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25 December, 2018 10:27:37 AM

Human rights in public health

The implementation of human rights in public health provides a basis to facilitate accountability for the progressive realisation of health-related human rights
Mohammed Abul Kalam, PhD
Human rights in public health

This year marks the 70th anniversary of both the birth of human rights law through the Universal Declaration of Human Rights (UDHR) and the birth of global health governance through the World Health Organization (WHO). Over the past 70 years, human rights have developed under international law as a basis for public health, providing a foundation for human rights realization through public health practice. Yet this “health and human rights” movement now faces unprecedented threats amidst a shift toward populism—with the populist radical right in ascendance in the United States and in countries throughout the world.
Human rights offer a universal framework to advance justice in public health, elaborating the freedoms and entitlements necessary to realize dignity for all. With international law evolving to address threats to health, a rights-based approach transforms the power dynamic that underlies public health. Rather than passive recipients of governmental benevolence, individuals are recognized as rights-holders, with human rights imposing corresponding obligations on governmental duty-bearers. - _edn1 Human rights law is now understood to be central to public health policies, programs, and practices. International human rights standards have been shown repeatedly to play a key role in public health over the past 70 years, framing health concerns within a legal context, integrating core principles into policy debates, and facilitating accountability for realizing the highest attainable standard of health.

In developing human rights law for public health promotion through the United Nations (UN), the WHO Constitution conceptualized for the first time that “the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being,” defining health positively to include “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” With human rights framing a healthier world out of the ashes of the Second World War, nations adopted the UDHR on December 10, 1948, embracing within it a set of interrelated economic and social rights by which:[e]veryone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widow-hood, old age or other lack of livelihood in circumstances beyond his control.

Seventy years ago, the UN proclaimed the UDHR as “a common standard of achievement for all peoples and all nations,” holding that the human right to health includes both the fulfillment of necessary medical care and the realization of underlying determinants of health—including food, clothing, housing, and social services.

However, the rapidly escalating Cold War would limit international opportunities to advance human rights for health in the UN system, with the 1966 International Covenant on Economic, Social and Cultural Rights providing only for “the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.” From the human rights system to global health governance, WHO would work with advocates in the 1970s to revitalize health-related rights in its “Health for All” campaign, which culminated in a rights-based approach to “primary health care” in the 1978 Declaration of Alma-Ata. Extending these human rights advancements in the years after the Cold War, the UN Committee on Economic, Social and Cultural Rights formally clarified state obligations regarding the right to health in 2000, finding that the right to health depends on a wide variety of interdependent and interrelated human rights through public health systems—including both preventive and curative health care and encompassing underlying social, political, and economic determinants of health.Given the dramatic development of these health-related human rights, the human rights system has now shifted from the development of human rights under international law to the implementation of those rights through national governance. Policy makers have been pressed to implement rights through national policies, assuring that the determinants of health are available, accessible, acceptable, and of sufficient quality.Each country has codified a unique set of constitutional obligations, laws, and regulations that implement international law through national policy, with contextually specific social movements frequently rallying to assure that “health is a human right.” Even in the United States, which has long resisted international human rights obligations—especially for economic, social, and cultural rights—there are expanding areas where health policies reflect human rights norms and increasing calls to realize the right to health.

The implementation of human rights in public health provides a basis to facilitate accountability for the progressive realization of health-related human rights. As governments have implemented human rights in health policy, scholars, practitioners, and advocates have sought to create accountability mechanisms to assess the progressive realization of rights, with these mechanisms committing governments to health-related rights, maximizing available resources through health policy, and improving programmatic results in health outcomes through: (1) Political advocacy: Social movements engage in political advocacy to analyze and assess public policy; to shape public awareness on national policies; and to press governments to comply with their health-related human rights obligations (whether by advocating human rights principles or by “naming and shaming” recalcitrant governments) (2)Litigation: With individuals enforcing human rights obligations through the courts, litigation empowers the judiciary to remedy rights violations—setting legal precedents to define government health obligations—and provides rights-based accountability in national, regional, and international courts and quasi-judicial bodies; and (3) Treaty monitoring: UN human rights treaty bodies monitor national implementation of treaty obligations—reviewing periodic reports, engaging in “constructive dialogue,” and issuing concluding observations—with these treaty bodies complemented in the past decade by the Universal Periodic Review, through which the UN Human Rights Council assesses the human rights performance of all UN member states.

With human rights developed, operationalized, and mainstreamed over 70 years, the realization of these rights is now imperiled by the populist radical right, threatening the protection of human rights and the advancement of public health. This right-wing populism seeks to undo the progress of past struggles, and it remains unclear how this opposition will affect the continuing evolution of human rights in public health.

In challenging the shared goals of human rights in public health, right-wing populism—abetted by the resurgent horrors of racism, xenophobia, anti-Semitism, and Islamophobia—seeks a nativist definition of the rights of citizenship. Populist politicians have thus sought to define ethnic nationalism to the exclusion of the common humanity first proclaimed in the UDHR. Politicians have advanced radicalized responses to the harms of a globalizing world, stirring mass fear about global “elites” and collateral anger toward international migration. This ethnic nationalism, viewing human rights as anathema to national identity, has subverted the universality of rights, undercutting the very foundation of the health and human rights movement. With liberal democratic values in retreat, populist governments have violated human rights principles, restricted civil society advocacy, repressed minority populations, attacked gender equality, ignored scientific evidence, and neglected public health. Where these human rights challenges have largely been met with silence by the global community, with national governments avoiding international sanctions for human rights violations, there are concerns that this unchecked repression of human rights will lead to a “post-human rights world.”

This right-wing populism also seeks to retrench nations inward, with rising nationalist movements directly threatening the cosmopolitan vision underlying global health and spurring isolationism in international affairs. As a direct response to the increasing interconnectedness of a globalizing world, populist nationalism has come to challenge the globalized world order and collective international decision-making. - _edn33 This backlash against “globalism” has led to nationalist attacks on the legitimacy of global institutions. Populist nationalism has thus sought to erect walls to re-divide an integrated world, with states abandoning the multilateral institutions that govern public health and human rights. This poses an existential threat to the global health governance system first established under WHO. The resurgence of national sovereignty is isolating national governments in addressing common health challenges. Undercutting the efforts of international organization to implement human rights in global health, such national retrenchment could lead to a rejection of both global governance and human rights as a basis for public health advancement.

Conclusion:Human rights have increasingly brought the world together in unprecedented public health cooperation over the past 70 years; however, the current populist age casts doubt on many of these governance successes and raises obstacles to future progress. Threats from the populist radical right have subverted the universality of human rights, rejected the science of public health, and threatened health cooperation within global governance. Where the development of WHO and the UDHR gave birth to a revolution in global governance for public health—binding the world together around shared rights-based values—the populist counterrevolution threatens to undo decades of progress and return us to a far less healthy world.  Public health practitioners have a crucial role in responding to the populist radical right, pursuing political advocacy to assure the future of human rights in public health. Reflecting on the progress of human rights at this critical time, there is a need for health professional and associations to support the rights-based public health workforce necessary to realize the highest attainable standard of health.

The writer is former Head, Department of Medical Sociology, Institute of Epidemiology, Disease Control & Research (IEDCR) Dhaka, Bangladesh, E-mail:



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Editor : M. Shamsur Rahman
Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

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