The Global Role of the World Health Organization

Abstract

The 21(st) century global health landscape requires effective global action in the face of globalization of trade, travel, information, human rights, ideas, and disease. The new global health era is more plural, comprising a number of key actors, and requiring more coordination of effort, priorities and investments. The World Health Organization (WHO) plays an essential role in the global governance of health and disease; due to its core global functions of establishing, monitoring and enforcing international norms and standards, and coordinating multiple actors toward common goals. Global health governance requires WHO leadership and effective implementation of WHO's core global functions to ensure better effectiveness of all health actors, but achieving this global mission could be hampered by narrowing activities and budget reallocations from core global functions.

Full text

Electronic copy available at: http://ssrn.com/abstract=1440918
The Global Role of the World Health Organization
Jennifer Prah Ruger and Derek Yach
The 21st century global health landscape requires effective global action in the
face of globalization of trade, travel, information, human rights, ideas, and
disease. The new global health era is more plural, comprising a number of key
actors, and requiring more coordination of effort, priorities and investments.
The World Health Organization (WHO) plays an essential role in the global
governance of health and disease; due to its core global functions of
establishing, monitoring and enforcing international norms and standards, and
coordinating multiple actors toward common goals. Global health governance
requires WHO leadership and effective implementation of WHO’s core global
functions to ensure better effectiveness of all health actors, but achieving this
global mission could be hampered by narrowing activities and budget
reallocations from core global functions.
GLOBALIZATION AND HEALTH
Globalization offers opportunities and challenges for global health and its
distribution.1 Prospects for health improvement are enhanced by the transfer of
medical and public health knowledge and technology from one part of the globe
to another, through, for example, sharing of best practices, health promotion and
prevention strategies and, of course, medical treatments. Further, all countries
benefit from international norms and standards and sustained global advocacy
for health. Outside the health sector the benefits of globalization range from
progress on gender empowerment and human rights to better prospects for
trade, information technology,2 and economic growth.3
Globalization has also accelerated the spread of infectious diseases, as
evidenced by the rapid outbreak of Severe Acute Respiratory Syndrome (SARS),
exacerbated existing health inequalities between and within countries, and been
associated with global marketing of unhealthy consumption patterns. Thus, the
primary challenge with twentieth century globalization relates to global
inequalities and externalities, in terms of not just health4, but other economic
and social indicators as well.5
The distribution of health benefits that result from the globalization
process depends on preexisting economic, social and political conditions within
countries, the fairness of trade and investment agreements, existing political
economy and the strength of the multilateral global health system. Globalization
presents certain problems that are substantial and beyond the capacity of
individual states to manage. Avoiding the perpetuation of an international class
of very poor countries excluded from most of the benefits of the global economy,
requires multifaceted and sustained support and cooperation by the international
health community at large.6

Electronic copy available at: http://ssrn.com/abstract=1440918
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THE GLOBAL IN GLOBAL HEALTH GOVERNANCE
Improving health and addressing health inequalities and externalities requires
effective international action on health that entails essential global health
functions beyond what individual nation-states can accomplish, even with
external assistance. Global functions can be distinguished from national or sub-
national functions in that they are beyond individual states’ capacity and entail
such categories as; norms and standards, global action, professional
management, financial resource transfer, scientific research capacity, and
leadership.7 International health actors have different roles in relation to these
global functions.
Global health functions can also be distinguished as actions taken to
promote global public health goods; measures that are also beyond the reach of
individual governments and independent groups, but that benefit all countries,
even at the country level.8 Global health goods include: global advocacy for
health; the use of bio-ethical and human rights instruments; surveillance for
diseases and risk; direct global action; investment in essential health problems;
and the use of norms and standards.9 Examples of such functions range from a
World Health Organization (WHO) 2001 World Health Day focus on mental
health as a global health priority, to WHO’s promotion of international ethics and
human rights through international legal instruments, and to WHO leadership in
developing global norms and standards such as the International Code of
Marketing of Breast-milk Substitutes, the Framework Convention on Tobacco
Control and the WHO International Sanitary Regulations.
PLURALISM IN GLOBAL HEALTH
In the first few decades following the creation of the United Nations (UN) and
WHO, there were few major international players with the political and/or
financial clout to influence global agendas. WHO, the Rockefeller Foundation,
United Nations Children’s Fund (UNICEF) and only in the last two decades, the
World Bank10 have in the past heavily influenced global health priorities for
research, policy and investment.
In the midst of an increasingly globalizing world, however, a new
international health framework is emerging; one that is no longer dominated by a
few organizations, but that consists of numerous global health actors. WHO is
now joined by many other players - some with a primarily financial investment
function and others with mixed finance-policy-operational functions.
Health debates have moved out of cloistered health departments and the
WHO, and are now regularly a part of G8 and other multilateral meetings. The
World Economic Forum has sponsored deliberations about health issues ranging
from HIV/AIDS and vaccines to obesity and tobacco control. The UN Security
Council has addressed HIV/AIDS and the private and non-profit sector has
developed as a force in international health as relatively new players like the
Global Fund for AIDS, Malaria and Tuberculosis (TB), the Bill and Melinda
Gates Foundation,11 and pharmaceutical companies such as Merck, Pfizer,
Novartis and GlaxoSmithKline play more important roles. Over 50 private-public

