Global constitutionalism, applied to global health governance: uncovering legitimacy deficits and suggesting remedies.

Rachel Hammonds,Gorik Ooms

doi:10.1186/s12992-016-0216-2

Abstract

BackgroundGlobal constitutionalism is a way of looking at the world, at global rules and how they are made, as if there was a global constitution, empowering global institutions to act as a global government, setting rules which bind all states and people.AnalysisThis essay employs global constitutionalism to examine how and why global health governance, as currently structured, has struggled to advance the right to health, a fundamental human rights obligation enshrined in the International Covenant on Economic, Social and Cultural Rights. It first examines the core structure of the global health governance architecture, and its evolution since the Second World War. Second, it identifies the main constitutionalist principles that are relevant for a global constitutionalism assessment of the core structure of the global health governance architecture. Finally, it applies these constitutionalist principles to assess the core structure of the global health governance architecture.DiscussionLeading global health institutions are structurally skewed to preserve high incomes countries’ disproportionate influence on transnational rule-making authority, and tend to prioritise infectious disease control over the comprehensive realisation of the right to health.ConclusionA Framework Convention on Global Health could create a classic division of powers in global health governance, with WHO as the law-making power in global health governance, a global fund for health as the executive power, and the International Court of Justice as the judiciary power.

Highlights

Global constitutionalism is a way of looking at the world, at global rules and how they are made, as if there was a global constitution, empowering global institutions to act as a global government, setting rules which bind all states and people.Analysis: This essay employs global constitutionalism to examine how and why global health governance, as currently structured, has struggled to advance the right to health, a fundamental human rights obligation enshrined in the International Covenant on Economic, Social and Cultural Rights
A Framework Convention on Global Health could create a classic division of powers in global health governance, with World Health Organization (WHO) as the law-making power in global health governance, a global fund for health as the executive power, and the International Court of Justice as the judiciary power
Summary: All of the three institutions we identified as comprising the core structure of the global health governance architecture have been given, or have managed to capture, rule-making authority at a level above the state-level

Summary

Discussion

Health appears as “one of the most dynamic realms of global governance today”, [3] as Youde argues. WHO is governed in accordance with the ‘one country one vote’ principle, but finds itself at the mercy of a handful of wealthier states These states accepted WHO as the leader of global health governance as long as its work was focused on infectious diseases. Charles I used his monarchic powers, the House of the Lords ( called ‘House of Peers’) and the House of Commons as he saw fit-probably in the way most convenient for his purposes It does not require a wild imagination to see a similar power game in global health governance today: the USA, and a handful of wealthier countries, use WHO when they need it to create buy-in from all other countries for infectious disease control; they use the World Bank when they do not need consent from other countries because they can buy compliance, or they create new institutions

Conclusion

Background

Findings