Global Health Governance and Role of States

Abstract

This chapter discusses the realm within which PEPFAR is implemented and recipient states play a role, that is, global health. The engagement to be pursued throughout this chapter departs from an exercise of reflection on the leading narratives on this topic by scholars, activists and policy makers. In this regard, context is very crucial: global health was elaborated in parallel with the emergence of human security as a paradigm of Western foreign policy for the post-Cold War, and this has held consequences in terms of the ‘securitisation’ of health-related issues. This intertwines with dimensions of social change inside the West in the last three decades under the influence of the sociology of risk, yet also juridical-institutional changes at the level of the World Health Organisation’s (WHO) International Health Regulations (IHR), which underwent revision in 2005. Nonetheless, the governance of global health remains faulty, as the plethora of national and international, public and private entities involved in global health are subject to no kind of world government. Global health governance’s incoherent status ultimately invites the appraisal of the role of traditional actors — states — in this domain, including weaker, smaller ones.