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partnerships have been established to address infectious diseases or
micronutrient deficiencies. Some like the Global Alliance for Vaccines and
Immunization (GAVI) have multi-billion dollar budgets. International Non-
governmental Organizations (NGOs) including Médecins Sans Frontières (MSF),
Oxfam and CARE now work in disaster relief and health emergencies and
contribute to policy development on issues like access to essential medicines.
Global health has benefited greatly from these new funds, initiatives and
actors. This pluralism, however, has resulted in a splintering of international
health agencies and an increasingly fragmented, uncoordinated, ad hoc and
incongruent global health agenda, creating a leadership gap for an overarching
convening and coordinating role. Within this multi-lateral environment, WHO
maintains its unique coordinating function as derived from its Constitution. It is
the only agency with the authority to develop and implement international health
norms and standards and facilitate ongoing dialogue among member states on
priorities. The benefits of cooperative supra-national action on global health
issues, while numerous, could, however, be hampered by a shift in WHO’s
budgetary allocations and policy priorities away from global normative
development toward operational work at the country level.
We consider the implications of these changes for the future of global
health governance and in particular, the future of WHO.
WHO CONSTITUTION, CORE FUNCTIONS, AND PROPOSED REFORMS
The work of the WHO is defined by its Constitution, which divides WHO’s core
functions into three categories: (1) normative functions, including international
conventions and agreements, regulations and non-binding standards and
recommendations; (2) directing and coordinating functions, including its health
for all, poverty and health, and essential medicine activities and its specific
disease programs; (3) research and technical cooperation functions,12 including
disease eradication and emergencies.
Over the past fifty years or so, the WHO has gone through various
permutations in prioritizing different aspects of these categories over others, and
its effectiveness in doing so has been the subject of analysis and criticism.13 For
example, in one of the most comprehensive analyses of the WHO, Fiona Godlee
critiqued WHO’s management, effectiveness, policy choices, headquarter-
regional negotiations and power struggle, and its weak operational capacity in a
series of articles in the British Medical Journal in the mid-1990s.14 At about the
same time, a self-study commissioned by the WHO analyzed the institutions
effectiveness in implementing its core functions and recommended reforms
focused especially on strengthening its technical capacity and its global health
and coordinating functions.15 And in 1996-1997, the WHO Executive Board held
6 special meetings to review the Constitution, recommending rewriting WHO’s
core functions to emphasize coordination, health policy development, norms and
standards, advocating health for all, and advice and technical cooperation.16
In the late 1990s, a group of international health scholars and
practitioners gathered in Pocantico, New York for a retreat on “Enhancing the
Performance of International Health Institutions” to examine whether the

