Untangling equality and non-discrimination to promote the right to health care for all

Health and Human Rights

Volumn 11, Issue 2, 2009, Pages 47-63

  MacNaughton, Illian ^a  

^a UNIVERSITY OF OXFORD   (United Kingdom)

Author keywords

[No Author keywords available]

Indexed keywords

CONCEPTUAL FRAMEWORK; HEALTH CARE; HEALTH POLICY; HUMAN RIGHTS; LEGISLATION; SOCIAL SECURITY; UNITED NATIONS; WELFARE PROVISION;

ARTICLE; HEALTH CARE DISPARITY; HUMAN; HUMAN RIGHTS; LEGAL ASPECT; ORGANIZATION AND MANAGEMENT; PERSONHOOD; PUBLIC HEALTH SERVICE; SOCIAL JUSTICE; SOCIAL PSYCHOLOGY; SOCIOECONOMICS; UNITED NATIONS; LEGISLATION AND JURISPRUDENCE; PREJUDICE;

HEALTHCARE DISPARITIES; HUMAN RIGHTS; HUMANS; PERSONHOOD; PREJUDICE; PUBLIC HEALTH ADMINISTRATION; SOCIAL JUSTICE; SOCIOECONOMIC FACTORS; UNITED NATIONS;

EID: 77951688006     PISSN: 10790969     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Article

References (169)

1. One of the purposes of the United Nations is to promote respect for human rights without distinction as to race, sex, language, or religion. UN Charter (1945), Article 1(3). Available at http://www.un.org/en/documents/charter/. See also, UN Charter, Articles 55 and 56 (members pledge to take action to promote human rights for all without distinction).
2. See, for example, UN Human Rights Committee (HRC), General Comment No.18, Non-discrimination (1989), Compilation of General Comments and General Recommendations Adopted by Human Rights Treaty Bodies, UN Doc. No. HRI/GEN/1/Rev.6 (2003), p. 146.
3. The International Bill of Human Rights is composed of the Universal Declaration of Human Rights (UDHR), G.A. Res 217A (III) (1948) (avail-able at http://www.un.org/en/documents/udhr/index.shtml),
4. the International Covenant on Civil and Political Rights (ICCPR), G.A. Res. 2200A (XXI) (1966), (available at http://www2.ohchr.org/english/law/ccpr.htm),
5. the International Covenant on Economic, Social and Cultural Rights (ICESCR), G.A. Res. 2200A (XXI) (1966) (available at http://www2.ohchr.org/english/law/cescr.htm).
6. A. Lester (Lord Lester of Herne Hill) and S. Joseph, "Obligations of non-discrimination," in D. Harris and S. Joseph (eds), The International Covenant on Civil and Political Rights and the United Kingdom (Oxford: Clarenden Press, 1995), p. 565;
7. W. McKean, Equality and discrimination under international law (Oxford: Clarenden Press, 1983), p. 288.
8. See, for example, J. Morsink, The Universal Declaration of Human Rights: Origins, drafting and intent (Philadelphia, PA: University of Pennsylvania, 1999), p. 45;
9. P. Hunt, Reclaiming social rights: International and comparative perspectives (Aldershot: Dartmouth Publishing, 1996), p. 92;
10. A. F. Bayefsky, "The prin-ciple of equality or non-discrimination in interna-tional law," Human Rights Law Journal 11/1-2 (1990), p. 1, n. 1.
11. M. Craven, The International Covenant on Economic, Social and Cultural Rights: A perspective on its development (Oxford: Clarenden Press, 1995), p. 154.
