By John Kirton, director, Global Governance Program
T he outbreak of the deadly Covid-19 pandemic in 2020 catalysed a proliferation of innovation in health practice, policy and governance. But almost four years later, serious questions remain about how integrated and impactful the many institutional innovations at the global, regional and country levels have been. Covid-19 and its ongoing offspring from new variants dramatically showed that the health of our planet and its living things is a highly integrated whole. It also showed that our ways of protecting and promoting their health and well-being remain fragmented, and consequently often fail to meet the growing global need. The midsummer arrival in 2023 of the unprecedented heat and extreme weather events around the world further showed that our planet is a single integrated ecosystem, on which its people, animals and plants directly depend to stay alive and thrive. Our failure to protect the health of our planet is harming the physical, mental and social well-being of its eight billion human inhabitants and their descendants for generations to come. The death and damage are compounded by the simultaneous eruption of several other, interconnected crises that threaten to overwhelm us: armed conflict between and within states, and resulting energy and food insecurity, inflation, debt crises and development lags. As a result, progress towards reaching the United Nations’ 17 Sustainable Development Goals is stalling as we pass the halfway mark to deliver them by 2030. The world thus urgently needs global health governance to
replace the fragmentation of an incomplete set of single silos with integration based on synergies among all its components and coherence as a comprehensive whole.
THE WORLD HEALTH ORGANIZATION At the centre of the global
health architecture stands the World Health Organization. It alone has the legal power and political responsibility “to act as the directing and coordinating authority on international health work”. It admirably defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. With full inclusiveness it affirms “the health of all peoples is fundamental to the attainment of peace and security and is dependent on the fullest co-operation of individuals and States”. The WHO and its governing body, the annual ministerial-level World Health Assembly, have initiated, overseen or contributed to many of the institutional and legal innovations catalysed by the Covid-19 crisis. These include efforts to revise the International Healthy Regulations and to create a fund for pandemic preparedness and response, COVAX and its Accelerator, and the WHO Hub for Pandemic and Epidemic Intelligence in Berlin. The crisis also led WHA member states to agree to increase to 50% the share of their WHO financing they give as assured, assessed contributions, rather than in voluntary, discretionary form. Yet the WHO’s budget remains only the size of that of a large hospital in a major city, while its responsibilities are
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HEALTH: A POLITICAL CHOICE Health: A Political Choice – From Fragmentation to Integration
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