Values in global health governance
Introduction Over the past several decades, political conflicts, economic volatility and large-scale cultural and social changes have strongly influenced not only global health problem and solution frameworks, but the very way we conceive of global health as a public good. As politicians, business people and cultural elites employ the language of global health to shape discourse and policies focused on displaced and migratory peoples, they have perhaps unwittingly broadened the classic public health agenda. As a consequence, that agenda now includes violence and its traumatic consequences, the health (and mental health) impact of natural and social catastrophes, other health-related problems from obesity to substance abuse, and the effect of pharmaceutical and digital technology innovations not previously considered to be core public health issues. They expand and reformulate the traditional spheres of public health, and challenge classic public health values. As a result, debates shaping global health research, ethics, policy and programs have developed along two parallel tracks. One can be characterized as a neo-liberal approach combining economics (liberalization of trade and financing; new mechanisms for product development for diseases of poverty involving public–private partnerships; cost-effectiveness analysis), disease-specific and biotechnology programs and security concerns. The other has focused on human rights, social justice and equity frameworks with a broader, more inclusive model of the determinants of health. This perspective calls for a transformation of the current fractured system of global health governance into a transparent and accountable system, better equipped to address the world's global health agendas.
