Governing Health

The authors expand their coverage in this edition from examining healthcare policy-making with a long-term political perspective to demonstrating their themes in four key periods: 1965, 1981, 1994, and 2000.

The past few decades have seen a massive increase in the number of international organizations focusing on global health. Campaigns to eradicate or stem the spread of AIDS, SARS, malaria, and Ebola attest to the increasing importance of globally-oriented health organizations. These organizations may be national, regional, international, or even non-state organizations-like Medicins Sans Frontieres. One of the more important recent trends in global health governance, though, has been the rise of public-private partnerships (PPPs) where private non-governmental organizations, for-profit enterprises, and various other social entrepreneurs work hand-in-hand with governments to combat specific maladies. A primary driver for this development is the widespread belief that by joining together, PPPs will attack health problems and fund shared efforts more effectively than other systems. As Chelsea Clinton and Devi Sridhar show in Governing Global Health, these partnerships are not only important for combating infectious diseases; they also provide models for developing solutions to a host of other serious global health challenges and questions beyond health. But what do we actually know about the accountability and effectiveness of PPPs in relation to the traditional multilaterals? According to Clinton and Sridhar, we have known very little because scholars have not accumulated enough data or developed effective ways to assess them-until now. In their analysis, they uncovered both strength and weaknesses of the model. Using principal-agent theory in which governments are the principals directing international agents of various type, they take a closer look at two major PPPs-the Global Fund to Fight HIV/AIDS, TB and Malaria and the GAVI Alliance-and two major more traditional international organizations-the World Health Organization and the World Bank. An even-handed and thorough empirical analysis of one of the most pressing topics in world affairs, Governing Global Health will reshape our understanding of how organizations can more effectively prevent the spread of communicable diseases like AIDS and reduce pervasive chronic health problems like malnutrition.

Provoking urgent questions about the politics of health in the twenty-first century, this collection interrogates how neoliberal approaches to governance frame health and risk in ways that promote individual responsibility and the implications of such framings for the well-being of the collective. The essays examine a range of important issues, including childhood obesity, genetic testing, HPV vaccination, Aboriginal health, pandemic preparedness, environmental health, disability policy, aging, contingent work, and women’s access to social services. With specific attention to the Canadian context, contributors reveal how neoliberal practices and policies shape the health experiences of individuals, disadvantaged groups, and communities by cultivating self-discipline while further exposing to harm the lives and bodies of those already marginalized in consumer society. Building on the theoretical conceptualizations of power and government of French philosopher Michel Foucault, the case studies extend our understanding of the effects of neoliberal practices and policies in relation to social class, gender, racialized identity, colonization, and ability, and provide insight into how health-related discourse creates new requirements for citizenship and forms of social stratification. A timely intervention in the field of health studies, Neoliberal Governance and Health establishes the need for critical interdisciplinary scholarship to counter the individualizing and marginalizing tendencies of health-related policy, practice and research.

The fascinating story of Tamiflu's development and stockpiling against global health threats.orld's most prominent medical countermeasure, Tamiflu. A pill can strengthen national security? The suggestion may seem odd, but many states around the world believe precisely that. Confronted with pandemics, bioterrorism, and emerging infectious diseases, governments are transforming their security policies to include the proactive development, acquisition, stockpiling, and mass distribution of new pharmaceutical defenses. What happens—politically, economically, and socially—when governments try to protect their populations with pharmaceuticals? How do competing interests among states, pharmaceutical companies, regulators, and scientists play out in the quest to develop new medical countermeasures? And do citizens around the world ultimately stand to gain or lose from this pharmaceuticalization of security policy? Stefan Elbe explores these complex questions in Pandemics, Pills, and Politics, the first in-depth study of the world’s most prominent medical countermeasure, Tamiflu. Taken by millions of people around the planet in the fight against pandemic flu, Tamiflu has provoked suspicions about undue commercial influence in government decision-making about stockpiles. It even found itself at the center of a prolonged political battle over who should have access to the data about the safety and effectiveness of medicines. Pandemics, Pills, and Politics shows that the story of Tamiflu harbors deeper lessons about the vexing political, economic, legal, social, and regulatory tensions that emerge as twenty-first-century security policy takes a pharmaceutical turn. At the heart of this issue, Elbe argues, lies something deeper: the rise of a new molecular vision of life that is reshaping the world we live in.

