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In line with the global trend, the Middle East and North Africa (MENA) region has been growing vulnerable to the direct and indirect health effects of climate change including death tolls due to climatological disasters and diseases sensitive to climate change since the industrial revolution. Regarding the limited capacity of MENA countries to adapt and respond to these effects, and also after relative failures of the previous negotiation in Glasgow, in the upcoming COP27 in Egypt, the heads of the region’s parties are determined to take advantage of the opportunity to host MENA to mitigate and prevent the worst effects of climate change. This would be achieved through mobilizing international partners to support climate resilience, a major economic transformation, and put health policy and management in a strategic position to contribute to thinking and action on these pressing matters, at least to avoid or minimize the future adverse consequences.

BackgroundInterest in digital technologies in the health care sector is growing and can be a way to reduce the burden on professional caregivers while helping people to become more independent. Social robots are regarded as a special form of technology that can be usefully applied in professional caregiving with the potential to focus on interpersonal contact. While implementation is progressing slowly, a debate on the concepts and applications of social robots in future care is necessary. ObjectiveIn addition to existing studies with a focus on societal attitudes toward social robots, there is a need to understand the views of professional caregivers and patients. This study used desired future scenarios to collate the perspectives of experts and analyze the significance for developing the place of social robots in care. MethodsIn February 2020, an expert workshop was held with 88 participants (health professionals and educators; [PhD] students of medicine, health care, professional care, and technology; patient advocates; software developers; government representatives; and research fellows) from Austria, Germany, and Switzerland. Using the scenario methodology, the possibilities of analog professional care (Analog Care), fully robotic professional care (Robotic Care), teams of robots and professional caregivers (Deep Care), and professional caregivers supported by robots (Smart Care) were discussed. The scenarios were used as a stimulus for the development of ideas about future professional caregiving. The discussion was evaluated using qualitative content analysis. ResultsThe majority of the experts were in favor of care in which people are supported by technology (Deep Care) and developed similar scenarios with a focus on dignity-centeredness. The discussions then focused on the steps necessary for its implementation, highlighting a strong need for the development of eHealth competence in society, a change in the training of professional caregivers, and cross-sectoral concepts. The experts also saw user acceptance as crucial to the use of robotics. This involves the acceptance of both professional caregivers and care recipients. ConclusionsThe literature review and subsequent workshop revealed how decision-making about the value of social robots depends on personal characteristics related to experience and values. There is therefore a strong need to recognize individual perspectives of care before social robots become an integrated part of care in the future.

Resumo O Fundo Global é uma das ONGs mais importantes do mundo quando se trata do desenvolvimento da saúde global. Em 2015 foi desembolsado quase dez por cento de todo o orçamento à assistência no mundo direcionada à saúde. Em 2011, iniciaram um processo de reforma em resposta a alegações do mau uso das doações recebidas. As reformas têm focado no processo de aplicação do dinheiro, já as estruturas da ONG e seu paradigma tem permanecido intactos. Esta análise trata os resultados das discussões sobre o Fundo Global, seu paradigma de supervisão e monitoramento, e os resultados derivados em Moçambique. Pesquisadores realizaram 37 entrevistas em pessoa e uma entrevista por telefone com 38 partes interessadas em Maputo, Moçambique e membros do Conselho e Secretariado do Fundo Global na Suíça. Os entervistados em Moçambique eram representantes das estruturas locais do Fundo Global (p. ex. destinatários principais), do Ministério da Saúde, e ‘agencias bilaterais ou multilaterais e adidos da saúde ou desenvolvimento de embaixadas parceiras em Moçambique. Foram também incluídos representantes das Nações Unidas, consultores, e coordenadores das ONGs. Codificação temática revelou preocupações quanto à combinação da supervisão fraca no país com os requisitos rigorosos de monitoramento e avaliação; processos que estão conectados ao financiamento baseado em desempenho. A análise revelou que, apesar das mudanças associadas ao New Funding Model (Novo Modelo de Financiamento), a maioria dos consultados, tanto em Genebra como em Maputo, reconhecem que aínda existem desafios na estrutura e no paradigma do Fundo Global. A falta de um escritório em Moçambique tem alguns efeitos negativos, causando dependência em parceiros nacionais e também ineficácia na coordenação. Devido à fraca capacidade de absorção e de gerenciamento no pais, é necessária mais supervisão da que é possível atualmente nas visitas do gerente de carteira em Genebra. Os parceiros em Moçambique fornecem apoio aos beneficiários do Fundo, mas as diferentes tarefas, responsabilidades e prestações de contas precisam ser definidas mais claramente para conseguir uma parceria bem-sucedida a longo prazo. Além disso, os tomadores de decisão em Genebra reconhecem que a coordenação local é imperativa para uma implementação bem-sucedida; os parceiros continuam a apreciar o aumento do envolvimento do Fundo em Moçambique. Atualmente, não existem requisitos institucionais para uma coordenação formal, e o Fundo não tem uma presença continua dentro de grupos de coordenação em Moçambique. O Fundo Global precisa moldar a implementação de projetos e procedimentos de monitoramento às realidades locais que seriam destacadas através de uma coordenação formalizada.