12. These are the four grounds of discrimination prohibited by the UN Charter. See UN Charter (see note 1), Art. 1(3).
13. McKean (see note 4), p. 285.
14. See, for example, S. Fredman, Human rights trans-formed: Positive rights and positive duties (Oxford: Oxford University Press, 2008) (focusing on India and South Africa);
15. R. O'Connell, "From equality before the law to the equal benefit of the law: Social and economic rights in the Irish constitution," in O. Doyle and E. Carolan (eds), The Irish Constitution: Governance and values (Dublin: Thomson Round Hall, 2008), pp. 327-346 (focusing on Ireland);
16. D. Meyerson, "Equality guarantees and distributive inequity," Public Law Review 19 (2008), pp. 32-51 (focusing on Australia, Canada, and the United Kingdom);
17. M. Langford, "The justiciability of social rights: From practice to theory," in M. Langford (ed), Social rights jurisprudence: Emerging trends in international and com-parative law (Cambridge, UK: Cambridge University Press, 2008), pp. 24-27 (surveying both international and domestic cases).
18. See, for example, Fredman (see note 9), p. 176; O'Connell (see note 9), p. 344.
19. As of May 1, 2009, 160 countries had ratified the ICESCR. United Nations Treaty Collection, ICESCR. Available at http://treaties.un.org/Pages/ViewDetails.aspx?src=TREATY&mtdsg_no=IV-3&chapter=4&lang=en. The United States is one of the few countries that has not ratified the ICESCR. Additionally, rights to education and health or health care are recognized in the majority of national con-stitutions. Katarina Tomaševski, Special Rapporteur on the right to education, Annual Report Submitted in Accordance with Commission on Human Rights Resolution 2000/9, E/CN.4/2001/52 (January 11, 2001), paras. 66 and 67 (right to education constitutionally guaranteed in 142 countries);
20. E. D. Kinney and B. A. Clark, "Provisions for health and health care in the constitutions of the countries of the world," Cornell International Law Journal 37/2 (2004), p. 287 (67.5% of countries have provisions on health or health care).
21. See, for example, D. Rae, Equalities (Cambridge, MA: Harvard University Press, 1981), p. 21;
22. A. Phillips, Which equalities matter? (Cambridge, UK: Polity Press, 1999), p. 3.
23. D. Rae, Equalities (Cambridge, MA: Harvard University Press, 1981), p. 21;
24. A. Phillips, Which equalities matter? (Cambridge, UK: Polity Press, 1999), p. 27.
25. UN Human Rights Committee, General Comment No. 25, The Right to Participate in Public Affairs, Voting Rights and the Right of Equal Access to Public Service (Article 25), UN Doc. No. CCPR/C/21/Rev.1/Add.7 (1996), para. 21.
26. D. Rae, Equalities (Cambridge, MA: Harvard University Press, 1981), p. 21;
27. D. Rae, Equalities (Cambridge, MA: Harvard University Press, 1981), p. 41.
28. D. Rae, Equalities (Cambridge, MA: Harvard University Press, 1981), p. 22.
29. A. Phillips, Which equalities matter? (Cambridge, UK: Polity Press, 1999), p. 27.
30. D. Rae, Equalities (Cambridge, MA: Harvard University Press, 1981), p. 32.
31. D. Rae, Equalities (Cambridge, MA: Harvard University Press, 1981), p. 34-35.
32. D. Rae, Equalities (Cambridge, MA: Harvard University Press, 1981), p. 35.
33. D. Rae, Equalities (Cambridge, MA: Harvard University Press, 1981), p. 35.
34. D. Rae, Equalities (Cambridge, MA: Harvard University Press, 1981), p. 20.
35. See, for example, ICCPR (see note 3), Article 2 (prohibiting "distinctions of any kind, such as race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth or other status").
36. D. Rae, Equalities (Cambridge, MA: Harvard University Press, 1981), p. 45.
37. D. Rae, Equalities (Cambridge, MA: Harvard University Press, 1981), p. 47.
38. D. Rae, Equalities (Cambridge, MA: Harvard University Press, 1981).
39. D. Rae, Equalities (Cambridge, MA: Harvard University Press, 1981).
40. D. Rae, Equalities (Cambridge, MA: Harvard University Press, 1981), p. 48.
41. The term "discrimination," in both common usage and in domestic law generally, refers to suspect classifications or unreasonable status-based distinctions. See McKean (see note 4), p. 10 ("The word 'discriminate' taken alone is now commonly used in the pejorative sense of an unfair, unreason-able, unjustifiable or arbitrary distinction, not only in English but in other languages."). Black's Law Dictionary, for example, defines "discrimination" as "[t]he effect of a law or established practice that confers privileges on a certain class or denies privileges because of race, age, sex, nationality, religion, or handicap." B. A. Garner (ed), Black's Law Dictionary (St. Paul, MN: Thomson West Group, 8th ed., 2004), p. 500.
