Health Governance

Health Governance

1. WHO

   • history
     • created to have normative power
       • power to establish norms of behaviour and conduct
     • not subject to political power
     • not created to deliver national health services
   • not international but world
   • advises governments on healthcare
   • horizontal and vertical approaches
   • hasn't used its normative suasion a lot
     • was successful with tobacco laws
   • areas of work
     • health systems and promotion
     • non-communicable diseases
     • communicable diseases
     • corporate services
     • preparedness, surveillance and response
   • tension between transnational response and state centrism
   • executive board of scientists, not politicians
     • elected for three years
     • less willing to work quickly
       • constructivism
       • took almost 6 months to declare the ebola outbreak an emergency
   • regional offices for coordination
     • may contradict Geneva office
       • may have too much agency
   • successes
     • small pox
     • swine flu
     • Avian flu
     • 99% reduction in Polio
   • created "for the attainment by all peoples of the highest possible level of health"
   • Strength in medical knowledge and surveillance

2. Alma Ata Declaration

   • communist ideologies
   • multilateralism
   • linked to social and economic rights
   • linked to social and economic rights
   • health is a consequence of underdevelopment
   • health as a right

3. Okinawa Declaration

   • health as a commodity
   • Capitalist Ideologies
   • health not about rights but economic development
   • poor health not because of poor social conditions
     • poor social conditions because of poor health
   • public-private partnerships
   • World Bank involvement

4. WHO failures

   • AIDS
     • HIV is treatable so this is due to a lack of access
   • Ebola
   • reasons for failures
     • inability to learn from the past
     • political fear
     • overreaction
     • underestimation
     • low budget and lack of resources
     • lack of local knowledge
     • states fear economic repercussions
     • earmarked donations
     • white doctor narrative
     • limited ability to apply information at a country level

5. Global health governance problems

   • hyper-pluralism
     • lack of coordination
   • top-down approach
   • competition between actors
   • competition between actors
   • exclusion of beneficiaries
   • geopolitics
   • recipient manipulation of aid
   • lack of a long term commitment to development
     • esp from the donor community
   • weak political commitment

6. World Bank

   • development programmes
     • emphasis on poverty
   • unrivalled financial resources
   • top down approach
     • based on short term visits to countries

7. UN Development Programme

   • helps govs meet basic social needs
   • UNFPA
     • focus on reproductive health
     • both have a focus on building capacity
   • interdisciplinary approach to health
     • health can get lost in development

8. UNICEF

   • focused on country operations
   • relies on other organisations for scientific and technical skills
   • vertical approach to health organisations

9. interpretation of different organisations' mandates leads to confusion

10. Tutorial

    • bioterrorism has made health part of security
      • the relevance of epidemics in relation to failed states and loss of social cohesion has made it a fp concern
    • pluralism has led to a splintering of international health agencies and an increasingly fragmented uncoordinated global health agenda
    • WHO was criticised for declaring an emergency about swine flu too early
    • Ebola was a crisis on three levels:
      • leadership
        • national govs didn't have the infrastructure to take leadership
        • afraid of the economic repercussions of being honest
      • adaption
        • the WHO could not adapt to the local culture
        • cultural resistance to a medical approach
      • innovation
        • not enough scientific knowledge
    • political accountability causes problems for the WHO
    • earmarked donations means lack of money for non comunicable diseases, chronic illnesses and food security
    • WHO prevents knowledge from becoming a commodity

11. A global policy agenda would include

    • reform/strengthening of institutions
    • control of unsafe goods
    • corporate responsibility
    • access to essential medicines, vaccines and health knowledge
    • primary health care and public health infrastructures
    • surveillance and information systems
    • professional capacity

12. attempts to withdraw state influence from markets, removing political momentum and allowing cooperation

    • led to the market being able to determine entitlement to health
    • attempts by developing countries to pursue legitimate strategies to secure drugs at affordable prices have been obstructed by pharmaceutical companies and northern governments
    • health governance must include comprehensive regulatory and sociopolitical intervention with an emphasis on redistribution

13. Resistance from states to Ebola help:

    • economic damage
      • put a negative spotlight on the state
    • closure of borders
      • fear about the pilgrimage to Mecca
    • hierarchy of knowledge and politics
      • disrupting social life