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Introducing Global Health Law

December 2019
The Journal of Law Medicine & Ethics 47(4):788-793

DOI:10.1177/1073110519897794

Authors:

Lawrence Gostin

Georgetown University

Benjamin Mason Meier

University of North Carolina at Chapel Hill

This introductory column examines the development of the field, detailing the evolving scope and content of global health law. Beginning in the early history of international health law, national governments have long sought to address infectious disease threats through international regulations. This focus on international health law structured global governance for health in the aftermath of World War II, with the establishment of the World Health Organization (WHO) bringing states together to respond to common public health threats. Yet, WHO’s early efforts to stem the international spread of infectious diseases have proven too narrow to meet the expanding legal challenges faced by a globalizing world. This column ends by framing the new field of global health law and outlining the leading global health threats that will be explored in future columns, demonstrating the power of this emerging field in conceptualizing the legal response to global health.

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788 journal of law, medicine & ethics

DOI: 10.1177/1073110519897794

Introducing Global Health Law

Lawrence O. Gostin, J.D., LL.D. (Hon.), is University Professor at Georgetown

University and the Founding Linda D. & Timothy J. O’Neill Professor of Global

Health Law at Georgetown University Law Center and Director of the World Health

Organization Center on National and Global Health Law. Benjamin Mason Meier,

J.D., LL.M., Ph.D., is an Associate Professor of Global Health Policy at the Uni-

versity of North Carolina at Chapel Hill and a Scholar at the O’Neill Institute for

National and Global Health Law.

Global Health Law

Lawrence O. Gostin and

Benjamin Mason Meier

Global health law describes the legal

frameworks that structure global

health. Laws and regulations, when

based on the best available evidence,

can promote healthy behaviors, regu-

late hazardous activities, and ensure

socially responsible corporate mar-

keting and products. These regula-

tory frameworks operate in virtu-

ally every realm of health, including

infectious and noncommunicable

diseases, mental health, injuries, and

the safety and eectiveness of vac-

cines, pharmaceuticals, and medi-

cal products. Law can help structure

universally affordable, accessible,

and equitable health systems that

promote universal health coverage.

Beyond discrete attention to health

risks, the rule of law and good gover-

nance are crucial for ensuring health

and well-being.

Where global health has come to

frame eorts to advance public health

across countries, law has become cru-

cial to addressing the global health

threats that have arisen in a rapidly

globalizing world. Globalization has

unleashed the spread of disease, con-

nected societies in shared vulnerabil-

ity, and highlighted the limitations

of domestic law in ensuring global

determinants of health. In this inter-

connected world, no country acting

alone can stem health hazards that go

beyond national borders. Yet if glo-

balization has presented challenges

to disease prevention and health pro-

motion, global health law oers the

promise of bridging national bound-

aries to advance global norms and

alleviate health inequities.

Arising out of international health

law — which has long structured

multilateral cooperation to respond

to infectious disease threats — global

health law seeks to structure the con-

temporary governance architecture

for global health. In responding to

health harms throughout the world,

global health law has “evolve[d]

beyond its traditional conﬁnes of for-

mal sources and subjects of interna-

tional law” to advance global health

with justice.1 This focus on global

health has necessitated action beyond

the reach of national governments,

requiring both state and non-state

actors to come together to respond

to globalized health threats. Global

health law seeks to frame this new

governance to respond to the major

health challenges of the twenty-ﬁrst

century.

The ﬁeld of global health law has

thus become a basis to conceptualize

the legal institutions that apply to the

changing public health threats, non-

state actors, and regulatory norms

that structure global health. Beyond

the traditional purview of interna-

tional health law, global health law

describes evolving legal efforts to

address:

• New health threats — including

non-communicable disease,

injuries, mental health, dangerous

products, and other globalized

health threats,

• New health actors — including

transnational corporations, private

philanthropists, civil society, and

other non-state actors, and

• New health norms — including

“soft law” instruments, global strat-

About This Column

Lawrence O. Gostin and

Benjamin Mason Meier serve

as the section editors for Global

Health Law. Professor Gostin is

University Professor at Georgetown

University and the Founding Linda

D. & Timothy J. O’Neill Professor of

Global Health Law at Georgetown

University Law Center and Director

of the World Health Organization

Center on National and Global

Health Law. Professor Meier is an

Associate Professor of Global Health

Policy at the University of North

Carolina at Chapel Hill and a Scholar

at the O’Neill Institute for National

and Global Health Law. This column

will feature timely analyses and

perspectives on law, policy, and justice

in global health.

