THE GLOBAL HEALTH SYSTEM: GOVERNANCE CHALLENGES AND INSTITUTIONAL INNOVATIONS

Harvard T.H. Chan School of Public Health: GHP 548 (2.5 credits)
Harvard Kennedy School of Government: IGA 490M (.5 credits)

LOCATION: HARVARD SCHOOL OF PUBLIC HEALTH (ROOM KRESGE 201)

SPRING 2016, MODULE 1 (Jan. 29-Mar 11, 2016)
Fridays, 12:30pm-3:20pm
INSTRUCTOR
Suerie Moon, MPA, PhD
Lecturer, Department of Global Health and Population, Harvard T.H. Chan School of Public Health
Co-Chair and Research Director, Forum on Global Governance for Health, Harvard Global Health Institute
Co-Director, Project on Innovation and Access to Technologies for Sustainable Development, Harvard Kennedy School
Office Location: Harvard Global Health Institute, 42 Church Street, Cambridge, MA 02138
Instructors Email: smoon@hsph.harvard.edu
Office Hours: HSPH Building 1, Fridays 11:20am-12:20pm (Location TBD)
TEACHING FELLOW
TBD

COURSE WEBSITE
The course will use a single HSPH-based Canvas website (HKS and students at other schools should contact the TF to
get access to this site) at: https://canvas.harvard.edu/courses/11214. Video lectures will be posted to the
website before class, and discussed in class. Assignments, some readings, and other useful links and resources will be
available on the website.

ENROLLMENT AND PREREQUISITES

The course is open to all graduate students across the university, but may be of particular interest to students of
public health and public policy. There are no formal pre-requisites, but prior exposure to public health and
international relations/global governance will be useful. Total enrollment will be capped at 40 students, with initial
preference going equally to HSPH and HKS students. Students may take the course for a grade or pass/fail
(auditors may be permitted by the Instructor, depending on class size). Students taking the course for a grade
will be given preference in case the course is over-subscribed.
COURSE DESCRIPTION
Public health challenges for example, Ebola, HIV/AIDS, obesity, neglected diseases, tobacco use, environmental
degradation, and underperforming health systems increasingly shape and are shaped by the political, economic,
and social aspects of globalization. Outbreaks of new infectious diseases, such as SARS or pandemic flu, can wreak
immediate economic havoc on a regional or global scale. Neglected diseases, such as sleeping sickness or mycetoma,
continue to cause immense human suffering. Meanwhile, international rules that fall outside the traditional health
sphere such as those governing intellectual property, agriculture, human migration, and greenhouse gas emissions
can have profound impacts on human health. While strong national health systems are critical for meeting
population needs, the effects of and capacities to respond to a particular health threat often lie outside the control of
any one nation state and outside the health sector.

WHAT KINDS OF QUESTIONS WILL WE EXPLORE?

What is the current institutional architecture of actors engaged in global health?

How suitable are existing institutions for responding to 21st century global health challenges?
What is the global health system, and what functions must it be perform?
Where are the major governance gaps?
Which tools and mechanisms have succeeded or failed to govern trans-border health threats, and why?
What innovative approaches have succeeded?
How can we improve our collective capacity to respond to increasingly complex global health challenges?

WHAT IS GLOBAL HEALTH?

Global health should not be understood only as foreign health, international health or the health of the poor, though
it may incorporate all these concepts. Rather, we use the term global health to refer to the health of all populations in
the world, regardless of nation-state, geographical position or stage of development. It includes an interdisciplinary set of
challenges that transcend national boundaries involving health determinants (social, political, economic), collections of
health problems, and the organized social response to these conditions (structured both within and outside of health
systems). The defining characteristic that makes global health global is its central concern with the impacts of
globalization on health, the transfer of health threats and opportunities across national borders, and the resulting state of
interconnection and interdependence among populations.

