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

How can corporate taxes contribute to sub-Saharan Africa's Sustainable Development Goals (SDGs)? A case study of Vodafone

BACKGROUND

The COVID-19 pandemic and the climate emergency threaten progress in reaching many of the Sustainable Development Goal (SDG) targets by 2030. The under-5 mortality and maternal mortality rates are well below the targets, and if we progress at the current pace, there is a high risk of not meeting the 2030 goals. Furthermore, the initial progress in the decline in child and maternal mortality since 1990 is likely to be eroded. Much of this progress has resulted from increased sanitation, drinking water, education, and health service coverage. The adequate provision of public services is possible if there is sufficient government funding. When governments have more income, they spend more on public services, which increases access to fundamental economic and social rights and, thus, contributes to the SDGs. One of the key drivers of government financing, taxation, constitutes 70% of government revenue in low- and lower-middle-income countries. Corporate income tax constitutes 18.8% of tax revenue in African countries compared to 10% of tax revenue in OECD countries. Therefore, it plays a critical role in SDG progress. This paper aims to quantify the contribution of one large taxpayer, that publishes their tax payments, (Vodafone Group Plc) on progress towards SDGs in six African countries. We use econometric modelling to estimate the impact of an increase in government revenue equivalent to Vodafone's average tax paid between 2007-2017.

RESULTS

We find that government revenue equivalent to Vodafone's taxes made a significant contribution to progress in attaining selected SDGs. We found that the revenue equivalent to Vodafone's taxes allowed 966,188 people to access clean water and 1,371,972 people to access basic sanitation each year. Over the time period studied, 858,054 children spent an extra year in school and 54,275 children under five years and 3,655 mothers survived. In just one of these countries, Tanzania, the revenue equivalent to Vodafone's tax contribution allowed 174,121 people to access clean water and 223,586 to access sanitation each year. Over the time studied 187,023 children spent an additional year at school, 6,569 additional children under five and 625 additional mothers survived.

CONCLUSIONS

These findings demonstrate that the reported contributions from a single multinational corporation drive SDG progress. Furthermore, it highlights the importance of transparent taxes and explores the responsibilities of global institutions, governments, investors, and multinational corporations.

Respecting, protecting and fulfilling the human right to health

Background

Human rights are best protected, promoted and guaranteed when they can compel binding and enforceability duty. One prominent criticism of category of human rights which includes the human right to health is that it is difficult, to assign the duties that correspond to these rights, because of stark disparity in how the main duty bearers approach their duties.

Methods

This paper adopts a doctrinal approach to examine and evaluate the duties to the right to health. The method in this study entails a detailed literature search to systematically evaluate the legal implications, regulations, arguments and policy regarding the nature of the obligation to the right to health. This study also engages with normative and philosophical aspects of human rights.

Results

This paper posits that human rights protect against common, serious, and remediable threats and risks, and ensure that there are remedies from governments and third parties. However, it is difficult to compel duties especially in regard to the right to health. First it is not easy to achieve a uniform standard for duty bearers implied by the words ‘highest attainable physical and mental health.’ Theorists discussed in the paper outline views of what this could mean, from serious to common health concerns. Second, the right to health is not a legally established right in many jurisdictions, making it difficult to enforce. This paper outlines different layers of state and non-state legal duty bearers to enforce the right to health.

Conclusion

The duty to respect, protect, fulfil and even remedy the right to health, will often be meaningless in practice without a clear identification of the necessary duty bearers to enforce them. The law is the starting point for this to not only enshrine this right as a legally enforceable one but also to clearly identify duty bearers. Without this, the human right to health as outlined under international and regional human rights law generates an implausible, or even impossible, profusion of duties. There remains much work still to be done especially on the moral and legal fronts in order to fully guarantee this right.

Trial Registration

Not applicable

Our work does not report results of a health care intervention on human participants. Registration is therefore not applicable.

Toward Human Rights-Consistent Responses to Health Emergencies: What Is the Overlap between Core Right to Health Obligations and Core International Health Regulation Capacities?

