Mark W. Zacher

The Politics of Global Health Governance

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Canadian foreign policy and international economic regimes

Acknowledgements Introduction Part One: Regulation of International Trade 1. The Evolution of Canadian Postwar International Trade Policy / Jock A. Finlayson, with Stefano Bertasi 2. Reflections on the Canada-U.S. Free Trade Agreement in the Context of the Multilateral Trading System / Christopher Thomas 3. Canada and the Ongoing Impasse over Agricultural Protectionism / Theodore H. Cohn 4. Canada and the Private International Trade Law Regime / A. Claire Cutler Part Two: Regulation of International Financial Transactions 5. Canadian Foreign Investment Policy: Issues and Prospects / James A. Brander 6. Canada and International Legal Regimes for Foreign Investment and Trade in Services / Robert K. Paterson 7. Canada and the International Monetary Regime / Michael C. Webb Part Three: Regulation of International Service Industries 8. Canada and the Changing Regime in International Air Transport / Martin E. Dresner and Michael W. Tretheway 9. Canada and the Evolving System of International Shipping Conferences / Trevor D. Heaver 10. Canada and the Movement Towards Liberalization of the International Telecommunications Regime / Steven Globerman, Hudson N. Janisch, Richard J. Schultz, and W.T. Stanbury Part Four: International Regulation of Resources and the Environment 11. The Evolution of Canadian Fisheries Management Policy Under the New Law of the Sea: International Dimensions / Gordon R. Munro 12. Air, Water, and Political Fire: Building a North American Environmental Regime / Don Munton and Geoffrey Castle Closing Perspective 13. Changing Multilateral Institutions: A Role for Canada / Sylvia Ostry Notes Contributors Index

International Trade Institutions and the North/South Dialogue

During the postwar period the world has witnessed a proliferation of international institutions concerned with economic matters, and several of the best known have been in the sphere of international trade. In the late 1940s strenuous efforts were devoted to the creation of a grandiose and multifaceted International Trade Organization (ITO) which was to be one leg of the institutional tripod on which the global economic order was expected to rest. The other legs were to be the International Monetary Fund (IMF) and the International Bank for Reconstruction and Development (IBRD). The ambitious ITO scheme came to naught in 1950, leaving an interim trade arrangement (the General Agreement on Tariffs and Trade or GATT) and several newly created United Nations bodies to fill the gap as best they could. Under the aegis of the United Nations several international commodity organizations were established in the late 195os and early i96os, and then in 1964 a major new body, the United Nations Conference on Trade and Development (UNCTAD), was created at the insistence of the developing countries. Through it, as well as other United Nationsaffiliated institutions and the General Assembly itself, the developing nations have persistently sought to alter the locus of regulatory authority for various trade issues, to increase the number of trade matters subject to conscious intergovernmental negotiation and regulation, and to reform the decision-making processes

Global Health Governance in the Twentieth Century

The nineteenth century was a remarkable period in terms of advances in transportation and telecommunications, expansion of international trade, and growth of migration. These developments both encouraged the spread of diseases and the incentives for preventing them. The middle decades of the century saw the introduction of steel-hulled steamships, railways, and telegraph—and increases in international commerce followed rapidly in the wake of these advances. The growth and impact of improvements in shipping were particularly notable. World shipping tonnage jumped from 700,000 tons in 1850 to 26,200,000 in 1910.1 The demand for raw materials doubled every nine years, and the demand for tropical agricultural products also rose markedly as a result of advances in transportation. To quote one author, technological progress was “pro-trade biased.”2

Disease Control: Transformation of Health Assistance Programs

The most extensive, complicated, and controversial of issues in international health collaboration concerns the provision of health assistance or financial and material aid programs aimed at improving health standards in developing countries. The importance of aid programs has been highlighted by a significant expansion in health assistance initiatives since the early 1990s. Marked changes in the perceived impacts of deficient health systems have dramatically expanded the scope of this strategy and the ways in which actors collaborate with one another in providing health assistance. To explore these changes and understand how collaboration to provide aid has evolved, this chapter is divided into four sections. The first section provides an overview of recent trends in the health assistance arena and suggests some possible explanations for these trends. The second section provides an overview of the actors that are currently involved in the provision of health assistance, with a focus on the roles they play. The third section analyzes and explains the four methods used to distribute aid, which are bilaterally between state governments; bilaterally from nongovernmental organizations (NGOs) to recipients; multilaterally through international organizations; and multilaterally through global health partnerships (GHPs).

