Next month, the WHO Executive Board will meet with a lengthy agenda, representing the range of serious health burdens and threats that persist. One challenge stands above the rest: immense global and national health inequities, linked to some 20 million deaths every year (about which more in an upcoming blog). The Executive Board could take a historic step towards health equality by beginning a formal WHO process towards a Framework Convention on Global Health (FCGH), the proposed global treaty to be based in the right to health and aimed at national and global health equality. (For more on the FCGH, see the FCGH platform statement and this briefing paper.) And there is reason to believe it could happen.
The Sustainable Development Goals, on the WHO Executive Board meeting agenda, provide an important entrée for the FCGH. While the SDGs and FCGH would cover some similar ground – such as assurances of universal access to health care, clean water, adequate sanitation, nutritious food, and decent housing – the FCGH could fill in critical SDG governance gaps:
Accountability. The SDGs are voluntary; the FCGH would be legally binding, creating additional routes of accountability, prominently the courts. The SDG follow-up and review process lacks an independent review mechanism; the FCGH could establish such mechanisms. People’s capacity to hold their governments accountable may prove the most important form of accountability; the FCGH could insist upon participatory processes and include measures that help empower people to claim their right to health, such as through a Right to Health Capacity Fund (p. 83-84). There is much more, too, the FCGH could do to enhance the accountability processes of the SDGs and for the right to health overall, as will be outlined in an upcoming article in the Health and Human Rights journal.
Universal health coverage. The SDGs include a target of universal health coverage. Yet how comprehensive will this coverage be? Will it be truly universal and non-discriminatory, including immigrants (whether or not documented)? Will the level of coverage depend on a person’s wealth, or whether or not they are formally employed? Will countries develop and implement the measures required to overcome the wide-ranging financial and myriad other barriers obstacles to access? The FCGH could establish standards that ensure that universal health coverage is comprehensive, equitable, and non-discriminatory. And it would include requirements on population-specific national health equity strategies, inclusive participation, removing barriers to effective access, and more.
Financing. The SDG agenda could cost perhaps $3.5-$5 trillion per year. The competition for resources will be intense. Will health receive the funds necessary to achieve SDG commitments? The SDG agenda includes no assurances. The FCGH could develop a domestic and international financing framework, stimulate action to increase revenue for health and development, and promote the equitable distribution of resources.
Global governance for health. The SDGs commit to universal access of medicine, yet unwarranted patent protections could make medicine unaffordable. The SDGs include a target on reducing non-communicable diseases, but do not confront trade in or marketing of cheap and unhealthy foods that can displace healthier, local alternatives. The SDGs call for substantial efforts to address health workforce needs in developing countries, but health workers continue to migrate from many poorer countries, with few incentives to stay and a decade of enhanced attention to the health workforce yet to yield the necessary results. Regulations on tobacco control, alcohol reduction, and more will be needed to achieve the health-related SDG, but what of investment treaties that enable corporations to challenge health regulations?The FCGH could use the power of binding law to elevate the place of health – and the right to health – in trade, investment, and other legal regimes, and set standards for undertaking right to health assessments to understand and mitigate the potential negative impact of actions taken outside the health sector on the right to health. And the treaty could advance Health in All Policies, strengthen corporate compliance with the right to health, and otherwise advance a global governance for health that is truly governance for health.
The views reflected in this expert column are those of the individual authors and do not necessarily represent those of the O’Neill Institute for National and Global Health Law or Georgetown University. This blog is solely informational in nature, and not intended as a substitute for competent legal advice from a licensed and retained attorney in your state or country.