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Governance Challenges in Global Health

Global health is at the threshold of a new era. Few times in history has the world faced challenges as complex as those now posed by a trio of threats: first, the unfinished agenda of infections, undernutrition, and reproductive health problems; second, the rising global burden of noncommunicable diseases and their associated risk factors, such as smoking and obesity; and third, the challenges arising from globalization itself, such as the health effects of climate change and trade policies, which demand engagement outside the traditional health sector.1 These threats are evolving within a multifaceted and dynamic global context characterized by great diversity among societies in norms, values, and interests, as well as by large inequalities in the distribution of health risks and the resources to address them. A robust response to this complex picture requires improved governance of health systems — certainly at the national level but also at a worldwide level in what could be thought of as the “global health system.” However, the concept of governance is still poorly understood despite its growing visibility in current debates about global health. In this article, we define and discuss the importance of good global governance for health, outline major challenges to such governance, and describe the necessary functions of a global health system.

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