In the wake of the COVID-19 pandemic, we members of the public have become hyper-aware of the importance of global health and the institutions large and small that shape it. For good and ill, we are far more prescient of the roles and challenges of governments, non-governmental bodies and international organisations such as the World Health Organisation (WHO). Understanding who these institutions are and what they could be doing to better protect and promote health has never been more important or timely. As of this writing, the world is reacting to multiple emergencies that impact human health, including an mpox outbreak in the Democratic Republic of the Congo, devastating humanitarian crises in Ukraine and Gaza and the Middle East, and the ever-increasing global threat of climate change. With the rise of right-wing populism in both North America and Europe, global health governance and public health are on a knife’s edge. Future generations of leaders in health, policy, law and governance are in a prime moment to help shape the emerging, multidisciplinary field of global health law.
Enter Gostin and Meier’s Global Health Law & Policy, an anthology of writings organised in chapters and groups to help chart the basis and boundaries of global health law. Global Health Law & Policy comes at a time when global health faces an “existential crisis” (p. xv) having been tested and found wanting in recent years with every portend of greater tests to come. There can be no doubt that political determinants to health are at their most extreme, which has and will continue to have reverberations into law, healthcare, public health and international order. To a scholar and lecturer of global health, the context is almost enough to be demoralising, begging the question: why produce a book like this at all?
Gostin and Meier’s answer to this question is, “to ensure justice for a healthier world, [it is] imperative for a foundational text to support students and scholars to address the global health challenges of the future through global health law and policy” (p. xvi). Gostin and Meier are ardent proponents of an interwoven discipline of law that bridges “national boundaries to alleviate global inequities” (p. xii). Leaders empowered with the skills and knowledge of global health law may yet see us through and build a more resilient future.
Gostin and Meier, long-time advocates and writers for global health law, lay out their mission to define and develop the discipline by exploring its applications to a range of relevant spaces. Bringing together dozens of global health scholars, this text lays out four foundational sections of global health law. This text is well written, cross-referential, littered with case studies to exemplify key points and sufficiently explanatory without becoming complex (a true accomplishment for lawyers and professors).
Section I, Chapters 1 to 5, lays the groundwork for global health law, introducing the frameworks and institutions that shape modern health governance. Gostin and Finch introduce the concept of global health law, tracing its evolution from post-World War II to the post-Covid era. The authors highlight that while global health law may be a new term for many readers, its development has been systematically charted over centuries. Chapter 1 underscores the link between global health law and public health principles.
Chapter 4 is exceptional for its careful histography of the Right to Health and the gradual shift in global health norms from a clinical focus to a social justice framework. Bueno de Mesquita and Forman describe how the Health and Human Rights movement, particularly during the HIV/AIDS crisis (p. 100), pushed for the inclusion of health rights in the broader human rights canon which had been reluctant to engage in social and cultural rights. Despite the progress, the authors note the limitations of global health law in achieving human rights goals, especially in response to public health emergencies. Their discussion on decolonising global health as “build[ing] on longer-standing critiques of human rights as a Western creation” (p. 111) is poignant, yet feels too brief. This self-awareness that global health law does not exist in a vacuum of ideas or perspectives is a theme that comes back throughout the text, but is a little too often given a short shrift.
Section II, Chapters 6 to 9, applies the frameworks discussed in Section I to infectious diseases (ch. 6) non-communicable diseases (ch. 7), mental health (ch. 8) and environmental and climate health (ch. 9).
Section III, Chapters 10 to 14, focuses on the financial and economic dimensions of global health law. These chapters cover Sustainable Development Goals (ch. 10), economic development and determinants for health (ch. 11), international trade and intellectual property rights (ch. 12), commercial determinants for health (ch. 13) and, ending with the stand-out chapter from this section, global funding (ch. 14). In Chapter 14, Halabi and Gostin dig deep into the realities of global health – a legion of actors, ideals and interests – and its mosaic of financial fonts and droughts. The proliferation (p. 378) – and some might say Balkanisation (S. Hoffman, “The Evolution, Etiology and Eventualities of the Global Health Security Regime” (2010) 25 Health Policy & Planning 510) – of global health actors has led to many funding streams, but has also undermined coordination and cohesion, inviting critiques of global health as an exercise of colonial entrenchment. In this chapter, Halabi and Gostin highlight COVID-19 and vaccine access (pp. 381–88) as a specific example of national interests (centred mostly in the Global North) stymieing global health equity. Few other chapters make this point as visually or comprehensively as Chapter 14, though this may relate in part to the recency of COVID-19 and its particularly nefarious way of both shedding light on health disparities while furthering them.
