URU, Alm.del - 2024-25 - Bilag 88: Rapport fra Ekspertgruppen for Global Sundhed om anbefalinger til styrkelse af Danmarks rolle indenfor global sundhed

Udenrigsudvalget 2024-25
URU Alm.del Bilag 88
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URU, Alm.del - 2024-25 - Bilag 88: Rapport fra Ekspertgruppen for Global Sundhed om anbefalinger til styrkelse af Danmarks rolle indenfor global sundhed

Contents

Foreword

.................................................................................................................................................................................

Summary of recommendations

....................................................................................................................................

1. Rationale and background

1.1.

1.2.

We can no longer take global progress in health for granted

..........................................................

Global health is no longer a Danish top priority

.....................................................................................

2. Recommendations from the Expert Group on Global Health

II.

III.

IV.

Denmark must invest more in global health

............................................................................................

Denmark should assume global leadership in health

.......................................................................

Denmark should transition from being a donor to a partner in health

.......................................

Denmark should make global health a national priority and approach it strategically

......

3. About the Danish Expert Group on Global Health

..........................................................................................

4. Appendix

..........................................................................................................................................................................

URU, Alm.del - 2024-25 - Bilag 88: Rapport fra Ekspertgruppen for Global Sundhed om anbefalinger til styrkelse af Danmarks rolle indenfor global sundhed

A PRESCRIPTION FOR GLOBAL HEALTH

Foreword

Denmark has a unique opportunity to be a global leader in health at a time when it is

needed more than ever.

Around the world, health systems experience a multitude of challenges; geopolitical unrest

and armed conflicts, economic instability, effects of climate change, decreasing support for

sexual and reproductive health and rights, the enduring consequences of the COVID-19

pandemic, as well as the risk of the next major health crisis looming. In many low-income

countries (LICs), these pressures are particularly acute due to health funding gaps, with the

risk of future pandemics adding further urgency. Despite this, global health efforts face

significant funding gaps, calling for new partnerships, innovative solutions and stronger

commitments.

Against this critical backdrop, we argue that Denmark has a unique platform to help advance

progress in global health. A stronger global health engagement will both benefit the countries

in most need, as well as the Danish population by contributing to the prevention of global

health crises that cut across borders. We also see a strong potential for increased Nordic

collaboration and joint leadership in global health that Denmark should seize.

We are facing a crucial moment for Danish development policy, building on the new strategy

for engagement with African countries and preparing the upcoming Danish Strategy for

Development Cooperation, expected in 2025. Denmark’s forthcoming Presidency in the

European Union (EU) in 2025 and non-permanent seat in the United Nations (UN) Security

Council 2025-2026 provide major opportunities for Denmark to assume global leadership

positions. Drawing on latest evidence and research, including insights from the third Lancet

Commission on Investing in Health, we argue that global health must be at the top of the

Danish agenda in the critical years ahead.

We open the report with a poem on the polio epidemic by Danish author Tove Ditlevsen to

illustrate the profound impact that health crises have on individuals, families and whole

societies. It also serves as a timely reminder that we live in a pandemic world. Interestingly, it

was the polio epidemic that inspired Denmark to invent what is today known as the concept of

the Intensive Care Unit; widely acknowledged – among many other important Danish health

innovations – as a critical global contribution. Now is the time for Denmark to seize that legacy

and position itself, once again, as a frontrunner in global health.

To do so, we argue that renewed Danish leadership should build on Denmark’s historical track

record and global recognition in several areas, while also rethinking the Danish approach so

that Denmark can move from being primarily a donor to a partner in health.

The Danish society and economy have benefited significantly over the past years from

progress in healthcare, health innovations and research. We believe there is potential for

Denmark to further strengthen synergies of expertise, know-how and funding across sectors.

Danish global health efforts should both be about official development assistance, but also

about innovative partnerships to create synergies, catalyze innovations, convening partners,

and pooling resources to make Danish strongholds in health more globally beneficial. If done

right, Denmark can make a significant contribution in addressing the major global health

challenges facing us today. In short, Denmark has both a moral obligation and a strong

domestic interest in investing more in health, so that everyone, everywhere can live long and

healthy lives.

The Expert Group on Global Health:

Angela Y. Chang, Anna Frellsen, Haifaa Awad, Justice Nonvignon, Steven L. B.

Jensen, Tobias Alfvén, Ulla E. Müller, Vibeke B. Christensen

URU, Alm.del - 2024-25 - Bilag 88: Rapport fra Ekspertgruppen for Global Sundhed om anbefalinger til styrkelse af Danmarks rolle indenfor global sundhed

A PRESCRIPTION FOR GLOBAL HEALTH

Summary of recommendations

Denmark Must Invest More in Global Health

Denmark should strengthen its investments in global health

to reduce health

inequality, halve premature mortality globally by 2050, and enhance its own security

through better responses to global health crises and pandemic preparedness.

Denmark should anchor its global health investments in human rights, including

through the advancement of sexual and reproductive health and rights (SRHR).

Moreover, special focus should be placed on populations in most vulnerable positions,

civil society and community-led interventions, including in humanitarian contexts.

Denmark should consistently allocate more than 0.7% of its Gross National

Income (GNI) to Official Development Assistance (ODA)

to ensure that an

increased focus on global health does not negatively impact on other development

priorities. This should not, however, be a precondition for an increased priority of global

health.

Denmark should increase the proportion of its ODA to Least Developed

Countries (LDCs) from 0.14% of GNI (2022) to 0.2% of GNI, aligned with previous

Danish levels and the UN target,

to better reflect its leadership in global poverty

eradication, health equality, and the “leaving no one behind” principle.

II. Denmark Should Assume Global Leadership in Health

Denmark should reinforce its global leadership in championing SRHR,

including

strengthening cross-regional and global alliances around SRHR, leveraging its non-

permanent UN Security Council seat to highlight the critical importance of SRHR for

peace and security, and advocating for its central role in realizing the Sustainable

Development Goals as well as the post-2030 development agenda.