COVID-19 has highlighted the responsibilities of states under the International Health Regulations (IHR), as well as state accountability in case of a breach. These approaches and dimensions are valuable, as many COVID responses have breached human rights. We should also look beyond this crisis and address country preparedness for effective and equitable responses to future infectious disease outbreaks. This paper assesses countries' international legal obligations to be prepared to respond to this and future public health emergencies. It does so from the perspective of the right to health, in interaction with the IHR. We analyze the functional relationship between the right to health and the IHR, focusing in particular on "core obligations" under the right to health and "core capacities" under the IHR. We find considerable parallels between the two regimes and argue in favor of more cross-fertilization between them. This regime interaction may enrich both frameworks from a normative perspective while also enhancing accountability and public health and human rights outcomes.

Primary healthcare services in the rural Eastern Cape, South Africa: Evaluating a service-support project

BACKGROUND

In 2012, 38% of the South African population resided in the rural areas of the country. The professional healthcare services are concentrated in the urban areas, resulting in an imbalance between urban and rural healthcare services.

AIM

The aim of this study was to evaluate the use of a non-governmental organisation (NGO)-supported mobile healthcare service in a remote area.

SETTING

Eastern Cape Province in South Africa.

METHODS

The walking distance between the community and the nearest fixed government healthcare service was evaluated and compared with the recommendations of World Health Organization (WHO). Services provided to people visiting the mobile community service were recorded, and descriptive data were analysed and compared with the anonymised patient records of the nearest fixed service clinic.

RESULTS

Of the 30 outreach points served by the NGO, 24 points were at a distance more than the WHO-designated walking distance and 11 points were more than twice the WHO-designated distance from the perspective of fixed clinic. The average headcount per annum of the outreach NGO mobile clinics exceeded those of the fixed Department of Health (DoH) clinics by an average of 250 patients per clinic session. The increase in services was also noteworthy, with a mean differential of 1774 services per annum for the same day above that of the DoH clinics.

CONCLUSION

Mobile services could make a difference to the utilisation of essential healthcare facilities. The provision of augmented NGO-led mobile clinical outreach services and joint government-NGO partnerships holds possibilities for improving healthcare for those living in remote rural areas.

A bibliometric analysis of global research output on health and human rights (1900-2017)

Background

Baseline data on global research activity on health and human rights (HHR) needs to be assessed and analyzed to identify research gaps and to prioritize funding and research agendas. Therefore, the aim of this study was to assess the growth of publications and research pattern on HHR.

Methods

A bibliometric methodology was used. Literature on HHR was retrieved using SciVerse Scopus for the study period from 1900 to 2017. Nine different search scenarios with different keyword combinations were used to retrieve the required documents. All types of documents published in peer-reviewed journals, including editorials, were included. The search strategy was validated.

Results

In total 6513 documents were retrieved with an h-index of 88 and an average of 9.8 citations per document. Publications on HHR field started as early as 1950 but showed a steep rise in the past two decades. Visualization of author keywords revealed that HIV/ AIDS, mental health, maternal and reproductive health, violence, ethics, torture, and refugees were most commonly encountered keywords. The journal "Health and Human Rights" was most active (n = 467; 7.2%) in this field. However, documents that appeared in The Lancet received the highest impact (29.5 citations per document). The United States of America produced the most in this field (n = 1817; 27.9%). Researchers in the region of Americas participated in approximately 45% of the retrieved documents while researchers in the Eastern Mediterranean region had the least contribution (2.5%). Researchers in high-income countries contributed to approximately 78% of the retrieved documents while researchers in low-income countries contributed to less than 5% of the retrieved documents. When data were standardized by population size, the research output from high-income countries was approximately four documents per one million inhabitants. For middle-income countries, the research output was 0.3 document per one million inhabitants. For low-income countries, the research output was 0.5 document per one million inhabitants.

Conclusions

Differential research productivity on HHR was seen among scholars in different world regions. World countries need to encourage and strengthen research on HHR in order to achieve the goals set in international agreements of human rights.

