Skip to Main Content
Have library access? Log in through your library
Global Health Law

Global Health Law

Lawrence O. Gostin
Copyright Date: 2014
Published by: Harvard University Press
  • Cite this Item
  • Book Info
    Global Health Law
    Book Description:

    Despite global progress, staggering health inequalities between rich and poor raise basic questions of social justice. Defining the field of global health law, Lawrence Gostin drives home the need for effective governance and offers a blueprint for reform, based on the principle that the opportunity to live a healthy life is a basic human right.

    eISBN: 978-0-674-36987-0
    Subjects: Law, Health Sciences, Sociology

Table of Contents

  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-x)
  3. Preface
    (pp. xi-xviii)
  4. Global Health Narratives: Listening to the Voices of the Young
    (pp. 1-10)

    I begin this book with the voices of young people living in poverty—the daily lives of girls and boys, young women and men, who inhabit filthy, congested cities or remote rural villages. These global health narratives are told by the young people themselves, or by passionate community activists living alongside them. The stories of Alois, Shefali, Ti Charles, Eneles, Namubiru Rashida, Johnny, and Molly speak for themselves.

    I am the oldest in my family. My father works at Indigo Mine and my mother died of AIDS a couple of months ago. I have two brothers and two young sisters...

  5. PART I Failures in Global Health and Their Consequences: Health Inequities in Today’s Globalized World

    • [PART I Introduction]
      (pp. 11-12)

      This first part of the book lays the foundation for themes that will permeate throughout—particularly global health with justice, in which all people live and work in conditions that allow them to lead healthy, productive lives. Chapter 1 considers four fundamental issues, which are among the most pressing in global health today: (1) the services universally guaranteed under the right to health, (2) states’ duties to safeguard the health of their own populations, (3) international responsibilities to contribute to improved health in lower-income countries, and (4) the governance needed to ensure that all states live up to their mutual...

    • CHAPTER 1 Global Health Justice Toward a Transformative Agenda for Health Equity
      (pp. 13-31)

      Consider two children—one born in sub-Saharan Africa and the other in Europe, North America, or another developed region. The African child is almost eighteen times more likely to die in her first five years of life. If she lives to childbearing age, she is nearly 100 times more likely to die in labor. Overall, she can expect to die twenty-four years earlier than the child born into a wealthy part of the world.¹ Collectively, such vast inequalities between richer and poorer countries translate into nearly 20 million deaths every year—about one in every three global deaths—and have...

    • CHAPTER 2 Globalized Health Hazards The Need for Collective Global Action
      (pp. 32-58)

      Chapter 1 explained why solutions to profound global health challenges require a framework of mutual responsibility. No state, not even the most wealthy, can insulate itself from the forces of globalization that propel health hazards throughout the world. In Chapter 2, I aim to deepen understanding of globalization and demonstrate the urgent need for collective global action to tackle the world’s most pressing health threats.

      Globalization can be understood as a process characterized by changes in a range of social spheres, including the economic, political, technological, cultural, and environmental arenas. Globalization is restructuring human societies, ushering in new patterns of...

    • CHAPTER 3 Global Health Law in the Broader Currents of Global Governance for Health
      (pp. 59-86)

      This chapter defines global health law and examines its salient features; it also discusses the importance of broader global governance in meeting the major challenges in today’s global health landscape. The distinction drawn between law and governance, however, should not imply that these are entirely separate concepts. Instead, they are interrelated, with no clear boundaries: law is a major aspect of governance, and features of governance can take the form of law—such as the constitutions, bylaws, and processes of global health organizations.

      At the same time, a wide variety of “soft” normative instruments could be classified either as law...

  6. PART II Global Health Institutions

    • [PART II Introduction]
      (pp. 87-88)

      Part ii contains a discussion of the institutional structures that undergird global governance for health. Governance requires institutions to do much of the work in global health, including setting health-promoting norms and priorities; mobilizing and expending resources to achieve health with justice; consulting with and guiding multiple actors to work more effectively and cooperatively; and setting targets, monitoring progress, and ensuring accountability for results.

      This part of the book begins with the most important institution in the global health architecture: the World Health Organization. With its rich history, constitutional authority, and worldwide legitimacy, the WHO is in a unique position...

