The Handbook of Global Health Policy

Contents

Figures and Tables

Notes on Contributors

Foreword

References

Acknowledgments

Introduction

Why Global Health Policy

The State of the Worlds Health

A New Kind of Handbook to Guide Action on these Challenges

Five Key Themes Emerging from the Book

Theme 1: Global Health is Increasingly Multidimensional, Requiring Innovation in Interdisciplinary and Collaborative Approaches

Theme 2: There is a Need for Greater Innovation in National and Global Health Governance

Theme 3: Health Aid to Developing Countries Requires Re-engineering

Theme 4: Scientific Evidence must be Balanced with Political and Ethical Considerations

Theme 5: Promoting Global Health is Clearly an Ethical Issue, But the Scope and Scale of Our Normative Commitment Remain Undetermined

Conclusions

References

Part I Global Health Policy and Global Health Governance

1 Understanding Global Health Policy

Introduction

Globalization and the Transformation of Global Health Policy

New Global Health Policy Actors

Global Health Policy Instruments and Levers

Contribution of Theory to Understanding Global Health Policy

Functional Rationality: The Policy Process as a Set of Stages or a System

Explanatory Theories of Policy Processes

Conclusions and Pointers for the Health Policy Analyst

References

2 Critical Reflections on Global Health Policy Formation: From Renaissance toCrisis

Introduction

From Renaissance to Crisis

How can the Crisis in Global Health be Explained?

Critical Understandings of Policy Formation

Overcoming the Four Rs: Recommendations

Conclusions

References

3 Contemporary Global Health Governance: Origins, Functions, and Challenges

What is Global Health Governance?

What Purpose does Global Health Governance Serve?

Why Would a Powerful State Agree to Work through Global Institutions?

Key Functions of Global Health Governance

Internationally Financed Action

International Regulation

Research and Surveillance

Major Developments in International Health Institutions: New Players and New Priorities

The Current Crisis in Global Health Governance

Dismantling Equity in International Institutions

Marginalizing Science from the Policy Process

Pursuing Donor Priorities

Privatizing Global Health

Conclusions

References

4 Global Health Justice and the Right to Health

Introduction

Debates about Health Justice at the Domestic Level

Limiting the Scope of Health Justice to the State

Cosmopolitanism and Broadening the Scope of Health Justice

Rights-Based Approaches to Health: Problematizing the Use of Rights Claims to Promote Social Justice at the Domestic and Global Level

Conclusions

References

Part II Narrowing the Gap Between Knowledge and Action

5 Measuring the Worlds Health: How Good are Our Estimates?

What are Health Metrics, and Why do They Matter to Global Health Policy?

Metrics for the Worlds Health

Measuring Population Health Loss: DALYs

Measuring Health System Performance: Effective Coverage

Data Sources for the Worlds Health Metrics

From Producing Health Metrics to Informing Policy: Are Our Estimates Good Enough?

Measuring the Attainment of MDG 5: Reducing Maternal Deaths

Measuring the Impact of Mexicos Health Reform: Seguro Popular

Moving Towards Better Health Estimates

Acknowledgments

References

6 Achieving Better Global Health Policy, Even When Health Metrics Data are Scanty

What is Global Health Policy – and What Health Metrics Data are Needed?

Scale of Health Metrics Data

Population Basis of Health Metrics Data

Linking Health Service Encounters with the Everyday Lives of Citizens

Uncertainties in Measuring Health

Ethical Issues in Health Metrics Data

Moving from Health Metrics Data to Health Policy

References

7 An Argument for Evidence-Based Policy-Making in Global Health

Introduction

Narrowing the Gap

Why Should We Use Evidence? Which Evidence Should We Use?

Using Different Types of Evidence to Answer Different Questions

Evidence-Informed Policies Improve Public Health

What are the Barriers to EBP in Global Health?