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institutional structure in international health was sufficient for a 21st century of
global health interdependence. The Pocantico report concluded, “the importance
of WHO was seen primarily for its global normative functions which need to be
strengthened and updated,”17 that “the emphasis on technical assistance has
often come at the expense of the normative role”, that “WHO should be the
‘normative conscience’ for world health” and that “WHO should assume
leadership in achieving more coherence and equity in the system.”18 A clear
emphasis was placed on WHO’s global, especially normative, functions. This
perspective was reiterated in an article by Jamison, Frenk and Knaul,19 who
argued that WHO had two separate types of functions: core (including global
normative work) and supplementary (including technical cooperation). While
the demand for both types has increased, the majority of new global health actors
address primarily operational functions, creating an even greater need for WHO’s
core global functions.
DECISIONS ABOUT THE FUTURE OF WHO’S WORK
Governments convened in Geneva in May 2009 to decide on the future budget for
WHO, in what was Director-General, Margaret Chan’s third World Health
Assembly. Their decisions will have a significant impact on the future of the
organization. It was an opportunity to prioritize core functions: to decide whether
WHO should reduce its global normative work in favor of becoming more
operational in-country or not. In coming years, tensions will arise within WHO
about budget shifts. Concerns about the future budgetary impact on many global
activities in advocacy, surveillance, norms, disease classification and
enumeration and research by senior staff will loom large. In 2007, Margaret
Chan delineated the core functions of WHO as providing leadership on critical
health matters; shaping research agenda; setting norms and standards and
monitoring their implementation; presenting ethical and evidence based policy
options; providing technical support and creating institutional capacity, and
monitoring and assessing health trends. She advocated a focus on these core
areas as the best way to co-ordinate with key players in global health, with the
Medium Term Strategic Plan (2008-2013) providing a rubric for these goals and
their funding. The most recent biennium reports have seen a shift in expenditure
patterns across WHO’s three core functions, with more resources being
earmarked for work in countries and regions.20 Greater emphasis on increasing
capacity and managerial skills at both the country and regional levels is required
to ensure greater transparency, accountability, and more efficient use of
resources.
TRENDS IN WHO LEADERSHIP
Despite the emerging consensus that a number of global health issues require
distinctly global health solutions, especially in the areas of global surveillance,21
norms and advocacy, coordination of new global players, and international health
law,22 thinking at WHO under the previous Lee administration reflected a move
in the opposite direction. The WHO Commission on Social Determinants of

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Health (CSDH) may be a noteworthy exception to this trend. In what follows, we
highlight several key policy changes at WHO in the past decade, which reflect this
shift in prioritization of WHO’s core functions and a narrowing of WHO’s health
agenda.
Change in Director-General Emphasis
Gro Harlem Brundtland left the WHO with a legacy of having put health
centrally on the development agenda, focusing on global governance in the form
of international treaties and norms, and emphasizing global surveillance and
systems of epidemic alert and response to translational health threats, like SARS,
by building and maintaining a strong base of technical expertise. Brundtland’s
route to Director-General reflected this emphasis.
Brundtland was elected as WHO Director-General on her credentials and
background in state politics as Norway’s Finance Minister and later Prime
Minister. As a result, her leadership was associated with greater independence
from the regions and health ministries and an emphasis on WHO’s core global
functions. For example, she used WHO’s convening function to spearhead the
Commission on Macroeconomics and Health, the Framework Convention on
Tobacco Control (with Food and Agriculture Organization (FAO) review), and
health systems assessment, to enhance the Codex Alimentarius Commission and
WHO-World Bank collaboration, to initiate a revision of the International Health
Regulations, and to support creation of GAVI, the Global Fund and more
coordination by the G-8 on international health.
Jong-Wook Lee’s inspiration came from his work on TB and vaccines at
WHO over two decades. His approach reflected his close advisors’ laudable
frustrations about the slow progress in getting effective AIDS and TB drugs to
patients. His solutions focused on shifting staff to countries, becoming more
operational on drug distribution and building up country offices. This is best
exemplified by WHO’s 3 by 5 initiative: a commendable effort to boost access for
3 million individuals to antiretroviral medicines in developing countries by 2005.
Margaret Chan has brought a different focus. She has built on her past
experience in communicable disease surveillance and response, enhanced
training for public health professionals, and collaborated at the local and
international level. She has focused WHO’s efforts in these areas, with an
emphasis on its strength in managing global outbreaks such as Avian Flu and
SARS. She has also focused on the ethical principle of equity, with specific
emphasis on the people of Africa and women.
WHO as an operational manager: The 3 by 5 Initiative
It is hard to critique the purpose of 3 by 5, as it is well-known that
antiretroviral medicines extend and improve the prospects for longevity and
quality of life among AIDS patients world-wide. However, the initiative
represented a significant shift away from WHO’s broad-based directive. The
Constitution authorizes WHO to act in the field to address urgent epidemics like
SARS and Ebola and includes support for eradication programs. Lee invoked the

