Global Health Governance as Shared Health Governance

PG as a global health justice theory joins with the theory of SHG to apply justice principles to health governance. SHG rests on a genuine commitment among global health actors to achieve health justice as opposed to pursuing narrow self, group, or state interests alone. SHG elucidates standards of global and domestic responsibility and accountability for health equity. It proposes a common conceptual and policy framework with a set of distinct but complementary responsibilities for governments, nongovernmental organizations (NGOs), the private sector, and individuals themselves. In the SHG framework, the state has duties to create conditions in which all individuals have the opportunity to be healthy and to reduce and prevent the shortfall between actual and potential health within their countries. Global actors have a duty to help shape conditions in which countries can develop and flourish and promote the health of their populations.

Global Health Justice and Governance

Critical and dangerous threats imperil global health. Serious health disparities, hazardous contagions that can circle our globalized planet in hours, a bewildering confusion of health actors and systems all combine in a kaleidoscopically fragmented, incoherent, and unjust global health enterprise. While a growing body of work in global justice and international relations explores moral issues and global governance, very little of it has linked principles of global health justice to governance to create a theory of global health. But the dangers confronting the world make a theoretical framework essential, to enable analysis of the current system and to ground proposals to reform it and align it with moral values. This book presents a global justice theory—provincial globalism (PG)—and links it with the theory of shared health governance (SHG) to offer an alternative to the prevailing modus operandi, which has manifestly failed to serve global health. The PG/SHG framework advances health capability, and specifically the capability to avoid premature death and preventable morbidity, as the proper goal of health systems and policy. This framework sees human flourishing as global society’s end goal and proposes an ethical demand for health equity as the criterion for evaluating global health policy and law. It examines the current actors in global health, assessing their strengths and weaknesses, and proposes assigning responsibilities to actors at all levels according to their functions and capabilities.

Shared Health Governance at the Domestic Level

While no society can guarantee good health, societies can, if they will, create the conditions—effective institutions, social systems, and practices—to support all members as they seek to achieve central health capabilities. The SHG model sets out allocations of responsibility, resources, and sovereignty to state and non-state actors and institutions, NGOs, the private sector, communities, families, and individuals themselves. The primary responsibility for efficiently preventing and reducing shortfall inequalities in central health capabilities falls to the state, because national governments have the authority and resources to create health system infrastructures, including health care, public health, and other systems affecting health. State duties include developing and maintaining a national health care and public health policy and system and guaranteeing a universal comprehensive benefits package of medically necessary and appropriate goods and services as well as ensuring the social determinants of health.

Global Health Inequalities and Justice

This chapter discusses challenges of global health inequalities in the current global health policy system. It then describes provincial globalism and a shared health governance framework as approaches to these challenges. Moral philosophers have for some time argued that global poverty and associated human suffering are universal concerns and that there is a moral obligation, beyond matters of charity, for wealthier countries to do more. Being serious about addressing the problem of global health inequalities requires developing a conception of global health justice. Moreover, addressing global health inequalities requires a reexamination of the norms and principles underlying global institutions in order to offer proposals for a better global health policy. This chapter sketches analytical components of provincial globalism, a framework that takes individuals to be the moral unit in both domestic and global contexts and that improves the prospects of alleviating global health inequalities. Provincial globalism promotes the realization of individuals’ health capabilities and supports a shared health governance that enables institutions to reexamine the objectives, policy goals, and decision-making procedures of the global health architecture. Shared health governance, in turn, provides standards for regulating global and domestic institutions and practices to create the conditions for realizing individuals’ health capabilities.