The Effectiveness of International Law on Public Health Inequities Within Ethnicity

Abstract

Ethnicity-based public health inequities continue worldwide, reflecting established failures in law, governance, and social justice. International legal instruments, including the International Covenant on Economic, Social and Cultural Rights (ICESCR), the Convention on the Elimination of All Forms of Racial Discrimination (CERD), and the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP), obligate states to provide equitable access to healthcare and address structural components of inequality. This article critically evaluates the effectiveness of these frameworks in advancing health equity, adopting a black-letter legal approach integrated with the social determinants of health models to assess whether ratified commitments have translated into quantifiable changes for marginalized ethnic populations. Case studies from Canada, Australia, and the United States—high-capacity health systems with entrenched inequities—portray the gap between normative commitments and practical implementation. Findings demonstrate that while international law has shaped discourse, promoted civil society advocacy, and influenced select policy reforms, weak enforcement, reliance on voluntary compliance, and insufficient accountability mechanisms curb its capability to generate consistent outcome-based change. Recommendations include establishing a framework convention on global health equity, strengthening the WHO’s mandate on racial justice, improving ethnic-disaggregated data reporting, and ingraining affected communities in policymaking. Normative strength is apparent, but operational impact remains dependent on an enforceable framework and sustained political will.

1. Introduction

Public health inequities along ethnic lines are one of the most persistent and entrenched global challenges in contemporary health governance (Williams and Mohammed 2009). By way of definition, Public health inequities are commonly regarded as systematic differences in health outcomes or access to healthcare that are avoidable, unjust, and rooted in social disadvantages (World Health Organization 2018). Such disparities in access to healthcare services, disease burden, and life expectancy disproportionately affect ethnically marginalized populations across both high-income and low- to middle-income countries. These inequities are neither incidental nor accidental; rather, they reflect systemic failures in law, governance, and social justice (World Health Organization 2018).

This issue transcends national boundaries and lies at the intersection of public health, human rights, and international law. Hence, legal instruments like, the International Covenant on Economic, Social and Cultural Rights (ICESCR), the Convention on the Elimination of All Forms of Racial Discrimination (CERD), the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP), establish both direct and indirect obligations on states to guarantee equal access to healthcare services and address structural factors driving ethnic inequity. These laws jointly demand that states should circumvent discriminatory practices and also take positive steps to deconstruct barriers that inappropriately harm ethnic minorities (Thornberry 2016; The General Assembly 2007; United Nations Treaty Collection 1979). This is because international law, through human rights treaties and global health instruments, frames health equity as an obligation of states and a matter of justice.

Health is recognized as a fundamental human right, and denial of health equity for ethnic groups implicates core principles of equality and non-discrimination in international law.1 The problem of health inequalities, therefore, challenges the global legal community to scrutinize not only state responsibilities but also the effectiveness of binding and non-binding instruments intended to secure the right to health for all.2

Normative and procedural frameworks are proffered by international law to hold states accountable through periodic reviews, reporting obligations, and the work of treaty bodies. Hence, the practical effect is dependent on state execution, political will, and institutional follow-up (Shah and Sivakumaran 2025; Wuerth 2025). Ultimately, despite numerous efforts on a global scale, the practical influence of International law on reducing ethnic health disparities remains contested (Dow and Rehkopf 2010).

This article critically examines the role if international law in addressing ethnic inequities in public health. Through an interdisciplinary legal analysis, the article interrogates whether these international legal frameworks have substantively advanced health equity for ethnic minorities or merely affirmed aspirational commitments. In doing so, it aims to illuminate the normative strengths, operational shortcomings, and potential reform pathways within international legal regimes seeking to address ethnic disparities in health outcomes.

While there is a wide range of research in public health investigating the social determinants of ethnic health inequities, and a parallel literature in international law addressing the right to health and non-discrimination, these two domains often operate in disciplinary silos. Most legal scholarships concentrate either on the normative strength of human rights instruments or the structural challenges of enforcement, while public health studies emphasize epidemiological patterns and local interventions. Comparatively little work has been performed to methodologically assess whether and how international legal frameworks have significantly sculptured public health outcomes for ethnic minorities. This study seeks to bridge that gap (Yearby 2022).

Particularly, this article contributes to the field by critically evaluating the operational influence of international legal obligations on ethnic health equity. It moves beyond rhetorical affirmations of human rights to analyze the real-world implementation and impact of legal instruments such as the ICESCR, CERD, and IHR. By combining doctrinal legal analysis with public health case studies, this study offers an interdisciplinary framework that is currently underdeveloped in the literature. It adopts the black letter standard to assess not just whether states have ratified legal instruments, but whether these commitments have translated into improved health outcomes for marginalized ethnic groups.

