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WHO advances the right to health for universal health coverage

The World Health Organization (WHO) has been central to the development of human rights for public health, and as the Organization seeks to mainstream human rights in global health governance, this year’s World Health Assembly (May 21-25) comes at a unique time and provides a key forum to advance the right to health as a moral foundation and political catalyst to advance universal health coverage.

WHO was established to provide global support for state efforts to realize health as a human right, with the WHO Constitution framing international health cooperation under the then-unprecedented declaration that “the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being.” With both the WHO Constitution and the Universal Declaration of Human Rights (UDHR) coming into force in 1948, there was great promise that these two commitments would complement each other, with WHO—like all United Nations (UN) specialized agencies—supporting human rights principles and standards in all its health policies, programs, and practices.

Yet, the promise of human rights to advance public health was long threatened by political constraints during the Cold War, WHO resistance to legal discourses, and medical ambivalence toward human rights. Where the 1966 International Covenant on Economic, Social and Cultural Rights (ICESCR) was seen to narrow the legal development of the right to health, subsequent leadership changes in WHO would seek to revitalize organizational efforts to engage with human rights, redefining international health goals to reflect human rights norms in the 1978 Declaration of Alma-Ata. This rights-based approach to health would endure in the early international response to HIV/AIDS, with WHO’s Global Programme on AIDS applying human rights principles to address the individual behaviors leading to HIV transmission, viewing respect for individual rights as a precondition for the public’s health.

Yet, the promise of human rights to advance public health was long threatened by political constraints during the Cold War, WHO resistance to legal discourses, and medical ambivalence toward human rights.

As human rights advancements flourished in the aftermath of the Cold War, WHO came to consider a more systematic operationalization of civil, cultural, economic, political, and social rights to an array of public health challenges. The 1993 World Conference on Human Rights first articulated organizational responsibilities for human rights through the Vienna Declaration and Programme of Action, expanding human rights implementation beyond the UN’s human rights mechanisms to encompass the entire UN system. Reflecting this cross-cutting approach to human rights, UN Secretary-General Kofi Annan called on UN specialized agencies in 1997 to “mainstream” human rights in all their activities. WHO took up this UN call, enlisting human rights advisors to operationalize human rights in WHO policies, programs, and practice. Building from this evolving work to advance a rights-based approach to health, WHO in 2012 brought together the core values of gender, equity, and human rights (GER) into one centralized mainstreaming team. This GER Team has emphasized the primacy of these interconnected values to health programming, offering the Organization a more unified, systematic, and standardized approach to mainstreaming across health programs.

The 2017 election of Tedros Adhanom Ghebreyesus as WHO Director-General has provided renewed leadership in advancing human rights in global health. With Dr. Tedros advocating tirelessly during his campaign that “universal health coverage is our best path to live up to WHO’s constitutional commitment to the right to health,” WHO has since invoked human rights as a foundation for its flagship universal health coverage (UHC) initiative—ensuring that quality health services can be accessed equitably and without financial hardship. Signaling Dr. Tedros’s determination to facilitate accountability for the progressive realization of the right to health through UHC efforts, WHO has recently sought to expand collaborations with civil society and signed a Memorandum of Understanding with the Office of the High Commissioner for Human Rights (OHCHR). These new partnerships examine human rights “to health and through health,” providing a moral foundation for WHO’s continuing efforts to frame UHC as the overarching focus of all WHO activities.

This week’s World Health Assembly, the first since the election of Dr. Tedros as Director-General, provides a landmark forum for consolidating these shifts toward human rights in global health governance. Drawing on a history of over sixty World Health Assembly resolutions that have addressed human rights on a variety of health programs, the Assembly will be adopting a series of rights-based resolutions alongside the WHO Global Programme of Work (GPW) for 2019-2023. Groundbreaking in its focus on rights-based political leadership in health, the current Draft GPW commits WHO to advocate for health at the “highest political level,” detailing that:

Consistent with its Constitution, WHO will be at the forefront of advocating for the right to health in order to achieve the highest attainable standard of health for all…. WHO will strengthen its health diplomacy and work to include health in global political bodies such as G20, G7, BRICS, and in regional and municipal political bodies.

The adoption of this GPW will serve as a political catalyst for WHO’s human rights leadership in global health governance, promoting the implementation of gender equality, health equity, and human rights in ways that address underlying determinants of health across the newly-developed Sustainable Development Goals (SDGs).

Looking beyond WHO, there is an imperative to understand human rights implementation across the larger global governance landscape that underlies public health. This rapidly expanding global health governance landscape—from the occupational safety and health policies of the International Labor Organization (ILO) to the nutrition security assistance of the UN Food and Agriculture Organization (FAO)—has led to a diverse range of institutional approaches to human rights mainstreaming. Where WHO seeks to put human rights at the center of global health governance, the proliferation of global institutions for public health provides a basis and a rationale to compare the unique institutional structures that facilitate organizational action to implement the right to health, health-related human rights, and rights-based approaches to health. As we simultaneously celebrate seventy years of human rights advancements since the UDHR and seventy years of global health governance through WHO, it is necessary to understand the institutional determinants of human rights mainstreaming as a basis to realize a future for human rights in global health.

Featured image credit: The World Health Assembly meets at the World Health Organization in Geneva, Switzerland (World Health Organization/Pierre Albouy)

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