Global Health Flashcards
global health governance
history
goes back to the 19th century
- 1851: International Sanitary Conference in Paris (to prevent spread of contentious decease)
- 1903: International Sanitation Convention (first international treaty regarding health + provided basis for IO
- 1907 Rome Agreement: Office International d’Hygiene Publique (first international bureaucracy concerning health)
- 1920 League of Nations Health Organization
WHO
1948
UN Specialized Agency
outgrown of the League of Nations Health Organization
League of Nations Health Organization
- mostly research
- controlled mostly by technical experts (medics) rather than diplomats
role of US in WHO
role as hegemon has been influential in the creation of the WHO
*also Brazil really influential
global health regime: a fragmented field
immensely fragmented field
Hard to place decision making at one specific place/actor
- national health ministries
- WHO
- other IOs: WTO, UN HRC, UNICEF)
- informal organizations
- public-private partnerships
- philanthropic foundations
- pharmaceutical companies
Why so many actors?
- Health research is expensive, states don’t have/want to give the money
WHO structure
194 members
- World Health Assembly (plenary body, pooled sovereignty)
- Executive Board (34 members for 3 years)
- Director General + Secretariat (daily activities)
- 6 regional offices = highly decentralized
How do politics come into play in the executive board of the WHO
Was meant as a technical body with technical experts
political aspect:
- at least 3 members should be of the UNSC
Became more and more political:
- countries send diplomats rather than technical experts
decentralized WHO structure
6 regional offices have grown historically
- there was already a regional body dealing with health in the Americas, this has been integrated in the WHO
- kept some freedom/autonomy -> decentralized/complicated (not al regions, bodies of the WHO have an equal say)
- each regional office submits a candidate for Regional Director to the Executive Board
WHO: rule-making
3
- conventions (can’t opt out, not many)
- regulations (members can opt out)
- recommendations and non-binding standards
the WHO is a rule-making organization: it shapes the legal regime
WHO conventions
2
are legally binding, once they are ratified
WHO has 1 convention: Framework Convention on Tobacco Control (2005)
- 178 state parties
WHO regulations
6
- in 5 enumerated areas
- adopted by the assembly, applied to all members by a specific deadline
- legally binding for states that did not file a reservation or opted out
- 1951 International Sanitary Regulations
- 1969 International Health Regulations (IHR)
*both these require reporting by states of outbreaks etc.
WHO Recommendations and non-binding standards
(soft law)
- can have an important impact on domestic law: when the WHO adopts a recommendation, member states have to domestically make a law on this
balancing WHO
- requests from member states and other stakeholders
- technical and scientific work
WHO Air Quality Guideline
4
- 2021
- not legally binding
- content: all air pollution can be dangerous for held
- EU implemented much higher thresholds than the WHO
WHO response global health crises
2003 SARS: travel restrictions pretty much right away, reformed the International Health Regulations (2005)
2014 Ebola: accused of responding to slow as it didn’t want to harm the economies of countries
2019/2020 Covid-19: balancing act between acquiring epidemiological information through WHO mission and enforcing PHEIC
Reformed International Health Regulations
2005
-> public health emergency of international concern (PHEIC)
- hasn’t always worked well: tension free trade and world health
One of the core dilemmas
trying to investigate in the country of origin requires kind treatment, but the WHO also wants to protect other countries (e.g by declaring PHEIC), which might insult the country of origin and cause the WHO to lose ability to research
WHO activities in global health crises
- providing personal protective equipment
- issuing guidelines for disease management (e.g. what needs to be done in labs and clinics)
- providing test kits to developing countries
- collecting and pooling information on clinical trials
- coordinating the growing number of institutions engaged in health related actions
budget WHO
assessed contributions stable
budget overall has increased through voluntary contributions
- primarily earmarked
- Germany, Bill and Melinda Gates, US, EU, WB, UK etc. biggest financiers
WHO Sustainable Financing Reform
2022
Sustainable Financing Group
- report adopted by WHO Assembly in May 2022
goal to increase assessed contributions to 50% by 2030 -> balance assessed and voluntary contributions
this year: 20% assessed contributions (before it was 10%)
the health governance agenda is broadened:
- multiple voices
- new money and institutional complexity
- wider concerns
- from health governance to governance for health
3 types public-private partnerships global health
- concerned with providing finance
- focusing on advocacy and coordination for specific heath issues
- those concerned with product development
WHO definition of health
(defined by the preamble):
a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity
- the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition
WTO and global health
Involved with trade-limiting measures adopted for health protection purposes
only a few successful cases
UN Human Rights Council (UN HRC) + Human Rights Treaty Bodies
access to determinants of health as a human right
Council of Europe
focus on social development, ethical issues, and human rights (incl. health)
harmonization of specifications for medical substances through the Convention on the Elaboration of a European Pharmacopoeia and its protocols
Technical collaboration IOs and lower income countries
-development
- provision of technical knowledge and skills in distinct technical areas
- building the institutional capacity of governments to plan and manage their own affairs
- set of very specific health-related Millennium Development Goals (MDGs) in the late 1990s, led to more development assistance, new IOs, partnerships and alliances.
greater domestic technical and institutional capacity -> reduced need for international assistance ->
- no need for development frameworks, countries will increasingly request help a la carte
- IOs will have a growing role in facilitating technical collaboration between developing countries
Organisation for Economic Co-operation and Development
OECD e.g. provides funding for the organisations in the Global Health System
weakening financial support from traditional OECD government donors ->
- non-state financiers major contributors
- growing interest in innovative financing
