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.

Donor countries support bilateral cooperation projects of considerable importance (for example, the US President's Emergency Plan for AIDS Relief in the fight against HIV and AIDS) and may also influence the strategies of international organizations. This influence can take various forms, by contributing to specific projects or by withholding regular contributions, by taking specific political positions within decision-making bodies (for example, in World Trade Organization (WTO) affairs or on the WHO Executive Board), or by collectively pushing for specific programmes.

The power of certain donor countries has also played an important part in creating new institutions outside UN System, such as The Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM). While progress has been made since the 2005 Paris Declaration on Aid Effectiveness, in which powerful donor countries committed to "put recipient countries in the driver's seat", there continues to be a significant power imbalance between recipient countries and donor countries, and between the North and the South.

Furthermore, even though such traditional divisions are still apparent, there are signs that geopolitical power balances are shifting. Large polities such as Brazil, Russia, India, China and South Africa - commonly referred to as BRICS - are emerging as economic powerhouses, dominant poles of power within their regions and new partners in development aid and trade for lesser-developed nations. For example consider the extent of China's involvement on the African continent as well as Russia's renewed confidence in exerting pressure in neighbouring countries. As recipient countries have better choice in terms of who they work with and how, and as emerging powers gain influence in international forums, this change in actors and roles will have important implications for future decisions and actions at the global level.


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