42. Fredman (see note 9), p. 176 ("the focus is on groups defined by race, gender or other status rather than their poverty or socio-economic position").
43. As Fredman (ibid.) acknowledges: "Prohibiting differentiation according to socio-economic status would inevitably lead to a concept of equality with distributive connotations, bringing a positive duty in its wake."
44. UDHR (see note 3), Articles 2 (non-discrimina-tion) and 7 (equality); ICCPR (see note 3), Articles 2 (non-discrimination) and 7 (equality); ICESCR (see note 3), Article 2 (non-discrimination).
45. Equality and non-discrimination are reiter-ated in many provisions of the Declaration. See, for example, UDHR (see note 3) Articles 1 ("All human beings are born free and equal in dignity and rights."), 10 ("Everyone is entitled in full equality to a fair and public hearing..."), 16 (Men and women "are entitled to equal rights as to marriage."), and 23 (Everyone "has the right to equal pay for equal work.").
46. UDHR (see note 3), Article 2.
47. UN Sub-Commission on the Prevention of Discrimination and the Protection of Minorities, First Session, UN Doc. No. E/C.4/52 (1947), p. 4.
48. UN Commission on Human Rights, Third Session, Summary Record of the Fifty-Second Meeting, UN Doc. No. E/CN.4/SR.52 (June 8, 1948), p. 5.
49. UN Commission on Human Rights, Third Session, Summary Record of the Fifty-Second Meeting, UN Doc. No. E/CN.4/SR.52 (June 8, 1948), p. 5.
50. J. Morsink, The Universal Declaration of Human Rights: Origins, drafting and intent (Philadelphia, PA: University of Pennsylvania, 1999), p. 113;
51. S. Skogly, "Article 2," in G. Alfredsson and A. Eide (eds), The Universal Declaration of Human Rights (The Netherlands: Kluwer Law International, 1999), p. 79;
52. M. Nowak, UN Covenant on Civil and Political Rights: CCPR commentary (Kehl, Germany: N.P. Engel, 1993), p. 52; but see Craven (see note 8), p. 175 (wealth "could hardly be considered 'suspect' ").
53. Interestingly, Article 1 of the American Convention on Human Rights (1969) has the same list of prohibited grounds of discrimination as the UDHR, the ICCPR, and the ICESCR, except that "property" is replaced by "economic status" in the English version. Article 1(1) of the Convention of the Rights of Migrant Workers and their Families (1990) lists both "economic position" and "property" as prohibited distinctions.
54. World Bank, World development report 2004: Making services work for poor people (Washington, D.C.: World Bank, 2003), pp. 38-39 (documenting countries in which rich people benefit more than poor people from public spending on health and education); see also Morsink (see note 5), p. 113 (substantial differ-ences in financing of education based on property tax in the US is discrimination based on property status).
55. J. Morsink, The Universal Declaration of Human Rights: Origins, drafting and intent (Philadelphia, PA: University of Pennsylvania, 1999), pp. 113-114.
56. ICCPR (see note 3), Article 2(1); ICESCR (see note 3), Article 2(2). The Committee on Economic, Social and Cultural Rights (CESCR) has urged governments to protect poor people from dis-crimination on the basis of "economic status." See, for example, CESCR, Concluding Observations of the Committee on Economic, Social and Cultural Rights, Canada, UN Doc. No. E/C.12.1/Add.31 (1998), para. 51. Oddly, the CESCR does not recognize that "property" in Article 2 of the ICESCR means "economic status" but has chosen to recognize "economic status" instead, under "other status." See CESCR, General Comment No. 20, Non-Discrimination in Economic, Social and Cultural Rights (Article 2, para. 2), UN Doc. No. E/C.12/GC/20 (2009), paras. 25 (property) and 35 (economic and social condition). This is unfortu-nate as the grounds explicitly enumerated are likely to require higher scrutiny than those covered by "other status."
