1
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Moser F, Bump JB. Assessing the World Health Organization: What does the academic debate reveal and is it democratic? Soc Sci Med 2022; 314:115456. [PMID: 36274457 DOI: 10.1016/j.socscimed.2022.115456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 09/17/2022] [Accepted: 10/09/2022] [Indexed: 11/05/2022]
Abstract
The World Health Organization (WHO), the leading global authority in public health, routinely attracts loud calls for reform. Although Member States negotiate reform internally, academic debate is more public, and can generate ideas and provide independent accountability. We investigate why authors advocate for WHO reform so commonly. We wondered if this literature had potentially useful themes for WHO, what methods and evidence were used, and we wanted to analyze the geography of participation. We conducted a systematic review using four databases to identify 139 articles assessing WHO or advocating for reform. We discuss these using categories we derived from the management literature on organizational performance. We also analyzed evidence, country of origin, and topic. The literature we reviewed contained 998 claims about WHO's performance or reform, although there were no standard methods for assessing WHO. We developed a framework to analyze WHO's performance and structure a synthesis of the claims, which find WHO imperiled. Its legitimacy and governance are weakened by disagreements about purpose, unequal Member State influence, and inadequate accountability. Contestation of goals and strategies constrain planning. Structure and workforce deficiencies limit coordination, agility, and competence. WHO has technical and normative authority, but insufficient independence and legal power to influence uncooperative states. WHO's identity claims transparency, independence, and courage, but these aspirations are betrayed in times of need. Most articles (88%) were commentaries without specified methods. More than three-quarters (76%) originated from the US, the UK, or Switzerland. A quarter of papers (25%) focused on international infectious disease outbreaks, and another 25% advocated for WHO reform generally. Many criticisms cite wide-ranging performance problems, some of which may relate to obstructive behavior by Member States. This literature is incomplete in the geographic representation of authors, evidence, methods, and topics. We offer ideas for developing more rigorous and inclusive academic debate on WHO.
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Affiliation(s)
- Fabian Moser
- Institute of Public Health, Charité - Universitätsmedizin Berlin, 10117, Berlin, Germany.
| | - Jesse B Bump
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, USA; Bergen Center for Ethics and Priority Setting, University of Bergen, Norway; Initiative on the Future of Health and Economic Resilience in Africa, Boston MA 02115, USA.
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2
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Stevenson M, Youde J. Public-private partnering as a modus operandi: Explaining the Gates Foundation's approach to global health governance. Glob Public Health 2020; 16:401-414. [PMID: 32762617 DOI: 10.1080/17441692.2020.1801790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In its first decade, The Bill and Melinda Gates Foundation (BMGF) focused much of its efforts on enabling the establishment of transnational public-private partnerships (PPPs) oriented towards increasing low-income country (LIC) access to essential health technologies. Critics have argued these efforts further enriched already profitable firms which long ignored the needs of populations with limited purchasing power, while lessening political will to invest in urgently needed public sector capacity to produce essential health technologies independently of market pressures. Missing from these critical analyses were the perspectives of those shaping BMGF's global health programming. Drawing on interviews with senior BMGF staff and external affiliates undertaken between 2010 and 2012, this article seeks to address this gap. We argue that BMGF's embrace of PPPs was adopted out of the belief that neither public agencies nor industry were capable of providing LICs with essential health technologies autonomously, and that their conflicting mandates required an honest broker to initiate and sustain collaboration between the two sectors. The Foundation's comparative advantage in global health governance was thus seen by those informing its work, as its capacity to negotiate such partnerships, which we argue has also been the basis of its agenda-setting influence in this domain.