    • CHAPTER 4 Fulfilling the Promise of the World Health Organization
      (pp. 89-128)

      The world health organization is the global health leader, endowed with a progressive constitution and international legitimacy. There is no substitute for the WHO, with its incomparable normative powers and influence. The WHO is a specialized United Nations agency with an expansive mandate and unequaled expertise. Virtually every country is a member of the agency, which provides the potential for democratic accountability and global impact. It is highly unlikely that the UN would grant the same expansive authority and global reach to an international organization created today.

      Despite this rich heritage, the WHO faces a crisis of leadership.¹ Today the...

    • CHAPTER 5 Old and New Institutions From the World Bank to the Global Fund, the GAVI Alliance, and the Gates Foundation
      (pp. 129-174)

      The global health landscape is evolving at a dizzying pace: whereas the World Health Organization stood unrivaled in the aftermath of World War II, today there are nearly 200 international health agencies and initiatives.¹ This does not even include the myriad international NGOs and foundations that play vital roles in global health. These new institutions bring a host of benefits—more funding, an enhanced voice for civil society, and innovative ideas—but also a mismatch between health needs and available funds, a fractured approach to health planning and financing, and inadequate leadership and accountability. Scholars and advocates, recognizing these deficits,...

  7. PART III International Law and Global Health

    • [PART III Introduction]
      (pp. 175-176)

      Having examined health inequities in a globalized world and the key global health institutions, I now turn to the core sources of law in global health. The method of development in Part III reflects the definition of global health law developed in Chapter 3. First, Part III describes the two major WHO normative treaties. The International Health Regulations (IHR), discussed in Chapter 6, manage the worldwide response to rapidly emerging health threats of international concern, such as pandemic influenza. Dating back to the mid-nineteenth century, the IHR represent the primary global strategy for “health security.” The WHO’s most recent treaty...

    • CHAPTER 6 The International Health Regulations Responding to Public Health Emergencies of International Concern
      (pp. 177-204)

      The world health assembly (WHA) adopted the revised International Health Regulations (IHR) on May 23, 2005—the only international rules governing global health security.¹ The assembly’s historic vote came at a time when public health, security, and democracy became intertwined, addressed at the highest levels of government. Former UN Secretary-General Kofi Annan envisaged the IHR as moving humanity toward a “larger freedom.”²

      What were the critical factors that galvanized states to create international rules to govern global health security?

      Traditionally, public health powers resided in sovereign states. Political leaders, however, came to realize that states acting in isolation could not...

    • CHAPTER 7 The Framework Convention on Tobacco Control The Global Response to Tobacco
      (pp. 205-242)

      Public health historians will look back in amazement at the sheer devastation wrought in our age by a single agricultural product. Tobacco claimed 100 million lives in the twentieth century—a death toll comparable to the combined casualties of the two world wars. To this day, a half-century after researchers demonstrated that smoking causes cancer, heart disease, and respiratory disease,¹ tobacco remains the leading cause of preventable death.²

      Tobacco, both combustible and smokeless (see Box 7.1), kills more people than AIDS, tuberculosis, and malaria combined—nearly 6 million people every year—and this is expected to rise to 8 million...

    • CHAPTER 8 Health and Human Rights Human Dignity, Global Justice, and Personal Security
      (pp. 243-269)

      Animated by the belief that health is a right, not a privilege to be purchased, AIDS advocates from South Africa and India to Latin America took to the courts to argue that human rights obligate government to provide AIDS medications—and they won. In India, the right to food has served up cooked meals to millions of schoolchildren. A regional human rights commission catalyzed the transformation of Paraguay’s mental health system from institutionalization to community care. In Colombia, where unsafe abortions are a leading cause of maternal death, the highest court demanded the legalization of abortions to protect women’s health....

    • CHAPTER 9 Global Health, International Trade, and Intellectual Property Toward a Fair Deal for the Global South
      (pp. 270-302)

      The international trade in goods and services is pervasive, traversing both political and geographic boundaries. The movement of products, services, and knowledge along routes of trade is the engine that drives economies, but it is also the means by which disease is spread and cultures homogenize. Trade provides countries with resources and technological advances to which they would not otherwise have access. It opens markets not only to life-saving products such as vaccines and medicines, but also to life-threatening products such as tobacco or asbestos. Trade agreements also can make essential medicines so expensive that they are out of reach...

