title: Global Health Governance at a Crossroads.
abstract: This review takes stock of the global health governance (GHG) literature. We address the transition from international health governance (IHG) to global health governance, identify major actors, and explain some challenges and successes in GHG. We analyze the framing of health as national security, human security, human rights, and global public good, and the implications of these various frames. We also establish and examine from the literature GHG's major themes and issues, which include: 1) persistent GHG problems; 2) different approaches to tackling health challenges (vertical, horizontal, and diagonal); 3) health's multisectoral connections; 4) neoliberalism and the global economy; 5) the framing of health (e.g. as a security issue, as a foreign policy issue, as a human rights issue, and as a global public good); 6) global health inequalities; 7) local and country ownership and capacity; 8) international law in GHG; and 9) research gaps in GHG. We find that decades-old challenges in GHG persist and GHG needs a new way forward. A framework called shared health governance offers promise.
authors.affiliation: Research Assistant for Dr. Ruger at the Yale University School of Public Health.
authors.forename: Nora Y
authors.initials: NY
authors.lastname: Ng
authors.affiliation: Associate Professor at Yale University Schools of Medicine, Public Health and Law (Adjunct) and Graduate School of Arts and Sciences.
authors.forename: Jennifer Prah
authors.initials: JP
authors.lastname: Ruger
references.citation: Lancet. 2008 Mar 8;371(9615):865-9
references.pmid: 18328932
references.citation: J Epidemiol Community Health. 2004 Aug;58(8):630-1
references.pmid: 15252060
references.citation: Lancet. 2000 Dec 16;356(9247):2102
references.pmid: 11145523
references.citation: Global Health. 2005 Apr 22;1(1):6
references.pmid: 15847685
references.citation: BMJ. 1999 Mar 27;318(7187):865-9
references.pmid: 10092271
references.citation: Public Health. 2009 Mar;123(3):265-74
references.pmid: 19278695
references.citation: Lancet. 2007 Sep 15;370(9591):935-6
references.pmid: 17869632
references.citation: JAMA. 2001 Oct 17;286(15):1886-92
references.pmid: 11597292
references.citation: Health Promot Int. 2006 Dec;21 Suppl 1:42-50
references.pmid: 17307956
references.citation: Lancet. 2008 Jan 19;371(9608):202-3
references.pmid: 18207012
references.citation: JAMA. 2004 Jun 2;291(21):2639-41
references.pmid: 15173158
references.citation: Soc Sci Med. 2004 Oct;59(8):1661-76
references.pmid: 15279923
references.citation: Lancet. 1998 Feb 14;351(9101):514-7
references.pmid: 9482466
references.citation: Ann N Y Acad Sci. 2008;1136:12-20
references.pmid: 17954668
references.citation: Lancet. 2009 Jun 6;373(9679):1993-5
references.pmid: 19493564
references.citation: Lancet. 2009 Jan 31;373(9661):416-22
references.pmid: 19167060
references.citation: Soc Sci Med. 2000 Sep;51(6):979-89
references.pmid: 10972440
references.citation: PLoS Med. 2007 May;4(5):e197
references.pmid: 17535110
references.citation: J Health Econ. 2007 May 1;26(3):505-35
references.pmid: 17112613
references.citation: PLoS Med. 2010 Jan 26;7(1):e1000193
references.pmid: 20126249
references.citation: Bull World Health Organ. 2002;80(12):970-4
references.pmid: 12571726
references.citation: Soc Sci Med. 2011 Jun;72(12):1948-55
references.pmid: 20619946
references.citation: Bull World Health Organ. 2001;79(9):875-81
