Paper 7: International Fora for the Protection, Promotion, and Enforcement of Human Rights Module 29: World Health Organisation (WHO) Development Team

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Paper Name: International Fora for the Protection, Promotion, and Enforcement Human Rights and of Human Rights Duties Module Name: World Health Organisation (WHO)

Description of Module

Subject Name Human Rights and Duties

Paper Name International Fora for the Protection, Promotion, and Enforcement of Human Rights

Module World Health Organization (WHO) Name/Title

Module Id 29

Pre-requisites

Objectives

Keywords

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Paper Name: International Fora for the Protection, Promotion, and Enforcement Human Rights and of Human Rights Duties Module Name: World Health Organisation (WHO)

World Health Organization (WHO) Introduction The World Health Organization (WHO) is a United Nations (UN) specialized agency responsible for coordinating health-related activities within the UN system. Article 1 of the WHO Constitution states that its objective “shall be the attainment by all peoples of the highest possible level of health,” with ‘health’ defined very broadly, in accordance with the Constitution’s preamble, as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”1

The WHO works to improve global health care on behalf of its 194 Member States. Its primary tasks include setting standards of care for the international community, improving the capacity of developing world health care providers via both direct funding and facilitating partnerships with third parties, and monitoring and publishing statistics on global health trends.

As set out in the WHO’s Twelfth General Programme of Work (for the period 2014-2019), the organization’s six ‘core functions’ include:

 Providing leadership on matters critical to health and engaging in partnerships where joint action is needed;  Shaping the research agenda and stimulating the generation, translation and dissemination of valuable knowledge;  Setting norms and standards and promoting and monitoring their implementation;  Articulating ethical and evidence-based policy options;  Providing technical support, catalyzing change, and building sustainable institutional capacity; and  Monitoring the health situation and assessing health trends.2

In addition to these six ‘core functions’, the WHO has adopted six ‘leadership priorities’ to give focus and direction to its public health agenda. These are:

1. Universal Health Coverage 2. The International Health Regulations (2005) 3. Increasing Access to Medical Products

1 Constitution of the World Health Organization, pmbl, art. 1. 2 World Health Organization, Twelfth General Programme of Work: Not Merely the Absence of Disease (2014), at 20. 3

Paper Name: International Fora for the Protection, Promotion, and Enforcement Human Rights and of Human Rights Duties Module Name: World Health Organisation (WHO)

4. Social, Economic and Environmental Determinants 5. Noncommunicable diseases 6. Health-related Millennium Development Goals3

Learning outcomes: • To understand the nature of WHO. • To look into its functions and objectives. • To see how the WHO is a mechanism for promoting human rights.

History Health has long been a concern of the international community, and was one of the themes taken up by the early international organizations of the pre-World War Two era. For example, 1902 saw the establishment of a Pan American Sanitary Organization in Washington, DC that was concerned with quarantines, general hygiene, education, and the spread of infectious diseases. An Office International d’Hygiène Publique was established in Paris in 1907 to deal with quarantine and sanitation conventions, as well as food hygiene, biological standardization, and hospital construction. In 1921, the League of Nations established a Health Organization, in accordance with Article 23 of the Covenant of the League of Nations, under which Members of League agreed to “endeavour to take steps in matters of international concern for the prevention and control of disease.”4 After the onset of World War Two, however, the Office International d’Hygiène Publique closed, and the League of Nations’ Health Organization was reduced to a fraction of its former scope, relegating action on international health to war-related organizations such as the United Nations Relief and Rehabilitation Administration.5

At the time of the founding of the United Nations in 1945, therefore, there was a significant need for a new organization that could address global health issues in the post-World War Two era. Article 55 of the newly written UN Charter committed the United Nations to “promote… solutions of international economic, social, and health related problems.”6 In keeping with this mandate, the UN’s Economic and Social Council began meeting in 1946 to outline a proposal for the foundation of a

3 Id. at 24-25. 4 Covenant of the League of Nations, art. 23(f). 5 Sir John Charles, “Origins, History, and Achievements of the World Health Organization,” 2 British Medical Journal 293, 294 (4 May 1968). Following the formation of the WHO, the League Health Organization, the Office International d’Hygiène Publique, and the United Nations Relief and Rehabilitation Administration were dissolved. The Pan American Sanitary Organization, however, survived. It is now known as the Pan American Health Organization (PAHO), and serves as both the specialized health agency of the Inter-American System and as the Regional Office for the Americas of the WHO. 6 UN Charter, art. 55. 4

Paper Name: International Fora for the Protection, Promotion, and Enforcement Human Rights and of Human Rights Duties Module Name: World Health Organisation (WHO)

World Health Organization under the UN umbrella. The Constitution of the World Health Organization was eventually presented for adoption at the International Health Conference held in New York from 19 June – 22 July 1946. It was signed by representatives of 61 states, and entered into force on 7 April 1948—a date now celebrated annually as ‘World Health Day’.

