Assessing Proposals for New Global Health Treaties: An Analytic Framework |
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| Authors: | Steven J Hoffman John-Arne R?ttingen Julio Frenk |
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| Abstract: | We have presented an analytic framework and 4 criteria for assessing when global health treaties have reasonable prospects of yielding net positive effects.First, there must be a significant transnational dimension to the problem being addressed. Second, the goals should justify the coercive nature of treaties. Third, proposed global health treaties should have a reasonable chance of achieving benefits. Fourth, treaties should be the best commitment mechanism among the many competing alternatives.Applying this analytic framework to 9 recent calls for new global health treaties revealed that none fully meet the 4 criteria. Efforts aiming to better use or revise existing international instruments may be more productive than is advocating new treaties.The increasingly interconnected and interdependent nature of our world has inspired many proposals for new international treaties addressing various health challenges,1 including alcohol consumption,2 elder care,3 falsified/substandard medicines,4 impact evaluations,5 noncommunicable diseases,6 nutrition,7 obesity,8 research and development (R&D),9 and global health broadly.10 These proposals claim to build on the success of existing global health treaties ( | Open in a separate windowNote. Global health treaties are those that were adopted primarily to promote human health.TABLE 2—Examples of the Diverse Regulatory Functions Among Existing International Treaties | Domestic Obligations | Foreign Obligations | | Positive Obligations | The Framework Convention on Tobacco Control (2003) requires countries to restrict tobacco advertising, promotion, and sponsorship | The International Health Regulations (2005) requires countries to report public health emergencies of international concern to the World Health Organization | | The World Trade Organization''s Agreement on Trade-Related Aspects of Intellectual Property (1994) requires countries to protect patent rights | The Constitution of the World Health Organization (1946) requires countries to pay annual membership dues | | Negative Obligations | The International Convention on Economic, Social & Cultural Rights (1966) prohibits countries from interfering with a person’s right to the highest attainable standard of health | The Biological Weapons Convention (1972) and the Chemical Weapons Convention (1993) prohibit countries from using biological and chemical weapons, respectively | | The Stockholm Convention (2001) prohibits countries from producing certain persistent organic pollutants | The Geneva Conventions (1949) prohibit countries from torturing prisoners of war |
Open in a separate windowBut whether international treaties actually achieve the benefits their negotiators intend is highly contested.11–13 There are strong theoretical arguments on both sides, and the available empirical evidence conflicts. A recent review of 90 quantitative impact evaluations of treaties across sectors found some treaties achieve their intended benefits whereas others do not. From a health perspective, there is currently no quantitative evidence linking ratification of an international treaty directly to improved health outcomes. There is only quantitative evidence linking domestic implementation of policies recommended in treaties with health outcomes. For example, Levy et al. found that tobacco tax increases between 2007 and 2010 in 14 countries to 75% of the final retail price resulted in 7 million fewer smokers and averted 3.5 million smoking-related deaths; the World Health Organization recommended this policy as part of its MPOWER package of tobacco-control measures that was introduced to help countries implement the Framework Convention on Tobacco Control.14 Evidence of treaties’ direct impact on other social objectives is extremely mixed.1Even if prospects for benefits are great, international treaties are still not always appropriate solutions to global health challenges. This is because the potential value of any new treaty depends on not only its expected benefits but also its costs, risks of harm, and trade-offs.15 Conventional wisdom suggests that international treaties are inexpensive interventions that just need to be written, endorsed by governments, and disseminated. Knowledge of national governance makes this assumption reasonable: most countries’ lawmaking systems have high fixed costs for basic operations and thereafter incur relatively low marginal costs for each additional legislative act pursued. But at the international level, lawmaking is expensive. Calls for new treaties do not fully consider these costs. Even rarer is adequate consideration of treaties’ potentially harmful, coercive, and paternalistic effects and how treaties represent competing claims on limited resources.11,15When might global health treaties be worth their many costs? Like all interventions and implementation mechanisms, the answer depends on what these costs entail, the associated risks of harm, the complicated trade-offs involved, and whether these factors are all outweighed by the benefits that can reasonably be expected. We reviewed the important issues at stake, and we have offered an analytic framework and 4 criteria for assessing when new global health treaties should be pursued. |
