Conclusion

Author(s):  
Benjamin Mason Meier ◽  
Lawrence O. Gostin

This concluding chapter analyzes the structural determinants of human rights mainstreaming for global health and considers common themes for the implementation of human rights through global governance for health. Human rights are implemented in global health through a dynamic global governance system—extending across the World Health Organization’s mandate to realize the right to health; United Nations specialized agency efforts to address health-related human rights; economic governance to support rights-based priorities in public health funding; and human rights governance to advance global health. The unique context of each institution is crucial to implementing human rights for global health; however, there are generalizable institutional themes that can be drawn from these experiences. By comparing the structures that facilitate organizational efforts to advance human rights across the contributing chapters in this edited volume, it becomes possible to understand the institutional determinants of the rights-based approach to health.

Author(s):  
Mary Robinson

Institutions matter for the advancement of human rights in global health. Given the dramatic development of human rights under international law and the parallel proliferation of global institutions for public health, there arises an imperative to understand the implementation of human rights through global health governance. This volume examines the evolving relationship between human rights, global governance, and public health, studying an expansive set of health challenges through a multi-sectoral array of global organizations. To analyze the structural determinants of rights-based governance, the organizations in this volume include those international bureaucracies that implement human rights in ways that influence public health in a globalizing world. Bringing together leading health and human rights scholars and practitioners from academia, non-governmental organizations, and the United Nations system, this volume explores: (1) the foundations of human rights as a normative framework for global health governance, (2) the mandate of the World Health Organization to pursue a human rights-based approach to health, (3) the role of inter-governmental organizations across a range of health-related human rights, (4) the influence of rights-based economic governance on public health, and (5) the focus on global health among institutions of human rights governance. Contributing chapters map the distinct human rights activities within a specific institution of global governance for health. Through the comparative institutional analysis in this volume, the contributing authors examine institutional efforts to operationalize human rights in organizational policies, programs, and practices and assess institutional factors that facilitate or inhibit human rights mainstreaming for global health advancement.


Author(s):  
Michel Sidibé ◽  
Helena Nygren-Krug ◽  
Bronwyn McBride ◽  
Kent Buse

This chapter argues that the current global health agenda has failed to put people and their rights at the center. With communities unable to have their voices heard, challenge injustice, and hold decision makers to account, states are ill-equipped to realize the Sustainable Development Goals (SDGs), including SDG 3 to ensure healthy lives and well-being for all. The chapter articulates a shift from a discretionary development paradigm to a rights-based paradigm for global health, building on rights-based approaches that have been proven to work—as in the AIDS response. Seven reforms are proposed, addressing: (1) priority-setting, (2) systems for health, (3) data and monitoring, (4) access to justice, (5) the need to safeguard the right to health across sectors, (6) partnerships, and (7) financing. These reforms call for a broad social movement for global governance for health, advancing and operationalizing rights-based approaches across the SDGs.


Author(s):  
Benjamin Mason Meier ◽  
Lawrence O. Gostin

This introductory chapter outlines the global governance institutions that structure the realization of human rights for global health. With this volume examining the relationship between human rights, global governance, and public health, a proliferating set of global governance institutions have developed policies, programs, and practices to operationalize human rights to address public health challenges in a globalizing world. As an institutional analysis that focuses on organizations, the organizations in this volume include those international bureaucracies that bear implementation responsibilities for health-related human rights. Examining institutional dynamics to implement human rights, the contributing authors analyze institutional factors that facilitate or inhibit human rights mainstreaming. This introduction concludes by recognizing the importance of comparative analysis in understanding institutional approaches to human rights in global health, outlining the research methods for studying human rights mainstreaming in global governance institutions and framing a new field of study on rights-based governance for global health advancement.


Author(s):  
Benjamin Mason Meier ◽  
Lawrence O. Gostin

This chapter frames the implementation of human rights law through global health governance. Global governance institutions have sought to translate human rights into public policy, shifting from the development of health-related rights under international law to the implementation of these normative standards in global policies, programs, and practices. This shift toward an “era of implementation” across an expanding global health governance landscape looks beyond the traditional “human rights system” in implementing human rights for global health. Analyzing human rights as part of global health law, this chapter examines how human rights have become a framework for global governance, with institutions of global health governance seeking to “mainstream” human rights across all organizational actions. This chapter concludes that there is a need for institutional analysis to compare organizational approaches conducive to the implementation of health-related human rights.


