From a Bounded View to a Globalized Perspective: Considerations on a Human Right to Health

: In this essay, I will argue that even when there are important difficulties concerning the possibility of a human right to health that must be ad-dressed, it is nonetheless a better strategy for promoting global health than the ones relying entirely on States ’ duties or on a duty to charity. The idea that there is such thing as a right to health is very controversial. One of the most important difficulties has been to determine if a right to health can be considered as a human right, as an institutional right or just as a humanitarian charitable cause.Which of these we take it to be will shape the possibility of a global demand for health. The idea that there is such thing as a right to health is very controversial, and “ there is no single universally agreed-upon interpretation of the right to health. of the most important difficulties has been to determine if a right to health can be considered as a human right, as an institutional right or just as a humanitarian charitable cause. Which of these we take it to be will shape the possibility of a global demand for health.

ing medicalcare for all, assuring the improvement of environmental conditions, reducing the stillbirth-rate and infant mortality,a nd with prevention and treatment of epidemic, endemic, occupational and other diseases (United Nations,Treaty Series,vol. 993,art.12).
Despite being recognizedassuch by the UniversalDeclaration and being reaffirmedb yt he ICESCR, there have been manya rguments that intend to show that both formulations are too vague, too demanding or even damaging ( Wolff 2012a), and that consequently, they do not offer ag ood account of what a human right to health could be. Although the ICESCR offers us am ore precise account,b othf ormulations face several problems and have been considered as posing as purious demandt hat cannot be legitimatelyc onsidered as a human right.
In this essay, Iwill arguethatevenwhen there are importantdifficulties concerningt he possibility of ah uman right to health that must be addressed, it is nonetheless ab etter strategyf or promotingg lobal health than the ones relying entirelyo nS tates' duties or on ad uty to charity.T os how this, Iw ill present two strongo bjectionst hat have been made against the possibility of ah uman right to health. The first corresponds to OnoraO ' Neill, who has pointed out that it is incoherent to propose ah uman right to health because to every right there must be ac orrespondentd uty and in this case, it is not possiblea llocate who should bear the correspondent duties.The second belongst oGopal Sreenivasan. Although he has presented different arguments to reject the possibility a right to health, here Iwill discuss onlyh is argument regardingt he 'doubly universal' condition for every human right,a nd how this condition cannot be met by ap retendedr ight to health. After reviewing these objections, Iw ill explain what would be astrategy that relies on aduty to charity for the global promotion of help. Iwill also arguehow this contrast allows us to appreciate the advantages of ah uman rights narrative.
Onora O'Neill'so bjection to ah uman right to health There are two main arguments that O'Neill poses against the possibility of a human right to health. The first stresses the interdependence between rights and obligations and denounces the incoherence of defending ah uman right to health that aims to be universallyclaimable, but that cannota llocate who is responsiblefor the claimed demands. The second argument focuses on the distinction between liberty and welfarerights to claim thataright to healthisproperly awelfarer ight and thata ssuch,i tc annot be regarded as ah uman, pre-institutional right.T ogether,t hese two arguments constituteastrongo bjection to the defendants of ah uman right to health.
