Global Health Governance System Research Articles

International governmental organizations in the global health governance system: the leading role of the World Health Organization

Issues of human health protection have gradually been integrated into the agenda of specialized UN agencies and other international intergovernmental organizations in the context of ensuring the achievement of sustainable development goals, as well as the development of effective measures to curb the formation of threats to human and state security in the field of health care.Given the institutional changes in global health governance that have taken place over the past two decades and, accordingly, the impact of the changing conditions and context of international governmental organizations (IGOs) on their interaction with other actors and their performance of changed functions in the world, that is globalizing, there is an increase in the role of IGOs in the process of political globalization due to the growing relevance of political processes at the world level. However, due to the inflexibility of the organizational settings of many IMUs in general and the lack of leadership of more influential actors and their hesitant response to increasing epidemics, particularly in developing countries, there was an opportunity for actors who do not usually have much decision-making authority. and law, to set the agenda and influence global policy in this area. Civil society organizations (CSOs) operated in the discursive field of global health governance, as well as at relevant interfaces, and strengthened their discursive power through opportunities for access to medicines. This particular area of global governance was to some extent already «occupied» by the usually weak participants in the global power structure, when more powerful players – IGOs – re-entered this field.This article focuses on the World Health Organization (WHO), the World Bank and the Joint United Nations Program on HIV/AIDS (UNAIDS) in global health governance, particularly in the fight against HIV/AIDS, and analyzes the interaction and the relationship between them, as well as with other relevant global health actors.

Building a global community of health for all: A positive discourse analysis of COVID-19 discourse

‘A global community of health for all’ has become a dominant concept in China’s global health governance system. Although this concept has been investigated by several studies in different domains, little attention has been given to its discursive legitimation in China’s media communication from a linguistic perspective. To fill this gap, the present study employs positive discourse analysis to investigate how the aforementioned concept is legitimised via the predominant discourses associated with COVID-19 in state-run Chinese English-language newspapers. The findings show that the Chinese news media attempted to formulate the positive discourses, including cooperation as a win-win solution, people’s lives and well-being as the priority and science as the spirit, though the discourses may not resonate with some countries. The findings shed light on the use of language by the media in promoting official ideologies, projecting China’s national image and improving China’s international relations amid a global health crisis.

Can the Sick Speak? Global Health Governance and Health Subalternity

Global Health Governance (GHG) uses a set of financial, normative, and epistemic arguments to retain and amplify its influence. During the COVID-19 pandemic, the GHG regime used its own successes and failures to prescribe more of itself while demanding further resources. However, the consistent failures of this form governance and its appeasement to a dominant neoliberal ideology lead to the following question: Is the global health governance regime failing at its goal of improving health or succeeding at other political and ideological goals that necessitate such failures? Using concepts and ideas from social theory and post-colonial studies; I examine the definitions, epistemic basis, and drivers of GHG and propose certain conditions for the legitimacy of a global health governance system. Examining historical and current cases, I find that the GHG regime currently fails to fulfil such conditions of legitimacy and instead creates spaces that limit rather than help many populations it purports to serve. Those spaces of sickness confine people and reduce them into a state of health subalternity. In being health subalterns, people’s voices are neither sought nor heard in formulating the policies that determine their health. Finally, I argue that research and policymaking on global health should not be confined to the current accepted frameworks that assumes legitimacy and benevolence of GHG, and propose steps to establish an alternative, emancipatory model of understanding and governing global health.

The Challenges of the Global Health Governance System in the Covid-19 Pandemic: Current Limitations and Possibilities for Reform

Resumo A pandemia de COVID-19 despertou reflexões latentes acerca das capacidades normativas e institucionais da OMS para responder a pandemias, instigando a comunidade internacional a repensar alternativas para que a crise não se repita. Com esse intuito, o presente artigo elenca sugestões para aproveitar mecanismos já existentes no sistema de governança da saúde global, assim como novas propostas advindas de uma reforma normativa e institucional da OMS.

