Child Health. She coordinated the development of the background paper on human rights for the UN ... more Child Health. She coordinated the development of the background paper on human rights for the UN Secretary-General's Global Strategy for Women's and Children's Health in 2010. Her work focuses on global health policy and partnerships, and the interchange between scientific evidence and socio-political values. She previously worked at the Center for Global Health and Development, Boston University, and the London School of Hygiene and Tropical Medicine. 2 Flavia Bustreo is Assistant Director-General at the World Health Organization (WHO) for Family, Women's and Children's Health. Previously she served as Director of The Partnership for Maternal, Newborn and Child Health. Dr. Bustreo was instrumental to the development of the UN Secretary-General's Global Strategy for Women's and Children's Health in 2010. Her work has focused on policy development and implementation concerning maternal and child health, both at the domestic and global level.
The scale of maternal mortality dwarfs the number of ‘disappearances’ and death penalty cases. Ye... more The scale of maternal mortality dwarfs the number of ‘disappearances’ and death penalty cases. Yet ‘disappearances’ and death penalty cases attract much more attention from the human rights community than preventable maternal mortality. ‘Disappearances’, for example, have a UN human rights ‘special procedure’, as well as international and regional human rights treaties. And so they should. ‘Disappearances’ are an extremely serious human rights issue. But so is preventable maternal mortality with its impact upon women’s rights to life, health, equality and non-discrimination. And yet there is not a single human rights mechanism with a focus on the immense problem of preventable maternal deaths.
This special issue of the Health and Human Rights Journal constitutes another step on the path to... more This special issue of the Health and Human Rights Journal constitutes another step on the path toward making the case for human rights-based approaches (HRBAs) to health. In 2003, the United Nations (UN) outlined the pillars of an HRBA to development, which include universality and inalienability, indivisibility, interdependence and interrelatedness, non-discrimination and equality, participation and inclusion, and accountability and the rule of law. 1 Since then, leaders from national governments and UN agencies have repeatedly emphasized the need to operationalize human rights and incorporate them into the implementation of policies, programs, projects, and other health-related interventions with a view to enhancing effectiveness. 2 Nevertheless, implementation efforts regarding HRBAs to health and development have faced, and continue to face, multiple challenges, including some degree of miscommunication and polarization between different fields, where the imperatives of health and human rights are not always seen as complementary and rights imperatives are misconstrued to ignore all concerns regarding cost-effectiveness. Even for sympathetic actors and institutions, there is a need to gather sufficient evidence of the impact of human rights to be persuasive to policy makers, donors, and the public alike. 3 Measuring evidence of impact is far from simple in an HRBA. It challenges three fields-human rights, public health, and medicine (as well as related communities and disciplines)-to bridge epistemological differences about the nature of what constitutes evidence and impact, as well as how to establish those truths. To begin with, the outcome of interest is not necessarily just the health outcome, or output, measured by such indicators as "deaths averted"; rather, HRBAs require both conventional health indicators and new measures for assessing effects. These effects include changes in legal and policy frameworks, as well as other qualitative changes. It may also be necessary to consider symbolic or ideational effects of HRBAs, such as transformations in public attitudes and perceptions, and the appropriation of a sense of entitlement, as some authors in this issue note. Standards of evidence also present challenges. As the experiences described in Mexico, Peru, India, and elsewhere underscore, HRBAs are inherently multi-level and multi-factorial, deeply embedded in social contexts and relationships. Standard medical and public health tools that rely
The right to health is coming of age: Evidence of impact and the importance of leadership At this... more The right to health is coming of age: Evidence of impact and the importance of leadership At this year's high-level session of the World Health Assembly, the right to the highest attainable standard of health was mentioned by Ministers of Health more often than at any recent meeting of the Assembly. 1 Nepal's Minister of Health and Population confirmed that his country has adopted a rightsbased approach to health. The South African Minister of Health spoke about health care as 'a birth right'. Colombia's Assistant Health Minister called for a 'global effort for the development and effective universalization of the human right to health'. Germany's Minister of Health emphasized that health is 'a key human right and of vital importance for all human development'. The US Secretary of Health and Human Services quoted the words of President Obama: access to healthcare is 'not some earned privilege-it is a right'. Speakers observed that the right to the highest attainable standard of health is enshrined in the Constitution of the World Health Organization. Multiple references to the right to the highest attainable standard of health (or 'right to health') came from every region of the world. Some health policymakers will be quick to dismiss these references as rhetorical. After all, these are high-level speeches, not detailed policy prescriptions. Nonetheless, speeches can tell us something. Sometimes they signal important shifts in opinion and direction.