Firstly, Iw ill address the argument about the interdependence between rights and obligations. O'Neill contends thats ome discoursesa bout human rights have abused ac osmopolitan rhetoric making rights the center of the discussions about justicea nd leaving behind concerns about the allocation of the correspondent obligations. After all, it is more promotable and certainlye asier to propose thats ome demand must be universallyc laimable as ah uman right than stating preciselyhow-and especially, by whom-that demand is supposed to be met.O'Neill says that: … onlyi fw ej ettison the entiren ormativity understanding of rights in favour of am erely aspirational view,can we breakthe normative link between rights and their counterpart obligations.Ifwetakerights seriouslyand see them as normative rather than aspirational, we must take obligations seriously. (O'Neill 2016,p .196) It would be one thing to defend ah uman right to healthi fw eo nlyp retend to point out an aspirationalo rh umanitarian goal thatw ould servea sa ni deal, without anyk ind of normative force-but this weak scenario is not what is expected from ahuman right to health. Forexample, the ICESCR has made it possible-through the Committeeo nEconomic, Social and Cultural Rights (CESC)to receive reports from its State partiesand to make some suggestions about what they can improve ( Gostin 2014,p .2 52).A lthough considered an important step, this has alsobeen regarded as insufficient.The main problem with focusingtoo much on the rights and leaving behind their counterpart obligations is that even if therei sa ni ndividual claim to health, there is no one that is accountable for meeting that demand-and aftera ll, 'rights are demands on others' (O'Neill 2000,p .1 26). From O'Neill'sr eading, it is incoherent to think about ah uman right to health if we cannot offer an account of who is responsible for what is being claimed. But this question about who is responsible in the specific case of ahuman right to health is what leads us to the second part of O'Neill'sobjection: the distinction between liberty and welfare rights.
Liberty rights have also been named 'civil and political rights' (Gostin 2014, p. 246) and 'negative rights' (Nagel 2005,p.127), because they onlydemand that others do not interferewith these rights.Ithas also been assumed that these liberty rights, preciselyb ecause they are negative rights, demand "no positive action or resourcec ommitments from government." (Gostin 2014,p .2 46) In contrast,w elfarer ights have been considered ak ind of 'positive right',b ecause they demand more thanj ust an on-interferencep olicy from States and from the international community.Welfare rights are also identified as 'economic, social and culturalrights' and, unlike liberty rights, it has been assumed thatthey implyamuch biggercommitment on behalf of the State (bothinterms of positive action and resources) in order to meet the claims of welfarer ights.
The idea that one of the most striking differencesb etween liberty and welfare rights is the level of commitment that is being asked from the States has been widelycriticized. If we think of this contrast in terms of individual liberties and socioeconomic rights to public goods, this certainlycan lead us towardsthis conclusion-but "the idea thatc ivil and political rights imposen oa ffirmative State obligations, while socioeconomic rights imposecosts on societies, is vastly oversimplified."¹ Departing from this explanation of the differenceb etween liberty and welfare rights in terms of positive or negative rights, and of the commitment assumed by the States, O'Neill explains the difference between liberty and welfare rights² in terms of aright'suniversality and its independence from anygiven institution. Liberty rights have auniversal scope, regardingboth their right-holders and their duty bearers.That is, anyhuman being has aright to freedom of speech or to freedom of religion. Equally, every human being has the duty to respect these rights of others, and States must assure that this condition is met.L iberty rights assume the whole international community botha st he right-holder and the duty-bearer.W elfare rights,h owever,c annot have this universal scope. Even if we consider that every human being has the right to health, its correspondent duty cannot alsorelyonthe whole international community.Providing health care, or preventive care such as vaccinations, is not at ask that can be  Form ored etail on how this has been used as an argument against the possibility of welfare rights (and especiallya gainst ah uman right to health), see: John Tasioulas and Effy Vayena (2015a). They arguet hat there is not an antagonistic relationb etween these rights, and that both liberty and welfare rights, require an important commitment in resources and in positive action by the government.  