## Introduction > In the move into global, though, [[global health governance]] continues to underemphasise the state and similarly overemphasises the role of [[Non-state actors]] and [[transnational actors (TNAs)]]. Through the lens of infectious diseases, this article argues that despite claims of globalization altering the political landscape such that nonstate actors and TNAs find themselves on more equal terms with the state, in fact the state remains the clear driver of international as opposed to global health policy. The article will proceed by first reviewing how GHG conceptualises globalization and the resulting impact on the emergence of a diverse governance structure. The second part will argue that despite these claims, a state driven, international framework persists. Finally, section three offers a state-based alternative to describe the current international system. While GHG offers great potential, it must more explicitly recognise the degree to which international health currently flows through the state and that this will likely remain for the short to medium term. ## Into the global: a review ### Globalization Globalization does not mean the state is rendered irrelevant by globalization. Dodgson, Lee, and Drager argue that states will neither disappear nor become redundant and they will remain key actors. McInnes and Lee explore how infectious diseases have moved onto the foreign policy and security agendas of many states. Accordingly, the speed and intensity of competing actors interacting, political globalization, has generated a new configuration of actors in which the state is one amongst many.20 ==A new framework was needed==. However, the extent to which globalization has created a new and more horizontally structured political environment has been overstated by GHG scholars. [[Globalization has challenged the state by reducing its scope for independent action and subnational groups demand greater representation and autonomy]] Developed from the Global Governance literature, GHG claims that globalization has challenged the state and diffused authority to a range of actors. As Rosenau notes, the relocation of authority away from the state was hastened as the constraints of the bi-polar world were unshackled which allowed for better political structures to emerge, people to more clearly identify wants, and economic changes to develop as well as for the exploration of interdependence issues that generated new forms of transnational collaboration.21 These transnational collaborations are particularly accelerated by globalization which poses significant challenges to states which forces states and other actors to increasingly interact. 22 This demonstrates the erosion of state sovereignty with globalization further exacerbating new challenges such as poverty, intrastate conflict, and population growth and has increased the number of agents that are and will continue to affect the resulting move towards a more inclusive, holistic form of governance. 23 Linklater claims that the state is in fact challenged on two fronts: ‘globalization has seriously reduced its scope for independent action and ... subnational groups demand greater representation and autonomy’. 24 Lawrence notes that the shift in authority emerges from ‘relationships that transcend national frontiers’.25 It is from this point of departure that GHG emerges and claims that the inclusion of a wide range of actors in the global health policy dialogue is both necessary and reality. ^93f855 Pereira notes that [[increasing numbers of non-state actors have continued to reduce national sovereignty]]. Despite no universally accepted definition of GHG, Dodgson, Lee, and Drager offer a point of departure: > GHG ... is distinguished [from International Health Governance] by the starting point that globalization is creating health needs and interests that increasingly cut across and, in some cases, are oblivious to state boundaries. To effectively address these global health challenges, there is a need to strengthen, supplement and even replace existing forms of IHG. ... [S]tate and nonstate actors have long interacted on health governance. The difference for GHG will lie in their degree of involvement and nature of their respective roles, varying with the health issue concerned.28 [[global health governance]] Thus, GHG includes states and international institutions like the WHO, charitable foundations and individuals, with globalization drawing these actors closer together in an unprecedented manner.29 ### Global Health Governance ## Post-International is Premature ### Overstated participation ### SARS and WHO ## International Public Health Society ### Response to Neorealism and [[neoliberalism]] ### SARS and International Public Health Society ## Conclusion