Global Health Governance: International Law and Public Health in a Divided World

David Bennett is the national director of the Department of Workplace Health, Safety and Environment at the Canadian Labour Congress in Ottawa.

Until recently, international public health as a policy issue has
languished in an obscure backwater. The catalogues of global death and
misery have been largely remote from the Western world. What has changed
is the emergence of potential global epidemics such as SARS (Severe
Acute Respiratory Syndrome) and avian flu. It is no longer in any one
nation’s interest to ignore international public health. We are in a
situation which Obijiofor Aginam of Carleton University describes as
“mutual vulnerability.” This is the occasion for a concerted
international attack on contagious diseases of all sorts.

The solutions that Aginam proposes are a combination of international
laws and properly funded transnational institutions. Unlike, say,
criminal or environmental law, international public health law is not
well developed. In fact, we have not much more than the International
Health Regulations of the U.N. World Health Organization. These
regulations deal only with surveillance, information-sharing, and
control measures for cholera, plague, and yellow fever. The only major
international institution in public health is a private foundation, The
Global Fund to Fight AIDS, Tuberculosis and Marlaria (GFATM).

Aginam supports the proposals for a United Nations Global Health Fund,
“a disease nonproliferation multilateral facility,” covering
prevention strategies, broad surveillance measures, and curative
therapies. The obstacles are formidable, including the claims of
national sovereignty as a bar to international action. In our divided
world, there are “stark disparities” in levels of wealth, health,
development, and surveillance capacities among nations. One obstacle,
which Aginam does not make enough of, is the onslaught on national
public institutions by the World Bank.

Global Health Governance is written with obvious passion and clear
argument. The issues it deals with are not well known. It deserves to be
widely read.