C. Toward a Framework Convention on Global Health

The problem of global health governance has perplexed scholars, and for good reason. International health law has a number of structural inadequacies—e.g., vague standards, ineffective monitoring, weak enforcement; and a “statist” approach that insufficiently harnesses the creativity and resources of non-State actors and civil society more generally. The question of whether international law can, or should, govern the diverse entities that influence global health is the subject of intense debate in the literature. Indeed, modern cutting edge global health governance initiatives eschew formal international legal regimes, such as the Global Fund, Global Health Security Initiative, and the International Finance Facility.

If law is to play a constructive role, new models will be required and here I make the case for a Framework Convention on Global Health. I am proposing a global health governance scheme incorporating a bottom-up strategy that strives to: build health system capacity; set priorities to meet basic survival needs; engage stakeholders to bring to bear their resources and expertise; harmonize the activities among the proliferating number of actors operating around the world; and evaluate and monitor progress so that goals are met and promises kept.

The framework convention-protocol approach is becoming an essential strategy of powerful transnational social movements to safeguard health and the environment. Two prime illustrations are the Kyoto Protocol to the U.N. Framework Convention on Climate Change and the Framework Convention on Tobacco Control. These framework conventions recognize that a collective effort is necessary to mitigate the threat that humans pose to health and the environment. Although far from perfect, environmental and health conventions offer inventive approaches to global governance, including “common but differentiated responsibilities” for developing and developed countries, multilateral funding mechanisms, and incentives to facilitate compliance.