references.pmid: 11584737
references.citation: Health Policy. 1993 May;24(2):125-44
references.pmid: 10126754
references.citation: Lancet. 2009 Mar 21;373(9668):987-9
references.pmid: 19304001
references.citation: Emerg Infect Dis. 1997 Jan-Mar;3(1):1-9
references.pmid: 9126439
references.citation: Science. 2002 Mar 15;295(5562):2036-9
references.pmid: 11896266
references.citation: Bull World Health Organ. 2000;78(4):549-61
references.pmid: 10885184
references.citation: Lancet. 2005 May 28-Jun 3;365(9474):1837-40
references.pmid: 15962458
references.citation: Br Med J. 1950 May 6;1(4661):1032-7
references.pmid: 15414351
references.citation: McGeorge Law Rev. 2004;35(1):45-104
references.pmid: 17063603
references.citation: J Epidemiol Community Health. 2006 Nov;60(11):928-36
references.pmid: 17053281
references.citation: Emerg Infect Dis. 2000 Mar-Apr;6(2):97-102
references.pmid: 10756142
references.citation: BMJ. 2004 Nov 6;329(7474):1096-100
references.pmid: 15528624
references.citation: Lancet. 2009 Jun 20;373(9681):2083
references.pmid: 19541019
references.citation: J Law Med Ethics. 2004 Fall;32(3):500-8
references.pmid: 15490597
references.citation: Glob Public Health. 2011;6(6):593-605
references.pmid: 20432102
references.citation: Med Health Care Philos. 2009 Aug;12(3):245-55
references.pmid: 19137414
references.citation: Georgetown Law J. 2008;96(2):423-443
references.pmid: 24748684
references.citation: Health Aff (Millwood). 2002 Nov-Dec;21(6):131-41
references.pmid: 12442848
references.citation: BMJ. 1996 Feb 3;312(7026):302-7
references.pmid: 8611793
references.citation: Public Health Rep. 2006 Sep-Oct;121(5):494-500
references.pmid: 16972501
references.citation: Lancet. 2000 Sep 2;356(9232):787-8
references.pmid: 11022924
references.citation: J Acquir Immune Defic Syndr. 2009 Nov;52 Suppl 1:S6-11
references.pmid: 19858943
references.citation: Environ Sci Technol. 2008 Jun 15;42(12):4298-304
references.pmid: 18605547
references.citation: Lancet. 1998 Feb 7;351(9100):434-7
references.pmid: 9482320
references.citation: Bull World Health Organ. 2001;79(12):1106-12
references.pmid: 11799442
references.citation: J Clin Invest. 2004 Mar;113(6):799-804
references.pmid: 15067309
references.citation: Glob Health Gov. 2010 Spring;3(2):1-20
references.pmid: 22506090
references.citation: PLoS Med. 2005 Feb;2(2):e14
references.pmid: 15736991
references.citation: BMJ. 1997 May 10;314(7091):1404-7
references.pmid: 9161318
references.citation: Health Aff (Millwood). 2004 May-Jun;23(3):155-66
references.pmid: 15160813
references.citation: Am J Public Health. 1990 Oct;80(10):1188-92
references.pmid: 2400028
references.citation: Lancet. 2009 Sep 19;374(9694):961-962
references.pmid: 19762077
references.citation: Curr Pharmacogenomics Person Med. 2009 Dec;7(4):225-230
references.pmid: 20613883
references.citation: BMJ. 2005 Jul 30;331(7511):246-7
references.pmid: 16051991
references.citation: Health Promot Int. 2009 Mar;24(1):94-102
references.pmid: 19171669
references.citation: JAMA. 1999 Jan 27;281(4):361-7
references.pmid: 9929090
references.citation: Trop Med Int Health. 2010 Feb;15(2):208-15
references.pmid: 20002617
references.citation: World J Surg. 2008 Apr;32(4):533-6
references.pmid: 18311574
references.citation: J Epidemiol Community Health. 1999 Aug;53(8):451-2
references.pmid: 10562861
references.citation: Am J Public Health. 2005 Jan;95(1):60-70
references.pmid: 15623860
references.citation: Lancet. 2002 Feb 2;359(9304):435-8
