“Everywhere but not specifically somewhere”: a qualitative study on why the right to health is not explicit in the post-2015 negotiations

Abstract

BackgroundThe Millennium Development Goals expire at the end of 2015 and global negotiations are underway to finalise the post-2015 Sustainable Development Goals. Much activism has occurred encouraging a post-2015 health and development goal embedded in the highest attainable standard of health (‘right to health’). Despite this, the right to health was absent in three key post-2015 intergovernmental Sustainable Development Goal proposals in 2014, one of which was reinforced by the United Nations General Assembly in September 2014 as the guiding document for ongoing interstate negotiations. This article examines why it appears the right to health, so far, is not gaining direct expression in post-2015 discussion.MethodsThis qualitative research is part of a broader study using thematic and discourse analysis examining the high-level policy debate on health goals in the discourse of the formulation of the post-2015 Sustainable Development Goals. Key-informant interviews were conducted in two interview rounds in 2013 and 2014, with participants from multilateral and other organisations (government, academia, civil society and philanthropy) responsible for health in the post-2015 development agenda (or the post-2015 development agenda more broadly). This study synthesises data from both interview rounds on Health and Human Rights in post-2015 Sustainable Development Goal negotiations.ResultsSix reasons why the right to health may not have gained effective traction in the unfolding post-2015 Member State negotiations were found. The first three reasons relate to broader issues surrounding human rights’ (including sexual and reproductive health and rights) positioning within international relations discourse, and the second three relate to the challenges of transforming the human right to health into a practically applied post-2015 health goal.ConclusionsThis paper reports the views of participants, many of who sit at the interface of United Nations and Member State negotiations, on the right to health’s location (and projected trajectory) at two temporal junctions in evolving post-2015 negotiations. The interviews provide insight into high-level hesitancy that the right to health be expressly incorporated in the final post-2015 health and development goal, as well as documents participants’ doubt that rights language will explicitly frame the broader Sustainable Development Goals, their targets and indicators.

What did the Go4Health policy research project contribute to the policy discourse on the sustainable development goals? A reflexive review

“…While rights are referred to in the preamble of the UN motion for the SDGs, Go4Health analysis noted that the right to health does not appear in the goals themselves, although the word right(s) is mentioned two times in the SDG3.b means of implementation [ 37 ]. Brolan et al’s [ 39 – 41 ] analysis of the UN resolution on the SDGs expressed concern on the lack of specific reference to the right to health in that resolution, and saw this as reflecting the erosion of rights as a construction in the post-2015 debate. This analysis of why the right to health was not explicit in the post-2015 policy negotiations is the only Go4Health paper directly cited in a UN General Assembly resolution [ 39 , 42 ].…”

Global health governance in the sustainable development goals: Is it grounded in the right to health?

“…It is in this concept of equity, however, that the right to health, because of its state‐centric orientation, produces unexpected outcomes when applied to global governance. As the analysis of UHC and the Right to Health pointed out (Ooms et al, ), while the Right to Health expects rectification of inequalities within states, and the privileging of marginalized groups – arguably including refugees and asylum seekers(Brolan et al, ) – it does not apply that expectation between states. The principle of shared responsibility in the Right to Health requires the international solidarity that would ensure a low‐income country meets the minimum standard for provision of health services, but at a global level, it does not compellingly articulate expectations of equity beyond that.…”

A Word of Caution: Human Rights, Disability, and Implementation of the Post-2015 Sustainable Development Goals

“…Also, the opinio juris component is equally feeble. This is because analysis of the high-level contemporary discourse on the formulation of the SDGs reveals it was never the collective intention of the UN General Assembly's Member States to create a piece of binding international law (especially human rights law) when engaging in the formulation of the text of the UN resolution on the post-2015 SDGs or in the formulation of its list of 17 goals therein [48]. Had this been otherwise, decision-making consensus between UN Member States would have been extremely difficult to reach at the UN in New York in September 2015 [48].…”