Swiss Foreign Health Policy Preliminary remark: Status of this document This policy paper is based on an internal agreement between the relevant services of the Swiss federal administration. Its main purpose is to improve the instruments of internal cooperation and to provide clear common objectives for all Swiss administrative services active in the field of foreign health policy. The drafting of the policy paper follows a decision of the Federal Council of 18 May 2005 to improve the coordination and coherence of Swiss foreign policy in the areas for which federal departments other than the Federal Department of Foreign Affairs are primarily responsible. The agreement on foreign health policy represents the first agreement of its kind. It has been signed by the Federal Councillors responsible for Foreign and Home Affairs and was subsequently submitted to the Federal Council on 9 October 2006. It is available for interested third parties, even if it was not drafted for the general public. SDC IO FOPH FDEA Seco SVS FOA DETEC FOEN FDJP FOM IIP DDPS FOCP NEOC FOSPO UN WHO UNICEF UNFPA UNAIDS WTO ILO Swiss Federal Department of Foreign Affairs Swiss Agency for Cooperation and Development Integration Office /FDEA Swiss Federal Department of Home Affairs Federal Office of Public Health Swiss Federal Department of Economic Affairs State Secretariat for Economic Affairs Federal Veterinary Office Swiss Federal Office for Agriculture Department of the Environment, Transport, Energy and Communications Federal Office for the Environment Federal Department for Justice and Police Federal Office for Migration Federal Institute of Intellectual Property Federal Department of Defence, Civil Protection and Sport Federal Office for Civil Protection National Emergency Operations Centre Federal Office for Sports United Nations World Health Organization United Nations Children s Fund United Nations Population Fund United Nations Programme on HIV/AIDS World Trade Organization International Labour Organization 1
Agreement on foreign health policy objectives Adopted by the and on 9 October 2006 0. Context In a closed session on 18 May 2005, the Federal Council decided to improve the coordination and coherence of Switzerland s foreign policy and to enhance interdepartmental collaboration in sectors in which the does not have the lead by concluding agreements on shared objectives between the and the departments responsible for the various sectors. The and the in collaboration with all concerned federal offices and departments have produced this policy paper in fulfilment of the Federal Council's mandate with respect to health aspects of the foreign policy (Foreign Health Policy, FHP). 1. Background 1.1 International context Health issues have gained significance in both domestic and foreign policy. The SARS epidemic of spring 2003 and the spread of avian influenza in autumn 2005 showed that increasing the interdependence of countries and societies also heightens vulnerability, and that internationally coordinated responses have become indispensable in solving "national" health problems. On the other hand, the improvement in general health status over recent decades has demonstrated both the advantages of internationally agreed standards and rules and the beneficial nature of the interaction between health and economic development. The growing importance of health issues presents new challenges and opportunities for Swiss foreign policy. Until now, foreign policy has only indirectly addressed health issues, as they were considered to form part of health and development policies. However, global interdependence calls for a comprehensive and coherent approach and for solutions that are coordinated at both national and international level. All the relevant policies should be integrated into a common framework. International collaboration on health matters has intensified and new international rules are established. Rising costs, greater mobility of patients, health professionals and services, and growing technical complexity are creating an even greater need for international standards and increased international cooperation. Moreover, population health and investments in the health-sector are becoming more important determinants of production and competitiveness. Public health is assuming an ever greater cross-border dimension in the areas of food safety, the safety of medicines and chemicals, radiation protection, safety at work, and many aspects of environmental policy. The WHO, other UN organizations (UNICEF, UNFPA etc.), the World Bank and the OECD are the major international organizations involved in coordinating and setting standards in the public health field. The EU influences the health systems and public health measures of Member States in a wide range of policy areas through regulations and through its agencies (EFSA European Food Safety Authority; ECDC European Centre for Disease Prevention and Control). The Council of Europe also sets internationally valid standards for the health sector (e.g. the European Pharmacopoeia). The World Bank and the WHO are the most important organizations