This article has been written by Ms. Aninditha Gandhe, a 2nd year student of Symbiosis Law School, Hyderabad. 

Abstarct

This legal research paper explores the transformative role of non-State actors (NSAs) in shaping global health governance, examining the complex dynamics that have propelled them into influential positions. The paper delves into the diverse spectrum of NSAs, including commercial entities, philanthropic foundations, international organisations, and non-governmental organisations (NGOs), and analyses their impact on health policies and resolutions. The study investigates the intricate factors contributing to the rise of NSAs, such as changes in governance frameworks, the dynamics of the global economy, and evolving societal aspirations. It critically evaluates the role of NSAs in global health diplomacy, emphasising their cooperative engagement through network diplomacy and their diverse contributions to agenda-setting and grassroots initiatives. Furthermore, the paper explores the legal implications of the increasing influence of NSAs, highlighting challenges and opportunities in governance strategies, including public-private partnerships and policy adjustments. The research also scrutinises the evolving role of NSAs in international forums, citing the UN Global Compact and the Framework of Engagement with Non-State Actors as pivotal developments. In assessing the consequences of NSAs’ involvement, particularly in healthcare delivery, the paper underscores the need for comprehensive reviews to gauge the impact on service quality and equity. Finally, it addresses the potential risks associated with the growing influence of financially powerful non-State actors within the United Nations, raising concerns about prioritising corporate interests over public health objectives. Overall, the paper provides a comprehensive examination of the multifaceted involvement of NSAs in global health, contributing to the ongoing discourse on the evolving landscape of international health governance.

Key Words: non-State actors, health, WHO, FENSA, UN. 

Introduction

Global health jurisprudence grounds future legal thinking about public health law in a global context in line with the global nature of the threats facing humanity’s health captures the interdependence between national and international law and reflects the increasingly significant role of non-State actors in international relations. Non-State actors (NSAs) have become essential in forming policies and resolutions in the complicated field of global health, bringing about a radical change in the dynamics of health governance. These actors encompass a wide range and include commercial companies, philanthropic foundations, international organisations, and non-governmental organisations (NGOs). Their impact arises from a complex interaction of elements that include changes in governance frameworks, the dynamics of the global economy, and the ever-changing aspirations of populations across the globe. This revolutionary role of NSAs highlights a paradigm shift in global health governance, where the combined influence of these various institutions sometimes outweighs the traditional authority of nation-States. The cooperative involvement of NSAs becomes increasingly crucial as the international community struggles with complex health issues, helping to shape solutions that adapt to the changing needs of our globalised society.

Non-State Actors (NSAs)

It is possible to define Non-State Actors for research purposes by comparing them to State characteristics. First off, unlike States, non-State actors do not have official authority over the populace. This does not, however, imply a lack of power because many have supporters, staff, and memberships. Some even become influential, perhaps even more so than a State, by serving as representatives for specific communities. Generally speaking, a non-State actor does not have formal authority over territory, while there are few outliers, like separatist movements or significant businesses. 

On the other hand, nations might not necessarily be in charge of their entire region. Finally, the conventional wisdom in international relations based on official ties between States is changing. As a result, Non-State Actors are becoming more accountable under international law. One example is the UN Global Compact (2000), which brings governments and multinational corporations together to encourage moral corporate conduct. 

Numerous non-State entities operate in global health diplomacy, primarily interacting through network diplomacy. The range of these actors is reflected in the WHO Register of Non-State Actors, which is currently being compiled. These actors include public-private partnerships, global health foundations and alliances, and their respective fields of interest. Many of them aim to bring together global agenda-setting and grassroots initiatives. 

‘Non-State Actors’ is a catch-all word with clear boundaries and is used negatively, where the problem lies. In addition to multinational corporations, private military groups, media outlets, terrorist organisations,  academic institutions, lobby groups, criminal organisations, labour unions or social movements, non-State actors include non-governmental organisations (NGOs). Each possesses a unique kind of power. While some intentionally work to undermine security and stability, others positively contribute to them. 

Factors related to the increase of non-State actors

Non-State Actors have risen to prominence through a deliberate evolution influenced by purposeful circumstances rather than an accidental one. Greater government responsibility was emphasised in the years following World War II. However, privatisation and outsourcing have reversed course in the last few decades, creating opportunities for non-State actors. This change highlights a trend in which organisations outside government increasingly take on activities and influence social processes. These individuals have been propelled into significant roles across multiple sectors by their conscious modifications to governance structures, deliberate alignment with global developments, and mindful reaction to growing public expectations. 

 The first causal factor lies in the emergence of a multipolar world order, wherein multiple power centres increase opportunities for Non-State Actors to exert global influence. A closely linked factor is the prevalence of globalisation, marked by free-market ideologies that empower large corporations, including those from the ‘Global South’ like India’s Tata and China’s Huawei. This era has also benefited NGOs, although the global economic recession of 2008 temporarily affected their funding.

Furthermore, the third wave of democratisation has spurred Non-State Actor activity, particularly at the local level, as increased global voices lead to organisational opportunities within civil society. Finally, normative changes like Steven Pinker’s “Rights Revolution” reflect a growing global awareness of people’s needs and a reduced tolerance for perceived injustice. This awareness catalyses grassroots action through civil society organisations. 

