The United Nations Day for South-South Cooperation last Friday must be taken as an opportunity to reflect about the place and opportunities for regional organisations in the South to provide leadership and direction in support of the right to health, equity and alternative practices of global (health) governance.
Back in 2005, during the Fourth Summit of the Americas in Mar del Plata, Buenos Aires, left-leaning Heads of State and anti-globalisation movements expressed their rejection to the US-led Free Trade Agreement of the Americas and brought to a close its negotiations. At the same time, South American leaders sealed a new deal towards alternatives modalities of regional governance. The birth of the Union of South American Nations (UNASUR) should be seen in this light. UNASUR crystallised as an ambitious integration project with renewed commitments on democratic principles, inclusion and human rights. Health in this context became a ‘locus for integration’ and a new framework to advance the right to health and legal paradigms linking citizenship and health. To varying extents, UNASUR institutionalised regional theme-specific networks and country-based working groups to implement health projects, enabled spaces for knowledge exchange and regional strategies for medicine production and commercialisation, and helped coordinating common positions acting as a global player in the advocacy of health equity.
Nearly a decade after that meeting in Mar del Plata, has UNASUR diplomacy enhanced the right to health? Last June, at a speech for the 35th biannual conference for the Economic Commission for Latin America and the Caribbean (ECLAC), General Secretary, Alicia Bárcena stated, “cooperation in Latin America and the Caribbean is at a turning point, as the region still needs aid, but is also able to provide aid.” Indeed, better-resourced and more confident Latin American governments are not only recipients and providers of aid but also carving out new spaces in global health diplomacy.
Regional health diplomacy: UNASUR as norm-entrepreneur?
Tackling germs, negotiating norms, and securing access to medicines are persistent challenges that disproportionally affect developing countries’ participation in global health governance. Furthermore, over the last two decades, the excessive focus on global pandemics and security in global health diplomacy, rendered peripheral diseases that usually strike the poor and vulnerable, creating situations of marginalisation and inequality across societies. In other words, what is ‘visible’ and ‘urgent’ – what defines risks and ‘high politics’ in health to use the language of International Relations – leads over what is ‘marginal’. Furthermore, who frames what and why depends on how actors, including government officials, non-governmental organisations (e.g. Medicins Sans Frontieres, Oxfam, the Gates Foundations), institutions (e.g. World Health Organisation, World Bank, UNICEF, UNAIDS), public-private partnerships (e.g. GAVI), position and negotiate interests in global health governance.
Since 2010, UNASUR took up this glove acting as a corrective to the side-lining of rights on account of risk/security concerns in international health politics. One of the first positions taken by UNASUR at the WHO was concerning the impact intellectual property rights on access to medicines and the monopolist position of pharmaceutical companies on price setting and generics. Led by Ecuador and Argentina, UNASUR successfully advanced discussions on the role of the WHO in combating counterfeit medical products in partnership with the International Medical Products Anti-Counterfeiting Taskforce (IMPACT), an agency led by Big Pharma and the International Criminal Police Organisation (Interpol) and funded by developed countries engaged in intellectual property rights enforcement. Controversies focused on the legitimacy of IMPACT and its actions seen as led by technical rather than sanitary interests, unfairly restricting the marketing of generic products in the developing world. At the 63rd World Health Assembly in 2010, UNASUR successfully proposed that an intergovernmental group replaced IMPACT to act on, and prevent, counterfeiting of medical products. This resolution was approved at the 65th World Health Assembly in May 2012. In the course of this meeting, UNASUR also lobbied for opening negotiations for a binding agreement on financial support and research enhancing to meet the needs of developing countries.
More recently, led by the Ecuadorian delegation, UNASUR presented to discussion at the WHO an action plan which aims to improve the health and wellbeing of people with disabilities. This action plan was successfully taken up at the 67th session of the World Health Assembly in Geneva, in May 2014, when the WHO’s 2014-2021 Disability Action Plan was approved. This plan focuses on assisting regional WHO member countries with less-advanced disability and rehabilitation programs and will be carried out by the WHO in conjunction with regional organisations such as: Caribbean Community (CARICOM), Central American Integration System (SICA), Southern Common Market (MERCOSUR) and UNASUR. This is not a minor issue as in countries that bear a ‘double burden’ of epidemic communicable diseases and chronic non-transmissible diseases. Supporting these developments, the South American Institute of Health Governance, UNASUR’s health think-tank, provides policy-oriented research, fostering debate and capacity building for policy-makers and negotiators in light of the post-2015 Development Agenda.
The limits of a broker
The presence of UNASUR in this type of health diplomacy, and its coordinated efforts to redefine rules of participation and representation in the governing of global health, are indicative of a new rationale in regional integration and regional policy-making in Latin America. These actions create new spaces for policy coordination and collective action where regional institutions become an opportunity for practitioners, academics and policy makers to collaborate and network in support of better access to healthcare, services and policy-making. For negotiators, UNASUR structures practices to enhance leverage in international negotiations for better access to medicines and research and development funding, as well as better representation of developing countries in international health governance. For advocacy actors, UNASUR represents a new normative platform for claiming and advancing the right to health within the region while at the same time attempting to establish itself as a broker between national needs and global norms, a political pathway that differs from the position held by Latin America in the past.
The experience of UNASUR opens an unprecedented opportunity to evaluate the ways regional organisations address rights-based concerns affecting ordinary people. It also teaches some important lessons while it highlights a troubling paradox. First, region should be seen as a space where politics and policy happens within a geographical space as much as trans-border actor with a unique capacity to rework and contest norms. Second, scholars interested in agenda setting in global politics, who often place attention to the dominance of powerful Northern-based actors, should address new corridors of diffusion and the agency of Southern regional arrangements as norm entrepreneurs advancing (human) rights. Researchers and practitioners interested in rights-based governance and development can’t afford to ignore Southern regional formation ambitions and their attempts rework global norms. Finally, innovative diplomatic intervention and South-South cooperation promoting rights, and the normative agency of regional organisation while must not be romanticised should neither be trivialised.
There however is a paradox at the heart of regional defense of equity. Normative claims about the morality of rights as an overarching approach to governance must not down-play politics. While UNASUR advocates health rights globally, regional frameworks pushing for reforms towards universal health systems are significantly filtered by quite conservative practices at the national level of politics. Translating normative principles into state action in support of better access to health care and medicines across Latin America remains uneven, affecting the bearers of (human) rights in different ways. This is reinforced by the absence of binding institutional mechanisms supporting fluent corridors of regional-national policy making.
Just as in Mar del Plata when the people (pueblos) buried the US-led FTAA ambitions, it is time to rethink not only whether a regional organisation such as UNASUR can itself become an entrepreneur advancing rights to health globally, but also how it can broker the right to, and universalisation of, health addressing the needs of economically and socially vulnerable populations through state action and reforms within the boundaries of member states.
 UNASUR Constitutional Treaty, at http://www.comunidadandina.org/unasur/tratado_constitutivo.htm, (3/3/2014)