Values, Policies and Rights

A coalition of civil society organisations and academics is initiating a Joint Action and Learning Initiative on National and Global Responsibilities for Health (JALI) to research key questions involving health rights and responsibilities, with the goal of securing a global health agreement and supporting social mobilisation around the right to health. A Framework Convention on Global Health would inform post-Millennium Development Goal global health commitments, be grounded in the right to health, help resolve unconscionable global health inequities, and ensure universal health coverage. JALI seeks to clarify the health services to which everyone is entitled under the right to health, the national and global responsibilities for securing this right, and global governance structures that can realise these responsibilities and close major health inequities.

Attempts by the United States to prolong the retention of variola (smallpox) virus stocks have been thwarted at the World Health Assembly (WHA) that met from 16 to 24 May. The WHA instead decided to put aside the US proposal in favour of resuming the discussion at the 67th WHA in 2014. The decision followed contentious discussions on a draft resolution, proposed by the US and several co-sponsors, that would have allowed continued retention of the existing virus stocks, with a report on progress of research only in five years' time (2017), at the 69th WHA. Despite an informal working group meeting to deliberate the issue, there was no consensus and a decision was then made to defer the discussion on the draft resolution. In the final decision adopted on 24 May, the WHA decided to strongly reaffirm the decisions of previous WHA sessions that the remaining stocks of variola virus should be destroyed. It also reaffirmed the need to reach consensus on a proposed new date for the destruction of variola virus stocks when research outcomes critical to an improved public health response to an outbreak so permit. It further decided to include a substantive item "Smallpox eradication: Destruction of variola virus stocks" on the provisional agenda of the 67th WHA session.

Global health financing has increased dramatically in recent years, indicative of a rise in health as a foreign policy Issue, in the form of global health diplomacy, which informs foreign policy decision-making in the advancement of international co-operation in health. In this paper, the authors review the arguments for health in foreign policy that inform global health diplomacy. These are organised into six policy frames: security, development, global public goods, trade, human rights and ethical/moral reasoning. Each of these frames has implications for how global health as a foreign policy issue is conceptualised. Differing arguments within and between these policy frames, while overlapping, can also be contradictory. This raises an important question about which arguments prevail in actual state decision-making. This question is addressed through an analysis of policy or policy-related documents and academic literature pertinent to each policy framing with some assessment of policy practice. The reference point for this analysis is the explicit goal of improving global health equity. This goal has increasing national traction within national public health discourse and decision-making and, through the Millennium Development Goals and other multilateral reports and declarations, is entering global health policy discussion. Initial findings support conventional international relations theory that most states, even when committed to health as a foreign policy goal, still make decisions primarily on the basis of the ‘high politics’ of national security and economic material interests. Development, human rights and ethical/moral arguments for global health assistance, the traditional ‘low politics’ of foreign policy, are present in discourse but do not appear to dominate practice. While political momentum for health as a foreign policy goal persists, the framing of this goal remains a contested issue. The analysis offered in this article may prove helpful to those engaged in global health diplomacy or in efforts to have global governance across a range of sectoral interests pay more attention to health equity impacts.

The UNAIDS Reference Group on HIV and Human Rights has called on UN Member States to reaffirm the focus on human rights that has driven thirty years of progress in the global HIV response. This statement sets out five non-negotiables for Member States as they negotiate the outcome document for the High-Level Meeting between now and June 8. It states that the outcome document should reaffirm the emphasis on a human rights approach that mutually obliges rich and poor nations to fulfil the human right to health and that respects, protects and fulfils the human rights of people living with, affected by and vulnerable to HIV and AIDS, as well as reaffirm Member States’ shared responsibility to realise the human right to health by setting clear targets for funding the HIV response. Governments should also commit to utilising, to the fullest extent possible, flexibilities under the TRIPS agreement to lower the price of essential medicines, as well as remove laws, policies, practices, stigma and discrimination that block effective responses to AIDS. They should reaffirm the centrality of people living with HIV to the response as well as their human rights to non-discrimination, treatment as prevention, and meaningful participation.