Role of non-State actors

In numerous low- and middle-income nations, governmental bodies are primarily responsible for delivering healthcare services to their populace, even though they may not be the exclusive providers. Beyond the realm of government, various entities contribute to healthcare coverage, yet this landscape has its challenges. This particular health policy, however unique in its subject and setting, clearly shows that non-State players were crucial to the policy’s development even though the State was initially in charge. They were not just agenda-setters, lobbying the government and such, but they also made significant contributions to the formulation and execution of medical policy. The World Health Organization (WHO) works closely with non-State actors to carry out its vital leadership role in global health and to operate as the main body guiding and coordinating actions related to international health. This proactive involvement aims to protect and advance public health globally. 

Beyond the UN Charter’s original scope of consultation, non-State actors now play a much more significant role. It now includes establishing agendas, engaging in negotiations head-on, and working together to develop standards. In the United Nations (UN) system, the Framework of Engagement with Non-State Actors (FENSA) is a groundbreaking framework that the World Health Assembly approved during its Sixty-sixth session in May 2016. This was the first intergovernmental agreement to produce a framework that explicitly addressed the role of non-State entities. In official relations, FENSA effectively codified and improved the status of non-State actors as observers. That is why it did not result in a significant revision of the rules that had been in place since the Third World Health Assembly. These regulations, which date back to that assembly, have traditionally allowed non-governmental groups to attend meetings of the World Health Organization’s governing bodies as observers and speakers.

Consistent with the growing field of multi-stakeholder diplomacy, various non-State actors from the commercial and civil society sectors, functioning at the international, regional, and national levels, take an active role in and exercise their influence in all three governance domains. Beyond typical government structures, organisations, foundations, academia, and the business sector are potent players in global health diplomacy. Social media is a standard tool non-State actors use in digital diplomacy to sway or coerce diplomats into taking a particular stand during negotiations. One example is the prominent role that social media played in the 2010 Médecins sans Frontières campaign, “Hands off our medicine!”. The aim was to deter the European Union from concluding a trade pact with India that would have placed limitations on manufacturing generic medications vital for treating tuberculosis and other illnesses. 

Non-State actors are not officially allowed to participate in international health talks inside the World Health Organization’s (WHO) governing bodies. Nevertheless, they are regularly asked to provide their opinions and suggestions and are welcome to participate in consultations. These non-State actors visit Geneva on occasions when the World Health Assembly and the Executive Board, the WHO’s governing bodies, meet. They do this to participate actively in advocacy campaigns, have casual conversations with negotiators, and make Statements during the governing bodies’ meetings if they have formal relations with the WHO. 

The increasing influence of non-State actors, particularly those wielding substantial financial resources, within the United Nations (UN) is a notable trend. These entities can exert significant political pressure on governments, often diverging from the broader public good. A clear illustration of this dynamic is evident in the realm of noncommunicable diseases, where powerful corporations can counteract the public health objectives set by governments. Notably, some nations need to be more diligent in regulating significant industries such as pharmaceuticals, food and beverage, tobacco, and alcohol.

This shift in regulatory efforts could have profound implications for global health policy initiatives. The growing prominence of non-State actors with substantial resources raises concerns about the potential compromise of public health priorities in favour of corporate interests. Notably, the UN is increasingly providing a platform for the perspectives and stances of various non-governmental entities, including international organisations, philanthropic foundations, academic institutions, advocacy groups, religious bodies, and humanitarian organisations.

One significant development in global health is the growing participation of non-State entities. Interestingly, the annual budgets of organisations such as Médecins Sans Frontières (MSF) and the Bill and Melinda Gates Foundation (BMGF) are almost equal to those of the World Health Organization (WHO). Global health has changed from being primarily shaped by the charitable endeavours of notable people and international organisations that work in this well-known field within the worldwide community. At the moment, it represents a multipolar field in which many non-State actors actively participate. In this context, many governments with limited resources are trying to figure out how to involve non-State actors in healthcare effectively. The consequences can be severe when these actors provide poor quality or too costly services. This situation tends to worsen health and income disparities. To enhance the contributions of non-State health actors, governance strategies are being considered, such as specific interventions like public-private partnerships and adjustments to policy and regulatory frameworks. Unfortunately, there is a lack of comprehensive reviews assessing the impact of these governance strategies on the quality and equity of services delivered by non-State actors 

Conclusion

In summary, a revolutionary change in the dynamics of health governance is indicated by the growing importance of non-State players in global health. The diverse contributions of groups, including non-governmental organisations, international organisations, commercial businesses, and charitable foundations, have challenged traditional ideas of authority held by nation-States. Deliberate modifications to governance frameworks, synchronisation with worldwide advancements, and adaptability to changing public expectations drive this progress. Non-State actors have an indisputable impact on policymaking, international health agendas, and multi-stakeholder diplomacy because of their critical responsibilities. However, as these organisations become more powerful, especially those with significant financial means, there are worries about possible conflicts of interest and the necessity of solid governance mechanisms to guarantee that public health goals take precedence over corporate ones. The involvement of non-State actors in collaborative efforts is becoming increasingly important in tackling intricate global health issues and customising solutions to meet the dynamic demands of our globalised society.

References 

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