The International Classification of Diseases (ICD) is developed and maintained by the World Health Organization (WHO). The Eleventh Revision of the ICD (ICD-11) took effect in January 2022 and is the first major revision of the classification in 30 years. The ICD-11 reflects huge advances during this time in scientific evidence, clinical practices, and health information systems. The ICD is used for the classification and reporting of all types of diseases, disorders, and health conditions. This chapter focuses specifically on the ICD-11 classification of Mental, Behavioral or Neurodevelopmental Disorders (MBND). It covers the overall context of the development and metastructure of the MBND classification as well as the priorities and components of the Clinical Descriptions and Diagnostic Requirements (CDDR). The chapter considers what is new in ICD-11 MBND (e.g., the lifespan and dimensional approach, new disorders or removal of categories, coding issues). ICD-11 in the global reform of mental health and care and the role of national European and international professional organizations in education and training of ICD-11 MBND for improving quality treatment and care are constituent parts of this chapter.

Chapter 1 sets the historical and theoretical background of the book. It starts by describing the regulatory battles that took place from the 1970s to adopt more stringent tobacco control measures. Then, it illustrates how the negotiations of the WHO Framework Convention on Tobacco Control and the subsequent WTO and international investment disputes can be considered the internationalisation of the tobacco wars. In this context, the concept of ‘lawfare’ is introduced as a descriptive device and analytical tool for the analysis of the book. The second part of the introduction introduces the second fil rouge of the book: evidence. It begins by defining the notion of evidence and by showing how, in the context of tobacco control, it can refer to different bodies of evidence that pertain both to the risk assessment and risk management dimension of tobacco control measures. This second part, moreover, shows how evidence has always been one of the key points of contention in the tobacco wars and has continued to be so in the international tobacco control lawfare. The introduction concludes with an explanation of the methodology employed, a reflection on its limits, and an outline of the content of the book.

Chapter 2 analyses the negotiation of the WHO Framework Convention on Tobacco Control (FCTC, 1998–2003). It illustrates that evidence was a key element of the negotiations and argues that the FCTC was developed as an evidence-based treaty to counteract the attacks on evidence by the tobacco industry. After a historical introduction, Section 2.2 outlines the theoretical background of the chapter, introducing the notion of ‘treaty entrepreneurs’. Sections 2.3, 2.4, and 2.5 proceed to delineate and analyse how the strategy on evidence unfolded during the FCTC negotiations. Section 2.3 illustrates how legal expertise from international environmental law was borrowed to build a treaty that could embed and develop evidence. Section 2.4 describes how evidence was mobilised to build the treaty. First, the treaty entrepreneurs relied on existing knowledge within the WHO; second, they served as a catalyst for the production of additional evidence from other relevant actors, most notably the World Bank. Section 2.5 reviews how the treaty entrepreneurs framed the available evidence and how the label ‘evidence-based’ started being used. Section 2.6, finally, draws some conclusions on the implications of adopting a strategy on evidence to push forward the negotiations of a treaty.

In addition to summarising the main findings of the book, this final chapter offers some reflections on the lessons that emerge from the history of the international tobacco control lawfare. The reflections are organised around the two main themes of the book: lawfare (Section 5.1) and evidence (Section 5.2). The first part offers some thoughts on the value of using ‘lawfare’ as an analytical tool, zooming in on the role of business actors in international regulation (Section 5.1.1) and on a reflexive account on one’s research (Section 5.1.2). The second part summarises the main topics related to evidence that have emerged in the book: the different types of evidence in risk assessment and risk management (Section 5.2.1), international law’s overreliance on evidence (Section 5.2.2), evidence as a weapon (Section 5.2.3), and evidence as an ideological battleground (Section 5.2.4).