Gostin and Meier

symposium 1: the promise and challenges of microbiome-based therapies • winter 2019 789

egies and action plans, and other

normative standards of global

health policy.2

Global health law instruments can

codify public health obligations

across the global health landscape,

realizing health and justice — both-

within and among nations. These

legal frameworks can promote good

governance among national and

global institutions, embracing values

of transparency, setting targets, mon-

itoring progress, structuring multi-

sectoral engagement, and facilitating

accountability. As legal scholarship in

global health has expanded, it is nec-

essary to consider global health law

as a distinct part of health law.

This introductory column exam-

ines the development of the field,

detailing the evolving scope and

content of global health law. Begin-

ning in the early history of interna-

tional health law, national govern-

ments have long sought to address

infectious disease threats through

international regulations. This focus

on international health law struc-

tured global governance for health

in the aftermath of World War II,

with the establishment of the World

Health Organization (WHO) bring-

ing states together to respond to

common public health threats. Yet,

WHO’s early eorts to stem the inter-

national spread of infectious diseases

have proven too narrow to meet the

expanding legal challenges faced by a

globalizing world. This column ends

by framing the new field of global

health law and outlining the lead-

ing global health threats that will be

explored in future columns, dem-

onstrating the power of this emerg-

ing ﬁeld in conceptualizing the legal

response to global health.

Origins in International Health

Law

Global health law is built upon the

foundations of international health

law. International regulation of pub-

lic health far predates modern health

law, with international agreements

long viewed by states as vital for col-

lective action to safeguard national

economic and security interests.3

Borne of a time when medicine was

unable to treat illness, the rapid

transmission of disease along trade

routes forced the major trading pow-

ers to acknowledge that infectious

diseases could no longer be construed

as solely within the sovereign author-

ity of independent states.4

This early “sanitary period,” marked

by its emphasis on the prevention

of epidemic disease, determined

the course of international public

health regulation through bilateral,

regional, and multilateral treaties.

The ﬁrst International Sanitary Con-

ference, held in Paris in 1851, brought

together physicians and diplomats to

reach consensus among those states

having trading interests in the Medi-

terranean basin.5 These states held a

second conference in Paris in 1859,

with subsequent conferences held

in Constantinople (1866), Vienna

(1874), Washington, DC (1881),

Rome (1885), Venice (1892), Dres-

den (1893), Paris (1894), and again

in Venice (1897). While international

sanitary regulations were crafted at

various points in the long march of

International Sanitary Conferences,

none of these early regulations mus-

tered the widespread national ratiﬁ-

cation required for adoption.6

This legislative inertia would not

be broken until widespread scientiﬁc

agreement was reached on disease

etiologies and government authori-

ties. By the time of the 1892 Ven-

ice Conference, states had reached

the necessary consensus on public

health practice to draft and ratify a

convention to prevent the spread of

infectious disease. At the eleventh

International Sanitary Conference in

Paris, delegates in 1903 drafted the

ﬁrst International Sanitary Regula-

tions of widespread applicability.7

The International Sanitary Regu-

lations set the stage for the Interna-

tional Health Regulations (IHR) that

followed and laid the groundwork

following World War II for the devel-

opment of international health law

through WHO.

Foundations of Global

Governance for Health

The 1946 WHO Constitution would

be the first treaty to codify states’

expansive post-war mandate for

medical care and underlying determi-

nants of health, with WHO’s consti-

Arising out of international health law — which

has long structured multilateral cooperation to

respond to infectious disease threats — global

health law seeks to structure the contemporary

governance architecture for global health. In

responding to health harms throughout the

world, global health law has “evolve[d] beyond

its traditional conﬁnes of formal sources and

subjects of international law” to advance global

health with justice. This focus on global health has

necessitated action beyond the reach of national

governments, requiring both state and non-state

actors to come together to respond to globalized

health threats. Global health law seeks to frame

this new governance to respond to the major

health challenges of the twenty-ﬁrst century.

