Global health. The current scenario and future perspectives

29 process by which organizations and procedures acquire value and stability”. By further searching who should validate procedures and organizations, one arrives at the “so-called strategic actors”, those who are “able to undermine governability by interfering in the economy and order”. Since its establishment in 1948, the formal orientation of the World Health Organization (WHO) has been that of the specialized agency for global health within the United Nations. However, it has lacked the necessary capacities, mandates and resources to exert effective leadership in all areas of global health and for the entire world. The capacity of the WHO to assume a global and effective leadership role has fallen far short due to the governance provided by its member countries. The organization does not cover all aspects of public health or all its disciplines and suffers from other structural problems, such as the excessive autonomy of its regional offices. The successive attempts to make the system more effective have resulted in improvements and changes in its governance. However, they do not seem to fully satisfy its stakeholders, especially the main contributors to global health, true strategic actors, who have started creating other parallel and associated organizations. Already in the Middle Ages, it was recognized that the management of certain communicable diseases was beyond what a single government could handle without coordinating with neighboring countries. However, effective cooperation agreements were only established towards the end of the 19th century. The International Sanitary Conference in Venice in 1892 established arrangements to prevent the transmission of cholera. Subsequent conferences added other communicable diseases such as yellow fever and smallpox. It is worth noting that the driving force behind these meetings was not solely epidemiological but also the need to prevent these diseases from affecting trade and the movement of people. To implement the recommended measures, the International Sanitary Bureau was created in the Americas in 1902. It later evolved into the Pan American Sanitary Bureau, which eventually became the Pan American Health Organization (PAHO). In Europe, the Office International d’Hygiène Publique was established in 1897 with similar objectives, although each institution worked within its own geographical area without coordinating with other areas or addressing common or global issues. The focus of these regional institutions was to support the policies and programs of member countries without attempting to create a collective vision or becoming direct implementers. This task was left to the member countries. Sovereignty versus Globality: the architecture of international relations and global health