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Hello my name is Siri Tellier and I'm a
Public Health Demographer for the Copenhagen School of Global Health.
In this course on global health, we take
the point of departure that global health deals with.
Situations where the health challenges transcend national borders, and
where the solutions also are beyond national shared social objectives.
This session of the course is therefore
concerned with how we manage those solutions.
In the attempt to create an organized
social response to health at the global level.
And that is what I shall refer to as global health governance.
I shall concern myself mainly with the processes rather than with the content.
To understand the present, it's often useful
to look back to see some historical milestones.
Health challenges which transcend boarders are not new.
Epidemics spread across the globe for hundreds of years.
And society's established measures to protect themselves from such threats.
Quarantine systems are one such measure.
But the thought that response should go beyond protecting your own society.
And engaging with others to do so, is more recent.
For four to five decades the health
governance architecture or landscape, seemed relatively clear.
During that period a sequence of health consensus processes
for example the auto conference on primary healthcare in 1978.
Provided assistance for focusing technical, financial, and political
attention on agreed approaches and revising them over time.
However, in the last one to two decades, the situation's become
much more complex and there are many dimensions of this complexity.
One is that there's a growing realization
that diseases, not to mention health, are interrelated.
And have common risk factors and therefore
this requires new complex these in responding.
It also relates to the growing realization that
factors generally considered outside the remit of health, such
as aging populations, climate change, migration, as well
as economic and trade relations, have major health impact.
Furthermore, it relates to the mechanisms and
structures which we have to address these challenges.
That is both in terms of what is often called a
health landscape or higher health
architecture that is the institutional arrangement.
But it's also in terms of our value systems,
for example, religious or social economic or political paradigms.
For example, do we really all take it for granted that equity is a goal in health?
To my mind, the last decade, the decade of the millennium development goals,
which were formulated in 2001 and
reformulated in 2007, has brought particular complexities.
Three developments have taken place simultaneously.
One is the developement of the
strongly health focused Millennium Development Goals.
Another is a tripling from about 10 billion to about
25 to 30 billion in official developement assistance for health.
That is callenged through channeled through a multiplication of health actors.
Including the so called global health initiatives.
In that period, we have also achieved major
progress toward all the health related entity goals.
But it also means that WHO's unique governance role is changing.
Perhaps as a reflection of this complexity, in the last five to ten
years a whole new field of study has come up regarding global health governance.
And health diplomacy is becoming a recognized field.
So, what is then this global health governance?
And let me go back to the
simple explanation which I mentioned in the beginning.
That global health governance is concerned with how
we manage the solutions to global health challenges.
There's no one single definition of global health
governance, but most such definitions include the following elements.
One is that global health governance is a combination of
formal and informal mechanisms, not just governments, but many other aspects.
But there's a range of institutions
and stakeholders involved, not only governments but
also civil society organizations, private sector, media,
as well as arguably the populations themselves.
Another is that the foremost, the format includes
consensus processes such as conference outcomes and medially
binding human rights conventions, and that related national
laws, as well normative guidelines and arguably public opinion.
Another element is that it goes beyond health
including for example, regulations regarding migration or trade.
And finally, of course is that the shared social objective
is to improve health for the population of the world.
It's also important to acknowledge what governance is not.
Governance is not government.
Governments have risk possibilities for democratic processes to set priorities for
collecting taxes to implement them, for legal processes to ensure compliance.
None of those mechanisms are necessarily available for global governance.
There are numerous examples of how this governance does
work, let me mention a few very practical examples.
Number one is normative guidelines such as the international
classification of disease, which is presently in its tenth
version and which is an absolutely indispensable precondition for
collecting data and comparing them across time and space.
Another is the legally binding conventions
such as the Framework Convention on Tobacco.
Another might be the voluntary codes of conduct for multi-national companies, and
a global compact between private sector and the and UN organizations.
You have also guidelines concerning the intellectual
property related to pharmaceuticals or the enormous
well built built up enormative framework for
setup for prioritizing financing and implementing humanitarian systems.
And we also have human rights monitoring
processes as well several society initiatives, either
regarding single issues such as breast milk
substitutes or HIV, or broader, people's health initiatives.
The challenges in developing such governance are great.
Building up what I mentioned above as the growing
complexity, let me mention a few of those challenges.
One is sovereignty.
The global government system of the United Nations is built up around the
principle of sovergn, sovereignty of nations
establishing legally binding or more informal mechanisms.
Which could be seen as infringing on that sovereignty, can be quite problematic.
Another challenge is accountability.
For WHO, it's governance is composed of member state
governments, which arguably have some accountability to their populations.
Some of the new health initiatives have very
inclusive government structures including for example civil society organizations.
But for others, there's built in accountability
back to the populations which are being served.
In either case the question is how a
minister of health which receives major official development assistance,
can remain accountable to it's own population or
rather becomes accountable too a far away funding mechanism.
A third challenge regard is regarding sectoral limitations.
The the classical definition of a health system is that it includes
only those actors whose primary function is to improve health.
This could be a killer assumption in a
world where those who have the biggest influence for
example various industries, tobacco, pharmaceutical companies and so
on, are not included in the in the governance.
This session has been about the history,
processes, challenges, and components of global health governance.
Thank you very much for listening.