Universal Human Rights in Theory and Practice

Some 18 million people die annually from poverty-related causes. Many more are suffering grievously from treatable medical conditions. These burdens can be substantially reduced by supplementing the rules governing pharmaceutical innovation. Established by the World Trade Organization's TRIPS Agreement, these rules cause advanced medicines to be priced beyond the reach of the poor and steer medical research away from diseases concentrated among them. We should complement these rules with the Health Impact Fund (HIF). Financed by many governments, the HIF would offer any new pharmaceutical product the opportunity to participate, during its first 10 years, in the HIF's annual reward pools, receiving a share equal to its share of the assessed health impact of all HIF-registered products. In exchange, the innovator would have to agree to make this product available worldwide at the lowest feasible cost of manufacture. Fully consistent with TRIPS, the HIF achieves three key advances. It directs some pharmaceut...

The Health Impact Fund: Enhancing Justice and Efficiency in Global Health

Introduction Millennium Development Goal (MDG) 7 addresses environmental sustainability, with a target (target 10) to "halve by 2015 the proportion of people without sustainable access to safe drinking water and basic sanitation". (1) Progress towards target 10 contributes significantly to the reduction of child mortality (target 5), major infectious diseases (target 8), maternal health (target 6) and quality of life of slum populations (target 11). It also contributes to gender equality and empowers women, and is linked to school enrolment and attendance, especially of girls (goal 3). Meeting the target would contribute to reducing poverty (target 1) and hunger (target 2) through use of water supply in industry and agriculture, saving productive time in accessing closer water sources and sanitation facilities, and contributing to workforce health. Importantly, improved water supply and sanitation promotes economic equity since the unserved tend to be the poorer and more vulnerable. In working towards the MDG target for water and sanitation, understanding resource requirements, resource gaps and where resources need to be deployed are critical. Corresponding assessments need to be based on reasonable estimates at global, regional and country levels. (2) Furthermore, comparing estimated finances required to existing funding levels helps to mobilize resources and to direct efforts to specific contexts (e.g. rural or urban) and to countries that are not meeting the MDG targets. (3) Since 2000, studies have estimated the cost of attaining one or both of the components of the target for water and sanitation at the global (4-8) and regional (2,9,10) levels. Reviews have compared these, which are in the range of US$ 9 to 30 billion per year at the global level. (11, 12) This wide range is largely explained by the different methodologies and unit cost assumptions. Different approaches to incremental improvement and on adequate service levels also contribute to the differences. Most studies have ignored the costs of maintaining existing coverage levels (the costs of operating, maintaining, monitoring and replacing existing infrastructure and facilities)--these are especially important as the global stock of assets increases and in the light of reports indicating wide variability on effective "working life". Toubkiss concludes, based on global cost studies, that "approximately US$ 10 billion per year would be required to supply low-cost water and sanitation services to people who are not currently supplied, and a further US$ 15 to 20 billion a year to provide them with a higher level of service and to maintain current levels of service to people who are already supplied" (our emphasis). Therefore, future financing studies should consider costs of operation, maintenance and replacement of existing as well as new water and sanitation infrastructure and facilities. (12) A major component of variability for sanitation is technology choice: a low-cost household improved latrine can provide both safety and privacy, yet waterborne sewerage must also include the cost of treatment to reduce health and environmental risks from the discharged wastewater. Thus Toubkiss concludes that in addition to the above costs "up to US$ 80 billion is projected solely for collecting and treating household wastewater". (12) While coverage has been advancing in many countries, recent estimates consistently show the sanitation component of the target to be significantly off-track, with a projected shortfall of 550 million people in 2015 from target achievement. (3) The drinking water component, while formally on-track (within 5% of target), is at the bottom limit of that range with prospects deteriorating. (13) Uneven progress between rural and urban populations is also often cited, and the lower baseline in rural compared to urban areas is well documented. (14) The importance of this is reflected in the fact that, uniquely among MDG indicators, rural-urban disaggregation is specified in the indicator definition, although there is no clear agreement that the target itself applies separately to rural and urban areas. …

Global Costs of Attaining the Millennium Development Goal for Water Supply and sanitation/Couts Globaux De la Realisation De L'objectif Du Millenaire Pour le Developpement Relatif a L'approvisionnement En Eau et a l'assainissement/Costos Mundiales del Logro del Objetivo De Desarrollo del Milenio Sobre El Abastecimiento De Agua Y El Saneamiento

On 19 September 2016, 193 countries committed to the New York Declaration for Refugees and Migrants. What does this mean for refugees?