This distinction has also been explained as ac ontrast between individuala nd collective rights.T he existenceo fc ollective rights has been widelyd iscussed (Spicker 2001,p .9 ). Even if O'Neill does not appeal to the distinctionb etween individual and collective rights to explain liberty and welfarerights,Iconsider that this is also an important distinction because both pairs of rights have been regarded as equivalent-liberty rights beingi ndividual rights, whilew elfare rights arecollective rights.Ifweaccept that for somethingtocount as aright it must be individuallyclaimable, this equivalency would provetobedetrimentaltothe defense of welfare rights and thus,toahuman right to health. This has raised arguments that there arenocollective rights and that therec annot be individual claims to collective public goods such as health or food. Thus,t his individualist featureo fh uman rights has been important to distinguish what can count as ah uman right and what should be excluded. Form ored etail, see: John Tasioulas and Effy Vayena (2015a;2015b). done by every individual around the world. Forconditions of health to be met it is necessary to appeal to certain institutions-in this case, States as primary agents of justicea nd other institutions like hospitals or clinics, as secondary agents of justice.³ ForO'Neill, the right to health cannot be regarded ahuman right because it does not have au niversal scope regardingt he duty bearers;t hat is, we cannot allocate its correspondent duties to the international community even if we want to ascribe the claimable individual right to every human being.M oreover, it cannot be ah uman right because it necessarilyr elies on the existenceo fc ertain institutions. Itsalleged universality as ahuman right cannot in fact be independent from institutional structures,and for this reason, O'Neill concludes that welfarer ights, such as the right to health "must be special, institutionalr ights rather than universal human rights." (O'Neill 2016,p .199) O'Neill'so bjection does not stop there. The first part of her objectiona ffirmed thatitisincoherent to normatively sustain human rights without allocating the duties implied in them. But from what Ih avesaid here, it would appear that this challengecan be dismissed because O'Neill recognizesthe States as primary agents of justice and other institutions (from hospitals to NGOs) as secondary agents of justice. At least,t his is the standard position when thinkingo f who is responsible for guaranteeinga nd protecting human rights, and this is how it is managed by the ICESCR and its State parties. But O'Neill not onlyconsiders that welfareright are institutional and not human rights-she alsostrongly criticizes this standard position for both human and welfarer ights,a nd discusses the great difficulties of allocating the duties of welfarer ights.
If ar ight to health is institutionalg iven its dependency on being fulfilled onlybycertain giveninstitutions, then the success of this kind of rights depends on the reliability of its institutions. But O'Neill, challenging the standard view, affirms that Statesa re ill suited to being primary agents of justicef or welfare rights. The same cosmopolitan rhetoric denounced by O'Neill for focusingt oo much on defending rights and tool ittle on allocating duties is also responsible for idealizing States' agency regardingt he institutionalr ight to health. She dis- The distinction between primaryand secondary agents of justiceisused by O'Neill to identify whoh as the greater responsibility regarding the realization of rights. Simon Caney explains O'Neill'sd istinction, sayingt hat while primarya gents of justice have al egislative and an executive role, secondary agents limit themselvestothe tasks assigned to them by the primary agents of justice. Caney further claims that this distinctionisvery importanttothinkingofhow human right'sc orrespondent duties can be allocated, but he claims that we could understand this difference as two compatible roles that can be adopted by different institutions,rather than different kinds of agents (Caney 2013,p p. 133 -156).
From aB ounded Viewt oaGlobalized Perspective tinguishesbetween an abstract and an idealizedtheory:abstraction, on the one hand, is indispensable, because onlyb yl eaving some act-descriptions indeterminate can we offer ap roposal that is suitable for ap lurality of diverse agents; idealization, on the other hand,does not leave indeterminate certain predicates and rather,iterroneouslyasserts or deniessome predicatesabout the agents involved (O'Neill 2000,p .68).
The standard view regarding the States' role as primary agents of justice for welfarerights is guilty of idealizing States' agency.O'Neill thinksthat every idealization leads us to a 'rosy view' in which individual rights are guaranteed by the State, and reminds us that: … we do not inhabit an ideal world. Idealized conceptions of justice simplydonot applyto international relations,s ocial relations or individual acts in aw orld in which states, men and women always lack the capacities and the opportunities of idealized agents. (O'Neill 2000,p .162) One wayt oa void this idealization is to recognize that States are ill suited for being the primary agents of justicef or welfare rights, because they lack either the capacities or the resources (or even both) needed to accomplish this. O'Neill identifiest hree possibilities thatn ot onlya ren'tf arfetched, but are rather common, and that could severelyu ndercut the effortst owards realizinga ni nstitutional right to health. States can be: (1) unjust with their own people, such as tyrannies and rogueStates;(2) incapable of securing justice for theircitizens because they either lack the capabilities to enforcet heir laws uccessfullyo rb ecause they lack the minimal infrastructure needed to secure welfare rights, such as schools or hospitals; or (3) weakened by different processes of globalization that give international agencies more power within theirb oundaries (O'Neill 2016,p p.164-165).
