The Role of International Organizations in Shaping Global Health Policies; A Comparative Study of the Cases of WHO and Global Fund
Chapter One
The objective of the Study
The main objective of this study is to investigate the role of international organizations in shaping global health policies. a comparative study of the cases of who and global fund. Specific objectives include to:
- Assess the impact of globalization on health and global health-related problems.
- Examine the effect of poverty on global health problems.
- Explore the impact of urbanization and lifestyle on global health problems.
- Investigate the effect of lack of access to basic social amenities on global health problems.
- Review global policies aimed at mitigating health-related problems.
CHAPTER TWO
LITERATURE REVIEW
Global Health is becoming more and more well-known and important worldwide. First and foremost, the growth of international infectious diseases sparks a great lot of media and public interest, and it also influences faculty and academic programme research goals (Bozorgmehr, 2018). Global health has also grown to be a significant focus of charitable activity. Despite the prominence it has gained over the past 20 years, there is still no agreed-upon definition for the complicated collective phrase “Global Health” in use today. Development is dependent on global health. The unequal allocation of research resources and finances to the people facing the most serious health issues in the globe is a significant problem. Due to this disparity, significant efforts are being made to refocus research on health issues in low- and middle-income nations (Bozorgmehr, 2018).
The international community has made tremendous progress in creating global health goals over the past 20 years. International and regional organisations, primarily the United Nations and the Organization of American States (OAS), have taken steps to clearly outline the most urgent health-related needs in the developing world, global health standards, and a variety of policies intended to encourage countries to strive to reach basic health thresholds. Additionally, a wide range of public and private non-governmental organisations (NGOs) have stepped up to offer funding for a variety of health programmes, primarily in developing countries (Dry, 2020).
Today, humanity must overcome planetary-scale, unprecedented social, economic, and environmental issues. New infectious diseases are emerging and spreading, chronic, degenerative, and socio-behavioural pathologies are becoming more common, the right to health is frequently contested or denied, utilitarian approaches view human health as a factor of economic growth rather than a right in and of itself, and access to care is frequently restricted as part of macroeconomic interventions, including public spending (WHO, 2020). Inequities between the North and the South of the world are getting worse overall, and the terms “North” and “South” no longer have any geographic meaning. Instead, it symbolises the gap between the few in the many Norths, where riches and possibilities are concentrated, and the masses in the many Souths, where modernity has not been welcomed and where poverty and marginalisation are the norms. Also, these injustices increase health risks and dangers, which has serious consequences for sustainable development (WHO, 2020).
Health is now widely acknowledged as a crucial component of human rights advocacy, global security, efficient governance, and sustainable economic growth (Min, Zhao & Slivka, 2018). The fact that three of the eight Millennium Development Goals (MDGs) outlined in the year 2000 by the United Nations Millennium Declaration – “the blueprint agreed to by all the world’s countries and all the world’s leading development institutions” – were related to health targets (MDG 4: Reduce child mortality; MDG 5: Improve maternal health; MDG 6: Combat HIV) demonstrates the increased relevance of health in global development policies since the late 1990s.
The Agenda 2030 and its universal and indivisible 17 SDGs, which set forward a far bigger agenda for global development, were confirmed by the Sustainable Development Goals (SDGs) approved in 2015. (Vandemoortele, 2020). In addition, this shift in focus to health has led to an unprecedented increase in financial resources at the worldwide level earmarked for the growth of the health industry. This trend has somewhat reversed since 2013, with 2017 levels being comparable to those of 2012, however (UNDP, 2019).
The number of global health projects and public and commercial entities engaging in global health governance have both grown significantly over the past few decades, creating an extremely complicated situation. Even the World Health Organization’s (WHO) role as the “directing and coordinating authority” in worldwide health has been questioned by this. The actors who have traditionally played a role in the health sector are changing in terms of relative importance. Economic factors have a significant impact on national and international public policies, favouring the improvement of economic investment-friendly environments over the promotion of health and management of the factors that have a detrimental effect on population health and living conditions(Labonté & Gagnon, 2020). However, the discussion on the need to protect and promote health in global governance processes outside of the global health system has been sparked by a parallel increased focus on the importance of the social, economic, political, and environmental determinants of health that are influenced by decisions made in other global policy-making arenas (such as those governing international trade, the environment, and migration). The term “global governance for health” has been used to describe this strategy (Labonté & Gagnon, 2020).
Almost everything has been thrown into the “global” pot, often re-labelling as “global” issues and modalities defined by terms (such as international) that have previously proven to be more than adequate, based on the range of topics covered by the resources that are currently available on global health. This tendency has also been present in the health field, which has resulted in conceptual and empirical imprecision (Kickbusch, Silberschmidt & Buss, 2021).
