THEORETICAL
Shared health governance (SHG) lays the theoretical foundation for collective action through the values that individual members of society share. It does not aggregate individual preferences into preferences for society as a whole, nor is maximizing self-interest the defining criterion.
SHG recognizes both that differences in preferences and utilities cannot be compared across individuals and that majority preferences do not always produce clear results due to intransitivity and that self-interest maximization is a dominated strategy for collective action. Rather, SHG’s answer is the evaluation of various social states and the governance that attaches to those states of affairs in terms of the common good.
In SHG the common good is the health capabilities of all members of society. We challenge the common view that the interests of powerful and wealthy actors should dictate the process and outcomes of global and national health governance.
SHG’s conditions are as follows:
(i) the conditions for all to be healthy are co-produced by multiple social actors, public and private, through a joint enterprise;
(ii) shared values and goals of society, through public moral norms, are necessary to co-produce the conditions for all to be healthy;
(iii) a shared commitment to a set of goals stimulate attention and role fulfilment across governance subsystems, binding the system together to achieve a common purpose;
(iv) shared resources are necessary.
We characterize the current model of health governance, global and the United States, domestic, as rooted in rational choice theory and characterize it as a rational actor model of health governance.