International law and public health.

Abstract

At the beginning of the 21st century there is widespread recognition that national and international health are inseparable. Societies are increasingly turning to innovative and diverse mechanisms of international health cooperation to gain control over the forces that are globalizing public health and related risk factors such as those outlined in this year's World Health Report (1). Consequently, international law is receiving unprecedented attention as a mechanism of global health cooperation. International cooperation is a fluid process which ranges from simply coordinating viewpoints on certain matters to setting hard rules in some cases. In the international legislative process, the corresponding continuum is from non-binding instruments, such as recommendations, guidelines, resolutions, declarations of principles and codes of conduct, to binding ones such as treaties. Some authors have recently contended that the boundaries between law and non-law, or so-called "soft law", are becoming blurred. They attribute this in part to the increasingly complex international system with its many variations of standards and instruments (2) and to the difficulties of securing widespread consent to new binding rules, whether by treaty or by custom. Although the concept of "soft law" remains controversial since instruments such as codes of conduct and resolutions are clearly not law in the sense conveyed by Article 38 of the Statute of the International Court of Justice, there is increasing use of such halfway stages in the lawmaking process in a several areas of international concern (3). Recognizing the growing importance of international law for public health, this special issue of the Bulletin is designed to give readers some idea of its scope, and to stimulate debate about the role of international organizations such as the World Health Organization in present and future efforts to codify and implement it. Though these articles present a wide variety of points of view, they represent only a small part of the breadth and depth of the issues currently involved. Several of these articles show how the growing complexity and diversity of international health law are a reflection of growing multilateral concern about the threats and opportunities to health posed by contemporary globalization. Aginam (pp. 946-951) considers how the International Health Regulations are being reconfigured in the light of the global and multisectoral challenges now facing communicable disease control. De Seixas Correa (p. 924) reflects on how the public health community is for the first time playing the leading role in international treaty negotiations, namely with respect to the Framework Convention on Tobacco Control, for which he is chairman of the negotiation process. The Framework Convention is designed to tackle one of the major global risk factors facing human health in the 21st century. Responses to other global health risks have led to a debate on transnational dietary factors. With respect to international normative approaches, Chopra et al. (pp. 952-958) indicate that the national and international dialogue taking place in this emerging area of public health concern is relevant to public health international law, and highlights in particular the importance of non-binding, soft-law approaches. In the context of current global health challenges one cannot overlook the links between public health and international measures to achieve more sustainable development strategies. …