What could a strengthened right to health bring to the post-2015 health development agenda?: interrogating the role of the minimum core concept in advancing essential global health needs

Abstract

BackgroundGlobal health institutions increasingly recognize that the right to health should guide the formulation of replacement goals for the Millennium Development Goals, which expire in 2015. However, the right to health’s contribution is undercut by the principle of progressive realization, which links provision of health services to available resources, permitting states to deny even basic levels of health coverage domestically and allowing international assistance for health to remain entirely discretionary.DiscussionTo prevent progressive realization from undermining both domestic and international responsibilities towards health, international human rights law institutions developed the idea of non-derogable “minimum core” obligations to provide essential health services. While minimum core obligations have enjoyed some uptake in human rights practice and scholarship, their definition in international law fails to specify which health services should fall within their scope, or to specify wealthy country obligations to assist poorer countries. These definitional gaps undercut the capacity of minimum core obligations to protect essential health needs against inaction, austerity and illegitimate trade-offs in both domestic and global action. If the right to health is to effectively advance essential global health needs in these contexts, weaknesses within the minimum core concept must be resolved through innovative research on social, political and legal conceptualizations of essential health needs.SummaryWe believe that if the minimum core concept is strengthened in these ways, it will produce a more feasible and grounded conception of legally prioritized health needs that could assist in advancing health equity, including by providing a framework rooted in legal obligations to guide the formulation of new health development goals, providing a baseline of essential health services to be protected as a matter of right against governmental claims of scarcity and inadequate international assistance, and empowering civil society to claim fulfillment of their essential health needs from domestic and global decision-makers.

Universal health coverage from multiple perspectives: a synthesis of conceptual literature and global debates

“…A group of scholars, building their opinions from a legal and human rights perspective, enshrined in various international covenants and treaties [ 45 – 49 ], argue that the concept of UHC implies the existence of a legal framework to ensure that every resident gets access to affordable health care [ 15 , 50 , 51 ]. This portrays UHC as a reformulation of the “ health for all” goal of the Alma Ata Declaration [ 15 , 22 , 52 – 54 ]. The view of UHC as a legal obligation imposed on all states that ratified the convention on the right to health [ 45 ], implies that UHC calls for all States to create legal entitlements to health care for all their residents [ 50 , 55 , 56 ], thereby placing the responsibility for the delivery of UHC on national governments [ 5 , 17 , 57 ].…”

An Analysis of the Impact of Minimum Core Human Rights Deprivation on Under Five Mortality.

“…The essence approach asserts that a rights based strategy will only reduce child mortality if minimum core rights are prioritized [11] and that a stronger minimum core could make a significant contribution towards global health equity [3]. However, the relationship between deprivation of minimum core rights and child survival has never been studied.…”

“…This resulted in a cleavage of the UDHR and the subsequent adoption of two covenants [2], one for civil and political rights which were immediately available and one for economic, social and cultural rights which were subject to progressive realisation, depending on available resources. Progressive realisation left loopholes which have allowed rights essential for survival to be deferred [3].…”

“…Attempts to compensate for these loopholes were made in 1989,when the United Nations Committee on Economic, Social and Cultural Rights (UNCESCR) conceptualised a minimum core set of rights, in order to establish a legal minimum set of protections, which should be immediately available and applicable to all, in all nations, despite different resources [3]. The hope was to establish a baseline of socioeconomic protections across all countries at different stages of their economic development [4].…”

Imagining Global Health with Justice: In Defense of the Right to Health

“…Scholars also criticize the right to health because it has insufficiently precise definitions of its key features [11]. Certainly, the right is vague and aspirational on its face: what is health, what rights flow from a right to health, and what are the exact services a state must provide?…”