Consequently, this article answers to calls within both legal scholarship and public health literature for a more integrated perspective on understanding health justice. It also builds on—but critically advances—the work of scholars like Paul Hunt, Alicia Ely Yamin, and others who have examined the right to health in broader terms, by applying a targeted focus on ethnicity-based disparities and offering practical recommendations to improve legal accountability (Yamin 2008; Gostin et al. 2019; Meier and Fox 2008).

Methodology

Fundamentally, this study design adopts the black-letter approach, which is based on legal positivism (manmade law), the scientific methodological approach of “immanent critique” often deployed within policy-oriented legal studies and socio-legal studies of “law in action” helps to illustrate whether laws have achieved their intended purpose. These legal methodologies will strengthen the theoretical and analytical dimensions of the issues under consideration.

2. Conceptualizing Public Health Inequities

The distinction between health “inequalities” and “inequities” is central to understanding and addressing ethnic disparities in global public health. While often used interchangeably, these terms present conceptually distinct phenomena. Health inequalities are measurable differences in health status observed across individuals or among socially relevant groups or populations, regardless of whether these differences are considered fair or unjust (Arcaya et al. 2015). The World Health Organization defines health inequities as avoidable and unfair health disparities that are consistently tied to social disadvantage (Arcaya et al. 2015). They arise when certain groups, in this case, defined by ethnicity or race, face structural disadvantages that lead to poorer health.

Ethnicity as a social category can correlate with a host of inequities: ethnic minority communities may endure poverty, segregation, environmental hazards, or stigmatization that directly and indirectly harm health (Gaskin et al. 2012). Ethnic disparities in health, such as increased maternal death rates among Indigenous women in Latin America or elevated diabetes prevalence in African American communities in the United States, are typically classified as inequities, as they stem not from biological variation but from social, political, and economic marginalization. Braveman describes health inequities as structural variations in access to opportunities available to groups to attain peak wellness, resulting in unequal and preventable differences in health outcomes (Braveman and Gottlieb 2014).

An effective way to understand these inequities is through the framework of social factors influencing health, which focuses on the Circumstances of birth, growth, living, working, and aging (Marmot et al. 2008). Often, there is an intersection between ethnicity and other social determinants, like income, education, housing, and legal status, compounding disadvantage through structural discrimination (Marmot et al. 2008, n. 10). For example, Indigenous populations globally experience systemic barriers to accessing culturally competent healthcare, a consequence of both colonial legacies and contemporary legal exclusion (Anderson et al. 2016). These realities create entrenched patterns of differential health outcomes, which cannot be rectified through health policy alone but require systemic legal and normative intervention.

International legal obligations reinforce the imperative to address such inequities. Under the International Covenant on Economic, Social and Cultural Rights (ICESCR), States are responsible for gradually advancing the right to health in a way that guarantees freedom from any discrimination, including racial or ethnic biases.3 General Comment No. 14 of the United Nations Committee on Economic, Social and Cultural Rights explains that healthcare facilities, products, and services should be available, accessible, acceptable, and of adequate quality for everyone (UN Committee on Economic, Social and Cultural Rights 2000). The United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP) further makes a provision for the right of indigenous peoples to access all health services without discrimination (The General Assembly 2007). Incorporating health equity into the framework of human rights norms shifts the discourse from a charitable or technocratic concern to one of legal entitlement and justice (Braveman 2014). Under a human rights approach, persistent ethnic disparities in health are seen as evidence of states’ failure to uphold obligations of equality and the International community’s inability to hold them accountable, rather than merely unfortunate social problems.

To steer the investigation across this study, a cohesive conceptual framework is engaged to combine a human rights-based approach to health (HRBA) with the social determinants of health (SDH) model. The HRBA conceptualizes health as a legally enforceable right rather than a policy aspiration, configuring state obligations under international law—especially the ICESCR and CERD—as pivotal to examining equity. Concurrently, the SDH model is used to understand how structural inequalities—such as poverty, racism, political exclusion, and legal marginalization—produce and perpetuate ethnic health inequities. Cooperatively, these frameworks allow for a structured evaluation of international law’s role: not just in terms of legal ratification, but in how these obligations are (or are not) articulated into practice, measured by access to services, health outcomes, and significant accountability (Kenyon et al. 2018).

Through this study, this concerted framework is operationalized in three ways: firstly, by examining whether legal commitments are in line with the SDH factors most pertinent to ethnic groups; secondly, by probing the implementation of legal obligations through national policy and health outcomes; and thirdly, by exploring the mechanisms for accountability, redress, and participation accessible to marginalized communities. In this way, the article does not treat international law as an abstract doctrine, but as a set of instruments whose effectiveness must be ascertained by their practical-world influence on ethnic health equity (Braveman and Gottlieb 2014).