  8. PART IV On the Horizon: The Quest for Global Social Justice

    • [PART IV Introduction]
      (pp. 303-304)

      Global health with justice is the animating theme of this volume. In the final part of the book, I use a series of penetrating case studies as a lens to examine the content and processes of global health equity. These case studies all have two vital features in common: (1) they tell gripping stories of prominent health threats of worldwide significance that demand substantial public attention (andaction); and (2) they illustrate the social, economic, and political factors that have driven major reforms—whether those factors have been positive (e.g., social mobilization) or negative (e.g.,industry obfuscation). (Other parts of the...

    • CHAPTER 10 “Getting to Zero” Scientific Innovation, Social Mobilization, and Human Rights in the AIDS Pandemic
      (pp. 305-340)

      There is no story in global health as transformative, aweinspiring, and yet as tragic as the AIDS pandemic. The disease was unknown only a generation ago—a medical curiosity among young gay men in New York and San Francisco in June 1981. Within a few short years, AIDS could be found on every continent, enveloping the world to become one of the most devastating pandemics in human history—causing untold human suffering, social disintegration, and economic destruction.

      The human immunodeficiency virus (HIV) is a rare retrovirus that insidiously attacks the immune system, triggering opportunistic infections and ultimately killing its host....

    • CHAPTER 11 The International Migration of Health Workers A Troubling Example of Global Injustice
      (pp. 341-358)

      The deep and enduring inequities between North and South, rich and poor, present myriad global health challenges. But one of the most vivid illustrations of global health injustice may be the international migration of health workers.¹ Highly skilled workers emigrate every day, leaving their countries devoid of crucial human resources. Professional search firms actively recruit health workers. Others migrate of their own accord in search of a better life. The search for a better life, however, is often thwarted by exploitation and discrimination in their destination countries. In view of the appalling shortages of health workers in low-income countries, global...

    • CHAPTER 12 Pandemic Influenza A Case Study on Global Health Security
      (pp. 359-382)

      Indonesia sent shock waves around the world in December 2006 when its minister for health, Siti Fadilah Supari, announced the decision to refuse to share samples of avian influenza A (H5N1) with the WHO’s Global Influenza Surveillance Network (since renamed the Global Influenza Surveillance and Response System, or GISRS). The international virus-sharing system provides vitally important virus samples and genetic sequence data needed to develop effective vaccines targeted to prevailing influenza strains. Invoking sovereign ownership of a virus isolated in its territory, Indonesia justified the move on grounds that the WHO had failed to ensure equitable access to the benefits...

    • CHAPTER 13 The “Silent” Pandemic of Noncommunicable Diseases
      (pp. 383-411)

      Global health governance has historically focused on infectious diseases—with good reason, as pathogens have taken an enormous human toll, and still do. This is slowly changing, with the emergence of a broadened concern for primary care and health system strengthening. Yet a further broadening—indeed a qualitative transformation—is now desperately needed to ameliorate the underlying risk factors that fall outside the traditional health care sector. The precipitous rise of noncommunicable diseases (NCDs) worldwide requires fundamental shifts in behavior, habit, and culture. No country can succeed on its own, as globalized forces drive the underlying causes of NCDs.


    • CHAPTER 14 Imagining Global Health with Justice
      (pp. 412-440)

      The scope and complexity of global health law—its expanse of hard and soft norms, its proliferation of institutions, and its often opaque processes—can be overwhelming, making it difficult to form an inspiring and unified vision for the future. Mired in this complexity, the international community defines success disease by disease—without a clear picture of what fundamental reform would actually look like. If readers agree with this book’s aspiration of global health with justice, then answering three simple questions may help pierce the haze.

      First, what should global health look like? That is, given optimal prioritysetting, funding, and...

  9. Notes
    (pp. 443-502)
  10. Glossary of Abbreviations, Key Terms, and Actors in Global Health
    (pp. 503-520)
  11. Acknowledgments
    (pp. 521-524)
  12. Index
    (pp. 525-541)