Human rights encompass civil, political, economic, social and cultural rights. They include everyone having a right to health, sexual and reproductive health and rights (SRHR), education and safe drinking water and sanitation. These rights have been formally and universally recognised by all countries from the 1948 Universal Declaration on Human Rights and reaffirmed through multiple treaties and declarations since. International human rights law sets out the obligation of states to respect and fulfil human rights for all. The international human rights framework can provide guidance on incorporating human rights into policy and practice. Human rights for human development rely on mutual accountability, whereby all actors, including citizens, communities, organisations and the government, are responsible for respecting and fulfilling mutually agreed human rights obligations.
Recent policy discussions have focused strongly on an equity and inclusion approach that targets the least served first (Pullan et al., 2014). In the health sector, this is health equity and health for all, where everybody has healthcare appropriate to their needs and situation, rather than equal healthcare, where everybody receives the same care options (MacLachlan et al., 2012). In education, the Education for All initiative aims to ensure equitable access to education including for individuals from vulnerable groups. In the water sector, there is a realisation that global progress on MDG7 has masked a failure to reach people and areas in most need of access to drinking water and sanitation (Pullan et al., 2014). An equity approach requires recognising the different needs of individuals and providing services that are accessible and affordable (Narayanan et al., 2012). All individuals have a right to access quality healthcare, education and safe drinking water and sanitation without discrimination or exclusion.
Health policy draws on the right to the enjoyment of the highest attainable standard of physical and mental health. Health and human rights are inextricably linked: human rights violations may have health consequences, and the design or implementation of health policies and programmes may either protect or violate human rights (MacLachlan et al., 2012). For example, the lack of access to effective care for most people living with most diseases in poor countries can be viewed as a violation of human rights (Gruskin et al., 2007). Marginalised groups are especially vulnerable (MacLachlan et al., 2012). Poor health of a minority can undermine the health of an entire population. Human rights are imperative in the delivery of care and implementation of public health programmes. For example, a human rights-based approach has a strong potential for improvements in mental health policy and implementation (Jenkins et al., 2011).
MacLachlan, M., Amin, M., Mannan, H., El Tayeb, S., Bedri, N., Swartz, L., … McVeigh, J. (2012). Inclusion and human rights in health policies: Comparative and benchmarking analysis of 51 policies from Malawi, Sudan, South Africa and Namibia. PLoS One, 7(5), e35864.
How does health policy reflect human rights? If social inclusion and human rights do not underpin policy formation, it is unlikely they will be realised in service delivery. This examination of policies from Malawi, Namibia, South Africa, and Sudan shows that advances in the rights discourse around vulnerable groups is not reflected in country-level policy. It establishes that the four countries had generally high levels of core concepts of human rights included in their policies, but lower to poor inclusion of specific policies for vulnerable groups.
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Gruskin, S., Mills, E. J., & Tarantola, D. (2007). History, principles, and practice of health and human rights. The Lancet, 370(9585): 449-455.
This review provides a brief history of health and human rights and uses HIV/AIDS as an example of the effectiveness of the human rights approach in improving health-related policy and practice. Integration of human rights in health systems is essential for improving public health at the individual and population level. The authors identify three topics that urgently need further work: (i) developing adequate monitoring instruments that measure both health and human rights concerns; (ii) building evidence of the effects of applying the health and human rights frameworks to health practice; and (iii) creating a research agenda on associations between health and human rights.
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Jenkins, R., Baingana, F., Ahmad, R., McDaid, D., & Atun, R. (2011). Social, economic, human rights and political challenges to global mental health. Mental Health in Family Medicine, 8(2), 87-96.
This paper discusses the social, economic, human rights and political challenges to mental health, highlighting implementation issues at country level as well as on the global development agenda. It draws on the small amount of published literature. It demonstrates the gaps in the global architecture for mental health and the need to strengthen the links between mental health and social development to ensure that factors that influence mental wellbeing, including access to adequate care, are effectively addressed. Human rights are an important lever for mental health policy and implementation. However, they have been used less effectively in low- and middle-income countries than in high-income countries, partly because of a relative lack of resources and, in some countries, less democratic systems. More international financing is needed to address growing mental illness.
