Understanding What Human Rights Brings to Development and Health Policy Debates: Global Health as a Reflection of Global (In)Justice

The field of global health has expanded exponentially in the last ten years. College and post-graduate programs on public health and global health have increased from 109 to 186 between 2007 and 2016.¹ In that context, Governing Global Health: Who Runs the World and Why? (hereinafter Governing Global Health) is a well-written, accessible book that describes how a set of critically important institutions engage in global health functions, and it should be read by this burgeoning group of practitioners and students of global health alike.

Indeed, the central issue that Chelsea Clinton and Devi Sridhar, the authors of Governing Global Health, set out to address is one that should concern everyone interested in creating equitable rule-based national and international systems and inclusive development in today’s world of egregious inequalities and spread of illiberal democracies:

We are also aware that for millions of women, children, and disadvantaged people around the world, the absence of efficient, effective, and equitable health systems is a source of vulnerability and distress, and part of a vicious cycle of poverty. Our concern in this book is to ask what at a global level can be done to change this picture.²

The conceptual framework that Clinton and Sridhar employ to analyze global health governance today and to arrive at recommendations for how to “change this picture” is “principal-agent theory,” which they argue helps to explain the relationship between principals (member states) and an international organization (the agent), and “how the initial aspirations of each were helped (or not) by their governance structures and financing dynamics” at the outset and over time.³

In conducting their four case studies of both multilateral and private institutions in global health, these two authors bring to bear substantial engagement in the field, which inexorably has informed their views. Chelsea Clinton is Vice Chair of the Clinton Foundation and was involved in the Clinton Global Initiative, as well as being an adjunct assistant professor of health policy and management at the Mailman School of Public Health at Columbia University. Devi Sridhar is Professor and Chair in Global Public Health at the University of Edinburgh Medical School and has long been involved in the boards of Partners in Health and Save the Children.

In this review, I make three points. First, I underscore that the book accomplishes much of what it sets out to do. That is, it not only characterizes the differences among four major institutions engaged in global health—the World Health Organization (WHO); the World Bank; the Global Fund for HIV/AIDS, Tuberculosis, and Malaria (Global Fund); and Gavi, the Vaccine Alliance (formerly Global Alliance for Vaccines and Immunization (GAVI, now “Gavi”)—but the book also provides an understanding of the relative scale of work of all of these organizations, which is enlightening even for those who are well-versed in global health. Governing Global Health also considers some other major players, notably the Gates Foundation, which in 2013 gave over USD 1 billion to global health,⁴ and exercises significant policy leverage as a member of the so-called “H8.”⁵

Second, I want to build on some points that Governing Global Health either does not address or only touches on briefly, and which sets apart an analysis of global health and governance from a human rights perspective. Finally, although Governing Global Health was technically published in 2017, I suspect the manuscript was turned in before many of the political upheavals of 2016. I want to suggest that because of the dramatic ascendance of conservative populist nationalism the world has seen in recent months, the portrait Clinton and Sridhar paint of who runs the world now stands as an urgent wake-up call for anyone who cares about global health as a public good.

First of all, despite the proliferation of global health work in recent years, most people working in...