60 years ago, the Universal Declaration of Human Rights laid the foundations for the right to the... more 60 years ago, the Universal Declaration of Human Rights laid the foundations for the right to the highest attainable standard of health. This right is central to the creation of equitable health systems. We identify some of the right-tohealth features of health systems, such as a comprehensive national health plan, and propose 72 indicators that refl ect some of these features. We collect globally processed data on these indicators for 194 countries and national data for Ecuador, Mozambique, Peru, Romania, and Sweden. Globally processed data were not available for 18 indicators for any country, suggesting that organisations that obtain such data give insuffi cient attention to the right-to-health features of health systems. Where they are available, the indicators show where health systems need to be improved to better realise the right to health. We provide recommendations for governments, international bodies, civil-society organisations, and other institutions and suggest that these indicators and data, although not perfect, provide a basis for the monitoring of health systems and the progressive realisation of the right to health. Right-to-health features are not just good management, justice, or humanitarianism, they are obligations under human-rights law.
This article tracks the shifting place of the international right to health, and human rights-bas... more This article tracks the shifting place of the international right to health, and human rights-based approaches to health, in the scholarly literature and United Nations (UN). From 1993 to 1994, the focus began to move from the right to health toward human rights-based approaches to health, including human rights guidance adopted by UN agencies in relation to specific health issues. There is a compelling case for a human rights-based approach to health, but it runs the risk of playing down the right to health, as evidenced by an examination of some UN human rights guidance. The right to health has important and distinctive qualities that are not provided by other rights-consequently, playing down the right to health can diminish rights-based approaches to health, as well as the right to health itself. Because general comments, the reports of UN Special Rapporteurs, and UN agencies' guidance are exercises in interpretation, I discuss methods of legal interpretation. I suggest that...
As health policy-makers around the world seek to make progress towards universal health coverage ... more As health policy-makers around the world seek to make progress towards universal health coverage they must navigate between two important ethical imperatives: to set national spending priorities fairly and efficiently; and to safeguard the right to health. These imperatives can conflict, leading some to conclude that rights-based approaches present a disruptive influence on health policy, hindering states' efforts to set priorities fairly and efficiently. Here, we challenge this perception. We argue first that these points of tension stem largely from inadequate interpretations of the aims of priority setting as well as the right to health. We then discuss various ways in which the right to health complements traditional concerns of priority setting and vice versa. Finally, we set out a three-step process by which policy-makers may navigate the ethical and legal considerations at play.
Prepared by the United Nations Special Rapporteur on the right of everyone to the enjoyment of th... more Prepared by the United Nations Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health Introductory Note A. Almost 2 billion people lack access to essential medicines. Improving access to existing medicines could save 10 million lives each year, 4 million of them in Africa and SouthEast Asia. Access to medicines is characterised by profound global inequity. 15% of the world's population consumes over 90% of the world 's pharmaceuticals. B. The Millennium Development Goals, such as reducing child mortality, improving maternal health, and combating HIV/AIDS, malaria and other diseases, depend upon improving access to medicines. One of the Millennium Development Goal targets is to provide, in cooperation with pharmaceutical companies, access to affordable essential drugs in developing countries.
