The effect of globalisation on health has attracted the attention of scholars and policymakers across multiple disciplines. But it is the first time that a research handbook (Edward Elgar) presents a comprehensive coverage of contemporary issues in global health law and governance, as explained by Graduate Institute Adjunct Professor Gian Luca Burci, coeditor with Brigit Toebes.
For the first time, a group of law and policy scholars have analysed the effect of globalisation on health from a legal point of view, drawing on knowledge from their respective fields. Why has this not been done before?
There is a growing body of literature on particular aspects of the interaction between health as a social and normative value as well as a human right, and various international legal regimes. However, most of this literature comes from scholars in their respective specific disciplines, e.g. economic law, environmental law or human rights. What was missing was a book bringing together these various strands of scholarship and offering a systematic overview of the core international instruments protecting human health as well as the interactions I just mentioned. The previous major book on global health law, by Lawrence Gostin of Georgetown University, has a very different approach to the topic.
A key concern is the regulation of international health protection, and in particular the use of international health instruments and the complex interaction between international law and health considerations. Can you elaborate on this and share some of your outputs?
The protection and promotion of human health have been seen until recently as essentially domestic topics, both at a scholarly as well as at a policy level. The only major exception is the prevention and control of infectious diseases, where international cooperation, the adoption of international conventions and the establishments of dedicated international organizations go back to the 19th century. The global dimension of health, in particular the fact that health is increasingly an input, an output and an indicator in many normative and political processes, has come to the centre of international policymaking processes very quickly since the 1990s. One of the main catalysts of this amazing transformation has been the HIV/AIDS pandemic, which confronted the public health community with complex issues of human rights and dignity, the impact of trade and investment liberalisation on access to life-saving medicines, and the tendency of many countries to frame infectious diseases as a national security question rather than a public health one.
The globalisation of health, and the need to factor health considerations in the design and implementation of international rules as well as in the governance of international institutions, has increased with global phenomena such as the growing pandemic of non-communicable diseases fuelled by consumption patterns (tobacco, alcohol, junk food, sweetened beverages) driven by liberal economic models. Preventing a worsening of this grave situation requires regulatory measures that affect trade and investment interests and confronts governments with the challenge of factoring their international obligations in public policy choices. While there is a consensus that health deserves a higher level of protection and equitable access, there are many controversies on the right balance between competing interests. I have focused in my scholarship on general questions about the development and future of global health law as well as on global health security, notably WHO’s International Health Regulations and cutting-edge issues such as the impact of biodiversity law on pathogen-sharing for public health purposes, and the normative response to the dramatic global increase in antimicrobial resistance.
What could be the impact of the current crisis of multilateralism we observe at the world level on international health policies?
The historical core of international control over the spread of infectious diseases still gathers global consensus, and the central role of WHO and the International Health Regulations are not challenged in this respect. The current political landscape, however, is preventing a rational and sober discussion on the proper balance between the protection of economic development, trade and investments on the one hand, and the sovereign authority of states to limit those rights for public health purposes. The current discussion is fragmented and highly emotional, and it’s difficult to envisage a broad agreement on some global principles and their practical implementation.
Moreover, there seems to be no appetite to even discuss the appropriateness of new global binding instruments to address urgent public health problems such as pathogen-sharing, pharmaceutical research and development for neglected diseases, and antimicrobial resistance. The default preference for “soft” normative approaches goes in parallel with the proliferation of international standards on topics such as the quality and safety of medicines and biological products, which is largely driven by corporate interests. This is part of the “informalisation of international lawmaking” analysed by Professor Joost Pauwelyn and other scholars, and raises delicate questions of legitimacy, accountability and inclusiveness that don’t find an institutional forum for discussion and deliberation.
Burci, Gian Luca, and Brigit Toebes, eds. Research Handbook on Global Health Law. Cheltenham: Edward Elgar. 2018.
Interview by Marc Galvin, Research Office