Environmental Engineering Reference
In-Depth Information
as driving change and providing disease surveillance, delivery, implementation, and
overall legitimacy. with HIv/aIDS in Brazil and with polio, civil society actors and
philanthropy provided the capacity that states clearly lacked. In the SarS case, less
capable southeast asian states effectively intervened in china's domestic affairs. Still,
china's shunning of taiwan shows the strength of the westphalian formula, even in
the face of clear risks to global health. and ultimately only national governments
are accountable and thus responsible for the health of their own citizens and others
inside and outside their own state.
International institutions are arising as effective and legitimate innovators in a
great diversity of forms. the wHo, the institution at the heart of the late 1940s
outburst of functional international organisations, has shown many remarkable
advances. In the case of SarS, it broke the old state monopoly by communicating
directly with citizens and disseminating the results, without the state's permission, to
people around the world. Similarly, the WHO issued geographically specific travel
advisories without the state's consent. It sent an evaluation team to china without
prior permission from the state. rather than defer to states whose responses were
clearly inadequate, and even though relatively few people actually died, the wHo
became the world's lead assessor, critic, and technical agency. two years before
SarS, the wHo had established the Global outbreak alert and response network
(GOARN) to communicate directly with internet-connected and empowered citizens,
bypassing their states. In May 2003 its members formally authorised the wHo to
gather data from non-state actors. and the new IHr eroded the state monopoly on
the reporting of pathogen-induced morbidity and mortality that the old ones had
contained. It is thus understandable that David Fidler (2004) has proclaimed that
SarS ushered in a post-westphalian world.
there are signs of such movement beyond the wHo and SarS. the wHo led
on tobacco, where it brought in civil society and where its public hearings withstood
counter claims that it was the instrument of a new northern-driven colonialism
attacking the state sovereignty so recently won by the South. the wHo's work on
health diplomacy involves public hearings, including those held via the internet. the
Un receives substantial sums not just from its state members, with their assessed and
voluntary contributions, but also from non-state actors such as rotary International
for polio. Global health initiatives and the G8 mobilise money for the Un as well
as address challenges directly, outside the Un. the monopoly on raising money
for public goods—a core claim of the sovereign state—has gone, especially with
bill and Melinda Gates, bill clinton, and other celebrities getting into the global
health governance game. the G8's involvement in health has made national leaders
global as well as state governors, and allowed them collectively to redefine their
interests and identity in favour of the global public good. as Gro Harlem brundtland
recognised, only leaders can share their states' sovereignty at first hand. Forman
affirms the coercive and persuasive power of domestic and international law in the
case of HIv/aIDS. there is thus much evidence that multi-stakeholder, multi-level
governance, through networks of international institutions and nongovernmental
actors, matter a great deal.
