Environmental Engineering Reference
In-Depth Information
Actors
Each of the five cases shows the broad range of actors now involved in the field of
global health. these range from individual activists, professionals, private firms,
nongovernmental organisations (nGos), states with their national and sub-national
governments and international institutions, with ever more types of actors entering
the global health game. Yet partly as a result of this expansion, rarely are these actors
all active at the start or at the end. Moreover, the resulting configuration still shows
considerable inequality in capability, skill, and the influence that results.
At the centre of this configuration stands the sovereign nation-state, acting
in the self-interested way in a self-help world that realist theory in international
relations predicts. as Kathryn white and Maria banda emphasise, these states have
the primary authority, accountability, and responsibility for regulation, education,
and enforcement. Yet within the central governments of consequential countries,
more departments are becoming involved, including the powerful departments
for agriculture, finance, development, trade, foreign policy, national security, and
national intelligence, as well as the traditionally low-ranking and isolated ones
responsible for environment and for health. national leaders too are becoming active
as health rises on the public policy agenda.
snonetheless, within large countries with federal systems, sub-national and local
governments play a critical role. Provinces, cities, and local hospitals were the first
responders when canada and china confronted the SarS crisis. and even when the
national government acts first, as in small compact polities such as Singapore and
Hong Kong, the decisions of local hospitals matter a great deal.
within and across national borders, private firms, foundations, and nGos play
an important part. as shown by Jillian cohen-Kohler, Jeff collin, and Kelley lee,
mega mergers have created powerful global firms that act on many fronts to secure
their preferred outcomes for access to affordable HIv/aIDS medicines and tobacco
control. Yet they are now countered by a growing and more global set of nGos
such as Médecins Sans Frontières (MSF), reinforced by the major development
and environmental civil society organisations now becoming active on the global
health front. Private philanthropy and foundations also matter, from the rockefeller
Foundation of old to today's rotary International, with the latter being one of the few
nGos to make financial contributions to the United nations system and to deploy
more than a million volunteers world-wide in the polio eradication cause. also active
at the societal level are the media, which revealed the presence of avian influenza
in Hong Kong in 1997. the internet, which facilitates wide-scale communication, is
becoming a key, fully global actor for engaging in surveillance, sharing information,
and directly shaping individual citizens' responses to disease.
International organisations and institutions are increasingly involved and
influential. Appendix 16-3 shows the leading actors in the large array of such bodies
now contributing to global health governance. Some have acquired the regulatory
authority once possessed by national governments, as the european Union has for
high-risk meats. the case of tobacco shows how individuals within international
