Sunday, February 24, 2019
Human Rights in Global Health: Rights-Based Governance for a Globalizing World, published by Oxford University Press, and edited by Benjamin Mason Meier and Lawrence O. Gostin, examines the ways in which access to health (including public health) has been framed (or, in some cases, not framed) as a human rights issue across the globe. The majority of the book focuses on efforts by the United Nations, but also includes chapters devoted to health-related priorities and activities by the World Bank, World Trade Organization, and other development programs.
When looking at global health governance, the editors and authors assess how organizations (both state- and non-state-based organizations) set priorities, draft and disseminate policies and other guidance documents, set and spend budgets, hire staff, implement programs, and partner with other organizations as ways to advocate for public health goals, particularly in instances where the public health aspect of broader human rights goal(s) is not as explicit. While many of the chapters in the book discuss the concept of “health” and related policies, much of the focus is specifically on public health, which inherently and historically includes social (or structural) determinants of health (political, economic, social, and cultural), a key concept to address when thinking about human rights and many of the underlying issues communities face in the struggle to achieve equity and prosperity.
The focus on public health also serves as a link to human rights and state accountability in a way that a focus solely on (medical) health would not. According to the editors, “[b]y addressing public health harms as human rights violations, international law has offered global standards by which to frame government responsibilities and evaluate health policies, shifting the global health debate from political aspiration to legal accountability under the ‘rights-based approach’ to health” (21). In doing so, the editors and authors also make a strong case for the ethical duty that falls on the shoulders of the global community to be more proactive and purposeful in developing, supporting, implementing, and enforcing health policies within governance structures. Outside of public health emergencies, though certainly most strongly reinforced by such emergencies, public health concerns know no borders and have the ability to impact international policy in a way that requires a collaborative and global approach.
The book is highly technical and rigorously researched, offering an in-depth look at the evolution of various human rights covenants that guide international human rights law and policy. Several chapters include insights into the negotiations between various state parties as covenants, treaties, laws, and guidance documents were developed over time. As one can imagine, there was often disagreement, not only surrounding the underpinning values and definitions of key terms (e.g., freedom, rights, health, standard of living), but also whether state actors would be required to act, and if so, in which instances. It is one thing to ask a state to enforce its own values, but another thing entirely to ask that state to enforce and advocate for another state’s values, which may not align well with its own (collective v. individual rights and responsibilities). Even the United States, when it has signed on to human rights documents, has been hesitant to articulate specific obligations and corresponding enforcement mechanisms for ensuring the “right to health.”
This lack of consensus has resulted in heavy reliance on the UN, and similar organizations, to act as the model and leader in achieving consistency, accountability, and action from its various partners. The book highlights the many achievements of the UN in pursuing a rights-based approach to health, but does not shy away from identifying areas in which the UN has not pushed hard or far enough to see real transformative and sustainable action. With so many competing interests across the globe, the UN and its associated agencies have not always been successful in reaching consensus and continuity within its own leadership in terms of human rights policies and priorities, including the extent to which they focus on health. As an example, tracing the leadership priorities of the Office of the UN High Commissioner for Human Rights (“OHCHR”), the book emphasizes the policy trends (and related budgetary and staffing models) of each High Commissioner to depict the intensity with which each focused on health. That chapter explains that “[t]he leadership of the OHCHR, however, has not consistently championed economic and social rights generally or the right to health in particular” (477). When they did focus on health, policies were often developed insofar as they also related to other programmatic priorities and population-based trends, which has resulted in greater focus on women’s health (i.e., reproductive health), the HIV/AIDS crisis, and sustainable development goals.
The major takeaway from Human Rights in Global Health is the need to understand the history, process, attitudes, and struggles that have either been overcome or continue to act as barriers to full integration of health policies in international law. It nicely sets a context for better understanding the push for a global right to health situated within a human rights framework. In order for states to be accountable for ensuring access to health, they need to agree and commit to seeing health as a human right (politically, judicially, administratively, socially), which in turn requires appropriate funding, devotion of resources, enforcement, and a sustainable strategy for all populations, especially a state’s most vulnerable population(s).