Kristin Sandberg, Steven J. Hoffman, Mark Pearcey

This paper examines how global health’s institutional architecture should be matched with its governance needs by drawing lessons from the field of global environmental governance.

Juan Vita/Anadolu Agency/Getty ImagesPhoto: Juan Vita/Anadolu Agency/Getty Images.

Global health governance has developed beyond the consideration of different policy choices; it now encompasses the design of sophisticated collective action processes that involve both state and non-state actors and aim to address increasingly complex transnational challenges. This leads to a pressing question: how should global health’s institutional architecture be matched with its governance needs? This paper responds to that question by drawing lessons from the field of global environmental governance. Not only are there correspondences in global systemic changes between the health and environment fields – in terms of the large number of actors, diverse initiatives and multiple levels of decision-making – but the institutions set up to facilitate collaboration are also similar. When reviewing the range of institutional options in global health governance, it makes sense to look to the global environmental governance domain for lessons learned, as the latter’s institutions have been subject to rigorous academic research for more than 30 years. This paper is a scoping review of research in that domain, and takes stock of the body of knowledge that now exists. It highlights three lessons that exemplify the potential for cross-fertilization on how global institutions can make a difference. By starting to draw links across sectors, the paper approaches the broader questions of how global environmental governance in the 21st century has developed in new and interesting directions, and what can be learned from these developments.

Key lessons

  • Coordination among the institutions of a complex and crowded governance system does not depend on grand overarching structures. Coordination can also be achieved through decentralized management and through decisions made within each institution or by institutional stakeholders. Synergy, however, can come at the cost of subordinating a given objective to stronger political or normative forces.
  • Scientific knowledge is not only a precondition for action but actually coevolves with it, necessitating institutional structures that protect its independence from politics, while simultaneously facilitating a productive interaction.
  • The effectiveness of global governance depends on states having both sufficient governmental capacity and the political will to forge national policy coherence in support of implementation.