790 journal of law, medicine & ethics

JLME COLUMN

tutional framework piercing the veil

of national sovereignty to respond

to public health threats throughout

the world. Complemented by a wide

range of other United Nations agen-

cies, which would support an expan-

sive array of health determinants

under their respective institutional

mandates, WHO would have consti-

tutional authority to adopt conven-

tions, regulations, and recommenda-

tions on any public health matter.8

With this international legal author-

ity to set regulatory norms for public

health, WHO assumed responsibility

for the IHR, creating a harmonized

surveillance and reporting system for

infectious disease control and setting

both binding state obligations and

permissible limitations on individ-

ual rights and commercial interests

for disease prevention.9 However,

beyond the IHR (last revised in 2005

to address past IHR weaknesses and

reﬂect modern health threats), WHO

has rarely exercised its lawmak-

ing powers, with states in the World

Health Assembly employing WHO’s

legal authority to develop only two

other treaties: the 1967 Nomen-

clature Regulations and the 2003

Framework Convention on Tobacco

Control.

There are limits to international

health law in creating universal legal

standards to ameliorate global health

inequities. Where once public health

was a central focus of international

negotiation, the international regu-

lation of public health has waned in

international relations, as states have

avoided limitations on their sovereign

authority.10 Because of the state-cen-

tric nature of international law, these

international health agreements have

been focused on infectious diseases

(that threaten security interests),

dependent on voluntary agreement

(exclusively by sovereign states),

and reliant on international consen-

sus (which results in unenforceable

norms).11 International health law is

seen as inherently incapable of facili-

tating collective action to address con-

temporary global health priorities.12

Although international health law

remains a necessary area of research

and practice, framingmultilateral

cooperation to respond to global

health security threats, such narrow

legal frameworks are incommensu-

rate with the rising health threats of a

rapidly globalizing world.13

International health law cannot

speak to contemporary changes in

statehood, international relations,

and global public goods for health.

With public international law bear-

ing most directly on states, which

exercise only limited influence on

the global forces that underlie pub-

lic health, the underlying conditions

for health are increasingly shaped

by non-state actors, including global

institutions, transnational corpora-

tions, individual philanthropists, and

civil society. As international health

Figure 1

International Sanitary Conference

Figure 2

World Health Assembly

Gostin and Meier

symposium 1: the promise and challenges of microbiome-based therapies • winter 2019 791

law has lost the capacity to inﬂuence

public health across the world, “global

health” has become the dominant ter-

minology to describe the interdepen-

dent needs of all peoples, rather than

those of particular countries, and the

global action necessary to meet these

needs across nations, actors, and sec-

tors.14 This focus on global health,

addressing global determinants of

public health, demands an expanded

scope and inﬂuence of health law to

meet the public health needs of an

interconnected world, redressing

health inequities within and across

countries through global health law.15

Applications to a Globalizing

World

Law is crucial to the advancement of

global health. Structuring health out-

comes through law, legal instruments

shape underlying determinants of

global health, and these “legal deter-

minants of health” provide a path to

safeguard public health in a global-

izing world.16 Yet legal capacities and

government authorities dier greatly

across countries, undercutting eorts

to assure global equity in health.17

There is a rising need for evidence-

based law reforms — in all countries

and through global governance.18

Global health law presents a legal

framework to structure new eorts

by the global community to advance

global health.19

Looking beyond the regulation of

states through international treaty

law, global health law can apply new

sources of soft law to facilitate coop-

eration across state and non-state

actors, frame new institutions of

global governance, and realize global

health with justice.

Global health law applies “soft” law

in global health policy. Where once

international health law was the only

option for states to address issues of

international health, contemporary

soft law instruments (including non-

binding international resolutions,

global strategies, and codes of prac-

tice) have proven far easier to negoti-

ate without the need for formal state

ratiﬁcation.20 While lacking the legal

enforceability of international law,

soft law nevertheless codiﬁes global

consensus to set priorities, mobilize

constituencies, create incentives,

coordinate actors, and facilitate

accountability. Without the practi-

cal need to develop international

law, global health law applies new

sources of soft law to bind the state

and non-state actors that inﬂuence

global health.

In an expanding global health

governance landscape, safeguarding

the public’s health requires coop-

eration among state and non-state

actors, and this coordination can be

fostered through global health law.

