Global health governance - the next political revolution

The recent Ebola crisis has re-opened the debate on global health governance and the role of the World Health Organization. In order to analyze what is at stake, we apply two conceptual approaches from the social sciences - the work on gridlock and the concept of cosmopolitan moments - to assess the ability of the multilateral governance system to reform. We find that gridlock can be broken open by a health crisis which in turn generates a political drive for change. We show that a set of cosmopolitan moments have led to the introduction of the imperative of health in a range of policy arenas and moved health into 'high politics' - this has been called a political revolution. We contend that this revolution has entered a second phase with increasing interest of heads of state in global health issues. Here lies the window of opportunity to reform global health governance.

The development of international health policies--accountability intact?

International health governance as it exists today is facing major structural challenges in view of globalization, the increased transfer of international health risks and the mounting challenge of health inequalities worldwide. As a consequence the capacity of nation states to ensure population health and to address major health determinants has been weakened. This paper explores health as an exemplary field to illustrate that we have entered a new era of public policy which is defined by increasing overlaps between domestic and foreign policy, multilateral and bilateral strategies and national and international interest. Cross border spill overs and externalities of national actions need to move into the core of public policy at the national and global level within a new rules based system. A new perspective on global health governance is further necessitated through the increased number of players in the global health arena. The organizational form that is emerging is based on networks and is characterized by shifting alliances and blurred lines of responsibility. The paper explores the emerging paradox of state sovereignty and makes a set of proposals to pool state sovereignty on health and structure the myriad of networks. Particular attention is given to the role of the World Health Organization within this process of change and adjustment. In using a framework from international relations analysis the paper explores how nation states are socialized into accepting new norms, values and perceptions of interest with regard to national and international health and what challenges emerge for the WHO in "inventing" global health policy.

Partnerships for health in the 21st century

This paper presents the results of a working group on partnerships in preparation for the WHO Health for All Policy for the 21st Century. The working group aimed to clarify the nature of partnerships for health, proposed six categories of partnerships and outlined principles and criteria for partnerships. It concluded that partnership building was a key strategic component of health development and underlined that WHO must increasingly see its role as one of mustering support for health from many players. In order to do so, WHO must change its organizational culture and mode of operation.

World Health Organisation: change and progress

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Self-care in health promotion

About 10 years ago academics discovered the fact that people actually take care of themselves. This was a process rather reminiscent of the academic discovery of poverty in the sixties [1. Poverty Studies in the Sixties. A Selected and Annotated Bibliography. U.S. Department of Health, Education and Welfare, Washington, D.C., 1970]. Like poverty, self-care had 'always been with us', but it had not been deemed worthy of scientific interest. Not only did this expose a gap within sociological research on health and medicine, it also gave new impetus to long-standing debates within sociology of knowledge and epistemiology. But not only academia discovered self-care. It was a key issue of the most influential social movement of the seventies, the women's movement, although often expressed in a terminology very different from that in academic quarters. And it was debated heavily in the medical system based on the growing popular interest in self-help and wellness. When it first emerged therefore, self-care was both an academic and a political issue--and it was unavoidable that the two should not only influence each other, but at times clash.