Moving Global Health Law Upstream: A Critical Appraisal of Global Health Law as a Tool for Health Adaptation to Climate Change
The relatively new discipline of global health law is a potentially powerful tool for promoting health adaptation to climate change. Unfortunately, global climate change will intensify exactly those health threats that have not been adequately addressed by multilateral cooperation with respect to health in the past, which has been dominated by security-based and treatment-focused approaches. Recent focus on biosecurity concerns such as the global spread of emerging infectious diseases and biological terrorism has further entrenched a security-based approach to global health law and policy that has origins in the earliest attempts at international health cooperation and is currently embodied in the 2005 revisions to the International Health Regulations. For the most part, the health threats associated with climate change are not of the type that have typically gained the attention of powerful industrialized countries concerned with the transboundary spread of emerging infectious diseases like SARS or novel strains of pandemic influenza. In recent decades, rapid innovation in medical technologies and other factors have led to an emphasis in health law and policy on adequate and equitable provision of health care services. International health law and policy have focused on objectives like the provision of antiretroviral therapy for HIV/AIDS patients more than on public health interventions such as vector control and access to basic necessities like food, safe drinking water, shelter, and sanitation. Yet the health threats associated with climate change will be impossible to address through medical technologies alone. Although security-based and treatment-focused efforts have sought to strengthen the core capacity of health systems as a secondary concern, it is not at all clear that they will make human populations more resilient to the impacts of climate change and environmental degradation. A responsibility-based approach under the United Nations Framework Convention on Climate Change principle of common but differentiated responsibility has the potential to foster an emerging reorientation of global health law along three main fronts: (1) an approach to global health law and governance that is driven by health equity and the importance of “upstream” determinants of health, including access to basic necessities like food, water, shelter, and sanitation; (2) better integration of health law and policy with non-health regimes such as human rights law and international trade law, as well as environmental law, land use, and urban planning; (3) an approach to public health threat response that emphasizes long-term resilience rather than emergency preparedness for extreme events.