Editorials |
Good governance for the public's health
Helmut BrandInstitute of Public Health NRW, Westerfeldstr. 35/37, D-33611 Bielefeld, Germany
Correspondence: Dr. Helmut Brand MSc, MFPH, DLSHTM, Institute of Public Health NRW, Westerfeldstraße 35/37, D-33611 Bielefeld, Germany, tel: +49 521 8007 223, fax: +49 521 8007 202, e-mail: Helmut.Brand{at}loegd.nrw.de
Good Governance is en vogue. It has become a leading concept in public administration. Here Good Governance stands for the aim of bringing together administrative bodies and all relevant stakeholders (citizens, NGOs, industry, etc.) to implement reforms improving the living conditions for all people. In ‘New Public Management’, Good Governance means working together coherently without relying on governments—rather following a principle of subsidiarity.
The concept of Good Governance is increasingly being discussed in the context of Public Health. In the following it shall be explained what exactly is meant by this buzzword, how Good Governance can be justified and how it can be translated into Public Health practice for the betterment of population health:
Governance means decision-making and the implementation of decisions. These decisions can be made within all different kinds of social institutions and arrangements and relate to communities, corporations, national and international levels. Good Governance is a concept articulated and conceptualized in the context of development and development aid. It was influentially formulated by the United Nations Economic and Social Commission for Asia and the Pacific (UNESCAP). Good Governance was meant to ensure that developing countries are free from oppression and corruption—and thus can prosper in wealth and health.
According to UNESCAP, the eight criteria of Good Governance are participation, consensus orientation, accountability, transparency, responsiveness, effectiveness, equity and abidance by the rule of law. Good Governance furthers democracy and fights corruption and violence. It links democracy to the well-being and health of populations.1
In Good Governance administrative and ethical benchmarks converge. Ethics in this context means: the reliance on social justice and informed participation in decision making—a moral requirement at least since the age of enlightenment. Equity reminds us to be just, not to exclude subgroups or individuals but to guarantee opportunities for all and to maintain the overall well-being of society—to which health significantly contributes. Participation is a requirement of procedural justice and is meant to include vulnerable groups in decision-making. It corresponds with the value that is reflected when demanding transparency. Transparency demands understandable information freely available for everyone. To be responsive and accountable means to serve all stakeholders and to be liable to them. This can best be achieved by building decision-making processes on a widest possible consensus. Only in this way can the best interest of the whole community be met and sustainability of the decision-making process can be achieved. Effectiveness demands to meet the needs of society and to be a good custodian of the goods entrusted by society that are at stake when making decisions. Finally, to follow the rule of law supports the demand for equity and fairness and means to be impartial, not corrupt and to protect the human rights of all.
These are the leading criteria becoming benchmarks one has to keep in mind when striving for Good Governance in the decision-making processes. Good Governance is both ethically required and instrumental to health.2 Setting these benchmarks within Public Health would be urgent in countries that were recently shattered by wars and violence or are currently in transition—in our European setting for example the former Yugoslavian states.1 At EU level, Good Governance is being striven for by trying to achieve well-being for example through ‘Health in all Policies’ and by involving all stakeholders to improve population health.
But Good Governance should also be a leading concept for Public Health on a local level. Also on this micro-level Good Governance grounds on the realization that the state is not omnipotent but that all stakeholders have to be involved in decision-making. An example is the ‘Local Coordination of Health Care’ in the German State of North-Rhine Westphalia (18 Mio inhabitants). In this state-wide initiative, local health conferences in all 54 districts and self-administered cities were established. These steady health conferences bring all stakeholders in health together, including citizens and patients to increase transparency and further participation in decision-making. These conferences set out priorities for their districts and established health programmes. They improved health reporting, health care and local networking in the districts. They work towards better health literacy and equity. Topics such as gender and health were brought on the working agendas. Local health conferences in North-Rhine Westphalia (NRW) became ‘planning bodies’ at a communal level. This initiative was twice evaluated and found to be a good working tool that served Good Governance ideals in ‘New Public Management’. Thus, as a tool that fulfils standards of Good Governance it serves towards a cooperative democracy and bettered health outcomes. As a consequence, the ‘Local Coordination of Health Care’ was included as a task to NRW's ‘Public Health Service Act’.3
To conclude, Good Governance is more and more being placed on the agenda of Public Health discourses—and rightly so, as Good Governance is good for health.
References
1 Laaser U, Donev D, Bjegovic V, Sarolli Y. Public Health and Peace. Croat Med J (2002) 43:107–13.[Web of Science][Medline]
2 Daniels Norman. Just Health. Meeting Health Needs Fairly (2007) Cambridge University Press: Cambridge. forthcoming.
3 Murza G, Werse W, Brand H. Local Coordination of Health Care in North Rhine-Westphalia. Interim Review of the North Rhine-Westphalian Model. Bundesgesundheitsblatt – Gesundheitsforschung – Gesundheitsschutz (2005) 48:1162–9.[CrossRef][Medline]
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