ULUSLARARASI SAĞLIK POLITIKASINDAN KÜRESEL SAĞLIK POLITIKASINA GEÇIŞ: AKTÖRLER, ÇERÇEVELER VE ZORLUKLAR

Öz

Son yirmi yıldır, özellikle küreselleşmenin hız kazanması ile birlikte, küresel sağlık alanındaki aktörlerin sayısı da çoğalmıştır. Böylece ulus devlet odaklı işleyen uluslararası sağlık yönetiminin (IHG) yerini, sivil toplum örgütlerini ve şirketleri bünyesine katmayı başaran küresel sağlık yönetimi (GHG) almıştır. Bu çalışma IHG modelinden GHG modeline yapılan bu geçişi farklı yönleriyle ele alacaktır. İlk olarak bu değişimin tarihsel arka planına ışık tutacak, sonra da bu iki modeli oluşturan aktörlerin rollerini inceleyecektir. Buna bağlı olarak küresel sağlık politikalarda dikey ve yatay modeller arasındaki gerilimi irdeleyecektir. Çalışma son olarak sağlık yönetiminin karşı karşıya olduğu zorlukların altını çizecektir. Bu zorluklar ihmal edilen tropikal hastalıklar (NTD), sağlığın sosyal belirleyicileri (SDH), kamu-özel ortaklıkları (PPP) ve fikri mülkiyet haklarıdır (IPR).

Anahtar Kelimeler

• küresel sağlık
• kamu sağlığı
• politika
• küreselleşme
• Dünya Sağlık Örgütü

THE SHIFT FROM INTERNATIONAL TO GLOBAL HEALTH POLICY: ACTORS, FRAMEWORKS, AND CHALLENGES

Öz

During the last two decades, particularly with the acceleration of globalization, there has been a proliferation of new actors in the field of global health. This resulted in a shift from international health governance (IHG) model, which recognizes nation state as the core actor, to global health governance (GHG) model, which incorporates civil society organizations and businesses. This article will explore this shift from IHG to GHG from multiple angles. It will first shed light on the historical origins of this phenomenon and then analyze the role of each actor that constitute these models. This will be followed by an assessment of the tension between vertical and horizontal approaches to global health policy. The article will finally underline the main challenges that are ahead of global health governance. These challenges are neglected tropical diseases (NTD), social determinants of health (SDH), public private partnerships (PPP), and intellectual property rights (IPR).

Anahtar Kelimeler

• global health
• public health
• policy
• globalization
• World Health Organization

Kaynakça

1. ‘t Hoen, E., Berger, J., Calmy, A., et. al. (2011). Driving a decade of change: HIV/AIDS, Patents, and Access to Medicine. Journal of the International AIDS Society, 14, 1 – 12.
2. Aginam, O. (2005). Global Health Governance: International Law and Public Health in a Divided World. Toronto: University of Toronto Press.
3. Balcius, J. and Novotny, T. E. (2011). New approaches to global health governance: The evolution to public-private partnerships. Journal of Commercial Biotechnology, 17, 233 – 240.
4. Birn, A. and Lexchin, J. (2011) Beyond patents: The GAVI Alliance, AMCs and improving immunization coverage through public sector vaccine production in the global south, Human Vaccines, 7 (3), 291 – 292.
5. Dudley, L. and Garner, P. (2011). Strategies for integrating primary health services in middle- and low-income countries at the point of delivery. Cochrane Database of Systematic Reviews, (7):CD003318.
6. Brown, T. M., Cueto, M. and Fee, E. (2006). The World Health Organization and the transition from ‘international’ to ‘global’ public health. American Journal of Public Health, 96 (1), 62 – 72.
7. Burrone, E., Gotham, D., Gray, et. al. (2019). Patent pooling to increase access to essential medicines. Bulletin of the World Health Organization, 97 (8), 575 – 577.
8. Buse, K. and Walt, G. (2000). Role conflict? The World Bank and the world’s health. Social Science and Medicine, 50 (2), 169 – 176