CHINA’S GROWING INVOLVEMENT IN GLOBAL HEALTH GOVERNANCE

The outbreak of the COVID-19 global pandemic has exposed deficiencies in global health governance. China has been active in making intellectual and material contributions to the global fight against COVID-19 while achieving significant progress in containing the epidemic domestically. China’s contribution to global cooperation in the fight against the virus can be reflected in: (1) China has actively shared its experience in COVID-19 control and the treatment of infected cases with the international community; (2) China has sent 37 medical expert teams to help improve measures of diagnosis, treatment, prevention and control in 34 countries as of July 2021; (3) China has done its best to provide medical supplies to more than 150 countries and 13 international organizations as of July 2021; (4) China has made efforts to make vaccine accessible and affordable in developing countries. The implications of China’s involvement in global health governance include: (1) advocating the concept of “building a global community of health for all”; (2) supporting the leadership role of the World Health Organization in global health governance; (3) improving the global health governance system and WHO’s ability; and (4) cultivating public health talent with knowledge of international rules and diplomatic skills.

La gobernanza global de la salud y los límites de las redes de expertos en la respuesta al brote de la Covid-19 en México

En el presente estudio se argumenta que a partir del sistema de gobernanza global de la salud se han configurado distintas redes de expertos que sirven como mecanismos para la difusión de ideas basadas en la evidencia científica, que promueven la cooperación y la implementación de recomendaciones originadas en la Organización Mundial de la Salud (oms). Sin embargo, el brote de la Covid-19 ha visibilizado las limitaciones de estas redes. En el caso de México, se han observado dos problemas principales: primero, la existencia de expertos miembros de una red transgubernamental que toman decisiones basadas en intereses políticos, dejando de lado las recomendaciones derivadas de lo global; y segundo, una comunidad epistémica dividida, con grupos rivales, lo que perjudica la actuación de estos expertos en su labor como transmisores de ideas y difusores de conocimiento.

World Health Organization and COVID-19 Pandemic: Assessing Effectiveness of Global Governance

Introduction. The central role in the formation of a global health governance system is assigned to the World Health Organization (WHO), which is part of the United Nations Family of Organizations. Amid increasing globalization, the challenges to human security have become more acute, including those related to the spread of dangerous infections, which grow to epidemics and pandemics. Faced with the COVID-2019 pandemic, WHO appears to have a number of structural problems that prevent it from successfully fulfilling its regulatory and coordinating functions. Materials and methods . Methodologically, the study is based on a critical analysis of relevant official and unofficial sources, as well as functional and chronological methods. Results. The article examines how WHO has been responding to the pandemic, what objective and subjective problems it is facing, what “failures" it has experienced and how they can be overcome through further reforms. It is concluded that despite the presence of, albeit limited, experience in combating mass infections, over the last decades WHO has failed to carry out the necessary structural reforms aimed at improving the effectiveness of the organization. The authors study how these “failures" affect the Organization's reputation, as well as what consequences that might lead to. Discussion and conclusion . WHO remains the key institution entrusted with the function to develop a global health governance system. At the same time, the Organization's relations with national states, its “disconnection" of national healthcare complexes, financing and accountability problems, as well as the ineffectiveness of the coordinating function result in its deteriorating role. Amid globalization, this factor contributes to the weakening international security, since the lack of effective pandemic management exacerbates the problems of national stability and human security.

Are national policies on global health in fact national policies on global health governance? A comparison of policy designs from Norway and Switzerland

BackgroundSince the signing of the Oslo Ministerial Declaration in 2007, the idea that foreign policy formulation should include health considerations has gained traction on the United Nations agenda as evidenced...

Introduction: Ebola and International Relations

The outbreak of Ebola Virus Disease (EVD) that gripped Liberia, Guinea and Sierra Leone through much of 2014 and 2015 was an enormous and in many ways unprecedented health emergency. Yet the outbreak was not only a global health event – it was also a global political event. In this introduction to the special issue we discuss the contribution that International Relations scholarship can make to analysing and understanding the Ebola outbreak and the global response to it. We group our comments around four key themes: (1) allocating responsibility in a diffuse global health governance system; (2) the causes and effects of Ebola being perceived as a global crisis; (3) the downsides of a security-driven approach to global health emergencies; and (4) issues of inequality both between and within countries, including those around gender, resources and power.

Will the Ebola Epidemic Serve To Make Reform of the Broken Health Research and Development Framework Go Viral?

