Crises as Catalyst: A New Social Contract Grounded in Worker Rights.

Three crises-climate change, the COVID-19 pandemic, and extreme economic and social inequality-intersect and have had devastating impacts on workers' rights to health, as well as the right to decent work, an underlying determinant of health. Yet these crises may act as catalysts, as responses present opportunities for transformation. Indeed, multiple international governance institutions and nongovernmental organizations have proposed new social contracts that aim to address the multiple challenges facing workers today. These initiatives promise to transform society to make workers and their families healthier and the planet more sustainable. They join and supplement earlier efforts at transformation, such as the 2030 Agenda for Sustainable Development. This article critiques (1) the market-fundamentalist neoliberal social contract, which gave rise to, or exacerbated, the three crises, and (2) the 2030 agenda and recent International Labour Organization proposals, which are all built on this neoliberal platform. Finally, the article argues for a social contract that is grounded in human rights-specifically worker rights-to address these crises and ensure greater protection of the health.

A Right-to-Health Lens on Perinatal Mental Health Care in South Africa.

South African women experience some of the highest rates of depression and anxiety globally. Despite South Africa's laudable human rights commitments to mental health in law, perinatal women are at high risk of common mental disorders due to socioeconomic factors, and they may lack access to mental health services. We used a right to mental health framework, paired with qualitative methods, to investigate barriers to accessing perinatal mental health care. Based on in-depth interviews with 14 key informants in South Africa, we found that (1) physical health was prioritized over mental health at the clinic level; (2) there were insufficient numbers of antenatal and mental health providers to ensure minimum essential levels of perinatal mental health services; (3) the implementation of human rights-based mental health policy has been inadequate; (4) the social determinants were absent from the clinic-level approach to mental health; and (5) a lack of context-specific provider training and support has undermined the quality of mental health promotion and care. We offer recommendations to address these barriers and improve approaches to perinatal mental health screening and care, guided by the following elements of the right to mental health: progressive realization; availability and accessibility; and acceptability and quality.

The Challenge of Interdisciplinarity in Operationalizing the Right to Health.

Interdisciplinary collaboration between the health and human rights communities is essential to operationalize the right to health. In practice, however, such collaboration has been infrequent. As noted by Jonathan Mann et al., the fields of health and human rights have "differing philosophical perspectives, vocabularies, professional recruitment and training, societal roles, and methods of work." These differences have posed barriers to interdisciplinary collaboration. This article focuses on interdisciplinarity-especially between health and human rights communities-as key to realizing the right to health. Drawing on interviews with experts on health and human rights, the article explores the challenges of interdisciplinarity at the Office of the High Commissioner for Human Rights (OHCHR), the United Nations (UN) agency charged with mainstreaming human rights, including the right to health, across the UN system. To operationalize the right to health, experts perceive the need (1) to move beyond legalistic concepts of the right to health; (2) to enhance appreciation of the right to health across UN agencies; (3) to employ health professionals at the OHCHR; (4) to develop deep expertise on the right to health to advise on operationalization; and (5) to understand the right to health as an expanded right that includes the social determinants of health.

Challenging Neoliberalism: ILO, Human Rights, and Public Health Frameworks on Decent Work.

In the 2008 report Closing the gap in a generation, the Commission on the Social Determinants of Health (CSDH) described "fair employment and decent work" as components of daily living conditions that have "powerful effects on health." The CSDH therefore proposed far-reaching structural changes to bring about decent work and health for all. Crucially, however, it failed to acknowledge two relevant international legal frameworks, the Decent Work Agenda of the International Labour Organization (ILO) and the right to decent work in international human rights law. This article compares the three frameworks for decent work-CSDH, ILO, and human rights-and makes two arguments. First, it contends that the CSDH, as a creation of the World Health Organization (WHO) and therefore part of the UN system, should have grounded its report-including the section on decent work-in the applicable international law, including the UN Charter and human rights treaties. Second, had the CSDH linked its report to established international law, it would have strengthened all three frameworks, bringing coherence to international law and policy and bolstering the power of the ILO, WHO, and the human rights mechanisms to counter neoliberalism toward achieving their common goal of decent work and health for all.

Engaging Human Rights Norms to Realize Universal Health Care in Massachusetts, USA.

Massachusetts is a national leader in health care, consistently ranking in the top five states in the United States. In 2006, however, only 86% of adults aged 19-64 had health insurance. That year, Governor Romney signed into law An Act Providing Access to Affordable, Quality, Accountable Health Care. By 2017, more than 96% of these adults were insured. The 2006 Massachusetts health insurance reform later became the model for the 2010 federal Patient Protection and Affordable Care Act, also known as Obamacare. This article examines, through a human rights lens, the 2006 Massachusetts health insurance reform 10 years after its implementation (2007-2017) to shed light on the effectiveness of this approach in achieving universal health coverage. Drawing on documentary and interview data, and applying international human rights norms, we found that (1) the 2006 Massachusetts health reform replaced a crisis of uninsurance with a crisis of underinsurance; (2) state leaders in health reform propose widely diverging solutions to the increasing health care costs, the inability of many residents to afford needed health care, and the persistence of medical bankruptcies; and (3) health care is recognized as a human right in Massachusetts, but understanding of the substance or potential of the right is limited.

