Click for next page ( 204


The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement



Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.

OCR for page 203
Appendix E Commissioned PaPer Global Health Governance Report Lawrence O. Gostin* Emily A. Mok** I. Introduction Global health is of primary importance to human functioning and well-being. Yet the state of global health by many measures is dire. The dual burdens of infectious and chronic diseases among the world’s poorest people are enduring. Profound disparities in health and life expectancy between the rich and poor are wide and resistant to change. And all countries, rich and poor, are at risk of pro - nounced health hazards from the movement of people, goods, and services. No country, acting alone, can adequately protect the health of its citizens or significantly ameliorate the deep problems of poor health in developing countries. The spread of disease, the importation of consumer goods, and the migration of health professionals cannot be adequately controlled by states in isolation, but depend on international cooperation and assistance. Globalization—the “process of increasing economic, political and social interdependence, and global integra - tion that occurs as capital, traded goods, people, concepts, images, ideas and values diffuse across national boundaries” (Taylor 2002)—is changing the way that states must protect and promote health due to the growing number of health hazards that increasingly cross national boundaries (Dodgson et al. 2002, Lee et al. 2002, Lee 2003). Globalization similarly demands creative solutions to *Associate Dean (Research and Academic Programs), the Linda and Timothy O’Neill Professor of Global Health Law, and Faculty Director of the O’Neill Institute for National and Global Health Law, Georgetown University **Visiting Researcher, O’Neill Institute of National and Global Health Law, Georgetown Univer- sity, and D.Phil candidate, Centre for Socio-Legal Studies, University of Oxford. 0

OCR for page 203
0 THE U.S. COMMITMENT TO GLOBAL HEALTH complex problems that affect the determinants of health such as in trade, human rights, and the environment (Dodgson et al. 2002). Despite the importance of a coherent strategy for global health, the tradi - tional system of international health governance, which primarily encompasses states and intergovernmental organizations (IGOs), has been unable to effectively govern in the new global health context (Dodgson et al. 2002). Today, the inter- national community faces a number of hard global health governance (GHG) problems. Here, we highlight several “grand challenges,” which are vital to the improvement of world health and the reduction in glaring health disparities (Gostin 2008a): • Leadership—WHO must gain the capacity and authority to establish a clear mission, achieve objectives, and influence health-promoting activi - ties globally. • Harness Creativity, Energy, and Resources for Global Health—The GHG system must create and align incentives of private/public actors and stake- holders to promote imaginative, well-funded solutions for global health improvement. • Collaboration and Coordination of Multiple Players—The GHG system must create effective partnerships and coordinate currently fragmented funding, programs, and activities to create synergies and avoid destructive competition among funders and service providers or, worse, with local government and business initiatives. • Basic Survival Needs—The GHG system must help build health systems and infrastructures that are scalable and sustainable to meet fundamental human needs, including sanitation, food and water, vector control, and maternal/infant health. • Funding and Priorities—The GHG system must gain agreement on fund- ing levels needed to achieve key priorities, the responsibility of rich states to devote adequate funding for international health assistance, and ensure adequate health system capacities in poor states. • Accountability, Transparency, Monitoring, and Enforcement—The GHG system must create rules for accountability, transparency, monitoring progress, and norm enforcement needed to fulfill commitments and meet goals. The conspicuous voids left by the traditional governance system in the face of global health crises have prompted the creation of various ad hoc initiatives sponsored bilaterally or by nonstate actors such as nongovernmental organiza - tions (e.g., humanitarian organizations, industry associations, foundations, and other private associations) and businesses (e.g., pharmaceutical companies). For some initiatives, states and IGOs have joined forces with nonstate actors to form public-private partnerships (PPPs) or “hybrid” organizations in an attempt to

OCR for page 203
0 APPENDIX E address global health problems such as the Global Fund for HIV/AIDS, Tuber- culosis and Malaria (“the Global Fund”) and the International Finance Facility for Immunisation (IFFIm). Despite the proliferation of actors and initiatives in the global health space, the current approach to governance is not solving the global health crisis. Numer- ous global health initiatives have missed or are missing their targets (e.g., WHO’s “3 by 5” initiative and the UN Millennium Development Goals) due, in part, to problems of governance. Furthermore, there is growing concern over the popu - larity of short-term, narrowly focused disease programs over long-term capacity building initiatives aimed at generalized health protection and promotion (Burris and Beletsky 2005). This commissioned Institute of Medicine paper addresses why the most important global health objectives are being hindered by global health gover- nance today. The most vital goals include improved health and longevity among the world’s poor, maternal and infant survival, reduced health disparities, and reduced spread of health hazards across national boundaries. First, in section II, we review the “grand challenges” for global health that need to be addressed by GHG. The issues highlighted are not meant to be an exhaustive list of today’s global health challenges, but rather to assist in understanding why global health has not progressed further and determining what needs to be done. In Section III, we survey the range of key global health actors and the decentralized environment within which they operate, and investigate the reasons behind their inability to meet contemporary global health challenges. The grow - ing overlap between institutional mandates, sectors, and laws has transformed global health into a disorganized world of territorial actors, uneven partnerships, and tenuously balanced multisectoral approaches. This section highlights the need for a more coherent approach to address the broad governance challenges of global health as a whole. Finally, in Section IV, we explore innovative approaches to global health governance. As the problems of global health governance continue to grow, several prominent scholars have devised creative solutions that may help to trans- form today’s global health situation. We briefly review their ideas and consider how they might function in practice. These proposals represent only a start to what clearly has to be a broadly conceived, imaginative approach to global health governance, where innovation is urgently needed. II. Grand Challenges in Global Health Today Globalization has dramatically transformed how the international commu - nity must respond to modern health hazards. As the forces of globalization (such as mass travel, trade, industrialization, and communication) bring states closer together, there is a newfound sense of urgency regarding the spread of disease due to the potential for widespread and rapid dispersion. A sudden rush to address

OCR for page 203
0 THE U.S. COMMITMENT TO GLOBAL HEALTH this issue in terms of national security has resulted in a greater focus on particu - lar health issues, such as HIV/AIDS and biosecurity, and resulted in an influx of narrowly focused, overlapping initiatives without a coherent sense of the big picture of global health. Today, many are wondering why health targets are not being reached and what has become of the investments made. Meanwhile, a number of other criti - cal health issues such as chronic conditions (Daar et al. 2007) and less popular diseases of poverty (i.e., the so-called “neglected diseases”) continue to be left at the wayside despite their significant burden on society—especially in resource- poor countries (Gostin 2008a). Overall, there is a sense that underlying health needs are being “obscured” by current tendencies for popular health initiatives (Burris and Beletsky 2005). The intractability of progress in global health can be attributed to a number of “grand challenges” (Gates Foundation 2003). These grand challenges are the enduring, hard-to-solve obstacles that persist in the political, legal, economic, and social contours of the current international landscape and prevent the achievement of global health with justice (Gostin and Taylor 2008). In this section, we high - light six of the key grand challenges in relation to global health governance. We offer more specificity regarding these challenges later in the paper. It is important to note that all of these challenges are interconnected and, in some instances, overlapping and a systemic approach is necessary to address these issues appro - priately and adequately. 1.  WHO Leadership The first grand challenge relates to the lack of leadership that WHO has exhibited in its role as the premier agency for health. WHO, despite its unique directive to lead using an array of powerful mechanisms (e.g., treaties and regula- tions) and legitimacy, has shied away from providing the much needed leadership for the promotion of international health. At the same time, other IGOs have chal- lenged WHO’s primacy in global health, such as the World Bank and WTO, using their resource-based or political powers (Gostin and Taylor 2008). Although this void in leadership is explained partly by structural and power dynamics at WHO, it has nonetheless resulted in flawed implementation of and weak compliance with WHO norms by states. Consequently, WHO needs to gain the capacity and authority to establish a clear mission, achieve objectives, and influence health- promoting activities globally. 2.  Harness the Creativity, Energy, and Resources for Global Health The second grand challenge is the need for the current international system of states and IGOs to harness the creativity, energy, and resources of other actors and stakeholders for global health. It is well understood that nonstate actors, such as civil society, foundations, and private enterprises, play an increasingly impor-

