The Handbook of Global Health Policy	3
	Contents	7
	Figures and Tables	11
	Notes on Contributors	15
	Foreword	31
	References	33
	Acknowledgments	35
	Introduction	37
	Why Global Health Policy	37
	The State of the Worlds Health	38
	A New Kind of Handbook to Guide Action on these Challenges	40
	Five Key Themes Emerging from the Book	42
	Theme 1: Global Health is Increasingly Multidimensional, Requiring Innovation in Interdisciplinary and Collaborative Approaches	42
	Theme 2: There is a Need for Greater Innovation in National and Global Health Governance	44
	Theme 3: Health Aid to Developing Countries Requires Re-engineering	46
	Theme 4: Scientific Evidence must be Balanced with Political and Ethical Considerations	48
	Theme 5: Promoting Global Health is Clearly an Ethical Issue, But the Scope and Scale of Our Normative Commitment Remain Undetermined	50
	Conclusions	51
	References	52
	Part I Global Health Policy and Global Health Governance	55
	1 Understanding Global Health Policy	57
	Introduction	59
	Globalization and the Transformation of Global Health Policy	61
	New Global Health Policy Actors	62
	Global Health Policy Instruments and Levers	67
	Contribution of Theory to Understanding Global Health Policy	71
	Functional Rationality: The Policy Process as a Set of Stages or a System	72
	Explanatory Theories of Policy Processes	73
	Conclusions and Pointers for the Health Policy Analyst	77
	References	78
	2 Critical Reflections on Global Health Policy Formation: From Renaissance toCrisis	83
	Introduction	85
	From Renaissance to Crisis	85
	How can the Crisis in Global Health be Explained?	88
	Critical Understandings of Policy Formation	91
	Overcoming the Four Rs: Recommendations	93
	Conclusions	94
	References	95
	3 Contemporary Global Health Governance: Origins, Functions, and Challenges	99
	What is Global Health Governance?	101
	What Purpose does Global Health Governance Serve?	101
	Why Would a Powerful State Agree to Work through Global Institutions?	102
	Key Functions of Global Health Governance	103
	Internationally Financed Action	104
	International Regulation	105
	Research and Surveillance	105
	Major Developments in International Health Institutions: New Players and New Priorities	106
	The Current Crisis in Global Health Governance	107
	Dismantling Equity in International Institutions	107
	Marginalizing Science from the Policy Process	108
	Pursuing Donor Priorities	108
	Privatizing Global Health	109
	Conclusions	110
	References	110
	4 Global Health Justice and the Right to Health	113
	Introduction	115
	Debates about Health Justice at the Domestic Level	115
	Limiting the Scope of Health Justice to the State	118
	Cosmopolitanism and Broadening the Scope of Health Justice	122
	Rights-Based Approaches to Health: Problematizing the Use of Rights Claims to Promote Social Justice at the Domestic and Global Level	125
	Conclusions	128
	References	128
	Part II Narrowing the Gap Between Knowledge and Action	133
	5 Measuring the Worlds Health: How Good are Our Estimates?	135
	What are Health Metrics, and Why do They Matter to Global Health Policy?	137
	Metrics for the Worlds Health	138
	Measuring Population Health Loss: DALYs	140
	Measuring Health System Performance: Effective Coverage	141
	Data Sources for the Worlds Health Metrics	143
	From Producing Health Metrics to Informing Policy: Are Our Estimates Good Enough?	147
	Measuring the Attainment of MDG 5: Reducing Maternal Deaths	148
	Measuring the Impact of Mexicos Health Reform: Seguro Popular	149
	Moving Towards Better Health Estimates	150
	Acknowledgments	151
	References	152
	6 Achieving Better Global Health Policy, Even When Health Metrics Data are Scanty	155
	What is Global Health Policy – and What Health Metrics Data are Needed?	157
	Scale of Health Metrics Data	158
	Population Basis of Health Metrics Data	160
	Linking Health Service Encounters with the Everyday Lives of Citizens	162
	Uncertainties in Measuring Health	162
	Ethical Issues in Health Metrics Data	164
	Moving from Health Metrics Data to Health Policy	165
	References	166
	7 An Argument for Evidence-Based Policy-Making in Global Health	169
	Introduction	171
	Narrowing the Gap	172
	Why Should We Use Evidence? Which Evidence Should We Use?	173
	Using Different Types of Evidence to Answer Different Questions	176
	Evidence-Informed Policies Improve Public Health	178
	What are the Barriers to EBP in Global Health?	180
	Mismatch Between Research Generation and Burden of Disease	180
	Systematic Reviews Do Not Reflect the Health Priorities of LMICs	181
