European perspectives on global health: a policy glossary

3. Europe must assert its role in global health governance
Key actors in global health
Key actors in global health are those actors
which either individually ( like international
organisations of influential nation-states ) or
as collective actors have an identifiable impact
on global health. They must be considered
important partners for <strong>European</strong> policy makers
depending on the issues involved and the
interests they pursue in specific global health
activities.
In order to locate entry points for “good” global
governance for health, a better understanding of the
present institutional architecture and the constellation
of interest and actors in global heath is necessary.
While in general international health circumscribes
the purview of the representatives of nation-states
interacting within the defined boundaries of an
international organisation such as the WHO, global
health is characterised by a growing and complex
assemblage of actors, interacting on a wide variety of
converging and conflicting interests. The rapid growth
of actors and activities in global health can at first
glance mask the governance problems inherent in this
new system. The key players are :
Nation-states play a central role in global
governance for health. Donor countries individually
or collectively exert an important influence on global
health affairs. Individual countries, depending on
their financial and political strength, develop bilateral
cooperation projects of considerable importance ( e.
g. US President’s Emergency Plan for AIDS Relief
( PEPFAR ) in the fight against HIV / AIDS ), might
influence strategies of international organisations
through contributions for specific projects or by
withholding regular contributions, might take
specific political positions in decision making ( e.
g. in World Trade Organization ( WTO ) affairs ) or
might collectively push for specific programmes. The
power of certain donor countries also has played an
important role in creating new institutions outside
UN Organisations like the Global Fund to fight AIDS,
Tuberculosis and Malaria ( GFATM ). There continues to
be a significant power imbalance between recipient
countries and donor countries and between the North
and the South.
Organisations for cooperation among
industrial countries have assumed an increasingly
important role for the coordination of interests
among these countries and for the preparation of
initiatives. The Organisation for Economic Cooperation
and Development ( OECD ) has long played a role in
monitoring health performance and coordinating aid
efforts. Since the late 1990s, the G7 / 8 has become
an important actor in global health, motivated by
the growing perception of health as a risk to global
security. Health plays an increasing role in G8
meetings ; the G8 were instrumental in developing
the proposal for a large global health fund to fight
major infectious diseases ( in particular HIV / AIDS ) and
in securing and coordinating the commitment of the
most powerful industrial nations to supporting global
health activities, e.g. in the context of supporting the
achievement of the Millennium Development Goals.
During recent years, organisations of middleincome
countries ( like Brazil, India, China, South
Africa ) have increasingly taken specific positions in
international politics and international organisations.
This involves to some degree taking a leading
position in new groupings of Southern countries
( like the “Group of 20 or 21” in WTO negotiations ;
“Friends of Development” in World Intellectual
Property Organization ( WIPO ) ). With respect to global
health governance ( GHG ), they play a growing role,
above all in the fields of expanding the options for
the development of local pharmaceutical R&D and
improving access to medicines in developing countries.
Regional organisations such as the <strong>European</strong>
Union, Association of East-Asian Nations ( ASEAN )
and the Organization of American States ( OAS ) have
significantly strengthened their health portfolio and
on the other end of the spectrum municipal actors
are engaging in worldwide cooperation to address
local problems. The Regional Offices of the WHO
aim to promote common public health strategies
within six regions. The <strong>European</strong> Union as a
regional organisation constitutes a special case as
it coordinates activities of its Member States and
( basically through the EU Commission ) develops
its own politics in global affairs. Due to a lack of a
common strategy in many fields of global health, and
a conflict with its Member States as to independent
action of the Commission in global health matters, the
Global Health Policy Glossary
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