Global health: WHO, the SDGs and the International Health Regulations

In short

Global health is the study and practice of improving health and reducing inequities for populations worldwide, through institutions and rules that cross national borders. Its architecture has three pillars examined together: the World Health Organization as the normative and coordinating agency, the Sustainable Development Goals as the 2015-2030 target framework, and the International Health Regulations (2005) as the only binding international law on outbreak detection and reporting. MPH papers on health policy and systems ask for WHO structure and functions, SDG 3 targets and indicators, IHR core capacities and PHEIC procedure, and India's obligations and performance against them. These are also standing interview topics for roles at the National Centre for Disease Control, NHSRC, state health societies, WHO-India and NPSP, UNICEF, Gates Foundation, PATH, Jhpiego, PHFI and the consulting arms of IQVIA, Deloitte and Sambodhi.

Explained

The World Health Organization: mandate, structure, functions

• Founded 7 April 1948 (now World Health Day) under its Constitution (signed 22 July 1946), the UN specialised agency for health; headquarters Geneva; 194 Member States.
• Constitutional definition: *"Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity"*, and the enjoyment of the highest attainable standard of health is a fundamental human right.
• Governing bodies: the World Health Assembly (WHA) meets annually in May (one vote per Member State, approves budget and resolutions); the Executive Board of 34 technically qualified members meets at least twice a year and sets the WHA agenda; the Secretariat is headed by the Director-General, nominated by the Board and appointed by the WHA for five years (renewable once).
• Three levels: headquarters, six regional offices, and country offices (~150). Regions: AFRO (Brazzaville), AMRO/PAHO (Washington), SEARO (New Delhi), EURO (Copenhagen), EMRO (Cairo), WPRO (Manila). India is in SEARO, whose Regional Committee meets annually; a Regional Director serves five years.
• Financing: assessed contributions (mandatory dues scaled to GNI and population, historically only ~16-20% of the budget) plus voluntary contributions (largely earmarked by donors). WHA74-77 approved a stepwise rise in assessed contributions towards 50% of the base budget, with a replenishment-style investment round; the US notified withdrawal in January 2025, and the 2026-27 programme budget approved at WHA78 (May 2025) was reduced accordingly — exact figures and the final budget envelope are being revised, so quote the mechanism rather than a precise number.
• Normative instruments and their legal force:
  • Conventions/treaties under Article 19 (two-thirds WHA vote, then national ratification): the WHO Framework Convention on Tobacco Control (FCTC), 2003 — India ratified 5 February 2004 and gave it domestic effect largely through COTPA 2003 — and its Protocol to Eliminate Illicit Trade in Tobacco Products.
  • Regulations under Articles 21-22 (adopted by the WHA, binding on all Members unless they reject or reserve within a stated period — "contracting out"): the International Health Regulations and the nomenclature regulations (ICD).
  • Recommendations, standards and guidelines under Article 23 (non-binding "soft law"): the Model List of Essential Medicines, air-quality guidelines, the International Code of Marketing of Breast-milk Substitutes, prequalification of vaccines and diagnostics, ICD-11 (in force 1 January 2022) and ICF.
• Core functions (WHA-agreed): leadership on health matters; shaping the research agenda; setting norms and standards; articulating ethical and evidence-based policy; technical cooperation and capacity-building; monitoring and assessing health trends.
• Strategy: the 13th General Programme of Work ran to 2025 with the "triple billion" targets (1 billion more benefiting from UHC, 1 billion more better protected from health emergencies, 1 billion more enjoying better health and well-being); GPW 14 covers 2025-2028 and reorganises around six strategic objectives (climate and health, health determinants, health systems/UHC, emergencies, science and digital, and WHO performance).
• Other key global actors (not WHO, often confused with it): the World Bank (financing, *World Development Report 1993 Investing in Health* which introduced DALYs into policy), UNICEF (child health; co-host of Alma-Ata 1978), UNAIDS, UNFPA, the Global Fund to Fight AIDS, TB and Malaria (2002), Gavi, the Vaccine Alliance (2000), Unitaid, CEPI, the Pandemic Fund (World Bank-hosted, 2022), Wellcome Trust and the Gates Foundation; IHME (Global Burden of Disease estimates, often differing from official national figures).
• Landmark declarations: Alma-Ata 1978 ("Health for All by 2000", primary health care as the route); Ottawa Charter 1986 (health promotion); Astana Declaration 2018 (reaffirmed PHC for UHC and the SDGs); the Commission on Social Determinants of Health (2008) and its three recommendations — improve daily living conditions, tackle the inequitable distribution of power/money/resources, measure and understand the problem.

