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APathfinderforGlobalHealth:

PotentialApproachesinWales

February2016


Contents

Executivesummary.......................................................................................3

Acknowledgments.........................................................................................4

Introduction..................................................................................................5

1.Health,globalisationandsustainabledevelopment...................................5

TheStrategicContext....................................................................................................6

2.Walesandglobalhealth.............................................................................9

3.PotentialapproachesinWales.................................................................11

The‘right’conditionsinWales(the‘WelshModel’)....................................................11

Principles....................................................................................................................12

PotentialapproachesinWales...................................................................................13

4.Conclusion...............................................................................................14

Figuresandtables.......................................................................................15

Sources.......................................................................................................18


ExecutiveSummary

This paper presents Wales’ response and potential approaches to the Global HealthEmergencies concerns and recommendations of the 32nd Annual Plenary Meeting of theInterActionCouncilinJune2015andaspirestoinformtheupcomingHighLevelExpertGroupmeetingoftheInterActionCouncilinFebruary2016.

The document recognises that health is multi-level: global, national, regional, local,

community and individual and that the connections between these are complex and

reciprocal, including wider determinants and inequalities. Globalisation, environmental,

socialandeconomicchallengesarerelatedtoplanetaryandhumanhealthandsustainable

development. Global Health Security is concerned with all aspects of human health,

including communicable and non-communicable diseases, emergencies and globalisation

processes. Good health and wellbeing is important prerequisite for sustainable

developmentandeconomicgrowth.

The paper outlines a possible Welsh ‘pathfinder for global health’, offering examples of

nationaldevelopmentscontributingtoincreasingawarenessofandstrengtheningresponse

toglobalhealthsecurity.Itshowcasestheexplicitandinterlinkedcommitmentofnational,

public and third sector bodies to sustainability, health and wellbeing, international

development and global citizenship through coordinated, coherent, cross-sector, multi-

agencyapproach.ThedocumentisframedbytheWelshpolicyandlegislativecontextand

considerstheEuropeanandUKcontext.

This‘pathfinder’shouldstrengthenWelshposition,promotepartnershipandcontributeto

mutuallybeneficialcollaborationsgloballyandgreateralignmentbetweenthefoursectors

ofacademia,industry,governmentandthenotforprofitsector.Therearesixspecificareas

whereWaleshasthepotentialtomakeadifference,subjecttothenecessaryengagement

andbrokering of ownership, namely: engaging throughnetworks; promoting research for

‘OneHealthAgenda’; support and training for health and relates professionals aswell as

capacitybuildingandutilisation;normativeandmoralleadershipforhealth;andsupporting

multi-sectorapproachtoimprovingnationalandglobalgovernanceforhealth.


Acknowledgments

The‘PathfinderforGlobalHealth:PotentialApproachesinWales’documenthasbeen

developedjointlybycontributorsfromPublicHealthWales,TheLearnedSocietyofWales

andAberystwythUniversityincludingProfessorColinMcInnes,ProfessorJohnWynOwen,

DrTraceyCooper,DrQuentinSandifer,ProfessorMarkBellisandDrMarianaDyakova.


APathfinderforGlobalHealth:

PotentialApproachesinWales

Introduction

Thispaperoutlines thepotential forWales tooffera ‘pathfinder forglobalhealth’andto

provideanexampleof relevantnationaldevelopments.Thegenesisof thedocumentwas

the final communiqué from the 32nd Annual PlenaryMeeting of the InterAction Councili,

heldinJune2015,andaimstoinformadiscussionataHighLevelExpertGroupmeetingon

GlobalHealthSecurity tobehostedby the InterActionCouncil inFebruary15-16,2016. It

describes potential approaches that Wales could take in response to the increasing

awarenessofglobalhealth,andglobalhealthsecurity,asapublic,policyandacademicissue

ofimportanceanditsimplicationsatnationalandlocallevel.

Thepaperisorganisedintothreesectionsstartingwithadescriptionofthecontext(Health,

globalisationandsustainabledevelopment),followedbyastatementoftheimplicationsfor

Wales(Walesandglobalhealth).Thepaperthenoutlinessomeofthedistinctiveconditions

in Wales (the ‘Welsh model’) before describing potential approaches that Wales might

pursue.

