Global governance could once be seen in relatively simple terms as the mechanisms of the UN that supported international cooperation. However, in today's world the picture is far more complex with many different institutions and agencies working together in different ways to address global issues. This section provides an introduction to the topic of global governance and the main actors engaged, with a focus on European  institutions, including inter-government organisations, EU agencies, global public private partnerships and academic business and civil society actors.

Global governance

Globalization

Global public goods

Global health governance

Global health diplomacy

Global health institutions

Health Governance & Governance for Health

Nation states as global health actors

Developing countries

Organizations for cooperation between countries

United Nations organizations

The World Trade Organization (WTO)

The Global Fund to Fight AIDS, Tuberculosis and Malaria

Global public-private partnerships (GPPPs)

Civil society and global health

Business actors and global health

European global health institutions

European broad-based intergovernmental institutions

Institutions of The European Union

The European Economic and Social Committee (EESC or ECOSOC)

The open method of coordination

Agencies of the European Union

European communicable disease surveillance networks

European civil society and global health networks

Actions and research on global governance for health and European institutions

Social Determinants of Health

Health in All Policies


 

Health Governance and Governance for Health

"Health Governance" refers to policy agenda setting processes, implementation and accountability within the health sector. It includes the management and administration of policies and resources in health, including processes for health systems strengthening.

"Governance for Health" describes a far more multifaceted and complex process of intersectoral collaboration and policy agenda setting, formulation, implementation and accountability whereby multiple sectors, groups of actors and levels of action collaborate and intertwine with the goal of fostering equitable health development. "Governance for Health" thus involves a large number of stakeholders in policy processes and transcends the boundaries of not only specific sectors (e.g. health, trade) but also 'levels' of governance (i.e. local, national, regional, international).

Kickbusch & Gleicher (2011) describe governance for health as "the joint actions of health and non-health sectors, of public and private sectors and of citizens for a common interest...attempts of governments and other actors to steer communities, countries or groups of countries in the pursuit of health as integral to well-being through both a 'whole of government' and a 'whole of society' approach."

Governance for health is based on an understanding that health is a human right, as well as on the 'social determinants of health,' or the notion that determinants and solutions for health often lie outside of the health sector. A good example of 'governance for health' is the 'Health in All Policies' approach, whereby the impact of non-health sector policies on health is considered. International organizations and member states have embraced these new concepts as evidenced by 'Health in All Policies' approaches as well as Social Determinants of Health initiatives, following the WHO Commission on the Social Determinants of Health and follow-up 2011 Rio World Conference on Social Determinants of Health.

Health in All Policies

The Health in All Policies (HiAP) approach recognizes and addresses the fact that many of the determinants of health lie outside of the health sector. HiAP encourages governments to take a more inclusive approach by making the improvement of population health a shared goal across all sectors of governance. HiAP is an instrument to address the social determinants of health through intersectoral and 'whole of government' policy and governance. It thus assesses and addresses the potential impact on health of policies that originate in government sectors other than health.

The key aspects cross sectoral healthy public policies were initially developed and endorsed by the first two International Conferences on Health Promotion in Ottawa (1986) and Adelaide (1988). With renewed political attention being paid to the social determinants of health following the work accomplished by the WHO Commission on Social Determinants of Health (CSDH 2005-08), HiAP and related concepts have figured prominently in both the CSDH's final report and the subsequent Rio Declaration on the Social Determinants of Health.

On the European level, an inclusive, intersectoral approach to health has been made a constitutional requirement by the Article 152 of the Treaty establishing the European Community which stipulates that "a high level of human health protection shall be ensured by all Community institutions in the definition of all Community policies and activities"(http://ec.europa.eu/health/archive/ph_information/documents/health_in_all_policies.pdf). As a consequence, a multisectoral approach is at the heart of EU health policies at all levels, from global health to action at the national level. In addition, individual member states consider the promotion of inclusive health governance a policy priority: Finland, for instance, produced a Council-endorsed report on HiAP in Europe during its 2006 presidency and will use its position as host of the 2013 Global Conference on Health Promotion to make Health in All Policies a focal element of the meeting.

Social Determinants of Health

Social Determinants of Health have been defined by the World Health Organisation (WHO) as "the circumstances in which people are born, grow up, live, work and age, and the systems put in place to deal with illness". A report published by the WHO Regional Office for Europe titled "Social Determinants of Health: The Solid Facts" (edited by Michael Marmot and Richard Wilkinson), explores ten key determinants and their interaction with health outcomes, namely

1. the social gradient as a correlation between groups' and individuals' relative position on the social ladder and the frequency of adverse health outcomes.