COURSE OBJECTIVES
This course is intended to equip students with a basic introduction to major public health challenges, focusing on
those that transcend national boundaries, and key related questions in global governance. Students will gain an
understanding of the current functioning of the global health system and its shortcomings, and exposure to new
approaches to addressing global public health challenges. Teaching methods in this intensive seven-week session will
include lectures, case studies, analytic writing, teamwork, and class discussion and debate. Students completing this
course will gain the knowledge and skills needed to:

Identify major global health challenges and key features of the current global health system
Describe the necessary functions of an effective global health system
Diagnose major governance gaps in the current system
Evaluate a wide range of tools and mechanisms for shaping global governance processes
Analyze threats and opportunities for health outside the health sector
Examine, assess and design interventions for improved governance

OVERVIEW OF CURRICULUM AND SCHEDULE

Half-term course (module)

Course begins Friday, January 29, 2016 and runs for seven weeks (Spring 1)
Meet weekly from 12:30pm-3:20pm with a short break
Flipped classroom: class time will primarily be spent on discussion and debate, not on presenting
information; therefore, students must watch required video lectures and complete readings before coming
to class.
Coursework assigned every week, with one major group assignment
Supplemental resources (not required; provided only as reference material)

ASSIGNMENTS AND GRADING

Student Expectations (Assignments and Participation)
Assignment 1
Thought Piece [350-500 words]
Good Governance What constitutes good global governance (for health)?
Assignment 2
Case Study

Teams of 3-5 students

Presentation [<7 minutes]: one week after assignment
Memo [<1000 words]: one week after assignment

Assignment 3
Term Paper

Short Term Paper [10 pages or <2,500 words] analyzing a threat to

public health and related global governance challenge

Class
Participation

Due Date

Grade

Thurs, 2/4, 9am

5%

Varies by team
Varies by team

15%
20%

Thurs, 3/10,
9am

50%

Throughout

10%

Academic Honesty & Citations

Students must observe Harvard University rules regarding the citation of sources. Any sentences or paragraphs
taken verbatim from the writing of (or interviews with) any other person or persons, or from your own writing
that has been published elsewhere, must be placed in quotation marks and their source must be clearly
identified. Changing the wording of a sentence or passage slightly does not evade the requirement for citation.
Indeed, whenever you are drawing an important argument or insight from someone else, even if you reword it
into your own words, a reference to the source is required. Including material from others in the assignments
without appropriate quotation marks and citations is regarded, as a matter of University policy, as a serious
violation of academic and professional standards and can lead to a failing grade in the course, failure to
graduate, and even expulsion from the University. (Source: Harvard Kennedy School Course Syllabus IGA408M: Learning from the Failure of Climate Policy, Professor David Keith, Spring 2014.)
Course Evaluations
Completion of the evaluation is a requirement for each course. Your grade will not be available until you submit
the evaluation. In addition, registration for future terms will be blocked until you have completed evaluations
for courses in prior terms.

COURSE SCHEDULE AND SYLLABUS

Case Studies: A significant portion of the course will be spent on case studies that illustrate the most important
governance challenges and key functions that need to be performed by the global health system. The table
below illustrates where several cases may lie at the intersection of governance challenges and functions. Some
of the cases will be taught this semester, while others have been taught in past years or are the subject of
ongoing curriculum development.

Functions of the
Global Health System

Sovereignty Challenge
Stewardship

-WHO Reform

Managing
Externalities

-Pandemic flu
-Climate change
-Ebola
-Sustainable, adequate
institutions for GPG
provision
-Priority-setting in
Development
Assistance for Health
(DAH)
-Predictable, adequate
flows of DAH

Global Public
Goods
Global
Solidarity

Governance Challenges
Sectoral Challenge
Accountability
Challenge
-Trade and Tobacco
-World Health Report
Control
2000
-Ebola

-Meningitis vaccine

-Ebola

-Food security

-Cholera in Haiti

SESSION 1

GOVERNANCE & THE GLOBAL HEALTH SYSTEM

Schedule for Jan 29, 2016

Time
12:30pm-1:30pm
1:30pm-2:05pm
2:05pm-2:20pm
2:20pm-3:20pm

Activity and Topic

Introduction to Global Health
Introduction to Course
Good Governance Memo Assignment & Case Studies
Break
Introduction to Global Governance & the Global (Health) System