regarding the implementation of global health measures. In recent years, new international fund-raising mechanisms (e.g. the Global Fund to Fight Aids, Tuberculosis and Malaria) and public-private partnerships (e.g. the Global Alliance for Vaccines and Immunization) have been set up in the public health field. New internationally binding regulations include the International Health Regulations issued by the WHO (2005) and the WHO Framework Convention on Tobacco Control (2003). Intensive international cooperation on health protection and health determinants has been in existence for some considerable time, for example in the form of the WTO's agreement on Sanitary and Phytosanitary Measures (SPS), the Codex Alimentarius, ILO conventions and environmental conventions. 2
Health is a fundamental component of sustainable human development and one of the main priorities of global partnership for development, security and human rights (UNO). Three of the eight Millennium Development Goals (MDGs) adopted by all UN member states in 2000 focus on health. These are MDG 4 reduce child mortality; MDG 5 improve maternal health; and MDG 6 combat HIV/Aids, malaria and other diseases. Development will not be possible without health. The industrialised countries are increasingly realising that it is in their own interest to cooperate with developing countries. Such a partnership also seeks to influence primary determinants of health, such as income, education, nutrition, the environment and water as well as social factors such as discrimination against women. 1.2 Swiss players The major actors in the Swiss administration are the for international health policy and the. Within the the SDC is responsible for development and humanitarian policy relating to health, while the Directorate of Political Affairs deals with general foreign policy issues related to health, questions concerning domicile, and specific topics such as consular protection abroad. Other federal offices also play an important role in the following areas: the Integration Office (FDEA/) in the cooperation with the EU; the FDEA (seco) in economic policy decisions relevant to health; the FDEA (FVO) in controlling communicable animal diseases; the FDEA (FOAG) in areas such as hygiene measures in primary food production; DETEC (FOEN) in environmental policy relevant to health; FDJP (IIP) in health aspects of intellectual property rights; FDJP (FOM) in issuing of visas and residence permits; DDPS (army) in health matters concerning the army and the tasks of the coordinated health service; DDPS (FOCP, NEOC) for emergencies related to nuclear accidents, and DDPS (FOSPO) in the promotion of physical activity and sport. 1.3 Coordination Systematic coordination with regard to the agendas of the WHO s World Health Assembly and the meetings of the WHO Regional Committee and the WHO Executive Board only exists within the International Health Policy Steering Committee 1 and the Interdepartmental WHO Working Group 2 2. The FOPH and the (Directorate of Political Affairs) work together closely and effectively on general foreign policy issues raised in health forums. However, cooperation only works on an ad hoc basis. Further discussions and consultation on specific topics take place between the FOPH and other federal offices in similar fashion. The coordinates health measures related to humanitarian and development policies with the relevant departments and federal offices primarily within the framework of the Interdepartmental Committee for Development and Cooperation. 2. Medium-term goals of foreign health policy The common goals of Swiss foreign health policy will be determined for the next five years. 2.1 Main issues Five main issues can be identified (the goals referred to can be found in the table under point 2.4). (1) Protect the health interests of the Swiss population (Goals 1 and 2) The emphasis lies on the protection against communicable (e.g. pandemic influenza) and noncommunicable diseases as well as general health and consumer protection issues. Experience in recent years has shown that these questions can only be tackled efficiently in conjunction with international organisations and Switzerland s neighbours. 1 consisting of the Directors/Heads of the FOPH, SDC, PA III, Geneva Mission, and the international delegates of the Swiss Conference of the Cantonal Ministers of Public Health. 2 (FOPH, FOSS), (, DSC, Directorate of Political Affairs, Geneva Mission), FDEA (seco), FDJP (FOM), Swiss Conference of the Cantonal Ministers of Public Health 3