What did the Go4Health policy research project contribute to the policy discourse on the sustainable development goals? A reflexive review

Background

In 2012, the European Commission funded Go4Health—Goals and Governance for Global Health, a consortium of 13 academic research and human rights institutions from both Global North and South—to track the evolution of the Sustainable Development Goals (SDGs), and provide ongoing policy advice. This paper reviews the research outputs published between 2012 and 2016, analyzing the thematic content of the publications, and the influence on global health and development discourse through citation metrics.

Findings and discussion

Analysis of the 54 published papers showed 6 dominant themes related to the SDGs: the formulation process for the SDG health goal; the right to health; Universal Health Coverage; voices of marginalized peoples; global health governance; and the integration of health across the other SDGs. The papers combined advocacy---particularly for the right to health and its potential embodiment in Universal Health Coverage—with qualitative research and analysis of policy and stakeholders. Go4Health’s publications on the right to health, global health governance and the voices of marginalized peoples in relation to the SDGs represented a substantial proportion of papers published for these topics. Go4Health analysis of the right to health clarified its elements and their application to Universal Health Coverage, global health governance, financing the SDGs and access to medicines. Qualitative research identified correspondence between perceptions of marginalized peoples and right to health principles, and reluctance among multilateral organizations to explicitly represent the right to health in the goals, despite their acknowledgement of their importance. Citation metrics analysis confirmed an average of 5.5 citations per paper, with a field-weighted citation impact of 2.24 for the 43 peer reviewed publications. Citations in the academic literature and UN policy documents confirmed the impact of Go4Health on the global discourse around the SDGs, but within the Go4Health consortium there was also evidence of two epistemological frames of analysis—normative legal analysis and empirical research—that created productive synergies in unpacking the health SDG and the right to health.

Conclusion

The analysis offers clear evidence for the contribution of funded programmatic research—such as the Go4Health project—to the global health discourse.

What do human rights bring to discussions of power and politics in health policy and systems?

Scholarly interrogations of power and politics are not endemic to the disciplines primarily tasked with exploring health policy and planning in the domestic or global domains. Scholars in these domains have come late to investigating power, prompted in part by the growing focus in domestic and global health research on the intersections between governance, globalization and health inequities. Recent prominent reports in this area increasingly point to human rights as important norms capable of responding in part to power differentials that sustain and exacerbate health inequities. Yet human rights law is not traditionally incorporated into health policy scholarship or education, despite offering important normative and strategic frameworks for public and global health, with distinctive contributions in relation to identifying and challenging certain forms of power disparity. This paper overviews two of these reports and how they see power functioning to sustain health inequities. It then turns to investigate what human rights and the right to health in particular may offer in addressing and challenging power in the health policy context.

Using international human rights law to improve child health in low-income countries: a framework for healthcare professionals

BACKGROUND

The Committee on Economic, Social and Cultural Rights states that the right to health is closely related to, and dependent upon, the realization of other human rights, including the right to food, water, education and shelter which are important determinants of health. Children's healthcare workers in low income settings may spend the majority of their professional lives trying to mitigate deficiencies of these rights but have little influence over them. In order to advocate successfully at a local level, we should be aware of the proportion of children living in our catchment population who do not have access to their basic rights. In order to carry out a rights audit, a framework within which healthcare workers could play their part is required, as is an agreed minimum core of rights, a timeframe and a set of indicators.

DISCUSSION

A framework to assess how well states and their developmental partners are adhering to human rights principles is discussed, including the role that a healthcare worker might optimally play. A minimum core of economic and social rights seeks to establish a legal minimum set of protections, which should be available with immediate effect and applicable to all nations despite very different resources. Minimum core rights and the impact that progressive realisation may have had on the right to health is discussed, including what they should include from the perspective of children's health. A set of absolute rights are suggested, based on physiological needs and aligned with the corresponding articles of the United Nations Convention on the Rights of the Child. The development indicators which are likely to be used to monitor progress towards the Sustainable Development Goals is suggested as a way to monitor rights. We consider the ways in which the healthcare worker could use a rights audit to advocate with, and for their community. These audits could achieve several objectives. They may legitimise healthcare workers' interests in the determinants of health and, as they are often highly respected by their community, this may facilitate them to be agents for change at a local level. This may raise awareness on basic human rights and their importance to health and contribute to a needed change in mind-set from one of development needs to absolute rights. The results may catalyse colleagues to analyse further the upstream reasons why children, and the families in which they live, are not having their rights met.