references.pmid: 11844535
references.citation: Theor Med Bioeth. 2006;27(1):95-114
references.pmid: 16532305
references.citation: Trop Med Int Health. 2010 Mar;15(3):321-8
references.pmid: 20070637
references.citation: Am J Public Health. 2005 Jan;95(1):8
references.pmid: 15675078
references.citation: Soc Sci Med. 2008 Nov;67(10):1571-9
references.pmid: 18771835
references.citation: N Engl J Med. 2006 Aug 17;355(7):645-7
references.pmid: 16914698
references.citation: Trop Med Int Health. 2006 Mar;11(3):255-7
references.pmid: 16553904
references.citation: Milbank Q. 2008 Jun;86(2):273-326
references.pmid: 18522614
references.citation: Health Promot Int. 2009 Nov;24 Suppl 1:i11-i18
references.pmid: 19914984
references.citation: Soc Sci Med. 2002 Jun;54(11):1615-20
references.pmid: 12113444
references.citation: Health Policy Plan. 2004 Sep;19(5):271-8
references.pmid: 15310662
references.citation: Lancet. 2004 Sep 4-10;364(9437):900-6
references.pmid: 15351199
references.citation: St Louis U J Health Law Policy. 2010;3(2):253-289
references.pmid: 25309679
references.citation: Emerg Infect Dis. 2006 Jul;12(7):1058-65
references.pmid: 16836821
references.citation: Bull World Health Organ. 2006 Dec;84(12):984-90
references.pmid: 17242835
references.citation: Public Health. 2005 Nov;119(11):969-73
references.pmid: 16185732
references.citation: Int J Health Plann Manage. 2009 Jan-Mar;24(1):3-25
references.pmid: 19165763
references.citation: PLoS Med. 2010 Jan;7(1):e1000089
references.pmid: 20069038
references.citation: Lancet. 2010 Jan 9;375(9709):166-9
references.pmid: 20109894
references.citation: J Epidemiol Community Health. 2012 Jul;66(7):653-61
references.pmid: 22170940
references.citation: J Int Relat Dev (Ljubl). 2008;11(4):415-440
references.pmid: 32288631
references.citation: QJM. 2002 Jul;95(7):469-73
references.pmid: 12096152
references.citation: Annu Rev Public Health. 2004;25:475-95
references.pmid: 15015931
references.citation: Science. 2006 Jan 13;311(5758):162-7
references.pmid: 16410496
references.citation: Glob Health Gov. 2009 Apr 1;2(2):1-11
references.pmid: 24729827
references.citation: Int J Health Serv. 2000;30(1):187-210
references.pmid: 10707305
references.citation: JAMA. 2011 Apr 27;305(16):1642
references.pmid: 21521840
references.citation: Bull World Health Organ. 2001;79(9):842-9
references.pmid: 11584732
references.citation: N Engl J Med. 2006 May 11;354(19):1977-81
references.pmid: 16687709
references.citation: Am J Public Health. 2005 Jul;95(7):1091-2; author reply 1092
references.pmid: 15961750
references.citation: Bull World Health Organ. 2007 Mar;85(3):192-9
references.pmid: 17486210
references.citation: QJM. 2005 Apr;98(4):299-304
references.pmid: 15781480
references.citation: Lancet. 2004 Sep 18-24;364(9439):1092-7
references.pmid: 15380971
references.citation: Spec Law Dig Health Care Law. 1998 Jul;(232):9-44
references.pmid: 10181049
references.citation: J Epidemiol Community Health. 2006 Nov;60(11):998-1003
references.pmid: 17053290
references.citation: J Health Econ. 2003 Mar;22(2):151-85
references.pmid: 12606142
references.citation: J Acquir Immune Defic Syndr. 2009 Nov;52 Suppl 1:S12-3
references.pmid: 19858928
references.citation: PLoS Med. 2010 Jan;7(1):e1000183
references.pmid: 20052277
references.citation: World Hosp Health Serv. 2004;40(4):12-4
references.pmid: 15751547
references.citation: Bull World Health Organ. 1987;65(4):535-46
references.pmid: 3319270
