Global health governance and the principle of subsidiarity: In defense of a robust decentralization approach

Abstract

Abstract Global health governance (GHG) scholars have conventionally advocated for a stronger World Health Organization, able to better centralize power and authority in decision-making processes addressing global health challenges. What we call “the centralization approach to GHG reform” has not led to the best outcomes. In challenging the centralization approach and showing where it fails, this article argues for a decentralized GHG reform, predicated on the principle of subsidiarity, as an alternative. We offer an applied ethics analysis of the principle of subsidiarity, which contradicts the conventional wisdom of the centralization approach. This normative article not only opens up a new way in the global health literature of theorizing the long-standing debate on GHG reform, but it also offers a new lens for responding to the current backlash against multilateralism by substantiating the complementarity and cooperation among global health stakeholders in times of pandemics and beyond.