David Patterson is a PhD candidate in the Faculty of Law at Groningen University. His research addresses the health impacts of climate change through a human rights lens. He is a member of the Groningen Centre for Health Law and the steering committee of the Law and Public Health section (EUPHA-LAW) of the European Public Health Association. In 2024 he co-founded the NNHRR Human Rights and the Climate Crisis Working Group.

This submission is being published as part of the series at HRH which is dedicated to Human Rights Day (s) in collaboration with the Groningen Centre for Health Law (GCHL) Blog

In March a US judge blocked billionaire Elon Musk and the Department of Government Efficiency from taking further steps to shut down the US Agency for International Development. In February Musk, one of the world’s richest men, symbolically waving a chainsaw, had pulled the plug on USAID, including on USAID’s child health programs. It is in this context that the theme of World Health Day 2025, celebrated on 7 April, is ‘Healthy Beginnings, Hopeful Futures.’ Yet the United Nations Charter and relevant UN resolutions and treaties all note the importance of international cooperation in promoting human rights and social and economic development. See e.g. Karimova (2014).  

Sir Michael Marmot, the renowned British epidemiologist and global public health advocate, champions investment in key social determinants of health: education; employment and working conditions; having the minimum income necessary for a healthy life; healthy and sustainable environments; taking a social determinants approach to prevention; tackling discrimination, racism and their consequences; and the climate emergency. The United Nations Committee on Economic, Social and Cultural Rights addressed the social determinants of health in General Comment 14 on the right to the highest attainable standard of health. The contribution of international human rights law and related States’ obligations to addressing the social determinants of health is well-recognised.

Who could disagree? Except when it comes to who should pay for these worthy investments. In February the UK government announced it would cut international development spending by 0.2% of GDP from 2027 to fund increased investment in defence. The British Prime Minister, Sir Keir Starmer, reportedly found this decision ‘difficult and painful.’ Yet according to the (now former) UK Minister of State for International Development and for Women and Equalities, Anneliese Dodds, Sir Keir found it easier to ‘remove food and healthcare from desperate people’ than to initiate a debate on increasing revenue through taxation and borrowing.

Proposals to cut international development spending have also been announced by Belgium (25%), France (>€2 billion), Netherlands (€2.4 billion), and Switzerland (CHF 110 million). At the same time, the threatened withdrawal of US support for Ukraine and related wider security concerns has led the European Union to propose to increase defence spending by €800 billion by 2030, which will further stress States’ health expenditure.

Hard times call for hard decisions, indeed. But it is apparently easier for political leaders in the Global North to reduce health and development spending on the world’s poor than to take a hard look at taxing the world’s super wealthy individuals, families and their private trusts. According to the World Inequality Report, 2022, ‘The richest 10% of the global population currently takes 52% of global income… The poorest half of the global population barely owns any wealth at all, possessing just 2% of the total. In contrast, the richest 10% of the global population own 76% of all wealth.’  Their playthings include super-yachts and private jets (lifestyles well outside our sustainable planetary doughnut) and also news and social media companies – allowing these moguls to manipulate truth and distort democracy.

Prominent economists such as Thomas Piketty propose three approaches to redistribute wealth; a broad-based, comprehensive income tax, a progressive wealth tax and a progressive inheritance tax. The UN Special Rapporteur on Extreme Poverty, Olivier de Schutter, has long argued that ‘the fight against income and wealth inequalities… should be at the heart of the search for post-growth approaches to poverty eradication.’ In February the Committee on Economic, Social and Cultural Rights reminded States Parties of their obligations regarding equitable taxation policies, including their extraterritorial obligations towards other States. The Committee noted that States have a duty to combat tax evasion and avoidance, including by corporations and high-net-worth individuals, through tax havens and financial secrecy (see E/C.12/2025/1).

For decades the public health community has welcomed private sector funding for health programmes and ‘public-private partnerships’ (PPPs). However these contributions also come with profound challenges of accountability and competing interests. With fresh eyes, in January Puyvallée and colleagues argue for ‘rebuilding our current understanding of partnership from the bottom up to deliver the global health partnerships we need, not just those we have.’

Tax reforms require social and political pressure. In February Richard Horton, editor of The Lancet (a medical journal) identified political struggle, along with taxation and education, as ‘the third lever to accelerate the journey towards equality.’  Horton urged merging climate activism and the fight to defeat inequality to deliver ‘the powerful force for social change that is so urgently needed.’

Healthy beginnings, hopeful futures. Today, with Paris Agreement climate promises leading to a 2.4 degrees C world, a 5-year-old in sub-Saharan Africa will face a 54-fold increase in heatwaves across her lifetime, estimates one online calculator (her very survival under such conditions is not considered in this modelling.) All States face immediate costs in mitigating and adapting to climate change. Richer States should also assist developing countries that are particularly vulnerable to the adverse effects of climate change in responding to loss and damage.

If we are serious about eradicating poverty and limiting climate havoc and other global health challenges for children and future generations, the human rights community must also address extreme income and wealth inequalities. For example, the Human Rights and the Climate Crisis Working Group of the Netherlands Network for Human Rights Research should engage with human rights scholars addressing extreme wealth inequalities and related issues of international solidarity, building on the climate change-related work of the United Nations Independent Expert on human rights and international solidarity (See A/HRC/44/44).

The international human rights system, grounded in the UN Charter, the Universal Declaration of Human Rights and UN human rights treaties and resolutions, provides a strong normative and legal framework for these conversations. It is far from perfect but, in the spirit of hopeful futures, let’s not throw the baby out with the bathwater. As rich States cut back global health and other critical development assistance, all States must explore other sources to make up the difference, including through equitable taxation policies and by abolishing tax havens and related financial secrecy. Healthy beginnings, hopeful futures, for all.