- Julio Frenk, executive vice president and directora,
- Jaime Sepúlveda, director generalb,
- Octavio Gómez-Dantés, project coordinatora,
- Michael J McGuinness, research fellowa,
- Felicia Knaul, professor and coordinatorc
- a Center for Health and the Economy, Mexican Health Foundation, Periférico Sur 4809, Tlalpan, 14610 México, DF
- b National Institute of Public Health, Cuernavaca, Mexico
- c Program in Health Economics, Center for Economic Research and Education, Mexico City
- Correspondence to: Dr Frenk
Health systems in countries all over the world are undergoing intensive reforms. Internationally, the existing institutions for multilateral cooperation are facing unprecedented challenges. Many are finding it increasingly difficult to fulfil their mandates. There is inefficient overlap of efforts among various multilateral organisations, while, paradoxically, there are voids of responsibility in executing some key functions. At the same time, other players, such as non-governmental organisations and transnational corporations, are gaining prominence.
Multiple forces are transforming the shape of the world and patterns of disease and health–creating a need for new institutional arrangements. Just as governments are reinventing their respective national health systems, so international health must be rethought so that it can respond effectively to the emerging challenges.
The new shape of the world
Nations no longer represent truly independent, sovereign countries. New global forces have eroded national borders, facilitating the transfer of goods, services, people, values, and lifestyles from one country to another. Countries are increasingly dependent on international trade. Transnational corporations control a large portion of the world's capital. Currencies leap from one financial market to the next, often defying national regulation.1
Political movements also generate transnational forces that place external pressure on individual nations. Interest groups organised around issues such as sex and sexual orientation operate transnationally in order to exert change at the national level. The continuing ties among related groups in different nations produce networks of communities with similar values and customs, which operate at both the local and international levels. These act as one more force pulling towards meta-national integration.
Certain forces resisting this globalisation have recently risen to prominence. At its extremes, this process has led to the development of religious fundamentalism. Recently, some of these fundamentalist movements have sought to give their “awareness” a political expression, creating intolerant and antidemocratic currents.2 In countries all over the …