Arachu Castro, Eric A. Friedman, Luiz Galvao, Martin Hevia, and Helia Molina
Historically, women in most parts of the world have been subject to deep discrimination which also harms children’s health in multiple ways. In this blog we argue that the Framework Convention on Global Health (FCGH), a proposed global treaty with human rights and equity as overriding goals and principles, could help address these harms.
The FCGH is especially important now in light of the particular harm that COVID-19 is causing women, girls, and all children to pandemic prevention, preparedness, and response. An estimated 463 million children had no access to remote learning when schools worldwide closed last year and people with less education typically have lower access to health services and worse health outcomes. It is also estimated that up to 80 million children may not receive vaccinations. Children face the greatest risks of illness and death from hunger and more than 270 million people are experiencing or at direct risk of acute hunger in the countries in which the World Food Programme operates, half due to COVID-19. Child marriages, typically involving girls, are increasing during the pandemic and may reach 13 million additional marriages. Family planning services, followed by immunization programs and maternal health services, have been most impacted by health care disruptions and maternal mortality is expected to increase.
The FCGH would bring additional accountability to the right to health and its functions would span three areas:
- equality, participation, accountability, and international cooperation and assistance
- resourcing the right to health
- ensuring accountability to the right to health in all sectors and for all actors, and from local to global levels.
In each of these areas, the FCGH holds special importance for women and children, and in some areas, would include provisions that would specifically contribute to their right to health. Key right to health principles are implemented into all FCGH processes.
Equality, participation, accountability, and international cooperation and assistance
Quality data on reproductive, maternal, newborn, and child health demonstrates increasing inequities, with many women and children being left behind, especially those with little wealth and poor education. The FCGH proposes health equity programs of action—detailed roadmaps to health equity that are systematic, addressing the range of determinants of health within populations experiencing health inequities. Programs will respond to root causes of health inequities, will be inclusive, and developed with the leadership of members of marginalized populations. Specifically addressing discrimination against women, the FCGH would affirm in binding law, as provided by the Committee on the Elimination of Discrimination Against Women’s General Recommendation 24, that failing to provide health services specific to women constitutes prohibited discrimination, and extend this definition of discrimination to services that women disproportionately seek.
The FCGH would not only set overall standards for people’s participation in health-related decision-making, but also require that members of marginalized populations, including women, have at least as much opportunity to participate as everyone else.
Women are often subject to mistreatment when seeking health services, even detention, violence, and abuses during childbirth. The FCGH would include measures to hold states to account for such failings, such as population-wide right to health education, access to justice, and country-determined effective local health accountability mechanisms including maternal and child death audits.
Resourcing the right to health
The FCGH would address funding and health worker shortages. There is an annual $33 billion funding gap in women’s, adolescents’, and children’s health and a global shortage of at least 18 million health workers which is a severe obstacle to women’s health and universal maternal and newborn care.
The FCGH would establish a global health financing framework, with globally agreed targets for all countries on national health financing and development assistance for health, and rights-based roadmaps and timelines developed nationally through inclusive processes. These would address inequities, such as women’s and children’s health.
The financing roadmap would align with the timeline and processes, and workforce strategies, to achieve universal health coverage including the underlying determinants of health—such as ensuring the adequate nutrition, clean water, and sanitation that are critical to children’s health.
Accountability in all sectors
Accountability for the right to health must extend beyond the health sector to all other sectors. Right to health impact assessments would become a key tool across all policies and programs. For example, conducting these assessments on policies and programs that affect environmental health could dramatically reduce mortality and morbidity, and lifelong developmental harm, in children.
The COVID-19 pandemic, with the inequities it has highlighted and exacerbated, should motivate the adoption of the FCGH. Along with the FCGH’s potential contribution to health equity are its direct and immense benefits for health security: increased trust and cooperation with public health measures, built from more accountability and participation; participatory planning, ensuring no population is neglected in pandemic preparations; and accountability and funding that will lead to stronger health systems.
European Council President Charles Michel has proposed a pandemic treaty, including to strengthen the IHR, a proposal that WHO Director-General Tedros Adhanom Ghebreyesus has welcomed. We agree the IHR requires strengthening, but truly preparing the world for the next pandemic requires an instrument that bridges the gap between right to health guarantees and people’s realities. It needs to create accountability and trust, strengthen health systems, and close the health inequalities that COVID-19 has revealed. That instrument is the FCGH.
It will set the world on a track of equity and human rights to ensure that no one is left behind. Leaders at WHO and the United Nations should join with civil society advocates and use their influence to encourage governments to help develop the FCGH. And as with so many other social justice movements past and present, women—from civil society leaders to grassroots community leaders—could lead the way.
Arachu Castro is at the Tulane University School of Public Health and Tropical Medicine, USA.
Eric A. Friedman is at the O’Neill Institute for National and Global Health Law, Georgetown University Law Center, USA, and Framework Convention on Global Health [FCGH] Alliance.
Luiz Galvao is at the Oswaldo Cruz Foundation-Fiocruz, Brazil, and FCGH Alliance.
Martin Hevia is at the Universidad Torcuato Di Tella, School of Law, Argentina, and FCGH Alliance.
Helia Molina is at the Facultad de Ciencias Médicas de la Universidad de Santiago de Chile, Chile.