Regulation of global health at a crossroads
Current ideas of how difficult health challenges should be handled cover a wide spectrum. On the one hand, some would argue in favour of unilateral and sector-specific instruments of governance, particularly using the architecture metaphor (10). This kind of metaphor belongs in a controllable, linear universe, where reductionist analysis can provide the answers. Others, in contrast, perceive the global health arena as an inherently ungovernable system. Some claim that dominating actors will fail to respect regulatory mechanisms that restrict their freedom of action, and have therefore little faith in regulatory instruments (11).
Gostin has proposed a solution that possibly will be located between those outlined above. He claims that a global health convention could constitute a method of mobilising civil society and enacting principles of good governance, including rules for coordination and collective action, and a common definition of what constitutes basic survival needs (12). The convention approach presupposes endorsement of specific case-oriented protocols over time, and thereby links into a process of legislation in which the governments can commit themselves in a stepwise manner as political consensus emerges.
Even though the idea of a convention is not based on complexity theory, it represents a method for establishing coherence in the complex interaction at grass-roots level and all the way up to the unpredictable field of international relations. Gostin’s proposal for a global health convention is discussed in another article in this series (13). We will now explore this idea from another angle; in order to be used in accordance with complexity theory, Gostin’s idea of a convention can be reformulated with regard to two of its aspects:
Governments are not the only actors participating in processes of global governance (11, 14). A convention which is based on complexity theory should therefore perhaps aim to commit influential NGOs and civil societies in the same manner as governments. This represents an extension of Gostin’s point of departure, where he presumes that governments will be the only formal parties to a convention.
A binding framework ought to be facilitating, rather than authoritarian. A facilitating form of government has retained some degree of central leadership, but permits initiatives and mobilisation of resources to alternate among various actors, depending on the matter at hand.
Integrating these aspects in Gostin’s idea of a global health convention could thereby help identify, consolidate and refine fragmented and widely dispersed informal procedures and regulations that are used by not only by governments, but by all global actors (11).
We claim that a facilitating global health convention has the potential to promote principles of good governance through participation, fair procedures and consensus-based minimum specifications. Such principles of governance must reflect the goals and total budgets of the entire system, for example by having the international community endorse formulations of strategy and a global fund for health (15). In total, these principles of governance could encourage creative solutions to complex problems (9), and they could help convert political debate into concrete action (16).