The Exercise of Public Health Sovereignty: Trends and Trajectories IHR Workshop Ottawa September 21, 2006

2 Public Health Sovereignty The implementation of the IHR 2005 raises many questions concerning changes in how nation-states exercise their sovereignty in terms of public health (public health sovereignty). Public health sovereignty in two senses –In the international context (international law) –Within states (constitutional, domestic law)

3 Four Trends from the Workshop From intergovernmental cooperation to the globalization of governance From decentralized government towards the centralization of governance From complacency in government towards intensification of governance From heterogeneity of approaches toward harmonization of strategies and operations

4 Interdependent Trends Globalization CentralizationIntensification Harmonization

5 Public Health Sovereignty and Governance: Transformations Public health’s “new world order” Globalization Centralization Intensification Harmonization

6 Examples from the Workshop Globalization of governance= IHR 2005 –More authority for WHO –Involvement of non-state actors –More demanding obligations on WHO member states Centralization of governance: the growing role of federal/national governments in public health, esp. infectious diseases Intensification of governance: the scaled-up activities of non- federal governments (e.g., China, India, France, Russia) Harmonization of governance: the importance of the IHR 2005, the changed nature of federal/sub-federal cooperation

7 The Trends as Trajectories: Driving Factors The heightened public health importance of new information and communication technologies The design of new public health strategies for globalized problems Conceptual changes in thinking about public health challenges (e.g., global health security, national health security) Involvement of non-governmental actors in governance activities The demand for and supply of new legislation/ norms/SOPs/MOUs