Governing global health: who runs the world and why? PDF
Preview Governing global health: who runs the world and why?
GoverninG Global HealtH • GoverninG Global HealtH • Who Runs the WoRld and Why? Chelsea Clinton and Devi Sridhar 1 1 oxford University Press is a department of the University of oxford. it furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide. oxford is a registered trade mark of oxford University Press in the UK and in certain other countries. Published in the United States of america by oxford University Press 198 Madison avenue, new York, nY 10016, United States of america © oxford University Press 2017 all rights reserved. no part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of oxford University Press, or as expressly permitted by law, by license, or under terms agreed with the appropriate reproduction rights organization. inquiries concerning reproduction outside the scope of the above should be sent to the rights Department, oxford University Press, at the address above. You must not circulate this work in any other form and you must impose this same condition on any acquirer. names: Clinton, Chelsea, author. | Sridhar, Devi lalita, author. title: Governing global health : who runs the world and why? / Chelsea Clinton and Devi Sridhar. Description: new York, nY : oxford University Press, [2017] identifiers: lCCn 2016022370| iSbn 9780190253271 (hardcover : alk. paper) | iSbn 9780190253295 (e-book) | iSbn 9780190253295 (e-book) Subjects: | MeSH: World Health organization. | Global Health | international Cooperation Classification: lCC ra441 | nlM Wa 530.1 | DDC 362.1—dc23 lC record available at https://lccn.loc.gov/2016022370 1 3 5 7 9 8 6 4 2 Printed by Sheridan books inc., United States of america For Charlotte and aidan, with all my love, Chelsea For sadegh, with all my love, devi Table of ConTenT s • Preface viii abbreviations xiii 1. Governing Global Health 1 2. big Questions and Case Studies 23 3. Shifts in Governance 48 4. Who Funds Global Health? 83 5. twenty-First-Century Governance 119 6. Disruption and reform 161 7. Final reflections 202 notes 217 index 267 vii PrefaCe • Throughout our travels across the world, whether to slums in new Delhi, health clinics in Port-au-Prince, or ministries of health in liberia and brazil, the health of all people has been at the forefront of our minds. How can we, alongside so many others, make a contribution to global health? That question is what prompted us to write this book. The same question should be at the top of the agenda set by every government, international development institution, and nongovernment organiza- tion (nGo). While health policy debates raise enormously complex issues about institutions, finance, behavior, and the role of markets, no issue has a more profound bearing on the human condition than health. as mothers of young children, we are acutely aware of the role that health systems play during periods of vulnerability. efficient and equitable health systems save lives and break the link between sickness and poverty. They are an integral part of the social contract. We are also aware that for millions of women, children, and disad- vantaged people around the world, the absence of efficient, effective, and equitable health systems is a source of vulnerability and distress, and part of a vicious cycle of poverty. our concern in this book is to ask what at a global level can be done to change this picture. viii preface ix Why now? at first glance, we live in the best of times of public health. People live longer than ever before. Child mortality is falling at an accelerating rate. in the first fifteen years of the twenty-first century, child deaths fell from ten million to just under six million deaths per year. according to UniCeF, roughly forty-eight million lives have been saved through a combination of more skilled birth attendants and higher vaccination rates (along with increased economic develop- ment and girls’ education, and other factors).1 Major killers like malaria, pneumonia, measles, and Hiv/aiDS are in retreat in the face of im- proved access to effective prevention, care, and new medicines. in all of these areas, national policy backed by international cooperation has made and continues to make a difference. Untold millions of people are living healthier, more productive, and longer lives than ever before. viewed from a different perspective, we are living in the worst of times. never has the gap between what we are capable of achieving— based on what we already know works—and what we actually achieve been greater. Hiv/aiDS rates are not falling for all populations, every- where. in 2014, tuberculosis, one of the world’s oldest diseases, claimed more lives than Hiv/aiDS. and, while we live in a world of astonish- ing technical progress and scientific advance, every year one million children die on the day of their birth and another million die in their first week. if there is one figure that demolishes any cause for compla- cency over what we have achieved since 2000, it is the sixteen thousand child deaths that occur every single day. The overwhelming majority of these deaths could be prevented through simple, effective, and afforda- ble health interventions or preventative measures we know work. Yet the human toll continues. For anyone needing a reminder of the destructive potential of ill health it arrived in the form of the 2014/2015 ebola outbreak. The epi- demic was preventable and containable. Yet more than twelve thou- sand people died and worldwide fear about a global pandemic took hold. both the ongoing crisis in child mortality and the ebola epidemic illustrate in very different ways what happens when health systems fail. of course, what is achievable in health is influenced by national wealth. Yet we know of all too many cases of relatively wealthy countries that achieve far less than they could, in part because of their failure to
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