9. Caines, K., Buse, K., Carlson, C., et al. (2004). Assessing the Impact of Global Health Partnerships. London: DFID Health Resource Centre.
10. Cairncross, S., Peries, H. and Cutts, F. (1997). Vertical health programmes. Lancet, 349 (Suppl. III), 20 – 22.
11. Castellani, A. and Chalmers, A. J. (1919). History of tropical medicine. In Manual of Tropical Medicine, 3rd ed. (pp. 3 – 38). New York: Wm Wood & Co.
12. Chisholm, B. (1950). The World Health Organization. British Medical Journal, May 6, 4661- 1027.
13. Cohen, J. (2006). The New World of Global Health. Science, 311 (January 13), 162 – 67.
14. David, B. and Casady, C. B. (2020). Proactive and strategic healthcare public-private partnerships (PPPs) in the coronavirus (Covid-19) epoch. Sustainability, MDPI, Open access journal, 12 (12).
15. Donkin, A., Goldblatt, P., Allen, J., et al. (2017). Global action on the social determinants of health. BMJ Glob Health, 1 – 17. Doyle, C. and Patel, P. (2008). Civil society organisations and global health initiatives: problems of legitimacy. Social Science and Medicine, 66 (9), 1928 – 1938.
16. Engels, D. and Zhou, X. N. (2020). Neglected tropical diseases: an effective global response to local poverty-related disease priorities. Infect Dis Poverty, 9 (10).
17. Fidler, D. (2001). The Globalization of Public Health: The First 100 Years of International Health Diplomacy. Bulletin of the World Health Organization, 79 (9), 842 – 49.
18. Frenk, J. and Moon, S. (2013). Governance Challenges in Global Health. The New England Journal of Medicine, 368, 936 – 942.
19. Frenk, J., Gomez-Dantes, O., and Moon, S. (2014). From sovereignty to solidarity: a renewed concept of global health for an era of complex interdependence. The Lancet, 383 (9911), 94 – 97.
20. Gopinathan, U., Watts, N., et al. (2019). Global governance and the broader determinants of health: A comparative case study of UNDP’s and WTO’s engagement with global health. Global Public Health, 14 (2), 175 – 189.
21. Heeringa, J., Mutti, A., Furukawa, M. F., et al. (2020). Horizontal and Vertical Integration of Health Care Providers: A Framework for Understanding Various Provider Organizational Structures. International Journal of Integrated Care, 20 (1), 1–10.
22. Helble, M., Ali, Z. and Lego, J. (2018). A comparison of global governance across sectors: Global health, trade, and multilateral development finance. ADBI Working Paper, No. 806, Asian Development Bank Institute (ADBI), Tokyo.
23. Held, D., Kickbush, I., McNally, K., et al. (2019). Gridlock, Innovation and Resilience in Global Health Governance. Global Policy, 10 (2): 161 – 177.
24. Hoen, E. F. M., Kujinga, T. and Boulet, P. (2018). Patent challenges in the procurement and supply of generic new essential medicines and lessons from HIV in the southern African development community (SADC) region. Journal of Pharmaceutical Policy and Practice, 11 (31).
25. Howard-Jones, N. (1950). Origins of international health work. British Medical Journal, 1 (4661), 1032 – 1037.
26. Kickbusch, I. (2000). The development of international health policies: Accountability intact? Social Science and Medicine, 51 (6), 979 – 89.
27. Kilama W. L. (2009). The 10/90 gap in sub-Saharan Africa: resolving inequities in health research. Acta Trop, 112 (Suppl 1), 8 – 15.
28. King, N. B. (2002). Security, disease, commerce: Ideologies of postcolonial global health. Social Studies of Science, 32 (5-6), 763 – 789.
29. Lee, K. (2010). How do we move forward on the social determinants of health: The global governance challenges. Critical Public Health, 20 (1), 5 – 14; Economist. (2008). The price of being well. Economist, 388 (8595), 59 – 60.
30. Lee, K. Sridar, D. and Patel, M. (2009). Bridging the divide: global governance of trade and health. The Lancet, 373 (9661), 416 – 422.
31. Lee K. (2010). Civil society organizations and the functions of global health governance: what role within intergovernmental organizations? Global Health Governance, Spring, 3 (2).
32. Lee, S. (1997). WHO and the developing world: the contest for ideology. In Andrew Cunningham and Bridie Andrews (Eds.), Western Medicine as Contested Knowledge (pp. 24 – 45). Manchester: Manchester University Press.
33. Leigland, J. (2018). Public-private partnerships in developing countries: the emerging evidence-based critique. The World Bank Research Observer, 33 (1), 103 – 134.
34. Levi, J., Raymond, A., Pozniak, A., et al. (2016). Can the UNAIDS 90-90-90 target be achieved? A systematic analysis of national HIV treatment cascades. BMJ Global Health, 1, e000010.
35. Magnussen, L., Ehiri, J. and Jolly, P. (2004). Comprehensive versus selective primary health care: lessons for global policy. Health Affairs, 23 (3), 167 – 76.