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“emergency” clause under the Constitution to justify shifts in staff and funds in
developing 3 by 5, although it is unclear whether these efforts were consistent
with the Constitution’s original intent. This evolving interpretation of WHO’s
powers, moreover, predicts future WHO responses to numerous other health
threats such as diarrhea and pneumonia in children.
Furthermore, 3 by 5 represents a narrowing towards specific diseases and
a focus on treatment over broader health determinants and health promotion
strategies. It reflects an emphasis on operational work at the country level.
Given the numerous actors and financial commitment already focused on
HIV/AIDS; a future WHO role could involve coordinating and convening
participants to ensure institutions work more closely within agreed norms and
standards.
Surveillance
The WHO Constitution identifies core functions such as epidemiological
and statistical services, control and eradication of communicable disease and
establishing international nomenclatures and classifications of diseases and
causes of death as essential to a world health information system. As a result, the
WHO has assumed a vital role in this area and been involved in technical
assistance to countries in developing their own health information systems.
Trends at WHO in the last several years, however, suggest a shift in priorities,
evidenced also by the emergence of other entities in academia23 and the US
government looking to fill a void left by WHO. The United States (US) Centers for
Disease Control and Prevention (CDC), for example, has moved into global health
surveillance by strengthening national public health and information systems;
developing an integrated global disease detection strategy; and establishing a
“code of conduct” for CDC and others on reciprocal information sharing.24
While these entities hold promise for more resources and expertise for
global information systems, a strong WHO is still necessary, as many
governments look to WHO to standardize methods, integrate information
systems and ensure the reliability and validity of health statistics.
THE WHO 2009/10 BUDGET: WHAT SET OF PRIORITIES?
The WHO budgetary process initiated by WHO administration and approved
annually by members of the World Health Assembly, delineates WHO priority
areas each year. Budgetary analysis over the last several years highlights a few
key trends in light of WHO’s global functions. First, the 2006-2007 programme
budget25 reflected an emphasis on essential health interventions and specific
diseases. Fifty-one percent of the budget, for instance, was allocated to health
interventions for areas ranging from HIV/AIDS to mental health and substance
abuse, including epidemic alert and response measures. Second, budgetary
changes reflected a shift in resources from headquarters to the regions. The
second largest budgetary allocation -- twenty-two percent of the budget, for
example -- was for effective support for member states, including WHO’s core
presence in countries. Because WHO’s regional directors have primary allegiance