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Affiliation(s)
- Michael Stevenson
- School of Public Health and Health Systems, University of Waterloo, Hamilton, Canada
| | - Jeremy Youde
- College of Liberal Arts, University of Minnesota Duluth, Duluth, MN, USA
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3
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Paul E, Brown GW, Ridde V. COVID-19: time for paradigm shift in the nexus between local, national and global health. BMJ Glob Health 2020; 5:e002622. [PMID: 32399261 PMCID: PMC7204939 DOI: 10.1136/bmjgh-2020-002622] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 04/13/2020] [Indexed: 12/25/2022] Open
Affiliation(s)
- Elisabeth Paul
- School of Public Health, Université Libre de Bruxelles, Bruxelles, Belgium.,Tax Institute, Liege University, Liege, Belgium
| | - Garrett W Brown
- Global Health Theme, POLIS, University of Leeds, Leeds, West Yorkshire, UK
| | - Valery Ridde
- CEPED (IRD-Universités de Paris), INSERM, Institut de recherche pour le developpement, Paris, France
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4
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Reddy SK, Mazhar S, Lencucha R. The financial sustainability of the World Health Organization and the political economy of global health governance: a review of funding proposals. Global Health 2018; 14:119. [PMID: 30486890 PMCID: PMC6264055 DOI: 10.1186/s12992-018-0436-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 11/07/2018] [Indexed: 11/25/2022] Open
Abstract
The World Health Organization (WHO) continues to experience immense financial stress. The precarious financial situation of the WHO has given rise to extensive dialogue and debate. This dialogue has generated diverse technical proposals to remedy the financial woes of the WHO and is intimately tied to existential questions about the future of the WHO in global health governance. In this paper, we review, categorize, and synthesize the proposals for financial reform of the WHO. It appears that less contentious issues, such as convening financing dialogue and establishing a health emergency programme, received consensus from member states. However, member states are reluctant to increase the assessed annual contributions to the WHO, which weakens the prospect for greater autonomy for the organisation. The WHO remains largely supported by earmarked voluntary contributions from states and non-state actors. We argue that while financial reform requires institutional changes to enhance transparency, accountability and efficiency, it is also deeply tied to the political economy of state sovereignty and ideas about the leadership role of the WHO in a crowded global health governance context.
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Affiliation(s)
- Srikanth K. Reddy
- Faculty of Medicine, School of Physical and Occupational Therapy, McGill University, Rabinovitch House, 3640 de la Montagne, Montreal, QC H3G 2A8 Canada
| | - Sumaira Mazhar
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Raphael Lencucha
- Faculty of Medicine, School of Physical and Occupational Therapy, McGill University, Rabinovitch House, 3640 de la Montagne, Montreal, QC H3G 2A8 Canada
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5
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Gopinathan U, Watts N, Lefebvre A, Cheung A, Hoffman SJ, Røttingen JA. Global governance and the broader determinants of health: A comparative case study of UNDP's and WTO's engagement with global health. Glob Public Health 2018; 14:175-189. [PMID: 29848178 DOI: 10.1080/17441692.2018.1476567] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
This comparative case study investigated how two intergovernmental organisations without formal health mandates - the United Nations Development Programme (UNDP) and the World Trade Organization (WTO) - have engaged with global health issues. Triangulating insights from key institutional documents, ten semi-structured interviews with senior officials, and scholarly books tracing the history of both organisations, the study identified an evolving and broadened engagement with global health issues in UNDP and WTO. Within WTO, the dominant view was that enhancing international trade is instrumental to improving global health, although the need to resolve tensions between public health objectives and WTO agreements was recognised. For UNDP, interviewees reported that the agency gained prominence in global health for its response to HIV/AIDS in the 1990s and early 2000s. Learning from that experience, the agency has evolved and expanded its role in two respects: it has increasingly facilitated processes to provide global normative direction for global health issues such as HIV/AIDS and access to medicines, and it has expanded its focus beyond HIV/AIDS. Overall, the study findings suggest the need for seeking greater integration among international institutions, closing key global institutional gaps, and establishing a shared global institutional space for promoting action on the broader determinants of health.