Notes
Instructor
Instructor

Instructor

Reading Assignments
Introduction to Global Health and the Global Health System
The Lancet Commission on Investing in Health (2013). Global health 2035: A world converging within a
generation. The Lancet 382(9908): 1898-1955. Link.
Frenk J, Gmez-Dants O, Moon S. (2014). From sovereignty to solidarity: a renewed concept of global health for
an era of complex interdependence. The Lancet 383 (9911): 94-97. Link.
Robinson E and Brewster A. (2013) Primer on Global Governance and Health. Cambridge: Harvard Global Health
Institute. Available at course website. SKIM
Introduction to Globalization, Global Governance, and Good Governance
Huynen M, Martens P, Hilderink HBM. (2005). The health impacts of globalization: a conceptual framework.
Globalization and Health 1:14. Link.
Keohane R O & Nye JS (2000). Introduction. In J. S. Nye, & J. D. Donahue (Eds.), Governance in a Globalizing
World (pp. 1-44). Washington D.C.: Brookings Institution Press. Available at course website.
Weiss TG (2000). Governance, Good Governance and Global Governance: Conceptual and Actual Challenges.
Third World Quarterly, 21(5), 795-814. doi:10.1080/014365900750011981. Link. [20 Pages]
Recommended Resources
Gostin L. (2014) Global Health Law. Cambridge, MA: Harvard University Press.
Ng N and Ruger JP (2011). Global Health Governance at a Crossroads. Global Health Governance, 3(2). Link. [37
Pages]
Graham J, Amos B, Plumptre T. (2003). Principles for good governance in the 21st century. Policy Brief No.15.
Institute on Governance, Ottawa, Canada. Link. [9 Pages]
Garrett L (2007). The Challenges of Global Health. Foreign Affairs. 86(1): 15-38. Link. [24 Pages]
Jamison DT, Frenk J, Knaul F. (1998). International collective action in health: Objectives, functions and rationale.
The Lancet. 351(9101): 514-517. Link. [4 Pages]
Szlezak NA, Bloom BR, Jamison DT, Keusch GT, Michaud CM, Moon S & Clark WC. (2010). The Global Health
System: Actors, Norms, and Expectations in Transition. PLoS Med. 7(1), e1000183. Link. [4 Pages]
Written or Oral Assignments
Assignment 1. Thought piece on what constitutes good global governance for health (350-500 words)

SESSION 2

GOVERNANCE CHALLENGES: SOVEREIGNTY

CASE 1: PANDEMIC FLU VACCINE

Schedule for Feb 5, 2016

Time
12:30pm-1:30pm
1:30pm-2:05pm
2:05pm-2:20pm
2:20pm-3:20pm

Activity and Topic

Class Discussion on Sovereignty Challenge (Re: Lecture 1 (video))
Review Good Governance Memos, Present Term Paper Assignment
Break

Notes

Case 1: Pandemic flu vaccine Class Discussion

Class

Class
Instructor

Reading Assignments
Sovereignty Challenge
Frenk J and Moon S. (2013). Governance Challenges in Global Health. The New England Journal of Medicine,
368:10. Link.
Fidler D. (2010) The Challenges of Global Health Governance. Working Paper. New York: Council on
Foreign Relations. Link.
Case 1: Pandemic Flu Vaccine
Case on Pandemic Flu Vaccine (Available on course website)
Kamradt-Scott A and Lee K. (2011) The 2011 Pandemic Influenza Preparedness Framework: Global Health
Secured or a Missed Opportunity? Political Studies 59: 831-47. doi: 10.1111/j.1467-9248.2011.00926.x
Link.
Video
Watch Lecture: Sovereignty
Recommended Resources
Fidler D. Architecture Amidst Anarchy: Global Healths Quest for Governance, Global Health Governance 1(1).
Link. [17 Pages]
Background on the UNFCCC: The International Response to Climate Change. (Skim documents in left menu
under Essential Background at: http://unfccc.int/essential_background/items/6031.php )
Moon S, Omole O. (2013). Development Assistance for Health: Critiques and Proposals for Change. Chatham
House Centre on Global Health Security. Working Papers. Link.
Shiffman, J. (2006). Donor Funding Priorities for Communicable Disease Control in the Developing World. Health
Policy and Planning, 21(6), 411. Retrieved from http://heapol.oxfordjournals.org.ezpprod1.hul.harvard.edu/content/21/6/411.short
UN Department of Economic and Social Affairs (UN DESA). (2012). World Economic and Social Survey 2012: In
Search of New Development Finance No. E/2012/50/Rev. 1). New York: United Nations. Link
Written or Oral Assignments
Assigned teams work on case study

