Paul H Hunt

Health systems and the right to health: an assessment of 194 countries

60 years ago, the Universal Declaration of Human Rights laid the foundations for the right to the highest attainable standard of health. This right is central to the creation of equitable health systems. We identify some of the right-to health features of health systems, such as a comprehensive national health plan, and propose 72 indicators that reflect some of these features. We collect globally processed data on these indicators for 194 countries and national data for Ecuador, Mozambique, Peru, Romania, and Sweden. Globally processed data were not available for 18 indicators for any country, suggesting that organisations that obtain such data give insufficient attention to the right-to-health features of health systems. Where they are available, the indicators show where health systems need to be improved to better realise the right to health. We provide recommendations for governments, international bodies, civil-society organisations, and other institutions and suggest that these indicators and data, although not perfect, provide a basis for the monitoring of health systems and the progressive realisation of the right to health. Right-to-health features are not just good management, justice, or humanitarianism, they are obligations under human-rights law.

Right to the highest attainable standard of health

This chapter introduces the right to the highest attainable standard of health, which is enshrined in several international treaties, as well as numerous national constitutions, giving rise to legally binding obligations on States. It outlines the complementary relationship between public health and the right to the highest attainable standard of health, and provides a framework for analysing this human right. This analytical framework, which deepens understanding of, and helps to identify appropriate responses to, public health issues, is then applied, by way of illustration, to neglected diseases, mental disability, sexual and reproductive health, and water and sanitation. The conclusion identifies the key features of a health system from the perspective of the right to the highest attainable standard of health.

Health impact assessment: The contribution of the right to the highest attainable standard of health

There are growing demands for governments to carry out human rights impact assessments prior to adopting and implementing policies. This article outlines a preliminary human rights impact assessment methodology, using the right to the highest attainable standard of health as the case study. The authors recommend a mainstreaming approach, which involves integrating human rights into existing impact assessment methodologies. Accordingly, they identify considerations that, from a human rights perspective, governments should incorporate into existing impact assessment methodologies in order to comply with their legal obligations to realize human rights. To test the mainstreaming methodology, the authors propose integrating the right to the highest attainable standard of health into health impact assessment.

Missed opportunities: human rights and the Commission on Social Determinants of Health.

All those responsible for ‘Closing the gap in a generation’ (1), the report of the Commission on Social Determinants of Health, deserve great credit for placing equity at the heart of the debate about health. This excellent report highlights vital issues that are often neglected. Others have emphasised the report’s many strengths and virtues. I will not repeat, but firmly endorse, these richly deserved remarks. In this supportive context, I offer some constructive criticism of the report. My remarks aim to deepen and advance the report’s analysis and recommendations. ‘Closing the gap’ is a human rights report, no less than a publication of Amnesty International, Human Rights Watch or the UN Human Rights Council. It exposes systemic inequality and discrimination on a global scale – and the struggle against inequality and discrimination lies at the heart of human rights. One of the cardinal objectives of the United Nations – set out in the opening article of the UN Charter – is to promote and protect human rights without discrimination. Equality and non-discrimination are key elements of the Universal Declaration of Human Rights, the 60th anniversary of which we celebrate next month. The entire post-1945 international code of human rights rests upon the principles of equality and non-discrimination (2), and these issues form part of the report’s fabric. But the report is a human rights report in other ways, too. The report is about poverty – and today it is recognised that poverty is a human rights issue (e.g. see Office of the UN High Commissioner for Human Rights (3,4)). Numerous human rights bear upon poverty: the rights to basic shelter, food, education and health-related services, as well as classic civil and political rights, such as freedoms of expression, assembly and association. The report is replete with other important human rights issues, the right to safe working conditions, the right to a safe environment and so on. So, in an important sense, ‘Closing the gap’ is a human rights report. And yet, strangely, it isn’t! Despite the multiple, dense connections between social determinants and human rights, the report’s human rights content is disappointingly muted. The human rights analysis is not absent, but underdeveloped and understated. The last 10 years have witnessed some remarkable changes in our understanding of human rights and health but, with honourable exceptions, the