(2) Harmonise national health policy with international health policy (Goals 3 5) Those sectors of industry that are affected by health protection measures such as the pharmaceutical and food industries have been internationally networked for a number of years. Healthcare provision, too, is taking on an increasingly international dimension as a result of technical developments and the migration of patients and staff. In light of these developments, which are being reflected in the growing role of the World Bank, the EU, the OECD and the WHO in public health, the aim is to adapt national policy as effectively as possible to the new international and regional framework. We are also interested in learning from international experience in order to further develop our health system and improve its cost-efficiency. (3) Improve the effectiveness of international collaboration on health (Goals 6 10) Because of the health sector s important status in our economy and development policy, Switzerland has a major interest in shaping international health policy. Careful harmonisation with the country's other foreign policy objectives and its interests in general is essential. (4) Improve the global health situation (Goals 11-14) Switzerland has a major economic and political interest in improving global health status, and this interest is particularly strong in the developing countries and countries in transition. The objective here is not least to strengthen the global partnership for development, security and human rights agreed and implemented in the context of the UN and for Switzerland to make a credible and acknowledged contribution. (5) To maintain our role as a host country to international organisations and base for major companies working in the health sector (Goals 15 and 16) Geneva plays a pivotal role in international health policy as 25 UN and other international organisations such as the WHO, UNAIDS, WTO, ILO etc. are based there, as are the representations of 154 nations and over 300 non-governmental organisations. It is in our interest to maintain and expand this important function of host country and conference venue. Switzerland must also represent the interests of the pharmaceutical industry, which is a major player in its economy, and safeguard the industry s base in the country. The issues involved include the impact of health policy on national and international trade policy. 2.2 Reconciling different interests The Foreign health policy has to satisfy all the different interests listed under point 2.1; its goal is to achieve a coherent and effective policy in the different sectors. It is not possible to avoid conflicts of interest. Therefore, one of the main tasks is to carefully weigh the different interests in specific cases and to reconcile national priorities with international developments in order to avoid an inefficient or incoherent approach as much as possible. Wherever possible, Switzerland should adopt congruent and coherent positions in the various international organisations that address different aspects of the same subject. One example is better access to affordable essential drugs for developing countries, as foreseen in the Millennium Development Goals. Switzerland with its major pharmaceutical industry and long humanitarian tradition is committed both to adequate protection for intellectual property and to access to essential drugs for the world's poorest countries. It remains to be mentioned that the private sector is becoming increasingly aware of its social and global responsibility in the field of health which will present new opportunities for cooperation. Another area in which interests need to be reconciled is trade policy. Measures introduced to protect health may restrict the free movement of goods or individuals. On the other hand, trade policy measures may have both negative and positive effects on the health of a country's population. This contradiction is taken into account by one of the major exceptions to the WTO's basic principle of unrestricted market access: measures essential to protecting health are permitted provided that they are not discriminatory or disguised restrictions to international trade. 2.3 Resources In view of the budget situation, no additional human or financial resources have been foreseen to implement this agreement. This means that the resources of the draft budget for 2007 and the financial 4
plan for 2008-2010 of the, and other participating federal offices will be used. The intention is for the new foreign health policy to use the existing budgets (regular WHO contribution at the FOPH, specific WHO contributions at the FOPH and SDC, funding for health programmes and projects) in a more specific and coordinated way. 2.4 Medium-term goals and priorities (over a timeframe of 5 years) The table below shows the most important foreign health policy goals. This agreement only mentions the medium-term goals as well as the lead offices and other relevant offices within the administration. The offices identified in the table are responsible for defining and implementing the objectives. The measures proposed in Chapter 3 are supposed to improve the coordination and coherence in view of an efficient and consistent achievement of the objectives. Switzerland will not be able to reach all the goals on its own. In case of international cooperation, decisionmaking or implementation, the objectives will serve as a basis for an active Swiss contribution which could take the form of special initiatives, international engagement or financial support. Interests Medium-term goals Lead office 1. Health interests of the Swiss population: 1. Strengthen the international monitoring networks for communicable diseases (e.g. pandemic influenza) by an undelayed implementation of the International Health Regulations (IHR). Involved 2. Maintain a high level of protection for Switzerland through international cooperation (in particular with the EU) in areas such as food safety, drug safety, radiation protection, chemicals and the environment These measures should be as economy friendly as possible. DETEC (FOEN) FDEA (seco, FVO, FOAG), DHA (Swissmedic) IO DDPS (FOSPO) 3. Maintain the health status and productivity of the Swiss population by adapting international strategies and targets relating to non-communicable diseases, particularly obesity. 