Human Rights in Global Health Governance

Benjamin Mason Meier, Margherita Marianna Cinà, and Lawrence O. Gostin

Institutions of global health governance are central to the advancement of health and human rights. Over the past 25 years, there has arisen an effort to formalize human rights implementation responsibilities across institutions of global governance, leading to a dramatic reframing in how international human rights law has been understood to influence the policies, programs, and practices of international organizations. It is increasingly necessary to understand the evolving relationship between human rights, global governance, and public health, examining the expansive set of international organizations that employ human rights in responding to public health challenges in a rapidly globalizing world.

Evolution of Human Rights in Global Governance

Even as human rights became central to global governance in the aftermath of World War II, states remained the primary duty-bearers for human rights. Working under the auspices of the United Nations (UN), states adopted the Universal Declaration of Human Rights (UDHR), International Covenant Civil and Political Rights (ICCPR), and International Covenant on Economic, Social, and Cultural Rights (ICESCR)—developing the normative foundation of the UN human rights system by codifying a range of rights under international law. With human rights law identifying individual rights-holders and corresponding state duty-bearers, national governments were seen to be the only parties bound by international law, with international organizations seen as relevant only in supporting state implementation of human rights.[1]

Yet, recent decades have seen crucial developments in the expansion of organizational responsibilities for human rights implementation. With the 1993 World Conference on Human Rights declaring a new post-Cold War consensus on human rights, calling for increased coordination of human rights implementation across the entire UN system, the resulting Vienna Declaration and Programme of Action (Vienna Declaration) established “the foundation for a holistic and integrated approach to human rights not only by the human rights machinery but also by the entire United Nations system.”[2] Following from this consensus on the centrality of human rights to international organizations, UN Secretary-General Kofi Annan called for the enhancement of human rights as a “cross-cutting” approach to all of the UN’s principal activities and programs, seeking to “fully integrate it [human rights] into the broad range of the Organization’s activities.”[3]

Where human rights development had long been cloistered within the UN human rights system, the Vienna Declaration and the Secretary-General’s call led to an expanded integration of human rights throughout the UN—implementing human rights across the global governance landscape. While not legal parties to human rights treaties, international organizations began “mainstreaming” human rights by incorporating human rights norms, standards, and principles into their policymaking practices, operational budgets, bureaucratic processes, and ultimately organizational culture.[4] These human rights mainstreaming efforts would provide a foundation for the implementation of human rights in global health governance, with international organizations accepting responsibilities to foster and promote health-related human rights.

Implementing Human Rights in Global Health Governance

Within the UN system of global health governance, responsibility for specific health functions is decentralized to a number of UN specialized agencies, with overlapping organizational mandates across economic, social, cultural, education, health, and related fields. Although WHO has served as the primary specialized agency for health, many other international organizations have long had authority to develop independent institutional policies and programs to address health within their respective spheres of influence, as seen in UN Children’s Fund (UNICEF) work on child health, UN Development Program (UNDP) work on health in development, and UN Population Fund (UNFPA) work on reproductive health. Such functional decentralization within the UN system has created a fragmented governance system for public health, with international organizations operating independently to address select health issues.[5] This decentralization, combined with a lack of a universally agreed definitions of human rights mainstreaming, led to institutional inconsistencies in the realization of universal rights.[6]

Global health governance institutions looked to coordination across international organizations to implement health-related human rights. Inconsistencies across institutions raised an imperative for a common understanding of human rights mainstreaming, which brought international organizations together in 2003 to adopt a “Statement of Common Understanding among United Nations Agencies on the Human Rights-Based Approach to Development Cooperation” (Common Understanding).[7] Organized under the UN Development Group (UNDG), the Common Understanding advised that all UN programs, policies, and technical assistance should take responsibility for the realization of international human rights and contribute to the development of the capacities of duty-bearers to meet their obligations and the capacities of rights-holders to claim their rights.[8] This Common Understanding created a framework for international organizations to develop detailed and institution-specific requirements for mainstreaming a range of interdependent health-related human rights in their organizational policies, programs, and practices.

Mainstreaming Human Rights in Global Health Governance

In mainstreaming human rights in global health governance, WHO has played a critical role in operationalizing human rights for global health. Seeking to realize the right to health, WHO has undertaken evolving efforts to integrate human rights in its activities and building capacity among WHO staff to implement human rights in their work.[9] WHO’s leadership has brought together organizational efforts to mainstream gender, equity, and human rights (GER), providing varied “entry points” to generate greater acceptance, understanding, and application of health-related human rights.[10] With WHO’s predominantly medical staff thought to be resistant to rights-based legal discourses, the GER team has sought to implement human rights norms and principles without explicit reference to international legal standards.[11] However, despite these innovative GER efforts, WHO’s human rights resources remain incommensurate to its mainstreaming task, with a single human rights officer tasked with overseeing human rights focal points and assessing mainstreaming efforts across the Geneva secretariat, in regional offices, and throughout country offices.

