A/HRC/17/25 9. In 1987, the landmark study by the United Nations Children’s Fund (UNICEF) “Adjustment with a Human Face” spurred global debate on the negative social impacts, including on health, of structural adjustment programmes prescribed by the international financial institutions as a means to achieve economic development. Three years later, in 1990, the United Nations Development Programme (UNDP) published the first Human Development Report. Alongside the report, UNDP created the Human Development Index, a summary measure of various human development indicators, such as maternal mortality, childhood education, gender disparities, poverty, etc. The index and report represented a major progression in development theory, which aimed to “[put] people back at the center of the development process” by going beyond income to assess people’s long-term wellbeing.10 This broader and holistic reconceptualization of development has been increasingly favoured and has facilitated efforts to recognize and incorporate human rights in development work.11 10. The evolved concept of development, which underwrites the MDGs and the contemporary development paradigm, represents a significant departure from these earlier views, making more evident the close overlap between development and human rights.12 This close interrelationship between development and human rights is clearly spelled out in the 2000 Millennium Declaration and was underlined at the 2010 High-level Plenary Meeting of the United Nations General Assembly on the MDGs. As the outcome document states, “respect for and promotion and protection of human rights is an integral part of effective work towards achieving the Millennium Development Goals”.13 11. The “capabilities” approach first articulated by Sen and developed by Nussbaum, which underlies the concept of human development, at its core requires removal of major sources of “unfreedom” in order for development to occur, including poverty, poor economic opportunities, tyranny, neglect of public facilities, and social deprivations.14 This very acknowledgement allows a clear space in which human rights-based discourse can guide development. The capabilities approach recognizes rights as both “constitutive” of and “instrumental” to the overall process of development;15 that is, rights and freedoms are not only necessary tools in achieving the goals of development, but that realization of rights should constitute an end-goal of development itself. More particularly, this approach holds that human rights are entitlements which make up a part of a set of central capabilities: a core set of freedoms, or rights, which form the basis of the very opportunities necessary to achieving a requisite level of human development. 12. When development is perceived in terms of human development and capabilities, it is evident that the right to health has both constitutive and instrumental relevance in respect of development and poverty reduction.16 The right is constitutive insofar as ill health and 10 11 12 13 14 15 16 UNDP, “History of the Human Development Report”. Available from http://hdr.undp.org/en/humandev/reports/ Peter Uvin, Human Rights and Development, (Connecticut, Kumarian Press, 2004), p. 49. Amartya Sen, “Human Rights and Capabilities”, Journal of Human Development, Vol. 6, No. 2 (July 2005), p. 151. Outcome document of the High-level Plenary Meeting of the General Assembly on the Millennium Development Goals “Keeping the promise: united to achieve the Millennium Development Goals” (A/RES/65/1), para. 53. Amartya Sen, Development as Freedom, p. 3. Amartya Sen, Development as Freedom, p. 35; see also Peter Uvin, Human Rights and Development (2004), p. 122. See OHCHR, Human Rights and Poverty Reduction: A Conceptual Framework (Geneva, United Nations, 2004) and OHCHR, Principles and Guidelines for a Human Rights Approach to Poverty Reduction Strategies (Geneva, OHCHR, 2006). 5