# Abstract [[Interesting Phrase]] Scholarly interrogations of power and politics are not endemic to the disciplines primarily tasked with exploring health policy and planning in the domestic or global domains. Scholars in these domains have come late to investigating power, prompted in part by the growing focus in domestic and global health research on the i==ntersections between governance, globalization and health inequities==. Recent prominent reports in this area increasingly point to human rights as important norms capable of responding in part to power differentials that sustain and exacerbate health inequities. Yet human rights law is not traditionally incorporated into health policy scholarship or education, despite offering important normative and strategic frameworks for public and global health, with distinctive contributions in relation to identifying and challenging certain forms of power disparity. This paper overviews two of these reports and how they see power functioning to sustain health inequities. It then turns to investigate what human rights and the right to health in particular may offer in addressing and challenging power in the health policy context. # Power, human rights and health policy “Yet human rights law and the right to health in particular offer important normative and strategic frameworks for public and global health, with the capacity to make considerable contributions to identifying and challenging power disparities.” (Forman, 2019, p. 492) “While not necessarily widely known outside the legal field, the legal specificity of the normative contribution of the right to health has been significantly enhanced by an important interpretation of the ICESCR article 12 issued in a 2000 General Comment by the United Nations Committee on Economic, Social and Cultural Rights. The Comment provides considerably greater interpretive specificity to the right to the highest attainable standard of health, defining its normative scope, identifying its essential elements, and demarcating the entitlements and correlative obligations that comprise its essence. While not a binding document, General Comment 14 is widely considered to be an authoritative interpretation of the right to health (Backman et al., 2008; Miller, Kismödi, Cottingham, & Gruskin, 2015; Tobin, 2012).” (Forman, 2019, p. 493) Perhaps the primary value of the right to health in international human rights law lies in the extent to which this normativity is linked to its codification within multiple international and regional legal instruments. WHO Constitution in 1946 The iconic Universal Declaration of Human Rights (UDHR) through article 25.1 The most authoritative iiteration of this (UDHR) rights appears in the 1976 International Covenant on Economic, Social and Cultural Rights The growing legalisation of these rights has enabled increasing numbers of individuals and civil society organisations globally to use the courts to challenge health policy-related decisions by governments and private actors (Gloppen, 2008; Hogerzeil, Samson, Casanovas, & Rahmani-Ocora, 2006; Yamin & Gloppen, 2011). There are therefore important downstream legal consequences from ratification which ensue less from benevolent state action than from active social movements able to access independent judiciaries willing to enforce these rights, and whose orders are respected and implemented by the government (Forman, 2013). In these circumstances, international human rights law offers powerful remedial tools such as litigation and rights-based advocacy to vulnerable populations claiming equitable access to healthcare services (Forman, 2013). These mechanisms permit social actors to access the immense potential of the normative and operational framework of the right to health (Tobin, 2012). “Moreover, to the extent that the right to [[health is]] itself a normative enterprise, it offers important tools to challenge and reconfigure health policy domain rooted in competing norms not conducive to health equity. The right to [[health is]], in this perspective, a critical tool for challenging power. Yamin makes this point forcefully: ‘Human rights are conceived of as rights precisely because they are entitlements that belong to humankind simply by virtue of being human. This fact carries extraordinary implications for the distribution of power in this world’ (Yamin, 1996, p. 403). For Yamin, this power vests in the extent to which rights ‘suggest, if not encode, certain definite conceptions of power, agency, causality and responsibility’ (1996, p. 403).” (Forman, 2019, p. 494) The potential function of rights frames becomes apparent in how it challenges the predominance of economic rationales and [[neoliberalism]] limitations in global health policy. It is argued that the function of neoliberal logics in the policy domain is totalizing, acting as a ‘deep normative core’ that overwhelmingly influences the nature and extent of policy preferences and solutions deemed useful for solving global health problems (Rushton & Williams, 2012). [[IMF and World Bank policies have increased poverty and inequality for poor countries due to their neoliberal views on trade, export-oriented growth model, finance and technologies|The impact of neoliberalism on health policy]] is viewed as extensive, from prioritizing technical and financial approaches to global health, commodifying essential health and social services, entrenching opposition to social spending, and amplifying the framing of health spending as an investment with ‘impressive returns’ (Forman et al., 2015; Jamison et al., 2013). Health as a human right challenges many of these outcomes and logics, framing individual health as a value in and of itself that demands appropriate resource allocations and which cannot be automatically trumped by competing private and public interests. Perhaps the most successful use of human rights logics (and strategies) has been in challenging the opposition to ensuring affordable AIDS treatment in low- and middle-income countries, resulting in transformative outcomes in global health policy and programs (Forman, 2008). In the aftermath of the AIDS treatment campaigns, the rhetoric of the right to health has become increasingly prevalent in global health policy statements from the social determinants of health to non-communicable disease to development, providing an important complement and challenge to purely economic and/or investment rationales. The relationship between the right to health and the exercise of power is therefore a complicated one, exemplified in Brazil for example, where use of the right to health in courts has tended to favour relatively privileged litigants (Ferraz, 2009), giving generous concessions to individual claims without consideration of their population impacts if generalised (Yamin & Gloppen, 2011). The Colombian experience is also troubling, with the highest per capita rate of right to health litigation in the world (3289 claims for each 1 million individuals, versus 206, 109, 29, 0.3, and 0.2 respectively for Brazil, Costa Rica, Argentina, South Africa, and India) (Moestad, Rakner, & Motta Ferraz, 2011, p. 282; Moestad et al., 2011). On the one hand, these cases are viewed as having detrimental impacts on existing inequities, giving generous concessions to individual claims without consideration of their impacts if generalised (Yamin, Parra-Vera, & Gianella, 2011). On the other hand, it is argued that high rates of right to health litigation in Colombia have not created these problems as much as responded to deeper institutional dysfunction and inequity arising out of a 1991 health sector reform process (Yamin et al., 2011). These contemporary contexts amplify rather than reduce the important role that human rights and the right to health may play in reinforcing the imperative for adequate and appropriate health funding at domestic and international levels, and in highlighting the individual and collective health and human rights needs that underscore such claims. # Conclusion Notwithstanding the limitations of the precision and enforceability of this right, its normative, empowering and challenging functions offer important tools to civil society, policy-makers, and researchers alike. Indeed, the participation of civil society and human rights actors in global health policy initiatives appears to be ==a crucial factor in creating persuasive and coercive pressures capable of fomenting political support for the right to health== in such contexts and ensuring its inclusion in such policies. Yet, for the legal framework of the right to health to make these contributions to health policy, ==it is equally important that the disciplinary silos that keep law and human rights hermetically sealed from other social science traditions be lowered and truly interdisciplinary approaches to health policy embraced and entrenched==. The challenge in this regard is double-fold: on the one hand, graduate programs in the health professions should include human rights training in their programs; on the other, legal and public health scholarship should more closely [[Power asymmetry|consider the way that power may function or distort outcomes in the human rights and health domain]]. # Citation To cite this article: Lisa Forman (2019) What do human rights bring to discussions of power and politics in health policy and systems?, Global Public Health, 14:4, 489-502, DOI: 10.1080/17441692.2017.1405457