Global Health Law.

Author:Burci, Gian Luca
Position:Book review

Global Health Law. By Lawrence O. Gostin. Cambridge MA, London: Harvard University Press, 2014. Pp. xvi, 541. Index. $55, 40.95 [pounds sterling], 49.50 [euro].

The 2014 (and still ongoing) outbreak of Ebola hemorrhagic fever in West Africa has again brought public health and its complex interactions with international law and politics to the fore. It has also confirmed the inadequacy of the current legal and governance frameworks to address health crises in a coordinated and sustained manner, and it has highlighted the deep and stubborn inequalities between and within countries in accessing, in an equitable way, both lifesaving services and the similarly important underlying conditions that enable populations to attain an acceptable level of health (the so-called "determinants of health" (p. xii)). Lawrence Gostin's Global Health Law starts with the statement that "[t]his is a unique moment to offer a systematic account of global health law" (p. xi), and his book could not be more timely indeed. In a way, it is a pity that the book was not published a year later so that it could have reflected on the lessons learned from the international response to the Ebola outbreak.

Notwithstanding a high level of political interest, scholarship in global health is relatively recent and generally focuses on public health or political and governance aspects. Research and scholarship on international legal and normative aspects were initially affected by the very limited scope of international law primarily dedicated to the protection of health, with the exception of a few pioneering scholars including Gostin. (1) Interest has grown during the last two decades due to the increasing centrality of health in the development and security agendas and the awareness of the complex interplay between public health and international legal regimes on topics such as trade, investments, human rights, and international security. Still, scholarship has mostly focused on discrete topics (2) or institutions, (3) rather than trying to embrace in a holistic way such a burgeoning field of inquiry.

This gap has now been largely filled in an original manner by Gostin's remarkable book, which provides a systematic and comprehensive introduction to contemporary global health challenges of interest to both a public health readership with a limited international legal and political literacy and international law scholars and practitioners without a direct knowledge of the specific features and problems of global health. Gostin is the founding Linda D. & Timothy J. O'Neill Professor of Global Health Law and Faculty Director of the O'Neill Institute for National & Global Health Law at Georgetown University Law Center. He is not a formalist but a passionate scholar with a tradition of engagement in public health and a strong sense of moral outrage at the flagrant inequalities and injustices in health, especially for the populations in developing countries. (4) Global Health Law fully reflects Gostin's personal and academic inclinations and overarching interest in law and governance as tools to aim at "[g]lobal health with justice" (p. 303), defined as "achieving the highest attainable standard of physical and mental health, fairly distributed" (p. xiii). Early on in the preface to Global Health Law, he defines several driving themes that recur throughout his analysis and encapsulate his teleological and governance-based approach: "health equity," "global solidarity," "health in all policies," "multiple regimes," "good governance," "health-promoting priorities," and "the right to health" (pp. xiii-xv). Gostin introduces the role of law in global health as follows:

Each global health problem is shaped by law's language of rights, duties, and rules of engagement, such as setting high standards, monitoring progress, and ensuring compliance. It is only through law that individuals and populations can claim entitlements to health services, and that corresponding state obligations can be established and enforced. (P. 18) The structure and approach of the book originate from a focused interest in how international law, institutions, and global governance processes have contributed to contemporary health problems and how they can be used to redress them. Human rights, in particular the "right to health," are seen as the central normative driver to unify an otherwise fragmented legal and governance field around the "imperative of health as a fundamental entitlement" (p. xv). Readers, in other words, should not expect a formal or systemic analysis of existing law but, instead, a cogent overview of the main contemporary public health problems and how international law, governance, and institutions can address them in an equitable and humane manner.

A conceptual problem plaguing this field of research, however, is precisely what constitutes "global health law" as well as the definition of related concepts such as "global governance for health (GGH)" in view of the fragmentation of international legal rules and multiplicity of international institutions along with the increasing role played by "soft" instruments created and applied by hybrid or private actors. Gostin defines the term global health law as "the study and practice of international law--both hard law ... and soft instruments ...--that shapes norms, processes, and...

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