Besuch bei der "Public Health Foundation of India"

New Delhi, 01.10.2012 - Allocution du Conseiller fédéral lors de sa visite à la "Public Health Foundation of India"

Dear Professor Reddy, Dear Professors, Ladies and gentlemen,

There are many differences between Switzerland and India: the Indian population is 150 times larger than that of Switzerland, the Himalaya is twice as high as are the Alps. Switzerland has a GDP per capita 13 times larger than does India, while your economy is growing much faster than ours.

But let me focus more on the commonalities between our two countries. India and Switzerland are proud democracies with federalist structures. Our health systems are characterized by combinations of public and private players. We both have an important pharmaceutical industry. We give high importance to top level scientific research. It is therefore no surprise that we agreed this morning with the Minister of Health and Family Welfare Shri Ghulam Nabi Azad to deepen our collaboration.

Ladies and gentlemen,

Health has never really known borders when it comes to infectious diseases. But at the same time, health care systems and health policy were for a long time largely national. Today, the markets for health goods and personnel have become largely globalized. This leads to the need for increased and improved international cooperation.

Switzerland has a particular interest in a well-functioning and transparent global health governance. We are a relatively small European country with an open economy. We are not a member of the European Union. Several large health-relevant industries are headquartered in Switzerland: for example pharmaceutical companies such as Novartis and Roche, food and drinks companies such as Nestlé and a strongly growing Swiss medtech industry. Swiss hospitals and clinics are well-known for the excellence of their services. Geneva is a city of global health, with the World Health Organization at its centre., complemented by many more health organizations and NGOs such as the World Heart Federation, of which Professor Reddy is the President-Elect.

All these aspects of global health make the formulation of our national policies a challenging task. I am convinced that we first have to do our homework, in other words: global health begins at home. In the case of Switzerland we have a national global health strategy called the Swiss Health Foreign Policy. In March this year, a revised version of this strategy was approved by the Swiss government. Some of its measures may appear as relatively boring administrative arrangements. I will try to illustrate why this attempt to have a coherent cross government policy is worth the effort, using concrete examples.

First on health systems:

Even though health systems are largely national we can learn a lot from others. Switzerland twice asked the World Health Organization (WHO) and the Organisation for Economic Cooperation and Development (OECD) jointly to review our health system; first in 2006 and again in 2011. By asking both organizations to work together we did not only push them into better cooperation. We also received a report which was fully accepted by all actors as a standard for the further development of our health system. Switzerland is one of the few countries which has achieved universal coverage while keeping a strong role for private actors including private insurance companies. Our successes and failures can be interesting for countries like India to study on the way to universal health coverage.

My next example addresses one of the biggest challenges for policy coherence in global health: Pharmaceutical policy.

I am convinced that the world needs both more innovation and better access for all to safe, efficacious and good quality medicines. We need both an innovative brand name industry and a strong generics industry. Where the market creates incentives for innovation, government should promote this favourable environment. It should provide an adequate protection of intellectual property rights. But where there are market failures, governments have to intervene and promote innovation. This is the case of basic research on neglected diseases.

On access to medicine we have made progress since 1997. This was the time when the South African government took several pharmaceutical companies to court because of the price of anti-retroviral therapies. For least developed countries differential pricing is a working policy. But for emerging economies such as India the challenge remains. Is there a reason why a poor person in India should pay more for a drug than a poor person in Africa? Is there a reason why a rich Indian should contribute less to Research and Development costs of new medicines than a person in Switzerland? We certainly have to continue to make progress on global pharmaceutical policies. How to keep incentives for private research where this works? How to organize and finance government intervention where there is market failure? How to fight effectively against the often fatal criminal falsification of medicines? How to make sure that all poor people in this world get access to all essential medicines ?

Next example: migration of health professionals.

Switzerland sometimes took critical positions during the negotiation of the WHO Global Code of Practice on the International Recruitment of Health Personnel. The reason for this was not that we ignored the problem. Our position was linked to a specific situation in Switzerland. We are highly dependent on foreign health professionals mostly from neighbouring countries such as Germany. Studies showed that Germany recruits in Poland and Poland in Ukraine, where there is a shortage of doctors. Hence, Switzerland is not directly, but indirectly through a domino-effect contributing to the shortage of health professionals in countries with lower wages. The recognition of this phenomenon was an important factor leading to the decision to increase the number of training places for doctors from 800 to 1100. Once again: Good global health begins at home.

My last example is Health governance.

Good governance of health is probably the biggest challenge that we will face in the years to come. How do federal countries such as Switzerland and India handle the collaboration between the central government and the provinces? How do we encourage all actors to contribute to the common goal of achieving universal health coverage at an affordable price? How do we tackle the epidemic of non-communicable diseases? How do we increase efforts for health promotion and prevention? All these are ultimately questions of good health governance.

Already now the health sector is one of the largest economic sectors with a global economic weight of 6 trillion US dollars (or as you would say here 30 lakh crore rupees) and expected to increase fourfold over the next 20 years. We certainly do not have the proper international regulations in place for such a huge sector.

The founders of WHO in 1948 gave it the mandate to act as directing and coordinating authority of global health. But WHO will need reform to be well prepared for the coming challenges. WHO will need a more predictable financing mechanism and better involvement of other stakeholders in its work. At the same time, the independence of the Organization as well as the modern and effective management of its financial and human resources and a clear system to set priorities must be guaranteed.

Switzerland is very actively committed to supporting these efforts. We also want to strengthen negotiation capacity of all actors through our support to the Global Health Programme of the Graduate Institute in Geneva which provides courses in global health diplomacy.

I am convinced that my visit to India today will help our two countries to work together more closely in order to tackle jointly the major challenges which we are facing in the field of health.

In order to collaborate, we first have to know each other. That is why I would be very happy to open the discussion with you. I look forward to the exchange of views with such a distinguished audience and would like to warmly thank Professor Reddy for his hospitality.

Thank you for your attention.

Adresse für Rückfragen

Peter Lauener, GS-EDI, Tel. 079 650 12 34


Eidgenössisches Departement des Innern

Bundesamt für Gesundheit

Generalsekretariat EDI