SESSION 3

GOVERNANCE CHALLENGES: SECTORAL

CASES 1 & 2: PANDEMIC FLU VACCINE and TRADE & TOBACCO

Schedule for Feb 12, 2016

Time
12:30pm-1:30pm
1:30pm-2:20pm
2:20pm-2:35pm
2:35pm-3:20pm

Activity and Topic

Case 1: Pandemic Flu Vaccine Team Presentations & Debate

Sectoral Challenge (Re: Lecture 2 (video)) Discussion

Break
Case 2: Trade Agreements & Tobacco

Notes
Teams
Class
Class

Reading Assignments

Sectoral Challenge
Alter KJ & Meunier S. (2009). The Politics of International Regime Complexity. Perspectives on Politics, 7(01), 13.
doi:10.1017/S1537592709090033 Link [10 Pages]
Karanikolos M, Mladovsky P, Cylus J, Thomson S, Basu S, et al. (2013) Financial crisis, austerity, and health in
Europe. The Lancet. 381(9874): 1323-1331. Link.
The Lancet-University of Oslo Commission on Global Governance for Health (2014) The political origins of health
inequity: prospects for change. The Lancet 383 (9917): 630-667. Link. SKIM
Lee, K, Sridhar D, Patel M. (2009) Bridging the divide: global governance of trade and health. The Lancet. 373
(9661): 416-422. Link.
Case 2: Trade Agreements & Tobacco
Trans-Pacific Partnership. Link. (SKIM)
Mitchell A, Sheargold E. (2014) Protecting the autonomy of states to enact tobacco control measures under
trade and investment agreements. Tobacco Control, ;24:e147-e153. Link.
McGrady B. (2011). Tobacco product regulation and the WTO: US-Clove Cigarettes. Briefing Paper. ONeill
Institute for National and Global Health Law. Link.
Video
Watch Lecture: Sectoral Challenge
Recommended Reading
McGrady B. (2014) Trade and Public Health: The WTO, Tobacco, Alcohol and Diet. Cambridge, UK: Cambridge
University Press.
Mercurio B. (2014) International Investment Agreements and Public Health: Neutralizing a threat through treaty
drafting. Bulletin of the World Health Organization 2014;92:520-525.
doi:http://dx.doi.org/10.2471/BLT.13.130955

Brandt AM. (2007) The Cigarette Century: The Rise, Fall and Deadly Persistence of the Product that Defined
America. New York: Basic Books.
Investment Treaty News. Available: https://www.iisd.org/itn/ SKIM
Marmot M, et al. (2008) Closing the gap in a generation: Health equity through action on the social determinants
of health. Final report of the WHO Commission on the Social Determinants of Health. Available:
http://www.who.int/social_determinants/thecommission/finalreport/en/
Written or Oral Assignments
Teams working on cases

SESSION 4

GOVERNANCE CHALLENGES: ACCOUNTABILITY

CASES 2 & 3: TRADE & TOBACCO and CHOLERA IN HAITI

Schedule for Feb 19, 2016

Time
Activity and Topic
12:30pm-1:30pm Case 2: Trade Agreements and Tobacco Team Presentations & Debate
1:30pm-2:20pm
Accountability Challenge (Re: Video Lecture) - Class Discussion
2:20pm-2:35pm
Break
2:35pm-3:20pm
Case 3: Cholera in Haiti Class Discussion