	Policy-Makers in LMICs Cannot Access Research Evidence	181
	Policy-Makers Do Not Use Evidence	182
	The “Black” Box of Implementation	183
	The New Landscape of Evidence Translation in Global Health	183
	Generation and Synthesis of Locally Relevant Evidence	184
	The Open Access Movement	184
	New Initiatives and Tools for Packaging Evidence for Policy-Makers	184
	Encouraging Linkage and Communication between Researchers and Policy-Makers	185
	Conclusions	185
	References	186
	8 Can Global Health Policy be Depoliticized? A Critique of Global Calls for Evidence-Based Policy	193
	Introduction	195
	Understanding Evidence-Based Global Health Policy	196
	The Pejorative Influence of Politics in Global Health Policy	197
	Producing Health Sciences Research: The Politics of Creating the Evidence Base	198
	Using Health Sciences Research: What to Value and How to Value Evidence in Decision-Making	199
	Wider Implications of a Depoliticized Approach to Evidence	203
	Conclusions: A Way Forward?	204
	References	206
	Part III The Politics of Risk, Disease, and Neglect	211
	9 Dietary Policies to Reduce Non-Communicable Diseases	213
	Introduction	215
	The Policy Problem	216
	Determinants of Food Choices and Dietary Behaviors	216
	The Policy Solution	217
	The Next Steps	223
	Conclusions	226
	References	227
	10 Ethical Reflections on Who is At Risk: Vulnerability and Global Public Health	231
	Introduction	233
	What is a Risk?	234
	What does it Mean to be Vulnerable?	234
	Vulnerability, Responsibility, and Moral Obligations	239
	Conclusions	241
	Notes	241
	References	242
	11 Ethical and Economic Perspectives on Global Health Interventions	245
	Introduction	247
	Hidden and Long-Term Returns to Disease Mitigation	248
	Infectious Disease: The Importance of Childhood	249
	Chronic Disease	249
	Infectious Disease, Cognitive Development, and Poverty	249
	Health Inequalities and Institutional Design	250
	Intergenerational Transmission of Health	251
	Health Interventions and Population Growth	251
	Globalization of Disease	252
	Health, Justice, and Global Institutions	252
	Patents and Drug Prices	252
	Global Institutions and Social Justice	254
	Conclusions	258
	Notes	258
	References	260
	12 Global Health Policy Responses to the Worlds Neglected Diseases	265
	What is a Neglected Disease?	267
	Why are They Neglected?	267
	The Decade of Change	268
	Policy Responses to Neglected Disease R&D	269
	Market-Based Solutions	269
	Non-Market-Based Solutions	275
	Debates and Controversies	278
	References	279
	13 The Fight for Global Access to Essential Health Commodities	281
	Introduction	283
	The Medical Innovation System is Failing Many Patients	284
	The First Problem: Medical Tools are Often Priced Out of Reach	285
	The Second Problem: Medical Tools to Address “Unprofitable” Diseases are Often Unavailable	287
	The Third Problem: Medical Tools are Often Unsuitable for Neglected Populations	289
	How to Ensure Better Access to More Appropriate Innovation	290
	Voluntary Measures	291
	Limiting and Overcoming Patent Barriers	293
	Compulsory Licensing and Trade Deals	294
	Innovation and Access: Towards a System that Delivers what Patients Need	295
	Alternative Approaches	295
	A New Global Framework: Could We Achieve a Global R&D Convention?	296
	Conclusions	297
	Acknowledgment	297
	References	298
	14 The Social Determinants of Health	303
	Introduction	305
	A Brief Genealogy of the SDH Approach	305
	Some Conceptual Clarifications	307
	Evidence Base for the Importance of SDHs	308
	Globalization of Production and Finance: Undermining SDHs?	313
	Conclusions	316
	References	317
	Part IV Diplomacy, Security, and Humanitarianism	323
	15 Arguments for Securitizing Global Health Priorities	325
	Introduction	327
	Securitization of Infectious Disease in the Post-Cold War World	328
	Reasons to Welcome the Securitization of Health	331
	Security Actors can Help Protect Us from the Health Effects of Infectious Diseases	332
	Diseases can Cause Significant Political, Social, and Economic Disruption	333
	There are Synergies between Public Health and Security Priorities	334
	Securitization brings Attention and Resources to Health	335
	Conclusions	336
	References	337
	16 Viral Sovereignty: The Downside Risks of Securitizing Infectious Disease	341
	Introduction	343
	Method	344
	Results and Discussion	345
	The Securitization of H5N1	345
	The International Scramble for Antivirals and Vaccines	346
	Turning Lethal Viruses into Diplomatic Bargaining Chips	349
