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The world’s failed response to COVID-19—characterized by weak health systems, a distrust in science, and vastly inequitable access to global public health goods—provides a historic opportunity to reform the global health architecture, including its legal norms, processes, and institutions. We argue that these reforms should be based on the principles of good governance for health: the right to health, equity, inclusive participation, global solidarity, transparency, and accountability.

This Perspective examines the global health architecture—its history, current state, and future. It begins by describing the principles of good governance for health, and then how current global health actors and instruments embody them or fall short. Finally, it examines reforms which are underway, particularly for health emergency preparedness and response (HEPR), and what others are needed to bring the global health architecture more in line with principles of good governance for health. Global health institutions and instruments, including new global health instruments currently being negotiated through the World Health Organization, should be reformed to fully incorporate the principles of good governance for health. Equity should be embedded into the prevention of, preparedness for, response to, and recovery from catastrophic health threats, within and across nations and sectors. Finally, robust and sustainable funding of key institutions, national health systems, and civil society would ensure more effective and just responses to health emergencies, including the daily toll of avoidable death and disease disproportionately experienced by poorer and more marginalized populations.

Embracing this reform agenda, guided by principles of good governance for health, could ensure that our institutions and systems can protect and promote the health of all populations everywhere.

Publication Citation

The Milbank Quarterly, Vol. 101, Issue S1: Special Centennial Issue: The Future of Population Health: Challenges & Opportunities, Apr. 2023, 734-769.