57. W. Vandenhole, Non-discrimination and equality in the view of the UN human rights treaty bodies (Antwerpen/Oxford: Intersentia, 2005), p. 134.
58. UDHR (see note 3), Article 7. Article 7 provides in part: "All are equal before the law and are entitled without any discrimination to equal protection of the law."
59. J. Möller, "Article 7," in Alfredsson and Eide (see note 39), p. 153.
60. ICCPR (see note 3), Article 26.
61. M. Nowak, UN Covenant on Civil and Political Rights: CCPR com-mentary (Kehl, Germany: N.P. Engel), p. 462.
62. T. Choudhury, "The drafting of Article 26 of the International Covenant on Civil and Political Rights," European Human Rights Law Review 5 (2002), p. 602.
63. M. Nowak, UN Covenant on Civil and Political Rights: CCPR com-mentary (Kehl, Germany: N.P. Engel), p. 466.
64. M. Nowak, UN Covenant on Civil and Political Rights: CCPR com-mentary (Kehl, Germany: N.P. Engel), p. 466.
65. M. Nowak, UN Covenant on Civil and Political Rights: CCPR com-mentary (Kehl, Germany: N.P. Engel), p. 468.
66. M. Nowak, UN Covenant on Civil and Political Rights: CCPR com-mentary (Kehl, Germany: N.P. Engel), p. 466. p. 459.
67. Choudhury (see note 48), p. 598 ("equal protec-tion of the law and nondiscrimination were seen as fundamentally different notions").
68. ICCPR (see note 3), Article 2(1) (State Party to present Covenant undertakes to respect and ensure "the rights recognized in the present Covenant, without distinction of any kind").
69. M. Nowak, UN Covenant on Civil and Political Rights: CCPR com-mentary (Kehl, Germany: N.P. Engel), p. 466., p. 465.
70. T. Choudhury, "The drafting of Article 26 of the International Covenant on Civil and Political Rights," European Human Rights Law Review 5 (2002), p. 598.
71. T. Choudhury, "The drafting of Article 26 of the International Covenant on Civil and Political Rights," European Human Rights Law Review 5 (2002), p. 602.
72. HRC (see note 2). The UN Human Rights Committee has also issued general comments on Article 3 (equal right of men and women) and Article 14 (right to equality before the courts).
73. HRC (see note 2), para. 7.
74. "None of the [human rights] Committees has paid much attention to a conceptual distinction between the principles of equality and non-discrimi-nation." Vandenhole (see note 43), p. 86.
75. HRC (see note 2), para. 12.
76. HRC (see note 2), para. 12.
77. ICCPR (see note 3), Articles 2 and 26.
78. HRC, Concluding Observations of the Human Rights Committee, United States of America, UN Doc. No. CCPR/C/USA/CO/3/rev.1 (2006), para. 22.
79. HRC, Concluding Observations of the Human Rights Committee, United States of America, UN Doc. No. CCPR/C/USA/CO/3/rev.1 (2006), para. 22.
80. HRC, Concluding Observations of the Human Rights Committee, Brazil, UN Doc. No. CCPR/C/BRA/CO/2 (2005), para. 20.
81. HRC, Concluding Observations of the Human Rights Committee, Canada, UN Doc. No. CCPR/C/CAN/CO/5 (2006), para. 24.
82. HRC, Concluding Observations of the Human Rights Committee, New Zealand, UN Doc. No. A/50/40 (1995), para. 182.
83. HRC, Concluding Observations of the Human Rights Committee, Japan, UN Doc. No. CCPR/C/JPN/CO/5 (2008), para. 29.
84. International Convention on the Elimination of All Forms of Racial Discrimination, G.A. Res. 2106A (XX) (1965). Available at http://www2.ohchr.org/english/law/cerd.htm.
85. Convention on the Elimination of All Forms of Discrimination Against Women, G.A. Res. 34/180 (1979). Available at http://www2.ohchr.org/eng-lish/law/cedaw.htm.
