Introduction

Global health matters. It matters to markets, states, individuals, and international institutions. Health is important to the ability of individuals to live more productive lives free from risk of their own pain, suffering or low self-esteem and that of their family and friends. State security, safety, and stability rests on keeping citizens healthy and protected from emerging global health threats or risks. Moreover, state economies are based on the production and labor force of healthy workers. Global health is integral to the growth and spread of markets in the reproduction of consumers and producers. Whether in terms of nutrition, ability to work, or susceptibility to disease, health continues to be the barometer of extreme poverty and inequality in the world. It remains at the cornerstone of questions of justice, equality, and rights. Such inequalities have become exacerbated as health risks, threats, and delivery have become globalized. Underpinning the United Nations’ Millennium Development Goals (MDGs) and multiple World Bank strategies for growth and development is the need to secure the health-whether mental or physical-of populations. The increased movement of goods, people, and diseases across borders and changes to the climate and environment makes individual health a global concern and a multifarious, complex issue in which to govern. Despite recognition that health matters, the provision of equitable

health is problematic. Health provision across societies varies and often depends on who takes responsibility: the state, the individual, or the market. The primary function of any state or society is to secure the well-being of its citizens. Individuals are similarly concerned with their own personal health and that of their families and communities. The

degree to which the state should provide treatment and education on health topics and threats, and to what extent and individual is capable of maintaining their own sufficient standard of health remains problematic. This contention rests on the ability of the state to provide basic services and capabilities and for individuals to have sufficient knowledge and wealth to maintain physical and mental well-being. Inequalities across society mean that health is more an asset that people can or cannot afford than a basic right or principle of our existence. The degree of such inequality varies between states and societies but globally the pattern of inequality takes on a North-South divide as inequalities become organized across and between states. It is awareness and a compulsion to address this inequality that has precipitated the emergence of a broad and complex system of global health governance. Global health is a unique arena of governance that integrates scientists,

medical practitioners, philanthropists, governments, and international institutions with grandmothers in local communities and self-styled celebrity advocates. Global health governance involves an amalgamation of various state, non-state, private, and public actors and as such has developed beyond the institutional role of the World Health Organization (WHO) and state-based ministries of health. In the most basic sense of the term global health governance refers to trans-border agreements or initiatives between states and/or non-state actors to the control of public health and infectious disease and the protection of people from health risks or threats. It is a fluid term that encompasses an ever-changing pattern of actors-both public and private, approaches, and priorities for those who are in the position to govern and those who are susceptible to poor health. Global health governance is not a new phenomenon but one of the

oldest forms of multilateral organization with its institutional origins preceding many intergovernmental organizations and governance systems. Structures of global health have emerged alongside increased state interdependency and a growth in world trade and the movement of goods and people. What is new about global health, however, is the accelerated impact trade, climate change, international finance, and security concerns have had on its governance and the flourishing of actors and arrangements to address and harness these issues to the benefit of better health for all. Global health is now the domain of finance ministries, international financial institutions, regional organizations, militaries, new funding initiatives based on evolved privatepublic partnerships, private philanthropy, celebrity endorsement, and business coalitions. These actors and initiatives center on the need to

improve the mental and physical well-being of all individuals, specifically those living in the global south, and to secure populations in the global north from the spread of infectious disease. This is pursued through the reconstruction of health systems, the provision of medicine and treatment, the sharing of knowledge, and increasingly, the monitoring of disease and risk through surveillance systems. The emergence of these actors and initiatives makes global health governance a confusing phenomenon based on multiple relationships that represent a merger between health and non-health specific interventions. The number of actors and initiatives involved in global health make

its governance a balancing act between competing interests of the private and public sector, horizontal and vertical methods of intervention, individual liberties and state intervention, and global decision-making with decentralized implementation. This book provides a way of understanding this balancing act and how these differences manifest themselves into better or worse health outcomes. As such, this book is an introduction to understanding global health governance: who decides what, how, and for whom. It introduces global health governance by outlining the roles of and intersecting relationships between old and new actors, the different approaches to understanding global health, and how specific conceptions of the right to health and health as a public good underpin global policy and intervention. It focuses on a range of health concerns, with a specific focus on HIV/AIDS, tuberculosis, malaria, maternal health, neglected tropical disease, and health system strengthening. In so doing it considers how specific health issues or approaches are prioritized and why some are neglected and how institutions for global health have adapted, changed, or declined.