Van de Pas Remco, Hill Peter S, Hammonds Rachel, Ooms Gorik, Forman Lisa, Waris Attiya, Brolan Claire E, McKee Martin, Sridhar Devi
Department of Public HealthInstitute of Tropical Medicine, AntwerpAntwerpen2000Belgium.
Clingendael InstituteThe HagueDen Haag2509 ABThe Netherlands.
Glob Chall. 2017 Jan;1(1):47-60. doi: 10.1002/gch2.1022. Epub 2017 Jan 10.
This paper explores the extent to which global health governance - in the context of the early implementation of the Sustainable Development Goals is grounded in the right to health. The essential components of the right to health in relation to global health are unpacked. Four essential functions of the global health system are assessed from a normative, rights-based, analysis on how each of these governance functions should operate. These essential functions are: the production of global public goods, the management of externalities across countries, the mobilization of global solidarity, and stewardship. The paper maps the current reality of global health governance now that the post-2015 Sustainable Development Goals are beginning to be implemented. In theory, the existing human rights legislation would enable the principles and basis for the global governance of health beyond the premise of the state. In practice, there is a governance gap between the human rights framework and practices in global health and development policies. This gap can be explained by the political determinants of health that shape the governance of these global policies. Current representations of the right to health in the Sustainable Development Goals are insufficient and superficial, because they do not explicitly link commitments or right to health discourse to binding treaty obligations for duty-bearing nation states or entitlements by people. If global health policy is to meaningfully contribute to the realization of the right to health and to rights based global health governance then future iterations of global health policy must bridge this gap. This includes scholarship and policy debate on the structure, politics, and agency to overcome existing global health injustices.
本文探讨了在可持续发展目标早期实施背景下的全球卫生治理在多大程度上基于健康权。剖析了与全球卫生相关的健康权的基本要素。从规范性、基于权利的角度评估了全球卫生系统的四项基本功能,分析了这些治理功能应如何运作。这些基本功能包括:全球公共产品的生产、各国间外部性的管理、全球团结的动员以及管理工作。本文描绘了2015年后可持续发展目标开始实施之际全球卫生治理的现状。理论上,现有人权立法将为超越国家前提的全球卫生治理提供原则和基础。但在实践中,人权框架与全球卫生及发展政策中的实践之间存在治理差距。这种差距可由影响这些全球政策治理的健康政治决定因素来解释。可持续发展目标中目前对健康权的表述不够充分且流于表面,因为它们没有将承诺或健康权话语与有责任的民族国家的具有约束力的条约义务或人们的权利明确联系起来。如果全球卫生政策要切实有助于实现健康权以及基于权利的全球卫生治理,那么未来的全球卫生政策迭代必须弥合这一差距。这包括关于结构、政治和行动主体的学术研究及政策辩论,以克服现有的全球卫生不公正现象。