Right to health and global public health research: from tensions to synergy?

‘Public health is the science and art of preventing disease, prolonging life and promoting health through the organised efforts of society’, or so argued Acheson, then Chief Medical Officer of the UK (Acheson 1988). According to international human rights scholars Gruskin and Maluwa, ‘international human rights law is about defining what governments can do to us, cannot do to us and should do for us’ (Gruskin & Maluwa 2002). Applied to the right to health, which means that international human rights law is about what governments should and should not do to promote people’s health: thus, despite their very different origins, the two concepts are rather similar. In this paper, we shall first explore the differences behind the two concepts to better understand the natural tension between them. Second, we shall explore how this tension is heightened when they interact at the global level by examining three cases. Finally, we shall explore the possible implications for universal health coverage if public health researchers and right to health scholars work together. Despite the similarities between public health and international human rights law, there are differences. Listing these differences is not necessary for our purpose: here, we merely intend to highlight a key difference in the emphasis each places on how to approach improving health. Those adopting a rights-based approach tend to stress the intensity of (governmental) efforts, whereas public health-based approaches tend to favour efficiency. The collective mobilisation and redistribution of (financial) resources is a cornerstone of the right to health: without public expenditure, there can be no public water, sanitation or healthcare services. The rights in the Universal Declaration of Human Rights were enshrined in two legally binding treaties, the International Covenant on Civil and Political Rights and the International Covenant on Economic, Social and Cultural Rights, which has been ratified by 161 states (United Nations Treaty Collection Databases). Resources are at the heart of the International Covenant on Economic, Social and Cultural Rights: a state that ratifies this treaty is legally required to ‘undertake to take steps, individually and through international assistance and cooperation, especially economic and technical, to the maximum of its available resources, with a view to achieving progressively the full realisation of the rights recognised in the present Covenant’ (emphasis added) (United Nations 1966). Efficiency is a main concern for public health scholars. They are trained to accept that ‘[t]here are limited resources that can be devoted to public health and the assurance of high-quality health services’ and that therefore, ‘an essential function of public health is to effectively plan, manage and administer cost-effective health services, and to ensure their availability to all segments of society’ (Detels 2009). Allow us to use ‘Hume’s Guillotine’ to elaborate this tension: David Hume’s (in) famous thesis that ‘from what is (or is not), nothing about what ought to be (or ought not to be) can logically be concluded’ (Schurz 1997). Although Hume’s thesis remains controversial, it is generally accepted that statements about what ought to be belong to a different epistemological order than statements about what is. To move from a descriptive premise to a prescriptive conclusion, a second prescriptive premise is needed. For example, if it is true that providing potable water improves people’s health, and if societies ought to improve the health of the people, then it can be logically concluded that societies ought to provide potable water to everyone. In a mixed syllogism as the one above – with a descriptive and a prescriptive premise – lawyers’ attention will be drawn to the prescriptive one. That is what they are trained for. For the descriptive premise, they have to lean on other sciences, empirical sciences. A typical right to health research paper will consider a given situation – for example, the water supply in a city has been privatised, many families cannot afford to pay for water, and there