The relationship between human rights and health is one that is now increasingly discussed throughout the world and rights-based approaches to public health issues are being promoted as having much to contribute to addressing health inequalities and achieving sustainable gains in population health.^1–4 To date, this relatively recent consideration of the relationship between human rights and health has largely concentrated on the right of individuals to health care and treatment and on the protection of individuals from physical harm.⁵ For example, rights-based approaches have been used to advocate for strengthened health care systems, to target maternal mortality and reproductive health, mental health care, and neglected diseases, and to raise the profile of underlying determinants such as the right to water and sanitation.^6–10 The work of the UN Special Rapporteur on the right to health, a position established in 2002, has done much to promote greater global attention to health and human rights.¹¹ However, the health sector has also recently been critiqued for its relative silence on human rights, with the suggestion that there is a general lack of awareness within the field regarding human rights and what they mean in practice.¹

Human rights are essentially freedoms and entitlements that are concerned with protecting the inherent dignity and quality of all human beings, and encompass civil, political, economic, social and cultural rights.^12,13 While human rights are inspired by, and grounded upon, moral values such as dignity, equality and access to justice they are also guaranteed legally and reinforced by international and national legal obligations.² The Universal Declaration of Human Rights (UDHR) ratified in 1948 is the foundation of international human rights law, and was the first global statement to recognize the inherent dignity and equality of all human beings.¹⁴ Subsequently, however, in the context of Cold War tensions, human rights became polarized into two separate categories as States prepared to turn the provisions of the Declaration into binding law.² The West claimed civil and political rights were primary with economic and social rights mere aspirations; the Eastern bloc argued that civil and political rights were secondary to the essential rights to food, health and education.² As a result, in 1966 two separate treaties were formed—the International Covenant on Economic, Social and Cultural Right s (IESCR)¹⁵ and the International Covenant on Civil and Political Right s (ICCPR).¹⁶ Since then, human rights have been reiterated by numerous international treaties, declarations and resolutions that protect human rights to varying degrees.¹³

International human rights treaties, commonly referred to as covenants or conventions, are legally binding on States that ratify them while conversely, human rights declarations are non-binding, although many encompass principles that are consistent with binding customary international law.^2,13 Traditionally, human rights have focused on the relationship between the State and individuals, with those States that have ratified international human rights treaties assuming obligations that are binding under international law to effect the human rights outlined within them. Additionally, some States have national laws protecting some human rights; and some explicitly protect human rights within their constitutions.^2,13

It is in this global context that the application of a human rights approach to childhood obesity prevention is gaining attention and is advocated as a particular lens through which childhood obesity prevention can be viewed.^5,17,18 Such an approach is increasingly considered as having an important contribution to make, although it is also acknowledged that a rights approach is likely to be most effective when utilized in combination with other paradigms.¹⁷

Within the array of human rights declarations, conventions and resolutions three are of particular relevance to the issue of childhood obesity: the UN Convention on the Rights of the Child,¹⁹ the right to adequate food,¹⁵ and the right to health.²⁰

UN Convention on the Rights of the Child

The Convention on the Rights of the Child¹⁹ was adopted and ratified by the United Nations in 1989 and is the first international instrument to incorporate the full range of human rights—civil, cultural, economic, political and social rights specifically in relation to children.²¹ It was developed in recognition of a need for children to have a convention explicitly acknowledging that they often need special care and attention that adults do not, and was motivated by a desire to increase international awareness that children have human rights as well as adults.²¹

The Convention on the Rights of the Child outlines these rights in 54 articles and two Optional Protocols, and identifies basic human rights for all children: the right to survival; to develop to the fullest; to protection from harmful influences, abuse and exploitation; and to participate fully in family, cultural and social life. Four core principles of the Convention on the Rights of the Child are also identified: non-discrimination; devotion to the best interests of the child; the right to life, survival and development; and respect for the views of the child.¹⁹

Particular rights outlined in the Convention on the Rights of the Child pertinent to childhood obesity prevention are the right to develop to the fullest and the right to protection from harmful influences, abuse and exploitation. These can be considered “developmental rights” where the underlying interest is to protect children from circumstances injurious to their well-being and ensure they are not exposed to risks which they do not have the adult capacity to appraise.⁵ It has been argued that more effective strategies for addressing childhood obesity can be developed and enacted by articulating the issue as one of children’s rights, not just of public health, and that the articles of UNCROC provide a useful template for coordinated interdisciplinary and strategic action.²²

