Global public health agreements are heralded as a success for the affirmation of the right to health within a complex and contested political landscape. However, the practical implementation of such agreements at the national level is often overlooked. This article outlines two radically different global health agreements: The Doha Declaration on the Trade-Related Aspects of Intellectual Property Rights (TRIPS) agreement and Public Health; and the Framework Convention on Tobacco Control (FCTC). We identify significant challenges in their implementation, particularly for low and middle income countries. Shifts in the policy network constellations around these two agreements have allowed for some positive influence by civil society. Yet industry influence at the national level constrains effective implementation and those affected by these policies have largely been left on the periphery. The broader provisions of these two agreements have been watered down by vested interests and donor conditions. We advocate for both activist and academic actors to play a significant role in highlighting the consequences of these power asymmetries. Deliberative democracy may be the key to addressing these challenges in a way that empowers those presently excluded from effective participation in the policy？process.
References
[1]
Lee, K.; Fidler, D. Avian and pandemic influenza: Progress and problems with global health governance. Glob. Public Health 2007, 2, 215–234, doi:10.1080/17441690601136947.
[2]
Bartsch, S.; Kohlmorgen, L. The Role of Civil Society Organisations in Global Health Governance. In Global Health Governance and the Fight Against HIV/AIDS; Hein, W., Bartsch, S., Kohlmorgen, L., Eds.; Palgrave Macmillan: Hampshire, UK, 2007; pp. 92–118.
[3]
Ng, N.Y.; Ruger, J.P. Global health governance at a crossroads. Glob. Health Gov. 2011, 3, 1–36.
[4]
Brown, T.M.; Cueto, M.; Fee, E. The World Health Organization and the transition from “International” to “Global” public health. Am. J. Public Health 2006, 96, 62–72, doi:10.2105/AJPH.2004.050831.
[5]
Silver, G.A. International health services need an interorganizational policy. Am. J. Public Health 1998, 88, 727–729, doi:10.2105/AJPH.88.5.727-a.
[6]
The Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria. Global Fund Welcomes US Secretary of State Hillary Clinton support for Global Fund; The Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria: Geneva, Switzerland, 9 November. Global Fund Welcomes US Secretary of State Hillary Clinton support for Global Fund; The Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria: Geneva, Switzerland, 2011.
[7]
World Trade Organisation. Understanding the WTO: Intellectual Property: Protection and Enforcement; World Trade Organisation: Geneva, Switzerland, 2011. Available online: http://www.wto.org/english/thewto_e/whatis_e/tif_e/agrm7_e.htm (acccessed on 12th December 2011).
[8]
Sell, S.K. Trips-plus free trade agreements and access to medicines. Liverp. Law Rev. 2007, 28, 41–75, doi:10.1007/s10991-007-9011-8.
[9]
World Trade Organization. Declaration on the TRIPS Agreement and Public Health; World Trade Organization: Geneva, Switzerland, 2001. Available online: http://www.wto.org/english/thewto_e/minist_e/min01_e/mindecl_trips_e.htm (accessed on September 2010).
[10]
Finnemore, M. Norms, culture, and world politics: Insights from sociology’s institutionalism. Int. Org. 1996, 50, 325–347, doi:10.1017/S0020818300028587.
[11]
t Hoen, E. The Global Politics of Pharmaceutical Monopoly Power: Drug Patents, Access, Innovation and the Application of the WTO Doha Declaration on TRIPS and Public Health; AMB Publishers: Diemen, The Netherlands, 2009.
[12]
t Hoen, E. TRIPS, pharmaceutical patents, and access to essential medicines. Chic. J. Int. Law 2002, 3, 27–46. 15709298
[13]
Sell, S.A. Private Power, Public Law: The Globalisation of Intellectual Property Rights; Cambridge University Press: Cambridge, UK, 2003.
[14]
Drahos, P. Four lessons for developing countries from the trade negotiations over access to medicines. Liverp. Law Rev. 2007, 28, 11–39, doi:10.1007/s10991-007-9014-5.
[15]
Correa, C.M. Intellectual Property Rights and Inequalities in Health Outcomes, WHO Commission on Social Determinants of Health. In Globalization Knowledge Network Research Paper; Institute of Population Health, University of Ottawa: Ottawa, Canada, 2007; pp. 1–28.
[16]
Millennium Development Goal Gap Task Force. Strengthening the Global Partnership for Development in a Time of Crisis; United Nations: Geneva, Switzerland, 2009; p. 50.
[17]
World Health Organisation (WHO). WHO Framework Convention on Tobacco Control; World Health Organisation: Geneva, Switzerland, 2005.
