Sunday, June 19, 2011
Guest Blogger Lindsay F. Wiley: The Joint Action and Learning Initiative for a New Global Health Agreement
My last global health law post, on WHO’s new PIP Framework for influenza pandemic preparedness, ended on a rather depressing note about the low likelihood of a strengthened commitment to global health equity at a time when money is tight. I’m going to attempt a rebound today with a post on an ongoing effort to promote a new international agreement on global health.
Larry Gostin and several international colleagues recently published an article on PLoS Medicine heralding their establishment of a new Joint Action and Learning Initiative to promote a new international agreement on national and global responsibilities for health. The article describes the formation of a coalition of civil society organizations and academics from the U.S., the U.K., Germany, Belgium, Norway, India, China, and South Africa to research “key conceptual questions involving health rights and responsibilities, with the goal of securing a global health agreement and supporting civil society mobilization around the human right to health.” The authors propose that a new agreement is needed to inform global health commitments as the Millennium Development Goals’ time-frame draws to a close. The Joint Action and Learning Initiative (JALI) aims to “clarify the health services to which everyone is entitled under the right to health, the national and global responsibilities for securing this right, and global governance structures that can realize these responsibilities and close major health equities.” In coming months, the JALI will undertake efforts to create the political space required for negotiation of a new agreement addressing these issues.
The agreement was initially proposed by Gostin as a possible Framework Convention (on the model of something like the U.N. Framework Convention on Tobacco Control or the U.N. Framework Convention on Climate Change). Elsewhere, I’ve argued that a Framework Convention on Global Health could make a major contribution to global efforts to adapt to the anticipated health impacts of climate change. Environmental degradation, which is being exacerbated by climate change, is already responsible for a significant portion of global disease burden – especially through its contribution to malaria and diarrheal illness. These problems have tended to be neglected by current law and policy structures. Public health specialists have a a fairly well-developed body of interventions for promoting better health through interventions like drinking water and sanitation improvements and vector control. What has been sorely lacking is the political will to commit sufficient resources to supporting these efforts in the communities where they are most needed. It’s a governance failure that Gostin’s proposed agreement might effectively address.
Recently, as I’ve been working on a project at the intersection of international disaster law and international health law, I’ve begun to think that the Framework Convention model is perhaps not ideally suited to the focus of the JALI’s proposed global health agreement. A different model, the Framework Agreement, might be a better fit. Framework Conventions are international instruments designed to set forth overarching commitments that will be fleshed out later in the form of protocols. For example, the Kyoto Protocol provided the emissions reduction targets that gave content to the broad commitments outlined in the Framework Convention on Climate Change. Such a model works well to structure continuing negotiation of concrete, binding obligations. But the subject of the proposed global health agreement – which would aim to meet “the basic survival needs of the world’s least healthy people” – might lend itself to a more flexible soft law mechanism. Framework Agreements – such as the highly successful Hyogo Framework for Action on Building the Resilience of Nations and Communities to Disasters – work well as a platform for promoting and supporting Member States’ domestic efforts to reach internationally agreed-upon goals and commitments to assistance.
Whatever form it takes, a new international agreement on global health could go a long way toward correcting what I perceive as an imbalance in international health law between the real health policy priorities of poor countries and the legal obligations imposed on them (primarily through the recently revised International Health Regulations, which include significant obligations to build rapid disease surveillance and response capacity to address disease outbreaks with potential for cross-border spread) to ensure “global health security” in the face of mutual interdependence.