International health law continues

to govern the actions of national gov-

ernments, especially where binding

obligations on states are necessary

to prevent infectious disease through

state action;21 however, international

relations between states does not

encompass the entirety of contem-

porary global health diplomacy.22

Shifting from international health

law (applicable to states) to global

health law (applied to both state and

non-state actors), a multi-level pro-

liferation of international, national,

nongovernmental, and corporate

actors have organized to address

a multi-sectoral array of determi-

nants of health.23 Global health law

can frame this expanding landscape

for global health, coordinating the

global community of state and non-

state actors through institutions of

global governance.24

Global health law shapes the legal

foundation of global governance for

health. Global governance has become

crucial in developing legal norms and

implementing those norms through

global institutions.25 Operating under

global health law, well governed

institutions can be more eective in

setting standards, coordinating dis-

parate actors, forming partnerships

with key stakeholders, and developing

consensus on shared goals for global

health.26 These new instruments of

global health law endow global insti-

tutions with the tools to negotiate a

shared vision of good governance for

global health, coordinate with other

organizations across sectors, and align

national law with global health law to

advance public health throughout the

world.27 Facilitating accountability

for these global health goals, global

health law can provide an institutional

basis for developing benchmarks,

monitoring progress, and enhancing

compliance.28

The application of global health

law can thereby establish a norma-

tive framework for achieving global

health with justice. In creating an

Figure 3

WHO Director-General Tedros Adhanom Ghebreyesus

792 journal of law, medicine & ethics

JLME COLUMN

imperative for global health insti-

tutions to meet an expanding set

of global challenges to underlying

determinants of health, global health

law can codify normative frame-

works to realize the human rights

that underlie global health.29 As the

limitations of international law have

moved global health law beyond the

conﬁnes of international legal agree-

ments, stakeholders have engaged a

diverse array of state and non-state

actors through the rise of new policy

institutions — institutions developed

through their normative foundations

in justice.30 Global health law can

solidify these vital norms for justice

across institutions, providing a foun-

dation for human rights in global

health.31

Column on Global Health Law

The expansion of health law schol-

arship to encompass global health

law has laid out a legal framework to

structure eorts by the global com-

munity to advance public health.

Through hard and soft law norm-set-

ting, global health law seeks to create

new policy institutions to alter behav-

iors, sustain funding, and coordinate

partnerships.32 Global health law

extends beyond the scope of discrete

health-focused international legal

agreements between national gov-

ernments — addressing an encom-

passing set of global health determi-

nants through the obligations of state

and non-state actors, structuring new

forms of global governance reﬂective

of the major global health threats,

and framing the normative foun-

dations necessary to realize global

health with justice.

This column will seek to capture

these contemporary advances in

the theory, research, and practice of

global health law. Early columns will

focus on the role of law in:

• global health security and the

International Health Regulations,

• non-communicable diseases and

WHO framework conventions,

• universal health coverage under

the Sustainable Development

Goals,

• immunization law to achieve wide-

spread vaccination and disease

prevention,

• zoonotic disease and the need for

laws at the intersection of public

health, animal health, and environ-

mental health,

• international trade law in structur-

ing commercial determinants of

health,

• planetary health and laws to miti-

gate and adapt to climate change,

and

• human rights law as a foundation

of global health governance.

This quarterly examination of con-

temporary advances in global health

law will build the research founda-

tion for global health law reforms,

analyze evidence-based legal inter-

ventions that promote public health,

and explore the normative inﬂuence

of human rights in global health.

Through these columns, it will be

possible to develop an understand-

ing of legal “best practices in global

health,” extending policy surveillance

and legal epidemiology globally to

understand how law reforms can best

succeed in improving public health.

Conclusion

With the rise of the ﬁeld of global health

law, this column seeks to expand the

reach of this interdisciplinary scholar-

ship as part of the larger ﬁeld of health

law. Global health law has become

central to health law in a globalizing

world, and it is necessary to broaden

the links between domestic and global

health law in legal theory, empirical

research, and normative application.

Extending burgeoning global health

analysis in the Journal of Law, Medi-

cine & Ethics, this column will pro-

vide a home for scholars to apply legal

analysis to promote global health,

serving as a central resource for aca-

demics, practitioners, and advocates

in the years to come.

Note

The authors are grateful to Lindsay Wiley,

Montrece Ransom, Edward Hutchinson,

and Aaron Kesselheim for recognizing

the importance of global health law to the

advancement of health law and for provid-

ing thoughtful advice in developing this

inaugural column. The authors have no

conﬂicts to declare.