In light of these difficulties,O ' Neill suggests that we cannot continue with our idealizedc onception of States' agencies, but nor can we wait until all these problems are solvedt oc ontinue the realization of institutional or human rights. To wait until States can be sufficient primary agents of justice would amount to returning to an aspirationalo rh umanitarian conception of rights, disregarding their normative role.
Instead of abandoning theirnormative role, O'Neill invites us to consider the possibilityofreplacing Statesintheir role as primary agents, and to be more flexible regardingwho can be responsible for the duties entailed in institutional and human rights. She argues that for the realization of an institutional right to health, it is indispensable to recognize the importance of globalization and how it has shaped the wayw et hink about epidemics, contagious diseases, the availability of vaccinationsa nd health services around the globe.F or example, some NGOs have been able to substitute for or substantiallya id different States in providinga ll the services that ar ight to health implies. O'Neill asks us to consider moreg lobalagents to whom we could allocate the correspondent duties of ar ight to health. This strategyh as the advantageo fn ot relying on an idealized conception of States' agency, and because is not territorially bounded, it can better address global health problems.
GopalS reenivasan'so bjection to ah uman right to health Gopal Sreenivasan has givenseveral arguments to refute the possibilityofaright to health.⁴ In this section, Iwill onlyexplain whyS reenivasan thinks that there cannot be a human right to health. Although he does not denythe existenceofa State'sd uty to takec are of the conditions for its citizen'sh ealth, he denies that we can find ac orrespondent right to this duty.F or Sreenivasan (as well as for O'Neill⁵), the relation between rights and duties can be explainedi nt he following way: for every right,there must always be ac orrespondent duty and ad uty  Sreenivasan has been astrong and extensive critic of apretended right to health. Iconsider it importantt ob rieflys ay herew hy he considers that anyr ight to health is unattainable. One of Sreenivasan'smost devastatingarguments against the possibilityofaright to health is to appeal to the 'natureofhealth'.This argument claims that health is an outcome that dependsonmany factors, amongthem, luck and biology.From this, he affirms that therecannot be anydutythat can be held against the Statetoassurethat all the relevant factors of health aremet.Given that therec an be no rights if therei sn oa llocation of the proper duties,aright to health cannot be understood as an outcome. He also considers the arguments that try to replace 'health' for 'health care' in the formulation of this human right to dismiss the 'natureo fh ealth' argument, and to claim that what is beingdemanded is not an outcome but aservice. He discredits this too, by pointingo ut that health care is just one part of whataright to health pretends to claim, so that it would be amorallydefeatingstrategytofalselyequatehealth to health care.These arguments arev ery importantt ounderstand Sreenivasan'sposition, but Ihavedecided to focus just on his argument against the possibility of ah uman right to health, and not against ar ight to health in general, because Ic onsider that it emphasizes an important difficulty entailed by a common conception of what it takesf or somethingt ober egarded as ah uman right.S ee: Sreenivasan (2012; 2016).  "While claim rights arem irror images of obligations,n ot all obligations have mirror images (…)T his thoughtb yi tself is reason enough to begin with obligations and not with rights." (O'Neill 2000,p .99) From aB ounded View to aG lobalized Perspective bearer,e veni fn ot every duty entails ar ight.S reenivasan explains this thought with the following example. Even if one accepts that: … thereisamoral duty to provide-or even, that some agent has amoral duty to provideindividuals in agiven population with herdi mmunity against contagious disease (…)[ one can still deny] that anyi ndividual has am oral claim-right that correlates with anya gent's moral duty to provide herdi mmunity. ( Sreenivasan 2016,p p. 347-348) He assumesthat the agent who could bear this duty is the 'domestic state' (Sreenivasan 2016,p.360), but even with this consideration, he rejects that from this duty we could conclude the existenceo faright to health.