	Conclusions	351
	Acknowledgment	352
	Note	352
	References	353
	17 The Changing Humanitarian Sector: Repercussions for the Health Sector	355
	Introduction	357
	The Changing Nature of Humanitarian Crises	358
	Rise of Local Confrontations	358
	Increasing Impacts of Natural Hazards	358
	Crises are Usually Multifactorial	358
	Humanitarian Aid Architecture	359
	Explosion of Western NGOs	359
	Rise of Southern and Eastern NGOs and Civil Society	359
	Centrality of the UN Family and a New Approach to Coordination	360
	New Role of the Armed Forces	363
	Aid and Profit: Growing Involvement of the Private Sector	363
	Killing Aid Actors for Political Gains	363
	Adjusting to a Diverse and Fast-Changing World	364
	Assessing Needs and Capacities: Multiple Contexts Require Diverse Responses	364
	Designing the Appropriate Response	365
	Adjusting Programs to Fast-Changing Situations	367
	Preparing for Future Humanitarian Crises	367
	Risk Management: Predicting the Challenges Ahead	367
	Rethinking Approaches	369
	Working in Insecure Environments	370
	Evaluating the Response	370
	Conclusion: Challenges and Opportunities Ahead	372
	Improving Humanitarian Operations in Settings of Global Urbanization	372
	Applying New Information Technology to Disaster Management	372
	Improving Local Disaster Management	373
	Restoring Holistic Humanitarian Principles	373
	References	374
	18 The Limits of Humanitarian Action	377
	Limits of Humanitarian Action	379
	Quantitative and Qualitative Limits	379
	External and Internal Barriers	379
	Five Main Types of Limit	380
	Political Barriers	380
	Organizational Barriers	382
	Technical Barriers	384
	Community Barriers	385
	Moral Limits	386
	Conclusions	387
	References	388
	Part V Financing and the Political Economy of Global Health	391
	19 The Global Health Financing Architecture and the Millennium Development Goals	393
	Introduction	395
	Progress Towards the Health MDGs	396
	Trends in Global Health Financing	397
	The MDGs Spurred a Substantial Growth in Global Health Financing	397
	The End of the Halcyon Days of Global Health Financing	398
	Uneven Distribution of Funding across the Health MDGs	398
	Areas Not Covered by the MDGs Receive the Least Financial Attention	400
	Targeting and Predictability of Funding Flows	401
	Key Players in the Global Health Financing Architecture: the Emergence of New Financing Institutions	401
	Fragmentation of the Global Health Landscape	402
	Unintended Side Effects Resulting from Fragmentation	403
	The Need for Domestic Financing	403
	Improving the Quality and Efficiency of Global Health Financing	405
	Increased Accountability	406
	Looking Forward: Lessons Learned and Recommendations	406
	Notes	407
	References	407
	20 Can International Aid Improve Health?	411
	Introduction	413
	Examining the Evidence	417
	The Economic Way of Thinking	420
	Incentives	420
	Donor Incentives	421
	Recipient Incentives	422
	Information	423
	Donors Information Problem	424
	Recipients Information Problem	425
	Conclusions	426
	Notes	426
	References	427
	21 The Exterritorial Reach of Money: Global Finance and Social Determinants of Health	429
	Introduction	431
	Implicit Conditionalities	431
	Capital Flight	434
	The Crisis of 2008	435
	Evidence on Health Outcomes	436
	Conclusions and Policy Implications	438
	References	439
	22 Trade Rules and Intellectual Property Protection for Pharmaceuticals	445
	Trade Rules and Intellectual Property Protection for Pharmaceuticals	447
	Pharmaceutical Patents Before and After TRIPS	448
	Pharmaceuticals Post-TRIPS and the “IP Access to Medicines” Contests	450
	PTAs and “TRIPS Plus” Pharmaceutical Standards	454
	Looking Ahead– Some Concluding Thoughts	456
	References	458
	23 The Health Systems Agenda: Prospects for the Diagonal Approach	461
	Introduction	463
	A Conceptual Base for Health Systems	464
	The Diagonal Approach	466
	The Diagonal Approach in Practice: Lessons from Mexico	468
	Mexican Health Reform	469
	Conclusions	472
	References	473
	24 Will Effective Health Delivery Platforms be Built in Low-Income Countries?	477
	Introduction	479
	First Decade of the “Global Health Revolution”: Where Did All the International Assistance Go?	479
	Why was Development Assistance for Health Allocated to Infectious Disease Control?	481
	First Hypothesis: The “Securitization” of Global Health	481
	Second Hypothesis: Exceptional Activism, Rooted in a Human Rights Approach	481
	Third Hypothesis: Avoiding the “Fatal Attraction” of Cheaper Solutions	482
	Fourth Hypothesis: Creation of a Brand New Financing Tool	483
