Elsevier

The Lancet

Volume 351, Issue 9101, 14 February 1998, Pages 514-517
The Lancet

Series
International collective action in health: objectives, functions, and rationale

https://doi.org/10.1016/S0140-6736(97)11451-9Get rights and content

Summary

To improve the performance of international health organisations, their essential functions must be agreed. This paper develops a framework to discuss these essential functions. Two groups are identified: core functions and supportive functions. Core functions transcend the sovereignty of any one nation state, and include promotion of international public goods (eg, research and development), and surveillance and control of international externalities (eg, environmental risks and spread of pathogens). Supportive functions deal with problems that take place within individual countries, but which may justify collective action at international level owing to shortcomings in national health systems—such as helping the dispossessed (eg, victims of human rights violations) and technical cooperation and development financing. Core functions serve all countries, whereas supportive functions assist countries with greater needs. Focus on essential functions appropriate to their mandate will better prepare international health organisations to define their roles, eg for WHO to focus on core functions and for the World Bank to focus on supportive ones.

Section snippets

International organisations and nation states

International health is characterised by different types of institution. However, we focus in this paper on WHO, which is the primary organisation in international health cooperation. We do not analyse the work that WHO is carrying out, but provide a framework to derive a definition of the functions of any effective world health organisation. Such a process can help efforts to bridge the gap between current performance and desired improvements.

Many attempts have been made to specify the

Core functions

The first type of essential function transcends the sovereignty of any one nation state, and therefore makes up the core of international health cooperation. These functions address problems of the “global commons”,9 in which individual decisions based on property rights are made ineffective by the fact that use of resources cannot be contained within boundaries. This is the case with both international public goods—when use by any one country producing them does not preclude use by other

Supportive functions

The second type of essential function deals with problems within individual countries that may warrant collective action at an international level owing to the shortcomings of national health systems; because they supplement activities that are primarily the responsibility of nation states, these functions are supportive.

In view of human-rights arguments and an ethical imperative to protect the health of people, irrespective of their nationality, the international community can become an “agent

Conclusions

The distinction between core and supportive functions has important implications. Core functions are an attempt to solve the global analogue of “market failures”—ie, situations in which costs and benefits of an action are not reaped exclusively by the individual agent, in this case, the nation state. Supportive functions, by contrast, are intended to compensate for “government failures”—ie, scenarios in which a government cannot fulfil its responsibilities independently. The ultimate goal of

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