36. Marten, R., & Smith, R. D. (2018). State support: a prerequisite for global health network effectiveness comment on ‘four challenges that global health networks face’. International journal of health policy and management, 7 (3), 275 – 277.
37. McKee, M. and Garner, P. and Stott, R. (2001). International Co-operation and Health. Oxford: Oxford University Press.
38. McKee, M. (2001). Epidemiology in the 21st Century: the challenges ahead. European Journal of Public Health, 11, 241 – 242.
39. Mills, A. (1983). Vertical vs horizontal health programmes in Africa: idealism, pragmatism, resources and efficiency. Social Science and Medicine, 17, 1971 – 1981.
40. Mills, A. (2005). Mass campaigns versus general health services: what have we learned in 40 years about vertical versus horizontal approaches? Bulletin of the World Health Organization, 83 (4), 315 – 316.
41. Msuya, J. (2005). Horizontal and vertical delivery of health services: what are the tradeoffs? Washington, DC: World Bank.
42. Oliviera-Cruz, V., Kurowski, C. and Mills, A. (2003). Delivery of health interventions: searching for synergies within the vertical versus horizontal debate. Journal of International Development, 15, 67 – 86.
43. Ooms, G., Van Damme, W., Baker, et. al. (2008). The ‘diagonal’ approach to Global Fund financing: a cure for the broader malaise of health systems? Globalization Health, 4 (6). 
44. Patel, P., Cummings, R. and Roberts, B. (2015). Exploring the influence of the Global Fund and the GAVI Alliance on health systems in conflict-affected countries. Conflict and Health, 9 (7).
45. Rochford C., Tenneti N. and Moodie R. (2019). Reframing the impact of business on health: the interface of corporate, commercial, political and social determinants of health. BMJ Global Health, 18 (4), e001510.
46. Ruger, J. P. (2014). International Institutional Legitimacy and the World Health Organization. Journal of Epidemiology Community Health, 68, 697 – 700.
47. Sands, P. (2019). Putting country ownership into practice: the global fund and country coordinating mechanisms. Health System Reform, 5 (2), 100 – 103.
48. Sayward, A. L. S. (2006). Constructing international authority in the World Health Organization. In Birth of Development: How the World Bank, Food and Agriculture Organization, and World Health Organization Changed the World, 1945-1965. (pp 137- 160). Kent State University Press.
49. Smith, J. and Lee, K. (2018). The role of the business sector in global health politics. In Colin McInnes, Kelly Lee and Jeremy Youde (Eds.) The Oxford Handbook of Global Health Politics. Oxford: Oxford University Press.
50. Spethmann, B. (2007). The RED brigade. Promo, 20 (2), 18 – 25.
51. Swidler, A. and Watkins, S. (2009). Teach a man to fish: the sustainability doctrine and its social consequences. World Development, 37 (7), 1182 – 1196.
52. Tchiombiano, S. (2019). Public health, private approach: the Global Fund and the involvement of private actors in global health, Face à Face, 15.
53. The General Assembly of the UN. (2018). Resolution A/Res/73/254, adopted on 20 December.
54. The World Health Organization (1948). Constitution of the World Health Organization. Geneva: World Health Organization.
55. Till, A., Dutta, N. and McKimm, J. (2016). Vertical leadership in highly complex and unpredictable health systems. British Journal of Hospital Medicine, 77 (8), 471 – 475.
56. Travis, P., Bennett, S., Haines, A. et al. (2004). Overcoming health-systems constraints to achieve the Millennium Development Goals. Lancet, 364, 900 – 906.
57. Venediktov, D. (1998). Alma Ata and after. World Health Forum, 19, 79 – 86.
58. Weindling, P. (1995). Social medicine and the League of Nations Health Organization. In Weindling International Health Organizations and Movements (PP. 134 – 153). Cambridge: Cambridge University Press..
59. Whyte, A., McCoy, D., Rowson, M., eds. (2005). Global Health Action: Global Health Watch Campaign Agenda. Umea: Russell Press.
60. Williams, O. D. and Rushton, S. (2011). Are the ‘good times’ over? Looking to the future of global health governance. Global Health Governance, 5 (1) (Fall), 1 – 19.
61. Wisner, B. (1988). Gobi versus PHC? Some dangers of selective primary health care. Social Science & Medicine, 26 (9), 963 – 969.
62. World Trade Organization. Declaration on the TRIPS Agreement and Public Health. (Adopted on 14 November 2001), WTO.doc WT/MIN(01)/DEC/2 (20 November 2001) https://www.wto.org/english/thewto_e/minist_e/min01_e/mindecl_trips_e.htm
63. Worth, J. (2006). Punk rock capitalism? New Internationalist, (November), 16 – 17.