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Sexual and Reproductive Health
Sexual and reproductive health rights have been developed from the International Conference on Population and Development and the Beijing Platform for Action. They include rights to decide freely and responsibly on all aspects of sexuality; being free from discrimination; to decide freely and responsibly the number and spacing of children; and to attain the highest standards of sexual and reproductive health.
Development discourse has been slow to recognise these rights, and policymakers are often reluctant to legislate on what is seen as a highly politicised and delicate area. The MDGs include SRHR in terms of reducing maternal mortality and ensuring universal access to reproductive health (MDG5; Yamin & Boulanger, 2013). Whilst the MDGs have increased attention to these issues, they have reduced the wider discussion around SRHR and women’s control of their bodies to a simplistic maternal health approach (Yamin & Boulanger, 2013). This excludes and simplifies the feminist and inequality agenda, shifting the discussion away from rights towards a technocratic and instrumentalist approach (Yamin & Boulanger, 2013). A rights-based approach allows a view of women and men as active subjects with control over their bodies, not passive objects of development programmes (Yamin, 2013).
Yamin, A. E., & Boulanger, V. M. (2013). Embedding sexual and reproductive health and rights in a transformational development framework: lessons learned from the MDG targets and indicators. Reproductive Health Matters, 21(42), 74-85.
This article argues that the MDGs have embedded normative values into the development discourse, which has been particularly detrimental for sexual and reproductive health rights. Whilst setting simple MDGs raised awareness and defined quantified targets, policy attention was diverted from structural human rights concerns. The MDG agenda has depoliticised women’s rights, and has undercut some of the gains made by the feminist movement. Women’s health is viewed as a basic need rather than a right, which removes women’s agency and choice. The article argues that there must be a strong narrative on social transformation to advance social, political, and gender justice.
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Yamin, A. E. (2013). From ideals to tools: applying human rights to maternal health. PLoS Medicine, 10(11): e1001546.
This article outlines achievements in applying human rights frameworks to maternal mortality and SRHR. It argues human rights-based approaches can help shape policy decisions. It charts some of the historical development of this approach through the 1990s onwards, including pressures from the women’s movement, the MDGs, and significant Human Rights Council decisions.
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Every person has a right to enjoy access to quality education, without discrimination or exclusion. The right to education is affirmed in numerous human rights treaties and recognised by governments in international goals including the Education for All (EFA) goals. Education must be available; accessible (including to the most marginalised); of acceptable quality, relevant, non-discriminatory and culturally appropriate; and adaptable to suit local context. Education is not only a right: it is key to human development through improving health, reducing poverty and fostering peace, democracy and economic growth.
However, formal education is still denied to millions around the world due to lack of resources, capacity and political will. Providing non-formal education can provide people with the life skills they need, and can be a transitional route back into the formal education system (Selim et al., 2013). Whilst international focus has been on providing access to education, quality and retention in education has not received the same attention. Consequently, even if children are attending school, the quality of education can be extremely poor and insufficient to equip children with the skills and knowledge they need to lift themselves out of poverty (UNICEF & UNESCO, 2007). A quality education cannot be achieved without recognising and committing to the human rights of children while they are in school. This includes respecting their identity, agency and integrity and addressing their rights to freedom from discrimination, to an adequate standard of living and to meaningful participation. Children cannot achieve their optimum development when they are subjected to humiliating punishment or physical abuse (UNICEF & UNESCO, 2007).
Selim, M., Abdel-Tawab, N., Elsayed, K., El Badawy, A., & El Kalaawy, H. (2013). The Ishraq program for out-of-school girls: From pilot to scale-up. Final report. Cairo: Population Council.
The Ishraq (Sunrise) multi-dimensional programme for 12 to 15 year-old out-of-school girls started in 2001. It prepares girls in rural Upper Egypt for re-entry into formal schooling using group-based programming. This report describes the reach and effects of the programme on participants and communities. One outcome was that 81 per cent of participants who took the national literacy exam passed, and more than half of those girls joined formal schooling.