One way in which this rights-based framework has been used in the context of childhood obesity prevention is in relation to food advertising to children on television.⁵ For example, arguments against food advertising to children have been made on the premise that children have less capacity than adults to comprehend completely the intent or persuasive nature of advertising, and consequently are less able to form critical assessments of advertisements.²³

Framing arguments against food advertising to children using a rights-based discourse has also been suggested to provide a strong rebuttal to counter claims in a number of ways.⁵ For example, the assertion that children would suffer from poorly funded television programming due to lost revenue is argued as being far less appealing when it then becomes an argument that the cost of children having television programs made for them is that they are exposed to harm.⁵ In a similar vein, contentions from the advertising sector that it would be pointless to ban television advertising to children because they would still be exposed to food advertising in program content, adult time slots and in other media²⁴ are also claimed to be made irrelevant by a rights-based approach.⁵ Furthermore, it is also argued that if food advertising to children is determined to be injurious to their health, and thus counter to their right to protection, bans on such advertising should be made without the need to provide empirical evidence that bans will decrease obesity rates.⁵

A recent practical application of UNCROC and a children’s rights approach to childhood obesity prevention has been their use in framing a set of seven principles (The Sydney Principles) to guide action on reducing food and beverage marketing to children through television and other media with the ultimate intent of forming an International Code on Food and Beverage Marketing to Children.¹⁸

The right to adequate food

The right to adequate food has been considered a human right since it was first articulated internationally in the UDHR in 1948. Article 25 of the UDHR¹⁴ and Article 11 of the IESCR¹⁵ state that

Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing …

Historically, this right to adequate food has largely been interpreted and applied in the context of freedom from hunger and undernutrition, the right to food in emergencies and to issues of food access and food security.^25,26 In 2000 the term “food” was identified as covering both solid foods as well as clean drinking water as an essential component of healthy nutrition.²⁷ It is now argued that a right to food approach encompasses not only these critical issues of freedom from hunger and of food security, but also should require States to respect and protect consumers and to promote good nutrition, including protecting the poor and vulnerable from unsafe food and inadequate diets and helping to address obesity.²⁸ The Right to Food Voluntary Guidelines produced by the Food and Agriculture Organization (FAO) of the United Nations explicitly places this issue on its right to food agenda with Guideline 10.2:

States are encouraged to take steps, in particular through education, information and labeling regulations, to prevent overconsumption and unbalanced diets that may lead to malnutrition, obesity and degenerative diseases.²⁹

This guideline clearly places obesity and some of its underlying determinants alongside those of malnutrition, and reframes the way in which the right to food is conceptualized. At present, these guidelines are voluntary and non-binding and hence States have no legal obligation to meet them nor are they enforceable. However, they do provide a platform from which to engage and develop further rights-based approaches to childhood obesity prevention and firmly place responsibility on states for the provision of education, responsible food labeling, and the prevention of obesity through poor diet and food consumption. The right of children and adolescents to adequate food was also extended to include a right to be free from obesity and related diseases by the UN System Standing Committee on Nutrition in 2007, along with a call for international regulation of marketing to children of food and beverages.³⁰ The extent to which action at a legislative and policy level to address these determinants of childhood obesity can be supported and strengthened by a right to food approach is an area for further exploration throughout the international community.

The right to health

The right to health, or in its fullest form, the right to the highest attainable standard of health, was first expressed in the constitution of the WHO in 1946.³¹ It was restated in the 1978 Declaration of Alma Ata and again in the World Health Declaration adopted in 1998 by the World Health Assembly.³² Within international human rights law, the right to the highest attainable standard of health is outlined within the UDHR¹⁴ and subsequently reiterated in Article 12 of UESCR which states that:

Parties to the present Covenant recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.¹⁵

This right to health is thus a claim to a set of social conditions, including norms, institutions, laws and an enabling environment that can best secure the realization of this right.² The nature of the right to health was further clarified in 2000 with the adoption of a General Comment on the right to health by the Committee on Economic, Social and Cultural rights which monitors the Covenant.²⁰ This General Comment recognized the close relationship between the right to health and other human rights including, but not limited to, the right to food, housing, work, education, participation, non-discrimination, equality and the prohibition of torture. In this way, the right to health was interpreted as including not only appropriate and timely health care, but also the underlying determinants of health.²

The need for the right to health to be universally recognized and understood as a fundamental human right has recently been reiterated with the sixtieth anniversary of UDHR.^1,3 Doing so, it is argued, acknowledges the need for a strong social commitment to good health and thus should be included in national and international health policy.³ The implications of the right to health, and its expanded focus to include underlying determinants of health, for childhood obesity prevention are yet to be fully explored as the wider public health community grapples with the translation of rights-based frameworks into practice.

