Transcript Beyond “the highest attainable standard”

Beyond “the
highest attainable
standard”:
Analyzing an
Evolving Right to
Health as a Means
of Protecting
Public Health
Benjamin Mason Meier, JD, LLM, MPhil
Columbia University
APHA Annual Conference
November 6, 2006
Health Harms in a
Globalized World
 Shared
Health
Dilemmas
Weakening of National
Health Infrastructures
 Degradation of the
Built Environment
 Rise of the
Transnational
Corporation

 “Double Disease
Burden”
 Infectious
Disease
 Chronic
Disease
Health Harms in a
Globalized World

Shared Health
Dilemmas
 Weakening
 Structural
of
National
Health
Infrastructures
Degradation of the
Built Environment
 Rise of the
Transnational
Corporation

Adjustment
Programs
 Weakening of
regulations that
protect health
 Crippling of
state health
programs
Health Harms in a
Globalized World


Shared Health
Dilemmas
Weakening of National
Health Infrastructures
 Degradation
the Built
Environment

Rise of the
Transnational
Corporation
of
 Changes in the Built
Environment
 Migration
 Employment
 Housing
Inequitable
Poverty
Ill
Health
Health Harms in a
Globalized World



Shared Health
Dilemmas
Weakening of National
Health Infrastructures
Degradation of the
Built Environment
 Rise
of the
Transnational
Corporation
 Exploiting New
Markets
 Subverting
National Regulation
 Damaging
Environments,
Local & Global
 Creating
Dangerous
Products
An Evolving Right to Health?
Expansiveness of Definition
Universal Declaration
of Human Rights
(1948)
GC14
WHO
Alma Ata
Seattle
Doha
ICESCR
UDHR
Washington
Consensus
TRIPs
 Art. 25
 (1) Everyone has
the right to a
standard of living
adequate for the
health and wellbeing of himself
and of his family,
including food,
clothing, housing
and medical care ….
An Evolving Right to Health?
Expansiveness of Definition
International Covenant
on Economic, Social
and Cultural Rights
(1966)
GC14
WHO
Alma Ata
Seattle
Doha
ICESCR
UDHR
Washington
Consensus
TRIPs
 Art. 12
1. The States Parties to
the present Covenant
recognize the right of
everyone to the
enjoyment of the
highest attainable
standard of physical
and mental health.
2. The steps to be taken
by the States Parties to
the present Covenant
to achieve the full
realization of this
right...
An Evolving Right to Health?
Expansiveness of Definition
Declaration of Alma Ata
(1978)
Alma
Ata
WHO
GC14
 Essential Aspects
of Primary Health
Care

Seattle
+
Doha
ICESCR
UDHR
Washington
Consensus
TRIPs
Individual
Medical Care

Preventive Public
Health
An Evolving Right to Health?
 The United Nations
Expansiveness of Definition
General Comment 14
(2000)
GC14
WHO
Alma Ata
Seattle
Doha
ICESCR
UDHR
Committee on
Economic, Social
and Cultural Rights
Washington
Consensus
TRIPs
 Obligations for
Public Health
within the
Individual right to
health
Public Health vs. Individual Health


Individual Health = Doctor/Patient
Public Health = Underlying Determinants of
Health
Underlying
Determinant
SES

*

Mechanisms
smoking

status
diet
Result
health status
Socioeconomic Status (SES) is a fundamental underlying cause of disease,
operating at a societal level and having effects on health status, no matter
the disease or the mechanism.
Individual Health Services vs. Public Health
Systems
A Right to Public Health?
The Individual Right to Health Is
Inapplicable to the National
Harms of Globalization
 A Collective Right to Public
Health Would Compel States to
Address Societal Inequities in
Underlying Determinants of
Public Health

A Right to Public Health?
Collective
Rights
 Public Health as a
Human Right
 Theoretical
 Programmatic
 International
Obligations



Human Rights as
Individual Rights
Origin of
“Solidarity Rights”
Responding to
Globalization –
Employing
collective rights for
health promotion
and disease
prevention
A Right to Public Health?

Collective Rights
 Public Health

Theoretical
Conceptualization
as a Human
Right
 Theoretical

 Programmatic
International
Obligations
Right to
Health
Right to
Public
Health
Level of
Analysis
Individual
Collective
Subject
of Right
Treatment
(Cessation)
Prevention
(Advertising)
 Programmatic
Components
 Substantive
 Procedural
A Right to Public Health?


Collective Rights
Public Health as a
Human Right
 Theoretical
 Programmatic


 International
Obligations

Rights-Based
Development
Discourses
International
Cooperation
“The
Globalization of
Public Health” –
Role of WHO
“The law must remain
stable, but it cannot
stand still.”
- Roscoe Pound