The Institution The WHO is headquartered in Geneva, Switzerland. However, its operations are spread across the headquarters, the Global Service Centre in Malaysia, six regional offices, and 150 individual country offices, making it one of the most decentralized of the UN agencies. The WHO employs more than 7000 public health experts, including medical doctors, public health specialists, scientists, epidemiologists, administrators, finance and information systems professionals, as well as experts in economics, health statistics, and emergency relief.

The WHO is composed of three primary organs: the World Health Assembly, the Executive Board, and the Secretariat.7 The World Health Assembly is its primary decision-making body, and consists of delegations from all 194 Member States, who meet annually in Geneva to determine the policies of the WHO.

The Executive Board is made up of 34 health experts, elected for 3-year terms. The Board acts as an executive agency for the World Health Assembly, implementing its decisions and policies, providing advice, and taking on other facilitative tasks.

The Secretariat of the WHO is the largest of the three primary organs, employing over 8000 staff. It is led by a Director-General, who is appointed by the World Health Assembly for a five-year (renewable) term. The current Director General is Dr. Margaret Chan, who was appointed on 9 November 2006, and was re-appointed for a second term that will continue through 30 June 2017.

Role as a Forum for Human Rights The human right to health is contained in a number of international and regional human rights treaties. Article 12 of the International Covenant on Economic, Social and Cultural Rights (ICESCR), for example, attests that:

1. The States Parties to the present Covenant recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.

7 Constitution of the World Health Organization, art. 9. 5

Paper Name: International Fora for the Protection, Promotion, and Enforcement Human Rights and of Human Rights Duties Module Name: World Health Organisation (WHO)

2. The steps to be taken by the States Parties to the present Covenant to achieve the full realization of this right shall include those necessary for:

(a) The provision for the reduction of the stillbirth-rate and of infant mortality and for the healthy development of the child;

(b) The improvement of all aspects of environmental and industrial hygiene;

(c) The prevention, treatment and control of epidemic, endemic, occupational and other diseases;

(d) The creation of conditions which would assure to all medical service and medical attention in the event of sickness.8

Additional protections are included in many international and regional instruments, including, for example, the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW),9 the Convention on the Rights of the Child (CRC),10 the European Social Charter, the African Charter on Human and Peoples’ Rights, and the Protocol of San Salvador to the American Convention on Human Rights in the Area of Economic, Social and Cultural Rights, to name a few.11

Because of its status as a UN specialized agency and its focus on “the attainment by all peoples of the highest possible level of health,” the WHO is a natural forum for human rights work with respect to the right to health. The WHO’s work to improve health systems around the world contributes directly to the fulfillment of every person’s right to health. However, the WHO’s position with respect to

8 International Covenant on Economic, Social and Cultural Rights (1966), art. 12. See also id. at arts. 7 (right to “safe and healthy working conditions”), 10 (right to special protection for mothers “during a reasonable period before and after childbirth” and protection for children from “work harmful to their morals or health or dangerous to life or likely to hamper their normal development”). 9 Convention on the Elimination of All Forms of Discrimination Against Women (1979), arts. 10 (right to education “to help ensure the health and well-being of families, including information and advice on family planning”), 11 (right to “health and to safety in working conditions, including the safeguarding of the function of reproduction” as well as special protection during pregnancy), 12 (eliminating discrimination in health care, and right to appropriate services during pregnancy, confinement, and the post-natal period), 14 (access to adequate health care facilities). 10 Convention on the Rights of the Child (1989), arts. 6 (right to life, survival, development), 19 (protection from physical and mental violence, injury, and abuse), 20 (protection for children in care of the state), 23 (special protection for disabled children), 24 (right to highest attainable standard of health). 11 See also Universal Declaration of Human Rights (1948), art. 25; International Convention on the Elimination of All Forms of Racial Discrimination (1966), art. 5; Declaration on the Rights of Mentally Retarded Persons (1971); Universal Declaration on the Eradication of Hunger and Malnutrition (1974); Declaration on the Rights of Disabled Persons (1975); Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care (1991). 6

Paper Name: International Fora for the Protection, Promotion, and Enforcement Human Rights and of Human Rights Duties Module Name: World Health Organisation (WHO)

human rights discourse has shifted over the last seven decades along with changing international political tides.

In its early years, the WHO Secretariat was active in helping to define the human rights agenda for public health. As then-WHO Director-General Brock Chisholm put it in 1951, “the whole programme approved by the World Health Assembly represents a concerted effort on the part of the Member States to ensure the right to health.”12 In keeping with this philosophy, the early WHO was active in pushing a broad understanding of the right to health in human rights instruments in line with the expansive positive definition in its own Constitution.

Beginning in the mid-1950s, however, Cold War politics led to a shift in the WHO’s strategy, and it began to move away from human rights discourse, preferring to position itself as a ‘technical’ organization (rather than a ‘political’ one).13 As Director-General Marcolino Gomes Candau stated in 1957, the WHO was not an organization “entrusted with safeguarding legal rights.”14 This altered focus allowed the WHO to maintain political neutrality during the 1950s and 60s, but it also meant that the organization gave up its leadership position with respect to defining the scope of the right to health within international human rights discourse.