3. Case Studies: Ethnicity-Based Public Health Inequities

Concrete examples from around the world starkly illustrate how ethnicity correlates with health inequity, and they reveal both the causes of these gaps and the (often limited) role that international law has played in addressing them.

The focal point of this study is on Canada, the United States, and Australia for three principal reasons. Firstly, these nations sustain proportionately high levels of healthcare infrastructure and significant state capacity, which underscores the prevalence of ethnic health inequities not as a matter of resource insufficiency, but of structural and legal failure. Secondly, all three have histories of settler colonialism and progressive racialized inequalities, specifically affecting Indigenous and historically marginalized communities. This makes them analytically useful for evaluating how historical injustice translates into present-day public health inequities. Thirdly, these nations are signatories to relevant international treaties—such as the ICESCR (Canada and Australia), CERD (all three), and UNDRIP—allowing for a critical examination of the gap between formal legal commitments and real-world health outcomes. Their incorporation dispenses insight into how international law interfaces with domestic policy in high-income democratic contexts, and the reason it often falls short notwithstanding robust normative frameworks (Lavoie et al. 2016).

The following case studies illustrate the depth of these disparities and critically assess the effectiveness of national and international legal responses.

Case Study 1: Indigenous Communities in Canada and Australia.

Even in countries with generally high standards of healthcare, Indigenous populations face notably worse health results compared to their non-Indigenous counterparts (Mitrou et al. 2014). In Canada, for example, researchers have identified the impacts of colonialism, racial discrimination, and inherited trauma as major contributors to worse health results and shorter lifespan among First Nations, Métis, and Inuit populations (Tjepkema et al. 2019). As of 2011, life expectancy for First Nations individuals was about 9–10 years lower than for other Canadians (Mitrou et al. 2014). Infant death rate among native communities was more than double that of non-native communities/non-indigenous populations (Mitrou et al. 2014). In Australia, the life span at birth for Aboriginal and Torres Strait Islander peoples is about eight years lower than that of non-Indigenous Australians, which is 71.9 years versus 80.6 years for men, and 75.6 years versus 83.8 years for women (Australian Bureau of Statistics 2023). These gaps are associated with increased rates of preventable illnesses, insufficient healthcare access in remote Indigenous areas, and enduring socio-economic inequities. Ironically, both Canada and Australia are parties to the ICESCR, meaning they are legally bound to protect this right without discrimination. Yet, the persistence of such disparities suggests a disparity between global pledges and national actions.

Case Study 2: African Americans in the United States.

Although the United States is among the globe’s richest countries, racial and ethnic health disparities persist, with African Americans notably experiencing far worse health results compared to their white peers (Macias-Konstantopoulos et al. 2023). Current statistics underscore the breadth of this inequity: Black Americans are more prone to chronic diseases and have a life expectancy that is almost five years lower than that of white Americans (72.8 vs. 77.5 years) (Artiga et al. 2024). One of the most alarming statistics is that Black mothers succumb to pregnancy-related issues at almost triple the rate of white mothers, while Black infant mortality is more than twice that of white infants (Artiga et al. 2024). These grim figures have roots in a long history of slavery, segregation, and institutional racism that created segregated neighborhoods, differential access to quality healthcare, and cumulative stressors often referred to as “weathering” (Artiga et al. 2024). U.S. civil rights law addresses some drivers of these disparities (for instance, prohibiting hospital segregation or race discrimination in insurance), but the United States notably is yet to ratify the ICESCR; hence, the entitlement to healthcare in national law is not formally recognized. International law has, therefore, had a more persuasive than binding role in this regard. Nonetheless, the U.S. is party to the Convention on the Elimination of Racial Discrimination (CERD), which has been interpreted to cover racial disparities in outcomes. The CERD Committee, in its 2022 review of U.S. compliance, expressed concern that intersecting factors, such as systemic racism and others, continue to obstruct equitable access to healthcare, resulting in significant racial disparities in maternal mortality (United Nations Committee on the Elimination of Racial Discrimination 2022). The U.S. has seen some recent improvements on certain metrics (the racial gap in infant mortality narrowed slightly pre-2020), but the enduring disparities and a 2023 study attributing 1.63 million excess Black deaths over the past two decades (Reitman 2023) attest that the promise of health equity remains far from realized.