Denmark should lead the way in shaping a new generation of Nordic political

leadership in global health by fostering stronger Nordic collaboration,

aligning

global health strategies at a regional level, and advancing Nordic leadership on joint

priority areas such as SRHR.

Denmark should take leadership in reform processes to promote accountable,

efficient governance within global health multilaterals (UN and other global

health initiatives [GHIs])

by actively championing initiatives such as the Lusaka

Agenda. This includes advocating for better spending practices, promoting flexible

financing, and strengthening transparency and accountability mechanisms.

Denmark should enhance humanitarian cooperation with multilateral partners,

emphasizing the protection of health personnel and patients in conflict zones,

including through its non-permanent seat in the UN Security Council.

By advocating sustainable solutions and safeguarding health infrastructure, facilities,

URU, Alm.del - 2024-25 - Bilag 88: Rapport fra Ekspertgruppen for Global Sundhed om anbefalinger til styrkelse af Danmarks rolle indenfor global sundhed

A PRESCRIPTION FOR GLOBAL HEALTH

and medical teams, Denmark can strengthen its humanitarian profile while upholding

international humanitarian principles.

Denmark should use its leadership role in climate to address the health

crisis.

Recognizing the fact that climate change greatly exacerbates health

challenges, Denmark should leverage its position in relevant global forums to take the

lead in ensuring that climate funding is increasingly geared towards addressing

climate-related health challenges.

III. Denmark Should Transition from Being a Donor to a Partner in Health

To position itself as an equal partner in its development cooperation efforts, Denmark should

further ground efforts in local priorities:

10.

Denmark should center its global health partnerships around country-driven and

locally led priorities to identify mutually beneficial collaborations,

for instance

through stronger health research partnerships, knowledge exchange and reciprocal

capacity building.

11.

Denmark should directly support regional health bodies and regionally

distributed manufacturing and supply chains,

for instance through support to the

African Union’s "Agenda 2063" and New Public Health Order.

12.

Denmark should actively promote sustainable financing and financial resilience

in LICs to allow governments to pay for their own health services.

This includes

advocating for debt relief to support LICs in prioritizing essential services and

championing the crowding in of domestic financing of health, encouraging recipient

governments to commit and fund basic health commodities while donors support

systems and public goods such as Research and Development (R&D) and digital

health innovation.

Denmark should also further leverage unique Danish strongholds for better Danish support:

13.

Denmark should apply its expertise in strengthening health systems

domestically and in other countries to focus investments on resilient, integrated

health systems with stronger primary health care,

including at the community level.

This includes strengthening health system infrastructure, ensuring consistent and

continuous access to essential health services, as well as training of healthcare

personnel.

14.

Denmark should embrace new types of partnerships and cross-sectoral

approaches by developing solutions with relevant partners across climate

adaptation, antimicrobial resistance (AMR), zoonotic diseases, food security,

and nutrition.

This includes leveraging the Danish life sciences industry and food and

agricultural sectors to address crosscutting challenges innovatively.

15.

Denmark should make its expertise from life science R&D and health innovation

globally available to support global access to affordable health products,

including by strengthening in-country and regional capacity, also through the EU, and

promoting peer to peer partnerships and technology transfers.

URU, Alm.del - 2024-25 - Bilag 88: Rapport fra Ekspertgruppen for Global Sundhed om anbefalinger til styrkelse af Danmarks rolle indenfor global sundhed

A PRESCRIPTION FOR GLOBAL HEALTH

IV. Denmark Should Make Global Health a National Priority and Approach it

Strategically

16.

Denmark should prioritize global health in the next Danish strategy for

development cooperation

to ensure stronger and more consolidated Danish efforts

in global health going forward.

17.

Denmark should develop a dedicated global health strategy

to strengthen the

coordination of Danish global health efforts, including SRHR, across policy areas such

as development, security, foreign policy, and health.

18.

Denmark should appoint a Global Health Ambassador

to coordinate health efforts

and promote collaboration across all relevant Danish authorities, academia, civil

society, private sector, and other sectors, leveraging and increasing synergies, as well

as focusing on educating the Danish public on the importance of global health to

ensure the sustainability of the support for global health investments.

19.

Denmark should further invest in the talent pipeline for new global health

champions and strengthen civil servant and technical capacity in the field

to fully

leverage the global impact of Danish investments and position Denmark firmly as a

leader in global health.

URU, Alm.del - 2024-25 - Bilag 88: Rapport fra Ekspertgruppen for Global Sundhed om anbefalinger til styrkelse af Danmarks rolle indenfor global sundhed

A PRESCRIPTION FOR GLOBAL HEALTH

1. Rationale and background

1.1.

We can no longer take global progress in health for granted

The world has made staggering achievements in global health.

Child mortality has halved

since 2000.

Major technological advances have been made, especially in vaccine production,

and the chance of dying prematurely is halved over the course of a generation in several

countries.

Progress in health has created the foundation for increased prosperity, human well-

being and economic growth for numerous countries worldwide.

At the same time, we are witnessing major challenges and setbacks in global health

today.

The global burden of disease is not borne equally, with countries in Sub-Saharan facing

a disproportionately heavy disease burden with a significantly lower life expectancy than the

global average.

Moreover, LICs bear the dual burden of communicable and non-

communicable diseases (NCDs) and limited investments in health.

Other inequalities add urgency to the unevenly distributed burden of disease.

Sub-

Saharan Africa is again significantly affected, as two thirds of the world’s population in extreme

poverty live in this region, rising even to three quarters when including all fragile and conflict-

affected countries.

Too many individuals in Sub-Saharan Africa lack access to essential

healthcare, a problem compounded by entrenched social factors like poverty, discrimination,

and gender inequality.

