Valuating the Potential New Governance Answers to Right to Health Questions in Canada.

itics have described lack of accountability as the "Achilles' heel" of publicly funded heath care in Canada. Growing decentralization and privatization in Canadian health care have contributed to concern from the public and the Committee on Economic, Social and Cultural rights for more coherent, transparent and accountable health care resource allocation decisions. A constitutional gloss was recognized by the Supreme Court of Canada's 2005 decision finding that restrictions on access to private health care, in the context of insufficiently justified long wait times in the public system, violated guarantees of security of the person. Meanwhile, governance theorists continue to suggest that the right kinds of citizen-participation-driven processes can overcome deficits in accountability in the provision of public services, particularly in decentralized systems. Dominant themes, which include benchmarking, parallel experimentation, flexibility, transpar ency and accounting, are increasingly evident in all levels of health care law and policy reform in Canada and in the international health and human rights discourse. This paper examines whether and how governance-based mechanisms can serve the right to health as understood in international law. It draws on two main examples: (1) access to needle exchange programs for the prevention of HIV/AIDS - an intervention that is well-supported by scientific and human rights literature but subject to ideological resistance and NIMBYism; and (2) management of wait lists for common medical procedures. The paper considers the hospitability of existing Canadian constitutional doctrine to governance based enforcement of a right to health, and evaluates he potential of procedurally-grounded solutions for overcoming abuse of rights of marginalized individuals and communities. ..PAT.-Unpublished Manuscript [ABSTRACT FROM AUTHOR]