First of all, he takes human rights to be aspecial kind of moral rights rather than international legal rights. Then, he asks what distinguishesh uman rights from other kinds of moral rights, and what makest hem "more than ar andom label for anyo ld universal standard of justice." (Sreenivasan 2016,p .3 60) The answer is what he calls the 'doublyu niversal' (Sreenivasan 2016,p .3 55) condition of every moral human right.Asthe name suggests, it alludes to two universality requirementst hatm ust be met by am oral right in order for it to be considered a human right.
The first universality requirement is called the 'synchronic universality' and it demands that "if anyhuman being has agiven human right,then every other contemporaryhuman being also has that right." (Sreenivasan 2016,p.3 55) This entails that every human being on earth has the sameclaim-right to health. Even if we overlook the difficulty (outlinedb yO ' Neill) of the allocation of the correspondent duties,t here is another problem when we consider whether ar ight to health can meet this first universality requirement.T hat anyh uman being on earth can claim her or his right to health regardless of the correspondent State'sr esources would be an idealization, if not as erious mistake.One cannot claim ar ight to healthw ithout consideringt he specific socioeconomic conditions thats hape one'sa ccess to healthc are, vaccinations, clean watero rf ood. From this, it seems problematic to assert that ar ight to health could meet the synchronic universality requirement, because even if we want to assert that every human being has ar ight to health, actual economic conditions willdetermine whether each one of them actuallyh as the possibility of claiming and receiving what is guarded by this right.
This consideration leads us to what Sreenivasan identifiesasthe 'moral substance' universality requirement,w hich he explains through the slogan: "One world, one standard." (Sreenivasan 2016,p.355) This second requirement affirms that "for anyp articular human right that all contemporaryh uman beingsh ave, the morals ubstance conveyedb yt he right is the samef or every right-holder." (Sreenivasan 2016,p.355) Thedifferencebetween the first and second universality requirement is thatt his last one adds at emporalc riterion on how a human right should be realized. ForS reenivasan, moral human rights should always rule out "the doctrine of 'progressive realisation.'" (Sreenivasan 2016,p .3 55) The realization of am oral human right to freedom of speech is not ag oal that must be graduallyachieved. Rather,itisamoral rule that states how we should act towards others' rights and what we could individuallyc laim as our right to do. But this is not the casew ith ah uman right to health. It is impossiblef or it to be realized at once. Rather,i tw ould seem thatw hat we consider to be the defining characteristics of ah uman right to health, such as access to some services and goods, is inherentlyrelative to aplan of progressive realization, depending on the limited resources and capacities thata ny State (as duty bearer) would have.A sane xample, Sreenivasan says "the state of Senegal simplycannot afford to spend $1038 (PPP) annually per capita on health." (Sreenivasan 2016,p .3 60) If we concluded that the State of Senegal cannot realize the human right to health as otherS tates are doing it duringt he same period, would this be enough to blame the State of Senegal for the failingo ft he human right to health?C ouldw eh old accountable all thoseS tates that,d ue to theirl imited resources, fall behind on the 'moral substance' universality requirement?
The most fundamental idea to Sreenivasan'ss econd universality requirement seems to be that human rights should exclude the possibility of different States implementing the same "right at different levels or to different standards without infringingo nt heir correlative moral duties." (Sreenivasan 2016,p .3 55) As stated by the ICESCR,ahuman right to health entails that every human being has the right to "the enjoyment of the highest attainable standard of physical and mental health." (United Nations,Treaty Series,vol. 993,art.12) The kind of healthcare that one can receive and claim varies greatlyfrom country to country.I tw ould seem that 'the highest attainable standard of physical and mental health' can onlyb ed etermined within each State'sb oundaries. If this is true, there can be no universallyclaimable human right to health, because the duties that correspond to this claim are dependent on the limited resourcesand capacities of the State as the morallyr esponsible duty bearer.
