around the bar
July 5, 2008

Global Healthcare Problems Require Global Legal Solutions Say International Public Health Advocates

As far back as 1604, the dangers of one public health problem still extant were not only known but rallied against by the King of England. In his Counterblaste to Tobacco, King James I decried the use of tobacco as both a danger to one’s health and a social annoyance, calling it a “filthie smoake” and a “vile custome.” An excerpt from this tract was cited by World Justice Forum panelist Dr. Peter Boyle, executive director of the International Agency for the Research of Cancer, as evidence of the historic nature of tobacco use as a threat to public health.

Dr. Boyle was joined on the panel for “Public Health and the Rule of Law” by moderator David Byrne, former EU commissioner for health and consumer protection; Barbara Hatcher, secretary general of the World Federation of Public Health Associations; Ilona Kickbusch, professor at the Graduate Institute of International Studies; and, Dr. Pekka Puska, director general of the National Public Health Institute of Finland.

From their individual perspectives the panelists described not only smoking, but the lack of clean water and sanitation, preventable diseases and the lack of access to healthcare as the major public health problems facing the world today. Each also urged some sort of global cooperation in overcoming these problems, including global health treaties, building public health components into successful international organizations like the World Trade Organization and strengthening the legal empowerment of people in affected parts of the world.

Puska assessed the political aspects of public health and related concerns succinctly by saying that foreign policy and war were the old ways of conducting international affairs, and that business and commerce have become the new ways but that the focus ought to be on health and environmental issues. He added that success in this area will be attained only through cooperation and collaboration among the general populace, private and public resources. One opportunity for such collaboration is in the prevention of deaths from cardiovascular disease, which represents one-third of the world’s mortality – the number one cause of death in industrialized countries and growing in developing ones.

Hatcher emphasized the need for improvements in public sanitation, drinking water and environmental quality, stating that a 10 percent improvement in global public health would result from significant advances in these areas. She also cited the need for a confluence of public health principles with other public policies including trade and general governance, stating that access to pharmaceuticals and healthcare, worker safety and environmental quality must become part of the international legal framework.

Describing the impact on public health as “the lens through which foreign policy should be conducted,” Kickbusch advocated a form of global health diplomacy throughout her presentation. This new form of diplomacy would encompass shared interests and responsibilities, new policy mechanisms and the evolution of global health law, and include such varied actors as governments, NGOs and philanthropists. She described efforts to date as moving along a continuum from “soft” to “hard” law, from suggestions to regulations, with a desired goal of better health security and improved international relations.

Boyle’s interest in the smoking problem was not strictly historical – he cited disturbing statistics that showed growth in tobacco use among less well-off populations and noted that these trends were reflected in increased incidence of lung cancer and myocardial infarctions. Perhaps his most telling statistics revealed that over 9 percent of the world’s disease could be prevented if people everywhere had access to clean water and basic sanitation and hygiene. In raw numbers, he noted that over 1.1 billion people in the world do not have clean drinking water and that more than 2.5 billion have no sanitation.

Byrne summarized the discussion by noting that “strong international action” is required if global health law is to become a reality and if people around the world are to be legally empowered to ensure their own good health and longevity.

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