OCR for page 203
0 APPENDIX E tant role in global health, but their role and obligations remain unclear. Businesses can offer great benefits for the health of the global community, for example, by innovations in pharmaceuticals, vaccines, and medical devices; producing and selling healthier foods and safer products; and creating healthier and safer places to work. Philanthropists can provide much needed resources for urgent and endur- ing health needs, as well as imaginative ideas for how to serve the health needs of poor people. And civil society has demonstrated the capacity for helping those within their communities and advocating for social change. The GHG system needs to devise a means to create incentives, facilitate, coordinate, and channel the activities of these nonstate actors. It needs to enhance health-producing activities and discourage harmful ones. How, for example, can the GHG system increase the involvement of the nonhealth sectors (e.g., food, energy, and transportation) and encourage them to think in health-conscious ways? It has even been suggested that WHO, or another international entity, could “monitor, evaluate, and rank corporations on their degree of ‘health responsibility,’ much the way that companies are ranked on their ‘greenness’” (Bloom 2007). Public-private partnerships (PPPs) have served as a primary means for engag- ing private industry in health initiatives in order to leverage industry strengths in research and development, product manufacturing, and product distribution. At the same time, private industry can benefit from the opportunities offered by engaging in such work. For example, PPPs offer pharmaceuticals the ability to obtain subsidies for research and assistance in clinical trials, as well as good PR for entry into drug markets (Buse and Walt 2002). This arrangement, however, could result in conflicts of interest between the pharmaceutical’s corporate strat - egy and PPP objectives. Overall, the GHG system needs to find a way to create and align the incentives for private/public actors and stakeholders to promote imaginative, well-funded solutions for global health improvement (Buse and Harmer 2007). 3.  Collaboration and Coordination of Multiple Players The third grand challenge is the need for collaboration and coordination among the multiple players in global health. A number of actors, beyond the tra - ditional state-centric governance system, now occupy the field of global health. This has resulted in rampant problems of fragmentation and duplication in the sea of funding, programs, and activities that span the global health domain. Such problems have crippling effects at the national level where “[developing coun - try] governments looking to tackle health problems . . . face a bewildering array of global agencies from which to elicit support” and, in consequence, typically results in overburdening the health ministries with “writing proposals and reports for donors whose interests, activities, and processes sometimes overlap, but often differ” (Bloom 2007, IDC 2008). Related to fragmentation among the current proliferation of actors is the growing competition between international NGOs and local service providers

OCR for page 203
0 THE U.S. COMMITMENT TO GLOBAL HEALTH (e.g., governments, business and community based organizations) for funding and human resources (Garrett 2007a). It is feared that this encroachment of interna - tional actors upon capable actors at the local level will hinder efforts at greater country ownership1 and control. When well-funded NGOs create AIDS clinics or other services on the ground, they are often able to offer more lucrative salaries and far better working conditions than local providers. This can drain public or private initiatives in the host country, making it even more difficult to provide sustainable services. Rather what is needed is a system of governance that fosters effective part - nerships and coordinates initiatives to create synergies and avoids destructive competition at all levels—international, national, and local (Rosenberg et al. forthcoming). Several recent efforts at coordination and harmonization among actors have been launched, such as the “Health 8” and the International Health Partnership,2 but it remains to be seen whether these initiatives will achieve their goals (International Health Partnership 2007, NORAD 2007, IOC 2008). 4.  Basic Survival Needs The fourth grand challenge pertains to meeting fundamental human needs through the development of scalable and sustainable health systems and infra - structures. Meeting fundamental human needs lack the glamour of high-technol - ogy medicine or rescue, but their value is the significant potential for impact on health because they deal with the major causes of common disease and disabili - ties across the globe. These needs are essential to restoring human capability and functioning, which one of us has termed “basic survival needs” (Gostin 2008a). Basic survival needs include sanitation and sewage, pest control, clean air and water, tobacco reduction, diet and nutrition, essential medicines and vaccines, and functioning health systems for the prevention, detection, and mitigation of disease and premature death. By focusing on these needs, the international community could dramatically improve prospects for the world’s population. A number of the needs are laid out in international agreements. Three of the eight MDGs, for 1 According to a recent U.K. International Development Committee report, developing countries’ “ownership” of their own development effort is a key aspect of aid effectiveness (IDC 2008). 2 The “Health 8” refers to the group of eight major international health-related agencies (i.e., WHO, World Bank, GAVI, UNICEF, UNFPA, UNAIDS, the Global Fund to fight AIDS, Tuberculosis and Malaria, and the Bill and Melinda Gates Foundation), which meet informally to discuss ways to scale up services and improve health-related MDG outcomes (International Health Partnership 2007, NORAD 2007). The International Health Partnership (IHP) is an effort that was launched in 2007 by some donor countries “to improve the coverage and use of health services—whether through public or private channels, or through non-governmental organisations—in order to deliver improved out - comes” related to the health-related MDGs and universal access commitments ( Lancet 2007, Ooms et al. 2008, International Health Partnership 2007). The International Health Partnership has also been a topic of discussion by the H8 and led to an interagency coordination process and common workplan known as IHP+ (for IHP and related initiatives).

OCR for page 203
0 APPENDIX E example, are health-related: child mortality, maternal health, and reducing the burden of infectious diseases (UN Dep’t of Int’l Econ. & Soc. Aff. 2006). The UN Economic & Social Council finds that basic survival needs are a core com - mitment of the right to health, including immunization, essential medicines, food, potable water, sanitation, disease prevention and treatment, primary health care, and health education (UN Comm. on Econ., Soc. & Cultural Rights, General Comment  2000). Building enduring health systems is critical to population health. Such health systems require sound infrastructures and human resources, which would give countries the tools to safeguard their own populations. Poor countries need to gain the capacity to provide basic health services themselves. Health system capacity has the added benefit of improving world health by significantly reduc - ing the potential for disease migration to other countries and regions. Local capacities empower health professionals to prevent, rapidly detect, treat, and con- tain health hazards before they spread out of control (WHO 2000). Unfortunately, as discussed in the next grand challenge, the priority placed on addressing basic survival needs and building health systems by international assistance tends to be low. The GHG system must find a way to redress this critical problem. 5.  Funding and Priorities The fifth grand challenge relates to the skewed priorities in international funding. Currently, a significant amount of funding is directed towards “specific diseases or narrowly perceived national security interests” that have been placed high on the global health agenda by a small number of wealthy donors (such as OECD countries, the Gates Foundation and the Global Fund) (Garrett 2007b, Gostin and Taylor 2008). As a result, funding tends to be diverted from the larger, systemic approaches, such as building stable local systems to meet basic survival needs (Prakongsai et al. 2008, Waddington 2004). In priority setting, a stronger cooperative approach needs to be taken between donors and recipient countries in defining and advancing developing country health agendas (Bloom 2007). Proper resource allocation based upon attainment of basic survival needs, support for basic infrastructure and capacity building, and cost-effective interventions have the potential to make donor funding go further. And, it is important to prioritize funding in light of its potential for health impact over a substantial period of time—e.g., 10 to 15 years (Levine 2008). The Disease Control Priorities Project (DCPP) is an illustration of a current effort to assist developing countries with the improvement of their health systems. The DCPP provides technical resources to inform policy making on topics such as the cost- effectiveness of different health-improving interventions and cross-cutting issues crucial to the delivery of quality health services (Laxminarayan et al. 2006). Funding needs to be provided at adequate and predictable levels that are scalable to needs. Such needs exist at both the international and national level, as

