Book reviews

Advancing the human right to health

Zuniga JM, Marks SP and Gostin LO, eds. Oxford: Oxford University Press, 2013. 480 pp.

This substantial volume commemorates the 65th anniversary of the Universal Declaration on Human Rights. As Paul Hunt (former special rapporteur to the United Nations on the right to health) writes in his foreword, since that Declaration ‘the right to the highest attainable standard of health has come a long way [but] the challenges remain enormous and diverse’.

Though the three editors are all US-based, they have recruited authors from several European countries as well as from Africa, South America, Japan and Haiti. Most are academics in law or in public health. The book has two very substantial sections – one on ‘the right to health in action’ (which provides a series of country-based overviews of recent experience) and one on ‘challenges and opportunities’, which is disease- rather than country-based. These are framed by an opening section on ‘the right to health in perspective’ and a concluding chapter on ‘the consequences of failure’.

The opening chapter (by Stephen Marks, one of the book's editors) provides a lucid but somewhat acronym-laden summary of the international legal framework and concludes that whereas ‘every country has accepted that human rights are universal’ and that all are ‘bound by at least one treaty containing a provision on the fright to health’, these rights are ‘of little value without effective means of promotion and protection at the national and international levels’.

In Section 2, Cabrera and Ayala then examine the potential of litigation to advance health rights and the potential for courts to undermine as well as to promote these rights. Nygren-Krug emphasises the need to enhance accountability at international, national and local levels. A provocative chapter by Pablos-Mendéz and Stone highlights the ‘moral imperatives’ towards health and equity and the potential synergy between promoting health and strengthening nations. Examples cited include responses to conflict (as in Timor-Leste) and to specific health challenges (such as HIV in Botswana). Friedman and Gostin then make the case for adopting a ‘Framework Convention on Global Health’ with the aim of setting a global health agenda and reducing health inequalities.

The third section provides summaries of current health and human rights legislation in Haiti, Ghana, India, South Africa, the Philippines, China, Brazil, Peru, Mexico, the UK, Japan and the US. These are useful sources of reference but make somewhat turgid reading. It would have been helpful to have more information on the extent to which newer legislation is (or is not) being translated into better and more equitable standards of healthcare.

To my mind, Section 2 is the most useful section of the book. Baer et al examine human health rights through the lenses of HIV, tuberculosis and malaria and emphasise the potential health benefits to HIV care of tackling discrimination, to malaria prevention of promoting the right to food, water, sanitation and housing and that attempts to control TB through involuntary hospitalisation and isolation breach individual human rights, whereas these rights can be respected through an emphasis on early diagnosis and better access to treatment. Cabrera and Gostin argue that ‘human rights and tobacco control are mutually reinforcing pillars’ whose connection needs to be strengthened ‘both in litigation and in policy development’. Yamin argues on similar lines for the linkage between women's rights and health. Other chapters examine the health rights of prisoners, the right to nutrition, issues of access to expensive medical products and technologies, health and human rights during conflicts and emergencies, and the potential role of genomics in enhancing health rights. Bochenek provides a lengthy and thoughtful analysis highlighting the ubiquity of state-sponsored torture and ill-treatment, the wide range of ill-treatment practiced in addition to torture, and the unacceptability of legislation that compels complicity in ill-treatment such as requiring involuntary sterilization or placing unacceptable restrictions on abortion. I would have welcomed some discussion on the continuing difficulties in accessing healthcare that asylum seekers often experience after fleeing from torture and other ill-treatment.

In the concluding chapter (which could and should have been much longer) Grover, Citro and Mankad focus on the needs of vulnerable and marginalised groups, on the protection of health-related freedoms (such as privacy, confidentiality and informed consent) and on the need for, and potential of, public participation in enhancing the right to health.

Lawyers and public health doctors are not always the easiest of bedfellows. This book represents a useful collaboration between their disciplines. It is at its best when examining specific and practical examples of challenges to health rights and successful initiatives to enhance those rights.

• © 2014 Royal College of Physicians