全球卫生法:全球卫生治理的新趋势

全球化对全球人口的健康产生了深刻影响.疾病全球化呼吁公共卫生治理的全球化.全球卫生治理与传统的国际卫生治理在治理主体、治理方式、治理结构及价值取向等方面存在区别.全球卫生治理的目标是让全世界人民获得可能的最高水平的健康标准.人人享有健康的美好理想只有通过全球卫生"善治"才能实现.而实现全球卫生"善治"的主要机制是国际卫...     

Advancing sexual health through human rights: The role of the law

Since the International Conference on Population and Development, definitions of sexuality and sexual health have been greatly elaborated alongside widely accepted recognition that sexual health requires respect, protection and fulfilment of human rights. Considerable progress has also been made in enacting or changing laws that affect sexuality and sexual health, in line with human rights standards. These measures include legal guarantees against non-discrimination and violence, decriminalisation of consensual sexual conduct and guaranteeing availability, accessibility, acceptability and quality of sexual health information and services to all. Such legal actions have had positive effects on health and specifically on sexual health, particularly for marginalised populations. Yet in all regions of the world, laws still exist which jeopardise health, including sexual health, and violate human rights. In order to ensure accountability for the rights and health of their populations, states have an obligation to bring their laws into line with international, regional and national human rights standards. These rights-based legal guarantees, while insufficient alone, are essential for effective systems of accountability, achieving positive sexual health outcomes and the respect and protection of human rights.     

Leveraging non-binding instruments for global health governance: reflections from the Global AIDS Reporting Mechanism for WHO reform

As countries contend with an increasingly complex global environment with direct implications for population health, the international community is seeking novel mechanisms to incentivize coordinated national and international action towards shared health goals. Binding legal instruments have garnered increasing attention since the World Health Organization adopted its first convention in 2003.     

What do human rights bring to discussions of power and politics in health policy and systems?

ABSTRACT

Scholarly interrogations of power and politics are not endemic to the disciplines primarily tasked with exploring health policy and planning in the domestic or global domains. Scholars in these domains have come late to investigating power, prompted in part by the growing focus in domestic and global health research on the intersections between governance, globalization and health inequities. Recent prominent reports in this area increasingly point to human rights as important norms capable of responding in part to power differentials that sustain and exacerbate health inequities. Yet human rights law is not traditionally incorporated into health policy scholarship or education, despite offering important normative and strategic frameworks for public and global health, with distinctive contributions in relation to identifying and challenging certain forms of power disparity. This paper overviews two of these reports and how they see power functioning to sustain health inequities. It then turns to investigate what human rights and the right to health in particular may offer in addressing and challenging power in the health policy context.     

Advancing health equity in the global marketplace: How human rights can help

The WHO Commission on Social Determinants of Health (CSDH) ascribed health disparities within and between countries to “a toxic combination of poor social policies and programmes, unfair economic arrangements, and bad politics.” This article analyzes the relevance of the international human rights framework (IHRF) to the Commission’s goal of reducing health disparities with reference to both social scientific and legal scholarship. We begin with an overview of the IHRF, demonstrating its potential as a challenge to the normative foundations of the emerging global economic order. We then survey the research literature on mechanisms to ensure accountability for realization of health-related rights, emphasizing the potential effectiveness of making human rights enforceable through the courts, and the special need for mechanisms to hold countries and international institutions accountable for obligations related to the human right to health. We conclude by identifying three key directions for further research, policy and advocacy: comparative human rights litigation, specifically the willingness of courts to address broad policy and budgetary issues; the conditions under which governments legislate or constitutionalize economic and social rights; and how rich, powerful countries affect economic and social rights outside their borders.     

Great expectations for the World Health Organization: a Framework Convention on Global Health to achieve universal health coverage

Establishing a reform agenda for the World Health Organization (WHO) requires understanding its role within the wider global health system and the purposes of that wider global health system. In this paper, the focus is on one particular purpose: achieving universal health coverage (UHC). The intention is to describe why achieving UHC requires something like a Framework Convention on Global Health (FCGH) that have been proposed elsewhere,¹ why WHO is in a unique position to usher in an FCGH, and what specific reforms would help enable WHO to assume this role.     

中国参与全球环境与卫生治理:机遇、挑战与对策

中国参与全球环境与卫生治理机遇与挑战并存。主要机遇包括:(1)全球环境与卫生治理的走向与中国在此领域的战略部署高度吻合,为其积极参与全球环境与卫生治理提供了强大的内生动力。(2)全球环境与卫生领域的资源为中国提供了有益的参考和借鉴,有利于加快和完善国内环境与卫生领域的治理。(3)全球环境与卫生问题具有公益性质,是中国展现负责任大国形象的重要领域。(4)当前全球环境与卫生治理的相关制度还有待规范和完善,这为中国争取更多的话语权提供了机遇。主要挑战包括:(1)中国国内环境与卫生问题层出不穷,从而使得中国参与全球环境与卫生治理时精力有限,同时也面临较大的国际压力。(2)中国缺乏全球环境与卫生战略。(3)全球"大卫生观"尚未完全建立,有待进一步拓展和完善。(4)智力支撑不足。(5)在中国国际定位方面,中外存在分歧且呈现扩大趋势。为有效参与全球环境与卫生治理,中国应统筹国内和国际两个层面采取一系列应对措施。     