As the Cold War wound to a close, the WHO returned to using human rights language. And when UN Secretary-General Kofi Annan called in 1997 for the UN specialized agencies to ‘mainstream’ human rights in their activities, then-WHO Director-General Gro Harlem Brundtland was ready to do so.15

The organization continues the process of incorporating human rights more fully into its mandate. As part of the ongoing reform process launched at the 2012 World Health Assembly, the WHO has committed to promoting the mainstreaming of gender, equity and human rights throughout all levels

12 Letter from Brock Chisholm, Director-General, WHO, to H. Laugier, Assistant Secretary-General, UN (Jan. 12, 1951), quoted in B.M. Meier & W. Onzivu, “The Evolution of Human Rights in World Health Organization Policy and the Future of Human Rights through Global Health Governance,” 128(2) Public Health 179 (2014). 13 B.M. Meier & W. Onzivu, “The Evolution of Human Rights in World Health Organization Policy and the Future of Human Rights through Global Health Governance,” 128(2) Public Health 179 (2014). 14 Letter from M.G. Candau, Director-General, World Health Organization, to Martin Hill, Deputy Under-Secretary for Economic and Social Affairs, UN (Feb. 19, 1957), quoted in B.M. Meier & W. Onzivu, “The Evolution of Human Rights in World Health Organization Policy and the Future of Human Rights through Global Health Governance,” 128(2) Public Health 179 (2014). 15 B.M. Meier & W. Onzivu, “The Evolution of Human Rights in World Health Organization Policy and the Future of Human Rights through Global Health Governance,” 128(2) Public Health 179 (2014). 7

Paper Name: International Fora for the Protection, Promotion, and Enforcement Human Rights and of Human Rights Duties Module Name: World Health Organisation (WHO)

of the organization.16 To that end, it has established a ‘Health and Human Rights Unit’ to serve as the focal point for human rights integration within the WHO mandate.

Today, the WHO’s human rights activities are far-reaching. It engages in awareness raising and capacity building activities (such as conducting workshops and training seminars, and producing popular and technical pamphlets and videos) with respect to the right to health at both regional and national levels. It submits statements and reports to UN bodies charged with monitoring and evaluating human rights issues. It includes human rights concerns in its policy recommendations to national governments. And it has generally attempted to adopt a ‘rights-based approach to health’, which aims to make human rights “a framework for health development,” examines “the human rights implications of any health policy, programme for legislation,” and makes human rights “an integral dimension of the design, implementation, monitoring and evaluation of health-related policies and programmes in all spheres, including political, economic and social.”17

In addition, the WHO maintains a number of more focused programs on issues of particular interest. The WHO’s QualityRights project, for example, seeks to improve human rights in mental health and social care facilities.18 The organization works to broaden access to medicines—an essential component of the right to health—by promoting best practices, new funding models, and other mechanisms. It has worked with the UN Office of the High Commissioner for Human Rights to develop strategies for protecting the right to health through and during poverty reduction.19 And it has paid special attention to promoting gender equality in the provision and distribution of health care.

Summary

Despite its extensive work in the field of human rights and world health, criticisms of the WHO’s level of commitment to a rights-based approach remain. Andraž Zidar of the British Institute of International and Comparative Law, for example, argues that the WHO’s 2005 International Health Regulations do not sufficiently integrate human rights, but instead only “allude” to rights as

16 World Health Organization, Twelfth General Programme of Work: Not Merely the Absence of Disease (2014), at 19. 17 World Health Organization, “25 Questions & Answers on Health & Human Rights,” 1 Health & Human Rights Publication Series 16 (July 2002). 18 World Health Organization, website, “WHO QualityRights Project—addressing a hidden emergency,” available at: http://www.who.int/mental_health/policy/quality_rights/en/ 19 Office of the High Commissioner for Human Rights & World Health Organization, “Human Rights, Health and Poverty Reduction Strategies,” 5 Health & Human Rights Publication Series 1 (December 2008). 8

Paper Name: International Fora for the Protection, Promotion, and Enforcement Human Rights and of Human Rights Duties Module Name: World Health Organisation (WHO)

something “external” to the Regulations.20 The 2005 International Health Regulations, which were updated in response to the threat of infectious diseases such as SARS, H1N1 influenza, Ebola, MERS, and Poliovirus, are “arguably the most important global health treaty of the twenty-first century.”21 Though they do include provisions guaranteeing that public health measures will be taken with full respect for human rights, Dr. Zidar argues that the Regulations should contain more specific human rights commitments.

20 Andraž Zidar, “WHO International Health Regulations and Human Rights: From Allusions to Inclusion,” International Journal of Human Rights (2015). 21 Lawrence Gostin, Global Health Law 35 (2014), quoted in Andraž Zidar, “WHO International Health Regulations and Human Rights: From Allusions to Inclusion,” International Journal of Human Rights (2015). 9

Paper Name: International Fora for the Protection, Promotion, and Enforcement Human Rights and of Human Rights Duties Module Name: World Health Organisation (WHO)