In an environment of globalization, urbanization and rapid technological innovation there is, therefore, an urgent need to rethink the role of research. And ensure that the research we undertake is relevant to improve health in developing countries.
[What are the present challenges for Global Health?]
Global health has made astonishing achievements during the last centuries. Life expectancy has increased dramatically in the last six decades due to improvement in public health infrastructure and rise in wealth and education. But the achievements have not been felt uniformly. Today, the global gap in life expectancy is the widest in human history ranging up to five full decades. This gap somehow captures the challenges for global health leaders as well as researchers.
In recent years, we have seen an increased focus on global health issues. We know there is a link between poverty and poor health. And we know that investments in improved health stimulate economic development and contribute to a general improvement of living standards.
When the world's leaders adopted the Millennium Development Goals in 2000 health issues were at the centre of their attention. Three of the eight goals relate directly to health: MDG4 on reducing infant mortality, MDG5 on improving maternal health, and MDG6 on combating HIV/AIDS, malaria and other infectious diseases. A recent review of all MDG's clearly indicates that especially MDG5 on maternal health shows the least progress. This is an issue we clearly need to address, and which I will come back to.
If we look at the last decade, the HIV/AIDS epidemic has dramatically changed the way we look at global health. In just 10 years, we have seen an explosion of new global health partners and a tremendous increase in global health spending. Since the beginning of 2000, the increase in foreign aid and private spending for global health has been six-fold. This has generated clear results. Millions of children have been immunized and are now safe from life threatening diseases. 3 million HIV-positive people are receiving life saving medicine. At the same time, the cost of AIDS medicine has decreased dramatically.
But despite the increased number of players and increased resources this has yet to provide tangible results in health for all. Although some health indicators have improved among certain groups, we witness an increasing gap in health outcomes, especially amongst women. Maternal health is simply not progressing in many developing countries.
The need to improve women's health in developing countries is a key issue for Denmark and something very close to my heart. The figures speak for themselves:
Each year more than half a million women die due to something as simple and natural as pregnancy and childbirth. To me this is really a scandal.
The direct implication is that millions of children every year are left without their mother - the primary caretaker in the family.
If we look at Africa, 1 out of 16 women risks dying due to complications related to pregnancy or childbirth. In Denmark, it is 1 woman out of more than seven thousand.
In my mind, this enormous difference in maternal mortality represents the most striking health disparity in the twenty-first century. And it tells me that even though we generally recognize the economic benefits of a healthy population, we still have far to go. The cost, for instance, of providing safe abortion is 1/10 of the cost of treating complications related to unsafe abortion. Therefore, we have to find new ways of portraying health expenditures. We have to present them as more than costs, but as sound economic investments that will save money and improve the productive assets of societies. Failing to do so means wasting a crucial opportunity.
[What is Denmark doing to improve global health?]
As you know, Danish development assistance has a strong profile within health. Bilaterally, we have been in the forefront of extensive reforms within the health sector in several developing countries. Multilaterally, Denmark is a strong advocate for effective and well-coordinated health interventions.
The focus on health will also be a core element of Danish development assistance in the years ahead. We will continue to strengthen our support to improve health and initiate strategically important interventions. One of the new activities in 2009 will be the launch a specific Fund to improve women's sexual and reproductive health and reduce maternal mortality. In 2009 alone I have set aside 85 million DKK to support concrete projects through the Fund.
It is important to ensure that the necessary structures are in place in order to deliver general health care services to the entire population. Denmark has built up a strong commitment to enhance national health systems in a number of the partner countries that we support. We will continue this work and constantly improve our investments in close partnership with the national governments.
When it comes to meeting the special needs of women, the strengthening of health systems is also essential. It requires a functioning health system at the local level to ensure that simple complications on pregnancy and childbirth do not develop into serious complications. Related to this is the issue of financial barriers to pay for emergency care and skilled delivery services. Even small user fees have shown to be a hindrance for women's access to services. We will therefore try to establish health care services free of charge for pregnant women and small children.