Notes
Teams

Class
Class

Reading Assignments[YE1]
Accountability Challenge
Grant R & Keohane R. (2005). Accountability and Abuses of Power in World Politics. American Political
Science Review, 99(1), 29-43. Link
Nye JS. (2001). Globalizations Democratic Deficit: How to make international institutions more accountable.
Foreign Affairs. 80(2): Link. [4 Pages]
Frenk J. (2010). The World Health Report 2000: Expanding the Horizon of Health System Performance. Health
Policy and Planning. 25: 343-345. doi:10.1093/heapol/czq034. Link. [3 Pages]
Chan M, Kazatchkine M, Lob-Levyt J, Obaid T, Schweizer J, et al. (2010). Meeting the Demand for Results and
Accountability: A Call for Action on Health Data from Eight Global Health Agencies. PLoS Med 7(1): e1000223.
doi:10.1371/journal.pmed.1000223. Link [4 Pages]
Case 3: Cholera in Haiti
Cholera in Haiti Case Study (Available on course website)
Video
Video Lecture: Accountability Challenge
Recommended Reading
Zrn, M. (2004). Global Governance and Legitimacy Problems. Government and Opposition. 39(2): 260-287. Link.
Ebrahim A, Weisband E, eds. (2007) Global Accountabilities: Participation, Pluralism, and Public Ethics.
Cambridge: Cambridge University Press.
Wild L & Domingo P (2010). Aid and Accountability in Health: Key Themes and Recommendations (No 44).
London: Overseas Development Institute. Link.
Written or Oral Assignments
Teams work on case

SESSION 5

TOOLS & MECHANISMS OF GLOBAL GOVERNANCE (Part 1)

CASES 3 & 4: CHOLERA IN HAITI and ACCESS TO MEDICINES & THE MENINGITIS A VACCINE

Schedule for Feb 26, 2016

Time
Activity and Topic
12:30pm-1:30pm Case 3: Cholera in Haiti Team Presentations and Debate
1:30pm-2:20pm
Tools & Mechanisms (Re: Video Lecture) Part 1 - Class Discussion
2:20pm-2:35pm
Break
2:35pm-3:20pm
Case 4: Access to Medicines & the Meningitis A Vaccine Class Discussion

Notes
Teams

Class
Class

Reading Assignments
Tools & Mechanisms
Krasner SD (1982). Structural Causes and Regime Consequences: Regimes as Intervening Variables. International
Organization, 36(2). Link.
Barnett M & Duvall R. (2005). Power in Global Governance. In M. Barnett, & R. Duvall (Eds.), Power in Global
Governance (pp. 1-32). New York: Cambridge University Press. Link (Available on course website)
Krisch N and Benedict K. (2006). Introduction: Global Governance and Global Administrative Law in the
International Legal Order. The European Journal of International Law. Link.
Case 4: Access to Medicines and the Meningitis A Vaccine
Case: Gordon R, et al. (2014) The Meningitis Vaccine Project. Link.
t Hoen E, Berger J, Calmy A, Moon S. (2011). Driving a decade of change: HIV/AIDS, Patents, and Access to
Medicines. Journal of the International AIDS Society, 14:15. Link.
WHO Consultative Expert Working Group on Research & Development. (2012) Research and Development
to Meet Health Needs in Developing Countries: Strengthening Global Financing and Coordination. Link.
(SKIM)
Video
Lecture on Tools and Mechanisms
Recommended Reading
Commission on Intellectual Property Rights, Innovation and Public Health (CIPIH). (2006). Public Health,
Innovation and Intellectual Property Rights. Geneva: World Health Organization (WHO). Link. (SKIM)
Pedrique B, Strub-Wourgaft N, Some C, Olliaro P, Trouiller P, et al. (2013) The drug and vaccine landscape
for neglected diseases (200011): a systematic assessment. The Lancet Global Health 1(6):e371-e379. Link.
Policy Cures. (2013). G-FINDER Report 2013: Neglected Disease Research and Development: The Public Divide
Link.
Rottingen J-A, Moon S, Tangcharoensathien V, Hoffman SJ. (2012) Multistakeholder Technical Meeting on
Implementation Options Recommended by the WHO Consultative Expert Working Group on Research &
Development (CEWG): Financing and Coordination. Link.
Hein W and Moon S. (2013) Informal Norms in Global Governance: Human Rights, Intellectual Property and
Access to Medicines. Aldershot, UK: Ashgate.
Written or Oral Assignments
Teams work on case

SESSION 6

TOOLS & MECHANISMS OF GLOBAL GOVERNANCE (Part 2)

CASE 4 & 5: ACCESS TO MEDICINES & THE MENINGITIS A VACCINE and WHO REFORM AFTER EBOLA

Schedule for Mar 4, 2016

Time
Activity and Topic
Case 4: Access to medicines & the meningitis A vaccine Team presentations and
12:30pm-1:30pm
debate
1:30pm-2:20pm
Tools and Mechanisms Part 2- Power in global governance Class Discussion
2:20pm-2:35pm
Break
2:35pm-3:20pm
Case 5: WHO Reform after Ebola Class Discussion