The Sustainable Development Goals and SDG 3

• Adopted by the UN General Assembly on 25 September 2015 in *Transforming Our World: the 2030 Agenda*, effective 1 January 2016, succeeding the Millennium Development Goals (2000-2015).
• Architecture: 17 Goals, 169 targets, ~231 unique indicators, monitored by the UN Statistical Commission's IAEG-SDGs; principles are universality (applies to rich and poor countries), integration, and "leave no one behind"; voluntary, not legally binding; reviewed at the High-Level Political Forum through Voluntary National Reviews (India has submitted in 2017, 2020 and later cycles).
• MDG vs SDG: MDGs had 8 goals/21 targets, were disease- and developing-country focused, and were drafted by UN experts; SDGs are universal, cover determinants and NCDs, include UHC, and were negotiated by Member States.
• SDG 3 — "Ensure healthy lives and promote well-being for all at all ages" has 13 targets: 9 outcome targets (3.1-3.9) and 4 "means of implementation" targets (3.a-3.d).

• Health also sits in SDG 1 (poverty), 2 (nutrition, stunting/wasting), 5 (gender, FGM, child marriage), 6 (water and sanitation), 11 (urban air quality), 13 (climate) and 17 (partnerships) — "health in all goals".
• India's machinery: NITI Aayog is the nodal body; the SDG India Index (since 2018, with NITI Aayog and MoSPI) scores states and UTs 0-100 on goal-wise and composite indices; MoSPI publishes the National Indicator Framework (NIF) and an annual *Progress Report*; states have SDG cells and some have district indices. Index scores are revised each edition, so cite the edition when quoting a score.
• Key Indian data sources for SDG 3: NFHS (NFHS-5, 2019-21; NFHS-6 fieldwork conducted 2023-25 with results releasing in stages), SRS (MMR, IMR, NMR, TFR — the official source), HMIS and NIKSHAY, the Civil Registration System, National Health Accounts estimates, and the Global TB Report for TB.
• Where India stands (latest official figures, SRS/NFHS): MMR 93 per 100,000 live births (SRS 2019-21); IMR 27 and NMR 19 per 1,000 live births, under-5 mortality 31 (SRS 2021 series); TFR 2.0 (NFHS-5) — below replacement; institutional deliveries 88.6% (NFHS-5). Figures are revised with each SRS bulletin.

The International Health Regulations (2005)