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Affiliation(s)
- Unni Gopinathan
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway.,Department of Global Health, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway.,Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health and Osgoode Hall Law School, York University, Toronto, Canada
| | - Nick Watts
- University College London, Institute for Global Health, London, UK
| | | | - Arthur Cheung
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Steven J Hoffman
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health and Osgoode Hall Law School, York University, Toronto, Canada.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - John-Arne Røttingen
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Division for Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway.,Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway
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6
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Lei M, Acharya N, Kwok Man Lee E, Catherine Holcomb E, Kapoor V. American Mock World Health Organization: An Innovative Model for Student Engagement in Global Health Policy. GLOBAL HEALTH: SCIENCE AND PRACTICE 2017; 5:164-174. [PMID: 28351883 PMCID: PMC5478225 DOI: 10.9745/ghsp-d-16-00138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 01/30/2017] [Indexed: 11/15/2022]
Abstract
The American Mock World Health Organization (AMWHO) is a model for experiential-based learning and student engagement in global health diplomacy. AMWHO was established in 2014 at the University of North Carolina at Chapel Hill with a mission to engage students in health policy by providing a simulation of the World Health Assembly (WHA), the policy-forming body of the World Health Organization that sets norms and transforms the global health agenda. AMWHO conferences are designed to allow students to take their knowledge of global health beyond the classroom and practice their skills in diplomacy by assuming the role of WHA delegates throughout a 3-day weekend. Through the process of developing resolutions like those formed in the WHA, students have the unique opportunity to understand the complexities behind the conflict and compromise that ensues through the lens of a stakeholder. This article describes the structure of the first 2 AMWHO international conferences, analyzes survey results from attendees, and discusses the expansion of the organization into a multi-campus national network. The AMWHO 2014 and 2015 post-conference survey results found that 98% and 90% of participants considered the conference "good" or "better," respectively, and survey responses showed that participants considered the conference "influential" in their careers and indicated that it "allowed a paradigm shift not possible in class."
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Affiliation(s)
- Mia Lei
- University of North Carolina, Chapel Hill, NC, USA.
| | - Neha Acharya
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | | | - Veronica Kapoor
- Fielding School of Public Health, The University of California, Los Angeles, Los Angeles, CA, USA
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Ooms G, Hammonds R. Global constitutionalism, applied to global health governance: uncovering legitimacy deficits and suggesting remedies. Global Health 2016; 12:84. [PMID: 27914471 PMCID: PMC5135750 DOI: 10.1186/s12992-016-0216-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Accepted: 11/15/2016] [Indexed: 11/10/2022] Open
Abstract
Background Global constitutionalism is a way of looking at the world, at global rules and how they are made, as if there was a global constitution, empowering global institutions to act as a global government, setting rules which bind all states and people. Analysis This essay employs global constitutionalism to examine how and why global health governance, as currently structured, has struggled to advance the right to health, a fundamental human rights obligation enshrined in the International Covenant on Economic, Social and Cultural Rights. It first examines the core structure of the global health governance architecture, and its evolution since the Second World War. Second, it identifies the main constitutionalist principles that are relevant for a global constitutionalism assessment of the core structure of the global health governance architecture. Finally, it applies these constitutionalist principles to assess the core structure of the global health governance architecture. Discussion Leading global health institutions are structurally skewed to preserve high incomes countries’ disproportionate influence on transnational rule-making authority, and tend to prioritise infectious disease control over the comprehensive realisation of the right to health. Conclusion A Framework Convention on Global Health could create a classic division of powers in global health governance, with WHO as the law-making power in global health governance, a global fund for health as the executive power, and the International Court of Justice as the judiciary power.
