China, International Society, and Global Health Governance

Author(s):  
Jeremy Youde

China possesses the world’s largest economy, but that economic clout has not necessarily translated into taking leading roles within existing global health governance institutions and processes. It is a country that both contributes to and receives financial assistance from global health institutions. It has incorporated health into some of its foreign policy activities, but it has largely avoided proactively engaging with the values and norms embodied within the global health governance system. This ambivalent relationship reflects larger questions about how and whether China fits within international society and what its engagement or lack thereof might portend for international society’s future. This chapter examines China’s place within global health governance by examining its interactions with international society on global health issues, its use of health as a foreign policy tool, and its relationships with global health governance organizations.

Author(s):  
Jeremy Youde

While Chapter 3 focuses primarily on the evolution of global health governance, Chapter 4 pays more attention to its contemporary manifestation as a secondary institution within international society. This chapter discusses the current state of the global health governance architecture—who the important actors are, how they operate, how they have changed over the past twenty-five years, and how they illustrate the fundamental beliefs and attitudes within the global health governance system. In particular, the chapter discusses the relative balance between state-based and non-state actors, as well as public versus private actors. This chapter highlights five key players within contemporary global health governance: states; the World Health Organization; multilateral funding agencies; public–private partnerships; and non-state and private actors


2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Yasobant Sandul ◽  
Walter Bruchhausen ◽  
Deepak B. Saxena

ObjectiveThe present study aims to operationalize one health approach through local urban governance system in a rapidly urbanized Indian city, Ahmedabad, India.In Ahmedabad (proposed Smart city), Gujarat, India:1. To understand the pattern of zoonotic diseases in reference to urban governance system2. To develop a conceptual One Health Governance framework with reference to zoonotic diseases3. To assess the key indicators for convergence for inter-sectorial professional collaborations in One HealthIntroductionSmart governance refers to the emergence of joint action by the health and non-health sectors, public and private actors and citizens. Although, there are growing literature on governance and its potential impact on health, major challenges on collective action across sectors have been witnessed in developing countries like India. In the same line, the current forms of Global Health Governance façades operational issues and does not sufficiently meet the needs at local levels. In light of these perceived shortcomings, the local governance becomes subject of interest and should be debated especially with reference to global urbanization.Rapid and unplanned urbanization followed by the combination of high population density, poverty and lack of infrastructure have more side effects and fostering conditions for communicable diseases to flourish. Evidence suggests that new megacities could be incubators for new epidemic and zoonotic diseases, which can spread more rapidly and become worldwide threats. In India, Ministry of Urban Development initiated the concept of converting few major cities into “Smart City” in 2015-16. However, one of the major critiques of available smart city guideline is that it has no such focus on prevention of emerging and/or re-emerging zoonotic diseases. The emergence and/or re-emergence of zoonotic diseases should be considered as potential threats for these upcoming Smart Cities and hence, should be addressed by one health approach (health and non-health sectors, public and private actors) through an appropriate local governance strategy.With rapid urbanization and healthcare transformation in India, the operationalization of one health approach might become a major challenge, because of, the absence of the systematic effect at the national level and urban cities are riven between central, state and municipal authorities in terms of health policy, planning, health needs etc. There is also lack of information sharing or collaborations between the health and non-health sectors, public and private actors at the city level. Understanding these challenges can offer important lessons for strengthening both local urban governance and One Health.MethodsFor Objective-1: To understand the pattern of zoonotic diseases in reference to urban governance system1. Is there existing literature indicates the importance of governance system in prevention of zoonotic diseases in urban settingsUrban Governance System & Zoonotic diseases (Systematic Review)2. Is prevalence of zoonotic disease vary in accordance with change of local urban governance(Outcome: Prevalence of Zoonotic diseases & Exposure: Governance Index for last 10 years)For Objective-2: To develop a conceptual One Health Governance framework with reference to zoonotic diseases1. Is there evidence of existing One Health Governance framework exists One Health Governance Framework(Systematic Review & SWOT Analysis)2. To map the urban agencies working for zoonotic diseases Institutions for zoonotic diseases (Mapping)3. Is convergence possible for One Health in prevention of Zoonotic diseases (Policy Maker, System-level professionals Qualitative Key Informant Interviews)For Objective-3: To assess the key indicators for convergence for inter-sectorial professional collaborations in One Health1. Is developed governance framework operational at field level- KAP among Healthcare providers, Veterinarians, Environmental specialists2. Is there possibilities of convergence at field level for One health in prevention of zoonotic diseases (Qualitative Key Informant Interviews)ResultsThis is first of kind unique study to come up with a local urban governance convergence approach for “One Health” for the upcoming Smart city Ahmedabad, which may further be scaled up to other smart cities of India.ConclusionsUrban Health governance framework for a smart city to develop an one health approach.References[1] World Health Organization. Governance for Health in 21st Century. Available from: http://www.euro.who.int/__data/assets/pdf_file/0019/171334/RC62BD01-Governance-for-Health-Web.pdf [Last Accessed on December 2016][2] Dodgson R, Lee K, Drager N. Global Health Governance: a Conceptual Review. London: London School of Hygiene and Tropical Medicine; 2002.[3] Burris S. Governance, Microgovernance, and health. Temple Law Rev. 2004;77:334–362.[4] Hein W. Global health governance and national health policies in developing countries: conflicts and cooperation at the interfaces. In: Hein W, Kohlmorgan L, eds. Globalization, Global Health Governance and National Health Policies in Developing Countries: an Exploration Into the Dynamics of Interfaces. Hamburg: Deutschen Uebersee-Instituts; 2003:33–71.[5] Navarro V, Muntaner C, Borrell C, et al. Politics and health outcomes. Lancet. 2006; 368(9540):1033-7. 


