SDGs, Accountability, and the Right to Health: A New Series
Carmel Williams
Accountability is a vital aspect of human rights. Without it, fundamental principles of human rights, including participation and transparency, are denied. With accountability comes trust—trust that duty bearers’ obligations and commitments can be monitored and reviewed; trust that the impacts of policy and practice will be scrutinized, reported, and adjusted when necessary; trust that people may claim their rights without fear of reprisal and that remedy is available when justified; and trust that people are, and will always be, treated with dignity.
It is therefore disappointing that accountability is weak in the 2030 Agenda foundation document for the Sustainable Development Goals (SDGs). Moreover, accountability from a human rights perspective is completely missing, despite the document’s recognition of the importance of human rights.
Accountability is labeled “follow-up and review” in the 2030 Agenda, and emphasizes statistical data and “broader measures of progress to complement gross domestic product” (para 48), which is alarmingly suggestive that human development is being measured purely in quantifiable and financial terms. No one would deny that statistics are important, and meaningful, especially when disaggregated to capture disparities between the best- and worst-off groups within and between countries. But human rights accountability must be much more than this, and it needs to include accountability beyond individual nations and beyond state actors. This matters when the private sector is given such prominence in the SDGs. As Alicia Ely Yamin has explained, “It is counterproductive to focus exclusively on the accountability of governments in the global South for unfair global rules that lie beyond their control.”1
Paul Hunt also raised this issue in his SDG Series perspective:
It is difficult for States at the national-level to hold accountable stakeholders, including non-state actors, for their transnational contributions and commitments to development, such as SDG17. One of the most important roles for global-level accountability is to strengthen accountability for these transnational contributions and commitments.
Hunt called for an independent review mechanism on health SDGs, which would report to the UN Human Rights Council and to the High-Level Political Forum, as well as other high-level political bodies in global health.
Eric Friedman, in his full paper on SDGs and accountability, proposes that a Framework Convention on Global Health (FCGH) would significantly strengthen accountability for the health-related SDGs:
Legally binding, the FCGH could facilitate accountability through the courts and catalyze comprehensive domestic accountability regimes, requiring national strategies that include transparency, community and national accountability and participatory mechanisms, and an enabling environment for social empowerment.
Friedman and Hunt both raise the crucial human rights issue of social empowerment and the critical role of civil society in monitoring progress and process. In so doing, they emphasize the need to study how change was achieved—through what have previously been described as ‘process indicators’—rather than looking solely at statistical measures. Yamin advocates going beyond social empowerment to political transformation, calling for an accountability that focuses on the changing relationship between citizens and the state, between people and health systems, and “aimed at change in the structural relations that underpin patterns of severe deprivation and underdevelopment.”2 She argues that SDG outcomes matter less than achieving changes in political processes and institutions, and that narrow targets and indicators for the SDGs will likely result in MDG-like “short-term, narrow improvements to remedy complex long-term goals.”3
As indicators are selected and agreed upon over the next few weeks of early 2016, this is an important time to engage and promote human rights-based approaches to accountability for the SDGs, to move beyond the narrow indicator-driven interventions of the MDGs towards a transformative agenda. The SDGs need an accountability that people can trust to identify anyone being left behind.
The Health and Human Rights Blog series welcomes your views on SDGs, Accountability and the Right to Health.
Carmel Williams, PhD, is Executive Editor of the Health and Human Rights Journal and Fellow at the FXB Center for Health and Human Rights, Harvard T.H. Chan School of Public Health| Harvard University
References
1. A. Yamin, Power, suffering, and the struggle for dignity, (Philadelphia, PA: University of Pennsylvania Press, 2015), p. 137.
2. Ibid., p. 69.
3. Ibid., p. 211.