Let me start off asking you, the reader, a question. When you think of the global health system, who do you consider the most important actors?
The World Health Organization… of course.
Doctors without Borders or MSF… merci.
Bill and Melinda Gates Foundation… duh
Well what about…
The World Trade Organization… huh?
The Climate Group… Who is this joker?
Let me explain.
I admit after three years of medical school, I have become a product of the disease- and intervention-focused American medical education system. However, it is clear from my first month of global health studies that confronting social determinants, like wealth and education, plays as an important role in ensuring the health of the global population, as behavioral modifications, medications, and surgical procedures do. Therefore, it is imperative that the global health system, already oversaturated with numerous agencies and groups with their own priorities, somehow involve those actors, like the WTO, who influence the social determinants of health. Dr. Julio Frenk, dean of the Harvard School of Public Health, identifies this need for “cross-sector interdependence” as one of the three main challenges that the global health governance system needs to overcome, asserting that “global health actors today are largely unequipped to ensure that health concerns are adequately taken into account in crucial policymaking arenas such as trade, investment, security, the environment, migration, and education”.
The challenges of these different policymaking arenas and the challenges to achieve interdependence between such arenas seem daunting. With the emergence of economic globalization, it is clear trade and health are interconnected. However, commercial interests often overshadow health interests in policymaking decisions concerning trade. For example, the WHO plays a limited role in trade decisions, only having “observer status” as WTO meetings – they can audit meetings but cannot participate in decision making procedures. Another arena in which cross-sector cooperation is needed is the environment. Per a report by the University College London Institute for Global Health Commission, the effects of climate change on health are vast and extremely threatening, from the expansion of vector-borne diseases to the “indirect effects of climate change on water, food security, and extreme climatic events”. However, as with trade, commercial interest surely acts as one of the main impediments to progress against climate change – for example regulating coal emissions will continue to be an unpopular policy if it negatively impacts the “bottom line” for many corporations and economic progress, in general.
I could make similar arguments for education, immigration policy, sanitation, and numerous other social drivers of health but that will surely put you to sleep. The point is that there are many non-health arenas with which the global health system needs to participate, and if the groups that make up the global health governance don’t cooperate with groups in such arenas, then they will certainly fail in ensuring the “physical, emotional, and social well-being” of every citizen of the world.
 Frenk, J., Moon, S., Governance Challenges in Global Health The New England Journal of Medicine, 368;10, pp. 936-942
Lee K., Sridhar D., Patel M. Bridging the divide: global governance of trade and health The Lancet, 373 (9661), pp. 416-22
 Costello A., Abbas M., Allen A., et al.; Managing the health effects of climate change. Lancet and University College London Institute for Global Health Commission. (2009) The Lancet, 373 (9676), pp. 1693-1733.
 WHO Definition of Health: “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”