OCR for page 203
0 THE U.S. COMMITMENT TO GLOBAL HEALTH WHO is highly dependent on Member States for financial resources to carry out its functions and developing countries need funding to build capacity. A prob- lem with current funding approaches is that there is no method of holding rich states accountable to provide sufficient and stable international health assistance to states that lack the capacity. For example, developed countries have not even fulfilled their pledges made in 1975 of giving 0.7 percent of gross national income (GNI) per annum on overseas development assistance (ODA). More than 30 years later, their real contribution has only recently risen to reach a high of 0.33 percent. In general, the GHG system must gain agreement on funding levels needed to achieve key priorities, the responsibility of rich states to devote adequate funding for international health assistance, and ensure adequate health system capacities in poor states. Figuring out innovative ways to ensure adequate and enduring levels of funding, and agreed-upon priorities, will be vital in ensuring that poor countries gain the capacity to deal with everyday health threats, as well as public health emergencies. 6.  Accountability, Transparency, Monitoring, and Enforcement Finally, the sixth grand challenge pertains to the need for greater transpar- ency, accountability, monitoring, and enforcement in meeting global health goals. Accountability in global health has been problematic. WHO and other IGOs are officially accountable to their Member States, but “they often lack detailed and realistic targets for health outcomes or for the intermediate actions they take to promote health” (Bloom 2007). States themselves tend to enter into voluntary, rather than binding, commitments towards health and it is difficult to hold them accountable under such weak mechanisms. Other actors, such as civil society, foundations, and corporations, report to an array of different interest groups and cannot be held accountable for their failures or shortcomings. At the same time, there is insufficient transparency both with respect to IGO and state decision making. Transparency, literally truthfulness and openness to view, has no fixed meaning, but most definitions include the following overlap- ping features: open governance, free flows of information, and civic participa - tion. These are values that support accountability and are widely believed to be hallmarks of good governance. Monitoring and enforcement in global health are similarly problematic. While there have been increased efforts to build “monitoring and evaluation” sys- tems to track the progress of various health initiatives, the lack of an enforcement mechanism generally leaves things at a voluntary level for the actors involved. Reliance on voluntary practice can be unreliable and unstable unless there are adequate incentives to drive performance. All in all, the GHG system needs to adapt by creating rules for accountability, transparency, monitoring progress, and norm enforcement for the fulfillment of commitments and achievement of goals.

OCR for page 203
 APPENDIX E To conclude, these six “grand challenges” represent some of the critical fea - tures needed in a coherent system of global health governance. To ensure effective and well-functioning health systems in poor countries, and to meet basic survival needs, the international community, in partnership with host countries, must invest in health system infrastructure. It is not simply the amount of money spent that is important, but how those resources are invested and used. This requires a structured approach that sets priorities, ensures coordination, and monitors and enforces results. Accomplishing a system of coordinated and effective interna - tional aid will require political will and a system that unifies the myriad efforts of states, IGOs, NGOs, businesses, and private foundations. On top of all of this is a need for clear and strategic leadership. As the next section indicates, current global health governance efforts have not been able to accomplish these goals, and a fresh approach is badly needed. III. The Inadequacy of the Current Approach to Global Health Governance As highlighted by the six grand challenges, the advancement of global health requires leadership, coordinated global health actors, priorities, basic survival needs, and accountability, transparency, monitoring, and enforcement. Unfortunately, as this section will illustrate, the current approach to global health governance has not been able to meet these needs. A central, and actually inher- ent, problem to the current approach is the lack of leadership in global health. Leadership unifies actors. It also sets the direction for priorities and has the potential to drive basic survival needs to the fore. At the same time, it can help align incentives and engage in monitoring and enforcement. Without clear leadership, current priorities have been skewed towards popu- lar, disease-focused initiatives and away from basic survival needs. A prolifera - tion of actors with “little or no formal mandate in health” has entered the global health domain and, in general, they have not worked well together. Despite the creation of novel financing mechanisms, such as the Global Fund, funding levels continue to be missed as separate mechanisms are adopted (e.g., PEPFAR). Over- all, accountability is questionable and enforcement has been nonexistent. This section points out the inadequacies in the current approach to gover- nance. First, it identifies the reasons behind the lack of global health leadership by the World Health Organization. It goes on to consider the proliferation of players in global health, through a look at several prominent actors (i.e., the World Bank, PEPFAR, the Gates Foundation, and the Global Fund), and presents some of the key criticisms regarding each of their approaches. Finally, the section concludes with a look at four emerging areas of overlap with the health sector and what the overlap means for GHG in terms of synergies and tensions.

OCR for page 203
 THE U.S. COMMITMENT TO GLOBAL HEALTH A.  The Lack of Leadership by the World Health Organization Leadership is vitally important to achieve vital objectives in global health. Individuals and organizations that take leadership can effectively influence the activities of multiple actors to establish a clear mission and achieve objec - tives. In the global health field, the United Nations established the World Health Organization (WHO) to exercise leadership. The WHO has in many ways been an admirable organization advancing world health, but it has failed to live up to expectations in its leadership role. The fault is not entirely its own, but the vacuum in leadership over the years has significantly impeded progress on the key parameters of global health. The WHO, the UN specialized agency for health, was established in 1948 and includes 193 member states. The WHO Constitution envisioned an agency that would act as the “directing and coordinating authority on public health” (Art. 2) and endowed it with extensive normative powers to proactively promote the attainment of “the highest possible level of health.” These powers include the adoption of conventions (Art. 19), the promulgation of binding regulations (Art. 21), and the recommendations (Art. 23), and monitor national health legislation (Art. 63). The WHO’s treaty-making powers are noteworthy. The agency can adopt binding conventions or agreements which, unlike normal treaties, affirmatively require States to “take action”—submitting the convention for ratification and notifying the Director General of the action taken and State’s reasons within 18 months (WHO Constitution, Art. 19 and 20). The WHO also possesses quasi- legislative powers to adopt regulations on a broad range of health topics—e.g., international epidemics; the safety, potency, and advertising of biologicals and pharmaceuticals; and a nomenclature for diseases, causes of death, and public health practices (WHO Constitution, Art. 21). WHO regulations, unlike most international law, are binding on Member States unless they proactively “opt out.” Once adopted by the World Health Assembly (WHA), the regulations apply to all WHO member countries, even those that voted against it, unless the government specifically notifies WHO that it rejects the regulation or accepts it with reservations. WHO’s binding normative powers, therefore, are extraordinary. It possesses the authority to oblige States to take health treaties seriously by submitting them to a national political process and informing the international community of the result. Its regulatory powers are even more far-reaching, as States can be bound by health regulations without the requirement to affirmatively sign and ratify. States, moreover, have ongoing duties to make annual reports to the agency of actions taken on recommendations, conventions, and regulations (WHO Constitu- tion, Art. 62). Despite these impressive powers, modern international health law is remark - ably thin—two of the three existing international health instruments predate the

