Gian Luca Burci and Andrew Cassels
This chapter discusses how the landscape for global health governance has evolved. It finds that the political importance of health as an international and global issue has changed radically. International health organizations started with a mandate to control the spread of infectious diseases between countries as a by-product of trade. Today, their work is central to economic development, poverty reduction, human rights, sustainable development, and the effective management of globalization. Any modern understating of the role and functions of International Organizations (IOs) in the field of health must now take into account the actions and interactions of a much wider range of institutional actors. While the World Health Organization (WHO) and IOs are most effective in meeting the need for legislative instruments, norms, standards and other global public goods, it is also the part of their agenda that is hardest to finance. There are many other players — internationally and locally — that are more adept at providing finance, implementing projects, and providing hands-on technical support in developing countries than normative IOs. Furthermore, the growing number of institutions involved in global health suggests the need for a much clearer division of labour in order to allow each one to play to its respective strengths.
The protection of public health is, traditionally, a responsibility of the State. Health measures embrace a variety of concerns. This article describes a complex of initiatives undertaken by World Trade Organization (WTO) Members, including the operation of health delivery systems, insurance schemes, and pharmaceutical controls. The TRIPS Agreement has also raised significant concerns about its potential effects on the pursuit of autonomous national health policies. This article discusses in detail the SPS Agreement, which imposes new requirements on WTO Members with respect to SPS measures that are distinct from the familiar requirements of the general agreement on tariffs and trade (GATT) 1994. For those health measures that fall outside of the scope of the SPS Agreement, the GATT 1994 principles on non-discrimination and import restrictions continue to apply.