The recent Ebola outbreak in West Africa has captured the public imagination as few other epidemics have, as its rapid spread and lethal effect demonstrated the devastating toll that infectious diseases can exact from a world unprepared to confront them. In light of the epidemic’s tragic consequences, numerous experts have called for reform of the system of global health governance whose shortfalls allowed the epidemic to assume the horrifying dimensions it did. Among the many inadequacies that the outbreak uncovered is the insufficient amount of research into and development of treatments and vaccines for infectious diseases of poverty, among them the so-called “neglected tropical diseases.” This lack of vital research and development long predated the present Ebola outbreak, and, given how widespread calls of reform have been since the epidemic, it bears assessing whether the crisis will provide the impetus necessary for meaningful change to the calcified research and development framework that has long ignored Ebola and like ailments. Due to a variety of factors that this Note seeks to explain, however, this will likely not be the case.

WHO's next? Changing authority in global health governance after Ebola.

The World Health Organization (WHO) occupies a central place in the system of global health governance and plays a key role in the control of epidemics and pandemics. The 2014 Ebola crisis in West Africa, however, saw widespread and sustained criticism of its performance, leading many to call for its reform and even replacement. This article moves on from initial analyses of the WHO's ‘failure’, to argue that the crisis has led to a shift in its authority as a global governor. It argues that the WHO's traditional basis of authority was largely expert and delegated; that it provided technical advice and normative guidance, and that its authority was ‘on loan’ from member states, who exerted considerable influence over the WHO. Its actions during the West African Ebola outbreak remained consistent with this, but it was unable to cope with what the outbreak required. The criticisms both of the WHO and the wider system of global health governance, however, have opened up a space where the balance of authority is shifting to one based more heavily on capacity—the ability to act in a crisis. If such a shift is realized, it will create different expectations of the WHO which, if they are not fulfilled, may lead to trust in the organisation declining and its legitimacy being compromised.

MERS and global health governance

The contemporary global health governance system has evolved over 150 years to facilitate cooperation among states in dealing with cross-border health concerns. This article uses the current outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) to examine global health governance’s history, evolution, and status within the political science literature. In particular, the article focuses on the International Health Regulations and the World Health Organization as leading elements of the global health governance system in order to examine both how the system operates and what its shortcomings are.

Conceptual Models for Global Health Governance

Globalization has led to an appreciation of a global politics beyond the control of nation-states and the traditional system of international relations. Global politics is characterized by a pluralization of governance mediated by a constant effort to establish shared norms of global public goods and bads to constrain the exercise of power or, expressed in another way, to attain a more equitable access to power resources. Traditional state institutions of national and international governance have become more diversified as a reaction to their inherent limitations and the increasing power of new forms of governance built by private actors. Though the state remains a powerful, often dominant, actor in governance, it competes with and sometimes is itself governed by a diverse set of non-state actors, including corporations, foundations, religious groups, social advocacy organizations and ‘dark networks’, such as al-Qaeda or narcotics cartels. States and traditional institutions of international governance are increasingly seen as complex assemblages in and of themselves, comprised of more or less well-networked nodes operating somewhere on the spectrum between cooperation and competition. States have actively embraced this pluralization, seeking to increase or protect their power by vigorous use of governance devices such as privatization and partnerships. These developments are clearly visible in the health sector, which has witnessed an institutional change from a structure that consisted primarily of independent national health systems and some international agencies devoted to controlling the cross-border effects of ill-health towards a system of global health governance (GHG). Contemporary GHG is characterized by a polycentric, distributed structure and a substantive concern with issues that affect populations worldwide directly (for example, the global spread of infectious diseases or antibiotic resistance) or indirectly (for example, political instability and global insecurity arising from extreme socio-economic inequality). Global health governance now requires management not merely of specific transborder epidemics, like SARS or avian influenza, but of the host of issues in health that arise at the intersection of a globalized economy and lives lived in particular localities. Dealing with ‘global’ health challenges increasingly requires attention not only to ‘horizontal’ coordination of global politics, but also to more effective vertical integration of global-level governance with governance at the national and local levels. Both practitioners and students of health policy require new conceptual tools to understand and influence GHG. During recent years, two models have been developed that, from different perspectives, address these characteristics of multiplicity of actors, flexibility of institutional arrangements and fluidity of relationships. The ‘nodal governance’ framework builds on network theories to describe distributed governance and the ways in which institutions project power across networks to govern the systems they inhabit. The concept of ‘interface’, refers to ‘a specific space, where two different social systems or fields of social order interact (here: global/national systems; institutional systems related to modes of regulation), which are characterized by specific institutions and specific backgrounds. Independently, the concepts of nodal governance and interfaces can help us to understand what constitutes the binding forces and the types of power mobilized among the multitude of actors in global health governance. Taken together, they illuminate key challenges to good GHG: improving democracy, efficacy and coordination. This chapter uses these two frameworks to understand the emerging dynamics of GHG and then illustrate their usefulness through a discussion of the global governance of HIV/AIDS.