Regional and inter-regional economic rules and the enforcement of the right to health: The case of Colombia

The regional policy level is often seen as a (potential) source of progressive policy-making in health (and in social policy more widely), complementing or substituting national policy levels, which are perceived as underperforming. While it can certainly be argued that there are important opportunities to adopt regional approaches to tackle border-crossing health issues, this article draws the attention to the fact that the linkage between (inter-)regional and national policy levels is not uni-directional. While in some instances the regional level may indeed take the lead in the promotion of (the right to) health, in other instances it may well be the other way round. This article focuses on the case of Colombia, where international economic rules have deeply permeated public policies in the health sector. On one hand, Colombia has been opening markets through the conclusion of regional integration arrangements (e.g. Andean Community and the Pacific Alliance) and the new generation of Free Trade Agreements. On the other hand, Colombia has been one of the most active emerging countries in promoting the right to health as a justiciable fundamental right, in line with the International Covenant on Economic, Social, and Cultural Rights of the United Nations mainly due to the judicial activism of the Colombian Constitutional Court with interesting implications for regional social governance. The article shows that national courts can play an important role in the protection of the right to health in a context of economic integration and the absence of regional balancing policies.

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

BACKGROUND

There is an emerging global consensus on the importance of universal health coverage (UHC), but no unanimity on the conceptual definition and scope of UHC, whether UHC is achievable or not, how to move towards it, common indicators for measuring its progress, and its long-term sustainability. This has resulted in various interpretations of the concept, emanating from different disciplinary perspectives. This paper discusses the various dimensions of UHC emerging from these interpretations and argues for the need to pay attention to the complex interactions across the various components of a health system in the pursuit of UHC as a legal human rights issue.

DISCUSSION

The literature presents UHC as a multi-dimensional concept, operationalized in terms of universal population coverage, universal financial protection, and universal access to quality health care, anchored on the basis of health care as an international legal obligation grounded in international human rights laws. As a legal concept, UHC implies the existence of a legal framework that mandates national governments to provide health care to all residents while compelling the international community to support poor nations in implementing this right. As a humanitarian social concept, UHC aims at achieving universal population coverage by enrolling all residents into health-related social security systems and securing equitable entitlements to the benefits from the health system for all. As a health economics concept, UHC guarantees financial protection by providing a shield against the catastrophic and impoverishing consequences of out-of-pocket expenditure, through the implementation of pooled prepaid financing systems. As a public health concept, UHC has attracted several controversies regarding which services should be covered: comprehensive services vs. minimum basic package, and priority disease-specific interventions vs. primary health care. As a multi-dimensional concept, grounded in international human rights laws, the move towards UHC in LMICs requires all states to effectively recognize the right to health in their national constitutions. It also requires a human rights-focused integrated approach to health service delivery that recognizes the health system as a complex phenomenon with interlinked functional units whose effective interaction are essential to reach the equilibrium called UHC.

Medicalization of global health 1: has the global health agenda become too medicalized?

Medicalization analyses have roots in sociology and have critical usefulness for understanding contemporary health issues including the 'post-2015 global health agenda'. Medicalization is more complex than just 'disease mongering'--it is a process and not only an outcome; has both positive and negative elements; can be partial rather than complete; and is often sought or challenged by patients or others in the health field. It is understood to be expanding rather than contracting, plays out at the level of interaction or of definitions and agenda-setting, and is said to be largely harmful and costly to individuals and societies. Medicalization of global health issues would overemphasise the role of health care to health; define and frame issues in relation to disease, treatment strategies, and individual behaviour; promote the role of medical professionals and models of care; find support in industry or other advocates of technologies and pharmaceuticals; and discount social contexts, causes, and solutions. In subsequent articles, three case studies are explored, which critically examine predominant issues on the global health agenda: global mental health, non-communicable disease, and universal health coverage. A medicalization lens helps uncover areas where the global health agenda and its framing of problems are shifted toward medical and technical solutions, neglecting necessary social, community, or political action.