Finding the Threads of Human Rights in the Global Health Tapestry: A Review of Human Rights in Global Health: Rights-Based Governance for a Globalizing World

A central challenge in understanding the systems and institutions that govern global health is that there are so many of them. As the number of actors and institutions participating in the governance of global health have proliferated, so too has the complexity of the systems that affect and influence global health. The relationships between these many players — national governments, intergovernmental agencies, nonprofit organizations, funding agencies, corporations, and others — are rife with tensions over resource allocation, political demands, and the prioritization of goals and strategies. Often, in this melee of conflicting priorities, human rights are overlooked or marginalized. Yet, the core ideas of human rights remain influential and integrally-woven throughout these systems of governance. ¹

A new book, Human Rights in Global Health Governance: Rights-Based Governance for a Globalizing World, edited by Benjamin Mason Meier and Lawrence O. Gostin, takes on the challenge of navigating the complex landscape of global governance for health to explain the profound influence that human rights have had, and could have in the future, in efforts to improve and protect health globally. The book accomplishes a feat that is rare in edited volumes: it manages to address its topic with both breadth and depth, as well as possessing a remarkable cohesion.

The book, divided into five substantive sections, examines how human rights have been integrated into the differing and intersecting roles of a wide variety of international institutions across the spectrum of global health. The first section provides a robust thematic overview of the architecture of global health and the evolution of human rights within the many parallel, coexisting systems of global health governance. This initial section identifies several themes that persist throughout the volume: the tension within institutions between technocratic/instrumental approaches and human rights approaches, the difficulty in operationalizing human rights across large institutions with changing priorities and fluctuating leadership, and the political and economic impediments that often complicate efforts to incorporate human rights norms into global governance for health.

The second section of the book provides an extended discussion of the integration of human rights into the World Health Organization (WHO). The WHO's importance in global health demands this level of attention, with chapters that focus respectively on the development of human rights within the organization, recent efforts at mainstreaming human rights throughout the organization, and future opportunities to expand the use and influence of human rights at the WHO. A wide-ranging third section follows, expanding this analysis to other intergovernmental organizations. Chapters provide deep and detailed analyses of the use of human rights by the United Nations Childrens' Fund (UNICEF), the International Labor Organization (ILO), the United Nations Economic, Social, and Cultural Organization (UNESCO), the United Nations Population Fund (UNPF), the Food and Agriculture Organization (FAO), and the Joint United Nations Program on HIV/AIDS (UNAIDS). These chapters reveal a similar trajectory in the application of human rights among these institutions, with limited attention paid to human rights prior to the mid-1990's followed by a shift to a more rights-based orientation as the United Nations leadership required the “mainstreaming” of human rights over the ensuing two decades. While UNAIDS stands out as the most rights-focused intergovernmental agency of those examined, all of these agencies have seen human rights norms filter into their programs and operations to some extent. This section also includes an interesting study on the inclusion of human rights in partnerships between inter-governmental agencies and external global health institutions, which concludes that human rights are rarely central to these partnerships.

The fourth section of the book explores yet another set of international institutions, focusing on development and funding agencies. Powerful global entities such as the World Bank and the World Trade Organization have resisted rights-based models, and while some of their initiatives have advanced the realization of human rights to health or development, these successes have not expanded the explicit influence of human rights within these institutions. Likewise, national foreign aid programs have eschewed human rights approaches. The Global Fund to Fight AIDS, TB, and Malaria provides a contrasting approach that employs rights-based models to protect the many marginalized people worldwide suffering from these three diseases.

The final section of the book provides some of the most interesting analysis as it tracks the development of global health governance within international human rights institutions. Chapters on the Office of the United Nations High Commissioner on Human Rights, the United Nations Special Procedures, human rights treaty bodies, and the United Nations Universal Periodic Review process demonstrate how the right to health has been advanced through some of the most dynamic recent initiatives in international human rights law and practice. These institutions have made some of the most signifi-cant normative contributions to the development of human rights for global health and provide some of the most promising models for expanding rights-based approaches to global health going forward.

The book is foremost about institutions and their complex, interactive roles in global health governance. Readers interested in the workings and priorities of particular institutions will find a wealth of information and context in the institution-specific chapters. The contributing authors represent an impressive collection of some of the most experienced and insightful experts and scholars working in global governance for health. This lends the volume authority, credibility, and urgency. Further, the book breaks new conceptual ground. I believe it to be the first book to attempt a comprehensive overview of human rights and global health through the lens of the different institutions that are most responsible for global health outcomes. It also provides an outstanding bibliography of the most important reports, articles, and scholarship related to global health governance.

Interestingly, not all of the contributors have the same assessment of the impact of human rights in global health. While there is general agreement on the desirability of expanding the influence of human rights across global health institutions, some contributors see a great deal of progress while others are more hesitant in their conclusions. Several of the contributors highlight a daunting list of factors currently obstructing effective global health governance, including ineffective coordination between intergovernmental institutions and national governments, the reluctance to work with and to differentiate between nongovernmental constituencies, the focus on specific pathogens or threats to health rather than on the effects these pathogens and threats have on individuals or populations, and finally, the failure to resist the inertia of short-term technical solutions instead of considering broader human rights implications when making policy decisions.

However, the sum of these discussions demonstrates both progress in the expansion of the influence of human rights in global health governance and an optimistic assessment of the potential for a greater role for human rights in the future. The numerous examples contained in this book reveal that there are many routes and methods to incorporate human rights within systems that affect global governance for health and many innovative ideas to be shared.

Ultimately, this book demonstrates the deep innovation present in global health institutions as they seek to incorporate human rights into their goals and their operations, as well as the persistent difficulty in linking human rights to the practice of global health. This volume presents a very sophisticated assessment of the past and current impact of human rights and a plethora of excellent ideas for expanding human rights models in the future, written by some of the most informed scholars and experts in the field. The future of human rights in global governance for health will be evidence-based, multilateral, and more focused on collaboration and implementation. This book provides a useful foundation for future scholars to build upon.