Malaria is an extremely serious human rights issue on an enormous scale. Although preventable and... more Malaria is an extremely serious human rights issue on an enormous scale. Although preventable and treatable, malaria kills well over 1 million people every year. A child dies from malaria every 30 seconds. It costs Africa US$12 billion every year. Six out of eight Millennium Development Goals cannot be achieved without tackling malaria. 1 Malaria is both a cause and consequence of poverty. Its impact is especially ferocious on the poorest: those least able to afford preventive measures and medical treatment. The impact is not only felt in terms of avoidable human suffering and death-but economic cost and burden. Malaria impoverishes families, households and national economies. The disease may account for as much as 40% of public health expenditure. In Tanzania, malaria accounts for 30% of the national disease burden. In Ghana, malaria care can cost up to 34% of a poor household's income. Malaria lowers worker productivity. It discourages investment. 2 Malaria is entirely preventable by way of an integrated package of interventions, including properly treated and maintained insecticide-treated nets, indoor residual spraying, information campaigns, and so on. If diagnosed and treated promptly and correctly, malaria is curable. Resistance to the cheapest drugs (such as chloroquine) is common throughout Africa. New artemisinin-based combination therapies (ACTs) are effective-but expensive and beyond the reach of many. 3 Recognising malaria as a right to health issue does not provide a magic solution to an enormous, complex problem. But the right to health perspective-the human rights analysis-adds something. It has a constructive contribution to make. My remarks tonight attempt to signal what that contribution is.
This presentation has three objectives: First, I would like to reflect briefly on the progress ma... more This presentation has three objectives: First, I would like to reflect briefly on the progress made by economic, social and cultural rights (ESCR) since the Vienna World Conference on Human Rights in 1993. Second, I aim to discuss some of the work undertaken by the UN Committee on Economic, Social and Cultural Rights (CESCR) in the last three or four years. Third, I make a few remarks about how international human rights can be used as an international shield. My treatment of these three topics is introductory. I am sure there are others in this room who can supplementand critiquewhat I have to say. I hope they will in the discussion afterwards.
This policy brief sets out some of the recent case law on the right to the highest attainable sta... more This policy brief sets out some of the recent case law on the right to the highest attainable standard of health and argues that this jurisprudence exposes the unnecessarily narrow construction of the social contract. The boundaries of the social contract can be expanded to encompass not only the civil and political elements, but also the social.
Child Health. She coordinated the development of the background paper on human rights for the UN ... more Child Health. She coordinated the development of the background paper on human rights for the UN Secretary-General's Global Strategy for Women's and Children's Health in 2010. Her work focuses on global health policy and partnerships, and the interchange between scientific evidence and socio-political values. She previously worked at the Center for Global Health and Development, Boston University, and the London School of Hygiene and Tropical Medicine. 2 Flavia Bustreo is Assistant Director-General at the World Health Organization (WHO) for Family, Women's and Children's Health. Previously she served as Director of The Partnership for Maternal, Newborn and Child Health. Dr. Bustreo was instrumental to the development of the UN Secretary-General's Global Strategy for Women's and Children's Health in 2010. Her work has focused on policy development and implementation concerning maternal and child health, both at the domestic and global level.
The scale of maternal mortality dwarfs the number of ‘disappearances’ and death penalty cases. Ye... more The scale of maternal mortality dwarfs the number of ‘disappearances’ and death penalty cases. Yet ‘disappearances’ and death penalty cases attract much more attention from the human rights community than preventable maternal mortality. ‘Disappearances’, for example, have a UN human rights ‘special procedure’, as well as international and regional human rights treaties. And so they should. ‘Disappearances’ are an extremely serious human rights issue. But so is preventable maternal mortality with its impact upon women’s rights to life, health, equality and non-discrimination. And yet there is not a single human rights mechanism with a focus on the immense problem of preventable maternal deaths.