WHO cannot be seen as the only institution responsible for human rights in global health governance. In a rapidly expanding global health governance landscape, it is necessary to look beyond WHO to understand how a larger set of international organizations has sought to mainstream human rights in a multi-sectoral approach to global health. Various UN programs, funds, and specialized agencies have played critical roles in implementing human rights under their respective health-related mandates in global governance. The International Labor Organization (ILO), for example, has adopted rights-based declarations on occupational safety and health and taken on a more active role in promoting human rights through international labor standards.[12] Other organizations with authority over discrete determinants of health—including HIV prevention and treatment, food and nutrition security, and child survival and development—have also sought to mainstream health-related human rights, developing both internal documents and external publications to clarify the institution-specific nature of this rights-based approach and to guide the practical transformation of human rights into organizational actions.

Conclusion

Human rights provide a unifying framework for global health governance, and over the past 25 years institutions of global governance have increasingly implemented human rights to advance global health. An expanding number of international organizations are now addressing human rights in a multisectoral array of global health threats, reflecting the interconnections across health-related human rights. Comparing these varied organizational efforts to mainstream human rights can support the development of common institutional structures and approaches that reflect “good practices” for human rights in global health governance. Initial studies have identified key institutional determinants associated with human rights mainstreaming: strong rights-based leadership within organizations and across states; specialized human rights units to translate norms and principles into bureaucratic application; rights-based collaborations that engage the human rights system, inter-organization partnerships, and civil society; and accountability mechanisms for assuring the organizational implementation of human rights.[13] Moving forward to analyze these crucial global governance institutions at the intersection of health and human rights, this understanding of rights-based governance in a globalizing world can provide a basis to secure a future of global health with justice.

Benjamin Mason Meier is an Associate Professor of Global Health Policy at the University of North Carolina at Chapel Hill and a Scholar at the O’Neill Institute for National and Global Health Law.

Margherita Marianna Cinà is a Fellow at the O’Neill Institute for National and Global Health Law at the Georgetown University Law Center.

Lawrence O. Gostin is the O’Neill Chair in Global Health Law, Director of the O’Neill Institute for National and Global Health Law, and Director of the WHO Collaborating Center on National and Global Health Law at Georgetown University.

References

[1] P. Alston. The United Nations and Human Rights: A Critical Appraisal (New York: Oxford University Press, 1992).

[2] M. Robinson, Five-year Review of the Implementation of the Vienna Declaration and Programme of Action: Interim report of the United Nations High Commissioner for Human Rights para 23, UN Doc. E/CN.4/1998/104 (1998).

[3] United Nations Development Group, The Human Rights Based Approach to Development Cooperation Towards a Common Understanding Among UN Agencies para 79 (2003). Available at: https://undg.org/document/the-human-rights-based-approach-to- development-cooperation-towards-a-common-understanding-among-un-agencies/.

[4] G. Oberleitner “A Decade of Mainstreaming Human Rights in the UN: Achievements, Failures, Challenges.” Netherlands Quarterly of Human Rights 26/3 (2008), pp. 359-390.

[5] M. Koivusalo and E. Ollila. Making a Healthy World: Agencies, Actors and Policies in International Health (New York: Zed, 1997).

[6] W. O’Neill and V. Bye, From High Principles to Operational Practice: Strengthening O.H.C.H.R. Capacity to Support U.N. Country Teams to Integrate Human Rights in Development Programming (Geneva: Consultancy report to the Office of the High Commissioner for Human Rights OHCHR, 2002).

[7] United Nations Development Group, The Human Rights Based Approach to Development Cooperation Towards a Common Understanding Among UN Agencies (2003). Available at: https://undg.org/document/the-human-rights-based-approach-to- development-cooperation-towards-a-common-understanding-among-un-agencies/.

[8] A. Frankovits. The Human Rights Based Approach and the United Nations System (Paris: UN Educational, Scientific and Cultural Organization, 2006).

[9] J. E. Oestreich. Power and Principle: Human Rights Programming in International Organizations (Washington: Georgetown University Press, 2007).

[10] B. M. Meier and Onzivu William “The Evolution of Human Rights in World Health Organization Policy and the Future of Human Rights Through Global Health Governance.” Public Health 128/2 (2014), pp. 179–187.

[11] R. Thomas and V. Magar. “Mainstreaming Human Rights across WHO.” in B.M. Meier and L.O. Gostin (eds) Human Rights in Global Health: Rights-based Governance for a Globalizing World, edited by Benjamin Mason Meier and Lawrence O. Gostin. (New York: Oxford University Press, 2018).

[12] L. Swepston. “The International Labor Organization: Human Rights to Health and Safety at Work.” in B.M. Meier and L.O. Gostin (eds) Human Rights in Global Health: Rights-based Governance for a Globalizing World (New York: Oxford University Press, 2018).

[13] B. M. Meier and L. O. Gostin. “Conclusion: Comparative Analysis of Human Rights in Global Governance for Health.” in Human Rights in Global Health: Rights-based Governance for a Globalizing World, edited by Benjamin Mason Meier and Lawrence O. Gostin (New York: Oxford University Press, 2018).