Global governance, international health law and WHO: looking towards the future Allyn L. Taylor1 Abstract The evolving domain of international health law encompasses increasingly diverse and complex concerns. Commentators agree that health development in the twenty-first century is likely to expand the use of conventional international law to create a framework for coordination and cooperation among states in an increasingly interdependent world. This article examines the forces and factors behind the emerging expansion of conventional international health law as an important tool for present and future multilateral cooperation. It considers challenges to effective international health cooperation posed for intergovernmental organizations and other actors involved in lawmaking. Although full consolidation of all aspects of future international health lawmaking under the auspices of a single international organization is unworkable and undesirable, the World Health Organization (WHO) should endeavour to serve as a coordinator, catalyst and, where appropriate, platform for future health law codification. Such leadership by WHO could enhance coordination, coherence and implementation of international health law policy. Keywords Treaties; International law; Legislation, Health; World health; International cooperation; Intersectoral cooperation; World Health Organization (source: MeSH, NLM). Mots cle´s Traite´ s; Droit international; Le´gislation sanitaire; Sante´ mondiale; Coope´ration internationale; Coope´ration intersectorielle; Organisation mondiale de la Sante´(source: MeSH, INSERM). Palabras clave Tratados; Derecho internacional; Legislacio´ n sanitaria; Salud mundial; Cooperacio´ n internacional; Cooperacio´n intersectorial; Organizacio´ n Mundial de la Salud (fuente: DeCS, BIREME). Bulletin of the World Health Organization 2002;80:975-980. Voir page 979 le re´sume´ en franc¸ais. En la pa´ gina 980 figura un resumen en espan˜ ol. Introduction the development of rational and effective international health law. Conventional international law is the primary international The planetary context of development has profound implica- legal vehicle by which international organizations can advance tions for global public health and, concomitantly, international international cooperation to improve global health status and health law — particularly conventional international treaty law. reduce the global burden of disease, so the article focuses on Today, the burgeoning field of international health law treaty law rather than other sources of international law. encompasses increasingly diverse and complex concerns, including aspects of biomedical science, human reproduction and cloning, disability, infectious and noncommunicable The evolution of international health law disease, and safety control for health services, foods and Globalization and the expanding domain pharmaceuticals (1, 2). Furthermore, international health law is of international health law increasingly recognized as integrally linked to most other Globalization is the process of increasing economic, political traditionally defined realms of international legal concern. and social interdependence, and global integration that occurs Despite growing awareness of the capacity of conven- as capital, traded goods, people, concepts, images, ideas and tional international law to complement national action and values diffuse across national boundaries (3). It has critical other forms of international collaboration, and serve as a implications for public health and global public health dynamic tool for multilateral health cooperation in an governance (4). Contemporary globalization encompasses increasingly interdependent world, little scholarly considera- many ‘‘interconnected risks and opportunities that affect the tion has been paid to how twenty-first century global health sustainability of health systems worldwide’’ (5). The significant lawmaking should be managed from an international institu- impact of globalization on public health has been examined in a tional basis. With a plethora of international organizations special edition of the Bulletin of the World Health Organization (6) sharing lawmaking authority for global health and with other and elsewhere (7–13). health actors engaged in the international legislative process, As a consequence of globalization, governments must international lawmaking shows potential for fragmented, turn increasingly to international cooperation to attain national uncoordinated and inefficient sprawl. public health objectives and achieve some control over the This article examines the forces and factors behind the transboundary forces that affect their populations. The expansion of conventional international health law and argues widespread influence of globalization has increased the need that the World Health Organization (WHO) can help enhance for new frameworks of international collaboration, including 1 Health Policy Adviser, World Health Organization , University of Maryland School of Law, 500 West Baltimore Street, Baltimore, MD 21201, USA (email: [email protected]). Ref. No. 02-0356 Bulletin of the World Health Organization 2002, 80 (12) 975 Special Theme – Global Public Health and International Law conventional international law, to address emerging opportu- has been elaborated in a number of international instruments, nities for and threats to global health and improve the health including the conventions on Climate Change and Biological status of poor states that have not benefited from globalization Diversity. Broad intersectoral action (on matters including — the so-called ‘‘losers’’ of globalization (14–17). The trade, agriculture, education and the environment) to improve burgeoning literature that analyses health and international global health status is also at the core of recent intergovern- health law as global public goods testifies to the significance of mental debates surrounding the proposed WHO Framework the globalization of public health for future international Convention on Tobacco Control (FCTC). cooperation, including conventional international law (18, 19). Globalization also has an impact on the development of International law and international international health law, because increasing global integration health development compounds exponentially the public health implications of As nations at all levels of development increasingly recognize other contemporary developments strongly connected with the need for frameworks for coordinated action on increasingly health status. For example, rapid worldwide dissemination of complex, intersectoral and interrelated global health problems, recent advances in scientific knowledge and technology has international health development in the twenty-first century propelled international agreement and action by providing the will be likely to include the expanded use of international law. It evidence and tools needed for effective national and is important to understand that conventional international law international action through a wide range of treaties — is an inherently limited mechanism for international coopera- including those concerned with the safety of chemicals, tion and that the international legislative process suffers from pesticides and food and the disposal of hazardous wastes. At numerous defects — including challenges to timely commit- the same time, the use of environmentally damaging ment and implementation — although considerable advances technologies has contributed to the codification of interna- have been made in the last few decades (26). The extent to tional law by propelling global health threats such as land which international agreements are effective — and under degradation, marine pollution, depletion of the ozone layer and what conditions — is a continuing source of theoretical climate change. Furthermore, continuing scientific progress fascination and dispute among scholars of international law and developments generate ongoing global debate on codify- and relations. ing new international commitments, including global bans on Despite their limitations, treaties can be useful for raising certain novel technologies, such as reproductive human public awareness and stimulating international commitment cloning (20, 21). and national action. Conventional international law can provide a legal foundation for international health commit- Issue linkage ments, and it can include institutional and procedural Globalization has also hastened the growth of international mechanisms to encourage compliance with international health law by enhancing contemporary appreciation of the norms by, for example, enhancing the capacity of states to interconnectedness of health and other contemporary global implement legal obligations. Such mechanisms established in concerns. International legal scholars have traditionally com- international agreements can include financial and technical partmentalized and treated substantive subject matters such as assistance, information exchange, scientific research and human rights, environmental protection, health and arms surveillance, as well as treaty supervision and dispute control, as discrete, self-contained areas with limited connec- resolution. tions (22). Scholars of international law have only recently identified and debated the relationship between different subjects of international law, such as trade and human rights, Global health governance and its limitations and human rights and environmental