12.04.18

Mapping the Evolution of the Right to Health at the Office of the High Commissioner for Human Rights

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This article was written by Gillian MacNaughton, Assistant Professor in the School for Global Inclusion and Social Development at the University of Massachusetts Boston, and Mariah McGill, a Senior Fellow with the Program on Human Rights and the Global Economy at Northeastern University School of Law.

The post of the UN High Commissioner for Human Rights was created in 1993 by the UN General Assembly on the recommendation of the World Conference of Human Rights, which took place earlier that year. The High Commissioner is an Under-Secretary General who reports annually to the Human Rights Council and to the General Assembly. It is the responsibility of the High Commissioner to promote and protect the enjoyment of all civil, cultural, economic, political and social rights by all people. Among these rights is the right to the highest attainable standard of physical and mental health (the right to health). This 1993 UN General Assembly resolution also created the Office of the High Commissioner for Human Rights (OHCHR) located in Geneva with a liaison office in New York.

The mission of the OHCHR is “to work for the protection of all human rights for all people; to help empower people to realize their rights; and to assist those responsible for upholding such rights in ensuring that they are implemented.”  The OHCHR works in four broad areas:

  1. providing support for the human rights mechanisms, including the Human Rights Council, the fifty-seven Special Procedures mandate holders appointed by the Human Rights Council, and the ten UN human rights treaty bodies,
  2. producing policy guidelines and tools that translate international human rights law into practice, and providing training, advice, and support to UN member states, civil society, and national human rights institutions,
  3. ensuring that human rights are mainstreamed into all UN programs in development, peace and security, governance and the rule of law, and
  4. supporting sixty field presences, which collaborate with governments and other UN entities to respond to human rights challenges in context.

I. The Seven High Commissioners for Human Rights

To date, there have been seven High Commissioners, as well as one Acting High Commissioner. Each of the High Commissioners has taken a different approach to fulfilling the responsibilities of the position – diplomat, human rights advocate and administrator – as well as toward the right to health. Beyond their individual influence, the discussion of the OHCHR through the eras of each High Commissioner paints a picture of the expanding work of the OHCHR on the right to health since 1994. Over this period, the health-related work of the OHCHR has evolved from a narrow focus on HIV/AIDS to diverse health topics, which are progressively integrated across programs today.

Table 1: High Commissioners for Human Rights

Term

Length of Service

Jose Ayala-Lasso

1994-1997

3 years

Mary Robinson

1997-2002

5 years

Sergio Vieira de Mello

2002-2003

8 months

Bertrand Ramcharan (Acting High Commissioner)

2003-2004

13 months

Louise Arbor

2004-2008

4 years

Navanethem Pillay

2008-2014

6 years

Zeid Ra’ad Al Hussein

2014-2018

4 years

Michelle Bachelet

2018-present

 

Jose Ayala-Lasso, an Ecuadorian diplomat, was the first High Commissioner for Human Rights.  While the OHCHR was small at that time, Ayala-Lasso repeatedly asserted the importance of economic and social rights, which are underlying determinants of health. 

Mary Robinson, former President of Ireland, was the second High Commissioner.  During her tenure, the UN Secretary-General merged the OHCHR and the Center for Human Rights, giving Robinson greater resources and staff.  Robinson was a champion of economic and social rights, maintaining consistently that all rights are indivisible. Under Robinson, the OHCHR began its health-related work, focusing on the HIV/AIDS epidemic.  For example, the OHCHR published, with the Joint UN Program on HIV/AIDS, the International Guidelines on HIV/AIDS and Human Rights in 1998. Robinson also established the position of Advisor on HIV/AIDS, which was the first health-focused staff position at the OHCHR.

Sergio Vieira de Mello, a Brazilian with decades of experience in the UN, was the third High Commissioner. After only eight months, he took a temporary leave to serve as the UN Special Representative in Iraq where he was tragically killed during a suicide bombing.  Bertrand Ramcharan then served as Acting High Commissioner for 13 months.  During his term, the OHCHR continued to work with UNAIDS and WHO on HIV/AIDS and human rights, and also collaborated with FAO on voluntary guidelines to realize the right to food, UN-Habitat on indicators to monitor the right to housing and WHO on indicators to monitor the right to health.   

During her four year term as OHCHR’s fourth High Commissioner, Louise Arbour frequently emphasized that extreme poverty was the most widespread denial of human rights and created a small team of dedicated professionals within the OHCHR to focus on economic, social and cultural rights.  Under Arbour, the Office continued to advance the right to health through collaborations with the WHO to develop right to health indicators, co-authoring publications on human rights-based approaches to poverty and health, and developing a fact sheet on the right to health.  Arbour also created a new desk on women’s rights and gender, which has played a strong role in developing the health-related work of the OHCHR in recent years.

