We often look to how the Framework Convention on Global Health (FCGH) would empower people, enhancing meaningful participation and government accountability to the right to health, with an emphasis on people who now have the least voice and to whom governments are least accountable. Such empowerment is central to the FCGH. Here, I focus on the advantages of this proposed treaty from the perspective of governments, especially ministries of health.
Over 70 years after the WHO Constitution and the Universal Declaration of Human Rights, the right to health still bears no relation to the reality of billions of people. Take, for instance, the chasm in health care quality and safety globally. Poor quality of care takes at least five to eight million lives yearly, leading to incalculable suffering and wasted resources. Marginalized populations are least likely to receive quality care. Closing this chasm requires participation, accountability, resources, and people to understanding their right to health.
The lack of access to quality health care is emblematic of the range of failings of the right to health to have yet been translated into the lived reality for large swaths of the world’s people, and the vast inequalities in health and quality health care that persist. Huge portions of the world’s population are also unable to access the underlying determinants of health, meaningfully participate in policymaking affecting their health, or hold governments, or anyone else, accountable for progress in health or quality health care. Health ministries lack the power and resources to provide quality universal health coverage.
Closing health inequities and gaps in access to quality health care, as well as to the underlying determinants of health, while addressing social and other determinants, demands raising accountability to the right to health in all of its dimensions – including its commitment to equality, meaningful participation, and adequate resources – to the highest possible level of commitment. A Framework Convention on Global Health (FCGH) would do just that. This global treaty would advance the right to health and health accountability, aiming to vastly reduce cavernous health inequities, including the quality chasm, and empower people and governments to better realize the right to health.
Why a treaty on the right to health?
The right to health is codified in international law through the International Covenant on Economic, Social and Cultural Rights and other treaties, but this has been deeply insufficient for realizing the right. And the right to health focuses on government responsibilities to their own populations, which remain central, yet also inadequate in our globalized world, where actions in one country can significantly contribute to or harm health elsewhere, and corporate action and power increasingly affect the right to health. What, then, would the FCGH add? How could it empower governments and societies to better realize this right?
To promote equity and participation: Ministries of health aim to maximizing the health of their people, and to do so equitably. They have signed onto WHO’s Framework on Integrated People-Centered Health Services, yet demands for quick results and fast progress on national indicators may impede their ability to promote participatory processes, to direct resources to hard-to-reach communities, or to ensure that expanded access to health care is expanded access to quality health care. This undermines efforts to create sustained, equitable, high-quality, safe, and effective health systems. Clear standards on participation and equity may be able to create the political space to direct more resources and attention to these priorities.
The FCGH would also empower ministers of health when engaging other ministries and the legislature. It would provide them legal backing in arguing for laws and policies that provide non-discriminatory care to all – a public health necessity – and help health ministers push back against policies that may drive people in marginalized groups underground. Similarly, where lack of political and economic power lead populations to receive fewer resources to access quality health care and benefit from other determinants of health, clear FCGH equity requirements could add to ministers’ arguments for equitable distribution.
To enable Health in All Policies: FCGH guidelines on respecting the right to health throughout government policies will require a Health in All Policies approach, for all sectors need to avoid harming health and contribute to healthier populations. The FCGH could enhance the authority of health ministers to engage with other ministries for joint policymaking, and may include measures, like health impact assessments, to facilitate this approach, helping meet health goals.
To protect against commercial determinants of health in international agreements and domestically: The unambiguous obligation to respect the right to health in all interactions, with the right elevated above commercial interests, combined with health impact assessments, will make the FCGH a powerful tool for governments to resist pressure to agree to terms that may harm health as they negotiate international agreements. And the FCGH could make it more likely that dispute resolutions bodies developed through trade and investment treaties will protect health in their rulings. Meanwhile, the FCGH would act as a shield against industry lawsuits against government regulations protecting and promoting health, and could empower health ministers in negotiations within the government on regulating companies, such as the food, beverages, and alcohol industries. And like the Pandemic Influenza Preparedness Framework, the FCGH could include creative mechanisms to bind private actors, opening up further pathways for protecting against harmful practices.
Ensuring national ownership
While FCGH stipulations would require certain government actions, they could do so in ways that maximize national ownership and involve joint and inclusive governance. Drawing on the approach of the Paris Agreement on climate change, at the heart of which is national target-setting within the scope of the overall shared commitment on greenhouse gas reduction, the FCGH could itself feature national target-setting, plus other flexibilities. For example, the FCGH could provide guidance and parameters in areas such as financing, equity, quality, health coverage, and participation and accountability mechanisms, with inclusive national processes then establishing national targets and timelines, selecting among a menu of options, or otherwise tailoring FCGH stipulations to national circumstances.
Thus, with a carefully calibrated mix of binding stipulations and national flexibility, the FCGH has the potential to be a create a powerful, innovative, 21st-century approach to the right to health, achieving under its auspices a healthy world, ones in which quality health care is universal, everyone benefits from the underlying and social determinants of health, and equity, participation, and accountability are at the center of national and global efforts to protect the public’s health.
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The views reflected in this blog 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.