ABSTRACT
Global health governance has been applied to a range of health concerns, illnesses, and biomedical research. Various health issues have been prioritized within the institutions that govern these concerns from tobacco in the World Health Organization (WHO) to maternal health within the World Bank and neglected disease within the Bill and Melinda Gates Foundation. What is similar between both old and new institutions involved in the governance of health and disease is the persistent interest and high profile accorded to the “big three” diseases: tuberculosis, malaria, and HIV/AIDS. Whilst some would argue that cancer, obesity, lifestyle choices, and tobacco-related diseases are the big health issues of the modern world, it is these three diseases that are met with policy frameworks and globally organized, large-scale financial assistance to tackle them. Whilst cancer research claims a high level of health financing in developed countries it does not undergo the same level of global coordination or policymaking; and whilst tobacco regulation is increasingly global through the Framework Convention on Tobacco Control (FCTC), it does not receive the same level of funding in seeing its fruition. The infectious aspect of tuberculosis and HIV, the global susceptibility to malaria, and the commitment between both the private and public sector marks these three diseases as exceptional. “The big three” are linked by the following factors. First, they are
most prevalent in developing countries, specifically sub-Saharan Africa and parts of South Asia. Second, infection with one often leads to susceptibility to another; this is specifically the case in the relationship
between HIV/AIDS and tuberculosis. HIV infection can increase susceptibility to malaria, but HIV/AIDS per se does not drive the recent resurgence in malaria.1 Third, they have all been internationally recognized as the three scourges on global health, and as such have become the central actors within a fund for global health, the Global Fund. Finally, they are tackled through global coordination frameworks at the state and local level. What sets them apart is the longevity of the diseases, the vectors of disease, and the ways in which they are addressed. Malaria and tuberculosis are said to be as old as mankind. In contrast, despite claims to AIDS existing as a form of “slim” disease in West Africa for the last 50 years, HIV was not formally identified until 1981. The governance of malaria and tuberculosis has evolved over centuries, yet it is the global nature of the governance of HIV/AIDS that has come to be applied to addressing these concerns. HIV/AIDS has received considerable political will and ensuing financial support in recent years, whereas efforts towards coordinated governance, will, and unity in approach to combating malaria and tuberculosis have waned. The governance of these three diseases has core similarities, the lessons of which can be applied to each other’s governance. This chapter outlines each of the big three diseases: what they are,
when they were first identified, what measures and approaches to combating them have been taken, and who is setting the agenda. The chapter first looks at malaria, before focusing on HIV/AIDS and then tuberculosis. The chapter draws together the main themes of “the big three” to identify what they tell us about global health governance before beginning to think about what they exclude from the global health agenda in Chapter 5.
