The OPERA Framework under which people live, which affect their health and have an impact on health inequalities. Qualitative approaches, such as conducting a capacity gaps analysis with rights holders can uncover some of these barriers. b) Understanding state constraints The capacity of the state, as the primary duty bearer, is also relevant to consider. This involves identifying constraints on the state from domestic or international sources that influence or constrain its capacity to fulfill the right(s) under review. This requires reflecting on the features that are particularly important in the context under review. Although such constraints will vary greatly depending on the context, they may broadly relate to: • • The conduct of third parties, such as corruption, business misconduct, elite capture, donor influence, aid conditionality, etc. Structural dysfunctions or conditions relating, for example, to decentralization, electoral processes, parliamentary procedures, political instability, environmental and climate volatility, international trade, investment, finance, monetary and debt policies, etc. In relation to the conduct of third parties, for example, systemic corruption and elite capture might reduce the efficiency of institutions and result in inequitable outcomes most detrimental to the poorest. A least-developed country that is severely debt-burdened might not be able to prioritize the allocation of its resources for economic and social rights fulfillment in light of repayments. The political and economic structures that dictate aid, trade, tax and debt policies might reduce the maneuver room that a state has for its own decision-making on the right in question. Competition to attract foreign investment may lead to weak regulatory frameworks that fail to effectively control harmful corporate activity. Human rights deprivations resulting from the actions of third parties may show a failure of the state to protect against rights violations. In some cases, they may show a failure by other states to meet their extraterritorial obligations (ETOs) to respect, protect and fulfill ESC rights beyond their borders, which in an era of increasing globalization, is all the more important to factor in through this step. As noted before, the components of steps in the OPERA framework do not necessarily need to be followed in strict sequence. In some contexts, such constraints may be so central that they merit a more central focus of the analysis. The factors identified in this step should not be seen as necessarily exonerating the state, as evidence must be found as to whether the state is making adequate and committed efforts to address the identified constraints to the best of its ability. For example in the case of corruption, the state might criminalize these acts through anti-corruption measures and promote greater transparency. What this analysis shows is how the actions or omissions of other actors impact on the state’s capacity to implement the right in question and how effectively the state is responding to these in line with its duty to protect ESC rights. c) Determining state compliance After taking adequate consideration of constraints faced by the state, an overall examination of the information collected in the previous three steps can be made to reach a comprehensive assessment of compliance with the obligation to fulfill the human right(s) under review. By linking to the various human rights principles and standards, the different steps provide a guide to the elements—or pieces of the puzzle—that must be taken into consideration when judging a state’s performance. 28