2. Harmonisation of national and international health policy 4. Multilateral and bilateral comparisons to obtain key information in view of further developing the Swiss health system and cost control. FDEA (seco) IO 5
5. Conclude bilateral agreements with the EU covering the EU's major health policy activities, or at least cooperate more closely in the following areas. Action programme in the field of health 2007-2013, European Centre for Disease Prevention and Control ECDC, European Food Safety Authority EFSA, various early warning systems (EWRS for communicable diseases, RASFF for food products, RAPEX for non-food products and RAS BICHAT for bioterrorism). 6. Manage migration of health professionals in a way that the needs of the labour markets in the industrialised countries and emerging economies are satisfied without depriving developing countries of health professionals that they need. 7. Strengthen the normative role of the WHO. and IO FDEA (seco) (delegate assembly) FDEA (FOAG) DETEC (FOEN) FDJP (FOM) 3. Improve international collaboration on health issues (delegate assembly) 8. Support cooperation between the WHO, OECD and EU on normative health issues to promote a greater use of synergies. (delegate assembly) IO FDEA (seco) 9. Improve international access to essential drugs both recognised and newly developed. (Swissmedic) FDJP (FOM) FDEA (seco) 10. Improve the efficiency of multilateral players in the fields of health, development cooperation and humanitarian aid (architecture, normative role, operational aspects). 6
11. Actively support the definition of international health standards for humanitarian crisis and emergency situations as well as associated implementation strategies. 12. Promote research to strengthen the empirical basis for effective health interventions. Influence the dialogue on global research priorities in the health field in order to reduce the disproportionate burden of disease in the southern hemisphere in a sustainable way. 13. Further develop, reform and harmonise the health systems in developing countries as well as crisis regions and transitional countries, focusing on economical and non-discriminatory access to health services and drugs. 14. Make appropriate contributions to eliminating the three significant poverty-related diseases of Aids, tuberculosis and malaria (MDG 6) paying particular attention to genderspecific issues. 15. Contribute to global strategies and programmes in the area of noncommunicable diseases with an emphasis on prevention, health promotion or reproductive health. (SER) 4. Improve the global health situation 16. Cooperate bilaterally or multilaterally to save lives, deliver aid to victims of natural disasters and armed conflict and re-establish their health. 5. CH as a host country to international organisations and a centre of industry 17. Consolidate and strengthen Geneva's position as an international centre of excellence for public and humanitarian health ("health capital of the world") as part of the Swiss host country policy. 18. Ensure an appropriate protection for intellectual property as an essential incentive for research and development of new drugs and vaccines. FDJP (FOM) (FOPH/ Swissmedic) FDEA (seco) 7
3. Measures to increase coordination and coherence 3.1 General The Federal Council is primarily responsible for these measures. It approves the medium-term goals and priorities of the foreign health policy and the implementing measures. The is in charge of the foreign policy coordination and defends Switzerland's foreign policy interests according to the statutes, the directives of 29 March 2000 concerning international relations of Swiss government services and the Federal Council's Foreign Policy Reports of 1993 and 2000. The is also the lead authority in matters relating to development policy and humanitarian, multilateral and bilateral programmes in the field of public health. The is the lead authority in matters relating to national health policy and Switzerland's contribution to international health policies pursuant to the FOPH statutes. 3. The present agreement on foreign health policy objectives does not concern the existing competencies of the federal offices. It does, however, give foreign health policy a more specific direction and improves coordination and coherence. Coherence in foreign policy and more efficient safeguarding of interests are the overriding objectives; coordination between the players in the administration is the instrument 4. 