Mechanisms of Accountability for the Realization of the Right to Health in China

Qiu, Shengnan; Macnaughton, Gillian

China ratified the International Covenant on Economic, Social and Cultural Rights (ICESCR) in 2001 and "has consistently emphasized its commitment to guaranteeing these rights" in its National Human Rights Action Plans. 4 Article 12 of the ICESCR recognizes the right of everyone to the highest attainable standard of physical and mental health (often referred to simply as the right to health). 5 It also establishes the obligations of states parties to take steps to achieve the full realization of the right to health by, for example, providing for infant and child health, improving environmental conditions and workplace safety, preventing epidemics and occupational diseases, and ensuring health care for all. Under Article 12, states parties are required to respect, protect, and fulfill the right to health, including the right to health care and the underlying determinants of health-such as nutritious food, potable water, and safe housing-by taking concrete and targeted steps to progressively realize the right. 6 Fulfilling these obligations involves complex processes and efforts on the part of the state. For example, it requires that the state implement a non-discriminatory and effective health system; that it guarantee the availability and accessibility of clean water and essential medicines; and much more. 7 Many state actors are involved in implementing these processes. In terms of the right to health, these actors constitute duty-bearers. Supervising and monitoring the actions of these actors in relation to their duties is essential. In this way, these duty-bearers can be held accountable if they fail to fulfill their respective obligations and responsibilities, or if they abuse their powers. Accountability is an important component in the realization of the right to health, and accountability mechanisms play crucial roles in the supervisory process required to enhance the realization of this right. 8 As this Western idea of accountability is a newly imported concept in China, this article examines how far, if at all, institutional norms and structures of accountability have been absorbed into or transformed to fit the existing Chinese legal, political, and cultural frameworks. In so doing, it reviews current Chinese institutional mechanisms and considers the use of less formal mechanisms by which duty-bearers might be held accountable for the right to health. More specifically, the article discusses judicial accountability, political accountability, administrative accountability, professional accountability, and social accountability. In short, it explores whether the Western concept of accountability has the potential to improve the protection of the right to health within China. The article concludes that there is a domestic accountability framework-although very different from that of Western democracies-operating at various levels in China with some capacity to protect the right to health. Nonetheless, this accountability framework involves largely top-down processes and fails to provide adequate avenues for rights-holders to complain and to seek remedies for violations of their rights. 9