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 of National Health Infrastructures   Degradation of the Built Environment   Rise of the Transnational Corporation  Structural 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 of the Built Environment   Rise of the Transnational Corporation  Changes in the Built Environment  Migration  Employment  Housing Ill Health Inequitable Poverty

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? Universal Declaration of Human Rights (1948)  Art. 25  (1) Everyone has the right to a standard of living adequate for the health and well- being of himself and of his family, including food, clothing, housing and medical care … UDHR WHO ICESCR Alma Ata Expansiveness of Definition Washington Consensus TRIPs GC14 Seattle Doha

An Evolving Right to Health? International Covenant on Economic, Social and Cultural Rights (1966)  Art 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 UDHR WHO ICESCR Alma Ata Expansiveness of Definition Washington Consensus TRIPs GC14 Seattle Doha

An Evolving Right to Health? Declaration of Alma Ata (1978)  Essential Aspects of Primary Health Care  Individual Medical Care +  Preventive Public Health UDHR WHO ICESCR Alma Ata Expansiveness of Definition Washington Consensus TRIPs GC14 Seattle Doha

An Evolving Right to Health? General Comment 14 (2000)  The United Nations Committee on Economic, Social and Cultural Rights  Obligations for Public Health within the Individual right to health UDHR WHO ICESCR Alma Ata Expansiveness of Definition Washington Consensus TRIPs GC14 Seattle Doha

Individual Health = Doctor/Patient Individual Health = Doctor/Patient Public Health = Underlying Determinants of Health Public Health = Underlying Determinants of Health MechanismsResult SES smoking health status statusdiet * * 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 Individual Health Services vs. Public Health Systems Public Health vs. Individual Health Underlying Determinant

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 Human Rights as Individual Rights Origin of “Solidarity Rights” Origin of “Solidarity Rights” Responding to Globalization – Employing collective rights for health promotion and disease prevention Responding to Globalization – Employing collective rights for health promotion and disease prevention

A Right to Public Health?  Collective Rights  Public Health as a Human Right  Theoretical  Programmatic  International Obligations Theoretical Conceptualization Theoretical Conceptualization  Programmatic Components  Substantive  Procedural Right to Health Right to Public Health Level of Analysis IndividualCollective Subject of Right Treatment (Cessation) Prevention (Advertising)

A Right to Public Health?  Collective Rights  Public Health as a Human Right  Theoretical  Programmatic  International Obligations Rights-Based Development Discourses Rights-Based Development Discourses International Cooperation International Cooperation “The Globalization of Public Health” – Role of WHO “The Globalization of Public Health” – Role of WHO

“The law must remain stable, but it cannot stand still.” - Roscoe Pound