Speech
to the UK-Australia Seminar: Health and Foreign Policy Seminar, Canberra
16 September 2003
Why Health Matters In Foreign Policy
Ladies and gentlemen… a great pleasure to be here this evening
I want to thank my colleague, Kay Patterson, her Department, and the Nuffield Trust for organising such a timely, and thought-provoking conference.
In the past foreign policy was seen largely as the preserve of the commentariat and foreign policy professionals.
For politicians, foreign policy was perceived – with a few notable exceptions – to neither win, nor lose you elections. Those days are long gone.
Terrorism, globalization and trans-national crimes, have made foreign policy a central concern for almost all Australians.
And increasingly health is providing a similar reason for domestic populations to be interested in foreign policy.
This evening I want to outline for you Australia’s current foreign policy imperatives…
...discuss why tackling disease and other global health problems should be a concern for foreign ministries in all countries…
…and set out a few ways Australia is addressing global health issues in its foreign policy.
Australian foreign policy imperatives
Australia faces a challenging international environment.
Terrorism and the spread of weapons of mass destruction threaten Australia, our friends and allies, as never before.
Challenges like these require a foreign policy focused on effective outcomes, not platitudes and posturing.
We are pragmatic and hard-headed in our approach to the issues we face in the real world.
We have contributed to the global fight against terror with our coalition partners in Afghanistan and in key multilateral forums.
We are working with regional partners to build effective counter-terrorism cooperation – cooperation which has already seen the successful prosecution of some of the Bali bombers.
In the fight against WMD proliferation we joined the international coalition to disarm Iraq and support efforts to achieve a nuclear weapons-free Korean peninsula.
And, as highlighted by the Proliferation Security Initiative naval exercise held in the Coral Sea, we are seeking effective means to prevent the illicit trade in WMD-related materials.
In our region we are addressing the dangers of state-failure by working with our Pacific Islands Forum partners to restore law and order and re-build institutions in Solomon Islands.
These challenges reinforce the importance of effective coalitions and the importance of our alliance with the United States, which remains fundamental to our security and prosperity.
Continuing active engagement with Asia remains central to our foreign policy, underlined by important trade links, valuable security relationships and growing people-to-people ties.
And we continue to pursue effective relationships with others beyond our region including in Europe and the Middle East.
An outcomes-driven foreign policy is the idea of using those means best suited to the challenges you face.
Sometimes this will mean working in regional groupings or coalitions of the willing.
Effective multilateral diplomacy remains important to peace and security and the UN system will be central, but it needs to adapt to remain relevant and responsive to today’s global challenges.
Foreign policy is also about grasping opportunities. Globalisation is a prime example. It offers great rewards, but it also imposes strict disciplines.
Our success in grasping these disciplines – our stable monetary and prudent fiscal policies, lower trade barriers and strong incentives for investment – is reflected in key global indices.
Australia, for example, was ranked equal seventh place in this year’s Economic Freedom of the World index (up two places).
But we are not resting on our laurels. We are working hard to get real outcomes from the Doha Round – which has clearly suffered a setback at Cancun.
We are pursuing regional and bilateral liberalisation, such as through our FTA with Singapore, and our negotiations with the United States and Thailand.
Finally, Australia’s values as a liberal, democratic society – of tolerance, opportunity and a fair go – inform our dealings with the world and our promotion of economic and political freedoms and good governance.
Health, international security and prosperity
Disease and global health issues certainly add to the uncertainty we face in the conduct of our foreign policy.
They may not first come to mind when we consider threats to international security. But they should come to mind.
Throughout history, pandemics like influenza have greatly threatened the security of nations.
As far back as 412 BC a major epidemic of influenza was recorded by the great physician of antiquity Hippocrates.
In 1781 the same disease afflicted two-thirds of the people of Rome and three-quarters of the population of Britain.
And from 1918 to 1919, the so called “Spanish flu” killed more than 20 million people – more in fact than died in World War I.
Most experts believe that it is only a matter of time before we see such a major pandemic again – especially given advances in travel and transport which can spread disease rapidly.
But the outbreak of SARS also showed that diseases which kill relatively few people can cause significant economic damage.
As a result of SARS Hong Kong’s GDP contracted 3.7 per cent in the June quarter and 0.3 per cent in the March quarter.
Singapore’s GDP contracted by 3 per cent in the June quarter 2003, partly reflecting a 62 per cent fall in tourist arrivals.
Fortunately partial economic indicators suggest that the SARS-induced economic shock has been relatively short-lived, and the overall impact on world economic growth is relatively small.
But we should not underestimate the impact that disease like this can have.
Health, of course, remains a critical issue for the developing world and for our efforts to eliminate poverty.
