International Law, Governance and Global Children’s Health

Abstract

From a medical perspective, we already know the leading causes of child mortality: acute respiratory infections, diarrheal diseases, and neonatal infections. For the vast majority of cases, we also know the appropriate medical treatments. The difficult challenge and tragedy of global children's health lies in applying proven solutions to known problems. In the State of the World's Children 2008: Child Survival, United Nations Children’s Fund (UNICEF) identifies the "[u]nderlying and structural causes of maternal and child mortality.” Among other factors, the report lists "[p]oorly resourced . . . health and nutrition services;" "[l]ack of hygiene and access to safe water or adequate sanitation;" and exclusion from essential health services "due to poverty and geographic or political marginalization."

This list hints at structural concerns that raise basic issues of governance not medicine. The report also acknowledges that these are complex and multidimensional problems in need of multidimensional solutions. "Their wide-ranging nature and interrelatedness require them to be addressed at different levels - community, household, service provider, government and international - in an integrated manner to maximize effectiveness and reach." This is a daunting challenge, but it is ultimately a challenge of effective governance, calling for frameworks that can facilitate exactly these forms of effective cooperation.

Making the diagnosis is easier than remedying its causes. Simple tasks, like providing clean water and proper sanitation requires surmounting all the difficult historic challenges involved in establishing effective forms of local governance in the first place. This is not easy. Indeed, the baseline expectation should be that structures enabling effective cooperation are the exception and not the rule, as they are difficult to establish and maintain. Moreover, areas where effective structures of local governance have not historically taken root are likely to be among the most difficult settings in which to build cooperative frameworks. Sustainable public health progress, however, is not possible unless one focuses on these governance dimensions.

This Chapter examines the role of international law and governance in the service of children's health. It explores the role and limits of classic international law. It argues for the need to shift from nations to networks as the effective unit of analysis, as well as the need to expressly recognize the role of law in creating and facilitating “frameworks of cooperation” that can ultimately connect the global-to-the-local. Governance must also be built from the grassroots up and not just from the top down.