The year 2016 could turn out to be a turning point for global health, new political realities and global insecurities will test governance and financing mechanisms in relation to both people and planet. But most importantly political factors such as the global power shift and “the rise of the rest” will define the future of global health. A new mix of health inequity and security challenges has emerged and the 2015 humanitarian and health crises have shown the limits of existing systems. The global health as well as the humanitarian system will have to prove their capacity to respond and reform. The challenge ahead is deeply political, especially for the rising political actors. They are confronted with the consequences of a model of development that has neglected sustainability and equity, and was built on their exploitation. Some direction has been given by the path breaking international conferences in 2015. Especially the agreement on the Sustainable Development Goals (SDGs) and the Paris agreement on climate change will shape action. Conceptually, we will need a different understanding of global health and its ultimate goals - the health of people can no longer be seen separate from the health of the planet and wealth measured by parameters of growth will no longer ensure health.

Politics play a central part in determining health and development outcomes as Gorik Ooms highlights in his recent commentary. As health becomes more global and more politicized the need grows to better understand the inherently political processes at all levels of governance, such as ideological positions, ideas, value judgments, and power. I agree that global health research should strengthen its contribution to generating such knowledge by drawing more on political science, such research is gaining ground. Even more important is – as Ooms indicates – that global health scholars better understand their own role in the political process. It is time to acknowledge that expert-based technocratic approaches are no less political. We will need to reflect and analyse the role of experts in global health governance to a greater extent and in that context explore the links between politics, expertise and democracy.

Public health instruments have been under constant development and renewal for decades. International legal instruments, with their binding character and strength, have a special place in this development. The start of the 21st century saw, in particular, the birth of the first World Health Organization (WHO)-era health treaties – the WHO Framework Convention on Tobacco Control (WHO FCTC) and its first Protocol. The authors analyze the potential impact of these instruments on global health governance and public health, beyond the traditional view of their impact on tobacco control. Overall, the very fact that globally binding treaties in modern-era health were feasible has accelerated the debate and expectations for an expanded role of international legal regimes in public health. The impact of treaties has also been notable in global health architecture as the novel instruments required novel institutions to govern their implementation. The legal power of the WHO FCTC has enabled rapid adoption of further instruments to promote its implementation, thus, enhancing the international instrumentarium for health, and it has also prompted stronger role for national legislation on health. Notably, the Convention has elevated several traditionally challenging public health features to the level of international legal obligations. It has also revealed how the legal power of the international health instrument can be utilized in safeguarding the interests of health in the face of competing agendas and legal disputes at both the domestic and international levels. Lastly, the legal power of health instruments is associated with their potential impact not only on health but also beyond; the recently adopted Protocol to Eliminate Illicit Trade in Tobacco Products may best exemplify this matter. The first treaty experiences of the 21st century may provide important lessons for the role of legal instruments in addressing the unfolding challenges in global health.

Global health has attracted growing attention from academic institutions. Its emergence corresponds to the increasing interdependence that characterizes our time and provides a new worldview to address health challenges globally. There is still a large potential to better delineate the limits of the field, drawing on a wide perspective across sciences and geographical areas. As an implementation and integration science, academic global health aims primarily to respond to societal needs through research, education, and practice. From five academic institutions closely engaged with international Geneva, we propose here a definition of global health based on six core principles: 1) cross–border/multilevel approach, 2) inter–/trans–disciplinarity, 3) systems thinking, 4) innovation, 5) sustainability, and 6) human rights/equity. This definition aims to reduce the century–old divide between medicine and public health while extending our perspective to other highly relevant fields. Overall, this article provides an intellectual framework to improve health for all in our contemporary world with implications for academic institutions and science policy.