1. Health,globalisationandsustainabledevelopment

Our world has become ever more interconnected and interdependent. Globalisation

processes (i.e. migration, global economy and trade, urbanisation, communication) and

environmentaldegradation (i.e. climatechange,deforestation, soil andwaterdecline)are

havingdirectandindirectimpactsonhumanhealthandwellbeing.Ina‘borderless’world,

localhealth threatscanbecomeglobalandglobalhealth threatscanhave localeffectsas

experience has shown with communicable and non-communicable diseases, natural

disastersandtheriskofthedeliberateuseofpathogensbyterrorists.

Thepopulationhealthimpactofglobalisationisseenmostclearlyintherapidandextensive

spreadofcommunicablediseases, includingoutbreaksofzoonotic infectionssuchasSARS

(2003)andH1N1(2009).Thesediseaseshavespreadacrosscontinentswithease,creating

health risks and fear not seen for generations. Almost a quarter of the global disease

burdenii is caused by modifiable environmental factors, such as physical, chemical and

biologicalhazardsiii.Globalisationaffectsalsoarangeofhealthgoodsandservices,including

themobilityofhealthprofessionalsandaccesstomedicines.


Social, environmental and economic instability and extremeevents are threats to all, but

thepooranddisadvantagedareaffectedthemost-maintainingandincreasinginequalities

within and between countries. At the same time the advent of modern and affordable

communications (i.e. smart phones) allows immediate information spread, i.e. everyone

knowseverythingeverywhere.Thus,peoplelivinginpovertyareconnectedtotheworldof

themost affluent while themost affluent see those suffering in poverty. This may raise

expectationsanddemands fromgovernments.Violence,conflict,populationdisplacement

andwarcanbetriggeredbygrowingpopulationsandscarcityofresources,pushinghealth

andsustainabilitysystemstotheirlimits.

Thus the challenges of globalisation are related to planetary and human health and

interlinked with sustainable development: “A growing body of evidence shows that the

healthofhumanityisintrinsicallylinkedtothehealthoftheenvironment,butbyitsactions

humanity now threatens to destabilise the Earth’s key life-support systems.”iv Health

security issues are reciprocally related with the three pillars of sustainability: economic,

socialandenvironmental(fig.1).Whilefoodconsumptionpatternsareriskfactorsformost

non-communicablediseases,unsustainableconsumptionoffiniteresourcesplaysakeyrole

inglobalwarming,foodandwatersecurity.Chronicconditionsalsoposeriskstosustainable

development, by increasing the probability of poverty through reduced income and early

retirementv. Good health is therefore an important prerequisite for both sustainable

developmentandeconomicgrowth.

Thestrategiccontext

Viewedfromdifferentperspectives,healthcanbeframedasahumanright;asecurityissue;

an equity issue; a legal obligation of governments; a global, national and personal

responsibility; a factor contributing to and dependent on economic growth; and a factor

contributing to and dependent on sustainable development. The global health security

agenda has to be considered both in developing and developed countries but requires

differentapproachesineachaswellasgloballyagreedprocesses,exchangeandstructures.

Co-ordinated, coherent and focused international activity,working inpartnership, sharing

knowledge,resourcesandcapacitywillallowustoalignandachieveourmutualhealthgoals

aswellastoperformhorizonscanningforglobalsecurityrisks,threatsandopportunities.

GlobalHealthSecuritycoversallaspectsofhumanhealth.Theglobalisedworldofthe21st

century and its economic, social and environmental challenges directly influence public

health(see‘GlobalHealthSecurityIssues’boxbelow).Globalwarmingandclimatechange,

migration,conflictandviolence,financialturbulence,andepidemicsofcommunicableand

non-communicablediseasesaffectallpeopleandcountries.Theyrequiremulti-level,multi-

disciplinary,cross-sectorandcross-countryapproaches.


Onaglobal level, in2014theUNSecurityCouncil, forthefirst time,declaredadisease–

Ebola–tobeathreattointernationalpeaceandsecurity,reflectingthegrowingconsensus

thatcommunicablediseasesrepresentsecuritythreatsvi.Thisfollowedaseriesofoutbreaks

(includingSARSin2003,H1N1in2009andMERSin2012)demonstratingthepotentialfor

pandemicstoemergeandspreadquicklyduetopopulationmobility,whiletheriskofhighly

virulentpandemicinfluenzaremains.TheInternationalHealthRegulationsvii,revisedoncein2005,areagainbeingscrutinisedtoenableabetterresponsetotheseglobalthreats.

