A/62/214 techniques and tools are needed. The traditional human rights techniques — “naming and shaming”, letter-writing campaigns, using test cases, slogans and so on — are insufficient for the task. While they still have a crucial role to play in the vindication of the right to health, 1 alone they are not enough. One of the new techniques needed is a way of monitoring the progressive realization of the right to health. For that reason, the Special Rapporteur devoted a report in 2006 to a human rights-based approach to health indicators (E/CN.4/2006/48). Another tool that needs more attention is constituted by impact assessments; for that reason, the present report includes a section on that issue. 12. The integration of the right to health into national and international policymaking also presents other challenges. For example, faced with limited resources, decision makers have to choose between different health policies and programmes, all of which contribute in one way or another to the realization of the right to health. One of the most difficult questions the Special Rapporteur is asked while on country mission is: “Given a finite budget, how can the Minister of Health prioritize health interventions in a manner that is consistent with the Government’s national and international human rights obligations?” 13. Over many years, the health community has generated extensive literature and practice on prioritizing and rationing health interventions. Cost-effectiveness and equity are among the principles used by health economists and ethicists to help guide policymakers through this difficult terrain. Although they have not solved the dilemmas (far from it), they have given the issues considerable attention. 14. By contrast, the human rights community has not yet given these important issues the sustained attention they deserve. With a few honourable exceptions, there is little human rights literature on the topic. 2 United Nations treaty bodies offer no detailed guidance on how States can prioritize in a manner that honours their binding human rights obligations. 15. This state of affairs is surprising, because priority-setting raises profound human rights issues. In practice, prioritization has often privileged the health needs of wealthy, urban populations over the entitlements of the rural poor. It has often marginalized the health entitlements of women, persons with disabilities and other disadvantaged groups. This mirroring and deepening of patterns of inclusion and exclusion is offensive to the right to the highest attainable standard of health. 16. Nonetheless, some still maintain that the human rights community should not involve itself in issues of prioritization. Their response to the prioritization problem is simple: allocate more resources to health. 3 This response is partly right. Many countries spend far less than the $34 per capita minimum health expenditure __________________ 1 2 3 07-45379 For example, see the report of the Special Rapporteur of January 2007 (A/HRC/4/28), sect. III. Some literature and court cases address the issue, such as Soobramoney v. Minister of Health, Constitutional Court of South Africa, case CCT 32/97, 26 November 1997; and F. AlvarezCastillo, T. K. Sundari Ravindran and H. de Pinho, “Prioritisation”, in T. K. Sundari Ravindran and H. de Pinho, eds., The Right Reforms? Health Sector Reforms and Sexual and Reproductive Health (University of Witwatersrand, 2005). Consistent with the State’s obligation, in article 2 (1) of the International Covenant on Economic, Social and Cultural Rights, to devote the maximum available resources to the right to health. 5