Reimagining governance: WHO outlines blueprint for sustainable global health resilience

The WHO’s 2025 report calls for stronger, multisectoral governance to make public health a shared national priority beyond crises like COVID-19. It urges countries to embed prevention, equity, and accountability into all government policies for resilient and equitable health systems.

A groundbreaking report by the World Health Organization (WHO), developed with the International Association of National Public Health Institutes (IANPHI) and research from WHO’s Health Systems Resilience and Essential Public Health Functions Team in Geneva, delivers a powerful case for overhauling how countries manage public health. Drawing on insights from global partners such as Santé publique France, the Ethiopian Public Health Institute, and the National Public Health Institute of Liberia, it argues that effective governance, not just medical capacity, determines how nations withstand health crises and protect their populations in the long term.

The World’s Health Systems Under Strain

The report opens with a stark warning: global health systems are struggling under the combined weight of pandemics, noncommunicable diseases, ageing populations, and climate change. It points out that up to 55% of health outcomes are shaped by social factors like income, housing, and education. Yet, most governments continue to invest heavily in hospitals and curative care, neglecting prevention and community health. The COVID-19 pandemic exposed this imbalance; even countries with universal health coverage found themselves unprepared for the social and economic ripple effects of a global health emergency.

Redefining “Governance for Public Health”

WHO’s report introduces a precise, operational definition of governance for public health: the processes, structures, and accountability mechanisms that ensure all sectors work together to deliver Essential Public Health Functions (EPHFs). These include disease prevention, health promotion, emergency management, and health equity. Effective governance, the report notes, depends on clear legal authority, sustainable financing, and collaboration between health ministries and other sectors such as agriculture, environment, education, and transport.

Ireland’s interdepartmental model, where ministries of agriculture, social protection, and environment coordinate on public health goals, is highlighted as an example of cross-sector success. However, the WHO warns that in many countries, such coordination happens only during emergencies, leaving systems fragmented once crises pass.

The Pillars of Good Public Health Governance

The WHO framework identifies three guiding principles for strong governance: integration, comprehensiveness, and shared responsibility. Integration ensures that all sectors align toward common health goals; comprehensiveness demands attention across the full spectrum of public health functions; and shared responsibility spreads accountability beyond the health ministry to all institutions affecting health outcomes.

The report draws on global examples. Germany’s legal requirement for preventive health funding, Japan’s structured public health laws, and South Australia’s “Health in All Policies” initiative all demonstrate how legislation and cross-sector collaboration can embed public health priorities across government systems.

Four Models of Governance Around the World

Countries organize their public health systems in different ways. WHO outlines four broad models:

1. Autonomous public health institutes, like those in Liberia and Canada, which enjoy financial and operational independence.

2. Semi-autonomous agencies, such as Nigeria’s Centre for Disease Control, which operates under the health ministry but with increasing independence.

3. Centralized ministries of health, as in Qatar and Thailand, where public health is managed within government structures.

4. Interministerial coordinating bodies, seen in Australia, where the central government leads cross-sector efforts.

The organization does not recommend a one-size-fits-all model but emphasizes that success depends on how well these structures embed legal authority, stable financing, and coordination.

A Call to Make Public Health a National Priority

WHO urges governments to conduct regular reviews of their governance systems every three to five years, using its practical checklist to assess laws, budgets, and accountability mechanisms. Governance, the report argues, should not emerge only during crises but function continuously, integrating public health into all national strategies. Temporary emergency committees cannot replace long-term institutional coordination.

Strong governance, WHO concludes, is not just an administrative concern; it is a public good that underpins national security, social trust, and economic resilience. Investing in governance means investing in prevention, preparedness, and equality. As the world faces overlapping threats, from pandemics to climate change, the message is unmistakable: health security begins with good governance.