Challenges Beyond Borders

Intensified cross-border movement of people, goods and information has created global risks beyond the capacity of any one nation-state to manage. The state-based system for international governance constructed after World War II lacks the political authority or enforcement powers to protect and promote global health. And yet globalization has positioned health as central to state interests and foreign policy on issues such as pandemics and vector-borne disease, the health impacts of trade and intellectual property regulations, and workforce migration. The challenge is how to effectively strengthen both global health governance and global governance for health, in order to collectively address shared risks such as the economic burden of chronic disease, health consequences of conflict, food and water insecurity, and environment and climate change. How can we improve the governance of actors in both the health and non-health sectors, foster communication and cooperation, and collaboratively construct new kinds of cross-sectoral alliances and policy instruments?

Subthemes

Globalization & Health

Infectious Diseases

Governance for Health

GLOBAL HEALTH GOVERNANCE

The effects of globalization on health call for clear and well-coordinated governance and stewardship by global actors. Global health governance refers mainly to those institutions and processes of governance which have a primary and explicit health mandate, such as the World Health Organization. But it also includes regional alliances, public-private partnerships and multilateral international consortia that focus on global health. The architecture of global health governance should be capable of functions at the global level (e.g., international collective action), but also support the strengthening of national health systems. The recent Ebola crisis has shown that weak health systems make countries more vulnerable and makes both the domestic and global response far more challenging. Of equal importance is to improve the coordination and collaboration of global health actors and funders to avoid duplication, redundancy and inefficiency, and better empower and support country priority-setting and decision making.

Below are examples of resources relevant to the overarching themes. Previously highlighted resources and additional resources can be found in our digital Repository.

Resources:

Progress on Household Drinking Water, Sanitation and Hygiene 2000-2022
This report, published jointly by the United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO), presents national, regional, and global estimates for water, sanitation, and hygiene (WASH) in households from 2000 to 2022. The report includes a special focus on gender and WASH, highlighting the impacts of drinking water, sanitation, and hygiene on women and girls worldwide, and how gender inequalities impact progress toward realizing global SDG targets for WASH.

Global Tobacco Epidemic Report 2023
This report from the World Health Organization (WHO) analyzes the global progress made in tobacco control by countries worldwide. The 2023 report marks 15 years since the 'MPOWER' measures were introduced–six guidelines established by the WHO Framework Convention on Tobacco Control (FCTC) to promote government action on tobacco control. The 'MPOWER' measures include monitoring tobacco use; protecting people from tobacco smoke; offering cessation help; warning about tobacco dangers; enforcing bans on advertising; and raising taxes. The report finds that significant progress has been made toward tobacco control measures globally. Still, it highlights the need to accelerate efforts in specific areas, including more widespread adoption of smoke-free places and ensuring compliance with smoke-free laws. 

Global Status Report on Road Safety 2023
This report from the World Health Organization (WHO) provides an overview of progress made toward global road safety. This 2023 report presents the first complete set of findings from the Decade of Action for Road Safety 2011-2020, assessing the burden of road traffic deaths worldwide and the actions needed to address gaps. This report presents road traffic deaths by region, evaluates how the burden has shifted over the past decade, and presents measures toward reducing the risk of death or injury, such as safe road infrastructure, speed management, and seat-belt use. The authors call for urgent action toward addressing road safety to achieve the global goal of reducing road traffic deaths by half by 2030.

EMERGING INFECTIOUS DISEASES

Insufficient financing and weak incentives currently exist for investment in research and development to tackle neglected and poverty-related diseases that make up the ‘unfinished agenda’ in less developed countries, as well as new infectious diseases that are emerging or re-emerging in the context of globalization. Consider malaria. If there’s any one disease that can be described as “global”—in its reach and in the impact of its consequences—it is malaria. Almost half of the world’s population is at risk for this illness, which can lead to anemia, incapacitation, and death; in Africa alone, malaria kills more children than any other disease. Malaria presents a medical challenge calling for advances in science and policy that counteract resistance to treatments and fulfill the need for vaccines. Yet malaria’s reach and impact reflect deeper challenges, a complex web of interrelated biomedical and socioeconomic problems, and the need for better communications among diverse stakeholders. Programs such as the Harvard University initiative, Defeating Malaria: From the Genes to the Globe, help leverage expertise in law, politics, business, education, engineering, and design to address every dimension of the malaria challenge.

Below are examples of resources relevant to the overarching themes. Previously highlighted resources and additional resources can be found in our digital Repository.

Resources:

The Role of HIV Viral Suppression in Improving Individual Health and Reducing Transmission
This policy brief from the World Health Organization (WHO) describes the available viral load testing approaches for monitoring how well antiretroviral therapy is working for people living with HIV. Antiretroviral therapy has transformed the lives of people living with HIV, altering the course of a once-fatal disease into a manageable chronic condition that can be treated. The brief is intended to be helpful to people living with HIV, healthcare providers, laboratory staff, program managers, and policymakers.

Regional Immunization Snapshots
These immunization snapshot brochures published by the United Nations Children’s Fund (UNICEF) provide key statistics on immunizations for each of the major world regions. These brochures include data visuals such as graphs and tables to show coverage levels of immunizations against specific diseases such as measles, polio, DTP-3 (diphtheria-tetanus-pertussis), and more in infants and children. For each region, the brochures show historical trends of vaccine coverage, cross-national and cross-regional comparisons, and tools to help users interpret the provided graphs and figures. Users can view the number of under-vaccinated children in each region and compare immunization coverage across countries within a region.