4. Causes of Public Health Inequities Within Ethnicity

Understanding why ethnic health inequities persist is essential for evaluating the success or failure of legal frameworks. This is so because these inequities do not emerge in a vacuum; they are the cumulative result of discriminatory policymaking, systemic racism, socio-economic exclusion, and legal neglect, which together hinder equitable access to health resources and protections. The factors are deeply interrelated and often mutually reinforced, thereby creating a vicious cycle that entraps certain ethnic groups in perpetual poor health.

4.1. Systemic Discrimination and Racism

In many societies, ethnic minority groups have historically been subject to discrimination that limits their social and economic opportunities. This can take blatant forms like segregated or inferior medical facilities in the Jim Crow-era United States or apartheid South Africa, as well as subtler contemporary forms like implicit bias in clinical encounters (Smith 2005). Discriminatory policies in housing, education, employment, and criminal justice contribute to health inequity by concentrating minorities in impoverished environments and high-stress circumstances (Smith 2005). The American Public Health Association succinctly notes that health disparities stem from policies and practices that unevenly distribute wealth, influence, and resources across communities, particularly along racial lines (American Public Health Association n.d.). The cumulative effect is that ethnic minorities often enter each generation at a health disadvantage.

4.2. Legal and Political Marginalization

Ethnic health inequities are frequently linked to the marginal status of minority groups in political decision-making and law. Indigenous peoples and ethnic minorities have sometimes lacked full citizenship or autonomy or have been excluded from public life (World Bank 2023). This marginalization can result in neglect by the state.4

It also means minorities may have less influence on health policy priorities or resource allocation. This encompasses the right to govern oneself and the right to participate in public affairs, as recognized under international human rights law.5 If these areas are neglected, minority communities’ needs may not be taken into consideration in health policies.6 Legal marginalization is both a cause and result of health inequity: poor health can further reduce a community’s ability to advocate for itself, reinforcing political disempowerment.

4.3. Economic Disparities

Poverty is a strong predictor of poor health, and due to historical injustices, ethnic minorities are often disproportionately represented among the poor. Lower income affects a person’s ability to obtain nutritious food, secure housing, and proactive healthcare, which invariably increases exposure to health hazards (National Academies of Sciences, Engineering, and Medicine 2021).

International law, through instruments like the ICESCR, obliges states to improve the socio-economic conditions underlying health.7 In practice, however, many states have not adequately targeted economic inequality among ethnic groups (Wike et al. 2025). A failure to equitably allocate resources, for instance, is a breach of the obligation to avoid deliberate discrimination and to prioritize vulnerable groups (Wike et al. 2025). In many countries, austerity policies or corruption have further limited the funds directed toward minority health programs, exacerbating the economic roots of health disparities.

4.4. Barriers in Healthcare Access

Even when health services exist, ethnic minorities may face unique barriers to accessing them. For example, the COVID-19 vaccination plan rolled out on the 27 December 2020 in Italy, included the entire population (healthcare workers, older adults, persons with other risk factors), but clearly excluded migrants from any of its targeted priority groups (Roberto et al. 2023). There may also be distrust of health systems due to historical abuses such as medical experimentation on minority groups or coercive practices. For example, Indigenous and Afro-descendant communities in Latin America frequently face discrimination in hospitals and clinics, which often discourages them from seeking necessary care (Castro et al. 2015). All these barriers mean that nominally “universal” health systems effectively leave significant ethnic gaps. Under international law, states are obligated to ensure the quality, acceptability, and accessibility of healthcare for all segments of the population; however, many have failed to meet these obligations (Castro et al. 2015).

4.5. Neglect and Accountability Gaps

The ongoing disregard for these communities in national legal frameworks is a major contributor to ethnic health disparities. The Convention on the Elimination of All Forms of Racial Discrimination is one of the many international treaties that many states have joined, but many have not incorporated these obligations into home laws or policies.

Legal scholars have critiqued the “implementation gap” between international obligations and national enforcement as a primary cause of persistent disparities (Tobin 2012). Moreover, where legal redress mechanisms exist, they are often inaccessible to ethnically marginalized populations due to linguistic, cultural, or financial barriers (Farmer 2003).

Additionally, international law has often failed to establish binding, group-specific obligations to protect ethnic minorities in public health contexts. While instruments like the UN Declaration on the Rights of Indigenous Peoples and CERD set out relevant standards, they lack robust enforcement mechanisms, rendering them normatively powerful but operationally weak.

5. Effects of Public Health Inequities on Ethnic Groups

The consequences of public health inequities for ethnic groups are severe and multifaceted. At the most direct level, these inequities translate into higher rates of illness and premature death for marginalized groups. This is evident in epidemiological data: for example, the excess mortality experienced by Black Americans, which reflects an estimated 1.63 million excess deaths compared to whites over two decades (Reitman 2023), underscores that racial health gaps are literally life-and-death matters. Likewise, indigenous communities in various countries suffer markedly higher mortality from preventable causes, and life expectancy gaps of the kind noted earlier mean that thousands of individual lives are cut short due to inequity (Reitman 2023). The WHO’s Commission on Social Determinants of Health captured this stark reality with the pronouncement that on a large scale, societal inequity is causing deaths (World Health Organization 2009).

