The World Health Organization (WHO), the only international intergovernmental organization dedicated to health, is in a unique position to encourage states’ adherence to standards prescribing global health goals. This is important since health law is a powerful tool for changing unhealthy behaviors and environments and fostering global coordination of health systems efforts (Marks-Sultan et al., 2016). For WHO’s normative leadership to materialize, the international standards adopted by it must be followed by concrete actions by national actors (decision-makers, legislators, health professionals, etc.). However, there is lack of evidence regarding the extent and scope of the integration of “WHO law” into state standards, an approach that is nevertheless essential to enhance this leadership. There are a number of reasons for this lack of data. First, the monitoring and control mechanisms for normative instruments produced by WHO are mainly based on self-assessment reports submitted by States. However, the quantity and quality of the data obtained vary. Regarding the quantity, not all States transmit data relating to the results obtained in the wake of the adoption of normative instruments and the volume of information presented remains variable. With regard to quality, the unreliability of data reported by States has been highlighted by expert groups tasked with evaluating the effectiveness of certain WHO normative instruments (WHO, 2015 a); b). This lack of data is also observed in university research. Some interesting studies exist, but their fragmentary nature complicates the overall assessment of WHO’s normative function.
To respond to this concern, this research will study, the impact of WHO’s normative action on the internal standards of Member States, and more specifically on their internal law (laws, regulations and case law). Seven countries serving as tracer cases will be analyzed: Canada, Costa Rica, France, Israel, New Zealand, Switzerland and the United States.
This study is carried out in four phases (each building on the result of the previous ones, following an iterative process):
Phase 1. An in-depth study of the literature on the law of international organizations, global health law, standardization, and multi-level governance has enabled the development of a theoretical framework on the landing process of international norms in domestic law and public policy (with a special focus on WHO norms). The aim was to identify factors facilitating or limiting this landing process (and notably the behaviour of States) and to highlight the main stages in the life cycle of an international norm.
Phase2. This phase consists in a macro-level study of the references to the WHO found in the domestic law (laws, regulations, case law) of 7 countries (Canada, Costa Rica, the United States, France, Israel, New Zealand, and Switzerland). More than 5000 national instruments were selected for the study. For this phase, a quantitative and qualitative analysis of the occurrence of references to the WHO is carried out. This analysis allows to identify the extent to which national authorities rely on the WHO or reject its norms, the actors relying on WHO norms in court decisions (e.g.,experts, judges, parties), which WHO norms are most often cited as well as their characteristics (ex: binding versus non-binding), and which health issues are most often at stake when the WHO is cited.
Phase3. This phase is dedicated to the conduct of semi-structured interviews with key national and international experts involved in the implementation of WHO norms in the 7 targeted countries. This step aims to better understand the landing process of the WHO norms within national jurisdictions (both in domestic law and in public policy, health agencies, etc.) in order to identify the legal, political, social, economic and organizational considerations that impact this process. It provides information and insights that cannot be found in the literature (Phase 1) and in domestic law (Phase 2).
Phase 4. This final phase is a comparative analysis of the results of the previous phases which aims to enrich the theoretical framework previously created and to develop key global health governance recommendations (both at the national and international level).
This project received the Insight grant by The Social Sciences and Humanities Research Council (file no. 435-2020-0470) and is also financed by the George Stellari Funds.