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Affiliation(s)
- Gorik Ooms
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, UK.
| | - Rachel Hammonds
- Law and Development Research Group, Faculty of Law, University of Antwerp, Venusstraat 23, 2000, Antwerpen, Belgium
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8
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Gopinathan U, Watts N, Hougendobler D, Lefebvre A, Cheung A, Hoffman SJ, Røttingen JA. Conceptual and institutional gaps: understanding how the WHO can become a more effective cross-sectoral collaborator. Global Health 2015; 11:46. [PMID: 26596963 PMCID: PMC4657201 DOI: 10.1186/s12992-015-0128-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 10/29/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Two themes consistently emerge from the broad range of academics, policymakers and opinion leaders who have proposed changes to the World Health Organization (WHO): that reform efforts are too slow, and that they do too little to strengthen WHO's capacity to facilitate cross-sectoral collaboration. This study seeks to identify possible explanations for the challenges WHO faces in addressing the broader determinants of health, and the potential opportunities for working across sectors. METHODS This qualitative study used a mixed methods approach of semi-structured interviews and document review. Five interviewees were selected by stratified purposive sampling within a sampling frame of approximately 45 potential interviewees, and a targeted document review was conducted. All interviewees were senior WHO staff at the department director level or above. Thematic analysis was used to analyze data from interview transcripts, field notes, and the document review, and data coded during the analysis was analyzed against three central research questions. First, how does WHO conceptualize its mandate in global health? Second, what are the barriers and enablers to enhancing cross-sectoral collaboration between WHO and other intergovernmental organizations? Third, how do the dominant conceptual frames and the identified barriers and enablers to cross-sectoral collaboration interact? RESULTS Analysis of the interviews and documents revealed three main themes: 1) WHO's role must evolve to meet the global challenges and societal changes of the 21st century; 2) WHO's cross-sectoral engagement is hampered internally by a dominant biomedical view of health, and the prevailing institutions and incentives that entrench this view; and 3) WHO's cross-sectoral engagement is hampered externally by siloed areas of focus for each intergovernmental organization, and the lack of adequate conceptual frameworks and institutional mechanisms to facilitate engagement across siloes. CONCLUSION There are a number of external and internal pressures on WHO which have created an organizational culture and operational structure that focuses on a narrow, technical approach to global health, prioritizing disease-based, siloed interventions over more complex approaches that span sectors. The broader approach to promoting human health and wellbeing, which is conceptualized in WHO's constitution, requires cultural and institutional changes for it to be fully implemented.
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Affiliation(s)
- Unni Gopinathan
- Institute of Health and Society, University of Oslo, Oslo, Norway.
| | - Nicholas Watts
- Institute of Global Health, University College London, London, UK.
| | - Daniel Hougendobler
- O'Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC, USA.
| | - Alex Lefebvre
- Faculty of Medicine, University of British Columbia, Vancouver, Canada.
| | - Arthur Cheung
- School of Medicine, The University of Queensland, Brisbane, Australia.
| | - Steven J Hoffman
- Global Strategy Lab, Faculty of Law, University of Ottawa, Ottawa, Canada.
- Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.
- Department of Clinical Epidemiology & Biostatistics and McMaster Health Forum, McMaster University, Hamilton, Canada.
| | - John-Arne Røttingen
- Division of Environmental Health and Infectious Disease Control, Norwegian Institute of Public Health, Oslo, Norway.
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9
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Gostin LO, Sridhar D, Hougendobler D. The normative authority of the World Health Organization. Public Health 2015; 129:854-63. [PMID: 26100341 DOI: 10.1016/j.puhe.2015.05.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 05/01/2015] [Accepted: 05/02/2015] [Indexed: 12/01/2022]
Abstract
The World Health Organization (WHO) was born after the devastation of World War II, as a normative agency endowed with unprecedented constitutional powers. But even as it has achieved stunning successes, such as the eradication of smallpox, it has failed to live up to the exalted expectations of the postwar health and human rights movement - exemplified most recently by its inadequate response to the Ebola epidemic. Our aim is to offer innovative ideas for restoring the Organization to its leadership position by exercising its normative authority, even as it faces a crowded and often chaotic global health architecture. Before doing so, it will be helpful to summarize the main tensions the Organization faces in today's global health landscape.