Navanthem Pillay was the fifth and longest serving High Commissioner.  During her tenure, the OHCHR continued to operationalize a human rights-based approach to HIV/AIDS through a series of publications and workshops.  The OHCHR also issued a report on maternal mortality and human rights and issued technical guidance on a human rights-based approach to reducing preventable maternal mortality and morbidity. Further, the OHCHR held an expert consultation on the right to health in armed conflict.  

Zeid Ra’ad Al Hussein served as the sixth High Commissioner for Human Rights until August 2018.  Much of the work health-related work under Zeid focused on sexual and reproductive health and rights and has included multiple publications, reports and forums. Most notably, the OHCHR in collaboration with the WHO launched the High-Level Working Group on the Health and Human Rights of Women, Children, and Adolescents to secure political support for implementing the Global Strategy for Women’s, Children’s and Adolescents’ Health 2016-2030 and the human rights-related measures in the SDGs.  In May 2017, the High-Level Working Group released its final report which recognized health care professionals as human rights defenders and stressed that achieving the right to health is a necessary prerequisite for fulfilling other human rights.  In November 2017, the OHCHR and the WHO signed a Framework of Cooperation committing both organizations to deepen collaboration to implement the High-Level Working Group’s recommendations. 

Since September 1, 2018, Michelle Bachelet has served as the seventh High Commissioner for Human Rights. Bachelet is a medical doctor and has a long history of working for the rights of vulnerable people, in particular for women, girls, and LGBT rights. She was the first Director of UN Women and Chair of the Partnership for Maternal, Newborn and Child Health. Accordingly, there is strong reason to believe that the OHCHR will take a particular interest in the right to health again under this new leadership.

II. Factors that Influence OHCHR Support of the Right to Health

We find that the following factors influence OHCHR support of the right to health.

A. Resources and Staff Capacity for Global Health Challenges

By December 2017, the OHCHR was employing 1,302 staff. The 2016-2017 budget was US$ 215.5 million, amounting to about 3.5 percent of the UN Secretariat regular budget. The OHCHR remains deeply underfunded relative to global human rights concerns. To subsidize the allocations from the UN Secretariat, the High Commissioners have sought voluntary contributions (largely from member states), which in 2017 reached US$142.8 million. Still the OHCHR staffing and funding remain extremely limited in view of its global human rights mission.

B. Recognition of Economic and Social Rights as “Real” Human Rights

For decades, the notion that economic and social rights while being worthy social goals are not as legitimate as civil and political rights has been widespread within the UN and amongst member states. In recent years, there has been a growing recognition of the importance of economic and social rights, but there is still resistance to their full recognition as “real” human rights.  Over the past two and half decades, the OHCHR has not played a consistently strong role in ensuring that economic and social rights are an equal part of the human rights agenda in part because the Human Rights Council, which determines a significant portion of the Office’s work, continues to prioritize civil and political rights.

C. Champions of the Right to Health Among OHCHR Leadership

Strong champions of the right to health both within and outside the OHCHR foster the mainstreaming of the right to health by recognizing that health affects the enjoyment of all human rights. All the UN High Commissioners for Human Right have expressed a commitment to economic and social rights or the right to health in particular but have not all actively promoted them to the same extent. As the High Level Working Group on the Health and Human Rights of Women, Children and Adolescents notes “you cannot uphold rights without bold, unapologetic leadership at the highest levels.”

D. Transition from Conceptualization to Operationalization of the Right to Health

A challenge to mainstreaming the right to health at the OHCHR is the difficulty in moving beyond a narrow legalistic understanding of the right to health to operationalizing it in the field. The OHCHR has played a crucial role in developing human rights instruments, elaborating the normative content of rights and monitoring state implementation. However, full implementation of the right to health requires moving beyond law and legal mechanisms to embrace extensive collaboration with health professionals and experts in a wide range of other fields, as health is impacted by many social determinants.  The transition from a legalistic focus on the right to health to operationalization can be seen in the recent work, such as OHCHR participation in the SDG process. 

Conclusion

Despite weak support for economic and social rights and limited resources, the OHCHR has advanced the right to health and health-related rights around the world, particularly in the areas of HIV/AIDS, women’s rights, and sexual and reproductive rights. More recently, the right to health is also increasingly integrated into many other areas, such as climate change, conflict areas, and detention centers.  Nonetheless, OHCHR struggles to address the right to health due to budget limitations and ideological challenges.  With the new High Commissioner, Michelle Bachelet, a physician with a background in public health, it is likely that the OHCHR will continue to deepen its health-related work in the years to come.

Posted in Global Health, Global Health Governance, Health and Human Rights, WHO ;

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