New York Declaration for Refugees and Migrants

OBJECTIVE\nTo examine how health aid is spent and channelled, including the distribution of resources across countries and between subsectors. Our aim was to complement the many qualitative critiques of health aid with a quantitative review and to provide insights on the level of development assistance available to recipient countries to address their health and health development needs.\n\n\nMETHODS\nWe carried out a quantitative analysis of data from the Aggregate Aid Statistics and Creditor Reporting System databases of the Organisation for Economic Co-operation and Development, which are the most reliable sources of data on official development assistance (ODA) for health from all traditional bilateral and multilateral sources and from partnerships such as the Global Fund to Fight AIDS, Tuberculosis and Malaria.\n\n\nFINDINGS\nThe analysis shows that while health ODA is rising and capturing a larger share of total ODA, there are significant imbalances in the allocation of health aid which run counter to internationally recognized principles of \"effective aid\". Countries with comparable levels of poverty and health need receive remarkably different levels of aid. Funding for Millennium Development Goal 6 (combat HIV/AIDS, malaria and other diseases) accounts for much of the recent increase in health ODA, while many other health priorities remain insufficiently funded. Aid is highly fragmented at country level, which entails high transaction costs, divergence from national policies and lack of coherence between development partners.\n\n\nCONCLUSION\nAlthough political momentum towards aid effectiveness is increasing at global level, some very real aid management challenges remain at country level. Continued monitoring is therefore necessary, and we recommend that a review of the type presented here be repeated every 3 years.

Where Did All the Aid Go? an In-Depth Analysis of Increased Health Aid Flows over the Past 10 years/Ou Est Allee Toute L'aide Sanitaire? Analyse Approfondie Des Flux Croissants D'aide Sanitaire Sur Les Dix Dernieres annees/?A Donde Ha Ido a Parar Toda la Ayuda? Analisis Detallado del Aumento De la Ayuda Sanitaria En Los Ultimos Diez Anos