Mismatch Between Research Generation and Burden of Disease

Systematic Reviews Do Not Reflect the Health Priorities of LMICs

Policy-Makers in LMICs Cannot Access Research Evidence

Policy-Makers Do Not Use Evidence

The “Black” Box of Implementation

The New Landscape of Evidence Translation in Global Health

Generation and Synthesis of Locally Relevant Evidence

The Open Access Movement

New Initiatives and Tools for Packaging Evidence for Policy-Makers

Encouraging Linkage and Communication between Researchers and Policy-Makers

Conclusions

References

8 Can Global Health Policy be Depoliticized? A Critique of Global Calls for Evidence-Based Policy

Introduction

Understanding Evidence-Based Global Health Policy

The Pejorative Influence of Politics in Global Health Policy

Producing Health Sciences Research: The Politics of Creating the Evidence Base

Using Health Sciences Research: What to Value and How to Value Evidence in Decision-Making

Wider Implications of a Depoliticized Approach to Evidence

Conclusions: A Way Forward?

References

Part III The Politics of Risk, Disease, and Neglect

9 Dietary Policies to Reduce Non-Communicable Diseases

Introduction

The Policy Problem

Determinants of Food Choices and Dietary Behaviors

The Policy Solution

The Next Steps

Conclusions

References

10 Ethical Reflections on Who is At Risk: Vulnerability and Global Public Health

Introduction

What is a Risk?

What does it Mean to be Vulnerable?

Vulnerability, Responsibility, and Moral Obligations

Conclusions

Notes

References

11 Ethical and Economic Perspectives on Global Health Interventions

Introduction

Hidden and Long-Term Returns to Disease Mitigation

Infectious Disease: The Importance of Childhood

Chronic Disease

Infectious Disease, Cognitive Development, and Poverty

Health Inequalities and Institutional Design

Intergenerational Transmission of Health

Health Interventions and Population Growth

Globalization of Disease

Health, Justice, and Global Institutions

Patents and Drug Prices

Global Institutions and Social Justice

Conclusions

Notes

References

12 Global Health Policy Responses to the Worlds Neglected Diseases

What is a Neglected Disease?

Why are They Neglected?

The Decade of Change

Policy Responses to Neglected Disease R&D

Market-Based Solutions

Non-Market-Based Solutions

Debates and Controversies

References

13 The Fight for Global Access to Essential Health Commodities

Introduction

The Medical Innovation System is Failing Many Patients

The First Problem: Medical Tools are Often Priced Out of Reach

The Second Problem: Medical Tools to Address “Unprofitable” Diseases are Often Unavailable

The Third Problem: Medical Tools are Often Unsuitable for Neglected Populations

How to Ensure Better Access to More Appropriate Innovation

Voluntary Measures

Limiting and Overcoming Patent Barriers

Compulsory Licensing and Trade Deals

Innovation and Access: Towards a System that Delivers what Patients Need

Alternative Approaches

A New Global Framework: Could We Achieve a Global R&D Convention?

Conclusions

Acknowledgment

References

14 The Social Determinants of Health

Introduction

A Brief Genealogy of the SDH Approach

Some Conceptual Clarifications

Evidence Base for the Importance of SDHs

Globalization of Production and Finance: Undermining SDHs?

Conclusions

References

Part IV Diplomacy, Security, and Humanitarianism

15 Arguments for Securitizing Global Health Priorities

Introduction

Securitization of Infectious Disease in the Post-Cold War World

Reasons to Welcome the Securitization of Health

Security Actors can Help Protect Us from the Health Effects of Infectious Diseases