OCR for page 203
 APPENDIX E agency. The WHA, at its first session in 1948, adopted World Health Regulation No. 1, Nomenclature with Respect to Diseases and Causes of Death, which formalized a long standing international process on the classification of disease (WHO 1990). By providing standardized nomenclature, the regulation facilitates the international comparison of morbidity and mortality data. The Nomenclature Rule was modest at onset, but it subsequently became merely advisory, now known as the International Classification of Diseases. The Rule is, therefore, technical, rather than normative, and recommended rather than obligatory. World Health Regulation No. 2, the International Health Regulations (IHR), dates back to a series of international sanitary conferences held in Europe dur- ing the second half of the nineteeth century to address the transboundary effects of infectious diseases. The sanitary conferences had little to do with improving health in developing countries. Rather, they reflected the national interests of European powers to prevent the importation of devastating tropical diseases (Howard-Jones 1975). The legal and diplomatic work begun by the international sanitary conferences eventually produced the International Sanitary Regulations (ISR), which the WHA adopted in 1951 and which were renamed the IHR in 1969 (Fidler 2005). Before the IHR was fundamentally revised in 2005, they applied only to cholera, plague, and yellow fever—the same diseases originally discussed at the first International Sanitary Conference in Paris (1851) (WHO 2005). Not unlike the original ISR, the revised IHR was motivated by the potentially drastic economic and security consequences of fast moving infectious diseases, in this case hemorrhagic fevers, SARS, avian influenza, and bioterrorism. The IHR’s primary focus is on “public health emergencies of international concern,” defined as “a public health risk to other States through the international spread of disease” (WHO 2005, IHR Art. 1). The IHR, therefore, historically and politi - cally, was intended to prevent transmigration of disease, rather than to improve health in poor countries. To be sure, the revised IHR is far more expansive and bold than its predecessors, but it is unlikely to do the work that is needed in global health—namely, to dramatically improve the plight of the world’s least healthy people (Fidler and Gostin 2006). The WHO did not create a health convention until 2003, when the WHA adopted the Framework Convention on Tobacco Control (FCTC) (WHO 2003). The FCTC declares the bold objective of protecting present and future generations from “the devastating health, social, environmental and economic consequences of tobacco consumption and exposure to tobacco smoke” (Art. 3). It adopts multidimensional strategies, including demand reduction, supply reduction, and tort litigation (Taylor and Lariviere 2005, Taylor and Bettcher 2000). Although a laudable achievement, the FCTC is almost sui generis because it regulates the only lawful product that is uniformly harmful. The FCTC was politically feasible because the industry was vilified for denying scientific realities, engineering tobacco to create dependence, engaging in deceptive advertising, and targeting youth, women, and minorities (Brandt 2007, Mehl et al. 2005).

OCR for page 203
 THE U.S. COMMITMENT TO GLOBAL HEALTH health. Overall, there are a variety of innovative ways to address the inadequacy of the current approach to GHG and a bold change needs to be adopted soon. V. Health in a New Political Era Today, we stand before a number of critical challenges in global health. This paper highlighted how the historical lack of leadership by WHO, despite its immense powers, has significantly impeded the international governance of health and opened the door to a proliferation of actors in the global health domain. Now, an array of nonhealth IGOs, bilaterals, nonstate entities, and GPPPs dominate the field. While these actors have introduced a number of creative ideas and a vast sum of new resources to tackle global health’s most difficult problems, they have also brought a new set of problems to global health in the form of misaligned priorities, heavily skewed funding, service duplication and competition, and unsustainability. Meanwhile, global health must contend with a variety of emerg - ing external forces such as trade, environment, and foreign policy. The overlaps between the health sector and these other fields hold the potential for tensions and synergies that need to be managed. At the same time, fundamental health needs continue to be neglected and health systems remain weak. Nonstate actors, especially at the local level, are not being sufficiently harnessed through partnership. Transparency and account - ability needs to be greater, and the monitoring and enforcement of commitments should be introduced. GHG needs to resolve the current imbalances and bring a greater sense of coherence to the “big picture” of global health. In addition, WHO must find a way to assert itself in this new global health environment. An innovative approach to GHG is sorely needed, and we reviewed a few creative, initial proposals on this subject. All in all, a dramatic change to the current GHG system is critical and the international community must be prepared to confront each of the grand challenges with clarity of purpose. As this paper sought to elucidate, many of the seemingly intractable prob - lems in global health could be addressed through improved global health gov - ernance. Leadership; harnessing creativity, energy, and resources; collaboration and coordination; meeting basic survival needs and health systems capabilities; prioritizing funding; and accountability, transparency, monitoring, and enforce - ment are some of the key grand challenges that the GHG system must address. And, yet, what is the role of the United States in terms of overcoming the current grand challenges? With the recent election of Barack Obama as President, atten - tion has turned towards the implementation of campaign promises and there are several notable global health policies (Gostin 2008b). For example, these policies include (Bristol 2008a, 2008b): • Increasing the capacity of health systems to deliver HIV/AIDS treatment.

OCR for page 203
 APPENDIX E Launching a “Health Infrastructure 2020 Plan.”8 • • Changes in PEPFAR, including an additional $1 billion over five years towards the HIV/AIDS epidemic in Southeast Asia, India, and Eastern Europe. • Greater U.S. funding and support toward multilateral programs (including the Global Fund to Fight AIDS, Tuberculosis and Malaria and the UN Millennium Development Goals). • Reforms in U.S. foreign assistance, including the doubling of yearly for- eign assistance to $50 billion by 2012 and 100 percent debt cancellation for the world’s heavily indebted poor countries. It is hopeful that these policies indicate a change from the prevailing unilateral approach taken by the United States and, perhaps, will bring our country into greater alignment with other donor countries possessing effective aid programs (Bristol 2008a, The One Campaign 2008). Though the current economic climate raises some concerns about the immediate feasibility of these ambitious policies, the opportunity for the incoming administration to change the U.S. approach towards global health should not be neglected in the near term. The Obama administration should still strive to shift the United States away from an approach of “exceptionalism” and demonstrate its “willingness to engage positively with the rest of the world” on global health (Rechel and McGee forthcoming). As a starting point, for example, there needs to be a change in U.S. foreign assistance from ideological approaches that have undermined or obstructed international health efforts (e.g., HIV prevention programs 9) toward policies that “favor realism and reliability” (Levine 2008). The Obama admin - istration could also show its global commitment to health through several other measures, which include the adoption of a new U.S. position on climate change (e.g., ratify the Kyoto Protocol), the reversal of health care worker “brain drain” from developing countries (e.g., build a supply of skilled workers domestically and limit international recruitment), and the promotion of fair trade for develop - ing countries (e.g., remove obstacles for poor countries in accessing essential medicines and vaccines and developing domestic health and safety protections) (Rechel and McGee forthcoming, Gostin 2008b). While these near-term changes would signal greater U.S. support for global health, the six “grand challenges” discussed earlier in this paper require a broader and deeper level of commitment to a dramatic change in governance for the long 8 The “Health Infrastructure 2020 Plan” has been described as “a global effort to work with develop - ing countries to invest in the full range of infrastructure needed to improve and protect both American and global health” (Bristol 2008a). 9 Key examples of detrimental policies under the Bush administration include the “block[age] of funds for needle or syringe exchange programmes . . . in countries with injection-driven epidemics” and an “obsession with abstinence-only approaches . . . [in countries] where the epidemic is driven by sexual contact” (Rechel and McGee forthcoming).

