Globalization has led to new health challenges for the twenty-first century. These new health challenges have transnational implications and involve a large range of actors and stakeholders. National governments no longer hold the sole responsibility for the health of their people. These changes in health trends have led to the rise of global health governance as a theoretical notion for health policy making. The Southeast Asian region is particularly prone to public health threats such as emerging infectious diseases and faces future health challenges including those of noncommunicable diseases. This study looks at the potential of the Association of Southeast Asian Nations (ASEAN) as a regional organization to lead a regional dynamic for health cooperation in order to overcome these challenges. Through a comparative study with the regional mechanisms of the European Union (EU) for health cooperation, we look at how ASEAN could maximize its potential as a global health actor. Our study is based on primary research and semistructured field interviews. To illustrate our arguments, we refer to the extent of regional cooperation for health in ASEAN and the EU for (re)emerging infectious disease control and for tobacco control. We argue that regional institutions and a network of civil society organizations are crucial in relaying global initiatives, and ensuring the effective implementation of global guidelines at the national level. ASEAN's role as a regional body for health governance will depend both on greater horizontal and vertical integration through enhanced regional mechanisms and a wider matrix of cooperation. At the turn of the twenty-first century, the concept of Global Health (Woodward et al. 2001) beyond the traditional World Health Organization (WHO) definition of health as "a state of complete physical, mental and social well-being" (World Health Organisation 2008), has been extended to encompass all cross-sectoral social determinants of health such as movements of people and products covering issues of trade, travel, food security, etc. at the global levels. Globalization has had such a strong impact on global health (McMichael and Beaglehole 2000), that it has brought a whole new meaning to the term health governance (Lee 2001). The erosion of national boundaries and the growing interdependence between nation states has forced global level cooperation (Wamala and Kawachi 2010). Globalization has led to a gradual loss of state sovereignty over policies related to social determinants of health such as trade policy (Kickbush 1999a, b), and inevitably thus a gradual loss of sovereignty over global health policy challenges. Globalization has stirred financial and political commitment and placed health at the center of the global political agenda (Drager and Sunderland 2007). It has also introduced new opportunities for inclusive action with the proliferation of communication channels (Goran 2010). Global health allows us to move beyond the state-centric understanding of health (Hewson and Sinclair 1999). National governments no longer have the sole capacity to guarantee the health of their people as health risks extend across borders and across sectors (Dogson et al. 2002), where health challenges must be addressed beyond the national levels and through cross-cutting, multilevel governance solutions (Duit and Galaz 2008) incorporating all actors: from nation states to United Nations organizations, international nongovernment organizations, the private industry, and civil society. Global health entails the need to theorize over a new global governance structure for health. Global governance may be understood as the "formal and informal institutions through which the rules governing world order are made and sustained"; these institutions can be governmental, nongovernmental private or public, formal or informal, at theglobal, theregional, thenationalor thelocal levels (Held et al. 1999). More specifically, health governance concerns the institutions, their actions and means adopted to organize the promotion and protection of the health of populations (Dodgson et al. 2002). Drager and Sunderland thus identify the need to renew the current global health governance (GHG) structure to better facilitate collective action (Drager and Sunderland2007). A GHG structure must reflect a continuous process of change and adapt to the new health challenges (Rosenau 1995; Duit and Galaz 2008). For this reason, we adopt a transformative approach to GHG explaining how the framework for cooperation on health must evolve and change to reflect the new challenges of the twenty-first century. What is the best GHG framework for cooperation in Southeast Asia? It has been suggested that a reliable governance mechanism for health may only surface once all actors understand health as a global public good insinuating that political and financial commitment should follow not only in times of emergency (a pandemic such as severe acute respiratory syndrome (SARS)) but also in the form of long-term capacity building and sustained cooperation for health (Kickbush 2005). How will sustained cooperation emerge? To answer this question, we turn to Regime theory. The concept of regimes for global health governance can be used as a way to collectively operationalize national initiatives at the global level (Kickbush 1999a, b). Regimes may be understood as "sets of implicit or explicit principles, norms, rules and decision-making procedures around which actors expectations converge in a given area of international relations" (Krasner 1983). Regime theory can serve as an analytical lens to explore the mechanisms for health policy cooperation in Southeast Asia in a contemporary context. It accounts for the expansion of nonstate actors and civil society, the increased opportunities for multilevel dialog between stakeholders and the subsequent proliferation of legal instruments (Koehane and Nye 1972, 1974). The emergence of the Framework Convention for Tobacco Control (2003) and the International Health Regulations (2005) as international legal treaties for global health, demonstrates the validity of regime theory for GHG. The incentive for cooperation between actors that are directly or indirectly involved in health at the national, regional, and global levels lies in the common health threats that transcend national borders and require cross-cutting multilevel governance solutions (Duit and Galaz 2008). In sum therefore, cooperation for health governance stems from an "amalgam of mutual interests", and the number of players involved (Axelrod and Keohane 1985).