86. CEDAW, General Recommendation No. 25, on Article 4, para. 1, of the Convention on the Elimination of All Forms of Discrimination against Women, on temporary special measures, UN Doc. No. HRI/GEN/1/Rev.7. (2004), p. 282, paras. 3 and 4.
87. CEDAW, General Recommendation No. 25, on Article 4, para. 1, of the Convention on the Elimination of All Forms of Discrimination against Women, on temporary special measures, UN Doc. No. HRI/GEN/1/Rev.7. (2004), paras. 8 and 9.
88. See CESCR (2009, see note 43); CESCR, General Comment No. 16, Article 3, The Equal Rights of Men and Women to the Enjoyment of All Economic, Social and Cultural Rights, UN Doc. No. E/C.12/2005/3 (2005).
89. Canadian Constitution Act 1982, Canadian Charter of Rights and Freedoms § 15(1).
90. Andrews V. Law Society of British Columbia (1989), 1 S.C.R. 143.
91. Law v. Canada (1999), 1 S.C.R. 497, para. 88 (revisiting Andrews).
92. Andrews V. Law Society of British Columbia (decision of Justice La Forest).
93. Andrews V. Law Society of British Columbia (decision of Justice La Forest).
94. S. Fredman, Discrimination law (Oxford: Oxford University Press, 2002), p. 70 (discussing non-enumerated groups attempts to define themselves as enumerated groups)
95. Gosselin v. Quebec (2002) 4 S.C.R. 429 (proving distinction on the enumerated basis of age, but failing to prove stereotype, prejudice, or disadvantage).
96. Kinney and Clark.The preamble to the WHO Constitution (1946) states, "The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition."
97. UDHR (see note 3), Article 25.
98. ICESCR (see note 3), Article 12(1).
99. ICESCR (see note 3), Article 12(2).
100. CESCR, General Comment No. 14, The Right to the Highest Attainable Standard of Health, UN Doc. No. E/C.12/2004/4 (2000).
101. CESCR, General Comment No. 14, The Right to the Highest Attainable Standard of Health, UN Doc. No. E/C.12/2004/4 (2000).
102. CESCR, General Comment No. 14, The Right to the Highest Attainable Standard of Health, UN Doc. No. E/C.12/2004/4 (2000).
103. CESCR, General Comment No. 14, The Right to the Highest Attainable Standard of Health, UN Doc. No. E/C.12/2004/4 (2000). 19, 34-36.
104. CESCR, General Comment No. 14, The Right to the Highest Attainable Standard of Health, UN Doc. No. E/C.12/2004/4 (2000) 12(b) (iii).
105. CESCR, General Comment No. 14, The Right to the Highest Attainable Standard of Health, UN Doc. No. E/C.12/2004/4 (2000). 19.
106. CESCR, General Comment No. 14, The Right to the Highest Attainable Standard of Health, UN Doc. No. E/C.12/2004/4 (2000).
107. CESCR, General Comment No. 14, The Right to the Highest Attainable Standard of Health, UN Doc. No. E/C.12/2004/4 (2000).
108. CESCR, Concluding Observations of the Committee on Economic, Social and Cultural Rights, Colombia, UN Doc. No. E/C.12/1/Add.74 (2001), para. 26.
109. CESCR, Concluding Observations of the Committee on Economic, Social and Cultural Rights, Colombia, UN Doc. No. E/C.12/1/Add.74 (2001), para. 26.
110. CESCR, Concluding Observations of the Committee on Economic, Social and Cultural Rights, Ecuador, UN Doc. No. E/C.12/1/Add.100 (2004), paras. 34, 36, 54.
111. CESCR, Concluding Observations of the Committee on Economic, Social and Cultural Rights, Canada, UN Doc. No. E/C.12.CAN/CO/4 (2006), paras. 15 and 52.
112. CESCR, Concluding Observations of the Committee on Economic, Social and Cultural Rights, United Kingdom, UN Doc. No. E/C.12/ GBR/CO/5 (2009), para. 32.