OCR for page 203
 THE U.S. COMMITMENT TO GLOBAL HEALTH term. In the past, the United States has been resistant to global health governance, refusing to ratify vital treaties or work cooperatively. It could make a genuine dif- ference by agreeing to fair terms of cooperation through international agreements and partnerships. Effective global health governance could dramatically improve life prospects for millions of people and diminish our collective vulnerabilities. Ultimately, this is an ideal for the Obama administration to pursue for the U.S. commitment to global health. Acknowledgments The authors thank Morgan Rog and Abiodun Baiyewu of the O’Neill Insti - tute for National and Global Health Law at Georgetown University for their research assistance and early contributions on the topics of environment and foreign policy in this paper. References Abbasi, Kamran. 1999. “The World Bank and World Health: Changing Sides.” British Medical Journal 318: 865-869. Abdullah, Abdul Samad. 2007. “International Health Regulations (2005).” Regional Health Forum 11, no. 1: 10-17. Attaran, Amir, K. Barnes, R. Bate, F. Binka, U. d’Alessandra, C. Fanello, L. Garrett, T. Mutabingwa, D. Roberts, and C. Sibley. 2006. “The World Bank: false financial and statistical accounts and medical malpractice in malaria treatment.” The Lancet 9531, no. 368: 247-252. Bartsch, Sonja. 2007. “The Global Fund to Fight AIDS, Tuberculosis and Malaria.” in Global Health Governance and the Fight Against HIV and AIDS, edited by Wolfgang Hein, Sonja Bartsch, and Lars Kohlmorgen. Basingstoke: Palgrave Macmillan. FIGURE E-1 WHO budget sources, 2006-2007. SOURCE: Diagram from Stuckler et al., 2008. E-1.eps

OCR for page 203
 APPENDIX E FIGURE E-2 Assessed and voluntary contributions to the WHO in 2006. SOURCE: Diagram from People’s Health Movement et al., 2008. E-2.eps Batniji, Rajaie. 2008. “Coordination and accountability in the World Health Assembly.” The Lancet. 372, No. 9641: 805. BBC News Online. 2000. “U.S.: AIDS is Security Threat.” May 1. http://news.bbc.co.uk/2/hi/ameri - cas/731706.stm (accessed June 15, 2008). Bernstein, Michael, and Myra Sessions. 2008. “A Trickle of a Flood: Commitments and Disbursement for HIV/AIDS from the Global Fund, PEPFAR, and the World Bank’s Multi-Country AIDS Program (MAP).” HIV/AIDS Monitor and the Center for Global Development. http://www. cgdev.org/files/13029_file_TrickleOrFlood.pdf (accessed June 15, 2008). Bettcher, Douglas, Derek Yach, and G. Emmanuel Guindon. 2000. “Global Trade and Health: Key Linkages and Future Challenges.” Bulletin of the World Health Organization 78, no. 4: 521-534.

OCR for page 203
0 THE U.S. COMMITMENT TO GLOBAL HEALTH Birn, Anne-Emanuelle. 2006. “Gates’s Grandest Challenge: Transcending Technology as Public Health Ideology.” Lancet 9484, no. 366 (2005): 514-519. Bloche, M. Gregg, and Elizabeth R. Jungman. 2003. “Health Policy and the WTO.” 2003. Journal of Law, Medicine & Ethics 31, no. 4: 529-545. Bloom, David. 2007. “Governing Global Health, Finance and Development.” Vol 44, no. 4. http:// www.imf.org/external/pubs/ft/fandd/2007/12/bloom.htm (accessed June 15, 2008). Blouin, Chantal, Nick Drager, and Richard Smith, eds. 2006. International Trade in Health Services and the GATS. Washington, D.C.: The World Bank. Bosselmann, Klaus. 2008. The Principle of Sustainability: Transforming Law and Governance. Hampshire, UK: Ashgate Publishing Ltd. Brandt, Allan M. 2007. The Cigarette Century: The Rise, Fall, and Deadly Persistence of the Product that Defined America. New York: Basic Books. Bristol, Nellie. 2008a. “Obama vs. McCain on Global Health.” Lancet 372, no. 9638: 521-522. Bristol, Nellie. 2008b. “Obama’s Plans for US and Global Health.” Lancet 372, no. 9652: 1797-1798. Bryce, Jennifer, Robert Black, Neff Walker, Zulfiqar Bhutta, Joy Lawn, and Richard Steketee. 2005. “Can the world afford to save the lives of 6 million children each year?” Lancet 365: 2193-2200. Burci, Gian Luca, and Claude-Henri Vignes. 2004. World Health Organization. The Hague: Kluwer Law International. Burris, Scott, and Leo Beletsky. 2005. “Conference Report.” The OSI Seminar on the Global Gov - ernance of Health, Salzburg, Austria, December 5-8. http://www.temple.edu/lawschool/phrhcs/ salzburg/OSI_Seminar_Final_Report.pdf (accessed June 15, 2008). Buse, Kent, and Gil Walt. 2002. “Globalization and Multilateral Public-Private Partnerships: Issues for Health Policy,” in Health Policy in a Globalising World, ed. Kelley Lee, Kent Buse, Suzanne Fustukian (Cambridge: Cambridge University Press), 41-62. Buse, Kent, and Andrew Harmer. 2007. “Seven Habits of Highly Effective Global Public-Private Health Partnerships: Practice and Potential.” Social Science & Medicine 64, no. 2: 259-271. Caines, Karen. 2005. “Background paper: Key evidence from major studies of selected Global Health Partnerships.” High Level Forum on the Health MDGs Working Group on Global Health Initiatives and Partnerships: 25-26 April 2005. http://www.hlfhealthmdgs.org/Docu- ments/GHPBackgroundPaperFinal.pdf (accessed June 10, 2008). Cohen, John. 2002. “Gates Foundation Rearranges Public Health Universe.” Science 295, no. 5562 (March): 2000. Congressional Budget Office. 2005. “A Potential Influenza Pandemic: Possible Macroeconomic Effects and Policy Issues, 2005.” http://www.cbo.gov/ftpdocs/69xx/doc6946/12-08-BirdFlu. pdf (accessed June 15, 2008). Daar, Abdallah S., Peter A. Singer, Deepa Leah Persad, Stig K. Pramming, et al. 2007. “Grand Chal - lenges in Chronic Non-communicable Diseases.” Nature 450 (November): 494-496. Daniels, Norman. 2006. “Equity and Population Health: Toward a Broader Bioethics Agenda.” Hast- ings Center Report 36, no. 4 (July/August): 22-35. Dodgson, Richard, Kelley Lee, and Nico Drager. 2002. “Global Health Governance: A Conceptual Review.” World Health Organization. http://libdoc.who.int/publications/2002/a85727_eng.pdf (accessed June 15, 2008). Drager, Nick, and David Fidler. 2007. “Foreign Policy, Trade and Health: at the Cutting Edge of Global Health Diplomacy.” Bulletin of the World Health Organization 85, no. 3 (March). Drager, Nick, and Laura Sunderland. 2007. “Public Health in a Globalising world: The Perspective from the World Health Organization.” In Governing Global Health: Challenge, Response, Inno- vation, edited by Andrew Fenton Cooper, John J. Kirton, and Ted Schrecker, 67-78. Hampshire, UK: Ashgate Publishing Ltd.