• A binding instrument under Articles 21-22 of the WHO Constitution; adopted by WHA58.3 on 23 May 2005, entered into force 15 June 2007; 196 States Parties (194 Members plus the Holy See and Liechtenstein). India is a State Party and accepted without reservation.
• Purpose and scope (Article 2): "to prevent, protect against, control and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks, and which avoid unnecessary interference with international traffic and trade."
• Why IHR 2005 replaced IHR 1969: the old rules covered only three notifiable diseases (cholera, plague, yellow fever — down from six), relied on state notification alone, and were bypassed in the 2003 SARS outbreak. IHR 2005 is all-hazards — any event that may constitute a public health emergency of international concern, including biological, chemical, radio-nuclear and unknown causes — and allows WHO to use non-state information sources (Article 9) and to seek verification from the State Party (Article 10).
• Obligations of States Parties:
  • Designate a National IHR Focal Point (NFP), accessible 24/7, communicating with WHO IHR Contact Points. India's NFP sits in the Ministry of Health and Family Welfare / Emergency Medical Relief division, operating through the National Centre for Disease Control (NCDC) and IDSP/IHIP surveillance.
  • Assess and notify WHO within 24 hours of assessing a potentially notifiable event (Article 6), then share timely, accurate public health information.
  • Develop, strengthen and maintain core capacities for surveillance and response (Annex 1) at local/community, intermediate and national levels, and at designated points of entry — airports, ports and ground crossings.
  • Routine capacities at points of entry: medical services and diagnostics, safe transport of the ill, trained personnel for conveyance inspection, safe water and food, vector control, waste management; plus contingency plans and dedicated space for assessment and isolation.
  • Apply health measures that are evidence-based, non-discriminatory and no more restrictive of traffic and trade than reasonably available alternatives (Articles 42-43); additional measures must be reported to WHO with the public health rationale within 48 hours.
  • Honour traveller rights (Articles 23, 31, 32): informed consent, dignity, privacy; invasive examination or vaccination may not be required as a condition of entry except as provided; Annex 6/7 lists vaccination for international travel — yellow fever is the only vaccination that may be required under the IHR (the polio and COVID-19 arrangements ran as temporary recommendations).
  • Issue Ship Sanitation Control (Exemption) Certificates (valid six months) and inspect conveyances; use the Maritime Declaration of Health and the Health Part of the Aircraft General Declaration (Annexes 8 and 9).
• Annex 2 decision instrument: the algorithm for deciding whether to notify. Four diseases are always notifiable, in a single case: smallpox, poliomyelitis due to wild-type or vaccine-derived poliovirus, human influenza caused by a new subtype, and SARS. A second list (cholera, pneumonic plague, yellow fever, viral haemorrhagic fevers, West Nile, and others of national or regional concern) is assessed against four questions: is the public health impact serious; is the event unusual or unexpected; is there a significant risk of international spread; is there a significant risk of international travel or trade restrictions. Two or more "yes" answers mean notify.
• PHEIC — "an extraordinary event which is determined to constitute a public health risk to other States through the international spread of disease and to potentially require a coordinated international response."
  • Process: the Director-General alone declares and terminates a PHEIC, after convening an Emergency Committee (advisory, from the IHR Expert Roster) and consulting the State Party; the DG then issues temporary recommendations, reviewed at least every three months. Standing recommendations may be issued under Article 16 on expert-committee advice. A Review Committee advises on amendments and on technical matters.
  • PHEICs declared so far: H1N1 influenza (2009), polio (2014, still in force), Ebola in West Africa (2014), Zika (2016), Ebola in DR Congo/Kivu (2019), COVID-19 (30 January 2020 - 5 May 2023), mpox (July 2022 - May 2023 and declared again 14 August 2024). The mpox determination was ended in September 2025 while the event remained a continuing emergency under WHO's own grading, so always distinguish the IHR PHEIC from WHO's internal grade 1-3 emergency grading.
  • Limitations repeatedly examined: no sanctions or enforcement; the DG cannot compel information or entry; "binary" declaration with no intermediate alarm; widespread travel bans in 2020 despite Article 43; States Parties' obligations on sharing samples and benefits are weak; funding of core capacities is domestic.
• 2024 amendments (WHA77, 1 June 2024): added a definition of pandemic emergency as a higher tier above PHEIC; inserted equity and solidarity as principles; required each State Party to designate a National IHR Authority for coordination (alongside the NFP); created a States Parties Committee and a Coordinating Financial Mechanism; strengthened access to health products. They entered into force on 19 September 2025 for States Parties that did not reject or reserve.
• The WHO Pandemic Agreement, negotiated by the Intergovernmental Negotiating Body, was adopted at WHA78 on 20 May 2025 under Article 19; it covers prevention, One Health, R&D, technology transfer and a Pathogen Access and Benefit-Sharing (PABS) system whose annex was still being negotiated, and it requires 60 ratifications to enter into force — it is not yet in force, and India's ratification status should be checked rather than assumed.
• Monitoring IHR capacity (the IHR Monitoring and Evaluation Framework): the mandatory annual States Parties Self-Assessment Annual Reporting (SPAR) — 35 indicators across 15 capacities, scored 1-5, the source of SDG indicator 3.d.1 — plus three voluntary components: the Joint External Evaluation (JEE), after-action reviews and simulation exercises. India's first JEE was in 2017 (JEE 1.0, 19 technical areas) and a second-edition JEE was conducted later; One Health and the National One Health Mission, the National Action Plan on AMR (NAP-AMR 2.0, 2025-29) and NCDC's Integrated Health Information Platform (IHIP, replacing paper IDSP reporting) are India's main IHR-strengthening instruments.
• Indian legal interface: the IHR is not self-executing. Port and airport health work runs under the Indian Port Health Rules, 1955 (made under the Indian Aircraft/Port legislation) and the Aircraft (Public Health) Rules, 1954; outbreak powers were used under the Epidemic Diseases Act, 1897 (amended 2020 to protect healthcare personnel) and the Disaster Management Act, 2005 during COVID-19. A consolidated Public Health (Prevention, Control and Management of Epidemics, Bio-terrorism and Disasters) Bill has been drafted repeatedly and is not enacted; health is a State subject under Entry 6 of the State List, while port quarantine and inter-state spread of disease are Union/Concurrent matters (Union List Entry 28, Concurrent List Entry 29) — which is why IHR compliance is a central obligation delivered through states.

