The personal and economic costs of alcohol-related harm are not met by the alcohol industry, which (like tobacco) is increasingly dominated by large multinational companies.
At the global level, there have been many calls for a binding international legal instrument on alcohol control; for example: here, here, and here.
Yet global health scholars warn that a framework convention on alcohol control would be premature at this point. Even if politically feasible, it might “bake in” weak norms that may do little to accelerate the implementation of priority policies for alcohol control.
WHO documents have referred to the alcohol industry as “economic operators” and framed them as global stakeholders in reducing alcohol-related harm, encouraging them to implement “self-regulatory initiatives”: see, eg, here (para 45), and here (p 135).
Contrast this with the realisation in the case of tobacco that there is a ‘fundamental and irreconcilable conflict of interest’ between the tobacco industry and public health interests (see Guiding Principle 1 here).
Acknowledging the significant influence of the alcohol industry at global and national levels, including efforts to influence policy and bias research, this report states:
‘Despite this a dialogue has continued with economic operators in alcohol production and trade at the international level seeking ways they can contribute to reducing the harmful use of alcohol in their roles as developers, producers, marketers and sellers of alcoholic beverages’ (p 130).
‘The main areas for the dialogue include self-regulation of marketing within coregulatory frameworks, labelling and consumer information, alcohol content in alcoholic beverages as well as provision of data useful for improving estimates of alcohol consumption in populations. In this context it has to be underlined that regulatory controls on the market must be decided and enforced by governments, with public health interests as the primary goals. Such regulations and their enforcement need to be protected from industry interference.’ (p 135)
The global alcohol industry has effectively exploited the prevailing conceptual approach to addressing NCDs – which emphasises public-private partnerships and a multisectoral, all-of-society approach.
In response, Public Health Division of the Pacific Community (SPC) has been driving an initiative to develop policies and legislative provisions for tackling the key risk factors, particularly tobacco use, harmful alcohol use, and dietary risks.
The result is the “Pacific Legislative Framework”.
This remarkable document, now available in English and French, consists of three parts.
The framework begins by setting out policy for addressing a surprisingly wide range of risk factors, including core areas of tobacco control, core areas of liquor control, health promotion, protection for breastfeeding, regulation of marketing of unhealthy foods and drinks to children, reducing consumption of salt, sugar and trans-fat in the diet, and tax measures for tobacco, alcohol and unhealthy food/sugar-sweetened drinks.
The “policy” element includes overall policy objectives and recommendations for each area, as well as priority areas for reform and a brief legislative plan.
The appendices to the Framework consist of draft legislative provisions covering each of the thematic areas/risk factors.
These provisions can be implemented as off-the-shelf legislation, or adapted by National Parliaments to national circumstances.
The Pacific Legislative Framework is an impressive effort – entirely driven by Pacific Island Countries and Territories themselves, in collaboration with the Pacific Community (SPC) and the WHO Western Pacific Regional Office.
The Framework is a logical extension in a chain of initiatives, driven by Pacific Island Countries and Territories, to address the burden of NCDs.
In 2017, the Pacific Monitoring Alliance for NCD Action (Pacific MANA) was established. Pacific MANA has developed a dashboard-style accountability tool to report on progress with policies and laws to address NCDs in Pacific Island Countries and Territories.
The MANA dashboard now functions as an accountability tool for action on NCDs in the Pacific.
There is a long way to go, and gaps to be filled, including political commitment and actions to prevent conflicts of interest that undermine tobacco control policies in the Pacific. There is also an urgent need for Pacific Island Countries and Territories to grow their capacity for enforcing public health laws.
The proposed pandemic instrument will almost certainly materialise too late to mitigate the impact of the global Covid-19 pandemic.
There is plenty of irony in the fact that while the European Union has led the push for a legally binding pandemic convention (see here and here), the EU continues to resist the proposal for a waiver of intellectual property rights under the World Trade Organisation’s TRIPS convention – in order to accelerate access to Covid vaccines and other technologies.
(See the TRIPS and Covid-19 waiver proposal here, and the EU’s counter-proposal here).
What do we know so far about the proposed pandemic instrument?
The World Health Assembly has opted for a World Health Organisation instrument, rather than a treaty negotiated under the broader, United Nations system, such as the UN Framework Convention on Climate Change.