Chapter 3 analyses how evidence has become a central element of the FCTC regime (2005–present). Section 3.1 captures the most important developments since the conclusion of the FCTC in 2003. Section 3.2 provides the theoretical framework of the chapter, focusing on the concept of path dependence in international organisations. Section 3.3 proceeds by showing that the development of the guidelines by the FCTC Conference of the Parties (COP) has been in effect a continuation of the strategy on evidence. Section 3.4 in turn highlights the second facet of the FCTC as an evidence-based regime, that is how the FCTC has mobilised new evidence at the national level. Sections 3.5 and 3.6 reflect on the consequences that the evidence-based approach has had on the outlook of the FCTC regime. Section 3.5 uses in-depth qualitative analysis to demonstrate that the evidence-based approach has reinforced the importance of the expertise of civil society organisations. Finally, Section 3.6 illustrates how the evidence-based approach has started to show its shortcomings in the work of the FCTC COP – particularly in the approach to new products like e-cigarettes (or ENDS) and in the (lack of) development of strategies to foster the implementation of tobacco control measures.

This chapter applies Pragmatic Constructivism to assess communities of practice in global health governance. It focuses on the problem of containing contagious diseases. This is one of the tasks of the World Health Organization (WHO) and its practice of declaring a Public Health Emergency of International Concern (PHEIC). Given the uncertainty surrounding such a practice, which could lead to the isolation of an effected state, the decision inevitably involves judgement calls rather than the pre-reflexive implementation of pre-planned steps. Applying the first Pragmatic Constructivist test to this practice means asking if the community of practice charged with making that judgement is properly constituted and sufficiently inclusive. The evidence suggests that it is not. The chapter problematizes practice that unduly privileges technical (in this case epidemiological) expertise over social and political advice. A second application of the two Pragmatic Constructivist tests focuses on an inconsistency internal to global health practices as they relate to the distribution of vaccines. Practices that achieve more comprehensive coverage, such as the local manufacture of vaccines, are being prevented by intellectual property practices. The chapter considers how the knowledge of the Covid pandemic challenges the epistemic authority of intellectual property practices.

This Chapter examines the tobacco industry in Southern Rhodesia and Zimbabwe within the context of global tobacco control regime, public health debates and the changing production factors between 1953 and 2000s. It discusses the role of the state and the tobacco lobby in entrenching the interests of the tobacco industry against the global pressures to reduce tobacco demand and supply and how this has shaped the country’s articulation of tobacco control measures and policies. The chapter further explores transitions in tobacco farming landscapes in post-land reform Zimbabwe and the implications for livelihoods, natural resources, social institutions and agrarian development.

In South Africa in the 1990s Prof. Robert Pattinson asked the minister of health to establish a CEMD based on the UK model. The first Report appeared in 1998. During the AIDS epidemic the president and officials were denialists and tried to alter the Reports. The Enquiry developed a system to report 'great saves'. Politicians were supportive and maternal mortality fell to 97/100,000 in 2019. In India, Dr VP Paily is the coordinator of Kerala’s Confidential Review of Maternal Deaths. The KFOG was founded in 2002 and the Review began in 2003, stimulated by the WHO. The government authorised hospitals to give the KFOG anonymised records of maternal deaths. Quality standards were developed, helped by NICE International. In 2019 the maternal mortality rate was 28/100,000. In the USA Prof. Elliott Main is the medical director of the California Maternal Quality Care Collaborative (CMQCC), established when mortality rose in the 2000s. It produced toolkits to tackle the leading causes and in 2012 established the Maternal Data Center, combining social and hospital data. Severe maternal morbidity is scrutinised. Mortality fell and similar initiatives have spread across the USA.

In the 1990s half a million women died each year from pregnancy-related causes. In 1995 the United Nations set the goal of a 75% reduction by 2015. A 43% fall was achieved. In 2020 the maternal mortality rate for low-income countries was 462/100,000 births. For every death, another 30 women suffer severe complications. Saving lives need not be expensive. As Prof. Mahmoud Fathalla said at the Safe Motherhood Movement launch in 1987, 'mothers are dying because societies have yet to make the decision that their lives are worth saving'. He had been inspired by the UK Enquiries. In 2004 WHO published a toolkit, Beyond the Numbers, mostly written by the director of the UK CEMD. It described how local mortality reviews, hospital-based or community-based, and near-miss reviews can be carried out without the government support which is needed for a national Enquiry. The principles of the CEMD apply to those reviews. Their aim is not to find scapegoats but to identify problems and suggest solutions. Confidentiality is vital if people are to be frank about individual and systemic failures. A safety culture requires support at individual, institutional and political levels.

