Global Health Governance and Policy

An Introduction

Eduardo Missoni, Guglielmo Pacileo, Fabrizio Tediosi

• Publisher: Routledge
• Year: 2019
• ISBN:
  9781351188975
• Edition: 1
• Topic: Medicine
• Subtopic: Public Health, Administration & Care

Global Health Governance and Policy outlines the fundamentals of global health, a key element of sustainable development. Taking an interdisciplinary approach, it explores the relationship between the globalization process and global health's social, political, economic and environmental determinants. It points the attention to the actors and forces that shape global policies and actions with an impact on peoples' health in an increasingly complex global governance context. Topics discussed include:

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• The relationship between globalization and the determinants of health

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• The essentials of global health measurements

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• The evolution of public health strategies in the context of the global development agenda

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• The actors and influencers of global health governance

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• The role of health systems

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• The dynamics and mechanisms of global health financing and Development Assistance for Health

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• Career opportunities in global health governance, management and policy

Looking in depth at some of the more significant links between neoliberal globalization, global policies and health, Global Health Governance and Policy: An Introduction discusses some specific health issues of global relevance such as changes in the ecosystem, epidemics and the spread of infectious diseases, the global transformation of the food system, the tobacco epidemic, human migration, macroeconomic processes and global financial crisis, trade and access to health services, drugs and vaccines, and eHealth and the global "health 4.0" challenge.

Written by a team of experienced practitioners, scientists and teachers, this textbook is ideal for students of all levels and professionals in a variety of disciplines with an interest in global health.

1 Introduction

A search made in 2018 on the most popular internet search engine using the key-word “globalization”¹ generates approximately 52,400,000 hits; the same search gave 35,800,000 hits only two years earlier and in 2005 there were only 7,000,000 results. Despite being increasingly and widely used, there is no agreement about the meaning of this term, which describes an essential characteristic of the contemporary era. Some consider globalization as just a new, captivating term to rename the expansion of the neo-liberal development model (which we prefer to define as “neoliberal globalization”), while others see in it a century-old process of integration which has seen an impressive acceleration since the second half of the last century. Whatever the interpretation, due to the technological advances in communications and transport and the ever-growing level of world interconnectedness, people, goods and diseases are moving fast across borders. World citizens and governments have to increasingly deal with these issues which have transnational dimensions and that require equally transnational responses. Also, the temporal dimension of globalization is modified with ever-faster technological, but also environmental and microbiological, changes. Additionally, cognitive changes have facilitated knowledge-sharing but also impacted the traditional cultures and behaviors, including production, distribution and consumption patterns. These have impacted health directly as have changes in the ecosystem. Humanity today faces unprecedented social, economic and environmental global, i.e. planetary, challenges.

The consequences are particularly significant in terms of human health: new infectious diseases are emerging and spreading; the prevalence of chronic, degenerative and socio-behavioral pathologies is increasing; the right to health is often questioned or denied; utilitarian approaches consider human health as a factor of economic growth, rather than a right in itself; access to care is often limited as part of macroeconomic interventions which include public expenditure reduction policies; and avoidable and unfair disparities in health outcomes, i.e. inequities,² are increasing. More in general, inequities between the North and the South of the world are increasing, whereby “North” and “South” have lost any geographical connotation. Instead, this represents the distance between the few in the various Norths in whose hands wealth and opportunities are concentrated, and the multitudes of the many Souths who are excluded from the benefits of modernity and suffer from poverty and marginalization. These inequities also exacerbate health risks and threats, with critical implications for sustainable development.

Health has been increasingly recognized as a key element of sustainable economic development, global security, effective governance and human rights promotion (Frenk 2010). Since the late 1990s, the role of health in global development policies has become more relevant, as shown by the fact that three out of the eight Millennium Development Goals (MDGs) set forth in the year 2000 by United Nations Millennium Declaration – “the blueprint agreed to by all the world’s countries and all the world’s leading development institutions” – were related to health targets (MDG 4: Reduce child mortality; MDG 5: Improve maternal health; MDG 6: Combat HIV/AIDS, malaria and other diseases).