Teaching “Global Health” also grew popular in line with this trend. Global health was emphasised in 2009 by The Lancet’s chief editor Richard Horton as a crucial component of universities’ educational, scientific, and moral missions (Yong et al.,2021). The concept of global health is being discussed more frequently in the media outside of the academic world. Institutions on the bilateral and international levels as well as private groups are placing more and more focus on it. New publications are devoted to this area of study, new generations of students and academics are drawn to the topic, and during the past ten or so years, the availability of courses in this emerging field has skyrocketed.
However, there is still much confusion about what global health entails and the topics covered in the courses that are offered there. For example, it has been suggested that the term “global health” is occasionally used to update previously existing courses in “international health,” “tropical medicine,” and other topics as a purely promotional measure (Stuckler & McKee, 2018). This is an intriguing conundrum since, as stated by Bozorgmehr (2018), “Social innovations are unlikely to evolve if ‘Global Health’ becomes or remains a cosmetic re-labelling of old patterns, objects, and interests”.
Health-financing reforms, universal health coverage, access to healthcare in rural areas, and other local or regional concerns are at the forefront of health policy in the majority of nations around the world as a result of the inherent difficulties that national health systems face. Yet, when a threat in the form of a potentially harmful infectious illness emerges, frequent public awareness of how global health has changed in the interim is raised (Davies, 2018). Cross-border, international, and increasingly global health issues get the attention of individuals in the Global North when lethal illnesses make the news. Although “killer viruses” and other epidemics have long been thought to be beaten or at least under control in high-income countries, a series of life-threatening situations brought on by them have grown more frequent in recent years.
With the emergence of dangerous infectious diseases like SARS (Severe Acute Respiratory Syndrome) in Southeast Asia in 2002, swine flu in the Northern Hemisphere winter of 2009–2010, MERS (Middle-East Respiratory Syndrome) in 2012, and avian influenza from 2013 onward, what started with the spread of the AIDS pandemic has further developed in an increasingly close time order. More than 11,000 people died as a result of the Ebola outbreak in Western Africa in 2014; the Eastern Democratic Republic of Congo outbreak five years later; the Zika virus in Brazil; and, most recently, the coronavirus pandemic that originated in the Chinese province of Wuhan and spread throughout the world (WHO, 2020).
This wave of continuously occurring epidemic outbreaks referred to as “health crises” frequently raises public awareness and makes headlines, especially in Europe and North America but also in South America and other developing countries of the world. Public interest in the health-related issues facing other nations and continents, however, is typically sporadic and fleeting. In the low- and middle-income nations of the Global South, particularly in Sub-Saharan Africa, where certain health risks still exist, that makes a significant difference. In low-income nations, particularly among the poorest populations, infectious diseases continue to be a serious health danger, and there is always a chance of developing endemic illnesses or even epidemics (Kickbusch, Cassar & Szabo, 2019).
But, today’s challenges for individuals and healthcare systems in underdeveloped nations go beyond infectious diseases. The disease spectrum is broadening as a result of the epidemiological change from infectious to chronic, non-communicable diseases. The majority of developing countries and countries in transition have been burdened by this previously dual burden of disease over the past few decades, which has been caused by bacterial, viral, or other pathogens on the one hand and health issues commonly referred to as chronic or civilisation diseases on the other (Schütte, 2018). The condition is made worse by the coexistence of dietary obesity, malnutrition, and undernourishment (Gouda et al., 2019).
Over the past 15 years, global health has grown to be one of the most crucial areas of foreign, development, and security policy, despite having minimal impact on national health policy debates within nations ( Sentes & Kipp, 2017). Political health and foreign policy texts typically use security as a contextual framework, and the securitization of health is regarded as a crucial aspect of public health governance (Alatas et al., 2020). The quick succession of endemic and epidemic outbreaks regarded as health emergencies has helped to create the securitization of global health, which is supported by several actors at the national and international levels who collaborate to target cross-border health concerns (Blakely et al., 2019). While global health tends to neglect and conceal long-term diseases like tuberculosis, the structural reasons for poor health and health inequities, acute epidemic breakouts are frequently perceived as a manifestation of globalisation (Gates, 2018). The growing international and political importance of global health necessitates more comprehensive governance strategies for national and regional institutions and mechanisms that are established to contribute to the governance of global health, as well as for institutions and processes of global governance that have a direct and indirect impact on health (global governance for health) (WHO, 2019).
Regardless of these ancillary topics, the concept of “Global Health” itself covers a wide range of topics like political perspectives, research, teaching, and clinical practice, and it aims to improve access to health care, the quality of the care provided, and the general health of people all over the world. In the sense of public health, global health includes both individual clinical care and prevention at the level of populations or individuals. The notion also entails looking at international contexts as well as the social, political, and economic determinants of health and coming up with solutions to current health issues, notwithstanding the complexity and heterogeneity of the definitions and parties involved. The understanding of Global Health ranges from health as an instrument of internal security and foreign policy to charitable philanthropies, public-private partnerships, general human rights and solidarity(Alvarado et al., 2020).
