Why has the United States of America Not Ratified the United Nations Convention on the Rights of the Child? The Veto Fulcrum as a New Health Policy Analysis Framework

Abstract

AbstractBackgroundThe United Nations Convention on the Rights of the Child (CRC) enshrines health as a human right among other rights for children, the fulfillment of which can be advanced by each member state legally endorsing the principles through ratification of the Convention. The most rapidly and widely ratified human rights treaty in history, only the United States of America of all of the UN state parties has not ratified the CRC. This study aimed to determine the reason(s) the CRC has not been ratified by the USA.MethodologyMethod design involved a mapping literature search and in-depth interviews with key stakeholders in the fields of global health, child rights, health policy, and US law.ResultsImplementing the health policy triangle to systematize themes into content, context, processes, and actors as opposition or proponents of ratification, finds the literature favors ratification of the CRC. Notably, the published literature focuses on pros and cons of ratification of the CRC, rather than reasons why the US has not ratified. Interview informants further expanded themes to elucidate how the history of opposition actors and processes has led to a chilling effect and a status quo of non-ratification, which has become increasingly challenging to overcome. Drawing on the veto player theory to explain the status quo and introducing a new policy analysis framework of a veto fulcrum reveals that within the process of ratification, single powerful actors at a veto fulcrum have made undemocratic decisions, obstructing CRC ratification.ConclusionsBy investigating American non-ratification of the CRC this research has forged a new policy framework, the veto fulcrum, which examines political systems where political actors – who might even be democratically elected – as veto players have extraordinary power to make executive decisions against public opinion, and against good health policy.What is already known on this topicPublished literature focuses on reasons for or against US ratification of the CRC, rather than reasons why America has not ratified.What this study addsApplication of the health policy triangle and veto player theory to answer why the US has not ratified the CRC.A new policy analysis framework approach – the veto fulcrum – to understand the correlation between actors and processes in the non-ratification of policy.Using a veto fulcrum framework highlights the ascendancy of single actors in policy decisions by examining how, by whom, and why these single actors make decisions and/or might be influenced.An outline on how the veto fulcrum framework can be applied to understand other policy decisions.How this study might affect research, practice, or policyUsing the policy framework of a veto fulcrum can identify and examine barriers to ratification or enactment of a health or other good governance policy.