From Nanny State to Nanny UN: WHO Strategy Paves Way for Global Governance of National Health Policies
CORPORATE CITIZENSHIP, ENVIRONMENT & HEALTH, HUMAN RIGHTS, SOCIETY & CULTURE
Wednesday, February 18, 2009
Recently, the World Health Organization (WHO), a specialized Member State agency of the United Nations, has focused its attention on what has been termed the “social determinants of health.” According to the WHO’s Commission on Social Determinants of Health (CSDH), the social determinants of health are “the social factors leading to ill health and inequities,” including unemployment, unsafe workplaces, urban slums, globalization and lack of access to health systems. In 2009, the WHO is continuing its foray into matters that should fall under the purview of national policymaking, governance, social welfare, and finance.
At the end of January, the WHO’s Executive Board held its 124th Session. One of the agenda items included a discussion of the Medium-Term Strategic Plan 2008-2013. The plan, which will guide the WHO’s work over the next six years, outlines thirteen specific “strategic objectives,” some of which deal with addressing the social determinants of health. In May 2009, the WHO’s 62nd World Health Assembly will consider the plan for adoption.
Strategic objective seven of the plan outlines the WHO’s intention to “address the underlying social and economic determinants of health through policies and programmes that enhance health equity and integrate pro-poor, gender-responsive, and human rights-based approaches.” The plan relies heavily on the recommendations of the CSDH, and states that, in order to ensure that everyone’s right to the highest attainable standard of health is met, governments, civil society, international organizations and other actors will need to address the “social and economic factors that determine people’s opportunities for health.” Thus, according to the WHO, in order to realize the right to health, States are obligated to address such issues as poverty, urbanization, social exclusion, education, the environment and employment. Of course, in light of the evolving Responsibility to Protect doctrine, one can imagine the WHO and the UN calling for humanitarian intervention in cases where a State, in their view, is not adequately implementing an equitable, “pro-poor, gender-responsive, and human rights-based approach” to health.
Strategic objective six of the plan calls for States to adopt policies that “promote health and development, and prevent or reduce the risk factors for health conditions associated with use of tobacco, alcohol, drugs and other psychoactive substances, unhealthy diets, physical inactivity and unsafe sex.” Citing such documents as the WHO Framework Convention on Tobacco Control and WHO’s Global Strategy on Diet, Physical Activity and Health, the plan would have States regulate the risk factors that lead to unhealthy lifestyles.
The plan also calls for States to oversee the process of “urbanization” in order to ensure the “promotion of environments supportive to physical activity.” The plan suggests that corporations have an obligation to promote good health and hints that industries such as alcohol, tobacco, processed-food and sugar should be more tightly regulated in order to eliminate the negative risk factors it views as determinants of health.
The work of the CSDH in identifying those social factors that can lead to or exacerbate ill health is instructive. However, when the instructive observations of the CSDH become prescriptive policy objectives of the WHO, the potential for the global governance of national health care and the loss of national sovereignty is significant.
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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