International health and global health have always been intimately connected to both the defence of national populations and business interests and goals. For instance, the US Institute of Medicine stressed the protection of citizens in the USA; they bluntly stated that four of the top ten pharmaceutical manufacturers worldwide control 40% of the global market and that the introduction of new drugs and vaccines in developing countries provides the pharmaceutical and vaccine industry in industrialised countries with good sales opportunities (Pickett & Wilkinson, 2020). The Federal Republic of Germany’s population protection and the nation’s export-oriented economy was given top priority by the German government in its first global health strategy (Hussain et al., 2020). Prioritizing neglected and poverty-driven diseases, the German Ministry of Education and Research is only slowly broadening the scope of issues in the context of Global Health Sciences (Cueto, 2018).
References
- Bozorgmehr K.(2018). Rethinking the ‘global’ in global health: a dialectic approach. Globalization Health.;6:19.
- Dry, S.(2020). Epidemics for all? Governing Health in a Global Age. Brighton: University of Sussex. https://www.episouth.org/doc/r_documents/Epidemics.pdf. Accessed 14 Aug 2019.
- WHO. (2020).: Making a Difference. The World Health Report 1999. Geneva: World Health Organization; https://www.who.int/whr/1999/en/whr99_ch2_en.pdf. Accessed 10 Dec 2019.
- Min J, Zhao Y, & Slivka L,(2018). The double burden of diseases worldwide: coexistence of undernutrition and overnutrition-related non-communicable chronic diseases. Obes Rev. ;19(1):49–61. doi: 10.1111/obr.12605.
- Vandemoortele J.(2020). SDGs: the tyranny of an acronym? Impakter 13. https://impakter.com/sdgs-tyranny-acronym. Accessed 28 Aug 2019.
- UNDP. (2019). Sustainable Development Goals. United Nations Development Programme; 2015. https://www.undp.org/content/dam/undp/library/corporate/brochure/SDGs_Booklet_Web_En.pdf. Accessed 2 Dec 2019.
- Labonté R, & Gagnon M.(2020). Framing health and foreign policy: lessons for global health diplomacy. Globalization Health.;6:14.
- Kickbusch I, Silberschmidt G, & Buss P.(2021). Global health diplomacy: the need for new perspectives, strategic approaches and skills in global health. Bull World Health Organ. 2007;85(3):230–232. doi: 10.2471/BLT.06.039222.
- Yong K, Shakow A, Mate K, Vanderwarker C, Gupta R, & Farmer P.(2021). Limited good and limited vision: multidrug-resistant tuberculosis and global health policy. Soc Sci Med. 2005;61(4):847–859. doi: 10.1016/j.socscimed.2004.08.046.
- Stuckler D, & McKee M.(2018). Five metaphors about global health policy. Lancet. ;372(9633):95–97. doi: 10.1016/S0140-6736(08)61013.
- Davies S.(2018). What contribution can international relations make to the evolving global health agenda? Int Aff. 2010;86(5):1167–1190. doi: 10.1111/j.1468-2346.2010.00934.x.
- Kickbusch I, Cassar & Szabo MM.(2019). A new governance space for health. Global Health Action.;7:23507. 10.3402/gha.v7.23507.
- Schütte, S.(2018). Connecting planetary health, climate change, and migration. Lancet. Planetary Health;2(2):E58-E59. doi: 0.1016/S2542–5196(18)30004–4.
- Gouda H, Charlson F, Sorsdahl K, Ahmadzada S, Ferrari A, & Erskine H.(2019).Global burden of disease study 2017. Lancet Glob Health. ;7(10):E1375–E1E87. doi: 10.1016/S2214-109X(19)30374-2.
- Sentes K, & Kipp W.(2017). Global burden of disease: huge inequities in the health status in developing and developed countries. Healthc Manage Forum. ;16(3):27–29. doi: 10.1016/s0840-4704(10)60229-3.
- Alatas V, Banerjee A, Hanna R, Olken B, & Tobias J.(2020). Targeting the poor: evidence from a field experiment in Indonesia. Am Econ Rev. ;102(4):1206–1240. doi: 10.1257/aer.102.4.1206.
- Blakely T, Hales S, & Kieft C, Nick Wilson N, Woodward A.(2019). The global distribution of risk factors by poverty level. Bull World Health Organ. 2005;83(2):118–126.
- Gates B.(2019). Prepared remarks to the 2005 world health assembly. 16.. Geneva: WHO. https://www.gatesfoundation.org/media-center/speeches/2005/05/bill-gates-2005-world-health-assembly. Accessed 24 Nov 2019.
- WHO. (2019). Global action plan: for the prevention and control of non-communicable diseases (2013–2020).