Editor’s Note: These papers are contributions to the ‘Policy Debate’ section of International Development Policy. In this section, academics, policy-makers and practitioners engage in a dialogue on global development challenges. Papers are copy-edited but not peer-reviewed. Instead, the initial thematic contribution is followed by critical comments and reactions from scholars and/or policy-makers or practitioners. This debate can be pursued on the Journal’s blog (http://devpol.hypotheses.org/956) where you are invited to share your reflections under your name.The initial paper was written by Monica Rull, from Doctors Without Borders (Médécins sans Frontières) Switzerland. Monica Rull provides an in-depth and lucid examination of the collective failure to respond in a timely and efficient manner to global epidemics. Starting from the recent Ebola crisis in West Africa, the piece pinpoints a number of weaknesses in the international system in terms of the identification of, and response to, global epidemics and suggests ways to improve it.The initial paper is followed by critical comments of two authors: Ilona Kickbusch, Director of the Global Health Programme and Adjunct Professor at the Graduate Institute of International and Development Studies, Geneva and Helen Lauer, Professor at the Department of Philosophy and Religious Studies, College of Humanities, University of Dar es Salaam.

The 21st century health society is characterized by 2 major social processes: the expansion of the territory of health and the expansion of the reflexivity of health. The boundaries of what we call the «health system» are becoming increasingly fluid and health has become integral to how we live our everyday life. Health itself has become a major economic and social driving force in society. This shifts the pressure for policy innovation from a focus on the existing health system to a reorganization of how we approach health in 21st century societies. The dynamics of the health society challenge the way we conceptualize and locate health in the policy arena, the mechanisms through which we conduct health policy and they redefine who should be involved in the policy process. This concern is beginning to be addressed within government through joined up government approaches, beyond government through making health everybody's business and beyond nation states as a new interface between domestic and foreign policy.La sociedad de la salud en el siglo xxi se caracteriza por 2 procesos sociales destacables: la expansión del territorio de la salud y la expansión de la reflexividad de la salud. Los límites de lo que llamamos «sistema de salud» son cada vez menos fijos y la salud se ha convertido en elemento esencial de nuestra vida cotidiana. La salud en sí misma se ha convertido en una fuerza fundamental del impulso económico y social. Todo ello lleva la presión sobre la innovación en política desde una orientación sobre los servicios de salud a centrarse en una reorganización de cómo enfocamos la salud en las sociedades del siglo XXI. La dinámica de la sociedad de la salud pone a prueba la forma en cómo se conceptúa la salud, en cómo la situamos en el terreno político y los mecanismo de aplicar políticas de salud. Todo ello redefine quién debe ser el sujeto del proceso político. Este asunto se comienza a tratar dentro de los gobiernos por medio de acciones coordinadas, más allá de los gobiernos haciendo que la salud sea una cuestión de todos los ciudadanos, y más allá de los países como una nueva intersección entre política interna y exterior.

Este artigo apresenta alguns componentes essenciais do desenvolvimento de capacidades em diplomacia da saúde global, conforme trabalhado pelo Programa de Saúde Global, e identifica algumas lições aprendidas. O Programa de Saúde Global do Graduate Institute of International and Development Studies de Genebra, é pioneiro nas iniciativas de desenvolvimento de capacidades em Diplomacia da Saúde Global, desde que foi realizado o primeiro curso em Genebra, em 2007. Está também envolvido na criação e realização de treinamentos executivos fora da Europa, com o intuito de refletir, de maneira adequada, a natureza global do curso. Consideram-se novos enfoques e metodologias de desenvolvimento de capacidades e exemplos concretos dos modelos aplicados ao ensino executivo. Isso inclui uma análise do que funciona melhor em termos de parcerias, integração e desenvolvimento dos materiais de ensino. O objetivo é compartilhar experiências em inovação na capacitação no ensino executivo. Cada seção analisa um tópico específico relacionado ao treinamento neste domínio e conclui com várias lições aprendidas.

Este artigo trata fundamentalmente do novo campo de estudo denominado diplomacia da saúde global e se concentra na diplomacia da saúde, na medida em que está relacionado às questões de saúde que transcendem as fronteiras nacionais e são globais por natureza. Debate ainda os desafios mais visíveis e a forma como estão sendo enfrentados pelos diferentes atores nos diversos níveis da governança em saúde. Descreve a natureza mutante da saúde global e da diplomacia da saúde global e analisa esses termos em contextos relevantes. Além disso, evidencia a intensificação do papel da saúde nos assuntos globais e nas relações exteriores, assim como o desenvolvimento de estratégias nacionais em saúde global estabelecidas por alguns países e resultante desse processo. Finalmente, enfatiza a necessidade de aprofundamento das análises neste novo campo de estudo, assim como a necessidade de estímulo à capacitação de diplomatas e outros profissionais que atuam hoje na arena da saúde global.