Universal health coverage and global health security — the two framings

• UHC (SDG 3.8): all people receive the health services they need, of sufficient quality, without financial hardship. Three dimensions of the "UHC cube": population covered, services covered, proportion of cost covered. Measured by the UHC service coverage index (14 tracer indicators across RMNCH, infectious disease, NCDs and service capacity) and by catastrophic health expenditure (out-of-pocket spending above 10% or 25% of household consumption).
• India's UHC instruments: Ayushman Bharat — Ayushman Arogya Mandirs (the renamed Health and Wellness Centres) delivering the Comprehensive Primary Health Care package, and PM-JAY with a ₹5 lakh per family per year cover, extended in 2024 to all citizens aged 70 and above (Ayushman Vay Vandana); the National Health Policy 2017 target of government health spending at 2.5% of GDP by 2025 was not met — National Health Accounts show government spending near 1.8-1.9% of GDP and out-of-pocket spending reduced to roughly 39-40% of total health expenditure (2021-22 estimates).
• Global health security framing: emphasises detection and containment of threats (IHR, GHSA, Global Health Security Index, biosecurity). Critique examined in MPH papers: security framing privileges donor-country risk and vertical disease programmes over everyday primary care, while UHC framing builds the systems that detect outbreaks in the first place — the two are complementary, and PHC is the shared foundation (Astana 2018).
• Global health law and governance debates to be able to argue: sovereignty versus collective action; vaccine nationalism and COVAX's shortfall; TRIPS flexibilities, compulsory licensing and the 2022 TRIPS decision; the Nagoya Protocol versus rapid pathogen sharing; donor earmarking distorting WHO priorities; brain drain and the WHO Global Code of Practice on the International Recruitment of Health Personnel (2010); climate-health under the WHO global strategy and the COP28 health declaration.