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Affiliation(s)
- L O Gostin
- Georgetown University Law Center, Law Center, 600 New Jersey Ave., NW, Washington, DC, USA.
| | - D Sridhar
- Centre for Population Health Sciences, University of Edinburgh, USA
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10
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Ippolito G, Di Caro A, Capobianchi MR. The Chronology of the International Response to Ebola in Western Africa: Lights and Shadows in a Frame of Conflicting Position and Figures. Infect Dis Rep 2015; 7:5957. [PMID: 26294954 PMCID: PMC4508539 DOI: 10.4081/idr.2015.5957] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Accepted: 04/20/2015] [Indexed: 11/23/2022] Open
Abstract
The ongoing Ebola virus outbreak in western Africa illustrates the threat coming from emerging infectious diseases and is perceived by the public as a preeminent public health problem[...]
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Affiliation(s)
- Giuseppe Ippolito
- National Institute for Infectious Diseases Lazzaro Spallanzani, Rome, Italy
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11
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Siedner MJ, Gostin LO, Cranmer HH, Kraemer JD. Strengthening the detection of and early response to public health emergencies: lessons from the West African Ebola epidemic. PLoS Med 2015; 12:e1001804. [PMID: 25803303 PMCID: PMC4371887 DOI: 10.1371/journal.pmed.1001804] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Mark Siedner and colleagues reflect on the early response to the Ebola epidemic and lessons that can be learned for future epidemics.
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Affiliation(s)
- Mark J Siedner
- Massachusetts General Hospital Center for Global Health, Boston, Massachusetts, United States of America; Harvard Medical School, Boston, Massachusetts, United States of America
| | - Lawrence O Gostin
- O'Neill Institute for National and Global Health Law, Georgetown University, Washington, D.C., United States of America
| | - Hilarie H Cranmer
- Massachusetts General Hospital Center for Global Health, Boston, Massachusetts, United States of America; Harvard Medical School, Boston, Massachusetts, United States of America
| | - John D Kraemer
- O'Neill Institute for National and Global Health Law, Georgetown University, Washington, D.C., United States of America; Department of Health Systems Administration, Georgetown University, Washington, D.C., United States of America
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12
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Hanefeld J, Walt G. Knowledge and networks - key sources of power in global health: Comment on "Knowledge, moral claims and the exercise of power in global health". Int J Health Policy Manag 2015; 4:119-21. [PMID: 25674577 DOI: 10.15171/ijhpm.2015.25] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 02/02/2015] [Indexed: 11/09/2022] Open
Abstract
Shiffman rightly raises questions about who exercises power in global health, suggesting power is a complex concept, and the way it is exercised is often opaque. Power that is not based on financial strength but on knowledge or experience, is difficult to estimate, and yet it may provide the legitimacy to make moral claims on what is, or ought to be, on global health agendas. Twenty years ago power was exercised in a much less complex health environment. The World Health Organization (WHO) was able to exert its authority as world health leader. The landscape today is very different. Financial resources for global health are being competed for by diverse organisations, and power is diffused and somewhat hidden in such a climate, where each organization has to establish and make its own moral claims loudly and publicly. We observe two ways which allow actors to capture moral authority in global health. One, through power based on scientific knowledge and two, through procedures in the policy process, most commonly associated with the notion of broad consultation and participation. We discuss these drawing on one particular framework provided by Bourdieu, who analyses the source of actor power by focusing on different sorts of capital. Different approaches or theories to understanding power will go some way to answering the challenge Shiffman throws to health policy analysts. We need to explore much more fully where power lies in global health, and how it is exercised in order to understand underlying health agendas and claims to legitimacy made by global health actors today.
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Affiliation(s)
| | - Gill Walt
- London School of Hygiene and Tropical Medicine, London, UK
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13
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Affiliation(s)
- Lawrence O Gostin
- O'Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC 20001, USA.