GlobalHealthSecurityIssues

1. Emergencies,includingenvironmental(natural/technologicaldisasters),economic(financialcrisis)andsocial/political(war,(bio)terrorism)

2. Epidemicsofcommunicablediseases,includingemergingonesandantimicrobialresistance

3. Epidemicofnon-communicablediseaseandtheirriskfactors(obesity,smoking,diet,etc.)

4. Globalisationimpacts:migration,urbanisation,globaltradeandcommunications,etc.

TheUnitedNationsSustainableDevelopmentGoals2016–2030viiirepresentamilestonefor

human and planetary sustainable development and an opportunity to address health,

inequalitiesandtheirwiderdeterminantsworldwide.Agreedbythe193MemberStatesof

theUN, theyconsistof17SustainableDevelopmentGoals (SDGs) (fig.2)and169targets.

TheyarepotentiallymorethansimplyafollowupfromtheMillenniumDevelopmentGoals,

rather representingamoreambitiousagendawhere the responsibility isplaced firmlyon

member statesix. The 2030 Agenda integrates all three dimensions of sustainable

development(economic,socialandenvironmental, fig.1), representingamajorshift from

multiplefragmentedparallelprocessestoasinglecomprehensiveanduniversalagendafor

the people, planet and prosperity, grounded in peace, justice, inclusiveness, strong

governance, and global partnership. It recognizes the goals’ interrelation and

interdependenceandexplicitly links them through their targets,meant to facilitate cross-

sector integration, policy coherence and whole of government, whole of society

approaches.

Health inthe2030AgendaisanexplicitoutcomeinitsownrightinSDG3:Ensurehealthylivesandpromotewell-beingforallatallages.Importantly,healthisalsoaninputtoother

goals, andameasureofhowwell sustainabledevelopment is progressing in general. The

global goals promote also the ‘One Health Agenda’, integrating planetary health(environment, ecosystem, plant and animal health) and human health through SDGs 2

(agriculture), 6 (water), 7 (sustainable andmodern energy), 12 (sustainable consumption

andproduction),13(climate),14(lifebelowwater)and15(lifeonland).Theyrecognizethat

eradicatingpovertyand inequality,creating inclusiveeconomicgrowthandpreservingthe


planet are inextricably linked, not only to each other but also to population health and

wellbeing;andrelationshipsbetweeneachoftheseelementsaredynamicandreciprocal.

On a European level, theWHO European Health 2020 Strategy and Policy Frameworkxrepresentsanothermilestone,aiming tosupportactionacrossgovernmentandsociety to

“significantlyimprovethehealthandwell-beingofpopulations,reducehealthinequalities,

strengthen public health and ensure people-centred health systems that are universal,

equitable, sustainable and of high quality”. All 53 European RegionMember States have

signed up to it and committed to its implementation. Health 2020 highlights the role of

healthandwellbeingaspublicgoodsandassetsforhumandevelopmentthatcontributeto

economic growth and strong, dynamic and creative societies. It promotes whole-of-

government and whole-of-society approaches through vertical and horizontal policies,

actionsandacrosssectorwork. Itrecognisesthatdifferentcountriesandcommunitiesare

atdifferentstartingpointsandcanpursuecommongoalsthroughdifferentpathways.Social

progress isbestmeasuredbyobjective indicatorsofhealth,healthequityandwell-being,

andthisincludestheconditionsinwhichpeopleareborn,liveandwork.

Health2020values,principlesandapproachesareclosely related to theSDGs, suggesting

commonopportunitiesandstrategiesforimplementationandprogress.

The United Kingdom strategy for 2008–2013, Health is Global,xi accepted a growingconsensusthatnationalhealthcouldnotbedivorcedfromglobaldevelopments, inhealth

andinrelatedfields,includingmacro-economicgrowthanddevelopment.Consideringthat

healthandhealthcare in theUK isadevolvedresponsibility,moreattention isneededto

definehowthenewglobalcontextaffectsdevolvednationsandhowtheycancontributeto

globalhealthsecurity.