The World Health Organization policy on global women's health: new frontiers

This article reviews formal and informal mechanisms through which the World Health Organization (WHO) is promoting policies for the advancement of women's health. Specific attention is given to select examples of innovative strategies the WHO has adopted in recent years to increase political commitment to women's and children's health and influence the development of policies supportive of country efforts to achieve Millennium Development Goals 4 (MDG4) and MDG 5 (to reduce child mortality and improve maternal health, respectively).     

Mapping the governance of human resources for health in Serbia

This article maps the current governance of human resources for health (HRH) in relation to universal health coverage in Serbia since the health sector reforms in 2003.The study adapts the Global Health Workforce Alliance/World Health Organization four-dimensional framework of HRH in the context of governance for universal health coverage. A set of proxies was established for the availability, accessibility, acceptability and quality of HRH. Analysis of official HRH documentation from relevant institutions and reports were used to construct a governance profile of HRH for Serbia from the introduction of the reform in 2003 up to 2013. The results show that all Serbian districts (except Sremski) surpass the availability threshold of 59.4 skilled midwives, nurses and physicians per 10,000 inhabitants. District accessibility of health workforce greatly differed from the national average with variances from +26% to −34%. Analysis of national averages and patient load of general practitioners showed variances among districts by ±21%, whilst hospital discharges per 100 inhabitants deviated between +52% and −45%. Pre-service and in-service education of health workforce is regulated and accredited. However, through its efforts to respond to population health needs Serbia lacks a single coordinating entity to take overall responsibility for effective and coordinated HRH planning, management and development within the broader landscape of health strategy development.     

The future of global health cooperation: designing a new World Health Organization

This article discusses some needed changes to the functioning and management of the World Health Organization (WHO). WHO is unable to meet new challenges and needs reform. The Executive Board of WHO initiated an internal review in 1992 that led to a management-related focus, while informal groups within the agency tackled funding constraints. Some governments and nongovernmental groups have proposed reorganization of international health assistance. The authors urge that the public health sector and researchers join the reform effort. WHO was established in 1948 and was the sole global health agency. The demand for greater international health cooperation has increased over time. WHO is an association of sovereign states. WHO demonstrated success in eliminating smallpox, promotion of health policy, collection and dissemination of epidemiologic information, and establishment of standards in health care and medical ethics. WHO staff comprises about 5000 persons. The annual budget is too small at about US$900 million. In 1995 only 56% of receipts were collected. WHO's constitution mandates complete health for all, but there has been a widening gap between rich and poor and those with access to health services and those without. Absolute and relative poverty are the main determinants of premature mortality and ill health. The major challenge for health policy is this disparity; the focus of international collaboration should be on this issue. The machine metaphor of organizational structure no longer works in today's world. The authors propose that WHO limit functions in health development and create a full mandate for dealing with determinants of health. WHO should be participatory, open to constituents, autonomous, and flexible. Member states must be more powerful in policy formulation. Program implementation should occur in independent programs in a decentralized system.     

Democratizing the World Health Organization

A progressive erosion of the democratic space appears as one of the emerging challenges in global health today. Such delimitation of the political interplay has a particularly evident impact on the unique public interest function of the World Health Organization (WHO). This paper aims to identify some obstacles for a truly democratic functioning of the UN specialized agency for health. The development of civil society's engagement with the WHO, including in the current reform proposals, is described. The paper also analyses how today's financing of the WHO – primarily through multi-bi financing mechanisms – risks to choke the agency's role in global health. Democratizing the public debate on global health, and therefore the role of the WHO, requires a debate on its future role and engagement at the country level. This desirable process can only be linked to national debates on public health, and the re-definition of health as a primary political and societal concern.     

金砖国家卫生外交政策及其参与全球卫生治理的经验

全球化进程使各国将全球卫生治理作为重要战略关切,作为新兴国家代表的巴西、俄罗斯、印度、中国、南非这五个金砖国家(BRICS)在全球卫生治理领域发挥着日益重要的作用。本文比较和分析了金砖国家的卫生外交政策及其参与全球卫生治理的行动,总结了金砖国家参与全球卫生治理的特点及可供中国借鉴的经验,同时提出了作为多边合作机制的金砖国家在全球卫生领域中所面临的挑战。     

The exercise of public health powers in an era of human rights: the particular problems of tuberculosis

