00:00:00,430 --> 00:00:00,430 [MUSIC]. 2 00:00:13,430 --> 00:00:13,480 Hello, my name is Siri Tellier 3 00:00:13,480 --> 00:00:16,780 and I'm a public health demographer 4 00:00:16,780 --> 00:00:19,299 within the Copenhagen School of Global Health. 5 00:00:20,410 --> 00:00:23,950 In this course on global health, we take the 6 00:00:23,950 --> 00:00:27,520 point of departure that global health deals with situations 7 00:00:27,520 --> 00:00:31,950 where the health challenges transcend national borders and where 8 00:00:31,950 --> 00:00:36,880 the solutions also are beyond national shared social objectives. 9 00:00:38,710 --> 00:00:41,520 This session of the course is therefore 10 00:00:41,520 --> 00:00:45,130 concerned with how we manage those solutions 11 00:00:45,130 --> 00:00:46,960 in the attempt to create an organized 12 00:00:46,960 --> 00:00:50,160 social response to health at the global level. 13 00:00:50,160 --> 00:00:54,780 And that is what I shall refer to as Global Health Governance. 14 00:00:56,890 --> 00:01:01,279 I should concern myself mainly with the processes, rather than with the content. 15 00:01:03,780 --> 00:01:05,970 To understand the present it's often useful 16 00:01:05,970 --> 00:01:09,640 to look back to see some historical milestones. 17 00:01:09,640 --> 00:01:13,460 Health challenges, which transcend borders are not new. 18 00:01:13,460 --> 00:01:16,740 Epidemics spread across the globe for hundreds of years 19 00:01:16,740 --> 00:01:21,900 and societies establish measures to protect themselves from such threats. 20 00:01:21,900 --> 00:01:23,910 Quarantine systems are one such measure. 21 00:01:25,470 --> 00:01:28,790 But the thought that response should go beyond protecting your 22 00:01:28,790 --> 00:01:32,940 own society and engaging with others to do so is more recent. 23 00:01:32,940 --> 00:01:39,350 For four to five decades the health governance architecture or landscape 24 00:01:39,350 --> 00:01:44,890 seemed relatively clear. During that period a sequence of health consensus processes 25 00:01:44,890 --> 00:01:49,700 for example the Alma Ata conference on primary health care in 1978 26 00:01:49,700 --> 00:01:52,020 provided a system for focusing technical, 27 00:01:52,020 --> 00:01:53,850 financial, and political attention on agreed 28 00:01:53,850 --> 00:02:00,900 approaches and to revising them over time. However in the last one to two decades 29 00:02:00,900 --> 00:02:04,080 the situation's become much more complex, and 30 00:02:04,080 --> 00:02:06,840 there are many dimensions of this complexity. 31 00:02:08,390 --> 00:02:11,050 One is that there is a growing realization that diseases, 32 00:02:11,050 --> 00:02:16,000 not to mention health, are interrelated and have common risk factors 33 00:02:16,000 --> 00:02:19,150 and therefore, this requires new complexities 34 00:02:19,150 --> 00:02:20,870 in responding. 35 00:02:20,870 --> 00:02:24,090 It also relates to the growing realization that 36 00:02:24,090 --> 00:02:28,050 factors generally considered outside the remits of health such 37 00:02:28,050 --> 00:02:31,500 as, aging populations, climate change, migration, as well 38 00:02:31,500 --> 00:02:35,890 as economic and trade relationships, have major health impact. 39 00:02:37,030 --> 00:02:39,480 Furthermore it relates to the mechanisms 40 00:02:39,480 --> 00:02:43,460 and structures, which we have to address these challenges. 41 00:02:43,460 --> 00:02:44,200 That is both 42 00:02:44,200 --> 00:02:46,066 in terms of what is often called the health 43 00:02:46,066 --> 00:02:50,950 landscape or hierarchial architecture that is the institutional arrangement. 44 00:02:50,950 --> 00:02:53,580 But it's also in terms of our value systems. 45 00:02:53,580 --> 00:02:57,210 For example, religious or socioeconomic or political paradigms. 46 00:02:57,210 --> 00:02:58,440 For example. 47 00:02:58,440 --> 00:03:01,850 Do we really all take it for granted that equity is a goal in the health? 