MainstreamingSustainableDevelopment–TheGovernment’svisionandwhatthismeansinpractice,2011xiisetsouttheUKcommitmenttoamoresustainableapproachtopolicyand

government action and promoting “the synergies between enhancing and protecting our

environmentandimprovingthequalityoflifeandhealthofourcommunities”.PublicHealth

EnglandhasalsopublisheditsGlobalHealthStrategy2014–2019xiiiaswellastheFacultyofPublic Health for 2015-2019xiv. Engaging in Global Health - The Framework for VoluntaryEngagement in Global Health by the UK Health Sector, 2014xv focuses on how voluntaryinternationaldevelopmentworkcancontributetobuildingandsustainingcapacity in low-

and middle-income countries. It also outlines the benefits and opportunities for UK

employers,professionalassociationsandindividualvolunteers.

WithinWalestheWell-BeingofFutureGenerations(Wales)Act2015xvi(WBFGA)representsafirstofitskindnationalsustainabledevelopmentlegislation.Itsmulti-dimensional,cross-

sector and multidisciplinary framework focuses on improving the social, economic,

environmental and cultural well-being of Wales. It poses a statutory requirement on all

public bodies to prioritise and take action in pursuit of the sustainable development

principle.TheActputsinplacesevenwell-beinggoals(fig.3)whichareinterrelatedwiththe


SDGsandhavedirectorindirectcontributiontoachievingpopulationhealthandwellbeing

inWalesandbeyond(table1).Itisauniquevehicleforthepromotionandimplementation

oftheglobalSDGsandthewidersustainabilityagenda.

TheCharterforInternationalHealthPartnershipsinWalesxvii(theCharter),developedbytheInternationalHealthCoordinationCentre (hostedbyPublicHealthWales), introducesand

aims toensurecommonprinciplesandstandards for internationalhealthworkacross the

NHSinWales.AllhealthboardsandtrustshavepledgedtotheCharterin2014,committing

to sound governance, organisational responsibility, reciprocal partnership, and good

practice. The Charter implementation links to theWBFGA and contributes directly to its

GlobalResponsibilityGoal(fig.3).

The SustainableDevelopmentCharter of Cynnal Cymruxviii (SustainWales)encourages andenables organisations in Wales to become more sustainable – to make decisions that

producethebest long-termoutcomesforthemselvesandforthefutureofWales.Signing

the Charter is a voluntary commitment aimed at improving the economic, social,

environmentalandculturalwell-beingofWales.

Public HealthWales Strategic Plan 2015–2018xix outlines its work ‘locally, nationally andinternationally, with our partners and communities’ in various public health areas ‘to

achieve a healthier, happier and fairerWales’. In doing so, it addresses its owndomestic

priorities,whilecontributingtothepublichealthprioritiesofothers.Theglobal,European,

UK and national strategic developments are reflected and require a clear and coherent

approachinternallyandexternally.

2. Walesandglobalhealth

Walesisaffectedbyglobalhealthintwodistinctways:

1) Healthdevelopments;and

2) Policydevelopments

Walesisnotimmunefrombroadertrendsanddevelopmentsinglobalhealth,including:

− the risk of novel infections and pandemics, especially related to antimicrobial

resistanceanditsimpactbothonthepeopleandonthefoodchain;

− themobilityofhealthprofessionalsandtheimpactonthecapacityofhealthsystems

inanincreasinglyglobalisedworkplaceforhealth;

− theglobalmarketforhealthandrelatedproducts;

− researchanddevelopmentprioritiesinhealth;

− thepromotionofunhealthyfoodproductsandlifestyles;and

− theaccumulationofharmfulenvironmentalimpacts,i.e.globalwarming.


Anothernothealthspecific,butrelevantdevelopmentistheconceptofglobalcitizenshipxx

(world citizenship), defining the idea that one’s identity transcends geographyor political

borders and that the planetary human community is interdependent and whole, i.e.

humankind is essentially one. This has implications for Wales – linking to the Global

Responsibilitywellbeinggoalof theWBFGAaswellas to theobligation to implement the

InternationalHealthRegulations(IHR).

Walesisalsoaffectedbyarangeofpolicydevelopmentsaspartoftheframeworkforglobal

governance.Someofthesepolicydevelopmentsareinthehealthsphere,forexample:

− Surveillanceandreportingofinfectiousdiseases;

− Controlofunhealthyfoodproducts(mostnotablytheWHOFrameworkConvention

onTobaccoControlxxi);

− Agreementsonstockpilingofpharmaceuticals;

− Waterstandards(forexample,blueflagbeaches);

Othersareoutsidethehealthspherebuthaveimplicationsforhealth,forexample:

− International agreements on patent protection, with implications for the

developmentofand/oraccesstopharmaceuticals;

− Economicdevelopmentpolicies;

− Tradeand investmentagreements,suchastheTransatlanticTradeand Investment

Partnership (TTIP)xxii being negotiated between European Union and the United

States.