OCR for page 203
 APPENDIX E Esty, Daniel C., Jack A. Goldstone, Ted Robert Gurr, Barbara Harff, Marc Levy, Geoffrey D. Dabelko, Pamela T. Surko, and Alan N. Unger. 1999. “State Failure Task Force Report: Phase II Findings.” Environmental Change & Security Project Report 5 (Summer): 49-72. Fidler, David. 1998. “The Future of the World Health Organization: What Role for International Law?” Vanderbilt Journal of Transnational Law 31, no. 5: 1079-1126. Fidler, David. 2002. “Global Health Governance: Overview of the Role of International Law in Pro - tecting and Promoting Global Public Health.” World Health Organization Discussion Paper No. 3 on Global Health Governance, May. Fidler, David P. 2005. “From International Sanitary Conventions to Global Health Security: The New International Health Regulations.” Chinese Journal of International Law 4, no. 2: 325-392. Fidler, David. 2007a. “Reflections on the Revolution in Health and Foreign Policy.” Bulletin of the World Health Organization 85, no. 3 (March). Fidler, David. 2007b. “Architecture amidst Anarchy: Global Health’s Quest for Governance.” Global Health Governance 1, no. 1 (January). http://diplomacy.shu.edu/academics/global_health/ journal/PDF/Fidler-article.pdf (accessed June 15, 2008). Fidler, David. 2008. “Navigating the Global Health Terrain: Preliminary Considerations on Mapping Global Health Diplomacy.” Globalization, Trade and Health Series Working Paper Series, World Health Organization, March. Foster, M. 2005. “Fiscal space and sustainability: towards a solution for the health sector.” Paper presented at the Third-High-Level Forum on the Health Millennium Development Goals, Paris, 14-15 November. http://www.hlfhealthmdgs.org/Documents/FiscalSpaceTowardsSolution.pdf (accessed June 15, 2008). Fox, Daniel M., and Jordan S. Kassalow. 2001. “Making Health a Priority of US Foreign Policy.” American Journal of Public Health 91: 1554-1556. Garrett, Laurie. 2005. “The Lessons of HIV/AIDS.” Foreign Affairs 84, no. 4 (July/August). Garrett, Laurie. 2007a. “The Challenge of Global Health.” Foreign Affairs 8 6, no. 1 (January/February). Garrett, L. 2007b. “Midway in the Journey: How to Promote Global Health; A Foreign Affairs Round- table (2007).” http://www.foreignaffairs.org/special/global health/garrett (accessed June 15, 2008). Garrett, Laurie. 2008. “Global Health and US Foreign Policy Considerations.” http://www.iom.edu/ CMS/3783/51303/52288/53023.aspx (accessed June 15, 2008). Gates Foundation. 2003. “Fourteen Grand Challenges in Global Health Announced in $200 Million Ini - tiative” Web announcement. http://www.gatesfoundation.org/GlobalHealth/BreakthroughScience/ GrandChallenges/Announcements/Announce-031016.htm (accessed June 15, 2008). Gellman, Barton. 2000. “An Epidemic of Inaction.” Seattle Times, July 14. Gilbert, Christopher, and David Vines. 2000. The World Bank. Cambridge: Cambridge University Press. Global Fund a. “Country Coordinating Mechanisms.” http://www.theglobalfund.org/en/apply/mechanisms (accessed June 15, 2008). Global Fund b. “Strategic Objective 2: Adapt to Country Realities.” http://www.theglobalfund.org/en/ files/publications/strategy/Adapt.pdf (accessed June 15, 2008). Global Fund. 2008. “Fact Sheet: The Global Fund’s approach to health systems strengthening (2008).” http://www.theglobalfund.org/documents/rounds/8/R8HSS_Factsheet_en.pdf (accessed June 15, 2008). Godlee, Fiona. 1997. “WHO Reform and Global Health.” (1997) WHO Reform and Global Health, British Medical Journal 1359, no. 314 (May): 1407-1409. Gostin, Lawrence O. 2008a. “Meeting Basic Survival Needs of the World’s Least Healthy People: Toward a Framework Convention on Global Health.” Georgetown Law Journal 96: 331-392. Gostin, Lawrence O. 2008b. “International Development Assistance for Health: Ten Priorities for the Next President.” Hastings Center Report 38, no. 5: 10-11.

OCR for page 203
 THE U.S. COMMITMENT TO GLOBAL HEALTH Gostin, Lawrence O. 2008c. “President’s Emergency Plan for AIDS Relief: Health Development at the Crossroads.” Journal of the American Medical Association 300: 2046-48, available at http://ssrn.com/abstract=1316871. Gostin, Lawrence O., and Allyn L. Taylor. 2008. “Global Health Law: A Definition and Grand Chal - lenges.” Public Health Ethics 1, no. 1: 53-63. Health and Environment Linkages Initiative a. “Environment and Health in Developing Countries.” http://www.who.int/heli/risks/ehindevcoun/en/index.html (accessed June 15, 2008). Health and Environment Linkages Initiative b. “What is HELI?” http://www.who.int/heli/aboutus/en/ index.html (accessed June 15, 2008). Heinzerling, Lisa. 2008. “Climate Change, Human Health, and the Post-Precautionary Principle.” Georgetown Law Journal 96: 445-460. Helble, Matthias, Emily Mok, Benedikte Dal, and Nusaraporn Kessomboon. Forthcoming. Interna- tional Trade and Health: Loose Governance across Sectors and Policy Coherence. London: Palgrave Macmillan. Howard-Jones, Norman. 1975. The Scientific Background of the International Sanitary Conferences, -. Geneva: World Health Organization. Incentives for Global Health. 2008. The Health Impact Fund. www.incentivesforglobalhealth.org (accessed June 21, 2008). IDC (International Development Committee—UK House of Commons). 2008. “Working Together to Make Aid More Effective.” Ninth Report of Session 2007-08/Volume I. 17 July. http://www. publications.parliament.uk/pa/cm200708/cmselect/cmintdev/520/520.pd f (accessed October 1, 2008). IOC (Intergovernmental Organisations Committee—UK House of Lords). 2008. “Diseases Know No Frontiers: How effective are Intergovernmental Organisations in controlling their spread?” First Report—July 21. http://www.publications.parliament.uk/pa/ld200708/ldselect/ ldintergov/ 143/14302.htm (accessed October 1, 2008) International Health Partnership. 2007. http://www.internationalhealthpartnership.net/ (accessed June 15, 2008). Kempa, Michael, Clifford Shearing, and Scott Burris. 2005. “Changes in Governance: A Background Review.” Prepared for the Salzburg Seminar on the Governance of Health. http://www.temple. edu/lawschool/phrhcs/salzburg/Global_Health_Governance_Review.pdf (accessed June 15, 2008). Kickbusch, Ilona. 2005. “Action on Global Health: Addressing Global Health Governance Chal - lenges.” Public Health 119: 969-973. Kickbusch, Ilona. 2006. “Defining and Shaping the Architecture and Shaping the Architecture for Global Health Governance.” Remarks Presented at German Overseas Institute and World Health Organization Workshop, Hamburg, Germany, February 22-24, 2006. Kickbusch, Ilona, Gaudenz Silberschmidt, and Paulo Buss. 2007. “Global Health Diplomacy: the Need for New Perspectives, Strategic Approaches and Skills in Global Health.” Bulletin of the World Health Organization 85, no. 3 (March): 161-244. Kohlmorgen, Lars. 2007. “International Governmental Organizations and Global Health Governance: the Role of the World Health Organization, World Bank and UNAIDS.” in Global Health Gov- ernance and the Fight Against HIV and AIDS, edited by Wolfgang Hein, Sonja Bartsch and Lars Kohlmorgen. Basingstoke: Palgrave Macmillan. Labonte, Ronald, and Matthew Sanger. 2006a. “Glossary on the World Trade Organisation and Public Health: Part 1.” Journal of Epidemiology and Community Health 60: 655-661. Labonte, Ronald, and Matthew Sanger. 2006b. “Glossary on the World Trade Organisation and Public Health: Part 2.” Journal of Epidemiology and Community Health 60: 738-744. Lakin, Alison. 1997. “The Legal Powers of the World Health Organization.” Medical Law Interna- tional 3, no. 1: 23-49. Lancet. 2007. “International Health Partnership: A Welcome Initiative,” 370, no. 9590: 801.