Health inequalities worsened under the COVID-19 pandemic, as the

large majority of doses of the COVID vaccines were acquired and administered in the

wealthiest countries. The failure of specifically high-income countries to live up to promoting

equity in the distribution of vaccines and other essential health commodities to low-and middle-

income countries during the pandemic led to a severe lack of trust and increased skepticism

towards high-income countries.

Current funding to address the global disease burden, especially in LICs, is insufficient

while health systems worldwide will likely face substantial challenges in the next

decades.

The global health funding gap is already immense and has been worsened by the

cascading effects of COVID-19, conflicts, climate change, and economic instability. Even

before the pandemic, low- and middle-income countries were already falling short by $371

billion annually in the health investments needed to achieve the Sustainable Development

Goals by 2030.

The recent report from The Lancet Commission for Investing in Health 3.0,

titled “Global Health 2050”, includes the prediction that health systems will face substantial

challenges over the next 25 years. Notably, there is about 50% chance that a new pandemic

causing 25 million or more deaths will occur between now and 2050.

Moreover, opposition to SRHR is intensifying in many regions, threatening global

progress and access to essential services, particularly for women, girls and LGBTIQ+

United Nations Inter-Agency Group for Child Mortality Estimation (2023). Levels and trends in child mortality, report (link).

The Lancet Commission on Investing in Health (2024).

Global health 2050: the path to halving premature death by mid-century

(link).

Kasprowicz, V.O., Chopera, D., Waddilove, K.D.

et al.

African-led health research and capacity building- is it working?.BMC

Public Health

20,

1104 (2020). https://doi.org/10.1186/s12889-020-08875-3

The World Bank Group assigns the world’s economies to four income groups: low, lower-middle, upper-middle, and high. For the 2025 fiscal

year, low-income economies are defined as those with a GNI per capita, calculated using the

World Bank Atlas method,

of $1,145 or less in 2023.

World Bank (2024). Development Indicators Database. Net ODA provided to the least developed countries (% of GNI). Last Updated:

03/28/2024.

Bill and Melinda Gates Foundation (2024). Gates Foundation Report Calls for Targeted Global Health Spending to Save Millions of Children

from Malnutrition and Disease (link)

OECD Flows by donor (ODA+OOF+Private) [DAC1]. Price base: Constant prices. Combined unit of measure: US dollar, Millions. Denmark has

incorporated a budget-balancing mechanism to ensure allocation of 0.70 percent of GNI over a three-year period despite fluctuations, e.g. in GNI.

Ugeskrift for læger (2019). Danmarks rolle i global sundhed

(link).

Folketingets Udenrigsudvalget (2005). Strategi for Danmarks Støtte til bekæmpelse af hiv/aids i udviklingslandene (link).

URU, Alm.del - 2024-25 - Bilag 88: Rapport fra Ekspertgruppen for Global Sundhed om anbefalinger til styrkelse af Danmarks rolle indenfor global sundhed

A PRESCRIPTION FOR GLOBAL HEALTH

strong multilateral systems, most recently underlined by the Danish commitment to the UN

Pact for the Future, which calls for eradicating poverty through targeted measures, including

health.

Over the past years, however, Denmark has diverted its development priorities away

from global health and, more recently, from poverty reduction as an overarching Danish

development priority.

Focus is shifting with priorities leaning towards migration, private

sector engagement and investments, climate, and humanitarian aid, such as support for

Ukraine (in 2022, almost 20% of bilateral ODA went to emergency response while only about

4% went to health).

Contributions to Gavi, the Vaccine Alliance, and the Global Fund to Fight

AIDS, Tuberculosis and Malaria (the Global Fund) are significantly lower compared to other

Nordic countries.

Moreover, in 2022 Denmark allocated only 0.14% of its GNI to LDCs,

where it historically consistently allocated around 0.2%. Additionally, Denmark has

discontinued funding for programs addressing the intersection of SRHR, climate change, and

gender equality, despite growing global recognition of these interconnected challenges.

Building on its strong track record and historic recognition in health, Denmark has a

unique platform now to step up its global health efforts

and take the lead in addressing

some of the most urgent global health challenges facing the world today.

UN General Assembly (2024) Seventy-ninth session. Agenda item 123. Strengthening of the United Nations system. Draft resolution submitted

by the President of the General Assembly: Pact for the Future

(link).

Kjær, A. M. (2022). The Paradigm Shift of Danish Development Policy (1990–2020).

Forum for Development Studies, 49(3),

345–371.

https://doi.org/10.1080/08039410.2022.2080762

OECD Data, Aid (ODA) by sector and donor (DAC5), Denmark, Bilateral ODA grants, Constant prices, USD Millions 2022

GFATM (2024) Allocation Funding. Country pledges for 2023-2025 (divided by 3 year for annual contribution) (link).

GAVI (2024). Donor Profiles Denmark, Norway, Sweden. Country contribution USD Millions 2023

(link).

Calculated as relative to total ODA volume as per OECD data for 2023.

Finansministeriet (2024). Forslag til finanslov for finansåret 2025

(link).

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A PRESCRIPTION FOR GLOBAL HEALTH

2. Recommendations from the Expert Group on Global

Health

Investments in global health have offered historically high returns and are arguably among

the most successful investments made by the international development community to date.

In this section, we unfold our list of recommendations to explain why we believe Denmark

and the world has a lot to gain from a strengthened Danish global health engagement.

Denmark must invest more in global health

Increasing investments in health, particularly in LICs, is not only urgent but also

supported by various economic, solidarity and security arguments.

Health investments offer substantial returns in both economic and human terms.

Public

health investments can yield up to 14.3 times their cost through reduced healthcare expenses,

increased productivity, and longer life expectancy.

Strengthening health systems and

epidemic preparedness not only prevents pandemics but also generates significant economic

benefits, with returns as high as 1,000:1 in some areas, like pandemic response.

