European Union and new regionalism: regional actors and global governance in a post-hegemonic era

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This argument contributes to existing debates about health diplomacy and diplomacy studies which have tended to focus on individual governments as agents of policy and policy diffusion Buss and do Carmo Leal ; Kickbusch and Ivanova Diplomacy is an expanding area of study and practice which although established in International Relations is now also taking hold in Public Health.

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Trans-border efforts of collective action cooperation in health, but only, are not new and can be traced back to the 19th century when negotiations on health were linked to surveillance and control of certain communicable diseases such as yellow fever, cholera and plagues. These efforts of health diplomacy or activism were oriented to improve responses to transnational problems and reduce the burden on national health systems, as well as to keep healthy corridors of trade see Herrero and Tussie and Cooper and Farooq in this Issue.

The creation of the World Health Organization WHO in has been a milestone for global health diplomacy, institutionalising sanitary regulations and norms for the control of infectious diseases and establishing a regulatory framework for global health governance Fidler, : Caught in the geo-political competition during the Cold War, however, it was not until the mids onwards when the WHO found significant political and intellectual impetus from state actors and social movements concerned with the human and social aspects of development which stimulated further thinking about development cooperation Fidler, We are interested in how regional organisations are placed in this revolution and what sort of insights they bring as well as to the dynamics they create in health governance.

International Organizations and Global Governance

The literature on global health diplomacy and governance, which has developed rapidly over recent years, focuses on either around the governance roles of specific international multilateral institutions e. This is not surprising as policy makers and social groups from the developed world have powerful resources to set agendas and act as rule-makers in global politics. In other words, who frames what and why depends on how actors are positioned and negotiate interests in global governance and health.

Dominant international frameworks risk pushing for universal norms to social development that in practice can be turn either conservative or a-contextual. Other big killers of the poor — such as pneumonia, measles and diarrheal diseases, which together accounted for more than 5 millions of deaths in — also received little attention. In other words, claiming, framing and advancing norms and policies have been associated with the global power of Northern actors. Less is known about the place of regional organisations in global health diplomacy.

Some empirical work on the role of Southern actors in support of health cooperation has been produced see Bliss, ; Kickbusch and Ivanova, ; Onzivu, As such, the argument goes, regional organisations and identities must be considered important keywords in advocacy and contention politics, as well as in the academic analysis of who acts, who frames and who contests global health policies. She goes on to claim that, as states pool resources together, they can play a distinctive role by 1 providing regional normative frameworks that can structure practices in support of social policies and rights-based governance, 2 creating opportunities for re allocation of material and non-material resources and thus for inclusion and 3 acting as unified representative actors in global political space enabling representation and claims-making, contesting and reworking global governance in support of global justice goals Riggirozzi, : In different ways, the research papers and The Forum substantiate these arguments and point to the need to investigate the relations of the regional level of analysis between the state and the globe, and the processes that connect regional and national politics within the regional space if we are adequately to analyse contemporary forms of power, regional activism and cooperation on health and other social issue areas.

Poverty-focused social policy research into what regional associations are doing as well as what they are saying is needed to help all stakeholders, locally, nationally and internationally to know what they can do to support pro-poor policies and programmes of concerted social action. Regional organisations can provide platforms for practitioners, academics and policy makers to collaborate and network towards this aim. Changes in global health diplomacy are taking place and warrant deeper study of the place of regional organisations in advancing and contesting new norms of governance.

Neglecting this jeopardises effective development aid and the global agenda related to the sustainable development goals. The papers in this issue are taken from the above discussion. The policy frames identified they argue respond to challenges these regions face.

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This is an important baseline analysis as framing, it could be argued, potentially supports not only different institutional frameworks but also very different kinds of collective action and allow different sorts of claims to be made by groups and movements, transnational activist networks, epistemic communities or policy entrepreneurs Keck and Sikkink, ; Risse et al.

While institutional settings and political regimes shape the opportunities and demands upon which actors are mobilised Tarrow, , the impact of regional organisations according to Amaya, Kingah and Rollet depends on their ability to harness their convening power and speak in a coherent voice on health matters. Established in , it has had from the outset a clear emphasis on reducing the regional social deficit.

Within this mission, health policies became a strategic factor in South America to collectively balance the legacy of neoliberal policies in the region. The paper describes the social, political and economic processes that explain the emergence of UNASUR and its focus on social policy through healthcare. Also with a focus on the South, the paper offered by Penfold and Fourie analyses how regional health is framed in the SADC and what type of governance arrangements and mis opportunities of diplomacy in relation to social protection as a mechanism to address health issues.

This paper assesses the role of SADC in health governance and argues that SADC has the potential to play more of a role in facilitating health policy and access to healthcare and medicines in the region. The article explores contradictory tendencies by exploring legal provisions managing the tension between the promotion of free trade and the enforcement of the right to health in the case of Colombia.

The closing article of the Issue is dedicated to a reflective analysis by Cooper and Farooq who speculate on whether health diplomacy is re-shaping the conceptualisation and practice of diplomacy.

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The article contends that the increased number and diversity of actors in the global health arena have changed the conceptualisation and practice of diplomacy, and a greater plurality in health governance. Furthermore, health diplomacy, because of its special character, opens up the possibility of diplomacy being done differently in subtle ways in micro-level, bringing to attention the issues, tensions and governance processes identified in the overall Special Issue.

A foremost critical challenge confronting many countries is how to develop a regionalism that will underpin efforts to achieve social development objectives and accelerate the realisation of the right to health and the ending of the global public health crisis. This is an agenda which many regional organisations and networks of civil society activists are already addressing, but all too often regional formations as sites of governance and policy-making are bypassed or ignored in on-going campaigns to strengthen social provision and rights in support of health.

