Governing global health: who runs the world and why?; Global health justice and governance

Abstract

The recent publication of two books on global health governance poses a dilemma for one's holiday packing. The first weighing slightly over a pound, has the feel of light reading, and its subtitle hints at sensational revelations. But the second, coming in at just under a kilogram, promises to add respectability to the contents of one's beach bag. So which book offers the better account of its subject? After spending my vacation with both of them, my conclusion is that if you guessed the latter then you have got the wrong definition of lightweight. Jennifer Prah Ruger starts by identifying three global health problems—inequalities, externalities and cross-border issues—each with a cursory justification. A rapid tour is then offered of problems in global health governance, followed by a potted history of theories of global health justice. Sadly, her previous book, Health and social justice (Oxford: Oxford University Press, 2009), casts a long shadow. The first 80 pages of the present work cover much material, yet are insufficient to set up the home run she clearly wants to hit: to develop a compelling theory of global health justice (i.e. provincial globalism), and to outline the features of global health governance (i.e. shared health governance), to enact it. According to provincial globalism, actors should promote ‘health capabilities’ to prevent premature mortality and avoid preventable morbidity for people everywhere, while respecting ‘priority for the worst off’. Provincial globalism should also include a theory of measurement based on ‘shortfall inequality’ and a theory of efficiency ‘to achieve equity goals as efficiently as possible’ (p. 140). Given its ‘core value’ of health agency, a lot of this comes down to what could be more simply called health education—though admittedly not just that. Then, with this background, shared health governance can step in: taking ‘health justice as its end goal’; the ‘common good’ as object; a global health constitution as foundation; and a global institute of health and medicine as its principal organ—the latter necessary since ‘rigorous science must undergird any rational plans for global health’ (p. 166). Prah Ruger then adds that the World Health Organization (WHO) ‘does not serve this function’ (p. 194)—an assertion oddly not supported by argument or evidence.