Finally, Section IV focuses on legal efforts to address health threats highlighting both the best and most frustrating aspects of global health. Chapter 15 focuses on the development of antimicrobial resistance in humans and animals and the challenges in new drug development, discussing the need for binding legal instruments to help guide government implementation of global best practices. Echoing earlier chapters, the authors contend that a One Health approach is necessary bring coordination at the national and international levels. Chapter 16 discusses the need for coordination specifically to sharing pathogen data. Authors Eccleston-Turner and Rourke argue that while lower- and middle-income countries have long provided samples and data for they have not always been positioned benefit from the results.
Chapter 17 focuses on sexual and reproductive health rights – rights that are currently under siege from populist right-wing fundamentalism and remind us of how fragile human rights can be. Chapter 18 delves deep into the need for accountability in conflict settings and critiques the limits and failures to protect people from harm under the current international frameworks. Chapter 19 connects health impacts from climate change to the risks of increasing future conflicts and humanitarian disasters. With an emerging body of climate law and decisions however (Sabin Center for Climate Change Law, https://climatecasechart.com), the authors are hopeful that global health law may use climate law to advance the protection and promotion of health as part of global efforts to mitigate, adapt and move forward in a world defined by more extreme weather and shifting environments. Finally, Chapter 20, penned by Gostin and Meier themselves, focuses on universal health coverage. Universal health coverage is a priority for the current WHO leadership, as the frequently felt presence of Director-General Tedros in the text reflects (not the least being his own forward to the text, starting on p. xi). Global health law has embraced universal health coverage as a means to address the full spectrum of primary health care needs as well as the determinants for those needs – providing a framework to address housing, nutrition, water, air and other factors that underscore human health.
Many chapters contain similar themes of failings and shortcoming in the global health space that global health law could remedy, if global institutions and governments simply adopt better, stronger and more accountable measures. Gostin and Meier have assembled an incredible team of writers for this anthology and if there is a fault with any of them it is their conviction that global health law is and will be the way forward for most if not all contemporary problems. Because the text covers a range of health topics, the binding glue between them is this doctrine of global health law – and in some chapters this glue is stickier than in others.
The anthological approach of the text is beneficial when discussing global health law and policy and is well suited for a semester course, though it does give rise to some repetition and overlap between individual chapters. The reader might well have wished that Gostin and Meier achieved slightly more diversity in subject matters discussed in the book, with a more nuanced or critical view of their topics and the limitations on global health law, doctrinally if not practically. With much of the book incorporating the authors’ adulations for what global health law could do to address the myriad challenges of the day, what global health law (1) does do, (2) does not do and (3) could not do (or do well) is worth some discussion. At the same time, defining global health law as a little bit of everything invites a critique that it best functions in theory and academic pursuit. The practice of global health law, as Gostin, Bosha and Meier note themselves (L. Gostin, S. Bosha and B. Meier, “Teaching Global Health Law: Preparing the Next Generation for Future Challenges” (2024) 52 Journal of Law, Medicine & Ethics 191) is still being developed from its academic source material – which includes Global Health Law & Policy itself – and how this discipline can and cannot translate into what practitioners do remains an ongoing project.
This is perhaps the distinction between Global Health Law & Policy and similar readings: Gostin and Meier envisioned their book as a classroom text. These chapters are the foundations for classroom discussion, led by the students and their instructors. The discussion questions at the end of each chapter prompt further conversation and reflection and invite students to draw connections and critiques between the chapters. This text captures the role of global health law as a uniting thread across many topics, a role that may be strengthened if many things occur to strengthen national health systems, global health governance, international cooperation and adherence to and accountability for human rights law. That premise is ambitious, important, agreeable and debatable – perfect for fruitful classroom discussion and student-driven inquiry.
The authors have made their case for the importance of global health law by outlining its evolution and integration into global health governance, and its gradual embrace of human rights law to understand and improve the determinants of human health. Their text inspires the reader to make it happen.