Let me also highlight HIV/AIDS which is still one of the biggest challenges in Africa. We will maintain our specific focus on HIV/AIDS prevention, treatment and care and ensure that our support to this will reach an annual figure of 1 billion Danish Kroner by 2010. A substantial part of this amount is allocated to the strengthening the health systems.
[How can we strengthen research and educational capacity within health?]
Now, let me turn to the reason why we are gathered here today. It is very exciting for me that the University of Copenhagen now scales up its activities for health by opening the Copenhagen School of Global Health. One of the purposes of the School is to promote health and development through research on major health problems affecting low- and middle-income countries. This is indeed a goal I share with you.
The Copenhagen School of Global Health opens at a point in time where we witness a noticeable shift in health research - from more traditional approaches to a broader focus on research for health. This goes hand in hand with the recognition that health is much more than the absence of disease. Research for health is part of a much broader context. The overall question to be asked is what kind of research is needed to bring about change in health in developing countries. To answer that, we need to study social, political, economic and ecological determinants for health. We need to look at systems and governance to make progress on health equity. And we need a close dialogue with many different stakeholders in the developing countries. I know that the University of Copenhagen is closely involved in research that documents the real barriers for health. And I believe that the new Copenhagen School of Global Health has an important role to play within this field.
Support to research for health is an integral part of Danish development assistance. In 2008, our support amounted to approximately 70 million DKK for this purpose. It is extremely important that African Universities become much closer partners to the global research networks. That they are able to benefit from the sharing of knowledge between researchers around the world. A key area for our support is therefore to strengthen the quality of health education and research in Africa. The Danish supported Masters Programme in International Health is a good example of this. Another example is the successful collaboration between African Universities and the University of Copenhagen in developing courses for enhancing skills and competencies for researchers and health workers from Africa.
In the future, we would like to see a stronger integration between research and development assistance, for instance through closer involvement of and by researchers from the developing countries. I am particularly happy that the Copenhagen School of Global Health intends to look at ways to strengthen the collaboration with partner universities in Africa and contribute to their institutional capacity.
Capacity building includes education and research skills. But it is equally important to build up communication skills in order to ensure that results are being used. Your research can play a vital role in changing the political decisions. The Copenhagen School of Global Health should help us look 10 - 15 - 20 years ahead and guide us to take decisions that ensure that we provide the best support to tackle the future health challenges. Communication is vital to be able to do that. I guess I am not stepping on anyone's toes by saying that this is not a key activity for many researchers. But I hope it is an issue you will include in your partnership with African research institutions.
[Health challenges ahead]
Looking ahead there are a number of key challenges of relevance to research for health. I have already mentioned women's health and HIV/AIDS as some of the cornerstones in our work. Malaria, TB and the impact of urbanization and climate change are other key challenges on our agenda. Another upcoming issue is the increasing burden of non-communicable diseases such as mental disorders, diabetes and cancers. When we look at estimates from WHO, these diseases will gradually assume a much larger burden of ill-health in the developing world. When it comes to diabetes the Danish company Novo Nordisk is at the forefront of research and is contributing actively to prevent and treat diabetes in the developing world. They have also made a very substantial and commendable contribution to the Copenhagen School of Global Health by providing funds for a professorship in global health.
Let me end by quoting the new secretary of State Hilary Clinton. When she took office in the new Obama government she stressed the need to work on women's health. She said: "Of particular concern to me is the plight of women and girls, who comprise the majority of the world's unhealthy, unschooled, unfed and unpaid."
I hope that her commitment to this agenda can contribute to stronger results. To the benefit of millions of women around the world. I am also confident that the new Copenhagen School of Global Health can make a good contribution to this as well as to other challenges. I wish you much success and look forward to a fruitful cooperation.
Thank you for your attention.