Beyond mortality, health inequities inflict profound suffering and reduce quality of life. Ethnic minorities often endure higher burdens of chronic diseases like diabetes, hypertension, HIV/AIDS, and disabilities (Pascoe and Richman 2009). These conditions can cause long-term pain, impairment, or stigma, affecting individuals, families, and entire communities. High morbidity can impede the ability of community members to work or obtain education, thereby perpetuating economic hardship (Pascoe and Richman 2009). In this way, health inequities contribute to poverty traps.8 This cyclical relationship between ill-health and poverty tightens the grip of disadvantage on ethnic minorities. It also has intergenerational effects as children who grow up malnourished or frequently ill may suffer developmental deficits, which will limit their opportunities later in life and continue the cycle of inequity.

Another significant effect is psychological and cultural. When ethnic communities experience substantially worse health outcomes, it often correlates with experiences of trauma, disempowerment, and loss of trust in societal institutions. Repeated exposure to premature deaths can inflict collective trauma and grief. This trauma can manifest as elevated rates of mental health issues, including depression, anxiety, and substance abuse (Subica and Link 2021).

In many Indigenous cultures, health is understood to encompass the comprehensive integration of spiritual and community wellness. As such, health inequities are seen as an attack on the social fabric and cultural integrity of these communities (Biles et al. 2024). The exclusion or neglect signaled by health inequities can also lead to feelings of alienation from the state. Communities may justifiably perceive that their lives are accorded less value, breeding resentment or eroding social unity.

However, it is important to note that amidst these negative consequences, there have been some galvanizing effects in terms of legal and political mobilization. The very starkness of ethnic health inequities has, in certain instances, prompted collective action and demands for change (Biles et al. 2024). For example, awareness of the high maternal death rates among Black women in the United States has led to the rise in Black maternal health advocacy groups and legislative initiatives. In this sense, inequities have sometimes become a rallying point for social movements seeking to claim rights. International human rights bodies, by documenting and publicizing disparities, have empowered local activists with moral and legal arguments. While these can be seen as positive externalities, they are, of course, responses trying to mitigate an underlying harm that should not exist in the first place. When certain ethnic groups are systematically denied this, the outcome is not only personal tragedy but also the fragmentation of societies along ethnic lines of well-being. This reality presses the question: How effective have international legal frameworks been in ameliorating these outcomes, and what more can be done?

6. International Legal Frameworks: ICESCR, IHR, and UDHR

Before exploring the effectiveness of international law in addressing ethnic health inequities, it is pertinent to illuminate what “effectiveness” means in this legal context. Contrary to domestic legal systems, international law often lacks strong enforcement mechanisms. A plethora of treaties relevant to health—such as the ICESCR and CERD—craft binding obligations theoretically, but their implementation leans largely on voluntary state compliance, political will, and domestic incorporation. Other instruments, such as the UDHR or UNDRIP, are non-binding or declaratory in character, hinging more on normative pressure than legal compulsion (Yamin and Constantin 2018).

Consequently, the effectiveness of international law must be analyzed along multiple hues: normative influence (for example, how laws contour discourse and expectations), institutional compliance (for example, whether states incorporate these norms into national law and policy), and outcome-based impact (for example, whether ethnic health disparities are reduced). It is also crucial to contemplate the structural pitfalls to enforcement: treaty bodies like the CESCR or the CERD Committee can issue concluding observations and general comments, but they lack the power to impose sanctions or compel reforms. Nations may neglect to submit reports, disregard recommendations, or selectively implement norms. These constraints do not make international law meaningless, but they do need a realistic evaluation of its reach and constraints (Glensy 2011).

Therefore, this study evaluates international legal frameworks not on idealized grounds, but in terms of how they operate within this constrained architecture. The paper investigates not only the existence of legal instruments but also whether they are complemented by viable enforcement mechanisms, responsive institutions, and considerable improvements in health equity. This approach demands that the discussion of legal impact remains grounded in the real-world dynamics of international law (Blum 2008).

International law has long recognized the entitlement to healthcare and the concept of equal treatment as essential components of social justice and human dignity. Three fundamental instruments—the International Covenant on Economic, Social, and Cultural Rights (ICESCR), the International Health Regulations (IHR), and the Universal Declaration of Human Rights (UDHR)—establish concurrent legal and normative obligations with the objective of safeguarding marginalized populations, including ethnic minorities, and promoting health equity. However, the extent to which these instruments offer effective protection and accountability mechanisms for addressing ethnicity-based health disparities remains a subject of critical scrutiny.

