Introduction

1. Introduction Social transformations through globalization engage an evolving framework for health rights, and formal human rights mechanisms must be transformed to reflect these changing needs and emerging threats. The right to health in article 12 of the ICESCR has been advanced as an individual right, focusing on individual access to health care at the expense of public health. This limited right to health has not been effective in forcing states to address burgeoning inequalities in the underlying determinants of health, hampering efforts to operationalize the right to health through public health programs. The Highest Attainable Standard: Advancing a Collective Human Right to Public HealthBenjamin Mason Meier, JD, LLM1 & Larisa M. Mori21 PhD Candidate, Sociomedical Sciences, Columbia University; 2 JD/MPH Candidate, University of California, Los Angeles The States Parties to the present Covenant recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health… -International Covenant on Economic, Social and Cultural Rights, Art. 12(1). The Globalization of Disease • Contemporary processes of economic globalization have resulted in the exacerbation of endemic diseases and the rapid spread of infectious diseases. • Where once public health measures were effective in safeguarding a state from infectious disease, modern diseases (e.g., AIDS, SARS, BSE, and drug-resistant tuberculosis) have spread as a result of globalization. • Growing poverty in the developing world is responsible for injurious health consequences, with structural adjustment programs having undermined advancements in individual medical care. • Developing states now carry a majority of the world’s disease burden but possess only a fraction of the world’s health resources, hampering national public health efforts. International Law—The Globalization of Public Health • Although economic globalization has had largely detrimental effects on health, the globalization of public health systems offers the prospect of reversing these insalubrious trends by addressing the underlying determinants of health. • The World Health Organization’s Framework Convention on Tobacco Control has shown states the benefits of employing international law to combat global disease. • International treaty making allows states to work cooperatively to uphold the human right to health, challenging the globalization of disease through the “globalization of public health.” An Evolving Right to Health The United Nations Committee on Economic, Social and Cultural Rights (CESCR) viewed the medicalized conception of health in article 12 as anachronistic in light of a modern understanding of health disparities. The CESCR acknowledged a correlation between individual and public health, finding states to be bound by both the individual and collective dimensions of the right to health and holding that there exist governmental responsibilities for addressing the “underlying determinants of health.” Objectives To assess ways in which the human right to health in article 12 of the International Covenant on Economic, Social and Cultural Rights (ICESCR) has evolved to meet global threats to public health; and To develop a collective right to public health to alleviate globalization’s impact on the underlying determinants of health. A Collective Human Right to Public Health The paradigm of individual health is no longer applicable to a globalized world, compelling a renewed focus on the collective social factors that facilitate the spread of disease. Through an emphasis on the underlying determinants of health, it becomes clear that the human right sought to be protected is a collective right. This collective human right—a right to public health—obligates states to address the fundamental social conditions that underlie disease. Conclusions Envisioning a public health component within the right to health would explicitly acknowledge the public health interventions necessary to fulfill individual health needs, alleviating many of the injurious inequities of globalization. By creating a framework for discussing public health as a human right, international legal bodies could derive concrete, measurable indicators for governments in enacting public health programs and assure that these governments can be held accountable for realizing the highest attainable standard of health. Methods Through formalistic legal analysis, this research examines whether modern processes of globalization necessitate a collective right to public health to address changes in the underlying determinants of health. This research focuses on a collective right to public health that complements the individual human right to health promulgated in article 12 of the ICESCR. This legal analysis is based upon the jurisprudential discourse surrounding the right to health and justified as a collective right independent of the individual right to health.