In LICs, including LDCs, it is evident that targeted health investments have

particularly transformative effects.

For example, for each $1 invested in targeted NCDs

interventions in LICs, an overall return of investment (ROI) of $7 can be generated,

constituting a high value for money investment.

Success stories of investments in health in

LDCs include Malawi, where life expectancy rose by 18 years between 2002 and 2019,

largely due to focused efforts on HIV, tuberculosis, and malaria, illustrating the profound

impact of strategic health investments.

Furthermore, Denmark has a moral obligation to leverage its strongholds and

experience within health innovation, research and science because solutions to

address and manage the global disease burden, are a significant driver of the Danish

economy.

Novo Nordisk A/S, fueled by the worldwide success of its pharmaceuticals, is

projected to contribute nearly half of Denmark’s Gross Domestic Product growth in 2024.

Remarkably, Novo Nordisk A/S’s market value of $570 billion now exceeds the total value of

the Danish economy, underscoring its profound economic impact.

This success creates an

economic opportunity for Denmark to reinvest an appropriate part of Danish GNI into global

health initiatives, addressing the very challenges that underpin its prosperity and ensuring

equitable access to health solutions worldwide.

While global health investments should be driven by solidarity and effective global

development, there is also an opportunity to align global efforts with Denmark’s self-

interest.

With its strong focus on security in Africa, Denmark can leverage better health and

robust health systems as key factors for healthy economies

and hence stability, and

Masters R, Anwar E, Collins B, Cookson R, Capewell S. (2017). Return on investment of public health interventions: a systemat ic review.

Epidemiol Community Health.71(8):827-834.

doi: 10.1136/jech-2016-208141. Epub 2017 Mar 29. PMID: 28356325; PMCID: PMC5537512.

FP Analytics (2022). The compounding economic dividends of global health investment. How investing in global health and healt h systems can

strengthen local economies (link).

WHO (2021). Saving lives, spending less: the case for investing in noncommunicable diseases

(link).

Reliefweb (2022). The Global Fund Results Report 2022 (link).

Born2Invest (2024). Novo Nordisk Responsible for Half of Denmark’s GDP Growth. News article by Eva Wesley, September 4 (link).

Fortune (2024). Novo Nordisk’s market value of $570 billion is now bigger than the entire Danish economy—creating a ‘Nokia risk’ for Denmark.

News article by Sanne Wass, Naomi Kresge and Bloomberg, May 1 (link).

WHO (2024). Health Financing and Economic (link).

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A PRESCRIPTION FOR GLOBAL HEALTH

conflict prevention. By strengthening health systems and pandemic preparedness in LICs,

Denmark enhances global and domestic health security, as epidemics can quickly become

global threats, as demonstrated by the COVID-19 pandemic.

In a time of multiple crises and considerable geopolitical shifts, it is increasingly

important that development frontrunners like Denmark set a normative standard of

what we want other nations to follow.

Denmark is ideally positioned to contribute to

tackling global health inequalities in LICs by building on its established rights-based

approach within global health. This recognizes that advancing public health requires

addressing the socioeconomic barriers to good health, especially those in vulnerable

positions.

In this context, the Expert Group recommends that first and foremost:

•

Denmark should strengthen its investments in global health

to reduce health

inequality, halve premature mortality globally by 2050, and enhance its own security

through better responses to global health crises and pandemic preparedness.

Denmark should anchor its global health investments in human rights, including

through the advancement of sexual and reproductive health and rights (SRHR).

Moreover, special focus should be placed on populations in most vulnerable positions,

civil society and community-led interventions, including in humanitarian contexts.

Denmark should consistently allocate more than 0.7% of GNI to ODA,

to ensure that

an increased focus on global health does not negatively impact other development

priorities. This should not, however, be a precondition for an increased priority of global

health.

Denmark should increase the proportion of its ODA to LDCs from 0.14% of GNI

(2022) to 0.2% of GNI, aligned with previous Danish levels and the UN target,

better reflect its leadership in global poverty eradication, health equality, and the “leaving

no one behind” principle.

•

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A PRESCRIPTION FOR GLOBAL HEALTH

II.

Denmark should assume global leadership in health

The years ahead provide a strong platform for Denmark to demonstrate global

leadership in health - particularly in areas where it holds a comparative advantage and

has unique contributions to make: SRHR, multilateral reforms, humanitarian efforts,

and leveraging its leadership role in climate to address the health crisis.

In 2025, Denmark will hold a non-permanent seat on the UN Security Council while also

presiding over the EU, providing Danish policymakers with a unique platform to influence

global agendas through multilateral engagement. Through the Security Council, Denmark can

advance priorities like Women, Peace and Security (“WPS”) and Youth, Peace, and Security

(“YPS”) agendas. Additionally, Denmark is set to assume the presidency of the Nordic Council

of Ministers in 2026 providing opportunities on a regional level.

For a small nation like Denmark, contributing to major multilateral organizations offers

an opportunity for increased influence and impact on the global stage.

It provides the

opportunity for Denmark to lead by example and influence other countries’ contributions, which

can be higher in volume. In 2023, 36% of Danish ODA was directed through multilateral

actors

, including the World Health Organization (WHO), UN Population Fund (UNFPA), UN

International Children's Emergency Fund (UNICEF), the World Bank, and key global health

funds like Gavi and the Global Fund. Denmark has consistently made significant contributions

to these multilateral organizations, focusing on partnerships that prioritize key areas in line

with Danish strongholds, such as gender equality and SRHR. Although geopolitical tensions

risk challenging the general support for multilateralism worldwide, it remains a unique vehicle

for safeguarding dialogue, managing mutual interdependencies and advancing collective

global action, including on cross-cutting issues such as pandemics.