It is now well accepted that unless governments and health authorities come to grips with HIV/AIDs in Africa – and indeed in the Asia-Pacific – this pandemic will have a major impact on development and economic growth.
In southern Africa HIV/AIDS has produced a generation of orphaned children and has decimated the most productive sector of the working population.
There are now more than 7.2 million people living with HIV/AIDS in the Asia-Pacific region.
Last year some 3000 people in the region were infected with the virus each day, a major threat to lives and national productivity.
No longer the preserve of health ministries alone
None of this is new. The impact disease and other health problems have on global security and prosperity have been understood for a number of years.
What has been less evident is a willingness on the part of governments around the globe to accept that international health issues are legitimate foreign policy concerns...
...that pandemics like HIV/AIDS can seriously weaken the national prosperity and security of severely affected countries...
...and that if we are to deal with these problems effectively global health can no longer be the preserve of national health ministries. It must also be the concern of foreign ministries.
In part, health has today become a foreign policy issue by force of circumstance; it has crept into the foreign policy agenda.
We saw, for example, how the issue of cheap life-saving drugs for developing countries became a significant international legal, political and economic issue.
Australia welcomed the recent agreement by the parties to the Doha Round that will ensure developing countries better access to affordable medicines to confront ravaging diseases such as HIV/AIDS, malaria and tuberculosis.
But it is also true that if we are to tackle global health issues effectively, foreign ministries must get involved.
Since the mid 1990s we have seen a greater internationalisation of efforts to tackle HIV/AIDS.
International diplomacy is playing a critical role in tackling the disease through the establishment of UNAIDS and global consensus such as the Millennium Development Goals.
But there is still more we can do.
For example, boosting global efforts to vaccinate against common childhood and communicable diseases…
…or strengthening surveillance systems and preparedness for outbreaks of infectious diseases…
…or efforts to improve the quality of river systems that extend through a number of national boundaries.
And because these often throw-up legal, cultural and, in some cases security, issues, diplomacy will continue to have a positive and necessary role to play.
Several countries, like the United States, the United Kingdom and Canada – and Australia – are making health an important component of their foreign policy objectives.
Australia has taken a lead role within our region in encouraging neighbouring governments to view health in a broader context.
At the ASEAN meeting in August last year, I launched the Asia Pacific Leadership Forum on HIV/AIDS.
This is designed to help decision-makers in the region share their experiences in fighting this epidemic and to underline that coordinated, whole-of-government approaches will be necessary to tackle and ultimately to defeat the disease.
In the last two years Australia has spent well over $85 million on activities aimed directly at reducing HIV infection in our region – part of our $200 million global HIV/AIDS initiative.
$230 million of our $1.9 billion aid budget in 2003-04 will be spent directly on health – or some 13% of the total.
But the most important contribution we can make to global health outcomes is in governance and capacity building.
That is, ensuring that governments in developing countries can themselves provide for the health and well being of their own citizens. But also to make sure that states do not fail – or in effect, become global health hazards.
Weak national institutions usually means such states cannot provide adequate health services to their own people.
This in turn impacts on a country’s ability to grasp the economic opportunities of globalisation and thereby to tackle poverty, which again in turn impacts on health.
But it can also become a health problem for neighbouring states and the broader international community. In particular, the inability of failed states to control population flows means that disease can spread more easily to neighbouring countries.
Failed states often become incubators for activities which either assists in the spread of disease – like people smuggling – or lay at the heart of some of the worlds major health problems – like drug trafficking.
Australia has made the promotion of good governance a key objective of our foreign and aid policy.
A significant focus of our good governance assistance has been directed to health and health services delivery. Australia will spend $230 million this year in our region to improve governance and human capacity in the health sector.
In the Solomons, for example, we are investing a considerable part of our assistance to restoring a functioning health system.
This is important in terms of the delivery of health services to Solomon Islanders.
But in a country like the Solomons with a weak sense of nationhood, the collapse of an already fragile health system would also have a major impact on stability and national unity.
Restoring the health system not only makes for a healthier citizenry, it gives them a reason to remain citizens and to retain a stake in the state’s institutions.
Through our support for good governance and capacity building, in the Solomons and elsewhere, we are not just helping to make individual citizens healthier, we are making states healthier.
Conclusion
In conclusion let me congratulate the Nuffield Trust and the Rand Corporation for the work they are doing in the field of health and foreign policy.
It is a complex issue, and I have mentioned only a few of the dimensions of the impact of foreign policy on global health. It certainly requires further exploration.
But there can be little doubt today that global health is a foreign policy issue. Australia has certainly made it a part of its foreign policy considerations.
And I welcome the efforts of Nuffield Trust to promote greater awareness of the linkages between these two key policy areas through conferences such as this one.
Thank you.