3.2 Measures 3.2.1 Measures undertaken by the Measure 1: Establishment of a coordinating unit for foreign health policy The coordinating unit is the contact point for all relevant enquiries from the FOPH and other offices of the federal administration and will be responsible for coordinating all health matters within the. The coordinating unit is responsible for collecting and forwarding relevant information from the to other involved offices in the federal administration. Communication with the 's foreign missions must always pass through the coordinating office, although other arrangements may be made with the in certain cases. The coordinating unit also ensures the coherence of the foreign health policy within the general Swiss foreign policy by weighing the different foreign policy interests and optimising global interests of all departments and the allocation of resources 5. Measure 2: Creation of an information platform for foreign health policy The is setting up a foreign health policy information platform as part of the APIS foreign policy information system. This platform will be available to all interested offices within the federal administration. The information platform contains all important basic documents and background information as well as an agenda showing the most important transactions, meetings and events in foreign health policy. The offices concerned, in particular the FOPH and the SDC, can upload their documents directly in the APIS system and update them. The coordinating unit uses the information platform to ensure that all the offices in the federal administration which are involved in the foreign health policy have the same background information and planning documents at their disposal. 3 Regulation governing the organisation of the (SR 172.212.1, Article 9) 4 The principles relating to mandatory consultation, dealings with other countries and contracts outside Switzerland as set out in the Instructions on international relationships maintained by the federal administration of 29 March 2000 also apply to foreign health policy. 5 Replaces the former International Health Policy Steering Committee 8
3.2.2 Measures undertaken by the Measure 3: Produce policy papers on subjects arising in foreign health policy and strengthen academic competence The draws up papers on specific aspects of foreign health policy in consultation with the other involved offices in the federal administration. These papers are uploaded to the information platform to support wider discussion and clarification of positions on important questions. The is strengthening "Geneva international" by establishing academic competence in international health issues. For this purpose the is providing start-up funding. The (SER) is including international health in the target agreement with the government-funded academic institutions in Geneva and Lausanne. Measure 4: Harmonisation with general foreign policy and other sectoral policies The international work of the is being actively aligned with Switzerland's general foreign policy and other sectoral policies. The regularly briefs the and other relevant offices on important developments in foreign health policy. The consults the competent offices on issues relevant to them. 3.2.3 Joint measures Measure 5: Creation of an Interdepartmental Conference on Foreign Health Policy (IC FHP)5 The IC FHP is headed jointly by the Director of the FOPH and a representative of the (State Secretary or representative nominated by him/her) and includes representatives of the (Directorate of Political Affairs, SDC, Geneva Mission, /FDEA Integration Office), DETEC (FOEN) and FDEA (seco), and the Swiss Conference of the Cantonal Ministers of Public Health (GDK). Stakeholders from other departments are called in as required. The IC FHP defines current priorities and joint projects (including action plans and resources). It is supported by the Interdepartmental Working Group on FHP 6, which in turn can convene and dissolve ad hoc working groups on specific subjects. Measure 6: Staff exchange and foreign missions If possible, a senior position in the FOPH's International Affairs section will continue to be held by a member of the diplomatic staff from the. One member of staff at each of the Missions in Geneva and Brussels will be assigned explicitly to the health dossier. Health-related topics may be included in the annual goals for the 's foreign missions. [EN translation found on Federal Office of Public Health's (BAG) website] 6 replaces the former Interdepartmental Working Group WHO; the Interdepartmental Working Group HFP will be headed jointly by the Director of the International Affairs section at the FOPH and the responsible Head of Department at the 9
This paper represents the views of its author on the subject. These views have not been adopted or in any way approved by the Commission and should not be relied upon as a statement of the Commission's or Health & Consumer Protection DG's views. The European Commission does not guarantee the accuracy of the data included in this paper, nor does it accept responsibility for any use made thereof.