Overview
The Lancet Commission on Global Governance for Health examines how global political, economic, and ecological structures shape health, with power and equity at the center of its analysis. Building on the 2014 Lancet University of Oslo Commission, which exposed the political origins of health inequity and five key governance dysfunctions, this new Commission responds to a world marked by intersecting crises: rising authoritarianism and protectionism, eroding multilateralism, nearly 200 armed conflicts, and accelerating climate change, biodiversity loss, and pollution. These trends deepen existing inequalities and reveal a global health architecture that often serves strategic and commercial interests over the needs of marginalized populations. The Commission focuses on the extractivist and neocolonial logic underpinning this architecture and sets out a forward-looking agenda to reconfigure global governance in service to health equity, sustainability, and justice.
About
The COVID-19 pandemic made visible what many communities have long experienced: fragile systems, stark disparities in access to vaccines and medical technologies, and a lack of genuine global solidarity. This is not an isolated failure, but a symptom of a broader pattern in which power asymmetries - gendered, socioeconomic, generational, and neocolonial - shape who benefits from global cooperation and who is left behind.
At the heart of this pattern is extractivism: systems, institutions, and “rules of the game” that concentrate political, economic, natural, human, and technological resources in the hands of a few, through non‑reciprocal and socio‑ecologically harmful processes. In global health, this means that knowledge, labor, data, pathogens, and even health gains are routinely extracted from low‑ and middle‑income countries to sustain the prosperity and influence of high‑income countries and powerful private actors. The post–World War II liberal order, with its professed values of democracy and multilateralism, has increasingly evolved into a privatized, poorly accountable system misaligned with health equity and social justice.
Yet the current moment is also one of possibility. The establishment of the Africa Centres for Disease Control and Prevention, pushes for regional vaccine manufacturing, and growing coalitions among LMICs signal a shifting balance of power and a demand for more democratic and inclusive governance. Around the world, regional institutions and local actors are asserting autonomy, leading innovation, and demonstrating that alternatives to extractivist models are both necessary and viable.
Overarching Aim
Catalyze a transition from vicious cycles of extractivism to virtuous cycles grounded in equity, sustainability, and justice.
Core Objectives
- Evaluate Megatrends: Analyze geopolitical, economic, ecological, and technological trends producing health inequities.
- Assess Determinants: Measure impacts across political, social, commercial, ecological, and digital determinants of health.
- Highlight Solutions: Document governance success stories and models for equitable alternatives.
- Deliver Recommendations: Provide actionable short- and long-term steps to reverse extractivism and build fairer systems.
Guiding Framework
Equity-centered and grounded in decolonization, intersectional justice, and environmental stewardship, the Commission advocates for the reform and revitalization of global institutions to make them inclusive, accountable, and effective.