There has been some drift in the governance of global health issues away from WHO in recent years to the broader UN system. This is illustrated by the High-level meetings of the UN General Assembly on non-communicable diseases (2011, 2014, 2018, 2025), the health agenda embodied within the Sustainable Development Goals, and many other instruments, strategies and processes. Of course, as the specialised health agency of the UN, the WHO remains centrally involved in helping to coordinate the response to many global health challenges.
The point, however, is that a multi-sectoral, all-of-government response is crucial if governments want to effectively tackle many of the world’s leading health challenges, from tobacco control to pandemics.
The envisaged pandemic instrument, however, will be a WHO instrument, overseen by a body that convenes the world’s health ministers, rather than heads of state. Implementation will be everything.
What kind of instrument?
Under the WHO Constitution, the World Health Assembly has authority to adopt conventions (Article 19), adopt Regulations (Article 21), or make recommendations (Article 23).
For the moment, all of these options are on the table.
This draft must then be presented to the intergovernmental negotiating body at its second meeting in August 2022 – by which time it is intended that the negotiating body will identify the constitutional basis for the new instrument: whether a convention, or regulations, or recommendations.
The intergovernmental negotiating body has been given a three-and-a-half-year timeline. It must present the outcomes of its deliberations to the World Health Assembly in May 2024 (WHA77), with a progress report to the WHA in 2023 (WHA76).
Relationship with the International Health Regulations
Legally-binding international instruments are rare in global health. Non-binding normative instruments (so-called “soft law”), are far more common: see discussion here.
Another binding instrument is the International Health Regulations (IHR) which (amongst many other things) impose obligations on WHO Member States to report and respond to events that constitute “public health emergencies of international concern”.
The IHR were revised and updated in 2003 following the SARS outbreak.
The limitations of the IHR, compliance problems, and lack of progress in implementation, have been investigated by many committees and expert bodies (see eg here, and here).
It’s safe to say that the failure of the IHR to effectively prevent and manage the Covid-19 pandemic, which has so far claimed nearly 5.6 million deaths, remains a driving force behind the WHA decision. What better illustration of the need for effective global governance of pandemics than Covid-19?
That doesn’t mean that any new pandemic instrument will replace or supplant the IHR. Far from it. The WHA decision calls for “coherence and complementarity” between the process of developing a new pandemic instrument and the work of the “Member States Working Group on Strengthening WHO Preparedness and Response to Health Emergencies” (a group established at the World Health Assembly in May 2021) “particularly with regard to implementation and strengthening of the IHR” (see para 1(4) here).
His more recent comments to the media illustrate the challenges of attempting to investigate the origins of SARS-CoV-2 as part of a WHO-convened expert team (more of which below).
This post briefly reviews two current Covid-19 review processes, as well as recent media reports about the WHO-convened Covid origins study.
At the World Health Assembly on 19 May 2020, the Assembly adopted resolution WHA73.1 on the Covid-19 response that, amongst many other things, requested the Director-General to carry out a review on “lessons learned from the WHO-coordinated international health response to COVID-19”, including the functioning of the International Health Regulations and “the actions of WHO and their timelines pertaining to the COVID-19 pandemic” (para 10).
Independent Panel for Pandemic Preparedness and Response
This Panel is co-chaired by the Rt. Hon. Helen Clarke, the former Prime Minister of New Zealand who more recently was Administrator of the UN Development Programme, and Her Excellency Ellen Johnson Sirleaf, the former President of Liberia.
Other key messages from the Independent Panel for Pandemic Preparedness & Response:
Non-pharmaceutical public health response measures (such as social distancing, hand hygiene and wearing masks) will need to continue to be implemented at scale globally, irrespective of whether a vaccine is rolled out.
The global pandemic alert system is not working and needs to come into the digital era, enabling preventive actions to be taken within days, rather than weeks. The process for declaring a public health emergency of international concern is not working.
The IHR lack teeth, and the incentives are too weak to ensure compliance. The Panel put this conclusion in more modest language: “The incentives for cooperation are too weak to ensure the effective engagement of States with the international system in a disciplined, transparent, accountable and timely manner” (p 7).
Review Committee on the Functioning of the International Health Regulation
The Committee pointed to the lack of a robust accountability mechanism to monitor and incentivise compliance with the IHR, beyond the requirement for States Parties’ and the Director-General to report to the World Health Assembly on the implementation of the Regulations (Art. 54). A “robust system of compliance evaluation built into the Regulations” was proposed as one possible approach.
