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International Organization and Public Health
Wayne State University Law School
Hammer, Peter J.

International Organizations and Public Health – Outline
–          What is the difference between international health and global health policy?
o   International health is nation & nation state working together to agree on border issues regarding health (within role and function of nation states)
o   Global health policy generally involves more actors than just nation states themselves – it is nation states + NGOs + private donors + social movements
–          Broad Public Health
o   Community
§  How a community changes and develops
o   Cosmology
§  How do we understand illness in various regions
o   Values
§  Individual, community, religious culture
o   Institutional infrastructure
§  Public, private, public / private mix
–          Tensions – Public or population based approaches
o   Community v. Individual
o   Public Health v. Clinical Care
o   State v. Market
–          Challenges of global policy issues (gap analysis)
o   Jurisdictional gap
§  The discrepancy between a globalized world & national separate units of policy-making
o   Participation gap
§  The continued focus of international cooperation on intergovernmental actors and marginalization of new global actors, civil society and private sector
o   Incentive gap
§  Over reliance of the operationalisation of international agreements on aid mechanisms while ignoring many other practical policy options that could make cooperation a preferred strategy for both developing and industrial countries  
o   Legitimacy / accountability gap
–          Public Health
o   Institute of Medicine definition – “what we as a society do collectively to ensure the conditions in which people can be healthy”
o   Always ask “What is the private self interest?
§  Strong special interests can trump public health
o   Levels of prevention
§  Primary
·         “Pure” prevention, or preventing the problem from occurring at all
§  Secondary
·         Involves prompt detection and successful management or treatment of the health condition so as to avoid actual damage to a person’s health
§  Tertiary
·         Seeks to limit the impairment, increase the quality of life and prolong life
o   Community Health – the work of public health
§  Assessment
§  Policy development
§  Assurance of services
§  Needs to learn / conduct assessments or modifications and become adaptive
–          3 MUSTS an organization needs to be successful
o   Accountability
o   Transparency
o   Legitimacy
–          Global Health Governance
o   Defined – as the actions and means adopted by a society to promote collective action and deliver collective solutions in pursuit of common goals
o   Essential elements
§  Deterritorialize health
§  Built on the concept that health is multisectoral  and multidisciplinary 
§  GHG mechanisms to ensure roles are complied with
·         Accountability – to who?
·         Transparency – to who? In what capacity
·         Legitimacy – to who? How?
o   Look at the links between globalization &…
§  Population-level health influences
§  National-level health influences
§  Household economy health influences
§  Health care system / sectors
§  Must consider health effects of drug and human trafficking and arms control
–          Agenda for action
o   Essential that the economic benefits of globalization extend to all countries and especially to low-income countries (the link from globalization to the national economy)
o   The economic benefits of globalization need to be translated into health benefits (the links from the national economy to the health care system, health-related sectors & the household economy)
o   Potentially adverse effects of globalization on population-level health influences (i.e. on tobacco marketing & cross-border transmission of infectious disease) must be minimized
o   The design & implementation of international rules need to take full account of their potential effects on the health care system and health-related sectors
–          Alma Ata
o   Primary health care definition – basic health services + community participation + intersectorial
o   Mahler’s PHC definition
§  Adequate food and housing
§  Homes without insects and rodents
§  Water adequate to permit cleanliness and safe drinking
§  Suitable waste disposal
§  Immunization against the major infectious diseases of childhood
§  Prevention and control of locally endemic disease
o   Questions of poverty, health and new technology – How do you allocate resources?
§  Need appropriate technology
§  Concentrate on simple problems
§  Start at periphery and work toward center
§  Make the discussion public
§  Do not leave decisions to technocrats
§  Water and sanitation is more important than medicines
·         A family in poverty cannot be healthy even with direct medical attention
·         A family in poverty can be healthy without direct medical attention
§  What is appropriate medical technology in the 1st world may NOT be appropriate medical technology in the 3rd world.
§  “Health for all” by 2000 – has obviously not happened
–          Ensuring health as a global public good through global governance
o   Health as a global public good should constitute the core of a global health policy: both as a value and as a resource
o   Ensure a reliable information base on global health
o   Ensure global health security
o   Support countries in developing a global health competence and responsibility
o   Act as a the global health broker
o   Act as a health oversight body
o   Establish a UN spokesperson on health and human rights
–          Bases of coope

exercise of human reasons
o   4 Sources
§  Treaties & conventions
·         Consent based agreements between states
·         International law on public health is heavily treaty-based
§  Customary international law
·         Similar to American common law
·         Evolved over time and are unwritten rules – not what states say they do but what states actually do
·         Must have these 3 elements
o   A particular pattern of state behavior is present generally in the international system (general state practice)
o   The pattern of state behavior is consistent throughout the international system (consistent state practice), and
o   States follow the pattern of behavior out of the sense that they are legally obligated to do so (opinio juris)
§  General principles of law recognized by civilized nations
·         Consists of legal principles found in domestic system of law that are useful in regulating the interactions of states
§  Judicial decisions 7 the writing of publicists
·         Judges and scholars do not create rules of international law, but only work with what has already been generated by state practices
·         Has to be positive law, not natural or normative law
–          Convention protocol framework
o   Environmental law used hard law to push the tobacco control policy
o   Held convention and passes protocols and treaty – which is law
o   Easier to get convention but harder to get others to pass the protocols
o   Framework protocol
§  Whereas international regulations press sovereignty harder through the “contracting out” provision, the framework protocol approach is more flexible because it tries to induce states to join the regime and become committed to the regime’s gradual evolution into effective global governance
§  The inverse triangle effect can hurt an international legal approach to a public health problem if state commitment remains largely at the framework treat level, while protocols are inadequately adopted and implemented
–          Hard law vs. soft law
o   Hard law – would be a treaty, it is consented to and binding
§  Social networks & soft law are frameworks for hard law implications
§  Formally is defined as a regime relying primarily on the authority & power of the state