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Missed opportunities: human rights and the Commission on Social Determinants of Health

All those responsible for ‘Closing the gap in a generation’ (1), the report of the Commission on Social Determinants of Health, deserve great credit for placing equity at the heart of the debate about health. This excellent report highlights vital issues that are often neglected. Others have emphasised the report’s many strengths and virtues. I will not repeat, but firmly endorse, these richly deserved remarks. In this supportive context, I offer some constructive criticism of the report. My remarks aim to deepen and advance the report’s analysis and recommendations. ‘Closing the gap’ is a human rights report, no less than a publication of Amnesty International, Human Rights Watch or the UN Human Rights Council. It exposes systemic inequality and discrimination on a global scale – and the struggle against inequality and discrimination lies at the heart of human rights. One of the cardinal objectives of the United Nations – set out in the opening article of the UN Charter – is to promote and protect human rights without discrimination. Equality and non-discrimination are key elements of the Universal Declaration of Human Rights, the 60th anniversary of which we celebrate next month. The entire post-1945 international code of human rights rests upon the principles of equality and non-discrimination (2), and these issues form part of the report’s fabric. But the report is a human rights report in other ways, too. The report is about poverty – and today it is recognised that poverty is a human rights issue (e.g. see Office of the UN High Commissioner for Human Rights (3,4)). Numerous human rights bear upon poverty: the rights to basic shelter, food, education and health-related services, as well as classic civil and political rights, such as freedoms of expression, assembly and association. The report is replete with other important human rights issues, the right to safe working conditions, the right to a safe environment and so on. So, in an important sense, ‘Closing the gap’ is a human rights report. And yet, strangely, it isn’t! Despite the multiple, dense connections between social determinants and human rights, the report’s human rights content is disappointingly muted. The human rights analysis is not absent, but underdeveloped and understated. The last 10 years have witnessed some remarkable changes in our understanding of human rights and health but, with honourable exceptions, the