UNICEF

Innocenti Research Centre

Research Watch – Health and Equity (No. 3/2012)

Equity, Human Rights, and Health: Here, There and

Back Again

Prof. Sofia Gruskin, Director of Program on Global Health

and Human Rights

USC Institute for Global Health

The Countdown to 2015 for Maternal, Newborn and Child Survival monitors coverage of priority

interventions to achieve the child mortality and maternal health Millennium Development Goals

(MDGs). A June 2010 Lancet article summarizing the report offered welcome news to those of us

concerned with the rights and health of children. It noted the need to go beyond the MDGs to truly

impact newborn, child and maternal survival, and emphasized work underway to develop measures

that "include elements that are indicative of social determinants of health" (pg 2036). It is promising to

see the donor community beginning to reengage with concepts related to equity and rights. It remains

unclear, however, if relevant measures can actually be married to the MDGs, and alongside this

whether current discussion of these measures in political for a are actually going to take us where we

need to go in terms of public health policy, research and practice - or at least any time soon.

Despite their importance on the global stage and their good intentions, the recent spate of political

declarations with a focus on health do not offer any conceptual, let alone procedural, clarity as to how

relevant measures will be developed or used. The Rio Political Declaration on Social Determinants of

Health, for example, brought together heads of government, ministers, government representatives,

UN officials, and civil society representatives (though civil society was not part of the negotiations) in

October of this year to move forward concerns with health equity through action on the social

determinants of health. Interestingly, the Rio Declaration pays formal tribute to the Millennium

Declaration, but refers only obliquely to the MDGs.

Its focus is achieving health and social equity, and it brings explicit attention to the relevance of

human rights principles to achieving its goals. It accompanies this with a detailed call for the

development and implementation of reliable measures of societal well-being, but with no explicit time

frame attached. The Rio Declaration came on the heels of the September Political Declaration on the

Prevention and Control of Non-communicable Diseases (the NCD Declaration), which included 34

heads of state in the negotiations. The NCD Declaration names the human right to health as relevant

to the prevention and control of non-communicable disease, references a range of global and regional

strategies and declarations, and also does not put the MDGs front and center. It notes, instead, on

two occasions “internationally agreed development goals, including the Millennium Development

Goals.” [emphasis added para 31 and 65].

The NCD Declaration also includes a call for a comprehensive global monitoring framework and for a

set of indicators capable of application across regional and country settings to be completed before

the end of 2012, but explicit attention to health inequities was sufficiently vague that it was good to

see the Rio Declaration specifically noting the need to ensure a focus on reducing health inequities in

taking it forward. Alongside their implicit sidelining of the MDGs, and their explicit language around

the need for monitoring, accountability and follow-up, it is of concern, therefore, that these new equity

and rights-oriented declarations, even as they do not have Programmes of Action attached, do not

find any well-defined equity sensitive measures to propose or support.

Why does this matter? It is worth recalling that the Millennium Declaration included strong attention to

human rights but by the time the MDGs had been drafted this had all disappeared. The lack of

attention to explicit measures is not a picayune issue. The international community has long

recognized that to achieve meaningful progress, rhetorical commitment is not enough. Concrete

measures and accountability mechanisms at global and national levels are required. The exclusion of

relevant concepts and language in these documents are the result of active political negotiation.

Every word of what is, and is not, in these documents matters because what is named is what, if all

goes according to plan, is measured. What matters most, in other words, is what is counted not,

unfortunately, what is said.

To be fair, determining appropriate measures sensitive to equity and human rights concerns, and with

global application, is not an easy task. Even as all agree on general principles, the devil is of course in

the details. All too often what has been counted falls back into a traditional paradigm of economic

inequity – measuring poorest and richest quintiles – not for lack of interest but for lack of agreement

on an appropriate measure, let alone what priority measures should be. While we all recognize the

need to go further, tested and validated measures bringing attention to geographic, ethnic, age and

gender disparities are few, let alone those which truly measure inequities and inequalities in health

and the related availability, accessibility, acceptability and quality of services as mandated under the

right to health. But this must be the goal, with important implications for the health and well-being of

children.

Building off these recent political commitments, it is incumbent on us all to bring to light relevant

measures and data sources, ensure sufficient funding for the development of robust measures where

they do not yet exist, and do all we can to ensure that equity and rights measures are fully integrated

into global accountability frameworks going forward. This will require political support and international

cooperation to allow us to develop the necessary research, and eventually policy and programmatic

interventions. This, in turn, will give a firm basis for work to ensure that poor, marginalized, and

vulnerable groups are given access to the health and other services to which they are entitled and,

ultimately, achieve better health.

(i) Bhutta et al., Countdown to 2015 decade report (2000-2010): taking stock of maternal, newborn

and child survival, The Lancet, Vol 375, 2032-2044, June 5, 2010