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to Ministries of Health from the countries they serve (as compared to allegiance
to WHO headquarters), efforts to strengthen WHO’s country offices reflect a
WHO that is more operational and less global. These signs point to more
autonomy, more funding and more power to WHO regional offices, likely at the
expense of such support for WHO headquarter staff and functions.
Another priority area in the 2006-2007 programme budget included
thirteen percent allocated for health policies, systems and products, which
includes areas of work ranging from health financing and social protection, heath
information, evidence and research policy to policy-making for health in
development. In the previous WHO administration, by comparison, “evidence
for health policy” as a work area increased thirty-three percent and “organization
of health services” increased by thirteen percent from 2000-2001 to 2002-
2003.26
A final priority area in the 2006-2007 budget27 was eleven percent
allocated to the determinants of health, which included related areas of work
ranging from gender, women and health to health promotion, tobacco, nutrition
and communicable disease research. By contrast, the previous WHO
administration increased spending on tobacco by fifty-seven percent and safe
motherhood programs by 237 percent between 2000-2001 and 2002-2003.28 We
are yet to see the results of this recently promulgated budget, and it is unclear
whether Dr. Chan will stay on this course or change directions.
The 2008-2009 budget was the first in a set of three budgets that will
make the Medium Term Strategic Plan (2008-2013) operational. The Medium
Term Plan will inform the WHO’s results-based framework by ensuring
continuity in objectives and a structure that better reflects the country and
regional needs. The WHO budgetary process for 2009-2010 approved in May by
members of the World Health Assembly, will illuminate WHO priority areas for
the coming two-year period, and will comprise the next stage in the Strategic
Plan.
WHO COMMISSION ON SOCIAL DETERMINANTS OF HEALTH
The WHO Commission on Social Determinants of Health (CSDH)29 provides a
noteworthy exception to the general movement described above. The CSDH
convened practitioners and academics to discuss existing knowledge on the social
determinants of health and to raise societal debate and advance policies to reduce
health inequalities between and within countries.30 In this way, the CSDH is
satisfying WHO’s agenda-setting role, by recognizing the social determinants of
health as a priority issue for international collaboration and state action, and
WHO’s role as reviewing, synthesizing and disseminating public health and social
scientific information on this priority issue. The CSDH recently issued its final
report and is currently in the process of disseminating its results to reduce global
health inequalities. Only time will tell whether its recommendations are effective,
but there is no doubting the global role of WHO in convening and focusing on
this topic in the production of global public goods for global health improvement.
The emphasis on the social determinants of health has informed the Medium
Term Strategic Plan. Of the thirteen strategic goals, the seventh goal is “To

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address the underlying social and economic determinants of health through
policies and programs that enhance health equity and integrate pro-poor, gender-
responsive, and human rights-based approaches.”28
RESPONDING TO GLOBALIZATION AND PLURALISM
Under Margaret Chan’s leadership, WHO must engage in the global health arena
with a stronger hold on its role in integrating, coordinating and convening the
global health agenda. In the past, strong WHO leadership has helped shape a
number of critical global health pathways including advocating the importance of
health in trade debates, human rights contexts, public-private partnerships,
treaty revisions and reinterpretations (e.g., in Trade-Related Aspects of
Intellectual Property Rights (TRIPS)), and in convening UN partners under the
umbrella of the UN Economic and Social Council (ECOSOC) to develop a UN-
wide policy on tobacco. Such leadership entails bringing together technical
experts in relevant areas such as law, economics and trade, as evidenced, for
instance, by the FCTC negotiations. Future WHO success on its key global
functions will require significant investments in in-house expertise in a number
of technical areas related to, for example, WHO’s work on FCTC implementation
and protocol development;31 the Codex Alimentarius Commission; revision and
implementation of International Health Regulations; analysis of the impact of
trade settlements on health; and efforts to move the Global Strategy on Diet and
Physical Activity into an implementation phase.
For WHO to execute its mandate and serve all countries, these areas of
work require support. In conclusion, three further examples of the need for
strong WHO involvement in governance are identified.
One future area of global governance for WHO centers on efforts to
converge on major trade issues concerning medicine. One example of such
efforts is the Kyoto-style medical treaty,32 which encourages countries who sign
on to invest a percentage of their gross domestic product in medical innovation
and enables countries to trade credits with other countries for investments in a
manner similar to that designated in the Kyoto protocol to control environmental
emissions.33 WHO is to play a critical role in agenda setting, treaty content,
consensus building and ultimately member state ratification and implementation
related to this treaty. No other international organization has the normative or
technical capacity or legitimacy to steward the success of efforts to address
distinctly global health issues such as finding treatments for neglected diseases
and orphan drugs in developing countries while at the same time addressing
concerns over intellectual property protection as a means to incentivize
innovative research and development.
A second major area of global governance for WHO involves WHO’s role
as an umbrella health agency coordinating international legal and non-legal
activities of different organizations. In this case the international health field can
learn from international experience in lawmaking in biotechnology (e.g.,
adoption of conflicting legal standards on intellectual property by organizations
with overlapping legal jurisdictions) and the international environmental arena
in which the absence of an overarching agency has led to “counterproductive and