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The utilisation of legal instruments by United Nations actors to restrict the exposure of children to unhealthy food and beverage marketing: a qualitative content analysis of UN instruments

Article

Full-text available

Jun 2023

Introduction United Nations (UN) agencies are influential global health actors that can introduce legal instruments to call on Member States to act on pressing issues. This paper examines the deployment and strength of global health law instruments used by UN actors to call on Member States to restrict the exposure of children to unhealthy food and beverage marketing. Methods Global health law instruments were identified from a review of four UN agencies that have a mandate over children’s exposure to marketing of unhealthy food and beverage products namely: the World Health Organization (WHO); the Food and Agriculture Organization (FAO); the United Nations General Assembly (UNGA) and the UN Office of the High Commissioner for Human Rights (OHCHR). Data on marketing restrictions were extracted and coded and descriptive qualitative content analysis was used to assess the strength of the instruments. Results A wide range of instruments have been used by the four agencies: seven by the WHO; two by the FAO; three by the UNGA; and eight by the UN human rights infrastructure. The UN human rights instruments used strong, consistent language and called for government regulations to be enacted in a directive manner. In contrast, the language calling for action by the WHO, FAO and UNGA was weaker, inconsistent, did not get stronger over time and varied according to the type of instrument used. Conclusion This study suggests that a child rights-based approach to restricting unhealthy food and beverage marketing to children would be supported by strong human rights legal instruments and would allow for more directive recommendations to Member States than is currently provided by WHO, FAO and UNGA. Strengthening the directives in the instruments to clarify Member States’ obligations using both WHO and child rights mandates would increase the utility of global health law and UN actors’ influence.

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Full-text available

Nov 2022

The Sustainable Deveopment Goals prioritize universal essential public services as the second most important development goal after human basic needs in a global perspective. Indonesia implements a public service provision standard with a territorial approach and a set of minimum population requirement that lead to urban bias, resulting in border areas failing to meet the requirements for the provision of public services. Daerah Istimewa Yogyakarta Province is one of Indonesia's provinces with more than 70% of its border areas being rural, and more than 40% of border villages having limited essential public services. Because of the territorial delivery system for essential public services, formal cross-border services require a significant amount of resources. Using quantitative approach by indexing essential public services availability, this paper examines changes of essential public services coverage when cross-border services are provided informally. The case of Pustu Panggang informal crossborder service delivery provides lessons on how informal collaboration works. Although it involves misdeeds and omissions, the application of informal collaboration in cross-border services increases essential public service coverage by 57 percent in Daerah Istimewa Yogyakarta Province's rural border areas. As a result, informal collaboration should be viewed as a low-cost coping strategy in Indonesia's efforts to provide universal public service coverage.

Government Wrong Policy Provides Tax Incentives to MSMEs During the Covid-19 Pandemic

Conference Paper

Full-text available

Jan 2022

Legal Protection Mechanisms and Consequences for Medical Negligence in Healthcare Services

Article

Jun 2023

Harsono Njoto

This study critically examines the role of legal safeguards in enhancing healthcare service quality. Utilizing normative legal research methods, the study employs legislative and conceptual approaches to explore the dual nature of legal protection: preventive and repressive, in the context of healthcare professionals adhering to established Standard Operating Procedures (SOPs). The findings suggest that healthcare practitioners' negligence level and the resultant harm to patients or the public determines the legal implications. Such implications range from allegations of SOP and ethical code violations, to civil litigation for damages, and even criminal charges if medical actions endanger lives, potentially causing patient mortality. Therefore, the study highlights the necessity for legal accountability for healthcare practitioners, emphasizing that their service delivery must align with the set SOPs. These findings have profound implications for policy-making, emphasizing the need for robust legal protection for both healthcare practitioners and service recipients, thereby ensuring improved healthcare service quality.Highlights: Dual nature of legal protection in healthcare. Negligence level dictates legal consequences. Emphasis on healthcare practitioners' legal accountability. Keywords: Legal Protection, Healthcare Services, Medical Negligence, Standard Operating Procedures, Legal Consequences

The WHO’s 75th anniversary: WHO at a pivotal moment in history

Article

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Apr 2023

The World Health Organisation (WHO) was inaugurated in 1948 to bring the world together to ensure the highest attainable standard of health for all. Establishing health governance under the United Nations (UN), WHO was seen as the preeminent leader in public health, promoting a healthier world following the destruction of World War II and ensuring global solidarity to prevent disease and promote health. Its constitutional function would be ‘to act as the directing and coordinating authority on international health work’. Yet today, as the world commemorates WHO’s 75th anniversary, it faces a historic global health crisis, with governments presenting challenges to its institutional legitimacy and authority amid the ongoing COVID-19 pandemic. WHO governance in the coming years will define the future of the Organisation and, crucially, the health and well-being of billions of people across the globe. At this pivotal moment, WHO must learn critical lessons from its past and make fundamental reforms to become the Organisation it was meant to be. We propose reforms in WHO financing, governance, norms, human rights and equity that will lay a foundation for the next generation of global governance for health.

