Harvey Lazar

Strategies for implementing the new International Health Regulations in federal countries

The International Health Regulations (IHR), the principal legal instrument guiding the international management of public health emergencies, have recently undergone an extensive revision process. The revised regulations, referred to as the IHR (2005), were unanimously approved in May 2005 by all Member States of the World Health Assembly (WHA) and came into effect on 15 June 2007. The IHR (2005) reflect a modernization of the international communitys approach to public health and an acknowledgement of the importance of establishing an effective international strategy to manage emergencies that threaten global health security. The success of the IHR as a new approach to combating such threats will ultimately be determined by the ability of countries to live up to the obligations they assumed in approving the new international strategy. However, doing so may be particularly challenging for decentralized countries, specifically those with federal systems of government. Although the IHR (2005) are the product of an agreement among national governments, they cover a wide range of matters, some of which may not fall fully under the constitutional jurisdiction of the national government within many federations. This tension between the separation of powers within federal systems of government and the requirements of an evolving global public health governance regime may undermine national efforts towards compliance and could ultimately jeopardize the regimes success. We hosted a workshop to examine how federal countries could address some of the challenges they may face in implementing the IHR (2005). We present here a series of recommendations, synthesized from the workshop proceedings, on strategies that these countries might pursue to improve their ability to comply with the revised IHR.

Understanding the Impact of Intergovernmental Relations on Public Health: Lessons from Reform Initiatives in the Blood System and Health Surveillance

Establishing effective intergovernmental relations is a key challenge to the development of successful public health policy. The first step in establishing a literature on this subject is to create a framework for characterizing the different forms of intergovernmental relations that exist in public health. This article provides a framework for synthesizing existing relevant literature, identifying gaps in knowledge, and ultimately developing national policies more favourable to public health. We apply this model to the case of blood safety, draw comparisons with health surveillance and derive a set of proposals to optimize the impact of intergovernmental relations on public health.

Establishing public health security in a postwar Iraq: constitutional obstacles and lessons for other federalizing states.

The public health consequences of the conflict in Iraq will likely continue after the violence has subsided. Reestablishing public health security will require large investments in infrastructure and the creation of effective systems of governance. On the question of governance, the allocation of powers in the new constitution of Iraq is critical. Given the ease with which public health threats cross borders, the constitution needs to grant to the federal government the legal authority to manage such threats and simultaneously meet international requirements. Unfortunately, the draft constitution does not accomplish this objective. If politically possible, the constitution should be amended to provide the federal government with this authority. If not possible, the Iraqi federal government would have two options. It could attempt to use alternative constitutional powers, such as national security powers. This option would be contentious and the results uncertain. Alternatively, the federal government could attempt to establish collaborative relationships with regional governments. Residual sectarian tensions create potential problems for this option, however. Reflecting on the Iraqi situation, we conclude that other federalizing countries emerging from conflict should ensure that their constitutions provide the federal government with the necessary authority to manage threats to public health security effectively.

Toward a new mission statement for Canadian fiscal federalism

Canada: State of the Federation, 1999-2000 identifies and explains major threads in Canadian fiscal federalism. Set against the cacophony over domineering and arrogant centralization from supporters of Quebec sovereignty/session on the one hand, and fears that excessive decentralization is fuelling an obsessively neo-liberal agenda on the other, these essays replace much of this heat with new light. The authors begin with an examination of recent developments in the theoretical literature surrounding fiscal federalism. They then examine some of the major issues facing the federation - Is there a vertical imbalance between federal and provincial governments? Does Ottawa collect more revenues than are needed relative to its spending responsibilities while the provinces are under-funded? How do federal-provincial struggles over money and jurisdictional power affect local government or the para-public sector, emerging aboriginal governments, and citizens? Federal government actions in 1999 suggest that Ottawa has not lost all of its interest in social outcomes. It is, however, seeking to influence the well-being of citizens by transferring money to them directly rather than through transfers to provinces. The authors suggest that if this trend continues the approach to the millennium will be seen as a watershed in public policy, given that current trends in Canadian fiscal federalism are as much about re-balancing the federation as they are about decentralization.

Rules, Rules, Rules, Rules: Multilevel Regulatory Governance

Rules, Rules, Rules, Rules: Multilevel Regulatory Governance , G. Bruce Doern and Robert Johnson, eds., Studies in Comparative Political Economy and Public Policy; Toronto: University of Toronto Press, 2006, xi, 372. The first stated purpose of this edited collection is to “clarify conceptually the nature, causes, and dynamics of regulatory governance in, or affecting, Canada” in a world where the international, federal, provincial and local spheres are “interacting, reinforcing and colliding.” The second is to “contribute practically to the debate on what kinds of principles and institutional approaches and changes can lessen the problems of multilevel regulatory governance” (3).