OCR for page 203
 APPENDIX E Laxminarayan, Ramanan, Anne J Mills, Joel G Breman, Anthony R Measham, George Alleyne, Mariam Claeson, Prabhat Jha, Philip Musgrove, Jeffrey Chow, Sonbol Shahid-Salles, and Dean T Jamison. 2006. “Advancement of global health: key messages from the Disease Control Priori - ties Project.” Lancet 367: 1193-208. Lee, Kelley, ed. 2003. Health Impacts of Globalization: Towards Global Governance. Houndmills, UK: Palgrave Macmillan. Lee, Kelley, Kent Buse and Suzanne Fustukian, eds. 2002. Health Policy in a Globalizing World. Cambridge: Cambridge University Press. Lee, Kelley, Alan Ingram, Karen Lock, and Colin McInnes. 2007. “Bridging Health and Foreign Policy : The Role of Health Impact Assessments.” Bulletin of the World Health Organization 85: 207-211. Levine, Ruth. 2008. “Healthy Foreign Policy: Bringing Coherence to the Global Health Agenda,” in The White House and the World: A Global Development Agenda for the Next U.S. President, ed. Nancy Birdsall (Washington, D.C.: Center for Global Development), 43-61. Levine, Ruth, and Kent Buse. 2006. “The World Bank’s New Health Sector Strategy: Building on Key Assets.” Journal of the Royal Society of Medicine 99: 569-572. Mallaby, Sebastian. 2005. “Saving the World Bank.” Foreign Affairs 84, no. 3 (May/June). McNabb, Scott J., Christopher R. Braden, and Thomas R. Navin. 2002. “DNA Fingerprinting of Mycobacterium Tuberculosis: Lessons Learned and Implications for the Future.” Emerging Infectious Diseases 8: 1314-1319. McNeil Jr., Donald. 2007. “Audit Finds Bush’s AIDS Effort Limited by Restrictions.” New York Times, March 31. Mehl, Garrett, Heather Wipfli, and Peter Winch. 2005. “Controlling Tobacco: The Vital Role of Local Communities.” Harvard International Review 27: 54-58. Nelson, Roxanne. 2004. “USA Urged to Accept Generic AIDS Drugs.” The Lancet 363, no. 9416: 1205. Norwegian Agency for Development Cooperation (NORAD). 2008. “Facilitation by the Health 8 Agencies.” http://www.norad.no/default.asp?V_ITEM_ID=11708 (accessed Oct. 1, 2008) Office of the UN High Commissioner for Human Rights. Special Rapporteur of the Commission on Human Rights on the Right of Everyone to the Enjoyment of the Highest Attainable Standard of Physical and Mental Health. http://www.ohchr.org/english/issues/health/right/ (accessed June 15, 2008). Okie, Susan. 2006. “Global Health—The Gates-Buffett Effect.” New England Journal of Medicine 355, no. 11: 1084-1088. The One Campaign. 2008. “The DATA Report 2008,” http://www.one.org/report/en/pdfs/2008_DATA _Report.pdf (accessed October 1, 2008). Oomman, Nandini, Michael Bernstein, and Steve Rosenzweig. 2008. “The Numbers Behind the Sto - ries.” Center for Global Development and the HIV/AIDS Monitor, April 17. http://www.cgdev. org/files/15799_file_theNumbersBehindTheStories.PDF (accessed June 15, 2008). Ooms, Gorik, Wim Van Damme, Brook Baker, Paul Zeitz, and Ted Schrecker. 2008. “The ‘diagonal‘ approach to Global Fund financing: a cure for the broader malaise of health systems?” Global- ization and Health. 4, no. 6. http://www.globalizationandhealth.com/content/4/1/6 (accessed October 20, 2008). Owen, John Wyn, and Olivia Roberts. 2005. “Globalisation, Health and Foreign Policy: Emerg - ing Linkages and Interests.” http://www.globalizationandhealth.com/content/1/1/12 (accessed June 15, 2008). People’s Health Movement, Medact, and Global Equity Gauge Alliance. 2008. Global Health Watch  (00-0). (London: Zed Books), http://www.ghwatch.org/ghw2/ghw2_report.php (accessed December 23, 2008). Piller, Charles, and Doug Smith. 2007. “Unintended victims of Gates Foundation Generosity.” Los Angeles Times. December 16.