Key points

• WHO - UN specialised agency, 1948, 194 Members, 6 regions; India in SEARO (New Delhi).
• Governance - WHA (annual, May) decides; 34-member Executive Board prepares; DG serves 5 years, renewable once.
• Article 19 - treaty power (FCTC 2003, ratified by India 2004); Articles 21-22 - regulations binding unless rejected (IHR, ICD); Article 23 - non-binding recommendations.
• Alma-Ata 1978 - "Health for All", PHC as the strategy; Astana 2018 reaffirmed PHC for UHC.
• SDGs - 17 goals, 169 targets, ~231 indicators, 2016-2030, universal and voluntary; MDGs had 8 goals and ended in 2015.
• SDG 3 - 13 targets: 3.1 MMR < 70; 3.2 NMR ≤ 12 and U5MR ≤ 25; 3.4 one-third cut in premature NCD mortality; 3.8 UHC; 3.d IHR capacity.
• SDG 3.8.1 - UHC service coverage index from 14 tracer indicators; 3.8.2 - catastrophic out-of-pocket spending (>10% / >25% of household consumption).
• NITI Aayog is India's nodal SDG agency; the SDG India Index ranks states; MoSPI maintains the National Indicator Framework.
• IHR (2005) - adopted 2005, in force 15 June 2007, 196 States Parties; all-hazards, replaced the 3-disease IHR 1969 after SARS.
• Notify within 24 hours of assessing an event; WHO may act on non-state information (Art. 9) and request verification (Art. 10).
• Annex 2 - single case always notifiable: smallpox, polio (wild or vaccine-derived), new-subtype human influenza, SARS; otherwise 2 of 4 criteria.
• PHEIC - declared and ended by the Director-General alone, on Emergency Committee advice, with temporary recommendations reviewed every 3 months.
• PHEIC list - H1N1 2009, polio 2014 (ongoing), Ebola 2014, Zika 2016, Ebola 2019, COVID-19 2020-2023, mpox 2022-23 and again from August 2024.
• 2024 amendments (in force 19 September 2025) - added pandemic emergency, equity, a National IHR Authority, a States Parties Committee and a financial mechanism.
• Pandemic Agreement adopted 20 May 2025 under Article 19; needs 60 ratifications and is not yet in force; the PABS annex was still under negotiation.
• Monitoring - SPAR is mandatory and feeds SDG 3.d.1; JEE, after-action reviews and simulation exercises are voluntary; India's first JEE was 2017.
• India's delivery - NCDC as the IHR nerve centre, IDSP/IHIP surveillance, Epidemic Diseases Act 1897 and DM Act 2005 for powers; a consolidated public health Act is still only a draft.
• Article 43 - additional health measures must be science-based and reported to WHO within 48 hours; mass travel bans in 2020 showed the rule is unenforceable.

Formulas and examples

Example 1 — MMR and whether a state meets SDG 3.1. A state records 540 maternal deaths against 6,00,000 live births in the reference period.

• MMR = (540 / 6,00,000) × 100,000 = 540 × 0.1667 = 90 per 100,000 live births.
• SDG 3.1 global target is < 70, so the state is above target; India's national MMR is 93 (SRS 2019-21), so the state is marginally better than the national average but still short.
• To reach 70 at the same number of births, deaths must fall to 0.70 × 6,00,000 /1,000 = 420, i.e. 120 fewer deaths, a 22.2% reduction.

Example 2 — neonatal and under-5 mortality against SDG 3.2. A district has 20,000 live births, 300 deaths at 0-28 days and a further 200 deaths between 29 days and 5 years.

• NMR = (300 / 20,000) × 1,000 = 15 per 1,000 → above the SDG target of 12.
• U5MR = ((300 + 200) / 20,000) × 1,000 = 25 per 1,000 → exactly at the SDG target of 25.
• Neonatal share of under-5 deaths = 300/500 = 60%, the usual Indian pattern, so further gains need newborn care (SNCU, home-based newborn care under the Home Based Care for Young Child programme), not only immunisation.

Example 3 — Annex 2 decision instrument. A district reports 12 cases of an unexplained severe febrile illness with 4 deaths; two cases are foreign nationals who have since flown home, and a neighbouring country has suspended poultry imports.