The Legal Duty of States to Cooperate in the Fight Against Pandemic Disease under the International Health Regulations

Article

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Apr 2023

Constantinos Yiallourides

The paper outlines the contemporary legal framework of global health focusing on the legal duty of States to cooperate in the surveillance, prevention, and control of epidemic and pandemic disease. The paper details, in particular, the content and nature of States’ duty to cooperate under the International Health Regulations – the primary international legal instrument governing the global response to such events. It also examines the role of the World Health Organization and other UN bodies in fostering cooperation between States in the fight against epidemics and pandemics.

Challenges and Prospects for the Intergovernmental Negotiations to Develop a New Instrument on Pandemic Prevention, Preparedness, and Response

Article

Mar 2023

Steven Solomon

As Member States of the World Health Organization (WHO) meet in an International Negotiating Body (INB) to negotiate a legally binding agreement on pandemic prevention, preparedness, and response for submission to the 77th World Health Assembly in May 2024, this column reflects on creative but pragmatic and complementary means that could be employed in the short timeframe allotted for this important global health law negotiation.

Between nation and empire: how the state matters in global health

Article

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Jan 2023

John Harrington

The role of the state has been underplayed in scholarship on global health. Taking a historical view, this paper argues that state institutions, practices and ideologies have in fact been crucial to the realisation of contemporary global health governance and to its predecessor regimes. Drawing on state theory, work on governmentality, and Third World approaches to international law, it traces the origins of the ‘health state’ in late colonial developmentalism, which held out the prospect of conditional independence for the subjects of European empires. Progress in health was also a key goal for nationalist governments in the Global South, one which they sought to realise autonomously as part of a New International Economic Order. The defeat of that challenge to the dominance of the Global North in the 1980s led to the rise of ‘global governance’ in health. Far from rendering the state redundant, the latter was realised through the co-option and disciplining of institutions at national level. To that extent, the current order has an unmistakably imperial character, one which undercuts its declared cosmopolitan aspirations, as evidenced in the approach to vaccine distribution and travel bans during the Covid-19 pandemic.

Royalty as a Way to Protect Creator: Current Conditions in Indonesia

Article

Jun 2022

Sitti Fatimah Maddusila

One of the legal rights that must be protected is intellectual property rights. This study analyzes intellectual property legal protection aspects based on a royalty system. This research is the normative legal research to produce legal arguments, usually called legal prescriptions. This study uses primary legal materials, which include: the 1945 Constitution of the Republic of Indonesia, the Patent Law, the Copyright Law, the Government Regulation on Song and/or Music Royalties, also the Plant Variety Royalties Act. Secondary legal materials include the results of studies and research on aspects of royalties in intellectual property rights. Non-legal material includes various non-legal studies of the royalty system in intellectual property. The approach in this research is a conceptual approach and a statutory approach. The results of the study confirm that the implication of the implementation of the royalty system in intellectual property rights requires the state to realize three fundamental legal values related to royalty policies, such as guarantees of legal certainty over the rules regarding royalties, guarantees of benefit from the distribution of royalties, as well as guarantees of fair distribution of royalties based on the principle of proportionality. In addition, legal protection with a royalty system in intellectual property rights needs to be carried out externally and internally.