	Preliminary Conclusion: An Opportunity for Integrating Infectious Disease Control with Health Systems Strengthening	484
	Infectious Disease Control Programs Building Health Delivery Platforms: Diagonal Approach, Bottom-Up and Top-Down	485
	Bottom-Up: The “Diagonal” Approach Applied in Ethiopia	485
	Top-Down: The Health Systems Funding Platform	487
	Conclusions	488
	References	490
	Part VI Health Rights and Partnerships	493
	25 A Rights-Based Approach to Global Health Policy: What Contribution can Human Rights Make to Achieving Equity?	495
	Introduction	497
	The Right to Health in International Human Rights Law	497
	Development of the Right to Health Within the United Nations	498
	Right to Health in Regional Human Rights Treaties	500
	Contribution of International Health Conferences	501
	General Comment 14 on the Right to the Highest Attainable Standard of Health	502
	The UN Special Rapporteur on the Right to the Highest Attainable Standard of Physical and Mental Health	503
	Critiques and Weaknesses of Human Rights and Right to Health	504
	Rights Inflation	504
	Vagueness/Formulation	505
	Ineffective/Damaging	505
	Deficiencies of International Law	506
	Contribution of Human Rights to Global Health Equity	506
	International and Regional Human Rights Procedures	506
	Regional Human Rights Mechanisms	508
	Domestic Litigation	509
	Rights-Based Advocacy	510
	Rights-Based Policy and Tools	511
	A Way Forward: Defining a Research Agenda for Global Health and Human Rights	512
	Conclusions	512
	References	513
	26 From Aid to Accompaniment: Rules of the Road for Development Assistance	519
	Introduction	521
	From Aid to Accompaniment	523
	Principle 1: Support Institutions that the Poor Identify as Representing their Interests	523
	Principle 2: When Possible, Fund Public Institutions to do their Job	523
	Principle 3: Make Job Creation a Benchmark of Success	528
	Principle 4: Buy and Hire Locally	529
	Principle 5: Co-invest with Governments to Build Strong Workforces and Civil Services	531
	Principle 6: Work with Governments to Provide Cash to the Poor	532
	Principle 7: Support Regulation of Non-State Service Providers	533
	Principle 8: Apply Evidence-Based Standards of Care	534
	Conclusions	535
	Acknowledgments	535
	References	536
	27 Global Health Partnerships: The Emerging Agenda	541
	Introduction	543
	Global Health Partnerships	543
	What Makes Global Health Partnerships Work?	544
	The Global Fund to Fight AIDS, Tuberculosis and Malaria	545
	The Global Funds Successes and Failures	548
	Conclusions	551
	References	553
	28 Partnerships and the Millennium Development Goals: The Challenges of Reforming Global Health Governance	555
	Introduction	557
	Partnerships and the “Global Health Revolution”	557
	Origins and Context of Global Health Partnerships	557
	Partnership Types and Initiatives	558
	The MDGs: Aspirational Targets for the Partnership Era	559
	Health-Related MDGs and the Social Determinants of Health	560
	MDGs as Partnerships	560
	MDGs and Global Health Governance	561
	Assessing Effectiveness: Partnerships and the MDGs	562
	Progress Toward the Health-Related MDGs	562
	Role of Global Health Partnerships	563
	Will the Health-Related MDG Targets be Met?	563
	Impediments to the Realization of the Health-Related MDGs	564
	Weak National Health Systems	565
	Poor Coordination and Misplaced Priorities	566
	Critical Assessments: Partnerships Beyond 2015	566
	Conclusions	568
	References	569
	Part VII Beyond Globalization	573
	29 Preparing for the Next Pandemic	575
	Introduction	577
	Examining the Threat and the Need for a Whole-of-Society Approach	577
	Strategies to Mitigate Pandemic Influenza	580
	Pharmaceutical Measures (Vaccines and Antivirals)	581
	Non-Pharmaceutical Measures (Basically, Everything Else)	583
	Conclusions	586
	Note	586
	References	587
	30 Globalization and Global Health	591
	Introduction	593
	History of Globalization and Health	593
	Information and Knowledge Access and Exchange	593
	Formal and Informal Flows of Capital	594
	Nourishment and Subsistence	596
	Disease and Mortality	597
	Globalization and Health Now	598
	Information and Knowledge Access and Exchange	598
	Formal and Informal Flows of Capital	600
	Nourishment and Subsistence	602
	Disease and Mortality	603
	Possible Futures of Globalization and Health	604
	Information and Knowledge Access and Exchange	605
	Formal and Informal Flows of Capital	605
	Nourishment and Subsistence	607
	Disease and Mortality	608
	Conclusions	608
	References	609
	Index	613