Introduction

The study of international relations historically paid little attention to international health. After the Cold War, health emerged from this neglect, transformed by how political actors framed health challenges. However, this transformation did not prevent global health governance (GHG) from experiencing disaster during West Africa's Ebola outbreak in 2014–15. With insights from earlier periods, the post-Cold War years and the Ebola epidemic reveal continuity and change in GHG demand that make health a rich case study for exploring the politics of global governance.

Using the demand variables guiding the “Why Govern?” project, this chapter analyzes demand for health governance from the latter half of the nineteenth century through the post-Cold War period until the Ebola outbreak. This analysis traces changes in demand from functional reasons in the first half of the twentieth century to normative ideas during the Cold War. Demand transformed after the Cold War across all variables, producing a “revolution” in GHG. The chapter includes case studies from this period that map GHG demand and assess outcomes. Finally, the chapter examines the Ebola epidemic in West Africa, which triggered GHG reform activities the impact of which is, as of this writing, uncertain.

Definitions and Demand Variables

Analyzing GHG confronts challenges arising from broad definitions of “global governance” and “health.” Global governance means management of transnational issues affecting much of the international system by states, international organizations and non-state actors through regimes shaped by power politics, functional cooperation and norms. The World Health Organization (WHO) defines health as the “state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” This definition implicates many policy areas, and GHG involves a sprawling “regime complex.” The challenge is to identify patterns of demand and outcomes across diverse health issues and governance regimes.

The “Why Govern?” project's demand variables guide this chapter's analysis of demand for GHG and how configurations of demand affect outcomes. The primary variables focus on:

1. • strategic demand, when states want to maintain or enhance national power and influence;

2. • functional demand, when states must cooperate to manage problems; and

3. • normative demand, when norms rather than state power or functional cooperation motivate state and non-state actors.