As our world becomes increasingly interconnected, the issues of global health justice and governance have come to the forefront of public health debates. Understanding global health justice and governance is essential to tackling health inequalities and ensuring the right to health is realized for everyone, in every location around the globe. In this article, I explore the complexities of global health justice and governance, looking at its implications, issues, and the possibilities of improved health outcomes through collaborative governance processes.
What is Global Health Justice and Governance?
Understanding the Concept of Global Health
Global health can be defined as the health of populations in a global context, which includes issues that transcend national borders and the interconnectedness of health systems. It is concerned with a wide array of health issues, from disease transmission and infectious diseases to health equity, and contemplates how we can respond collectively to global health issues. Global health justice is a concept closely tied to global health, which looks at health as a matter of fairness, and prompts us to consider the rights of all peoples to reasonably accessible health care, and the obligations of societies to care for the health needs of other nations. As Jennifer Prah Ruger articulately stated, “the theory of global health justice lays the normative groundwork for understanding the roles and responsibilities of global actors in advancing health as a global public good.”
The Role of Health Governance in Global Health Justice
Health governance is key to realizing global health justice through the creation of frameworks that entrench health policy processes and priorities by all actors in health governance. Realizing health governance draws players and organizations from government, international organizations (like the World Health Organization), philanthropy, and non-governmental organizations together to address the disparities in health. Governance structures need to contain inclusive processes responsive to diverse populations so that policies can equitably and justly prioritize health. Health equity must be included in governance strategies to have the most effect on health interventions for underserved populations.
Key Principles of Health Equity in Governance
The commitment to health equity is at the foundation of health governance, which implies an ongoing commitment to structural determinants of health. Health equity principles for governance involve providing access to health services, ensuring access to quality health care, and ensuring the need to address the social determinants of health that ultimately lead to inequalities in health. When health policies are grounded in these principles, they can better help ameliorate the effects of inequity and better serve a just health system. In global governance, moral issues must also be included in order to recognize, and have the capability to emphasize and uphold, the right to health around the world.
How Does Global Health Impact Health Systems Worldwide?
The Interconnection Between Global Health and Local Health Systems
There is fundamentally an interrelationship between global health and local health systems so that improvements in global health can be reflected in better health outcomes at the local level. However, too often the global health system presents limitations and discontinuities which undermine local health systems. For example, the COVID-19 pandemic involved global health issues that took precedence over local health issues and the capacity of local health systems to face global health problems and, led to crises in health governance. In health systems that encourage greater communication and coordination between global health and local health policies, these systems would be better prepared to respond to vulnerable public health situations, including global health threats.
Challenges Faced by Health Systems in Achieving Global Health Goals
While there is considerable consensus about the need for unified health governance, there continues to be many obstacles faced by health systems everywhere. These obstacles include insufficient funding, civil unrest, and the ongoing existence of health inequities. Health systems struggle for funding for health to reduce these inequities so policies can be articulated, monitored, and evaluated. Health actors are often fragmented in terms of their responses to health issues. When there is no coordination among the health actors (collaboration, duplication, or conflict) there is little ability to set out a pathway toward addressing health issues that are consistent with global health objectives: health governance.
Case Studies on Successful Health Governance Initiatives
The potential for improved health outcomes through effective health governance can be understood through successful health governance examples. For instance, the effective cooperation of countries under the Global Fund to fight AIDS, Tuberculosis and Malaria has figuratively been one of the world’s major health campaign through shared health governance to mobilize health resources and coordinate responses from the international domain down to the country level. The overall result has been an improvement in health capacities and reduction of disease burden in participating countries. Thus, these types of case studies show how inclusive and shared health governance are consequential, and transformational change is possible through proper health governance.
What Are the Main Challenges in Global Health Governance?
Addressing Inequality in Global Health Access
One of the greatest challenges in the governance of global health is the problem of inequality in access to health. Health inequalities exist between geographic locations, various socio-economic classes and in many cases, are the result of the systemic discrimination that many individuals face. In these examples, the utilitarian theory of justice, as highlighted by authors quoted as Prah Ruger, indicates that access to health resources should be equitable, as it is a matter of justice. Without addressing basic inequalities, health governance [here is the opportunity to combine the points previously made that when faced with such a basic inequality, these actors must accept that they risk preventing as opposed to solving the inequality, therefore such an avoidable situation makes it vital for those in positions of global power, to be conscious of equity in their health initiatives.
The Impact of Global Justice on Health Policy Development
The connection between global justice and the development of health policy is paramount as we continue to develop governance strategies. Policies should reflect a moral and ethical commitment to human health, meaningful ownership of the concept of health as the shared responsibility of all countries, and realization that a legally binding framework will help ensure equitable, extensive, and just health policies. We must move beyond an exclusive mindset rooted in national priorities and seek a more unified perspective towards health governance at a global level consistent with the ideals of global justice.
Strategies to Overcome Obstacles in Health Governance
To address the challenges involved in global health governance, a multifaceted strategy is important; a combination of cooperative strategies, resource allocation, and accountability mechanisms will go a long way to address global health challenges. In addition, transparent governance structures can promote trust in the health sector by ensuring health policies are adhered to, reiterated and monitored. While the terms ‘health or health capability’ are principally prioritised, governance structure can be used to strengthen and promote health equity, and explicitly address the moral dilemmas often overlooked in (global) health governance.
