L6 - Global Health Governance + WTO Flashcards
What is equity in global health governance?
Equity = Absence of remediable inequities.
Inequity: Inequality + remediable + reasonable effort + fair process (national level).
Global Level Challenges:
Is inequity remediable?
What constitutes reasonable efforts?
What defines a fair process?
Right to health?
Right to Health: Obligation of governments to provide healthcare. Emergent human right, not fully crystallised (especially internationally).
Think about a human rights perspective on health. Are there traces of this in international
human rights law and other international agreements?
Western States - Favoured ICCPR: Focus on freedom (negative rights). (Example: Protection from interference, civil/political rights)
Communist States - Favoured ICESCR: Focus on entitlements (positive rights). (Example: Access to healthcare, economic/social rights)
Key Distinction: Freedoms (Negative Rights): Freedom from government interference ≈ civil and political rights.
Rights/Entitlements (Positive Rights): Obligation for government to provide services ≈ economic, social, and cultural rights.
International Law:
ICCPR and ICESCR reflect competing priorities of “freedoms” vs. “entitlements.”
Human rights to health primarily addressed under ICESCR Article 12 (right to the highest attainable standard of health).
How was health addressed in the MDGs, and how now in the SDGs?
Health in MDGs vs. SDGs:
MDGs (2000–2015):
Focused on three specific health targets:
Child Mortality (Goal 4)
Maternal Health (Goal 5)
Combat Infectious Diseases (Goal 6, e.g., HIV/AIDS, malaria).
SDGs (2015–2030):
Broader approach to health under SDG 3: Good Health and Well-being.
Retained the three MDG targets (child mortality, maternal health, infectious diseases).
Expanded scope to include:
Target 3.8: Achieve universal health coverage (UHC).
Target 3.a: Strengthen tobacco control.
Target 3.d: Enhance global capacity for early warning, risk reduction, and health risk management (ties to global health security).
Leadership Influence:
WHO Director-General Tedros Adhanom emphasizes Universal Health Coverage (UHC) as a cornerstone of global health under the SDGs.
Discuss critically the concept of and policies concerning global health security.
Focus: Prevent/manage global health threats (e.g., pandemics, IHR).
Criticism:
Prioritises high-income countries; neglects systemic health issues in poorer nations.
Relies on vertical (disease-specific) approaches, weakening national health systems.
Benefit: Saves lives by controlling outbreaks.
Solution: Horizontal approaches (health system strengthening) address root causes and prepare for both specific and general health challenges.
What is universal health coverage?
Ensures access to essential, quality health services (promotion, prevention, treatment, rehab, palliative care) without financial hardship.
Aims to address major causes of disease and death with adequate service quality.
Challenges:
4.5 billion lack primary health services (e.g., newborn care, response capacity).
Half of the global population lacks access to social security.
You should understand the essence of the WHO’s International Health Regulations, and the notion of PHEIC within them.
IHR (est. 1969, revised 2005):
Legally binding treaty to coordinate epidemic prevention, preparedness, and response.
Key elements:
- Surveillance capacity to detect outbreaks.
- Mandatory notification of potential PHEICs.
- National response capacities required.
- WHO disseminates info to member states.
PHEIC (Public Health Emergency of International Concern):
- Declared by WHO Director-General with Emergency Committee advice.
- Indicates exceptional global health risks needing coordinated action.
- Leads to non-binding WHO recommendations (e.g., travel advisories, containment).
Examples: COVID-19, 2014 Ebola outbreak.
Purpose of IHR: Enhance global public health security by improving preparedness, communication, and collaboration to prevent and respond to international disease outbreaks.
Which fundamental policy changes have been visible in global health governance over time? Why was the 1978 Alma-Ata conference important? And subsequently the neoliberal turn?
Alma-Ata Declaration (1978):
Goal: “Health for All by 2000.” Declared health a fundamental human right.
- Advocated horizontal approaches (health system strengthening).
- Linked health to social, economic reform (NIEO context).
- Emphasised state responsibility for public health.
1980s Neoliberal Turn:
- Alma-Ata deemed too broad, costly, and socialist.
-Shift to Selective Primary Health Care (disease specific focus).
- IMF/World Bank reforms: budget cuts, privatisation, user fees.
- Focus on vertical approaches and global health security.
- Weakened national health systems.
Recent changes to the IHR
Definition of Pandemic Emergency: Defined as a form of PHEIC with no specified consequences.
WHO Coordination: Better coordination during PHEIC to ensure timely, equitable access to health products, but no legal power for equity.
Financial Mechanism: Vague provisions for developing countries; no committed funds. Rich countries resisted a WHO Fund.
Essence: WHO gains more authority in coordinating health emergencies.
Criticism:
No robust review mechanism or enforcement (no compliance “police”).
Lack of detail on preparedness requirements (e.g., PPE).
No strong, legally binding commitments on equity and finance.
Global South Criticism: Demands equitable access to health products and better terms in research & development agreements.
Global health justice?
Global Health Justice: Access to health and addressing remediable inequalities (e.g., maternal/child health).
Key Comparison: Health Security: Vaccines, emergency preparedness.
Health Justice: Broader access, equity in health systems.
Horizontal and
vertical approaches? (health)
Vertical: Disease-specific focus (e.g., targeting one illness).
Horizontal: Strengthening entire health systems (e.g., preventive care, broader readiness).
Global health security?
Focus: Infectious diseases with global spread (e.g., MDG 6: Combat HIV/AIDS, malaria).
Narrower concept than the right to health.
Evaluate the WHO’s performance during Covid-19. Was it impactful? Explain.
- IHR + WHO were marginalised as countries chose to pursue their own policies - national sovereignty prevailed
- closing borders (against historical WHO preference)
- export restrictions for medical supplies
- vaccine nationalism
WHO weaknesses
- no real powers, underfunded, reduced to ‘meta governance’ role, IHR suffered from mock compliance, many countries had been hollowed out from NL
How was the WHO affected by great power politics?
- relationship with china
- 29 May 2020: Trump leaves WHO - 1/6 of budget gone (undone by Biden)
- challenges of navigating between powers
- 80% of funding from MS and philanthropists
You should be aware about the issues of supply of pandemic-related health products
(protectives, diagnostics, therapeutics, vaccines).
- Opposition from EU, UK, on vaccines ‘IP’
- US support of waiver for vaccines, but opposed to waiver for medicines
June 2022 compromise:
- waiver only applied to vaccines, only for developing countries, countries using compulsory licensing can export but the latter cannot re-export
- Critics disappointed: it took too long, it’s not for all pandemic-related products, not for all countries
