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Begin New Search Political Geography Global Focus Author Christoph Strupat

1. Global health at a crossroads: policy recommendations in light of the Lancet Global Health 2050 Report

Author:
Christoph Strupat, Marco Schäferhoff, Martin Siegel, and Anna-Katharina Hornidge
Publication Date:
01-2025
Content Type:
Working Paper
Institution:
German Institute of Development and Sustainability (IDOS)
Abstract:
At a time of global crisis and competing priorities, investing in health is among the most impactful and cost-effective decisions governments and stakeholders can make. Beyond being a fundamental right, health is a catalyst for growth, stability and resilience – particularly in uncertain times. The new Global Health 2050: the path to halving premature death by mid-century (Global Health 2050) report (Jamison et al., 2024) of the Lancet Commission on Investing in Health (the Commission) builds on a legacy of evidence-driven reports to provide strategies for making health a cross-cutting enabler of the Sustainable Development Goals (SDGs). Global Health 2050 provides a roadmap for further health improvements in all countries by mid-century, arguing that by 2050 countries can reduce by 50% the probability of premature death (PPD) in their populations. The Commission calls this goal “50 by 50”. Germany has solidified its role in global health through significant investments in the health sector and by designating global health as a political priority, as demonstrated by its Global Health Strategy and the inclusion of global health as one of the core themes of the Federal Ministry for Economic Cooperation and Development (BMZ). Given this political priority, it is essential to assess the implications of the Global Health 2050 report for Germany’s global health agenda, especially as global health stands at a crossroads following the withdrawal of the United States (US) from the World Health Organization (WHO) and cuts to its global health programmes. Therefore, the aim of this policy brief is to build upon the Commission’s findings and draw from scientific evidence to provide key recommendations for Germany’s global health agenda. Five recommendations have been synthesised that align with Germany’s global health engagement and offer promising strategies to help achieve the 50 by 50 goal: 1. Sustain or ideally increase funding for the Gavi, The Vaccine Alliance, and the Global Fund to Fight AIDS, Tuberculosis and Malaria at the upcoming replenishment conferences and strengthen Germany’s global health leadership through strong bilateral support, investments in pandemic preparedness and response (PPR) and better interministerial coordination. 2. Reconsider non-communicable diseases (NCDs) in future strategic direction of German international cooperation by reducing financial and geo-graphical barriers to access to medicines and addressing key NCD risk factors. 3. Promote health taxes on tobacco, alcohol, and sugar-sweetened beverages that can serve as an effective strategy to improve public health and generate domestic revenue. 4. Increase funding for R&D in neglected diseases. Expand regional manufacturing, and enhance global health innovation coordination to strength-en global health security and reduce dependence on external supply chains. 5. Nepal serves as a good example of Germany’s bilateral health and social protection support: advancing the 50 by 50 goal could be achieved by strengthening national health insurance, addressing climate risks, expanding health taxes and enhancing pharmaceutical access through the Arrow mechanism.
Topic:
Development, Investment, Public Health, Global Health, and Disease
Political Geography:
Global Focus

2. Health Financing in Times of Multiple Crises: Analysis and Recommendations

Author:
Christoph Strupat, Pooja Balasubramanian, Srinivasa Reddy Srigiri, and Anna-Katharina Hornidge
Publication Date:
01-2023
Content Type:
Policy Brief
Institution:
German Institute of Development and Sustainability (IDOS)
Abstract:
The COVID-19 pandemic has exposed the fragility of health systems and highlights the need for renewed efforts to finance pandemic preparedness, prevention and response (PPR) mechanisms, and universal health coverage (UHC). Two lessons emerge from this global health challenge. First, it has shown that global problems need global solutions, as well as the agency of local and national actors to make them work, so it is recommended that public health be considered a global public good. This requires solidarity between rich and poor countries to attain a globally “highest attainable standard” for managing pandemics and other public health emergencies. The provision of such a global public good requires substantial public resources. Furthermore, the focus should not only be on preventing the spread of diseases but also on detecting and fighting infectious diseases at their source. The second lesson is that prevention is a good investment, as it costs less than remedial interventions at later stages. Health systems can be considered as the means by which health priorities, such as pandemic PPR and UHC, can be operationalised. Studies show that health systems that could effectively leverage both robust health security core capacities (e.g. laboratories) and fundamental UHC interventions (e.g. accessible health facilities) were often in a better position to protect their citizens against the negative impacts of the COVID-19 pandemic. Focusing on the landscape of health financing in low- and middle-income countries (LMICs), it becomes clear that during the COVID-19 pandemic there was a substantial increase in international health financing. However, continued high out-of-pocket expenditure (OOPE) in LMICs points to a structural imbalance in health financing, which is one of the major barriers for achieving SDG3. Further contribution from international development assistance and an increase in domestic government expenditure by LMICs through improved mobilisation of domestic resources is therefore impera-tive. Funding gaps to achieve PPR and UHC in LMICs are small in relation to the projected costs of a pandemic such as COVID-19. However, as global debt levels soar, fiscal spaces to close these funding gaps become smaller. The following policy options for governments and international development partners should be considered to protect and improve spending on health in times of shrinking fiscal spaces: reallocation within budgets towards health, better priority-setting of health financing, and greater use of debt-to-health swaps, health taxes and national health insurance schemes. Importantly, investment in health is critical not just for the health benefits, but also because of the positive socio-economic impacts that result, in excess of the level of investment. Improved well-being and health outcomes translate into higher productivity and income, with a benefit–cost ratio of nine for low-income countries and 20 for lower-middle income countries. Given the high rates of unemployment in many LMICs, investments that create jobs in the healthcare sector are also beneficial for other sectors. Evidence shows that for every healthcare professional job that is created, 3.4 jobs are created on average in other sectors. As a large proportion of healthcare workers is female, these new jobs can be an opportunity for young women, in particular, and can help to promote female empowerment and gender equality. Altogether, these long-term benefits affirm that investment in health can enable large spillover effects on the social and economic dimensions of sustainable development and the implementation of the 2030 Agenda for Sustainable Development.
Topic:
Health, Governance, Finance, Crisis Management, and COVID-19
Political Geography:
Global Focus

