Joint Action and Learning Initiative
derway (e.g., the International Health Partnership and related initiatives and the Global Fund-GAVI- World Bank Health Systems Funding Platform), they have not transformed governance and fund- ing of the global health system. More fundamen- tal changes are required.
A coalition of civil society and academics has therefore launched the Joint Action and Learning Initiative on National and Global Responsibilities for Health (JALI). JALI seeks to develop a post- Millennium Development Goal (MDG) framework for global health, one rooted in the “right of ev- eryone to the enjoyment of the highest attainable standard of physical and mental health”1
(“right to
health”) aimed at securing universal health cover- age for all people. 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 responsibili- ties. JALI’s goal is a global agreement, such as a Framework Convention on Global Health (FCGH), which sets priorities, clarifies and creates account- ability for national and international responsibili- ties, and strengthens or develops corresponding institutions, such as a Global Health Fund.
In all of its work, JALI will be guided by the right to health, which is guaranteed by the Universal Decla- ration on Human Rights and the International Cov- enant on Economic, Social, and Cultural Rights, among other instruments. The most authoritative interpretation of this right, which has since been built upon by a series of reports by the United Nations (UN) Special Rapporteurs on the right to health and supplemented by decisions of national courts, comes from General Comment 14 of the UN Committee on Economic, Social and Cultural Rights (CESCR). The right to health, which covers both health care and the underlying determinants of health, contains four “interrelated and essen- tial elements,” namely health goods, services, and facilities must be available, accessible to ev-
eryone (including being affordable and geographi- cally accessible), acceptable (including culturally), and of good quality. States must respect, protect, and fulfill the right to health. That is, they must themselves refrain from interfering with people’s ability to realize this right (such as by discrimina- tion in access to health services), protect people from violations of this right by third parties, and actively ensure the full realization of this right. The right emphasizes equality and meeting the needs of disadvantaged populations, as well as the im- portance of people’s participation in health-related decisions. It includes certain “core obligations,” such as non-discrimination and ensuring essential primary health care.2
Even as JALI bases its efforts on the right to health, JALI will seek to further clarify this right, and ensure that it meets today’s realities and the expectations of populations, especially disadvan- taged communities. For example, court decisions have expanded the possibilities for immediately enforceable aspects of the right to health, and the relationship between the right to health and non- state actors such as corporations requires ampli- fication. Principles central to all social, economic, and cultural rights, such as progressive realization and the requirement that states spend the maxi- mum of their available resources towards achiev- ing these rights, require more precise standards both to inform states and to enhance accountabil- ity. The tensions that can occur between human rights law and other international legal regimes, such as trade, will need to be resolved – in favor of health and human rights.
JALI will draw inspiration from, and collaborate with, civil society movements, which are central to securing and ensuring adherence to a global health agreement. Such movements have spurred momentous transformations in health. Advocates changed the world’s response to AIDS from one marked by discrimination to one focused on em- powering marginalized people and scaling up HIV
ILSA Quarterly » volume 20 » issue 1 » October 2011
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