[18]
Mamadu, H.M.; Glantz, S.A. Civil society and the negotiation of the Framework Convention on Tobacco Control. Glob. Public Health 2009, 4, 150–168, doi:10.1080/17441690802095355.
[19]
Framework Convention Alliance. FCA Membership Directory. Available online: http://www.fctc.org/index.php?option=com_sobi2&catid=8&Itemid=26 (accessed on 27 February 2012).
[20]
Mamadu, H.M.; Hammond, R.; Glantz, S.A. International trade versus public health during the FCTC negotiations, 1999-2003. Tob. Control 2011, 20, 1–10, doi:10.1136/tc.2010.040279.
[21]
Assunta, M.; Chapman, S. Health treaty dilution: A case study of Japan’s influence on the language of the WHO Framework Convention on Tobacco Control. J Epidemiol. Commun.Health 2006, 60, 751–756, doi:10.1136/jech.2005.043794.
[22]
Grüning, T.; Weishaar, H.; Collin, J.; Gilmore, A.B. Tobacco industry attempts to influence and use the German government to undermine the WHO Framework Convention on Tobacco Control. Tob. Control 2012, 21, 30–38, doi:10.1136/tc.2010.042093.
[23]
Innovative Medicines South Africa (IMSA). Referencing Pricing–Background Informtion and IMSA Position; IMSA: Houghton, South Africa, N.D; pp. 1–4. Available online: http://www.imsa.org.za/files/Library/IMSA%20Position%20Statements%20and%20Issues(1)/IMSA% 20Position%20on%20Reference%20Pricing.pdf (accessed on 8 March 2012).
[24]
World Health Organisation (WHO). Global Progress Report on Implementation of the WHOFramework Convention on Tobacco Control; World Health Organisation: Geneva, Switzerland, 2010.
[25]
Albuja, S.; Daynard, R.A. The Framework Convention on Tobacco Control and the adoption of domestic tobacco control policies: The Ecaudorian experience. Tob. Control 2009, 18, 18–21, doi:10.1136/tc.2008.026385.
[26]
Sussman, S.; Pokhrel, P.; Black, D.; Kohrman, M.; Hamann, S.; Vateesatokit, P.; Nsimba, S.E.D. Tobacco control in developing countries: Tanzania, Nepal, China and Thailand as examples. Nicotone Tob. Res. 2007, 9, S447–S457.
[27]
Lin, V. The Framework Convention on Tobacco Control and health promotion: strengthening the ties. Global Health Promotion 2010, 17, 76–80, doi:10.1177/1757975909358365.
[28]
Wipfli, H.; Stillman, F.; Tamplin, S.; Luiza de Costa e Silva, V. Achieving the Framework Convention on Tobacco Control’s potential by investing in national capacity. Tob. Control 2004, 13, 433–437, doi:10.1136/tc.2003.006106.
[29]
Ross, H.; Stoklosa, M. Development assistance for global tobacco control. Tob. Control 2011.
[30]
Callard, C. Follow the Money: How the billions of dollars that flow from smokers in poor nations to companies in rich nations greatly exceed funding for global tobacco control and what might be done about it. Tob. Control 2010, 19, 285–290, doi:10.1136/tc.2009.035071.
[31]
Calain, P. From the field side of the binoculars: A different view on global public health surveillance. Health Policy Plan. 2007, 22, 13–20, doi:10.1093/heapol/czl035.
[32]
The Global Fund Adopts New Strategy to Save 10 Million Lives by 2016; The Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria: Geneva, Switzerland, 2011.
[33]
Médecins Sans Frontières (MSF). MSF Response to Unprecedented Decision to Cancel Funding Round of the Global Fund to Fight AIDS, TB and Malaria; Médecins Sans Frontières: Geneva, Switzerland, 2011.
[34]
World Health Organisation (WHO). WHO Report on the Global Tobacco Epidemic; World Health Organisation: Geneva, Switzerland, 2009.
[35]
Bloomberg Philanthropies and Bill and Melinda Gates Foundation. Michael Bloomberg and Bill Gates Join to Combat Global Tobacco Epidemic; Bloomberg Philanthropies and Bill and Melinda Gates Foundation: New York, NY, USA, 23 July 2008. Available online: http://www.tobaccofreecenter.org/files/pdfs/en/Bloomberg-GatesReleaseFinal.pdf (accessed on 8 December 2011).
[36]
Beall, R.; Kuhn, R. Trends in compulsory licensing of pharmceuticals since the Doha declaration: A database analysis. PLoS Med. 2012, 9, e1001154, doi:10.1371/journal.pmed.1001154.
