Introduction

Other chapters in this book demonstrate the profound changes accompanying globalisation, which are altering the manner and the ability of nation-states (particularly in low-income countries) to formulate and implement health policy. More specifically, later chapters expose how a variety of challenges cannot be met efficiently at the national level, but require additional collective international, if not global, approaches. Moreover, the ascendancy of organised capital over the power of the nation-state adds impetus to intergovernmental co-operation. Indeed, it has been argued that: ‘short of a backlash against globalisation, states will have little choice but to pool their sovereignty to exercise public power in a global environment now mostly shaped by private actors’ (Reinicke and Witte 1999). Consequently, new multilateral institutions and instruments are being established, others reformed and some given hitherto unprecedented powers (e.g. the binding nature of the World Trade Organization Agreements), and a number of new forms of global governance are emerging. As globalisation forces a shift from state-centric politics to more complex forms of multicentred governance, and makes the desirability of global level mechanisms for the governance of global problems more apparent, a new set of challenges to the existing multilateral system comes into play.

In relation to the United Nations (UN), two trends in the nature of the emerging global governance architecture are observable, although the notion of the emergence of any system of global governance remains contested (Dodgson et al. 2000).