Author(s):  
Jeremy Youde

English School theorizing specifically emphasizes the evolutionary and adaptive nature of international institutions, and global health governance institutions have undergone significant evolution and adaptation since the mid-nineteenth century. Since the first efforts to promote international cooperation on quarantine regulations, global health governance has become increasingly institutionalized, expanded to include a broad range of actors, and broadened its normative orientation. This chapter examines the evolution of global health governance by focusing on seven key moments and institutions: the International Sanitary Conferences; the League of Nations Health Office; the World Health Organization; the Health for All by 2000 movement; the International Health Regulations; the Global Fund to Fight AIDS, Tuberculosis, and Malaria; and the Bill and Melinda Gates Foundation. These seven points illustrate both the changes within global health governance and the changing ideas about moral obligation and responsibility.


Author(s):  
Jeremy Youde

Institutions are foundational to the English School and to the very concept of international society, so it makes sense that scholars would pay attention to them. What’s curious, though, is how much ambiguity permeates the discussion of primary and secondary institutions within English School theorizing. There is a lack of agreement among authors about what constitutes a primary institution, and secondary institutions receive almost no attention because they are merely formal organizations with no independent power within international society. This chapter distinguishes between primary and secondary institutions, describes the emergence of moral obligation and responsibility as a primary institution, explains why secondary institutions are constitutive of international society, and makes the case for global health governance as a secondary institution.


Author(s):  
Benjamin Mason Meier ◽  
Lawrence O. Gostin

This chapter frames the implementation of human rights law through global health governance. Global governance institutions have sought to translate human rights into public policy, shifting from the development of health-related rights under international law to the implementation of these normative standards in global policies, programs, and practices. This shift toward an “era of implementation” across an expanding global health governance landscape looks beyond the traditional “human rights system” in implementing human rights for global health. Analyzing human rights as part of global health law, this chapter examines how human rights have become a framework for global governance, with institutions of global health governance seeking to “mainstream” human rights across all organizational actions. This chapter concludes that there is a need for institutional analysis to compare organizational approaches conducive to the implementation of health-related human rights.


Author(s):  
Jeremy Youde

English School theorizing is particularly relevant for understanding why and under what circumstances actors choose to contribute to coordinated international actions. English School theory has both a rich history and a nuanced understanding of the international environment that allows it to comprehend the emergence of complex systems like global health governance as an institution within international society. This chapter describes the foundations of the English School and highlights its usefulness for understanding the expansion and resilience of global health governance. At the same time, this chapter expands upon the English School, pushing it to address the role of non-state actors within international society and incorporate political economy into its theorizing. While this institution has emerged, it does not always operate in an optimal fashion, nor does it obviate the fact that states may sometimes act in selfish ways.


Author(s):  
Jeremy Youde

In the 1980s, health was a marginal issue on the international political agenda, and it barely figured into donor states’ foreign aid allocation. Within a generation, health had developed a robust set of governance structures that drove significant global political action, incorporated a wide range of actors, and received increasing levels of funding. What explains this dramatic change over such a short period of time? Drawing on the English School of international relations theory, this book argues that global health has emerged as a secondary institution within international society. Rather than being a side issue, global health now occupies an important role. Addressing global health issues—financially, organizationally, and politically—is part of how actors demonstrate their willingness and ability to help realize their moral responsibility and obligation to others. In this way, it demonstrates how global health governance has emerged, grown, and persisted—even in the face of global economic challenges and inadequate responses to particular health crises. The argument also shows how English School conceptions of international society would benefit from expanding their analytical gaze to address international economic issues and incorporate non-state actors. The book begins by building a case for using the English School to understand the role of global health governance before looking at global health governance’s place in international society through case studies about the growth of development assistance for health, the international response to the Ebola outbreak, and China’s role within the global health governance framework.


Author(s):  
Colin McInnes

The international governance of health predates the establishment of the World Health Organization in 1948. This chapter, however, argues that over the past two decades two major transformations have reshaped the politics of global health governance. The first is the emergence of the narrative of global health, which has created a perceived requirement to place increased emphasis on global governance mechanisms. This in turn implies that power should reside less at the national level and more at the global. Second, the institutional ‘architecture’ has been transformed by the emergence of new actors who are having an impact on health policy and outcomes. Combined, these two transformations have had a number of political effects, including a higher profile for global health issues and especially crises; a diffusion of power and authority; the creation of a ‘market’ for funding, with consequences in turn for how the ‘power of the purse’ operates; an increased expectation of the ability of global institutions to act to prevent or mitigate crises; and competing norms over what health is for.


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