Offline: Challenging America’s hegemony in global health

Abstract

The H8 is an informal and unofficial board that runs global health. Created in 2007, its members include UN agencies (WHO, UNICEF, UNAIDS, and UNFPA) and health financing institutions (the World Bank, the Global Fund, and GAVI), together with the Gates Foundation. The H8 aims to improve coordination between its diverse and sometimes competing members. The H8 is a powerful group. Yet, despite that power, there are no publicly available minutes of its meetings. There is no H8 website where one can review its work or the issues it discusses. The H8 is the antithesis of transparency. When its members are asked the H8’s purpose, the answer is that it is merely a group of like-minded colleagues who meet to share ideas privately about working together more effectively. There is much to be said for this kind of informality. The bureaucracy of WHO’s governing bodies, for example, is too often a brake on progress in health. WHO’s leadership is constrained by limits imposed from its least ambitious member states. The energy and resources that WHO’s Executive Board and World Health Assembly absorb frequently distract the agency’s attention from its true mandate: achieving results in countries. Still, although the idea of the H8 has attractions, this global governance mechanism fails the test of equity. Why? Because five of its eight leaders are from one already politically dominant country—the US. Only WHO, UNAIDS, and UNFPA are led by non-Americans. It is no exaggeration to say that the US has a hegemony in global health. It is time this hegemony was challenged.