Wales, likeotherdevolvednations intheUK,hasresponsibilityfortheprovisionofhealth

services and the protection of citizens from health threats as well as for its health

legislation.However,significantareasofpolicythataffecthealthinWales,suchastradeand

international development, are not devolved. While Wales has numerous programmes

which contribute towards global health developments, itsmechanism for influencing the

broader determinants of global health also rests in its ability to effectively engage and

influencetheUKGovernment.

Two related trends are emerging. The first is a growing acceptance that governancearrangements for global health need strengthening. The 2014-15 West African Ebola

outbreakthrewintosharpreliefthe inadequaciesofthecurrentsystem–fromincountry

infrastructure, through surveillance to response. The international community is now

lookingatwhatcouldbedonebetterbyinternationalagenciesandtoconsiderthecorrect

approachandwhether thestructuresneedtobereformed.Global threatsandchallenges

requireglobalsolutions.Thisiscomplicatedbyagrowingawarenessthathealthisnotonly

inter-sectoral, but also scalar. The links between poverty and poor health are well

established,tyingarangeofotherpolicyissues(suchaseconomicgrowth,socialexclusion,

accesstoeducationandsocialmobility)tothepromotionofhealth.Whatwenowfaceisa


situation where these broader policy issues at a global level can impact upon nationalhealth,inWalesandelsewhere.

The second trend is reframinghealthasasecurity issue, i.e.health is fundamental to the

securityofthe individual, thecommunityandthestate.Thishas largelybeendiscussed in

termsofthespreadofcommunicablediseases,mostnotablyHIVandpandemic influenza.

Diseasessuchasthesehavethecapacitytoaffectnotonlylargenumbersofindividualsbut,

if the morbidity/mortality rate (or the fear of contagion) is sufficiently high – they can

damage economic performance and even the functioning of the state. Some countries,

notably the US, have seen national and international public health capabilities as critical

national security assets. TheUNSecurity Council has passed resolutionsonbothHIV and

EbolaVirusDisease(EVD)andconsideredthe2014EVDoutbreakinWestAfricaathreatto

international peace and security. TheWHO presented its strategy against the threats of

communicablediseaseasonethatwouldstrengthenglobalhealthsecurity.

Howeverhealthsecurityisnotlimitedtocommunicablediseases.‘Westernisation’,presents

increasing threats to individuals and populations from chronic diseases and diseases

consequentonchanginglifestyles.Theseareevidencedbyrisinglevelsofobesity,smoking

insomeregionsoftheworldandincreasingprevalenceofspecificdiseasessuchasdiabetes.

Theirimpactsdirectlyconnectpublichealthwiththeconceptofhumansecurity,placingthe

individualandnotjustthestateasthecentreofsecurityconsiderations.

3. PotentialapproachesinWales

The‘right’conditionsinWales(the‘WelshModel’)

The‘Welshmodel’consistsofthefollowinginterconnectedandinterdependentelements:

1. Explicit national (Welsh Government) commitment to sustainable development and

cross-sector work. The Well-Being of Future Generations (Wales) Act 2015 with 7crosscuttingwellbeinggoals,embodiesawhole-of-governmentapproach(fig.3).

2. Explicitpublicsectorcommitmenttothesustainabledevelopmentprincipleandagenda,

including health, wellbeing and equity. This is a statutory requirement for all public

bodies (arising from theWBFGA), ensuring horizontal collaboration. In addition, there

hasbeenacoordinatedeffortbetweenWelshGovernment,PublicHealthWales,other

stakeholdersandthepublictoaligntheSDGsandtheirtargetsandindicatorswiththe

WBFGAgoalsanditsnewlydevelopedindicators;andinduecoursewiththenewPublic

HealthOutcomesFramework forWales.Thus, there isa realopportunityanddrive to

createacoherentaccountabilityframeworkwithmeaningful,relevantandtransferable

targets / indicators. These can help implementing the SDGs across Wales as well as

provideanexampleofverticalcollaborationandalignment.


