Richard D. Smith
The configuration of economic actors has shifted dramatically in recent decades as a consequence of the shift from an international to global economy. The 21st century thus faces a fundamentally different economic landscape, with governance far less about formal nation-state negotiation, and far more about informal mechanisms of state and non-state negotiation. Although economic power has always played a role in defining international health governance, this changing global economic context has increased the role of economic power in the development of global health governance. To ensure the continued protection and enhancement of global health, it is imperative for the health profession to recognize and more actively engage with this changing economic context, in order to seize opportunities and minimize risks to global health. If it does not, the danger is that global health governance will increasingly be determined by economic organizations with the principle concern not of health but of market liberalisation, ultimately constraining the capacity of nation-states to undertake measures to protect and enhance the health of their populations.