113. CESCR, Concluding Observations of the Committee on Economic, Social and Cultural Rights, United Kingdom, UN Doc. No. E/C.12/ GBR/CO/5 (2009), para. 32.
114. CESCR, Concluding Observations of the Committee on Economic, Social and Cultural Rights, United Kingdom, UN Doc. No. E/C.12/ GBR/CO/5 (2009), para. 32.
115. CESCR, Concluding Observations of the Committee on Economic, Social and Cultural Rights, Australia, UN Doc. No. E/C.12/AUS/CO/4 (2009), para. 28.
116. CESCR, Concluding Observations of the Committee on Economic, Social and Cultural Rights, Australia, UN Doc. No. E/C.12/AUS/CO/4 (2009), para. 28.
117. CESCR, Concluding Observations of the Committee on Economic, Social and Cultural Rights, Australia, UN Doc. No. E/C.12/AUS/CO/4 (2009), para. 28.
118. CESCR, Concluding Observations of the Committee on Economic, Social and Cultural Rights, Australia, UN Doc. No. E/C.12/AUS/CO/4 (2009), para. 28.
119. CESCR, Concluding Observations of the Committee on Economic, Social and Cultural Rights, Australia, UN Doc. No. E/C.12/AUS/CO/4 (2009), para. 28, para. 8. Formal equality is equality is law. For example, laws must not deny equal social security to women on the basis of marital status. Substantive equality is equality in fact. Achieving equality in fact will require more than repealing laws that deny equality. It will require laws that prohibit discriminatory practices, and in some cases may require special measures, such as affirmative action, until de facto equality is achieved.
120. Formal equality is equality is law. For example, laws must not deny equal social security to women on the basis of marital status. Substantive equality is equality in fact. Achieving equality in fact will require more than repealing laws that deny equality. It will require laws that prohibit discriminatory practices, and in some cases may require special measures, such as affirmative action, until de facto equality is achieved.
121. See, for example, P. Hunt, UN Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, Annual Report to the Human Rights Council, UN Doc. No. A/HRC/7/11 (2008), para. 15. Available at http://daccess-dds-ny.un.org/doc/UNDOC/GEN/G08/105/03/PDF/G0810503.pdf?OpenElement.
122. The Special Rapporteur understood the health concept of "equity" - meaning equal access to health care according to need - to be akin to equality and non-discrimination in human rights law.
123. The Special Rapporteur understood the health concept of "equity" - meaning equal access to health care according to need - to be akin to equality and non-discrimination in human rights law.
124. United Nations Treaty Collection;
125. see ICESCR Article 12(2) (d) (State parties shall take steps necessary for "the creation of conditions which would assure to all medical service and medical attention in the event of sickness").
126. United Nations Treaty Collection, ICCPR, 164 parties as of April 14, 2009. Available at http://treaties.un.org/Pages/ViewDetails.aspx?src=TREATY&mtdsg_no=IV3&chapter=4&lang=en.
127. See, for example, P. Hunt, UN Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, Annual Report to the Commission on Human Rights, UN Doc. No. E/ CN.4/2006/48 (2006), para. 20. Available at http://www2.ohchr.org/english/bodies/chr/sessions/62/listdocs.htm.
128. See, for example, P. Hunt, UN Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, Annual Report to the Commission on Human Rights, UN Doc. No. E/ CN.4/2006/48 (2006), para. 20. Available at http://www2.ohchr.org/english/bodies/chr/sessions/62/listdocs.htm.
129. See, for example, P. Hunt, UN Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, Annual Report to the Commission on Human Rights, UN Doc. No. E/ CN.4/2006/48 (2006), para. 20. Available at http://www2.ohchr.org/english/bodies/chr/sessions/62/listdocs.htm.
130. See ICESCR, Article 13(2) (e) (parties to the Covenant agree to actively pursue the development of a system of schools).
131. Brown v. Board of Education, 347 US 483 (1954). Available at http://supreme.justia.com/us/347/483/.
132. A. M. Gross, "The right to health in an era of privatisation and globalisation: National and international perspectives," in D. Barak-Erez and A. M. Gross (eds), Exploring social rights: Between theory and practice (Portland, OR: Hart Publishing, 2007), pp. 289-339.
