Last month, a new issue appeared of the journal Health and Human Rights. It deals with international cooperation and health care obligations. Some of the articles I find not very innovative; they argue that international human rights law, in particular the International Covenant on Economic, Social and Cultural Rights, leads to an obligation of ‘rich’ countries to contribute to health care world-wide – a so-called ‘extra-terrotorial obligation’). The general article 2 of the covenant says that “each State Party to the present Covenant” must “take steps, individually and through international assistance and co-operation”, “to the maximum of its available resources” “to achieving progressively the full realization of the rights recognized in the present Covenant”. This article, in particular the “through international assistance and co-operation” clause, can then be applied to the right “to the enjoyment of the highest attainable standard of physical and mental health”, featured in article 12.
Among academics and NGOs working on economic, social and cultural rights (for example in the ETO-consortium) this is a standard line of argument. It gets more interesting when attempts are made to see what extra-territorial obligations might actually mean in practice). An article by Gorik Ooms and Rachel Hammonds argues that an ‘adequate package of health care interventions’ (the ‘core content’ of the right to health) should where necessary be provided by international assistance. According to World Health Organization standards, this minimum costs (only!) US $ 40 per person per year. Part of this could be provided by the government of the country in question. If government income is 20 % of GDP (apparently considered a reasonable amount by international financial institutions) and 15 % of their budget goes to the health sector (a percentage African governments have committed to), 3 % of GDP would go to this minimum package. Inhabitants of countries where this 3 % is less than US $ 40 would qualify for international assistance. A calculation can then be made of the total cost to fulfill the international obligation under this scheme: US $ 49 billion, just over 0,1 % of the combined GDP of the high-income countries. This compares with a current level of development assistance for health of US $21·8 billion (2007 figure).
Obviously, a series of objections and obstacles would have to be overcome to create a reasonably effective global health justice system. Still, this approach – which could possibly be applied to other social-economic rights as well – seems to be a more reasonable way of calculating the level of international financial transfers than the 0,7 % of GDP that was once set, of which nobody knows anymore why it must be 0,7 %.