In an era in which governments withdraw from international commitments, prioritize national policies and seem reluctant to cooperate at a multilateral level, a global instrument reaffirming the right to health may look impossible. Yet, in the midst of this exacerbated nationalism, there are advocates for a Framework Convention for Global Health (FCGH), a treaty aimed at closing the inequalities in access to health care. By clarifying priorities in the health agenda and promoting accountability and participation strategies, the FCGH is meant to strengthen the right to health and adapt it to a globalized world. Although the international arena may not appear ready for such a widespread pledge, tobacco control arises as a contemporary example of successful international health regimes and paves the road for deeper multilateral cooperation in global health.
The FCTC turned out to be one of the most significant accomplishments of the WHO, rallying global support against tobacco and motivating many states to develop far-reaching tobacco regulation. This treaty gave birth to a series of institutions and norms that harmonize state interests over this particular matter. The FCTC helped shape an international regime in the field of health. In international relations literature, international regimes refer to rule-oriented institutions created by states, that limit their legal freedom of action but enhance predictability and promote cooperation to achieve similar goals.
Unfortunately, there have been several difficulties in having the same level of legitimacy and effectiveness across the global health landscape. There has been an increase in players and resources, but their efforts are often impeded by an uncoordinated and incoherent system. Part of this fragmentation may be due to the lack of leadership guiding cooperative practices in the global health realm. The position of the WHO, as the envisioned centralized forum for these topics, has been challenged over the last few decades by other institutions that emerged to deal with specific global health issues, such as HIV/AIDS or tuberculosis.
Despite this seemingly fragmented scenario, the success of the FCTC is evidence of the possibility of an international regime on global health. The performance of the FCTC raises hopes on the feasibility of the FCGH. Establishing such a wide international framework on global health requires the coordinated efforts of a complex web of international actors, such as states, international organizations, enterprises and NGOs. That level of harmonization demands a strong center that fosters multilateralism and involvement from different stakeholders. Given that effectiveness enhances legitimacy, the experience of the FCTC suggests that WHO’s leadership in the FCTC could be also asserted at the FCGH level.
Whether that happens or not, the FCTC exemplifies that the construction of international rules and procedures can vastly reproduce at a domestic level, legitimizing and allowing the continuity of an effective regime. In my opinion, one thing is undeniable: the successes of the FCTC lays the path for a greater regime in global 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.