The Social and Political Context of Disease Outbreaks: The Case of SARS in Toronto

Dans cette étude, nous avons utilisé un cadre théorique relevant de l'écologie politique afin de construire un modèle critique et systémique pour expliquer comment il est possible de gérer une maladie infectieuse émergente, comme le SRAS, dans notre univers mondialisé. Nous espérons qu'un tel modèle contribuera à la mise en place de politiques de gestion des risques plus réalistes. Nous commençons par établir et analyser les interactions qui, dans l'environnement social et humain, ont facilité l'apparition de l'épidémie de SRAS dans un contexte local, celui de Toronto. Ensuite, nous montrons que cette épidémie a mis en lumière les insuffisances profondément ancrées du système actuel de gestion mondiale de la santé. Nous mettons l'accent sur le fait que, en cette ère de mondialisation, il est imprudent de trop concentrer efforts sur le plan local. L'analyse des épidémies doit plutôt se faire dans une perspective mondiale, et doit tenir compte du fait que les liens entre les pays développés et les pays en développement relèvent de l'écologie politique. We adopt a political ecology framework to delineate a critical and systemic model that explains how an emerging infectious disease (EID), such as SARS, is dealt with in our globalized world. It is our hope that such a model will contribute to the development of more realistic risk-management policies. First, we focus on identifying and analyzing particular social and human-environment interactions that facilitated the spread of SARS within a local Toronto context. Second, we describe how the SARS outbreak brought to light the deeply rooted inadequacies involved in the current system of global health governance. We stress that in our globalized world it is unwise to focus too narrowly on the local context. The analysis of disease outbreaks must adopt a global perspective that considers the political ecological nature of the relationships between the developed and developing world.

Influence and opportunity: reflections on the U.S. role in global public health.

Today's global health crisis illustrates many of the transnational governance challenges the United States faces today. In the arena of global health, the United States can create a new role for itself by moving beyond a national-interest paradigm and strengthening its "soft power" position in health. Health in recent administrations has moved beyond being "just" a humanitarian issue to being one with major economic and security interests. Despite U.S. unilateralism, new approaches to global health governance are being developed by other actors, who have influenced the U.S. agenda and made important contributions. Yet a larger leader is still needed, especially in identifying and following a sound legal and regulatory global health governance system; bringing political legitimacy; and setting priorities. Responsible political action is needed to develop a new mindset and lay the groundwork for better global health in the future.

Global public health: revisiting healthy public policy at the global level

Globalization is increasingly growing into a network of interdependent and interconnected nations people capital and information that challenges the internal sovereignty of nation states. Health care policy which is protected by the nation state loses its sovereignty over policies related to health determinants. Two trends have been seen in the international health cooperation: significant increase in the players in the international health arena and the subtle but systemic erosion of internal sovereignty. Therefore the global public health should fill the government gap on health issues and development processes that are independent of territory and must try to balance the impact of globalization on internal health sovereignty. By the 21st century a new organizational form of governance will create a network that includes nongovernmental organizations and the private sector; newer forms of joint decision-making will emerge to collectively operationalize internal sovereignty at the global level. A move towards global public health must overcome three challenges: 1) the framing of health as a valued global public good; 2) the response to globalization through a new inclusive system of global health governance; 3) the development of global regimes codes of conduct and mechanisms of accountability in the aim of improved global health. Public health schools must be at the forefront in the analysis of developments planning of public health patchworks and networks and new instrument and mechanism proposal.