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14
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Affiliation(s)
- Lawrence O Gostin
- From the O'Neill Institute for National and Global Health Law, Georgetown University Law Center, and the World Health Organization (WHO) Collaborating Center on Public Health Law and Human Rights, Washington, DC (L.O.G.); and the WHO Collaborating Centre for Population Health Research and Training, University of Edinburgh, Edinburgh, and the Blavatnik School of Government, University of Oxford, Oxford - both in the United Kingdom (D.S.)
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15
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Ruger JP. International institutional legitimacy and the World Health Organization. J Epidemiol Community Health 2014; 68:697-700. [PMID: 24599988 DOI: 10.1136/jech-2013-203272] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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16
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Taylor A, Alfven T, Hougendobler D, Tanaka S, Buse K. Leveraging non-binding instruments for global health governance: reflections from the Global AIDS Reporting Mechanism for WHO reform. Public Health 2014; 128:151-60. [DOI: 10.1016/j.puhe.2013.08.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 08/27/2013] [Accepted: 08/29/2013] [Indexed: 11/29/2022]
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17
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Ooms G, Marten R, Waris A, Hammonds R, Mulumba M, Friedman EA. Great expectations for the World Health Organization: a Framework Convention on Global Health to achieve universal health coverage. Public Health 2014; 128:173-8. [PMID: 24411617 DOI: 10.1016/j.puhe.2013.06.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Revised: 06/20/2013] [Accepted: 06/26/2013] [Indexed: 11/29/2022]
Abstract
Establishing a reform agenda for the World Health Organization (WHO) requires understanding its role within the wider global health system and the purposes of that wider global health system. In this paper, the focus is on one particular purpose: achieving universal health coverage (UHC). The intention is to describe why achieving UHC requires something like a Framework Convention on Global Health (FCGH) that have been proposed elsewhere,(1) why WHO is in a unique position to usher in an FCGH, and what specific reforms would help enable WHO to assume this role.
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Affiliation(s)
- G Ooms
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
| | - R Marten
- Rockefeller Foundation, New York, USA
| | - A Waris
- Law School, University of Nairobi, Nairobi, Kenya
| | - R Hammonds
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - M Mulumba
- Center for Health Human Rights & Development, Kampala, Uganda
| | - E A Friedman
- O'Neill Institute for National and Global Health Law, Georgetown University, Washington D.C., USA
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18
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Parkhurst JO, Vulimiri M. Cervical cancer and the global health agenda: Insights from multiple policy-analysis frameworks. Glob Public Health 2013; 8:1093-108. [PMID: 24236409 PMCID: PMC3877944 DOI: 10.1080/17441692.2013.850524] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 09/04/2013] [Indexed: 12/31/2022]
Abstract
Cervical cancer is the second leading cause of cancer deaths for women globally, with an estimated 88% of deaths occurring in the developing world. Available technologies have dramatically reduced mortality in high-income settings, yet cervical cancer receives considerably little attention on the global health policy landscape. The authors applied four policy-analysis frameworks to literature on global cervical cancer to explore the question of why cervical cancer may not be receiving the international attention it may otherwise warrant. Each framework explores the process of agenda setting and discerns factors that either facilitate or hinder policy change in cases where there is both a clear problem and a potential effective solution. In combination, these frameworks highlight a number of crucial elements that may be needed to raise the profile of cervical cancer on global health agendas, including improving local (national or sub-national) information on the condition; increasing mobilisation of affected civil society groups; framing cervical cancer debates in ways that build upon its classification as a non-communicable disease (NCD) and an issue of women's rights; linking cervical cancer screening to well-funded services such as those for HIV treatment in some countries; and identifying key global policy windows of opportunity to promote the cervical cancer agenda, including emerging NCD global health discussions and post-2015 reviews of the Millennium Development Goals.