Recommendations to strengthen the IHR have been circulating for years. See here and here for short, helpful, reviews.
The Committee noted that “A peer-review mechanism, based on the Universal Periodic Review used by the Human Rights Council,” could be a useful way of strengthening countries’ levels of preparedness and response, and compliance with their legal obligations (para 18).
The interim report states that WHO requested verification of the initial reports on 1 January, receiving a response from the China Focal Point on 3 January.
Under the IHR, States Parties are supposed to reply to WHO requests for verification or further information within 24 hours (IHR, Art. 10), but the report notes that delay beyond 24 hours is not unusual.
The Committee stated that the timelines for country response are not realistic, given that social media can result in information reaching the public domain before a comprehensive risk assessment is completed. It also noted that “countries may be reluctant to report on events if they perceive consequences, mainly related to travel and trade, deriving from early notification.”
In an ideal world, perhaps borders could remain open and watertight screening, contact tracing and isolation measures could effectively prevent spread. But it’s a brave country that completely trusts its own implementation of these important public health controls: SARS-CoV-2 is devilishly infectious, and aerosol transmission can occur even when normal hotel quarantine and infection controls are in place.
Public health experts regard Australia’s travel bans as an important and necessary part of Australia’s successful response. For example, Duckett and Stobart regard “Australia’s decision to close its borders to all foreigners on 20 March to ‘align international travel restrictions with risks'” as a “turning point” in Australia’s response.
In her evidence to the Senate Select Committee Inquiry into Australia’s Response to Covid-19, Professor Raina MacIntyre, who leads the Biosecurity Program at the Kirby Institute at the University of New South Wales, described travel bans (border closures) as “the single most important measure” (para 2.43), a conclusion supported by this modelling study. Unfortunate – certainly, but necessary to avoid importing new cases.
WHO-convened Global Study of the Origins of SARS-CoV-2
In late January, an international team of virologists travelled to Wuhan on a fact-finding mission as part of a WHO-convened global study into the origins of SARS-CoV-2.
However, when you consider the scale of the death and economic harm caused by Covid-19, it is simply breath-taking that such an outbreak should go unexamined. Not surprisingly several inquiries are now proceeding.
Investigating the origins of SARS-Cov-2 was and is unavoidably sensitive, not only because it involves asking where the virus may have originated, and the conditions that facilitated its spread into the human population, but because the likely time period during which the first-observed cases arose goes to China’s level of compliance with the IHR, and the impact this may have had on the international spread of SARS-CoV-2.
The controversy surrounding the WHO-convened study has escalated since the international team left Wuhan.
Dr Dwyer also told the ABC that the expert team’s request to test stored samples of blood donations made in Wuhan around December 2019 was denied, apparently for legal reasons, although it might have given a picture of SARS-CoV-2 levels in the wider community at that time.
These sources of information might have given a clearer picture of whether and how much virus was circulating in the community prior to December 2019.
“We also know the Chinese were reporting the people who went to hospital were really sick,” Dr Dwyer said. “But we now know there’s a lot of ordinary transmission going on between otherwise healthy people, so there must’ve been many, many more cases in December than were identified.”
The scientists wrote that “We have…reached the conclusion that the joint team did not have the mandate, the independence, or the necessary accesses to carry out a full and unrestricted investigation into all the relevant SARS-CoV-2 origin hypotheses – whether natural spillover or laboratory/research-related incident”.
Under the International Health Regulations, which govern global management of infectious disease outbreaks, a declaration that a PHEIC exists is a prerogative of the Director-General, and triggers the requirement to issue temporary recommendations, after receiving information from the Emergency Committee (See IHR, Arts. 15, 49).
You can see the WHO Director-General’s recommendations to the People’s Republic of China here. (And see here for the most recent WHO situation reports).
2019-nCoV was first identified in Wuhan, China, around 12 December.
As at 6 February 2020, over 28,060 cases had been identified in China, with 564 deaths; 24 countries outside China have also identified cases, with one death confirmed in the Philippines.
In Australia, as at 6 February, 15 cases of 2019-nCoV had been identified in 4 States: 5 in Qld, 4 each in NSW and Victoria, and 2 in SA. You can see latest updates for Australia, and other resources here.
