This chapter looks at the remit of, and the activities engaged in by, different organizations and groups involved in global health. These include major world organizations (notably the World Health Organization and World Bank), constellations of public– private partnerships, non-governmental organizations and social movements. It also examines the role of philanthropy, asking whether it is more appropriate to speak of “philanthrocapitalism”.

Wrapped up in the geopolitics of health are issues of global health security: issues that have inevitably come to the fore during the Covid-19 pandemic but that emerged some years earlier when new strains of influenza were appearing and the earlier coronavirus infection (severe acute respiratory syndrome: SARS) appeared on the world scene. The second half of the chapter therefore explores what is meant by health security.

As the quote at the start of the chapter suggests, we need to examine the relative power of the different agencies involved in global health, and where power lies in determining who gets “secured”, how and where.

Governance

My focus here is on relations between the actors involved in global health – nation states and organizations of different types – and less on the governance within states or organizations. The latter matters greatly, of course. For example, there is a close relationship between maternal mortality rates among a set of 174 countries and indicators of their governance (government effectiveness, regulatory quality, rule of law, control of corruption, voice and accountability, and political stability and absence of violence – all indicators proposed by the World Bank) in those countries (Ruiz-Cantero et al. 2019). The stronger the governance, the lower the rate of maternal mortality.

As well as exploring the roles of nation states and major intergovernmental organizations, the governance of global health is seen as “stemming from a configuration of public private partnerships (PPPs) between governmental agencies and programs, NGOs and charitable foundations, including the omnipresent Bill & Melinda Gates Foundation and other “philanthrocapitalists” entwined with the neo-liberal order” (Lovell, Read & Lang 2019: 522). Each of these actors – and the relations between them – is discussed in this chapter.