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Affiliation(s)
- Justin O. Parkhurst
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Madhulika Vulimiri
- Department of Health Policy and Management, University of North Carolina, Chapel Hill, NC, USA
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Gagnon ML, Labonté R. Understanding how and why health is integrated into foreign policy - a case study of health is global, a UK Government Strategy 2008-2013. Global Health 2013; 9:24. [PMID: 23742130 PMCID: PMC3680218 DOI: 10.1186/1744-8603-9-24] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Accepted: 05/31/2013] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Over the past decade, global health issues have become more prominent in foreign policies at the national level. The process to develop state level global health strategies is arguably a form of global health diplomacy (GHD). Despite an increase in the volume of secondary research and analysis in this area, little primary research, particularly that which draws directly on the perspectives of those involved in these processes, has been conducted. This study seeks to fill this knowledge gap through an empirical case study of Health is Global: A UK Government Strategy 2008-2013. It aims to build understanding about how and why health is integrated into foreign policy and derive lessons of potential relevance to other nations interested in developing whole-of-government global health strategies. METHODS The major element of the study consisted of an in-depth investigation and analysis of the UK global health strategy. Document analysis and twenty interviews were conducted. Data was organized and described using an adapted version of Walt and Gilson's policy analysis triangle. A general inductive approach was used to identify themes in the data, which were then analysed and interpreted using Fidler's health and foreign policy conceptualizations and Kingdon's multiples streams model of the policymaking process. RESULTS The primary reason that the UK decided to focus more on global health is self-interest - to protect national and international security and economic interests. Investing in global health was also seen as a way to enhance the UK's international reputation. A focus on global health to primarily benefit other nations and improve global health per se was a prevalent through weaker theme. A well organized, credible policy community played a critical role in the process and a policy entrepreneur with expertise in both international relations and health helped catalyze attention and action on global health when the time was right. Support from the Prime Minister and from the Foreign and Commonwealth Office was essential. The process to arrive at a government-wide strategy was complex and time-consuming, but also broke down silos. Significant negotiation and compromise were required from actors with widely varying perspectives on global health and conflicting priorities. CONCLUSIONS As primarily an exploratory study, this research sheds significant light on the global health policymaking process at the level of the state. It provides a useful and important starting point for further hypothesis driven empirical research that focuses on the integration of health in foreign policy, how and why this happens and whether or not it makes an impact on improving global health.
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Affiliation(s)
- Michelle L Gagnon
- Institute of Population Health, University of Ottawa, 1 Stewart Street, Ottawa, Ontario, K1N6N5, Canada
| | - Ronald Labonté
- Canada Research Chair, Globalization / Health Equity, Faculty of Medicine, Institute of Population Health, University of Ottawa, 1 Stewart Street, Ottawa, Ontario, K1N6N5, Canada
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Hammonds R, Ooms G, Vandenhole W. Under the (legal) radar screen: global health initiatives and international human rights obligations. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2012; 12:31. [PMID: 23153090 PMCID: PMC3534496 DOI: 10.1186/1472-698x-12-31] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 10/26/2012] [Indexed: 11/10/2022]
Abstract
UNLABELLED BACKGROUND Given that many low income countries are heavily reliant on external assistance to fund their health sectors the acceptance of obligations of international assistance and cooperation with regard to the right to health (global health obligations) is insufficiently understood and studied by international health and human rights scholars. Over the past decade Global Health Initiatives, like the Global Fund to fight AIDS, Tuberculosis and Malaria (Global Fund) have adopted novel approaches to engaging with stakeholders in high and low income countries. This article explores how this experience impacted on acceptance of the international obligation to (help) fulfil the right to health beyond borders. METHODS The authors conducted an extensive review of international human rights law literature, transnational legal process literature, global public health literature and grey literature pertaining to Global Health Initiatives. To complement this desk work and deepen their understanding of how and why different legal norms evolve the authors conducted 19 in-depth key informant interviews with actors engaged with three stakeholders; the European Union, the United States and Belgium. The authors then analysed the interviews through a transnational legal process lens. RESULTS Through according value to the process of examining how and why different legal norms evolve transnational legal process offers us a tool for engaging with the dynamism of developments in global health suggesting that operationalising global health obligations could advance the right to health for all. CONCLUSIONS In many low-income countries the health sector is heavily dependent on external assistance to fulfil the right to health of people thus it is vital that policies and tools for delivering reliable, long-term assistance are developed so that the right to health for all becomes more than a dream. Our research suggests that the Global Fund experience offers lessons to build on.