133. D. McCoy, "Financing health care: For all, for some, for patients or for profits?" in The NorthSouth Institute, The global right to health: Canadian development report 2007 (Ottawa: Renouf Publishing, 2006), pp. 59-83, 66.
134. D. McCoy, "Financing health care: For all, for some, for patients or for profits?" in The NorthSouth Institute, The global right to health: Canadian development report 2007 (Ottawa: Renouf Publishing, 2006), p. 70.
135. People's Health Movement, Medact and Global Equity Guage Alliance, Global health watch 2005-2006 (London/New York: Zed Books, 2005), p. 63.
136. People's Health Movement, Medact and Global Equity Guage Alliance, Global health watch 2005-2006 (London/New York: Zed Books, 2005), 64-65.
137. Fundar-Centro de Análisis e Investigación, International Budget Project and International Human Rights Internship program, Dignity counts: A guide to using budget analysis to advance human rights (2004), p. 10. Available at http://www.iie.org/IHRIP/Dignity_Counts.pdf. The system is considerably more complicated than presented here.
138. A. González Rossetti, "Change teams and vested interests: Social security reform in Mexico," in R. Kaufman and J. Nelson, Crucial needs, weak incentives: Social sector reform, democratization, and globalization in Latin America (Baltimore, MD: John Hopkins University Press, 2004), pp. 70-71 (identifying two additional tiers, private health care for the wealthy and a complete lack of health care for a rural population of mostly indigenous people).
139. A. González Rossetti, "Change teams and vested interests: Social security reform in Mexico," in R. Kaufman and J. Nelson, Crucial needs, weak incentives: Social sector reform, democratization, and globalization in Latin America (Baltimore, MD: John Hopkins University Press, 2004), pp. 10-11.
140. A. González Rossetti, "Change teams and vested interests: Social security reform in Mexico," in R. Kaufman and J. Nelson, Crucial needs, weak incentives: Social sector reform, democratization, and globalization in Latin America (Baltimore, MD: John Hopkins University Press, 2004), pp. 50-51.
141. A. González Rossetti, "Change teams and vested interests: Social security reform in Mexico," in R. Kaufman and J. Nelson, Crucial needs, weak incentives: Social sector reform, democratization, and globalization in Latin America (Baltimore, MD: John Hopkins University Press, 2004), p. 13.
142. D. Elson, Budgeting for women's rights: Monitoring government budgets for compliance with CEDAW (New York: UNIFEM, 2006), p. 25 (relying on Dignity Counts).
143. See J. Frenk and O. Gómez-Dantés, "Ideas and ideals: Ethical basis of health reform in Mexico," Lancet 373/9673 (April 25, 2009), pp. 1406-1408 (explaining that the intent of the second tier of the health care system was to provide health care protection to 50 million people who had none).
144. See CESCR (2009), para. 13 (justification for differentiation based on prohibited grounds must be reasonable and objective; measures adopted must be proportional to a legitimate aim that is compatible with the Covenant).
145. Corte Constitutional de la República de Colombia, Sala Segundo de Revisión (2008), Constitutional Court of Colombia, Sentencia No T-760 de 2008.
146. A. Yamin and O. Parra-Vera, "How do courts set health policy? The case of the Colombian Constitutional Court," PLoS Medicine 6/2 (2009). Available at http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1000032
147. Sentencia No T-760, p.185 (continuance of two systems of health care violates the constitutional right to equality).
148. See Chaoulli v. Quebec Attorney General (2005) 1 S.C.R. 791, para. 78 (discussing national public health care systems that allow some people to opt out by purchasing private insurance).
149. The US Supreme Court decided in San Antonio Independent School District v. Rodriguez, 411 U.S. 1 (1973), that there is no right to education under the US Constitution and, therefore concluded under a minimal level of review that the highly unequal school financing system at issue was not a violation of equal protection.
150. Brigham V. State of Vermont, 166 Vt. 246 (1997).
151. National Access Network, State By State. Available at http://www.schoolfunding.info/states/state_by_state.php3 (listing state cases challenging school funding systems).
