In an era characterized by intersecting crises across the globe, there is an increasing need to better understand the interplay of geopolitics, human security and health equity.
This was the focus of this year’s Prince Mahidol Award Conference (PMAC), a global multi-stakeholder forum co-hosted by the Prince Mahidol Award Foundation, the Government of Thailand and other partners including the United Nations Development Programme (UNDP), held 22-27 January 2024 in Bangkok, Thailand.
The forum provided an opportunity to examine the often overlooked geopolitical dynamics impacting the health and well-being of people and planet, together with pathways towards a fairer and more sustainable world. The conference focused on themes of global governance for health; identifying the roles of actors shaping commercial determinants of global health; and decolonization of global health. Nearly 1,000 participants joined from countries around the world.
UNDP was actively involved in the week-long conference. Dr. Mandeep Dhaliwal, Director of the HIV and Health Group at UNDP, moderated a parallel session on ‘Transformative Digital Technology for Future Health’ on 25 January. The session examined the role of geopolitics in shaping the governance system for digital technologies for health.
Transformative digital technologies such as artificial intelligence (AI) and cloud computing have significant potential to accelerate research and development of new vaccines and medicines, facilitate faster and more accurate diagnosis of medical conditions, and improve treatment effectiveness based on individual patient data.
“The digital health landscape is evolving rapidly,” said Dr. Mandeep Dhaliwal. “We need to acknowledge the challenges and complexities, particularly those related to ensuring data privacy, security and non-discrimination, much of which are heavily influenced by the geopolitical environment.”
“Digital tools can play a pivotal role in advancing the Sustainable Development Goals (SDGs) and fulfilling the pledge to leave no one behind,” she added.
Digital technologies can empower marginalized communities by promoting access to information, education and health care, while enhancing efficiency in public services, improving governance and fostering economic growth.
However, at the same time, there is a concentration of technological power in economically advanced nations and non-state actors, and a lack of clear accountability mechanisms. Without the right safeguards and protocols on standards and regulations governing ethical and rights-based use, emerging technologies such as AI could potentially undermine the delivery of quality-assured health care, and even limit access to health care, particularly for marginalized communities.
UNDP, together with the World Health Organization, World Bank and Alliance for Health Policy and Systems Research, also organized a side event titled ‘Taxing Bads for the Greater Good: Health Taxes as Policy Pathways to Achieve the SDGs,’ on 22 January.
In this session, international experts and country representatives examined the use of health taxes through the lens of accelerating the SDGs. The session also addressed the contentious issue of industry interference in health tax policymaking and the consequences of prioritizing commercial interests over public health and sustainable development.
Roy Small, Policy Specialist on Health at UNDP, presented on the concept of ‘green taxes’ – taxes that are imposed by governments on goods or activities that are detrimental to the environment, such as pollution, carbon-intensive transport, and exploitation of natural resources.
“UNDP is calling for a new development paradigm that replaces the chase of GDP growth at all costs with a new aim for the highest standard of living within our planet's limits,” noted Roy Small. “Green taxes are a policy solution that can help set us on this course.”
Green taxes are designed to internalize the social and environmental costs of activities that harm the planet, thereby making these more expensive and less appealing. The aim is to shift corporate and individual behaviour towards sustainable practices that safeguard planetary health.
An additional objective of green taxes is revenue generation – in Sweden, for example, the total environmental tax revenue in 2022 amounted to $9.3 billion, or 1.6 percent of its GDP. The promise of untapped revenue from green taxes includes support for essential investments in health care and development.
Through the Tax for SDGs Initiative, UNDP is supporting countries to leverage taxation as a tool for revenue collection and a policy instrument to drive achievement of the SDGs, including SDG 3 on health and well-being for all.
In the same side event, Sudyumna Dahal, Regional Economist for Asia-Pacific at UNDP, presented findings from ongoing regional work on leveraging taxation as a tool to promote the SDGs, referencing the example of the Investment Case for Tobacco Control in Lao PDR, developed by the Lao Ministry of Health, RTI International, UNDP, Secretariat of the WHO FCTC, and WHO.
The investment case found that a long-term Investment License Agreement (ILA) offering significantly reduced tax and other privileges for tobacco companies has played a role in fostering elevated levels of tobacco use and related illness – annually claiming the lives of more than 6,700 Laotians, and costing the economy 2.3 percent of its GDP.
“The Asia-Pacific region hosts 7 of the world's top 10 countries with the highest smoking rates and 6 out of the top 10 countries with the highest smoking-related death rates,” said Sudyumna Dahal. “This underscores the urgency to take decisive action in reducing tobacco industry interference and enhancing tobacco taxation across Asia-Pacific.”
The investment case makes several recommendations, including the proposal that the Lao PDR government not extend the ILA. It also recommends that the government increase tobacco taxes and support tobacco farmers to transition toward alternative crops or livelihoods. Should the recommendations be adopted, it is projected that 25,000 lives could be saved and LAK 10 trillion ($480 million) in health costs and economic losses could be avoided by 2034.
PMAC 2024 provided important insights into the interplay between geopolitics, human security and health equity, highlighting how factors and forces outside of the health sector impact public health. It also charted solutions, for example the need for more robust global health governance focused on global public goods, equity and access. Above all, this year’s PMAC underscored the urgency to work together to ensure a more equitable, healthier and sustainable future.