Global governance for health: a proposal

Global health governance structures today are failing to address the global health crises either of communicable or non-communicable diseases (NCDs). I demonstrate that global health governance is characterised by a market justice approach to health and a lack of global health leadership, as evidenced by the negotiation of global intellectual property regulations and recent debates on access to NCD medicines. This raises three challenges for global health: (i) addressing broad participation, (ii) the dilution of the meaning of global health, and (iii) the co-optation of the global health agenda by corporate interests. Analysing the existing proposals from scholars in global health governance, I demonstrate that features of a policentric model of constitutional interpretation could be adapted to the global health context. I suggest that the three challenges can be addressed by establishing the respective roles and authority of the multiple global health actors under a post-Westphalian 'multicentric global governance for health' model. By tackling the trend of market justice in health and the absence of leadership in global health, multicentric global governance for health offers a framework in which WHO, States and non-State actors can collectively govern global health so as to promote equity and social justice.Les structures de gouvernance de la santé mondiale n'ont pas su répondre à la crise sanitaire mondiale à l'égard des maladies soient transmissibles ou non transmissibles. Je démontre que la gouvernance de la santé mondiale se caractérise par une approche à la santé de justice de marché et un manque de leadership en santé mondiale, comme en témoigne la négociation de règlements mondiaux sur la propriété intellectuelle et l'accès aux médicaments pour les maladies non transmissibles. Ceci soulève trois défis pour la santé mondiale: (i) aborder la question d'une large participation, (ii) l'affaiblissement du sens à donner à la santé mondiale, et (iii) la cooptation du programme sanitaire mondiale par des intérêts corporatifs.Suivant l'analyse des propositions de spécialistes en matière de gouvernance de la santé mondiale, je propose que des caractéristiques d'un modèle policentrique d'interprétation constitutionnelle pourraient être adaptées à un contexte sanitaire mondial. Je soutiens que les trois défis pourraient être traités en établissant les rôles respectifs des multiples acteurs en santé globale dans un modèle post-Westphalien de « gouvernance mondiale multicentrique pour la santé ». En attaquant la tendance de justice de marché en santé ainsi que le manque de leadership en santé mondiale, la gouvernance multicentrique pour la santé offre un cadre dans lequel l'Organisme mondiale de la santé, les États et les acteurs non Étatiques peuvent collectivement gouverner la santé mondiale afin de promouvoir l'équité et la justice sociale

Is health diplomacy keeping pace with global health developments? Implications for access to medicines strategies in the post-2015 MDG framework

As the 2015 deadline to achieve the Millennium Development Goals (MDGs) draws near, efforts to ensure access to essential medicines face new challenges in light of new resource constraints. To help assess those challenges, a summary analysis of published data was undertaken to examine the increasing discontinuity between the geographic focus of donor-country programs on low-income countries (LICs) and the geographic location of the increasing majority of the poor and the global burden of preventable disease within middle-income countries (MICs). This disconnect has put new pressure on both donor and government resources for essential medicines, prompting greater consideration of strategies through which global health investments can leverage market resources to achieve global health goals and benefit the poor in both LICs and MICs. To help assess the policy environment for strategy change, country-level health workers from low and middle-income countries with high burdens of disease who participated in the International AIDS Conference (AIDS 2012) in Washington, DC, were surveyed to examine their views of the respective responsibilities of various institutions to finance access to essential medicines in their countries. While the 102 respondents rated the future financing responsibility of their governments higher than any other entity (4.8 versus 3.6-4.0, p\u3c0.0001), most did not distinguish responsibility levels among a range of international organizations. Nor did the respondents anticipate any decrease in the future financing responsibilities of those entities, with seven of nine rated significantly higher in the future than in the past. The limited understanding of the roles and reach of different global health institutions is highlighted as an impediment to improving access-to-medicines strategies because it likely constrains the ability of country level stakeholders to engage in the global health strategy dialogue. Sitting at the intersection of the trade and health agendas, the access-to-essential-medicines field is built on the uneasy links between global public health programming and private sector drug research, development and marketing agendas. The two analyses combine to highlight major health diplomacy challenges inherent in reconciling the broad range of state and non-state actor perspectives within the post-2015 development agenda