6.1. International Covenant on Economic, Social and Cultural Rights (ICESCR)

The ICESCR came into force in 1976 and has been the cornerstone of international legal protection of the right to health. Article 12 of the ICESCR affirms the right of every individual to achieve the best possible level of physical and mental well-being (Blum 2008). It is important to emphasize that Article 2(2) requires states to ensure the safeguard of this right without bias based on factors like race, color, or national origin. Together, these provisions create a clear legal obligation for states to address health disparities impacting ethnic minorities. The UN Committee on Economic, Social, and Cultural Rights (CESCR) further clarified the normative content of the right to health under the ICESCR in General Comment No. 14 (2000) (UN Committee on Economic, Social and Cultural Rights 2000). CESCR emphasized that states have “immediate obligations” to ensure non-discriminatory access to healthcare and to prioritize vulnerable populations (UN Committee on Economic, Social and Cultural Rights 2000, Article 30). The Comment outlines the “AAAQ” criteria (Availability, Accessibility, Acceptability, Quality) for health facilities.9 It also notes that states have “core obligations” that should be secured even when resources are constrained.10 Failure to meet these core obligations for disadvantaged ethnic communities could amount to a contravention of the Covenant.

In terms of accountability, there is a requirement of the ICESCR states to submit reports periodically to the CESCR detailing their implementation of rights, including measures taken to reduce health inequities.11 The Committee reviews these reports and issues Concluding Observations, often calling out countries on ethnic health gaps. However, while these observations are authoritative interpretations, the ICESCR lacks a direct enforcement mechanism.12 Thus, compliance relies on a combination of domestic incorporation of the Covenant, pressure through public reporting, and the mobilization of civil society. The ICESCR framework is robust in principle, but in practice its effectiveness varies.

Some countries have constitutionalized the right to health or enacted strong anti-discrimination laws in health, partly due to ICESCR influence, and in those contexts, one can see modest improvements (Arrieta-Gómez 2018). In many other cases, however, ICESCR’s promises remain aspirational; economic and social rights often receive less immediate attention than civil-political rights (Kalantry et al. 2009), and not all states have invested the “maximum of available resources” to bridge ethnic health divides, as Article 2(1) requires. Nonetheless, the ICESCR provides a crucial legal framework and moral pressure: it affirms that eliminating health inequities is not optional charity but a binding obligation, and it supplies a yardstick against which to measure state performance.

6.2. International Health Regulations (IHR) (2005)

The International Health Regulations (2005), adopted under the WHO Constitution, constitute a specialized legal framework that is binding on all WHO member states (World Health Organization n.d.). Its main goal is to prevent and address the international spread of diseases, while also minimizing any unnecessary disruptions to trade and travel (World Health Organization n.d.). Unlike the ICESCR, the IHR does not have the status of a human rights treaty per se; it is more technical in nature, focusing on surveillance, notification, and containment of public health emergencies such as epidemics. However, the IHR (2005) explicitly incorporates some equity-relevant principles. Article 3 stipulates that its implementation must fully respect the dignity, human rights, and fundamental freedoms of individuals. This provision was included to safeguard against the infringement of human rights through measures like quarantine, isolation, or travel restrictions, ensuring that health measures are applied in a fair and non-arbitrary manner. Additionally, Article 3.3 of the IHR emphasizes that the Regulations should be guided by the goal of universal application, aimed at protecting all people worldwide from the international spread of disease. The universalistic phrasing, “protection of all people”, reflects an ideal of equity: no population should be left vulnerable to infectious hazards.

The IHR also recognizes differing capacities among states and calls for collaboration. Under Article 44, States Parties agree to collaborate and assist each other, with WHO’s help, in building and maintaining the core public health capacities needed. This is relevant to equity because many of the countries or regions that lack such capacities and, hence, are epicenters for uncontrolled outbreaks. In theory, the IHR’s cooperative provisions are a tool for reducing international health inequities: wealthier states and the WHO are supposed to support capacity-building in resource-poor settings, thereby ensuring all populations are better protected.13 Despite these intentions, the IHR’s effectiveness on equity has been limited. Compliance with the IHR’s capacity requirements has been uneven and many states missed the initial 2012 deadline to meet core capacities and continued to seek extensions for years (Ijaz et al. 2012). The IHR lacks strong enforcement; it relies on what has been termed a “horizontal compliance mechanism” (Burci and Quirin 2018), essentially peer pressure and transparency, whereby states report their own progress and are subject to review at the World Health Assembly (Burci and Quirin 2018). There are no sanctions for non-compliance. As a result, the global inequity in health preparedness persisted; this reality was highlighted starkly by the COVID-19 crisis in 2020 (Forman et al. 2024). During the COVID-19 pandemic, the IHR’s principles of solidarity and non-discrimination were tested, as travel bans targeting specific regions, vaccine nationalism, and unequal access to medical supplies highlighted gaps that the IHR could not entirely prevent (Forman et al. 2024).