2. early life, with slow growth and low emotional support during early childhood as key factors contributing to poorer health later in life,

3. stress, with the psycho-social risks of continuing anxiety, insecurity, low self esteem, and lack of control over one's public and private life negatively impacting individual and collective health outcomes,

4. social exclusion as a source of stress and an obstacle for access to public services and social support,

5. working conditions, as source of stress and a direct cause of ill health in the absence of adequate workplace health protection measures,

6. unemployment as another source of stress and a key factor that negatively impacts an individual's place on the social ladder

7. social support, in regard to both the emotional and practical support characterizing good social relations,

8. addiction, with alcohol dependence, illicit drug use and tobacco consumption all pointing towards underlying social and economic marginalization

9. healthy food, with both over- and under-nutrition contributing to the  overall burden of disease,

10. transport, in regard to the adverse effects of increasing road traffic (accidents, pollution, stress, decreased physical activity, social isolation) and the benefits of reliable public transportation systems and environments encouraging physical activity (walking and cycling) and stimulating social interaction.

The WHO Commission on Social Determinants of Health (CSDH), set up in 2005, identified the achievement of health equity as the overarching goal in addressing the social determinants of health. Its final report 'Closing the Gap in a Generation' (2008) put forward three key recommendations, namely to "(1) to improve daily living conditions, (2) to address the inequitable distribution of power, money and resources and (3) to measure and understand the problem and assess the impact of action". It emphasized the intersectoral nature of both health problems and solutions and called for a new inclusive approach where "health and health equity may not be the aim of all social policies but they will be a fundamental result". The social determinants of health approach is thus closely tied to 'Health in All Policies' strategies.

In May 2009, the 62nd World Health Assembly endorsed the CSDH report and requested WHO to "convene a global event to discuss renewed plans for addressing the alarming trends of health inequities through addressing social determinants of health". As a result, the 2011 Rio World Conference on the Social Determinants of Health was convened in October 2011 and adopted the Rio Political Declaration on Social Determinants of Health. The declaration expressed political support for priority action on the social determinants of health, affirming the right to the enjoyment of the highest attainable standard of health and stressing the importance of intersectoral mechanisms such as the Health in All Policies approach.

 

Global governance

Governance describes how societies structure policy responses to the challenges they face. Governance involves government, but the two terms are not synonymous because governance often occurs outside the formal state-based institutional and legal arrangements that characterize governments. Thus, within nation states, regional and local government, and civil society and business institutions are recognized as playing important roles in governance.

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Globalization

This is defined as the "widening, deepening and speeding up of worldwide interconnectedness in all aspects of contemporary social life" (Held et al 1999). Its driving forces are the cultural, social, economic and technological movements that shape our world.

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Global public goods

These are defined as goods and services that are ‘non-rival' and ‘non-excludable'. The converse ‘global public bads' are threats and negative influences that will affect all nations and possibly have an intergenerational impact. No one can be excluded from their benefits or disbenefits, and their consumption by one person does not diminish consumption by another.

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Global health governance

This describes the system of ethical values, organizations and processes that address global health issues.

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Global health diplomacy

the multi-level and multi actor negotiation processes that shape and manage the global policy environment for health (Kickbusch 2007).

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Global health institutions

Nation-states are the foundation stone of global governance. They co-ordinate their engagement with global health governance through a variety of collectives, including organizations for cooperation between countries. Nation states are sovereign in the United Nations system, in particular in the World Health Organization, UNICEF, UNAIDS; the World Bank and other global interstate organizations such as the World Trade Organization. However, their influence is a product of wealth and power, political influence and diplomacy. In recent years, global public private partnerships and an increasingly diverse set of business and civil society actors have played leading roles in the funding and delivery of international health initiatives, working with nation states and international organizations in most but not all cases.

 

 


Nation states as global health actors

Nation states play a central role in global governance for health. Their main role includes governance of their own health and care services, health protection, research and monitoring, and the management of the national and global impact of their policy actions. It is increasingly being realized that good governance of health necessarily requires attention to global health issues, for example, in the recruitment and training of staff, research and development, the control of environmental health and monitoring of infectious diseases. In addition, states participate in the governance of interstate institutions and are involved in international health diplomacy with other states. In some cases, governments have developed strategies for national policy in respect of global health.

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