3. Explicit National Health Service (NHS) commitment to the Charter for International

Health Partnerships inWales. All health boards and trusts have pledged to it and are

implementing it, ensuring better governance and organisational responsibility for

international health work, reciprocal partnerships (of benefit both to the Welsh and

foreignpopulations)andfollowinggoodmedicalandpublichealthpractice.

4. Explicitgovernmentalcommitmenttocoordination,coherenceandnationalsupportfor

international health work across the NHS and whole of Wales, through the

establishment of the International Health Coordination Centre (IHCC) within Public

HealthWales.

5. Wide community and non-governmental commitment towards sustainability and

partnershipwork(whole-of-societyapproach).Thisisembodiedinestablishmentofthe

Hub Cymru Africa with overarching responsibilities for coordination and funding of

developmental work in Africa; theWales for Africa Health Links Network, supporting

health partnerships with Sub-Saharan Africa; theWelsh Council for Voluntary Action,

supportingandrepresentingWales’thirdsector;theCynnalCymruCharter,etc.

6. Explicitandfunctionalcommitmenttocross-sector,multi-agencyandmulti-disciplinary

approach, bridging the gaps in a cross-sector governance for health. This includes the

establishmentofjointpostsandprogrammesofworkforhousingandhealth;policeand

crimeandhealth;environmentandhealth;sportsandphysicalactivity.

7. Explicit consideration of the Global Citizenship idea and plans to improve health

professionals’ understanding and develop their capacity in global health, global

responsibility and citizenship. This is undertaken by the IHCC with a scoping

questionnaireandexploringopportunitiesforeducationandtrainingacrosstheNHS.

Principles

TheproposalsinthispaperareframedbytheWelshpolicyandthelegislativecontextofthe

WBFGA Sustainable Development Principlexxiii (fig. 4), including long-term; prevention;

integration;collaborationandinvolvement.

ItisalsoguidedbythePrudentHealthcareprinciplesxxiv(fig.5)ofco-production;priorityofgreatest health need and most effective use of skills and resources; doing only what is

neededanddoingnoharm;andreducinginappropriatevariation.

Thepaper recognises thathealth ismulti-level: global, European,national, regional, local,

community and individual and that the connections between these are complex and

reciprocal,includingwiderdeterminantsandinequalities.

Furthermore,theseproposalsarebasedonandcancontributetoprogressionoftheunique

‘Welsh model’ of linking global and national sustainable development with health and


wellbeing. It presents an opportunity and provides a vehicle to implement the 17 UN

SustainableDevelopmentGoalsinWales.

PotentialapproachesinWales

Severalpresentthemselvesforconsideration:

1. Todemonstrateanovelapproachlinkinghealth,wellbeingandsustainabledevelopment

onanationallevel.The‘Welshmodel’canbescaledup(globally)ordown(locally)and

itsapproachescanbeadaptedandusedinvariouscontextsandsettings.

2. To contribute to further progress in meeting the new global, European and UK

challenges and opportunities, supporting global health security, emergency

preparednessandsustainabilityacrossWales,theUKandbeyond.

3. To promote cross-sector partnership and governance as well as health system

strengtheningacrossgovernment,academia,industryandthethirdsector.

4. TodescribetheWelshroleandprovideacoherentandrelevantcontributiontothe‘UK

offer’onglobalhealth.

5. ToinformtheInterActionCouncil’sagendaandpriorities.

The Pathfinder should strengthen theWelsh position, promote partnership working and

contributetomutuallybeneficialcollaborationsgloballyandgreateralignmentbetweenthe

foursectorsofacademia,industry,governmentandnon-profit.

TherearesixspecificareaswhereWaleshasthepotentialtomakeadifference,subjectto

thenecessaryengagementandbrokeringofownershipofrelevantactionsbytherelevant

WelshandUKagencies,andindoingsoserveasanexampletoandbeanactiveparticipant

intheGlobalHealthSecurityandsustainabilityagenda.

I. Networks

Walespossessesarichvarietyofformalandinformalnetworks,bothwithinthehealth

andrelated fields.Someof thesearewithotherdevolvednationsandagencies, some

are UK-wide, and some are international. Wales can use these as platforms for

influencing progressive policies. Examples include: Wales’ leading role in the WHO

European Regions for Health Network, especially for sustainability and health; Public

Health Wales membership and active partnership within EuroHealthNet and the

InternationalAssociationofNationalPublicHealthInstitutes(IANPHI);andadeveloping

collaboration with the Commonwealth Secretariat, supporting its programme of

strengthening the sustainability of delivering universal health coverage.

