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The unconscionable health gap: a global plan for justice


Health has special meaning and importance to individuals and communities. WHO's Constitution states that “the enjoyment of the highest attainable standard of health” is a fundamental human right. International law, moreover, requires states to guarantee the right to health. The UN has specified the norms and obligations of the right to health, and appointed a Special Rapporteur.1 

Despite robust international norms, health disparities render a person's likelihood of survival drastically different depending on where she or he is born. WHO urges “closing the health gap in a generation” through action on the social determinants of health.2  As the Marmot Commission observed: “the social conditions in which people are born, live, and work are the single most important determinant of good or ill health.”3

International health assistance has quadrupled over two decades rising to US$21·8 billion in 2007.4 This level of funding might seem impressive but sits modestly beside the annual $1·5 trillion spent globally on military expenditures (2·43% of global gross domestic product), and $300 billion in agricultural subsidies. Foreign aid simply is not predictable and scalable to needs and often reflects donors' geostrategic interests rather than the key determinants of health. Developed countries recognise the health gap, but are resistant to taking bold remedial action.

If the health gap is unfair and unacceptable, how can the international community be galvanised to make a genuine difference? I propose an international call to action through a global plan for justice—a voluntary compact between states and their partners. Such a global plan for justice—a soft norm—could be achieved as easily as the passage of a World Health Assembly resolution that authorised the Director-General to negotiate funding, priorities, and implementation. It would not require a treaty or new governance structure, but would encourage WHO to exercise its constitutional powers and leadership.


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[A longer & more detailed version of this article can also be accessed online for free from the Harvard Law and Policy Review. See: 4 Harvard Law & Policy Review 271-294 (2010), available at]


1 Committee on Economic, Social and Cultural Rights. General comment 14: the right to the highest attainable standard of health. (accessed Jan 4, 2010).

2 World Health Assembly. Reducing health inequities through action on the social determinants of health. (accessed Jan 4, 2010).



Health Inequality