Facilitative governance: Transforming global health through complexity theory

Complexity in Global Health- Bridging Theory and Practice

Increasingly, health reflects an integrated outcome of a growing globalized system. Economic, political, cultural, environmental, and other global processes profoundly influence how we understand and approach health challenges. As these occur in a webbed, dynamic, and interdependent fashion, health can be viewed as a complex issue. Drawing from this understanding, in this viewpoint, I assert applying complexity theory to produce a definition of the field of global health. Complexity theory tenets such as non-linearity, transdisciplinarity, open-system analysis, and global-local phenomenology can provide a theoretical basis for a substantive understanding of global health phenomena and a richer instrumental approach to global health challenges. Harmonization between complexity theory and global health may provide the foundation to close the health equity gap put forth by the global health agenda.

Sustainable development goals for global health: facilitating good governance in a complex environment

Increasing complexity is following in the wake of rampant globalization. Thus, the discussion about Sustainable Development Goals (SDGs) requires new thinking that departs from a critique of current policy tools in exploration of a complexity-friendly approach. This article argues that potential SDGs should: treat stakeholders, like states, business and civil society actors, as agents on different aggregate levels of networks; incorporate good governance processes that facilitate early involvement of relevant resources, as well as equitable participation, consultative processes, and regular policy and programme implementation reviews; anchor adoption and enforcement of such rules to democratic processes in accountable organizations; and include comprehensive systems evaluations, including procedural indicators. A global framework convention for health could be a suitable instrument for handling some of the challenges related to the governance of a complex environment. It could structure and legitimize government involvement, engage stakeholders, arrange deliberation and decision-making processes with due participation and regular policy review, and define minimum standards for health services. A monitoring scheme could ensure that agents in networks comply according to whole-systems targets, locally defined outcome indicators, and process indicators, thus resolving the paradox of government control vs. local policy space. A convention could thus exploit the energy created in the encounter between civil society, international organizations and national authorities.

Global health politics: neither solidarity nor policy: Comment on "Globalization and the diffusion of ideas: why we should acknowledge the roots of mainstream ideas in global health"

The global health agenda has been dominating the current global health policy debate. Furthermore, it has compelled countries to embrace strategies for tackling health inequalities in a wide range of public health areas. The article by Robert and colleagues highlights that although globalization has increased opportunities to share and spread ideas, there is still great asymmetry of power according to the countries' economic and political development. It also emphasizes how policy diffusion from High Income Countries (HICs) to Low- and Middle-Income Countries (LMICs) have had flaws at understanding their political, economic, and cultural backgrounds while they are pursuing knowledge translation. Achieving a fair global health policy diffusion of ideas would imply a call for a renewal on political elites worldwide at coping global health politics. Accordingly, moving towards fairness in disseminating global health ideas should be driven by politics not only as one of the social determinants of health, but the main determinant of health and well-being among-and within-societies.