Babel Impulse Spurs WHO Global Health Equity Research Agenda
ENVIRONMENT & HEALTH, SOCIETY & CULTURE
Wednesday, January 13, 2010
The beginning of the 21st century is being marked by global governance ambitions arising from the Babel Impulse—the inherent desire of an elite cadre of world leaders and bureaucrats to articulate and build a tower of secular ethical norms designed to relieve the world of wealth disparities and human suffering that they attribute to the refusal of developed nations and transnational businesses to share the knowledge and means to generate wealth. This modern-day Tower of Babel is being built by a matrix of human rights governance networks that generate research and soft law norms that, in theory, will settle to form the hard law foundation of perpetual peace and security.
Thus, in a manner eerily reminiscent of the biased and non-transparent research process conducted by the United Nations and its appointed researchers to identify a broad range of domestic policies that would need to be globally governed to eliminate the inequitable impacts of global climate change, the World Health Organization (“WHO”) is embarking on a research agenda designed to identify the domestic “social determinants of health” which must be globally governed to eliminate inequitable global health outcomes.
In 2009, the Final Report of the WHO’s Commission on Social Determinants of Health (“CSDH”) (the “Report”) defined health equity as “the absence of systematic differences in health, both between and within countries, that are judged to be avoidable by reasonable action.” In the Report, the CSDH concluded that “social injustice is killing people on a grand scale” and made three overarching recommendations: improve people’s daily living conditions; tackle the inequitable distribution of power, money, and resources; and measure and understand the problem and assess the impact of action. (emphasis added) As it focuses on identifying and addressing the political, social, and economic causes of health inequities, the WHO is engaging in a fundamental shift in its approach to global health research.
Accordingly, the WHO has moved into what it refers to as the “third wave” in global health research. In the first phase, WHO-led global health research focused on biological disciplines and on developing medical solutions to be provided through individual patient care. The past two decades have witnessed a second wave of global health research, one marked by enlarging disciplinary perspectives, stakeholder analysis, and recognition that health systems can be designed more effectively through new knowledge. As explained by the WHO, in contrast to these first two waves of global health research, which, for the most part, were rooted in natural science and technology, the third wave of global health research, “explicitly links broader social, political and economic determinants with improvements in equity in health, within and across countries.”
The Geneva, Switzerland-based Equity Analysis and Research Unit of the WHO’s Ethics, Equity, Trade and Human Rights, Information, Evidence and Research Cluster (the “Unit”) is responsible for pursuing the WHO health equity research agenda. On September 9, 2009, the WHO published an issues paper commissioned by the Unit titled “Priorities for research on equity and health: Implications for global and national priority setting and the role of the WHO to take the health equity research agenda forward.” The geographic representation of the authors of the paper includes Australia (one), Canada (five), Chile (one), Sweden (two), Switzerland (one), and United Kingdom (three). Thus, the Unit relied on a handful of public health professionals, most of who hail from countries with nationalized health care systems, to author a paper that sets forth the priorities for international research on “equity and health.”
Unsurprisingly, the paper identifies four “generic directions” for WHO policy, program development, and resource allocation that will increase the ability of WHO’s Secretariat to “generate innovative responses” to global health inequities so as to “better serve its Member States,” including:
1. Bringing in the social scientists! The paper calls for the building of a critical mass of professional staff with backgrounds in social science and other non-medical disciplines. Obviously, since the WHO is going to move from a science-based medical research and policy organization to an agent for social transformations, it needs to broaden the competencies of its professional team.
2. Building the advocacy network! The paper calls for the building of networks for research support and advocacy and pursuing new research focused on “social determinants of health and health equity” with academic research units, civil society organizations, and other multi-lateral entities with relevant expertise.
3. Building the war chest! The paper calls for establishing and expanding a budget dedicated to supporting research and research policies relating to social determinants of health and health equity.
4. Building the measuring stick! The paper calls for the update and use of norms and standards for the monitoring and assessment of health inequalities and health inequities within and between nations.
The paper submits that, by advancing in these four areas, the WHO can take a leadership role in influencing policy, developing norms and standards, facilitating knowledge transfer, and promoting international cooperation in a manner that helps to alter or eliminate the political, social, and economic conditions that lead to health inequalities that, in turn, foster health inequities.
Thus, the beat goes on. Just as a few “independent” and unaccountable researchers commissioned by the Intergovernmental Panel on Climate Change produced climate change research that was relied upon to justify the global governance of domestic environmental and economic policies, the WHO is commissioning a few “independent” and unaccountable researchers to produce health equity research that will be relied upon to justify the global governance of domestic health, environmental, economic, and social policies.
Jim Kelly is the President of Solidarity Center for Law and Justice, P.C., a public interest civil and human rights law firm based in Atlanta, Georgia. The opinions expressed herein are his own.
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