references.citation: Lancet. 2007 Apr 21;369(9570):1373-1378
references.pmid: 17448824
references.citation: Filaria J. 2003 Sep 9;2(1):13
references.pmid: 13129436
references.citation: Bull World Health Organ. 2001;79(8):748-54
references.pmid: 11545332
references.citation: Lancet. 2009 Feb 7;373(9662):508-15
references.pmid: 19150128
references.citation: Health Aff (Millwood). 2004 May-Jun;23(3):167-76
references.pmid: 15160814
references.citation: Global Health. 2008 Sep 16;4:8
references.pmid: 18796148
references.citation: BMJ. 1994 Dec 3;309(6967):1491-5
references.pmid: 7804058
references.citation: Soc Sci Med. 2011 Jun;72(12):1956-64
references.pmid: 20675024
references.citation: Bull World Health Organ. 2001;79(9):869-74
references.pmid: 11584736
references.citation: Yale J Law Humanit. 2006;18(2):3
references.pmid: 25309105
references.citation: Lancet. 1997 Sep 13;350(9080):750-1
references.pmid: 9297988
references.citation: JAMA. 2007 Jul 11;298(2):225-8
references.pmid: 17622606
references.citation: Lancet. 2007 Dec 8;370(9603):1887-8
references.pmid: 18068498
references.citation: Crit Public Health. 2010;20(1):5-14
references.pmid: 27630450
references.citation: Soc Sci Med. 2008 May;66(9):1928-38
references.pmid: 18291566
references.citation: Food Drug Law J. 2004;59(2):355-81
references.pmid: 15298016
references.citation: Development (Rome). 2005 Jun 1;48(2):65-69
references.pmid: 25598648
references.citation: Proc Natl Acad Sci U S A. 2007 Oct 9;104(41):16038-43
references.pmid: 17913894
references.citation: J Public Health Policy. 2010 Apr;31(1):74-87
references.pmid: 20200527
references.citation: Bull World Health Organ. 2003;81(7):475
references.pmid: 12973638
references.citation: J Law Med Ethics. 2007 Winter;35(4):534-44, 511
references.pmid: 18076506
references.citation: PLoS Med. 2005 Jan;2(1):e8
references.pmid: 15696218
references.citation: Nat Rev Microbiol. 2006 Dec;4(12):900-8
references.pmid: 17088933
references.citation: J Public Health Med. 1997 Jun;19(2):171-8
references.pmid: 9243432
references.citation: JAMA. 2010 Jul 7;304(1):76-84
references.pmid: 20606152
references.citation: Bull World Health Organ. 2002;80(12):975-80
references.pmid: 12571727
references.citation: Bull World Health Organ. 2000;78(5):699-709
references.pmid: 10859865
references.citation: Lancet. 2003 Sep 13;362(9387):903-8
references.pmid: 13678979
references.citation: Lancet. 2010 Jan 2;375(9708):67-76
references.pmid: 20109865
references.citation: Chic J Int Law. 2002 Spring;3(1):27-46
references.pmid: 15709298
references.citation: World Dev. 2009 Jul;37(7):1182-1196
references.pmid: 20161458
references.citation: Br Med Bull. 2009;90:7-18
references.pmid: 19376802
references.citation: Lancet. 2009 Jan 24;373(9660):325-31
references.pmid: 19167061
references.citation: Soc Sci Med. 2007 Jan;64(2):259-71
references.pmid: 17055633
references.citation: Health Policy. 2007 Nov;84(1):89-100
references.pmid: 17449135
references.citation: Antipode. 2007 Nov;39(5):846-873
references.pmid: 32313325
references.citation: Health Policy Plan. 2008 Nov;23(6):369-75
references.pmid: 18689437
references.citation: Lancet. 2003 Feb 8;361(9356):523-6
references.pmid: 12583963
references.citation: PLoS Med. 2010 Jan 19;7(1):e1000179
references.pmid: 20087415
references.citation: Soc Sci Med. 2005 Jun;60(12):2661-71
references.pmid: 15820578
references.citation: Lancet. 2007 Oct 27;370(9597):1471-4
references.pmid: 17972367