Introduction 1
Ⅰ Clarifying expectations 6
Ⅱ Constructing a meaning for the right to health 8
A The history of the right to health 8
B The conceptual foundations of the right to health 9
C The need for a persuasive methodology 10
D The meaning of health 11
E The obligation of states to recognize the right to health 11
1 Charting the History of the Right to Health 14
Ⅰ Introduction 14
Ⅱ From invisible to inalienable: the recognition of the right to health 16
Ⅲ The origins of the right to health 19
A The need to navigate the dangers of excessive liberalism and collectivism 19
B The nexus between war, rights, health, and peace 23
C The WHO and the right to the highest attainable standardof health 27
D The adoption of the UDHR and its aftermath-a common enemy unites then the Cold War divides 30
E Using history to understand the meaning of the right to health 33
Ⅳ The role of public health in delivering the right to health 34
A The ancient commitment to collective action to protect health 34
B The reality of mixed motivations underlying collective health measures 35
C The rise and fall of the Enlightenment 36
D State expansion and the Industrial Revolution-towards an instrumentalist vision of public health 37
E The rebirth of rights and the struggle for justice 38
F Transforming national differences into an international commitment 39
Ⅴ Conclusion: looking into and beyond the history of the right to health 41
2 The Right to Health-Its Conceptual Foundations 44
Ⅰ Introduction 44
Ⅱ The preliminary question: the need to interrogate the conceptual foundations of the right to health? 47
Ⅲ The conceptual foundations of the right to health 49
A Looking for foundations in incompletely theorized agreements 49
B The idea of a human right to health 50
C Grounding rights in interests 52
D A social interest theory of rights 54
E Dignity as both coterminous and foundational 56
F Beyond individualism 57
G Dynamic but not arbitrary 59
Ⅳ Dealing with the detractors: a defence of the right to health 60
A The libertarian objection 60
B The status objection 63
C The formulation objection 65
D The relativist challenge 67
E The resource allocation dilemma 69
Ⅴ Conclusion-an imperfect but good justification 73
3 A Methodology to Produce a Meaning for the Right to Health 75
Ⅰ Introduction 75
Ⅱ The act of interpretation: from intentionalism to persuasion 78
Ⅲ Defining the interpretative community-moving beyond states towards a communitarian model 81
Ⅳ Seeking to persuade by constructive engagement 86
A Providing a transparent account of the interpretative process 86
B The features required for constructive engagement 88
Ⅴ Conclusion-towards a common understanding 118
4 The Meaning of the Highest Attainable Standard of Health 121
Ⅰ Introduction 121
Ⅱ The scope of the interest in which the right to health is grounded 123
A The distinct nature of the international formulation 123
B The meaning of health 125
C Moving beyond a biomedical definition of health 126
D The danger associated with inflating the right to health 130
Ⅲ The freedoms associated with health 132
A The right to sexual and reproductive freedom-an adolescent perspective 133
B Freedom from medical experimentation 144
C Freedom from non-consensual medical treatment 144
Ⅳ The qualitative nature of the entitlements under the right to health 158
A Availability 159
B Accessibility 167
Ⅴ Conclusion-a socially manageable meaning of health 173
5 The Obligation to Recognize the Right to Health by All Appropriate Means 175
Ⅰ Introduction 175
Ⅱ The obligation to 'take steps' 177
Ⅲ The meaning of 'all appropriate means' 178
A A margin of discretion 178
B Legislative measures 179
C Using the tripartite typology to identify 'other appropriate measures' 185
D Using the work of the human rights treaty monitoring bodies to develop an understanding as to the nature of'appropriate measures' 197
Ⅳ Conclusion-moving towards a sufficiently specified account of the measures required to secure the right to health 224
6 The Progressive Obligation to Realize the Right to Health 225
Ⅰ Introduction 225
Ⅱ The meaning of'maximum available resources' 226
A Towards a dynamic understanding of available resources 226
B Developing social resources 230
C Seeking international co-operation as a source of resources 231
Ⅲ The progressive nature of a state's obligations and the process for prioritization 232
A The need for a dialogue 232
B Addressing the resource allocation dilemma 235
Ⅳ The concept of minimum core obligations 238
A Genesis and inflation 238
B In search of a principled basis for minimum core obligations 241
C In search of a practical content for the minimum core obligations under the right to health 243
Ⅴ Conclusion-progressive as a pragmatic and principled process 252
7 Specific Measures Required to Secure the Right to Health 254
Ⅰ Introduction 254
Ⅱ The obligation to diminish infant and child mortality 255
Ⅲ The obligation to provide medical assistance and health care, especially primary health care 261
A Introduction 261
B The emphasis on primary health care 263
Ⅳ The obligation to combat disease and malnutrition 267
A Introduction 267
B Disease prevention 269
Ⅴ The obligation to ensure occupational health and safety 286
Ⅵ The obligation to provide pre-natal and post-natal health care for mothers 287
A A progressive or immediate obligation 287
B The meaning of 'appropriate' pre- and post-natal care 289
Ⅶ The obligation to raise awareness and ensure access to information concerning health 291
A Introduction 291
B The information about health which all segments of society are entitled to receive 291
Ⅷ The obligation to develop preventive health care, guidance for parents, and family planning education and services 296
A Introduction 296
B The obligation to develop preventive health care 297
C The obligation to develop guidance for parents 298
D The obligation to develop family planning education and services 299
Ⅸ Conclusion-deference with limits 301
8 The Obligation to Abolish Traditional Practices Harmful to Health 303
Ⅰ Introduction 303
Ⅱ The nature of a state's obligation-making progress towards effective abolition 305
Ⅲ The practices to be abolished: 'traditional practices prejudicial to the health of children' 306
A Prejudice to health as a contested concept 306
B The identification of those practices to be abolished 307
Ⅳ Measures to abolish traditional practices prejudicial to a child's health 314
A Case study: female genital cutting 314
B The problem of classification 315
C The nature and health consequences of the practice 316
D The measures to be adopted by states 317
Ⅴ Conclusion-the need for a culturally sensitive approach 323
9 The International Obligation to Secure the Right to Health 325
Ⅰ Introduction 325
Ⅱ The nature and scope of the international obligation to co-operate 327
A A vision of qualified solidarity 327
B The obligation to promote and encourage co-operation under the CRC 329
C A tripartite international obligation 331
Ⅲ Case study: the impact of the international obligation to co-operate on access to medicines 351
A The dilemma: Intellectual property rights v access to medicines 351
B Can TRIPS be justified? 354
C Trade law and human rights-in search of system coherence 364
D TRIPS and access to medicines-adjusting and reviewing expectations 366
Ⅳ Conclusion 368
Conclusion 371
Appendix 376
Select Bibliography 381
Index 403