Moving towards new global health governance
There are several reasons why the issue of global health governance needs to be reviewed.
The health sector has no longer the sole control “over health” as health is influenced by a multitude of factors. The social determinants of health are the conditions in which people are born, grow, live, work, age and die. Such conditions have a much bigger impact on population health than the health sector itself. In the last 20 years, economic transformation in the global economy has vastly increased the resources available for investment in health but has also resulted in massively increased social and economic inequalities, including in health status. There is an urgent need to understand how public health can be better protected and promoted in the realm of global governance.
Actions taken by governments and actors outside the health sector – in relation for instance to trade, economics, migration, conflict and the environment – increasingly have an impact on people’s health in ways that are not properly identified or monitored. There are political determinants of health where global accountability is deficient.
The private sector plays an increasing role in governing health. The intensified inter-relations, connections and mutual dependencies between States, societies and corporate businesses can be described as the commercial determinants of health. The way in which global food, soda and tobacco do their business, and how they interact with each other and with national, regional and international organizations needs to be much better understood by public health actors.
Health has become one of the most important of the world’s industries. The last decade alone has seen a doubling of global health spending from 3 to 6.5 trillion USD.
Health has increased in importance on the national and global policy agendas. More and more national elections are won or lost on population health matters. Increasingly, public health issues and policy are discussed by heads of state. Finally, there are an increasing number of actors – new global health institutions, increasing interest by non-state actors active in global health.
In broad terms, global health governance concerns the actions and means adopted by a society to organize itself in the promotion and protection of the health of its population. The organization and function can be formal or informal to prescribe and proscribe behaviour. The governance mechanism can be situated at the local/subnational, national, international and global levels. Health governance can also be public, private or a combination of both.
Core functions of the global health system include the production of global public goods, management of externalities across countries, mobilization of global solidarity, and stewardship. This means architecture is also needed to support technical work, monitoring, multilateral negotiations, etc.
Global health governance is often used to refer to the governance of the global health system and focuses on the actors and institutions with the primary purpose of health. Global governance for health refers to all other governance areas that can affect health and implicitly, it makes the normative claim that health equity should be an objective for all sectors.
This sub-theme will consider that there currently exists no global mechanism that follows all parallel and ongoing discussions related to global public health, particularly given the broad spectrum of fora addressing issues that impact public health including the World Trade Organization, ILO, WIPO, NGOs, civil society and others. The broad spectrum of subject-matter with direct impact on public health (trade, climate change, development, governance, water sanitation, etc.) further heightens inherent complexities and challenges.
Today there is increasing recognition that the existing rules, institutional mechanisms and forms of organization need to evolve to better respond to the emerging challenges of globalization and ensure that globalization benefits those currently left behind in the development process.
This sub-theme will address both the issues of “global health governance” as well “global governance for health”:
On global health governance, discussions will be held around the following issues:
- The role of state actors – UNAIDS, WHO, UNICEF, GAVI, World Bank, G8, G20, regional health collaborations and others;
- The role of the non-state actors – private sector, social enterprise and civil society organizations, especially in terms of health in critical underprivileged groups;
- Appropriate and effective monitoring and evaluation mechanisms as well as global health information systems to ensure transparency, accountability and fit for purpose.
On global governance for health, discussions will be held around:
- Social, political and commercial determinants of health and “health in all policies;”
- Appropriate coordination mechanisms to ensure that health is being considered in broader policy development (joined-up government at all levels);
- Appropriate instruments to assess the potential health and social impact of policies during the policy development process.