Framework Convention on Global Health: Advancing Health Equity

1. A Framework Convention on Global Health: Advancing Health Equity Tim EvansDean, School of Public Health, BRAC University Partners in Population and Development Inter-Ministerial Conference November 2012, Dhaka, Bangladesh

2. Overview • What is the Framework Convention on Global Health (FCGH)? • Why an FCGH? • Benefiting the Global South • Towards an FCGH • Legal pathways towards a global health treaty

3. A Framework Convention on Global Health: The Basics

4. Background to the FCGH: Persisting Health Inequities and Challenges • Health inequities • Life expectancy in Sub-Saharan Africa (2011): 54 years • Life expectancy in high-income countries (2008): 80 years • Continued and emerging global health challenges • AIDS, TB, hunger, maternal and child deaths, lack of access to sanitation, etc., persist • Rapidly growing NCDs, injuries in the South

5. Background to the FCGH: Global Response Required and Possible • Pressures requiring global response • Growing but insufficient funding • Health worker migration • Population growth • Trade and intellectual property (access to medicines) • Global industry (e.g., tobacco, “big food”) • Power of law • Framework Convention on Tobacco Control • 176 countries party to FCTC • Action: more than 60% of 72 long-term state parties have increased tobacco taxes and expanded smoke-free public places

6. Proposed Response: The FCGH • Proposal for a new global health treaty • Core elements defined • Framework convention – global framework and commitments with protocols on specific issues (e.g., R&D, health worker migration) • UN Secretary-General Ban Ki-moon (2011): “Let the AIDS response be a beacon of global solidarity for health as a human right and set the stage for a future United Nations framework convention on global health.” • UNAIDS has strongly endorsed the need for an FCGH

7. Central FCGH Elements • Universal health coverage • Standards for health systems, public health interventions, underlying determinants of health • Financing framework covering domestic and global health financing • Right to health grounding, including accountability, participation, equity • Elevate health in other regimes (e.g., trade, financing, agriculture) • Alignment with national health strategies and systems • Innovative financing mechanisms • Strong mechanisms of monitoring, evaluation, and compliance

8. Benefitting the Global South

9. Health and Equity • Legal framework for policies and funding to significantly close health inequities and benefit health especially of least healthy populations • Health equity • Country-specific equity targets and strategies • Prioritize and support policies and processes to meet health needs of marginalized populations • Women’s rights • Address violence against women (e.g., legal capacity-building, norm change) • Maternal and child mortality audits

10. Population and Sustainable Development • Wealth from health • Productivity increase from better health • Improved child health > improved education > increased wealth • Sustainable development and population • Universal health coverage to include comprehensive reproductive health services • Reduce child mortality > reduced fertility

11. Access to Medicines and Health Workers • Protect access to medicines • Require bilateral and multilateral trade agreements to protect access to medicine • R&D • Protocol based on WHO’s Consultative Working Expert Group • Targets on public financing for R&D to address health needs in the South • Research outcomes as global public goods • Health worker migration • Build on WHO Global Code of Practice on the International Recruitment of Health Personnel

12. Accountable Health Systems • Accountability > increased confidence and legitimacy of state • Strengthen government efforts to improve population health • State and development partners ultimately all accountable to the public, especially those suffering most from health inequities • Mechanisms • Transparency • Remedies to health rights violations • Corrective measures where shortcomings

13. Country-led Processes • Establish legal norm and mechanisms to increase development partner alignment with national health plans developed through inclusive, participatory processes • Framework for sufficient, predictable, long-term financing • Benefiting the people: Strengthen capacities and policies to ensure community and civil society input in local, national, and international/development partner policies and to advance the right to health • Inclusive and participatory processes for translating FCGH norms to national targets and policies

14. From Proposal to Law: The First Steps

15. Possible Pathways Towards the FCGH • UN General Assembly • Establish committee to explore possibility (and begin drafting?) an FCGH • Request member states to submit to Secretariat views on an FCGH • World Health Assembly • Request Director-General initiate process towards an FCGH • Establish working group to negotiate and draft an FCGH • UN Human Rights Council • Human Rights Council Advisory Committee to explore or negotiate an FCGH

16. PPD Actions • Advance the FCGH • Briefing of PPD member state UN ambassadors • UN or WHA resolution to support and initiative process towards an FCGH • PPD permanent representative to UN and PPD ambassador send diplomatic correspondence to UN Secretary-General • Support FCGH principles in post-2015 development goals • The FCGH and the post-2015 development agenda • FCGH and Post-2015 Incorporation, available at http://jalihealth.org/publications.html

17. Involving Civil Society and Communities • Ensure FCGH meets the needs of poorest and most marginalized populations • Support Southern civil society and communities in input into FCGH • Civil society and communities as crucial allies towards a transformative FCGH

18. Joint Action and Learning Initiative on National and Global Responsibilities for Health (JALI) • What is JALI? • A global civil-society led coalition advocating for and supporting development of an FCGH • Committed to an ambitious treaty that will truly be grounded in the right to health • Initiating broad and inclusive process to develop FCGH contents

19. JALI • Who is JALI? • Steering Committee and Secretariat members • Center for Human Rights and Development (Uganda) • Communications for Development Centre (Nigeria) • Centre for Excellence for Universal Health Coverage (Bangladesh) • Medico International (Germany) • O’Neill Institute, Georgetown University Law Center (USA) • Hélène De BeirFoundation(Belgium) • Individual members from Brazil, India, Kenya, Nigeria, Norway, United Kingdom • Advisory Panel being formed • Who supports JALI? • Rockefeller Foundation

20. For Further Information… • JALI developing a “framework of a framework” to give more detail on the proposed FCGH • Draft planned for end of 2012 • www.jalihealth.org • Contacts • Sameera Hussain (sameera@bracu.ac.bd), School of Public Health, BRAC University, Bangladesh • Moses Mulumba (mulumbam@gmail.com), Center for Human Rights and Development, Uganda • Eric Friedman (eaf74@law.georgetown.edu), Georgetown University Law Center, USA