GLOBAL HEALTH POLICY

Health policy is broadly defined as ‘goals and means, policy environments and instruments, processes and styles of decision-making, implementation and assessment. It deals with institutions, political power and influence, people and professionals, at different levels from local to global’ (Leppo 1997). Global health policy can thus be understood as the ways in which globalisation may be impacting on health policy and, alternatively, what health policies are needed to respond to the challenges raised by globalizing processes.
Interest in global health policy can be seen as an extension of a desire, in more recent literature on globalisation, to understand the knock-on effects of current neo-liberal and market-driven forms of globalisation, on public policy especially in relation to social policy. While much of the globalisation literature remains heavily focused on the economic and financial sectors (World Bank 2000), many of the policy areas neglected until recently are now being addressed. Initially, these efforts have come from scholars in social policy who observe the often adverse effects that globalisation is having on the social sectors such as education, housing and health. Deacon (1997) argues, for example, that national social policy is increasingly determined by global economic competition and certain international organisations. Social policy must thus be understood in terms of global social redistribution, social regulation, social provision and empowerment (Deacon 1997). Alternatively, Kaul et al. (1999: 452) conceptualise the shortfalls of globalisation in terms of the undersupply of global public goods defined as exhibiting characteristics which are ‘nonexcludable, [and produce] nonrival benefits that cut across borders, generations and populations’.
More recently, attention to the social sectors has come from economic analyses, prompted by externalities of the global financial crisis of the late 1990s, revealing the interconnectedness and mutual vulnerability of national economies and societies. As well as eliciting extensive reflection of the need to strengthen global economic governance (e.g. banking regulation) (Stiglitz 1999), the links between economic and social policy were brought more sharply into focus. As Reinicke (1998: 1) writes:
without a greater effort to understand the origin and nature of the current global transformation and its implications for public policy, we will continue to react to events rather than act to shape the future course of world politics. Such passivity will leave our societies vulnerable to the risks that change will undoubtedly bring, while forgoing the gains that a more active policymaking could realize.
In relation to the health sector, concerns for nascent global public policy has initially centred on threats to national security or at least the security of high-income countries. In the context of reframing post-cold war foreign and defence policy, this perspective has focused on selected health threats such as infectious diseases, biological and chemical weapons, human migration, and illicit drug trafficking. The global health policy agenda in the US, in particular, has sought to channel the so-called ‘peace dividend’ to health risks arising from globalisation (Institutes of Medicine 1997; Raymond 1997).
Internationally, global health policy has been cast to emphasise the links between health and economic development led by theWorld Health Organisation (WHO). Recognising economic integration as a key driver of current forms of globalisation, WHO has strengthened its efforts to understand issues such as multilateral trade agreements, capital flows and macroeconomic policy and their implications for public health. In this respect, Director-General Gro Harlem Brundtland has frequently sought to argue that the protection and promotion of public health is a core requirement of sustainable globalisation (Brundtland 1999a).