Book Review

Governing Global Health: Challenge, Response, Innovation

N Engl J Med 2007; 357:2527-2528December 13, 2007

Article

Governing Global Health: Challenge, Response, Innovation
(Global Environmental Governance.) Edited by Andrew F. Cooper, John J. Kirton, and Ted Schrecker. 296 pp. Aldershot, England, Ashgate Publishing, 2007. $99.95. ISBN: 978-0-7546-4873-4

Governing Global Health admirably addresses the rapidly escalating global war with disease that is currently being lost. It focuses on the major global health challenges of the 21st century, including HIV–AIDS, malaria, tuberculosis, avian influenza, cancer, polio, obesity, cardiovascular disease, asthma, severe acute respiratory syndrome (or SARS), and bioterrorism. It then provides analysis of how well existing institutions and ideas have responded to these challenges and what innovations will be required if we are to prevail. The book consists of contributions from 18 experts from the University of Waterloo (in Ontario), the University of Ottawa, the University of Toronto, and other organizations that are involved in governing global health. It reads seamlessly as it places the challenge in historical perspective and makes the case for the critically needed response.

There is no question that disease is riding on the back of globalization and has thus far been outpacing our response to it. Global health is in crisis, and as the editors state in their introduction to the book, “the war for global health is being waged and lost on many fronts. The already massive body count is mounting fast.”

The editors explain that our existing lines of defense against this onslaught are “an ever more elaborate edifice of intergovernmental global health institutions, . . . regional organizations,. . . informal, plurilateral bodies, . . . [and] a growing array of multistakeholder networks, public-private partnerships, and committed action by civil society actors.” These institutions and approaches have failed to control the crisis, let alone turn the tide. As is discussed in the book, even the three United Nations Millennium Development Goals that are directly concerned with health, along with the others that relate to important determinants of health, are on a trajectory for failure. The message of this excellent book is a plea “to stop the avoidable human slaughter the status quo is on course to make in the coming years.” The response needs to be huge and immediate, and it needs different ideas and institutions. Staying with antiquated institutional structures and constricted thinking will guarantee failure.

The issues and challenges are complex and interwoven, surmounting nation states and the single-issue institutions of old, and they involve broader considerations such as national and international security, the environment, trade, and socioeconomic determinants of health. The authors carefully examine and evaluate the United Nations, the World Health Organization, the Group of Eight (G8), and new multistakeholder bodies as platforms for and agents of change, and they conclude that they all come up short as they are currently structured and directed. The editors emphasize that “merely increasing investments or incremental improvements in the old systems” will be woefully inadequate, and they hammer home the point that innovation is needed in long-standing ideas and institutions of global health governance.

It is in the specification of what innovations are needed that the book goes from excellent to good because it does not offer an abundance of compelling examples. But if the innovative and necessary changes in institutions and ideas that are needed were perfectly clear, matters would be simpler.

The editors conclude that “Designing, developing, and delivering the successor system will require the talents of many from national and sub-national governments, international institutions, healthcare professionals, philanthropists, the private sector, local communities, nongovernmental organizations (NGOs), faith groups, committed individuals, and victims from around the world.” This book gives the reader an excellent perspective on the war against the spread of disease as well as some unvarnished and high-resolution views of the terrain and the challenge before us that must be met and vanquished.

Kenneth E. MacWilliams, M.B.A.
Woodrow Wilson Associates, New York, NY 10022
macwilliams@post.harvard.edu