Furthermore, in 2025,

there are several upcoming replenishment opportunities for health multilaterals that provide

rationale for reflecting on Denmark’s multilateral global health support.

Denmark has clear international ambitions when it comes to human rights, sexual and

reproductive health and gender equality.

This is reflected in its 2022 “Foreign and

Security Policy Strategy” and the priority areas for Denmark’s non-permanent seat at the UN

Security Council, which includes ensuring women’s rights. Denmark should continue to take

a leadership role on human rights, SRHR, gender equality and the rights of groups in

vulnerable positions and use its position in multilateral fora such as the UN Security Council

to leverage these agendas also when it comes to LICs.

However, global political shifts are threatening global support for SRHR and could

complicate Denmark’s ability to secure strong alliances for its SRHR efforts.

On a regional level, the Nordics are well-positioned to advance support for global

health and defend support for SRHR, being the fifth largest ODA donor combined.

The Nordics have a long-standing legacy of strong global health efforts, including significant

contributions to GHIs and representation in the senior leadership of most of these, however,

this would require stronger collaboration to effectively leverage each country’s strongholds.

OECD Data, Aid (ODA) Total flows (DAC1), Denmark, Constant prices, USD Millions 2022

The Independent Panel (2021), COVID-19: Make it the Last Pandemic.

Chapter 8

Geopolitical tensions challenging multilateralism (link).

UNDP (2023): The value of strong multilateral cooperation in a fractured world. Blog by Ulrika Modeer and Tseg aye Lemma (link).

Center for Global Development (2024). The 2024–2025 Replenishment Traffic Jam (link).

UNRISD (2023) The International Anti-Gender Movement. Understanding the Rise of Anti-Gender Discourses in the Context of Development,

Human Rights and Social Protection. Working paper by Haley McEwen and Lata Narayaswamy (link).

OECD Data, Aid (ODA) Total flows (DAC1), Denmark, Constant prices, USD Millions 2022

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A PRESCRIPTION FOR GLOBAL HEALTH

There are clear arguments for supporting GHIs specifically, and their effective

operations.

Global health multilaterals have made significant strides in global health and

toward achieving Sustainable Development Goal 3. For instance, the Global Fund

partnership has contributed to saving 65 million lives through their health programs since

2002, and Gavi's vaccine programs have contributed to preventing over 17 million deaths in

low- and middle-income countries between 2000 and 2020, while noting that these results

were reached in a collaborative effort with governments and healthcare workers. However,

the impact could be bigger, as experts call for optimizing how GHIs operate. The Lusaka

Agenda highlights five key shifts needed to improve effectiveness of GHIs: (i) Focus on

strengthening primary healthcare, (ii) Catalyze sustainable, domestically financed health

services, (iii) Promote equity in health outcomes, (iv) Achieve strategic coherence, and (v)

Improve coordination in product development and regional manufacturing.

Denmark has

emphasized these issues in its partnerships with GHIs like the Global Fund and WHO and is

advocating for reforms in the UN and international financial systems to make them more

representative and effective.

Furthermore, Denmark could more proactively support the integration of health

interventions with efforts to address other global issues, including conflict and the

effects of climate change.

This aligns with the priority areas for Denmark’s non-permanent

seat at the UN Security Council, which specifically includes safeguarding humanitarian

principles and addressing the effects of climate change.

Firstly, Denmark can strengthen its humanitarian profile by increasing its focus on the

humanitarian, development and peace interventions.

Proactive support for this nexus is

important, as the number of crises impacting people’s health has been increasing: United

Nations estimates show that 300 million people will need humanitarian assistance and

protection in 2024 with over half (165.7 million) in need of emergency health assistance. As

Denmark already recognizes the importance of this nexus, specifically focusing on access to

health and SRHR as priority areas

, it now has the opportunity to more strongly put this

nexus on the global agenda.

Secondly, there is a need for more attention to how climate change exacerbates the

health crisis, and more climate funding should be geared towards addressing climate-

related health challenges.

The latest report of The Lancet Countdown on Health and

Climate Change highlights that the threat of the climate crisis to human health is now at its

highest.

Climate change creates particularly acute and long-term challenges in infectious,

vector-borne, and waterborne diseases, NCDs, and SRHR, affecting marginalized groups

disproportionately.

This indicates that there is a need for more attention to health in climate

responses, internationally but also in Denmark.

Denmark is uniquely positioned to do so, as it takes pride in its role as a green nation

and has positioned itself as a country adept at providing impactful solutions at the

intersection of climate/environment and development.

In the Finance Act for 2024, the

Danish government for the first time set aside a notable 35% of development aid for green

The Lusaka Agenda, launched on December 12, 2023, is the outcome of a 14-month multi-stakeholder dialogue process, culminating in five

formulated key shifts for evolving global health initiatives and priorities,

Future of Global Health Initiatives (2023). The Lusaka Agenda: Conclusions Of The Future Of Global Health Initiatives Process (link).

Permanent Mission of Denmark to the UN (2024). Statement by Denmark at the 79th Session of the General Assembly of the United Nations

(link).

Ministry of Foreign Affairs Denmark (2022). How-to note for implementation of “The World We Share” - Social sectors and social Safety nets

(link).

Romanello et al. (2024) The 2024 report of the

Lancet

Countdown on health and climate change: facing record-breaking threats from delayed

action. The Lancet

Volume 404(10465)

pp. 1847-1896, doi:

10.1016/S0140-6736(24)01822-1

Alliance for Global Health (2024). The climate crisis and global health climate.

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interventions.

At an international level, Denmark has shown leadership by hosting Climate

Ministerial meetings, gathering around 40 climate leaders and ministers from around the

world to push for climate action and ambitious results of the UNFCCCs’ Conference of the

Parties (COP).

