Intraoperative radiotherapy for breast cancer

578 www.thelancet.com Vol 383 February 15, 2014 his colleagues argue in the fi nal report of The Lancet– University of Oslo Commission on Global Governance for Health. They are about power. They are about elites. And they are about a rigid consensus among these powerful elites that prevents most attempts to question the norms on which political decisions are made. Yet elites are only as powerful as the systems that support the status quo. And global systems, such as those in trade, investment, or security, should (but do not always) have mechanisms for civil society participation and links with international norms that already exist to protect health. The Commission addresses seven political domains that shape health and contribute to inequity within populations: fi nance, intellectual property, trade and investment treaties, food, corporate activity, migration, and armed confl ict. It examines the obstacles to eff ective global governance for health. And fi nally, it proposes mechanisms to improve the accountability of all those who infl uence health through these diff erent sectors. Proposals that could better articulate a way in which civil society engages in global policy, together with ideas for how international institutions could be mandated to produce health equity impact assessments, are worthy of consideration and debate. The Commission includes contributors from 13 countries, including India, Brazil, Thailand, Tanzania, Ghana, Namibia, South Africa, and the occupied Palestinian territory. They have provided an opportunity to pause and refl ect on a problem of emerging and serious importance. The era after the Millennium Development Goals is one that will be substantially more complex than today. The link between poverty and sustainability is not simple. Exclusive anti-poverty measures will not solve some of the biggest health threats people face. Solutions will require specifi c input from diff erent regions, countries, and individuals— and a more critical understanding than has hitherto been displayed by policy makers of the determinants of human survival and wellbeing. Success will demand courage and fl exibility to challenge the consensus that so inhibits the changes needed to bring about greater equity. This Commission can, we hope, be a contribution to this need for greater critical understanding and challenge.