You can see a timeline of events from Australia’s perspective here, and from a US perspective here.
From a legal perspective, how is Australia managing the risks posed by 2019-nCoV?
Australian citizens currently in China are permitted to re-enter Australia, but must self-isolate for 14 days. This means not attending public places including work, school or university, or childcare, not allowing visitors into the home and wearing a surgical mask if it becomes necessary to leave the home for medical treatment. See here.
With the exception of the blanket travel ban, which a number of other countries including New Zealand, and the United States have also imposed, Australia’s response remains low-key.
States and Territories are primarily responsible for managing outbreaks of infectious diseases within their territories, and this remains the case with 2019-nCoV.
The Commonwealth, on the other hand, has “primary responsibility for international border surveillance and responding to public health events occurring at international borders”: see the National Health Security Agreement (para 22).
The Australian Government Department of Health website states that:
Australia has not yet imposed centralised control or activated the coercive powers that are available if this outbreak were to gain momentum.
In Australia, the Australian Health Protection Principal Committee (AHPPC) is the peak body for national emergency health planning, preparedness, response and recovery during public health emergencies. AHPPC is administered by the Office of Health Protection, a division of the Australian Department of Health.
The National Health Security Agreement identifies a number of potential triggers for a coordinated national response, led by the AHPPC, with operational control vested in the Director of Human Biosecurity. However, it remains for the Commonwealth to assess whether the risks of disease transmission are so significant that they require a centralised, national operational response (see para 24).
An audit of the Health Department’s coordination of communicable disease emergencies notes the relative ambiguity of the conditions that would justify a national operational response (see pp 30-33, 47).
With travel bans keeping imported cases to a minimum, and limited scope for significant person-to-person spread within Australia, the States and Territories will very likely continue to retain operational control.
For example, under ss. 44-46, entry and exit requirements (as distinct from recommendations) may be imposed on classes of people to prevent the spread of a “listed human disease”, and there are civil penalties for failing to comply.
Similarly, individuals can be subjected to a “human biosecurity control order” containing any of a number of specific “biosecurity measures”, including isolation measures (s 97), restrictions on movement and behaviour (s 87), and the requirement to undergo examination and provide body samples (ss 90-91).
However, as s 44(1) and s 60 makes clear, these powers apply to a “listed human disease”: they exist to prevent a “listed human disease” from entering or spreading in Australia.
Section 42 contains the test that the Director of Human Biosecurity (the Commonwealth Chief Medical Officer) must apply before he or she lists a human disease. (The test is whether the disease is communicable and may cause significant harm to public health, and if the Director of Human Biosecurity has consulted with the chief health officers of the States and Territories.)
While there is nothing in principle to prevent the Chief Medical Officer from issuing a legislative instrument making 2019-nCoV a listed human disease under s 42, I am not aware that this has happened.
This does not mean that self-isolation “recommendations” are voluntary. It simply means that cases or contacts entering Australia are subject to the relevant State or Territory legislative framework that governs disease spread.
In NSW, “Novel Coronavirus 2019” was scheduled under the Public Health Act 2010 (NSW) by executive order on 21 January. As a result, a number of statutory obligations and public health powers thereafter apply to identified cases, and to those who have come in contact with a case.
For example, 2019-nCoV is notifiable by medical practitioners and laboratories (ss 54-55). A person infected with 2019-nCoV who is in a public place must take reasonable care not to spread the condition (s 52), and the Secretary of the NSW Health Department may direct a person to undergo medical examination on reasonable suspicion that they represent a risk to public health (s 61). There is a financial penalty for non-compliance.
If a person who is infected with or has been exposed to 2019-nCoV is behaving in a way that will likely endanger the public’s health, the Chief Health Officer of NSW can make a public health order requiring the person to refrain from behaviour that places others at risk and to undergo medical treatment and testing (s 62).
These are time-limited orders not exceeding 28 days (s 63) which can be reviewed by the Civil and Administrative Tribunal and, where necessary, extended (ss 65-66). Failure to comply with a public health order may result in a substantial fine (up to $11,000) or imprisonment.
These muscular State (and Territory) laws are, of course, premised on an infectious condition being scheduled under the Act, and on there being an adequate case definition to identify cases and contacts.