At a time of multiple crises, the Expert Group recommends that:

•

Denmark should reinforce its global leadership in championing SRHR,

including

strengthening cross-regional and global alliances around SRHR, leveraging its non-

permanent UN Security Council seat to highlight the critical importance of SRHR for peace

and security, and advocating for its central role in realizing the Sustainable Development

Goals as well as the post-2030 development agenda.

Denmark should lead the way in shaping a new generation of Nordic political

leadership in global health by fostering stronger Nordic collaboration,

aligning

global health strategies at a regional level, and advancing Nordic leadership on joint

priority areas such as SRHR.

Denmark should take leadership in reform processes to promote accountable,

efficient governance within global health multilaterals (UN and other GHIs)

actively championing initiatives such as the Lusaka Agenda. This includes advocating for

better spending practices, promoting flexible financing, and strengthening transparency

and accountability mechanisms.

Denmark should enhance humanitarian cooperation with multilateral partners,

emphasizing the protection of health personnel and patients in conflict zones,

including through its non-permanent seat in the UN Security Council.

advocating sustainable solutions and safeguarding health infrastructure, facilities, and

medical teams, Denmark can strengthen its humanitarian profile while upholding

international humanitarian principles.

Denmark should use its leadership role in climate to address the health

crisis.

Recognizing the fact that climate change greatly exacerbates health challenges,

Denmark should leverage its position in relevant global forums to take the lead in

ensuring that climate funding is increasingly geared towards addressing climate-related

health challenges.

•

Finansministeriet. Finansloven for 2024 (link).

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III.

Denmark should transition from being a donor to a partner in health

a. Grounding efforts in local priorities

To fulfil the Danish ambitions of advancing equal partnerships with public authorities

and civil society, partnerships in health should be grounded in local priorities.

The

shift towards ‘localization’ in the global development and humanitarian sector emphasizes

the importance of transferring decision-making power, resources, and leadership to local

actors, such as governments, communities, and local NGOs. It aligns closely with the goals

of national health system strengthening, which seeks to build resilient, effective, and

equitable health systems by leveraging local expertise and resources. This shift recognizes

that sustainable development outcomes, especially in health, are most effective when they

are driven by those who understand the local context, culture, and needs. Particularly,

involving community-based organizations and local leaders in healthcare delivery fosters

people-centered, community-led approaches that are tailored to local contexts, which

increases relevance, acceptance, and effectiveness.

In line with the localization agenda, Denmark’s new strategy for engagement with

African countries (“Africa Strategy”) is based on the ambition of equal partnerships

and respectful cooperation grounded in shared interests with African countries.

stated in Africa’s New Public Health Order, investing in African health systems is essential to

achieve Africa’s own development ambitions as outlined in Agenda 2063, and an equally

important and strategic investment for global health and economic security.

Investments on

the African continent seem particularly urgent considering that Africa is the region with the

smallest share of public spending allocated to health (7.3% of total public expenditure—or

4.9% of GDP—compared to the global average of 10.7%).

Furthermore, Sub-Saharan Africa

is the region with the second-highest proportion of healthcare costs covered by out-of-pocket

payments (30.4%), surpassed only by South Asia.

Out-of-pocket payments lead to

significantly lower healthcare coverage, particularly for the poorest segments of the

population, and contribute to pushing families further into poverty.

Given Africa’s health investment gap, prioritizing global health efforts—identified as a

key focus by multilateral African institutions— in Africa would be a way to align

Danish development efforts with priorities on the continent.

However, skepticism from

low-and middle-income countries—exacerbated by unequal COVID-19 vaccine distribution—

to the collaboration approach of high-income countries means Denmark must also work to

rebuild trust through equitable partnerships.

In line with Lancet’s Global Health 2050 report, it could be particularly effective to

provide support in areas where local priorities intersect with specific health

interventions that are reported to be effective in addressing premature deaths.

The

report proposes that

focused health investments

could drive dramatic improvements in human

welfare by the middle of the century. The Commission identified 15 health conditions that

account for the majority of the global gap in life expectancy (eight communicable diseases and

Erku D, Khatri R, Endalamaw A, Wolka E, Nigatu F, Zewdie A, Assefa Y (2023). Community engagement initiatives in primary health care to

achieve universal health coverage: A realist synthesis of scoping review. PLoS One. 18(5):e0285222. doi: 10.1371/journal.pone.0285222

O’Mara-Eves, A., Brunton, G., Oliver, S. et al. The effectiveness of community engagement in public health interventions for disadvantaged

groups: a meta-analysis. BMC Public Health 15, 129 (2015). https://doi.org/10.1186/s12889-015-1352-y

Abdalla S M, Koya S F, Jamieson M, Verma M, Haldane V, Jung A et al. Investing in trust and community resilience: lessons fro m the early

months of the first digital pandemic BMJ 2021; 375 :e067487 doi:10.1136/bmj-2021-067487

ALNAP (2021) Localisation re-imagined: Localising the sector vs supporting local solutions (link).

Africa Centres for Disease Control and Prevention (2023). The New Public Health Order: Africa’s health security Agenda (link).

WHO (2023) World Health Statistics report. Annex

(link).

World Bank Group (2024) Global Health Expenditure database (link).

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maternal health conditions, seven noncommunicable diseases), and recommends prioritizing

these to halve the likelihood of early death by 2050.

At the same time, the current political environment and the new Africa Strategy

indicates a potential shift away from infectious disease prevention in Africa to NCDs,

the continent where most of the LICs are situated, as stated before.

With the launch of

the new Africa Strategy, the government announced that it will close its embassies in two LICs,

Mali and Burkina Faso, and open new embassies in lower-middle income countries Senegal,

Rwanda and Tunisia. The Africa plan also signals a focus shift away from infectious diseases

such as HIV and tuberculosis which are heavy disease burdens in LICs particularly in Africa,

towards increased focus on NCDs and AMR.

The localization agenda is a critical component of health system strengthening in LICs,

particularly in ensuring that external aid is used to strengthen local systems rather than

replacing them.

