Interlinking Germany’s Global Health Strategy at the European Level

Consolidation of EU approaches

Even before the Covid-19 pandemic, the EU supported third countries in addressing health issues. This commitment, based on a broad definition of “global health”, is also understood as part of development coopera­tion. However, it goes beyond development aid and touches on various areas of the EU’s external action. When it comes to external action, the EU has significantly more room to manoeuvre than in its internal affairs, which are characterised by highly restricted health policy competences.

Driven by the pandemic, the EU’s various ambitions and approaches were first con­solidated in November 2022 in its “Global Health Strategy”, which pursues three main goals: enhancing global health security, strengthening health systems, and promot­ing health and well-being. Health security includes preventing or rapidly containing threats such as pandemics and antimicrobial resistance in cooperation with the World Health Organization (WHO). Strengthening health systems involves ensuring universal coverage, improving infrastructure, and en­hancing the training of professionals. Finally, the aim of promoting health and well-being is to combat inequalities, improve nutrition and mental health, and influence the socio-economic determinants of health in a posi­tive manner. To implement the strategy, detailed action plans are to be developed, and regular evaluations are to be conducted. However, the “Global Health” document only mentions inter-ministerial meetings and coordination within the framework of the “Team Europe” approach.

Overall, the substantive added value of the EU for the member states lies in the extensive investments in health security and health systems, in technical support and crisis response capabilities, and in the eco­nomic and political influence that enables the pursuit of a “Health in All Policies” approach. However, the added value from the coordination of European approaches is not yet apparent. Generating this is even more important, as a cursory glance at the EU strategy is enough to realise that, due to its scope, it necessarily overlaps with the agendas of the member states, including Germany.

Germany’s global strategy

Germany’s commitment to global health is reflected in a long tradition of international initiatives, increasingly accompanied by concept papers. The 2020 strategy of the Federal Government defined five main goals: promoting health, addressing environmen­tal and health issues together, strengthen­ing health systems, addressing cross-border health threats, and promoting research and innovation.

Germany is committed to supporting WHO and advancing cooperation to im­prove global health governance. International health initiatives are to be strengthened to prevent and control pandemics and other health threats. This includes pro­moting the resilience of and accessibility to health systems, improving health infra­structures, and training health personnel. In all these measures, attention must also be paid to overcoming inequalities in the health sector. Research and innovation are to be advanced through support for the development of new medicines, vaccines, and technologies.

Regarding the instruments to implement these goals, the strategy mentions Germany’s involvement in international forums and networks, financial support for health initiatives, and a focus on policy coherence. The commitment to global solidarity and the universal human right to health is em­phasised. In line with this, an integrated approach to addressing global health prob­lems is pursued. It is noteworthy that the document assigns the EU a rather modest role, stating that it can set international (data protection) standards through “inno­vation-friendly regulations”. This contradicts the ambitions of the EU outlined above. Furthermore, Germany does not explicitly assign the EU the task of coordinating the actions of member states. The role of other EU members is not considered at all.

Strategies of other member states

While numerous EU member states have published guidelines for improving national health, only France, the Netherlands, and Sweden have published global health strat­egies.

The “Stratégie Française en Santé Mon­diale” was presented at the end of 2023. It is entirely focused on “Universal Health Coverage” (UHC) and emphasises the fight against diseases and better anticipation of, prevention of, and responses to health crises. The document prioritises the Sustain­able Development Goals (SDGs), overcoming inequalities, and addressing climate change. It is committed to the “One Health” ap­proach and the protection of human rights and French values.

The Netherlands’ strategy, the “Neder­landse Mondiale Gezondheidsstrategie” of 2023, takes a slightly different approach by explicitly prioritising the strengthening of the global health architecture over other concerns. Pandemic preparedness and response, along with the health implications of climate change, are also high on the agenda in the Dutch document. How­ever, it differs in its concrete priorities by focusing on sexual and reproductive health and rights (SRHR), antimicrobial resistance, sustainable health care, and access to medi­cal countermeasures and supplies.

Sweden has adopted a completely differ­ent approach with its “Strategi för Sveriges samarbete med Världshälsoorganisationen (WHO)”. The concept, presented in 2021, explicitly views Sweden’s goals through the lens of its collaboration with WHO and out­lines how the Swedish government should support the United Nations (UN) organisation in specific areas of activity. Other key aspects include achieving the SDGs, imple­menting UHC, improving the global health architecture, and broadly promoting healthy living. Even this brief overview shows how differently each country’s priorities are set.

Systematic text analysis

The systematic examination of the strategy documents utilises text analysis methods such as relative word frequency and the mentioning of specific topics. Employing statistical models, the author calculated the distances between the different strategies in terms of their content, provided a syn­thesis of key points, and identified similar­ities and differences in the texts.

Alignment of initiatives

The analysis shows that Germany can find strategic partners in several areas among EU member states and the EU itself. The greatest content proximity is seen with the Netherlands, particularly in the areas of “One Health”, “Planetary Health”, climate, and the environment. These substantive overlaps provide a solid foundation for close collaboration and joint initiatives in global health policy. France is another important partner for Germany, especially in research and development and concerning UHC. The French strategy also emphasises access to medical care, which is another commonality. The EU strategy has intersections with the German one in the areas of cross-border health threats and digitalisation of health systems. Despite dif­ferences in other areas, the EU remains an important actor for Germany, mainly due to its role in coordinating and supporting the member states concerning cross-border health threats. Sweden uniquely focuses on WHO and strengthening the international health architecture. Although this creates a greater distance from the German strategy regarding the content, Sweden should be a central partner in German initiatives con­cerning WHO and global health institutions.

Recommendations for further implementation by 2030

The analysis reveals significant differences in strategic priorities and underscores the need for greater integration of approaches. The following measures are recommended for German and European policy to improve the effectiveness and coherence of efforts:

• Strengthen EU coordination: The EU should provide a stronger platform for the mutual consideration of strategic priorities. In its role as a coordinator, the EU could promote better alignment and greater coherence of national strategies. One possibility would be to go beyond project coordination and, based on the outlined priorities, establish member state working groups that pursue health policy goals through the division of tasks.

• Consider other strategies in further implementation: The health strategies of the EU and its member states make little reference to each other, which has so far hindered effective integration. During the review process, Germany should consider the national priorities of other countries with the help of EU bodies and, through the EU, seek coopera­tion with member states.

• Intensify bilateral and multilateral dialogues: Regular coordination meetings between health ministries and rele­vant institutions can help identify common priorities and bridge differences. Informal inter-ministerial exchanges on specific areas are also a viable option.

• Develop joint projects and research initiatives: The development and imple­mentation of joint research projects – particularly in the areas of “One Health”, pandemic preparedness, and digitalisa­tion – could strengthen cooperation and create synergistic effects. Here, too, the EU can play a role as a hub for intergov­ernmental cooperation.

Overall, the examination of the strategy documents shows that the German gov­ern­ment has numerous opportunities for fruit­ful collaboration with EU member states in global health policy. However, the EU must fulfil its important role as a coordinator. Through close cooperation with the Nether­lands, France, Sweden, and the EU, Ger­many can pursue its goals even more effec­tively and contribute to strengthening global health. Ultimately, this also requires alignment with political practices and the implementation of the strategies. Uncover­ing shared interests, which this analysis has done, can serve as an important basis for evaluating the state of cooperation in the individual areas of action.