Normative Foundations of Global Health Law.

International health law, or what is now also called global health law, is a relatively new academic field. In its broadest definition, it includes all international legal regimes relevant to public health—international environmental law, international humanitarian and human rights law, international trade and labor law, international laws relating to arms control, and so on.1 Construed more narrowly, it incorporates only those international legal regimes specifically designed to address health threats. The two most notable examples are the International Health Regulations (focused on infectious diseases) and the World Health Organization’s (WHO) Framework Convention on Tobacco Control (FCTC) (focused on chronic diseases). There is an important distinction between international health law and global health law. International health law connotes a more traditional approach derived from rules governing relations among nation-states. Global health law, on the other hand, is developing an international structure based on the world as a community, not just a collection of nation-states. This structure is inclusive of individuals and nongovernmental organizations, especially where health problems are seen as truly global. Globalization has heightened the need for worldwide public health cooperation. International health law developed originally in the mid-nineteenth century to control infectious diseases and has transformed over time to include multiple norms and standards and to become a significant component of foreign policy.2 Amidst these changes, however, a lack of normative theory has left the field without a basis for justice or common ground on the ethics and governance of threats to global health. Moreover, research to date has neglected normative problems, as well as the role of global health justice in addressing such problems, especially in establishing moral norms that guide the roles of international and domestic law as tools of public health. This Essay offers a normative theory of global health law. It builds on a theory of health and social justice I have long been developing and extends this theory in evaluating the role of international law in health. This theory takes human flourishing as the end goal of a global society and proposes that global health law be examined in terms of an ethical demand for health equity.3 This ethical demand will likely require legal instruments for realization, but it will also require individuals, states, and nonstate actors to internalize public ethical norms in support of global health goals. This Essay also argues that global health law should be examined in the contexts of international relations and global public policy and that law and policy should be linked at the global and domestic levels. Philosophical underpinnings of global health law cannot be studied separately from other global and domestic tools to reach global health equity. This Essay comprises three parts. Part I offers normative foundations for the future of global health law and presents a theory of global health equity. Part II analyzes the role of global health law in achieving health equity, examines the effectiveness and limits of international health law, and considers the conditions necessary for the effectiveness of global health law. Part III offers an analysis of global health law vis-a-vis domestic health law and policy. The Essay concludes by arguing that solutions to global health disparities and externalities require more than international treaties, conventions, and recommendations. They require domestic health policy, law, and institutional reforms establishing sustainable, government-sponsored health systems, including universal health insurance and public-health and health-care infrastructures. Thus, the success and future of global heath law depend as much on domestic health policy and law as they do on international health law itself.