Donors can support localization by channeling funds through local

governments and organizations, thus building long-term capacity and sustainability, and more

importantly, by encouraging governments to invest in health, albeit in an incremental manner.

It is important to note that funding for critical services, such as public health have been

hampered by the serious debt crises that many countries are facing, with a large share of

public spending going toward servicing public debt, instead of critical services. In Africa,

countries on average spend 1.5 times more public funds on interest payments for debt than

on their healthcare sectors.

Denmark has been supporting efforts to finding sustainable

solutions to this debt crises, e.g. through being part of the Paris Club.

It was also among the

first countries to forcefully argue that debt cancellation and increased allocation of resources

on favorable terms were the solutions to the debt problems of poor countries.

To position itself as an equal partner in its development cooperation efforts, the Expert Group

recommends that:

•

Denmark should center its global health partnerships around country-driven and

locally led priorities to identify mutually beneficial collaborations,

for instance

through stronger health research partnerships, knowledge exchange and reciprocal

capacity building.

Denmark should directly support regional health bodies and regionally distributed

manufacturing and supply chains,

for instance through support to the African Union’s

"Agenda 2063" and New Public Health Order.

Denmark should actively promote sustainable financing and financial resilience in

LICs to allow governments to pay for their own health services.

This includes

advocating for debt relief to support LICs in prioritizing essential services and

championing the crowding in of domestic financing of health, encouraging recipient

governments to commit and fund basic health commodities while donors support

systems and public goods such as R&D and digital health innovation.

•

UNCTAD (2024), Debt at a glance database (link).

The Paris Club is an informal group of 22 creditor countries that collaborate to find sustainable solutions for debtor nation s facing repayment

difficulties, which originated in 1956. The Club is working closely with the International Monetary Fund and World Bank to uphold principles of

international financial stability. Read more (link).

UN General Assembly (2003), 85

session. Letter dated 29 October 2003 from the Permanent Representative of Denmark to the United

Nations addressed to the Secretary-General (link).

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b. Leveraging unique Danish strongholds for better Danish support

In addition to grounding efforts in local priorities, Denmark should focus its health

partnerships in areas where Denmark can make a unique contribution, leveraging

Danish strongholds, convening power and expertise from across sectors.

Rethinking

Denmark’s approach to global health partnerships will require Denmark to further pool and

catalyze expertise, funding and know-how, not just from Danish efforts in international

development but also from across the wider public sector, R&D community, private sector

industries, foundations, and more.

When it comes to strongholds in international development and traditional global

health, Denmark has a strong track record in building health systems domestically, and

also internationally specifically around supply chains and building hospitals.

Although

health system strengthening may not currently be on top of the agenda of Danish development

policy, the legacy remains. Denmark can build on its global expertise in health supply chains,

including infrastructure, developed over the years, and share its expertise of domestic health

systems strengthening efforts.

Furthermore, Denmark should think beyond traditional aid to explore new avenues of

advancing global health partnerships, including cross-sector collaborations to make

more of the Danish expertise and know-how available to partners.

This includes

advancing more research collaborations and exchanges in health programs to share Danish

expertise with partners in LICs - and learn more from them. In addition, more innovative

partnerships are needed across the wider Danish public sector, private sector and foundations,

to pool and share more Danish know-how, expertise and innovations in health as global public

goods. Rather than just benefitting the Danish society, the strong Danish experiences with

health should be considered a significant asset that can be leveraged much more to build

impactful and equal partnerships.

Denmark should also strengthen efforts to maximize synergies and catalyze funding in

collaboration with leading industries and foundations working in health.

Denmark hosts

several major private companies and foundations working within health, including the world’s

biggest foundation. If Denmark manages to further pool funding and expertise from across

sectors, the country is better positioned to be a global leader in innovative partnerships that

can make a significant difference in addressing some of the major global health challenges

facing the world today.

Denmark holds specific expertise in areas across multiple industries, that can inform

effective and innovative health solutions globally.

For example, Denmark has one of the

world’s most advanced biotech and life science clusters, driven by strong public-private

collaborations. Denmark is recognized for its expertise in food innovation, producing high-

quality, safe, and hygienic food products with significant national and international impact.

Furthermore, Denmark has a long track record in surveillance of antimicrobial consumption

and resistance in bacteria from food animals, food of animal origin, and humans, for example

through its DANMAP program the Danish Integrated Antimicrobial Resistance Monitoring and

Research Program.

There is specific potential for Danish life science research institutions and companies

to boost global access to affordable health products, supporting resilient and regional

Danish Ministry of Foreign Affairs (2024). Doing Business in Denmark (link).

DANMAP (2024). About DANMAP (link).

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manufacturing and supply chains, especially in Africa.

One of the biggest health-related

challenges in Africa is that the continent is heavily dependent on the import of medicines and

equipment from other parts of the world. Up to 95% of all medicines and 99% of all vaccines

consumed in Africa are imported.

This dependency leads to unstable and unequal

access to medicine and equipment, which became a particularly significant problem during

the COVID-19 pandemic. Although Africa has skilled researchers and a growing life sciences

and biotechnology sector

, there is a lack of capacity and infrastructure for innovation,

research, development, and production of medicines that could lead to greater

independence and growth—while simultaneously strengthening health and security on the

continent.

Addressing the challenge by increasing production capacity would benefit both the

Danish and African private sectors and increase access to life-saving medicines.

LICs undergo epidemiological transitions, NCDs such as diabetes, cardiovascular diseases,

and cancers are becoming major health issues. Denmark has experience with NCD prevention

and treatment and should invest in expanding its expertise to LICs. Danish initiatives could

focus on education, prevention, and the development of health systems that can manage both

infectious diseases and NCDs.

Investments in global health product development yield substantial returns.