In the light of scares about potential pandemics such as swine fever and avian flu, the issue of global health and its governance is of increasing concern to scholars and practitioners of medicine, public health, social work, and international politics alike. Providing a concise and informative introduction to how global health is governed, this book: Explores the various ways in which we understand global health governance Explains the "nuts and bolts" of the traditional institutions of global health governance, highlights key frameworks and treaties and their relative successes and failings Examines the actors in global health governance, their purpose, influence and impact Offers an in depth analysis of the effectiveness of global health interventions, focusing particularly on HIV/AIDS, tuberculosis and malaria. Highlighting the wide variety of actors, issues and approaches involved, this work shows the complex nature of global health governance, forcing the reader to examine who or what really governs global health, to what outcome, and for whom.

Drawing on various disciplinary perspectives, this book re-focuses the debate on what makes a good health system, with a view to clarifying the uses of social science research in thinking about health care issues in Africa. The explosion of the HIV/AIDS pandemic, the persistence of malaria as a major killer, and the resurgence of diseases like tuberculosis which were previously under control, have brought about changes in the health system, with implications for its governance, especially in view of the diminished capacity of the public health facilities to cope with a complex range of expanded needs. Government responsibilities and objectives in the health sector have been redefined, with private sector entities (both for profit and not-for profit) playing an increasingly visible role in health care provisions. The reasons for collaborative patterns vary, but chronic under-funding of publicly financed health services is often an important factor. Processes of decentralisation and health sector reforms have had mixed effects on health care system performance; while private health insurance markets and private clinics are pointers to a growing stratification of the health market, in line with the intensified income and social differentiation that has occurred over the last two decades.These developments call for health sector reforms.

In an era of rapid and extensive globalisation, the world faces a wide range of transboundary problems that require effective collective action. Key among these are threats to human health that do not recognise national borders, and include emerging and re-emerging infections, rising rates of chronic diseases, inadequate access to affordable and safe medicines, spreading anti-microbial resistance and the health effects of climate change. These threats require a transnational response and thus pose significant challenges to global health governance, as well as to long established notions of national sovereignty. This book investigates the neglected question of the impact of a rising Asia on the management of transboundary health problems. The chapters examine the role played by Asia in the governance of a range of global health issues, from development assistance in health, to global health instruments dealing with tobacco control and disease outbreaks, to health research and knowledge products, and the book concludes by examining the broad themes of a rising Asia’s role in the complexity of global health governance. The various analyses are tied together by a common focus on Asian countries’ use of the sovereignty principle, and seek to understand how traditional notions of national sovereignty can both clash with, and enhance, governance objectives in global health. In addition, the contributors examine the interaction between global, regional and domestic institutions, and present current ideas in Asia on the challenge of governing global health. With an inter-disciplinary approach that combines international relations, public policy and public health, this book will be invaluable to both scholars and policy makers working in these fields, as well as Asian politics, social policy and governance more generally.

In recent years the spread of diseases such as AIDS, SARS and avian flu has pushed health issues towards the top of the international agenda. Such outbreaks have serious political, economic, and social consequences and remind the world of the necessity of global cooperation in order to deal effectively with the challenges they pose. Global Health Governance offers a comprehensive introduction to the changing international legal environment, the governmental and non-governmental actors involved with health issues, and the current regime’s ability to adapt to new crises. Part 1 focuses on the evolution of international regulations aimed at stopping the spread of health problems across borders. Over the last 150 years, the nature of such cooperation, the motivations of the parties involved, and the diseases covered, has changed radically. Part 2 examines some of the most prominent actors in global health governance today, ranging from traditional intergovernmental organizations, such as the WHO and the World Bank, to private philanthropic organizations that exist outside regular global governance structures. Part 3 concentrates on some of the most pressing issues facing global health governance today, including access to pharmaceuticals, the costs and benefits of making health a security issue, and the role of civil society organizations. Global Health Governance provides an accessible and insightful analysis of an evolving realm of global governance and cooperation. It will appeal to students of global health politics, global governance, international organization, and human security.