Mechanisms of Accountability for the Realization of the Right to Health in China.

China ratified the International Covenant on Economic, Social and Cultural Rights in 2001. It thus bears obligations under Article 12 of the covenant to take appropriate measures at the domestic level to realize the right to health in China. Accountability is an important component of the right to health. This article examines whether the Western concept of accountability, recently imported into China, has the potential to improve the protection of the right to health within China's existing political, legal, and cultural framework. In so doing, it reviews current Chinese institutional mechanisms and considers the use of less formal mechanisms by which duty-bearers might be held accountable in China. More specifically, this article provides an overview of a range of health-related accountability mechanisms, including judicial, political, administrative, professional, and social accountability arrangements. It concludes that although there is the basis of an accountability framework for the right to health in China, the effective operation of accountability mechanisms is hindered by longstanding cultural and political barriers.

Neglected Population, Neglected Right: Children Living with HIV and the Right to Science.

The laws, language, and tools of human rights have been instrumental in expanding access to lifesaving treatment for people living with HIV. Children, however, remain a neglected population, as evidenced by inadequate child-specific and child-friendly HIV treatment options. In this article, we explore the right to science, a potentially powerful but underdeveloped right in international law, and its application to research and development for pediatric HIV treatment. Drawing on reports of human rights bodies and scholars and applying the human rights typology of state obligations to respect, protect, and fulfill, we argue that states have five core obligations related to research and development for child-specific and child-friendly treatment: (1) adopting a public goods approach to science and science policy; (2) including and protecting children in research activities; (3) adopting legal and policy frameworks to support research and development through public funding and private sector incentives; (4) promoting international cooperation and assistance; and (5) ensuring the participation of marginalized communities in decision-making processes. In concluding, we make a number of recommendations for states, human rights bodies, international organizations, civil society, and private industry to further develop and implement the right to science.

Human Rights Impact Assessment: A Method for Healthy Policymaking.

Two decades ago, Lawrence Gostin and Jonathan Mann developed a methodology for human rights impact assessment (HRIA) of proposed public health policies. This article looks back over the last 20 years to examine the development of HRIA in the health field and consider the progress that has been made since Gostin and Mann published their pioneering article. Health-related HRIA has advanced substantially in three ways. First, the content of the right to health has been delineated in greater detail through domestic and international laws and policies. Second, the UN human rights mechanisms have recommended that governments undertake HRIAs and have issued guidelines and methodologies for doing so. Third, nongovernmental organizations and international organizations have developed HRIA tools and carried out case studies to demonstrate their feasibility. In this light, the article concludes by recognizing the substantial progress that has been made in HRIA over the last 20 years and by considering some challenges that remain for health-related HRIA.

The Impact of Human Rights on Universalizing Health Care in Vermont, USA.

In 2010, Vermont adopted a new law embracing human rights principles as guidelines for health care reform, and in 2011, Vermont was the first state in the US to enact framework legislation to establish a universal health care system for all its residents. This article reports on the Vermont Workers' Center's human rights-based approach to universal health care and the extent to which this approach influenced decision makers. We found the following: (1) by learning about the human right to health care and sharing experiences, Vermonters were motivated to demand universal health care; (2) mobilizing Vermonters around a unified message on the right to health care made universal health care politically important; (3) using the human rights framework to assess new proposals enabled the Vermont Workers' Center to respond quickly to new policy proposals; (4) framing health care as a human right provided an alternative to the dominant economics-based discourse; and (5) while economics continues to dominate discussions among Vermont leaders, both legislative committees on health care use the human rights principles as guiding norms for health care reform. Importantly, the principles have empowered Vermonters by giving them more voice in policymaking and have been internalized by legislators as democratic principles of governance.

The value of mainstreaming human rights into health impact assessment.

Health impact assessment (HIA) is increasingly being used to predict the health and social impacts of domestic and global laws, policies and programs. In a comprehensive review of HIA practice in 2012, the authors indicated that, given the diverse range of HIA practice, there is an immediate need to reconsider the governing values and standards for HIA implementation [1]. This article responds to this call for governing values and standards for HIA. It proposes that international human rights standards be integrated into HIA to provide a universal value system backed up by international and domestic laws and mechanisms of accountability. The idea of mainstreaming human rights into HIA is illustrated with the example of impact assessments that have been carried out to predict the potential effects of intellectual property rights in international trade agreements on the availability and affordability of medicines. The article concludes by recommending international human rights standards as a legal and ethical framework for HIA that will enhance the universal values of nondiscrimination, participation, transparency and accountability and bring legitimacy and coherence to HIA practice as well.

Untangling equality and non-discrimination to promote the right to health care for all.

Equality and non-discrimination are core principles in international human rights law, and all members of the United Nations have legal obligations to promote these principles. Although widely adopted into law, interpretations of the rights to equality and non-discrimination, as well as their relationship to each other, vary considerably across jurisdictions. At the international level, there are separate provisions on equality and non-discrimination in the human rights treaties, yet legal scholars tend to treat the two concepts as one. This article examines the equality and non-discrimination provisions in the International Bill of Human Rights to consider their potential for addressing economic and social inequalities. The article proposes a legal framework that recognizes positive equality as distinct from status-based non-discrimination. Finally, it argues that both of these distinct rights have important roles in contributing to realizing social rights, in particular, a right to health care.