European perspectives on global health: a policy glossary

3. Europe must assert its role
in global health governance
Governance describes how societies structure
policy responses to challenges they face and
responsibilities they bear. Governance involves
government, but the two terms are not
synonymous because governance often occurs
outside the formal state-based institutional
and legal arrangements that characterise
governments. Global governance for health
describes the structure and processes through
which the global health issues are addressed.
In the past, experts tended to analyse national
governance ( governance with a single state ) and
international governance ( governance between
sovereign states ). Global governance represents a
third level of governance characterised by new actors,
new processes, and new norms designed to help
societies individually and collectively manage the
positive and negative aspects of globalisation.
Global governance has emerged as a critical issue for
public health and health policy because globalisation
has dramatically affected these policy endeavours and
radically changed the challenges and responsibilities
societies and their governments face in the health
field. Public health is no stranger to the need for
states to cooperate with each other to address
health problems. International governance of public
health began to emerge in the mid-19th century
and continued with the World Health Organization
( WHO ) after World War II. Globalisation has, however,
rendered the territorial, State-centric approaches of
national and international governance increasingly
inadequate, because it weakens the ability of formal
government and intergovernmental structures to
retain control over political, economic, and social
phenomena. Globalisation has also empowered
non-State actors, especially through new information
technologies that allow them to participate more
Global Health Policy Glossary
effectively and efficiently in policy and governance
endeavours.
Globalisation has, for example, de-territorialised the
dynamics of many social determinants of health,
which requires bringing new actors, new processes,
and new norms to bear on the task of governing
globalised health. Health ministries and international
health organisations have inadequate reach and
authority to address globalised health determinants.
Global governance’s emergence does not mean that
the quality and effectiveness of national governance
and international governance in the health context are
unimportant. All three levels of governance are now
necessary but not sufficient individually to manage
the challenges and responsibilities of health policy in
the 21st century. Indeed, it is critical that governments
develop a coherent approach to global governance for
health across policy sectors at the national level.
Global governance literature often stresses the
importance of new actors in the governance of issues
that transcend territorial borders. This phenomenon is
true with respect to global health governance because
experts have repeatedly emphasised the growth of the
involvement of non-state actors ( e.g., non-governmental
organisations, multinational corporations ) in creating
and managing globalised health problems. The global
capabilities of these new actors produce new governance
processes as states and international organisations
address or access these capabilities for governance
purposes. A prominent new governance process in global
health is the public-private partnership, which attempts
to harness governmental, intergovernmental, and nongovernmental
contributions to improve aspects of health
in the world. Global health has also seen the proliferation
of policy networks and new financing mechanisms that
include public and private participants.
In addition to new actors and new governance
processes, global governance involves the creation
and pursuit of new norms as the objectives of
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