Moreover,wec an conclude that States with the most limited resourcesa re not the onlyones that cause this failuret omeet the second universality requirement.E veni nt hosec ountries thatcan guarantee access to health care to all its citizens, and that regulate access to clean water,food and preventive goods such as vaccinations, there is always room for improvement.U nlikeo ther human rights likethe right to freedom of expression, ahuman right to health can be pro-moted more fittingly,a ccordingt ot he needs of the people, by better infrastructure, resources and education.
The difficulty arising from the second universality requirement has led to the consideration of welfare rights as secondary rights,and this is reflected by international agreements: Scholars sometimes frame civil and political rights as "first generation" and economic, social, and cultural rights as "secondg eneration".D espitet he unity and equal status of human rights in the UDHR,i nternationalt reaties reflectt his divide. The ICCPR demands immediatestate compliance, while the ICESCR is progressively realizable. The collective nature of socioeconomic rights,t he progressive realization, and connection to resources meant that they would not be as rigorously enforced. The second generation of rights -although of equal value-has in practice been relegated to secondary status. ( Gostin 2014, p. 246) Unlikehuman rights that can be enforced right away (for example, to prevent the obstruction of liberty rights), aright to health can onlybeachieved progressively. The ICESCR recognizest his in its second article by stating that: Each StateParty to the present Covenant undertakes to takesteps,individuallyand through international assistancea nd co-operation, especiallye conomic and technical, to the maximum of its available resources, with aview to achievingprogressively the full realization of the rights recognized in the present Covenant by all appropriatemeans, including particularlyt he adoption of legislative measures. (UnitedN ations,T reaty Series,v ol. 993,art.2 ) This article leads us to accept what Sreenivasan denounces-that is, that aright to health cannot meet the second universality requirement: "'One world, one standard' turns out to be ar ather challenging requirementf or ar ight to health to satisfy." (Sreenivasan 2016,p.361)Ifhuman rights are characterized by virtue of their doubly universaln ature, and ar ight to healthc annot satisfy these requirements,i tf ollows that,j ust as O'Neill also concluded,apretendedr ight to health cannot be regarded as ahuman right.F urthermore, even when O'Neill accepts thati tc an be an institutional right,s he pointso ut severe difficulties entailed in its realization. In the same way, Sreenivasan'scriticisms lead us to question whether it is aw orthys trategyt ok eep trying to defend the existenceo fa right to health, even when it would not be considered as ah uman right. Along the lines of both authors' arguments, we could ask now whether it would be bettertojust consider acertain duty towards health, thatStatesshould bear,evenifthis does not have acorrelateclaim-right.What would that duty be?
Taking globalh ealth seriously: the insufficiency of ad uty to charity O'Neill'sand Sreenivasan'sarguments have pointed out the difficulties of realizing ar ight to health even within aS tate'sb oundaries. As long as this right depends on institutional structures and these are insufficient,t he realization of this right will be at risk. When we consider these difficulties from ag lobal point of view,t he problem seems to amplify.I faS tate cannot successfully bear its duty towards its ownc itizens, what kind of duty could be enforced between different States to promoteh ealth globally?
If we decide to abandonthe human rights narrative,and even the defense of an institutional right to health, it would still be possiblet os ay that every State bears aduty to its own citizens to provide conditions for their health.⁶ But here I want to suggest thatthe strategyofconsideringStates' duties is also insufficient for promotingh ealth conditions for every human being.
The question about what kind of States' duties could promoteh ealthg loballyh as raised ad ebate between cosmopolitans and communitarists about the existenceofi nternational dutiestojusticea nd, in this case, of international duties to promotehealth. Iwill not discuss this debate here. Instead, Iwant to point out how unsatisfactory it is to establish ad uty to charity as an international strategyt op romoteh ealth.