Disease Containment: Surveillance Systems, Emergency Responses, and Transborder Regulations

The cliche that the world is becoming a smaller place has a particular resonance in the field of global health. Outbreaks of virulent diseases can occur anywhere at anytime, and given how interconnected the world is nowadays, a disease can spread around the globe in a matter of days. Therefore, it is imperative that outbreaks of infectious diseases are contained rapidly to prevent them from becoming global threats. To accomplish this feat, three things are necessary: sophisticated surveillance systems to discover outbreaks in a timely fashion; efficient emergency response programs for medical experts to contain disease outbreaks before they spread; and finally effective transborder regulations to prevent or slow the propagation of diseases. This chapter examines how all three of these strategies of disease containment have evolved and thus how they have helped to create a stronger coordinated global health regime.

Health and Global Governance: Concluding Perspectives

In the first chapter of this study, literature on the nature of global governance is reviewed. The salient features concerning the existence of formal and informal institutions and rules that are created to manage the interdependencies among governmental and nongovernmental actors. Of particular relevance to this study is Oran Young’s statement that “the demand for governance in world affairs has never been greater” and that it has become “difficult for states or other autonomous actors to isolate themselves from events occurring in other parts of the world, however much they might wish to do so.”1 As James Rosenau indicated in his seminal book on the topic, Governance without Government, both the concept and practical manifestation of governance transcends the scope of governmental activities. Although state governments are an integral part of governance procedures, they also include other groups that are becoming increasingly important and active within the public realm, including civil society groups, private transnational corporations, and wealthy foundations. Nowhere is this multi-actor feature of governance more prominent than within the regime to combat infectious diseases.

Overview of Infectious Diseases and Analytical Framework

Health, or the lack thereof, has shaped human civilizations for millennia, and it is undoubtedly going to be a predominant issue throughout the twenty-first century. Health is the ultimate unifying issue for humankind—the world is becoming an ever smaller place, and microbes that cause devastating diseases do not stop for border guards. More and more we are coming to understand that people with diseases located anywhere from down the street to the other side of the globe have important and varied impacts on our well-being. Health has become more than a medical issue; it is also a development issue, a commercial issue, a humanitarian issue, and a security issue.

Disease Cures: International Patent Law and Access to Essential Medicines

Access to essential medicines has long been a concern for health professionals, development experts, and governments globally; however, since the formal establishment of the World Trade Organization (WTO) in 1995, this issue has become a serious concern for trade specialists as well. The concept of essential medicines was popularized in 1977 with the publication of the first World Health Organization (WHO) Model List of Essential Medicines. According to WHO “[e]ssential medicines are those that satisfy the priority health care needs of the population.”1 Today, the term is strongly associated with medicines for infectious diseases that kill millions—particularly diseases such as HIV/AIDS, malaria, and tuberculosis, although it covers numerous drugs designed to meet basic health needs.

Power in Transition: The Peaceful Change of International Order

it limits the usefulness of the book in the classroom—most beginning graduate students may have trouble grasping Sullivan’s point without having read many of the original sources first. Curiously, there is relatively little discussion of constructivism, one of the most notable recent theoretical approaches. Despite these flaws, Sullivan’s work will be of interest to specialists who wish to have a thoughtful guide to ongoing debates in the field of international relations theory and to those who wish to rethink the conventional wisdom concerning those debates.