48 00:03:04,160 --> 00:03:08,670 To my mind the last decade, the decade of the millennium developments goals, 49 00:03:08,670 --> 00:03:11,170 which were formulated in 2001 and 50 00:03:11,170 --> 00:03:15,960 reformulated in 2007, has brought particular complexities. 51 00:03:17,350 --> 00:03:20,670 Three developments have taken place simultaneously. 52 00:03:20,670 --> 00:03:25,330 One is the development of the strongly health focused, minimum development goals. 53 00:03:25,330 --> 00:03:27,090 Another is a tripling from 10 billion 54 00:03:27,090 --> 00:03:30,090 to about 25 to 30 billion 55 00:03:30,090 --> 00:03:32,538 in official development assistance for health 56 00:03:32,538 --> 00:03:36,962 and that is channelled through a 57 00:03:36,962 --> 00:03:39,274 multiplication of health actors 58 00:03:39,274 --> 00:03:42,130 including the so called global health initiatives. 59 00:03:42,130 --> 00:03:46,962 In that period we have also achieved major progress 60 00:03:46,962 --> 00:03:49,722 toward all the related MDG goals, 60 00:03:49,722 --> 00:03:55,722 but it also means that WHO unique governance role is changing. 60 00:03:56,722 --> 00:03:58,722 Perhaps as a reflection of this whole complexity 60 00:03:58,722 --> 00:04:01,722 in the last five to ten years a whole new field of study 60 00:04:01,722 --> 00:04:06,722 has come up regarding global health governance. 60 00:04:06,722 --> 00:04:10,722 and health diplomacy is becoming a recognized field. 60 00:04:10,722 --> 00:04:16,722 So, what is then this global health governance? 60 00:04:16,722 --> 00:04:21,722 Let me go back to the simple explanation, I mentioned in the beginning 60 00:04:21,722 --> 00:04:24,722 that global health governance is concerned with 60 00:04:24,722 --> 00:04:28,722 how we manage the solutions to global health challenges. 60 00:04:30,722 --> 00:04:34,722 There is no one single definition of global health governance 60 00:04:34,722 --> 00:04:40,722 but most such definitions include the following elements: 60 00:04:40,722 --> 00:04:44,722 One is that global health governance is a combination 60 00:04:44,722 --> 00:04:46,722 of formal and informal mechanisms 61 00:04:46,722 --> 00:04:49,722 not just governments but many other aspects 60 00:04:49,722 --> 00:04:52,722 that there is a range of institutions and stakeholders involved 60 00:04:52,722 --> 00:04:55,722 not only governments but also several society organisations, 60 00:04:55,722 --> 00:04:59,980 private sector, media, as arguably the populations themselves 62 00:05:01,980 --> 00:05:04,950 Another is that the formats, the format includes 63 00:05:04,950 --> 00:05:09,130 consensus processes such as conference outcomes and legally binding 64 00:05:09,130 --> 00:05:12,920 human rights conventions and that related national laws, 65 00:05:12,920 --> 00:05:16,080 as well as normative guidelines and arguably, public opinion. 66 00:05:18,870 --> 00:05:22,180 Another element is that it goes beyond health. 67 00:05:22,180 --> 00:05:26,380 Including for example, regulations regarding migration or trade. 68 00:05:28,430 --> 00:05:31,610 And finally, of course, is that the shared social objective 69 00:05:31,610 --> 00:05:34,600 is to improve heath for the population of the world. 70 00:05:36,460 --> 00:05:41,290 It's also important to acknowledge what governance is not. 71 00:05:41,290 --> 00:05:43,989 Governance is not government, governments have 72 00:05:43,989 --> 00:05:47,920 responsibilities for democratic processes to set 73 00:05:47,920 --> 00:05:50,970 priorities for collecting taxes, to implement 74 00:05:50,970 --> 00:05:54,360 them, for legal processes to insure compliance. 75 00:05:54,360 --> 00:05:59,290 None of those mechanisms are necessarily available for global governance. 76 00:06:00,540 --> 00:06:03,610 There are numerous examples of how this governance does 77 00:06:03,610 --> 00:06:06,590 work, let me mention a few very practical examples. 78 00:06:06,590 --> 00:06:09,010 Number one is normative guidelines such 79 00:06:09,010 --> 00:06:12,030 as The International Classification of Disease. 