The political economy of global health and public policies

Global Health has evolved into a broad and heterogeneous group of public and private institutions and their respective agendas addressing health issues around the world, which some authors have described as "open source anarchy". In such a context, we can observe numerous sources of conflict between these forces that ultimately reveal the inextricably political nature of health beyond its mere biomedical definition and data-based metrics. Among the most obvious conflicts are the current debate over the feasibility of health systems, particularly the financial basis for universal health coverage; the disparate landscape of institutions that shape global governance of health, at the centre of which the World Health Organisation plays a prominent role; the increasing influence of private institutions, particularly those engaged in so-called philanthrocapitalism, such as the Bill and Melinda Gates Foundation; and, no less relevant, the securitisation and politicisation of global health issues, such as the recent Public Health Emergency of International Concern (PHEIC) due to the COVID-19 pandemic. A fundamental continuity between these phenomena is the ongoing tension between the neoliberal, market-oriented approach to health and the publicly funded approach to health that has accompanied the expansion and complexity of global health issues from the beginning. The security approach, ubiquitous in the response to all major global health crises at the beginning of the 21st century, focuses too much on containing disease rather than addressing its structural causes on the ground. It follows that socio-economic inequalities and lack of access to basic health conditions for large segments of the population do not come to the fore when an acute crisis occurs. Neoliberal policy-making is unable to meet the need for health equity and accountable leadership to address such challenges.