Diseases can Cause Significant Political, Social, and Economic Disruption

There are Synergies between Public Health and Security Priorities

Securitization brings Attention and Resources to Health

Conclusions

References

16 Viral Sovereignty: The Downside Risks of Securitizing Infectious Disease

Introduction

Method

Results and Discussion

The Securitization of H5N1

The International Scramble for Antivirals and Vaccines

Turning Lethal Viruses into Diplomatic Bargaining Chips

Conclusions

Acknowledgment

Note

References

17 The Changing Humanitarian Sector: Repercussions for the Health Sector

Introduction

The Changing Nature of Humanitarian Crises

Rise of Local Confrontations

Increasing Impacts of Natural Hazards

Crises are Usually Multifactorial

Humanitarian Aid Architecture

Explosion of Western NGOs

Rise of Southern and Eastern NGOs and Civil Society

Centrality of the UN Family and a New Approach to Coordination

New Role of the Armed Forces

Aid and Profit: Growing Involvement of the Private Sector

Killing Aid Actors for Political Gains

Adjusting to a Diverse and Fast-Changing World

Assessing Needs and Capacities: Multiple Contexts Require Diverse Responses

Designing the Appropriate Response

Adjusting Programs to Fast-Changing Situations

Preparing for Future Humanitarian Crises

Risk Management: Predicting the Challenges Ahead

Rethinking Approaches

Working in Insecure Environments

Evaluating the Response

Conclusion: Challenges and Opportunities Ahead

Improving Humanitarian Operations in Settings of Global Urbanization

Applying New Information Technology to Disaster Management

Improving Local Disaster Management

Restoring Holistic Humanitarian Principles

References

18 The Limits of Humanitarian Action

Limits of Humanitarian Action

Quantitative and Qualitative Limits

External and Internal Barriers

Five Main Types of Limit

Political Barriers

Organizational Barriers

Technical Barriers

Community Barriers

Moral Limits

Conclusions

References

Part V Financing and the Political Economy of Global Health

19 The Global Health Financing Architecture and the Millennium Development Goals

Introduction

Progress Towards the Health MDGs

Trends in Global Health Financing

The MDGs Spurred a Substantial Growth in Global Health Financing

The End of the Halcyon Days of Global Health Financing

Uneven Distribution of Funding across the Health MDGs

Areas Not Covered by the MDGs Receive the Least Financial Attention

Targeting and Predictability of Funding Flows

Key Players in the Global Health Financing Architecture: the Emergence of New Financing Institutions

Fragmentation of the Global Health Landscape

Unintended Side Effects Resulting from Fragmentation

The Need for Domestic Financing

Improving the Quality and Efficiency of Global Health Financing

Increased Accountability

Looking Forward: Lessons Learned and Recommendations

Notes

References

20 Can International Aid Improve Health?

Introduction

Examining the Evidence

The Economic Way of Thinking

Incentives

Donor Incentives

Recipient Incentives

Information

Donors Information Problem

Recipients Information Problem

Conclusions

Notes

References

21 The Exterritorial Reach of Money: Global Finance and Social Determinants of Health

Introduction

Implicit Conditionalities

Capital Flight

The Crisis of 2008

Evidence on Health Outcomes

Conclusions and Policy Implications

References

22 Trade Rules and Intellectual Property Protection for Pharmaceuticals

Trade Rules and Intellectual Property Protection for Pharmaceuticals

Pharmaceutical Patents Before and After TRIPS

Pharmaceuticals Post-TRIPS and the “IP Access to Medicines” Contests

PTAs and “TRIPS Plus” Pharmaceutical Standards

Looking Ahead– Some Concluding Thoughts

References

23 The Health Systems Agenda: Prospects for the Diagonal Approach

Introduction

A Conceptual Base for Health Systems

The Diagonal Approach

The Diagonal Approach in Practice: Lessons from Mexico

Mexican Health Reform

Conclusions

References

24 Will Effective Health Delivery Platforms be Built in Low-Income Countries?

Introduction

First Decade of the “Global Health Revolution”: Where Did All the International Assistance Go?

Why was Development Assistance for Health Allocated to Infectious Disease Control?