Cholera Fact Sheet
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This fact sheet from the World Health Organization (WHO) provides a general overview of cholera. It offers key facts about the disease, and includes information about the history of cholera, its epidemiology, major risk factors, and the burden of disease worldwide. It also includes information on prevention and control, surveillance efforts, treatment, various intervention methods, and vaccines. The fact sheet also details the WHO’s response efforts in addressing cholera worldwide.

GLOBAL GOVERNANCE

Global governance for health refers mainly to those institutions and processes of global governance that do not have primary health mandates, but that can directly or indirectly influence health, such as trade and finance, security and foreign policy, migration and labor, or agriculture and environment. The institutional actions within these domains influence health determinants within countries and are often the drivers of the global flows of health-relevant risks between countries. The health sector will need to acquire an understanding of these domains, develop relationships with its representatives, and engage in new kinds of alliances if health is to be considered in their strategies and policies. Even then, there will be formidable challenges given the competing interests of powerful global actors, and the relative paucity of mechanisms and instruments for cross-sectoral global policy. Global health leaders and leaders who value global health—both have a role to play in meeting these challenges.

Below are examples of resources relevant to the overarching themes. Previously highlighted resources and additional resources can be found in our digital Repository.

Resources:

World Development Report 2023
The 2023 edition of the World Development Report (WDR), published annually by the World Bank, explores the role of migration in development, examining how cross-border movements of migrants and refugees impact international development. The report highlights that 184 million people worldwide live outside of their country of nationality, and offers a framework to maximize the development impacts of migration, including how migration can help achieve the global Sustainable Development Goals (SDGs).

The State of Global Learning Poverty: 2022 Update
This report, published by the World Bank, the United Nations Children’s Fund (UNICEF), the U.K Government’s Foreign, Commonwealth & Development Office (FCDO), the United States Agency for International Development (USAID), and the Bill and Melinda Gates Foundation, delves into the global learning crisis impacting millions of children worldwide—and the impacts of the COVID-19 pandemic on learning poverty. The report finds that the learning crisis, which predated the pandemic, was made more severe by COVID-related school closures and disruptions. The report outlines the current challenges impacting children’s learning outcomes worldwide and highlights the need for high-quality learning data across countries.

World Report 2024
This annual report, published by Human Rights Watch (HRW), summarizes data about global human rights conditions and practices from more than 100 countries and territories worldwide. This year’s report, focusing on events from 2023, highlights the incredible threats to human rights and their protection worldwide in the face of widespread repression, selective government outrage, and transactional diplomacy – all of which resulted in significant costs for the human rights of peoples across the globe. 

Regional Profile

The Next Pandemic Flu

Outbreaks of both the H5N1 and H1N1 influenza strains have illustrated that the global institutions charged with preventing and responding to these pandemics are not up to the task. With both, there were significant problems with the development, production, and distribution of flu vaccines. Indeed, stemming a modern-day pandemic depends on the rapid development, sufficient production, and equitable, timely access to influenza vaccines, all within a complex global context. Compounding these challenges are the disease-specific “unknowns” related to the emergence of a new virus, including severity levels, transmission ease, human immunity, and drug vulnerability. Explore a teaching case that highlights the challenges of managing externalities and sovereignty through the example of pandemic flu. Learn more through a perspective on the future of the Pandemic Influenza Preparedness (PIP) Framework, initially established to promote the fair sharing of public health–related pandemic influenza samples between countries.

Population Snapshot

Vaccine Partnerships for Population Health

This case follows the vaccine development for Meningitis A, a disease that routinely caused deadly epidemics in Sub-Saharan Africa. The case explores why this vaccine had not been developed previously and how the creation of the Meningitis Vaccine Project (MVP)—a partnership between the World Health Organization (WHO) and PATH, a non-governmental organization—enabled the vaccine to be successfully developed over 10 years by creating a novel product development partnership. Students examine why the public/private partnership was successful and how such a model could be applied to the development of other vaccines and health technologies. Additionally, the case explores the strategies applied by Marc LaForce, the MVP’s director and veteran public health advocate, to make the MVP a success.

Sector Perspective

Global Governance for Health

Many of the factors that influence health are outside the direct control of national governments and often also outside the control of the health sector. How can global governance processes outside the health system better protect and promote the health of the world’s population? This was the driving question explored by The Lancet-University of Oslo Commission on Global Governance for Health. The Commission’s work was published in an extensive report in The Lancet on February 11, 2014. The report examines power disparities and dynamics across a range of policy areas that require improved global governance: economic crises and austerity measures, intellectual property, foreign investment treaties, food security, transnational corporate activity, irregular migration, and violent conflict

Featured

Global Security

This commission report The Neglected Dimension of Global Security: A Framework to Counter Infectious Disease Crises considers the evidence supplied by four workshops convened by the Institute of Medicine to analyze the international management and response to infectious disease outbreaks. Since the 2014 Ebola outbreak many public—and private—sector leaders have seen a need for improved management of global public health emergencies. The effects of the Ebola epidemic go well beyond the three hardest-hit countries and beyond the health sector. Education, child protection, commerce, transportation, and human rights have all suffered. The consequences and lethality of Ebola have increased interest in coordinated global response to infectious threats, many of which could disrupt global health and commerce far more than the recent outbreak. The report offers recommendations to guide policy makers, international funders, civil society organizations, and the private sector.