Author(s):  
John Tasioulas ◽  
Effy Vayena

This chapter offers an integrated account of two strands of global health justice: health-related human rights and health-related common goods. After sketching a general understanding of the nature of human rights, it proceeds to explain both how individual human rights are to be individuated and the content of their associated obligations specified. With respect to both issues, the human right to health is taken as the primary illustration. It is argued that (1) the individuation of the right to health is fixed by reference to the subject matter of its corresponding obligations, and not by the interests it serves, and (2) the specification of the content of that right must be properly responsive to thresholds of possibility and burden. The chapter concludes by insisting that human rights cannot constitute the whole of global health justice and that, in addition, other considerations—including the promotion of health-related global public goods—should also shape such policy. Moreover, the relationship between human rights and common goods should not be conceived as mutually exclusive. On the contrary, there sometimes exists an individual right to some aspect of a common good, including a right to benefit from health-related common goods such as programs for securing herd immunity from diphtheria.


Author(s):  
Stephen P. Marks

This chapter applies two approaches to global economic governance of relevance to global health funding agencies. The first is the human rights-based approach to development, with its theoretical grounding in social justice and capabilities and with its practical applications in agencies engaged in development assistance and financing of health interventions, with particular relevance to the 2030 Development Agenda. The second approach is that of the right to development, as clarified in terms of policy, process, and outcomes, and as applied to the three funding programs that direct resources to global health issues. The chapter concludes that the mainstreaming of the human rights-based approach to development has been integrated into practice—albeit on a modest scale—more than the right to development, due primarily to a lack of incentives, notwithstanding the potential of both approaches to inflect global governance institutions in ways that advance human rights for global health.


Author(s):  
Lawrence O. Gostin ◽  
Benjamin Mason Meier

This chapter introduces the foundational importance of human rights for global health, providing a theoretical basis for the edited volume by laying out the role of human rights under international law as a normative basis for public health. By addressing public health harms as human rights violations, international law has offered global standards by which to frame government responsibilities and evaluate health practices, providing legal accountability in global health policy. The authors trace the historical foundations for understanding the development of human rights and the role of human rights in protecting and promoting health since the end of World War II and the birth of the United Nations. Examining the development of human rights under international law, the authors introduce the right to health as an encompassing right to health care and underlying determinants of health, exploring this right alongside other “health-related human rights.”


Author(s):  
Joia S. Mukherjee

This chapter focuses on governance, a key building block of a health system. A government is responsible for the health of its people. It sets the health strategy and oversees the implementation of health programs. External forces and actors influence the governance of the health sector. This chapter explores governance of health from the perspective of the nation-state coordinating its own health system (sometimes called governance for global health). The chapter examines the internal and external forces that influence national governance for global health. The chapter also looks beyond the level of the nation-state to explore the concept of global governance for health. In the interconnected and globalized world, global governance for health is needed to coordinate the geopolitical forces that impact health and its social determinants.


Author(s):  
Jeremy Youde

While Chapter 3 focuses primarily on the evolution of global health governance, Chapter 4 pays more attention to its contemporary manifestation as a secondary institution within international society. This chapter discusses the current state of the global health governance architecture—who the important actors are, how they operate, how they have changed over the past twenty-five years, and how they illustrate the fundamental beliefs and attitudes within the global health governance system. In particular, the chapter discusses the relative balance between state-based and non-state actors, as well as public versus private actors. This chapter highlights five key players within contemporary global health governance: states; the World Health Organization; multilateral funding agencies; public–private partnerships; and non-state and private actors


Author(s):  
Gisela Hirschmann

How can international organizations (IOs) like the United Nations (UN) and their implementing partners be held accountable if their actions and policies violate fundamental human rights? Political scientists and legal scholars have shed a much-needed light on the limits of traditional accountability when it comes to complex global governance. However, conventional studies on IO accountability fail to systematically analyze a related, puzzling empirical trend: human rights violations that occur in the context of global governance do not go unnoticed altogether; they are investigated and sanctioned by independent third parties. This book puts forward the concept of pluralist accountability, whereby third parties hold IOs and their implementing partners accountable for human rights violations. We can expect pluralist accountability to evolve if a competitive environment stimulates third parties to enact accountability and if the implementing actors are vulnerable to human rights demands. Based on a comprehensive study of UN-mandated operations in Afghanistan, Bosnia, and Kosovo, the European Union Troika’s austerity policy, and global public–private health partnerships in India, this book demonstrates how competition and human rights vulnerability shape the evolution of pluralist accountability in response to diverse human rights violations, such as human trafficking, the violation of the rights of detainees, economic rights, and the right to consent in clinical trials. While highlighting the importance of studying alternative accountability mechanisms, this book also argues that pluralist accountability should not be regarded as a panacea for IOs’ legitimacy problems, as it is often less legalized and might cause multiple accountability disorder.


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