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UNICEF, & UNESCO. (2007). A human rights-based approach to education. UNICEF and UNESCO.
This document describes what is meant by a human rights-based approach to education, and its key issues and challenges. It provides a framework to guide policy and programme development and implementation to attain Education for All.
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Access to safe drinking water (a water source that is protected from contamination) and sanitation facilities are fundamental human rights and are essential for good health. The right to safe drinking water and sanitation was fully recognised by the United Nations General Assembly and the United Nations Human Rights Council in 2010. Governments, considered as the primary duty bearers of rights, are obliged to include the rights to water and sanitation in their national legal systems and to ensure these rights are enforced. The meaning and legal obligations of these rights have been explained in a recent handbook (UN Special Rapporteur, 2014).
Where countries have recognised the right to sanitation, accelerated progress in coverage has been noted (DFID, 2011). So a human rights approach is likely to be more equitable and inclusive than the approach in those countries that have no specific rights focus (Narayanan et al., 2012). Although there is progress in reaching MDG7, high geographical inequality in drinking-water supply and sanitation (WSS) across sub-Saharan Africa highlights the need to reduce inequalities to reach the lowest coverage areas and population groups (Pullan et al., 2014).
Pullan, R. L., Freeman, M. C., Gething, P. W. & Brooker, S. J. (2014). Geographical inequalities in use of improved drinking water supply and sanitation across sub-Saharan Africa: Mapping and spatial analysis of cross-sectional survey data. PLoS Medicine, 11(4).
This paper uses data on household reported use of open defecation and improved WSS from 138 national surveys undertaken from 1991–2012 in 41 countries. The data are used to develop maps of WSS coverage in Sub-Saharan Africa and show geographical inequalities beyond simplistic rural-urban analysis, which provides the entry-point for an equity and inclusion approach. Identifying and targeting inequalities in access and use are essential to achieving the goal of universal water and sanitation.
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UN Special Rapporteur. (2014). Realizing the human rights to water and sanitation: A Handbook. OHCHR. United Nations Human Rights.
This handbook is the product of six years of work by the first UN Special Rapporteur on human rights to water and sanitation. It is presented in nine booklets for governments, donors and national regulatory bodies. It explains the legal obligations that arise from these rights, provides guidance on implementation, and shares examples of good practice.
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DFID. (2011). Assessing the impact of a right to sanitation on improving levels of access and quality of services: Executive summary. London: DFID in association with Coffey International Development.
Does formal recognition of a right to sanitation (RTS) increase levels of availability and access to quality, affordable and adaptable sanitation services? This study finds that progress towards these goals seems to be faster in countries that have recognised an RTS. It is highly probable that sanitation services in countries seeking to fulfil an RTS will be more equitable and inclusive than elsewhere. However, attributing successes to a rights approach will require better monitoring and evaluation that includes rights-sensitive indicators. A further finding is that what makes formal recognition meaningful is a participatory approach to working to fulfil rights: citizen-state engagement is crucial.
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Narayanan, R., van Norden, H., Gosling, L., & Patkar, A. (2012). Equity and Inclusion in Sanitation and Hygiene in South Asia: A Regional Synthesis. IDS Bulletin, 43(2), 101-111.
This paper strongly advocates for an equity approach to WASH which specifically targets the excluded. In part, this is to prevent elite capture and increase in the inequality gap. In South Asia, the gains in sanitation have mainly been among the richest quintiles. An equity approach requires addressing the attitudinal, environmental and institutional barriers to adequate WASH.
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- Combaz, E. (2013). Poor people’s rights and successful legal actions (GSDRC Helpdesk Research Report), Birmingham, UK: Governance and Social Development Resource Centre, University of Birmingham.
- Crichton, J., Haider, H., Chowns, E. & Browne, E. (2015). ‘Rights and health, water and sanitation’ in Human rights: Topic guide. (Revised ed.) GSDRC.
- The Right to Education Project
- The Rights To Water And Sanitation