Global health governance in the sustainable development goals: Is it grounded in the right to health?

Abstract

This paper explores the extent to which global health governance – in the context of the early implementation of the Sustainable Development Goals is grounded in the right to health. The essential components of the right to health in relation to global health are unpacked. Four essential functions of the global health system are assessed from a normative, rights‐based, analysis on how each of these governance functions should operate. These essential functions are: the production of global public goods, the management of externalities across countries, the mobilization of global solidarity, and stewardship. The paper maps the current reality of global health governance now that the post‐2015 Sustainable Development Goals are beginning to be implemented. In theory, the existing human rights legislation would enable the principles and basis for the global governance of health beyond the premise of the state. In practice, there is a governance gap between the human rights framework and practices in global health and development policies. This gap can be explained by the political determinants of health that shape the governance of these global policies. Current representations of the right to health in the Sustainable Development Goals are insufficient and superficial, because they do not explicitly link commitments or right to health discourse to binding treaty obligations for duty‐bearing nation states or entitlements by people. If global health policy is to meaningfully contribute to the realization of the right to health and to rights based global health governance then future iterations of global health policy must bridge this gap. This includes scholarship and policy debate on the structure, politics, and agency to overcome existing global health injustices.

Polycentrism in Global Health Governance Scholarship Comment on "Four Challenges That Global Health Networks Face"

“…Among the Sustainable Development Goals adopted in 2015, Goal 3 is about ensuring health and well-being for all at every stage of life. 12 , 13 While this goal is aligned with a number of more specific targets and indicators, there is no uniform procedure for how ‘health for all’ is to be reached. 14 A probable scenario is that public actors at the international, regional, national, and subnational level together with private actors will design and implement policy actions for attaining Goal 3.…”

What did the Go4Health policy research project contribute to the policy discourse on the sustainable development goals? A reflexive review

“…The focus on governance and Go4Health’s anticipation of new governance frameworks reflected recognition of the progressive erosion of WHO’s leadership, the rise of new players, the fragmentation of global governance, and the precedent established with the emergence of new structures and networks around the release of the MDGs [ 26 , 66 , 67 ]. In health, the ambitious expansion of the SDG health agenda—particularly the inclusion of non-communicable diseases—called for new governance [ 68 , 69 ], as would the demands generated by Go4Health’s commitment to the right to health [ 68 ].…”

“…In this paradigm, “Ensure healthy lives and promote well-being for all at all ages” should focus on health and wellbeing rather than treatment of disease [ 40 ]. But given the path dependence implied in addressing the “unfinished business of the MDGs” [ 31 , 68 ], the format of the nine SDG3 targets has reiterated the same disease targeted approach, further reinforced by the selection of indicators. Although the increased scope of the SDGs now arguably addressed most elements of the global disease burden [ 68 ], Go4Health was concerned that they did not adequately exploit the multi-sectoral potential of the SDGs.…”

The Sustainable Development Goals: Contextualizing Africa's Economic and Health Landscape

“…The right to health refers to the entitlement of all humans to organized efforts by society that promote and improve health and the corresponding obligations of governments and the international community, as enshrined in international human rights law . The representations of the right to health in the SDGs are considered insufficient and superficial as there are no direct commitments or right to health discourse . The indicators required for UHC monitoring in the SDGs that incorporate the legal principles to the right to health include progressive realization of the right to health and fulfillment of the minimum core obligations, cost‐effectiveness, nondiscrimination, shared responsibility, participatory decision making, and attention to vulnerable and marginalized groups .…”

“…The indicators required for UHC monitoring in the SDGs that incorporate the legal principles to the right to health include progressive realization of the right to health and fulfillment of the minimum core obligations, cost‐effectiveness, nondiscrimination, shared responsibility, participatory decision making, and attention to vulnerable and marginalized groups . However, the right to health also requires the rights to water and sanitation, food, housing, education, and collectively, to development . Therefore, without basic human needs being met, the right to health cannot be achieved.…”