Global Health Governance and the Challenge of Holding Power to Account

David McCoy, Anuradha Joshi, Rajat Khosla, Marta Schaaf and Alicia Ely Yamin (2024). Global Health Governance and the Challenge of Holding Power to Account. UNU International Institute for Global Health.

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  • Author David McCoy
    Anuradha Joshi
    Rajat Khosla
    Marta Schaaf
    Alicia Ely Yamin
    Title Global Health Governance and the Challenge of Holding Power to Account
    Publication Date 2024
    Place of Publication Kuala Lumpur
    Publisher UNU International Institute for Global Health
    Pages 16
    Language eng
    Abstract While there is much to celebrate about the many institutions, actors, and initiatives that form the global health system, there are also problems with how the system is governed. Some of these relate to inequities and unmanaged conflicts of interest that are rooted in power imbalances and which leave certain actors with excessive and undue influence. By contrast, poorer countries and communities with the biggest stake in the global health system working equitably, effectively, and efficiently have little power by which to hold the system accountable. This intersecting issue of power, accountability, and global health governance is the focus of this Working Paper. The paper is broken into three sections. The first section discusses the meaning of global health governance and the role of accountability within governance structures and systems in general. It describes the current system of global health governance as being nested within a wider system of global political and economic governance, shaped by international relations, globalisation, and the dominance of neoliberal ideas and policies in recent decades. This has seen, among other things, shifts of power from state-based actors and institutions to more distant and less accountable global actors, as well as from democratic and public institutions to private actors and market forces. In doing so, the Working Paper draws particular attention to the power and accountability of powerful private actors and whether they are sufficiently held accountable. The second section unpacks the concept of accountability and describes five elements that are required for accountability to function (standards; data and information; answerability; sanctions; and remedy). It highlights the importance of independence in accountability and the challenges of holding powerful actors accountable. It then presents a three-layered framework to map accountability as a component of good global health governance. The final section concludes by calling for more discussion about power and accountability in global health, while also emphasising the need for rigorous research in identifying and helping correct harmful and unhealthy accountability deficits.
    Keyword Global Health
    Governance
    Power
    Accountability
    Copyright Holder UNU International Institute for Global Health
    Copyright Year 2024
    Copyright type Creative commons
    DOI 10.37941/RR/2024/2
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    Created: Mon, 03 Jun 2024, 17:39:09 JST by Silvia Fancello on behalf of UNU IIGH