Medicine Health

Governing Global Health

Who Runs the World and Why?

by Chelsea Clinton, Devi Sridhar Review by David Lorimer, December 2017

Published: 2017
Publisher: Oxford
Format: Hardback
Pages: 282 pp.
ISBN: 9780190253288

Publisher’s description

The past few decades have seen a massive increase in the number of international organizations focusing on global health. Campaigns to eradicate or stem the spread of AIDS, SARS, malaria, and Ebola attest to the increasing importance of globally-oriented health organizations. These organizations may be national, regional, international, or even non-state organizations-like Medicins Sans Frontieres. One of the more important recent trends in global health governance, though, has been the rise of public-private partnerships (PPPs) where private non-governmental organizations, for-profit enterprises, and various other social entrepreneurs work hand-in-hand with governments to combat specific maladies. A primary driver for this development is the widespread belief that by joining together, PPPs will attack health problems and fund shared efforts more effectively than other systems. As Chelsea Clinton and Devi Sridhar show in Governing Global Health, these partnerships are not only important for combating infectious diseases; they also provide models for developing solutions to a host of other serious global health challenges and questions beyond health. But what do we actually know about the accountability and effectiveness of PPPs in relation to the traditional multilaterals? According to Clinton and Sridhar, we have known very little because scholars have not accumulated enough data or developed effective ways to assess them-until now. In their analysis, they uncovered both strength and weaknesses of the model. Using principal-agent theory in which governments are the principals directing international agents of various type, they take a closer look at two major PPPs-the Global Fund to Fight HIV/AIDS, TB and Malaria and the GAVI Alliance-and two major more traditional international organizations-the World Health Organization and the World Bank. An even-handed and thorough empirical analysis of one of the most pressing topics in world affairs, Governing Global Health will reshape our understanding of how organizations can more effectively prevent the spread of communicable diseases like AIDS and reduce pervasive chronic health problems like malnutrition.

As the title implies, this informative book is about the governance of global health, with a particular analysis of the four largest players, the World Bank, the WHO, and the public-private partnerships of the Global Fund to Fight Aids, TB and Malaria, and the Gavi vaccination partnership. The first two represent older style institutions, while the latter embody a new partnership approach. In both cases there are issues around input and output legitimacy and a more general insistence on an approach involving measurement and results. As many readers will be aware, the Gates Foundation is a major player in global health promotion. The overall analysis is shaped by principal – agent theory concerning the relationship between member states and international organisations. There are informative chapters on governance and funding, and the authors summarise major health challenges for the 21st century in terms of prevention, management and treatment of non-communicative diseases (NCDs), universal health coverage and pandemic preparedness. Even over the last 20 years, there has been a considerable shift so that globally NCDs now account for 55% of years lost to early death, disability and ill-health - a sign of the pervasive and encroaching impact of what is referred to as the diseases of civilisation.

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