Engaging Health as a Human Right

Today there is much more to know and understand about health and the systems of healthcare than the new discoveries of both dis-ease and cure, new technologies, or simply the work of more vegetables and ‘Meatless Mondays’. When it comes to human rights, however, it is not often immediately considered that there is a direct relationship between health and human rights; that, at a personal level, being well is not only about making healthy vs unhealthy choices but on a larger scale includes having health as a human right.

When looking at health and human rights closely it can be said that they are complementary approaches. The relationship that exists between the two must factor in many elements from personal to socio-political.

Concerned efforts towards this work would help us revitalise the health field while contributing to the enrichment of human rights thinking and practice, as well as offer new ways in which an understanding can be found and a means to advance the well-being of people can be offered in the modern world. Fundamentally, the understanding of the relationship puts forward that the promotion and protection of health are inseparable from the promotion and protection of human rights and dignity.

Taking greater responsibility for healthcare

Over and above the issue of access, the right to health care is about the duty of the state to ensure that people are protected from living conditions that harm their health, rather promoting, fulfilling and maintaining, said access, availability and quality of care. This duty extends beyond the government when people live in situations that violate their human rights, as is the case with regards to social and environmental factors. For example:

  • In South Africa during the 20th century, thousands of mine workers experienced a continuous deterioration of their health as a result of the conditions in the mines while many others lost their lives
  • Still today, many people are exposed to the risk of cholera because of poor sanitation in the areas where they live and access to clean water
  • Also, people have a greater risk of infection with HIV because they have no access to information (i.e the right to basic education)

Further, it is also the responsibility of large multinational corporations to respect, and where possible, defend and promote people’s right to health. This is because we live in a globalised economy where the actions of one entity have a direct impact on the health and environment of another. For instance, the exploitation of labour forces in developing countries that robs those individuals of their physical health but also has detrimental effects on their emotional and psychological well-being due to poor working conditions.

The concepts of health

With the reality of the ‘shortness of life’, it is no wonder that we often think about our health and the health of those we care about on a daily basis. No matter our background, gender, age or socio-economic situation, health is considered to be the most fundamental of assets. Without it, we are prevented from engaging fully in society and are challenged even further by the obstacles presented in life. In the same breath, we are quick to sacrifice whatever is necessary to preserve the health of those we love and even further wish them an almost immortal existence free of pain and death. This is to say that when we speak of what it means to be well, we refer to health and living in a state of well-being.

When reflecting on human rights, the right to health is pivotal in living a life of dignity. We should all have the equal opportunity to enjoy the highest possible standard of the various dimensions of health – physical, emotional, psychological, social, environmental – that all contribute to overall well-being. The highlighting of the argument for rights to health is not new, being first articulated by the WHO who defined health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” in their 1946 Constitution. These rights are to be enjoyed by all people regardless of their differences for us to truly say we have embraced and provided them with the right to health (in all its dimensions).

Human rights in modern times

Despite having a long history behind human rights thinking, the modern ideas that we have of human rights remain as prevalent as ever and continue to be tested, hopeful, ambitious and complex. The 1945 United Nations agreement that forms the bases of these rights is that all people are ‘born free and equal in dignity and rights’ even though we know this is not always held to be the case.

In terms of health, these same sentiments remain true and are aligned to the ideas later adopted by the Universal Declaration of Human Rights in 1948. Rights, including the right to health, form part of the dignity of self, that health alongside other rights is foundational to freedom, justice and peace, that rights are universal, indivisible and interdependent, and that rights inhere in individuals because they are human.

Human rights and its approach to health

The human rights-based approach to health provides clear principles for the way in which health policies and service delivery should be met, how to target discriminatory practices, and how to address unjust power relations that are at the centre of inequitable health outcomes. The recognition of health as a human rights to health, as with other rights, includes both freedoms and entitlements:

  • Freedoms include the right to control one’s health and body (for example, sexual and reproductive rights) and to be free from interference (for example, free from torture and non-consensual medical treatment and experimentation)
  • Entitlements include the right to a system of health protection that gives everyone an equal opportunity to enjoy the highest attainable level of health

The core components of the right to health

Defined in General Comment 14 of the Committee on Economic, Social and Cultural Rights – a committee of Independent Experts, responsible for overseeing adherence to the agreement – the right includes the following core components:

Availability

Refers to the need for a sufficient quantity of functioning public health and health care facilities, goods and services, as well as programmes for all. Availability can be measured through the analysis of disaggregated data to different and multiple aspects including by age, sex, location and socio-economic status and qualitative surveys to understand coverage gaps and health workforce coverage.

Accessibility

Requires that health facilities, goods, and services must be accessible to everyone. Accessibility has four overlapping dimensions:

  • Non-discrimination
  • Physical accessibility
  • Economic accessibility (affordability)
  • Information accessibility

Assessing accessibility may require analysis of barriers – physical financial or otherwise – that exist, and how they may affect the most vulnerable, and call for the establishment or application of clear norms and standards in both law and policy to address these barriers, as well as robust monitoring systems of health-related information and whether this information is reaching all populations.

Acceptability

Relates to respect for medical ethics, culturally appropriate, and sensitivity to gender. Acceptability requires that health facilities, goods, services and programmes are people-centred and cater to the specific needs of diverse population groups and in accordance with international standards of medical ethics for confidentiality and informed consent.

Quality

Facilities, goods, and services must be scientifically and medically approved. Quality is a key component of Universal Health Coverage and includes the experience as well as the perception of health care. Quality health services should be:

  • Safe – avoiding injuries to people for whom the care is intended;
  • Effective – providing evidence-based healthcare services to those who need them;
  • People-centred – providing care that responds to individual preferences, needs and values;
  • Timely – reducing waiting times and sometimes harmful delays.
  • Equitable – providing care that does not vary in quality on account of gender, ethnicity, geographic location, and socioeconomic status;
  • Integrated – providing care that makes available the full range of health services throughout the life course;
  • Efficient – maximizing the benefit of available resources and avoiding waste

Remembering our rights

Health and human rights have rarely been linked in an explicit manner. With few exceptions, notably involving access to health care, discussions about health have rarely included human rights considerations. Similarly, except when obvious damage to health is the primary manifestation of a human rights abuse, such as with torture, health perspectives have been generally absent from human rights discourse.

Explanations for the dearth of communication between the fields of health and human rights include differing philosophical perspectives, vocabularies, professional recruitment and training, societal roles, and methods of work. In addition, modern concepts of both health and human rights are complex and steadily evolving. On a practical level, health workers may wonder about the applicability or utility (“added value”), let alone necessity of incorporating human rights perspectives into their work, and vice versa. In addition, despite pioneering work seeking to bridge this gap in bioethics, the philosophy of law, and public health law, a history of conflictual relationships between medicine and law, or between public health officials and civil liberty advocates, may contribute to anxiety and doubt about the potential for mutually beneficial collaboration.

Still, health and human rights are both powerful, modern approaches to defining and advancing human well-being. Attention to the intersection of health and human rights may provide practical benefits to those engaged in health or human rights work, may help reorient thinking about major global health challenges, and may contribute to broadening human rights thinking and practice. However, meaningful dialogue about interactions between health and human rights requires common ground.