• Disease is not on the always-notifiable list of four → apply the four questions.
• Serious public health impact? Yes (case fatality 4/12 = 33.3%). Unusual/unexpected? Yes (unknown aetiology). Risk of international spread? Yes (cases departed by air). Risk of trade/travel restriction? Yes (import suspension).
• 4 of 4 "yes" — two are enough — so the NFP must notify WHO within 24 hours of assessment, under Article 6, and continue to share information.

Example 4 — catastrophic health expenditure (SDG 3.8.2). In a survey of 2,000 households, 260 spent more than 10% of household consumption out of pocket on health, and 70 of those spent more than 25%.

• Incidence at the 10% threshold = 260/2,000 × 100 = 13.0%; at the 25% threshold = 70/2,000 × 100 = 3.5%.
• One such household consumes ₹1,80,000 a year and paid ₹36,000 out of pocket: ratio = 36,000/1,80,000 = 20% — catastrophic at the 10% threshold, not at 25%.
• Interpretation: service coverage (3.8.1) can rise while 3.8.2 worsens if expansion is financed out of pocket — both halves of SDG 3.8 must be reported together.

Example 5 — SPAR score and SDG 3.d.1. A country scores 35 IHR indicators and the levels sum to 126 out of a maximum 175 (35 × 5).

• Score = 126/175 × 100 = 72. Reported as SDG indicator 3.d.1 = 72 on 0-100.
• If 7 indicators sitting at level 2 are raised to level 4, the sum rises by 7 × 2 = 14 → 140/175 × 100 = 80.
• SPAR is self-assessed; a JEE is external and peer-reviewed, and typically returns lower scores for the same capacities — never present the two as interchangeable.

Where it is used

• Government and regulators: MoHFW's International Health Division and Emergency Medical Relief; NCDC (IHR Focal Point work, IHIP/IDSP, One Health, NAP-AMR); Airport and Port Health Officers issuing ship sanitation certificates and screening travellers; NITI Aayog and MoSPI for SDG monitoring and the SDG India Index.
• Multilateral and bilateral bodies in India: WHO Country Office and SEARO, the National Polio Surveillance Project (a WHO-India network repurposed for measles-rubella and VPD surveillance), UNICEF India, UNFPA, the Global Fund's principal recipients, Gavi-supported immunisation introductions (PCV, rotavirus, HPV).
• National programmes framed to SDG targets: National Health Mission and State PIPs; the National Strategic Plan for TB Elimination; NP-NCD; measles-rubella elimination; Mission Indradhanush; Ayushman Bharat and PM-JAY reporting against 3.8.
• NGOs, foundations and research: PHFI, ICMR institutes, IIPS (which runs NFHS), Jhpiego, PATH, Population Council, Gates Foundation India, Wellcome-funded projects — roles in M&E, surveillance strengthening and policy analysis.
• Private sector and consulting: IQVIA, Deloitte, KPMG, Sambodhi, Oxford Policy Management and Niti/World Bank-funded projects evaluating state health systems, pandemic preparedness and SDG-aligned financing; CSR health portfolios reporting against SDG 3.
• Job roles that test this directly: public health specialist/consultant in state health societies, surveillance medical officer, M&E officer, health policy analyst, epidemiologist at a district or state surveillance unit, technical officer (IHR/health security), and UPSC/state PSC public health and CHS interviews.

