Global public action needs to tackle global health policies

Our understanding of global public action is dominated by experiences from global campaigns and a focus on human rights, environmental and gender issues. In health and pharmaceutical policies, global public action is influenced also by strong commercial interests, so public action needs to analyse carefully the precise content of the policies it promotes.A paper from the Open University, in the UK, discusses how public action on pharmaceuticals has influenced global health policies and the institutional basis of global health governance. The authors ask two key questions. First, they consider how the emphasis on different interests across countries can divert attention away from conflicts of interest between commercial and public sectors. Second, they ask what kinds of health and pharmaceutical policies should be promoted, and how these relate to institutional structures and policy priorities in the health sector at both national and global levels. While non-governmental public action influences the agenda of global policymaking, for instance on trade, its role in influencing solutions to the problems highlighted is more limited. In contrast to trade policies, more substantial changes have taken place within global health policies and governance. When goals of global public action become focused on specific diseases or access to particular technologies over and above others it may undermine the democratic accountability of global health governance, the wise use of public resources, health systems development, and longer-term access to healthcare within developing countries.Looking at campaigns for access to medicines, the study finds that commercialisation is a challenge for global public action itself. Key findings include: •Calls for universal access to medicines are important, but have to be set in a broader context, as they can also be used to create a demand for new and expensive medicines or divert focus from alternative avenues for tackling the health problems•Global campaigns have had some success in terms of access to medicines, particularly for first-line treatment in HIV and AIDS.•Global campaigning and in particular responses to it have also contributed to some problematic or negative outcomes for sustainability, global governance of health, and the organisation and resource distribution within health systems.•The emphasis on access to medicines as a development issue has often served the core interests of industry better than it has served the health interests of the developing world.The paper concludes that public action on health needs to tackle the content of health policies and articulate more clearly common interests between countries at different levels of development. This could include:•shifting from disease-based to policy-based campaigning, emphasising that pharmaceutical issues form part of broader health and industrial policy strategies•recognising the broader public policy context in the field•raising the profile for the rational and appropriate use of medicines within a broader set of health policy options•tackling the commercialisation of non-governmental public action•setting global public action in the context of global and national democratic accountability, governance and sustainability.