[37]
Birn, A. Gate’s grandest challenge: Transcending technology as public health ideology. Lancet 2005, 366, 514–519, doi:10.1016/S0140-6736(05)66479-3.
[38]
Baum, F. From Norm to Eric: Avoiding lifestyle drift in Australian health policy. Aust. N. Z. J. Public Health 2011, 35, 404–406, doi:10.1111/j.1753-6405.2011.00756.x.
[39]
Baum, F.E.; Sanders, D.M. Ottawa 25 years on: A more radical agenda for health equity is still required. Health Promot. Int. 2011, 26, 253–257.
[40]
De Leeuw, E.; Clavier, C. Healthy public in all policies. Health Promot. Int. 2011, 26, 237–244.
[41]
Hunter, D.J.; Popay, J.; Tannahill, C.; Whitehead, M. Getting to grips with health inequalities at last? Marmot Review calls for renewed action to create a fairer society. BMJ 2010, 340, 323–324, doi:10.1136/bmj.c323.
[42]
Barraclough, S.; Marrow, M. The political economy of tobacco and poverty alleviation in Southeast Asia: Contradictions in the role of the state. Glob. Health Promot. 2010, 17, 40–50, doi:10.1177/1757975909358243.
[43]
Lv, J.; Su, M.; Hong, Z.; Zhang, T.; Wang, B.; Li, M. Implementation of the WHO Framework Convention on Tobacco Control in mainland China. Tob. Control 2011, 20, 309–314, doi:10.1136/tc.2010.040352.
[44]
Collin, J. Global health, equity and the WHO Framework Convention on Tobacco Control. Glob. Health Promot. 2010, 17, 73–75, doi:10.1177/1757975909358363.
[45]
Chapman, S.; Freeman, B. Feature: From brand to bland—The demise of cigarette packaging. BMJ 2011, 343.
[46]
Basheer, S. India’s tryst with TRIPS: The patents amendment act 2005. Indian J. Law Technol. 2006, 1, 15–46.
[47]
Médecins Sans Frontières (MSF). Brazilians Demand Greater Access to Crucial HIV Drug; Médecins Sans Frontières: Geneva, Switzerland, 2011.
[48]
Médecins Sans Frontières (MSF). What Future for India’s Patent Act? Novartis vs. Union of India; Médecins Sans Frontières: Geneva, Switzerland, 2011.
[49]
Médecins Sans Frontières (MSF). Examples of the Importance of India as the “Pharmacy of the Developing World”; Médecins Sans Frontières: Geneva, Switerland, 2011.
[50]
Srinivasan, S. The Compulsory Licence for Nexavar. Econ. Polit Weekly, 2012. Available online: http://www.epw.org.in/epw/uploads/articles/17300.pdf (accessed on 25 April 2012).
[51]
Bilaterals.org. EU-India FTA-Consultation Draft on IPR Chapter (April 2010), 2010. Available online: http://www.bilaterals.org/spip.php?article17290 (accessed on 11 September 2011).
[52]
De Gucht, K. Letter to Executive Director MSF Mr. von Schoen-Angerer; Médecins Sans Frontières: Geneva, Switzerland, 2010. Available online: http://msfaccess.org/sites/default/files/MSF_assets/Access/Docs/ACCESS_letter_ECTradeCommisioner_Gucht_ENG_2010.pdf (accessed on 12 September 2011).
[53]
Médecins Sans Frontières (MSF). India Says ‘No’ to Policy that Would Block Access to Affordable Medicine; Médecins Sans Frontières: Geneva, Switzerland, 2011.
[54]
Stone, D.A. Policy Paradox: The Art of Political Decision Making; Norton: New York, NY, USA, 2002.
[55]
Rosenberg, S. Comparative Chart of Pharmaceutical Patent and Data Provisions in the TRIPS Agreement, Free Trade Agreements between Trans-Pacific FTA Negotiating Countries and the U.S. and the U.S. Proposal to the Trans-Pacific FTA 2011. Public Citizen: Washington, DC, USA, 2 December 2011. Available online: http://www.citizen.org/Page.aspx?pid=5231 (accessed on 8 March 2012).
[56]
Citizen Trade Campaign. Leaked Trans-Pacific FTA Texts Reveal U.S. Undermining Access to Medicine; Citizen Trade Campaign: Washington, DC, USA, 2011. Available online: http://www.citizenstrade.org/ctc/blog/2011/10/22/leaked-trans-pacific-fta-texts-reveal-u-s-undermining-access-to-medicine/ (accessed on 8 March 2012).
[57]
Dryzek, J.S. Deliberative Global Politics: Discourse and Democracy in A Divided World; Polity Press: Cambridge, UK, 2006.
