Article Title: Human Rights-based Approaches and the Right to Health: A Systematic Literature Review
Author: David Patterson
Journal: Journal of Human Rights Practice
Publication Year: 2024
Health is not merely a medical or service-delivery issue; it is increasingly recognized as an important domain for the realization of human rights. In recent decades, the relationship between human rights and health has developed into a significant field of inquiry in legal studies, public policy, and global health, while the “human rights-based approach” has attracted growing attention as a framework for designing, evaluating, and analysing policies and programmes related to the right to health. Yet the widespread use of this approach has not necessarily resulted in a single and coherent understanding of its foundations, components, and legal requirements.
Within interdisciplinary literature, concepts such as “human rights,” the “human rights-based approach,” and the “right to health” are sometimes used with different definitions and implications. These differences can blur the distinction between a legally binding framework and an approach that is merely ethical or policy-oriented. The article takes this problem as its point of departure and, through a systematic review of the existing academic literature, seeks to clarify how the human rights-based approach to health has been understood, defined, and applied in scholarly work.
The author demonstrates that differences in disciplinary perspectives and a lack of conceptual clarity can lead to imprecise uses of legal concepts and even to the neglect of some of the fundamental bases of the right to health. He further warns that repackaging the right to health as a human rights-based approach to health, if undertaken without sufficient attention to the legal foundations and requirements of that right, may result in certain essential elements being overlooked. Accordingly, the article emphasizes the need for greater precision in defining key concepts, more active involvement of human rights specialists in public health research, and stronger collaboration across the fields of law, human rights, and health sciences.
Introduction
In the introduction, the author opens the discussion by asking: “What is the current status of the human rights-based approach to health in international law?” He emphasizes that this question is relevant not only to human rights scholars and advocates, but also to public health specialists and those working in other related fields. The article specifically examines peer-reviewed literature published between 2000 and 2021 and distinguishes itself from earlier studies, which had generally either addressed rights-based approaches to development or discussed only selected major frameworks relating to human rights and health.
The author then identifies one of the central problems in this field: the absence of a single, universally agreed definition of the human rights-based approach and the differing understandings of concepts such as human rights and the right to health across disciplines. In his view, these differences are often left unstated, with the result that authors and readers may understand the same terms and concepts differently.
The introduction also cautions that some scholarly works do not accurately represent the legal foundations of the human rights-based approach to health. Accordingly, the article is structured first to explain the origins of this approach in the literature on human rights-based approaches to development, then to examine the evolution of its normative content, and finally, through a systematic review of the existing literature, to highlight disciplinary differences and the need for greater dialogue among law, human rights, and public health.
Origins of the Human Rights-based Approach in Development Literature
The second section of the article examines the origins and evolution of human rights-based approaches to development, showing that these approaches emerged within the broader expansion of the international human rights system following the establishment of the United Nations and the adoption of the Universal Declaration of Human Rights. The adoption of the Declaration on the Right to Development in 1986, followed by United Nations efforts to mainstream human rights throughout development policies and programmes, played an important role in consolidating this approach.
In the decades that followed, however, differing understandings emerged regarding the components of a rights-based approach, including participation, non-discrimination, accountability, empowerment, and access to information. In 2003, the United Nations Development Group introduced a common understanding built around three principal elements: that all development programmes should contribute to the realization of human rights; that human rights standards and principles should guide development programming; and that the capacities of rights-holders and duty-bearers should be strengthened.
This framework also emphasized principles such as universality, indivisibility, the interdependence of rights, participation, inclusion, accountability, and the rule of law. Despite its widespread use by United Nations agencies and programmes, the UN Common Understanding has not been formally endorsed by United Nations intergovernmental bodies.
In subsequent years, organizations such as the Organisation for Economic Co-operation and Development, the World Bank, and the United Nations Sustainable Development Group focused increasingly on the challenges involved in implementing and evaluating these approaches. The 2019 United Nations guidance described the human rights-based approach as a framework that is normatively grounded in international human rights standards and principles and operationally directed towards the promotion and protection of human rights.
This framework encompasses civil, political, economic, social, and cultural rights, as well as the right to development, and places particular emphasis on strengthening the capacities of rights-holders to claim their rights and of duty-bearers to meet their obligations. Over time, the approach has also been extended to newer areas such as climate change and has increasingly been regarded as a means of improving both the quality and equity of development policies.
The Normative Evolution of the Human Rights-based Approach to Health
The third section of the article traces the normative evolution of human rights-based approaches to health, beginning with the recognition of the right to health in the Universal Declaration of Human Rights and subsequently in Article 12 of the International Covenant on Economic, Social and Cultural Rights. The author shows that, from the 1980s onward, particularly through the work of Jonathan Mann in the field of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS), the relationship between health and human rights gradually entered the realm of international health policymaking.
The development of human rights guidelines on HIV/AIDS in the 1990s and the issuance of General Comment No. 14 by the Committee on Economic, Social and Cultural Rights in 2000 marked important steps towards clarifying the content of the right to health. Thereafter, the World Health Organization and other United Nations bodies sought to formulate the concept of a human rights-based approach to health, although these instruments did not always rely on identical definitions or components. During this period, key elements such as dignity, equality, non-discrimination, participation, accountability, transparency, and empowerment gradually came to be regarded as central components of the approach.