A population’s health and well-being is primarily a national responsibility. Every state owes all of its inhabitants a comprehensive package of essential health goods and services under its obligations to respect, protect, and fulfill the human right to health. Yet health is also a global responsibility. Every state has a duty to ensure a safe and healthy world, with particular attention to the needs of the world’s poorest people. Improving health and reducing unconscionable health inequalities is both an international obligation under the human right to health and a matter of global social justice.The mutual obligations of states to safeguard the health of their own inhabitants and the health of people everywhere are poorly defined, with serious adverse consequences for world health. These obligations must be better understood. Central questions of vital importance to the health of the world’s population include: What are the duties of all states to ensure the right to the highest attainable standard of health for all their inhabitants? What are the components of a comprehensive package of essential goods and services under the right to health to which people everywhere are entitled? How specifically can states’ duties to govern well be incorporated into and realized through the health system? One of the most inadequately understood obligations is the responsibility of the international community to augment the capacity of low- and middle-income states to ensure their population’s health, with the specific contours of this obligation ill-defined. Indeed, international financial assistance is framed as “aid,” rather than an expression of mutual responsibility, leaving the flawed impression that international health assistance is a matter of charitable discretion rather than an international human rights obligation. The approach to health assistance as charity rather than as an obligation also means that this assistance is unreliable over the longer-term, leading to the reluctance of low- and middle-income countries to use it for recurrent public health expenditures. Continued and accelerated improvements in global health will require significant and reliable funding at a time of extended economic uncertainty and budget belt-tightening in many countries. Progress on global health therefore risks stagnating unless states have clarity on, accept, and adhere to national and international obligations to respect, protect, and fulfill the human right to health. Translating state obligations into improved health will also require building a more robust and effective global health governance structure. Current global health initiatives are too often undermined by a host of now well-recognized weaknesses: Global health actors do not sufficiently coordinate their activities with each other or the host countries, leading to fragmentation, nor do they make and keep longer-term funding commitments, leading to unpredictability. Development partners do not set the priorities required to meet all human health needs, and lack accountability for their own global health commitments. Host countries are not empowered to take “ownership” of health planning and programs. And the international community does not adequately monitor and evaluate programmatic effectiveness. Our aim is to propose a coherent global health governance framework for the post-MDG period that will clarify national and global responsibilities for health, enable countries to effectively carry out these responsibilities, and create accountability around them. In order to achieve this, we are establishing the Joint Action and Learning Initiative on National and Global Responsibilities for Health (JALI). The primary purpose of the JALI is to catalyze and facilitate research, broad consultations, and campaigns that will lead to a global compact. Towards this end, the JALI will rigorously and systematically address the following issues: Clarify the essential package of health goods and services to which all human beings are entitled as part of their right to health; Clarify the responsibility of all states, even the poorest, to provide this essential package of health goods and services to all of their inhabitants; Assess the gap between the conditions (financial and others) for the provision of an essential package of health goods and services, and the domestic capacity of and use of that capacity by poorer countries - the gap for which the international community should take responsibility; Clarify the international responsibility to build the capacity of low- and middle-income states to provide an essential package of health goods and services to their inhabitants; Clarify the principles of good governance, both nationally and globally, including transparency, honesty, and accountability; Propose a coherent global health governance architecture to ensure robust national and global responsibilities for health. In particular, the JALI will answer the following four key questions: What are the essential services and goods guaranteed to every human being under the human right to health? What is the responsibility that all states have for the health of their own populations? What is the responsibility of all countries to ensure the health of the world's population? What kind of global health governance is needed to ensure that all states live up to their mutual responsibilities?

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The Joint Action and Learning Initiative on National and Global Responsibilities for Health

The article comprises a conceptual framework to analyze the strengths and weaknesses of a global health convention. The analyses are inspired by Lawrence Gostin's suggested Framework Convention on Global Health. The analytical model takes a starting-point in events tentatively following a logic sequence: Input (global health funding), Processes (coordination, cooperation, accountability, allocation of aid), Output (definition of basic survival needs), Outcome (access to health services), and Impact (health for all). It then examines to what degree binding international regulations can create order in such a sequence of events. We conclude that a global health convention could be an appropriate instrument to deal with some of the problems of global health. We also show that some of the tasks preceding a convention approach might be to muster international support for supra-national health regulations, negotiate compromises between existing stakeholders in the global health arena, and to utilize WHO as a platform for further discussions on a global health convention.

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Examining the Global Health Arena: Strengths and Weaknesses of a Convention Approach to Global Health Challenges

A framework convention on obesity control

/pdf/can-we-trust-doping-tests-ovsdlzcj2b.pdf

Can we trust doping tests

The ‘Migration Period’ of the Middle Ages (300–700 AD) resulted in dramatic changes in the architecture of populations in Europe. Many would argue that we are currently in the midst of a similar ‘Migration Period’ (1, 2). The 2015 refugee crisis might seem to some like an overwhelming tidal wave of humans. While the term ‘migrant’ is often used in communicating to a broad audience, the complexities of the many subgroups under this terminology are often lost. Refugees are a subset of the broader category of migrants. The United Nations High Commissioner for Refugees (UNHCR) reports 67.7 million people of concern worldwide (refugees, asylum seekers, internally displaced persons and stateless persons) of which more than 17 million are refugees (3). In Europe, Eastern Europe has the largest proportion people of concern (6.2 million) compared to the rest of Europe (3.9 million), with over 50 % of those being internally displaced persons (3). Europe’s proportion of refugees (5.2 million) is less than 1 per cent of the total European population (3).

Harald Siem

Papers

The Joint Action and Learning Initiative on National and Global Responsibilities for Health

Examining the Global Health Arena: Strengths and Weaknesses of a Convention Approach to Global Health Challenges

A framework convention on obesity control

Can we trust doping tests

Migrant health is global health.