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inconsistent results.”34 In this capacity, WHO could fill a void in global health
leadership in efforts to promote more integrated and effective collective decision
making in global health.35
A third major area of global governance for WHO involves continuing to
reform and update existing global regulations for infectious disease control, such
as the International Health Regulations (IHR).36 Such work is consistent with a
general consensus that improving global health in the 21st century will require
multilateral coordination and cooperation among states through both
international legal and non-legal instruments and with a major role for WHO as
convener, coordinator and channel for codifying future health laws.37
In conclusion, progress on WHO’s unfinished global health agenda
requires emphasizing its uniquely global health functions. In May 2009 the
Executive Board and Director-General, Margaret Chan, had the task to debate
and decide what priority to place on WHO’s core functions and mandate; the
effectiveness of the global health community in achieving global heath gains will
depend upon it.
Jennifer Prah Ruger is Associate Professor at Yale University, former Health
Economist and Presidential Speechwriter at the World Bank and former
member and health and development satellite secretariat of WHO Director-
General Gro Harlem Brundtland’s Transition Team.
Derek Yach is Director of Global Health Policy at PepsiCo and past Executive
Director at WHO.
1 Derek Yach and Douglas Bettcher. “The globalization of public health, I: Threats and
opportunities,” American Journal of Public Health 88, no. 5 (1998):735-744.
2 Wendy Harcourt, “Women’s health, poverty and globalization,” Development 44, no. 1 (2001):
85-90; United Nations Development Programme, Human Development Report 1999:
Globalization with a Human Face (New York: Oxford University Press, 1999).
3 William Savedoff and T. Paul Schultz, eds., Wealth from Health: Linking Social Investments to
Earnings in Latin America (Washington, DC: Inter-American Development Bank, 2000).
4 Jennifer Prah Ruger, “Health and social justice,” The Lancet 364, no. 9439 (2004): 1075-1080
5 Jennifer Prah Ruger, “Ethics of the social determinants of health.” The Lancet 364, no. 9439
(2oo4): 1092-1097.
6 Jennifer Prah Ruger, “Health and development,” The Lancet 362, no. 9385 (2003): 678.
7 Lincoln Chen, D. Bell, and L. Bates, “World health and institutional change,” presented at
Pocantico Retreat: Enhancing the Performance of International Health Institutions, Pocantico,
NY, February 1-3, 1996.
8 Derek Yach, Sev Fluss, and Douglas Bettcher, “Health and the environment,” Politica
Internazionale No. 1-2 (Jan. – Apr. 2001).
9 Ibid.
10 Jennifer Prah Ruger, “Changing role of the World Bank in global health,” American Journal of
Public Health 95, no. 1 (2005): 60-70; Jennifer Prah Ruger, “What will the new World Bank head
do for global health,” The Lancet 365, no. 9474 (2005): 1837-1840; Jennifer Prah Ruger, “Global
Health Governance and the Role of the World Bank,” Lancet 370, no. 9597 (2007): 1471-1474.