3. Global Access to COVID-19 Vaccines: Challenges in Production, Affordability, Distribution and Utilisation

Author:
Andreas Stamm, Christoph Strupat, and Anna-Katharina Hornidge
Publication Date:
01-2021
Content Type:
Working Paper
Institution:
German Institute of Development and Sustainability (IDOS)
Abstract:
The COVID-19 pandemic and the ongoing vaccination process calls for decisive, internationally coordinated and forward-looking action. We propose short-, medium- and long-term actions and emphasise that the political pressure for action should not only focus on short-term management, but on building long-term structures that are crucial to prepare for future epidemics or pandemics. Four key challenges need to be addressed in order to achieve global control of COVID-19 by using vaccines. First, vaccines need to be produced at scale; second, they should be priced affordably; third, they have to be allocated globally so that they are available where needed; and fourth, they have to be deployed and utilised in local communities. Challenges in production are producing some of the main bottlenecks, but the others – in particular vaccine scepticism and utilisation – need to be considered early enough to enable smooth global vaccination campaigns. Addressing the four key challenges, we recommend the following short, medium- and long-term actions. In the short term, we advise accelerating global vaccination efforts by scaling up financial support for the COVAX initiative. In the medium term, we suggest establishing regional production centres in priority countries, providing the necessary intellectual property through voluntary patent pools and fostering information campaigns and civil society participation to increase vaccination willingness and utilisation. In the long term, we recommend establishing Global Pandemic Centres of Excellence in all world regions – analogous to the CGIAR system in the agricultural sector – that are responsible for medical research, vaccine production, distribution and delivery.
Topic:
International Cooperation, Vaccine, COVID-19, and Coordination
Political Geography:
Global Focus

4. Revenue Collection and Social Policies: Their Underestimated Contribution to Social Cohesion

Author:
Francesco Burchi, Christoph Strupat, and Armin von Schiller
Publication Date:
01-2020
Content Type:
Policy Brief
Institution:
German Institute of Development and Sustainability (IDOS)
Abstract:
Social cohesion is an important precondition for peaceful and economically successful societies. The question of how societies hold together and which policies enhance social cohesion has become a relevant topic on both national and international agendas. This Briefing Paper stresses the contribution of revenue collection and social policies, and in particular the interlinkages between the two. It is evident that revenue mobilisation and social policies are intrinsically intertwined. It is impossible to think carefully about either independently of the other. In particular, revenue is needed to finance more ambitious social policies and allow countries to reach goals, such as those included in the 2030 Agenda for Sustainable Development. Similarly, better social policies can increase the acceptance of higher taxes and fees. Furthermore, and often underestimated, a better understanding of the interlinkages between revenue generation and social policies can provide a significant contribution to strengthening social cohesion – in particular, concerning state–citizen relationships. In order to shed light on these interlinkages, it is useful to have a closer look at the concept of the “fiscal contract”, which is based on the core idea that governments exchange public services for revenue. Fiscal contracts can be characterised along two dimensions: (i) level of endorsement, that is, the number of actors and groups that at least accept, and ideally proactively support, the fiscal contract, and (ii) level of involvement, that is, the share of the population that is involved as taxpayer, as beneficiary of social policies or both. In many developing countries, either because of incapacity or biased state action towards elite groups, the level of involvement is rather low. Given the common perception that policies are unjust and inefficient, in many developing countries the level of endorsement is also low. It is precisely in these contexts that interventions on either side of the public budget are crucial and can have a significant societal effect beyond the fiscal realm. We argue that development programmes need to be especially aware of the potential impacts (negative and positive) that work on revenue collection and social policies can have on the fiscal contract and beyond, and we call on donors and policy-makers alike to recognise these areas as relevant for social cohesion. We specifically identify three key mechanisms connecting social policies and revenue collection through which policy-makers could strengthen the fiscal contract and, thereby, enhance social cohesion: 1. Increasing the effectiveness and/or coverage of public social policies. These interventions could improve the perceptions that people – and not only the direct beneficiaries – have of the state, raising their willingness to pay taxes and, with that, improving revenues. 2. Broadening the tax base. This is likely to generate new revenue that can finance new policies, but more importantly it will increase the level of involvement, which will have other effects, such as increasing government responsiveness and accountability in the use of public resources. 3. Enhancing transparency. This can stimulate public debate and affect people’s perceptions of the fiscal system. In order to obtain this result, government campaigns aimed at diffusing information about the main features of policies realised are particularly useful, as are interventions to improve the monitoring and evaluation system.
Topic:
Development, Finance, Economic Growth, Tax Systems, Transparency, and Social Cohesion
Political Geography:
Germany and Global Focus