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1 Global Health Governance (2007)


Increased concern about global health has focused attention on governance questions, and calls for new governance architecture for global health have appeared. This article examines the growing demand for such architecture and argues that the architecture metaphor is inapt for understanding the challenges global health faces. In addition to traditional problems experienced in coordinating State behavior, global health governance faces a new problem, what I call “open-source anarchy.” The dynamics of open-source anarchy are such that States and non-State actors resist governance reforms that would restrict their freedom of action. In this context, what is emerging is not governance architecture but a normative “source code” that States, international organizations, and non-State actors apply in addressing global health problems. The source code’s application reveals deficiencies in national public health governance capabilities, deficiencies that are difficult to address in conditions of open-source anarchy. Governance initiatives on global health are, therefore, rendered vulnerable.