January 9, 2017
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WASHINGTON — As the world’s leading global health organizations – the World Health Organization, World Bank and United Nations – face significant political changes and challenges internally and externally, two global health law experts point out that galvanizing solidarity around the right to health is more critical now than perhaps ever before.
A “growing tide of populism threatens the solidarity upon which global health is based,” warn two global health law experts in the January issue of Health Affairs. Lawrence O. Gostin, faculty director at Georgetown Law’s O’Neill Institute for National and Global Health Law, and Eric A. Friedman, an associate with the institute, examine the major influences on global health in the coming years and suggest core priorities that could “galvanize political commitments and financing.”
The recommendations come against a background of major changes in global health leadership. The election of UN Secretary-General António Guterres and re-election of World Bank President Jim Kim along with the World Health Assembly’s choice in May to succeed WHO Director-General Margaret Chan could impact how successful the organizations are at garnering support for global health as a priority.
Gostin and Friedman describe the overarching challenges writing: “All these institutions confront shared challenges—mandates exceeding their resources, harnessing multi-stakeholder engagement, and commanding the international community’s confidence.” They add though that “Each possesses unique strengths that give policymakers reason to be cautiously optimistic.” The author’s note that the path forward is especially uncertain with the election of Donald J. Trump as U.S. President because the US has traditionally embraced a strong role in global health leadership, ranging from President George W. Bush’s AIDS and malaria initiatives to President Barack Obama’s work on Ebola, Zika, and the Paris climate change agreement. “The President-elect, however, opposes the Paris Agreement, threatens to block entry of Syrian refugees, and believes the UN is ‘weak,’ ‘incompetent,’ and ‘unfriendly’ to America,” the authors write.
“Donald Trump’s presidency poses a major risk to global health and the key institutions leading the charge, mainly the World Health Organization,” says Gostin. “His statements that contradict science such as on global warming are the antithesis of the evidence-based policies we need. And if he does not support WHO and global health politically and financially, it will be truly harmful to the world's health. United States leadership on health has never been more important. It has perhaps never been in such peril.”
Despite the political transitions, varying priorities and financial challenges, Gostin and Friedman lay out a list of core priorities that could shore-up political commitment and financial support, including a focus on global health security, mass migration, strengthening health systems, and climate change.
The authors say that all such eras face political opportunities and headwinds, and these will influence whether political leaders can advance their priorities. Gostin and Friedman see political mobilization (set by leaders such as UN Secretary-General Ban Ki-moon, and German Chancellor Angela Merkel), economic transitions among lower income countries, and the election of leadership at the WHO, UN and World Bank among top opportunities. Leading issues to create political headwinds include unsure follow-through for calls to make global health a priority, financial constraints, and institutional distrust.
Finally, the authors spell out what principles should guide the UN, WHO and World Bank when navigating the opportunities and perils. “The best course is to forge a cooperative agenda among the three institutions, while utilizing their particular strengths,” Gostin and Friedman write.
The authors say all three leading global health organizations could improve governance by more fully embracing human rights, including socioeconomic equity, inclusive participation of civil society and marginalized communities, and more transparency and accountability. Additional recommendations focus on predictable, sustainable and innovative financing in an era of strong competition for international funding and on addressing conflicts of interest. “Continued reliance on voluntary funding places all three institutions in financial jeopardy, particularly the UN’s humanitarian funding and WHO’s entire operations,” Gostin and Friedman write.
In conclusion, the authors say that the health threats and challenges faced by world health leaders today would be challenging under any circumstances, but are especially so now with the rise of nationalist politicians. Gostin and Friedman write that the UN, World Bank and WHO “have a special responsibility to foster that solidarity” and should “mobilize the world around a powerful vision of rights and equity that would embed the right to health in national and global health governance.”
The O’Neill Institute for National and Global Health Law at Georgetown University is the premier center for health law, scholarship, and policy. Its mission is to contribute to a more powerful and deeper understanding of the multiple ways in which law can be used to improve the public’s health, using objective evidence as a measure. The O’Neill Institute seeks to advance scholarship, science, research, and teaching that will encourage key decision-makers in the public, private, and civil society to employ the law as a positive tool for enabling more people in the United States and throughout the world to lead healthier lives.