HEALTH RIGHTS variety of strategies through which to approach establishing the enforceability of the right to health, there is clear precedent for two approaches in particular. First, the ‘indirect approach’ uses procedural rights which are generally enforceable.25 That is, once a state has taken steps to implement health rights, courts are obligated to ensure that it is done in a non-discriminatory manner, which affords judicial protections.26 Freedom from discrimination (equal protection) will be key to many cases relating to health and a healthy environment.27 Similarly, the rights to due process and/or judicial protection become relevant in most cases. Second, the ‘integration approach’ entails building health into judiciallyprotected civil rights.28 The ECHR has adopted this integration approach and it has been explicitly advocated by a former Inter-American Court judge.29 The rights to life and physical integrity have figured prominently as civil rights connected with the right to health.30 Regional human rights institutions, such as the African Commission and the Inter-American Commission on Human Rights, can also be asked to undertake site visits to examine situations of alleged violations of the right to health or a healthy environment. Also, these bodies can issue precautionary measures in situations that present imminent danger of irreparable harm, and requesting such precautionary measures does not require the prior exhaustion of domestic remedies. Although only a trickle compared with the potential demand, there is a discernable trend toward the enforcement of programmatic aspects of the right to health by judiciaries in a number of countries.31 This has largely been driven by the advent of effective anti-retroviral medications (ARVs) for HIV/AIDS.32 Other cases have involved securing treatment for different conditions, and obliging the government to develop a national plan.33 Indigenous peoples and minorities may choose to avail themselves of foreign courts in order to hold transnational corporations (TNCs) accountable for violations of health-related rights. Such litigation has generally been brought in the United States where many TNCs are headquartered, and where there are a number of other incentives for public interest law firms to take on such cases.34 Costs and jurisdictional hurdles remain significant obstacles to undertaking this strategy, however, lawsuits have been brought for bodily and property damages stemming from environmental pollution that has had health effects.35 Guidelines for successful advocacy Raise awareness about health rights Advocacy on the right to health refers not only to securing remedies in legal cases, but also to creating a consciousness of health issues (including reproductive and sexual health) as matters of fundamental rights. Members of indigenous and 47