Interview questions

• Q: What is the difference between a WHO regulation and a WHO recommendation? A: A regulation adopted under Articles 21-22 (such as the IHR) binds all Member States unless they reject or enter a reservation within the stated period; a recommendation under Article 23, like the Essential Medicines List, is advisory only.
• Q: Which diseases must be notified to WHO on a single case? A: Smallpox, poliomyelitis due to wild-type or vaccine-derived poliovirus, human influenza caused by a new subtype, and SARS — the Annex 2 always-notifiable list.
• Q: Who declares a PHEIC, and on whose advice? A: The WHO Director-General alone declares and terminates it, after convening an Emergency Committee whose role is advisory and after consulting the affected State Party.
• Q: How many "yes" answers in the Annex 2 decision instrument trigger notification? A: Two or more of the four criteria — serious public health impact, unusual or unexpected, significant risk of international spread, significant risk of travel or trade restrictions.
• Q: What did the 2024 IHR amendments change? A: They added a higher "pandemic emergency" tier above PHEIC, wrote in equity and solidarity, required a National IHR Authority alongside the Focal Point, and created a States Parties Committee and a Coordinating Financial Mechanism; they took effect on 19 September 2025.
• Q: Is the WHO Pandemic Agreement binding on India today? A: No — it was adopted at WHA78 in May 2025 under Article 19 but needs 60 ratifications to enter into force, and until a state ratifies it creates no obligation; its PABS annex was still being negotiated.
• Q: What is the difference between SPAR and a JEE? A: SPAR is the mandatory annual self-assessment of 35 indicators that feeds SDG indicator 3.d.1; a JEE is a voluntary external peer evaluation, usually producing more conservative scores.
• Q: Why did the IHR need rewriting after 2003? A: SARS spread internationally while the 1969 rules covered only three diseases and depended on states notifying; the 2005 revision made the instrument all-hazards and let WHO use non-state information.
• Q: SDG 3.8 has two indicators — why both? A: 3.8.1 measures whether people get the services they need and 3.8.2 whether they are ruined paying for them; coverage can expand through out-of-pocket spending, which improves one and worsens the other.
• Q: Which Indian laws were used for COVID-19 containment, and what is the gap? A: The Epidemic Diseases Act, 1897 (amended 2020) and the Disaster Management Act, 2005; the gap is that neither is a modern public health statute with graded powers and safeguards — the consolidated public health Bill remains a draft.
• Q: Can a country require COVID-19 or polio vaccination for entry under the IHR? A: Yellow fever is the only vaccination the IHR itself permits as a condition of entry; polio and COVID-19 measures operated as temporary recommendations, and additional measures must be science-based and reported to WHO within 48 hours under Article 43.
• Q: How are the SDGs enforced? A: They are not — they are a voluntary political framework reviewed through Voluntary National Reviews at the High-Level Political Forum; only the IHR and treaties such as the FCTC carry legal obligations.

Common mistakes

• Treating the SDGs as binding law: they are voluntary, while the IHR and the FCTC are legally binding instruments — do not put them in the same category.
• Saying the WHA or the Emergency Committee declares a PHEIC; the Director-General does, and the Committee only advises.
• Listing the Annex 2 always-notifiable diseases wrongly — adding cholera or Ebola, or omitting vaccine-derived poliovirus.
• Confusing an IHR PHEIC with WHO's internal grade 3 emergency, and confusing either with the new "pandemic emergency" tier.
• Quoting the 24-hour and 48-hour clocks interchangeably: 24 hours to notify an assessed event (Article 6), 48 hours to justify additional measures (Article 43).
• Mixing up Alma-Ata 1978 (PHC, Health for All) with the Ottawa Charter 1986 (health promotion) and Astana 2018 (PHC for UHC and the SDGs).
• Quoting MMR per 1,000 or NMR per 100,000 — MMR is per 100,000 live births, child mortality rates are per 1,000 live births; and quoting SDG India Index or NFHS numbers without the edition and year.
• Claiming the National Health Policy 2017 target of 2.5% of GDP has been achieved; government health expenditure is still around 1.8-1.9% of GDP.

Related topics

Health systems in India: primary, secondary and tertiary care · Health policy analysis and planning · Health financing and economic evaluation: cost-effectiveness and DALYs · Public health law in India · Epidemiological surveillance and outbreak investigation · Universal health coverage and health equity.