Joint Action and Learning Initiative
from 8.7% to 9.6% of government budgets from 2000 to 2007), it will not be until 2049 that aver- age health sector spending among African coun- tries reaches 15% of their budgets.
These benchmarks set a minimum bar for nation- al funding responsibilities, which extend beyond the health sector. National health responsibilities should comply with well-defined, measurable in- ternational standards, balanced against the flex- ibility necessary to respect national priorities, health profiles, and needs.
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States also have a responsibility to govern well, derived from central human rights tenets, such as participatory processes, transparent and ac- countable government, and non-discrimination and equality. Well-designed legal rules and institu- tional arrangements can facilitate honest admin- istrations, openness, and accountability, along with meaningful civil society and community par- ticipation in decision-making. The law, moreover, should guarantee equality and non-discrimination on the basis of race, sex, religion, disability, and other statuses. Measures to enhance account- ability to communities in India’s National Rural Health Mission, and Brazilian policies to reduce health disparities, offer instructive lessons.
3. What duties do states owe to people beyond their borders in securing the right to health?
Resource-poor states lack capacity to ensure all of their people even core health goods and services, much less a fuller realization of the right to health. Countries in a position to assist are obliged to do so under principles of international law and global social justice. The Committee on Social, Economic and Cultural Rights has declared that cooperation towards realizing the right to health is “an obliga- tion of all States,” particularly those “in a position to assist others.”7
All countries have mutual re-
sponsibilities towards ensuring the health of the world’s most disadvantaged.
Beyond development assistance, coordination and coherence is required across sectors, as global
health can be improved or harmed through state and international policies and rules that govern areas such as trade, intellectual property, health worker migration, international financing, and debt relief. These responsibilities extend to the exercise of state power and influence over multilateral insti- tutions such as the World Bank, International Mon- etary Fund, and World Trade Organization.
We invite readers to join JALI to develop widely shared understandings of national and global responsibilities for health. It is time to define— and to meet—these responsibilities, and to take a giant step towards transforming a world of gaping health inequalities into one of social justice and global health equity.
International aspects of the right to health are ill-defined. With limited exceptions, such as the commitment of wealthy countries to spend 0.7% of gross national product on official development assistance, health and development commit- ments are framed collectively, vaguely, or not at all. Even when countries make commitments, they often fail to follow through. For example, only one month after countries at the 2010 UN MDG Summit committed to provide “adequate fund- ing” for the Global Fund, pledges at the replenish- ment conference fell billions of dollars short. The Summit called for accelerated development as- sistance for health, though the rate of increase in assistance dropped during the global recession. Budget shortfalls in the aftermath of the financial downturn further threaten assistance levels.
4. What kind of global governance for health is needed to ensure that all states live up to their mutual responsibilities?
Translating a shared understanding of national and global responsibilities into new realities requires effective and democratic global governance for health. Notwithstanding the Paris Declaration on
ILSA Quarterly » volume 20 » issue 1 » October 2011
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