The Universal Declaration of Human Rights (UDHR), adopted by the General Assembly of the United Nations in 1948, is the foundational document of modern human rights. In Article 25, the UDHR lays out the right to health: “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing, and medical care and necessary social services.” Although the right to health is as absolute as the rest of the rights outlined in the UDHR, there has always been an uneasy relationship between this particular right and its implementation. The International Covenant on Economic, Social and Cultural Rights (ICESCR) was developed to define those aspects of the UDHR that do not fall under civil and political rights, including health, education, and working conditions. Its prescriptions are vague, however, and weakened by a clause called “progressive realization,” which means that signatories to the covenant are only bound to do as much as they can afford (especially developing nations). The clause leaves a gray area for how to realize the right to health.
This vagueness is further exacerbated by divisions between the global communities that focus on health and rights. In 2005, Philip Alston pointed out the debate in the human rights and development communities about whether to classify poverty as a human rights violation. He further outlines that there’s less focus on the realization of economic, social, and cultural rights than on civil and political ones. Alston concludes that the human rights and development “agendas resemble ships passing in the night, even though they are both headed for very similar destinations.” The links between human rights and development (and by extension, health) are essential for the realization of both agendas, but collaboration and communication don’t always occur. Furthermore, there’s greater reluctance to solve for economic, social, and cultural rights, where questions arise around workers’ rights, redistribution of wealth, social security and welfare, and other issues. While most nations and people would decry both genocide and poverty, solving for the former is somewhat more straightforward than the latter.
However, there is no single, overarching right that should or can be realized on its own. Clear lines exist to illustrate the effects of a lack of one right on another. For example, vast gender inequalities in sub-Saharan Africa have contributed to women carrying a disproportionate burden of the HIV/AIDS epidemic: a young woman in sub-Saharan Africa is eight times more likely to be living with HIV than a man of the same age. Although we can increase access to anti-retroviral drugs, improve prevention tactics, or push for laws that will further enfranchise and empower women, we cannot achieve one without the others. To (badly) paraphrase Dr. Martin Luther King, Jr., inequalities anywhere affect equality everywhere.
The US has been a champion of certain (though not all) aspects of the UDHR, especially around democracy and participatory governance, freedom of expression, and other civil and political rights. This piecemeal stance on rights is problematic, however. Vast inequalities in economic, social, and cultural rights have had an adverse effect on health. In a much-simplified view, the American “pull yourself up by your bootstraps” mentality, combined with a unique federal-state system and continuing discrimination against marginalized populations, has made it difficult to realize the right to health.
One glaring example is the Southern state of Mississippi, whose HIV epidemic was the subject of a March report by Human Rights Watch (HRW). Mississippi is one of the poorest and least healthy states in the US. Racial inequality is pervasive: the rate of poverty among African Americans is three times that of whites, and African Americans in Mississippi are dying of HIV/AIDS at ten times the rate of white Mississippians. The stories and statistics provided by HRW paint the portrait of an HIV epidemic in much less affluent country, and indeed, HRW writes: “In Mississippi, the percentage of people with HIV not receiving care or support services is comparable to that in Botswana, Ethiopia, and Rwanda.” There’s a wide range of factors contributing to the HIV epidemic in the state, including:
Though an inability or unwillingness to address civil, political, economic, social, and cultural human rights, Mississippi is failing to curb its HIV epidemic. It’s a difficult topic to address, which is why realizing the right to health is so convoluted—I don’t envision the Governor of Mississippi calling for an acceptance of federal HIV/AIDS funding (which is available), nor would that be enough to promote health and human rights in the state. Even more remote is a rights-based solution to address poverty, poor health, racism, and homophobia, which are key to ending inequalities in HIV/AIDS care and to bring the epidemic under control. There’s no clear solution, especially in a nation so consumed by political divisions.
What Mississippi’s HIV/AIDS epidemic does illustrate, however, is that each right as outlined in the UDHR (or since accepted) cannot exist in a vacuum. We must start addressing them simultaneously, we must look beyond just torture or just gender discrimination or just HIV. Health and human rights cannot be two ships passing in the night because it’s easier that way. In the long run, it won’t be.
