This dissertation examines the rise of global health assistance among states, multilateral institutions and NGOs. Resources devoted to global public health expanded rapidly in the 1990s and 2000s, outpacing other areas of development. New agencies have emerged to address public health issues, and existing organizations such as the UNDP, World Bank and EU have expanded their global health operations. Critics fear that the global health regime will become inefficient as it grows, duplicating tasks and skewing resources. The regime complex literature predicts similar suboptimal outcomes. These fears are overblown. While certain inefficiencies are likely as any regime expands, data shows that the allocation of resources generally reflects global health needs. Increased competition, thought to lessen efficiency, has actually pressured multilateral actors to specialize. Specialization offsets the problem of overlapping tasks.

The modern global health regime is characterized by increased size, competition, specialization, and a prevailing consensus that emphasizes health as a central component of international development. This consensus holds that societal health prefigures economic growth. The international community, moreover, should cost effectively use increased aid to address the worst disease burdens in the poorest countries. In the cases of states, domestic interests play a role in shaping specialization patterns. Pressure from increased international competition has pressed multilateral institutions to reform and adapt to changing conditions in order to remain relevant in a denser global environment. The diverse cases explored in this dissertation (US, Japan, Sweden, Canada, World Bank, WHO, UNDP and EU) show high degrees of specialization and a surprisingly similar adherence to the consensus.