Moving on, the IHR does not directly address chronic health inequities within countries; rather, it is event-focused, so its scope regarding ethnic disparities is indirect and primarily exercised through urging general capacity improvements and fair application of measures. But in terms of accountability, it places much trust in states’ goodwill and the collective interest.

6.3. Universal Declaration of Human Rights (UDHR)

Adopted by the United Nations General Assembly in 1948, the Universal Declaration of Human Rights (UDHR) is a resolution that, while influential, does not have binding legal force. lxix Nevertheless, it is a fundamental text of the contemporary human rights system and has had a significant impact on international norms and subsequent treaties.

The Universal Declaration of Human Rights (UDHR) is a non-binding resolution that was adopted by the United Nations General Assembly in 1948. Unfortunately, it does not establish enforceable legal obligations on its own (Dolinger 2016). Nevertheless, it is a fundamental text of the contemporary human rights system and has had a significant impact on international norms and subsequent treaties (Dolinger 2016). Several provisions of the UDHR are directly relevant to public health inequities. Article 1 provides freedom and equality in dignity and rights to all human beings. Establishing equality as a bedrock principle,14 Article 2 guarantees the rights and freedoms without any discrimination, including based on race or color or other status.15

These clauses mean that from the very inception of the human rights movement, racial/ethnic equality was recognized as fundamental; thus, the foundational Human Rights document implicitly condemns any systematic racial disparities, including in health. Additionally, Article 25(1) of the UDHR lays out a broad right to an adequate standard of living for health and well-being.16 While the UDHR’s wording, “standard of living adequate for health…including medical care,” is somewhat broader than a focused “right to health,” it clearly encompasses health determinants and care, and frames them as entitlements. Crucially, because Article 25 applies to “everyone” and Article 2 forbids distinctions like race, one can read the UDHR as asserting that it is unacceptable for any ethnic group to be deprived of those health-related rights.

The UDHR’s impact on the issue has been largely normative and inspirational. It provided the template for binding treaties like the ICESCR and has been cited in countless international and national documents advocating equal health rights. For example, the United Nations Sustainable Development Goals (SDGs), particularly SDG 3, which aims to ensure healthy lives and promote well-being for all, and SDG 10, which focuses on reducing inequalities both within and among countries, echo UDHR commitments and have galvanized international cooperation partly on that basis. Some of its provisions, including the non-discrimination principle, are also considered reflective of customary international law (Dolinger 2016). That means even states that have not joined specific treaties are broadly expected to refrain from racially discriminatory practices, including in health. The language of the UDHR has been incorporated into the constitutions of many newly independent states, frequently resulting in constitutional guarantees of equality and, in some cases, the right to health.

However, as the UDHR is not binding, its effectiveness depends on it being implemented through other means such as national laws, international treaties, and public opinion. Though its greatest strength is its universality and moral authority. Yet, the UDHR on its own cannot ensure compliance; it relies on voluntary adherence and the gradual formation of a culture of human rights. In areas of health inequity, it reminds the international community that gross disparities are inconsistent with our shared ideals of humanity. The UDHR’s soft power should not be underestimated: it set the normative stage that made legally binding advances possible. Simply put, the UDHR provides the ethical and legal blueprint that health equity is a right for all ethnic groups, but it takes the other frameworks and vigorous enforcement to realize that vision.

7. Recommendations: Strengthening International Law for Ethnic Health Equity

To address persistent ethnic disparities in public health, international legal frameworks must move beyond normative affirmation toward enforceable commitments and institutional innovation. The following recommendations propose feasible yet impactful reforms that can enhance the capacity of international law to drive systemic change.

