Abstract
The scope and complexity of global health can be overwhelming, making it difficult to form an inspiring and unified vision for the future. Mired in this complexity, the international community defines success disease by disease‹without a clear picture of what fundamental reform would actually look like. If the aspiration of global health with justice is the right goal, then answering three simple questions may pierce the haze.

First, what would global health look like? That is, given optimal priority-setting, funding, and implementation, to what level of health should we aspire, and with what provision of health-related services? Posing these three elementary questions, of course, oversimplifies a field that is fraught with tensions and trade offs. But I want to imagine a more ideal future for world health, with bold proposals to get there. After thinking about these three basic questions, I turn to an idea for innovative global governance for health‹a Framework Convention on Global Health.

Second, what would global health with justice look like? Global health seeks to improve all the major indicators of health, such as infant and maternal mortality and longevity. Global health with justice, however, requires that we look beyond improved health outcomes for the population as a whole. Although overall population health is vitally important, justice requires a significant reduction in health disparities between the well-off and the poor. Societies that achieve high levels of health and longevity for most, while the poor and marginalized die young, do not comport with social justice.

Third, what would it take to achieve global health with justice? That is, once we clearly state the goal, and meaning, of global health with justice, what concrete steps are required to reach this ambitious objective? This raises fundamental challenges, intellectually and operationally, as the response cannot be limited to ever-greater resources, but must also involve improved governance‹at the country and international level and across multiple sectors.

Lawrence O. Gostin is University Professor, Georgetown University’s highest academic rank conferred by the University President. Prof. Gostin directs the O’Neill Institute for National and Global Health Law and was the Founding O’Neill Chair in Global Health Law. He served as Associate Dean for Research at Georgetown Law from 2004 to 2008. He is Professor of Medicine at Georgetown University, Professor of Public Health at the Johns Hopkins University, and Director of the Center for Law & the Public’s Health at Johns Hopkins and Georgetown Universities.

 Prof. Gostin holds a number of international academic professorial appointments: Visiting Professor (Faculty of Medical Sciences) and Research Fellow (Centre for Socio-Legal Studies) at the University of Oxford, United Kingdom; the Claude Leon Foundation Distinguished Scholar and Visiting Professor at the University of Witwatersrand, Johannesburg, South Africa; and the Miegunyah Distinguished Visiting Fellow and Founding Fellow of the Centre for Advanced Studies (Trinity College), University of Melbourne. Prof. Gostin serves as Secretary and a member of the Governing Board of Directors of the Consortium of Universities for Global Health.

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Dr. Susan Kasedde currently serves as Senior Advisor and Team Leader on HIV and Adolescents for UNICEF based in New York since November 2009. In this role, she has contributed towards global level evidence generation, technical guidance development, advocacy, global partnership development, and technical assistance towards the global response towards HIV prevention, treatment and care in adolescents aged 10 - 19. Since 2011, on behalf of UNICEF, Susan has coordinated a series of efforts including documentation of global practices in the care of adolescents living with HIV; mathematical modeling with the Futures Institute to assess the impact and cost of scale up of proven high impact HIV prevention, treatment and care interventions within a holistic response, on new HIV infections and AIDS deaths in adolescents; and a systematic review with the London School of Hygiene and Tropical Medicine to confirm evidence on effective approaches for programming to reduce HIV infection, illness and death in adolescents. This work has contributed to stronger advocacy and technical guidelines for programming for adolescents, a group of children previously largely neglected. In 2013, the documentation on adolescents living with HIV was a major contribution to the new WHO guidelines on HIV testing and counseling and care in adolescents. The impact modeling and systematic review are among a series of key papers that will be released in a special supplement on HIV prevention, treatment and care in adolescents at the International AIDS Society Conference in Melbourne, Australia in 2014.

 Susan joined UNICEF having served since 2007 as Regional Adviser with the UNAIDS Regional Office for Eastern & Southern Africa. In that role, she was responsible for coordinating analytic work on the epidemic and response and modes of HIV transmission in several high HIV burden countries, working extensively with government teams and partners in the highest HIV burden countries in the world to use an incidence model to predict the next 1000 new HIV infections and assess alignment of national strategies with the national epidemic. Susan has over 18 years of experience working on adolescents sexual and reproductive health of which 16 of those have been focused on HIV in adolescents. Susan holds a doctorate in Epidemiology and Population Health from the London School of Hygiene & Tropical Medicine, a Masters degree in Public Health from Boston University and Bachelors degrees in Biomedical Science and French. Susan is a national of Uganda and speaks English and French.

Why do community-based education and social persuasion programs for promoting healthy lifestyle and preventing chronic disease sometimes fall short of our expectations? Why are population effects so difficult to engineer and why are they so ephemeral?

This research carried out at USC, the Claremont Graduate University, and collaborating institutions in China integrates across social, behavioral, and neurocognitive sciences to address those questions. We conclude tentatively that the answer to each of the questions may lie in individual and context variability relative to program response, and that in order to more fully address the question of prevention program response variability requires engagement and integration across several levels of science to consider the roles of social groupings, environmental selection and design, social influence processes, and brain biology.

What works in one social, cultural or organizational setting may not be so effective in another. What works for persons with certain genetic and experiential backgrounds may be totally ineffective for persons with different dispositional or personality characteristics. In a series of community/school based prevention trials carried out in markedly different southern California and central China settings, we have uncovered domains of consistent response, and other domains of substantial environment- and disposition-based response variability.

A social influences based smoking prevention program framed in collectivist values and objectives worked to prevent smoking in one cultural setting but not another. And an individualist framed social influences program worked in the setting where the collectivist program did not. But the characteristics of the particular settings, which defined program success or failure, were different from what conventional (e.g., cultural psychology) wisdom would have led us to expect. Furthermore, both within and across cultural settings, the same individual dispositional characteristics moderated or determined program effectiveness, again in ways not predicted by the common cultural and behavioral science wisdom.

In recent studies carried out both in China and the U.S. we have found affective decision deficits, with known neural underpinnings, to account for rapid progression to regular smoking and binge drinking. These deficits are akin to the dispositional characteristics found earlier to moderate prevention program effects. Subsequent brain imaging studies confirm the hypothesized regions of neural involvement. Together these findings hold promise for more effective – situation and phenotype specific – approaches to engendering and sustaining more optimal individual and population health behavior.