The Lancet

Global Health 2050 report showed that about 80% of the decline in mortality in children

younger than five years from 1970 to 2000 across 95 low-income and middle-income countries

can be attributed to the dissemination of new health technologies.

To further leverage unique Danish strongholds for better Danish support, the Expert Group

recommends that:

•

Denmark should apply its expertise in strengthening health systems domestically

and in other countries to focus investments on resilient, integrated health systems

with stronger primary health care,

including at the community level. This includes

strengthening health system infrastructure, ensuring consistent and continuous access to

essential health services, as well as training of healthcare personnel.

Denmark should embrace new types of partnerships and cross-sectoral

approaches by developing solutions with relevant partners across climate

adaptation, AMR, zoonotic diseases, food security, and nutrition.

This includes

leveraging the Danish life sciences industry and food and agricultural sectors to address

crosscutting challenges innovatively.

Denmark should make its expertise from life science R&D and health innovation

globally available to support global access to affordable health products,

including

by strengthening in-country and regional capacity, also through the EU, and promoting

peer to peer partnerships and technology transfers.

•

WHO (2021). Inside Africa’s drive to boost medicines and vaccine manufacturing

(link).

Africa CDC (2022). Partnerships for African Vaccine Manufacturing (PAVM) Framework for Action, Version 1

(link).

PLOS Global Public Health (2022) African biotech holds the key to transforming not just the health of African people, but our economies as well,

November 29

(link).

The Lancet Commission on Investing in Health (2024).

Global health 2050: the path to halving premature death by mid-century.

(link)

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IV.

Denmark should make global health a national priority and approach it

strategically

An enabling setup and strong civil servant capacity is essential for Denmark to

reclaim and solidify its position as a global health frontrunner and to build a Nordic

block for global health.

Addressing the complex and interconnected challenges of global

health requires a clear strategic vision, coupled with effective processes and cross-entity and

cross-sector coordination. Enhancing civil servant expertise will further empower Denmark to

navigate the multilateral system, influence international health agendas, and strategically

direct larger global contributions toward innovative and impactful solutions.

For Denmark to become a global leader in global health, the Expert Group recommends

that:

•

Denmark should prioritize global health in the next Danish strategy for

development cooperation

to ensure stronger and more consolidated Danish efforts in

global health going forward.

Denmark should develop a dedicated global health strategy

to strengthen the

coordination of Danish global health efforts, including SRHR, across policy areas such as

development, security, foreign policy and health.

Denmark should appoint a Global Health Ambassador

to coordinate health efforts

and promote collaboration across all relevant Danish authorities, academia, civil society,

private sector, and other sectors, leveraging and increasing synergies, as well as

focusing on educating the Danish public on the importance of global health to ensure the

sustainability of the support for global health investments.

Denmark should further invest in the talent pipeline for new global health

champions and strengthen civil servant and technical capacity in the field

to fully

leverage the global impact of Danish investments and position Denmark firmly as a leader

in global health.

•

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3. About the Danish Expert Group on Global Health

In August 2024, the Danish Alliance for Global Health commissioned the Expert Group on

Global Health to provide tangible policy recommendations for ways to strengthen Denmark’s

engagement in global health.

The Expert Group brings together leading Danish and international experts with knowledge in

global health, partnerships, and financing, constituting the following members:

•

Angela Y. Chang,

Associate Professor, University of Southern Denmark & member of the

Lancet Commission on Investing in Health

Anna Frellsen,

CEO Maternity Foundation

Haifaa Awad,

Medical Doctor and Chairwoman, ActionAid Denmark

Justice Nonvignon,

Technical Director at Management Sciences for Health, and

Professor at University of Ghana

Steven L. B. Jensen,

Senior Researcher, Danish Institute for Human Rights

Tobias Alfvén,

Professor, Karolinska Instituted

Ulla E. Müller,

Director, UNFPA Nordic

Vibeke B. Christensen,

Medical Doctor & Advisor for Doctors Without Borders

The expert group was tasked with developing recommendations, arguments and evidence for

how to most effectively focus and strengthen Denmark’s efforts within global health – now, and

in the years ahead. The present report is the result of their collaborative efforts.

To develop the present report, the Expert Group embarked on a series of working sessions

from August to December, including thematic deep dives, external presentations and focused

readings. The discussions, as well as the pre-read materials developed for all sessions, were

grounded in new knowledge and evidence from the global health field, including the recently

launched report from the third Lancet Commission on Investing in Health, Global health 2050.

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4. Appendix

List of abbreviations used

•

Africa CDC:

Africa Centres for Disease Control and Prevention

AIDS:

Acquired immunodeficiency syndrome

AMR:

Antimicrobial resistance

AU:

African Union

EU:

European Union

GHI:

Global health initiative

GNI:

Gross national income

HIV:

Human immunodeficiency virus

LDCs:

Least developed countries. The term "least developed countries" is used by the

UN to refer to countries experiencing multiple vulnerabilities. As per August 2024, there

were 45 countries designated by the United Nations as least developed countries,

entitling them to preferential market access, aid, special technical assistance, and

capacity-building on technology among other concessions. The majority of these

countries are classified as “low-income countries” according to the World Bank

classification.

LGBTIQ+:

Lesbian, gay, bisexual, transgender, intersex, queer or questioning and

inclusive of other sexual orientations, gender identities, and expressions not explicitly

listed, such as asexual, pansexual, and non-binary.

LICs:

Low-income countries. The World Bank Group assigns the world’s economies to

four income groups: low, lower-middle, upper-middle, and high. For the 2025 fiscal year,

low-income economies are defined as those with a GNI per capita, calculated using the

World Bank Atlas method, of $1,145 or less in 2023.

NCDs:

Non-communicable diseases

NGOs:

Nongovernmental organizations

ODA:

Official development assistance

R&D:

Research and development

SRHR:

Sexual and reproductive health and rights

UN:

United Nations

•

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