Public health legislation provides powers of removal to hospital and detention in circumstances where a patient with active, infectious tuberculosis (TB) is unwilling to comply with the recommended treatment programme. However, these public health powers were drafted at a time of very different scientific understandings of the epidemiology of disease, and at a time of a very different appreciation of the balance between State paternalism and individual rights. The re-emergence of TB as a serious threat to public health in Britain, and the increasing incidence of multi-drug-resistant TB raises concerns about public health approaches to non-compliant patients. The Human Rights Act (1998) introduces into English domestic law, protections against interference with individual rights by public authorities. The Human Rights Act not only provides a new basis of challenge of the exercise of powers by a public body, but has also had implications for the development of traditional means of challenge such as judicial review and litigation for damages. The consequence is that NHS authorities and local authorities are now more vulnerable to challenge in the exercise of public health powers. Health bodies should explore all possible alternatives to detention of a patient suffering from TB. It is to be hoped that the heralded reform to public health legislation is undertaken as a priority.     

Homeless encampments: connecting public health and human rights

The COVID-19 pandemic is exacerbating longstanding issues related to homelessness, including lack of affordable housing, unemployment, poverty, wealth inequality, and ongoing impacts of colonization. Homelessness is often accompanied by narratives rooted in individual blame, criminalization, and reinforcement of substance use and mental health-related stigma. Visible homelessness, in the form of encampments, is a manifestation of government policy failures that neglect to uphold the human right to housing, and demonstrate eroding investments in affordable housing, income and systemic supports. Encampments make visible that some in our community lack basic determinants of health such as food, water, sanitation, safety, and the right to self-determination. In order for public health to effectively and equitably promote health and enact commitments to social justice, we argue that public health must adopt a human rights approach to housing and to homeless encampments. Embracing a human rights perspective means public health would advocate first and foremost for adequate housing and other resources rooted in self-determination of encampment residents. In the absence of housing, public health would uphold human rights through the provision of public health resources and prohibition on evictions of encampments until adequate housing is available.     

Health care, public policy and the courts: black health status as a civil rights issue.

In the U.S.A. serious differences in the health status between black and white citizens continue to exist. Black Americans are less healthy and receive less health care than while Americans. The discrimination is examined as a civil rights issue with focus on both the policy and judicial perspectives of the application of Title VI of the Civil Rights Act of 1964 and the implementative effects of the Hill-Burton Act of 1946. The application, and compliance and enforcement, of civil rights to health care is complicated by a captivity process involving Federal agencies, by corporate medical rights emphasizing a business approach to health care, and by a liberal pluralistic political arena in which certain influential groups prevail over others. In order for black health status and care to improve in the U.S.A., blacks must continue to utilize the judicial system to seek redress of health care inequities. Second, they must utilize their demonstrated political power to demand better treatment from the medical establishment.     

The World Health Organization and Global Health Governance: post-1990

This article takes a historical perspective on the changing position of WHO in the global health architecture over the past two decades.     

传染病问题的全球治理机制及其完善

为了应对新发传染病带来的全球卫生危机,国际社会发展和完善了现代国际卫生合作机制,初步形成了传染病的全球治理机制。由于受到全球经济发展不平衡、国际民主失衡与冲突频发、多个并存的国际组织公共卫生职能重叠、非政府组织参与全球卫生治理的有效性有待提高等因素的影响,初具雏形的传染病全球治理机制还比较粗糙,有待在传染病治理的实践中接受检验并不断完善。建议加强世界卫生组织的领导地位、增加全球卫生投入、改善全球经济治理机构、推动国际政治民主化、协调伙伴关系、明确非政府组织的法律地位、重视健康的决定因素。     

Appraisal of guidelines developed by the World Health Organization

Objective

To appraise the quality of guidelines developed by the World Health Organization (WHO) that were approved by its Guidelines Review Committee (GRC) and identify strengths and weaknesses in the guideline development process.

Study design

Cross-sectional.

Methods

Three individuals independently assessed GRC-approved WHO guidelines using the Appraisal of Guidelines for Research and Evaluation II instrument (AGREE II). Scores were standardized across domains and overall quality was determined through consensus.

Results

124 guidelines met inclusion criteria and were assessed. 58 guidelines were recommended for use, 58 were recommended with modifications and eight were not recommended. The highest scoring domains across guidelines were scope and purpose, and clarity of presentation. The recommended guidelines had higher rigor of development and applicability domain scores in comparison to other guidelines. 77% of the guidelines referenced an underlying evidence review and 49% used GRADE to assess the body of evidence or the strength of the recommendation. The domains in need of improvement included stakeholder engagement, editorial independence, and applicability. Guidelines not recommended for use were generally insufficient in their rigor of development.

Conclusions

WHO guidelines need further improvement, most importantly in the rigor of their development (i.e., use of evidence reviews). Other areas for improvement include increased stakeholder engagement, a more explicit process for recommendation formulation and disclosure of interests, discussion of the facilitators, barriers, resource implications, and criteria for monitoring the outcomes of guideline implementation. WHO guidelines can improve through increased transparency, adherence to the WHO Handbook for Guideline Development, and better oversight by the GRC.