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Brief analytical summaries or syntheses #27

Governance for health in the 21st century :
a study conducted for the WHO Regional Office for Europe


The WHO Regional Office for Europe recently presented conclusions from an in-depth study of current thinking and innovative practices in governance for health in the 21st century. The study recommends different ways that public authorities can strengthen health governance through collaboration.


In this study, ‘governance for health’ is defined as the attempts of governments or other actors to steer communities, countries or groups of countries in the pursuit of health as integral to well-being through both a ‘whole-of-government’ and a ‘whole-of-society’ approach. It positions health and well-being as key features of what constitutes a successful society and a vibrant economy in the 21st century and grounds policies and approaches in values such as human rights and equity. Governance for health promotes joint action of health and non-health sectors, of public and private actors and of citizens for a common interest. It requires a synergistic set of policies, many of which reside in sectors other than health as well as sectors outside of government, which must be supported by structures and mechanisms that enable collaboration. It gives strong legitimacy to health ministers and ministries and to public health agencies, to help them reach out and perform new roles in shaping policies to promote health and well-being.

Analysis and results

Key messages: governance and its context

The governance challenges faced by the health sector are not unique: all sectors are experiencing major shifts.

The contextual drivers of change are interdependence, complexity, co-production and Europe’s transition from industrial to knowledge-driven societies.

The problems require systems approaches that involve a wide range of society and multiple levels of governance, from local to global, with increasing relevance of regional and local levels.

The new context leads to the new governance dynamics of diffusion, democratization and shared value.

Health is a major macroeconomic factor and, increasingly, a critical component of business models and strategies. Businesses must reorient themselves towards strategies built on shared value, which can enhance their competitiveness while also advancing social agendas.

The role of government in governance remains critical and is expanding in many areas of modern life.

Key messages: governance for health and well-being

Governance for health and well-being is a central building block of good governance; it is guided by a value frame that includes health as a human right, a global public good, a component of well-being and a matter of social justice.

The expanded understanding of health includes consideration of health as an emerging property of many societal systems; it therefore requires action in many systems, sometimes with and sometimes without the involvement of the health sector.

Whole-of-government and whole-of-society approaches reflect this reality and are grounded in strategies that enhance ‘joined-up’ government, improved coordination and integration and diffusion of responsibility for health throughout government and society.

Governance for health builds on experiences gained in the health arena with intersectoral action, healthy public policy and health in all policies.


On the basis of a review of case studies of new approaches to governance for health, five types of smart governance for health are proposed for consideration, which should be combined in whole-of-government and whole-of-society approaches :

  • Governing by collaboration
  • Governing through citizen engagement
  • Governing by a mix of regulation and persuasion
  • Governing through independent agencies and expert bodies
  • Governing by adaptive policies, resilient structures and foresight

Implications and recommendations

Positioning health

First and foremost people’s health and well-being must be a goal for the whole of government and whole of society.

Basing policy on new metrics

A systematic effort, such as a clearing-house, might be initiated, for continual collection of robust evidence on the impact of a wide range of policies on health and of health on other policies.

Institutionalized processes for whole-of-government approaches

To harness health and well-being, institutionalized whole-of-government structures and processes are required within government to facilitate cross-sector problem-solving and to address power imbalances.

Innovative partnerships for whole-of-society approaches

Many of the current health challenges could be better resolved through whole-of-society approaches, which include civil society and the private sector as well as the media.

A commitment to the informed citizen and to citizen participation

The health sector must commit itself to the highly participatory nature of smart governance for health. This includes e-gov, i-gov and m-gov approaches as well as a comprehensive strategy to strengthen health literacy.

A global perspective

The new governance for health should integrate all levels of governance, from the local to the global.

An outreach-oriented, innovative, supportive Regional Office

The health sector can support other arms of government by assisting them in setting policies and attaining goals.

A joint commitment to governance innovation

Finally, it is proposed that in the context of Health 2020 Member States and the Regional Office:

  • initiate a process for assessing and monitoring progress in governance for health in the European Region.
  • consider establishing a multidisciplinary European institute of governance for health


Governance for health in the 21st century: a study conducted for the WHO Regional Office for Europe

Gouvernement du Québec
© Gouvernement du Québec, 2018