The human rights responsibility of international assistance and cooperation in health

As a result of globalization, the actors and processes affecting the right of everyone to enjoyment of the highest attainable standard of physi-cal and mental health (the "right to the highest attainable standard of health" or "right to health") are increasingly internationalized. This is particularly the case in low-income countries, where the right to health is influenced, positively and negatively, by international debt relief efforts, trade agreements, humanitarian and development assistance, and the national health policies of, and pharmaceutical research and develop-ment carried out in, high-income countries. During the twentieth century, the health of people across most parts of the world steadily improved. However, progress has significantly slowed in recent years, particularly in low-income countries, where there is still an extremely high burden of preventable conditions (Commission on Macroeconomics and Health 2001, 40). A significant reason for this is the lack of resources of those living in poverty, and their governments, to ensure access to health-related services. In recent decades, high-income countries have expressed increasing commitment to improving health in low-income countries, both as a goal in its own right and as an integral element of development and poverty-reduction initiatives (Swedish International Development Cooperation Agency 2002, 7; U.K. Department for International Development 2007c, 3). This is reflected in the Millennium Declaration, which was adopted in 2000 by the largest gathering of heads of state and government in history, and which gave rise to a set of development objectives, now com-monly known as the Millennium Development Goals (MDGs). Health is a prominent theme among the eight goals, which also include a commit-ment to a global partnership for development (goal 8). The MDGs and various other international political commitments in-clude agreements by states to increase funds for development, including health, in low-income countries, and create a supportive international pol-icy environment with this objective in mind. However, these good inten-tions have not-on the whole-been followed by the required injection of funds.1 Furthermore, particular policies of some high-income states, including certain trade policies, create a difficult environment for the im-provement of health in some low-income countries (Oxfam 2006). Under several international human rights treaties, including the UN International Covenant on Economic, Social, and Cultural Rights (1966), states have a human rights responsibility of international assistance and cooperation in health. This means that states have a legal responsibility to ensure that their laws, policies, and activities support, and do not ob-struct, the enjoyment of the right to health in other countries. Given the impact of high-income states on the right to health in low-income states, this responsibility has particular relevance in the context of the relation-ship between these countries. The human rights responsibility of international assistance and coop-eration in health has only recently attracted significant attention from international human rights mechanisms, civil society, and states. This chapter focuses on the contribution of Paul Hunt, the first UN special rapporteur on the right to the highest attainable standard of health,2 to elaborate the meaning and scope of this responsibility. The special rapporteur's analysis builds on the conceptual framework on economic, social, and cultural rights, including international assistance and coop-eration, developed by the Committee on Economic, Social, and Cultural Rights, and others. The special rapporteur has applied this analysis in the context of the right to the highest attainable standard of health, including particular right to health issues such as sexual and repro-ductive rights, mental health, access to medicines, and water and sanita-tion. He has also applied this analysis to specific interactions between high-and low-income states, including multilateral and bilateral trade agreements, development assistance, and the activities of international organizations.