'We need a truly global response to public health challenges'

The Ebola crisis has graphically highlighted the dilemmas of addressing public health challenges across a globalised world: infectious diseases are no respecters of international borders. A Wellcome Trust funded conference in Birmingham on 21 and 22 November explored critical perspectives in relation to Global Health Law, reflecting on the new book of that name by Professor Lawrence O Gostin of Georgetown University, US.

The challenges for global public health are broader than the critical ‘emergency’ situation of Ebola that we face at present, with a spectrum of issues that need to be considered. Emergencies happen, but, despite the publicity they receive, they are only the tip of the iceberg. On a day-to-day basis, equally serious challenges are posed by issues such as smoking and obesity. To really tackle global health challenges, there need to be truly global responses.

But herein lies the rub: while attaining high-level agreement at international meetings and through international declarations provides part of the solution, this only goes so far. Translating such a commitment at regional and individual state levels requires effective dialogue, real communication, and co-operation – but also, crucially, political commitment and money. In an age of international austerity, the demands of global health can frequently be shunted to one side. There are examples where global public health measures have had influence on the approaches of regional political groupings and states. One example is the World Health Organization Framework Convention on Tobacco Control in 2003, which has proved influential in guiding approaches of member states who are signatories to the Convention. In Europe, for example, engagement with the Convention has provided some of the backdrop to the European Union’s (EU) efforts in this area, culminating in new regulation in the form of the Tobacco Directive in 2014. Yet even the latter measure illustrates the problems of trying to enable global health and global justice in the light of political and, at times murky, business realities. The progress of the Directive was accompanied by the resignation of the EU Health Commissioner, John Dalli, in October 2012 and an investigation by the European Ombudsman into complaints that the Commissioner did not disclose some 114 meetings with lobbyists from the tobacco industry.

Professor Gostin talks eloquently of reframing the debates around global health in terms of human rights and global justice. This is a call to arms. In relation to communicable diseases, which raise critical cross-border threats, states have been willing to engage. This is demonstrated by the International Health Regulations, which provide a framework for dealing with disease transmission. That does not mean, though, that international responses are sufficient to address such emergencies. As Professor Gostin has argued, what is needed is, in effect, an international disaster contingency fund to provide financial support. True responses to the challenges of global health require global vision, global structures and, critically, global governmental political will, co-operation and resources. Without such a truly effective global response, we are faced with the sad likelihood that in another decade, the resources received to tackle Ebola epidemics may come largely from the sincere efforts of a group of celebrities singing ‘Do they know it’s Christmas?’

Dr Sheelagh McGuinness
Birmingham Fellow, Birmingham Law School, University of Birmingham

Professor Jean McHale
Professor of Health Care Law, University of Birmingham