The shibboleth of human rights in public health
Authors: Lawrence O Gostin, Tamira Daniely, Hanna E Huffstetler, Caitlin R Williams, Benjamin Mason Meier
Journal: The Lancet Public Health (2020)

Human rights discourse has greatly influenced advocacy for justice in public health. Yet, beyond rhetorical claims, how can we employ human rights to achieve the aspiration of health with justice? Without human rights education to support public health practice, human rights have become a shibboleth of public health—raised frequently to signal devotion to justice, but employed rarely in policy, programming, or practice. As advocates respond to the public health injustices of populist nationalism during an unprecedented pandemic, human rights education must be an essential foundation to hold governments accountable for implementing rights to safeguard public health. Human rights are based on the powerful idea of equal dignity for all people. By establishing international standards for health justice, human rights have been transformed from the rhetorical to the actionable, as legal obligations have been developed to realise the highest attainable standard of health.1Gostin LO Sirleaf MVS Friedman EA Global health law: legal foundations for social justice in public health.in: Gostin LO Meier BM Foundations of global health and human rights. Oxford University Press, New York City, NY2020: 45-66Google Scholar Governments have established these universal rights under international law through the UN, beginning in the Universal Declaration of Human Rights and elaborated through an evolving range of health-related rights.2Gostin LO Meier BM Thomas R Magar V Ghebreyesus TA 70 years of human rights in global health: drawing on a contentious past to secure a hopeful future.Lancet. 2019; 392: 2731-2735Summary Full Text Full Text PDF PubMed Scopus (23) Google Scholar By structuring government responsibility for the promotion of health, international human rights law can translate calls for justice into public health action. Human rights law thus defines what governments must, or must not, do to ensure the equitable enjoyment of health for all. International human rights law obligates governments to realise specific rights through health policies, programmes, and practices.3MacNaughton G Duger A Translating international law into domestic law, policy, and practice.in: Gostin LO Meier BM Foundations of global health and human rights. Oxford University Press, New York City, NY2020: 113-132Google Scholar This national implementation of international law seeks to translate human rights law into public health realities, structuring fairness in health policy making and affording equal rights to health goods and services. Human rights empower civil society movements for health justice by proclaiming a global standard for physical, mental, and social wellbeing. Through this global standard, human rights require government action to respect human freedoms, protect individuals from harm, and fulfill basic needs. Seeking to ensure government action, a range of policy mechanisms exist to facilitate accountability for national implementation. By providing an external check on government efforts, these accountability mechanisms require government officials to show how they have either realised, or taken progressive steps to realise, their human rights obligations.4Meier BM Huffstetler H Bueno de Mesquita J Monitoring and review to assess human rights implementation.in: Gostin LO Meier BM Foundations of global health and human rights. Oxford University Press, New York City, NY2020: 155-176Google Scholar This process not only identifies which aspects of health policy are insufficient or harmful, but also provides opportunities for redress of health grievances, with human rights advocacy holding governments to account for implementing international human rights law.5Amon JJ Friedman E Human rights advocacy in global health.in: Gostin LO Meier BM Foundations of global health and human rights. Oxford University Press, New York City, NY2020: 133-154Google Scholar The current era—beset by a devastating pandemic and resurgent nationalism—has presented new challenges in facilitating government accountability to respect, protect, and fulfill human rights to advance public health. In response to the COVID-19 pandemic, some governments have violated human rights and undermined global governance, retrenching inward when global solidarity is needed most.6Pūras D Bueno de Mesquita J Cabal L Maleche A Meier BM The right to health must guide responses to COVID-19.Lancet. 2020; 395: 1888-1890Summary Full Text Full Text PDF PubMed Scopus (25) Google Scholar It is necessary for the next generation of leaders to reinvigorate the commitment to universal rights in public health, implement human rights through public health practice, and lead rights-based advocacy to ensure that governments are held accountable.7Gostin LO Constantin A Meier BM Global health and human rights in the age of populism.in: Gostin LO Meier BM Foundations of global health and human rights. Oxford University Press, New York City, NY2020: 439-458Google Scholar In preparing this next generation of leaders, human rights education provides a necessary foundation for public health engagement. The academic discipline of health and human rights amplifies demands for justice in public health, reimagining claims for health-related rights through health policy reforms. Schools of public health have increasingly developed courses on human rights, combining rigorous understanding of international legal standards with public health science. Public health programmes have long embraced a focus on justice, but recent curricular reforms seek to strengthen student understanding of human rights under international law, examining how the realisation of rights shapes the lived reality of health.8Meier BM Evans DP Kavanagh MM Keralis JM Armas-Cardona G Human rights in public health: deepening engagement at a critical time.Health Hum Rights. 2018; 20: 85-91PubMed Google Scholar These legal foundations provide an actionable basis for public health students to become human rights advocates, mainstreaming human rights norms and principles in public health policies, programmes, and practices. As public health responds to rising challenges of health injustice, in the pandemic response and beyond, strengthening human rights training for the next generation is imperative. Through shared competencies for human rights education in public health, faculty can promote common terminology and core knowledge. This standardised education on the inextricable linkages between human rights and public health provides a path for students to understand international law, facilitate human rights implementation, and hold governments accountable. By engaging public health students to place human rights at the centre of their careers, human rights advocacy can move beyond sloganeering to build a future for health with justice. We declare no competing interests.