The Sustainable Development Goals (SDGs) approved in 2015 confirmed the central role of global health in the much broader agenda for global development as defined by the Agenda 2030 and its universal and indivisible 17 SDGs.³

This shift in attention to health has also resulted in an unprecedented growth of financial resources at a global level destined for the development of the health sector, a trend that has been partially reversed since 2013, with 2017 levels comparable to those of 2012.⁴

Over the last few decades, the number of global health initiatives as well as both public and private actors involved in the global health governance increased substantially, leading to a highly complex scenario. This has even challenged the World Health Organization’s (WHO) mandate as the “directing and coordinating authority” in international health. Indeed, the relative weight of the actors traditionally active in the health sector is changing. Economic forces strongly influence national and international public policies that tend to benefit the creation of favorable environments for economic investments, over health promotion and control of the determinants negatively impacting on the living conditions and health of the populations.

However, a parallel increased focus on the importance of the social, economic, political and environmental determinants of health that are influenced by decisions made in other global policy-making arenas (such as those governing international trade, environment, migration) has prompted the debate on the need to protect and promote health in global governance processes outside the global health system. This approach has been conceptualized as “global governance for health” (Frenk and Moon 2013).

Judging by the scope of topics covered by existing resources on global health, almost everything has been thrown into the “global” pot, often re-labeling as “global” issues and modalities defined by terms (such as international) that have proven perfectly adequate in the past. “The health field has been equally guilty of this tendency which, in turn, has led to conceptual and empirical imprecision” (Lee 2004).

According to the same trend, teaching “Global Health” also became fashionable. In 2009, Richard Horton, chief editor of The Lancet, highlighted that global health was becoming a critical aspect of the educational, scientific and moral mission of universities (Horton 2009). Beyond the academic sector, the media are increasingly referring to the idea of global health. International and bilateral institutions as well as private organizations are also putting increasing emphasis on it. The subject attracts new generations of students and scholars, new journals are dedicated to this field of studies, and the offer of courses in this new area has been booming over the last decade or so.

However, there is still wide discrepancy about what global health stands for and about the content of global health courses offered around the world, whereby sometimes the denomination global health is arguably used to refurbish pre-existing courses in “international health”, “tropical medicine” and others in a mere response to marketing needs (Koplan et al. 2009). This presents an interesting conundrum because, as pointed out by Bozorgmehr (2010), “Social innovations are unlikely to evolve if ‘Global Health’ becomes or remains a cosmetic re-labeling of old patterns, objects, and interests”.

Thus, the question arises “what should be taught when we teach global health?” (Missoni and Martino 2011), and by extension what is the scope of global health governance and policies?

Regarding the definition, there has been some debate over the past years. The term global health was, and still is, applied liberally and with little attempt to fully explain the true definition and contents of the terminology (Bozorgmehr 2010). Clearly, once the global health community examines how health determinants and policies range beyond the interactions between nation states, the inadequacy of the “international” attribute becomes evident (Missoni and Martino 2011). Similarly, the need to include multiple consolidated disciplines (sociology, political sciences, economics, anthropology, environmental sciences and others) allows the understanding of global health as more than simply the global dimension of public health (Fried et al. 2010). Also, what is meant with global health policies and projects and how they are implemented are deeply discordant (Rieder 2016).

