New structures and ways of policymaking are bringing democratic and social concerns into regional politics. While not without problems, the new post-hegemonic (i.e., a post U.S.-dominated region) regional multilateral organizations, such as the Bolivarian Alliance of the Americas (ALBA), the Union of South American Nations (UNASUR) and the Community of Latin American and Caribbean States (CELAC), are recasting politics in the region bringing attention to new trends and drivers in the policy and study of regionalism.
As a result, today we have a real opportunity to assess how southern regionalism (and different efforts at regionalism—regionalisms, if you will) become political spaces where policies are redefined and the norms of global political economy can be renegotiated.
South American regionalism is going global.
Established in Cuzco, Peru in 2004, UNASUR set out three principal goals, two of which were fairly standard: to re-invigorate intra-regional cooperation and create physical infrastructure (roads, energy and communications) to support better regional development. The third goal was a commitment of greater political cooperation in poverty eradication and improved health outcomes. UNASUR’s Constitutive Treaty explicitly declared the need to foster integration in support of social inclusion, poverty eradication and the realization of rights. With that declaration, supporting rights-based social policy came to be framed as a regional responsibility.
One of those central areas is health. Tackling germs, negotiating norms, and securing access to medicines are persistent challenges that disproportionally affect developing countries’ ability to promote the health and safety of their populations and interactions with the global health community.
Furthermore, in the past two decades, diseases that especially strike the poor and vulnerable have been pushed to the periphery by the excessive worldwide focus on global pandemics and security. The global health agenda is disproportionately framed by a selection of heavyweight actors, including government officials, nongovernmental organizations (e.g. Medicins Sans Frontieres, Oxfam, the Gates Foundation), multilateral institutions (e.g. World Health Organization, World Bank, UNICEF, UNAIDS), and public-private partnerships (e.g. GAVI), which base the strategies not just on moral principles, but also, often, their own understanding of what is globally relevant and cost-effective in health cooperation and technical assistance programs. The risk is that what is “visible” and “urgent’ and “global” leads over what is “marginal” and “peripheral,” overlooking situations of marginalization and inequality across societies.
In response, UNASUR has become a pro-active player in advancing a new regional diplomacy on health issues focused on redistribution and rights. One of the first positions taken by UNASUR at the World Health Organization was on the impact of intellectual property rights on access to medicines and market dominance of pharmaceutical companies in price setting and limiting generics. Led by Ecuador and Argentina, UNASUR successfully advanced discussions on the role of the WHO in combating counterfeit medical products. Those discussions focused on the alliance between the WHO and 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. UNASUR’s argument was that IMPACT’s work with WHO was more focused on unfairly restricting production and trade of generic products in the developing world—their own private interests—than—as they claimed—sanitary or health issues. In short, that the WHO-IMPACT relationship was a conflict of interest.
At the 2010 63rd World Health Assembly, UNASUR succeeded in replacing IMPACT with an intergovernmental group to prevent and punish the counterfeiting of medical products. UNASUR’s resolution for the change was approved at the 65th World Health Assembly in May 2012. In the course of the meeting, UNASUR also lobbied for opening negotiations for a binding agreement on greater financial support and more research to meet the needs of developing countries.
More recently, led by the Ecuadoran delegation, UNASUR presented an action plan for discussion at the WHO 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 WHO member countries that have less-advanced disability and rehabilitation programs.
This is not a minor issue in countries that bear a double burden of communicable diseases and chronic non-transmissible diseases. These developments have been supported by the South American Institute of Health Governance (ISAGS), created in 2008 as UNASUR’s health think-tank to act as knowledge broker gathering, assessing and benchmarking health policy and targets; as well as a training hub offering technical support and capacity building for policymakers that fill ministerial positions, negotiators that sit in the international fora, and practitioners that liaise with the general public.
UNASUR’s activism and voice have become pivotal in the promotion of health and the right to health. While still a neglected partner in global efforts to tackle poverty, UNASUR offers unique opportunities to strengthen actions on poverty and equity. In light of the UN’s post-2015 development agenda UNASUR can offer effective, context-specific, policy interventions. Their voice and agenda can help refocus the discussion among conservative development institutions, such as the World Bank, on the goals of social justice and act as a counterbalance to security-driven concerns that dominate international health politics.
All this demands attention to the global role of newfound regional actor.