Global constitutionalism, applied to global health governance: uncovering legitimacy deficits and suggesting remedies
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Global constitutionalism, applied to global health governance: uncovering legitimacy deficits and suggesting remedies Gorik Ooms1*
and Rachel Hammonds2
Abstract Background: Global constitutionalism is a way of looking at the world, at global rules and how they are made, as if there was a global constitution, empowering global institutions to act as a global government, setting rules which bind all states and people. Analysis: This essay employs global constitutionalism to examine how and why global health governance, as currently structured, has struggled to advance the right to health, a fundamental human rights obligation enshrined in the International Covenant on Economic, Social and Cultural Rights. It first examines the core structure of the global health governance architecture, and its evolution since the Second World War. Second, it identifies the main constitutionalist principles that are relevant for a global constitutionalism assessment of the core structure of the global health governance architecture. Finally, it applies these constitutionalist principles to assess the core structure of the global health governance architecture. Discussion: Leading global health institutions are structurally skewed to preserve high incomes countries’ disproportionate influence on transnational rule-making authority, and tend to prioritise infectious disease control over the comprehensive realisation of the right to health. Conclusion: A Framework Convention on Global Health could create a classic division of powers in global health governance, with WHO as the law-making power in global health governance, a global fund for health as the executive power, and the International Court of Justice as the judiciary power. Keywords: Global health governance, Global constitutionalism, Health security, Right to health
Background Global constitutionalism is a school of thought in international law and international relations studies. According to Falk, global constitutionalism is about the “extension of constitutional thinking to world order” [1]. The “familiar solution”, or so argues Falk, would be “the establishment of a world government with centralized institutions equipped with coercive machinery”. But it would be a mistake “to reduce the perspective of global constitutionalism to governmental alternatives to the state system”: [1] constitutional thinking can be applied to global governance that does not take the form of a global government. * Correspondence: [email protected] 1 Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK Full list of author information is available at the end of the article
Global health governance, defined by Fidler as “the use of formal and informal institutions, rules, and processes by states, intergovernmental organizations, and nonstate actors to deal with challenges to health that require crossborder collective action to address effectively”, [2] includes several institutions that have been giv
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