The proposed Sustainable Development Goals (SDGs) appear to be an improvement, or at least a thoughtful reaction, to some persistent criticisms of the Millennium Development Goals (MDGs). Among these criticisms was the relegation of TB to a non-enumerated “other disease” alongside mention of HIV/AIDS and malaria in MDG6.
To the extent that the MDGs were meant to “shape a broad vision to fight poverty in its many dimensions,” it seemed odd, to say the least, that the foremost disease of poverty—affecting 9 million people a year and resulting in 1.5 million deaths—was left out.1 In addition, the two MDGs that focused specifically on health took a decidedly vertical approach, with MDG5 focusing on maternal health and MDG6 on combating particular diseases. This criticism is old news now, but it’s worth mentioning because Goal 3 of the proposed SDGs takes a very different, more horizontal approach to health promotion; it calls for ensuring “healthy lives” and promoting “well-being for all.”2
What does this mean for TB’s place in the global development agenda? On one view, we might say that TB was neglected in the agenda even during the bad old days when vertical disease-specific approaches reigned supreme, as highlighted by its exclusion from MDG6. But let’s not get mired in the past. SDG 3.3 specifically mentions TB alongside HIV/AIDS and malaria. While this may not be cause for celebration, I think we can call it an upgrade. And to be fair, the UN has consistently highlighted progress made in prevention, diagnosis, and treatment of TB as central to the realization of MDG6.
But how is TB treated in comparison with other health issues that are mentioned by name in the proposed SDGs? I would argue it’s not treated with enough specificity to act as a meaningful inducement to improve current approaches to combating the disease. I note here the specific endorsement of the WHO Framework Convention on Tobacco Control in SDG target 3.a and the TRIPS Doha Declaration in SDG target 3.b.3 If we think the SDGs will shape the development agenda by focusing attention and resources, specific SDG endorsement may provide a boost to the use of these mechanisms and to further entrench the norms they establish. This leads me to ask, why is the WHO End TB Strategy not mentioned? What about the Stop TB Partnership Global Plan to Stop TB? Their absence is regrettable.
Let’s now consider how human rights are treated in the context of health. First, it’s worth mentioning that the term “human right(s)” appears only five times in Transforming our World: The 2030 Agenda for Sustainable Development.4 What about specific rights—does the term “right to health” appear in the SDGs? Sadly, it does not. Only a handful of rights are mentioned by name, including the rights to development, self-determination, an adequate standard of living, food, water and sanitation, good governance, and the rule of law. Oddly enough, the last two “rights” here—good governance and rule of law—are not traditionally understood as human rights at all; in fact, they do not appear in the three primary international human rights instruments—the Universal Declaration on Human Rights, the International Covenant on Civil and Political Rights and the International Covenant on Economic, Social and Cultural Rights. Moreover, even the non-binding Guiding Principles on Business and Human Rights are mentioned by name.5 This makes it all the more astonishing that a global agenda on development, driven by the UN, fails to acknowledge that health is a human right.
In 2004, the first UN Special Rapporteur on the Right to Health, Paul Hunt, wrote: “Underpinned by universally recognized moral values and backed up by legal obligations, international human rights provide a compelling normative framework for national and international policies designed to achieve the [MDGs].”6 I would go further and argue that human rights provide a compelling legal and normative framework upon which to build the global development agenda.
In this sense, the proposed SDGs represent a failure to integrate human rights, and the right to health in particular, into the global development agenda. For people with TB, and those that are particularly vulnerable to the disease, this may mean their rights go unacknowledged in the work of development. In essence, it will mean the powerful role human rights can play in combating TB—in fighting stigma and discrimination, in protecting privacy, in ensuring access to good quality testing and treatment—may remain untapped.
Brian Citro is a Clinical Lecturer in Law and Associate Director of the International Human Rights Clinic, University of Chicago Law School. He is also a Guest Editor of the forthcoming June 2016 issue of the Health and Human Rights Journal with a special section “TB and the Right to Health”. Submission of papers to the June 2016 issue are open until 30 September 2015.
1 WHO, Global Tuberculosis Report 2014, Executive Summary.
2 Transforming our World: The 2030 Agenda for Sustainable Development, Finalised text for adoption, August, 2015. Available at: https://sustainabledevelopment.un.org/content/documents/7891Transforming%20Our%20World.pdf
3 Ibid, p. 14
4 Ibid (omitting two times the term is used in the name of international instruments)
5 Ibid, para. 67.
6 UN Doc A/59/422, para. 48.