Governing Global Health: Challenge, Response, Innovation (2008)

GOVERNING GLOBAL HEALTH: CHALLENGE, RESPONSE, INNOVATION Andrew Cooper, John Kirton and Ted Schrecker (eds) Aldershot: Ashgate Publishing 2007, HB 320 pp, GBP 55.00 ISBN 978-0-7546-4873-4The concept of 'governing global health' is problematic. Is there a specific set of governance structures through which 'global health' is 'governed'? Does it include the political and economic conditions which shape people's health chances or only the policies and funding of health care? Does it apply to the health of the rich or just the health of the poor? Or is it only the health of the poor when their poor health threatens the health of the rich?Governing Global Health: Challenge, Response, Innovation is a collection of 14 essays dealing with policies adopted by the rich countries and multilateral institutions regarding the health and health care of people in developing countries. Some of the chapters offered useful analyses, and the collection as a whole provides excellent material for a discourse analysis of conversations regarding global governance and health.The book has three main parts, plus introductory and concluding chapters by the editors. Global challenges and responses sets out some of the background. Zacher provides a brief history of the World Health Organization's role in the international control of communicable disease counterposed against the rise of the World Trade Organization and in particular the role of the Trade Related Intellectual Property Agreement (TRIPS) in 'governing' access to essential medicines. Orbinski highlights the role of social movements, featuring the role of Medicins Sans Frontieres (MSF) (and a global social movement behind it), in forcing the WTO (at the Doha Ministerial Council meeting in 2001) to amend the TRIPS Agreement to make it (slightly) easier for small poor countries to access generic medicines. In the third of the background essays, Fidler explores the idea of 'securitisation' of public health, which means that the health problems of poor people in the developing world are constructed as security threats to the well being of the rich countries and prioritised accordingly.The second main part of the book deals with The central institutions: The multilateral system. Drager and Sunderland describe the role of the WHO, focusing in particular on the Commission on Macroeconomics and Health (and its conclusions regarding the productivity case for increased development assistance) and the dialogue between WHO and the WTO in pursuit of 'policy coherence' between health objectives and the regulation of global trade. Bradford and Hsu and White discuss the Millennium Development Goals (and the bleak prospects for their achievement), and Blouin explores the implications of the General Agreement on Trade in Services (GATS) for the achievement of the Millennium Development Goals (MDGs) (she is not positive).The third main section focuses on the G8, the promises and declarations which have emerged from the various leaders' meetings and the institutional initiatives that have been supported through the G8, notably the MDGs and the Global Fund for AIDS, TB and Malaria (GFATM). There is a muted debate across this section. While Kirton and Manned celebrate the new role of the G8 in global health governance, Schrecker, Labonte and Sanders present a more broadly based and balanced assessment. Aginam returns to the role of the TRIPS Agreement and measures the G8 against the criterion of access to essential medicines and points out that little progress has been made in creating a more supportive regulatory regime despite the long drawn out negotiations to amend the TRIPS Agreement to give effect to the 2001WTO Doha Declaration. Finally, O'Manique explores the role of the G8 in global health governance against criteria derived from the human rights paradigm.I found this collection annoying but fascinating. My annoyance arose in part from the editors' selfserving celebration of the achievements of the G8 in 'global health governance' (set against the 'failure' of the WHO), without any exploration of the deliberate policy of certain G8 members to hobble the WHO by not paying their assessed contributions to the WHO budget. …