Early on in an outbreak of a novel infectious disease, a precise, workable case definition may not exist, together with information about modes of transmission, incubation period (prior to symptoms) and capacity for pre-symptomatic transmission. See here for the somewhat unwieldy definition of a “suspect case” of 2019-nCoV adopted in NSW, and Victoria, respectively.
Are you interested in studying health and medical law? Click here or here, for more information.
“Climate change is influencing the frequency and severity of dangerous bushfire conditions in Australia and other regions of the world, including through influencing temperature, environmental moisture, weather patterns and fuel conditions. There have been significant changes observed in recent decades towards more dangerous bushfire weather conditions for various regions of Australia.”
BOM is not a political organisation, but an executive agency of the Australian Government, established in 1906, charged with providing weather services and advice.
“The suggestion that any way shape or form that Australia, accountable for 1.3% of the world’s emissions, that the individual actions of Australia are impacting directly on specific fire events, whether it’s here or anywhere else in the world, that doesn’t bear up to credible scientific evidence”.
“[C]ommunities are increasingly under threat from extreme weather-driven events caused by climate change. If it’s not time now to speak about climate change and what’s driving these events – when? This fire season is going to go for months, so do we just simply get gagged? Because I think that’s what happening; some people want the debate gagged because they don’t have any answers”.
“The Grenfell fire in London? People talked about the cause from day one. Train crashes? They talk from day one. And it’s OK to say it’s arsonists’ fault, or pretend that greenies are stopping hazard-reduction burning – which simply isn’t true – but you’re not allowed to talk about climate change. Well we are, because we know what’s happening.”
“Well they don’t need the ravings of some pure, enlightened and woke capital city greenies at this time when they’re trying to save their homes and when they’re going out in many cases and saving other people’s homes and leaving their own homes at risk; what they don’t need is Adam Brandt and Richard Di Natale [Australian Greens’ politicians] trying to get a political point score on this, and it is disgraceful, it is disgusting, and I’ll call it out every time.”
It’s an interesting political position for the Nationals to take. It’s not woke, inner city, latte-sippers who stand to lose their homes to fire.
It’s homeowners on the edges of cities, rural and regional Australians, including those living on the land – in the grip of a drought that grinds on and on.
Climate change has risen rapidly to become one of the most important – perhaps the pre-eminent – public health challenge.
“You got it Mick! And if you point to the lack of action on root causes you’ll be “called out” for “exploiting personal tragedy for political gain”. But don’t worry, it’s OK to discuss the proximate causes and to show sympathy and solidarity with those who are suffering”.
“But if they cannot examine root causes, then how will they strengthen their defences against these terrible events?”
“They won’t”, says Scotty. “That’s the point. Ultimately these guys have ideological objections to being part of the solution”.
“Reminds me of an old saying”, says Mick. “Nero fiddled while Rome burned”.
“It’s like I’ve always said”, said Scotty. “No need to invade. Just sit back. They’re terra-forming the planet and getting it ready for us, without even being asked”.
On Friday 6 December 2019, the Board of the University of Sydney Law School voted unanimously in favour of a resolution declaring a climate change emergency.
The BMJ has published an Opinion calling on the Director-General of the World Health Organisation, Dr Tedros Adhanom Ghebreyesus, and the United Nations High Commissioner for Human Rights, Dr Michelle Bachelet, to jointly initiate a process to develop International Guidelines on Human Rights, Healthy Diets, and Sustainable Food Systems.
180 signatories from 38 countries have supported this Open Call – experts in global health and development, human rights, food systems, and HIV.
You can join the Call and add your name in support here, at the Healthy Societies 2030 website.
Healthy Societies is also hosting supporting documents, including a suggested process for strengthening links between human rights and healthy diets at the global level, and moving towards international guidelines. (You can contribute to the discussion form, follow on twitter, and join the mailing list).
But pausing for a moment.
How would International Guidelines on human rights and healthy diets make a difference?
These Guidelines helped to consolidate the framing of global strategy for HIV prevention and treatment in terms of the human rights of those affected by HIV.
And they provided language and conceptual tools for civil society organisations to hold governments to account.
In the BMJ Opinion, we argue that joint WHO/OHCHR guidelines could have a similar effect, by putting people at the centre of food systems, and strengthening the protection of health in global and national policies.
Framing global strategy effectively: the example of HIV
Getting global strategies right matters because they affect national strategies, actions and budgets.
