Global Health: A Centralized Network Searching (in Vain) for Hierarchy

Abstract

Efforts to govern health globally have broadened considerably since the 1850s in terms of the subjects, goals, participants, and instruments of governance efforts. Originating in a thin, limited set of rules formally agreed by states, the contemporary global health system has evolved into a complex, dense, yet fragmented network involving governance processes both within and outside the health sector, engaging hundreds of state and non-state actors across all countries. Broader global trends shaped health governance, but key features of the current system also owe much to the particularities of specific events: the HIV/AIDS pandemic, West African Ebola crisis, and most recently Covid-19. Can contemporary networked governance processes can add up to a coherent, functional system for protecting global public health, or is more hierarchy needed? The World Health Organization is a central convenor, legitimator, adviser, and political arena in a fragmented system, but has not yet been empowered to assume the role of a directive coordinator. The extent to which major powers will construct a more hierarchical system is an open question in a world that is not yet post-Westphalian nor truly multipolar.