80 00:06:12,030 --> 00:06:13,830 Which is presently in its tenth version and 81 00:06:13,830 --> 00:06:19,740 which is absolutely indispensable precondition for collecting data and 82 00:06:19,740 --> 00:06:22,550 comparing them across time and space. 83 00:06:22,550 --> 00:06:24,820 Another is the legally binding conventions 84 00:06:24,820 --> 00:06:27,810 such as the Framework Convention on Tobacco. 85 00:06:27,810 --> 00:06:30,870 Another might be the voluntary codes of conduct. 86 00:06:30,870 --> 00:06:34,460 For multinational companies and the Global Compact 87 00:06:34,460 --> 00:06:40,410 between private sector and, and UN organizations. 88 00:06:40,410 --> 00:06:45,300 You have also guidelines concerning the intellectual property related 89 00:06:45,300 --> 00:06:48,100 to pharmaceuticals. Or the enormous 90 00:06:50,520 --> 00:06:54,090 Well built built up normative framework for, 91 00:06:54,090 --> 00:06:59,300 setup for prioritising, financing, and implementing humanitarian systems. 92 00:06:59,300 --> 00:07:04,180 And we also have human rights monitoring processes, as well as, civil 93 00:07:04,180 --> 00:07:07,130 society initiatives, either regarding single issues 94 00:07:07,130 --> 00:07:09,645 such as breast milk, substitutes, or HIV. 95 00:07:09,645 --> 00:07:13,440 Or broader peoples' health initiatives. 96 00:07:13,440 --> 00:07:15,710 The challenges in developing such governance 97 00:07:15,710 --> 00:07:16,850 are great. 98 00:07:16,850 --> 00:07:20,520 Building on what I mentioned of as the growing complexity. 99 00:07:20,520 --> 00:07:23,090 Let me mention a few of those challenges. 100 00:07:24,150 --> 00:07:25,340 One is sovereignty. 101 00:07:25,340 --> 00:07:28,690 The global governance system of the United Nations Is 102 00:07:28,690 --> 00:07:31,440 built up around the principle of sovereignty of nations. 103 00:07:32,730 --> 00:07:37,960 establishing legally binding or more informal mechanisms, which can be 104 00:07:37,960 --> 00:07:42,040 seen as infringing on that sovereignty can be quite problematic. 105 00:07:43,450 --> 00:07:45,900 Another challenge is accountability. 106 00:07:47,630 --> 00:07:51,930 For WHO, it's governance is composed of member state 107 00:07:51,930 --> 00:07:56,420 governments, which arguably have some accountability to their populations. 108 00:07:57,770 --> 00:08:00,390 Some of the new health initiatives have very 109 00:08:00,390 --> 00:08:05,790 inclusive government structures, including for example several society organizations. 110 00:08:05,790 --> 00:08:08,840 But for others there is littl, built in accountability 111 00:08:08,840 --> 00:08:11,120 back to the populations which are being served. 112 00:08:11,120 --> 00:08:14,450 In either case, the question is how a 113 00:08:14,450 --> 00:08:19,290 Minister of Health, which receives major, official development assistance, 114 00:08:19,290 --> 00:08:22,340 can remain accountable to its owner population, or 115 00:08:22,340 --> 00:08:25,630 rather becomes accountable to a far away funding mechanism? 116 00:08:27,640 --> 00:08:32,270 A third challenge regard, is regarding sectoral limitations. 117 00:08:33,680 --> 00:08:38,160 The the classical definition of a health system is that it 118 00:08:38,160 --> 00:08:44,160 includes only those extras whose primary function is to improve health. 119 00:08:44,160 --> 00:08:46,160 This could be a killer assumption. 120 00:08:46,160 --> 00:08:48,860 In a world where those who have 121 00:08:48,860 --> 00:08:53,710 the biggest influence for example there is industries, 122 00:08:53,710 --> 00:08:56,270 tobacco, pharmaceutical companies and so on, are 123 00:08:56,270 --> 00:08:59,630 not included in the in the governance. 124 00:09:00,890 --> 00:09:03,330 This session has been about the history, 125 00:09:03,330 --> 00:09:08,190 processes, challenges, and components of global health governance. 126 00:09:08,190 --> 00:09:08,190 [INAUDIBLE] 127 00:09:08,190 --> 00:09:12,810 Thank you very much, for listening. 128 00:09:12,810 --> 00:09:12,810 [MUSIC]