Getting human rights right in global health policy

Abstract

Global health policy advocates have repeatedly called for a post-2015 development agenda in which global health policy goals are embedded in a human rights framework. This appeal echoes the insistence on the part of a wide range of agents—including the UN, non-governmental organisations, governments, and ordinary citizens—that human rights should be a fundamental basis for the new development goals in general. Interpreted sympathetically, this emphasis on human rights embodies a vital insight into their distinctive moral signifi cance. The adoption of goals concerned solely with the promotion of human welfare, such as our interests in health, prosperity, and education, is not suffi cient. Human rights inject a distinctive moral dimension into policy objectives, and one that is especially responsive to the plight of victims of injustice worldwide. Human rights are universal moral rights that all people possess merely by virtue of their humanity. They mark the threshold at which each individual person’s interests generate obligations on the part of others to respect, protect, and promote those interests in various ways. The violation of an obligation is a moral wrong; however, by contrast, no wrong is committed by the mere impairment of another’s interests or by leaving them unpromoted. For example, neither beating a rival applicant for a coveted job nor failing to give someone your spare healthy kidney for a transplant necessarily involves any wrongdoing. Human rights are a distinctive moral register of critical assessment, beyond evaluations that merely track rises and falls in welfare. A well-established doctrine of international human rights law now exists. However, the morality of human rights is independent of its legal recognition. Moreover, not even a presumptive case always exists for the enactment of human rights as (enforceable) legal entitlements. Law is just one mechanism of implementation that exists alongside others, including social conventions, public opinion, and the instillation of a rights-respecting ethos. Whether or not human rights should be legalised depends on what works in all circumstances. To make human rights legally enforceable can sometimes even be counter-productive. For example, in Brazil, the legalisation of the right to health seems to have led to a transfer of health resources to the wealthier people who can aff ord the cost of litigation. Although human rights are extremely important for global health policy, in this Viewpoint we contest two widespread assumptions about their signifi cance. The fi rst assumption—exclusivity—is that human rights should be the sole or exclusive basis of global health policy. The second assumption—inclusivity—is that insofar as human rights are relevant to global health policy, they are included within the right to health. Both exclusivity and inclusivity are, we believe, highly problematic assumptions. We cannot rely exclusively on human rights to develop global health policy; and to the extent that human rights are relevant, we cannot restrict ourselves to the right to health.