What could public health advocates do more effectively to encourage governments to act on underprioritized global health concerns? One important component largely missing from current strategies is the international human rights framework. Human rights principles and standards, including the right to the highest attainable standard of health, offer powerful moral arguments which can reinforce calls for action made on humanitarian grounds. In addition, the human rights framework brings into play established systems of national and international legal obligations and tools to assess performance by governments and international institutions. This enables the private sector and civil society to hold accountable all actors involved in achieving sustainable progress on major health challenges.
Health's roles in foreign policy
The effectiveness of the global response to the severe acute respiratory syndrome (SARS) and avian influenza outbreaks demonstrates that where health challenges pose a global and immediate risk, governments have been prepared to take rapid coordinated action to prevent or mitigate them. In contrast, international efforts to combat human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) were initially painfully slow because governments perceived the disease to be confined both geographically and in terms of populations at risk. By the time governments recognized that these assessments were misguided it became extremely difficult to contain the spread of the disease around the world.
Though the global impacts of HIV/AIDS are now understood, the response remains inadequate. Expensive, targeted AIDS treatment programmes reach large numbers of people in rich countries because viable pharmaceutical markets coincide with well-resourced health systems. At the same time, in the vast majority of developing countries, where self-financing markets and robust health systems are not in place, millions are perishing for want of treatments that could be made available if adequate resources were brought to bear. Despite the enormous advocacy efforts and commitment of some public and private actors, the need for additional strategies to confront the disease remains.
Numerous other health threats have received even less global attention. More than one billion people do not have access to safe water, one of the fundamental determinants of health. Some 2.6 billion lack access to sanitation, 10 million children die of preventable diseases each year and one of every 16 African women dies as a consequence of pregnancy. Despite the horrific statistics, these threats to health rarely make the international political agenda.
Growing awareness of the long-term impacts of health inequities on regional and global stability have led to initiatives such as the UN Millennium Development Goals, debt cancellation and increased international development assistance commitments. But lack of access to the basic determinants of health doesn't present an immediate threat to wealthy countries' national interests. And those suffering the most from these health problems--poor people in general and poor women in particular--lack the political voice and resources needed to demand change at home and on the international stage.
The lesson seems to be: where awareness and interests coincide, effective international responses to health threats are possible. But where only one of these is present, significantly less action is taken, and in cases where neither occurs, no coordinated approach is likely to emerge.
Rights: from principles to practice
How can the human rights framework move foreign policy concerns towards greater focus on global health challenges where no immediate threats to national security or economic interests are at stake?
First, human rights can help decision-makers assess risk. The human rights framework--by focusing attention on vulnerable populations, minorities, the rural poor and women especially, who are most often neglected and marginalized--forces those in authority to ask hard questions about whose needs are not being met, and whose voices are not being heard. …