1. International Obligations through Collective Rights: Moving from Foreign Health Assistance to Global Health Governance Benjamin Mason Meier, JD, LLM, PhD Assistant Professor of Global Health Policy University of North Carolina – Chapel Hill Ashley M. Fox, MA, PhD Post-doctoral Fellow Harvard School of Public Health November 9, 2009

2. Outline 1.Background – Foreign Assistance for Global Health 2.Results – Limited Evolution of the Right to Health to Codify International Obligations 3.Analysis – Collective Rights as a Means to International Obligations 4.Proposal – Employing Collective Rights for Global Health Governance a.Development b.Implementation BackgroundResultsAnalysisProposal

3. Foreign Assistance for Global Health Entrenched poverty – Neoliberal Development Policy Neoliberal Development Policy – Health Inequity Foreign Assistance – ODA – Megaphilanthropy – IFIs Vertical vs. Horizontal Aid – Biomedical services – Primary health care systems BACKGROUND ResultsAnalysisProposal Ill Health Inequitable Poverty

4. Human Rights-Based Approach to Foreign Assistance Human Right = Valid demand & Corresponding duty (An Individual has a right against the State in relation to Health) Demand of Rights Programs to Realize Rights Duty bearer Rights holder BACKGROUND ResultsAnalysisProposal

5. The existing gross inequality in the health status of the people particularly between developed and developing countries as well as within countries is politically, socially and economically unacceptable and is, therefore, of common concern to all countries. Limited Evolution of the Right to Health to Codify International Obligations 1945 1965 1985 2005 Universal Declaration of Human Rights International Covenant on Economic, Social and Cultural Rights Declaration of Alma-Ata Millennium Development Goals General Comment 14 UN Special Rapporteur on the Right to Health MDGs for Health Background RESULTS AnalysisProposal

6. Incomplete Success of the Right to Health Right to Health Cannot Address Primary Health Care Is a Right to Medicines All We’ve Got? Right to Health Cannot Address International Development What is Sovereignty in a Globalized World? – State responsibility for human rights is unable to address changes to state sovereignty – Where the violator is an international institution or transnational corporation, human rights law cannot provide redress to the national victim Background RESULTS AnalysisProposal

7. Collective Rights as a Means to International Obligations Collective Rights as Necessary to Realize Global Public Goods The Rise of Collective Rights to Challenge Global Institutions BackgroundResults ANALYSIS Proposal

8. Employing Collective Rights for Global Health Governance Vector of Rights for Interconnected Determinants of Health International Obligations against the International Community – Enforce Global Health Commitments – Channel Assistance to Primary Health Care – Ensure Cooperation in International Institutions Collective Rights – Development – Implementation BackgroundResultsAnalysis PROPOSAL

9. A State has a right against the International Community in relation to Primary Health Care Systems Demand of Rights (International/Intra- national) Developing State – Rights holder International Community – Duty bearer Policies to Realize Rights RespectProtectFulfill Refraining from infringing states’ autonomy to develop primary health care systems Regulating transnational private actors Promoting cooperation through international institutions BackgroundResultsAnalysis PROPOSAL

10. Developing Human Rights Claims – Policies to Realize Collective Rights RespectProtectFulfill Refraining from infringing states’ autonomy to develop primary health care systems Regulating transnational private actors Promoting cooperation through international institutions BackgroundResultsAnalysis PROPOSAL

11. Implementing Human Rights Claims – Demand of Collective Rights International – Restructure international institutions – Create multilateral global governance institutions Primary Health Care through WHO Intranational – Ensure assistance is channeled through General budgetary support Sector-wide approaches to national primary health care systems BackgroundResultsAnalysis PROPOSAL

12. Benjamin Mason Meier, JD, LLM, PhD Assistant Professor of Global Health Policy University of North Carolina – Chapel Hill bmeier@unc.edu