Health, Social Injustice and Global Action

The work of The Lancet - UiO Commission is soon coming to an end. Read some of the Commission Chair's, Ole Petter Ottersen, reflections on the process and outcomes.

From the last Commission meeting in Oslo, April 2013.

Credit: John Hughes Photo

Over a year and a half ago, the first meeting of The Lancet – UiO Commission on Global Governance for Health took place in Oslo. As argued in The Lancet commentary on the Commission (Ottersen, Frenk, Horton, 2011), our starting point was, that global governance processes in non-health policymaking arenas often are not sensitive to public health. Rather, health concerns can come into direct conflict with other powerful interests, such as protecting national security, safeguarding sovereignty, or pursuing economic goals.

What, then, is to be done? Of course there is no easy answer to this question – but such problems are at the crux of the challenge Commissioners have discussed over a series of meetings. In Arusha in Tanzania, we decided that we should develop bold recommendations on ways to combat the greatest affronts to health, taking care not to sidestep the big, difficult issues that can be linked to deficits in health-oriented global governance.

The Political Determinants of Health

Our work builds on the The Commission on Social Determinants of Health which provided powerful evidence of how societal inequalities skew the distribution of health. While the latter  Commission drew attention to the political conditions underpinning unfair economic and societal arrangements, its analysis did not aim to address the global processes, institutions and actors creating the conditions that cause health inequity. Our Commission has sought to pick-up where the CSDH left-off, by attempting to provide a candid assessment of power dynamics and issues of unequal power across a range of policy arenas which require improved global governance for health: food security, foreign investment treaties, international finance, transnational corporations, trade related aspects of intellectual property rights, irregular migration and armed conflict. Thus, while The Commission on Social Determinants of Health dealt with the “causes of the causes”, our commission is concerned with the “causes of the causes of the causes” – the political determinants of health.

Addressing Global Governance Dysfunctions

Many deficiencies in global governance were identified and discussed  during our meeting in New Delhi, India. Representatives of Indian civil society movements, authorities, and academia furthered the Commission’s awareness by shedding light on numerous cases in the Indian context where global governance practices and arrangements created harmful effects on well-being, particularly for the poor. In his presentation, the UN’s Special Rapporteur on the Right to Health, Advocate Anand Grover, also reminded us  that one of the main preconditions  for realizing the right to health, is due consideration of health in international treaty regimes.

In our report we are asking ”under what conditions do shared interests, objectives and standards among global actors to protect communities and human livelihood prevail, and when do they fall apart?”. Our work will clearly show that health is far from being a shared objective on the global arena. Many of the extant global institutions have proved to be insufficiently democratic, inflexible to change, weak, and unable to hold actors to account.

Towards Health Equity as a Shared Objective Across Sectors

In the Commission report which is set to be published in The Lancet this autumn, we propose a number of recommendations that offer concrete steps towards addressing the identified dysfunctions of global governance. The report  will send a strong message to the international community and to all actors that exert influence in processes of global governance:  we must not any longer regard health solely as a technical and biomedical issue but recognize the need for cross-sectoral action and distributive justice in our efforts to address health equity.

It has been an inspirational journey to chair this Commission. The commission was put together to represent the broadest possible range of cultural and geographical backgrounds. We realized that this diversity could make it difficult to reach consensus on the issues at hand, as many of these are far from being politically neutral. But we also understood that if we were to arrive at a consensus, diversity would make the message so much stronger.The stakes were high. Now we can conclude that consensus was reached. And we have the audacity to believe that our report will matter.


  • Ottersen, O.P., Frenk, J., Horton, R. (2011), "The Lancet - University of Oslo Commission on Global Governance for Health - In collaboration with Harvard Global Health Institute", The Lancet, Volume 378, Issue 9803, pp. 1612-1613, 5 November 2011
By Ole Petter Ottersen
Published July 28, 2013 8:45 PM - Last modified June 12, 2018 2:07 PM