Global Health Institute

As an intern at the Office of Global Affairs at the US Department of Health and Human Services this fall semester, I had the opportunity to help prepare HHS leadership to attend the 2019 G20 Health Ministers’ Meeting held in Okayama, Japan. The meeting was one of the eight ministerial gatherings that took place in addition to the G20 Summit. At these multilateral meetings member states work to advance ongoing collaboration and reaffirm shared commitments to address global health issues. The meetings also provide a platform for the member states to establish or further advance diplomatic relationships among themselves. The main themes of this year’s G20 Health Minister’s meeting was The Achievement of Universal Healthcare, Response to Aging Societies, and Health Risk Management and Health Security/Antimicrobial Resistance (AMR). 

At the conclusion of these meetings, member states often adopt a shared declaration. In the Okayama Declaration of the G20 Health Ministers, the member states agreed to various commitments in regards to The Achievement of Universal Healthcare such as “provide gender-responsive interventions to meet health needs of all and recognize immunizations is one of the most cost-effective health investments”. Other issues included in the declaration included promotion of health data and technologies, reform of health workforce programs, and cooperation with the private sector for financial sustainability of health systems. While there are often areas of disagreement on these issues, the high-level consensus of their importance by prominent member states an important signal that attention will be given to these issues. 

Similarly, in regards to the theme of Response to Aging Societies, the member states agreed on the importance of quality of life, utilization of health data, and addressing dementia-inclusive environments in society. The declaration also included action items such as encouraging OECD and other organizations to urge WHO to respond to its responsibility to prepare a Decade of Healthy Ageing 2020-2030 proposal and to treat aging as one of its priorities. Similarly, the declaration outlines more specific action items such as asking the member states to develop a national implementation plan in response to the WHA-endorsed Global Action Plan of the Public Health Response to Dementia 2017-2025 and focus their efforts on particular areas such as elderly labor market and early detection of dementia. The G20 consensus on the issue of aging is updated to address the evolving trends of demographic shifts and how the world’s public health system should prepare for the growing burden. 

The meeting is an important occasion where the health ministers and high-level health officials from various countries convene at one place. Health ministers and officials often hold bilateral meetings to reaffirm the importance of health cooperation, exchange each country’s health priorities, and explore future collaboration opportunities and ideas. On the sideline of the G20 Health Minister’s Meeting, for example, the HHS Deputy Secretary Eric Hargan represented the US and met with Health Minister Tawfig AlRabiah from Saudi Arabia to strengthen the two countries’ partnership on Global Health Security Agenda and the promotion of vaccines use. 

Another outcome was the signing of a Memorandum of Understanding (MoU) to establish a common line of goals and actions. Deputy Secretary Hargan also visited South Korea during this trip and signed a MoU between the U.S. Centers for Disease Control and Prevention (CDC) and the Korea CDC. The two CDCs agreed to collaborate on various public health issues including infectious disease outbreaks, anti-microbial resistance, and vaccine-preventable diseases. Specific action items such as information exchange and routine consultation are also listed to direct cooperative effort effectively.

Meetings like the G20 Health Ministers Meeting are important because they help prioritize public health issues among the member states and mobilize countries’ political leadership to address critical public health issues in the coming years. For readers who are interested in the high-level global health policy and hope to be informed, a quick and easy way is to follow the chief US health officials’ Twitter accounts to stay updated. And a reading recommendation for those who want to learn even more is a textbook titled 21st Century Global Health Diplomacy published by World Scientific. 

Angela Lu (NHS’20) is a senior in the School of Nursing and Health Studies studying in healthcare Management and Policy and Public Health. She is currently a Global Health Officer Intern at the Office of Global Affairs in the US Dept. of Health and Human Services. She is also a Student Fellow with the Global Health Institute at Georgetown University.

The right to health has received widespread recognition in international law. Most notably, the International Covenant on Social, Economic and Cultural Rights (ICSECR) recognizes the “right of everyone to the enjoyment of the highest attainable standard of physical and mental health” (Art. 12.1). Despite a clear legal obligation on the part of governments to protect, promote, and fulfill this, they often fail to meet the health needs of marginalized groups such as indigenous women, those with mental health problems, and migrants. In this blog post, I will provide an overview of the different accountability mechanisms that exist to hold governments accountable to their right to health obligations, while noting the importance of social accountability mechanisms at the local level. 

Types of Accountability Mechanisms

An accountability mechanism is the “procedure through which government is answerable for its acts or omissions in relation to right to health obligations” (http://repository.essex.ac.uk/9717/1/accountability-right-highest-attainable-standard-health.pdf). Different types of accountability mechanisms exist: judicial (courts); quasi-judicial (human rights institutions); administrative (human rights commission); political (elections); and social (civil society). Each has its strengths and weaknesses. Judicial mechanisms arguably receive the most attention due to high-profile cases where litigants have secured access to life-saving medical treatment through judicial decisions (see e.g. Minister of Health v Treatment Action Campaign). The legal process is undeniably a powerful accountability mechanism in allowing rights-holders to challenge government legislation and policy through the courts. However, marginalized populations often encounter barriers in accessing justice through the courts; the justice system is often too complex, expensive, or culturally insensitive for these groups to navigate.

Social Accountability Mechanisms

Social accountability mechanisms are becoming increasingly important in keeping governments accountable to marginalized people’s right to health and, in my view, deserve greater attention. This type of accountability generally involves the use of citizen action to keep government conduct in check. For instance, the Treatment Action Campaign (TAC) engaged in massive public mobilization and extensive media campaigns to draw attention to the South African government’s restrictions on access to antiretrovirals. 

Social accountability mechanisms at the local level have become more prominent among NGOs seeking to foster citizen participation. On this point, various techniques that allow marginalized populations to assess the performance of government health services have been developed and implemented. CARE Malawi, for example, has developed the “community score card” as a technique for citizens to systematically address local-level barriers to health services and facilitate good governance. The underlying principles of the community score card include participation, inclusion of voice, accountability and transparency, equity, and shared responsibility and obligation. There is evidence that these social accountability mechanisms have a positive effect on health outcomes (https://coregroup.org/wp-content/uploads/media-backup/documents/Resources/Tools/Social_Accountability_Final_online.pdf). 

Conclusion

Human rights, including the right to health, are no more than window-dressing without adequate accountability mechanisms. Accountability provides governments and public officials with the opportunity to explain their actions. Where there are mistakes, accountability demands some form of redress. While human rights actors have traditionally put much effort in using the courts and the electoral process to keep governments accountable, social accountability mechanisms at the local level such as community scorecards deserve attention for their beneficial effects on health outcomes, participation, and empowerment. 

Benny Chan (LLM ’20) is a Global Health Law Scholar at Georgetown University Law Center and a student fellow with the Global Health Initiative.