How Can Shared Health Governance Improve Global Health Outcomes?
The Importance of Collaborative Health Policy Frameworks
Shared health governance highlights the need for collaborative health policy systems designed to bring together various groups of stakeholders for decision-making. This type of governance aims to develop relationships in different areas, including partnerships between countries/regions, global health organisations, and local communities, leading to better health interventions that consider the specific needs of populations. It will contribute to improving the health systems’ capacities locally, resulting in healthcare implementations that better reflect the realities of the situation (local versus global health policies) and health actors’ intentions to improve the health of people globally.
Examples of Shared Governance Models in Public Health
There are many examples of shared governance models and in public health where collective action can lead to health improvement. The Global Vaccine Alliance (GAVI) is one successful example of shared governance harnessing human and financial resources from multiple stakeholders to achieve health outcomes. GAVI has successfully positioned itself to increase vaccine access to low and middle income countries, demonstrating the potential of shared governance, where collective stakeholder action can yield positive health outcomes in relation to pressing public health problems.
Benefits of Inclusive Approaches to Health Governance
Inclusive approaches to health governance can have many advantages. They promote better stakeholder involvement, which encourages commitment on the part of stakeholders. This ownership leads to more effective implementation of health systems which ultimately builds better health outcomes. Inclusive approaches to health governance also enable and allow marginalized communities in the health governance decision-making process to be better aligned and adapted to their needs. As well, they foster commitment from stakeholders who have ownership which enables the strengthening of health systems.
What Role Does Health Capability Play in Achieving Global Health Justice?
Defining Health Capability in the Context of Global Health
Health capability is the extent to which individuals and communities can achieve good health outcomes and is a core tenet of health capability paradigm. Within the scope of global health justice, health capability highlights development of the capacity of populations to access the resources and services needed to protect and build their health. This perspective shifts attention from health outcome attainment to the conditions that allow individuals to pursue their health outcomes based on their own goals, consistent with the ways in which health equity is framed.
Measuring Health Capability Across Different Regions
Assessing health capability across different bounded areas is very difficult due to differences in social determinants of health and health systems, however, if measurable indicators are determined to assess health capability, there are opportunities to assess health capability and inform health policy decisions. Using indicators such as access to health services, quality of services and health literacy, health policy leaders can examine indicators for a specific geographic region or demographic community. Examining these parameters we can begin to identify actions to where they could layer the improvements that could be realised by targeting particular policies or demographics to improve the health capabilities of populations that may be marginalised.
Enhancing Health Capability for Better Health Equity
Improving health capability is vital to improving health equity and realizing global health justice. Improving health capability could involve expanding educational opportunities, strengthening health care infrastructure; building health literacy; and developing community capacity to engage in health activities. Policy choices that target the structural determinants of health will allocate resources into an environment where all have the capacity to achieve their health potential. Using this holistic framework will improve health outcomes, but also reflects a moral commitment to the imperatives of global justice and governance.
FAQs
Q: What are the principles of global health justice?
A: The principles of global health justice include equity in health access, the promotion of health capabilities for all, and addressing health inequities that arise due to social determinants. These principles guide moral issues and global governance in public health.
Q: How does global justice and international relations relate to public health?
A: Global justice and international relations are essential in understanding how health policies are shaped and implemented across borders. They emphasize the importance of mutual collective accountability among nations to address health inequities and ensure that all populations can achieve optimal health outcomes.
Q: What role do health actors and systems play in promoting global health justice?
A: Health actors and systems are crucial in implementing the principles of global health justice. They work to create health policies that prioritize equity, engage in interdisciplinary approaches, and develop frameworks that support human flourishing and the central health capabilities of individuals.
Q: What is the significance of the Mailman School of Public Health in global health governance?
A: The Mailman School of Public Health contributes to global health governance by educating future leaders, conducting innovative research, and advocating for policies that address moral values and health law to improve global health architecture and reduce health inequities.
Q: How can evaluation of the current global health systems inform future policies?
A: Evaluation of the current global health systems helps identify gaps and strengths in health governance. This assessment is vital for developing new global health policies that are equitable, effective, and responsive to the needs of diverse populations while addressing health inequities.
Q: What are the moral issues and global governance challenges in addressing health inequities?
A: Moral issues in global governance related to health inequities include the ethical distribution of healthcare resources, the responsibility of wealthier nations to support poorer countries, and the need for fair representation in health decision-making processes. Addressing these challenges is essential for achieving global health justice.
Q: What is meant by the theoretical framework of global health justice?
A: The theoretical framework of global health justice provides a conceptual basis for understanding how health rights and responsibilities are distributed globally. It integrates ethical principles, health law, and the role of global institutions in promoting health equity and accountability in public health.
Q: How do moral values influence global health policy?
A: Moral values play a significant role in shaping global health policy by guiding decisions about resource allocation, prioritizing vulnerable populations, and establishing the ethical standards that inform health governance. These values are essential for fostering equitable health systems and addressing health inequities.
Q: In what ways can new global health initiatives improve health agency among populations?
A: New global health initiatives can enhance health agency by empowering communities, promoting participation in health decision-making, and fostering local ownership of health programs. This empowerment is crucial for enabling individuals to advocate for their health rights and achieve better health outcomes.