Department of Political Science, University of Toronto, 84 Queen's Park, Toronto, Ontario, Canada, M5S 2C5, Canada.
Health Policy Plan. 2010 Nov;25(6):510-22. doi: 10.1093/heapol/czq037. Epub 2010 Aug 22.
Attention to global health security governance is more important now than ever before. Scientists predict that a possible influenza pandemic could affect 1.5 billion people, cause up to 150 million deaths and leave US$3 trillion in economic damages. A public health emergency in one country is now only hours away from affecting many others.
Using regime analysis from political science, the principles, norms, rules and decision-making procedures by which states govern health security are examined in the historical context of their punctuated evolution. This methodology illuminates the catalytic agents of change, distributional consequences and possible future orders that can help to better inform progress in this area.
Four periods of global health security governance are identified. The first is characterized by unilateral quarantine regulations (1377-1851), the second by multiple sanitary conferences (1851-92), the third by several international sanitary conventions and international health organizations (1892-1946) and the fourth by the hegemonic leadership of the World Health Organization (1946-????). This final regime, like others before it, is challenged by globalization (e.g. limitations of the new International Health Regulations), changing diplomacy (e.g. proliferation of global health security organizations), new tools (e.g. global health law, human rights and health diplomacy) and shock-activated vulnerabilities (e.g. bioterrorism and avian/swine influenza). This understanding, in turn, allows us to appreciate the impact of this evolving regime on class, race and gender, as well as to consider four possible future configurations of power, including greater authority for the World Health Organization, a concert of powers, developing countries and civil society organizations.
This regime analysis allows us to understand the evolution, etiology and eventualities of the global health security regime, which is essential for national and international health policymakers, practitioners and academics to know where and how to act effectively in preparation for tomorrow's challenges.
关注全球卫生安全治理比以往任何时候都更加重要。科学家预测，一场可能的流感大流行可能会影响 15 亿人，导致多达 1.5 亿人死亡，并造成 3 万亿美元的经济损失。一个国家的公共卫生紧急情况现在只需几个小时就可能影响到其他许多国家。
利用政治学中的制度分析，从历史演变的角度考察了国家治理卫生安全的原则、规范、规则和决策程序。这种方法阐明了变革的催化因素、分配后果以及可能的未来秩序，有助于更好地了解这一领域的进展。
确定了四个全球卫生安全治理时期。第一个时期的特点是单方面的检疫法规（1377-1851 年），第二个时期的特点是多次卫生会议（1851-192 年），第三个时期的特点是几项国际卫生公约和国际卫生组织（1892-1946 年），第四个时期的特点是世界卫生组织的霸权领导（1946-????）。与之前的制度一样，这一最终制度也受到全球化的挑战（例如，新的《国际卫生条例》的局限性）、不断变化的外交（例如，全球卫生安全组织的扩散）、新工具（例如，全球卫生法、人权和卫生外交）和冲击激活的脆弱性（例如，生物恐怖主义和禽流感/猪流感）。这种理解反过来又使我们能够理解这一不断演变的制度对阶级、种族和性别产生的影响，并考虑权力的四种可能的未来配置，包括世界卫生组织更大的权威、权力协调、发展中国家和民间社会组织。
这种制度分析使我们能够理解全球卫生安全制度的演变、病因和最终结果，这对于国家和国际卫生政策制定者、从业者和学者来说是必不可少的，他们需要了解在何处以及如何有效地采取行动，为明天的挑战做好准备。
