The Joint Action and Learning Initiative:
Towards a Framework Convention on Global Health* by Lawrence O. Gostin and Eric A. Friedman
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Sub-Saharan Africa is 53 years—only two years higher than in the United States a century ago, and 27 years lower than in high-income countries today. The most basic human needs continue to elude the world’s poorest people. In 2010, approx- imately 925 million people were suffering from chronic hunger, 884 million people lacked access to clean water, and 2.6 billion people were without access to proper sanitation facilities. Even after decades of progress, nearly 8 million children die annually be- fore they reach the age of five, and a woman in Sub-Saharan Afri- ca is almost 140 times more likely to die during or shortly after preg- nancy during her lifetime than a woman in a developed country. More than 4 million people die annually of AIDS, tuberculosis, or malaria, overwhelmingly in devel- oping countries.
A
decade into the twenty-first century, billions of people have yet to benefit from the health advances of the twen- tieth century. Life expectancy at birth in
states, dramatic health differences exist and are closely linked with socioeconomic status. A black unemployed youth in Baltimore, Maryland has a lifespan 32 years shorter than a white corporate professional.
JALI seeks to clarify the health
goods and services to which all people are entitled, national and global responsibilities to secure the health of the world’s population, and governance structures required to realize these responsibilities.
JALI’s goal is a global agreement which sets priorities, clarifies and creates accountability for national and international responsibilities, and strengthens or develops cor- responding institutions.
These inequities do not exist because of a lack of know-how, as recent progress demonstrates. The number of people receiving AIDS treatment in low- and middle-income countries grew 22-fold from 2001 to 2010, reaching 6.6 million people by the end of 2010—even as at least 9 mil- lion more are in need of treat- ment. Brazil has overcome vast inequities to achieve near universal coverage of skilled birth attendants for all income quintiles.
Rather, such global health disparities will likely persist until there is fair and effective global governance for health, which entails the organization of national and global norms, institutions, and processes
Within countries, too, there are gross health in- equalities. In Nairobi, Kenya, the death rate for children under five in the worst-off slums is a frac- tion of the rate in the wealthiest neighborhoods. Coverage of skilled health personnel during deliv- ery is a meager 30% for women in the poorest quintile in 38 countries with among the highest levels of maternal death, compared with more than 80% coverage for women in the wealthiest quintile in these countries. Even within wealthy
that collectively shape the health of the world’s population. Global governance for health goes beyond the health sector. It requires remediation of the currently unfair and detrimental health im- pacts of international regimes (e.g., trade, intel- lectual property, and finance); developing stable, responsive, democratic political institutions; and effectively addressing such social determinants of health as women’s equality. Although helpful reforms to donor funding arrangements are un-
ILSA Quarterly » volume 20 » issue 1 » October 2011
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