This special issue of the Health and Human Rights Journal constitutes another step on the path to... more This special issue of the Health and Human Rights Journal constitutes another step on the path toward making the case for human rights-based approaches (HRBAs) to health. In 2003, the United Nations (UN) outlined the pillars of an HRBA to development, which include universality and inalienability, indivisibility, interdependence and interrelatedness, non-discrimination and equality, participation and inclusion, and accountability and the rule of law. 1 Since then, leaders from national governments and UN agencies have repeatedly emphasized the need to operationalize human rights and incorporate them into the implementation of policies, programs, projects, and other health-related interventions with a view to enhancing effectiveness. 2 Nevertheless, implementation efforts regarding HRBAs to health and development have faced, and continue to face, multiple challenges, including some degree of miscommunication and polarization between different fields, where the imperatives of health and human rights are not always seen as complementary and rights imperatives are misconstrued to ignore all concerns regarding cost-effectiveness. Even for sympathetic actors and institutions, there is a need to gather sufficient evidence of the impact of human rights to be persuasive to policy makers, donors, and the public alike. 3 Measuring evidence of impact is far from simple in an HRBA. It challenges three fields-human rights, public health, and medicine (as well as related communities and disciplines)-to bridge epistemological differences about the nature of what constitutes evidence and impact, as well as how to establish those truths. To begin with, the outcome of interest is not necessarily just the health outcome, or output, measured by such indicators as "deaths averted"; rather, HRBAs require both conventional health indicators and new measures for assessing effects. These effects include changes in legal and policy frameworks, as well as other qualitative changes. It may also be necessary to consider symbolic or ideational effects of HRBAs, such as transformations in public attitudes and perceptions, and the appropriation of a sense of entitlement, as some authors in this issue note. Standards of evidence also present challenges. As the experiences described in Mexico, Peru, India, and elsewhere underscore, HRBAs are inherently multi-level and multi-factorial, deeply embedded in social contexts and relationships. Standard medical and public health tools that rely
The right to health is coming of age: Evidence of impact and the importance of leadership At this... more The right to health is coming of age: Evidence of impact and the importance of leadership At this year's high-level session of the World Health Assembly, the right to the highest attainable standard of health was mentioned by Ministers of Health more often than at any recent meeting of the Assembly. 1 Nepal's Minister of Health and Population confirmed that his country has adopted a rightsbased approach to health. The South African Minister of Health spoke about health care as 'a birth right'. Colombia's Assistant Health Minister called for a 'global effort for the development and effective universalization of the human right to health'. Germany's Minister of Health emphasized that health is 'a key human right and of vital importance for all human development'. The US Secretary of Health and Human Services quoted the words of President Obama: access to healthcare is 'not some earned privilege-it is a right'. Speakers observed that the right to the highest attainable standard of health is enshrined in the Constitution of the World Health Organization. Multiple references to the right to the highest attainable standard of health (or 'right to health') came from every region of the world. Some health policymakers will be quick to dismiss these references as rhetorical. After all, these are high-level speeches, not detailed policy prescriptions. Nonetheless, speeches can tell us something. Sometimes they signal important shifts in opinion and direction.
60 years ago, the Universal Declaration of Human Rights laid the foundations for the right to the... more 60 years ago, the Universal Declaration of Human Rights laid the foundations for the right to the highest attainable standard of health. This right is central to the creation of equitable health systems. We identify some of the right-tohealth features of health systems, such as a comprehensive national health plan, and propose 72 indicators that refl ect some of these features. We collect globally processed data on these indicators for 194 countries and national data for Ecuador, Mozambique, Peru, Romania, and Sweden. Globally processed data were not available for 18 indicators for any country, suggesting that organisations that obtain such data give insuffi cient attention to the right-to-health features of health systems. Where they are available, the indicators show where health systems need to be improved to better realise the right to health. We provide recommendations for governments, international bodies, civil-society organisations, and other institutions and suggest that these indicators and data, although not perfect, provide a basis for the monitoring of health systems and the progressive realisation of the right to health. Right-to-health features are not just good management, justice, or humanitarianism, they are obligations under human-rights law.
This article tracks the shifting place of the international right to health, and human rights-bas... more This article tracks the shifting place of the international right to health, and human rights-based approaches to health, in the scholarly literature and United Nations (UN). From 1993 to 1994, the focus began to move from the right to health toward human rights-based approaches to health, including human rights guidance adopted by UN agencies in relation to specific health issues. There is a compelling case for a human rights-based approach to health, but it runs the risk of playing down the right to health, as evidenced by an examination of some UN human rights guidance. The right to health has important and distinctive qualities that are not provided by other rights-consequently, playing down the right to health can diminish rights-based approaches to health, as well as the right to health itself. Because general comments, the reports of UN Special Rapporteurs, and UN agencies' guidance are exercises in interpretation, I discuss methods of legal interpretation. I suggest that...
