Article Text

Download PDFPDF
Global health governance as shared health governance
  1. Jennifer Prah Ruger
  1. Correspondence to Jennifer Prah Ruger, Yale University School of Public Health, 60 College Street, P.O. Box 208034, New Haven, CT 06520, USA; jennifer.ruger{at}


Background With the exception of key ‘proven successes’ in global health, the current regime of global health governance can be understood as transnational and national actors pursuing their own interests under a rational actor model of international cooperation, which fails to provide sufficient justification for an obligation to assist in meeting the health needs of others. An ethical commitment to providing all with the ability to be healthy is required.

Methods This article develops select components of an alternative model of shared health governance (SHG), which aims to provide a ‘road map,’ ‘focal points’ and ‘the glue’ among various global health actors to better effectuate cooperation on universal ethical principles for an alternative global health equilibrium. Key features of SHG include public moral norms as shared authoritative standards; ethical commitments, shared goals and role allocation; shared sovereignty and constitutional commitments; legitimacy and accountability; country-level attention to international health relations.

Results A framework of social agreement based on ‘overlapping consensus’ is contrasted against one based on self-interested political bargaining. A global health constitution delineating duties and obligations of global health actors and a global institute of health and medicine for holding actors responsible are proposed. Indicators for empirical assessment of select SHG principles are described.

Conclusion Global health actors, including states, must work together to correct and avert global health injustices through a framework of SHG based on shared ethical commitments.

  • Global health ethics
  • global health governance
  • shared health governance
  • health capability paradigm
  • ethics in epidemiology
  • philosophy of science
  • policy development
  • public health policy

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Funding This research was supported, in part, by the Open Society Institute of the Soros Foundation and the Whitney and Betty MacMillan Center for International and Area Studies. JPR is supported in part by an Investigator Award from the Patrick and Catherine Weldon Donaghue Medical Research Foundation (grant DF06-112) and a Guggenheim Fellowship.

  • Competing interests None.

  • Provenance and peer review Commissioned; externally peer reviewed.