What then does a rights-based approach mean, in practice, to childhood obesity prevention beyond, as others have said,⁴ “having a good heart behind efforts and actions” ? It is claimed that one key contribution of human rights to public health is the provision of a persuasive argument for government responsibility to not only provide health services but also to address underlying determinants of health such as poverty, deprivation, marginalization and discrimination.⁴ In the context of childhood obesity, this challenges the placing of responsibility for childhood obesity prevention within the family context³³ and clearly makes it an issue of governmental concern. In this way, a rights-based approach to childhood obesity can form the basis for action at a societal level, which is vital, given that childhood obesity is now widely recognized as a “societal rather than a medical problem”.¹⁷

One argument against a human rights approach to health is the lack of binding legislation demanding that they be achieved.³ While this issue of enforcement does create real challenges, this does not mean that rights-based approaches should be abandoned or dismissed as idealistic and unfeasible. Human rights provide an important overarching framework, or “parent” to guide legislation³⁴ as well as many other ways of furthering the cause of particular rights.³ Legislation is not the only requirement for the fulfillment of rights; rather public discussion, social monitoring, investigative reporting and social work all have critical roles to play.³⁵

Advocacy using a language of human rights, including those outlined within UNCROC, as well as the right to adequate food and the right to health, is a powerful way of drawing attention to issues related to childhood obesity prevention. This might include mobilizing public opinion and advocating for governmental and institutional changes to implement rights, even if they are not yet legally established.⁴ Such advocacy can play an important role in moving such institutions towards a situation where human rights are legally enforceable.⁴ Already, within childhood obesity prevention the ongoing work regarding marketing to children using a human rights framework provides an example of such advocacy in action. Similar advocacy is possible using a human rights approach to address other factors contributing to childhood obesity, such as safe spaces for physical activity and access to healthy food alternatives. Using the language of a rights-based approach for protecting children may help to avert the alternative risk-based approach where the health outcomes for children are somehow supposed to be balanced against the profitability of the industries developing and marketing unhealthy foods.

Consideration of human rights as they apply to childhood obesity prevention is an important area of work. Application of rights-based approaches to addressing childhood obesity are emerging internationally, and have so far largely focused on addressing issues of food marketing to children. Advocacy using the language of human rights as it applies to other determinants of childhood obesity prevention is suggested as having much to contribute towards addressing this issue, given that framing childhood obesity within a rights context firmly places responsibility at a governmental level rather than with families or individuals. Further exploration is needed to actualize such approaches in order to achieve positive outcomes for children.

1 Editorial. The right to health: from rhetoric to reality. Lancet 2008; 372: 2001.

2 World Health Organization: Questions and Answers on Health and Human Rights. Geneva: WHO, 2002.

3 Sen A.: Why and how is health a human right? Lancet 2008; 372(9655): 2010.

4 Gruskin S, Tarantola D: Health and human rights: overview. In: Heggenhougen K, Quah S eds. International Encyclopedia of Public Health. San Diego: Academic Press, 2008: 137–146.

5 Ingleby R, Prosser L, Waters E: UNCROC and the prevention of childhood obesity: the right not to have food advertisements on television. J Law Med 2008; 16(1): 49–56.

6 Hunt P, Bueno de Mesquita J.: Reducing Maternal Mortality. Colchester UK: University of Essex, 2008.

7 World Health Organization: WHO Resource Book on Mental Health, Human Rights and Legislation, World Health Organization, 2005.

8 Hunt P, Steward R, Bueno de Mesquita J, Oldring L.: Neglected Diseases: A Human Rights Analysis. Colchester Essex: University of Essex, 2007.

9 Pillay N.: Right to health and the Universal Declaration of Human Rights. Lancet 2008; 372(9655): 2005–2006.

10 Hunt P, Backman G: Health Systems and the Right to the Highest Attainable Standard of Health. Colchester, UK: Human Rights Centre, University of Essex, 2008.

11 Office of the United Nations High Commissioner for Human Rights: Human Rights Council Resolution 6/29 Special Rapporteur on the Right of Everyone to the Enjoyment of the Highest Attainable Standard of Physical and Mental Health United Nations, 2007.

12 Office of the United Nations High Commissioner for Human Rights and the United Nations Staff College Project: Human Rights: A Basic Handbook for UN Staff. United Nations, 1999.