23 September 2015

A new paper identifies priority areas for reform as the global health architecture confronts emerging challenges in the post-2015 era.


Marco Schäferhoff

Associate Director, SEEK Development

Elina Suzuki

Consultant, SEEK Development

Steven J Hoffman

Assistant Professor of Law; Director, Global Strategy Lab, University of Ottawa

Philip Angelides

Research Assistant, Centre on Global Health Security


A Pakistani health worker gives polio vaccines to children in the suburbs of Lahore, Pakistan, February 2015. Photo: Associated Press.
A Pakistani health worker gives polio vaccines to children in the suburbs of Lahore, Pakistan, February 2015. Photo: Associated Press.


  • Current deliberations on global health in the post-Millennium Development Goals era have largely focused on what will be needed to achieve the new health targets set out in the Sustainable Development Goals (SDGs), but more is needed now on how to respond to the challenges post-2015.
  • Strong, resilient and equitable systems that enable all people to live healthy lives are required at country level – the global health architecture should be rethought in a way that best supports the building of these systems.
  • A fundamental shift affecting global health is the rising burden of non-communicable diseases (NCDs). The ageing of the population – a key driver in the rise of NCDs – represents a significant challenge to global health. Low-income and lower-middle-income countries that are still battling infectious diseases are faced with a ‘double burden’ of disease that in many cases overstretches already weak health systems.
  • The recent Ebola crisis in West Africa has shown that weak health systems make countries more vulnerable, and underscores the importance of strengthening these systems to protect global health security. There is a need for enhanced global disease surveillance and detection capacities, as well as improved international coordination in responding to emerging health threats.
  • Many low- and middle-income countries are projected to experience substantial economic growth into the next decade, which should enable them to spend more on health themselves. The capacity of the global architecture should be strengthened to support countries in expanding their fiscal space for, and commitment to, financing for health and health systems, and to increase public funding for poor and vulnerable populations – particularly women and children.
  • Global health funders must continue to explore how their strategies can address the rising challenges of poor populations and pockets of high disease burden in middle-income countries. Supporting fragile states more effectively will also be critical in the SDG era, as their populations are disproportionally affected by major health problems.
  • Insufficient financing and weak incentives currently exist for investment in research and development (R&D) to tackle neglected and poverty-related diseases. Expanding R&D financing and the range of incentives for investing in R&D is a priority area for action.
  • There is a need for stronger leadership in global health. One proposal involves the creation of a new organization, termed UN-HEALTH. This would bring together, based on a common results framework, all UN agencies with health-related mandates. Alternatively, a UN Health Commission could be set up to improve coordination without the radical changes to the architecture required for a UN-HEALTH.