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11 Bill and Melinda Gates Foundation, Global Health Program,
http://www.gatesfoundation.org/GlobalHealth/ (accessed 27 February, 2009)
12 Gian Luca Burci and Claude-Henri Vignes, World Health Organization (London, UK: Kluwer
Law International: 2004).
13 Gill Walt, “WHO under stress: Implications for health policy,” Health Policy 24, no. 2 (1993):
125-144.
14 Fiona Godlee, “WHO in retreat: is it losing its influence,” British Medical Journal 309, no. 6967
(1994): 1491-1495; “WHO in crisis,” British Medical Journal 309, no. 6966 (1994): 1424-1428
and “WHO fellowships – what do they achieve?” British Medical Journal 310, no. 6972 (1995):
110-112.
15 WHO, Report of the Executive Board Working Group on the WHO Responses to Global
Change (Geneva, WHO: 1993).
16 WHO, Review of the Constitution and regional arrangements of the World Health
Organization, Report of the special group, Executive Board 101st Session, EB101/7, 1997.
17 Pocantico Retreat, Enhancing the Performance of International Health Institutions, February 1-
3, 1996.
18 Ibid.
19 Dean Jamison, Julio Frenk, and Felicia Knaul “International collective action in health:
objectives, functions, and rationale,” The Lancet 351, no. 9101 (1998): 514-517.
20 WHO Draft Medium-Term Strategic Plan 2008-2013. Available at
http://www.who.int/gb/e/e_mtsp.html (accessed April 3, 2009).
21 Christopher Murray, Alan Lopez, Suwit Wibulpolpraser, “Monitoring global health: time for
new solutions,” British Medical Journal 329 (2004): 1096-1100.
22 David Fidler, “Fighting the Axis of Illness: HIV/AIDS, Human Rights, and US Foreign Policy.”
Harvard Human Rights Journal 17 (Spring 2004): 99-136; Allyn Taylor, “Global governance,
international health law and WHO: looking towards the future,” Bulletin of the World Health
Organization 80, no. 12 (2002): 975-980.
23 Murray Lopez and Suwit Wibulpolprasert, “Monitoring global health: time for new solutions.”
24 US Centers for Disease Control and Prevention, Global Disease Detection (GDD) Consultation,
GDD Conference Group Reports, Miami, December 8-9, 2004.
25 World Health Organization , Proposed Programme Budget, 2006-2007,
http://www.who.int/gb/ebwha/pdf_files/PPB2006/e percent20part percent20I.pdf (accessed
March 13, 2005)
26 World Health Organization, Proposed Programme Budget 2002-2003,
http://www.who.int/gb/ebwha/pdf_files/PPB2002/anglais/part percent201.pdf (accessed 27
February, 2009)
27 World Health Organization , Proposed Programme Budget, 2006-2007,
http://www.who.int/gb/ebwha/pdf_files/PPB2006/e percent20part percent20I.pdf (accessed 27
February, 2009)
28 World Health Organization, Proposed Programme Budget 2002-2003,
http://www.who.int/gb/ebwha/pdf_files/PPB2002/anglais/part percent201.pdf (accessed27
February 2009)
29 Jong-wook Lee, “Public health is a social issue,” The Lancet 365, no. 9464 (2005): 1005-1006.
30 Michael Marmot, “Social determinants of health inequalities.” The Lancet 365, no. 9464
(2005): 1099-1104.
31 Derek Yach, “Injecting greater urgency into global tobacco control,” Tobacco Control 14 (2005):
145-148.
32 Medical Research and Development Treaty (MRDT)
http://www.cptech.org/workingdrafts/rndtreaty4.pdf (accessed 27 February, 2009).
33 Andrew Jack, “WHO members urged to sign Kyoto-style medical treaty,” Financial Times,
February 25, 2005.
34 Allyn Taylor, “Global governance, international health law and WHO: looking towards the
future.” Bulletin of the World Health Organization 80 (12) (2002) : 975-980; Patricia Birnie and
Alan Boyle, International law and the environment (Oxford: Oxford University Press: 2002).

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35 Jennifer Prah Ruger. “Global tobacco control: an integrated approach to global health policy.
Development 48(2) (2005): 65-69.
36 Lawrence Gostin, “International infectious disease law: revision of the World Health
Organization’s international health regulations.” Journal of the American Medical Association
291(21) (2004): 2623-2627.
37 Allyn Taylor, “Global governance, international health law and WHO: looking towards the
future.” Bulletin of the World Health Organization 80, no. 12 (2002): 975-980; Allyn Taylor,
Douglas Bettcher, Sevi Fluss, Katherine DeLand, Derek Yach, “International health law
instruments: An overview,” in Roger Detels, Robert Beaglehole, Mary Ann Lansang and Martin
Gulliford eds., Oxford Textbook of Public health: The Scope of Public Health (Oxford: Oxford
University Press, 2002), 359-86.