152. Mashava V. President of the Republic of South Africa, Case CCT 67/03 (September 2, 2004).
153. Mashava V. President of the Republic of South Africa, Case CCT 67/03 (September 2, 2004).
154. Mashava V. President of the Republic of South Africa, Case CCT 67/03 (September 2, 2004).
155. CESCR (2009, see note 43), para. 34: CESCR, General Comment No. 13, The Right to Education (Article 13 of the Covenant), UN Doc. No. E/C.12/1999/10 (1999), para. 35; HRC, Concluding Observations of the Human Rights Committee, Suriname, UN Doc. No. CCPR/CO/80/SUR (2004), para. 19; HRC, Concluding Observations of the Human Rights Committee, Mongolia, UN Doc. No. CCPR/C/79/Add.120 (2000), para. 15.
156. R. O'Connell, "From equality before the law to the equal benefit of the law: Social and economic rights in the Irish constitution," in O. Doyle and E. Carolan (eds), The Irish Constitution: Governance and values (Dublin: Thomson Round Hall, 2008), p. 337.
157. For example, Reynolds v. Sims, 377 U.S. 533 (1964) (one person, one vote ruling for state legislatures).
158. M. Davis, "The spirit of our times: State constitutions and international human rights," New York University Review of Law and Social Change 30 (2006), pp. 372-374 (documenting positive rights to welfare, health, education, and work in state constitutions).
159. C. Albisa and J. Schultz, "The United States: A ragged patchwork," in The justiciability of social rights: From practice to theory, p. 245.
160. C. Albisa and J. Schultz, "The United States: A ragged patchwork," in The justiciability of social rights: From practice to theory, pp. 245-246 (suggesting strategies for asserting health care rights under state constitutions).
161. World Bank, World development report 2004: Making services work for poor people (Washington, D.C.: World Bank, 2003), pp. 38-39c
162. See C. Newdick, "Accountability for rationing - theory into practice," Journal of Law, Medicine and Ethics 33/4 (2005), p. 662
163. see, for example, Rogers V. Swindon Primary Care Trust (2006) EWCA Civ. 392 (plaintiff was denied the Herceptin recommended by her doctor, although the drug was funded for all those who had doctor's recommendations in other health care districts). There is no positive right to equality in the UK; therefore, the plaintiff claimed that denial of the drug was arbitrary.
164. V. Afonso da Silva and F. Vargas Terrazas, "Claiming the right to health in Brazilian courts: The exclusion of the already excluded," Social Science Research Network (2008). Available at http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1133620
165. see also, F. F. Hoffmann and F. R. N. M. Bentes, "Accountability for social and economic rights in Brazil," in V. Gauri and D. M. Brinks (eds), Courting social justice: Judicial enforcement of social rights in the developing world (Cambridge, UK: Cambridge University Press, 2008), pp. 142-143 (middle class has appreciably better access to courts than poorer class because they may bring right to health claims via private counsel).
166. S. Gloppen, "Litigation as a strategy to hold governments accountable for implementing the right to health" Health and Human Rights: An International Journal 10/2 (2008), pp. 21, 25, and 31-32.
167. A. M. Gross, "The right to health in an era of privatisation and globalisation: National and international perspectives," in D. Barak-Erez and A. M. Gross (eds), Exploring social rights: Between theory and practice (Portland, OR: Hart Publishing, 2007), pp. 337-339
168. see, for example, Soobramoney V. Minister of Health, KwaZuluNatal (1998) 1 South African Law Report 765 (South African Constitutional Court), para. 33 (to manage limited resources, sometimes state will need "to adopt a holistic approach to the larger needs of society rather than to focus on the specific needs of particular individuals").
169. R. O'Connell, "From equality before the law to the equal benefit of the law: Social and economic rights in the Irish constitution," in O. Doyle and E. Carolan (eds), The Irish Constitution: Governance and values (Dublin: Thomson Round Hall, 2008), p. 333 (suggesting this avenue for interpreting the Irish Constitution).