Accountability for the human right to health through treaty monitoring: Human rights treaty bodies and the influence of concluding observations

ABSTRACT

Employing novel coding methods to evaluate human rights monitoring, this article examines the influence of United Nations (UN) treaty bodies on national implementation of the human right to health. The advancement of the right to health in the UN human rights system has shifted over the past 20 years from the development of norms under international law to the implementation of those norms through national policy. Facilitating accountability for this rights-based policy implementation under the right to health, the UN Committee on Economic, Social and Cultural Rights (CESCR) monitors state implementation by reviewing periodic reports from state parties, engaging in formal sessions of ‘constructive dialogue’ with state representatives, and issuing concluding observations for state response. These concluding observations recognise the positive steps taken by states and highlight the principal areas of CESCR concern, providing recommendations for implementing human rights and detailing issues to be addressed in the next state report. Through analytic coding of the normative indicators of the right to health in both state reports and concluding observations, this article provides an empirical basis to understand the policy effects of the CESCR monitoring process on state implementation of the right to health.

KEYWORDS:

• Right to health
• human rights monitoring
• Committee on Economic, Social and Cultural Rights
• United Nations
• accountability

Acknowledgements

The authors are grateful to: Maria Virginia Brás Gomes, Paul Hunt, Eibe Riedel and Margaret Satterthwaite for their insightful reflections on public health monitoring through human rights treaty bodies; to Neha Acharya, Hunter Baehren, Alison Domonoske, Robert Kohut, Hunter McGuire and Anisha Padma for their dedicated research assistance and yearlong effort to code state reports and concluding observations; and to Jodi Heymann, Scott Burris and Hanna Huffstetler for their thoughtful comments on previous drafts of this article.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1. Although China submitted two reports in this timeframe, this outlier was excluded from the analysis because one of its reports far exceeded the CESCR’s guidelines for report length (comprising 1218 paragraphs, compared to an average of 483 paragraphs among all other state reports).

2. The frequency of codes is divided by the number of paragraphs in each of the respective state reports, ensuring comparability across reports where the number of paragraphs differs across countries.

3. Seeking to alleviate this concern for non-reporting states in the years to come, the UN High Commissioner for Human rights recently ‘exposed’ those states that are delinquent in their reporting to treaty bodies and committed to making this information public.

4. While this article analyses select associations between concluding observations and state reports, the full dataset of codes for this project can be found at http://bmeier.web.unc.edu/files/2017/04/Right-to-Health_Monitoring_Dataset_04022017.xlsx, and the authors encourage other researchers to identify additional correlations across right to health indicators that may have been overlooked in the present analysis.