An Academic Field Emerges

With globalization giving rise to new public health threats across nations, connecting societies in shared vulnerability, these globalizing forces have created the conditions for the cross-border spread of health threats, including the rapid increase in infectious diseases, commercial determinants of non-communicable diseases, and industrial challenges to environmental health. These global determinants of health have exposed the limitations of domestic public health law.Reference Gostin and Meier¹ Global health law has become necessary to address these common threats and shared burdens through coordinated action, bridging the gap between global norms and national laws to promote global health.Reference Gostin and Meier²

The field of global health law offers the promise of bridging national health authorities to advance public health, framing the norms, processes, and institutions of global governance for health.Reference Gostin³ Arising out of international health law — which narrowly focuses on infectious disease regulations among states — global health law has come to encompass an expansive scope of health challenges and legal authorities, including both “hard” law treaties that bind states and “soft” law policy instruments that bring together state and non-state actors. These law and policy frameworks provide a foundation to unite actors against global threats, striving for health equity for the most disadvantaged and presenting a legal framework to structure health efforts by the global community.Reference Toebes, Burci and Toebes⁴

As an academic field, global health law has become a basis to study these law and policy frameworks that apply to the new set of public health threats, non-state actors, and regulatory instruments that structure global health. This recognition of new forms of global governance to realize justice in global health led to the seminal treatise, Global Health Law (Harvard University Press 2014), which offered an initial definition and theory of the field.Reference Gostin⁵ Through an encompassing definition of global health law, with law and policy instruments addressing a range of health challenges across state and non-state actors, the rise of scholarship in the field has examined how a proliferation of international, national, non-governmental, and corporate actors can come together to address a multisectoral array of health determinants.Reference Gostin⁶

The expansion of health law scholarship to encompass global health law has provided a foundation to study the law and policy frameworks that structure efforts by the global community to advance global health. Looking beyond the regulation of states through international treaty law, global health law scholarship has analyzed new global policies to facilitate cooperation across state and non-state actors, frame new institutions of global governance, and realize global health with justice.Reference Gostin and Meier⁷ The rapidly expanding literature in the field has fostered a generation of global health law scholars, and given rise to the need for educational programs to train future practitioners.

Educational Programs to Train Future Practitioners

In a world of growing global inequities, sustained health challenges, and new pandemic threats, global health law education can support training for a new generation of practitioners to advance law and policy frameworks to support global health. An education in global health law equips practitioners to address global health threats, providing normative knowledge for public health advancement based on internationally agreed standards.Reference Ruger⁸ This academic study of the field is designed to inculcate global solidarity in responding to public health issues and emergencies of international concern.Reference Rowthorn⁹ Viewing the world not as a collection of states but as a community whose survival depends on working together, practitioners thus understand the need for “cooperation between governments, to address common challenges and achieve shared goals.”Reference Ahmed, Bleckner and Knight¹⁰ Beyond understanding this imperative for cooperation, practitioners are trained in critical technical skills to support health systems strengthening through the creation of strong national legal and policy infrastructures aligned with global frameworks for disease prevention and health promotion.Reference Baytor and Cabrera¹¹

While ongoing global health law reforms remain crucial in establishing a legal foundation for global health, this does not discount the importance of academic instruction to prepare students to address future challenges. These continuing reforms provide further evidence of the need for trained technical experts, whose understanding of current law and policy frameworks will be critical to ensure that future reforms are inclusive and address gaps in protection. Global health law education can demystify global health governance, leveling the playing field in global health diplomacy.Reference Kickbusch, Silberschmidtb and Buss¹² With current law reforms criticized for diplomatic negotiations that are exclusionary of low- and middle-income countries (LMICs), the global health agenda remains driven by high-income countries (HICs) and distorted in ways that marginalize issues relevant to the Global South.Reference Pattanshetty¹³ Building capacity in legal frameworks, rights, and responsibilities can thus become crucial for advancing a decolonial approach to global health law, facilitating greater equity in global health. Academic programs must be alive to the history and enduring legacy of colonialism and its impact on global health, which enables the dominance of HICs in shaping global health standards and undermines the agency and autonomy of LMICs.Reference Hussain¹⁴

Global health law education has expanded rapidly to meet this need, growing beyond a few course offerings to encompass formal Masters and LL.M. programs in different regions of the world.

