Advancing the right to health through the Universal Periodic Review

The Universal Periodic Review (UPR) is a comprehensive, State-to-State peer review mechanism of the UN Human Rights Council which was introduced in 2006 to scrutinize the human rights record of every UN Member State. Designed to redress the perceived country bias and selectivity of the UN Commission on Human Rights, its predecessor, the recommendations that have emerged from the UPR has been criticized for being overly focused on civil and political rights to the detriment of economic, social, and cultural rights. This perception may have contributed to the relative under-use of this process in global health governance. However, following the adoption of the 2030 Sustainable Development Agenda, the UPR has started to attract increasing attention. NGOs, think tanks, UN agencies, and ‘interested’ Member States consider that it creates opportunities for a wide, multi-sectoral dialogue at both national and global levels, and that, under the 2030 Agenda, it can strengthen accountability, including for economic, social and cultural rights.

These shifts suggest that the UPR has an unfulfilled potential: to strengthen national processes of monitoring and accountability, increase international scrutiny of a range of issues, and focus attention on the realization of the right to health.

In 2015, WHO began a two-year project with the Human Rights Centre Clinic at the University of Essex to study how health has been addressed by the UPR. The project reviewed references to health in UPR recommendations to identify trends and patterns – how frequently health was mentioned, which health issues were mentioned most frequently, whether the issues mentioned were the most pressing, and what can be inferred from the ways in which States received and made recommendations. The aim was to determine whether the UPR offers opportunities to which international organizations such as WHO should give more attention. Could the UPR advance global health and human rights accountability? If so, how might WHO and other actors make the fullest use of it?

The report reviews the extent to which health was addressed during the first and second cycles of the UPR. It asks what could be done to increase the UPR’s influence on the right to health, and what role UN Specialized Agencies such as WHO might play. It is written primarily for health and human rights advocates, activists, and policymakers.

The report exposes some surprising trends that challenge current perceptions that the UPR has neglected economic, social, and cultural rights and more specifically health issues.

Indeed, even a relatively narrow reading of ‘health’, that excludes some of its underlying determinants, showed that nearly a quarter of all recommendations (in the first cycle) were health-related – a trend that continued in the second cycle.

The health-related recommendations showed widespread concern for gender-based violence2 and harmful practices. These comprised over one-third (33%), while issues relating to maternal, child, and adolescent health composed nearly a quarter (21%). On the other hand, mental health and HIV were not frequently raised, suggesting that health issues have not been scrutinized equally.

The same pattern was mirrored across all regions throughout the first cycle. Three topics of health were the subject of two-thirds of all recommendations associated with health. Some region-specific patterns also emerged. Nutrition figured highly among recommendations to southeast Asian countries and non-communicable diseases in the Western Pacific.

Similarly, certain issues were consistently underreported in recommendations across almost all other regions. Notwithstanding the regional trends above, under-reported issues included nutrition, water and sanitation, non-communicable and other communicable diseases, access to essential medicines, and mental health.