From revolution to bureaucratization: human rights law becomes central to global health governance


The General Director-Elect of the World Health Organization (WHO), Tedros Adhanom Ghebreyesus of Ethiopia, during the World Health Assembly, in Geneva, Switzerland.

As the paradigm for human rights implementation shifts to reflect the rise of institutions of global governance, it is necessary to analyze the pathways by which global health organizations operationalize human rights in institutional policies, programs, and practices. 

While the traditional United Nations (UN) human rights mechanisms have a mandate to promote and protect human rights, they do not have the exclusive institutional competence, expertise, or capacity to ensure the implementation of human rights. States did not originally envision that human rights would be implemented by international organizations, yet it is now clear that advancing human rights requires a multi-sectoral range of global institutions.

Institutions of global health governance have been crucial to developing human rights in the field of public health, and these institutions are now seen as essential to implementing human rights through their operations. Shifting from the development of rights under international law to the implementation of rights through organizational actions, the global health governance landscape provides a pathway to implement human rights to realize the highest attainable standard of health.

Global health governance has become a basis to address the broader social, economic, and political conditions that underlie public health. Such expansive determinants of global health are relevant to a wide range of intergovernmental organizations, funding agencies, and international bureaucracies. These determinants encompass, among others, the occupational health and safety concerns addressed by the International Labor Organization (ILO), the health sector financing facilitated by the World Bank, and the nutrition security efforts undertaken by the UN Food and Agriculture Organization (FAO).

Human rights law is now understood to provide a central normative framework for governing global health, offering universal standards for the advancement of public health and placing public health obligations on the global community. Health-related human rights have been firmly established under international law, developing through an evolving set of international norms to cover an expanding range of underlying determinants of health. Although this international legal framework bears most directly on states, human rights have also provided a normative foundation for global health law and framed an implementation framework through global health governance.

Global health institutions have assumed responsibility for implementing human rights—in both the mission they pursue and the ways in which that mission is carried out. They assist states in implementing human rights and provide states with the international standards, technical assistance, and accountability mechanisms to facilitate the realization of health-related human rights. Beyond support for state duty-bearers, these organizations have independent responsibilities—as manifestations of the global community—to implement human rights through their institutional policies, programs, and practices to promote health.

These organizational obligations are part of a larger movement to operationalize human rights in global governance. The Vienna Declaration and Programme of Action, adopted at the 1993 World Conference on Human Rights, established the need for attention to human rights through the entire United Nations. UN Secretary-General Kofi Annan extended this international consensus for human rights implementation across international organizations, calling for the promotion of human rights as a “cross-cutting” approach throughout the UN system.

This system-wide effort has sought to “mainstream” human rights in global governance, bringing human rights “from the periphery to the center of policymaking or programming.” Such a holistic incorporation of human rights in global governance has required institutions to translate international legal obligations into rights-based organizational actions.

Mainstreaming has necessitated a wholesale repurposing of institutional operations—encompassing policies, programs, and practices at the organization, department, and individual level. Organizations have approached mainstreaming in diverse ways: revising the organization’s mission to incorporate human rights standards (e.g., UNICEF reformed its mission to reflect the Convention on the Rights of the Child); prioritizing human rights through a dedicated mainstreaming office (e.g., the World Health Organization’s gender, equity and human rights team); or changing the ways in which the organization engages states (e.g., the new funding model of the Global Fund to Fight AIDS, TB, and Malaria).

While some institutions have expressed a commitment to human rights as central to their mission, others have embraced a “rights-based approach,” adopting human rights principles in their public health practice. In this rights-based approach to health, the UN Population Fund (UNFPA) has worked with non-governmental advocates to advance sexual and reproductive health and rights (SRHR) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) has employed human rights to catalyze civil society engagement. Across this continuum of human rights mainstreaming in global health, institutions have faced opportunities and challenges—both in their approach to human rights and in their application of rights-based principles.  

"While some institutions have expressed a commitment to human rights as central to their mission, others have embraced a “rights-based approach,” adopting human rights principles in their public health practice".

To harmonize these organizational efforts across the United Nations, the UN Development Group (UNDG) initially adopted a 2003 “Statement of Common Understanding among United Nations Agencies on the Human Rights-Based Approach to Development Cooperation.” Through the UNDG Human Rights Working Group, UN human rights advisors have collaborated across organizations to examine the application of human rights standards to practical programmatic issues. These efforts to coordinate organizational efforts give hope for a shared approach to human rights mainstreaming in global governance for health.

As divergent approaches remain, comparative research is needed to understand different organizational approaches to integrating human rights in global health. This requires analyzing governance structures through organizational leadership and member state support, staff influences through human rights officers and technical units, outside collaborations with the UN human rights system and civil society, and accountability mechanisms through internal monitoring and external review. 

Human rights are implemented in global health through a dynamic global governance system—extending across WHO’s mandate to realize the right to health; UN specialized agency efforts to address a range of health-related human rights; economic governance to support rights-based priorities in public health funding; and human rights governance to advance global health. Through comparative institutional analysis of human rights in global governance for public health, it is possible to recognize varied approaches to human rights mainstreaming, analyze structural determinants of human rights implementation, and develop empirical bases to assess the influence of human rights in global health institutions. 

The mainstreaming of human rights in global health governance is far from complete, and progress is by no means assured, yet studying these tentative institutional operations can bring understanding to how organizations are transforming human rights from the language of revolution to the process of bureaucratization.