As health policy-makers around the world seek to make progress towards universal health coverage ... more As health policy-makers around the world seek to make progress towards universal health coverage they must navigate between two important ethical imperatives: to set national spending priorities fairly and efficiently; and to safeguard the right to health. These imperatives can conflict, leading some to conclude that rights-based approaches present a disruptive influence on health policy, hindering states' efforts to set priorities fairly and efficiently. Here, we challenge this perception. We argue first that these points of tension stem largely from inadequate interpretations of the aims of priority setting as well as the right to health. We then discuss various ways in which the right to health complements traditional concerns of priority setting and vice versa. Finally, we set out a three-step process by which policy-makers may navigate the ethical and legal considerations at play.
Prepared by the United Nations Special Rapporteur on the right of everyone to the enjoyment of th... more Prepared by the United Nations Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health Introductory Note A. Almost 2 billion people lack access to essential medicines. Improving access to existing medicines could save 10 million lives each year, 4 million of them in Africa and SouthEast Asia. Access to medicines is characterised by profound global inequity. 15% of the world's population consumes over 90% of the world 's pharmaceuticals. B. The Millennium Development Goals, such as reducing child mortality, improving maternal health, and combating HIV/AIDS, malaria and other diseases, depend upon improving access to medicines. One of the Millennium Development Goal targets is to provide, in cooperation with pharmaceutical companies, access to affordable essential drugs in developing countries.
Malaria is an extremely serious human rights issue on an enormous scale. Although preventable and... more Malaria is an extremely serious human rights issue on an enormous scale. Although preventable and treatable, malaria kills well over 1 million people every year. A child dies from malaria every 30 seconds. It costs Africa US$12 billion every year. Six out of eight Millennium Development Goals cannot be achieved without tackling malaria. 1 Malaria is both a cause and consequence of poverty. Its impact is especially ferocious on the poorest: those least able to afford preventive measures and medical treatment. The impact is not only felt in terms of avoidable human suffering and death-but economic cost and burden. Malaria impoverishes families, households and national economies. The disease may account for as much as 40% of public health expenditure. In Tanzania, malaria accounts for 30% of the national disease burden. In Ghana, malaria care can cost up to 34% of a poor household's income. Malaria lowers worker productivity. It discourages investment. 2 Malaria is entirely preventable by way of an integrated package of interventions, including properly treated and maintained insecticide-treated nets, indoor residual spraying, information campaigns, and so on. If diagnosed and treated promptly and correctly, malaria is curable. Resistance to the cheapest drugs (such as chloroquine) is common throughout Africa. New artemisinin-based combination therapies (ACTs) are effective-but expensive and beyond the reach of many. 3 Recognising malaria as a right to health issue does not provide a magic solution to an enormous, complex problem. But the right to health perspective-the human rights analysis-adds something. It has a constructive contribution to make. My remarks tonight attempt to signal what that contribution is.
This presentation has three objectives: First, I would like to reflect briefly on the progress ma... more This presentation has three objectives: First, I would like to reflect briefly on the progress made by economic, social and cultural rights (ESCR) since the Vienna World Conference on Human Rights in 1993. Second, I aim to discuss some of the work undertaken by the UN Committee on Economic, Social and Cultural Rights (CESCR) in the last three or four years. Third, I make a few remarks about how international human rights can be used as an international shield. My treatment of these three topics is introductory. I am sure there are others in this room who can supplementand critiquewhat I have to say. I hope they will in the discussion afterwards.
This policy brief sets out some of the recent case law on the right to the highest attainable sta... more This policy brief sets out some of the recent case law on the right to the highest attainable standard of health and argues that this jurisprudence exposes the unnecessarily narrow construction of the social contract. The boundaries of the social contract can be expanded to encompass not only the civil and political elements, but also the social.
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