Notes
Teams
Class

Class

Reading Assignments
Tools and Mechanisms Part 2
Cooper, Andrew F., English, John. (2005) International Commissions and the Mind of Global Governance.
Tokyo: United Nations University Press. Link.
Price, R. M. (2003). Transnational Civil Society and Advocacy in World Politics. World Politics, 55(4), 579606. Link
Labont, Ron; Gagnon,Michelle L (2010) Framing health and foreign policy: Lessons for global health
diplomacy. Globalization and Health 6:14. Link.
Case 5: WHO Reform After Ebola
Stocking B, et al. (2015) Report of the Ebola Interim Assessment Panel- July 2015. Link.
Moon S, et al. (2015) Will Ebola change the game?: Ten essential reforms before the next pandemic. The Lancet
386 (10009): 2204-2221. Link.
Clift C. (2014) Whats the World Health Organization for? London: Chatham House Centre on Global Health
Security. Final Report of the Working Group on Governance. Link. (EXECUTIVE SUMMARY ONLY)
Bloom B. (2011). WHO needs change. Nature. 473: 143-145. Link.
Silberschmidt G. (2013). Global health governance and WHO reform. (Guest lecture) Video available on course
website.
Special Issue of Public Health on WHO Reform (January 2014): Read introduction and SKIM other articles as
relevant Link.
Recommended Reading
Lee K. (2008) The World Health Organization. London: Routledge.
Chorev N. (2012) The World Health Organization between North and South. Ithaca: Cornell University Press.
Godlee F. (1997) WHO Reform and Global Health: Radical Restructuring Is the Only Way Ahead. British Medical
Journal 314: 135960. Link.
Rockefeller Foundation (1996) Enhancing the Performance of International Health Institutions (Pocantico retreat).
Cambridge, MA: Rockefeller Foundation, Social Science Research Council, Harvard School of Public Health, 1996.
Smith R. (1995) WHO: Change or Die. British Medical Journal, 310: 54344. Link.
Walt G. (1994) WHO Under Stress: Implications for Health Policy. Health Policy 24 : 12544.

Chow, Jack C. (2010). Is the WHO Becoming Irrelevant? Foreign Policy. December. Link.
Written or Oral Assignments
Teams work on case

10

SESSION 7

CASE 5 & SYNTHESIS: WHO REFORM AFTER EBOLA

Schedule for March 11, 2016

Time
Activity and Topic
12:30pm-1:30pm Case 5: WHO Reform after Ebola Team Presentations and discussion
1:30pm-2:20pm

Course Synthesis Exercise

2:20pm-2:35pm

Break
Course Closing and Evaluation

2:35pm-3:20pm

Notes
Teams
Instructor,
Class

Instructor,
Class

Reading Assignments
Course Synthesis and Closing
Health and the Sustainable Development Goals
Recommended Reading
Read introduction and assessments of proposals of interest. Hoffman, Steven J. (ed). (2011). Student Voices 2:
Assessing Proposals for Global Health Governance Reform. McMaster Health Forum. March. Link.
Gostin, Lawrence O.; Mok, Emily A. (2010). Innovative Solutions to Closing the Health Gap between Rich and
Poor: A Special Symposium on Global Health Governance. Journal of Law, Medicine & Ethics. Fall. 38(3): 451458. Link.
Moon, S., Szlezak, N. A., Michaud, C. M., Jamison, D. T., Keusch, G. T., Clark, W. C., & Bloom, B. R. (2010). The
Global Health System: Lessons for a Stronger Institutional Framework. PLoS Medicine, 7(1), e1000193. Link.
Ooms, Gorik; Stuckler, David; Basu, Sanjay; McKee, Martin. (2010). Financing the Millenium Development Goals
for health and beyond: sustaining the Big Push. Globalization and Health. 6: 17. doi: 10.1186/1744-8603-6-17.
Link.
Ruger, Jennifer Prah. (2008). Normative Foundations of Global Health Law. The Georgetown Law Journal. 96:
423-443. Link.
Written or Oral Assignments
Term Papers

11