Health justice – worldwide!
Health as a public good, and global
health governance
Nicoletta Dentico
Health policy adviser, Italian Global
Health Watch (OISG)
Berlin, 17-18 September 2010
Pioneering paradigms for change in
international development
Different decades seem to usher in new champions of
change in the health landscape:
 the developmental state approach in the ’60s
and ‘70s, with lead from WHO and national plan
 free-market forces (WB and WTO) and nongovernmental organizations (NGOs) in the ’80s and
90s
 the new millennium and its hybrid variant:
public-private partnerships (PPPs) and the rise of
venture philantropy in response to market failures and
state failures
The seduction of today’s
mobilizing concept: partnership
Public and private partnerships (PPPs)
are generally defined as initiatives where
public interest actors, private sector
companies and/or civil society
organizations enter into an alliance to
achieve a common purpose, pool core
competencies, share risks,
responsibilities, resources, costs and
benefits (Rein et al., 2005)
Pragmatism and institutional shift
• PPPs are seen as logical response to the structural
changes in the state-market-society relations
occurred since the ‘80s [globalization, the rolling back of state
responsibilities, the expanding of civil society, the massive growth of
corporate actors, the emergence of new actors like NGOs, the
strenghtening of so called technocratic policy making]
• Governance shift from institutional arrangements
based on formal structures to functional coalitions &
multistakeholder initiatives, which leverage on
complementarity skills to achieve greater impact
• Principled pragmatism, rather than politics, is the
key word – model for englithened global capitalism
(Likovsky, 2005)
• Voluntary approaches vs. norms and regulations
A few headlines for an expanding agenda
• Changing fortunes in the roaring nineties and the rise of
PPPs;
• Systemic inequity, growing inequalities and the
reactivation of philanthropic sentiments (doubling of
corporate foundations in the US from 1295 in 1987 to
2549 in 2003) strategic philantropy (Porter and Kramer
2003; Knudsen 2004) – health the privileged ground!
• Declining trends in official development assistance;
• Corporate globalisation and the legitimization of an
economic system controlled by corporate elites;
• Hegemonic strategy behind the upsurge of PPP
discourse and practice – reaction to emergence of
campaigns/ movements concerned with power of TNC:
not only defence to societal pressure, also leadership!!
The UN as the main paladin of
the partnership ideology
• The UN Global Compact (UN-BP)
• Global health funds
• The MiIllennium Development
Goals
MDG Declaration, section III, para 19 “ to develop strong
partnerships with the private sector and with civil
society organizations in pursuit of development and
poverty eradication”
The Babel Tower
• Global health has ascended in the
international political agenda, and it’s “the
talk of the hall”
• The raft of new organisations, istitutes,
funds, alliances, centres and specific
initiatives with a global health remit has
radically transformed – geopolitically
and culturally – the global health scene
Any potential developmental downside?
• Need to shift from “the more the marrier” approach
to critical thinking as part of the health justice package
• Issues of winners and losers; conflict of interests,
controversial policy agendas; priority setting criteria; the
politics of knowledge; the institutional reform; imbalances
in power relations – the equal footing factor
• increasing fragmentation; vertical approaches,
accountability, issues of coordination and
complementarity; the horizontal relationships and the
potential for structural fragmentation
• The role of WHO (cfr. the pharma agenda)?
• Governments and their constitutional obligations?
Then?
Attention needs to be given to HOW the growing
patchwork of alliances and initiatives in health
could be turned into a system of global health
governance built on existing organisations,
common values and agreed regimens, to
provide global health public goods, including
health research, the generation and
dissemination of knowledge, norms and
regulatory standards. While the determinants
of health and the measures to address health
problems have become subject to
transnational forces, intergovernmental
collaboration is becoming more and more
essential
Meaning that….
• The laissez-faire approach to this model, with its
questions of governance and accountability,
needs to turn to a more responsible attitude by
those who care for the right to health – more
policy research
• While it is not possible to give a sweeping value
judgement on PPPs, it is urgent to select and
promote only those partnerships that are
congruent with both government priorities and
UN goals, and which enhance local ownership
and decentralization;
We need to transform the discourse on
collaborations
• A bolder leadership from WHO – back to the
future!
• Sustainable financing mechanisms for countries
to properly respond to health needs – the wealth
poverty line discourse!
• Urgently create a framework for health
partnerships governance and accountability
• Resume and enhence a post 2008 corporate
accountability convention (the WSDS in
2003)