Gorik Ooms is a human rights lawyer and a global health scholar, Professor of Global Health Law & Governance at the London School of Hygiene & Tropical Medicine, Adjunct Professor at the Law Faculty of Georgetown University, and Visiting Professor at the Faculty of Medicine and Health Sciences of Ghent University. He is a member of the Lancet-O’Neill Institute and the Georgetown University Commission on Global Health and the Law.
The concept of ‘minimum core obligations’ was originally advanced by the United Nation’s Committee on Economic, Social and Cultural Rights (henceforth, ‘the Committee’) to address the pitfall of ‘progressive realisation’, stipulated in the International Covenant on Economic, Social and Cultural Rights (henceforth, ‘the Covenant’).
For the readers who are not familiar with this legal jargon:
- Human rights can be broadly (and somewhat artificially) divided into two families: freedoms and entitlements. Freedoms are the rights we have because our societies are obliged to not do something: they are (somewhat misleadingly) called negative rights, because the corresponding obligation is negative. For example, our freedom of expression relies on societies not interfering when we express our opinion, no matter how much our society dislikes our opinion. Entitlements are the rights we have because our societies are obliged to do something: they are called positive rights, because the corresponding obligation is positive. For example, our entitlement to education relies on our society collecting financial resources and subsidising schools. While the Universal Declaration of Human Rights contains human rights of both families, freedoms and entitlements were separated when the International Covenant on Civil and Political Rights and the Covenant were written. Freedoms were included in the International Covenant on Civil and Political Rights, entitlements were included in the Covenant.
- Freedoms are supposed to be cheap for societies, as it does not cost anything to not interfere with people when they express their opinion, practice their religion and so on. Obviously, it can cost quite a lot to establish and run a police and justice system that will protect these freedoms – the idea that freedoms are cheap is an illusion. Nevertheless, all states that ratified the International Covenant on Civil and Political Rights are expected to realise all freedoms immediately. Entitlements are understood to be quite expensive. Therefore, states that ratified the Covenant are expected to realise all entitlements progressively. While we all have a right to attain the highest standard of health we can attain, the corresponding obligation of our societies is “to take steps”, in accordance with “maximum available resources” (Article 2(1) of the Covenant). Therefore, while we all have the same right to health, in principle, the efforts we can claim (like prevention or treatment) depend on the wealth of the society we live in.
- States that ratified the Covenant accepted to be monitored by a commission of experts: that is essentially the job of the Committee. The Committee understood that the concept of progressive realisation, while reasonable, became an easy excuse for states that did not really try hard. Therefore, in its General Comment 3, the Committee argued that “a minimum core obligation to ensure the satisfaction of, at the very least, minimum essential levels of each of the rights is incumbent upon every State party.” The crucial argument is that “[i]f the Covenant were to be read in such a way as not to establish such a minimum core obligation, it would be largely deprived of its raison d’être”. In other words: if states can easily argue that they are willing but, unfortunately, unable to realise these entitlement rights, these rights are meaningless.
As soon as the concept of minimum core obligations gained currency, it divided scholars. One the one hand, it seems to contradict the principle that ‘ought implies can’, in Latin: ‘ad impossibilia nemo tenetur’. Nobody, no state, can be held to do the impossible. To avoid that, we could define minimum core obligations at the level of whatever the poorest state is reasonably able to do. But that would set a standard at such a low level that it would deprive the concept of minimum core obligations of its raison d’être: only a handful of countries would be challenged by such a standard. In General Comment 14, on the right to health, the Committee followed a different path. In paragraph 43, it established a list of minimum core obligations, which include food, water, sanitation, housing, essential medicines… In paragraph 44, it established a list of “obligations of comparable priority”. Then in paragraph 45, it avoids the ‘ought implies can’ pitfall, by referring to another element in Article 2(1) of the Covenant, name the obligation to take steps “individually and through international assistance and co-operation”. In other words, if some states are willing but unable to meet their minimum core obligations, other states are obliged to step in: the ‘ought implies can’ principle is applied to all states (that ratified the Covenant) collectively; together, they can. While I support that interpretation, in principle, as long as states needing assistance have no practical means to make wealthier countries provide the assistance they should provide, it does not solve the problem.
John Tasioulas’ working papers on Minimum Core Obligations and The Minimum Core of the Right to Health have many virtues. The most brilliant element, in my opinion, is the way he deals with the abovementioned dilemma.
The baseline is not ascertained by asking what is feasible for the most dysfunctional or ‘failed’ state. This would be comparable to specifying the obligations of parenthood by reference to what is feasible for the most incompetent of parents. (Minimum Core Obligations, pages 23-24.)
Where should we look for the baseline then? In recent years, the concept of ‘failed states’ has been replaced by ‘fragile states’, or ‘fragile situations’. The World Bank keeps a Harmonized List of Fragile Situations. The list includes countries or territories with a low Country Policy and Institutional Assessment (CPIA) score, and/or the presence of a United Nations and/or regional peace-keeping or political/peace-building mission during the last three years, if these countries or territories are eligible for support from the International Development Association (IDA). The IDA – also known as the ‘soft loan arm’ of the World Bank – supports ‘low income countries’: countries with a Gross National Income (GNI) of less than US$1005 per capita. So, a practical and sensible approach would be to look at the states that have a capacity immediately above these fragile states: countries that are about to ‘graduate’ from low income country status, with a better CPIA score and no recent peace-keeping or peace-building interventions. Senegal comes to mind: the GNI per capita is $950 according to the World Bank Atlas method. Or Cambodia, where the GNI per capita is $1140.
Looking at the level of ‘efforts to improve health’ (healthcare, water, sanitation, housing,…) these countries do provide would only be the first step. What we really want to know is the baseline these countries can provide.
Once we would have such a baseline established, a double question arises:
- What should the international community do with regards to countries that are willing but unable to achieve the baseline?
- What should the international community do with regards to countries that are able but unwilling to achieve the baseline?
Here again, Tasioulas’ brilliant analogy provides guidance (although I am not sure he would agree). Countries that are willing but unable to live up to their minimum core obligations should be treated like we would treat parents that are willing but unable to be responsible parents: the international community should assist them, not as a matter of charity but as a matter of justice. Countries that are able but unwilling to live up to their minimum core obligations should be treated like we would treat parents that are able but unwilling to be responsible parents. They should be treated as states that violate human rights on a scale – if measured by the consequences – that may exceed most acknowledged ‘crimes against humanity’. The international community has a responsibility to protect the people of these countries.