The challenges of global health reform in the 21st century

This brief article was originally written for the newsletter of the Global Health Centre of the Graduate Institute of Geneva. Its aim is to introduce the second year of the research project on “How to Break the Gridlock in Global Health Governance”, on which I am working as one of the two principal investigators.

When looking at the changing landscape of global health over the course of the last two decades, it appears evident that the significant progress and breakthroughs that have occurred in this relatively short period of time have also left a number of issues unaddressed.

On the one hand, the three Millennium Development Goals (MDGs) relating to health have remained unmet, despite huge improvements in low- and middle-income countries with respect to infectious diseases as well as reproductive, maternal and child health. On the other, the emergence of new (and often unprecedented) health threats, such as those represented by the shifting burden of disease and mortality towards non-communicable diseases, more severe outbreaks and pandemics, and increasing risks associated with climate change and environmental degradation (link), poses troubling questions over the capability of the global health system to deal with the ever increasing interconnectedness and complexity characterising the field.

In this context, a central challenge to make the global health system fit for the 21st century is that of understanding what kind of role governance has played in some of the major achievements, and in particular what has made specific advancements possible; why certain solutions were chosen over others; and whether those solutions can now provide valuable insights into how to deal with emerging issues.

From such perspective, it can be argued that global health governance has witnessed a significant degree of institutional innovation and political agency, both within and beyond the World Health Organization (WHO) and other multilateral agencies, and WHO itself has demonstrated to be capable of organizational learning in the aftermath of health crises such as SARS and H1N1.

At the same time, however, two major concerns remain. First, these developments have been mainly driven by cosmopolitan moments which opened limited windows of opportunity for reform but left some of the structural weaknesses of the current governance architecture unaddressed. More specifically, the possibility of identifying pathways that may lead to gridlock in global health governance, while not entirely representative of the post-1990 global health landscape, certainly represents a critical alarm bell for a system which is called upon to deliver on the targets set by Sustainable Development Goal 3 while dealing with the daunting task of tackling the broader determinants of health in an increasingly interconnected world.

Secondly, as evidenced by the recent High-level meeting on antimicrobial resistance (AMR), which yielded a strong political declaration at the 71th Session of the United Nations General Assembly, increasing importance is attached to global health and its implications for national and international security, economic well-being, and economic and social development. In this sense, the shift of global health from sectoral issue to major topic discussed in the highest spheres of politics and governments, constitutes not only an opportunity but also an additional challenge for the global health governance system: as it creates the conditions for mobilizing action, it also requires multi-sectoral approaches to be adopted, coordination among actors to be strengthened, and increased institutional flexibility to be achieved.

At the Global Health Centre, the ongoing research project on “How to break the gridlock in global health governance”, which is currently entering its second year, is trying to provide an answer to these complex challenges and highlight potential options for reform by conducting in-depth research about how pathways to gridlock have manifested themselves across different health threats; identifying institutional changes and responses; and uncovering the causal dimensions between them. As such, the project will not only be able to provide a valuable contribution to the current understanding of how global health governance has evolved in the past two decades, but also, more importantly, describe how such gridlock has been overcome or can now be avoided.

Funded by the Swiss Network for International Studies (SNIS) and working with a number of different partners across academia, international organisations, civil society, and the private sector, “How to break the gridlock in global health governance” started in October 2015 and is expected to last for two years.

  • Download research summary (pdf)
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