The Highest Attainable Standard: The World Health Organization, Global Health Governance, and the Contentious Politics of Human Rights Benjamin Mason Meier Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy under the Executive Committee of the Graduate School of Arts and Sciences COLUMBIA UNIVERSITY 2009 © 2009 Benjamin Mason Meier All Rights Reserved ABSTRACT The Highest Attainable Standard: The World Health Organization, Global Health Governance, and the Contentious Politics of Human Rights Benjamin Mason Meier The human right to health—proclaimed seminally in the 1948 Universal Declaration of Human Rights (UDHR) and codified in the 1966 International Covenant of Economic, Social and Cultural Rights (ICESCR) as “the right of everyone to the enjoyment of the highest attainable standard of physical and mental health”—has become a cornerstone of global health governance. Heralded as a normative framework for international public health, the right to health is seen as foundational to the contemporary policies and programs of the World Health Organization (WHO). It was not always so. This dissertation traces the political history leading up to WHO’s invocation of human rights for the public’s health. With both the UDHR and WHO coming into existence in 1948, there was great initial promise that these two institutions would complement each other, with WHO upholding human rights in all its activities. In spite of this promise and early WHO efforts to advance a human rights basis for its work, WHO intentionally neglected the right to health during crucial years of its evolution, with the WHO Secretariat renouncing its authoritative role in human rights policy to pursue medical care programming. Through legal analysis and historical narrative, this research examines the causes and effects of WHO’s early contributions to and subsequent abandonment of the evolution of health rights. Where WHO neglected human rights—out of political expediency, legal incapacity, and medical supremacy—it did so to its peril. After twenty-five years shunning the development of the right to health, WHO came to see these legal principles as a political foundation upon which to frame its “Health For All” strategy under the 1978 Declaration of Alma-Ata. But it was too late. This dissertation concludes that WHO’s constrained role in developing and implementing international human rights for health set into motion a course for the right to health that would prove fatal to the goals of primary health care laid out in the Declaration of Alma-Ata. TABLE OF CONTENTS ACKNOWLEDGEMENTS ...................................................................................III PREFACE.......................................................................................................... VIII INTRODUCTION..................................................................................................1 THE WORLD HEALTH ORGANIZATION, HUMAN RIGHTS, AND THE FAILURE TO ACHIEVE HEALTH FOR ALL......................................................2 I. Background – Foundation of the World Health Organization, Human Rights Frameworks, and International Systems of Coordination in Health and Human Rights ......................................................5 A. Charter of the United Nations.................................................................................................................8 B. Constitution of the World Health Organization......................................................................................9 C. Universal Declaration of Human Rights...............................................................................................15 D. International Cooperation for Health Rights ........................................................................................21 II. Theory & Methods ..................................................................................................................................25 A. Legal Analysis ......................................................................................................................................28 B. Discourse Analysis................................................................................................................................32 III. Results – The Birth, Death, and Resurrection of Human Rights in WHO Programming: How Early Intransigence Toward Human Rights Crippled World Health Organization Efforts to Achieve Health for All ................................................................................................................................................36 A. WHO Influences Human Rights (1948-1953)......................................................................................37 1. Draft International Covenant on Human Rights – Human Experimentation....................................45 2. Draft International Covenant on Human Rights – The Right to Health ...........................................51 a. Commission on Human Rights ....................................................................................................54 b. WHO Executive Board ................................................................................................................63 c. International Covenant on Economic, Social and Cultural Rights...............................................68 B. WHO Neglects Human Rights (1953-1973).........................................................................................75 1. Human Rights Development – The International Treaty Framework Expands Without WHO.......80 a. Economic, Social and Cultural Rights .........................................................................................81 b. Rights of the Child .......................................................................................................................89 c. Discrimination Against Women...................................................................................................90 d. Racial Discrimination ..................................................................................................................93 2. Human Rights Implementation – WHO Abandons Its Human Rights Mission .............................100 a. Advisory Services ......................................................................................................................100 b. Reporting....................................................................................................................................107 c. Awareness ..................................................................................................................................115 C. WHO Rediscovers Human Rights (1973-1979) .................................................................................122 1. Human Rights Implementation – WHO Prioritizes Human Rights in Health Programming.........131 a. Reporting....................................................................................................................................131 b. Inter-Agency Studies..................................................................................................................139 i. Human Experimentation ......................................................................................................140 ii. Torture..................................................................................................................................142 iii. Racism and Apartheid..........................................................................................................147 iv. Disability..............................................................................................................................151 v. Child Nutrition .....................................................................................................................152 vi. Scientific & Technological Developments ..........................................................................154 i c. Education....................................................................................................................................163 2. Human Rights Development – WHO Incorporates Health in the International Treaty Framework .............................................................................................................................................................168 a. Women’s Rights.........................................................................................................................168 b. Rights of the Child .....................................................................................................................172 3. An Evolving Right to Health – The Declaration of Alma Ata as a Rights-Based Approach to Realize WHO’s Health for All Strategy .............................................................................................175 a. New International Economic Order ...........................................................................................177 b. Health for All .............................................................................................................................183 c. Declaration of Alma-Ata............................................................................................................185 IV. The Failure of Health Rights to Reflect Health Discourse...............................................................192 V. Analysis – Where the Failure Lies .......................................................................................................199