• Establish a Framework Convention on Global Health Equity: The international community should negotiate a new treaty that is specifically focused on health equity and the right to health. This treaty could incorporate existing instruments such as the ICESCR and ICERD, but it would also establish explicit standards for reducing health disparities between and within countries, establish objectives for states to achieve in terms of narrowing ethnic health inequalities, and establish more robust accountability mechanisms. Some of health challenges faced by the marginalized and the impoverished would be significantly reduced by a treaty that is rooted in the right to health and principles of justice. Additionally, it would establish an accountability regime with robust standards, monitoring, and enforcement.
• Strengthen WHO and UN Mandates on Equity: International institutions should more assertively use their existing authority to champion ethnic health equity. The WHO’s mandate, for instance, could integrate equity criteria into its evaluation of health systems. Its powers should be reinterpreted and expanded to ensure that structural determinants of ethnic health inequities are addressed, not merely health emergencies. This could mean establishing a WHO Special Rapporteur on Health Equity and Racial Justice, tasked with monitoring ethnic disparities and advising states on rights-based interventions. WHO should also be empowered to issue binding guidelines under Article 21 of its Constitution, particularly on equity-based health resource allocation.
• Enhance Accountability and Participation: To translate legal obligations into reality, enforcement and inclusion must improve. One recommendation is to bolster the monitoring of health inequities: states should be required to collect and submit data on key health indicators broken down by ethnicity. Failure to do so or to show improvement should invite scrutiny. The international community could create an independent “Health Equity Watch”—perhaps under UN auspices—to track countries’ progress and call out inertia or regression. Additionally, affected communities should be given a voice in international processes. Mechanisms could be created for indigenous people and other minority representatives to participate in relevant WHO meetings or UN discussions.
• Intersectoral and Inclusive Reforms: Because the roots of health inequities lie in various sectors, international law’s approach must be holistic. Treaties and global strategies should encourage “Health in All Policies” and require that states evaluate the equity impact of legislation. Moreover, the inclusion of marginalized ethnic groups in policy design is key. International guidelines could insist that any national health plan or SDG implementation strategy include consultation with minority communities. This aligns with the right to participation and can improve outcomes, as policies that reflect community input are more likely to be effective and fair.
• Leverage Regional Human Rights Systems: Regional entities frequently possess enhanced enforcement and oversight capabilities. To address ethnic health disparities, the jurisprudence of the European, Inter-American, and African human rights systems should be developed within the context of the right to health and non-discrimination. In this regard, the African Commission on Human and Peoples’ Rights has the opportunity to establish principles that specifically address the health rights of indigenous populations in Africa.

8. Conclusions

In conclusion, international law has established a strong normative foundation that denounces public health inequities along ethnic lines as inconsistent with fundamental human rights. Treaties like the ICESCR and the broad principles of the UDHR affirm that all people are entitled to health and well-being without discrimination, and frameworks such as the IHR acknowledge the importance of universal protection. Yet, as this analysis has shown, a profound gap exists between the ideals of international law and the lived reality of many ethnic minority communities. The current international legal regime has been only partially effective in remedying ethnic health disparities–effective in articulating rights and goals, but less so in enforcement and actual outcomes. The persistence of stark health gaps reflects weaknesses in implementation, accountability, and political prioritization.

To totally comprehend this gap, it is necessary to acknowledge that international law functions within a system that is deficient in centralized enforcement. Most of the legal instruments considered—such as the ICESCR, CERD, and UNDRIP—depend on mechanisms like voluntary reporting, peer review, and normative pressure instead of judicial coercion. Nations can ignore treaty body recommendations with negligible consequences, and there are no supranational bodies empowered to enforce compliance in most cases. This structural deficiency makes outcome-based impact challenging to attain, particularly in areas necessitating long-term, systemic reform such as ethnic health equity.

Accordingly, “effectiveness” in this context must be appraised in relative, not absolute, terms: Has international law impacted national discourse? Has it affected domestic legislation or policy reform? Has it mobilized civil society or created moral pressure? And, critically, has it led, however, to quantifiable changes in health equity for marginalized ethnic groups? These questions acknowledge the minimal but not insignificant power of international legal frameworks in advancing equality.

However, the trajectory is not entirely bleak. There is an evolutionary trend toward greater attention to health equity in global governance. In the last two decades, there have been more explicit focus on social determinants of health, more engagement of human rights bodies with health issues, and proposals for innovative legal instruments. The concept of “health equity” is now embedded in the Sustainable Development Goals and international discourse, indicating a shift towards operationalizing what were once abstract commitments. Going forward, a combination of strengthened legal frameworks, political will, and grassroots advocacy will be needed to translate commitments into change.

Conclusively, international law can act as a strong pedal for health equity—not because it drives change in every case, but because it delineates obligations, elevates neglected matters, and offers tools for advocacy and accountability. Its commitment lies in its capacity to propel states toward greater equity, even when formal enforcement is not strong. The ultimate measure of its effectiveness will be whether, in years to come, the health of historically marginalized groups markedly improves and converges with that of majority groups, vindicating the promise that human rights and the rule of law can help drive social justice and health for all.