These programs often bring together courses across three main domains of study: (1) healthcare law, including courses on insurance law and laws regarding healthcare practice, (2) public health law, including legal aspects of communicable and non-communicable diseases and commercial determinants of health, and (3) global health law, including global health governance, international human rights law, and global health security.Reference Xu and Wang¹⁵

With many programs concentrated in HICs, there remain global disparities in global health law education. The United States has become one of the leading providers of national and global health law education, with over 20 health law LL.M. programs across universities.¹⁶ (Similarly, the United States leads the world in global health diplomacy education — with 28 programs nationwide — followed by the United Kingdom (9) and Switzerland (5).Reference Pattanshetty¹⁷) Given the geographic location of these programs, the cost of attendance can be prohibitive to scholars from LMICs, even where scholarships are available. This inequity in access to education has led to calls for truly “global” health education, enabling more global health educational programs to be developed and taught at institutions in LMICs, allowing students in both LMIC and HIC contexts to be exposed to diverse faculty and pedagogy.Reference Binagwaho, Ngarambe and Mathewos¹⁸

At the forefront of global health law education, Georgetown University Law Center’s Global Health Law LL.M. program was established in 2007, recognizing that law would be a critical tool for shaping healthy countries and societies. The creation of this Georgetown LL.M. program coincided with the creation of the O’Neill Institute for National and Global Health Law — a joint Georgetown University project of the Law Center and School of Nursing and Health Studies.Reference Gostin¹⁹ Recognizing the rapidly changing landscape at the intersection of law and governance, Georgetown Law partnered with the Graduate Institute of International and Development Studies in Geneva in 2009 to introduce its second health law LL.M. in Global Health Law and International Institutions.Reference Gostin, Cabrera and Kim²⁰

Global health law training programs have since expanded dramatically throughout the world. Many early educational programs at the intersection of health and law were spurred by the HIV/AIDS pandemic. For example, universities in Thailand, South Africa, and Ukraine received funding for four clinical legal education programs whose goal was to create a “cadre of legal professionals to combine their legal skills with an understanding of health issues and the challenges facing underserved and socially marginalized groups.”Reference Ezer²¹ The law clinics in these contexts were seen as an important entry-point for engaging law students in health issues of global importance, such as access to medicines and quality of care.²² Continuing demand for global health law courses has grown in an effort to address health inequities through legal education,Reference Sharon²³ and in the COVID-19 era, there is seen to be greater demand for courses focused on global health law, particularly addressing legal frameworks and negotiations impacting access to essential medicines and vaccines.Reference Jacobsen and Waggett²⁴ In China, health law has been identified as a key area of focus for higher education amid the COVID-19 pandemic, as the Chinese government considers new approaches to establishing centers of learning in the field.Reference Xu and Wang²⁵

This interdisciplinary education will be crucial to building the future of the field. Faculty have now established a wide range of global health law courses in universities throughout the world — within schools of law, policy, public health, social work, nursing, and medicine. In law schools, global health law courses and clinics tend to include more skills building, providing instruction that equips practitioners to use the law to advance global health and address factors that promote disease proliferation and affect the ability of people to live healthy lives. Looking beyond law schools, law and policy courses are being designed to provide public health practitioners with an awareness of the legal frameworks that impact or affect their work.Reference Ransom²⁶ Courses in global health law now cover a wide breadth of topics, providing students with understanding, for example, of the role of the WHO, the importance of human rights in global health, the impact of international legal frameworks on domestic health delivery, and the intellectual property laws and regimes governing drug patents.²⁷

These courses must expand globally, especially in regions where there remain few global health education programs and few training opportunities for students. New courses are now being developed in LMICs, as seen in Afya na Haki (an African research and training institution that advances health, human rights, and sexual and reproductive health and rights), which recently launched a fully funded one year fellowship program and holds regular training workshops on health and human rights.²⁸ Where a deficit of global health law education programs remains in LMICs,Reference Pattanshetty²⁹ universities or other research entities in HICs have introduced global health law summer schools and internship programs to bridge the knowledge gap and expand education in global health law. For example, the O’Neill Institute at Georgetown Law offers summer and winter internships to law students from around the world, the Global Health Law Consortium offers a global health law summer school in Geneva for global participants with a legal background, and McGill University in Canada and the University of Groningen in The Netherlands offer a global health law summer school open to medical practitioners and health policy and law students.³⁰

The Rise of Academic Resources

To expand education in the field, new educational resources can provide a foundation for greater inclusion of global health in legal studies — and law in global health studies. This interdisciplinary teaching will be necessary to engage the next generation in global health law practice.