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Yale Researcher Addresses Institute of Medicine

The Institute of Medicine invited Yale’s Jennifer Prah Ruger to testify on global health institutions and governance.

Establishing health policies that are effective and responsive to people’s needs is never easy, especially when the guidelines will be instituted on a global scale.

The Institute of Medicine (IOM), a Washington, D.C.–based organization that provides advice to the U.S. Congress and others on issues relating to biomedical science, medicine and health, seeks to do just that. To help with the process, the agency turns to individual experts for advice and to formulate new policy ideas.

The organization recently invited Yale’s Jennifer Prah Ruger to serve on a panel that addressed how the current arrangement of global health institutions and governance might be changed to better meet the needs of people who depend upon it.

Ruger, an assistant professor at the School of Public Health and co–director of the Yale/World Health Organization Centre for Health, Policy and Research, spoke about the need for change in the way that global health governance is currently structured and in the way that health care is delivered.

“Global health governance is becoming more complex with the increase in actors and funding available,” said Ruger. “This meeting comes at an opportune time, as creating guidelines and a framework for how to distribute resources and set priorities are of crucial importance. The focus on donor–driven development has led to limitations in the effectiveness of interventions and we need to chart a way forward for the United States and other partners.”

Ruger’s testimony at the June 26 meeting touched upon several themes; including how economically powerful countries and wealthy organizations and foundations currently wield most of the power on global health issues and policies. As a result, these institutions dominate policy decisions and resource allocation, resulting in a system where recipient countries have few options and little recourse. Ruger argued that what is needed is a more equitable global health system based on the principles of global health justice. She advocates a “shared health governance” paradigm, where governments, institutions, providers and individuals work together to create an environment where all have the capability to be healthy. This framework removes health and disease control from the narrow interests of powerful countries and institutions and allows for the creation of partnerships characterized by a shared goal, clearly articulated objectives, well–defined responsibilities, accountability and capacity–building within recipient countries. This framework should prove useful in articulating the role of the United States in global health governance.

Ruger said that reducing gaps in preventable mortality and morbidity between wealthy and poor countries is a moral imperative in the 21st century for the global health community.

The IOM deliberations will culminate in a brief report made available in December to coincide with the U.S. presidential transition. A final 150–page report is slated for release early next year. It is hoped that the report, comprised of evidence–based recommendations, will provide a platform for the new administration and Congress, and inform U.S. decisions about commitments in global health governance. Ruger will be involved in continual review and will contribute a paper on international and domestic institutions and global justice to the report.