One of the main problems regarding international relations of justiceisthat it recognizeseachState'ssovereignty as fundamental, up to the point that it does not necessarilye ntail anye nforceable duties towards otherS tates-or even towards human beingst hat are not citizens, even if they are within that State's boundaries. One strategyt oa void the problems corresponding to international duties of justicehas been to appeal to aduty to charity between States. This strategy has had importanto utcomes, and has been more easilya dopted because a duty to charity is less demanding for Statest han the recognition of an enforceable human right to health. Thisd uty to charity onlys upposes that: "one can help others in serious distress without excessive cost to oneself." (Nagel 2008, p. 52) It does not impose how manyr esourcess hould be invested towards pro- Idonot intend to address here the degreeuptowhich aStateshould careand provide for the conditions of health of its citizens;nor whether this would have to involveevery Stateproviding universal access to health care, or even to vaccinations and clean water and food. Iconsider simplythat all States should bear this duty,evenifweaccept that therecould be varyingdegrees of each State'sl evel of commitment.
From aB ounded Viewt oaGlobalized Perspective moting global health-rather,i tc an be left up to each State to decideh ow to managet heir aid towardso ther countries.
Although this duty to charity has been carried out with fewer problems than the strongenforcement of an alleged human right to health, it faces serious objections when regarded as as olution or as away to promoteg lobal health. Two strongc riticisms of the duty to charity as ar eplacement of the human rights strategya re: firstly, that ad uty to charity always entails ad ubious distinction of who is most in need and thus most deserving the correspondentaid, creating more inequality;and secondly, that charity neither remedies nor corrects the underlying structures from which manyh ealthp roblems arise at an international level-it merelyr eaffirms the dependence of some States on others.
Ad uty to charity is flawed from its very conception as av iable wayt op romote global health. Firstly, it could be argued that all foreign aid should be directed towardshelping those most in need. This leads to the distinction between the 'very poor' and the 'relatively poor' (Millum 2012,p.27), which creates more inequality:t he international community can leave behind thosew ho are not most in need-even when they face severe health problems-because their aid is not (yet) intended for them. But how can it be decided who is most in need?A nd who decides wheret he aid should go?T his undetermined structure of charity has promoted that biased political and economic interests become the factors that decidew ho receivesh elp now,a nd who should wait until their situation worsens to receive it.
The second problem with charity is that even when regarded as ad uty,i t necessarilye ntails ar elation between unequalp artners-one in desperate need and one with enough resources to help others without compromising its own interests. If we rely on this structure to promoteg lobal health, therec an be no real progress;j ustm omentaryr elief for those in the most vulnerable positions, but without an actual solution. The point of these criticisms is not that ad uty to charity is useless. Instead, it emphasizes that it is not an actual solution because it does not challengethe causes thatobstruct the realization of the conditions for health.
Every action that can be regarded as charity assumes from the start aparallel between inequality of wealth and inequality of power (Nagel 2008, p. 52). From this starting point,global healthd oes not stand ac hance, because the resources needed to promoteitare still being withheld from thoseinneed.Furthermore, weak Statesc ould arguet hat they are not able to perform their duties towards their citizens duetolack of donations,and giventhat aid is not mandatory and it is not areliable sourceofresources, this attitude could lead to aworsening of the conditions of health for citizens of these countries (Gostin 2014,p .1 9). Appeals to charity,evenwhen regarded as aspecial international duty,may still seem am oref easible wayt op romote globalh ealtht han posing ah uman right to health, which faces the criticisms presented earlier.B ut in fact,aduty to charity would not accomplish much towards this global goal, because: Rich donors remainrich (…)the poor remain poor,though,for the moment,not in desperaten eed. Humanitarian aid is essentiallyc onservative;i tp reserves existingp ower structures( … )B yc ontrast recognizings omeone'sr ights is (…)t op ut them in control (…)I ti s to accept another person'sl egitimatec laims to power. Rights claims aren ot restrictedt o needs,but also extend to liberties and opportunities (…)H umanitarianism is, therefore, attractive to those whoa re in powera nd liket ok eep things that way. (Wolff 2012a, p. 8) If we take seriously the thought of global health, it seems thatt here are important reasons to recover the human rights narrative,e venw ith all its problems. Here, Iw ill present what Ic onsider to be three of the most relevant reasons to continue with the human rights narrative.