Acesso a medicamentos como um direito humano

Este articulo analiza el componente del derecho al disfrute del mas alto nivel posible de salud que se relaciona con el acceso a los medicamentos, incluyendo los medicamentos esenciales. Utilizando el marco analitico del derecho a la salud que ha sido desarrollado en los anos recientes, la primera seccion se concentra en las responsabilidades de los Estados. La segunda seccion provee una breve introduccion a las responsabilidades de las companias farmaceuticas.This article considers the component of the right to the highest standard of health that relates to medicines, including essential medicines. Using the right-to-health analytical framework that has been developed in recent years, the first section focuses on the responsibilities of States. The second section provides a brief introduction to the responsibilities of pharmaceutical companies.

The right to health: from the margins to the mainstream

In September I was appointed special rapporteur. Although nominated by New Zealand I serve in my personal capacity as an independent expert. The rapporteur’s mandate is vast and vague: to gather right-to-health information from all sources to identify areas of cooperation to report on the status of the right to health throughout the world and to make policy and legislative recommendations. I am expected to undertake two country missions every year. All this on a part-time basis—and supported by one UN researcher. With my first report due in the New Year I am consulting with states civil society organisations UN specialised agencies and international financial institutions such as the World Bank and International Monetary Fund (IMF). The basic challenge is to promote and protect the international right to health. This requires different approaches for different constituencies. Whereas one approach might assist a developing state a different approach may be needed for a developed state. What might resonate with an association of health professionals might not work with the World Bank and IMF. And then there is the important question of how to approach the private sector. (excerpt)

Universal health coverage, priority setting, and the human right to health

As health policy-makers around the world seek to make progress towards universal health coverage they must navigate between two important ethical imperatives: to set national spending priorities fairly and efficiently; and to safeguard the right to health. These imperatives can conflict, leading some to conclude that rights-based approaches present a disruptive influence on health policy, hindering states’ efforts to set priorities fairly and efficiently. Here, we challenge this perception. We argue first that these points of tension stem largely from inadequate interpretations of the aims of priority setting as well as the right to health. We then discuss various ways in which the right to health complements traditional concerns of priority setting and vice versa. Finally, we set out a three-step process by which policy-makers may navigate the ethical and legal considerations at play.

Are drug companies living up to their human rights responsibilities? The perspective of the former United Nations Special Rapporteur (2002-2008).

As one viewpoint of three in the PLoS Medicine Debate on whether drug companies are living up to their human rights responsibilities, Paul Hunt (the UN Special Rapporteur on the Right to Health) and Rajat Khosla argue that pharmaceutical companies have been noncompliant and that better accountability mechanisms are needed.

The human right to medicines

Este articulo analiza el componente del derecho al disfrute del mas alto nivel posible de salud que se relaciona con el acceso a los medicamentos, incluyendo los medicamentos esenciales. Utilizando el marco analitico del derecho a la salud que ha sido desarrollado en los anos recientes, la primera seccion se concentra en las responsabilidades de los Estados. La segunda seccion provee una breve introduccion a las responsabilidades de las companias farmaceuticas.This article considers the component of the right to the highest standard of health that relates to medicines, including essential medicines. Using the right-to-health analytical framework that has been developed in recent years, the first section focuses on the responsibilities of States. The second section provides a brief introduction to the responsibilities of pharmaceutical companies.

Taking Economic, Social and Cultural Rights Seriously

A few years ago I gave a talk in Ireland on economic, social and cultural rights. I explained that these fundamental human rights place binding legal obligations on the Irish Government. At the end of my remarks, we had comments and questions. The first speaker said that she was very surprised -never before had she heard about these binding economic, social and cultural rights. They must be, she said, “the best kept secret in Ireland.”