Can minimum core obligations survive a reasonableness standard of review under the optional protocol to the International Covenant on Economic, Social and Cultural Rights?

• Author: Forman, Lisa
• Position: 7th National Health Law Conference

IN 2013, AFTER TWENTY years of debate, an Optional Protocol to the International Covenant on Economic, Social and Cultural Rights came into operation, enabling the international justiciability of this Covenant's rights for the first time. Under this mechanism, individuals within ratifying countries can submit complaints to the Committee on Economic, Social and Cultural Rights alleging violations of Covenant rights, including health. The Protocol ushers in a new era for the international justiciability of this right, with the potential to advance its normative development and offer material gains to applicants. In this light, the Committee's enforcement may prove an important crucible for the evolution of rights like health. Yet the Committee's interpretive approach to this right may conflict with the adjudicative approach laid out in relation to the Protocol. For example, Protocol guidelines adopt a 'reasonableness approach' to adjudication (drawn from the South African Constitutional Court), which may contradict the Committee's core obligations approach to interpreting economic, social, and cultural rights. This analysis remains speculative given the nascent nature of the mechanism. Accordingly my paper will contrast the Committee's adjudicative rules against earlier interpretations of the right to health to analyze its potential approach to enforcement, and to consider the implications for individual complainants, domestic litigation, and indeed, the evolution of the right to health more generally.

EN 2013, APRES VINGT ans de debats, un protocole facultatif du Pacte international relatif aux droits economiques, sociaux et cultureis a pris forme. Pour la premiere fois, on prevoit la possibilite d'intenter des poursuites internationales aux termes de ce pacte. Selon ce mecanisme, les personnes qui habitent les pays signataires peuvent porter plainte aupres du Comite des droits economiques, sociaux et cultureis pour violation presumee des droits prevus dans le Pacte, y compris le droit a la sante. Le Protocole marque le debut d'une ere nouvelle : la possibilite d'intenter des poursuites internationales au nom de ce droit, avec possibilite de progres dans le developpement de normes et de gains financiers pour les demandeurs. Ainsi, l'application des droits que fera le Comite pourrait s'averer un important creuset pour Involution des droits comme le droit a la sante. Cependant, l'approche interpretative que prend le Comite face a ce droit peut entrer en conflit avec l'approche quasi judiciaire enoncee relativement au Protocole. Par exemple, les lignes directrices du Protocole adoptent une approche de > a l'arbitrage (tiree du Tribunal constitutionnel de l'Afrique du Sud/South African Constitutional Court), qui peut etre en contradiction avec les obligations premieres du Comite, a savoir interpreter les droits economiques, sociaux et cultureis. Cette analyse demeure cependant de l'ordre de la speculation etant donne la nature embryonnaire du mecanisme. Par consequent, ce texte mettra en opposition les regles d'arbitrage du Comite et les interpretations anterieures du droit a la sante afin d'analyser son approche possible a l'application des regles et de prendre en consideration les implications pour les plaignants, les litiges nationaux et, de fait, Involution du droit de la sante de maniere plus generale.

CONTENTS I. Introduction II. Disparities between economic, social, and cultural, and civil and political rights III. The Evolution of the Optional Protocol A. Negotiating history of the Optional Protocol B. Reasonableness as a response to concerns about justiciability IV. The South African reasonableness standard V. Reconciling reasonableness with a minimum core approach to the right to health VI. Conclusion I. INTRODUCTION

In 2013, an Optional Protocol to the International Covenant on Economic, Social and Cultural Rights (ICESCR) came into operation, which will allow people in ratifying states to lodge claims of violations of economic, social, and cultural rights with the United Nations Committee on Economic, Social and Cultural Rights (CESCR). (1) While CESCR's recommendations issued under the optional protocol will not be legally binding, they may offer material benefits for claimants and increased accountability for health policy and decision-making. The protocol will also provide an important new source of interpretation with the potential to advance understanding of economic, social, and cultural rights like health, and accordingly to influence courts and policy makers at multiple levels.

Yet the optional protocol took decades to pass given broad contestation over the justiciability of economic, social, and cultural rights. In an effort to resolve such concerns, the protocol, alone amongst similar mechanisms, specifies a standard of review based on reasonableness. This standard is not explicitly articulated in the ICESCR, and is drawn from South African jurisprudence on socioeconomic rights. South African courts interpret the reasonableness standard to require states to act reasonably to meet the basic needs entitlements in the national constitution. While judicial enforcement has enabled some progressive outcomes, the standard effectively turns rights like health, into more procedural than substantive guarantees. This outcome is animated in the South African Constitutional Court's rejection of minimum core obligations discussed in part IV below. (2) These are obligations that the CESCR interpreted into economic, social, and cultural rights to reflect their most essential prioritized aspect that should be protected from limitless restrictions in the name of progressive realization and resources. It is therefore a pressing question whether and how the Committee will incorporate a reasonableness standard into a core obligations-consistent framework around the right to health, particularly when it comes to resource-demanding claims that fall into the purview of basic needs. This paper will explore these questions in light of disparities at the United Nations between economic, social, and cultural rights on the one hand, and civil and political rights on the other; the passage of the optional protocol and reasonableness standard; the origins of the reasonableness standard in South African jurisprudence, and its emergence in CESCR interpretations. Finally, it will consider the potential implications of the reasonableness standard for a minimum core obligations approach to the right to health.

2. DISPARITIES BETWEEN ECONOMIC, SOCIAL, AND CULTURAL, AND CIVIL AND POLITICAL RIGHTS

   The 1948 Universal Declaration of Human Rights protects civil and political, as well as economic, social, and cultural rights, and was to be the basis of a single binding human rights treaty. (3) However, Cold War politics saw these sets of rights split into two separate treaties in the form of the International Covenant on Civil and Political Rights (ICCPR4) and the International Covenant on Economic, Social and Cultural Rights (ICESCR). (5) Contestation saw these treaties take almost 30 years to come into effect: both treaties were drafted in the 1950s, opened for signature in 1966, and came into effect in 1976. While the rhetoric of the indivisibility and interdependence of these two sets of rights pervades the international human rights system, there are significant institutional and textual differences when it comes to their interpretation and enforcement. For example, while both treaties came into effect in 1976, the Human Rights Committee (HRC), which oversees the ICCPR, was established that same year, as was the ICCPR's first optional protocol, which created an individual complaints mechanism for violations of civil and political rights. In contrast, it took 11 years before ICESCR had a comparable oversight body with the CESCR becoming operational in 1987, and 37 years before the ICESCR's optional protocol came into operation in 2013. These differences are both symbolic and practical: on the one hand, they belie the rhetoric of indivisibility between the two sets of rights. On the other, civil and political rights have had a several decades head-start in terms of jurisprudential development...