Ratification of human rights treaties: the beginning not the end.

I appreciate Alexis Palmer and colleagues’ empirical research on the eff ects of ratifi cation of human rights treaties on population health (June 6, p 1987). Despite their conclusion that ratifi cation has no benefi ts on health, issues surrounding the eff ect of human rights norms within treaties are complex and might not be fully captured through an analysis of correlations between ratifi cations of international treaties and selected aggregated indicators. Quantifi able improvements require a range of measures, including incorporation of treaty obligations into domestic legislation and, just as importantly, appropriate public spending on health personnel and infrastructure, policy development, and national plans of action. One major advantage of treaty ratifi cation is that it obliges states to have their progress—or lack of it—periodically examined by independent experts on the various committees (or “Treaty Bodies”) that assess whether or not states are doing what they said they would do. The Treaty Bodies receive information from a broad range of sources, including civil society. Although not an enforcement process in the strict sense, reporting has had profound eff ects on the enjoyment of human rights in many states, and I would encourage more health specialists to make better use of this means to stimulate change in their national health systems. I hope Palmer and colleagues’ study stimulates further debate and, more importantly, further concerted action by doctors, lawyers, health administrators, and nongovernmental organisations to push states into making tangible improvements in public health around the world. Navi Pillay [email protected]