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Affiliation(s)
- Rachel Hammonds
- Institute of Tropical Medicine, 155 Nationalestraat, 2000, Antwerp, Belgium
| | - Gorik Ooms
- Institute of Tropical Medicine, 155 Nationalestraat, 2000, Antwerp, Belgium
| | - Wouter Vandenhole
- Faculty of Law, University of Antwerp, Stadscampus, S.V.132 Venusstraat 23, 2000, Antwerp, Belgium
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Mackey TK, Liang BA. A United Nations Global Health Panel for Global Health Governance. Soc Sci Med 2012; 76:12-5. [PMID: 23121855 DOI: 10.1016/j.socscimed.2012.09.038] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Revised: 04/18/2012] [Accepted: 09/27/2012] [Indexed: 11/30/2022]
Abstract
The World Health Organization now relies upon voluntary contributions tied to specific projects, underwriting 75% of operations. A resulting cacophony of non-governmental, foundation, and private sector actors have emerged overlapping and fractionating WHO programs. In this expanding world of "global health organizations," WHO's role must be redefined. We propose coordination of global health initiatives through a United Nations Global Health Panel with active participation of WHO. Given recent events, the UN is poised to take a greater leadership role in global health.
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Affiliation(s)
- Tim K Mackey
- Institute of Health Law Studies, California Western School of Law, San Diego, CA 92101, USA.
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Tucker JD, Fenton KA, Peckham R, Peeling RW. Social entrepreneurship for sexual health (SESH): a new approach for enabling delivery of sexual health services among most-at-risk populations. PLoS Med 2012; 9:e1001266. [PMID: 22815654 PMCID: PMC3398968 DOI: 10.1371/journal.pmed.1001266] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Joseph Tucker and colleagues argue for social entrepreneurship, a new approach to help improve delivery of sexual health services.
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Affiliation(s)
- Joseph D Tucker
- University of North Carolina Project-China, Guangzhou, China.
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Promoting global health: utilizing WHO to integrate public health, innovation and intellectual property. Drug Discov Today 2012; 17:1254-7. [PMID: 22728776 DOI: 10.1016/j.drudis.2012.06.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Revised: 05/31/2012] [Accepted: 06/15/2012] [Indexed: 11/30/2022]
Abstract
The appropriate role of innovation and intellectual property (IP) in global public health is a controversial issue. Discussion is one-sided, with potential benefits advocated by industry in stark contrast to condemnation by certain civil society players. WHO's Public Health, Innovation and Intellectual Property Department (PHI) was established to address healthcare resource need for developing countries, assess impact of innovation and IP on access to medicines, explore innovative funding mechanisms for R&D and provide evidence-based policy-making recommendations in response to the changing global health landscape. Importantly, PHI could represent a potential forum to bridge shared, yet often diverse, interests and opportunities between various public and private stakeholders, a crucial issue for ensuring the future viability of WHO.
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Gostin LO, Friedman EA, Ooms G, Gebauer T, Gupta N, Sridhar D, Chenguang W, Røttingen JA, Sanders D. The Joint Action and learning initiative: towards a global agreement on national and global responsibilities for health. PLoS Med 2011; 8:e1001031. [PMID: 21572991 PMCID: PMC3091848 DOI: 10.1371/journal.pmed.1001031] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Lawrence Gostin and colleagues discuss their work on the Joint Action and Learning Initiative on National and Global Responsibilities for Health (JALI), which aims to secure a global health agreement (such as a Framework Convention on Global Health) that would inform post-Millennium Development Goal global health commitments.
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Affiliation(s)
- Lawrence O Gostin
- O'Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC, USA.
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