OCR for page 203
 THE U.S. COMMITMENT TO GLOBAL HEALTH Prakongsai, Phusit, Walaiporn Patcharanarumol, and Viroj Tangcharoensathien. 2008. “Can earmark - ing mobilize and sustain resources to the health sector?” Bull World Health Organization. 86, no. 11: 898-901. Rechel, Bernd, and Martin McKee. Forthcoming. “Obama’s Victory: Implications for Global Health.” Lancet. Roemer, Ruth, Allyn Taylor, and Jean Lariviere. 2005. “Origins of the WHO Framework Convention on Tobacco Control.” American Journal of Public Health 95, no. 6: 936-938. Rose, Geoffrey. 1992. The Strategy of Preventative Medicine. Oxford: Oxford Medical Publications. Rosenberg, Mark, et al. 2009. Real Collaboration: What it Takes for Global Health to Succeed. New York and Berkeley: Milbank Memorial Fund and University of California Press, forthcoming. Ruger, Jennifer Prah. 2007. “Global health governance and the World Bank.” Lancet 370 (October): 1471-1474. Ruger, Jennifer Prah, and Derek Yach. 2005. Global Functions at the World Health Organization. British Medical Journal 330: 1099-1100. “The Side-Effects of Doing Good.” 2008. The Economist, February 21. Silberschmidt, Gaudenz, and Ilona Kickbusch. 2008. “Coordination and accountability in the World Health Assembly—Authors’ reply.” Lancet 372, no. 9641: 806. Silberschmidt, Gaudenz, Don Matheson and Ilona Kickbusch. 2008. “Creating a committee C of the World Health Assembly.” Lancet 371: 1483-1486. Smith, Richard D. 2006. “Trade and Public Health: Facing the Challenges of Globalisation.” Journal of Epidemiology and Community Health 60: 650-651. Smith, Kirk R., Carlos F. Corvalán, and Tord Kjellström. 1999. “How Much Global Ill Health Is At - tributable to Environmental Factors?” Epidemiology 10, no. 5: 582. Stolberg, Sheryl G. 2008. “In Global Battle on AIDS, Bush Creates Legacy.” New York Times, January 5. Stuckler, D., H. Robinson, M. McKee, L. King. 2008. “World Health Organization Budget and burden of disease: a comparative analysis.” Lancet 372: 1563-1569. Taylor, Allyn. 1992. “Making the World Health Organization Work: A Legal Framework for Uni - versal Access to the Conditions of Health.” American Journal of Law and Medicine 18, no. 4: 301-346. Taylor, Allyn. 2002. “Global Governance, International Health Law and WHO.” Bulletin of the World Health Organization 80, no. 12. Taylor, Allyn. 2004. “Governing the Globalization of Public Health.” Journal of Law, Medicine & Ethics 32, no. 3: 500-508. Taylor, Allyn, and Douglas Bettcher. 2000. WHO Framework Convention on Tobacco Control: A Global “Good” for Public Health.” Bulletin of the World Health Organization 78: 920-929. UNAIDS. 2005. Global Task Team, 2005. http://www.unaids.org/en/CountryResponses/MakingThe MoneyWork/GTT/ (accessed June 15, 2008). UN Comm. on Econ., Soc. & Cultural Rights. General Comment : The Right to the Highest Attain- able Standard of Health. U.N. Doc. E/C.12/2000/4,2000. U.N. Dep’t of Int’l Econ. & Soc. Aff., “Millennium Development Goals Report 2006.” http://www. un.org/millenniumgoals/ (accessed June 15, 2008). United Nations Environment Programme a. “First Inter-ministerial Conference on Health and En - vironment in Africa: Health Security through Healthy Environments.” http://www.unep.org/ health%2Denv/ (accessed June 15, 2008). United Nations Environment Programme b. “Organization Profile.” http://www.unep.org/PDF/UNEP OrganizationProfile.pdf (accessed June 15, 2008). United Nations Environment Programme c. “Press Release, April 7, 2008: Climate Change will Erode the Foundations of Health.” http://www.unep.org/Documents.Multilingual/Default.asp?Docume ntiD=531&ArticleID=5767&l=en (accessed June 15, 2008).

OCR for page 203
 APPENDIX E United Nations Framework Convention on Climate Change. “Essential Background.” http://unfccc. int/essential_background_convention/items/2627.php (accessed June 15, 2008). U.S. Office of the Press Secretary. 2007. “Fact Sheet: President Bush Announces Five-year, $30 Bil - lion HIV/AIDS Plan.” White House Press Release, May 30. http://www.whitehouse.gov/news/ releases/2007/05/20070530-5.html (accessed June 15, 2008). United States President’s Emergency Plan for AIDS Relief, 2006. “Chapter 10—Strengthening Multi- lateral Action.” http://www.pepfar.gov/pepfar/press/81041.htm (January 2, 2009). United States President’s Emergency Plan for AIDS Relief. 2008. “Making a Difference: Funding.” The United States President’s Emergency Plan for AIDS Relief, Press Release, February, 2008. http://www.pepfar.gov/press/80064.htm (accessed January 2, 2009). Waddington, Catriona. 2004. “Does earmarked donor funding make it more or less likely that devel - oping countries will allocate their resources towards programmes that yield the greatest health benefits?” Bulletin of the World Health Organization. 82, no. 9: 703-706. Widdus, Roy. 2001. “Public-Private Partnerships for Health: Their Main Targets, Their Diversity, and Their Future Directions.” Bulletin of the World Health Organization 79, no. 8. World Bank. “Working for a World Free of Poverty.” World Bank Group. http://siteresources. worldbank.org/EXTABOUTUS/Resources/wbgroupbrochure-en.pdf (accessed June 15, 2008). World Bank. 2007a. “World Bank Approach paper: Evaluation of the World Bank’s Assistance for Health, Nutrition, and Population.” Independent Evaluation Group, World Bank Sector, The - matic and Global Evaluations Unit, July 27. World Bank. 2007b. “Healthy Development.” The World Bank Strategy for HNP Results, April 24. World Bank. 2008. “WHO and World Bank Join Forces for Better Results from Global Health Invest - ments.” World Bank Press Release—August 6, 2008. http://go.worldbank.org/82SEUUC3E0 (accessed January 2, 2009). WHO Constitution. 1946. Constitution of the World Health Organization. http://www.who.int/ governance/eb/who_constitution_en.pdf (accessed January 2, 2009). WHO (World Health Organization). 1990. “History of the development of the ICD (International Classification of Diseases): 1990.” http://www.who.int/classifications/icd/en/ (accessed June 15, 2008). WHO. 2000. “The World Health Report 2000, Health Systems: Improving Performance.” http://www. who.int/whr/2000/en/whr00_en.pdf (accessed June 15, 2008). WHO. 2003. “Framework Convention on Tobacco Control.” WHO Doc. A56/VR/4 (May 21, 2003). http://www.who.int/gb/ebwha/pdf_files/WHA56/ea56r1.pdf (accessed June 15, 2008). WHO. 2005. “Revision of the International Health Regulations 2005.” Fifty-Eighth World Health Assembly. http://www.who.int/gb/ebwha/pdf_files/WHA58/WHA58_3-en.pdf (accessed Janu- ary 2, 2009). WHO. 2006. “Resolution WHA 59.26” http://www.who.int/gb/ebwha/pdf_files/wHA59/A59_R26-en.pdf (accessed January 2, 2009). WHO. 2007a. “Fact Sheet: Climate and Health (2007).” http://who.int/mediacentre/factsheets/fs266/ en/ (accessed June 15, 2008). WHO. 2007b. “Aid Effectiveness and Health: Working Paper No. 9.” http://www.searo.who.int/ LinkFiles/Health_Systems_Aid_Effect_and_Health_WP-9.pdf (accessed June 15, 2008). WHO. 2007c. “Working for health: An introduction to the World Health Organization.” Geneva. www. who.int/about/brochure_en.pdf (accessed October 10, 2008). WHO. 2008a. “Resolution WHA 61.21” http://www.who.int/gb/ebwha/pdf_files/A61/A61_R21-en.pdf (accessed June 15, 2008). WHO. 2008b. “World Health Day 2008: Protecting Health from Climate Change.” http://www.who. int.world-health-day/en/index.html (accessed June 15, 2008). WHO/WTO. 2002. WTO agreements and public health: a joint study by the WHO and the WTO Secretariat. Geneva: World Health Organization, 2002.

OCR for page 203
 THE U.S. COMMITMENT TO GLOBAL HEALTH WTO. 1998. “Understanding the WTO Agreement on Sanitary and Phtyosanitary Measures (1998).” http://www.wto.org/english/tratop_e/sps_e/spsund_e.htm (accessed June 15, 2008). Yamey, Gavin. 2002. “WHO in 2002: Why does the world still need WHO?” British Medical Journal 325: 1294-1298. Young, Oran. 1997. “Global Governance: Toward a Theory of Decentralized World Order.” In Global Governance: Drawing Insights from the Environmental Experience, edited by Oran Young, 273- 300. Cambridge, MA: MIT Press.