At the core of the debate is the fact that health is political and that spaces for policy intervention exist at different levels. A governance debate needs first to be based on the realisation that health cannot be addressed without a real involvement of people and their organisations at all the levels, and that it is essential to have an open debate about the values attached to health.

We enter an historical phase of health interdependence with the joint recognition of health as global public good and of the fact that "no individual or nation state can fully guarantee its own health" (Kaul et al., 1999:297) thus cooperation among nations becomes mandatory.

In these times of excessive wealth creation and accumulation, and when it costs about $30-$40 per capita to provide basic healthcare coverage in a low-income country, access to health care becomes a very contentious political issue. The solutions become clear and sustainable if seen from a perspective of redistributive justice. And in that context it would seem appropriate to gradually shift to social health-insurance systems, which operate on the bases of solidarity contributions among high-income and low-income groups. This would be the main source for financing universal health access.

As different interventions are proposed, the importance of the state and the public sector becomes essential, calling in fact for a reliable and accountable mechanism for global governance and a strengthened public sector at all levels.