Foundations of Global Health & Human Rights arrives at a time when gains in population health and human rights are threatened by a global pandemic and populism. This edited volume provides a foundational understanding of health- and rights-based law and principles. It describes what human rights law does and does not do to enhance global health and thus helps to clarify misconceptions about individual and collective rights that are far too evident in COVID-19 times. Consequently, this is a timely and essential read for those working in public health, social policy, and human rights.
A primary focus throughout is on how the principle of social justice is used to understand the creation and propagation of health inequities. A human rights focus gives legal and humanitarian rational to improve social inputs to health as an avenue for advancing well-being. The focus is not merely on health outcomes but also on the process through which inequities become embodied.
NORMS AND PRINCIPLES
The first of four sections focuses on the normative foundation of individual rights, the translation of these norms into human rights law, and the reframing of public health into an issue of social justice in which inequity becomes “public health harms”—a violation of international law that therefore requires adjudication and remedy (p. 45). This section is the driest but most essential part of the book, as it lays out the historical context for our modern understanding of human rights and global health. These chapters describe the evolution of positive and negative rights and codification of the same in various United Nations instruments. They outline the roles of rights holders and duty bearers and look specifically at state obligations to respect, protect, and fulfill the right to health through progressive realization.
IMPLEMENTATION AND ACCOUNTABILITY
The second section tells us, “Human rights can be understood as a formal legal regime, a movement, and a universalizing approach to claiming entitlements” (p. 150). The progression from a regime to a lived experience is the central concern. Section 2 begins with an overview of actors and processes and then shifts to domestic implementations of health and human rights law to better address health inequities. Various chapters explore the tools of advocacy, monitoring, litigation, and human rights mainstreaming.
Two chapters in this section stand out. Chapter 6 by Joseph J. Amon and Eric Friedman provides a detailed discussion of how rights violations in the early days of HIV/AIDS mobilized the community of victims and brought about more inclusive policy that protected the victims rather than punishing them. The authors also explore rights violations in relationship to drug dependency, an approach that is too often overlooked in the substance abuse pandemic.
Chapter 8 by Colleen M. Flood and Bryan Thomas is galvanizing. The authors explore how litigation has furthered health-based human rights, for it is only through adjudication that health-based obligations are progressively realized. It was fascinating to learn that health-related human rights litigation is a recent occurrence that opened up only after the end of the Cold War. Flood and Thomas show how civil and political rights violations, such as discrimination and marginalization, intersected with the health-based right of access to health and the tides of democratization and decolonization to form a perfect storm for progress.
CONTEMPORARY APPLICATIONS
The third section is where the case studies are found. Although this will no doubt be the section of greatest interest to students, the book editors advise against treating any chapter or section independently from the whole, and I have to agree. Jurisprudence and advocacy methods, so carefully laid out in the previous sections, are here applied to diverse health issues. “Contemporary Applications” opens by examining different approaches used to manage communicable disease: a public health approach, a human rights approach, and a securitized approach. Whereas in section 2 we see how the human rights approach addressed failures of the public health approach during the early days of HIV/AIDS, here we see the tensions and possibilities that arise through the securitization of infectious disease as more resources and heightened attention are brought to bear but with the tradeoff of the loss of civil and political rights. This chapter is especially useful given the dual crises of protecting life and liberties during the COVID-19 pandemic.
Section 3 also considers how human rights law is applied to noncommunicable disease, disability, mental health, and reproductive rights. In so doing, the authors challenge us to consider an expansive understanding of vulnerability not just across risk groups but across the life course. Other chapters consider what the rights are to health inputs vis-à-vis water and sanitation and commercial determinants of health.
NEW CHALLENGES
The final section is where we see aspirational statements about where and how health-based rights can strengthen and protect human health and a warning about where failures of social justice and the reversal of progress loom. Section 4 lays out the institutional development and policy framing for rights-based aspects of international development, international trade, complex humanitarian emergencies, and globalized health research. This is a useful reference for anyone beginning to explore these issues. Alexandra L. Phelan’s chapter on planetary health is especially compelling. Here, we learn that climate law only recently emerged at the international level, and the right to a healthy environment has yet to gain widespread support despite the existential threat posed by climate change.
The book closes with an exhortation from Gostin, Constantin, and Meier to guard against the rising tide of populism and its potential to harm human rights norms and legal protections and its ability to unravel global health governance. The authors end with a call for collective action to protect and strengthen these institutions. Let us hope that their optimism about course correction proves correct.
This book is accessible, and it is successful in explaining how human rights law strengthens health protections. Each section builds logically, adding details and examples. The writing style is clear, and there is consistency in language and structure across the chapters, no easy task given the number of contributing authors. One feels the confident editorial hands of Gostin and Meier throughout; they ensure that there is sufficient overlap and repetition of concepts and nomenclature to build the story, without bogging the reader down in redundancies. Each chapter includes helpful Questions for Consideration that remind the reader of the main points of the reading while encouraging higher-order thinking.
There is a lot of information to convey to achieve the stated goal of providing “a detailed understanding of the complex relationship between global health and human rights” (p. xv). This is done with clarity and organization, but sometimes at the loss of a critical examination of debates in global health and human rights. The case studies throughout the book are global in nature and do especially well in highlighting how health rights law often progresses more strongly outside North America and Europe.
Although the chapter authors draw largely from North America and Europe, there are several authors from Africa, Latin America, and Asia. Diverse representation is important. There is more work to be done in this area, but this is a good effort at including a global perspective.
The main downside is that, given the release date, the book cannot address real-time application to the current pandemic. Instead, it provides a structured, readable primer on human rights law and its application to global health writ broad. It is up to the reader to apply this framework to our current crisis. This book certainly gives one the tools for such analysis.
CONFLICTS OF INTEREST
The author has no conflicts of interest to declare.