[MUSIC].
Hello, my name is Siri Tellier
and I'm a public health demographer
within 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 should 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 borders are not new.
Epidemics spread across the globe for hundreds of years
and societies establish 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 Alma Ata conference on primary health care in 1978
provided a system for focusing technical,
financial, and political attention on agreed
approaches and to 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 is a growing realization that diseases,
not to mention health, are interrelated and have common risk factors
and therefore, this requires new complexities
in responding.
It also relates to the growing realization that
factors generally considered outside the remits of health such
as, aging populations, climate change, migration, as well
as economic and trade relationships, 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 the health
landscape or hierarchial architecture that is the institutional arrangement.
But it's also in terms of our value systems.
For example, religious or socioeconomic or political paradigms.
For example.
Do we really all take it for granted that equity is a goal in the health?
To my mind the last decade, the decade of the millennium developments goals,
which were formulated in 2001 and
reformulated in 2007, has brought particular complexities.
Three developments have taken place simultaneously.
One is the development of the strongly health focused, minimum development goals.
Another is a tripling from 10 billion
to about 25 to 30 billion
in official development assistance for health
and that is channelled 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 related MDG goals,
but it also means that WHO unique governance role is changing.
Perhaps as a reflection of this whole 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?
Let me go back to the simple explanation, I mentioned in the beginning
that global health governance is concerned with
how we manage the solutions to global health challenges.
There is 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
that there is a range of institutions and stakeholders involved
not only governments but also several society organisations,
private sector, media, as arguably the populations themselves
Another is that the formats, the format includes
consensus processes such as conference outcomes and legally binding
human rights conventions and that related national laws,
as well as 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 heath for the population of the world.
It's also important to acknowledge what governance is not.
Governance is not government, governments have
responsibilities for democratic processes to set
priorities for collecting taxes, to implement
them, for legal processes to insure 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 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 multinational companies and the Global Compact
between private sector and, and UN organizations.
You have also guidelines concerning the intellectual property related
to pharmaceuticals. Or the enormous
Well built built up normative framework for,
setup for prioritising, financing, and implementing humanitarian systems.
And we also have human rights monitoring processes, as well as, civil
society initiatives, either regarding single issues
such as breast milk, substitutes, or HIV.
Or broader peoples' health initiatives.
The challenges in developing such governance
are great.
Building on what I mentioned of as the growing complexity.
Let me mention a few of those challenges.
One is sovereignty.
The global governance system of the United Nations Is
built up around the principle of sovereignty of nations.
establishing legally binding or more informal mechanisms, which can 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 several society organizations.
But for others there is littl, 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 its owner population, or
rather becomes accountable to 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 extras 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 there is 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.
[INAUDIBLE]
Thank you very much, for listening.
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