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[MUSIC]

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[BLANK_AUDIO]

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Hello my name is Siri Tellier and I'm a

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Public Health Demographer for the
Copenhagen School of Global Health.

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In this course on global health, we take

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the point of departure that global health
deals with.

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Situations where the health challenges
transcend national borders, and

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where the solutions also are beyond
national shared social objectives.

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This session of the course is therefore

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concerned with how we manage those
solutions.

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In the attempt to create an organized

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social response to health at the global
level.

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And that is what I shall refer to as
global health governance.

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I shall concern myself mainly with the
processes rather than with the content.

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To understand the present, it's often
useful

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to look back to see some historical
milestones.

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Health challenges which transcend boarders
are not new.

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Epidemics spread across the globe for
hundreds of years.

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And society's established measures to
protect themselves from such threats.

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Quarantine systems are one such measure.

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But the thought that response should go
beyond protecting your own society.

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And engaging with others to do so, is more
recent.

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For four to five decades the health

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governance architecture or landscape,
seemed relatively clear.

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During that period a sequence of health
consensus processes

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for example the auto conference on primary
healthcare in 1978.

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Provided assistance for focusing
technical, financial, and political

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attention on agreed approaches and
revising them over time.

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However, in the last one to two decades,
the situation's become

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much more complex and there are many
dimensions of this complexity.

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One is that there's a growing realization

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that diseases, not to mention health, are
interrelated.

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And have common risk factors and therefore

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this requires new complex these in
responding.

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It also relates to the growing realization
that

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factors generally considered outside the
remit of health, such

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as aging populations, climate change,
migration, as well

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as economic and trade relations, have
major health impact.

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Furthermore, it relates to the mechanisms
and

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structures which we have to address these
challenges.

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That is both in terms of what is often
called a

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health landscape or higher health

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architecture that is the institutional
arrangement.

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But it's also in terms of our value
systems,

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for example, religious or social economic
or political paradigms.

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For example, do we really all take it for
granted that equity is a goal in health?

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To my mind, the last decade, the decade of
the millennium development goals,

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which were formulated in 2001 and

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reformulated in 2007, has brought
particular complexities.

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Three developments have taken place
simultaneously.

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One is the developement of the

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strongly health focused Millennium
Development Goals.

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Another is a tripling from about 10
billion to about

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25 to 30 billion in official developement
assistance for health.

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That is callenged through channeled
through a multiplication of health actors.

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Including the so called global health
initiatives.

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In that period, we have also achieved
major

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progress toward all the health related
entity goals.

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But it also means that WHO's unique
governance role is changing.

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Perhaps as a reflection of this
complexity, in the last five to ten

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years a whole new field of study has come
up regarding global health governance.

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And health diplomacy is becoming a
recognized field.

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So, what is then this global health
governance?

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And let me go back to the

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simple explanation which I mentioned in
the beginning.

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That global health governance is concerned
with how

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we manage the solutions to global health
challenges.

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There's no one single definition of global
health

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governance, but most such definitions
include the following elements.

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One is that global health governance is a
combination of

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formal and informal mechanisms, not just
governments, but many other aspects.

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But there's a range of institutions

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and stakeholders involved, not only
governments but

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also civil society organizations, private
sector, media,

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as well as arguably the populations
themselves.

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Another is that the foremost, the format
includes

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consensus processes such as conference
outcomes and medially

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binding human rights conventions, and that
related national

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laws, as well normative guidelines and
arguably public opinion.

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Another element is that it goes beyond
health

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including for example, regulations
regarding migration or trade.

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And finally, of course is that the shared
social objective

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is to improve health for the population of
the world.

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It's also important to acknowledge what
governance is not.

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Governance is not government.

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Governments have risk possibilities for
democratic processes to set priorities for

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collecting taxes to implement them, for
legal processes to ensure compliance.

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None of those mechanisms are necessarily
available for global governance.

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There are numerous examples of how this
governance does

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work, let me mention a few very practical
examples.

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Number one is normative guidelines such as
the international

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classification of disease, which is
presently in its tenth

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version and which is an absolutely
indispensable precondition for

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collecting data and comparing them across
time and space.

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Another is the legally binding conventions

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such as the Framework Convention on
Tobacco.

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Another might be the voluntary codes of
conduct for multi-national companies, and

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a global compact between private sector
and the and UN organizations.

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You have also guidelines concerning the
intellectual

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property related to pharmaceuticals or the
enormous

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well built built up enormative framework
for

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setup for prioritizing financing and
implementing humanitarian systems.

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And we also have human rights monitoring

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processes as well several society
initiatives, either

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regarding single issues such as breast
milk

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substitutes or HIV, or broader, people's
health initiatives.

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The challenges in developing such
governance are great.

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Building up what I mentioned above as the
growing

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complexity, let me mention a few of those
challenges.

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One is sovereignty.

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The global government system of the United
Nations is built up around the

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principle of sovergn, sovereignty of
nations

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establishing legally binding or more
informal mechanisms.

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Which could be seen as infringing on that
sovereignty, can be quite problematic.

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Another challenge is accountability.

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For WHO, it's governance is composed of
member state

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governments, which arguably have some
accountability to their populations.

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Some of the new health initiatives have
very

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inclusive government structures including
for example civil society organizations.

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But for others, there's built in
accountability

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back to the populations which are being
served.

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In either case the question is how a

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minister of health which receives major
official development assistance,

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can remain accountable to it's own
population or

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rather becomes accountable too a far away
funding mechanism.

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A third challenge regard is regarding
sectoral limitations.

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The the classical definition of a health
system is that it includes

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only those actors whose primary function
is to improve health.

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This could be a killer assumption in a

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world where those who have the biggest
influence for

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example various industries, tobacco,
pharmaceutical companies and so

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on, are not included in the in the
governance.

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This session has been about the history,

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processes, challenges, and components of
global health governance.

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Thank you very much for listening.