A focus on human dignity, preventing discrimination, empowering those with, or at risk of HIV, and ensuring that no one is left behind – these human rights values lie at the core of global strategies to prevent transmission and treat infection.
It wasn’t always that way.
In Australia, in the 1980s and early 1990s, public debate about rising rates of HIV infection was often framed by prejudice and fear.
In Australia at that time, otherwise sane people were arguing that everyone in the country should be tested for HIV, and those with HIV should be removed from society or quarantined in the desert somewhere.
Fortunately, a kinder, more rational and humane approach – a human rights approach – prevailed.
By working with and through those affected by HIV – rather than against them – HIV rates have remained low in Australia.
It didn’t happen by accident. It took a great deal of effort to ensure that national strategy was framed in such a way as to make it effective.
(The Honourable Michael Kirby, a former Justice of the High Court, and tireless advocate for a human rights approach to HIV – especially during the critical decades of the 1980s and 1990s – is one of the signatories to this Open Call).
Why a human rights frame for healthy diets and sustainable food systems?
So human rights have played an honourable role in the global response to HIV.
But how could they have a similar positive impact on nutrition, diet, and health around the world?
Some of the most urgent public health problems today revolve around the interlinked crises of obesity, poor nutrition, hunger, and climate change.
The starting point is that in many countries, market forces are failing to deliver healthy diets, adequate nutrition and sustainable food systems.
If framing food purely as a commodity, and if framing food systems purely as business networks supplying commodities in response to market demand – was effective, then countries wouldn’t be buckling under the strain of a massive, preventable burden of diabetes, obesity and chronic, diet-related diseases.
The Lancet Commission on Obesity called for “a radical rethink of business models, food systems, civil society involvement, and national and international governance” to address these problems.
While many actions will need to be taken, the BMJ Opinion argues that human rights concepts and language are powerful, under-used tools.
Interested in the quality of food and drinks served in schools? Or the stealth marketing of unhealthy foods and drinks to children using online platforms? You could, of course, revert to the well-worn concepts of parental responsibility and consumer choice. How’s that working out?
International human rights law provides a powerful way to frame these, and other challenges.
States owe an obligation to respect, protect and fulfil the right to health, as recognised in Article 12 of the International Covenant on Economic, Social and Cultural Rights.
Joint WHO/OHCHR guidelines could help to push human rights concepts and language beyond the “UN human rights silo”.
The subtle form of forum sharing and coalition building that we advocate, through joint WHO/OHCHR guidelines, is increasingly recognised in other areas of the global health response, such as the Global Strategy to Accelerate Tobacco Control (2019), adopted by the Conference of the Parties to the WHO Framework Convention on Tobacco Control.
Many new ideas appear surprising at first glance. And action at the global level may appear indirect, and abstracted from reality.
However, International Guidelines on human rights and healthy diets could help to mobilize multisectoral action, strengthen the accountability of States and the private sector, and deepen community engagement in the urgent task of developing healthier, fairer and sustainable food systems.
Let’s leave no one behind.
You can join the Open Call on Dr Tedros and Dr Bachelet here.
The International Health Regulations (IHR) (2005) are the primary global instrument for responding to, and seeking to prevent and limit the impact of public health emergencies of international concern, including communicable diseases with pandemic potential. The International Health Regulations are legally binding on all World Health Organization (WHO) Member States, including Australia. The IHR were revised following the SARS outbreak in 2003.
Over the past decade, the world has faced a number of significant health events, including H1N1 pandemic influenza in 2009, the 2014–2016 Ebola outbreak in West Africa, and the 2018 Ebola outbreaks in the Democratic Republic of Congo. Each of these events has tested the utility and function of the revised IHR.
In this seminar, a panel of leading experts in public health law and global health security will examine whether the International Health Regulations are meeting their goal of protecting public health, international trade, and human rights, and whether the obligations in the IHR are sufficiently robust to respond to ever more complex public health emergencies.
The speakers are:
Dr Mark Eccleston-Turner, Lecturer in Law, Keele University
Title: The WHO response to Ebola in the DRC: a critical analysis of the legal application of the International Health Regulations
Dr. Alexandra Phelan, Centre for Global Health Science and Security, Georgetown University; Adjunct Professor, Georgetown University Law Center
Title: Human Rights under the International Health Regulations in an era of nationalism: laws in Australia and the United States
Dr. Sara Davies, A/Professor in International Relations, School of Government and International Relations, Griffith University
Title: The Politics of Implementing the International Health Regulations
Venue: Sydney Law School, Monday 17 June, 6.00-7.30pm.