Bozorgmehr (2010) identifies four ways in which the term “global” is understood in the health literature. The first meaning for global is: “worldwide” or “everywhere”. The second criterion refers to health issues that are not limited by national boundaries (e.g. pandemics and the spread of infectious disease). According to the third criterion, the term global refers to a broad-spectrum approach that is multidisciplinary in character. Thus, the study of global health is the study of social, political, economic, biological and technological relationships that impact health in diverse means. Highlighting the diversity and complexity of those relations in the global space, Rieder (2016) synthetizes global health as “a set of processes that occur at the intersections of transnational networks”. Finally, the term “global” refers to what Scholte (2002) coined “supra-territoriality”, or social connections that move beyond simple territorial geography, a phenomenon which has increased exponentially through both the number of social media tools as well as the number of users. According to Bozorgmeher (2010), it is the fourth interpretation – supra-territoriality – that allows global health to focus “on the globality of the social determinants of health and the power relations in global social space” (Bozorgmeher 2010). However, it is important to note that underlying these four interpretations of the terminology “global” is one unifying ideal: equity. Addressing the current inequities in health status worldwide has become one of the primary goals in all global health studies (CSDH 2008).

Lack of agreement on the definition of global health and a general discord regarding theories that can generalize findings do not yet allow the classification of global health as a self-standing discipline. Indeed, as pointed out above, an interdisciplinary approach is essential to understand this new area of studies and the complexity of this approach may have limited the education of practitioners and the emergence of an intellectually robust field (Kleinmann 2010).

More recently, the concept of “planetary health” was launched by The Lancet (Horton et al. 2014) and supported by the Rockefeller Foundation, with a scope supposedly going beyond the boundaries of “the existing global health framework to take into consideration the natural systems upon which human health depends”. It was nevertheless presented as “A New Discipline in Global Health” (Rodin 2015), thus part of this interdisciplinary area of studies. In the original “Manifesto”, planetary health is presented as “an attitude towards life and a philosophy for living” (Horton et al. 2014). The emphasis on people and equity, the recognition of the impact of neoliberal globalizations on health and the sustainability of human development, as well as the focus on equity and on “interdependence and the interconnectedness of the risks we face” (Horton et al. 2014), all belong to a comprehensive understanding of global health. The ecosystem is undoubtedly one of the most important determinants of human health and in that sense the emphasis that planetary health places on the link between human health and a healthy planet is highly welcome.

In Italy, global health as a field of studies, research and practice was identified from the very beginning of the debate at the end of the 1990s, with the interaction between globalization and health. This would include the planetary dimension of the issues at stake; a people-centered, human right and health determinants approach; ethically minded and focused on equity. Thus, the global health goal would require global responses with solid roots in local awareness and action, and moral responsibility toward future generations (Berlinguer 1999).⁵

Since 2008, we have adopted a definition that encompasses most of the elements discussed above, such as interdisciplinarity, focus on equity, people-centered and health determinants approach, the worldwide transnational dimension of both determinants and solutions:

Global health is an emerging area for interdisciplinary studies, research and practice that considers the effects of globalization on health – understood as a complete state of physical, mental and social well-being – and the achievement of equity in health for all people worldwide, emphasizing transnational health issues, determinants and solutions, and their interactions with national and local systems.

(CERGAS 2011)

The development and implementation of transnational, i.e. global, solutions imply global governance and policies, a dimension of global health that, in our opinion, is still lacking an introductory, but comprehensive textbook in the English language.

To this end,we use an interdisciplinary approach, combining health sciences with economic, social and management sciences, in exploring global health, social, political, economic and environmental determinants, and the role of both State and non-State actors in an increasingly complex global governance scenario.

The book is divided into three sections: the first provides an overview on the links between globalization, development and health; the central section focuses on global governance and health; and the third offers an insight on most relevant global issues and related policies.

In the first section, an introductory chapter (Chapter 2) sets the theoretical bases that connect development, globalization and health. It first briefly and critically illustrates how the concept of development was generated, and how it evolv...

Table of contents

• Cover
• Halftitle Page
• Title Page
• Copyright Page
• Contents
• List of illustrations
• Acknowledgements
• List of abbreviations
• 1 Introduction
• Section 1 Globalization, development and health
• Section 2 Global governance and health
• Section 3 Global policies and issues
• Index