The article further demonstrates how this approach evolved from a broad human rights concept into a more operational framework for the design, implementation, and evaluation of health policies and programmes. Within this framework, identifying rights-holders and duty-bearers, and strengthening the capacities of both groups, assumes a central role. Concepts such as the progressive realization of the right to health, international assistance and cooperation, and the availability, accessibility, acceptability, and quality of health facilities, goods, and services also became incorporated into the normative content of the approach.
Its application in areas such as HIV/AIDS and, in particular, the reduction of preventable maternal mortality and morbidity contributed to the practical development of this framework. At the same time, the author emphasizes that different institutions and instruments have formulated the elements of the human rights-based approach to health in different ways, resulting in a certain degree of conceptual fragmentation. Nevertheless, these developments have helped to clarify some of the core elements of the human rights-based approach to health, even though differences remain among various institutions and instruments regarding its definition, scope, and constituent elements.
Methodology and Systematic Literature Review
The fourth section of the article is devoted to the systematic literature review and the study’s methodology. The author adopts a legal doctrinal perspective and uses the PRISMA approach for the systematic review, adapting it to the particular features of research in international law.
The search was conducted through the WorldCat library catalogues and covered English-language, peer-reviewed articles published between 2000 and 2021. The principal search terms were “rights-based approach” and “right to health.” After duplicate and irrelevant records had been removed, 60 articles were selected for textual analysis. Each article was then reviewed and scored against a set of pre-defined questions.
The author also used EPPI-Reviewer software to conduct automated full-text searches, analyse the data, and cross-check the results. Any discrepancies between the manual review and the software-generated results were subsequently reviewed and corrected.
In discussing the study’s limitations, the author notes the difficulty of confirming the legal qualifications of all authors, the restriction of the search to English-language articles, and the exclusive use of the WorldCat library catalogues. Nevertheless, he considers the resulting set of 60 articles sufficient to address the study’s principal research question.
Overall, this section demonstrates that the study was designed to provide a systematic and, as far as possible, objective picture of the existing literature on human rights-based approaches to health.
Key Findings: Conceptual Ambiguity, Legal Challenges, and Practical Potential
The fifth section of the article first addresses the differences between the language of law and that of health. The author explains that interdisciplinary dialogue on the right to health is complicated by conceptual differences among notions such as health, public health, healthcare, and the right to health. The review of the 60 articles shows that, although approximately two-thirds provided a definition of the human rights-based approach, only a small proportion referred directly to the UN Common Understanding. At the same time, most of the articles referred to elements such as non-discrimination, participation, accountability, transparency, rights-holders, and duty-bearers.
The author also shows that a variety of terms, including “human rights approach,” “rights-based framework,” and “human rights perspective,” have been used interchangeably. This terminological diversity, combined with differences in disciplinary backgrounds, constitutes one of the principal sources of conceptual ambiguity in the field.
Another part of the discussion focuses on the legal qualifications of the authors and the extent to which the studies draw on relevant legal frameworks. More than two-fifths of the articles had no author with a legal qualification or legal academic affiliation, while roughly one-fifth contained evident legal inaccuracies or omitted relevant legal instruments and frameworks. Some articles also failed to distinguish clearly between legally binding treaties and non-binding resolutions, or relied solely on ethical and policy-based sources.
The author emphasizes that such shortcomings may result in an incomplete understanding of the legal nature of the right to health, particularly in relation to issues such as States’ obligations, progressive realization, the allocation of scarce resources, and the role of international law and regional instruments. By contrast, some studies demonstrate that the proper use of a human rights framework can move health policymaking beyond the level of ethical recommendation and connect it to specific obligations incumbent upon States.
The author then highlights the practical value of the human rights-based approach across several dimensions: community participation, the principle of “leave no one behind,” the creation of an enabling environment for the realization of rights, the mutual reinforcement of economic and social rights, the provision of technical guidance for the implementation of health policies, and attention to the social determinants of health.
This approach can contribute to the empowerment of vulnerable groups, greater accountability, and stronger links between health policy, equality, and social justice. At the same time, the article also discusses a number of criticisms, including the difficulty of operationalizing the approach, the risk of inadequately translating legal concepts into the field of health, resistance among some actors, and the possibility that existing structures of power within academic disciplines may be reproduced.
Ultimately, the author argues that these criticisms do not provide grounds for abandoning the rights-based approach. Rather, they underscore the need for greater conceptual clarity, stronger interdisciplinary collaboration, and greater precision in the use of legal foundations.
Conclusion
In conclusion, the author emphasizes that divergent understandings of the human rights-based approach to health reflect the absence of a shared understanding of the concept itself and, more fundamentally, of the legal basis of the right to health in international law. Researchers should therefore define clearly the terminology and conceptual frameworks they employ and place the legal character of international treaties at the centre of this approach.
The article further notes that there is still no comprehensive and commonly accepted definition of the human rights-based approach to health, and that broader guidance from the Human Rights Council could help to clarify the concept. The author warns that merely repackaging the “right to health” as a “human rights-based approach to health” may result in essential elements of the right being overlooked.
To address the existing challenges, the article considers it necessary to strengthen interdisciplinary research and collaboration among specialists in human rights, law, and public health. The selection of peer reviewers with complementary expertise could also help reduce legal errors and omissions in research in this field. Finally, the creation and strengthening of interdisciplinary centres working at the intersection of health, law, and human rights is proposed as a means of overcoming the historical barriers to dialogue and mutual understanding among these disciplines.
Note
Patterson, David. (2024). Human Rights-based Approaches and the Right to Health: A Systematic Literature Review. Journal of Human Rights Practice, 16(2), 603-623. DOI: 10.1093/jhuman/huad063