II. Research

A number of opportunities exist, across health, life and social sciences, to make a

difference to our understanding of the drivers and consequences of global health

development.These includebothuniversitiesandother researchorganisations.Wales


has particular strengths in rural health and agriculture, global health governance and

withthe‘OneHealthAgenda’.

III. Supportandtraining

It is unrealistic to consider a small nation such asWales providing large scale generic

training to low income countries.However, targetedpackagesbuildingonestablished

and recognised, or readily developed, strengths and utilisingmodern technologies for

enhanced delivery are realisable. Examples include the ongoing developmental and

educationalactivitiesofHubCymruAfricaincludingtheWalesforAfricaHealthLinks,as

wellastheGlobalCitizenshiptrainingplannedforhealthprofessionals.

IV. Capacitybuildingandutilisation

WHOisdevelopinganenhancedresponsecapacity for largescalehealthemergencies.

Keytothisisa‘surgecapacity’,wherebyprofessionalsnotonlyfromthehealthsector,

but others aswell, can bemobilised on a global scale. EnsuringWales can effectively

contributetothisisonewayinwhichitscapacityandcanbeutilised.

V. Normativeandmoralleadership

EnsuringWalesremainsfullycompliantwithkeyhealthgovernanceinstruments,suchas

theInternationalHealthRegulations(IHRs).WhilenoagencyinWalescanlayclaimtobe

theNationalIHRFocalPointfortheUnitedKingdom,bodiesinWalescanprovidemoral

leadershipinensuringthattheUKmeetsitsinternationalobligationsandPublicHealth

Wales actively supports Public Health England in the discharge of its responsibilities

undertheIHRforpublichealththreatsthatmightimpactonWales.Anotherexampleis

PrudentHealthcareandensuringhealthorganisationsfollowitsprinciples(fig.5).

VI. Multi-sectoralapproachandgovernanceforhealth

Wales isuniquelyplacedtoshare itsgovernancemodel,basedontheWBFGAandthe

elements described above. Open and pro-active collaboration with other countries,

regionsandauthoritiesacrossEuropeandtheworldcanpromote,supportandprovide

an incentive for developing effective and functional cross-sectoral governance

elsewhere, protecting, promoting and improving health and wellbeing on a national

level, but also supporting global health governance and responsiveness to common

threatsandchallenges.

4. ConclusionThispaperdescribespotentialapproachestothedevelopmentofaPathfinderforGlobal

Healthbasedona‘Welshmodel’that,togetherwithnewlegislation(WBFGA),provides

aplatformforincreasingawarenessandstrengtheningtheresponseinWalestoglobal

healthandglobalhealthsecurity,asimportantpublic,policyandacademicissues.


Figuresandtables

Figure1:Thethreepillarsofsustainabledevelopment:economic,socialand

environmental

Figure2:The17UNSustainableDevelopmentgoals(2016–2030)


Figure3:Well-BeingofFutureGenerations(Wales)Act2015Goals

Figure4:SustainableDevelopmentPrinciple


Figure5:PrudentHealthcareprinciples

Table1:GlobalHealthSecurityandimplementingtheUNSDGsandtheWBFGAGoals

DirectcontributiontoGlobalHealthSecurity

UNSDGs WalesWBFGAGoals

Goal#1PovertyGoal#2HungerandfoodsecurityGoal#3HealthGoal#6WaterandsanitationGoal#10InequalityGoal#13ClimatechangeGoal#16Peaceandjustice

AhealthierWalesAgloballyresponsibleWales

IndirectcontributiontoGlobalHealthSecurity

UNSDGs WalesWBFGAGoals

Goal#4EducationGoal#5Genderequalityandwomen’sempowermentGoal#7EnergyGoal#8EconomicgrowthGoal#9Infrastructure,industrialisationGoal#11CitiesGoal#12SustainableconsumptionandproductionGoal#14OceansGoal#15Biodiversity,forests,desertificationGoal#17Partnerships

AresilientWalesAmoreequalWalesAWalesofcohesivecommunitiesAprosperousWales


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