What role do international organizations play in international law? Similar to states, they have international legal personality, responsibilities, and immunities.  This chapter focuses on the preeminent global intergovernmental organization, the United Nations, and details the functions and limits of its principal organs.  Special attention is given to the General Assembly, Security Council, and International Court of Justice. The European Union is the leading example of a regional, supranational organization, and its authority and institutions are discussed in detail as well. The chapter concludes with brief considerations of other major international organizations, including the North Atlantic Treaty Organization, the Organization of American States, the African Union, and the World Health Organization.

In this chapter, Fruzsina Molnár-Gábor and Johanne Giesecke consider specific aspects of how the application of AI-based systems in medical contexts may be guided under international standards. They sketch the relevant international frameworks for the governance of medical AI. Among the frameworks that exist, the World Medical Association’s activity appears particularly promising as a guide for standardisation processes. The organisation has already unified the application of medical expertise to a certain extent worldwide, and its guidance is anchored in the rules of various legal systems. It might provide the basis for a certain level of conformity of acceptance and implementation of new guidelines within national rules and regulations, such as those on new technology applications within the AI field. In order to develop a draft declaration, the authors then sketch out the potential applications of AI and its effects on the doctor–patient relationship in terms of information, consent, diagnosis, treatment, aftercare, and education. Finally, they spell out an assessment of how further activities of the WMA in this field might affect national rules, using the example of Germany.

Chapter 6 investigates the WHO’s malaria and tuberculosis control programs in the 1950s and 1960s, which made use of statistical collection and analysis. Numbers had become omnipresent in program design and implementation by this time, and experts at the WHO and in the Taiwanese government used their public health knowledge to justify their selection of statistics. WHO experts and Taiwanese health officers also used numbers to advocate for their programs. In particular, experts curated numbers to bolster their arguments in the context of ongoing policy debates at the WHO. Their ways of curating numbers were different as they occupied different positions within global health policy-making. Experts within the WHO mobilized their knowledge on the diseases in question to justify their selection of certain statistics over others, while their Taiwanese colleagues used numbers to present Taiwan as a viable testing ground for WHO policies, with a view to obtaining financial and technical support.

Chapter 5 describes efforts by UNRRA and the WHO to rebuild a health statistics reporting system from 1943, when UNRRA took over the LNHO’s international epidemiological intelligence efforts. The WHO also developed an all-encompassing statistical system to gather statistics collected through research, administration, and policy-making. Just like the LNHO, the WHO established a tiered network for spreading its statistical practices, but sought broader geographic coverage. By including statisticians from different regions in the standard-making process, the WHO took local variation into account when making standards. A case study on the Republic of China – which still ruled the mainland in 1943 but was exiled to Taiwan in 1949 – shows that UNRRA and the WHO’s statistical reporting was often undermined by geopolitics and administrative constraints.

Yi-Tang Lin presents the historical process by which statistics became the language of global health for local and international health organizations. Drawing on archival material from three continents, this study investigates efforts by public health schools, philanthropic foundations, and international organizations to turn numbers into an international language for public health. Lin shows how these initiatives produced an international network of public health experts who, across various socioeconomic and political contexts, opted for different strategies when it came to setting global standards and translating local realities into numbers. Focusing on China and Taiwan between 1917 and 1960, Lin examines the reception, adaptation, and appropriation of international health statistics. She presents the dynamic interplay between numbers, experts, and policy-making in international health organizations and administrations in China and Taiwan. This title is also available as Open Access.