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Reviewed by:
  • Global Health Law by Lawrence O. Gostin
  • Margaux Hall (bio)
Lawrence O. Gostin, Global Health Law (Harvard University Press, 2014), ISBN 978-0-674-72884-4, 541 pages.

I. INTRODUCTION

Health care law is sometimes jokingly referred to as the “law of the horse”—meaning that health care law consists [End Page 242] of nothing more than conventional rules borrowed from other “coherent” legal fields, as each of those rules applies to the services, interactions, and institutions that relate to health care.1 Those of us who have dedicated our careers to the field have offered competing views of the themes that pervade health care law and its constituent parts. One theme is the intrinsically private, individualized relationship of trust that emerges around health care. A patient entrusts her doctor as healer to counsel and guide her through options that are often scientifically and ethically complex.

In Global Health Law, Larry Gostin offers an alternative, compelling view of health care law as a field that expands far beyond the examination of individual relationships—a field that is inherently global. As we have recently observed through the devastating spread of Ebola across West Africa and, briefly, to Europe and the United States, it is impossible to contain infectious diseases within national borders. Overpopulation and environmental degradation similarly pose cross-border threats to our well-being, as do health conditions inextricably tied to globally-relevant cultural concerns like violence. At the same time, we have unprecedented access to information about the pervasive health disparities that exist among global citizens. Through geospatial maps, we can now see how our geography maps onto stark health disparities both between and within nations.2 An individual child’s likelihood of dying before the age of five is highly correlated to where she is born—what continent, what country, and whether in urban or rural parts thereof—and to her socioeconomic means. That so much of an individual’s health turns on these factors, rather than innate biological or hereditary factors, is tragic and stoppable.

Gostin rallies these facts as a global call to arms. He examines international law, human rights, and principles of global governance as they relate to health care and proposes a new vision of Global Health Law as a field that is committed to correcting these disparities. Gostin’s Global Health Law is based in mutual, cross-national commitment to promoting health and the predeterminants of health for all global citizens. He proposes a new Framework Convention on Global Health, akin to the UN human rights conventions that have been promulgated over the past several decades.

His vision is as inspiring as it is courageous. I use the word courageous because there is longstanding skepticism regarding whether human rights treaties and other “soft law” mechanisms can resolve collective action constraints and motivate nations to act outside of self-interest. Scholars have conducted “empirical” analyses of the results of states ratifying human rights treaties, with certain unfavorable, albeit heavily-contested, results. In one study, Professor Oona Hathaway concluded that although the practices of countries that ratify human rights treaties are generally better than the practices of countries that have not done so, treaty ratification is often associated with worse practices than otherwise expected.3 How can nations have worse human rights records after ratifying [End Page 243] human rights treaties? Hathaway posited that since human rights treaties tend to be weakly monitored and enforced, a country may be able to ratify a treaty and gain expressive-benefits, including reduced pressure to improve practices, with few attendant costs.4 As other scholars have noted, one of the greatest human right to health victories of recent times—the enactment and upholding of the Affordable Care Act—took place in a country that does not embrace either positive rights or a “human right to health”.5 We have a vivid example of how human rights “ends” such as universal coverage are attainable through alternative legal reform strategies.

It is easy to discount human rights through such lines of criticism. Yet human rights activists that have continued to fight for stand-alone Conventions (including a recent advocacy push for a new Convention on the Rights of...

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