The acute relevance of thinking and acting regionally as well as locally and globally when it comes to strengthening health provision becomes especially apparent in the context of current global social policy and development agendas. The definition and delivery of international development goals need effective and robust frameworks that can mobilise and sustain the necessary political and policy impetus among the widest range of actors over time. Regionalist modes of cooperation, coordination and governance are in this context a vital feature of those frameworks. With particular reference to African contexts, she argues that although regional integration agendas no longer remain limited to trade and financial integration progress by regional and international communities to address how to better develop and harness more substantive regionalist institutional arrangements in support of inclusive social development remains lamentably slow.

This regional project and the multiple strategies it devises to enact this should be guided by the values and principles of human rights, democracy, transparent and accountable governance, active participation of citizens and civil society organisations. The necessity of a strengthened regionalism in which human rights are firmly embedded resonates strongly with the article by Dainius Puras, the UN Special on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. Human rights and the right to health, he argues, need to be embedded in the Sustainable Development Goals.

Human rights are, then, indispensable to a sharper and more consistent focus on regional governance and inclusive social development in the post Sustainable Development Goals implementation framework.

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The possibilities of Southern regional organisations having a more substantial role not just in implementing global development agendas but also framing and shaping the ideas and principles that underpin them must be taken more seriously. Mariana Faria highlights a critical feature of the work of the UNASUR, notably its efforts to advance and embed a social determinant of health perspective in the post development agenda. The question of how to develop a strengthened regional agenda which is not confined to implementing donor-defined and donor-funded initiatives is also discussed by Keneilwe Mooketsane and Molefe Phirinyane and by Erica Penfold in relation to Africa.

Acknowledging reliance on donors in development initiatives in Africa, Mooketsane and Phirinyane argues for a discernible and more visible role for the African Union and the African regional bodies such as SADC and E conomic Community of West African States ECOWAS in leading the development of African regional health strategies involving multiple development partners drawn from African states, civil society, the private sector and donors.

They highlight the responsibilities of donors in helping to bring about the conditions for this, where one crucial element is to support the regionalisation of health and inclusive social development agendas along with the institutional frameworks capable of enacting them. She also draws out more precisely the challenges in actually growing a strengthened regional health governance in the continent: unequal political power between governments, civil society and donors, and the proliferation of undemocratic governments that do not always regard civil society as a development partner.

She urges SADC and other actors to rethink the place of regional governance within the post SDG and implementation framework in order to ensure that health security and justice become actual outcomes rather than remain an aspiration.

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She argues that despite the increased activism of ASEAN health officials on tobacco control, they are hampered by their lack of mandate on economic issues which is firmly located within the realm of trade and its liberalisation and by the lack of progress by ASEAN health and trade officials in finding ways of pursuing a public health agenda together. She urges them to do so to harmonise public health and economic objectives. Here, the role of public health activists in addressing regional economic and not just health policy in order to affect health outcomes becomes paramount: They need to be better prepared to move from broad critiques of trade liberalisation to make specific, appropriate and effective requests and demands in the interests of public health protection.

Given the presence of regional organisations in global trade liberalisation and integration projects, regional agendas and organisations should move much more to the foreground of transnational public health activism. In short, public health communities need to develop their own practices of regional pro-health activism and diplomacy which include the arena defined as regional health policy but which also address other sectoral policies impacting health. The role of regional actors including regional organisations themselves in stimulating expansive regional agendas capable of integrating and balancing multiple agendas impacting health is clearly paramount in the realisation of people-centred inclusive social development in the post era.

There are signs that the post sustainable development round is cognisant of the potential role of regional fora in global health governance. The potential role of multilateral development organisations and donors in providing financial support to stimulate and support such initiatives is not inconsiderable; here, regional bodies are obvious extant regional partners with mandates, institutional capacity, networks and resources to take up this leadership role post She concludes by signalling the need for further research and analysis on existing good practices and the potential of regional bodies and partnerships in order to feed into on-going discussions about the implementation of sustainable development not just as a set of abstract goals but as a living reality.

Edited by Tanja A. Börzel and Thomas Risse

Her research focuses on the political economy of development and regionalism, with an interest in the Americas. Her work focuses on the implications of transnationalisation and globalisation processes for social policy as a field of academic study and as a political practice. Nicola is particulalry interested in global and regional governance and its relationship to systems of health provision, state and non-state strategies of transnational advocacy and policy networks.

National Center for Biotechnology Information , U. Global Social Policy. Glob Soc Policy. Pia Riggirozzi and Nicola Yeates. Author information Copyright and License information Disclaimer. Email: ku. This article is distributed under the terms of the Creative Commons Attribution 3.

European Union and New Regionalism

Abstract Poverty reduction and health became central in the agendas of Southern regional organisations in the last two decades. Introduction The presence of world-regional actors in spheres and practices of public policy-making and governance is taking hold as a vibrant subject of research and political agendas focused on-going processes of restructuring of social policy-making and delivery.

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Locating and debating regionalism Regionalising Global Social Policy Despite a wide array of political-economic projects of varying compositions, capabilities and aspirations, expectations of what regional governance can deliver have been evaluated primarily in terms of trade liberalisation and trade integration. Yeates and Deacon and Yeates b set out several principled advantages in building a social policy dimension to regional groupings of nations, as follows: Regional organisations offer their member access to broader social policy options attuned to their specific contexts.

Regions and regionalism as spaces for policy-making and action Two and a half decades ago, debates in the political economy of regionalism and development were dominated by debt crisis, austerity and a new economy of the market — often linked to a high point of US influence over regional politics across the South Gamble and Payne, : —; Phillips, Overview of articles in this Special Issue The papers in this issue are taken from the above discussion.