“WHO was founded on the principle that all people should be able to realize their right to the highest possible level of health. ‘Health for all’…is the driving force behind our efforts to urge all countries to make progress towards universal health coverage.”
Dr. Tedros Adhenom Ghebreysus
Director-General of the World Health Organization
Over the course of two chapters in the groundbreaking new edited volume, Human Rights in Global Health: Rights-Based Governance for a Globalizing World, we argue that the World Health Organization (WHO) has in recent years begun to operationalize human rights in health through the translation of fundamental human rights principles — participation, equality, non-discrimination, and accountability — and key components of the international standard on the right to health. Looking ahead, we lay out three shifts that will be needed to make these changes sustainable and identify some early positive trends that could pave the way for a new era for health and human rights at WHO.
WHO’s mainstreaming strategy has evolved toward a more integrated approach that encompasses gender, equity, and human rights. Undertaken as part of broader organization-wide reforms, this innovative shift (the first of its kind in the UN system) offered a more efficient, powerful, and unifying concept for human rights mainstreaming and led to a focus on the practical and operational components of human rights to provide a common value system and language across all three fields.
An integrated set of mainstreaming “standards” were developed, derived from international human rights norms, to guide WHO staff on how to incorporate these values into their work. Actions included data disaggregation, participatory processes, non-discrimination, equity and gender analysis, and implementation and follow-up on recommendations of human rights bodies. These standards were formally introduced into organizational planning and evaluation tools, evidence-based guideline development processes, and evidence and data collection; assessment tools were developed to support country health planning and programing.
As these mainstreaming efforts have continued, a more nuanced shift has been taking place across the Organization, with the adoption of strategies firmly grounded in fundamental principles of human rights. Firstly, a growing number of programs — across mental health, violence and injury, disability, sexual and reproductive health and non-communicable disease — are now tracking and monitoring the role of law in promoting public health and protecting human rights. The Organization’s flagship commitment to Universal Health Coverage (UHC) further acknowledges that ensuring affordable health care coverage and tackling the social and commercial determinants of health will be contingent on engaging with other actors in law reform processes.
Secondly, following the adoption of the 2030 Sustainable Development Agenda, attention to, and involvement of, “marginalized populations” — those left behind in the dramatic health gains made under the Millennium Development Goals (MDGs), including the poor, older persons, ethnic minorities, people living with HIV or other health conditions, key populations at risk of HIV, people with disabilities, women, girls and adolescents — is now a guiding principle that must shape all public health policy, including and in particular, UHC reforms. This principle has become so central that it has been proposed as a specific pillar in the Organization’s new five-year General Programme of Work (GPW) for 2019-2023.
Lastly, accountability and advocacy, coupled with the greater participation of non-state actors, has acquired a new prominence in a field traditionally deemed technical, rather than political. Through the global leadership and partnership invested in the United Nations (UN) Secretary General’s Every Woman Every Child initiative, novel accountability tools have emerged such as the Commission for Information and Accountability (CoIA) and the Independent Expert Review Group (iERG), which have called for stronger and more inclusive national accountability mechanisms. This has been echoed at the international level by calls for greater UN engagement in human rights review processes, a call endorsed in the recommendations of the High-Level Working Group on the Health and Human Rights of Women, Children and Adolescents.
These shifts have occurred against the backdrop of WHO’s flagship initiative on UHC as well as the landmark Commission on Social Determinants of Health, which recognized that health cannot be improved without addressing the underlying social determinants of health. Buoyed by a steadily growing alliance of non-state actors and activists, the discourse around UHC has evolved from being “the most powerful concept that public health has to offer” to being a matter of human rights and one of political choice.
The operationalization of human rights principles into practice has doubtless unearthed as many challenges as it has set new precedents, foremost among which will be ensuring that these practices truly reflect the core values inherent in human rights. Furthermore, WHO’s explicit mainstreaming efforts continue to be limited in scale due to a lack of dedicated financial and human resources at both headquarters and country level. In order to secure this transformation to a more rights-based era, we propose that three further shifts are needed.
Firstly, the organization should transform its constitutional commitment to human rights into a more operational mandate through its governing bodies. A formal governing body commitment to human rights could detail the precise scope and requirements of this commitment using rights-based indicators and provide for interim reporting and accountability toward health-related Sustainable Development Goals (SDGs) through annual reviews to the World Health Assembly. It would send a strong message to WHO staff and external partners that WHO has both a duty and a mandate to support the realization of human rights in public health, securing the gains of the past and acting as a bulwark against the uncertainties of the future.
Secondly, WHO could pursue a more strategic engagement with partners at the intersection of health and human rights, including the UN human rights system, at country and global level. Notwithstanding its unique normative role, there is nonetheless enormous potential for WHO to engage more strategically and supportively with the broad constellation of “human rights mechanisms” — including the Human Rights Council, Special Procedures mandate holders, human rights treaty bodies, and the UPR — to support member states to meet, and report on, their obligations under the right to health.
Thirdly, since evidence drives health policy and decision-making, WHO should support innovative and multidisciplinary research models to better capture the impact of human rights on health and wellbeing, as a key to unlocking deeply entrenched cynicism and resistance to human rights by health practitioners and policymakers. Human rights-based approaches are often long-term, complex, multi-sectoral, and multi-stakeholder. While remaining unequivocal in its support for human rights, WHO should continue to lobby and invest in participatory and qualitative research into the impact of human-rights-based interventions for health.
The shifts described above — both the explicit mainstreaming strategy and the more implicit shaping of health policy and programming — have the potential to profoundly reframe the importance of human rights in global health, and to engineer the kind of “culture change” that is needed to put rights at the center of WHO’s work. Steadfast leadership and commitment will be necessary for this culture change to occur. WHO’s new Director-General, Dr. Tedros Adhanom Ghebreyesus, has made clear his determination to rise to this challenge. As inequalities continue to grow globally, pandemics become yet more globalized, and the world faces unprecedented population growth, humanitarian disaster, migration, climate change, and dramatic epidemiological shifts from communicable to chronic diseases, the expectations for what the Organization can and should do have never been greater.
A firm commitment to human rights by the world’s “global guardian of public health” has never been more crucial.
Rebekah Thomas is the Technical Officer for Human Rights in the Gender, Equity and Human Rights Team at the World Health Organization.
Veronica Magar is the Team Leader for Gender, Equity and Human Rights at the World Health Organization.
Read more about the World Health Organization’s efforts to mainstream human rights in: Human Rights in Global Health: Rights-Based Governance for a Globalizing World (2018) available from Oxford University Press or Amazon.com