First Hypothesis: The “Securitization” of Global Health

Second Hypothesis: Exceptional Activism, Rooted in a Human Rights Approach

Third Hypothesis: Avoiding the “Fatal Attraction” of Cheaper Solutions

Fourth Hypothesis: Creation of a Brand New Financing Tool

Preliminary Conclusion: An Opportunity for Integrating Infectious Disease Control with Health Systems Strengthening

Infectious Disease Control Programs Building Health Delivery Platforms: Diagonal Approach, Bottom-Up and Top-Down

Bottom-Up: The “Diagonal” Approach Applied in Ethiopia

Top-Down: The Health Systems Funding Platform

Conclusions

References

Part VI Health Rights and Partnerships

25 A Rights-Based Approach to Global Health Policy: What Contribution can Human Rights Make to Achieving Equity?

Introduction

The Right to Health in International Human Rights Law

Development of the Right to Health Within the United Nations

Right to Health in Regional Human Rights Treaties

Contribution of International Health Conferences

General Comment 14 on the Right to the Highest Attainable Standard of Health

The UN Special Rapporteur on the Right to the Highest Attainable Standard of Physical and Mental Health

Critiques and Weaknesses of Human Rights and Right to Health

Rights Inflation

Vagueness/Formulation

Ineffective/Damaging

Deficiencies of International Law

Contribution of Human Rights to Global Health Equity

International and Regional Human Rights Procedures

Regional Human Rights Mechanisms

Domestic Litigation

Rights-Based Advocacy

Rights-Based Policy and Tools

A Way Forward: Defining a Research Agenda for Global Health and Human Rights

Conclusions

References

26 From Aid to Accompaniment: Rules of the Road for Development Assistance

Introduction

From Aid to Accompaniment

Principle 1: Support Institutions that the Poor Identify as Representing their Interests

Principle 2: When Possible, Fund Public Institutions to do their Job

Principle 3: Make Job Creation a Benchmark of Success

Principle 4: Buy and Hire Locally

Principle 5: Co-invest with Governments to Build Strong Workforces and Civil Services

Principle 6: Work with Governments to Provide Cash to the Poor

Principle 7: Support Regulation of Non-State Service Providers

Principle 8: Apply Evidence-Based Standards of Care

Conclusions

Acknowledgments

References

27 Global Health Partnerships: The Emerging Agenda

Introduction

Global Health Partnerships

What Makes Global Health Partnerships Work?

The Global Fund to Fight AIDS, Tuberculosis and Malaria

The Global Funds Successes and Failures

Conclusions

References

28 Partnerships and the Millennium Development Goals: The Challenges of Reforming Global Health Governance

Introduction

Partnerships and the “Global Health Revolution”

Origins and Context of Global Health Partnerships

Partnership Types and Initiatives

The MDGs: Aspirational Targets for the Partnership Era

Health-Related MDGs and the Social Determinants of Health

MDGs as Partnerships

MDGs and Global Health Governance

Assessing Effectiveness: Partnerships and the MDGs

Progress Toward the Health-Related MDGs

Role of Global Health Partnerships

Will the Health-Related MDG Targets be Met?

Impediments to the Realization of the Health-Related MDGs

Weak National Health Systems

Poor Coordination and Misplaced Priorities

Critical Assessments: Partnerships Beyond 2015

Conclusions

References

Part VII Beyond Globalization

29 Preparing for the Next Pandemic

Introduction

Examining the Threat and the Need for a Whole-of-Society Approach

Strategies to Mitigate Pandemic Influenza

Pharmaceutical Measures (Vaccines and Antivirals)

Non-Pharmaceutical Measures (Basically, Everything Else)

Conclusions

Note

References

30 Globalization and Global Health

Introduction

History of Globalization and Health

Information and Knowledge Access and Exchange

Formal and Informal Flows of Capital

Nourishment and Subsistence

Disease and Mortality

Globalization and Health Now

Information and Knowledge Access and Exchange

Formal and Informal Flows of Capital

Nourishment and Subsistence

Disease and Mortality

Possible Futures of Globalization and Health

Information and Knowledge Access and Exchange

Formal and Informal Flows of Capital

Nourishment and Subsistence

Disease and Mortality

Conclusions

References

Index