International Obligations through Collective Rights: Moving from

Foreign Health Assistance to Global Health Governance

Benjamin Mason Meier, JD, LLM, PhDAssistant Professor of Global Health PolicyUniversity of North Carolina – Chapel Hill

Ashley M. Fox, MA, PhDPost-doctoral Fellow

Harvard School of Public Health

November 9, 2009

Outline1. Background – Foreign Assistance for Global

Health2. Results – Limited Evolution of the Right to

Health to Codify International Obligations3. Analysis – Collective Rights as a Means to

International Obligations4. Proposal – Employing Collective Rights for

Global Health Governancea. Developmentb. Implementation

Background Results Analysis Proposal

Foreign Assistance for Global Health• Entrenched poverty –

Neoliberal Development Policy

• Neoliberal Development Policy – Health Inequity

• Foreign Assistance– ODA

– Megaphilanthropy

– IFIs

• Vertical vs. Horizontal Aid– Biomedical services

– Primary health care systems

BACKGROUND Results Analysis Proposal

IllHealth

Inequitable Poverty

Human Rights-Based Approach to Foreign Assistance

Human Right = Valid demand & Corresponding duty(An Individual has a right against the State in relation to Health)

Demand of Rights

Programs to Realize Rights

Duty bearer

Rights holder

BACKGROUND Results Analysis Proposal

The existing gross inequality in the health status of the people particularly between developed and developing countries as well as within countries is politically, socially and economically unacceptable and is, therefore, of common concern to all countries.

Limited Evolution of the Right to Health to Codify International Obligations

1945 1965 1985 2005

Universal Declaration of Human Rights

International Covenant on Economic, Social and Cultural Rights

Declaration of Alma-Ata

Millennium Development Goals

General Comment 14

UN Special Rapporteur on the Right to Health

MDGs for Health

Background RESULTS Analysis Proposal

Incomplete Success of the Right to HealthRight to Health Cannot Address Primary Health Care

• Is a Right to Medicines All We’ve Got?

Right to Health Cannot Address International Development• What is Sovereignty in a

Globalized World?– State responsibility for human

rights is unable to address changes to state sovereignty

– Where the violator is an • international institution or • transnational corporation,human rights law cannot provide redress to the national victim

Background RESULTS Analysis Proposal

Collective Rights as a Means to International Obligations

• Collective Rights as Necessary to Realize Global Public Goods

• The Rise of Collective Rights to Challenge Global Institutions

Background Results ANALYSIS Proposal

Employing Collective Rights for Global Health Governance

• Vector of Rights for Interconnected Determinants of Health

• International Obligations against the International Community– Enforce Global Health

Commitments– Channel Assistance to

Primary Health Care– Ensure Cooperation in

International Institutions

Collective Rights– Development– Implementation

Background Results Analysis PROPOSAL

A State has a right against the International Community in relation to Primary Health Care Systems

Demand of Rights

(International/Intra-national)

Developing State – Rights holder

International Community – Duty bearer

Policies to Realize Rights

Respect Protect Fulfill

Refraining from infringing states’ autonomy to develop primary health care systems

Regulating transnational private actors

Promoting cooperation through international institutions

Background Results Analysis PROPOSAL

Developing Human Rights Claims – Policies to Realize Collective Rights

Respect Protect Fulfill

Refraining from infringing states’

autonomy to develop primary

health care systems

Regulating transnational private actors

Promoting cooperation

through international institutions

Background Results Analysis PROPOSAL

Implementing Human Rights Claims – Demand of Collective Rights

• International– Restructure international

institutions – Create multilateral

global governance institutions

• Primary Health Care through WHO

• Intranational– Ensure assistance is

channeled through • General budgetary

support• Sector-wide

approaches to national primary health care systems

Background Results Analysis PROPOSAL

Benjamin Mason Meier, JD, LLM, PhDAssistant Professor of Global Health PolicyUniversity of North Carolina – Chapel Hillbmeier@unc.edu