The Rise of International Health Law

Article

Full-text available

Jan 2022

V. S. Malichenko

INTRODUCTION. Over the past decades under the influence of demographic processes, economic shocks, morbidity increase and other systemic problems a whole spectrum of threats to health has gradually formed at the international level, characterized by severe socio-economic consequences for each country regardless of the welfare level. Today, the challenges of ensuring universal coverage of services, access to safe, quality medicines, control of health care costs, effective response to health emergencies, antibiotic resistance are not limited by the WHO regulations, but are included in the agenda of the UN, ILO, FAO and other intergovernmental organizations. The need to form a unified approach to regulate activities of numerous participants in international healthcare regulation has served as an incentive for the gradual development of international legal regulation of the field of health protection, becoming the subject of study by leading legal scholars, as well as international organizations. The presented article provides a comprehensive analysis of the main historical stages in the development of international cooperation in the field of health protection, which served as the basis for the formation of international health law in the field of health protection as a new branch of international law. Special attention in the article is paid to the assessment of the role of globalization processes in changing the nature of threats to human and public health and their impact on the formation of global health governance concept. Based on the systemic problems that emerged during the COVID-19 pandemic, the author formulated the main directions for improving the international legal regulation of the health sector. MATERIALS AND METHODS. During article preparation the following document were studied: acts of a universal and regional nature, resolutions of international organizations, legal positions of UN specialized agencies, as well as professional scientific associations. The theoretical basis of the research are the scientific works of national and foreign scientists in the field of international law and international relations in the field of health protection. The article was prepared using the general scientific method of cognition, including the formal logical and situational method and private law methods, such as comparative, historical and formal legal methods. RESEARCH RESULTS. Within the framework of the study, a conclusion was formulated about the formation of "international health law" as a new branch of international law, uniting international legal norms and principles governing the relations of subjects of international law, as well as other participants in international relations in the field of human health. In the work, the author presents the main sources of "international health law" and formulates the subject of regulation of this branch of law. DISCUSSION AND CONCLUSIONS. Describing the features of international cooperation in the field of health protection, expressed in an increase in the number of involved international organizations and other participants which are not subjects of international law, the author substantiates the formation of the concept of global health management and analyzes the main scientific publications in this area. Having studied the nature of health threats that have formed over the past decade under the influence of globalization processes, as well as the systematic problems of international cooperation demonstrated by the coronavirus pandemic, the authors emphasize the need to implement the repeatedly proposed initiative to develop a universal act that forms the basis of international legal regulation of health protection.

Impact of the WHO Framework Convention on Tobacco Control on global cigarette consumption: Quasi-experimental evaluations using interrupted time series analysis and in-sample forecast event modelling

Article

Full-text available

Jun 2019

Objective To evaluate the impact of the WHO Framework Convention on Tobacco Control (FCTC) on global cigarette consumption. Design Two quasi-experimental impact evaluations, using interrupted time series analysis (ITS) and in-sample forecast event modelling. Setting and population 71 countries for which verified national estimates of cigarette consumption from 1970 to 2015 were available, representing over 95% of the world’s cigarette consumption and 85% of the world’s population. Main outcome measures The FCTC is an international treaty adopted in 2003 that aims to reduce harmful tobacco consumption and is legally binding on the 181 countries that have ratified it. Main outcomes were annual national estimates of cigarette consumption per adult from 71 countries since 1970, allowing global, regional, and country comparisons of consumption levels and trends before and after 2003, with counterfactual control groups modelled using pre-intervention linear time trends (for ITS) and in-sample forecasts (for event modelling). Results No significant change was found in the rate at which global cigarette consumption had been decreasing after the FCTC’s adoption in 2003, using either ITS or event modelling. Results were robust after realigning data to the year FCTC negotiations commenced (1999), or to the year when the FCTC first became legally binding in each country. By contrast to global consumption, high income and European countries showed a decrease in annual consumption by over 1000 cigarettes per adult after 2003, whereas low and middle income and Asian countries showed an increased annual consumption by over 500 cigarettes per adult when compared with a counterfactual event model. Conclusions This study finds no evidence to indicate that global progress in reducing cigarette consumption has been accelerated by the FCTC treaty mechanism. This null finding, combined with regional differences, should caution against complacency in the global tobacco control community, motivate greater implementation of proven tobacco control policies, encourage assertive responses to tobacco industry activities, and inform the design of more effective health treaties.

The Lancet commission on global health law: the transformative power of law to advance the right to health

Article

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Jan 2019

Lawrence O. Gostin

70 years of human rights in global health: drawing on a contentious past to secure a hopeful future

Article

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Dec 2018

The Universal Declaration of Human Rights, adopted on Dec 10, 1948, established a modern human rights foundation that has become a cornerstone of global health, central to public health policies, programmes, and practices. To commemorate the 70th anniversary of this seminal declaration, we trace the evolution of human rights in global health, linking the past, present, and future of health as a human right. This future remains uncertain. As contemporary challenges imperil continuing advancements, threatening both human rights protections and global health governance, the future will depend, as it has in the past, on sustained political engagement to realise human rights in global health.

Global health law: defining the field

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