An internationally renowned scholar in the fields of law and public health, Lawrence O. Gostin recently published Global Health Law (Harvard University Press, 2014). It has been called the defining work of an emerging field. In carving out an agenda for reform that is rooted in global equality, Gostin’s insights are profoundly applicable to the unfolding Ebola crisis in West Africa, which has exposed cruel gaps in access to health care.
Gostin is University Professor at Georgetown Law, the Founding O'Neill Chair in Global Health Law, Faculty Director of the O'Neill Institute for National and Global Health Law, and Director, World Health Organization Collaborating Center on Public Health Law & Human Rights. Interview by Dayna Kerecman Myers, Associate Editor of Global Health NOW.
With nearly 200 countries in the world, global health law seems like an exceedingly difficult prospect. How can countries be encouraged to act beyond their self-interest to advance a health framework based on justice and equality?
States have a compelling interest in curbing the spread of pathogens, such as novel influenzas and SARS. Emerging diseases pose not only health hazards but also deep social, economic, and human rights impacts. The current Ebola crisis, however, did not mobilize states until now. Why? Ebola virus is not airborne, and advanced health systems can contain it. But this has left a gaping governance deficit, with West Africa in the grips of an existential crisis. Perhaps Ebola will be a clarion wake-up call for greater global solidarity and governance.
In your recent article in the Lancet, you argue that even poor governments should allocate at least 15% of their budgets to health. What could be done to encourage compliance?
If states joined together collectively to achieve more robust health systems, everyone would be better off. What lower-income states need is an assurance by richer states to help them build health system capacity. Lower-income states, in return, would have to invest in health themselves. A health systems fund could be structured in just this way, perhaps undergirded by an international agreement, such as a Framework Convention on Global Health based on the human right to health. This kind of collective action would redound to the benefit of all countries.
You’ve highlighted transparency as a potential area for improvement—especially in the pharmaceutical and tobacco industries. How would you prod them towards greater transparency?
Transparency is just one of the key components of good governance, including monitoring progress, honesty (no corruption), community participation and accountability. All stakeholders have a duty to govern themselves well, including international organizations, governments, and the private sector. Good governance should be in the constitutional mandate of international organizations such as UNAIDS, the Global Fund and the GAVI Alliance. It is up to governments to ensure that the private and charitable sectors are honest and transparent. A well-regulated society aims to ensure that all actors are held to high ethical standards.
In your book and elsewhere, you’ve advocated for a Framework Convention on Global Health to fix structural deficiencies in low- and middle-income countries. How do you plan advance that goal?
We are advancing a Framework Convention on Global Health (FCGH) from the bottom up, through intense civil society engagement and social mobilization. In my book, Global Health Law, I point to the AIDS movement as a model for social action. We also expect that the BRICs states and other emerging economies will champion the Convention at the WHO and United Nations. Since the Convention is based on the human right to health, it has a powerful message.
You launch your book with an unusual approach—voices of young people around the world. How did you find these children, and can you share your favorite story?
When I proposed a traditional book foreword, written by Bill Gates, Michael Bloomberg, or Margaret Chan, Harvard University Press said no one was interested in what they had to say—too predictable. They sent me back to the drawing board and I am so glad they did. By starting the book with the real-life stories of young people in their own words, it vividly shows the human dimension of global health, which can be easy to forget. I worked with civil society partners in lower-income countries such as Bangladesh, Haiti and Uganda, who helped children convey their everyday lives in the most moving way. My favorite global health narrative was actually by a young man in the United States, designed to show that global health is not a distant concept or reserved for very poor countries. Joe, a young boy living on the Blackfeet Reservation in Montana told us about the drugs, alcohol, gambling and physical abuse he encountered while growing up. He ends this way, “My life is over, but what about the children.” It makes me weep whenever I read these narratives.