Dr T argues that substantive equality as a goal allows for the addressing of structural and indirect discrimination and for the identification and elimination of the power dynamics that have perpetuated the systems and patterns of privilege and disadvantage that outlived formal colonialism.

To achieve substantive equality in the realization of the right to health, laws and policies should address the intersectional nature of discrimination, namely the lived experiences of those who experience discrimination on multiple grounds. In particular, the Special Rapporteur plans to look into the interrelated and entrenched obstacles operating at different levels that stand between individuals and their enjoyment of sexual and reproductive health rights.

Her thematic reports have thus far focused on –

  1. Impact of covid 19 on Sexual and Reproductive Health Rights.
  2. Violence and the rights to health: A non-binary approach.
  3. Racism and the right to health. 
  4. Digital innovation and technology and the right to health.
  5. Food & nutrition and the right to health.

With additional human rights themes to be examined in future.

Themes of priority 

Global health in the era of the COVID-19 pandemic:

COVID-19 is exposing existing structural fault lines, showing us that, even at our best as a global community, health systems were inadequately prepared, insufficiently resourced, and lacked the necessary agility to shift focus onto the global health emergency without putting at risk other rights and essential services. Among others, quality health care and related services are only possible to the extent to which health-care workers receive adequate protection from occupational exposure, experience fairness in the recruitment process and are remunerated fairly. 

Sexuality, gender-based violence and femicide:

In the Declaration on the Elimination of Violence against Women, proclaimed by the General Assembly by its resolution 48/104, the term “violence against women” is defined as “any act of gender-based violence that results in, or is likely to result in, physical, sexual or psychological harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life”. Pursuant to article 4 (c) of the Declaration, States should exercise due diligence to prevent, investigate and, in accordance with national legislation, punish acts of violence against women, whether those acts are perpetrated by the State or by private persons. 

Sexual and reproductive health rights:

Under the right to health framework, States have an obligation to respect, fulfil and protect the right to sexual and reproductive health, including in relation to contraception and family planning. Violations of the obligation to respect the rights to sexual and reproductive health include criminalization of women undergoing abortions; the criminalization of consensual sexual activity between adults; banning or denying access in practice to sexual and reproductive health-care services and medicines, including as a result of discrimination based on race or ethnic origin;32 and the prescription of involuntary, coercive or forced medical interventions – e.g., in the case of forced sterilization of women with disabilities or women from minority or indigenous groups. 

Innovation and digital technology:

Sexual and reproductive health rights, digital interventions and tele-health: Technological developments in health care have proven to be an instrumental element in the provision of health care and have improved our quality of life. Innovation and digital technology have improved our ability to store, share and analyse health information. They have also increased provider capabilities and improved patient access to health-care services, all of which have been instrumental to, inter alia, handling the COVID-19 pandemic. 

Racism and the right to health: 

It has been largely documented that racism leads to increased rates of mortality and morbidity.45 Therefore, in order to comprehensively address the systemic racism embedded in global health, an intersectional approach must be employed because race interacts with other social locations, including gender; sexual orientation; level of education; and economic, disability or other status, to determine an individual’s access to health care. 

Health equity:

All people have a fundamental need for health care, yet inequalities in health status and access to health-care services persist. As a result of broader social and economic issues, individuals who are marginalized because of poverty, gender, ethnicity, social norms, or stigma and discrimination experience negative health outcomes. Medical interventions are not the main determinants of health. Health outcomes are rather determined by underlying and social factors, including nutrition, housing, work environment, education, discrimination, violence, and the presence or absence of war, among others.

Non-communicable diseases: reproductive cancers:

WHO has set out to eliminate cervical cancer by 2050 in an attempt to avoid the deaths of millions of women and girls. The strategy, backed by WHO member States at the World Health Assembly 2020, involves vaccinating 90 per cent of girls by the age of 15; screening 70 per cent of women by the age of 35, and again by the age of 45; and treating 90 per cent of women identified with cervical disease. Figures from 2018 indicate that 570,000 women were diagnosed with cervical cancer and 311,000 died. If it is not stopped, annual case numbers are projected to reach 700,000, with 400,000 associated deaths, by 2030.54