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International public health law: not so much WHO as why, and not enough WHO and why not?

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Abstract

To state the obvious, “health matters”, but health (or its equitable enjoyment) is neither simple nor easy. Public health in particular, which encompasses a broad collection of complex and multidisciplinary activities which are critical to the wellbeing and security of individuals, populations and nations, is a difficult milieu to master effectively. In fact, despite the vital importance of public health, there is a relative dearth of ethico-legal norms tailored for, and directed at, the public health sector, particularly at the international level. This is a state of affairs which is no longer tenable in the global environment. This article argues that public health promotion is a moral duty, and that international actors are key stakeholders upon whom this duty falls. In particular, the World Health Organization bears a heavy responsibility in this regard. The article claims that better health can and must be better promoted through a more robust interpretation of the WHO’s role, arguing that neither the WHO nor international law have yet played their necessary part in promoting health for all.

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Notes

  1. The Ottawa Charter (1986) states that the conditions and resources for health are peace, shelter, education, food, income, stable ecosystem, sustainable resources, and social justice and equity.

  2. The WHO is a UN organisation formed in 1948 and governed by the World Health Assembly which is comprised of delegates from each of the 193 member states. For more on the WHO, see http://www.who.int/en/.

  3. Indeed, the link between poor health and social and political instability and failure is supported by evidence (Gostin et al. 2008; Kennedy et al. 1998; Lewis 2006).

  4. For example, see the Universal Declaration of Human Rights (1948), European Convention for the Protection of Human Rights and Fundamental Freedoms (1950), the Declaration of Alma-Ata on Primary Health Care (1978), the Ottawa Charter for Health Promotion (1986), UN Convention on the Rights of the Child (1989), UN’s Agenda 21 (1993), the Rio Declaration (1992), the Jakarta Declaration on Leading Health Promotion into the twenty-first Century (1997), UNESCO’s Universal Declaration on the Human Genome and Human Rights (1997), and the Council of Europe’s Convention on Human Rights and Biomedicine (1997).

  5. This reasoning is partially grounded on my interpretation of solidarity and my ranking of that value in the modern context. For example, I have argued (Harmon 2005) that health solidarity, as an ethical value, must become a more integral aspect of out social and political actions, driving them toward responses that adopt a broad, community perspective and that have a global reach. In doing so, I draw on UNESCO (2005, p. 10), which suggests that solidarity is an ethical imperative of growing importance given ideals of collective social protection and fair opportunity and the existence of serious inequalities in access to healthcare worldwide.

  6. By way of example, the European Court of Justice has been a protagonist in empowering individuals to obtain medical treatment in member states other than where they are resident, and therefore a facilitator of social integration in the European context. For example, see Decker v. Caisses de Maladie des Employés Privés [1998] ECR I-1931, and Kohll v. Union des Caisses de Maladie [1998] ECR I-1931, wherein the court rejected mobility limiting arguments to the effect that expenditure control was necessary and the risk of upsetting the financial balance of domestic social security systems was a danger.

  7. The WHO reports life expectancy by region as follows: Africa—46 (M), 48 (F); Americas—71 (M), 77 (F); South-East Asia—61 (M), 64 (F); Europe—68 (M), 77 (F); Eastern Mediterranean—61 (M), 64 (F); Western Pacific—70 (M), 74 (F). The countries with the lowest life expectancy rates and healthy life expectancy rates are African. Compared to life expectancy in the UK of 76 (M) and 81 (F), life expectancy rates in Lesotho are 35 (M) and 40 (F), Swaziland are 33 (M) and 36 (F), and Zimbabwe are 37 (M) and 36 (F). (WHO 2005, p. 13).

  8. These Grand Challenges are listed as follows: Vaccines: (1) create effective single-dose vaccines for use shortly after birth; (2) prepare vaccines that do not require refrigeration; (3) develop need-free vaccines delivery methods; (4) devise reliable tests in model systems to evaluate vaccines; (5) design antigens for effective, protective immunity; (6) learn which immunological responses provide protective immunity; Insect Control: (7) develop genetic strategies to deplete/incapacitate disease-transmitting insects; (8) develop chemical strategies to deplete/incapacitate disease-transmitting insects; Nutrition: (9) create a full range of optimal nutrients in a single staple plant species; Infection: (10) discover drugs that minimise the occurrence of drug-resistant micro-organisms; (11) create therapies that can cure latent infections; (12) create immunological methods that can cure chronic infections; Disease/Health Measurement: (13) develop technologies that permit quantitative assessments of population health; and (14) develop technologies that permit assessment of individuals for multiple conditions/pathogens at point-of-care (see Varmus et al. 2003).

  9. For more on the possible reasons for the WHO’s failure to adopt a more robust law-making role in the past, see Arai-Takahashi (2001) and Magnusson (2007).

  10. Gostin et al. (2008) has referred to the IHR as the high-water mark for the exercise by the WHO of its normative powers.

  11. Reliance on market-driven economic policies and/or organisations to achieve social goals such as public health or even to set priorities complimentary to public health will prove unsuccessful (McMichael and Butler 2006). Concerns about trade policies on public health have also been expressed by Labonte (2003); Checa et al. (2003), and others.

  12. Such a convention has been advocated by Lawrence Gostin and others (see Gostin 2007; Gostin et al. 2008; and Gostin and Taylor 2008).

  13. By contrast, trade organisations are very adept and practical/pragmatic at norm-making and advancing the interests of their field, which is decidedly not driven by human rights or human wellbeing concerns.

  14. Some effort has been made by the Committee on Economic, Social & Cultural Rights (2000) to make this right more meaningful; also see the work of the subsequent Special Rapporteur.

  15. As both of these points suggest, the WHO is a politicised organisation that is constrained by the more powerful governments that are its members, and it is therefore sometimes constrained in ways that other international actors, whether NGOs or purely private actors, are not.

  16. The environmental sector—which is a health-related sector and which has formed the Global Legislators for a Balanced Environment, which has a remit of developing a web of legal instruments aimed at protecting the environment—has been much more successful at getting its issues onto the all-important WTO policy agenda (Yach and Bettcher 1998).

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Acknowledgements

The author would like to acknowledge the valuable contribution of Dr. Graeme Laurie, Professor of Medical Jurisprudence, University of Edinburgh, and Director, AHRC SCRIPT, as well as the anonymous reviewers.

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  1. ESRC InnoGen and AHRC SCRIPT, University of Edinburgh, Old College, South Bridge, Edinburgh, EH8 9YL, Scotland, UK

    Shawn H. E. Harmon

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Correspondence to Shawn H. E. Harmon.

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Harmon, S.H.E. International public health law: not so much WHO as why, and not enough WHO and why not?. Med Health Care and Philos 12, 245–255 (2009). https://doi.org/10.1007/s11019-008-9175-6

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