INTERVIEW: Why Sweden’s role in global health is so important

David Nabarro, one of the nominees for director-general of the World Health Organization, on why Sweden's feminist foreign policy could help improve global health.

INTERVIEW: Why Sweden's role in global health is so important
What role can Sweden play in global health? Photo: Claudio Bresciani/TT

Nabarro, 67, is a special adviser to the UN secretary-general on the 2030 Agenda for Sustainable Development, and a former UN special envoy on Ebola 2014-2015. The Local spoke to him about global health and the role Sweden can play on the UN Security Council in improving health worldwide.

What's the single most important issue in global health?
The issue that most concerns me, is how to ensure that there is equity in health throughout the world. So, that women have the same opportunities for ensuring their good health as men. How to ensure that poor people have the same health experience and opportunities as wealthy people. How to ensure that disabled people have the same access to health care as people who are able bodied. The disparities in health in our world today are big and to quite a significant extent increasing. And so, seeking equity is a main focus of mine. 

David Nabarro, nominee for Director-General of the WHO. Photo: Christine Olsson/TT
What role can Sweden play in this?
Sweden has identified some of the inequities that exist and at the same time it has identified some of the opportunities that can be implemented to overcome them. In Sweden you have some of the best epidemiology and communications about that epidemiology. I'd like to identify particularly Hans Rosling and his work. I've worked closely with him on a number of issues. And what the work of Hans and other epidemiologists has shown us is that there are real opportunities to address inequities.
Sweden has led on the identification of the need for gender equity in health. If we look at the Swedish experience it has indicated really clearly that you can, by focusing on the interests of women and increasing the extent to which women participate in action for health. That makes a great difference.
And the Swedish approach to having equal numbers at least of women and men in senior decision making positions is an example and I am very impressed by the way in which the Swedish government under Prime Minister Löfven has moved forward on this. I particularly take note of the way this has been approached by your foreign minister Margot Wallström and also by the people responsible for health. Sweden has also put human rights at the centre of health issues and that rights approach to health is key to greater equity.
I'd like to particularly point out Sweden's role in supporting better access to the care necessary for sexual and reproductive health, that fits with the rights. Sweden has identified a number of future threats to health that will have an impact on health equity. One of those being what we call antimicrobial resistance, where Swedish scientists have identified the reality that if we don't watch it, resistance to antibiotics could result in even more deaths than cancer in two or three decades' time. I can't remember the exact date.
So what I am trying to say, is that whether we are talking about governance, rights, particular disease threats or experiences of women, that the Swedish engagement has been very, very powerful and will continue to be powerful. There are other areas as well, but I have just chosen those as examples.

Prime Minister Stefan Löfven and his government. Photo: Maja Suslin/TT
Is there anything Sweden can learn from other countries?
There are a number of issues that still are unresolved. I would not wish to be trying to judge what's happening in Sweden, but I want to pick out issues that are of global importance, that we've all got to work on. One of them is the emergence of non-communicable diseases increasingly as being responsible for a very large number of deaths. Seven out of ten deaths in our world today are due to chronic diseases, for example cardiovascular or respiratory diseases or diabetes, which is an endocrinological disease. Many of these non-communicable diseases are linked to how we live, what we eat, whether we exercise and also they can be linked to what's happening in our atmosphere and in the environment. So, I am particularly keen to see much greater emphasis on what can be done.
Now this again is where Sweden can be helpful, because the actions you need to reduce the incidents of non-communicable diseases have to be undertaken outside the health sector, in education or in environmental work or in water sanitation or in the food sector. That's one very strong area for the future. The second is to be prepared for outbreaks of severe infections diseases, particularly those that come from the animal population. These are areas in which Swedish engagement is hugely important.
It is important to be prepared for bird flu and other animal infection diseases. Photo: AP Photo/Murad Sezer 

As you argue engagement is important on those issues, is Sweden engaged enough?
It's difficult because Sweden is one of the most engaged countries in multilateral affairs. Sweden is active among the Scandinavian nations, so contributes to Nordic work on these issues and I would say that in general across Nordic nations it is pretty good.
But the Swedish role has to be increasingly important on the European level where we need to get very strong focus on non-communicable diseases and very strong focus on sexual and reproductive health. And then there is the Swedish role inside the European region of WHO, where that's been very good.
But then we go to Sweden's role in the multilateral system which is becoming increasingly important. My basic request to Sweden is: stay strong, stay engaged, stay multilateral. Even though there might be some forces that encourage a pullback from that. Because in health you need to be able to be multilateral. You can not deal with these health threats we've got just staying inside your country. So keeping Sweden where it is is the real challenge right now.
Swedish Foreign Minister Margot Wallström meeting UN Secretary-General António Guterres. Photo: Pontus Höök/TT
Sweden is a non-permanent member on the UN Security Council 2017-2018. Is there anything it can do in that role that will have an impact on global health too?
What happens in the Security Council is key. This is the ultimate decision-making body and Sweden has already played a major role in its first two weeks and has as President of the Security Council to make the point about what has to be done on peace and security and linking that to development and equality.
But let's go further than that. We need to look at how climate change is affecting peace and security and indeed will affect health. We need to look at how the kind of nativism and protectionism that is coming in some countries will also make it really hard to maintain health because diseases cross borders. So, the approach that Sweden takes in the Security Council will be key.
Lastly, I think that Sweden will bring a gendered approach to multinational thinking and action that is key to all aspects of our future. You know, unless we feminize development and make it a feminist issue for men and women, we will make big mistakes. And so, although some will say the gender issues should not stay in the Security Council but in other organs of the international system, I say: No! Having women involved in peace and security, women involved in global governance in a 50/50 way is key for all aspects of future development. And we've learned that from how the current Swedish government is behaving in multilateral affairs.
Interview by The Local's intern Christian Krug.


Sweden records world’s first case of bird flu in a porpoise

A porpoise found stranded on a Swedish beach in June died of bird flu, the first time the virus has been detected in one of the marine mammals, Sweden's National Veterinary Institute said on Wednesday.

Sweden records world's first case of bird flu in a porpoise

“As far as we know this is the first confirmed case in the world of bird flu in a porpoise,” veterinarian Elina Thorsson said in a statement. “It is likely that the porpoise somehow came into contact with infected birds,” she said.

The young male was found stranded, alive, on a beach in western Sweden in late June. Despite efforts from the public to get it to swim out to deeper
waters, it was suffering from exhaustion and died the same evening.

The bird flu virus, H5N1, was found in several of its organs. “Contrary to seals, where illnesses caused by a flu virus have been detected multiple times, there have been only a handful of reports of flu virus in cetaceans”, Thorsson said.

The virus has also previously been detected in other mammals, including red foxes, otters, lynx and skunks, the institute said.

Europe and North America are currently seeing a vast outbreak of bird flu among wild birds.