[58]
The Peoples Health Movement. The People’s Health Movement: A People’s Campaign for Health for All-Now! Peoples Health Movement, 2006. Available online: http://www.phmovement.org/en/node/189 (accessed on 10 September 2011).
[59]
Global Health Watch, Homepage. Available online: http://www.ghwatch.org/ (accessed on 13 December 2011).
[60]
Cohen, E.R.M.; Hassan, M.; Berndston, K.; Saunders, V.; Hadfield, T.; Panjwani, D.; Persad, D.L.; Minhas, G.S.; Daar, A.S.; Sing, J.A.; Singer, P.A. Public engagement on global health challenges. BMC Public Health 2008, 8, 1–8, doi:10.1186/1471-2458-8-1. 18173844
[61]
Fishkin, J.S. Response to critics of when the people speak: The deliberative deficit and what to do about it. Good Soc. J. 2010, 19, 68–76, doi:10.1353/gso.0.0089.
[62]
Baber, W.F.; Bartlett, R.V. Deliberative Environmental Politics: Democracy and Ecological Rationality; The MIT Press: Cambridge, MA, USA, 2005.
[63]
David, A.; Esson, K.; Perucic, A.; Fitzpatrick, C. Tobacco Use: Equity and Social Determinants. In Equity, Social Determinants and Public Health Programmes; Blas, E., Kurup, A.S., Eds.; World Health Organisation: Geneva, Switzerland, 2010; pp. 199–218.
[64]
Hansen, K.M.; Anderson, V.N. Deliberative democracy and the deliberative poll on the euro. Scand. Polit. Stud. 2004, 27, 261–286, doi:10.1111/j.1467-9477.2004.00106.x.
[65]
He, B.; Thorgerson, S. Giving the people a voice? Experiments with consultative authoritative experiments in China. J. Contemp. China 2010, 19, 675–692, doi:10.1080/10670564.2010.485404.
[66]
Yankelovich, D.; Rosell, S.; Gantwerk, H.; Friedman, W. The next big step in deliberative democracy. Kettering Rev. 2006, Fall, 54–66.
[67]
Americaspeaks. Public Impacts: Evaluating the Outcomes of the CaliforniaSpeaks Statewide Conversation on Health Care Reform; Americaspeaks: Washington, DC, USA, N.D.. Available online: http://californiaspeaks.org/wpcontent/_data/n_0002/resources/live/CaSpks%20Evaluation %20Report.pdf (accessed on 4 March 2012).
[68]
Fung, A.; Taeku, L. The Difference Deliberation Makes: A Report on the CaliforniaSpeaks Statewide Conversations on Health Care Reform; Californiaspeaks, 2008. 2008. Available online: http://archonfung.net/docs/reports/CASpeaksReportFinalv3.pdf (accessed on 4 March 2012).
[69]
CaliforniaSpeaks: The Public Weighs in on Current Health Care Reform Proposals; Americaspeaks: Washington, DC, USA, N.D. Available online: http://ckgroup.org/wp-content/uploads/2011/05/CA-Speaks-Report.pdf (accessed on 4 March 2012).
[70]
Commers, M. Determinants of Health: Theory, Understanding, Portrayal, Policy; Kluwer Academic: Dordrecht, The Netherlands, 2002.
[71]
Hooker, C.; Chapman, S. Deliberately personal: Tobacco control debates and deliberative democracy in New South Wales. Crit. Public Health 2006, 16, 35–46, doi:10.1080/09581590600601916.
[72]
Brown, G.W. Safeguarding deliberative global governance: The case of the global fund to fight AIDS, tuberculosis and malaria. Rev. Int. Stud. 2010, 36, 511–530, doi:10.1017/S0260210510000136.
[73]
Harman, S. The World Bank and HIV/AIDS: Setting a Global Agenda; Routledge: London, UK, 2010.
[74]
Drager, N.; Sunderland, L. Governance and Moving Forward the Global Health Agenda: A Perspective from the World Health Organization. In Proceedings of the Annual Convention of the International Studies Association (ISA) Chicago, IL, USA, 28 February-2 March 2007; pp. 1–9.
[75]
Legge, D. Global Health Governance—The Need for Democratic Reform. In Proceedings of the Global Health Governance Reform Initiative; Geneva, Switzerland: 14-15 May, 2010.
[76]
Kickbusch, I.; Hein, W.; Silberschmidt, G. Addressing global health governance challenges through a new mechanism: The proposal for a Committee C of the World Health Assembly. Glob. Health Gov. 2010, Fall, 550–563.