This free event is a side-event to the first Global Health Security Conference in Sydney, Australia held from 18 – 21 June 2019.
The summary Guide, like the full report, was a collaboration between the World Health Organisation, International Development Law Organisation, Sydney Law School, and the O’Neill Institute for National and Global Health Law at Georgetown University, Washington DC.
The aim of the original report, published in January 2017, was to raise awareness about the role that the reform of public health law can play in advancing the right to health and creating the conditions in which people can live healthy lives.
The Update and Summary Guide keeps the same focus: providing an introduction to the role of law in health development, with links to the full report, while also drawing attention to topics that were beyond the scope of the original report, and to links between law and the health-related Sustainable Development Goals.
The Update and Summary Guide integrates new health data and refers to new developments, including a list of highly cost–effective legal measures for reducing risk factors for non-communicable diseases (“NCDs”), drawn from the updated Appendix 3 of the WHO Global Action Plan for Prevention and Control of NCDs. It also references selected new decisions, such as the unsuccessful claim by a tobacco company against Uruguay’s tobacco control laws, and the decision of the Constitutional Court of Colombia confirming the right to receive information about the health effects of sugary drinks.
The New York Times reports that US officials threatened to unleash trade sanctions and withdraw military aid from Ecuador unless it withdrew a resolution at May’s World Health Assembly calling on governments to “protect, promote and support breast-feeding”.
The article is worth reading in its entirety.
As the father of a currently breastfeeding infant, I find this kind of behaviour utterly repellent.
There are echoes of Right to Health language (respect, protect, fulfil) in the resolution which might have displeased the Americans, but the real motivator was American support for large corporate manufacturers of breast-milk substitutes.
Then Russia stepped in, and the intimidation apparently stopped.
“We’re not trying to be a hero here”, said a Russian delegate to the World Health Assembly, “but we feel that it is wrong when a big country tries to push around some very small countries, especially on an issue that is really important for the rest of the world.”
Plenty of ironies here. But they have a point.
According to the New York Times report, a Department of Health and Human Services spokesperson said: “The resolution as originally drafted placed unnecessary hurdles for mothers seeking to provide nutrition to their children. We recognize not all women are able to breast-feed for a variety of reasons. These women should have the choice and access to alternatives for the health of their babies, and not be stigmatized for the ways in which they are able to do so.”
Well gosh, that ought to sort out the doubters.
The Lancet reports that scaling up breast-feeding to near universal levels could avoid 823,000 deaths of children under 5 each year, and 20,000 maternal deaths from breast cancer.
Breastfeeding protects both mother and child, and it’s free, which is important if you’re poor.
Yet for billion dollar formula companies, the temptation to monetise the act of feeding by targeting young mothers, is just irresistible.
Read the Guardian’s investigation into Nestle’s marketing practices flogging formula to poor women in central Manila here. Then weep.
Amongst other things, it requests the WHO Director-General to provide, upon request, “technical support to Member States to establish, review and implement national laws, policies and programmes to support infant and young child feeding”.
The Code prohibits the advertising of infant formula and other breast-milk substitutes to the general public, to pregnant women and mothers, and to health workers who are concerned with infant and maternal nutrition. It also prohibits the giving of samples and other incentives for purchase. Governments are urged to implement the Code through national legislation, regulations or other suitable measures.
In addition, the Code states that infant formula should contain a clear statement of the superiority of breastfeeding, and a statement that the product should only be used following advice from a health worker. The container and labels should not contain pictures of infants, or include pictures or text that “may idealize the use of infant formula”.
Appropriately, the resolution does urge Member States (of the World Health Organisation) to strengthen national initiatives to implement the Code.
However, when you put it all together, it appears the Trump administration does not want sovereign countries receiving technical support from WHO about how best to frame their laws and policies to prevent predatory marketing practices that breach the Code.
It’s the Trump administration’s war on breastfeeding women.
Click here for information about the Australian Breastfeeding Association.
If you’re interested to learn more about law and non-communicable diseases, Sydney Law School is offering a Masters unit, “Law, Business & Healthy Lifestyles” in the coming semester. Click here for more information.