First,o ne weighty flawo fad uty to charity is that it disentangles global health from ac orrespondent sense of responsibility.F rom the point of view of charity,wealthier States do not have an obligation to make donations or provide aid to others, and weak States maye xcuse themselvesa nd disregard their responsibilities towards their citizens just by maintaining that they have not receivede nough resources.I nt his scenario wheren oo ne is responsible, charity leavesu sw ith af ar mored iminished hope of achieving globalh ealth. A human rights narrative,a lthough having the problem of allocating specific duties, recognizes the need of asking who would be responsible for achieving those rights.
Second, if we consider global healtht ob e' ag loballys hared responsibility' (Golin 2014,p .1 9), we must make explicit the damaginge ffect of international omissions. Ad uty to charity cannot address the lack or insufficiency of donations as am orallyw orrisome omission, preciselyb ecause it does not recognize anyi nherent responsibility for donors. The human rights narrative,byc ontrast, makes visible the impact of omissions: Individuals mayhavebeen wronged through neglect,but no rights would have been violated, on such av iew.H owever,o ncet he claim is made that rights will be violated if assistancei sn ot forthcoming, the argument has shifted to one of justice:t hat we neglect or violatep eople'sr ights by failing to help. (Wolff 2012b, p.79) Unlikeaduty to charity,anappeal to human rights can point out the need to find agents that are responsible for global health. It can also help to denounce what is not being done to promoteit, and to emphasize the need to repair this failure.
At hird advantage of the human rights narrative is that it does not presuppose ah ierarchic structure in which what motivates global health is not a human entitlement but,o no ne hand an ever ending need and, on the other, mere philanthropic donations. Givent hatc harity has as its coret he idea of need as its motive,i tc annot end it; charity'sa im is just to brieflym itigate it.
These three reasons offer an important counterweight to criticisms of human rights and of the possibility of ahuman right to health. One of the most relevant flaws of ahuman right to health, as regarded by O'Neill and Sreenivasan, is that it does not meet certain universality requirements that are usuallyconsidered to be the defining features of anyhuman right that can be legitimatelyregarded as such. But these criticisms do not necessarilyf orceu st oabandon this narrative. Instead, they can be seen as good motivestorevisewhat we consider fundamental about human rights and, perhaps,t or econsider how have we been thinking about their universality.

Concludingr emarks
One wayinwhich globalization has shaped theoretical discussions about health is that it has shown how flexible and limited boundaries are, when we consider health problems and the resources and capabilities we have to address them. The multitudinous factors that are relevant to people'shealth around the globe cannot be bounded within States.C ertain "situations can onlyr eallym ake sense from ag lobal perspective thatt akes in the structure thata ffect people'sl ives (…)And it is onlyfrom aglobal perspective that options for addressingtheir difficulties can be identified." (Millum 2012,p .2 ) This changeo fp erspective,w hich is necessary to address contemporary problems of health, has not yetf ound an appropriatet heoretical justification. One wayi th as been defendedi sb yp osing ah uman right to health. But this idea has receiveds trongobjections that question whether it is actuallyp ossible to claim a human right to health, and whether this would be the best strategyto promotehealth. In this essay, Ihaveintended to show that although it is not free from difficulties,i ts till is the best strategya vailable in order to continue to defend ag lobal perspective on health. Much still needst ob es aid about how a right to health can be considered ahuman right if it does not possess the universal requirements that we have ascribed to other human rights since their inception. Iconsider thatthese objections raise an important challengetothe waywe think not onlyabout global health, but about human rights in general. Perhaps, in adopting this global perspective,wecould reconsider the wayw ethink about